The Asklepios study started 10 years ago when 2,500 subjects were screened between 2002 and 2004. And all of the 90+ publications we have for the moment are from those cross-sectional data. This is called round 1. Since 2011, in round 2, all of those patients have started to come back for a 10-year follow-up. At this moment, approximately 1,750 of those patients have been seen. The patients were followed by general practitioners (GP), and the GP again provided the information about what has happened with the medical status in the past 10 years including drug therapy: not only the drugs that they are taking at the moment were evaluated, but, because patients often use many drugs, the chronicles of drugs for major risk factors, for hypertension, lipids, contraceptives and more. Then, patients come to the study center where the same cluster of examinations are undertaken by one single doctor, Prof. Ernst R. Rietzschel and one study nurse, just like 10 years ago. Again, using a single observer at the two time frames has kept the methodology very strict.

Cardiovascular disease (CVD) is an important cause of morbidity and mortality in dialysis patients. Brachial-ankle pulse wave velocity (baPWV) is more efficient to handily assess arteriosclerosis than aortic PWV. The cardio-ankle vascular index (CAVI) is also a novel blood pressure-independent arterial stiffness parameter. In dialysis patients, both baPWV and CAVI are increased compared to general subjects. Several studies have demonstrated that increased baPWV is associated with carotid atherosclerosis and diastolic left ventricular dysfunction in hemodialysis (HD) patients. In addition, higher baPWV is related to all-cause and cardiovascular (CV) mortality. CAVI is similarly associated with CVD. However, baPWV is superior to CAVI as a predictor of CV outcomes in HD patients. Besides these outcomes, a close relationship exists between sarcopenia, abdominal visceral obesity and arterial stiffening. Reduction of thigh muscle mass is inversely correlated with baPWV and CAVI in males. Abdominal fatness is also associated with increased arterial stiffness in females. These observations provide further evidence of higher risk of CV events in HD patients with sarcopenic obesity. In addition, arterial stiffness is associated with cerebral small vessel disease and decreased cognitive function in the elderly. However, it is unknown whether arterial stiffness may be useful as an early indicator of cognitive decline in dialysis patients. Because dialysis patients are at risk of developing dementia, more studies are needed to elucidate the causal link between arterial stiffness and cognitive impairment.

Background: Hypertension is strongly associated with cardiovascular disease. It has been reported that arterial stiffness is related to cardiovascular mortality and morbidity in hypertensive patients and that the physiological evaluation of arterial stiffness may assist clinicians in the early detection of atherosclerosis. Summary: It has been demonstrated that increased arterial stiffness is an independent predictor of cardiovascular disease, including stroke. Arterial stiffness is associated with structural changes in the brain. However, the stiffness responses of muscular arteries are different from those of elastic arteries, and so the impact of arterial stiffness and the conclusions to be drawn may be different depending on the region in which the measurement is taken. Key Messages: In this review, we summarize the current literature describing the association between arterial stiffness, including carotid-femoral and brachial-ankle pulse wave velocity and cardio-ankle vascular index, and cardiovascular disease, specifically stroke. We discuss the utility and prognostic significance of regional arterial stiffness measurements.

The Korean Society of Hypertension published new guidelines for the management of hypertension in 2013 which fully revised the first Korean hypertension treatment guideline published in 2004. Due to shortage of Korean data, the Committee decided to establish the guideline in the form of an ‘adaptation' of the recently released guidelines. The prevalence of hypertension was 28.5% in the recent Korean National Health and Nutrition Examination Survey in 2011, and the awareness, treatment, and control rates are generally improving. However, the risks for cerebrovascular disease and coronary artery disease which are attributable to hypertension were the highest in Korea. The classification of hypertension is the same as in other guidelines. The remarkable difference is that prehypertension is further classified as stage 1 and 2 prehypertension because the cardiovascular risk is significantly different within the prehypertensive range. Although the decision-making was based on office blood pressure (BP) measured by the auscultation method using a stethoscope, the importance of home BP measurement and ambulatory BP monitoring is also stressed. The Korean guideline does not recommend a drug therapy in patients within the prehypertensive range, even in patients with prediabetes, diabetes mellitus, stroke, or coronary artery disease. In an elderly population over 65 years old, drug therapy can be initiated when the systolic BP (SBP) is ≥160 mm Hg. The target BP is generally an SBP of <140 mm Hg and a diastolic BP (DBP) of <90 mm Hg regardless of previous cardiovascular events. However, in patients with hypertension and diabetes, the lower DBP control <85 mm Hg is recommended. Also, in patients with hypertension with prominent albuminuria, a more strict SBP control <130 mm Hg can be recommended. In lifestyle modification, sodium reduction is the most important factor in Korea. Five classes of antihypertensive drugs, including angiotensin-converting enzyme inhibitors, β-blockers, calcium antagonists, and diuretics, are equally recommended as a first-line treatment, whereas a combination therapy chosen from renin-angiotensin system inhibitors, calcium antagonists, and diuretics is preferentially recommended.

Back ground: Recent advances in psychological, medical, and physiological research have led to a new way of thinking about health and illness. This conceptualization, which has been labeled the biopsychosocial model, views health and illness as the product of a combination of factors including biological characteristics (e.g., genetic predisposition), behavioral factors (e.g., lifestyle, stress, health beliefs), and social conditions (e.g., cultural influences, family relationships, social support).Objectives: Create awareness about psychological support, understanding behavioral and contextual factors, preventing illness. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20347 Pulse Vol.6 January-December 2013 p.37-40

Extended spectrum ?-lactamase (ESBLs), produced by Gram negative organisms, are enzymes capable of hydrolyzing extended spectrum cephalosporins, penicillins and monobactam but inactive against cephamycin and imipenem. Detection of some ESBL strains are missed by Double disc synergy test but detected by three dimensional test. So this study was carried out to see the rate of ESBL producer by three dimensional test and double disc synergy test among Gram negative bacteria. Total 110 Gram negative isolates were studied, among them 30 were wound swab isolates and 80 were laboratory isolates, of which 88(80%) were ESBL producer. Three dimensional tests detected ESBL in 88 (80%) strain whereas 66.36% strains detected by double disc synergy test, so 15 (13.63%) isolates were missed by Double disc synergy test. In this study among the 30 wound swab isolates Three dimensional test detected 26 (86.67%) whereas 14 (46.67) were detected by double disc synergy test and similarly among the 80 laboratory isolates, three dimensional test detected 62 (77.5%) and double disc synergy test detected 59 (73.75%). So, the three dimensional test has been found to be better than Double disc synergy test in the detection of ESBLs. ESBL producing organisms are resistance to most of the antibiotics but 100% sensitive to Imipenem. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20328 Pulse Vol.6 January-December 2013 p.12-19

Background: Bangladesh is an iodine deficient region and the government of Bangladesh, with assistance of UNICEF had initiated a universal salt iodinization program to provide iodized salt by the middle of 1994. Breast milk is the only source of iodine for exclusively breast-fed infants. Iodine deficiency and iodine excess both have bad impact on infant’s health. Objectives: To assess the iodine status of lactating mothers and their breast-fed infants and to evaluate whether maternal iodine status reflects the iodine status of their breast-fed infants. Material and methods: This observational analytical study was carried out in the department of biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka with active cooperation of Kumudini Women’s Medical College Hospital, Mirzapur, Tangail involving fifty lactating mothers and their exclusively breast-fed infants. Early morning urine and breast milk samples were collected in dry and clean plastic containers free from any chemical contamination. Urinary iodine was used as an indicator for assessing iodine status. All statistical analysis was done by using SPSS (Statistical Program for Social Science) 12 version software package for windows. Results: The median (range) urinary iodine concentration of lactating mothers and their breast-fed infants were 225.25 ?g/L (61.50-530.00) and 225.75?g/L (100.50-526.00). 96% (48) mothers had no biochemical iodine deficiency (UIE ?100?g/L), only 4% (2) mothers had mild biochemical iodine deficiency (UIE, 50-99?g/L). There was no biochemical iodine deficiency of breast-fed infants. The median breast-milk iodine concentration was 157?g/L which was more than three times of recommended minimum concentration (50?g/L). Iodine in breast milk of lactating mothers was positively correlated with their urinary iodine excretion (P&lt;0.01). Infant’s urinary iodine was positively correlated with iodine concentration in breast milk (P&lt;0.01) and also positively correlated with urinary iodine of lactating mothers (P &lt; 0.01). Conclusion: Lactating mothers and their breast-fed infants in this study were iodine sufficient. Iodine status of exclusively breast-fed infants can be determined by the iodine status of their mothers. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20283 Pulse Vol.6 January-December 2013 p.6-11

A 28 year old male patient of psoriasis was admitted in a tertiary care hospital of Bangladesh with typical skin lesions for 18 years, nail changes for 16 years, arthritis for 12 years and eye changes for 3 years. In addition he had other rare extra articular complications like severe aortic stenosis, moderate aortic regurgitation and mild mitral regurgitation. He had a positive family history of psoriasis. HLAB27 is positive and X-ray of hands and feet showed classical findings of psoriatic arthritis. We presented the case to show the early age of onset, severity of the disease with rapid progression and multiple extra articular complications. DOI: http://dx.doi.org/10.3329/pulse.v5i2.20266 Pulse Vol.5 July 2011 p.48-53

Apollo Hospitals Dhaka surely stepped ahead than any other hospital of Bangladesh for reducing medication errors significantly. From the very beginning of its establishment, reducing medication errors was taken as a major challenge and effective and approved strategies were developed when no other hospital took efforts in this regard. Strategies included tracking incidents of medication errors, analyzing, reporting &amp; arranging proper training sessions for hospital staffs etc. All four types of errors like Prescription errors, Transcription errors, Dispensing errors and Administration errors are rectified and officially reported by hospital pharmacists. Along with these, Prescription Reviewing, Medication Reconciliation, incidents of Adverse Drug Reactions (ADR) are also monitored to ensure rational drug use for patients. With all its efforts, Apollo Hospitals Dhaka was able to reduce the rate of medication errors within the internationally acceptable range. DOI: http://dx.doi.org/10.3329/pulse.v5i2.20265 Pulse Vol.5 July 2011 p.41-47

Introduction Percutaneous Electrosclerotherapy technique for the treatment of cutaneous hemangioma is introduced as an alternative and minimally invasive treatment mode. The aim of the study was to evaluate the response of percutaneous electrosclerotherapy on cutaneous hemangioma, as monotherapy or in adjunct to surgery. Materials and Methods Fourteen patients with 10 females and 04 males underwent percutaneous electrosclerotherapy for the treatment of cutaneous hemangioma mostly on head and neck in Plastic and Cosmetic Surgery department of Apollo Hospitals Dhaka from January 2009 to June 2010. Percutaneous Electrosclerotherapy was applied through a Colorado needle with an intention to cauterize the bulk of the lesion at the tip of the needle but not burning the skin. Pre and post operatively the size of the lesions were measured to see the percentage of regression. Results Percutaneous Electrosclerotherapy was done in all 14 cases. Most of the lesions (78%) were smaller in size (&lt;5cm) and the site was mostly in head and neck (57%), more than half of the patients (57%) got significant benefit from this procedure. The regression of size is mostly in children &lt;10 years which is noted in about 65%. The only complication found was overlying skin necrosis due to burn in 35% of patients which was managed usually by simple dressing and antibiotics with complete healing. Conclusion Percutaneous Electrosclerotherapy is effective monotherapy for smaller hemangioma and prior to surgery to reduce the volume, operation time, bleeding, as well as post operative scar. It can be done easily with minimal hospital stay, less cost and complication DOI: http://dx.doi.org/10.3329/pulse.v5i2.20262 Pulse Vol.5 July 2011 p.26-30