ObjectivesThere are conflicting data on the relationship between the time of symptom onset during the 24-hour cycle (circadian dependence) and infarct size in ST-elevation myocardial infarction (STEMI). Moreover, the impact of this circadian pattern of infarct size on clinical outcomes is unknown. We sought to study the circadian dependence of infarct size and its impact on clinical outcomes in STEMI.MethodsWe studied 6,710 consecutive patients hospitalized for STEMI from 2006 to 2009 in a tropical climate with non-varying day-night cycles. We categorized the time of symptom onset into four 6-hour intervals: midnight–6:00 A.M., 6:00 A.M.–noon, noon–6:00 P.M. and 6:00 P.M.–midnight. We used peak creatine kinase as a surrogate marker of infarct size.ResultsMidnight–6:00 A.M patients had the highest prevalence of diabetes mellitus (P = 0.03), more commonly presented with anterior MI (P = 0.03) and received percutaneous coronary intervention less frequently, as compared with other time intervals (P = 0.03). Adjusted mean peak creatine kinase was highest among midnight–6:00 A.M. patients and lowest among 6:00 A.M.–noon patients (2,590.8±2,839.1 IU/L and 2,336.3±2,386.6 IU/L, respectively, P = 0.04). Midnight–6:00 A.M patients were at greatest risk of acute heart failure (P<0.001), 30-day mortality (P = 0.03) and 1-year mortality (P = 0.03), while the converse was observed in 6:00 A.M.–noon patients. After adjusting for diabetes, infarct location and performance of percutaneous coronary intervention, circadian variations in acute heart failure incidence remained strongly significant (P = 0.001).ConclusionWe observed a circadian peak and nadir in infarct size during STEMI onset from midnight–6:00A.M and 6:00A.M.–noon respectively. The peak and nadir incidence of acute heart failure paralleled this circadian pattern. Differences in diabetes prevalence, infarct location and mechanical reperfusion may account partly for the observed circadian pattern of infarct size and acute heart failure.

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Background: Urinary tract infection (UTI) is a common complication occurring in obstetric patients, posing adverse risks to both the mother and fetus. The aim of this study is to analyse the bacteriological profile and antimicrobial susceptibility pattern of uropathogens in obstetrics and gynaecology ward for the effective treatment. Methods: A total of 404 urine samples from pregnant women with different gestational age were processed for the isolation of uropathogens and tested against ten classes of antibiotics. Uropathogens from significant bacteriuria cases were isolated and identified by standard procedures from January 2020 to December 2021. Antibiotic susceptibility was studied by Kirby Bauer disk diffusion method. Results: Significant bacteriuria in 16.3% samples, Escherichia coli (E. coli) was the most common uropathogens followed by Enterococcus sp. and Klebsiella pneumoniae (K. pneumoniae). E. coli showed highest resistance to ceftazidime, cotrimoxazole and ciprofloxacin while exhibiting high sensitivity to imipenem, meropenem, and amikacin. Moreover, major proportion of isolates of K. pneumoniae were resistant against ceftazidime, ciprofloxacin, and nitrofurantoin; and for Enterococcus species against penicillin and gentamycin, but 100% sensitive to vancomycin and teicoplanin, and 92.3% to linezolid. Conclusions: There is a need for screening of antenatal patients for UTI and it is recommended that pregnant women should undergo periodic screening for UTI, so as to monitor the sensitivity pattern of the uropathogens and for the development of specific antibiotic policies based on local susceptibility patterns.

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