Harold Clifton Urschel, Jr, passed away on November 12, 2012, aged 82. He was born in Toledo, Ohio on February 17, 1930 to Loma Elizabeth Powell Urschel and Harold Clifton Urschel Sr. His was an interesting and unusual childhood in large measure the harbinger of his remarkable life. His father was an engineer, an inventor and entrepreneur who founded the Urschel Engineering Company. During Hal’s early childhood the family moved to rural Arkansas where his Father developed a zinc and copper mining company. His Mother homeschooled Hal and instilled in him the desire for learning as well as for the morality and faith of her Father, Hal’s grandfather, a Methodist Bishop. Hal nurtured his love for the outdoors, which continued throughout his life exemplified by his passion for hunting and fishing . His Mother recognized the need to civilize the nativist young boy, and they returned to Bowling Green, Ohio where he spent his high school years. His Father died of heart disease at the age of 41, leaving Hal’s Mother with 3 children to manage. They moved back with her family, and Hal was greatly influenced by the academic environment provided by Bowling Green University. Bowling Green also happened to be where the Cleveland Browns professional football team began their football season. Under the indirect influence of Paul Brown, the legendary coach of the Cleveland team, Hal became an outstanding football player, becoming an all state selection in football in Ohio. He was recruited by several major college teams, but his Mother thought Princeton University was the best fit for her son, who was also an outstanding academic student. Hal went to Princeton, along with another Ohio football player, Dick Kazmaier, who won the Heisman Trophy. Hal’s Princeton football career was successful and his teams were undefeated his freshman and senior years. He went on to Harvard Medical School, and trained in surgery at the Massachusetts General Hospital.

The most significant event of an eventful life was the almost chance opportunity to spend time with someone else’s date when he injured himself with a ski pole during a ski trip in New England. Elizabeth Bradley (Betsey) was a Wellesley undergraduate, the daughter of two physicians. Her Mother was an internist, her Father a Navy career physician who rose to the rank of Admiral in the Navy Medical Corps. Betsey was Hal’s anchor, to use a Navy term. She moderated his enthusiasm with exquisite diplomacy and good taste, became an important member of the Harvard University community, and was every bit as much of an achiever as was her husband. In between all these activities she became Mother to 5 fantastic children, who, with their Mother, survive Hal: Harold C. Urschel, M.D. (wife Christi Carter Urschel), Bradley Van Fleet Urschel (wife Bonny Urschel), Sterling Locke Urschel, Amanda Elizabeth Goldstein (husband Robert Goldstein M.D.), and Susanna McKinley Urschel. Hal and Betsey have 7 grandchildren: Everest Goldstein, Haley Urschel, Chancellor Urschel, Rush Urschel, Bear Goldstein, Carr Urschel, and Liam Walters. His sister-in-law, Virginia Byers Urschel, cousins Mary Beth and Louis Horvath, and many nieces and nephews also survive him. He was preceded in death by his brother, William Powell Urschel and his sister, Elizabeth Ann Urschel.

It is no easy task to sum up the life of this remarkable man, it had so many different facets. Just about the time you focus on his brilliant surgical career one is reminded to recall the devotion to his family. When you remember the iconoclastic curmudgeon, you find yourself remembering as well the man of a thousand genuinely profound quotations. He was at one time or another, sometimes all at once, aggressive, kind, caring, brutally honest, and diplomatic, but above all devoted to his family, his friends, his faith and his profession. He had enough energy for 100 surgeons. He and Betsey were tireless in their professional activities, and at the time of his death he was at the American Heart Association meeting in Los Angeles, where he was presenting material on his latest research interest, the use of stem cells for the treatment of a heart failure. He was a Past President of the Society of Thoracic Surgeons, the Southern Thoracic Surgical Association, the American College of Chest Physicians, and the Texas Surgical Association. He has been a Governor of the American College of Surgeons, Chairman of the American Board of Thoracic Surgery, Chairman of the Residency Review Committee for Thoracic Surgery, and a member of every important national and international medical and surgical society. His death leaves an empty place in the hearts of his family and friends, but we live on blessed by the warmth of our long association with him.

Hal’s favorite quotation is that of Hippocrates inscribed on the wall of Building 5 at the Harvard Medical School:

LIFE IS SHORT
THE ART IS LONG
THE OCCASION INSTANT
THE EXPERIMENT PERILOUS AND THE
DECISION DIFFICULT

Courtesy: CTSNet 

Boehringer Ingelheim (Germany) which began this study in August 2011 has halted the RE-ALIGN trial investigating the use of Dabigatran (Pradaxa) in patients with artificial heart valves. The phase 2 dose-ranging study was stopped because investigations into the dosing regimen "did not achieve the desired results," according to the company.

The study was testing three doses of dabigatran in patients with newly or previously implanted mechanical aortic valves, but concerns have been raised about the risk of valve thrombosis with the newer anticoagulant. In September 2012, as reported by heartwire, Canadian physicians reported the cases of two women who had undergone valve replacement years prior and had been faring well on warfarin but who subsequently suffered valve thrombosis when they were switched to Dabigatran. Dabigatran is not approved for patients with mechanical valves. It is approved by the Food and Drug Administration for preventing strokes and systemic embolism in patients with nonvalvular atrial fibrillation. Dabigatran is currently approved for use in Europe for venous thromboembolism prophylaxis after hip- and knee-replacement surgery but is not approved in the US for this indication.

"The presence of an artificial heart valve in patients is a clinical condition that is distinct from those for which dabigatran is an approved treatment," Boehringer Ingelheim stated in a press release. "In view of the interim trial results, the company is currently in discussions with the relevant regulatory authorities to reinforce the product label text accordingly and to discuss appropriate communication to physicians and relevant healthcare providers."

The RE-ALIGN study was started in December 2011, and approximately 370 patients were expected to be enrolled. The study's completion date was initially sometime in 2018.

Study of dabigatran in mechanical heart valve patients halted.

Hypertension along with diabetes has become one of the most dreaded chronic illnesses in India. To understand the disease we first need to understand  the basics of blood pressure. Our blood flows through our arteries with pressure. This pressure is determined by the pumping of the heart as well as resistance to the flow of blood by the arteries. Due to genetics, high cholesterol or other reasons, the wall of the blood vessels get thickened leading to increased resistance for the blood to flow. Due to this, even the heart has to pump harder. This causes the blood pressure to go up causing hypertension. All the complications mainly stem from thickening of the vessel walls, leading to reduced blood flow to different body parts. Some of the more serious complications of hypertension include:

1. Coronary artery disease (CAD): Elevated blood pressure makes the arteries (blood carrying vessels) thick and narrow and damage their lining (endothelium). This acts as a starting point for the formation of a clot which can grow and this block the blood supply to the heart. When there isn’t enough blood supply to the heart, its efficiency is reduced and the tissues are damaged leading to angina (chest pain). The tendency to develop coronary artery disease is more if you have other risk factors like diabetes, obesity and family history.

2. Heart failure: When the blood pressure is high it increases the workload of the heart and the heart has to pump the blood against this elevated pressure and in this process the heart has the work more. The heart pays the price of this hard work by thickening its muscle wall especially the left ventricle and many times this thick heart(hypertrophied)  may not be able to pump enough blood to the different organs thus compromising the body needs and eventually leading to heart failure.

3. Brain haemorrhage (stroke): Hypertension increases the risk of brain haemorrhage by almost 10 times. It weakens the small vessels in the brain causing them to rupture. In fact high BP is responsible for 80% of all heart attacks and stroke.

4. Aneurysm: Hypertension also weakens the vessel wall causing it to bulge. This forms an aneurysm (distension or a pouch-like structure in the vessel wall) which can rupture and is invariably fatal.

5. Kidney damage: Elevated blood pressure damages the small vessels in the kidney. This reduces the blood supply to it and the kidney starts losing its normal functions and eventually leads to kidney failure.

6. Vision loss: Blood vessels in the eye (retinal vessels) are narrowed and the vision can get impaired leading to retinopathy and eventually blindness.

7. Sexual dysfunction: The arteries supplying the penis can get narrowed leading to reduced blood supply and erectile dysfunction in males.

8. Memory: Hypertension has also been associated with memory loss.

9. In pregnancy it can cause convulsions in the mother eventually leading to coma and preterm labour. The babies that are born are usually low in weight.

Hence, the high blood pressure is not just a reading on your sphygmomanometer/BP monitor but a warning to work towards reducing your BP and prevent the disastrous complications. In short monitor your BP, take proper treatment and bring about lifestyle changes and move towards a healthy life!

By: Dr Varuna Mallya

The benefit of tight glycaemic control in the post-operative setting has come under increasing scrutiny of late. Initial small scale studies suggesting large clinical benefits have been followed by much larger multi-centre trials demonstrating neutral or even harmful effects of tight blood sugar control, with most investigators pointing towards the high occurrence of hypoglycaemia as being the main problem associated with therapy. These studies have been almost exclusively in adults but the role of tight glycaemic in critically ill children is less well understood. In this study, Agus et al examined whether tight glycaemic control reduces morbidity after paediatric cardiac surgery. In a two-centre, prospective, randomized trial, 980 children, 0 to 36 months of age, undergoing surgery with cardiopulmonary bypass were recruited. Participants were randomly assigned to either tight glycaemic control (with the use of an insulin-dosing algorithm targeting a blood glucose level of 4.4 to 6.1 mmol/l) or standard care in the cardiac intensive care unit. Continuous glucose monitoring was used to guide the frequency of blood glucose measurement and to detect impending hypoglycaemia. The primary outcome was the rate of health care-associated infections with secondary outcomes including mortality, length of stay, organ failure, and hypoglycaemia. A total of 444 of the 490 children assigned to tight glycaemic control (91%) received insulin versus 9 of 490 children assigned to standard care (2%). Although normoglycaemia was achieved earlier (6 hours vs. 16 hours, P<0.001) and was maintained for a greater proportion of the critical illness period (50% vs. 33%, P<0.001), tight control failed to show any benefit in the primary outcome (8.6 vs. 9.9 per 1000 patient-days, P=0.67), any of the secondary outcomes or in post-hoc analyses of high risk sub-groups. Due to the use of continuous glucose monitoring the rate of severe hypoglycaemia (<2.2 mmol/l) were very low occurring in only 3% of patients.

Source: Allistair Lindsay @ BMJ Group Blogs 

Conclusions:

Tight glycaemic control can be achieved with a low hypoglycaemia rate after cardiac surgery in children, but does not significantly change the infection rate, mortality, length of stay, or measures of organ failure, as compared with standard care.

• Agus MS, Steil GM, Wypij D, Costello JM, Laussen PC, Langer M, Alexander JL, Scoppettuolo LA, Pigula FA, Charpie JR, Ohye RG, Gaies MG; SPECS Study Investigators. Tight glycaemic control versus standard care after paediatric cardiac surgery. N Engl J Med. 2012 Sep 27;367(13):1208-19.

For a long time I have been making efforts to organise teaching and training in Medical Statistics on the CSiI, but failed miserably. I now feel that this wonderful site by UCLA can partly contribute towards that aim. 

This is an Internet-based probability and statistics E-Book. The materials, tools and demonstrations presented in this E-Book would be very useful for statistics educational curriculum. The E-Book is initially developed by the UCLA Statistics Online Computational Resource (SOCR). However, all statistics instructors, researchers and educators are encouraged to contribute to this project and improve the content of these learning materials. There are 4 novel features of this specific Statistics EBook. It is community-built, completely open-access (in terms of use and contributions), blends information technology, scientific techniques and modern pedagogical concepts, and is multilingual.

Copyrights: The Probability and Statistics EBook is a freely and openly accessible electronic book developed by SOCR and the general community.