scholarly journals A comparative study between results of different modalities of management of cervical intraepithelial neoplasia I

2021 ◽  
Vol 53 (1-2) ◽  
pp. 8-12
Author(s):  
Eti Saha ◽  
Fouzia Begum ◽  
Zannatul Ferdous Jesmin ◽  
Muckti Kaniz Fatema
Keyword(s):  
Early Stage ◽  
Expectant Management ◽  
High Rate ◽  
Treatment Modalities ◽  
P Value ◽  
Stage Of Development ◽  
Group A ◽  
Group B ◽  
Cold Coagulation

Background: Carcinoma cervix is a preventable disease. It runs a long preinvasive stage, such as Normal - CIN I - CIN II - CIN III - Cancer cervix. It can be prevented at early stage of development with proper diagnosis, treatment & follow up. A major portion of CIN I spontaneously regress but some need treatment. Obiective: The purpose of this study was to determine the frequency of abnormal colposcopic findings during the 1 year follow up period in patients of CIN I treated with cold coagulation, LEEP and expectant management. Materials and Methods: This retrospective study was conducted in colposcopic centre of Khulna medical college hospital, Khulna, Bangladesh from January 2018 to December 2019. After confirmation of CIN I, ladies were arranged in three groups according to their treatment modalities - Expectant management (group A), Cold coagulation (group B) & LEEP (group C). They were reexamined with colposcopy after 6 months, or after one year of first visit. Persistence or reappearance of CIN was assayed & correlation between colposcopic results during follow up of different groups was analysed. Results: Total 195 ladies were diagnosed colposcopically as CIN I. Of them 75 women were confirmed by histological examination. Among 75 ladies, 25 ladies received no treatment, grouped as group A. Forty ladies treated with cold coagulation falls in group B, whereas 10 ladies who treated with LEEP were grouped as group C. Distribution of age, parity, monthly income, education, marital age, age at first delivery was similar in different group. During follow up persistence of disease were found in 2(13.3%) ladies who did not receive any form of treatment, 3(10.7%) who were treated with cold coagulation (p value 0.333) and 1(12.5%) lady who received treatment with LEEP (p value 0.667), were not significant. Conclusion: Colposcopic surveillance without treatment appears reasonable in treating CIN I because of the high rate of spontaneous regression of CIN 1, but adherence to the follow up should be emphasized to the patients during the follow up visits. Bang Med J Khulna 2020: 53 : 8-12

A Study on Frozen Shoulder and its clinical management through Nasaapana and Nasya

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Praveenkumar H. Bagali ◽  
A. S. Prashanth
Keyword(s):  
Medical Science ◽  
Frozen Shoulder ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Animal Kingdom ◽  
Shoulder Joints ◽  
Group A ◽  
Group B

The unique position of man as a master mechanic of the animal kingdom is because of skilled movements of his hands and when this shoulder joints get obstructed, we call it as Apabahuka (Frozen shoulder), we do not find satisfactory management in modern medical science. Various effective treatment modalities have been mentioned which reverse the pathogenesis, Shodhana is advised initially followed by Shamana therapies. In the present study 30 patients were selected incidentally and placed randomly into two groups A and B, with 15 subjects in each group. Group A received Amapachana with Panchakola Churna, Jambeera Pinda Sweda and Nasya Karma. Group B received Amapachana with Panchakola Churna, Jambeera pinda Sweda and Nasaapana. In both the groups two months follow up was done. Both groups showed significant improvement in the signs and symptoms of Apabahuka as well as the activities of daily livings, thereby improving the quality of life of the patients. Nasya Karma and Nasaapana provided highly significant results in all the symptoms of Apabahuka. In the present study as per the clinical data, Nasaapana is found to be more effective than Nasya Karma.

A Comparative Study of Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana in the Management of Shweta Pradara

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Renuka M. Tenahalli
Keyword(s):  
Vitamin C ◽  
Early Stage ◽  
Pathological Condition ◽  
Before And After ◽  
Group A ◽  
Phosphorus Iron ◽  
Group B ◽  
Busy Schedule ◽  
Iron And Calcium

Shweta Pradara (Leucorrhoea) is the disease which is characterized by vaginal white discharge. Vaginal white discharge this symptom is present in both physiological and pathological condition, when it becomes pathological it disturbs routine life style of the woman. Most of the women in the early stage will not express the symptoms because of hesitation and their busy schedule. If it is not treated it may leads to chronic diseases like PID (Garbhashaya Shotha etc.) Charaka mentioned Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana. This treatment is used in Shweta Pradara shown positive results, hence a study was under taken to assess its clinical efficacy. 30 diagnosed patients of Shweta Pradara were randomly selected, allocated in three groups. Group A and Group B received Amalaki Choorna with Madhu and Vata Twak Kashaya Yoni Pichu Dharana respectively and Group C received Amalaki Choorna with Madhu followed by Vata Twak Kashaya Yoni Pichu Dharana for 15 days. The patients were assessed for the severity of the symptoms subjectively and objectively before and after the treatment and at the end of the follow up. Data from each group were statistically analyzed and were compared. No side effects were noted and it may be considered as an effective alternative medicine in Shweta Pradara (leucorrhea). Amalaki is rich in natural source of vitamin C and contains phosphorus, iron and calcium. Honey contains carbohydrate, vitamin C, phosphorus iron and calcium. All together these help to increase Hb% and immunity. Vata Twak Kashaya contains tannin which helps to maintain normal pH of the vagina.

scholarly journals 465 No Role for Postoperative Antibiotics in Uncomplicated Appendicitis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Ayoub ◽  
Y Tryliskyy ◽  
M K Baig
Keyword(s):  
Wound Infection ◽  
P Value ◽  
Nice Guidelines ◽  
Uncomplicated Appendicitis ◽  
Perforated Appendix ◽  
Group A ◽  
Preoperative Antibiotics ◽  
Group B ◽  
Variable Practice

Abstract Introduction Several studies have shown benefit from use of preoperative antibiotics in reducing postoperative infection after appendectomy as well as efficacy of postoperative antibiotics in complicated appendicitis (defined as perforated appendix or presence of pus in peritoneum). While for uncomplicated appendicitis, several studies showed no benefit from antibiotics postoperatively but there are no clear NICE guidelines till now and so surgeons have different practice based on their preferences. Method This study included patients who had appendectomy for uncomplicated appendicitis in Worthing hospital from 1st July 2019 till 30th June 2020. The end point was 30-day follow up postoperatively for wound infection or collection. Results 90 patients were admitted with uncomplicated appendicitis with age 6-80 years (mean of 31.3). 46 patients (51%) did not receive postoperative antibiotics (group A) and 44 (49%) received postoperative antibiotics (group B) with a variable practice from one dose to 8-day course. postoperatively, only 1 patient (2.1%) in group A developed wound infection requiring drainage while none in group B developed complications (p-value=1). Conclusions Administration of postoperative antibiotics in uncomplicated appendicitis showed no superiority over non-administration. in addition, they add extra cost on NHS. So, their routine use postoperatively is not recommended, however, larger studies are required to confirm this.

scholarly journals Comparable Efficacy of Terbinafine and Itraconazole in the Treatment of Tinea Pedis

2013 ◽  
Vol 21 (2) ◽  
pp. 74-79
Author(s):  
Md Abdul Wahab ◽  
Mohammad Jamal Uddin ◽  
Biswas Shahen Hassan ◽  
Md Zafrul Islam ◽  
Ishrat Bhuiyan ◽  
...  
Keyword(s):  
Fungal Infection ◽  
Tinea Pedis ◽  
Comparable Efficacy ◽  
P Value ◽  
Mycological Cure ◽  
Efficacy Analysis ◽  
Group A ◽  
Group B

Background: Tinea pedis (athlet’s foot) is the most common fungal infection. Relapse is common in tinea pedis and may be result of recurrence following inadequate treatment or reinfection. Objective: To evaluate the comparable efficacy of terbinafine and itraconazole in the treatment of tinea pedis. Methods: 120 patients of tinea pedis confirmed by KOH microscopy were included in the study. The study was carried out in three different Hospitals and Private Chambers for a period of 3 years from July 2006 to June 2009. Mean age of the patients was 40.28±10.23. The patients were devided into 2 equal group:A & B. Group- A was given terbinafine 250 mg/day and group-B was given intraconazole 200 mg/day for 2 weeks. Results: Follow up 2 weeks after cessation of therapy revealed clinical and mycological cure of 93.3% in terbinafine group and 86.6% in itraconazole group. Conclusion: Efficacy analysis revealed that terbinafine is superior than itraconazole in the treatment of tinea pedis (P value 0.224). DOI: http://dx.doi.org/10.3329/bjmed.v21i2.13615 Bangladesh J Medicine 2010; 21: 74-79

scholarly journals COMPARISON OF THE EFFICACY OF ANTIBIOTIC-STEROID AND ICHTHAMMOL GLYCERINE WICK IN TREATMENT OF ACUTE OTITIS EXTERNA

2021 ◽  
Vol 71 (Suppl-3) ◽  
pp. S612-16
Author(s):  
Maryam Khan ◽  
Kamran Ashfaq Ahmed Butt ◽  
Naeem Riaz ◽  
Zaheer Ul Hassan ◽  
Attique Ahmed ◽  
...  
Keyword(s):  
Experimental Study ◽  
Otitis Externa ◽  
The Other ◽  
Military Hospital ◽  
P Value ◽  
Similar Response ◽  
Quasi Experimental ◽  
Group A ◽  
Group B

Objective: To compare the efficacy of steroid antibiotic wick with Ichthammol Glycerol wick in the management of Acute Otitis Externa in terms of tenderness and clearance of discharge/debris. Study Design: Quasi-experimental study. Place and Duration of Study: ENT Out Patient department of Combined Military Hospital Peshawar and Hayatabad Medical Complex Peshawar, from May to Nov 2018. Methodology: A total of 250 patients were included and divided into two groups of 125 each. After necessary suction clearance topical Ciprofloxacin/Dexamethasone (Cipotec-D) wick was placed in auditory canal of group A patients and topical Glycerol/Ichthammol wick was placed in group B. Follow up visits were done on 3rd and 7th day of starting the treatment. Results: Group A patients responded better in terms of tenderness (88%) however both groups had similar response in terms of discharge reduction (7.2% vs 6.4%). In terms of efficacy neither of the treatment proved more efficacious compared to the other (p-value 0.058). Conclusion: While steroid antibiotic wick is significantly more efficient in terms reducing tenderness, in terms of overall efficacy and discharge reduction Ichthammol/glycerol is equally effective.

scholarly journals Ilioinguinal Neurectomy and Chronic Post-Operative Pain After Inguinal Hernia Repair

2020 ◽  
pp. 1-7
Author(s):  
Aliya Ishaq ◽  
Muhammad Shadab Khan ◽  
Mariya Ishaq ◽  
Ayesha Saba ◽  
Turab Pishori
Keyword(s):  
Inguinal Hernia ◽  
P Value ◽  
Third Wave ◽  
Brisk Walking ◽  
Healthcare Facilities ◽  
Nerve Preservation ◽  
Post Operative Pain ◽  
Group A ◽  
Group B

Objective: This study aims to determine the effect of preservation /division of ilioinguinal nerve in patients undergoing lichenstein hernioraphy on severity of chronic post operative pain as well well as presence /absence of groin numbness. Method: A randamised control trial was conducted for a period of six months on 60 patient fulfilling inclusion criteria who underwent lichenstein hernioraphy at general surgery department of Liaquat National university hospital Karachi , Pakistan. Result: A total of 60 patients undergoing elective inguinal hernia mesh repair were Included in study and divided in two groups with 30 patients each. Only male patients were included in the study as female gender was one of the exclusion criteria so gender stratification was no considered. Patients between 17 to 77 yrs of age were included in study and randomly divided in two groups. Mean age of population in group A is 42.96 +/- 17.76 an in group B is 54.23 +/- 15.0. The minimum age of the patient in Group A is 17 years and maximum age is 73 years whereas minimum age of the patient in Group B is 20 years and maximum age is 77 years. 45.9% Patients in group A (Nerve preservation group) have right inguinal hernia. 54.0%% Patients in group B (Nerve Division group) have right inguinal hernia. 56.5%% Patients in group A (Nerve Preservation group) have left inguinal hernia. 43.4% Patients in group B (Nerve Division group) have left inguinal hernia. Chronic groin pain while different physical activities and groin numbness in nerve preservation and nerve division group was assessed at three and six months follow ups in all patients of the study population. 3% of the patients from nerve preservation group had mild pain during climbing stairs at three and six months follow up and the P-Value was 0.313 which is statistically not significant. 10% of the patients from nerve division group and 50% patients from nerve preservation group had pain during brisk walking at three months follow up and the P-Value was 0.001 which is statistically significant. 23% of the patients from nerve division group and 60% patients from nerve preservation group had pain during brisk walking at six months follow up and the P-Value was 0.004 which is statistically significant. 13.3% patients from nerve preservation group had moderate pain during brisk walking at three months follow up while none of the patient from nerve division group had pain and P-Value was 0.038 which is statistically significant. 6.6% of the patients from nerve preservation group had moderate pain during brisk walking at six months follow up while none of the patient from nerve division group had pain and p-value was 0.150 which is statistically in significant. 20% of the patients from nerve division group and 30% of the patients from nerve preservation group had mild groin numbness at three months follow up with P-Value of 0.371 which is statistically in significant. 33.3% of the patients from nerve division group and 30% of the patients from nerve preservation group had groin numbness at six months follow up with a p-value of 0.781 which is statistically in significant. Conclusion: Prophylactic ilioinguinal neurectomy during Lichtenstein tension free inguinal hernia repair decreases the incidence of exertional chronic post operative pain as compare to the nerve preservation group. However the cutaneous neurosensory disturbance/groin numbness between the two groups has no difference in term of outcome. In order to prepare ourselves from a expected third wave of Covid-19, we should not repeat mistakes that we made during previos waves. We should refrain ourselves from dismantling our enhanced healthcare facilities, there should not be any sorts of shortage of oxygen , hospital beds, and drug that we have already witnessed. We must have an aggressive containment measure comprising of a really strong and pro-active surveillance system. This can be achieved by increasing the capacity of the existing surveillance system by identifying active cases early. We must ensure that we should follow “social vaccine” of proper masking, avoid indoor gatherings, and proper sanitization. Our vaccination programme needs a boost. We should vaccinate a large section of people before any third wave hits us. The more we vaccinate, the better prepared we are. As medical professionals, it must be ensured that proper scientific protocol must be implemented while handling Covid-19 cases. And last but not the least efforts must be made to fill up vacancies seen in our public health system, especially for frontline healthcare workers. As it is anticipated that the young children are more vulnerable to the forthcoming third wave, efforts are to be sought in order to start vaccination of the younger children in our country. Trials for which has already been started in India and across the world. Till the time vaccine is made available, the resources are to be mobilized to build up healthcare facilities catering the vulnerable age group in this third wave such as building up of more paediatric wards, paediatric ICU’s , training of healthcare personals in handling the emergencies for expected third wave .In addition to these efforts , more and more paediatric covid care centers must be set up at various parts of the country. Equally important is making arrangements for rehabilitation centers for the orphans. Countries like US, Singapore and UAE have already started vaccinating the children in age group between 12 to 15 years with Pfizer-BioNTech Covid vaccine. It’s a high time that the government in India must consider for allowing “expedited approval pathway” to the companies like Pfizer for their Covid-19 vaccine for children. All these combined efforts from everyone may ensure that the country and world may remain well equipped against these subsequent waves of this deadly virus and pave the path of the triumph in the near future.

scholarly journals BREAST ABSCESS;

2017 ◽  
Vol 24 (01) ◽  
pp. 89-94
Author(s):  
Muhammad Umar Javed ◽  
Sidra Aleem ◽  
Sheraz Jamil Asif ◽  
Javed Iqbal
Keyword(s):  
Needle Aspiration ◽  
P Value ◽  
Breast Abscess ◽  
Group A ◽  
Mean Size ◽  
Duration Of Disease ◽  
Recurrent Breast ◽  
Group B ◽  
Incision Drainage

Objectives: To compare the recurrence rate between incision drainage andmultiple needle aspiration for breast abscess treatment. Study Design: Randomized ControlledTrial. Setting: Department of General Surgery, Bahawal Victoria Hospital, Bahawalpur. StudyDuration: 29th September 2015 to 29th June 2016. Materials & Methods: A total of 60 femalepatients with breast abscess of <2 cm in size and of duration <2 weeks between 20 to 40 yearsof age were included. Patients with multiple breast abscesses, recurrent breast abscesses andcomplicated abscesses were excluded. The patients were randomized into Group A (incisionand drainage) & Group B (needle aspiration), by using lottery method. Follow up was done forup to 7 days and recurrence was noted. Results: The mean age of patients in group A was30.83 ± 5.67 years and in group B was 31.53 ± 5.73 years. Mean duration of disease was 7.58± 2.83 days. Mean size of abscess was 0.86 ± 0.43 cm. Recurrence was found in 07 (23.33%)patients in group A (incision drainage) while in 21 (70.0%) patients in group B (multiple needleaspiration) with p-value of 0.000 which is statistically significant. Conclusion: The recurrencerate is less after incision & drainage as compared to multiple needle aspirations for treatingbreast abscess.

scholarly journals COMPARISION OF CEMENTED VERSUS UNCEMENTED HEMIARTHOROPLASTY OF THE HIP.

2019 ◽  
Vol 26 (07) ◽  
pp. 1057-1061
Author(s):  
Dr. Hafiz Salman Saeed ◽  
Farhad Alam ◽  
Muhammad Yousaf ◽  
Iqra Fayyaz
Keyword(s):  
Controlled Trial ◽  
P Value ◽  
Orthopaedic Department ◽  
Residual Pain ◽  
Uncemented Hemiarthroplasty ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Trial Setting

The objective of this study was to compare the mean residual pain after cemented versus uncemented hemiarthroplasty of hip. Study Design: Randomized Controlled Trial. Setting: Orthopaedic Department, Allied Hospital, Faisalabad. Period: September 2016 to October 2017. Materials and Methods: Total 150 patients were admitted in orthopedic Department of Allied Hospital Faisalabad according to inclusion & exclusion criteria. After taking informed written consent, all patients were divided into two groups randomly. Cementedhemiarthroplasty was done in Group A patients and uncemented hemiarthroplasty was done in group B patient. All procedures were done by surgeon who has minimum 5yrs post fellowship experience. Monthly Follow up was done and residual pain was noticed at the end of 6th month. All the data was analyzed by using SPSS version 20.0. Results: In this study, in Group-A the patients between 65-75 years of age were 57.33% (n=43) and between 76-85 of age were 42.67% (n=32). In Group B the patients between 65-75 years of age were 56%(n=42) and between 76-85 years were 44% (n=33). The mean+sd was calculated and it is 73.49+4.99 years in Group-A patients and 73.73+4.74 years in Group-B patients. In Group A, males were 61.33% (n=46) and female were 38.67% (n=29). In Group B, males were 57.33% (n=43) and female were 42.67% (n=32). When we compared the residual pain after cemented versus uncemented hemiarthroplasty of the hip, it shows 1.69+0.35 in Group-A patients and 2.62+0.30 in Group-B patients. When we calculated p-value it was 0.0001 showing a significantdifference. Conclusion: It is concluded that residual pain in cemented hemiarthroplasty is lower than uncemented hemiarthroplasty. 

Prognostic value of non-ischemic ring-like left ventricular scar pattern in patients with apparently idiopathic ventricular arrhythmias: a CMR imaging study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Nucifora ◽  
D Muser ◽  
S Castro ◽  
R Casado Arroyo ◽  
D Benhayon ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Prognostic Significance ◽  
Imaging Study ◽  
Left Ventricular ◽  
High Rate ◽  
Life Threatening ◽  
History Of ◽  
Group A ◽  
Group B

Abstract Background The presence of left ventricular (LV) late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has been correlated to life-threatening arrhythmic events in patients with apparently idiopathic ventricular arrhythmias (VAs). Aim of the present study was to investigate the prognostic significance of a specific LV-LGE phenotype characterized by a subepicardial/midmyocardial “ring-like” pattern of fibrosis. Methods Out of a total of 518 consecutive patients with apparently idiopathic VAs who underwent CMR study, 79 (15%) had evidence of LV-LGE. Of these, 23 (4%) patients had LV LGE with ring-like pattern, defined as subepicardial or midmyocardial LGE involving at least 3 contiguous segments in the same slice (group A), while 56 (11%) patients had LV LGE with no ring-like pattern (group B). The remaining 439 patients had no LGE (group C). The end-point of the study was a composite SCD, resuscitated cardiac arrest and nonfatal episodes of ventricular fibrillation or documented sustained ventricular tachycardia. Results Group A patients were more frequently males compared to groups B and C (96% vs. 79% vs. 52%; p&lt;0.01) and had more frequently a family history of SCD and/or cardiomyopathy (30% vs. 11% vs. 5%; p&lt;0.01). All patients in Group A showed VAs with a predominant RBBB morphology vs. 38 (68%) patients in Group B and 65 (15%) in Group C (p&lt;0.01). During a follow-up of 63±39 months, the composite outcome occurred in 13 patients (57%) in Group A vs. 11 (20%) in Group B and 2 (1%) in Group C (p&lt;0.01). Conclusion In patients with apparently idiopathic VAs, a nonischemic LV-LGE with a ring-like pattern at CMR is associated with a high rate of malignant arrhythmic events during follow-up. Funding Acknowledgement Type of funding source: None

scholarly journals Short-term outcome of Manual Thrombus Aspiration for patients Undergoing Primary PCI for Acute STEMI Showing LargeThrombus burden

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M N Penjameen ◽  
E M Elfekky ◽  
R R Elias ◽  
A I Nassar
Keyword(s):  
Systolic Function ◽  
P Value ◽  
Primary Pci ◽  
Thrombus Aspiration ◽  
Culprit Lesion ◽  
Short Term ◽  
St Segment ◽  
Group A ◽  
Group B

Abstract Background Thrombus aspiration (TA) might have a potential role in STEMI patients with heavy thrombus burden. The objective of several prospective trials whether routine TA in STEMI patients, contributes to a reduced mortality. After the first promising results, mainly based on the single center (TAPAS trial), results of the largest randomized trials to date (TASTE) study and (TOTAL) study, have not shown any significant differences in all-cause mortality, re-hospitalizations or stent thrombosis after a maximum of one-year follow-up period Objectives The aim of this prospective study is to study the in-hospital & short term out-come of using manual thrombus aspiration in STEMI patients undergoing primary PCI & showing large thrombus burden. Results The study included 209 patients referred to (CCU) of (Ain Shams University hospitals) with diagnosis of STEMI, who had under-gone primary PCI, with evidence of heavy thrombus burden . All the patients received DAPT, 99% had received GPIIbIIIa antagonists. The patients were divided into 2 groups: group (A) included 73 patients, who had under-gone manual thrombus aspiration followed by PCI to culprit lesion +/- other vessels & and group (B) included 136 patients, who had under-gone primary PCI of culprit lesion+/- other vessels, using the standard technique, without thrombus aspiration, within the period from 11/2016 till 7/2018(21 months),and they were followed up during hospital stay & for one month following hospital discharge. No stents were used in 13.7% of group (A), but no stents were used on 3.7% of group (B) (p value= 0.007). TIMI III flow had been achieved in 94.5% of group (A), 80.1% of group (B)(p value = (0.020) . MBG 3 had been achieved in 82.2% of group (A), 58.1% of group (B) . ST-segment resolution &gt; 70% had been achieved in 8.2% of group (A), that hadnot been achieved in group (B) (p value =0.003). Mortality(among MACE) was the only event detected (p value 0.026). Follow up MACE were statisticalLy significant results (p value=0.022) . Statistically highly significant results regarding, LV systolic function EF %, p vaue= 0.001, had been achieved . Conclusion In STEMI patients with evidence of heavy thrombus burden, a strategy of manual aspiration thrombectomy is valuable in reducing index hospitalization mortality, and 1 month follow-up rates of mortality, TIMI flow, better MBG, ST-segment resolution, in addition to left ventricular systolic function .

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