Background-For the diagnosis of myocardial cell damage the measurement of the serum concentrations of myofibrillar antigens has several potential advantages over the assessment of traditional serological markers. These include the expression of myofibrillar antigens as cardiospecific isoforms and their high intracellular concentrations. Recently a sensitive and specific enzyme immunoassay for cardiac troponin T has been developed that shows little crossreactivity with skeletal isoforms. Objective To characterise myocardial cell damage after orthotopic heart transplantation, concentrations of circulating troponin T were measured prospectively in serial blood samples from 19 consecutive patients taken during the first three months after transplantation. Results-Mean (SD) serum concentrations of cardiac troponin T reached a maximum of 3-6 (1.8) ,ug/l at 7-1 (4.2) days after transplantation and remained higher than 0*5 4ugIl (twice the detection limit of the assay) in all patients for at least 43 days (mean (SD) 59 (20) (Br HeartJI 1993;69:395-398) For the diagnosis of myocardial cell damage the measurement of serum concentrations of myofibrillar proteins (such as actin, myosin, tropomyosin, and the troponin complex) has several potential advantages over the measurement of traditional serological markers. These include the expression of myofibrillar proteins as cardio-specific isoforms and their high intracellular concentrations.1 A sensitive and specific enzyme immunoassay has been developed for cardiac troponin T which shows little cross-reactivity with the skeletal troponin T isoforms."3 As shown in previous studies, circulating troponin T is not detectable in the absence of cardiac muscle damage; serum concentrations increase only when troponin T is released from damaged myocytes during severe ischaemia45 or myocardial infarction.6 These studies showed that the diagnostic efficiency of troponin T measurements was better than that of total creatine kinase (CK) or CK-MB to CK ratios.In the present study we attempted to evaluate myocardial cell damage after orthotopic heart transplantation by serial measurements of troponin T. Patients and methods PATIENTSWe studied 19 consecutive patients (mean (SD) age 52 (6) years, two women) who underwent orthotopic heart transplantation

Background1.7 billion Muslims worldwide obey divine commands of fasting for a month. This may increase the probability of the acute complications of diabetes during the fasting period.Design and methodsWe primarily aimed to compare the incidences and duration of Diabetic ketoacidosis (DKA) admissions during Ramadan compared to the month before (Shaaban) and the month after (Shawal) as well as the average pre-Ramadan six months' admissions. Our secondary objective was to assess the different incidence of DKA between Ramadan and the other months regarding precipitating factors, fasting practices in people admitted with DKA and gender differences.This was a prospective study that included all Muslims who were admitted with DKA to major hospitals in the United Arab Emirates, Sudan, Tunisia and Morocco during the pre-Ramadan month, Ramadan and post-Ramadan month, in addition to the average monthly admissions during the last six months before Ramadan. Demographics, clinical, and laboratory indices were collected and analyzed to assess primary and secondary end points.ResultsOne hundred seventy patients were admitted during the study duration, 56 were admitted during Ramadan and 63 in Shawal. Six months before Ramadan showed an average admission of 56 + 7 per month. All those admitted during Ramadan were people with type1 diabetes. 29.8 % of those admitted during Ramadan did not receive structured education program on diabetes management in Ramadan. Non-compliance to medications represented the commonest cause for admission in the whole study period. Hospital stay was comparable through different months, but the duration of acidosis was longest during Ramadan month.ConclusionIn concordance with DKAR1, DKAR international showed higher rates of DKA during Ramadan when compared to preceding Lunar month (Shaaban). In Shawal, however, the rates of DKA admission were higher than the average monthly DKA admissions. The duration of acidosis was longer in Ramadan group and positively correlated with duration of diabetes. Many patients did not receive structured education about diabetes and fasting Ramadan. Our study calls for formal pre-Ramadan education and enforces the need for advice against fasting in patients who already experienced DKA in the months preceding Ramadan.

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We read with great interest the paper by Cheikh Rouhou et al., which was recently published online in TheScientificWorldJOURNAL[1]. In this article, the authors report a new case of pulmonary and vertebral blastomycosis from Tunisia. They found that the probable reservoir of Blastomyces dermatitidis is the soil. Blastomycosis is considered a rare and sporadic disease in Africa, unlike in some endemic regions in Canada or in the upper Midwest in the U.S. In fact, few cases of the disease were reported in the African literature and only one case was reported in the Moroccan literature. In 2005, there was a case of thoracic blastomycosis. It was primarily suspected to be a pulmonary carcinoma, but was never histologically confirmed. All the biopsies performed showed inflamed material. The medical student taking care of the patient found out that his patient sells used clothes (he imports secondhand clothes from the U.S. and Canada, and resells them in his store). Therefore, our medical student suspected that the patient's symptoms could be due to an imported disease. The medical staff recommended performing a mycological study. Culture on Sabouraud's dextrose agar at 25°C further confirmed the presence of B. dermatitidis northamericanus. A mycological study was then performed on the clothes sold by the patient. It showed a considerable amount of blastomycosis spores, a finding that concludes that the infection was due to massive and chronic inhalation of the spores present in the imported clothes. The patient was treated with a daily 400-mg dose of fluconazole for 12 months, a treatment that led to a great clinical and radiological improvement. So far, the patient has shown no evidence of recurrence. Our case illustrates two important facts: the first is that medical students play an important role in the diagnosis and treatment of new diseases in our university hospitals, and the second is that imported clothes are not always safe. There should be a strict and thorough verification of imported clothes in order to prevent deadly disease.