Circulating soluble receptor for advanced glycation end products: relation to vascular complications and oxidative stress in type II diabetic patients

Advanced glycation end products [AGEs] and their specific receptor [RAGE] system play an important role in the development of diabetic vascular complications. Recently, an endogenous secretory receptor form, called soluble RAGE [sRAGE] has been identified in human sera. Interestingly, it was reported that sRAGE binds AGE ligands and acts as a decoy receptor that neutralizes AGE actions. To clarify the relationship between serum sRAGE levels and micro-and macrovascular complications as well as oxidative stress in type 2 diabetic patients. This cross-sectional study was conducted on sixty patients with type 2 diabetes mellitus and twenty age and sex matched healthy subjects serving as controls. All patients and control subjects were subjected to a thorough clinical assessment, and measurement of fasting blood glucose, glycosylated haemoglobin [HbA[1C]], lipid profile, 24 hours urinary albumin excretion, high sensitivity CRP [hsCRP],oxidized low density lipoprotein [oxLDL], and sRAGE. The presence of retinopathy and the intima-media thickness [IMT] of the carotid artery were also evaluated. Serum sRAGE levels were significantly lower in patients with type 2 diabetes mellitus compared to control subjects and were inversely correlated with HbA[1C], hsCRP, 24 hours urinary albumin excretion, and oxLDL. Using multiple stepwise regression analysis, HbA[1C],, hsCRP, and urinary albumin excretion remained independent determinants of serum sRAGE levels. In addition, serum sRAGE levels were inversely correlated with mean carotid IMT in diabetic patients only. Also, serum sRAGE levels were significantly lower in diabetic patients with retinopathy compared to those without retinopathy and in diabetic patients with macroalbuminuria compared to those with normo- or microalbuminuria. Serum sRAGE levels were decreased in type 2 diabetic patients and low serum sRAGE levels may be a risk factor for the development and progression of diabetic vascular complications

Anesthetic implications in OPCAB revascularization of ischemic heart

Off-pump coronary artery bypass [OPCAB] surgery is being adopted more frequently as a much safer and economical procedure to re-vascularize the ischemic heart. The anaesthetic management of such surgeries represent a particular challenge due to the nature of the surgery necessitating the use of a stabilizing technique and the need for displacement or verticalization of the heart to reach the coronary to be anastomosed, as well as the need to keep the anaesthesia time as short as possible to achieve fast- tracking and early extubation. This work studies the role of anaesthesiologist during such surgeries, and the methods adopted to maintain haemodynamic stability as well as monitor and manage intraoperative ischemia, while using an anaesthetic technique that ensures fast-track and early extubation. Retrospective non randomized analysis. National heart Institute, Department of Anaesthesia. 30 consecutive patients undergoing OPCAB surgery by the same surgeon. Anaesthesia Induced by Thiopental sodium, Pancuronium bromide and Fentanyl intravenously, and maintained by isoflurane or sevoflurane inhalation. Of the 30 patients; 4 patients required proceding to cardiopulmonary by pass [13%]. Of the 24 patients: 6 patients [25%] required epinephrine infusion of up to 1.5mic/min intraoperatively, 16 patients [60%] required inotropic support for > 12 hrs postoperatively. The remainder were treated with volume expansion in case of hemodynamic instability. Anesthetic management and cardiovascular pharmacological intervention by the anaesthetist can ensure safe completion of OPCAB surgery in 87% of cases, without the Hazards of cardiopulmonary by pass

Role of HLA-B27 in high grade atrioventricular block and sick sinus syndrome

There has been an association between HLA-B27 and cardiovascular affection. Furthermore, a significantly increased prevalence of HLA-B27 was found in men with pacemakers who had no clinical or radiological signs of HLA-B27 associated disease. This study was planned to obtain more insight into the association between HLA-B27 and high grade AV block [HG-AVB] and sick sinus syndrome [SSS], and the possible role of HLA-B27 in causing this block. HLA tissue typing was preformed on 200 normal Egyptians [control] and 75 Egyptian pts who had permanent pacemakers implanted for HG-AVB and SSS who had no clinical or radiological signs of HLA-B27 associated disease. The pacemaker pts were classified into 3 groups according to the aetiology of AVB and SSS, group 1 included 5 pts with acquired HG-AVB, group II included 10 pts with congenital complete heart block and group III included 60 pts with idiopathic HG-AVB or SSS. HLA-B27 was present in 5/200 [2.5%] normal healthy Egyptians, in 6/60 [10%] pts with idiopathic HG-AVB and SSS [group III]. However, HLA-B27 was negative in both groups I and II. There was a statistically significant higher prevalence of HLA-B27 in pts with idiopathic HG-AVB/SSS than in both normal Egyptians and pts with acquired or congenital AVB [p < 0.05]. HLA-B27 might have a role in the aetiology of idiopathic AVB however, further research is needed to obtain more insight into its role and the role of other factors in idiopathic AVB

Immunohistochemical study of epithelial cell markers in carcinoma of urinary bladder

Immunohistochemical expression of keratin proteins and epithelial membrane antigen [EMA] were studied in 23 specimens of bilharzial associated human bladder cancer, using an indirect immunoperoxidase method on formalin fixed paraffin embedded sections.Expression of both tumour markers was detected in vast majority of differentiated carcinomas with relative superiority of keratin proteins to EMA immunoreactive staining for keratin proteins was diffuse intracytoplasmic and more uniform allover tumour tissue, compared to the prominent cell membrane localized, but less consistent reaction for EMA.The associated bilharzial reaction induced no detectable influence on distribution, intensity nor consistency of immunoreactivity for either tumour markers.Great variability in expression of both tumour markers was noticed in poorly differentiated carcinoma [2 adenocarcinomas were negative for keratin and positive for EMA and 2 squamous cell carcinomas were negative for EMA and positive for keratin proteins] which issues an advice to evaluate both tamour markers in poorly differentiated tumours in order to optimize detection of these neoplasms