Predictive value of ischaemia modified albumin [IMA] in patients with acute coronary syndromes [ACS]

Establishing a diagnosis of acute coronary syndrome in the clinical setting remains a challenging task. The advent of testing for cardiac biomarkers such as myoglobin, creatine kinase [CK-MB], and the troponins has facilitated this process. Unfortunately, although these blood markers are extremely sensitive for the identification of patients with myocardial necrosis, their ability to identify patients with acute coronary ischaemia remains limited. During myocardial ischaemia, several changes occur in the amino terminus of ischaemia, several changes occur in the aminot terminus of albumin. Therefore, if reliable, an assay measuring IMA might represent a promising marker for early identification of patients with myocardial ischaemia. To assess the role of IMA and its predictive value for early diagnosis of patients with acute coronary syndromes. Seventy three patients with suspected ACS attending the emergency department at Assiut university hospital were included in addition to -sex and age matched -20 healthy control subjects. All patients were presented within 6h of the typical chest pain episode with negative troponin and normal serum albumin levels. Any patient with liver diseases, renal failure, anaemia, malignancy, acute infections, peripheral vascular diseases, cerebral ischaemia and physical exercise within the last 48 hours was excluded. Full history, clinical examination and standard 12 lead ECG, laboratory investigations including CPK, IMA, CRP, lipogram, kidney and liver functions were done. Twenty two patients were diagnosed as non ischaemic chest pain [NICP] and 51 cases as ACS. CPK and troponin levels were normal in all groups at presentations but 6 hours later CPK levels were significantly higher in ACS patients if compared with NICP or control groups [p<0.000]. on the other hand, IMA levels were statistically significantly high in ACS group only [p<0.000] with a good negative predictive value to diagnose NICP [86.3%]. Moreover, IMA levels were statistically significantly higher in patients finally diagnosed as unstable angina [UA] than those who diagnosed as non ST elevation myocardial infarction [NSTEMI] [p<0.04] meanwhile, it is insignificantly higher than that in STEMI patients. The sensitivity of IMA to predict ACS cases [94.1%] was higher than that of ECG [78.4%] and CPK at presentation [14.7%] and after 6 hours [54.7%]. On the other hand, the specificity of IMA, ECG, CPK at presentation and 6 hours later [86.4%, 90.9%, 86.4% and 97% respectively]. IMA can be used at the emergency setting to exclude the diagnosis of ADS. Moreover, the use of IMA as a diagnostic biomarker in addition to standard markers of myocardial injury is very useful for the evaluation of patients with suspected ACS

Evaluation of erectile function in patients with myocardial infarction

In this study, 120 patients with a history of myocardial infarction [MI] and admission to coronary care unit for their erectile function were prospectively evaluated using the questioner of international index for erectile function after reviewing their medical records. Patients with erectile dysfunction [ED] were seen by psychotherapist and evaluated for this problem using the office injection test, color duplex ultrasound and were offered certain choices for management using oral non-specific medication, i.e. sildenafil citrate, self-injection pharmacotherapy, vacuum constriction device and prosthesis. The patients were followed up for one year. Forty out of the 120 patients had no problem with their erection. For the 80 patients with erectile dysfunction, 5 were feared of doing sex and refuse further evaluation. All patients refused the vacuum device as well as ten patients were not on nitrite therapy and were put on sildenafil oral pills. Sixty patients were put on pharmacotherapy program using self-injection of trimix. Five patients were non-responders to pharmacotherapy using trimix and three of them had prosthesis. During one-year follow up, one patient in the oral therapy group stopped the treatment since he was put on nitrite therapy and eleven patients stopped the injection. No ECG changes could be detected in the pharmacotherapy group

Effect of ligation of subclinically color duplex detected varicocele on semenogram

A prospective study was conducted to demonstrate a clinical evidence that varicocelectomy is of benefit in patients with a subclinical varicocele. The study included 90 patients 24 to 37 years old [mean age 32] with a subclinical varicocele who presented with infertility. Duration of infertility was 1 to 5 years [mean 3.1]. The evaluation consisted of history and physical examination, including palpation of the scrotum with the patient upright during valsalva maneuver. No patient reported previous history of cryptorchidism, hydrocele, testicular trauma or underwent surgery of the urogenital tract. All patients had normal hormonal pattern. Ultrasound was done with the patient supine before and during a valsalva maneuver. The cutoff for a positive study was venous diameter greater than 3 mm. Two groups of patients could be identified according to the improvement postoperatively. The first group was those patients [58 patients] with sperm concentration more than 10 million/cc showed significant improvement in the total motile sperms. The second group [32 patients] with sperm concentration less than 10 million/cc showed insignificant improvement in both the count and motility. The viscosity did not change in both groups