The Role of Hematological Indices in Patients with Acute Coronary Syndrome

Background: Acute coronary syndrome (ACS) including ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina - is an umbrella term for life-threatening situations that occur when the blood supply to the heart is altered due to destabilization of a previously stable atherosclerotic plaque. This alteration hinders the heart muscle from functioning properly and even could lead to death. This study aimed to identify the role of hematological indices in patients with acute coronary syndrome. Methods: This prospective cohort study was carried out on 75 patients; they were divided into 3 groups each of them included 25 patients. Group I represent patients with myocardial infarction (MI), group II represents patients with unstable angina (UA) and control group included 25 subjects. All patients were subjected to complete history taking, clinical examination and routine laboratory investigation. Patients also were subjected to electrocardiography, transthoracic echo Doppler and coronary angiography. Results: Regarding hematological indices for prediction of MI, the ROC revealed: NLR ? 4.45 with sensitivity 96%, specificity 92%, Area under the curve 0. 99 and accuracy 94%. RDW ? 14.15 with sensitivity 96% specificity 72%, Area under the curve 0.973 and accuracy 84%. PLR ? 88.8 with sensitivity 96%, specificity 96%, Area under the curve 0.994 and accuracy 96%. MPV ? 9.65 with sensitivity 68%, specificity 52%, Area under the curve 0.646 and accuracy 60%. PDW ? 15.15 with sensitivity 96%, specificity 96%, Area under the curve 0.998 and accuracy 96%. Conclusions: There is a high demand for a reliable, accessible, noninvasive, and hematological prognostic marker in ACS, which would identify patients of high cardiovascular risk in secondary prevention and tailor the therapy to their needs. The inflammatory processes play a key role in the development of atherosclerosis, destabilization of atherosclerotic plaques and formation of clots on the plaque surface. There is a significance role of NLR, PLR, PDW, MPV, and RDW in the prognosis of ACS

Protrusion of the infraorbital canal into the maxillary sinus: A cross-sectional study in Cairo, Egypt

Purpose@#The aim of this study was to investigate the prevalence of infraorbital canal protrusion in an Egyptian subpopulation using cone-beam computed tomography and to describe its radiographic representation. @*Materials and Methods@#This retrospective cross-sectional study was conducted using the records of 77 patients and 123 maxillary sinuses. The full lengths of the sinuses were visible for the detection of infraorbital canal protrusion. The infraorbital canals were classified into 3 types based on their relation to the sinus. If the septum was present, its length and its distance from the sinus floor were measured. Qualitative and quantitative variables were described as percentages and means with standard deviations, respectively. @*Results@#The infraorbital canal most commonly presented as the normal confined type (detected in 78.1% of sinuses), whereas the suspended (or protruded) variant was found in 14.6% of the examined sinuses. The septal length ranged from 0.9 to 5.1 mm, with a mean of 2.8±1.1 mm. The distance to the sinus floor ranged from 5.2 to 29.6 mm depending on the sinus shape and size. @*Conclusion@#The present study indicates that protrusion of the infraorbital canal is not rare, and surgeons that use the maxillary sinuses as corridors for their procedures must be more cautious, especially in the upper lateral confines of the sinus.

A Short Term Clinical Outcome of Provisional versus Routine Kissing Balloon Technique after Main Vessel Crossover Stenting for Coronary Bifurcation Lesions

Background: Kissing Balloon Inflation (KBI) technique was the first technique for percutaneous intervention in bifurcation lesions. It's the standard strategy in the two-stent procedure. Its benefit in one-stent approach remains uncertain. Several trials comparing KBI strategy with the No-KBI strategy in one-stent technique did not show any advantages in the clinical outcome. Clinical outcome and the follow up of ischemic symptoms is a useful method to compare the effectiveness of both strategies.Aims: To study the short-term clinical outcome (3and 6 months) of provisional versus routine kissing‑balloon technique after main vessel stenting for coronary bifurcation lesions.Patients and Methods: The study included sixty consecutive patients. They were randomized to receive different side branch (SB) intervention strategies: group I (provisional final kissing balloon inflation group -PFKBI) (FKBI only when SB Flow less than TIMI 3) and group II (routine final kissing balloon inflation group –RFKBI).Results: 1-Dissection of side branchand conversion to two stent strategy was significantly higher in PFKBI group (14,3%) than in RFKBI group (0) 2-The amount of dye, total procedure time and time of admission was significantly higher in RFKBI group. 3-Chest pain immediately after the procedure was significantly higher in PFKBI group while at 3 and 6 months follow up no significant difference between both groups was noticed. 4-MACE, target lesion revascularization (TLR) and stent thrombosis were similar between both groups at 3 and 6 months.Conclusions: Main vessel stenting with and without final kissing balloon dilatation was associated with favorable and similar 3 and 6-month clinical outcomes

Evaluation of serological test in the diagnosis of Helicobacter pylori and risk factors associated with the infection

Background: Serological testing has been widely used for the diagnosis of H. pylori. This study aimed to evaluate the serological test and to determine the sensitivity and specificity of the test in the diagnosis of H. pylori. The study also aimed to address if there are risk factors like blood grouping, Smoking, Age, gender, and residence of the patients associated with H. pylori infection.Methods: A prospective cross‑sectional study was performed among 100 symptomatic patients attending Dr. Suliman dispensary, Elnehoud city in west Kordofan state-Sudan, from March to September 2016. H. pylori were detected on plasma by using Healgen immunochromatography test cards from Xiamen Boson Biotech Co., Ltd (China), and identified from a stool by using monoclonal antigen detection from the same trademarked company. Data for the risk factors associated with the infection were assessed in a participant interview.Results: The serological test showed significant differences when compared to the stool antigen test p-value = 0.000. The statistical analysis showed moderate sensitivity and high specificity of the serological test compared to the stool antigen detection test. The study also showed that smoking [odds ratio (OR): 1.20, 95% confidence interval (CI): (1.24-4.02) and blood grouping (OR: 1.10, 95% CI: (1.08-1.60) were risk factors for H. pylori infection.Conclusions: The serological test showed high specificity and moderate sensitivity in comparison to the stool antigen test. The increased risk of H. pylori infection associated with smoking and blood grouping.

Comparison between Pharmaco-invasive Strategy and Primary Percutaneous Coronary Intervention According to Percutaneous Coronary Intervention Related Delay

Aim:This study aimed to compare between the effect ofpharmacoinvasive strategy (PI)& primary percutaneous coronary intervention (P-PCI) according to PCIrelated delay (door to ballon) on the mortality and morbidityduring in-hospital stay and after 30-day follow up. Moreover, leftventricular systolic function was assessed by two-dimensional echocardiography at cardiology department, Tanta University. Patients and Methods:The study was conducted on 300 patients that were dividedinto 2 main groups. Group A consisted of patients had primaryPCI as reperfusion therapy and further divided into threegroups according to PCI related delay (door toballon). Group A1, PCI-related delay is ≤60 minute(92patients). Group A2, PCI-related delay is >60 to ≤ 90 minute. (54patients). Group A3, PCI-related delay is >90minute (78 patients). The second group (group B), include patients who undergopharmaco-invasive strategy, PCI within 24 hour afterthrombolysis (76 patients). the second group, coronary angiography was done immediately in cases of failedthrombolysis and for successful thrombolysis; coronaryangiography was performed within 3 –24 hours. Results:During hospital stay, more patients in group A3 died than those of group B orgroup A1, A2 with no statistical significance.In addition, morepatients in group A3 showed heart failure symptoms withstatistical significance than those of group B, A1 and A2. Bleeding complications occurred significantly moreingroupB. Duringfollowupvisits more patients in group A3 complained ofheart failure symptoms with statistical significance than those of group B, A1, A2 patients. Conclusion:Primary PCIwithout door to balloon time delay (≤90 minutes)was encouraged and hadthebest results on morbidity and mortality. Also, pharmacoinvasive strategy was encouraged as being better than primary PCIwhen door to balloon time showed marked delay( <90 minutes)

Allolobophora caliginosa coelomic fluid ameliorates gentamicin-induced hepatorenal toxicity in rats

Objective: To explore the efficacy of earthworm's coelomic fluid against gentamicin-induced hepatic and renal toxicity in rats. Methods: The animals were divided randomly into three groups (n = 6 per group): control, gentamicin, and Allolobophora caliginosa coelomic fluid-treated groups. Toxicity was established after injection of gentamicin daily for 8 days at a dose of 100 mg/kg. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total proteins, albumin, creatinine, urea, uric acid, malondialdehyde, glutathione, catalase and histopathology of tissues were investigated in the study. Results: Allolobophora caliginosa coelomic fluid significantly decreased urea, creatinine, uric acid, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and malondialdehyde levels while significantly increasing levels of total proteins, albumin, glutathione and catalase. The histopathological investigation showed partial restoration of renal and hepatic architecture. Conclusions: This study shows the potency of Allolobophora caliginosa coelomic fluid in improving the biochemical and histopathological changes induced by gentamicin in the liver and kidney of the rats.

Evaluation of serum level of 25-hydroxy vitamin d in vitiligo patients

Introduction: Vitiligo is an acquired skin disease characterized by loss of functional melanocytes from the epidermis. Despitethe several factors studied, the pathogenesis of vitiligo remains unclear. Vitiligo could be associated with low vitamin D levels. The aim of this study was to evaluate serum 25(OH) D levels in vitiligo patients in comparison of normal controls. Methods: After meeting inclusion and exclusion criteria, serum 25 hydroxy vitamin D levels were assayed, in all subjects included in this case control study (21 patients and 21 age and sex matched healthy individuals). Vitiligo disease activity index (VIDA), affected body surface area (BSA),site of lesion, age of patients and duration of vitiligo were evaluated in relation to vitamin D level. Results: A total of 42 participants were enrolled in our study, 21 patients with vitiligo and 21 who served as controls. The mean serum level of vitamin D were significantly decreased in the patients group as compared with the control group ( 17.3ng ̸ml ± 5.3 vs 25.8 ng/ml ±7.9, P = 0.006). There was non-significant correlation between vitamin D level with age, duration of vitiligo, and affected body surface area (P>0.05), but there was significant difference in 25(OH)D levels between different grades of VIDA. Conclusion: In this study, we found a significant 25(OH) D deficiency in patients with vitiligo, suggesting that vitamin D deficiency may plays a role in the pathogenesis of vitiligo

Reduction of Plasma Adiponectin in Egyptian Obese Children with Nonalcoholic Fatty Liver Disease.

Background: Obesity, insulin resistance and dyslipidemia are the most significant risk factors of non-alcoholic fatty liver disease (NAFLD) in children, and a major cause of liver-related morbidity. The aim of this study was to evaluate the serum levels of adiponectin, leptin and fasting insulin in obese children with NAFLD to explore the role of adiponectin in the pathogenesis of this disease. Materials and Methods: The fasting serum levels of adiponectin, leptin, glucose, insulin, ALT, AST, total bilirubin, direct bilirubin, albumin, alkaline phosphatase, creatinine, cholesterol, triglycerides, HDL, LDL, GGT and CRP were measured in a group of 50 NAFLD children after making ultrasonography and 40 other participants were considered as a control group with comparable age, sex and body-mass index. Results: Plasma adiponectin was found significantly low in NAFLD children than its level in control group (3.23± 2.5 vs 11.0 ± 2.95 ng/dl). Moreover, NAFLD group had significantly higher insulin resistance, fasting insulin 11.4± 4.9 vs 4.7±3.1 mu/l levels in comparison with control group. Regarding serum leptin, there was no significant difference. An inverse correlation was observed between adiponectin and homeostatic model assessment (HOMA-IR), fasting insulin, leptin, triglycerides, ALT, AST, GGT and BMI. Conclusion: This data supports a role for low circulating adiponectin value in the pathogenesis of NAFLD and its association with insulin resistance.

Prevalence of intestinal parasites and its impact on nutritional status among preschool children living in Damanhur city, El-Behera goveftnorate, Egypt

This cross sectional study was done in Damanhur City, the Capital of El-Behera Governorate to detect the prevalence of intestinal parasitic infection among preschool aged children and to find out its effect on their nutritional status. Five-hundreds children aged between 2-6 years were enrolled; a detailed questionnaire, complete clinical and anthropometric assessment as well as complete stool analysis and blood picture were done. The study revealed that 51.8% preschool children were infected; Cysts of Entamoeba histolytica and Giardia lamblia were found in 16.8%, and 14.8% respectively. In 1.8% of cases, both cysts were found together. Ova of Ascaris lumbricoides, Enterobius vermicularis, Ancylostoma duodenale and Hyme-nolepis nana were detected in 14%, 3.4%, 5% and 0.2% of cases, respectively. In 0.4% of cases, ova of A. lumbricoides and E. vermicularis were found together. Mixed infections were found in 3.6% of children. Significantly lower weight for age z-score [WAZ] and weight for height z-score [WHZ] were found among infested children compared to non-infested ones [P<0.05]. Moreover, stunting was found in 44.1%, underweight in 39.1% and wasting in 11.5% of infested children. Prevalence of anemia among all studied population was 39%; 48.6% in infested group compared to 28.8% in non-infested children [x=20, P<0.001]. Improper hand washing, and playing in the street bare footed, together with playing with animals and family history of parasitic infestation were considered the independent predictors of parasitic infestation by using binary logistic regression

Biofilm formation by e-coli causing catheter associated urinary tract infection [CAUTI] in Assiut university hospital

Urinary tract infections [UTIs] are the most common cause of nosocomial infection and up to 80% of UTIs are associated with the use of urinary catheter. Inappropriate use of this device may lead to an increase incidence of infectious complications. It has been estimated that 65 % of nosocomial infections are biofilm associated urinary tract infections, loading the health care system enormous costs. These biofilm infections are 10 to 1000 times more resistant to the effects of antimicrobial agents. In this study urine samples were collected from 150 patients with CAUTI [group 1] giving one hundred and fifty bacterial isolates and 70 non catheterized UTI patients [group 2] giving fifty bacterial isolates. Out of the two hundred isolates the most common isolated pathogens were: Escherichia coli[E.coli] [50%] in group I, [48%] in group 2, followed by Klebsiella [26.7%] in group J, [28%] in group 2, pseudomonas aeruginosa [8%] in group 1, [12%] in group 2 then Staphylococcus aureus [8.6%] in group 1, [4.%] in group 2, Proteus [4.6%] in group 1, [4%] in group 2, and lastly, Candida albicans [2%] in group 1,[4. %] in group 2. The E.coli isolates were evaluated for biofilm formation using congo red agar [CRA] and microtitre plate methods. Out of 99 E.coli isolates; 27 were non biofilm forming in group 1, 19 isolates in group 2 while 48 isolates were biofilm forming in group 7, only 5 isolates in group 2 . Using microtitre plate method; out of 48 biofilm forming isolates in group 1; 8 isolates [16.6%] were weak biofilm forming, 10 [20.8%] were moderate biofilm and 30 isolates [62.5%] were strong biofilm forming while, 3 isolates were weak biofilm forming in group2. The two methods used to detect biofilm formation [CRA test and spectrophotometer], both are valid tests. CRA is simpler but spectrophotometer differentiates between weak and strong biofilm producers

Screening of microhematuria in school children

Microhematuria [MH] is present in 0.5 - 2% of children. A renal or urologic disorder may present with symptom obviously pointing to the urinary tract as hematuria or the kidneys may be involved in several different systemic diseases including the vasculitis syndromes, collagen vascular diseases and the thrombotic microangiopathic diseases due to variable etiologies. Each of these diseases has important renal manifestations that may symptomatise as hematuria. We aimed to detect and depict any eventual correlation that might make microhematuria a useful tool on the predictive level on renal participation in medical disorders. More especially so in tropical settings, where specific diseases are expected to have an insulting impact upon the kidney if not the whole organisms and to determine the prevalence of microhematuria in healthy school aged children the study was conducted on 100 children with MH detected by dip- sticks and confirmed microscopically, the age range from 6 to 12 years either symptomatic or not. It was conducted among healthy children attending the outpatient clinic of the National Hepatology and Tropical Medicine Research Institute [NHTMRI] and in 2 primary schools, through screening of 5342 children by dipsticks for microhematuria. Cases were compared with 20 healthy children of the same age and sex matched as a control. All cases were subjected to full history taking, clinical examination and laboratory studies including complete urinalysis, urine culture and sensitivity, urinary Ca/creatinine ratio, blood urea nitrogen, serum creatinine, serum complement C3, CBC, retics, ASOT, CRP, ESR and coagulation profile [PT, PTT, BT and CT]. Pelvi-abdominal ultrasonography was done for all cases. In selected cases, 1VU, voiding cystourethragraphy, DMSA scan and renal biopsy were done The prevalence of MH was 1.9%. Glomerular group represented 14% and included, acute post streptococcal glomerulonephritis, APSGN [9%], IgA nephropathy [3%] and membranoproliferative glomerulonephritis [2%], non-glomerular group represented 42% of the studied cases and included UTI [24%], hypercalciuria [14%], renal stone [2%], UPJ obstruction [1%] and VUR [1%] and group of unidentified cause of MH [44%] who had no MH after 6 months of follow up Dipsticks can be used as a useful screening test for MH; however this should be confirmed by microscopic examination of the urine. The most common glomerular cause of MH in the event study was APSGN whereas the most common nonglomerular cause was UTI and hypercalciuria. Follow up is recommended for cases of MH with unidentified origin. MH is positively suggested as reliable simple, however preliminary tool in clinical diagnosis of renal and urological disorders

Seroma formation after surgery for breast cancer

Seroma formation is the most frequent postoperative complication after breast cancer surgery. We carried out a study to investigate the effect of various demographic, clinical and therapeutic variables on seroma formation. A retrospective cross sectional study of patients who underwent surgical therapy for breast cancer with either modified radical mastectomy [MRM] or breast preservation [BP] was carried out. The demographic data and clinical information were extracted from case records. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument [electrocautery or scalpel], use of pressure garment, and duration of drainage. The multiple logistic regression analysis was performed to estimate odds ratios. A total of 158 patients with breast cancer were studied. The mean age of the patients was 46.3 years [SD +/- 11.9]. Seventy-three percent underwent modified radical mastectomy and the remaining 27% received breast preservation surgery. Seroma occurred in 35% of patients. In multivariate logistic regression analysis an association of postoperative seroma formation was noted with modified radical mastectomy [OR = 2.83, 95% CI 1.01-7.90, P = 0.04]. No other factor studied was found to significantly effect the seroma formation after breast cancer surgery. The findings suggest that the type of surgery is a predicting factor for serorna formation in breast cancer patients