Subjective evaluation of smell dysfunctions before and after different nasal surgeries

Background: olfactory dysfunctions affect daily life activities. Nasal surgeries primarily aims at elimination of nasal obstruction and removal of nasal polyps or inflamed mucosa. Improved olfactory function after these surgeries may be a secondary benefit

Objectives: this study aimed to evaluate different types of smell dysfunctions before and after different nasal surgeries and its liability to improve or not after surgery and to discuss CT scan results in these cases in correlation to clinical and surgical results

Study Design: prospective study

Methods: a total of 50 patients were included in this prospective study [32 men, 18 women; age range was 20-49 years, mean age 32 years, standard deviation =7.3years]. Patients were suffered from different nasal diseases requiring surgical interference and complaining of smell dysfunctions as one of the main nasal symptoms. Patients were selected from those attending E.N.T Clinic in Bab EL-Sharia Hospital, Faculty of Medicine, Al-Azhar University from February 2017 to April 2018. Prior to surgery, patients received a detailed otorhinolaryngologic examination included nasal endoscopy. Olfactory function was evaluated subjectively. CT scan nose and paranasal sinuses [coronal and axial] was done before the surgical interference and repeated after complete healing of the operation. Questionnaire was directed to each patient to tell which type of smell dysfunctions he was complaining of and the severity of this dysfunction, this questionnaire was repeated after the complete post-operative period. The patients were followed up after the operation in scheduled sessions for five months

Results: after different nasal surgeries no change of olfactory dysfunction was found in 26% and improvement was seen in 74%. As regard patients underwent endoscopic sinus surgery no change of olfactory dysfunction was found in 32% and improvement was seen in 68%; however in the septoplasty group no change of olfactory dysfunction was found in 50% and improvement was seen in 50% and in septoplasty and inferior turbinectomy group, no change of olfactory dysfunction was found in 14.3% and improvement was seen in 85.7%. in patients who had hyposmia no change of olfactory dysfunction was found in 17.9% and improvement was seen in 82.1%, whereas in patients who had anosmia, no change of olfactory dysfunction was found in 42.9% and improvement was seen in 57.1%; patients who had cacosmia, no change of olfactory dysfunction was found in 14.3% and improvement was seen in 85.7%. Free postoperative CT was found in 92% and recurrence was seen in 8%

Conclusion: the different nasal surgeries showed significant effect on olfactory function in Patients with subjective olfactory dysfunction. However, considerable number of patients with olfactory dysfunctions did not improve after surgery. CT scan is useful in the assessment of patients with olfactory dysfunction associated with many sinonasal diseases

Compromising bradycardia: management in the Emergency Department of National Heart Institute

The need to treat bradycardias is dictated primarily by the clinical Presentation of the patient [1]. Bradycardia may bean incidental finding in asymptornatic patients [2]. On the other hand, bradycardia may present with haemodynamic instability and loss of consciousness [3]. Out of the bradycardic rhythms to be encountered in these patients, high grade atrioventricular-block represents a significant portion [4]. Compromising bradycardia requires an effective diagnostic and therapeutic approach [1]. The goal of initial management is stabilization by increase of the ventricular rate by both pharmacological and non-pharmacological interventions, sometimes even cardiopulmonary resuscitation is required [5]. A careful clinical workup for potential causes, including ischacmic and non-ischaemic aetiologies, is crucial for successful management [6]. There are only a few reports available on the management and outcome of patients presenting with compromising bradycardia to the emergency department [ED] [1]. This study include 210 consecutive patients, with compromising bradycardia, admitted to the emergency department of National Heart Institute [tertiary Care hospital] within eight month period, 107 patients [51%] females, 103 patients [49%] males, whose age ranged from 25 to 89 years. The aim of this study is to report the incidence, symptoms, presenting rhythm, underlying mechanism, management, and outcome of patients presenting with compromising bradycardia to the emergency department and to assess the incidence of patients in need for temporary and permanent pacing. All patients were subjected to full history taking, general and local cardiac examination, resting 12-leads ECG and routine laboratory investigation

Clinical predictors and outcomes associated with acute return of pulmonary vein conduction during pulmonary vein isolation for treatment of atrial fibrillation

Radiofrequency ablation has become a common trend in management of cases of AF refractory to medical treatment. Recurrence of AF is a common observation both acutely and late during follow up. To determine the clinical predictors of acute reconnection of pulmonary vein potentials during PVI and late recurrence of AF on follow-up, respectively. A cohort of 14 patients referred to the EP labs of the NHI and Ain Shams University for PVI between January 2007 and February 2008 were studied. PVI of arrhythmogenic PVs was performed segmentally. PVI was defined as entry and exit block using a multipolar Lasso catheter. All veins were resampled to confirm isolation after 20-60niinutes. There were 14 patients who underwent isolation of 56 pulmonary veins during the study period. Acute reconnection of at least one vein occurred in 7 patients [50%] and 10 of the 56 pulmonary veins targeted [18%]. The left superior PV was most likely to acutely recover conduction compared with the other veins. Predictors of acute reconnection could not be accounted for given possible technical difficulties and the small sample size. During the three month follow up period, recurrence of AF occurred in 3 patients representing 21.4% of the cohort. It was found to be higher in female gender, left atrial size>or equal 4.Scms, age older than 50 years, non-paroxysmal type of AF and an EF of less than 50%. Many clinical criteria can affect acute reconnection of PVPs during PVI for patients with AF. According to previous studies large left atrium, older age, hypertension, non-paroxysmal type of AF are the most likely acute predictors. As regards short term follow-up, factors that could be considered include gender, age, left atrial size, EF and type of AF. The importance of detection of acute recurrence of PVPs and re-isolation has also become evident through this study

Role of mitral annular calcification in detection of coronary artery disease in women over 60 years

In this study, the diagnosis of MAC by TTE was made from January 2006 to January 2007 in female patients over the age of 60 years. Of these, 50 patients underwent coronary angiography for various reasons and formed the study group. These patients were compared to 50 age-matched patients without MAC who underwent coronary angiography for the same reasons during the same period and these patients formed the control group. Comparison between the two groups of patients with special emphasis on age, risk factors, echocardiographic and angiographic findings. There was no significant difference in age, risk factors, electro-cardiographic, echocardiographic and reasons for coronary angiography between patients with and without MAC. The main finding of our study was that mitral annular calcification is a predictor of the presence of severe stenosis [70% diameter stenosis] in at least one major epicardial coronary artery on angiography between the two groups of patients. The study group had significantly higher rates of severe obstructive CAD as 3-vessel disease and left main CAD but similar rates of single vessel disease and 2-vessel disease. Therefore, mitral annular calcification is an indicator of a higher prevalence of triple vessel disease [28%vs 16%, p=] or significant left main coronary artery stenosis [6% vs. 2% p=] so In female patients above 60 years of age, the absence of mitral annular calci-male fication was an indicator of a lower risk of obstructive coronary artery disease

Detection of thrombogenicity induced by radiofrequency catheter ablation

The aim of this study is to determine the independent and incremental procoagidant effect of RF ablation by assessing biochemical marker of thrombogenicity. The biochemical markers used in this study is direct measures of fibrinolysis [d-dimer, DD]. This study is a comparative clinical trial that was conducted in EP laboratory of National Heart Institute. This study included forty patients are divided into twenty patients referred for radio-frequency transcatheter ablation in right side of the heart [patients with AVNRT] and twenty patients with accessory pathway in the left side of heart with supraventricular tachycardia. Patients with history of recent electrophysiological study [EPS], malignant disease, history of embolic events, recent surgery or trauma, history of atrial fibrillation, active thrombotic process, renal failure, cerebrovascular stroke or previously identified coagulopathy or thrombocytopenia were excluded from the study. No medications affecting the function of the platelets and coagulation system was administered in any of the study subjects. Any antiarrhythmic drugs were withdrawn prior to study. All patients included in the study were subjected to full history taking, thorough clinical examination, resting 12-lead electrocardiogram, transthoracic echocardiography, CBC, FT, PTT, routine laboratory investigations. D-dimer measurement was measured immediately after insertion of the venous sheaths, before introduction of the electrode catheters, on completion of EPS and mapping, before production of the first RF ablation [post-EPS measurements], after completion of the RF procedure [post-RF measurements], before sheath removal and at 36 to 40 hours later and before discharge from the hospital. The D-dimer level in all the studied patients increased significantly after EPS and in spite of that it decrease before discharge it is still significantly higher than that of the baseline level [P < 0.001]. In patients with AVNRT [right sided] and in patients with AP [left sided] the D-dimer level increased significantly after EPS and it decrease before discharge but it was still significantly higher than that of the baseline level [P < 0.001]. Comparison between left and right sided ablation showed no significant difference in the D-dimer level [P > 0.05]. Both right and left sided EPS ablation was associated with an increase in the D-dimer level and this increase continued until discharge

Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction

Cardiogenic shock is the severest clinical expression of left ventricular failure due to extensive damage of the myocardium [at least 40% of LV mass is affected] in more than 80% of AM patients in whom it occurs and the remainder have a mechanical defect such as VSD or papillary muscle rupture or predominant RV infarction. The challenge for the clinician is to promptly and thoroughly identify the patients at risk for developing cardiogenic shock; and so, preventive measures may be implemented in an attempt to avert the development of cardiogenic shock. This study was performed to develop clinical and biochemical criteria to predict the occurrence of cardiogenic shock in AMI patients who were treated with thrombolytic therapy [streptokinase] within 24 hours from the onset of chest pain. Sixty [60] patients with AMI who were treated by thrombolytic therapy [streptokinase] were included in this study. All patients were subjected to; complete history taking and full clinical examination; resting 12 leads surface ECG; laboratory investigations [serum level of total CPK and CK-MB measured daily for at least 48 h., random blood sugar, fasting lipid profile, serum level of sodium and potassium, serum level of urea and creatinine, acute phase reactants as [erythrocyte sedimentation rate [ESR], total leucocytic count, C-reactive protein [CRP]]]; and echocardiography. The sixty patients were divided into 2 groups; Group A, which included 30 patients with AMI who were treated by thrombolytic therapy and developed cardiogenic shock and Group B, which included 30 patients with AMI who were treated by thrombolytic therapy and did not develop cardiogenic shock. A statistical comparison was held between group A and group B. Which revealed that the mean age in group A was 63 +/- 6.51 year, while; in group B was 45 +/- 5.04 year which is highly significant between the two groups [P<0.01 [HS]]. Also; This study revealed that patients who were female gender; obese; diabetic; had previous history of AMI; extensive anterior MI and anterior MI; past history of hypertension; family history of IHD; heart rate [>124]; Killip classes [II or III]; systolic blood pressure < 100 mmHg; ejection fraction of the left ventricle < 42% and C-reactive protein level >35 mg/L in the first few hours on presentation are predictors of development of shock after thrombolytic therapy. In this study; patients presented with extensive anterior MI were associated with a greater reduction in left ventricular ejection fraction [LVEF] and more reduction in SBP and presented to emergency room [ER] by Killip class II and III and were diabetic more than patients presented with other types of MI locations and they had worse prognosis [cardiogenic shock]. It is possible to estimate with accuracy the risk of shock. A simple criteria that can predict the risk of cardiogenic shock after thrombolytic therapy for AMI patients who did not present with shock based primarily on the older age of the patient [above 63 year] and findings easily derived from the physical examination upon presentation such as female sex, diabetic, prior MI, anterior MI or extensive anterior MI, systolic blood pressure < 100 mmHg, heart rate >124 beat/min., Killip class [II and III] and left ventricle ejection fraction < 42% and the laboratory data such as serum level of C-reactive protein >35mg/L

Value of ST - segment elevation in predicting infarcts size and left ventricular function at discharge in patients with perfused acute anterior myocardial infarction

The electrocardiogram [ECG] is simple and non-invasive and can be recorded at bed side, its role in the diagnosis of acute myocardial infarction [AMI] is well established. We are aiming through this study to assess the predictive value of ST segment elevation pattern in reperfused anterior myocardial infarction as an index of infarct size and left ventricular function [LVF]. The study was conducted on 40 patients who were admitted to the Coronary Care Unit of the National Heart Institute between October 2000 and may 2001 with the diagnosis of first time acute anterior wall myocardial infarction. All patients included in the study were submitted to: Full history taking and clinical examination, laboratory investigation including: Serum cardiac enzymes CPK, LDH on admission, at 6 hour intervals for the first day and then daily until discharge, standard resting 12 electrocardiogram A 12 lead ECG was recorded immediately before reperfusion. Evaluation and classified the shape of ST elevation in V3 into 3 types: Concave type: ST-T segment rise with downward convexity group I, 2] straight type: ST-T segment raised obliquely like an inclined plane group II and convex type: ST-T segment rise with upward convexity Left ventricular function was evaluated by echocardiography: The left ventricle was divided into segments wall motion score is assigned [or each segment. Left sided cardiac catheterization with coronary angiography was performed to all patients within 2 weeks after the onset of infarction coronary artery patency was determined by TIMI grade 2,3. The grade of collateral filling in the LAD was evaluated according to the criteria of Rentrop et al. [no 0, visible filling of any collateral channel; 1] filling only of side branches without visualization of the epicardial segment; 2] partial filling of the epicardial segment; 3] complete filling of the epicardial segment, a good collateral channel was defined as grade 2,3 and poor collateral channel as grade 0 or 1. There was no significant difference in the smoking between the 3 groups regarding smoking, hypertension, Diabetes Mellitus and dyslipidemia. The infarct related artery [IRA] was the left anterior descending in 4.0 patient [100 percent of cases]