Routine early coronary angioplasty versus ischaemia-guided coronary angioplasty after successful thrombolysis in patients with acute anterior STEMI

Background: the potential benefits of routine early intervention after thrombolysis include prevention of re-infarction, recurrent ischemia, and reduction of the infarct size and mortality

Aim of the work: the purpose of this study is to compare routine early coronary angioplasty in patients with acute anterior STEMI after successful thrombolysis versus ischaemia-guided coronary angioplastyas regards the occurrence of MACCE

Study design: a total number of 100 patients with acute anterior STEMI received thrombolytic therapy and then were randomly assigned to either routine invasive strategy or ischemia based strategy based on risk stratification by stress myocardial perfusion scan done within 30 days of the onset of AMI with subsequent CA after demonstration of residual myocardial ischemia and or good viability

Results: the cumulative incidence of MACCE including recurrent ischemia, stroke, MI, HF or mortality was significantly lower in theroutine early invasive strategy

Conclusion: STEMI patients who cannot undergo timely primary PCI should receive prompt fibrinolysis followed by early routine invasive strategy

Assessment of cardiac involvement of hepatitis C virus; tissue Doppler imaging and NTproBNP study

Hepatitis C disease burden is substantially increasing in Egyptian community, it is estimated that prevalence of Hepatitis C virus [HCV] in Egyptian community reach 22% of total population. Recently there is a global alert of HCV cardiovascular complications. To evaluate LV diastolic functions of HCV patients using tissue Doppler Imaging and NTPBNP. 30 HCV patients of 30 years, sex and BMI matched controls were evaluated by PCR, ECG, Echocardiography "conventional Doppler, pulsed wave tissue Doppler [PW-TD], strain rate imaging" and NTPBNP to assess LV diastolic functions. Mean age was 32.8 years +/- 5.1 in HCV group, 29.8 years +/- 6.6 in control group. Cardiovascular anomalies and predisposing factors were excluded. HCV group has shown significant increase in QTc interval, significant statistical increase in A wave, deceleration time; [p < 0.05], highly significant decrease in tissue Doppler E[a] [p < 0.001], highly significant decrease in A[a] [p < 0.001], highly significant increased E/E[a] ratio [p value < 0.001], significant decrease in E[a]/A[a] ratio and significant increase in SR[a] [p < 0.05]. NTPBNP levels showed highly significant increase with mean value 222 pg/ml +/- 283 in HCV group and 32.7 pg/ml +/- 21.2 in control group [p value < 0.001]. The best cut-off value of NTPBNP to detect diastolic dysfunction in HCV group was 213 pg/ml. No statistical differences in SRe/SRa and E/SRe ratios were observed, however they had significant correlation with NTPBNP level and tissue Doppler parameters. The best cut-off value of E/SRe ratio to detect diastolic dysfunction in HCV group was 0.91, with 75% sensitivity and 100% specificity. This data show the first direct evidence that HCV infection causes diastolic dysfunction without any other predisposing factors, probably due to chronic inflammatory reaction with mild fibrosis in the heart. Previous studies did not follow strict inclusion and exclusion criteria that confirm the independent role of HCV to cause diastolic dysfunction. Tissue Doppler was more sensitive to diagnose diastolic dysfunction than conventional Doppler

Impact of vulval warts on uterine cervix-new colposcopic finding

There is a growing interest in human papilloma virus [HPV] infection of the cervix. The aim of, this work, is to study the impact of vulval warts on HPV related cervical disease and to compare, the results with findings in women without vulva warts. Seventy women paticipated in this work: 30 cases with vulval warts [study group] and 40 cases withhout vulval warts [control group]. All cases were subjected for full medical history, cervicovaginal cytology, colposcopy and biopsy from colposcopically abnormal areas. Cytological examination revealed 7 cases with cervical HPV infection [23.3%] in the study group, compared to 2 cases in the control group [5%] [P<0.01]. Three study cases showed dyskaryosis [2 mild and one moderate]. Abnormal colposcopic findings were detected in 13 cases of the study group [43.2%], compared to 3 cases [7.5%] of the control group [P<0.01]. The finding of micropapillary aceto - white epithelium with partial iodine uptake was prominently associated with cervical HPV infection in cases of vulval warts. Histopathology of the colposcopically directed biopsies revealed 5 cases with HPV infection [Flat condyloma in 2 cases and flat condyloma with CINI in 3 cases] and 2 cases with CIN, [one CINI I and one CIN II] in the study group, compared to only one cases of flat condyloma in the control group. The importance of these findings are discussed