Does vitamin C and E supplementation have a protective role in mild preeclampsia?

Oxidative stress has been proposed as a key factor involved in the development of pre-eclampsia. Supplementation with antioxidant vitamins has been proposed to reduce the risk of preeclampsia and perinatal complications, but the effects of this intervention are uncertain. Was to assess if supplementing women with mild pre-eclampsia with antioxidants in the form of [Vitamin C 1000mg + Vitamin E 400IU] during the third trimester of pregnancy might help to counteract oxidative stress and thereby prevent or delay the incidence of severe pre-eclampsia?. This research includes of 30 mild pre-eclamptic women, all were primigravidae with singlctone gestation in the third trimester [28-32 weeks of gestation]. Fifteen of them were supplemented with [Vitamin C 1000mg + Vitamin E 400IU] tablets] daily until delivery and were considered as the study group [PE-CE]. The control group [n=15] were not supplemented with vitamin C and E tablets [PE]. Measurement of serum nitric oxide level [NO] was assessed initially on the first visit and re-evaluated at the end of the study using ELISA. Follow-up of all pregnant women was done until delivery. Significant increase in serum NO levels were realized among PE-CE group compared to the controls. Also, significant decrease in serum NO levels among PE group were obtained at the end of the study; reflecting the significant decrease in oxidative stress among the pre-eclamptic group who received anti-oxidants. Significant negative correlation between serum NO level and mean arterial blood pressure was evident in PE-CE group. Patients with pre-eclampsia are exposed to oxidative stress, which may have a role in the pathogenesis of the disease. Supplementation with the antioxidants vitamin C and E could be considered in the management of mild pre-eclampsia and to be routinely administered in mid trimester pregnancy

value of cardiac troponin I as a predictor of cardiac events after percutaneous coronary intervention

Elevation of cardiac troponin I [cTnI] is not uncommon after coronary interventions. Many studies tried to find factors responsible for this elevation and its prognosis on short and long term follow up. Whether or not elevation of cardiac troponin post coronary interventions is responsible for early in hospital and late adverse outcome is still under debate. To identify different predictors of cardiac troponin I elevation after coronary interventions, and to assess the relation between cardiac troponin I elevation post coronary interventions and [early and late] adverse clinical outcome. The study included 50 consecutive patients who underwent coronary angioplasty with stenting in the Cardiac Catheterization Laboratory at Benha University Hospital during the period from December 2004 to December 2005. Full medical history and clinical data were obtained from the patients with special emphasis on the major documented risk factors for coronary artery disease [CAD] [age, sex, obesity, smoking, diabetes mellitus, hypertension, hypercholesterolemia, positive family history of CAD], and history of previous myocardial infarction [MI] or anginal attack. Twelve-lead standard surface electrocardiogram [ECG] was done routinely before and after intervention, echocardiography was also done to determine the global left ventricular systolic function, and coronary angiography was done for all patients and angiographic analysis was performed. Stenosis was considered when there was > 75% reduction in luminal diameter at coronary angiography. Quantitative measurements of the target lesion was performed before intervention by measurement of the lesion length, minimal luminal diameter and reference diameter. Percutaneous Coronary Intervention [PCI] was done and stenting for all patients . The procedure was considered successful when the residual stenosis in the dilated segment was less than 20%. Troponin I and CK-MB were measured 2 hours before the procedure and 8 and 24 hours after the procedure by immuno-inhibition based on the change in troponin I and CK-MB level. The patients were divided into 2 groups: Group I: No elevation of cTnI [0.4ng/l] and, Group II: cTnI [>0.4 ng/l], which was subdivided into Group IIA: with elevated cTnI + CK-MB > 25 IU/L, and Group IIB: with elevated cTnI + CK-MB 25 IU/L. New ST depression and T wave abnormalities post procedural were predictive of post procedural elevation of cardiac troponin I after PCI [p < 0.05]. Parameters of quantitative angiographic analysis of the lesions including preprocedural minimal luminal diameter [p < 0.01], diameter stenosis [p < 0.01] and post procedural minimal luminal diameter [p<0.01] and diameter stenosis [p < 0.05] were strongly associated with post procedural cardiac troponin I elevation. Shorter stent length was also associated with cardiac troponin I elevation post cath. [p < 0.01]. Positive predictive value of cardiac troponin I post procedural for early complications was 23.1% and negative predictive value was l00%. Concordant cardiac troponin I and CK-MB elevation post procedural were strong predictors for early in hospital complications [p<0.01]. Positive predictive value for concordant cTnI and CK-MB elevation for early complications was 60% and negative predictive value was 100%. No association was found between cardiac troponin 1 elevation post cath or concordant elevation of cardiac troponin I and CK-MB elevation with late adverse clinical outcome

value of pulse-wave doppler tissue imaging during dobutamine stress echocardiography in detection of right coronary artery narrowing

The importance of right ventricalar function in acute and chronic cardiac affection is well established. Is to assess the value of pulse wave Doppler tissue imaging [PWTDI] during dobutamine stress echocardiography in detection of right coronary artery narrowing. 40 subjects were divided into two groups according to the presence [patient group] or absence [control group] of significant > 70% isolated right coronary artery narrowing proved by coronary angiography. All patients studied had right coronary artery dominance, they were subjected to the following: complete history taking and thorough clinical examination, 12 leads resting surface electrocardiography, resting standard echo Doppler study, coronary angiography, doubtamine-atropine stress echocardiography with pluse-wave Doppler tissue sampling. There was no statistically significant difference between the two groups as regard to early [E] and late diastolic [A] velocity in cm/sec by pulse wave tissue Doppler at rest, low dose and high dose dobutamine. p > 0.05. Regarding the ejection phase velocity in cm/sec. [EJ] by pulse-wave Doppler tissue there was no statistically significant difference between the control and the patient groups at rest and low dose dobutamine p > 0.05., however at higdose dubutamine there was a highly statistically significant difference [p < 0.01] and it was found that a progressive increase of the ejection phase velocity [EJ], expressed by a more than 25% increase from 10 microg/kg/min [low dose] to peak dobutamine stress was predictive of normal or insignificantly narrowed right coronary artery [RCA]. Whereas a blunted increase, expressed by < 25% increase of velocity, was predictive of a significantly narrowed RCA. The sensitivity, specificity, negative predictive value, positive predictive value and accuracy of pulse-wave Doppler tissue sampling in detection of right coronary artery narrowing was 80%, 75%, 79.2%, 76.9% and 78% respectively. Analysis of the right ventricular wall was accessible using the pulsed wave tissue Doppler sampling in all cases while visual assessment was not. Pulsed wave tissue Doppler sampling is a valuable tool to detect right coronary artery narrowing when combined with dobuta-mine-atropine stress echocardiography

2'-Deoxycytidine as a potential biomarker for detection of hepatocellular carcinoma

Background: 2'-deoxycytidine [Dcyd] is one of four major nucleosides found in the different normal body fluids due to dissolution of dead cells, and is increase in the presence of malignancy. Previous studies proved that it can be used as a marker for bladder cancer and acute lymphoblastic leukemia. The aim of this study is to assess 2'Dcyd as a possible biological marker in hepatocellular carcinoma [HCC]

Methods: four groups were evaluated for the level 2'-Dcyd as well as alpha-fetoprotein [AFP]; a control group [n = 20], 20 cases of chronic liver diseases [CLD], 20 cases of hepatitis C [HCV] 60 cases of HCC

Results: in the patients with HCC, 2'-Dcyd serum level was 8-fold higher than normal level. It was 3-fold higher in HCV group. A mild increase was noted in patients with chronic liver diseases. Levels >/= 0.14 of 2'-Dcyd had a sensitivity of 93% and specificity of 90% for diagnosis of HCC. It also recorded a sensitivity and specificity of 90% for diagnosis of HCV

Conclusions: for diagnosis of HCC, 2'-Dcyd is no better than AFP, as it is elevated in viral hepatitis C. A combination of AFP and 2'-Dcyd could provide broader information in diagnosis and treatment decision

Predictive value of c-reactive protein for coronary in stent restenosis

C-Reactive protein [CRP] should be measured in all patients undergoing coronary angioplasty for prognostic stratification. Preprocedural levels are of proved efficacy. CRP levels can be used as a guide to therapy in PCI. The aim of this study is to evaluate the predictive value of CRP plasma leve1 for coronary instent restenosis [ISR]. This study included 60 patients who underwent successful coronary stenting. All patients included in. this study were subjected to the following. Full history taking, thorough clinical examination, risk factors evaluation, 12 leads surface ECG, plain chest x-ray echocardiography, coronary angiography and laboratory investigations [Blood sugar level lipid profile and CRP] with follow up period for six month. Patients were classified into two groups according to ISR. Group [I] with ISR included 22 patients [43.1%] and 22 lesions treated with 25 stents [45%]. Group [II] without ISR included 29 patients [59.9%] with 29 lesions treated with 30 stents [55%]. At follow up, focal ISR [<10 mm] was detected in 5 patients [22.7%]. diffuse [>10 mm] in 7 patients [31.8%], proliferative ISR in 5 patients t22. 7%] and total occlusion in 5 patients [22.7%]. In restenotic group [I] 8 patients [36.4%] were asymptomatic, two p [9.1%] had unstable angina and 12 patients [54.5%] had stable angina. In the non restenotic group [II] 22 patients [75.9%] were asymptomatic four patients [138%] had unstable angina and three patients [102%] had stable angina. Clinical, lesional and procedural variables are not associated with in creased risk of ISR. The only variable for exclusion of ISR was a normal level of CRE in plasma [72 hours after coronary stenting]. Its specificity was [100%]