impact of transradial versus transfemoral approach for percutaneous coronary intervention on the outcome of patients presenting with acute coronary syndrome

Background: The transfemoral approach [TFA] has been until presently the main-stay for arterial access PCI in the setting of acute STEMI, while the transradial approach [TRA] is gaining ground in elective as well as primary procedures

Objectives: to assess the impact of transradial versus transfemoral approach for PCI on the outcome of patients presenting with acute coronary syndrome

Patients and Methods: prospective study was conducted on 100 patients presenting to Ain Shams University Hospitals Coronary Care Unit [CCU] with recent onset acute coronary syndrome [whether unstable angina [UA]/non-ST-segment-elevation MI [NSTEMI] or ST-segment-elevation MI [STEMI]] undergoing revascularization via percutaneous coronary intervention [PCI]. Patients were randomized into 2 equal groups, for the first group PCI was performed via TFA while for the second group via TRA

Results: Our study found that, with TRA we get less bleeding, less local vascular complications [8 [16%] vs 2 [4%], p=0.045] and less amount of dye used [169.60 +/- 21.28 versus 187.00 +/- 37.65 ml, p=0.006] without significant increase in fluoroscopy time [10.86 +/-4.88 versus 9.76 +/-4.74 mins, p=0.256] or radiation exposure. Although there was no significant difference in mortality and morbidity, TRA offers the patient a more simple procedure with less hospital stay [3.4 +/-0.948 versus 3.86 +/-0.808 days, p<0.01]

Conclusion: Radial artery access is a safe and effective approach for management of ACS. If performed by experienced operators, TRA should be the standard access in managing ACS specifically in STEMI

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

Feeding camel milk and Nigella sativa oil [NS] and their effect on the immunity of children with viral hepatitis

Camel milk is known for its antimicrobial properties, and used for treatment of diabetes and liver diseases in folk medicine. So, this study aimed to find out the health benefits of camel milk alone or mixed with Nigella sativa [NS] oil on outcome of viral hepatitis among children. 35 [14 girl and 21 boy] children infected with viral hepatitis with mean age 8.1 +/- 3.6 years were selected from outpatients of Minufiya University and Monshaat Sultan hospitals, Minufiya Governorate, Egypt. The selected children were divided into 4 groups; control group [CG] [n=5] they didn't receive any dietary intervention; milk group [MG] [n=10] they receive 100ml/day of camel milk; oil group [OG] [n=10] they receive 2ml/day of NS oil; and milk oil group [MOG] [n=10] they receive 100 ml of camel milk in addition to 2 ml of NS oil daily. The children were free living and receive their standard medical treatment and normal diet without any modification. The dietary intervention continued for 35 consecutive days. Blood samples were collected from subjects at baseline and after dietary intervention period for determination of ALT, AST, IgG, IgM, alkaline phosphatase, bilirubin, hemoglobin, and HCT. The results showed that feeding camel milk alone decreased IgM by 34.5% and increased IgG by 84.3%, while mixing it with NS oil resulted in decrement of IgM by 47.1% and increment of IgG by 91.7%, and surprisingly NS oil decreased IgM by 64.8% and increased IgG by 72.7%. Whereas, the concentration of elevated liver enzymes decreased significantly by the dietary intervention, especially among group fed camel milk alone or combined with NS oil. In conclusion, feeding camel milk alone or mixed with NS oil had a favorable affect on health status of children with viral hepatitis

Open versus arthroscopic acromioplasty with intact rotator cuff

Twenty patients [22 shoulders] were selected for either open acromioplasty or for arthroscopic acromioplasty. All suffered from chronic impingement syndrome in the presence of intact rotator cuff, which conservative treatment had been unsuccessful. The minimum follow-up was 12 months for both groups. There was no statistical difference in mean postoperative shoulder scores between the two operative groups. However, there were more excellent and good results in the open group as compared with arthroscopic group [72.7%, vs 63.6%, respectively]. In addition there was a higher percentage of fair and poor results in arthroscopic group as compared to open group [36.4%, vs 27.3%, respectively]. As regard to the function and pain, postoperatively, there were a satisfactory results in around 80% of cases for either open or arthroscopic acromioplasty. Arthroscopic acromioplasty associated with shorter hospital stays and faster achievement of maximal pain relief as compared with open acromioplasty. Choice of the technique depends on expertise of surgeon

Treatment of recalcitrant lateral epicondylitis of the elbow by surgical release of the common extensor origin

A prospective non-randomized study of 21 patients with recalcitrant lateral epicondylitis of the elbow was carried out to evaluate the results of the surgical release of the common extensor origin. The dominant arm was involved in 76.2% of the patients. The average duration of symptoms before the operation was 19 months [range, 9-38 months]. The average duration of follow up was 24 months [range of 10-42 months]. The results of the current study suggested that the release of the common extensor origin is an acceptable surgical modality to provide an effective treatment for the resistant lateral epicondylitis when nonoperative management fails

Ender nailing in femoral sheft fractures in children

Twenty-three patients with diaphyseal femoral shaft fracture were treated by internal fixation by ender nails. Retrograde nailing was done for all cases using 3 or 4 mm ender nails through medial and lateral approaches by an incision proximal to the distal femoral physis by 2 cm, then, insertion of two ender nails, one on each side, to provide more rotational stability. The aims of this work were to evaluate the results of ender nailing in femoral shaft fracture in children with head injury, poly-trauma or open fractures and to assess the results with the known results of conservative methods. The results obtained were excellent as regards the rate of union [100%], convenience to the patients, satisfaction of the family and minimal accepted complications. The study emphasized on ender nailing in selected diaphyseal fractures in children because it is safe and easy, allows rapid mobilization, early weight bearing, with less disruption of family life and shorter hospitalization