role of oxidative stress in the pathogenesis of systemic lupus erythmatosus [SLE] among some Iraqi patients

Systemic Lupus Erythematosus [SLE] is a chronic progressive autoimmune disorder with a wide spectrum of clinical and immunological abnormalities, predominantly developed in women of childbearing age, oxidative stress has been postulated in many pathological conditions including atherosclerosis, inflammatory conditions and some autoimmune disease such as multiple sclerosis, rheumatoid arthritis and Systemic Lupus Erythematosus [SLE]. The present study was conducted to support the idea of oxidative stress during the pathogenesis of [SLE] among some Iraqi patients, comparing it with healthy controls group matched for the same sex and age. Twenty-three Iraqi Arab patients [21 females and 2 males] with Systemic Lupus Erythmatosus [SLE] admitted to Baghdad Teaching Hospital were included in the present study, and have been compared with 13 healthy controls The patients group were diagnosed as having SLE according to the basis of the revised criteria of the American College of Rheumatology, Analysis of the parameters of oxidative stress, serum malondialdehyde [MDA] and glutathion [GSH] was performed in all patients before starting any type of drug treatment and their levels were compared with those belong to healthy controls. The results presented in this study showed elevated serum MDA concentration in the SLE patients group compared to healthy control; however, this elevation failed to reach the statistically significant [P<0.05]. Significant variation was also demonstrated in serum levels of glutathione between both patients group, in which serum GSH level was significantly lower in the diseased group compared to healthy controls [P<0.05]. Oxidative stress mechanism can be proposed as a cause and / or consequence in the pathogenesis of SLE, supporting the theory of free radical -induced tissue damage in this respect

Diastolic function abnormalities in rheumatoid arthritis: relation with disease duration and severity

Cardiac involvement is common in patients with rheumatoid arthritis [RA] and cardiovascular disease represent the most common cause of death in those patients. Data about left ventricular diastolic function abnormalities in patients with RA are scarce. The aim of this study was to evaluate left ventricular filling abnormalities as early predictor of asymptomatic cardiac involvement in patients with RA and 10 to study the correlation between diastolic function abnormalities with disease duration and severity. This study enrolled 31 patients affected by RA according to ACRA criteria who had no evidence of cardiac disease, and compared with 10 age and gender matched control group. All patients were subjected to clinical evaluation and Iaboratory testing which included sedimentation rate [ESR], rheumatoid factor [RF] and blood picture. All patients and I'onirol group were subjected to echo-Doppler study for assessment of the mitral flow and measurements of maximal [early diastolic flow velocity [Peak E] [m/sec], maximal late diastolic flow velocity [Peak A] [m /sec], E/A ratio, the area under the the atria I filling velocity curve [Time velocity integral of the velocity waveform representing left atrial contraction, TVI of A [m/sec]. The total area under the mitral flow velocity curve [Time velocity integral of the velocity Wave form representig diastolic filling, TVI of DF [m/sec] and ratio of A/TVI of DF. There was a statistically significant impairment in left ventricular filling pattern in patients with rheumatoid arthritis compared to the control group as evidenced by taeased E/A ratio [0.96 +/- 0.29 in RA patients versus 1.38 +/- 0.19 in ihe control group, p=0.0017]. Also, there was a statistically significant difference in the TVI of A/TVI ofDF [0.46 +/- 0.16 in the patients group versus 0.33 +/- 0.058 in the control group, p=0.017. There was a significant negative correlation between the E/A ratio and the age of the patients with RA [p=0.0181 4p-[1.4216]. Interestingly, in patients with subcutaneous nodules, we found a significant correlation between E/A ratio and the number of swollen joints [p=0.0341 and r=-3.162]. to; was a significant correlation between TVI of A/TVI of DF and disease duration in patients with RA [p=0.0028 and dl.4W5]. Also, There was a significant negative correlation between hemoglobin level and TVI of A/TVI of DF ratio [p=0.034 and r=-0.65]. The prevalence of diastolic dysfunction is high in patients with rheumatoid arthritis. This raises the importance of performing echocardiography in these patients particularly those with long disease duration, patients with seropositive sera especially when they have a combination of subcutaneous nodules and increased number of swollen joints.

Radiofrequency ablation of unresectable liver malignancies: evaluation of the laparoscopic approach

In this study, 12 consecutive patients with unresectable hepatic malignancies were treated with laparoscopic RFA. A total of 28 tumors with median tumor volume of 35 mm [8-58] were detected in the 12 patients. The group included seven patients with hepatoma arising on a background of cirrhosis and five patients with multiple deposits from primary colorectal cancer. Total ablation was performed in seven patients with hepatoma and five patients with secondary deposits. Total ablation with a minimum of 0.5 cm margin was achieved in 26 lesions [92%]. No complications were encountered postoperatively and all patients were discharged within two days of the intervention. After a median follow-up of 11.8 months, local recurrence occurred in one patient [8%] and new hepatic tumors developed in two patients [16%]. This study confirmed the safety and therapeutic potential of laparoscopic ultrasound-guided RFA in patients with inoperable hepatic tumors

Biphasic positive airway pressure ventilation [BIPAP] versus synchronized intermittent mandatory ventilation with pressure support [SIMV/PSV] after pediatric open heart surgery

Biphasic positive airway pressure [BIPAP] is a mode of ventilation, which allows unrestricted spontaneous breathing at any moment of the ventilatory cycle. Following open-heart surgery in adults, this mode of ventilation [BIPAP] is being accepted with a decrease in the need for sedation and a shorter time of intubation. In this study we compared BIPAP versus synchronized intermittent mandatory ventilation with pressure support [SIMV/PSV] following open-heart surgery in children for simple congenital cardiac anomalies. Twenty-four children aged 4-12 year undergoing repair of simple congenital cardiac anomalies, were randomly classified postoperatively into two equal groups. Group I ventilated by BIPAP mode of ventilation and Group II ventilated by SIMV/PSV mode of ventilation. Evita 4 ventilator was used in this study. Midazolam and morphine were used and adjusted according to comfort scale. In this study we compared between BIPAP and SIMV/PSV as regards hemodynamic data, ventilatory parameters, the needs for sedation and analgesia and the mean duration of endotracheal intubation. The two groups were comparable as regards the demographic data. There were significant differences between the two groups regarding better hemodynamic stability, increased comfort scale, and decreased the needs for sedation and analgesia in group I when compared to group II The ventilatory parameters were significantly better in-group I with better minute ventilation, lower PaCO[2] and higher PaO[2] when compared to group II. The mean duration of endotracheal intubation was significantly shorter in-group I when compared to group II. BIPAP is an effective, safe and easy to use mode of ventilation in children following open-heart surgery for simple congenital anomalies. Further assessment needed for its use in more complicated cases