predictor of collateral formation in congenital heart diseases

Vascular endothelial growth factor is potent stimulators of angiogenesis. Children with cyanotic congenital heart disease often experience the development of widespread formation of collateral blood vessels, which may represent a from of abnormal angiogenesis resulting in increased morbidity and mortality. To determine whether children with cyanotic congenital heart disease have elevated serum levels is of vascular endothelial growth factor compared to children with acyanotic heart disease. Serum was obtained from 44 children with cyanotic congenital heart disease and 36 children with acyanotic heart disease. Vascular endothelial growth factor levels were measured in the serum of these patients by sandwich enzyme immunoassay. Vascular endothelial growth factor was significantly elevated in children with cyanotic congenital heart disease compared to children with acyanotic heart disease [159.3 +/- 48.1pg/ml vs. 85.4 +/- 1 8.7pglml, respectively, p<0.001]. In the cyanotic group, oxygen saturation [Sa02] was negatively correlated with VEGF [r=-0.53 1, p<0.001] while hemoglobin was positively correlated [r=0.781, p=0.007]. No significant correlations were found in the acyanotic group. Children with cyanotic congenital heart disease have elevated systemic levels of vascular endothelial growth factor directly related to the degree of cyanosis [SaO2 and hemoglobin levels]. These findings suggest that the widespread formation of collateral vessels in these children may be mediated by vascular endothelial growth factor

Facilitated percutaneous coronary interventrion: a new treatment strategy for acute myocardial infarction

Restoring patency of infarct related artery [IRA] is the ultimate goal which can be achieved either pharmacologically [using thrombolytic therapy] or mechanically [through percutaneous coronary intervention [PCI]. The latter needs a sophisticated setup, an equipped Cath. Lab. and a skilled team. Such a system might not be always available, and a full dose thrombolytic therapy is the next best alternative. Recently there is a trend towards "facilitated PCI" whereby low dose thrombolytic and/or antiplatelet therapies are used prior to primary PCI, aiming at an early, complete, and sustained epicardial flow and myocardial perfusion. To compare the efficacy and safety of facilitated PCI with standard primary PCI, we studied 40 pts with acute myocardial infarction [AMI] divided into 2 groups. A study group consisted of 20 pts [18M, 2F, mean age 46.3 +/- 11.5y], all received 750.000 u of streptokinase combined with GP IIb/IIIa receptor inhibitor "tirofiban" 0.4ug/kg/min over 30min followed by 0.1ug/kg/min over 48 hours. Twenty pts [15M, 5F, mean age 54 +/- 8.6y] served as control group [no thrombolytic nor antiplatelet therapy]. Both groups underwent PCI within [73 +/- 18min] from randomization. Angiographic patency was expressed in terms of TIMI flow grading system, ECG criteria comprised extent and rapidity of ST segment resolution and laboratory criteria involved early peaking of CK-MB within 12 hours from randomization. Besides clinical evaluation in terms of major adverse cardiac events [MACE], echocardiographic parameters [LVEDD and LVEF] were used to assess LV function before and after PCI and monthly thereafter for 6 months. Compared to the group subjected to PCI alone, those who had preceding adjunctive pharmacological therapy "facilitated PCI" exhibited significantly greater TIMI 3 flow [84%: vs 60%, p<0.05], smaller LVEDD [5.0 vs 5.5, p<0.05], significantly higher LVEF [55.4% vs 50.7%, p<0.05] and lower rate of MACE [0% vs 20%]. Patients with facilitated PCI also exhibited significantly higher ST segment resolution, [58% vs 45%, p<0.05] and earlier peaking of CK-MB [85% vs 35%] compared to control group. Facilitated PCI offers an excellent way of circumventing the time delay preceding PCI that is frequently encountered on hospital admission of pts with acute MI. Through combining interventional, fibrinolytic and GP IIb/IIIa inhibitor therapy, facilitated PCI provides a more rapid, complete and sustained patency of IRA than primary PCI alone without the adverse effects of full dose thrombolylic therapy and a with better outcome in terms of lesser MACE and preserved LV function

Short-term growth and bone turnover in children with persistent asthma during inhaled steroid therapy

Although the change in therapy of bronchial asthma towards inhaled corticosteroids [ICS] is supported by both pathophysiological findings and efficacy data, its safety is often questioned. Many pediatricians are still concerned about the potential adverse effects of long-term treatment with inhaled corticosteroids, particularly on growth. As a result, this class of medication remains underused in children in many countries. The objective of this study is to compare the formation and degradation markers of bone turnover in asthmatic children who are using inhaled fluticasone propionate [FP]. The present study included 45 asthmatic children, of the age group 6-12 years, They were divided into two groups: Group 1: 26 patient with mild to moderate persistent asthma, receiving FP via pressurized metered dose inhalers [pMDI] at dosages equal to or below 200 mcg/day and Group II: 19 patients with moderate to severe persistent asthma, receiving FP at doses above 200 mcg/day. The study also included 14 healthy, nonatopic, non-asthmatic children as controls. All asthmatic children were subjected to: full medical history taking, symptom score calculation, thorough clinical examination, anthropometric measurements, Peak expiratory flow rate [PEFR] monitoring as well as pulmonary function testing before and after treatment, laboratory investigations including CBC with absolute eosinophilic count [AEC] calculation and total serum IgE once, serum calcium, phosphorous, alkaline phosphatase. Carboxy terminal of procollagen I [PICP] and Carboxy terminal telopeptide of type I collagen [ICTP] by radioimmunoassay as markers for bone formation and degradation respectively, before and after treatment with inhaled FP for 6 months. PICP and ICTP were also assessed once in controls. The results of the present work demonstrated a statistically significant decrease in asthma symptom score in both groups, as well as improvement of all asthma symptoms. A statistically significant increase in mean weight and height was observed in both groups that was within the normal percentiles. However, no statistically significant increase in mean body mass index [BMI] was demonstrated in either group. As regards pulmonary functions, a statistically significant increase in mean Forced expiratory volume in the first second [FEV[1]] Forced expiratory volume in the first second/Forced vital capacity [FEV[1]/FVC] and Forced expiratory flow through the midportion of the FVC [FEF[25-75]] was detected after treatment. No statistically significant difference between pre-and post-treatment mean values of serum calcium, phosphorous, and alkaline phosphatase was demonstrated. However, a statistically significant decrease was observed in post-treatment mean values of both PICP and ICTP as compared to pretreatment values with a significant positive correlation between both analytes implying a decrease in rate of bone turnover. No suppression of statural growth should occur in asthmatic children treated with inhaled FP if used at the conventional doses tailored to disease severity. A slowing down of bone turnover rate may occur, which is coupled for both formation and degradation markers. PICP and ICTP are sensitive markers that might be early indicators for potential growth suppression

Tumor necrosis factor-alpha and insulin level in obesity

The aim of this study was to measure the plasma level of TNF-alpha in obese subjects in comparison with lean ones as well as to correlate its level with the serum insulin level. Thirty-five subjects with a wide range of values for the body mass index [BMI 18.5 +/- 63 kg/m2] were included in this study. The subjects were divided into two groups according to BMI. For all subjects, serum total cholesterol triglycerides, high density lipoprotein cholesterol [HDL- C], low density lipoprotein cholesterol [LDL-C], serum insulin and plasma level of TNF-alpha were assayed. All subjects had normal glucose tolerance as determined by WHO criteria. The study concluded that the plasma level of TNF-alpha was found elevated in obese subjects and this elevation was related to BMI and insulin resistance. So, TNF-alpha can be considered as a system regulating insulin action in obesity leading to insulin resistance with all its hazards in these patients