Anion gap in congenital cyanotic heart disease

Our aim was to study the changes in electrolytes "represented by the Anion Gap" [AG] in the patients complaining of congenital cyanotic heart disease [CCHD] and we tried to correlate these changes to the severity of clinical manifestations and the hemodynamic state. The present study included twenty five patients complaining from CCHD. Nineteen of them were males [76%] and 6 were females [24%]. The study was concluded on and two types of CCHD, tetralogy of Fallot [TOF], [77 patients, 68%] and transposition of great arteries [TGA], [8 patients, 32%]. Their age ranged between 5 days and 4 years. Ten age and sex matched children were also selected as control group. All were presented to Cardiology Clinic in New Children Hospital, Cairo University. All subjects participating in this study underwent the following: Full History taking, thorough clinical examination, 12-lead ECG, cardiac series X-ray, full echocardiographic study, catheterization and anion gap detection. The study revealed that, in patients with CCHD, the level of HC03 and Na are nearly the same as in normal children, while CI is highly different. Regarding the severity of clinical manifestations, a highly significant positive correlation was observed between the anion gap and severity of clinical manifestations in patients with TGA, while there was no significant correlation between the anion gap and severity of clinical manifestations in TOF patients, thus the anion gap may be used as an indicator of the severity of clinical manifestations in TGA patients. Ako a negative correlation was observed between the level of HCOJ and the severity of clinical manifestations of these patients. The anion gap was found to have a significant negative correlation with the ejection fraction [EF] of the patients and a new equation may be used for anion gap calculation as follows: [AG 48.82 - 0.41 x EF]

Conclusion and Recommendations: the anion gap should be a routine laboratory investigation in every case of CCHD, especially TGA. From this study, we can conclude that measurement of anion gap could be of help in follow-up of severity of case of CCHD and so routine assessment of this parameter is recommended. The use of the newly developed equation could be of help of assessment of EF and consequently the severity of cardiac condition of the patients. The anion gap can be calculated in patients with CCHD using the EF: Y = a - bx [where Y anion gap, a 48.82, b = 0.41 and x = EF]

Protective effects of 4-methylpyrazol in comparison with n acetylcysteine against acetaminophen-induced hepatotoxicity in rats

N- Acetylcysteine [NAC] is the only available antidote for acetaminophen [APAP] poisoning. 4- Methylpyrazole [4-MP]. a well-known inhibitor of alcohol dehydrogenase, has also been shown to inhibit CYP2El [one of the cytochrome P450 system] which has been identified to be involved in APAP bio activation in human beings. The aim of this study was to evaluate the hepatoprotective effect of 4-MP in comparison with NAC against APAP- induced hepatic necrosis in rats. APAP [2.000, g/kg] was given to 6 groups of animals by gavage; group 7 acted as control. After 4 hours. group 3 received 4-MP [200 mg/kg] orally; group 4 received 200 my/kg 4- MP followed by 4 doses at 12 hours intervals; group 5 received 140 mg/kg NAC and group 6 received 140 mg/ kg NAC followed by 70 mg/kg every 4 hours for 12 doses. The results obtained from this study indicated that the administration of 4-MP or NAC [both single and repeated - dose regimen] after 4 hours toxic dose of APAP significantly inhibited hepatotoxicity in the rate with little superiority of 4-MP as reflected by significantly lower levels of serum transaminases [AST and ALT] and lesser degrees of hepatic necrosis

Effect of guanfacine on kidney, heart and GABA level in DOCA and salt hypertensive rats

Experimental hypertension, was induced in rats by intramuscular injection of desoxycorticosterone [DOCA] in a dose of 50 mg/kg body weight/week for six weeks, in addition to salt in drinking water. Guanfacine was given to normotensive and hypertensive rats intraperitoneally in a daily dose of 0.09 and 0.18 mg/kg body weight for 30 days. Induction. of hypertension resulted in significant reduction in the neurotransmitter gamma aminobutyric acid [GABA] concentration in the brain, hypertrophy of the cardiac muscle and nephrosclerosis with impaired renal function. However, these histophathological and biochemical changes were paradoxically decreased after giving guarifacine in a daily dose of 0.09 mg/kg body weight for 30 days, as a result of marked decrease of blood pressure. The hypertensive rats treated with 0.18 mg/kg body weight of guanfacine for 30 days showed marked increase in the incidence and severity of cardiac and renal histopathological changes, due to the combined toxic effect of guanfacine and hypertension. The increased GABA concentration in the brain and the reduction in blood pressure after giving the drug were more significant with the low dose. In normotensive groups, rats treated with guanfacine in a daily dose of 0.18mg/kg body weight for 30 days showed moderate renal toxicity, while no biochemical or histopathological changes were observed with 0.09 mg/kg body weight of guanfacine. The two doses of guanfacine induced insignificant changes in both blood pressure and GABA concentration in the brain as compared to control non-treatment rats. Thuse law dose of guanfacine is considered more effective and safe and so it is superior to high dose in the ambulatory treatment of hypertension

Blood lead level in patients with cancer larynx

Several studies have implicated asbestos and nickel as risk factors in the aetiology of cancer larynx. Lead compounds were also found to induce tumours in experimental animals. In the present study, blood lead levels were estimated in 21 patients suffering from cancer larynx, there was insignificant statistical correlation between blood lead levels and the occurance of cancer larynx, although the fact that six patients showed blood lead levels higher than the normal values for the Egyptian population

Rectus abdominis myocutaneous flap: analysis of 40 cases

We present a series of 40 cases who underwent reconstructive procedures using rectus abdominis myocutaneous units. The transplanted tissue comprised superior pedicle [26 cases], inferior pedicle [11 cases], and as free muscle flap [3 cases]. The application fell into three groups i.e.; 1. breast and chest wall reconstruction; 2. groin, genital, and trochanteric area; and 3. leg and heel ulcer. The results show that surgical dissection of flaps is relatively easy and has a wide range of applications that can be used for different surgical reconstructive problems. Surgical dissection has a low incidence of complications for flap viability as well as for donor site

Evaluation of three hearing and fitting formulae using real ear measurement

The general goal of fitting a hearing aid is to optimize the patient's quality of hearing. Selection of hearing aid parameters is based on gain and frequency response of the aid. It is a difficult task to compare various fitting formulae relative to their values in satisfying patient's needs. In this study 109 ears were examined and the results of their real ear measurement according to the 3 fitting formulae were compared. From the results it was concluded that NALII is superior to POGO II and Libby's formulae