relation between red cell distribution width [RDW] and coronary artery calcium score [CACS] in the diabetic patients undergoing coronary CT angiography

Background: red cell distribution width is a marker associated with increased mortality and morbidity in cardiac patients, however it's relation with coronary artery calcium score [CACS] is not well studied yet

Aim of the work: this study aimed to assess the relation between red cell distribution width [RDW] and coronary artery calcium score [CACS] in the diabetic patients undergoing coronary CT angiography

Patients and methods: this study was conducted on 60 patients presented for assessment of coronary artery disease [CAD] by coronary CT angiography and they were categorized into 2 groups, group [A] diabetics[30 patients],group[B]non-diabetics [30 patients], All patients included in this study were subjected to: History Taking, complete physical examination, multi-slice CT coronary angiography [MSCT] including calcium score[CACS], laboratory investigations including complete blood count [CBC] including RDW[SDandCV], serum calcium level[total and ionized], erythrocyte sedimentation rate [ESR], lipid profile

Results: higher RDW[SD] was associated with the presence of greater coronary complexity of CAD and higher calcium score. In our study total serum calcium and RDW [SD] were found to be independent predictors of high Ca score more than 100, while ionized calcium and systolic blood pressure[SBP] were independent predictors of high Calcium score more than 400. Cut off value of RDW to predict high calcium score [more than 100] was RDW[CV] more than 13.45 and RDW[SD] more than44.45, while Cut off value of RDW to predict high calcium score [more than 400] was RDW[SD] more than 45.1

Conclusions: a greater baseline RDW[SD] value was independently associated with the presence of a greater coronary complexity of CAD and higher calcium score

Slow cryopreservation is not superior to vitrification in human spermatozoa; an experimental controlled study

Spermatozoa cryopreservation is used for the management of infertility and some other medical conditions. The routinely applied cryopreservation technique depends on permeating cryoprotectants, whose toxic effects have raised the attention towards permeating cryoprotectants-free vitrification technique. To compare between the application of slow cryopreservation and vitrification on human spermatozoa. This was an experimental controlled study involving 33 human semen samples, where each sample was divided into three equal parts; fresh control, conventional slow freezing, and permeating cryoprotectants-free vitrification. Viability and mitochondrial membrane potential [MM.P] of control and post-thawing spermatozoa were assessed with the sperm viability kit and the JC-1 kit, respectively, using fluorescence-activated cell sorting analysis. Significant reduction of the progressive motility, viability and MMP was observed by the procedure of freezing and thawing, while there was not any significant difference between both cryopreservation techniques. Cryopreservation resulted in 48% reduction of the percentage of viable spermatozoa and 54.5% rise in the percentage of dead spermatozoa. In addition, high MMP was reduced by 24% and low MMP was increased by 34.75% in response to freezing and thawing. Progressive motility of spermatozoa was correlated significantly positive with high MMP and significantly negative with low MMP in control as well as post-thawing specimens [r=0.8881/ -0.8412, 0.7461/ -0.7510 and 0.7603/ -0.7839 for control, slow and vitrification respectively, p=0.0001]. Although both cryopreservation techniques have similar results, vitrification is faster, easier and associated with less toxicity and costs. Thus, vitrification is recommended for the clinical application

Extracapsular cataract extraction and posterior chamber intraocular lens implantation in eyes with pre-exiting trabeculectomy

The purpose of this study is to evaluate the effects of extra capsular cataract extraction with posterior chamber intraocular lens implantation [ECCEePCIOL] on the intraocular pressure [IOP] control in eyes having previous trabeculectomy operation. Forty five eyes of 45 patients that underwent ECCEePCIOL after previous trabeculectomy operations are included in the present study. Evaluation of preoperative, intraoperative, and postoperative factors and their effects on IOP control after ECCEePCIOL was done. Follow-up period after surgery ranged from 8 to 24 months. Complete success was achieved in 25 eyes [55.5%] [with no need for antiglaucoma medications or surgery to control IOP], qualified success [using antiglaucoma medications to control IOP] in 16 eyes [35.5%], and failure [e needing for antiglaucoma surgery to control IOP] in 4 eyes [8.88%]. The study showed the factors associated with less control of IOP were: younger patients [with age less than 45 years], uveitic and neovascular glaucoma, intraoperative iris manipulation, preoperative IOP more than 15 mmHg and maximum postoperative IOP more than 25 mmHg. To evaluate the effects of cataract extraction on the intraocular pressure [IOP] control in eyes having previous trabeculectomy. A total of 45 eyes of 45 patients who underwent extracapsular cataract extraction [ECCE] with posterior chamber intraocular lens [PCIOL] implantation after previous irabecidectomy operations are included in the present study. Evaluation of preoperative, intraoperative and postoperative factors and their effects on IOP control after cataract extraction was done. After mean post operative follow up of 8-24 months, 16 eyes [35.5%] were in need for additional glaucoma medications [qualified success], and 4 eyes [8.88%] needed another filtering operation [failure] to control the IOP, Complete success obtained in 25 eyes [55.5%]. Mean IOP at the last visit had increased 2 mmHg above the preoperative level. The median interval from the ECCE to the addition of antiglaucoma medication was 2 months, and to further glaucoma surgery was 5 months. Postoperative hypotony was noticed in 4 eyes [8.88%] that improved in 3 and persisted in one eye. When doing ECCE in eyes with preexisting trabeculectomy, some factors are associated with less control of IOP these factors include: younger patients with age less than 45 years, uveitic and neovascular glaucoma, intraoperative iris manipulation, preoperative IOP more than 15 mmHg and maximum post operative IOP more than 25 mmHg

BRCA1 gene expression in women breast cancer in relation to other prognostic markers

Breast cancer causes major part of cancer deaths in women and is increasing in incidence. This study assessed the BRCA1 gene expression in breast cancer in women, and compared it with other known prognostic factors for the disease. Thirty patients with positive family history of breast cancer were selected from Beni-Suef and Cairo Universities Hospitals, Egypt for the study. A control group of 10 healthy subjects were also included. Blood samples were withdrawn for routine laboratory and tumor marker [CA15-3] being done by ADVIA Centaur. Archival formalin-fixed paraffin-embedded breast cancer tissues were obtained from the pathology files. Histological types and grading of the tumor were assayed. The immunohistochemistry [IHC] and RNA extraction were also done. Histological grading of the carcinomas was done according to the system of Scarff-Bloom-Richardson. Cells from MCF-7 cell line grown in Roswell medium [Gibco BRL] and known to express BRCA1 were processed into paraffin and used as positive controls for both IHC and real-time reverse transcription-polymerase chain reaction [RT-PCR]. BRCA1 expression was correlated with age, histological type and grade of breast cancer, estrogen and progesterone receptor status, and CA15-3. After statistical analysis of the data, demonstrable BRCA1 mRNA was found in 6 patients samples [20% of the breast cancer tissues] while the other patients showed 80% negative BRCA1 mRNA expression as well as the control group. A positive significant relationship was demonstrated between BRCA1 [mRNA] expression and high histological grade, negative estrogen and progesterone receptor status, and high levels of serum CA15-3. A significant negative correlation was found between BRCA1 mRNA expression and age [r=-0.683; p<0.01] The study demonstrated lack of BRCA 1 gene expression [mRNA] in the majority of breast cancers in Egypt and confirmed the relationship between BRCA1 expression and parameters that determine poor prognosis in breast cancer. Our results suggested that BRCA1 is seen in high-risk women known with positive family history of breast cancer. Strategies for recruitment of Egyptian women in studies of genetic testing for different breast cancer genes have varied levels of success. Our study highlights the need for further studies in this population group

Cardioprotective effects of adenosine during surgical correction of congenital heart diseases

Objective: To evaluate cardioprotective effects of adenosine on myocardial recovery during repair of CHD using CPB and included 40 pediatric patients ASA II and III

Patients and Methods: Patients were allocated into 2 equal groups [n=20]: Control group [group C] and Adenosine group [group A]. In group A, 3 minutes after starting the CPB, adenosine 150 micro g/kg/minute was infused for 6 minute and was added to the cardioplegia in a concentration of 200 micro mol/L. In group C, 3 minutes after starting CPB, equal volume of saline infused for the same period of time. Ischemic time, duration of CPB, total duration of mechanical ventilation and PICU stay were recorded. Cardiac indices were obtained using trans-esophageal Doppler probe. Hemodynamic parameters were recorded at different times. Blood levels of CK-MB isoenzyme and neutrophil count were measured before and after CPB

Results: Adenosine administrations improved the cardiac indices and significantly induced elevation of SVI, CI and PVI at 15-min and 1-hr after CPB and till 6-hrs after admission to PICU in comparison to group C. The sum of epinephrine doses was significantly higher in group C than in group A from 6-hrs till 36-hrs, and also its duration of infusion was significantly higher in group C than in group A at 24,36, and 48-hrs. The total duration of mechanical ventilation, and ICU stay were higher in group C than in group A nevertheless this difference did not reach a statistical significance. There was a non-significant difference between both groups as regards changes of HR, SBP, DBP and CVP. There was a non-significant difference between both groups as regards the mean ischemia time and CPB duration. Mean of estimated levels of CK-MB were significantly elevated at 24, 48hrs after admission to PICU in both groups compared to their baseline levels and significantly decreased at 48-hrs compared to levels estimated at 24-hrs hours after admission to PICU with a non-significant difference between both groups. Neutrophil count was non-significantly elevated in group C but decreased in group A compared to their baseline levels, with a significantly higher count in group C compared to group A

Conclusion: Use of Adenosine resulted in improvement of postoperative cardiac performance in terms of CI, PVI and SVI in patients undergoing surgical correction of CHD. It also decreased the sum of epinephrine doses, the total duration of epinephrine use and the number of patients needed inotropic support

Abbreviation: SV: Stroke volume; Cardiac index; SVI: Stroke volume index; SVRI: Systemic vascular resistance index; FTc: Time of systolic flow corrected for heart rate determines the preload; PVI: Peak velocity index to determine myocardial contractility [It is the maximum velocity of blood measured during systole normalized for body surface area]; CK-MB: creatinine kinase isoenzyme; HR: Heart rate; SBP: Systolic BP; DBP: Diastolic BP, CVP:Central venous pressure; CPB: Cardiopulmonary bypass; PICU: Pediatric ICU; CHD: Congenital heart disease; BIS: Bispectral index; ACT: Activated clotting time; CO=SV*HR [L/min]; SVI = SV/BSA [ml/m2]; CI=CO/BSA [L/min/m2]; SVR=[MAP-CVP]/CO*79.7 [dyne.sec.cm-5]; SVRI =SVR/BSA [dyne.sec.cm-5.m2]; PVI=PV/BSA [dyne/sec/m2]

Isoflurane provides better myocardial protection than midazolam in pediatric patients during open heart surgeries

Objectives: This study was designed to evaluate the applicability of anesthetic myocardial protection [pre-conditioning and minimization of reperfusion injury] using two anesthetic regimens on plasma levels of cardiac troponin T [cTnT], as a marker of myocardial ischemia, in pediatric patients assigned for surgical correction of congenital heart diseases using cardiopulmonary bypass [CPB]

Patients and Methods: The study included 60 patients [36 males and 24 females]. Patients were randomly allocated in 2 equal groups: Midazolam group received a continuous infusion of midazolam [0.2 mg/kg/hour] and Isoflurane group maintained by an end-tidal concentration of isoflurane of 1-1.5% throughout the operation. Six blood samples were taken for estimation of plasma cTnT levels immediately after induction of anesthesia [S1], 8- hours [S2], 16-hours [S3], 24-hours [S4], 36-hours [S5] and 48-hours [S6] after aortic cross-clamping

Results: Plasma cTnT levels estimated after aortic cross-clamping [S2-S6] showed a significant [P1<0.001] elevation in both groups compared to levels estimated in S1 sample. Moreover, plasma cTnT levels showed a progressive increase in all patients irrespective of anesthetic regimen used reaching a peak levels in S4 sample and started to decline thereafter but still significantly higher compared to levels estimated in S1 sample. Plasma cTnT levels estimated in S2 sample showed a non-significant increase in midazolam group compared to levels estimated in isoflurane group. On contrary, plasma cTnT levels estimated in midazolam group at 16, 24, 36 and 48 hours after aortic cross-clamping were significantly higher [P[6]=0.034, 0.01, <0.001 and =0.031, respectively] compared to levels estimated in isoflurane group. In midazolam group, there was a positive significant correlation between mechanical ventilation time and plasma cTnT levels estimated at 24-hours [r=0.413, p=0.023], respectively. However, such correlations were non-significant despite being positive in isoflurane group, [r=0.265, p>0.05]

Conclusion: It could be concluded that the hypothesis of anesthetic myocardial protection [preconditioning and minimization of reperfusion injury] is applicable for pediatric patients with congenital heart disease who are assigned for cardiac surgery. Isoflurane-based anesthesia minimized myocardial ischemic and reperfusion injury and provided efficient cardioprotection irrespective of the type of cardiac lesion