Selenium and thyroid hormone status pre and post open heart surgery in children with congenital heart disease

Transient myocardial ischemia that occurs during cardiac surgery leads to oxidative stress and production of free radicals. Selenium [Se] status has important implications for cardiovascular morbidity and mortality as selenium is an integral component of the enzymes glutathione peroxidase and 5-iodothyronine deiodinase. Thyroid hormones have important effect on the heart and peripheral vascular system. Cardiopulmonary bypass [CPB] results in low triiodothyronine [T3] state, due to central depression of the hypothalamic pituitary axis together with impaired conversion of T4 to T3 secondary to reduced activity of iodothyronine deiodinase. This work aimed to study the effect of cardiopulmonary bypass on selenium and thyroid hormone status in infants and children with congenital heart disease [CHD]. Also it aimed to study the possible effect of selenium and thyroid hormone status on the hemodynamic condition of these infants and children after open heart surgery. Twenty five children were subjected to open heart surgery in the Cardio Thoracic Unit, Pediatric Hospital, Cairo University. The patients were subjected to full history taking, general and local cardiac examination, M mode, 2D and Doppler Echocardiography. Serum samples were collected, at the induction of anesthesia and 48 h after cardiopulmonary bypass for assessment of selenium, free T3[FT3]and free T4[FT4] levels. Assessment of serum selenium takes place at [NRC] using graphite furnace atomic absorption spectrometry [GFAAS]. Assessment of FT3 and FT4 takes place at Radioactive Isotope Department using RIA technique. Significantly lower postoperative selenium, FT3 and FT4 serum levels, compared to those at the induction of anesthesia, were found [p< 0.005, 0.025, and 0.025 respectively]. Longer CPB time was associated with lower FT3 and FT4 levels [r =0.49 and 0.63 respectively]. On the other hand higher FT3 and FT4 levels were associated with less time needed for inotropic support [r =0.48 and 0.60 respectively]. There is significant decrease of selenium, free T3 and freeT4 levels after cardiopulmonary bypass. The degree of decrease of thyroid hormones is affected by CPB time. Thyroid hormone levels have an evident impact on the myocardial functions and hemodynamic condition after open heart surgery

Diabetes mellitus in Saudi Arabia

Diabetes mellitus [DM] is a major public health problem worldwide, and it is a known risk factor for coronary artery disease [CAD]. New recommendations for the diagnosis of diabetes have changed the epidemiology of DM. Therefore, we designed this study with the objective to determine the prevalence of DM among Saudis of both sexes, between the ages of 30-70-years in rural as well as urban communities. This work is part of a major national project: Coronary Artery Disease in Saudis study [CADISS] that is designed to look at CAD and its risk factors in Saudi population. This study is a community-based national epidemiological health survey, conducted by examining Saudi subjects in the age group of 30-70-years of selected households over a 5-year period between 1995 and 2000. Data were obtained from history, fasting plasma glucose levels, and body mass index. The data were analyzed to classify individuals as diabetic, impaired fasting glucose and normal, using 1997 American Diabetes Association [ADA] criteria, which was adopted by the World Health Organization [WHO] in 1998, to provide prevalence of DM in the Kingdom of Saudi Arabia [KSA]. A total of 17232 Saudi subjects were selected in the study, and 16917 participated [98.2% response rate]. Four thousand and four subjects [23.7%], out of 16917 were diagnosed to have DM. Thus, the overall prevalence of DM obtained from this study is 23.7% in KSA. The prevalence in males and females were 26.2% and 21.5% [p<0.00001]. The calculated age-adjusted prevalence for Saudi population for the year 2000 is 21.9%. Diabetes mellitus was more prevalent among Saudis living in urban areas of 25.5% compared to rural Saudis of 19.5% [p<0.00001]. Despite the readily available access to healthcare facilities in KSA, a large number of diabetics 1116 [27.9%] were unaware of having DM. The overall prevalence of DM in adults in KSA is 23.7%. A national prevention program at community level targeting high risk groups should be implemented sooner to prevent DM. We further recommend a longitudinal study to demonstrate the importance of modifying risk factors for the development of DM and reducing its prevalence in KSA

Remodeling annuloplasty of the rheumatic mitral valve: a clinical, surgical and echocardiographic study

Between March 1992 and February 1993, ten patients underwent mitral annuloplasty using the rigid Carpentier ring. All patients had severe mitral insufficiency [MI] of rheumatic etiology. Two patients were in New York Heart Association [NYHA] functional class II, six in class III and two in class IV. Two patients had isolated MI, seven had mitral and aortic insufficiency and one had mitral, aortic and tricuspid insufficiency. Associated surgical procedures involved aortic valve replacement in eight patients and De Vega tricuspid annuloplasty in one patient. Doppler echocardiography obtained before discharge revealed absent or minimal [1+/4+] MI in nine patients and mild [2+] MI in one patient. Final follow up in February 1994 showed absent or 1+ MI in six patients, 2+ in two and 3+ in two and 3+ in another two patients. The functional class improved to class I in six and class II in four patients. The study suggested that mitral annuloplasty using Carpentier ring could be considered, with special precautions, as the procedure of choice in patients with rheumatic MI

Bilharzial arthropathy of the temporomandibular joint

Bilharziasis was experimentally induced in Swiss albino mice in order to study the histopathological changes in the TMJ in case of bilharzial infection. The bony components of the joint showed massive chronic inflammatory cell infiltration. The articular disk [meniscus] showed thickening and hyperplastic changes with narrowing of the joint space. The articulating surfaces showed erosions and irregularity. It was concluded that bilharziasis can cause arthropathy of the temporomandibular joint [TMJ]

Empyema in infancy and childhood in Taif, Saudi Arabia

This report deals with 40 patients with empyema, 82.5% of them were under 5 years of age. Bronchopleural fistula was present in 20% and bilateral empyema was present in one patient only. The clinical picture and bacteriology were discussed. Closed tube drainage gave 100% cure with no mortalities. No open drainage or decortication were resorted to

Iatrogenic perforation in caustic esophagitis

Perforation of the oesophagus is a serious complication of dilatation of caustic strictures. This report illustrated the value of early conservative treatment [within 12 hours] in 40 patients with iatrogenic perforation of the oesophagus after corrosive intake. Conservative treatment reduced the mortality from 60% to 15% provided these patients are managed within 12 hours from perforation. Dilatation after healing of the perforation is risky in corrosive strictures, as an alternative retrosternal colon interposition was performed for 22 patients