Methylenetetrahydrofolate reductase gene polymorphism in coronary artery disease patients

Coronary artery disease occurs with the interact ion between environmental influences and genetic factors. Genetic susceptibility may be caused by mutations and polymorphisms in a variety of genes mainly involved in blood coagulation, metabolism of lipids, homocysteine and or iron. The most common form of genetic hyperhomocysteinemia results from the production of a thermolabile variant of methylene tetrahydrofolate reductase [MTHFR] with reduced enzymatic activity. This study was performed on ninety individuals selected with normal serum glucose, kidney, liver, and thyroid function test and lipid profile. They classified into: Group I: 27 apparently healthy persons as control group. Group II: 3 apparently healthy persons with elevated homocysteine level. Group III: 27 CAD patients with normal coronary angiography. Group IV: 33 CAD patients with abnormal coronary angiography. The following specific investigations were done for all the studied persons:- Serum homocysteine [Hcy], serum folic acid [FA] and MTHFR genotyping by PCR-RFLP

Results: In group III three patients had elevated Hey [11.1%]. There was significant elevation of Hey level in group IV compared to group I [P<0. 05].however there were insignificance differences in mean value of folic acid of the studied groups compared to each other. As regard the relation between the MTHFR polymorphisam and hey and FA levels, in group I there was significant elevation of serum Hey level in carriers of CT genotype compared to carriers of CC genotype [P<0.05]. Homocysteine level was highly elevated in patients had TT genotype in group III and group IV when compared to CC and CT genotypes and this was statistically highly significant [<0.000] in group IV, but insignificant elevation in group III Folic acid level was not differing between patients had TT genotype when compared to CC and CT genotype in all studied groups and that was statistically insignificant. When we study the severity of CAD in group IV there was insignificant elevation of serum Hey level in group of one vessel affection compared to group of two vessel and multi vessel affection, there was Significant elevation of serum Hey level in group of >/= 90% stenosis compared to group of >50-75% stenosis and 75-90% stenosis. However there was insignificant difference in serum FA between the groups compared to each other. Homozygous TT was detected in group of one vessel affection and with >90% stenosis. Carriers of TT genotypes in group of one vessel affection and in>/= 90% stenosis had highly significant elevation [P<0.000] of serum homocysteine compared to CC and CT genotypes in the same group

Conclusion: Our findings support that homozygous MTHFR TT genotype is a genetic risk factor for CAD

Evaluation of the outcome of transobturator vaginal tape in management of stress incontinence in women

To evaluate the therapeutic results of a minimally invasive anti-incontinence operative procedure-the tension free vaginal tape [TVT]-obturator. With this prospective, observational, and consecutive patient series, TVT-obturator surgery was performed, according to de Leval [2003], on 44 patients with urodynamically proven stress urinary incontinence. Follow-up lasted 3-24 month. The demographic and therapeutic aspects of the patient group data were evaluated. The TVT-obturator required neither bladder catheterization nor intraoperative diagnostic cystoscopy. 4 patients [9.09%] with postoperative voiding difficulties had urethral bladder catheterization for 1-4 d; there were 4 cases [9.09%] of early therapeutic failure rate for the TVT-catheterization for 1-4 d; there were 4 cases [9.09%] of early therapeutic failure rate for the TVT-obturator, no postoperative field infections were noted. Use of the TVT-obturator, a novel midurethral sling, seems to reduce the incidence of some of the operative complications novel midurethral sling, seems to reduce the incidence of some of the operative complications associated with the TVT, primarily bladder penetration and postoperative outlet obstruction. The early therapeutic results and the cost-effectiveness of the TVT-obturator appear similar to those reported for common TVT surgery

Foetal weight assessment using sonographic femoral length: Honarvar equation

To evaluate the accuracy of the femoral length, by Honarvar equation during ultrasonographic examination at [36] weeks of gestation as a predictor of actual birth weight. A prospective observational study. Department of OB/GYN, women's health Hospital, Assuit University, Assiut, Egypt. Outpatient obstetric care clinic. One hundred [100] pregnant women at 36 weeks of gestation, were recruited in this study. Real time ultrasound examination was done to measure the femoral length, then the estimated foetal, weight was calculated using the Honarvar 2 equation. The correlation between estimated foetal weight [EFW] and real weight was tested by Pearson correlation coefficient and the relationships with the age and body mass index [BMI] of the mother, the gender of the neonate and parity were tested by multiple regression. there was significant correlation between sonographic EFW by the Honarvar 2 equation and the actual birth weight of the offsprings. Therefore, this equation is a valid method for foetal weight estimation, It also doesn't depend [no significant correlation] upon the maternal age, BMI and parity or neonatal sex. The Honarvar formula produced the best estimate of the real birth weight and its use is recommended

Evaluation of maternal morbidity in association with multiple repeated lower segment cesarean sections [more than four]

To determine the safety of repeated multiple caesarean sections more than four by comparing the outcome to a control group with lower number of repeated caesarian sections. Study design: A retrospective case-control study. Department of OB/GYN, women's health Hospital, Assiut University, Assiut, Egypt. Fifty patients who had previous four caesarian sections or more were compared to another control group of 50 patients who had lower number of repeated caesarian sections, as regards potential intra and post operative complications; including duration of surgery, degree of adhesion and possible adjacent organ injury. Also; dehiscence or rupture scar; blood transfusion and intensive care unit [ICU] admission were reported. in the study group [>/= 4 previous caesarian sections] the operative and hospital stay time were significantly longer with a higher rate of infra-operative adhesions, ileus and bladder injury than control group. The incidence of abnormal placentation [placenta accrete], caesarian hysterectomy and the need for blood transfusion was higher than that of the control group. There was no significant difference in postoperative complications or ICU admission. The neonatal outcome was comparable in the two groups and there was no maternal or fetal mortality. multiple repeated lower segment caesarian sections >/= 4 appears to be associated with higher rate of serious complications, so such patients must be advised to have the surgery in a tertiary obstetric care center with satisfactory facilities including a blood bank and adult as well as neonatal intensive care units. Also counseling about sterilization should be offered

Intraperitoneal lidocaine for postoperative pain relief after laparoscopic ovarian drilling

To evaluate the efficacy and safety of intraperitoneal installation of lidocaine as regards postoperative analgesia after laparoscopic ovarian drilling for polycystic ovarian syndrome [PCOs]. A prospective, randomized placebo controlled study. Setting department of Obstetric and Gynecology, maternal health center, Assuit University, Assuit, Egypt. This study was done upon fifty women undergoing operative laparoscopic ovarian drilling for polycystic ovarian syndrome [PCOs] under general anaesthesia, all patients were subjected to skin infiltration of 2.5 ml of lidocaine 2% at the site of Verres needle and trocar insertion. Patients were allocated randomly to one of two groups; group A [lidocaine group] 25 patients received 150 mg intraperitoneal lidocaine hydrochloride in the Douglas pouch, 50mg before CO[2] inflation and 100mg left in the peritoneal cavity, and the group B [control group] 25 patients received only saline [0.9% NaCl] instead of lidocaine. Shoulder and pelvic pain were evaluated using visual analogue score, postoperative analgesic requirements [the need for intramuscular non steroidal anti-inflammatory drugs, ketorolac 30], and time to return to normal daily activities were evaluated in the ambulatoiy unit and after discharge during the first 48 postoperative hours, The collected data were analyzed using SPSS [statistical package for social science] program and Chi square test [the probability of error P]. Pain score, analgesic requirements and time to return to normal daily activities were significantly reduced in patients who received intraperitoneal lidocaine [P <0.05]. Intraperitoneal installation of 150 mg lidocaine is simple to use, resulting in effective long lasting analgesia and improves the postoperative course

One-lung ventilation under general anesthesia: is it appropriate for thoracic surgery?

The study comprised 30 [ASA grades II and III] patients aged 47-72 years, randomly allocated into three equal groups [n=10] according to type of anesthesia administered and number of lungs ventilated: Group I anesthetized using continuous intravenous general anesthesia [GA] with two-lung ventilation [TLV], group II received GA with one-lung ventilation [OLV] and group III received thoracic epidural anesthesia [TEA] combined with GA with OLV. Arterial and venous blood gases, heart rate HR], and mean arterial pressure [MAP] were measured during TLV, 15 [OLV+15] and 30 min after beginning OLV [OLV+30]. Duration of surgery, the number of blood bags used for transfusion, and postoperative analgesia requirements were recorded. Hemodynamic parameters showed nonsignificant changes between patients administered GA, whereas there was significant [P<0.05] decrease in MAP and HR in TEA group and 7 patients required administration of 10 mg of IV ephedrine in group III. OLV resulted in significant [P<0.05] reduction of PaO2, SaO2, CaO2 and Cc02 in groups II and III at OLV+15 compared to group I, and in group III compared to group II. At OLV+30, there was significant [P<0.05] reduction of all measured pamameters in groups II and III compared to group I. and in group III compared versus group II. All patients showed an increased Qs/ Qt% 15 and 30 min after OLV, however, the increase was significant [P<0.05] in groups II and III compared both to group I and to their percentages measured during TLV. Despite the non-significant difference between groups II and III, at OLV+15, there was a significant [P<0.05] increase of Qs/Qt% in group III, at OLV+30 compared to group II. Hemoglobin [Hb] concentrations showed a significant [P<0.05] decrease at OLV+30 in all patients compared to their starting levels. Group II showed the least decrease of Hb concentration. OLV had significantly [P<0.05] reduced the duration of surgery in group II compared to group I and non-significantly compared to group III. Furthermore, OLV had significantly [P<0.05] reduced the need of blood transfusion in both group II and III compared to group I. All patients included in groups I and II required postoperative analgesia, while only 4 patients in group III required additional analgesia. There were no complications encountered with TEA technique. We can conclude that OLV under TEA combined with general anesthesia is not appropriate for thoracic surgical procedures while OLV under continuous general intravenous anesthesia is appropriate for safe thoracic surgical procedures

Simultaneous flexor carpi ulnaris transfer and selected flexor origin release for pronation flexion deformity of the forearm and hand in spastic paralysis

A procedure of simultaneous flexor carpi ulnaris [FCU] transfer and selected flexor pronation origin [FPO] release was presented for the treatment of 35 hemiplegic cerebral palsy patients with pronation flexion deformity of the forearm, h and and wrist. The patients were divided into four groups as regards the severity of deformity, surgical recommendation, potential h and function and prognosis. Pattern A included six patients with very mild deformity treated by FCU transfer and selected release of pronator teres origin with a very good functional result. Pattern B included 15 patients with mild deformity treated by FCU transfer and selected release of FPO from the medial epicondyle only with a good functional result. Pattern C included nine patients with moderate deformity treated by FCU transfer and selected release of FPO from the medial epicondyle and upper third of the forearm with a fair functional result. Pattern D included five patients with severe deformity treated as pattern C but to improve the appearance and hygiene with a poor functional result. This procedure reduced the power of wrist and finger's flexion by the release of FPO and reinforced the power of wrist extension and supination by FCU transfer. After a mean of four years follow up, the appearance of the h and and forearm was improved in all patients. No patient lost any motion and all patients gained some forearm, wrist and h and motion and there was not overcorrection of the h and or wrist deformities

bacteriologic study for the hygienic evaluation of a new thermoplastic resilient liner material

This study aimed to investigate the colonization of the oral micro-organisms on Eer koflex, the new thermoplastic material, to evaluate its hygienic usage. The results revealed the absence of colonization of the oral micro-organisms on the Erkoflex material. While colonies were high in count after 4 and 8 weeks of denture use on the hard aery lie denture base fitting surface. It has bean concluded that, this thermoplastic resilient material is hygienic for clinical use in lining aery lie dentures for long periods

Reproductive prolificacy, growth responses and mortality rates in pregnant ewes and their lambs supplemented with selenium and vitamin E

Supplementation with either selenium or vitamin E or both had a significant effect on reproductive performance in sheep, when compared with control group. Significant response in growth rate was recorded, varied from p <0.05 to 0.001 at birth, until 3rd week, with increases in gain/day. High% of number of lambs born/ewe reaching to 130, 120 and 160% for vitamin E, selenium and vitamin E and selenium groups, respectively. Mortality rate was markedly reduced, with its elevation in control group reaching to 75%, developing WMD, while none of the lambs of supplemented groups developed WMD. Increased number of ewes with multiple births [twins and triplets], but there was no difference between supplemented groups. Decreased percentage of ewes had either dystocia or vaginal prolapse and the incidence of abortion

effect of vitamin E and selenium in the treatment of a field out break of white muscle disease in lambs

A flock of 30 one-week old lambs [10 clinically affected with WMD and the rest were apparently clinically normal] were successfully treated with selenium and vitamin E injection. Whole blood selenium concentration and glutathione peroxidase activity GSH-PK were determined, with highly significant correlation between them [r = 0.958, P <0.001], indicating selenium deficiency. Serum CK and AST activities were proportional to the extent of muscle damage and permit the objective diagnosis either clinically or subclinically without sacrifice of the animal. It was recommended that diagnostic efforts should differentiate between WMD due to selenium or vitamin E or due to combined deficiency, although the sparing effects between selenium and vitamin E