Enoxaparin versus unfractionated heparin in acute ischemic stroke [in-evolution type] differential effects of enoxaparin on von Willebrand factor release and a possible relation to improved clinical outcomes

The significance of low-molecular-weight heparins [LMWHs] in the management of acute stroke remains controversial. One hundred patients with acute ischemic stroke in evolution were enrolled [with symptoms of stroke within eight hours of randomization]. Patients were randomized to receive Unfractionated Heparin [UFH] at a dose 5000 IU by IV bolus, followed by a continuous IV infusion; or to Enoxaparin [ENOX] at a dose of 0.5 mg per kilogram body weight. Therapy was continued for 10 days. National Institutes of Health Stroke Scale [NIHSS] and Computed Tomography [CT] scan were performed in all patients at the time of admission, and after 48 hours of randomization. It was found that, the mean baseline National Institutes of Health Stroke Score [NIHSS] was 9.14 +/- 0.62 among patients randomized to UFH, vs. 7.86 +/- 0.54 among patients randomized to ENOX [p = 0.2]. At discharge, the mean NIHSS showed a statistically significant difference in favor of the ENOX group [7.9 +/- 0.82 for the UFH arm versus 4.96 +/- 0.54 for the ENOX arm; p = 0.002]. The mean NIHSS after therapy in patients who demonstrated neurological improvement was 5.6 +/- 0.46 in the UFH arm, as opposed to 3.65 +/- 0.39 in the ENOX arm [p = 0.001]. A deterioration in the clinical neurological condition [progressive stroke symptoms] inspite of treatment with anticoagulant therapy was seen in 20% [n = 10] of the patients in the UFH treatment arm and no patients in the ENOX treatment arm showed this condition [p = 0.005]. No statistically significant differences were observed for pulmonary embolism, deep venous thrombosis, recurrent strokes, or death. It was concluded that, Enoxaparin [+ aspirin] was superior to UFH [+ aspirin] in reducing adverse neurological disability after acute ischemic stroke in evolution. This superiority was not associated with reductions in mortality, and could be explained by blunting of von Willebrand factor release by Enoxaparin

Appraisal of myocardial function and early results in both off-pump and conventional coronary artery bypass grafting

Conventional coronary artery bypass grafting [CABG] is both safe and effective. Off-pump coronary artery bypass [OPCAB] is an emerging procedure. It is assumed that elimination of cardiopulmonary bypass for CABG has the potential for reducing postoperative morbidity. The aim of our work is to achieve an evaluation of both CABG techniques as regards indications, surgical techniques, complications, feasibility and indirectly assessing early ventricular function after both procedures. This is a prospective study done in Maadi Armed Forces Hospital. It comprised 66 patients starting on November 2000 till November 2003. Patients were done by 3 visiting surgeons. Patients were divided into 2 groups, group [A] with 33 patients done on CPB from November 2000 till May 2001, group [B] with 33 patients done with off-pump technique using Medtronic Octopus 2-0 and 3-0 tissue stabilizers positioned over the Octobase retractor. Group [A] had an age of mean 49 +/- 6.8 years, while group [B] had an age of mean 52 +/- 7.4 years. No significant statistical difference in age, sex or ejection fraction existed between the two groups [P > 0.05]. Slightly more grafts were performed in the traditional CABG group than in the OPCAB group. There was a highly significant statistical difference [P < 0.001] as regards postoperative cardiac enzymes assay [Troponin I] and operative time in hours, and significant statistical difference [P < 0.05] as regards postoperative ECO improvement. The highly significant reductions in transfusion requirements, intubation time, ICU and overall hospital lengths of stay are very beneficial both to the patient directly and to society in general. All the previous results are in favour of OPCAB procedure with platelets and clotting factors being better preserved, with lower dose of heparin utilized and patients are kept warm throughout the procedure. OPCAB patients are ventilated throughout the entire procedure and many of them are ready for extubation very early, almost immediately at the end of the procedure, with earlier extubation, earlier ambulation and thus quicker recovery and discharge from hospital than the conventional CABG. Hence, our study verifies the impression of a more favourable early clinical result with OPCAB procedure, which has been encouraging with reduced trauma associated with this type of operations. Not all patients can undergo the exciting new OPCAB procedure which differs according to anatomic, hemodynamic considerations together with availability of experience of the surgical team. This new procedure needs careful and objective study in the future

Endomyocardial fibrosis in Egypt: Is there any relation to schistosomiasis

The aim of this work was to study the profile of antibodies specific to Schistosoma mansoni worm and egg antigens in the serum and pericardial fluid in patients with endomyocardial fibrosis EMF. The study was conducted on nine of our patients previously diagnosed as EMF by 2D echocardiography and cardiac catheterization. Pericardiocentecis and analysis of pericardial fluid was done for all patients. Measurement of specific immunoglobulins G, M and A for soluble worm antigen preparation [SWAP] and soluble egg antigen [SEA] in the serum and pericardial effusion was done using an enzyme linked immunosorbent assay furthermore, SWAP specific IgG in serum and pericardial fluid was fractionated by enzyme immunoblot assay. All patients had specific SWAP and SEA IgG in their sera and pericardial fluid. SWAP IgM was negative in all sera but positive in pericardial fluid of three patients. SEA IgM was positive in four serum samples and six pericardial fluid samples. SWAP and SEA IgA was negative in all samples. There was statistical disagreement between the serum and pericardial anti SEA IgM suggesting the possibility of its local cardiac production. This study confirms the presence of antibodies specific to S.mansoni antigens in the serum and pericardial fluid of patients with EMF and suggests that EMF in Egypt is an immunologicaly mediated lesion of S.mansoni

Systolic time intervals in chronic obstructive pulmonary disease

Fifteen male patients with the diagnosis of COPD were subjected to clinical, radiological, electrocardiographic and respiratory function studies. Arterial blood gases, pH and systolic time intervals were estimated. There were prolongation of PEPI, shortening of the LVETI and increase in the PEP/LVET ratio. The shift from normal was corresponding to the severity of COPD. Significant correlation was also found between PEPI,PEP/LVET and arterial blood gases, but no relation was found between the pH, respiratory functions and STIs