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

relationship between acidic proteases and pathogenicity of the infective juveniles of heterorhabditid nematodes

The infective juveniles [IJs] of five Heterorhabditis bacuriophora strains, entomopathogenic nematodes, demonstrated great variation in their pathogenicity to three full grown larvae of Galleria mellonella, Spodoptera littolaris and Agrotis ipsilon after 48 hr post infection. The infectivity could be arranged in a descending order as follows: EB7 > EG8 >EB6 > EA2 > EG7. The mean mortality% of G. mellonella was increased by increasing the length of exposure time to each nematode strain individually. The activity of acidic proteases was evaluated in the five H. bacteriophora strains and ranged from 27.3 to 112.9 units/10 [5] IJs with specific activity ranged from 13.2-76.3 units/mg protein. Highest insect mortality% was recorded in the strains of proteolytic activity > 55.0 units/10 [5] IJs [EB7 and EG8] except H. bacteriophora EG7. The least proteolytic activity was estimated in the least invasive strain, H. bacteriophora EA2. The relationship between pathogenicity and proteolytic activity is discussed. Acidic proteases zymogram revealed variation among strains with respect to the number and the relative mobility of the bands. Total protein and infectivity were tracked during storage of IJs of H. bacteriophora EB7. The consumption of protein indicated that proteins might be significant energy reserves. Acidic proteases have been purified from II. bacteriophora EB7. Three isoenzymes of acidic proteases, PI, PII, PIII, were resolved by ion exchange chromatography. The isoenzyme PII was further purified by chromatography on Sephacryl S-200 and specific activity increased to 441.7 units/mg protein which represents 22.5 folds purification

Effect of protein malnutrition on the immune system of normal rats treated with some immuno depressant drugs

The aim of the present work is to investigate the influence of protein malnutrition on the immuno-toxicological effect of cyclophosphamide [15mg/kg body weight /day for 5 days] and azathioprine [5mg/kg per day for 6 days] treatment on male rats. Two diet groups were used, each of 40 rats, a protein standard diet and a protein malnourished one. Protein malnutrition was induced by restricting the amount of casein in diet to 5% instead of 20% which is the approximate ideal concentration. Histopathology of spleen and thymus, body weight, organ weight and circulating immunoglobulin were chosen as parameters for this study. Histologically, the splenic haemopoeisis was reduced and was a loss in the follicular cells after cyclophosphamide and azathioprine treatment in the normal protein group. The tyniphoid follicles became more structurally disorganized and contained fewer cells in protein malnourished treated group. Thymuses from all treated groups revealed severe loss of lymphocyts but more depletion was obtained in malnourished rats after cyclophosphamide and azathioprine treatments. Significant decrease in circulating immunoglobulin, body weight and organ weight in treated groups was also noticed

Macro and micromorphological study of flower, fruit and seed of astragalus trigones DC

The macro- and micromorphological characters of the flower, fruit and seed of Astragalus trigonus DC, Fabaceae [Papilionaceae], growing in Egypt were presented

Macro- and micromorphological study of Tamacetum Santolinoides [DC] Feinbr and Ferting [Pyrethrum Santolinoides DC] Part I: flower-heads

The macro- and micromorphological characters of the flower heads of Tanacetum santolinoides [DC.] grown in Egypt, are presented with the aim of finding out the characters of this diagnostic organ, by which it could be identified in both the entire and powdered forms

Macro- and micromorphological study of Tamacetum Santolinoides [DC] Feinbr and Fertig [Pyrethrum Santolinoides DC] Part II: leaf, stem and rootstock

The macro- and micromorphological characters of the leaves, stems and rootstocks of Tanacetum santolinoides [DC.] grown in Egypt, are presented with the aim of finding out characters by which the plant could be identified and differential from other closely related species