Subclinical atherosclerosis in patients with early rheumatoid arthritis

Rheumatoid arthritis [RA] patients have increased mortality and morbidity as a result of cardiovascular [CV] and cerebrovascular diseases. Surprisingly the extent of atherosclerosis [AS] in RA is not known, nor have standard CVD risk factors have been fully evaluated. Study of these changes in early RA and early diagnosis of AS in this population might trigger more aggressive prophylaxis. To demonstrate subclinical atherosclerosis in early RA and possible underlying mechanism. 60 patients with early RA and 40 controls matched for age, sex and traditional risk factors for AS were selected. All patients and controls were subjected to a complete history and full clinical examination, laboratory assessment and carotid ultrasonography. Patients with early RA had average greater cIMT than controls and an increased prevalence of atherosclerotic plaques. Positive association between cIMT and age, joint count, disease activity score [DAS], smoking, serum cholesterol and c-reactive protein [CRP] were observed. Age and CRP were independently associated with atherosclerosis. Patients with early RA developed accelerated atherosclerosis compared with controls. Age and CRP are strong predictors for occurrence of CV disease before onset of symptoms

Oxidative stress and inflammatory marker: possible pathogenic role in acute coronary syndrome

Acute coronary syndrome [ACS], which comprise unstable angina [UA] and acute myocardial infarction [AMI] are multifactor diseases involving both thrombotic and inflammatory processes. C-reactive protein [CRP] has emerged as independent risk indicator of active atherosclerosis. Reactive oxygen species [ROS] are key mediators of signaling pathways that underlie vascular inflammation in atherogenesis starting from the initiation of fatty streak development through lesion progression to ultimate plaque rupture. CRP directly up-regulate AND[P]H oxidase p22 [phox] and enhance ROS generation. Recently it has been shown that 8-iso-prostaglandin F2 alpha [8-iso-PGF2_] is a specific, chemically stable and quantitative marker of oxidative stress in vivo. It is formed in situ in cell membranes following free radical attack on the arachidonic acid. To counteract the effect of ROS, cells are endowed with a complex antioxidant network that operates to prevent or limit oxidant damage. The present study was designed to investigate the changes of 8-iso-PGF2_, total antioxidant capacity [TAC] and CRP levels in patients with acute coronary syndrome in order to evaluate the role of oxidative stress as well as inflammation in pathogenesis and consequence of the disease. The present study included 30 patients with ACS and 15 healthy, age and sex-matched controls. The patients were divided into two groups; 15 patients with UA and 15 patients with AMI. Serum leuel of 8-iso-PGF2-_ was measured using an ELISA kit Serum CRP and TAC levels was measured by turbidimetric immunoassay and colorimetric methods respectively. Serum levels of both 8-iso-PGF2- _, and CRP were significantly increased in patients compared with control [p<0.05]. TAG showed significant decrease in patients with AMI when compared to controls [p<0.05]. It could be concluded that elevated levels of 8-iso-PGF2-_ and CRP together with decreased TAC level contribute directly and actively to the pathogenesis of ACS. The oxidative stress is likely to either induce or intensify the inflammatory action, and may co-affect with inflammatory factors to accelerate plaque rupture. The evaluation of oxidative stress would enable formulation of specific antioxidant therapy as promising strategy against atherogenesis for an early intervention and better management of the disease

Closed mitral valvotomy in patients with rheumatic mitral stenosis and associated aortic regurge

This work comprised 300 patients with tight mitral stenosis [MS] who underwent closed mitral valvotomy [CMV] operation and subdivided into two main subgroups: Subgroup A with MS and without associated aortic regurge [AR] [MS group] and comprised 100 patients and subgroup B with MS and associated AR [MS-AR group] and comprised 200 patients [130 patients had AR grade up to I/IV and 70 had AR grade ranged from >1/IV to II/IV; 180 patients had normal preoperative left ventricular, LV, dimensions and 20 patients had mild increased LV dimensions] [end systolic diameter, ESD, up to 4.2 cm and end diastolic diameter, EDD, up to 6.2 cm]. All patients were subjected to CMV operation, preoperatively and postoperatively [within three months, one year and three years]; clinical and Doppler echocardiographs evaluation. The study concluded that CMV operative can be done safely for patients with tight MS and associated AR up to grade II/IV and even among those patients having mild increased LV dimensions [ESD up to 4.2 cm and EDD up to 6.2 cm]. A longer follow up period [up to ten years] was recommended for these patients to evaluate the rate of the progression of AR and the need of AV replacement among them

Percutaneous transluminal angioplasty versus cononary artery bypass grafting in patients with depressed left ventricular function

The aim of this study was to compare clinical and functional status after coronary artery bypass grafting or percuraneous coronary angioplxty [PTCA]. The study included 96 patients; 86 patients were males and 10 patients were females with age ranged from 28 years to 66 years [mean of 29]. The patients were divided into two groups, group I undergoing CABG and group II undergoing PTCA. Assessment of global left ventricular function via measuring ejection fraction by modified Simpson's role technique and regional systolic function by dividing the left ventricular into 16 segments as documented by ASE was carried out. LV function indices improved slightly significant or non- significantly in CABG group than PTCA and both groups had the same survival rate. The need for intervention was more in PTCA group. In-hospital mortality was more in CABG group, anginal attacks and need for anti ischemic medications were more prevalent in PTCA group. There was no significant difference between both groups regarding quality of life. The study concluded that CABG does not appear to be associated with unacceptable morbidity. Patients with graftable vessels and reduced EF should not be denied CABG on the basis of their reduced LV function, for many of these patients CABG is probably the most appropriate treatment