Assessment of circulating MCP-1 level and 2518A>G gene polymorphism in systemic lupus erythematosus / Avaliação do nível de MCP-1 circulante e polimorfismo do gene 2518A> G no lúpus eritematoso sistêmico

Lupus nephritis (LN) is a major contributor to morbidity and mortality in patients with Systemic Lupus Erythematosus (SLE). This study aims to investigate the possible role of a functional polymorphism in the regulatory region of the monocyte chemo-attractant protein-1 (MCP-1) gene and MCP-1 blood level in the diagnosis of LN and in correlating the MCP-1 blood levels with disease activity. The study included 56 SLE patients and 56 controls. All the SLE patients suffered from LN. An analysis of MCP-1 gene polymorphism by polymerase chain reaction was performed followed by restriction fragment length polymorphism (PCR-RFLP) analysis and MCP-1 blood level was determined using the ELISA technique. Calculation of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was performed. Serologic tests included the determination of antinuclear antibody (ANA) and anti-double-stranded (ds) DNA antibodies, Complement C3 and C4 levels. A significant increase in the frequency of genotype A/G and a decrease in the frequency of genotype A/A were found among patients with active LN compared to inactive LN. There was a statistically significant difference in the blood level of MCP-1 between LN patients and controls. Also, MCP-1 blood levels were significantly higher in active LN patients than inactive LN. A significant positive linear correlation was detected between MCP-1 blood level and SLEDAI, creatinine, and 24 hours protein in LN patients. These results suggest that an A/G genotype together with the measurement of the blood level of MCP-1 can be a useful tool for detection and follow up of active LN.

A nefrite do lúpus (LN) é um dos principais contribuintes para a morbidade e mortalidade em pacientes com o Lúpus Eritematoso Sistémico (LES). Este estudo tem como objetivo investigar o possível papel de um polimorfismo funcional na região reguladora do gene da proteína quimioatraente de monócitos-1 (MCP-1) e do nível sanguíneo de MCP-1 no diagnóstico de LN e na correlação do sangue de MCP-1 níveis com atividade da doença. O estudo incluiu 56 pacientes com LES e 56 controles. Todos os pacientes com LES sofriam de LN. Uma análise do polimorfismo do gene MCP-1 por reação em cadeia da polimerase foi realizada seguida pela análise do polimorfismo do comprimento do fragmento de restrição (PCR-RFLP) e o nível sanguíneo do MCP-1 foi determinado pela técnica ELISA. O cálculo do índice de atividade da doença sistêmica do lúpus eritematoso (SLEDAI) foi realizado. Os testes sorológicos incluíram a determinação de anticorpos antinucleares (ANA) e anticorpos anti-DNA de fita dupla (ds), níveis de Complemento C3 e C4. Um aumento significativo na frequência do genótipo A/G e uma diminuição na frequência do genótipo A/A foram encontrados entre os pacientes com LN ativo em comparação com o LN inativo. Houve uma diferença estatisticamente significante no nível sanguíneo de MCP-1 entre pacientes com LN e controles. Além disso, os níveis sanguíneos de MCP-1 foram significativamente mais altos em pacientes com LN ativo do que com LN inativo. Uma correlação linear positiva significativa foi detectada entre o nível sanguíneo de MCP-1 e SLEDAI, creatinina e proteína de 24 horas em pacientes com LN. Esses resultados sugerem que um genótipo A/G, juntamente com a medição do nível sanguíneo de MCP-1, pode ser uma ferramenta útil para a detecção e acompanhamento do LN ativo

Effect of combining epidural with general anesthesia on recovery after spine surgery: randomized controlled study

Background: Fast track techniques have been applied to reduce surgical stress response and to provide effective perioperative analgesia, thereby improving patient''''''''s recovery and reducing postoperative morbidity. The present study was undertaken to assess the effect of using combined general/epidural anesthesia (CGEA) on early recovery after lumbar spine surgeries. Subjects and Methods: The current prospective randomized clinical study had included a total of 40 patients who underwent elective one or two level laminectomy/discectomy. Patients were randomized and divided into two groups; general anesthesia (GA) group (group I) and combined general/epidural anesthesia group (CGEA) (group II). Patient characteristics, anesthesia time, surgical time, heart rate, mean arterial pressure (MAP), anesthetic / analgesic requirements, the occurrence of intraoperative bradycardia and/or hypotension, time to extubation, time to post anesthesia care unit (PACU) discharge and duration of PACU stay were recorded and considered for analysis. Results: It was observed that CGEA was significantly associated with reduction of intraoperative anesthetics / analgesic requirements, shorter time to extubation, time for PACU discharge and duration of PACU stay but on the expense of higher incidence of intraoperative hypotension. Conclusion: This study proved that CGEA seems to be an effective fast track anesthetic protocol in patients undergoing elective lumbar spine surgeries

Accuracy of lung ultrasonography in diagnosis of community acquired pneumonia as compared to chest x-ray in pediatric age group

Objective: It was aimed at investigating the role of lung ultrasonography in assessment of pneumonia as compared to chest x-ray in pediateric age group

Purpose: to evaluate the ultrasound efficiency in the assessment of pneumonia in pediatric age group as compared to chest x-ray

Methodology: This study was carried out at the general pediatric wards and PICUs of El-Demrdash hospital, Ain Shams University.40 patients were clinically diagnosed with pneumonia. For every child included in the study, a chest x-ray and a chest US were performed

Result: the detection rate of consolidative patches was higher in ultrasound compared to the x-ray technique

Conclusion: Lung ultrasound is safe and accurate for the diagnosis suspected cases of community acquired pneumonia and it is more sensitive than chest X-ray and allows a radiation free technique for detection of consolidations in children, thus reducing radiation exposure in this population

Expression of CD 44 and MIB-1 in serous and mucinous ovarian tumors

In ovarian cancer, alterations in the extracellular environment are critical for tumor Initiation, progression and intra-peritoneal dissemination. Some markers have been used to study the progression of ovarian tumors, one of them is CD44 which shown to play critical roles in ovarian ameer metastasis. Tumor proliferation is known to be important factor in tumor growth. This can be measured by assessment of expression of MIB-1 protein in the tumor cells. To examine the immunohistochemical expression of CD44 and MIB-1 in a spectrum of serous and mucinous ovarian tumors [benign, borderline and malignant tumors] and to evaluate the correlation between intensity of markers expression with relevant clinicopathological criteria [Age, size, hilaterality, gross picture and stage]. Immunohistochemical staining of 120 samples [65 benign, 10 borderline, 30 malignant and 15 metastatic deposits] of spectrum of serous and mucinous ovarian tumors for CD44 and MIB-1 was performed using tissue microarray [TMA] and statistical analyses was done with SPSS [chi-square test]. In whole tumors, expression of [1] 44 in tumor cells [CD-44-T] was low in 20[80%] and high in 5[20%] of benign tumors, low in [70%] and high in 3[30%] of borderline tumors, and low in 24 [83%] and high in 5[17%] of malignant tumors with no significant association in transition from benign to malignant tumours [P 0.70]. Stromal CD44 [CD-44-S] expression was low in 33[94%] and high in 2[6%] of benign mmors, low in 8[80%] and high in 2[20%] of borderline tumors and low in 23[77%] and high in [23%] of malignant tumors with significant association in transition from benign to borderline to 14[CD44-M] showed reactivity in 9[25%] of benign tumors,5[50%] of borderline tumors and 21[72%] of malignant tumors with high significant association in transition from benign to malignant tumors [P<0.001]. In whole tumors, twenty three specimens [31%] showed high PI. All benign tumors had low PI. High significant association was detected between high PI and transition from benign to borderline to malignant tumors [P<0.001] with significant positive correlation between MIB-1 and CD44-M [P 0.013]. Our findings indicates that stromal and membranous expression of with transition from benign to borderline to malignant tumor, so increase in CD44 may play an important role in tumor progression and can be a target of more effective therapies

Cognitive impairment in non-neuropsychiatric systemic lupus erythematosus

Systemic lupus erythematosus [SLE] is a chronic autoimmune disease which can cause prominent central nervous system [CNS] involvement. Cognitive dysfunction is one of the major neuropsychiatric syndromes of SLE. To evaluate cognitive functions in SLE patients without evident neuropsychiatric manifestations and to find out if it is correlated with disease activity and with treatment. Thirty SLE patients without evident neuropsychiatric manifestations were evaluated. The evaluation included full clinical examination, assessment of SLE disease activity index-2k [SLEDAI-2k], routine laboratory investigations, autoantibodies assessment and cognitive function assessment using Montréal cognitive assessment [MoCA] scale and trail making test [TMT] [part A and part B]. Twenty apparently healthy individuals were taken as control. Cognitive dysfunction is present in all SLE patients included in our study. During assessment of cognitive functions, a highly statistically significant difference was observed between patients and control subjects, even with equal levels of education. While patients with higher educational levels were as impaired as those with lower levels of education. Cognitive dysfunction was not correlated with disease activity or with the doses of drugs used for treatment. But a statistically significant positive correlation was noted between deterioration of cognitive functions and the disease duration. Cognitive dysfunction is a prominent feature in SLE patients without symptoms of CNS involvement. Psychological evaluation should be performed for each SLE patient to detect cognitive dysfunctions. Psychological intervention is recommended to prevent further deterioration. Correlation with disease duration should pay attention to the chronicity of disease

Consanguinity, family history, and risk of epilepsy: a case control study

To assess the association between consanguinity and family history in the risk of developing epilepsy later on in life. A case control study was carried out using data from 234 records comprising cases and controls in the proportion of 1:2. The cases were 76 patients suffering from idiopathic epilepsy, and the controls were 151 diseases patients who were non-epileptics. Data were analyzed using PASW Version 18.0. Chi square test was used to test associations and a binary logistic regression was done to calculate the adjusted odds ratio. The study population comprised 53.7% males and 46.3% females. 48.3% of the cases were of South Asian origin. The most common age group among the cases and the controls was 11-40 years. Both family history and consanguinity had an association with epilepsy. 81% of cases had a positive family history when compared to the 19% in the controls. The odds ratio was 18.37 [CI= 8.37-40.3]. 17% of cases had a positive history of consanguinity compared to the 31% in the controls. The odds ratio was 0.46 [CI= 0.22-0.90]. An adjusted odds ratio was done and the net effect was calculated. It was seen that the adjusted odds ratio for family history was 17.7 [CI=8.04-39] and the adjusted odds ratio for consanguinity was 0.53 [CI=0.23-1.19]. Therefore, family history has a significant association with epilepsy. There was a significant association between family history and risk of developing epilepsy and there seems to be no link between epilepsy and consanguinity. However, most of our patients did have a positive family history

Value of 3D volume rendering technique computed tomography in suspected foreign body aspiration in children

Foreign body aspiration is primarily a disease of children under 3 years of age. Diagnosis depends on history, physical examination and radiological findings. Considering the possible complications of bronchoscopy and the absence of frank history in many cases evaluation of such cases, using recent modalities of computed tomography may help to establish a diagnosis in suspected cases. The objective of this study was to determine the value of using volume rendering technique in diagnosis of suspected cases of foreign body aspiration. Fifty infants and children suspected to have foreign body aspiration were included in the study, clinical presentations, X-ray and 3 D volume rendering technique [VRT] CT findings and results of bronchoscopic examination for the presence of foreign body were recorded. The study included; 24 males and 26 females with mean age of 2.74[1.6] years. Duration before presentation ranged from 3 to 60 days. A definite history of chocking was obtained from 74% of cases. X-ray way positive in 76% of cases, while CT showed foreign body in 44 cases [88%] and 6 [12%] were diagnosed as pneumonia. On performing rigid bronchoscopy; one case was found to be false negative and one case found to be false positive; giving VRT technique sensitivity of 97.9% and specificity 85.7% Localized hyperinflation and bronchial obstruction were the most common positive CT findings. On Bronchoscopic removal; 74% of foreign bodies were organic. Evaluation of foreign body aspiration of the airway in children can be accomplished by using a 3D volume rendering technique, computed tomography. It may be useful both in showing the exact location of a foreign body before bronchoscopy and in ruling out a foreign body in patients with a low level of suspicion and normal or nonspecific findings on chest radiography

Intravenous paracetamol is as effective as morphine in knee arthroscopic day surgery procedures

To conduct a prospective randomized study comparing the analgesic effect of Intravenous Paracetamol with Intravenous Morphine in postoperative pain control of patients undergoing knee arthroscopic surgery as day cases. Eighty four patients were randomised into two groups on the basis of the last digit of their medical number. Odd numbers were given Paracetamol [Group-I] and even Morphine [Group-II]. All patients underwent Examination under Anaesthesia [E.U.A] and knee arthroscopy +/- a partial menisectomy as day cases and had to stay of a minimum of 4 hours post surgery. A standardize General Anaesthesia was given to both groups. An intra-articular injection of 20mls of 0.5% Marcaine was given to all patients. Postoperative pain was assessed up to 4 hours using the Verbal Rating Scale [V.R.S.]. The adverse effects of the drugs were also observed. Of 84 patients, 76 were males and 8 females. The age range was from 18 to 69 years, weighing from 55 to 90kg. Paracetamol [Group-I] had 43 patients and there were 41 patients in the Morphine [Group-II] Group. The results according to VRS, from 0 to 4 hours showed no difference in the analgesic effect of the two groups, but much less adverse effect were noted in Group-I. In our study both intravenous Paracetamol and Intravenous Morphine seems to have the same analgesic effect. However, side effects with Intravenous Paracetamol were much less

Developing nursing blood borne pathogen control plan for Mansoura university hospital

Blood borne infections pose a serious threat to health and well-being of health care workers in Egypt. Hepatitis B, Hepatitis C and HIV have in common the blood borne pathway of transmission and severity of their outcome Occupational health and safety aims at prevention of such transmission at different levels eg. vaccination prevention for Hepatitis, post exposure prophylaxis and follow up after exposure. Also OSHA's final rule made it mandatory that health care facilities assumed responsibility for protection of their employees from exposure to Blood borne pathogen by eight components such as person protective equipment, universal precaution engineering control, work practice control, Hepatitis B prophylaxis training and education record keeping. The aim of this study was to design a blood borne pathogen control plan for Mansoura University hospital through assessing nurses knowledge and awareness related to Blood borne pathogen control, assessing the viability of equipment and supplies in various department in the designated hospital, designing the blood borne pathogen control plan based on the assumed data, and examining the validity of the designated plan. The study was conducted in Surgical and Obstetric units at Mansoura University hospital in ten departments. The subjects of this study were composed of two groups, namely a nursing group, and a jury group. Nursing group included 104 subjects were chosen from the above mentioned hospital departments. Jury group consisted of 50 subjects, divided into two subgroups which include 25 medical and 25 nurses Study tools included, questionnaire format aimed to assessing nurse's knowledge related to blood borne pathogen control. Checklist aimed to checking the Blood borne pathogen control plan in the studied hospital and opinionative sheet aimed to test the validity of the developing Blood borne pathogen control plan. The results revealed that nurses knowledge about the blood borne pathogen control plan was low Meanwhile, nurses knowledge was high [59 %] in relation to getting and staying vaccinated while the knowledge was low [34 %] in relation to report and get help with any needle stick accidents. Whereas nurse leaders, awareness about the Blood borne pathogen control plan was very low in addition to all the nurses leader [100.0%] were aware about the absence of training programs and an explanation of exposure control plan. All the nurses [100%] were aware about the lack of clear duties and responsibility for nursing staff in the Blood borne pathogen department. Equipments and supplies for Blood borne Pathogen control as observed in various departments were mostly observed to be available, and in a working state, and good storage. As far as the validation of the blood borne pathogen control plan presented in the study, the majority of the members of the two groups of jury agreed upon all items regarding form of the plan and upon the general evaluation items of the plan. No statistically significant differences could be detected between the two groups. It is concluded from the study that health care workers are at risk of exposure to different occupational hazards especially blood borne infection which may have a direct or cumulative deleterious effect on their health as a result of many factors such as lack of staff nurses knowledge related to blood borne pathogen prevention, lack of hospital policy and system related to blood borne prevention, lack of nurses adherence to blood borne prevention and absence of Blood borne pathogen control plan. The study recommend that report the percentage of Blood borne infection among health care working in Egypt, increase nurses' knowledge related to Blood borne infection prevention, apply control plan in different departments in different hospitals and governorate, develop policies and regulations adherent to Blood borne prevention, mandatory testing of health care workers is not justified on the basis of current scientific evidence strategies for preventing transmission of blood borne pathogens should be reviewed as new information becomes available and re-evaluated as to their effectiveness and standards for infection control practices in health care settings and mechanisms to implement and evaluate these standards should be developed

Developing student evaluation of the clinical learning environment scale for female college of health science Kingdom of Saudi Arabia

Within nursing, there is a strong demand for high-quality, cost-effective clinical education experiences that facilitate student learning in the clinical setting. The clinical learning environment is the interactive network of forces within the clinical setting that influence the students' clinical learning outcomes. The identification of factors that characterize clinical learning environment could lead to strategies that foster the factors most predictive of desirable student learning outcomes and ameliorate those which may have a negative impact on student outcomes. In order to make comparison between clinical learning environment and explain variations in out comes of clinical learning there is a growing need in nursing research for reliable and valid measures of the student clinical learning environment. This research developed the student evaluation of clinical learning environment scale which measures nursing student perceptions of their clinical learning environment. A quality student clinical experiences considered critical to nursing education. This paper describes the refinement and testing of the student evaluation of clinical learning environment scale, an instrument designed to measure nursing student perceptions of the clinical learning environment. The study was conducted in two Female colleges of health science [Unaizah and Aljouf].The subject composed of two groups of nursing students and clinical instructors. The student group A total of 120 second year nursing students from above mentioned college completed the student evaluation of the clinical learning environment questionnaire in March and April 2007 in the 2[nd] semester. In addition 82 second year nursing students completed three pretest questionnaires from Unaizah and Aljouf during December in the 1[st] semester 2006.The clinical instructor group: It comprised of 18 clinical instructors from above mentioned college. Four tools were used for data collection, namely a questionnaire format, to assess the important factors influencing student learning in the clinical setting. Questionnaire format, to assess aspects of the clinical setting that facilitate learning and that hinder learning. A questionnaire format for student evaluation of the clinical learning environment. It based on instructors and students input from the perceptions of important factors of the clinical setting and important aspect that hinder or help learning. It composed of 47 items with liker-based agreement response opinions, divided among four scales: Communication and feedback, learning opportunities, learning support, and department atmosphere [initial questionnaire] and a questionnaire format, for student evaluation of the clinical learning environment. It based on student input from the initial questionnaire. It composed of 44 items with liker-based agreement response opinions. [Final questionnaire]. Data analysis indicated that students responded consistently to the instrument as a whole and to the four scales. Test-retest correlations for all scales were statistically correlated between individual student evaluations. Three items were not significant correlated. Overall, the Student Evaluation of the Clinical Learning Environment scale appears to be a reasonably valid and reliable measure

Eeffect of melatonin on cerulein-induced pancreatitis in adult male albino rats: histological and histochemical study

Acute pancreatitis [AP] is a complex disease associated with significant complications and a high rate of mortality. The aim of this work was to study the effect of the antioxidant melatonin on cerulein-induced pancreatitis in adult male albino rats. Thirty two adult male albino rats were used and randomly divided into four groups: first group [control]; second group [melatonin treated]; third group [cerulein treated] and fourth group [melatonin and cerulein treated group]. At sacrifice, blood samples were drawn for biochemical study and pancreas specimens were prepared for histological, and histochemical study. Melatonin reduced serum amylase and lipase activities, which were highly significantly elevated in cerulein induced pancreatitis. Histologically there was wide separation between pancreatic lobules, the acinar cells showed degeneration and vacuolation and lost their zymogen granules. There was dilatation and congestion of blood vessels, interstitial hemorrhage and cellular infiltration. Ultrastructurally, there was disorganized dilated rough endoplasmic reticulum [RER], marked decrease in zymogen granules, mitochondrial damage and cytoplasmic vacuoles. Immunohistochemically, pancreatic sections of cerulein treated rats showed a strong immune reaction for transforming growth factor-beta [TGF-beta] and vascular endothelial growth factor [VEGF]. Melatonin improved the biochemical, histological, and histochemical picture of pancreas. In conclusion, melatonin was found to be effective in cerulein-induced acute pancreatitis by preventing oxidative stress so prevents other pathological mechanisms of AP from being developed inside acinar cells

Ultrastructural and immunohistochemical study on the effect of alendronate sodium [fosamax] on liver of adult male albino rats

Alendronate sodium [fosamax] is a potent inhibitor of osteoclast-mediated bone resorption and is used for treatment of osteoporosis and Paget's disease of bone. The aim of this work was to study the ultrastructural and immunohistochemical changes of liver of adult male albino rats after alendronate sodium [fosamax] administration. Thirty six adult male rats were used in this study and randomly divided into three groups; control, fosamax treated for short period and fosamax treated for long period. At sacrifice, blood samples were drawn for biochemical study and liver sections were prepared for histological, ultrastructural, histochemical and immunohistochemical study. Fosamax treated rats showed a time dependent highly significant increase in liver function tests. Liver sections of treated rats showed dilated congested central veins and blood sinusoids with interstitial hemorrhage, perivascular cellular infiltration and many necrotic cavities. Some nuclei were shrunken and others were fading out. Ultrastructurally, there was marked mitochondrial alterations, loss of studded ribosomes from RER and increased amount of dilated smooth endoplasmic reticulum, secondary lysosomes, lipid droplets and glycogen granules. Fosamax treated rats showed a decrease in succinic dehydrogenase enzyme activity with increase in acid phosphatase enzyme activity and a strong positive immunoreactivity for bcl-2 and galectin-3. These changes were time dependent and appeared more obviouse in fosamax treated rats for long period. In Conclusion, it has became clear that prolonged use of fosamax leads to subtle hepatic damage so it is recommended from physicians treating patients with alendronate or related drugs to be alert for the possibility of liver dysfunction by monitoring properly such effects by routine measurement of liver enzymes and to stop this medication on occurrence of liver dysfunction

Measuring quality of nursing services for type II diabetic patient in University Hospital

High quality care is a right for all patients and the responsibility of all nurses who deliver it. The aim of the study is to assess structural standard in University Hospital, to assess process standard as provided to type II diabetic patients, and to assess patient satisfaction as an outcome standard of quality of nursing care. The study conducted in Mansoura University Hospital. The structural standards had good quality, also, patients' satisfaction as an outcome of quality of nursing care was good. While, process standards applied to diabetic patients type II had poor quality, the study findings pointed to that there are a positive correlation between structure components and care process of quality of patient care as well as between structure components and outcomes measurement. While this correlation was not found between care process provided to diabetic patient Type II and outcome measurements. It is recommended that nursing standards must be communicated with the nursing staff in each hospital which will help them to improve the quality of care rendered

Work-related stress, burnout and coping among nurses in University Hospitals

To investigate the extent of burnout among nurses, to ascertain which aspects of nursing work were related to burnout and to examine the relative contribution to burnout made by these different variables [demographic factors, stress and coping strategies]. This study included a total of 200 nurses working at medical and surgical wards, in Man-soura and Zagazig University Hospitals [100 nurses from each hospital]. The study tools included a demographic interview data sheet, a Nursing Stress Scale, Modified Jalowiec and Powers Coping Scale and The Burnout Potential Inventory. Nurses stress in Mansoura and Zagazig University Hospitals were mainly in the form of physical stresses, mainly due to workload. Total stress scores were significantly higher among nurses in Mansoura University Hospital than those among Nurses in Zagazig University Hospital. Affective-oriented coping was higher than the problem-oriented coping. Nurses in Mansoura showed significantly higher scores for coping than those in Zagazig. In both University Hospitals, conflict and overload mean scores were high. Nurses in Mansoura University Hospital sustained significantly higher conflict and poor teamwork while those in Zagazig University Hospital sustained significantly higher punishment. Age, income, and years of experience in nursing had significantly negative correlation with stress scores and burnout and significantly positive correlation with coping scale. There was a positive significant correlation of stress with burnout in both Mansoura and Zagazig and a negative significant correlation of coping with burnout. Stress and coping scores were significantly higher among nurses having Diploma with specialty than those with Diploma in nursing only. Nurses in University Hospitals experience occupational stress. With less age, salary and years of experience in nursing work-related stress becomes more perceived. Affective-oriented coping strategies are resorted to more than the problem-oriented coping. Nurses in Mansoura cope better than those in Zagazig. The hospital organization should monitor staff conflict and must ensure that workloads correspond to workers capabilities and resources. Training places should put more emphasis on preparing nurses to deal with the emotional needs of their patients, with detached concern. Stress inoculation training which teaches nurses appropriate coping skills could be implemented. Particularly, vulnerable groups of nurses, such as those with diploma with specialty, should be monitored regularly for signs of burnout. They should be the primary targets for ongoing training and/or preventive interventions such as stress inoculation training

Myocardial ischemia and neurological outcome after coronary artery bypass grafting with or without cardiopulmonary bypass

Background: Off-pump coronary artery bypass B] is an emerging. It is assumed that munition of cardiopulmonary bypass Pli]for coronary artery bypass graftingBG] has the potential for reducing lucrative morbidity. In this study, we cstigated the effect of coronary Miscularization with or without vv.rdiopulmonary bypass on myocardial ,H hernia and neurological outcome

Methods: Forty patients [31 males] with average in undergoing coronary revascularizatipn, median stemotomy,withorwithout utrdiopulinonary bypass were divided into to groups: Group I: 20 patients undergoing OPIAB and group II: 20 patients undergoing B] with CPB. Troponin T [TNT] and CK-MB for detection of myocardial ischemia : performed6.12,24,48,hoursafter anon Hemodynamic changes, heart rate, ,;i blood pressure, central venous pressure,nonary capillarywedgepressureand line index were measured preoperatively postoperatively. Neurological outcome, amount of blood loss and blood or bloodproducts transfusion were also measured. As well as, intubation time, ICU stay were recorded

Results: The results of this study showed significant reduction in myocardial ischemia and infarction post revascularization in group I in comparison to group II, 1 patient in OPCAB group developed ischemic changes with increase TNT and Ck-MB and developed non fetal myocardial infarction [MI] while in group II, four patients developed ischemic changes, three of them were showed elevated Ck-MB and two with elevated TNT concentrations and developed non fetal MLThere was no neurological complication in OPCAB group while in group II one patient was developed delayed recovery and delirium, and another patient was developed cerebral stroke postoperatively. Blood loss and blood transfusion were in a significantly lower with OPCAB group. There were significant shorter intubation time and ICU stay in OPCAB group than in group II

Conclusions: OPCAB can be safely performed in selected patients. Elimination of CPBsignificantly reduce postoperative myocardial ischemia and neurological complications. Prospective randomized trials are need to define better patients selection and long-term benefits of OPCAB