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

Uncomplicated laparoscopic cholecystectomy to drain or not to drain

Background: gallstones are present in about 10% to 15% of adult population. Between 1% and 4% of these adults become symptomatic every year. Laparoscopic cholecystectomy first performed by philippe Mouret in Lyon, France in the late 80s, has gained acceptance at the standard of care for patients requiring cholecystectomy. Laparoscopic cholecystectomy provides a safe and effective treatment for most patients with symptomatic gall stones. Laparoscopic cholecystectomy for acute cholecystitis is mainly performed after the acute cholecystitis episode subside because of the fear of higher morbidity and need for conversion from laparoscopic to open cholecystectomy

Aim of the Work: the need for routine abdominal drainage in uncomplicated laparoscopic cholecystectomy. Benefits and harms of intra abdominal drains in uncomplicated laparoscopic cholecystectomy

Patients and Methods: the study included 50 patients from Al Azhar University Hospital and with chronic calcular cholecystitis in period from February 2016 to June 2018. They were randomly assigned into one of the two study groups: Group I: with tubal drains; Group II: without drains. The later group wasn't selected except after making sure that a drain is not required by the operating surgeon. Patients were selected on the basis of the following criteria.?? Ethical approval from local ethical committee of surgery department was obtained

Results: data obtained from the present study were selected statistically analysis computed using SPSS. Continuous data were expressed in the form of mean + SD while categorical data were expressed in the form of count and percent. Comparison of continuous data was performed utilizing student t test, while categorical data were done using chi-square test. P value less than 0.05 was considered statistically significant. In group A [with drain] according to the sex is arranged as 7 male patients and 18 female patients, according to the age is arranged between 23-60 years and according to BMI is arranged between 18-30 [kg/m[2]] in group B [no drain] according to the sex is arranged as 5 male patients and 20 female, according to the age is arranged between 25-60 years and according to the BMI is arranged between 20-35[kg/m[2]]. No statistically significant differences between the two studied groups according to domographic data

Conclusion: use of drain didn't result in reduction of postoperative complications. It was also associated with prolonged operative time, higher pain levels and longer hospital stay

Autologous serum in dry eye disease

Background: The tear film overlays the ocular surface and provides the interface between the eye and the external environment. The tear film is essential for the nutrition and protection of the ocular surface and for clear vision as the tear film is the first refractive surface of the eye

Aim of the Work: the purpose of this study was to review the efficacy, complications and safety of using autologous serum in dry eye

Patients and Methods: thirty patients of moderate to severe dry eye selected from Ophthalmology Out-Patient Clinics, Al-Hussein University Hospitals. All patients were subjected to Schirmer 1 test, Tear break - up time [TBUT], and Fluorescein clearance test

Results: The mean value of Schirmer 1 test before the use of autologous serum was 2.83 mm +/- 0.83 SD while after use of autologous serum was 5.33 mm +/- 9.99 SD. The mean value of TBUT test before the use of autologous serum was 9.50 sec +/- 1.20 SD while after use of autologous serum was 9.433 sec +/- 1.52 SD. The mean value of FCT before the use of autologous serum was 100 % positive while after use of autologous serum was 76.7 % positive. The difference between before and after use of autologous is statistically significant as P-value < 0.001

Conclusion: this study revealed that autologous serum eye drops were found effective and safe in treatment of severe dry eye disease, as evidenced by improvement in subjective assessment of symptoms, Schirmer's 1teast, tear film break-up time [TBUT] and fluorescein clearance test [FCT]

Effects of intravitreal injection of ranibizumab on intraocular pressure

Background: the administration of anti-vascular endothelial growth factor [anti-VEGF] agents has become an application of IVIs to treat a variety of retinal and choroidal neovascular diseases including neovascular age-related macular degeneration, vein occlusion with macular edema, and diabetic maculopathy. ranibizumab is the most commonly used anti-VEGF treatments for retinal disease. While Intravitreal ranibizumab appears to be safe and effective but it can cause adverse effects as intraocular inflammation, cataract, vitreous haemorrhage, and increased intraocular pressure

Aim of the work: this study aimed to Evaluation of Iop changes after intravitreal injection of Ranibizumab retinal and choroidal neovascular diseases as neovascular age-related macular degeneration [AMD], central vein or branch vein occlusion with macular edema, and diabetic maculopathy

Patients and Methods: this prospective study was carried out from March 2018 to September 2018 on 35 eyes of patients attending outpatient clinic of Al-Azhar University Hospitals and Ophthalmology Department of Research Institute of Ophthalmology in Giza. All participant names were hidden and were replaced by code numbers to maintain privacy of the patients. IOP was measured Using Applanation tonometer and Perkins tonometer before IVI of ranibizumab immediately after injection, 30 minutes, 1ST day, 1st week, and 1st month after injection

Results: IOP was highly increased immediately after injection of ranibizumab, preoperative mean IOP 15.31+/-3.70, immediate after injection mean IOP 24.62+/-11.38, then it started to decrease till reaching normal values in the first 24h after injection, 1st 24hours mean IOP 16.31+/-3.60.The mean IOP for patients who were previously injected was 16.47+/-3.74 pre injection, and it was 30.88+/-12.55 immediately after injection, it still decreasing till reaching 20.24+/-2.77 after 30 minutes, we follow the patients after 1 day it was 18.41+/-3.12, then it became 18.29+/-3.62 after 1 week, and 17.88+/-3.33 after 1 month. The mean IOP for patients who were the first time to be injected was 14.22+/-3.41 pre injection, Immediate after injection the mean IOP was 18.72+/-5.92, after 30 minutes of injection the mean IOP was 15.44+/-3.99 mm Hg, after 1 day of injection the mean IOP was 14.33+/-2.87 mm Hg, We followed up the patients to one week after injection and we checked the IOP. The mean IOP after one week was 13.72+/-2.93mm Hg, We continue following the patients for one month and checked IOP, The mean IOP was 14.06+/-3.21 mm Hg

Conclusion: IOP tends to increase after intravitreal injection of Ranibizumab 0.05ml [0.5 mg]. It causes mainly a transient immediate increase in intraocular pressure especially in patients who exposed to repeated intravitreal injection. This elevation of IOP tends to normalize after one day

Recommendations: this study recommend monitoring of IOP after intravitreal injection of ranibizumab and Care should be taken for cases with multiple injections and predisposing risk factors like glaucoma and glaucomatous patients

Incidence of malignancy in Egyptian patients with cold thyroid nodule[s]: retrospective study

Background: this study was to evaluate the incidence of malignancy in Egyptian patients with cold thyroid nodule[s] after total thyroidectomy and histopathlogical analysis and the final result in our study was the incidence of malignancy in Egyptian patients with cold thyroid nodule[s] was [20%]

Aim: the aim of the work was to evaluate the incidence of malignancy in Egyptian patients with cold thyroid nodule either solitary thyroid nodule or dominant cold nodule in multi-nodular goiter through retrospective study

Materials and Methods: the study was carried out on 30 Egyptian patients suffering from cold nodule[s] in the thyroid gland. Patients were managed at Al- Azhar University hospital; Cairo; Egypt. The study was controlled retrospectively. Ethical approval from the local Ethics Committee of Surgery Department was obtained

Results: according to the descriptive statistics of our study, the total number of cases was thirty patients, twenty-six of them were females and four were males, also the mean age of studied group was [37.87]. The final results of post-operative histopathological examination were twenty-four cases diagnosed as benign and six malignant cases

Conclusion: in this retrospective study the final results of histopathological examination were 24 benign cases [80%] and 6 cases were malignant [20%]. So in our study the incidence of malignancy in Egyptian patients with cold thyroid nodule[s] was [20%]

Comparative study between Alvarado score and appendicitis inflammatory response score in diagnosis of acute appendicitis

Background: The appendix is a worm like extension of caecum and for this reason has been called "vermiform appendix". Appendicitis may occur due to several reasons, such as an infection of the appendix, but the most important is the obstruction of appendiceal lumen. Acute appendicitis has remained the most common acute surgical condition of the abdomen in all ages and of course, a common disease in surgical practice. The usual picture of appendicitis is often not classical, leaving in many cases a diagnostic problem. In patients with questionable findings, the aggressive surgical approach has been "when in doubt, take it out, "and the price paid is the frequent removal of normal appendix

Aim of the Work: The aim of the work is to evaluate the appendicitis inflammatory response [AIR] score and compare its performance in predicting the risk of appendicitis to the Alvarado score

Patients and Methods: In this randomized prospective study, 100 patients with acute pain in right lower quadrant of abdomen were admitted to the surgical department of Al-Hussain University Hospital in the period from June 2017 to October 2017. All the patients had indications for appendectomy. The present study was carried out among patients suffering from acute pain in right lower quadrant of abdomen

Results: This randomized prospective study comprised 100 patients, of whom 52 were females [52%] and 48 were males [48%]. Their ages ranged from 16 to 42 years old with a mean age of 21 years. These 100 patients were presented with acute pain in right lower quadrant of abdomen. All female cases proved to be pregnant were excluded from the study. Recurrent sub-acute appendicitis were also excluded from the study. Patients with known abdominal malignancies or previous abdominal surgery were also excluded from the study

Conclusion: This prospective study comprised 100 patients with acute right iliac fossa pain for evaluation and comparing between Alvarado score and AIR score in diagnosis of acute appendicitis. The present study showed that the AIR score has a good statistical discrimination for patients with acute appendicitis and outperforms the Alvarado score

Coblation tonsillectomy versus dissection tonsillectomy: a randomized prospective clinical study

Introduction: tonsillectomy has been practiced since antiquity. It continues to be one of the most commonly performed surgical procedure. Tonsillectomy produces an open wound that heals by secondary intention. The major postoperative morbidity problems are haemorrhage and pain. Coblation tonsillectomy being a relatively recent introduced technique depends on applying radiofrequency current with lower frequency than bipolar diathermy, allowing for significantly less painful and more rapid healing of tonsillar fossae

Aim of work: is to compare between the traditional dissection tonsillectomy and coblation tonsillectomy. This implies all aspects of surgery including operative time, postoperative course and incidence of complications

Patients and methods: during the period from January to August 2014 a sixty patients [29 males and 3 1 females] were scheduled for tonsillectomy. Their ages ranged from 5 to 16 years with the mean age 8.2 +/- 3.5 years. Patients enrolled in this study were divided into two groups. Group A: [30] underwent surgery using the conventional dissection ligation method, while Group B: [30] underwent Coblation tonsillectomy

Results: the mean score for the operative time was 33.8 minutes in [group A] as compared to 41.5 minutes in [group B] while the mean score for intra-operative blood loss was 104.5 ml in [group A] and 36.4 ml in [group B].Postoperative mean visual analogue scale [VAS] scores of pain for Group A were 7, 7.3, 6.73, 5.8, 5.3,4.87 and 4.5 in the first seven postoperative days respectively, while Mean scores for Group B were 7, 5.97, 5, 4.06, 3.87, 3.13 and 3 in the first seven postoperative days respectively. Regarding as return of normal swallowing [score 4] was achieved on the sixth day [mean 6.16 day] in Group A, and on the fourth day in Group B [mean 3.97 day]. On the seventh postoperative day, the percentage of normal pink mucosal lining was found to be 50% of the tonsillar bed in Group A, as compared to 75% in the coblation group [Group B]. Reactionary haemorrhage occurred in one case in the coblation group in comparison to two cases in the conventional group

Conclusion: coblation tonsillectomy proved to be safe and effective; however, reducing cost and addressing its postoperative complication rate are mandatory before considering it as the modality of choice for this commonly performed procedure

Irbesartan in mild to moderate hypertensive patients a phase IV clinical trial

This study examines the efficacy of Irbesartan as a potent angiotensin receptor antagonist in achieving the recommended target SBP and DBP in diabetic [<130/80] and non-diabetic patients [<140/90], and the role of adding HCTZ in achieving control of BP in patients not responding adequately to Irbesartan mono-therapy. Moreover, the study emphasizes on the rate of BP control, and analyzes the rate of reduction in different treatment subgroups [Irbesartan 150 mg alone, Irbesartan 300 mg alone, and Irbesartan 300 mg plus HCTZ 12.5 mg]. The study also evaluates the safety profile in each treatment subgroup and the extent of its tolerability as compared to efficacy outcomes. Methods: This multicenter, prospective, open, non-randomized, non-comparative phase IV setting spanned a 3-months [12 weeks] treatment period for each patient, and was preceded by a 7 days prestudy screening period. 1630 subjects were actually enrolled. Each patient was assigned to 5 scheduled visits. The first 3 visits were for dose titration; one visit for follow up and dose maintenance, and a 5th visit for final assessment. The study was considered completed for a patient at the time he/she completed all scheduled study procedures [5 visits]. Patients started on Irbesartan 150 mg, taken orally, once daily with 24 hour interval for 3 weeks; if target BP is not achieved, patient was switched to Irbesartan 300 mg for further 3 weeks; and if target BP was still not achieved, patient was switched to Irbesartan 300 mg plus HCTZ 12.5 mg, for the rest of the study duration. The starting dose and the dose titration schedule were modified according to the Investigator's judgment and patients' BP response. . Results: By the end of the 3 month trial duration [week 12], 91.18% [1324 patients, n= 1452] of the overall ITT population who completed the study reached the target BP irrespective of their treatment subgroup with better BP control for non-diabetic patients, 96.04% [1116 patients, n= 1162] compared to 71.71% [208 patients, n= 290] for diabetics, p<0.001. The percentage of ITT population treated by Irbesartan 150 mg and reached the target blood pressure was 82.7% [81 patients, n= 98] for diabetic patients and 99.0% [500 patients, n=505] among non-diabetics patients, p<0.001. For patients failed to be controlled with Irbesartan 150 mg and treated with Irbesartan 300 mg, the percentage of those reaching the target BP among diabetics was 76.0% [76 patients, n=100] and 96.6% [314 patients, n=325] among non- diabetics, p<0.001. Proportion of enrolled patients reaching a blood pressure target were 55.4% [51 patients, n=92] among diabetics and 90.96% [302 patients, n=332] among non-diabetics for patients treated with Irbesartan 300 mg plus HCTZ 12.5 mg, p<0.001. Irbesartan showed a significant reduction in both mean systolic blood pressure [33.16 mmHg [21.11%], 33.09 mmHg [20.53%], and 29.63 mmg [18.09%] for any Irbesartan 150 mg, 300 mg, and 300 + HCTZ, respectively, p<0.001] and mean diastolic blood pressure [18.61 mmHg [18.98%], 18.42 mmHg [18.61%], and 16.07 mmHg [16.17%] for Irbesartan 150 mg., 300 mg, and 300 + HCTZ, respectively, p<0.001]. That was evident from the third week of treatment throughout the study period till week 12. The percentages of patients that reached the target blood pressure [controlled] were significantly higher in non-diabetics [99% [500], 96.6% [314], and 90.96% [302], for Irbesartan 150 mg, 300 mg, and 300 mg +HCTZ, respectively, p<0.001]compared to diabetics [82.7% [81], 76% [76], and 55.4% [51] for Irbesartan 150 mg, 300 mg, and 300 mg + HCTZ, respectively, p<0.001] for each of the Irbesartan strengths

Dementia: clinical-neurobiochemical correlations

This study aimed at correlating the cognitive impairments and their neuropathological basis in AD and VaD with the neurobiochemical changes in brain tissues using proton magnetic resonance spectroscopy [[1]H-MRS]. Twenty patients diagnosed as having dementia [10 with AD, and 10 with VaD] were included in this study and compared with 10 normal control subjects. Dementia patients were selected using DSM IVR, HIS, ADDTC and NINCDS. Patients were submitted to the following battery of investigations: Thorough clinical examination, routine Laboratory investigations, and various neuropsychological scales [MMSE, CAMCOG, Blessed DR scale, and Hamilton depression scale]. Brain MRI and MRS were done for all patients and control subjects. Cognitive impairment was significantly more prominent in AD patients compared to VaD patients. The most consistent neurochemical differences between demented patients and normal control subjects were significant reductions of the NAA/Cr and NAA/MI ratios at PCG and NAA/Cr ratio at Lt STG, and elevation of MI/Cr ratio at PCG, while the most consistent differences between AD and VaD patients were significant reductions of the NAA/Cr and NAA/MI ratios at PCG, Lt STG and elevated MI/Cr ratio at PCG in patients with A.D. Significant correlation was observed between the reduced NAA/Cr, NAA/MI and elevated MI/Cr ratio at PCG and changes in various neuropsychological variables studied in AD patients. Clinical neuropsychological testing is a fairly good tool for differentiation of the types of dementia [AD versus VaD]. However the neurochemical changes in brain tissues measured using [[1]H-MRS] are useful not only in distinguishing between dementia of the Alzheimer's type and vascular dementia but also explaining their neuropathological background

Central nervous system involvement in chronic inflammatory demyelinating polyradiculoneuropathy: a clinical, neurophysiological and radiological study

The frequency of the association between CIDP and CNS lesions is probably underestimated. To assess the frequency of CNS involvement in CIDP patients, and to study the characteristics of this possible association. Forty patients [20 males, and 20 females] aged between 19 and 50 years [mean 33.12 +/- 9.3 years] fulfilling the clinical, neurophysiological and CSF criteria of INCAT for the diagnosis of CIDP were submitted to complete general and neurological assessment, laboratory investigations, CSF analysis, neurophysiological evaluation [NC studies, evoked potentials [VEPs, BAEPs, SSEPs]], and MRI brain and spinal cord. Clinical evidences of CNS involvement were recorded in 12 patients [30%] of CIDP patients, abnormally delayed VEPs latencies were recorded in 16 patients [40%], abnormal BAEP latencies in 12 patients [30%], abnormal SSEP latencies in 22 patients [55%], and abnormal latencies in more than one modality in 13 patients [32.5%], MRIs brain and spinal cord were abnormal in 10 patients [25%]. CIDP patients with clinical and/or radiological evidences of CNS involvement had a significantly younger age of disease onset, more frequent relapsing-remitting pattern of the disease course, more prolonged disease duration, and less favorable response to therapy than those without evidences of CNS involvement. CIDP patients with delayed evoked potentials' latencies and/or MRI demyelinating lesions were more frequent in CIDP patients with clinical evidences of CNS involvement. Moreover, MRI lesions were more frequent in those having abnormal visual evoked potential responses. Finally, there was a percentage of CIPD patients who showed a subclinical central neurophysiological and/or radiological abnormalities. CIDP is frequently associated with various clinical, neurophysiological and radiological evidences of CNS involvement. MRI and evoked potentials are useful non-invasive techniques for demonstrating this association

Cytogenetic study in juvenile myoclonic epileptic patients

The association of chromosomal imbalance and neurological abnormalities is well known. These chromosomal abnormalities may indicate that chromosomal sites where atypical neurological characteristics could be mapped. The purpose of our study was to search for cytogenetic abnormalities in patients with juvenile myoclonic epilepsy. This work was carried out on fifteen patients presenting to Epilepsy Centerof Neurology Department of Alexandria Main University Hospital. The age of juvenile myoclonic patients ranged from 16 to 38 years. Ten patients have myoclonic and generalized Tonic-Clonic seizures, 3 patients have myoclonic, absences, and generalized tonic-clonic seizures, and 2 patients have myoclonic seizures only. All patients were cytogenetically normal as all of them had normal karyotypes

Improved procoagulant activity and dyslipidemia in obese patients post bariatric surgery

Obesity is an increasing health problem worldwide. Obesity has characteristics of a prothrombotic state along with other endocrine and metabolic disturbances. We focused on the pathophysiological substrate of hypercoagulability and the potential consequences of weight loss post bariatric surgery on biochemical markers of procoagulant activity and dyslipidemia. A total 24 morbidly obese patients [18 women, 6 men] of mean age 32.96 +/- 5.9 and mean BMI 44.25 +/- 2.8 kg/m2 underwent restrictive gastric surgery [vertical banded gastroplasty,VBG]. Body mass index, blood pressure, lipid profile, plasma fibrinogen and plasminogen activator inhibitor-1 were monitored at baseline, 6 and 12 months post surgery. A significant weight loss was observed in all patients during the one year follow-up period. Mean body mass index was 44.25 +/- 2.8 kg/m2 before surgery, and significantly decreased to 37.79 +/- 2.60 kg/m2 at 6 month [p<0.001] and to 35.62 +/- 2.69 kg/m2 at 12 [P<0.001] months post bariatric surgery. After the dramatic weight reduction, a significant reduction in TC [p<0.01], LDL-C [p<0.01] and TG [p<0.001], plasma fibrinogen [p<0.001] and PAI - l [p<0.001] levels were observed throughout 12-month follow-up, with a significant rise in HDL-C[p<0.001]. Bariatric surgery could optimize cardiovascular risk profile and exert beneficial effects on thrombosis and the hemostasis axis in obesity. Weight loss resulted in improved metabolic parameters, suggesting a lowered atherogenic risk

Utility of plasma n-terminal pro brain natriuretic peptide in the assessment of left ventricular systolic dysfunction

The diagnosis of heart failure [HF] is difficult, with both overdiagnosis and underdiagnosis occurring commonly in practice. Echocardiography is a standard technique in the evaluation of left ventricular function. Natriuretic peptides have been proposed as useful markers of left ventricular dysfunction. The aim of the study was to evaluate the utility of plasma amino-terminal pro-brain natriuretic peptide [NT-proBNP] for the detection of left ventricular systolic dysfunction. We measured NT-proBNP in 70 patients referred for cardiac and echocardiographic evaluation due to known symptomatic HF in 20 and high risk for HF in 50 patients. Left ventricular ejection fraction [LVEF] was determined by echocardiography and patients were categorized into 2 groups, patients with LVEF >45% and patients with LVEF<45%. There were 39 patients with LVEF >45% [31 men and 8 women with a mean age of 53 +/- 5.1 years] and 31 patients with LVEF <45% [29 men and 2 women with a mean age of 59 +/- 6.1]. There were no differences between groups regarding age or body mass index. The mean NT-proBNP concentration in patients with LVEF <45% was significantly higher than that in patients with LVEF >45% [1025 +/- 697.5 pg/ml vs. 55 +/- 30.3 pg/ml, p<0.0001]. All patients with LVEF <45% had NT-proBNP value >100 pg/ml and 36 of 39 patients with LVEF >45% had NT-proBNP value <100 pg/ml. Using this cut-off value the NT proBNP was 100% sensitive and 92% specific with negative predictive value of 92% and positive predictive value of 94% for detection of patients with LVEF <45%. Our results suggest that measurement of NT-proBNP with a commercially available diagnostic kit can be reliable for detection of left ventricular systolic dysfunction as indicated by LVEF <45%

Lean PCOS: is it inflammatory or insulin resistant state?

The syndrome of polycystic ovary [PCOS] is one of the most frequent disorder in women [obese and lean]. PCOS is a complex and heterogenous disorder and there is still a debate for its endocrine, metabolic and inflammatory pathogenesis our aim to evaluate the insulin resistance and the inflammatory marker in lean PCOS women. A total of 28 lean women fulfilling the diagnostic criteria of PCOS compared with a 20 age and BMI matched healthy control women were enrolled in the study. C reactive protein, insulin resistance index [HOMA-IR], Adiponectin and endocrin parameters [LH, FSH, Testosterone, SHBG, 17 OH progesterone, TSH and prolactin] were measured. HOMA-IR was significantly higher in lean PCOS as compared with control group [p < 0.05], however CRP and serum adiponectin were not statistically different between the two groups. Lean PCOS is associated with insulin resistance which is independent of adiposity. Adiponectin does not seem to be actively involved in the pathogenesis of PCOS and lean PCOS is not associated with low grade inflammation

Elevated serum resistin levels in women with prior gestational diabetes

Resistin was not studied before as a potential biochemical mediator of insulin resistance in patients with prior GDM. Gestational diabetes mellitus [GDM] is a risk factor for both type 2 diabetes [DM2] and insulin resistance syndrome. Early reports suggested that resistin is associated with insulin resistance and type 2 DM. However subsequent studies have not supporting these findings. The aim of this study is to evaluate the role of resistin as a biomarker of insulin resistance in women with prior GDM. This study was conducted on 20 women with a history of GDM and 16 women with a history of normal pregnancy [control group]. The two groups were matched regarding the age, BMI, postpartum duration and the parity numbers. For all subjects, Serum resistin and HOMA IR were measured. As compared with control group, HOMA IR and serum resistin were significantly higher in women with history of previous GDM [3.97 +/- 0.71 Vs 3.51 +/- 0.5, P = 0.034], [4.9 +/- 0.89 Vs 3.5 +/- 1.06, P = 0.011] respectively. Furthermore serum resistin levels was significantly positively correlated with both BMI and HOMA IR in women with prior GDM [r 0.500, P = 0.025; r 0.527, P = 0.017] respectively. To the best of our knowledge, this is the first study addressing resistin in women with prior GDM which might explain the underlying pathogenetic mechanisms for future development of type 2 DM

Acute elastic recoil of coronary stents immediately after their implantation

The objective of this study was to evaluate the acute elastic recoil of coronary stents immediately [10 minutes] after balloon deflation, because of the close relation of this elastic recoil and the late restenosis of coronary stents. Forty patients with isolated coronary lesion were studied immediately after stenting following successful coronary angioplasty. Coronary angiography before stenting showed mean reference diameter of 2.23 +/- 0.58 mm and mean minimal lesion diameter of 0.65 +/- 0.35 mm with mean percentage stenosis of 70.7 +/- 9%. On the other hand, mean diameter of stent during balloon inflation was 2.37 +/- 0.8 mm, while mean duration of inflation through the stent was 15.3 +/- 4 seconds and mean pressure used for stent deployment was 13.6 +/- 4 bars. The immediate post stent angiography showed satisfactory results in all patients with mean stent diameter, 10 minutes after deployment of 2.02 +/- 0.30 mm and mean percentage elastic [ER] of 11.6 +/- 2.36%. All angiographic measures were done with the help of computer-based cardiovascular angiography analysis system [Artrex Image Comm]. The mean ER was much less than that previously reported after pTCA in previous studies and also better than that reported for post stenting in stress trial [11.6% vs 17%]. On the other hand, different types of stents were used [XT stents 17, NIR stents 12 and Palmaz Schatz stents 11] and they did not show any difference in absolute ER among the three subgroups according to the selected stent [XT = 0.51 +/- 0.49 mm, NIR = 0.45 +/- 0.41 mm and PS = 0.56 +/- 0.53 mm]. Furthermore, in this study, pressure up to 18 bars was used for stent deployment [13.6 +/- 4 bars] and this technique optimized stent opposition to the vessel wall increased final stent diameter and reduced elastic recoil and hence late restenosis

Pulmonary microangiopathy and its association with retinopathy and nephropathy in type 2 diabetes mellitus: role of ACE and ET-1

Aim: The microvascular complications in type 2 diabetes mellitus are associated with high morbidity mortality. Their pathogenesis is not fully understood in spite of recent advances. Although some authors have reported normal pulmonary function in diabetics, others found abnormalities including impaired diffusing capacity. The aim of this study was to assess the presence of pulmonary microangiopathy [as determined by lung diffusing capacity for carbon monoxide, DLco] in type 2 diabetic patients and to analyze the correlation between DLco and various diabetic factors. We also aimed to association between DLco and serum levels of ACE and ET-1 [markers of endothelial damage in various diabetic microangiopathies]. Subjects and Thirty-eight type 2 diabetic patients without over lung disease and 20 age and sex-matched :ontrols were enrolled in the study. All patients ontrols were non-smokers. Glycosylated haemoglobin [HbA-1c] was measured as an indicator of control. The presence of diabetic retinopathy was detected by ophthalmoscopic examination and the presence of diabetic nephropathy was determined by measuring the 24-hour urinary albumin excretion [UAE]. A global spirometry was performed and DLco was measured by the single-breath method corrected by alveolar volume [DLcoA/VA]. Forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1] and FEV1/FVC were within normal in diabetics. Diabetic patients showed a significant reduction of% DLcoA/VA that was greater in those not receiving insulin and those with diabetic microangiopathy. The serum levels of ACE and ET-1 were significantly higher in diabetics [ACE and ET-1 level were more elevated in those with diabetic microangiopathy]. Percent DLcoA/VA was negatively correlated with serum ACE, ET-1 and UAE values. Conclusions: These data suggest the existence of microangiopathic involvement of pulmonary vessels in type 2 diabetic patients particularly in presence of retinopathy and/or nephropathy. Elevated serum levels of ACE and ET-1 as well as microalbuminuria are significant independent predictors of the existence of pulmonary microangiopathy. Insulin resistance may be central to the pathogenesis of pulmonary microangiopathy. Exogenous insulin administration, e.g. via the inhaled route, may be used in diabetics to improve their DLco

Left ventricular structural alterations in treated hypertensives with or without nocturnal fall in blood pressure

The lack of the normal nocturnal fall in blood pressure in hypertensive patients has been suggested to augment target organ damage. The aim of our study was to assess the effects of dipper and non-dipper BP profiles, in treated hypertensives on left ventricular structural alterations. This study included 85 patients with treated hypertension. They were divided into 2 groups, group I included 26 patients with controlled clinic BP and group II, included 59 patients with ucontrolled and resistant BP. All patients underwent 24-hour ambulatory blood pressure [BP] monitoring and echocardiographic examination. Using ambulatory BP measurements patients were classified into dipper and non-dippers in each group. Using echocardiographic measurements of left ventricular [LV] dimensions, LV mass was calculated and indexed for body surface area to obtain the left ventricular mass index [LVMI]. LV hypertrophy [LVH] was diagnosed when LVMI was >110g/m2 in women and >134g/m2 in men. LV relative wall thickness [LVRWT] was calculated with values <0.45 were considered normal for both sexes. LV geometric pattern was estimated according to the relation between LVMI and relative wall thickness. The prevalence of non-dippers was significantly higher in group II [53%] than in group I [31%]. There were no differences in the demographic and metabolic characteristics as well as mean 24-h BP values in dippers and non-dippers in both groups. There was higher prevalence of LVH in group II [37%] compared to group I [19%]. However, the prevalence of LVH was similar in dippers and non-dippers in group I [16% and 25%, respectively] and group II [61% and 65%, respectively]. LVM, LVMI, LVRWT and LV fractional shortening were similar in dippers and non-dippers in both groups. Most patients in group I had normal LV geometry with only 2 patients of each of the dippers and non-dippers showing eccentric LVH. Group II patients had higher incidence of concentric LVH both in dippers and non-dippers [39% and 42 and respectively]. Our results indicate that the non-dipping BP profile, diagnosed on the basis of a single ABPM, in treated hypertensives with or without BP control is not associated with an increase prevalence of LVH or LV geometric alterations