In vitro and in vivo evaluation of the antiangiogenic activities of Trigonella foenum-graecum extracts

Objective: To assess the antiangiogenic activity of fenugreek. Methods: Different fractions of fenugreek crude extracts were prepared and their anti-angiogenic properties were assessed using the ex vivo rat aortic ring assay and in vivo chicken embryo chorioallantoic membrane (CAM) assay. They were investigated for their direct cytotoxic activity in the MCF7 cells using the MTT assay. Results: The ethanol extract showed 100％ inhibition of blood vessel outgrowth from primary tissue explants in the rat aortic ring assay at a concentration of 100μg/mL while the other extracts did not show significant antiangiogenic activity. The ethanol extract was therefore investigated at varying concentrations and exhibited a significant dose dependent effect. The CAM assay coincided with the results of the aortic ring assay as ethanol extract showed a significant inhibition of formation of new blood vessels. The extracts only showed anti-proliferative activity at the highest concentration of 400μg/mL towards MCF7 breast cancer cell lines in the MTT assay. Conclusions: Findings of the both assays confirmed that the ethanol extract inhibited vascularization significantly. Further studies on the ethanol extract would be beneficial in isolating the active ingredient responsible for the inhibition.

Patterns of thrombospondin genes polymorphisms in acute myocardial infarction patients in Ismailia City

Thrombospondin [TSP] 2 and 4 are multidomain calcium-binding extracellular glycoproteins which play a role in platelet aggregation and inflammatory response. TSP-2 has chemotactic and mitogenic activities for vascular smooth muscle cells while TSP-4 mRNA is expressed by endothelial and smooth muscle cells in vascular wall, and brain endothelial cells produce the protein both in vivo and in cell culture, localization consistent with its pro-atherogenic effects. These common functions may be central to the roles of the thrombospondins in coronary artery disease and myocardial infarction [MI]. In the present study, the association of the TSP-2[3949 T-+G, rs8089] and TSP-4 [Ala387Pro 1186 G-+C, rs866389] gene variations and MI among Egyptian patients living in Ismailia city has been examined. Both rs8089 and rs 1866389 were studied in 50 acute MI patients and 50 controls using Real-Time polymerase chain reaction. The prevalence of TSP-2 and TSP-4 alleles was not different in MI patients compared to controls [P> 0.05]. Although the minor allele homozygotes [GG] of TSP-2 seems to confer reduced risk of MI [OR: 0.42 95% CI=0.095-1.89] this was not statistically significant [P> 0.05]. The distribution of different TSP-4 genotypes did not differ between MI patients and controls [P>0.05]. Total cholesterol was statistically significantly higher [P=Q.Q2] in carriers of minor allele [C] of TSP4 [GC+CC]. Although, both polymorphisms showed no statistically significant difference in MI patients regarding all other measured conventional risk factors. However, the frequency of TTGC haplotype is statistically significantly higher in MI patients [24%] than in controls [6%] [P value=0.0226]. Our data suggests that although association analysis with MI did not reach significance, an at-risk haplotype of common variants located in THBS2 and THBS4 may be part of the genetic determinants for MI in the Egyptian population living in Ismailia city

Preliminary study on single nucleotide polymorphism [rs12255372] in transcription factor 7 like 2 [TCF7L2] gene in type 2 diabetes patients resident in Ismailia city

To detect the allele frequency of SNP [rs 12255372] in Ismailia city. This study included 91 T2D patients [26 males and 65 females] and 47 control subjects [22 males and 25 females]. They were subjected to history taking [personal history, duration of the disease and family history], anthropometric measurements, laboratory investigations including: FBG, 2hPPBG and lipid profile and genotyping of the SNP rs [12255372] using RT-PCR. The study revealed that the frequency of the high risk allele [T] was 53.3% in the patients group and 47.7% in the control group with odds ratio 1.14 and the FBG level and 2h PPBG level was significantly higher in patients homozygous for the high risk allele [TT] than patients who were heterozygous for the high risk allele [GT]. The minor allele frequency [T] was higher in patients group than in control group but it was higher than the frequency detected in previous studies done worldwide. This high frequency of the [T] allele, if it is replicated in other areas in Egypt, we can say that this high frequency of the high risk allele [T] may be one of the factors that Egypt is one of the top ten countries regarding the prevalence of the T2D

Effect of green tea extract on cyclosporine-induced nephrotoxicity in rats

Cyclosporine A [CsA] is a potent and effective immunosuppressive agent but its action is frequently accompanied by severe renal toxicity. The present study was designed to investigate the possible protective effect of green tea extract [GTE] on CsA-induced nephrotoxicity in rats. Animals were assigned into three groups as follows: I: CsA group, given CsA [50 mg/Kg body weight per day, subcutaneously] for 10 days: II: CsA + GTE group, supplemented with 100 mg/Kg body weight GTE as a daily oral dose three days before and concurrently with CsA treatment and III: control group, received the vehicle [olive oil, in the appropriate volume, subcutaneously]. Administration of GTE significantly ameliorated the renal tubular injury caused by CsA as evidenced by decreased urinary enzymes leakage [N-acetvyl-beta-D-glucosaminidase [NAG]. lactate dehydrogenase [LDH] and y-glutamy1 transferase [y-GT] as well as urinary glucose excretion. The deranged renal function was manifested by a significant increase in serum urea and craetinine levels, however, serum sodium and potassium levels were not significantly affected. GET succeeded in improvement of renal dysfunction by normalizing serum urea and creatinie levels. The renal oxidative stress was significantly reduced by GTE administration as evidenced by decreased malondialdehyde [MDA] level as well as enhancement of the antioxidant enzymes glutathione reductase [GR] and gIutathione- S-transferase [GST], however, to significant change in the increased renal gIutathione [GSH] content was observed. The protective effect of GTE was also evidenced by lowering the increased serum and renal nitrte/ nitrate [NOx] levels together with decreasing the elevated renal cytosolic calcium. These findings clearly indicate the protective potential of GTE against CsA-induced nephrotoxicity and suggest a significant contribution of its antioxidant activity to this beneficial effect

Biochemical effects of chronic abuse of ergogenic aids in rats

To investigate the potential health risks associated with recommended or overdoses of amino acids mixture such as Power Mix [PM], Branched Chain Amino Acids [BCAAs] or Ceratine [Cr] supplementation as ergogenic aids for short or long-term rats. Male Sprague Dawley rats were assigned into two major groups; the first group was orally treated with the above mentioned supplements for six weeks [short-term], and the second group was treated similarly but for twelve weeks [long-term]. Each of the short- and long-term group was subdivided into seven subgroups which were treated as follows: PM [0.8 g/kg/day], PM [2.4 g/kg/day], BCAAs [0.2 g/kg/day]. BCAAs 0.6 g/kg/day], Cr [2 g/kg/day], Cr [6 g/kg/day] and controls [kept without treatment]. Plasma amino acids levels beside renal, thyroid, adrenal, and hepatic functions were estimated. Significant elevation in total amino acids concentration was found as result of feeding with the three dietary supplements. Results showed significant increase in serum creatinine level in rats ingested with these ergogenic aids except the low dose of PM given for short- or long-term. High doses of the three supplements given for both short- and long-term and low doses of BCAAs and Cr given for long-term caused significant elevation in serum uric acid level. Significant increase in serum NAG activity was observed among the three dietary supplements. Also, significant rise in serum AST and ALT activities was obtained after feeding the three dietary supplements except the low dose of PM given for short-term. Serum T3 level was significantly increased by feeding BCAAs or Cr in high doses for long-term. None of the three supplements exerted significant change in serum TSH and T4 levels. High doses of PM, BCAAs or Cr given for either short- or long-term caused significant increase in serum corticosterone and significant decrease in plasma ACTH levels. The three dietary supplements resulted in significant increase in cytosolic AST and ALT activities except the low dose of PM given for short- and long-term as well as low dose of BCAAs and Cr given for short-term. The three dietary supplement except low dose of PM fed for short-term, caused significant rise in mitochondrial AST activity. This study showed that supplementation of high-dose of PM, BCAAs or Cr given for long-term as ergogenic aids induced renal and hepatic damage as well hormonal disturbances

Synthesis and in-vitro cytotoxic activity of novel benzo[b]phenazine-6,ll-Dione and 1,4-Naphthoquinone derivatives

5, 12 - Dihydrobenzophenazine-6, 11-diones, 2-Arylamino-3-chloro-l, 4-naphthoquinones and 6, ll-dihydrobenzo[b]phenazine-6, 11-diones, were synthesized from 2, 3-dichloro-l, 4-naphthoquinone and arylamines/ phenylenediamines. Studying the cytotoxicity using EAC and human cell lines revealed that 5, 12-dihydrobemo[b]phenazine-6, ll-dione [3] and 3-chloro-2-[2- pyridylamino]-l, 4-naphthoquinone [10] showed selective cytotoxicity against the human lung carcinoma cell line [H460] superior to doxorubicin. Compound 3 [16.25 uM] was 1.3 times higher than that of doxoruhicin. However, 1C50 value of compound 10 was 9.90 uM which was 2 times higher than that [20.10 uM] of doxorubicin. These compounds were inactive against liver carcinoma [HEPG2], brain tumor [U251], cervix carcinoma [HELA] and breast carcinoma [MCF7] cell lines

Effect alpha globlin gene deletion and gamma globin gene -158 [C/T] polymorphism in beta-thalassemic patients

The beta-thalassemias [beta- thalassemias] are among the most common autosomal recessive disorders. They have a remarkably high frequency in the Mediterranean region and represent one of the most common genetic diseases in Egypt. In this study, the spectrum of beta-thalassemia mutations and genotype-to-phenotype correlations were defined in 32 beta- thalassemic patients [beta- thlassemias major and intermedia] with varying disease severity in two cities of the Suez Canal region. Ten different mutations were identified and the most frequent ones were: IVSI-6 [T-C] [37.5%], IVSI-110 [G-A] [34.4%] and both IVSI-1 [G-A], IVSII-745 [C-G] and -102 [C-G] [12.5% each]. There was a wide spectrum of phenotypic severity in all patients. We studied the Xmnl polymorphism [C/T] in gamma- globin gene position -158 of beta- thalassemia as a modulating factor of the disease severity. Presence of the polymorphism was found in two patients and this was not sufficient to explain the diversity of the phenotype encountered. Co-inheritance of alpha thalassaemia as a modulating factor was not evident in our patients. In conclusion, we have been unable to find a molecular basis for the benign clinical course in all our patients. Other genetic or acquired factors must be hypothesized which ameliorate the clinical condition

C-Reactive protein, Tumor Ncrosis Factor-alpha, interleukin-6 and cortisol in type 2 diabetes mellitus

Recently an abundance of evidence has emerged demonstrating a close link between immunity, inflammation, obesity, insulin resistance and type 2 diabetes mellitus. Activation of innate immunity with production of inflammatory markers was suggested to provide a new model for the pathogenesis of type 2 diabetes and the metabolic syndrome. This may result in new approaches for predicting and managing of type 2 diabetes and its complications. We evaluated the state of obesity and diabetes mellitus of thirty nine male type 2 diabetic patients and nineteen age-matched male healthy subjects as control. This evaluation was performed via assessment of the body mas index [BMI], fasting and postprandial [PP] blood glucose and insulin, insulin resistance and fasting C-peptide. Then we assessed the plasma levels of the most important inflammatory markers; C-reactive protein [C-RP], tumor necrosis factor alpha [TNF-alpha], interleukin-6 [IL-6] and the total leucocytic count as well as the stress hormone cortisol. Our results showed BMI above 30 for both patients and controls which indicated obesity of the two groups. Both fasting and PP glucose were 167.9 +/- 10.3 and 289.8 +/- 16 mg/dl respectively for patients and 96.4 +/- 1.96 and 108.47 +/- 4.6 rng/dl respectively for the control whish confirmed the diagnosis of diabetes mellitus. The C-RP was significantly higher in diabetics. Although the difference did not reach statistical significance fasting and PP-insulin, insulin resistance levels were higher in the diabetic patients compared to the control. Regarding the results of the acute phase reactants and the biornarkers for inflammation, we found a significant increase in C-RP, TNF-alpha, IL-6 and cortisol in the diabetic patients compared to the control. But no change could be detected in the total leucocytic count. This association between hyperglycemia and increased inflammatory markers may indicate a relationship between them. But the question which of them preceded and led to the other is still uncertain. Further studies with different approaches may be needed to solve this puzzle

Study of the structure of the polypentenamere

Polypentenamer is obtained by ring opening metathesis polymerization [ROMP] of cyclopentene. This linear product does not present cross-links or detectable secondary ramifications. However, its structural units are geometric isomers with different cis and trans configurations. The objective of this study is to compare the effect of temperature on the fractions of the cis and trans structural units in the polymer, with theoretical thermodynamic predictions, and to determine the distribution type of these different units within chains that constitute the polymer. The polypentenamer studied in this work, is obtained from bulk polymerization in the gaseous phase of pure cylopentene in presence of only tungsten hexachloride as catalyst without any other reagent. Fractions of the cis and trans structural units in polymer chains, are calculated from [13]C NMR spectra as a function of the polymerization temperature. The experimental results do not agree with thermodynamic predictions. The kinetics of the processes leading to cis or trans units probably follow more than one mechanistic scenario

Tissue doppler echocardiographic assessment of right ventricular function in patients with acute inferior myocardial Infarction

Unlike left ventricular [LV] function, right ventricular [RV] function has not been widely studied after myocardial infarction [RVMI]. Furthermore, rapid, accurate, and widely available non-invasive evaluation of RV function still presents a problem. The purpose of this study was to determine whether parameters derived from tissue Doppler imaging [TDI] of tricuspid annulus could be used to detect RV infarction and so to assess RV function in patients with first acute inferior myocardial infarction [AIMI]. Patients and. We examined 27 patients with first AIMI admitted to CCU at El Minia University Hospital between March 2005 and October 2007, 12 with [group I] and 15 without ECG signs of RVMI [group II]. Twenty adults served as controls [group III]. Patients with any cardiovascular risk factor were excluded. Tissue Doppler Echocardiographic [TDE] study included recording of peak systolic [Sm], early diastolic [Em], late diastolic [Am] and [Em/Am] ratio of tricuspid annular velocities at 2 sites corresponding to the septum and RV free wall from apical 4 chamber view. Ejection time [ET], isovolumic relaxation time [IVRT], and isovolumic contraction time [IVCI'] were also recorded, then, Tie index [MPI] was calculated for each site. Standard echo Doppler study, electrocardiogram [ECG] and cardiac enzymes were also performed. Patients with AIMI had significantly reduced peak Sm, Em, Am and Em/Am ratio and increased IVRT, IVCT, ET and Tei index at the 2 sites especially at the RV free wall [infarction site] compared with healthy controls. At septal side of the tricuspid annulus, the peak Sm, Em, and Am were significantly reduced in group I compared with both group II, p=0.032. p<0.0001, p=0.001 respectively and group Ill, p<0.0001 for all velocities, with slightly significantly reduced velocities in group II compared with controls, p=0.012, 0.016, 0.030 respectively. The Sm/Am ratio was significantly decreased in group I compared with both group II, p<0.0001 and group Ill, p<0.0001 without significant difference between the latter two groups. While, the IVRT, IVCT, and ET were significantly increased in group I compared with both group II, p=0.004, 0.043, 0.005 and group Ill, p<0.0001, 0.0001, 0,026 respectively. Apart from ET, both of IVRT and IVCT were also increased in group II compared with group lII, p=0.03, 0.009. The septal MPI was significantly increased in both group I, p=0.002 and group II, 0.003 compared with controls without difference between both groups. On the other hand, at RV free wall, these myocardial velocities and Em/Am ratio were significantly reduced only in group I compared with both group 11, [p<0.0001 for all, p=0.029 for Em/Am ratio] and group Ill, [p<0.0001 for all, p=0.016 for Em/Am ratio] without significant difference between the latter two groups. While, IVRT, IVCT, ET, and RV MPI were significantly increased also only in group I compared with both group II, p<0.0001 for all and group Ill, p<0.0001 for all, without significant difference between the latter two groups. At Sm cutoff value of <12 cm/s, we were able to detect RVMI by 85% sensitivity, 93% specificity, 92% PPV, and 87% NPV, while at RV MPI >0.7, these were 92%, 100%, 100%, and 93% respectively. Systolic and diastolic myocardial velocities at the tricuspid annulus can be easily and quickly recorded by pulsed wave TDE. The decreased velocities and increased MPI seem to be an expression of regionally reduced myocardial function especially at the RV infarction site and so reflects RV systolic and diastolic dysfunction. Therefore, TDE can be used to assess RV systolic and diastolic function in patients with AIMI

Rotational versus standard quantitative coronary angiography: a comparative study

Standard coronary angiography [SA] has some limitations and complications. Technology has been developed to perform rotational coronary angiography [RA] that may overcome SA limitations and complications while keeping the diagnostic accuracy. RA is a technique that provides with one contrast injection, a panoramic or dynamic cineangiogram of the coronary tree, during up to 180 rotation of the gantry. The purpose was to compare RA and SA regarding diagnostic accuracy and patient safety. Our study included 20 patients with a clinical indication for diagnostic coronary angiography [CA] at Cardiology Department, El Minia University Hospital. Patients were subjected to: SA [4 fixed projections for LCA and 2 for RCA] and RA [2 projections for LCA [RAO 60- LAO 60- caudal and cranial] and [1 projection for RCA [RAO 30- LAO 90- cranial]]. Acquisition of additional static angiographic projections was done for better diagnostic assessment whenever needed after SA and/or RA. QCA analyses were performed on two views [first from SA and second from RA] showing a significant lesion. Radiation dose [RD], contrast volume [CV], total number of frames [TNF], total number of image acquisitions [TNIA], additional projections [AP], reference vessel diameter [RVD], minimal lumen diameter [MLD], lesion percent stenosis [LPS] and lesion length [LL] were evaluated and compared between the two angiographic techniques. We analyzed 38 lesions. Their distributions were: 19[50%] in LAD, 9[23.68%] in RCA, 7[18.42%] in circumflex and 3 [7.89%] in the diagonals. There were no statistically significant differences between SA and RA derived QCA data in MLD[1.197 +/- 0.651 Vs 1.175 +/- 0.642], RVD[2.8l9 +/- 0.961 Vs 2.752 +/- 0.99], LPS [65.495 +/- 16.225 Vs 64.989 +/- 16.426], and in LL [12.575 +/- 6.392 Vs 12.406 +/- 6.338], p ns for all. At the same time, RA derived QCA data strongly correlated with SA derived QCA data with correlation coefficient, 0.99 1, 0.975, 0.994, and 0.996 respectively. On the other hand, RD was 44% less [245.83 +/- 132.17 Vs. 442.23 +/- 272.55 mGy], CV was 45% lower. [24.28 +/- 10.78 Vs. 43.98 +/- 20.77 ml], TNF was 45% fewer [162 +/- 65.54 vs. 293.21 +/- 142.83], TNIA was 59% lower [1.82 +/- 0.67 vs. 4.46 +/- 1.88], and AP was 82% lower beyond the pre specified protocol [0.21 +/- 0.49 vs. 1.179 +/- 1.249] in the RA compared to the SA technique, p<0.0001 for all. RA-derived QCA has similar diagnostic accuracy and strongly correlates with SA derived QCA. Furthermore, RA has better safety as it leads to a significant reduction in radiation exposure and contrast use. In the future therefore, RA may replace SA and should be compared with MSCT CA in diagnosis of CAD especially if coupled with minimally invasive approaches such as radial access and use of 4 French devices

Molecular characterization of hair cuticle and its extracted proteins in seven mammalian species

Hair is an of the epidermis in mammals and consists of two large groups of human hair proteins. One is hard -keratins and the other is matrix proteins. The present investigation aimed to compare the ultrastructural of the hair scale using the scanning electron microscope, and the proteins and amino acids content of the keratin in seven mammalian species. The values of the hair thickness, x/y feret and hair pattern of the species in the present study confirm the presence of species-specific characteristics and ultra structural variation. The situation in man differs from the wild mammals due to damage of hair cuticle caused by mechanical abuse, exposure to ultraviolet radiation and chemical over processing. The maximum amount of extracted proteins from hair keratin was analyzed by SDS-PAGE. The electrophoretic patterns showed an overall degree of similarity. However, differences exist between species in the intensity of stain. Quantitatively, the electrophoretic patterns scanned and analyzed using gel protein analyzer. The results showed no difference between the molecular mass of some species, but different in molecular mass distribution. Amino acid composition of keratin of mammalian hair species of the present study showed some variation, especially for methionine, isoleucine, lysine and arginine. The other amino acids studied are significantly present in most hair. One of the later amino acid is cysteine. Cysteine is a very important due to the presence of disulfate cross-links

Ventilatory functions response to incentive spirometer versus diaphragmatic breathing in elderly females

The aim of this study was to investigate the effect of different methods of breathing exercises on ventilatory function in elderly. Thirty female volunteer subjects were selected from Palestine Hospital with age ranged between 75-85 years [mean age 79.06 +/- 2.7]. They underwent a pre- and post-ventilatory function test to mark out the values of FVC, FEV1 and MVV. They were classified into two groups: Group I [15 subjects performed incentive spirometer] and group II [15 subjects performed diaphragmatic breathing exercise]. Every subject trained for 30 minutes 3 times/week for 3 months. The results showed that group II was better in improving FVC as the mean was 1.37 +/- 0.3 and became 2.43 +/- 0.43 and for FEV1 the mean was 1.21 +/- 0.28 and became 2.21 +/- 0.36, but group I was better in improving MVV that was 41.71 +/- 06.64 and became 60.19 +/- 11.46

Spectrophotometric determination of pantoprazole sodium in presence of its degradation products

Four spectrophotometric procedures [A-D] for the determination of pantoprazole sodium were investigated. Procedures A and B are stability-indicating methods to determine the intact drug in presence of its degradation products; sulfenamide and sulfenic acid prepared by degrading the pure drug in borate buffer [pH 8] at 37C for 5 days. Procedure A is based on first derivative spectrophotometric measurement in ethanol at 305 nm, whilst procedure B involves coupling of the drug with 2,6-dichloroquinone chlorimide in ethanoldimethylformamide mixture to yield a purple coloured product picked at 515 nm. Procedures C and D depend on charge transfer complexation with dichlorophenol indophenol and dichloronaphthoquinone in CHCl3-methanol and dimethylformamide yielding blue and orange radical anions with lambda max at 640 and 495 nm, respectively. Regression analysis of Beer's plots show good correlations [r=0.9992- 0.9999] and the calibration curves are linear over the ranges of 5-20 mug ml-1, 30-240 mug ml-1, 2-16 mug ml-1 and 40-320 mug ml-1 for procedures A,B,C and D, respectively. The detection limits range between 0.14 and 4.16 mug ml-1. Procedures A and B retain their accuracies in presence of up to 60% and 30% of pantoprazole degradation products, respectively. The average recoveries for commercial tablets are 98.9-100.4%. The results proved to be reproducible and in accordance with those given by a compendial method[11]

Efficacy of combined exercises for balance, mobility and strength to reduce risk falls in elderly subjects

This study was conducted to investigate the effect of exercise programs of balance, mobility, and strength to reduce falls in elderly population. A total of 60 subjects with age 65:80 years with previous falling history participated in the study. The subjects were divided into three equal groups [1] a control group received no exercise program, [2] exercise group 1 received a program of balance exercise and mobility exercise, and [3] exercise group 2 received a program of balance exercise and strengthening exercise. The exercise program was delivered twice daily 6 days/week for three months. Each subject is evaluated before and after the exercise program using balance test and functional mobility test Analysis of the data revealed that both exercise groups were significantly higher than the control group on all measures of balance and mobility tests, the significant difference was clear between groups in tandem stance and single limb stance, P< 0.0001. When comparing each exercise group to control there was significant increase of both exercise groups than control group P=0.001. In addition when comparing both exercise groups regarding the five conditions of the balance test there was increase of exercise group 1 than exercise group 2 but this increase was not significant where P< 0.2. Four months followup revealed only 1 fall due to environmental hazards among the exercise groups and 3 falls among non exercise group. In conclusion multidimensional exercise can improve balance and mobility function which could be reflected on reducing the falling frequency of older individuals with emphasizing on the preferable effect of combined balance and mobility exercises than combined balance and strengthening exercises

Role of transcranial magnetic stimulation [TMS] in prediction of ischemic stroke outcome

There is still controversy about the prognostic value of motor evoked potenials [MEPs] in the assessment of hemiplegia. In order to underst and the role of TMS in studying the integrity of corticospinal tract we have performed such study on Patients with first ever established is-chemic stroke in the domaine of MCA territory, their age ranged from 17-82 years with a mean age of 61.8 + 31.1 years. Functional recovery was assessed by using Sc and inavian Neurological Stroke Score [sss], the Barthed Activities of Dialy Living Index [BI], and the motor score to assess the motor function status of upper and lower limbs. Electrophysiolgical assessment by using TMC to both first dorsal interosseous [FDI] and Tibials anleiror [TA] muscles. These assessments were carried out at the same time in 2 sessions, the first session was within 3 days from the onset of the symptoms and the second was 14 days later. At the first session, MEP was elecited from FDI in the hemiplegic side in 36% and from TA of the same side in 48%. CMCT of these patients was significantly prolonged compare to the healthy side of the same patient. On the second session, there was no significant shortening of the CMCT to FDI and TA. There were inversed correlation between CMCT to TA with sss [r = 0.6]. From this work we conclude that, early performed transcramial magnetic stimulation is a valuable prognostic tool for motor recovery from stroke

Dobutamine-transesophageal echocardiography versus dipyridamole thallium-201 scintigraphy for assessment of myocardial viability

Dipyridamole Thallium-201 scintigraphy have been widely used to differentiate between scar tissue and viable but not functioning myocardium and showed superiority over dobutamine stress echo-cardiography. The development of transesophageal echocardiogram [TEE] may overcome many of transthoracic limitations. To compare dobutamine stress TEE and Dipyridamole thallium scintigraphy in detection of myocardial viability. The study included 27 patients with coronary artery disease [CAD] and severe segmental wall motion abnormalities [SWMA] on resting echocardiogram who were scheduled for revascularization either through angioplasty or bypass surgery [CABG]. Dobutamine-TEE and dipyridamole thallium scintigraphies were done within 5 to 7 days before revascularization. Post-revascularization resting echocardiography was done 14 to 21 days to assess any improvement of SWMA as a sign of myocardial viability. Although the sensitivity of dobutamine TEE to detect myocardial viability was higher than that of thallium scintigraphy [89% vs. 72% respectively] but it did not reach statistical significance [P=0.06]. However, the specificity of TEE was significantly higher than that of scintigraphy [83% vs. 67%, P=0.04] and the total diagnostic accuracy of dobutamine TEE to detect myocardial viability was significantly higher than that of dipyridamole thallium scintigraphy [88% vs. 71% p = 0.05]. In the presence of severe SWMA, dobutamine TEE could detect myocardial viability more frequently than dipyridamole thallium scintigraphy

Is operative laparoscopy safe for the management of disturbed ectopic pregnancy?

This study was carried out on 35 women with disturbed ectopic pregnancy [EP] of whom eleven were suffering from hypovolemic shock with hypotension, tachycardia and central venous pressure [CVP] <0.0 cm H2O. An anesthesiologist was involved early in the management who secured a central vein and recorded CVP. Laparoscopic surgery was done for all cases. The results indicated that hemoperitoneum was significantly higher among women with hypovolemic shock. Blood transfusion was given to five patients in the hypovolemic group. Laparoscopic salpingostomy was frequently performed in both the stable and the hypovolemic groups, while salpingostomy was performed infrequently due to either tubal damage or unwanted future pregnancy. Conversion to laparotomy was required in only two patients in the hypovolemic group and one in the stable group. All patients made full recovery and had an uncomplicated postoperative course. It was concluded that even in hemodynamically unstable women with EP, it is possible to perform laparoscopic surgery when competent equipment, experienced laparoscopic surgeon, efficient anesthesiologist and advanced cardiovascular monitoring are available. The ability to convert rapidly to laparotomy, if required, must be considered