Predictors of Bleeding after Percutaneous Coronary Intervention

Background: Acute coronary syndrome patient outcomes have been improved using early invasive techniques. The aim of this study was to investigate the incidence, location, and severity of bleeding in PCI-treated cases to identify patient risk profiles and increased bleeding occurrences. Methods: This prospective observational study evaluated percutaneous coronary angiography in 80 patients with hypertension and diabetes mellitus who planned to undergo primary or elective PCI. The cases were separated into 2 groups; those who reported bleeding (n=11) and those who did not (n=69). All patients underwent physical examination, laboratory evaluation, 12-lead electrocardiography, and PCI. Results: In univariate regression analysis, age (OR: 1.09, 95% CI: 1.009 – 1.192), female gender (OR: 4.32, 95% CI: 1.157 – 16.131), history of peripheral arterial disease (OR: 7.31, 95% CI: 1.585 – 33.742), and femoral site of vascular access (OR: 9.6, 95% CI: 2.263 – 40.721) were independent predictors of major bleeding after PCI. In multivariate regression analysis, age (OR: 1.12, 95% CI:1.014 – 1.269), female gender (OR: 13.75, 95% CI: 1.983 – 161.2), history of peripheral arterial disease (OR: 43.38, 95% CI: 3.754 - 1042) and femoral site of vascular access (OR: 13.29, 95% CI: 2.233 – 128.5) were independent predictors of major bleeding after PCI. Conclusions: Patients who reported bleeding after PCI had a significantly higher age, prevalence of female sex, serum creatinine, and transfemoral intervention before and after intervention compared to patients who did not report bleeding, while haemoglobin and transradial intervention before and after intervention were significantly lower in the bleeding cases than in the non-bleeding cases.

Relationship between Duration of Diabetes Mellitus and Gensini Score in Patients Undergoing Diagnostic Coronary Angiography

Background: Gensini (G score) is one of the most widely used scoring systems in cardiology. It is an objective method to determine the coronary artery disease severity according to angiographic findings. The aim of this work was to assess the relation between G score and the chronicity of diabetes mellitus (DM) in cases undergoing coronary angiography. Methods: This prospective cohort research was carried out on 300 cases with diabetes mellitus (DM) on antidiabetic treatment who were referred to diagnostic coronary angiography for suspected coronary artery disease. G score was calculated for measurement of the coronary artery disease severity. During the period from October 2020 to Aril 2022 Results: Age, smoking, chronicity of DM, cholesterol, triglycerides test, and electrocardiogram were statistically prominent positively related with G score, while female gender was statistically significant negative relation with it. Also. Mean G score was statistically prominent higher in cases with ischemic changes than in cases without ischemic changes. Therefore, the chronicity of DM was statistically significant predictor of G score. Conclusions: significant positive relation between the G score and the chronicity of DM.

Coronary Artery Ectasia as a Predictor of Major Adverse Cardiac Events in Patients with Acute ST Elevation Myocardial Infarction

Background: Coronary artery ectasia (CAE) is characterised as localised or widespread non-obstructive lesions of the epicardial coronary arteries with a luminal dilation more than 1.5 times the neighbouring normal segments or vessel diameter. Isolated CAE is CAE in the absence of severe coronary artery stenosis. This aberrant dilatation of coronary arteries can produce angina pectoris and even myocardial infarction in people without coronary artery disease owing to vasospasm, dissection, or thrombus. The purpose of this study was to evaluate the connection between CAE and major adverse cardiac events (MACE) following acute myocardial infarction with ST elevation. Methods: This was a prospective cohort study which was carried out on 300 cases. Cases were divided into two groups: Group I: including about 22 STEMI cases with CAE and Group II: including about 278 STEMI cases without CAE. All cases in this study were subjected to full history taking, clinical examination, laboratory tests, standard 12-leads ECG, resting transthoracic echocardiography (TTE), and coronary angiography. Results: Regarding MACE in the studied groups, Incidence of reinfarction and cardiac death were significant higher in cases with STEMI and CAE than cases with STEMI alone. In univariate regression analysis, CAE (OR: 3.59, p value =0.022) was a significant predictor of cardiac death but age, male sex, and EF were not. Also, in multivariate regression analysis CAE (OR: 3.49, p value =0.029) was a significant predictor of cardiac death but age, male sex, and EF were not smoking with high warfarin consumption. Further, Markis classification 1 and 3 were the most frequent phenotype among cases. In STEMI cases, the incidence of reinfarction and cardiac death were significantly higher in cases with STEMI and CAE than cases with STEMI alone. So, CAE is a significant predictor of cardiac death.

Acute Coronary Syndrome in Egyptian Women during their Reproductive Age Period

Background: Young women have low risk of acute coronary syndrome (ACS) during their reproductive period, mainly due to the physiologically protective effect of estrogen hormone on the coronary endothelium. The purpose of this study was to assess the risk factors of ACS in the Egyptian women patients during their reproductive age period, who admitted to Tanta University Cardiovascular department hospital. Results: Obesity, hypertension, diabetes mellitus, chronic kidney disease, systemic lupus erythematosus, myocardial bridge, cushion syndrome and radiotherapy for breast cancer were significantly independently ACS risk factors that correlated to the SYNTAX score. There is significance of coefficient of the independent variable in the risk factors (Group A, group B, group C separately and groups A, B, C together) on the severity and level of SYNTAX score in ACS. The regression analysis was significant in groups A and B of ACS risk factors separately. While the regression analysis was significant and there was a clear relationship between ACS risk factors- groups A, B, C. together and SYNTAX score. Conclusions: There was a positive relationship between the increase total number of ACS risk factors subgroups (Traditional, Nontraditional and Gynecological) and the severity of coronary artery stenosis that assessed by SYNTAX scorer.

Risk Factors and In-hospital Outcome of Young Adults Presented with Acute Myocardial Infarction and Treated with Primary PCI

Background: Acute myocardial infarction (AMI) is often characterised pathologically as the death of cardiomyocytes as a consequence of persistent ischaemia result in an acute imbalance among oxygen supply and demand. Coronary artery disease (CAD) is the leading cause of death worldwide. AMI mainly affects patients older than 40 years of age, however, young can suffer MI. In the developing countries, CAD is becoming an epidemic, where it occurs in younger persons at greater rates. Clinical features and prognosis of young patients tend to vary from those of older individuals. the outcomes of a MI may be especially severe at a young age because of its larger potential influence on the patient's psyche, capacity to work, and socioeconomic burden. AMI is less prevalent in young people than in older persons, since only 2 to 6 % of the younger population suffers from the condition. Primary PCI is the optimal therapy for STEMI if it can be done promptly, preferably within 90-120 minutes of provider contact. Methods: The present research performed on 60 subjects who had AMI and treated with primary PCI. The cases were allocated into 2 groups, group 1 involved young subjects aged 40 years old or less (30 patients) and group 2 involved older patients aged more than 40 years (30 patients). All patients underwent complete history taking, cardiological clinical examination, investigations, coronary angiography and PCI. Results: Concerning age there was statistically significant difference among two groups while there was no significant difference regarding to sex. regarding risk factors there was significant difference among both groups regarding to hypertension, DM, previous MI, cerebrovascular disease and drug abuse. Regarding to laboratory investigation, there was no significant difference regarding CK, CKMB, creatinine and random blood sugar. There was no significant difference regarding to culprit artery and TIMI flow after PCI while there was statistically significant difference regarding number of vessels involved. Regarding to outcome there was no significant variation among the two groups regarding to acute HF, cardiogenic shock, re-infarction, and death. As regarding to bleeding, it was significant higher in group II. Conclusions: Prevalence of Acute ST Elevation Myocardial Infarction “STEMI” in young people is increasing due to sedentary and stressful lifestyle and bad habits as smoking and addiction. The most widespread and important risk factors in these patients are smoking, addiction, mental stress and hyperlipidemia with less prevalence of hypertension and diabetes mellitus. Young patients present most commonly with anterior then inferior STEMI.

Predictors of Left Ventricular Dysfunction after Percutaneous Primary Coronary Intervention in Acute Anterior Myocardial Infarction

Background: Primary percutaneous coronary intervention (PCI) has revolutionized the outcome and management of acute myocardial infarction. However, the occurrence of left ventricular dysfunction remains relatively common event following acute myocardial infarction and in associated with an adverse prognosis in these patients. this work aimed to investigate to the left ventricular dysfunction predictors following PCI for anterior myocardial infarction (AMI) using different parameters: Tissue Doppler imaging (TDI), Biomarkers (Troponin, CK-MB) and Echocardiography Methods: This research was conducted prospectively on 50 patients aged from 40 to 70 years old, presenting by first anterior myocardial infarction and treated with PCI. All cases were subjected to full history, full clinical examination, laboratory investigations, resting 12 leads electrocardiography, two dimensions echocardiography and tissue doppler imaging. Results: Highly statistically significant between EF baseline with EF on discharge and EF on discharge with after 3 months p-value was <0.001. Pre balloon dilatation, S wave of tissue Doppler imaging on discharge and S wave tissue Doppler imaging after 3 months were predictors for left ventricular systolic function. Conclusions: Persistent LV dysfunction following successful primary PCI is infrequent and is related to poor clinical outcomes at 3 months clinical follow-up. Tissue Doppler on discharge and after three months after myocardial infarction are independent predictors of LV dysfunction after anterior STEMI and can be used to predict occurrence of LV remodelling after 6 months.

Impact of scissors type used for episiotomy on the prevalence of obstetric anal sphincter injury: randomised controlled trial

Aim: to compare between the prevalence of obstetric anal sphincter injury [OASIS] after cutting mediolareral episiotomy by angled, curved or straight scissors in women in labour

Methods: the current randomized controlled trial was conducted at Ain Shams University Maternity Hospital. The participating women were randomly allocated into three arms. Arm [A]: women had mediolateral episiotomy cut by angled scissors. Arm [c]: women had mediolateral episiotomy cut by curved scissors .Arm [s]: women had mediolateral episiotomy cut by straight scissors. Primary outcome was the occurrence of Obstetric Anal Sphincter Injuries [OASIS]

Results a total of 300 primiparous women were included. The overall incidence of OASIS was 5%, 17% and 15 % in arm A,C and S respectively

Conclusion: using angled scissors in cutting mediolateral episiotomy results in less cases of obstetric anal sphincter injury compared to cutting episiotomy by straight or curved scissors

Validated spectrofluorimetric method for the determination of atorvastatin in pharmaceutical preparations / 药物分析学报

A rapid,sensitive and simple spectrofluorimetric method was developed for the estimation of atorvastatin.In this method,the native fluorescence characteristics of atorvastatin have been studied in both acidic and basic media.High sensitivity was obtained with 5％ acetic acid at 389 nm using 276 nm for excitation.Regression analysis showed a good correlation coefficient (r=0.9995) between fluorescence intensity and concentration over the range of 1.5-4 μg/mL with detection limit of 0.012 μg/mL.The proposed method was successfully applied to the analysis of atorvastatin in pure and pharmaceutical dosage forms with average recovery of 100.29±0.47％.The results were compared favorably with those of the reported method.

An outbreak of CTX-M-15-producing Klebsiella pneumoniae isolates in an intensive care unit of a teaching hospital in Kuwait.

Objective: This study reports an outbreak of Klebsiella pneumoniae infections in 14 patients during a 2-month period (August-September, 2008) in the intensive care unit (ICU) of a teaching hospital in Kuwait. Materials and Methods: The clinical sources were blood (9), urine (3) and respiratory secretions (2) identified by the automated VITEK-2 ID System. Susceptibility testing was performed by the E-test method. Extended-spectrum β-lactamase (ESBL) production was assessed using the ESBL E-test and confirmed by PCR. Carriage of bla genes was determined by PCR and sequence analysis. The transferability of resistance phenotypes was demonstrated by conjugation experiments and clonal relatedness was determined by PFGE. Results: The isolates were susceptible to imipenem, meropenem, and tigecycline and produced ESBL. All isolates yielded an amplicon of 499 bp with universal consensus primers (MA primers). DNA sequence analysis showed that they all harboured blaCTX-M-15 and blaTEM-1 genes. The environmental isolate obtained from a suction machine was also CTX-M-15/TEM-1 producer. The resistance phenotypes were transferrable to the Escherichia coli J53 r strain. PFGE, revealed two clones, A and B, related with a Dice coefficient of >94.1%. A mortality rate of 21.4% was recorded. Conclusion: The outbreak was contained by robust and aggressive infection control measures. This study highlights the first outbreak of CTX-M-15-producing K. pneumoniae associated with high mortality in an adult medical ICU in Kuwait.

Characterization of two isolates of prunus necrotic ringspot virus [PNRSV] from peach and apricot in Egypt

Two isolates of PNRSV were isolated from peach and apricot trees at the Experimental Station of the Faculty of Agriculture, Cairo University, Giza, Egypt. The peach isolate of PNRSV [PNRSV-PF] was differentiated from the apricot isolate [PNRSV-AP] by ten differential host species. Both isolates were purified successfully with the electro-elution technique. Both isolates had A[max] and A[min] at 260 and 240 nm respectively. The A260/280 ratios were 1.55 and 1.60 for the AP and the PF isolates, respectively. Electron microscopy examination showed spherical virions with ca 27-29 nm in diameter. Both isolates had molecular weight of coat protein subunits of 29 kDa, determined by polyacrylamide gel electrophoresis [SDS-PAGE]. Antisera raised against the two isolates detected their counter antigens in peach and apricot trees. Both antisera cross reacted with their homologous and heterologous antigens in dot blot immunoassay [DBIA] and agar-double diffusion [ADD] tests. The two virus isolates appeared to belong to the same sero-group and represent two different pathotypes. PNRSV-AP varied in sero-grouping of that of beet necrotic ringspot ilarvirus, a tentative isolate of PNRSV, when examined in ADD test. Indirect ELISA showed that 64.2% of 210 tested apricot trees were infected, while 150-inspected peach trees showed 29.5% infection. Four sets of primers were used to amplify both movement protein [MP] and coat protein [CP] genes of the two Egyptian isolates of PNRSV isolated from apricot and peach trees. Amplicons of the correct size [ 894 bp] for the MP gene and [ 704 bp] for the CP gene were obtained from the two examined isolates of PNRSV. Nested PCR using specific primers for both the MP and the CP genes confirmed the authenticity of the PCR amplified products. RT-PCR detected successfully the presence of PNRSV in the pollen grains of infected apricot and peach trees. Nucleotide sequences of the MP genes of the two isolates were revised by the GenBank and given the accession # EU100388 for the peach isolate and EU106649 for apricot isolate. Phylogenetic analysis of RNA 3-MP showed ca 65% similarity between PNRSV-AP and PNRSV-PF; indicating that the two isolates of PNRSV are distantly related. The relatedness between the two isolates and other PNRSV isolates is discussed

Soluble L-Selectin and intercellular adhesion molecule-1 in serum of asthmatic children

Infiltration of cells into the lung in bronchial asthma is regulated by several expressions of cell adhesion molecules [CAMs] on cells present in the airways, and may play a role in the pathogenesis of bronchial asthma. The object of the study was to assess the levels of circulating forms of the cellular adhesion molecule ICAM-1, and L-selectin, in young children with bronchial asthma, and to investigate the relation between disease severity and these levels. Serum levels of sICAM-1 and sL-selectin were determined by using commercially available enzyme-linked immunosorbent assay kits in 30 children [19 males and 11 females], suffering from chronic bronchial asthma, their ages ranged from 2-14 years [6.73 +/- 3.18 ys], in addition to 18 healthy children of matching age and sex as a control group. The results showed that serum level of sICAM-1 was significantly higher in asthmatic children compared to controls [48.84 +/- 32.15 ng/ml vs 24.88 +/- 23.72 ng/ml, p< 0.009]. serum level of sL-selectin was significantly higher in asthmatic children compared to healthy subjects [2354.81 +/- 715.66 ng/ml vs 1625.63 +/- 638.12 ng/ml, p<0.001]. children with severe asthma had significantly higher levels of sICAM-1 [86.95 +/- 21.14 ng/ml] than children with moderate asthma [45.9 +/- 13.32 ng/ml] and those with mild asthma [14.66 +/- 9.79 ng/ml, p<0.001]. also, children with severe asthma had significantly higher levels of sL-selectin [3039.42 +/- 380.42 ng/ml] than children with moderate asthma [2452.45 +/- 219.86 ng/ml] and those with mild asthma [1540.05 +/- 597.59 ng/ml, p< 0.001] serum levels of sICAM-1 and sL-selectin had significant negative correlation with age, and significant positive correlation with total leukocytic count neutrophil count, total lymphocyte, eosinophil and monocytes counts. This study provides further evidence that serum concentrations of sICAM-1, and sL-selectin are increased in acute asthma. Levels were significantly higher in severe than in mild or moderate cases

search for ureaplasma urealyticum in the semen of infertile men

The potential role of ureaplasma urealyticum in human infertility makes it desirable to screen barren couples for this infection. Semen specimens from 30 patients were studied. The presence of Ureaplasma was looked for by use of Mycofast kit [liquid technique]. U. Urealyticum was found in 6 [20%] patients in high numbers 10[5]/ml. These results were correlated with some semen parameters [% of abnormal forms and motility]. Infertile patients with Urealplasma had an over-all decrease in semen quality, those lacking ureaplasma also had this poor semen quality with few exception. These data provide some evidence for the association of ureaplasma genital infection and male infertility. So I recommend culture of the semen for ureaplasma as part of investigation of infertility

Latex particle aggultination tests as an adjunct to the diagnosis of bacterial meningitis

A prospective study using a latex particle agglutination test for the detection of bacterial antigens in CSF has been carried out in 90 patients with meningitis. The antigens sought were those of Str. pneumoniae, H. influenzae b, N. meningitidis groups A, C, Y, W, 135, N. meningitidis B, E. coli, Kl. and Str. group B. Eighty-five patients had proven bacterial meningitis and the rest had aseptic meningitis. The bacteria causing meningitis included N. meningitidis [group B in four and groups ACYW 135 in 56], Str. pneumoniae [20 patients] and H. influenzae b [five patients]. The sensitivity and specificity of the tests were as good as those reported from developed countries. With both technical feasibility and good sensitivity and specificity, the Wellcogen agglutination tests seem to be useful and reliable for the rapid diagnosis of bacterial meningitis, especially in situations where pre-hospital treatment with antibiotics are possible

Antibiotic susceptibility patterns and some potential virulence factors of clinical isolates of serratia marcescens

During 8-month period, 20 strains of S. marcescens were isolated predominantly from hospitalized patients. These isolates were tested for the occurrence of nine potential virulence determinants. DNase, lecithinase, lipase, proteolytic activity and motility were demonstrated in 100% of isolates, hemolytic activity in 40%, urease activity in 30% and pigmentation in 20%. Generally, these strains were sensitive to many antibiotics, mainly aminoglycosides, third generation cephalosporins and the newer quinolines and resistant to ampicillin, cephalothin, cefamandole and tetracyclines

Haemorrhagic colitis and escherichia coli. 0157: H7

This work included 71 patients with bloody diarrhea aiming to determine the role of Escherichia coli 0157: H7 [E. coli 0157: H7] that has recently associated with hemorrhagic colitis [HC] in all age group and with hemolytic uremic syndrome [HUS] in children. All patients were from villages near by Rositta and Kafr-El- Dawar. This study was carried out during the period from May 1989 to October 1990, where outbreaks and many sporadic cases have been reported. Thorough clinical and laboratory investigations were done. Bacteriological study of the stool samples revealed heavy growth of E. Coli with no other definite bacterial pathogen in 66 cases, E. coli 0157: H7 was identified in only two of these 66 samples, one from case of HC and the second from HUS. The other 64 E. coli have not been serotyped. Klebsiella oxytoca was the pathogen in 3 cases whereas campylobacter in only two cases. E. coli 0157: H7 isolates were sensitive to aminoglycosides and tetracyclines but resistant to ampicillin cephalothin, chloramphenicol, and trimethoprim- sulfamethoxazole. Also, these serotypes were not invasive by standard tests. From this study, it was concluded that E. coli 0157: H7 is a rare serotype in this locality

Clinical, bacteriological and mycological study for otitis externa

Otitis externa is a localized inflammatory skin disorder affecting the external auditory canal and pinna. Many etiological factors are known diseases as seborrheic dermatitis and general disease as diabetes, local factors as scratching, and excessive sweating might predispose to the disease. External climatic condition as high temperature and humidity might share in the development of the disease

Nasal carriage of staphylococcus aureus among diabetic patients

Nasal carriage of S. aureus was studied in 150 diabetic patients [50 adults IDDM, 50 adults NIDDM and 50 diabetic children] and 150 non-diabetic persons [50 children and 100 adults]. The carriage rate of S. aureus was significantly higher in diabetic children [80%] than in normal children [30%], in adults the carriage rate was higher in IDDM to be 35%. There was a marked drop in the carriage rate of the S. aureus after topical use of gentamicin cream [52.6%]

Identification of the microbial flora of the normal and diseased vagina in pregnant and non pregnant women

The vaginal flora was studied in 100 sexually active women [mean age 30 years, range 20-38]. 50 were pregnant and 50 non- pregnant. Each group included 30 women complaining of heavy vaginal discharge and 20 asymptomatic. High vaginal swabs were taken and subjected to full bacteriological study. Nearly all women either symptomatic or not harbor pathogenic or potentially pathogenic microorganisms. The predominant microorganisms were G. vaginalis, Lactobacilli, Diphtheroid, Micrococci and Staph. epidermidosis. It was concluded that the vaginal flora was similar regardless of vaginitis or amount of vaginal discharge and the major difference was more prevalence of known vaginal pathogens [T. vaginalis and C. albicans] among women with vaginitis. No attempt was made to seek viruses, chlamydia and mycoplasma

bacteriology of secretory otitis media [SOM] in children

Aerobic and anaerobic bacteriological cultures were taken from middle ear effusions and the respective nasopharynx of 20 patients with secretory otitis media [SOM]. 70% of the effusions and 80% of the nasopharynx yielded positive culture for aerobic bacteria. The most frequent species in effusion samples were Staph. epidermidis and H. influenzae, while N. catarrhalis, H. influenzae and Staph. epidermidis were the most frequent species in the nasopharynx. Anaerobes were not isolated. In conclusion, it appears that aerobic bacteria may play a role in the pathogenesis of SOM and it can be assumed that the nasopharyngeal colonization may be a substantial causal factor of middle ear inflammation

Ophthalmia neonatorum in Tanta prevalence of chlamydia trachomatis

During nine months, 112 infants 1-4 weeks old with purulent ocular discharge and 40 normal infants were studied opthalmologicaly and microbiologicaly for bacteria and chlamydia aetiology. Infants with conjunctivitis were divided into two groups : group [A] had no treatment and group [B] treated before with no response. Pathogenic bacteria were cultured in 49.1% of all cases. Chlamydia was found in 9.6% in group [A] and in 38% in group [B]. In other words Chlamydial ophthalmia neonatorum is not uncommon in Tanta