Detection of occult cor-Pulmonale using dobutamine stress echocardiography in patients with schistosomal hepatic fibrosis

The presence of early diastolic dip of the ventricular septum has been reported to be able accurately diagnose occult cor-pulmonale during cycle ergo meter exercise test in patients with chronic obstructive pulmonary disease [COPD]. This study was conducted to test the ability of dobutamine stress echocardiognaphy [DSE] to detect cases of occult corpulmonale among patients with hepatosplenic schistosomiasis. The study included 25 patients aged 35.6+/=l2.7 years with hepatosplenic schistosomiasis [group 1, 15 males and 10 females] compared to 25 age- and sex-matched patients with COPD [group II]. M-mode echocardiognaphic ventricular septal motion, left ventricular shape [determined by short-axis 2-dimensional echocandiography], and pulmonary artery [PA] acceleration time [determined by pulsed Doppler echocardiognaphy] were measured at rest and during DSE. The ventricular septal motion and PA acceleration time were normal at rest in all patients. In gnoup 1, 22 patients [88%] reported marked downward ventricular septal motion in early diastole during DSE, indicating distortion of left ventricular shape. In group II, only 11 patients [44%] showed the same change during DSE. There is significant decrease in PA acceleration time in patients who showed septal dip in both groups from rest to DSE. It could be concluded that occult cor pulmonale can be diagnosed by the appearance of an early diastolic dip of the ventricular septum and distorted left ventricular shape during DSE in patients with hepatosplenic schistosomiasis. This method may be useful in selecting cases for medical treatment for early cor-pulmonale

Modulation of immune activation and lipoproteins in chronic heart failure

Heart failure is a major problem of public health associated with poor outcome in the advanced stages, thus justifying its prevention based on the prevention and treatment of its principle etiological factors. In chronic heart failure mesenteric venous congestion leads to increased bowel permeability, bacterial translocation and thereby endotoxin release. The increased endotoxine challenge is hypothesized to cause immune activation, which might have an important role in the progression of heart failure. This study is designed to examine the degree of immune activation, to study the degree of endotoxin, interaction and to evaluate the beneficial immune regulatory effects of high density lipoprotein, [HDL] as an endotoxin, binding protein in CHF. We studied thirty five patients with CHF [Age 50+9 Years NYHA 2.7 +/- 0. 4, LVEF 28.0 +/- 6 all mean +/- SEM and eight healthy control subjects matched for age and sex. Serum levels of cholesterol, HDL-C, LDL-C, soluble tumor necrosis factor-alpha [sTNE-alpha], soluble tumor necrosis factor reteptor-l [sTNFl]., sCDI4, kidney function test, and liver function test were assessed. Patients with CHF had increased concentration of sTNF-Rl [P=0.005], TNF- alpha <0.05. whereas HDL levels were decreased [P=0.007]. sCDl4 [indicative of endotoxine cell interaction] was significantly increased, and correlated positively with TNF-alpha [r=0.68, P<0.001] and inversely with MDL. TNF-alpha as a measure of immune activation was inversely correlated with HDL [r=0.36, P=0.045]. From the present study we could concluded that in CHF patients increased concentrations of sCDI4 are related to lower HDL levels and increased concentration of TNF-alpha. This may support the role of HDL in the modulation of immune activation and cytokine and cytokine release in CHF

New biochemical markers in chronic heart failure

We investigated the plasma levels of tumour necrosis factor-alpha [TNF-alpha], leptin and insulin, and their relation to body mass index [BMI] in 80 male patients who presented with chronic heart failure [mean age: 47 +/- 4 years] at Tanta University Hospital. Plasma leptin, TNF-alpha and insulin were significantly increased and BMI significantly decreased in New York Heart Association classes III and IV patients. TNF-alpha, leptin and insulin were positively correlated, and TNF-alpha and BMI and leptin and BMI were negatively correlated in stages III and IV of heart failure. We conclude that cytokine neuroendocrine activation may form part of advanced stage heart failure. It may also be responsible for worsening cachexia, and can be used as a marker to determine disease severity

Neurosecretory cell types and distribution in unfed female hyalomma dromedary II[Acari: ixododiea: ixodidae] synganglion*+1

Thirteen NSC types have been observed in the unfed female Hyalomma dromedarii synganglion. Distribution of these types was based on cell shape, size, and staining reaction of their contents. The NSC are grouped in 13 centers, namely protocerebral, cheliceral, stomodeal pons, palpal, oesophageal, globular, olfactory glomerular, four pedal, opisthosomal and postoesophageal. Each center contains one or more cell types