ABSTRACT
Pulmonary hypertension in sickle cell disease (SCD) is a complex phenomenon resulting from multiple overlapping etiologies, including pulmonary vasoconstriction in the setting of chronic hemolytic anemia, diastolic dysfunction, and chronic thromboembolic disease. The presence of pulmonary hypertension of any cause in SCD confers a significant increase in mortality risk. Evidence to guide the management of patients with sickle cell disease and chronic thromboembolic pulmonary hypertension (CTEPH) is scant and largely the realm of case reports and small case series. Centered on a discussion of a complex young patient with hemoglobin hemoglobin SC who ultimately underwent treatment with pulmonary thromboendarterectomy, we review the available literature to guide management and discuss and overview of treatment of CTEPH in SCD, considering the unique considerations and challenges facing patients suffering from this multisystem disease.
ABSTRACT
Propofol-induced neurotoxicity in developing brain is an evolving problem. Magnesium is proved to be neuro-protective when administered antenatally in case of pre-eclampsia and eclampsia. The aim of this work is to investigate the protective role of magnesium sulphate (MgSO4) against propofol-induced neurotoxicity in developing rats cerebral cortex (CC). Forty albino rats of the Sprague-Dawley strain aged 5 to 7 days were divided into four groups; Control group (Group A); MgSO4 group (Group B) receiving MgSO4 at a dose of 270 mgkg; Propofol group (Group C) receiving propofol at a dose of 20 mgkg; and Propofol+ MgSO4 group (Group D) receiving both drugs simultaneously. All drugs were given by intra-peritoneal (IP) injection. 48 hours following exposure, blood samples were collected from rats for cytochrome-c plasma assay. Also, Specimens from rats CC were processed for light microscopic examination. An immune-histo-chemical study was conducted using Glial Fibrillary Acidic Protein (GFAP) and Bcl-2-associated X protein (BAX).Propofol administration led to disruption of the cortical laminar architecture, with a significant decrease in the number of pyramidal cells. Also, GFAP and BAX immune-stained sections revealed a significant increase in the area percentage of their immune-reaction as compared to the control group, together with a significant increase in the serum level of cytochrome-c. Administration of MgSO4 with propofol could improve the histological picture of the cortex, including its laminar appearance and neuronal density. Also MgSO4 could decrease GFAP and BAX immune-reaction, with no change that could be noticed in the serum level of cytochrome-c. MgSO4 could be used as neuro-protective agent against propofol-induced cortical injury in infant rats
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