The possible utility of global longitudinal strain in the risk-stratifying process of non-ST elevation-acute coronary syndrome.

BACKGROUND: There are various ways that coronary artery disease (CAD) might present itself. Individual risk stratification for non ST-elevation-acute coronary syndrome (NSTE-ACS) patients should determine whether invasive coronary angiography and revascularization should be scheduled. AIM OF WORK: To assess the possible utility of left ventricular global longitudinal strain in the risk-stratifying process of NSTE-ACS. SUBJECTS AND METHODS: The cardiology department of Zagazig University in Egypt organized and oversaw this cross-sectional study. The practical portion was carried out on 90 patients with NSTE-ACS based on European society of cardiology (ESC) guidelines (and they agreed for invasive strategy) between May 2019 and December 2020 at Salalah Heart Center in Sultanate of Oman. All patients underwent a full clinical examination, 12-lead ECG, and serial high-sensitivity troponin T (hs-TnT) in addition to a thorough history taking process. On patient's admission, the GRACE risk score was assessed. All patients who were suspected of having NSTE-ACS upon admission underwent transthoracic echocardiography, including two-dimensional speckle tracking (2D-ST). Left ventricular global longitudinal strain (LV-GLS %) was measured and analyzed using 2D speckle tracking. SYNTAX Score was determined for all patients. RESULTS: By analysis of the performance of LV-GLS% in prediction of high risk by GRACE score, we found that with cutoff (≥-13.8), the AUC was (0.944) with sensitivity, specificity, PPV, NPV, and accuracy (0.944, 93.3%, 84%, 53.8%, 98.4%, 85.6%), respectively. CONCLUSION: Global longitudinal strain can predict accurately high-risk NSTE-ACS patients by GRACE score.

Benchmark Dose Approach to DNA and Liver Damage by Chlorpyrifos and Imidacloprid in Male Rats: The Protective Effect of a Clove-Oil-Based Nanoemulsion Loaded with Pomegranate Peel Extract.

Pesticides are widely used around the world to increase crop production. They also have negative impacts on animals, humans, and the ecosystem. This is the first report evaluating a novel pomegranate-extract-loaded clove-oil-based nanoemulsion (PELCN) and its potential for reducing oxidative stress and DNA damage, as well as its hepatoprotective effects against imidacloprid (IM) and chlorpyrifos (CPF) toxicity in male rats. The benchmark dose (BMD) approach was also used to study the dose-response toxicity of IM and CPF. IM and CPF were administered daily for 28 days at doses of 14, 28, and 54 mg/kg body weight (bw) of IM and 1, 2, and 4 mg/kg bw of CPF via drinking water. The PELCN was administered orally at a dose of 50 mg/kg bw/day of pomegranate extract, 500 mg/kg bw of the clove oil nanoemulsion, and IM or CPF at high doses in the drinking water. In male rats, IM and CPF caused a reduction in body weight gain and hepatotoxic effects as evidenced by increases in the liver enzymes AST, ALT, and ALP. They caused oxidative damage in the liver of male rats as indicated by the decreased liver activity of the GST, GPX, SOD, and CAT enzymes and decreased serum TAC. IM and CPF produced a significant dose-dependent increase in DNA damage in hepatocyte cells, resulting in moderate to severe liver damage with cells that are more inflammatory and have enlarged sinusoids and compacted nuclei. IM had a higher BMD than CPF for both body and liver weight, suggesting that CPF was more dose-dependently toxic than IM. Albumin was a highly sensitive liver biomarker for IM, while total protein was a biomarker for the CPF-treated rats. GPx was an extremely sensitive biomarker of oxidative stress in the IM treatment, while CAT and GPx were highly sensitive parameters in the CPF-treated rats. Therefore, at comparable doses, CPF has a higher potential to cause liver damage and oxidative stress than IM. The hepatotoxicity of IM and CPF can be mitigated by administering a nanoemulsion containing clove oil and pomegranate extract. The nanoemulsion acts as a protector against the oxidative stress caused by these insecticides, especially at high doses. The nanoemulsion based on clove oil increases the bioavailability and stability of the pomegranate extract, which has antioxidant properties.

Single-nucleotide polymorphism of ADRß2 and CDKN1B genes in Egyptian patients with coronary artery in-stent restenosis.

BACKGROUND: In-stent restenosis is a common complication after percutaneous coronary intervention. The purpose of the current study is to look for associations of genetic variation in adrenergic beta-2 receptor (ADRß2), and cyclin-dependent kinase inhibitor 1B (CDKN1B) genes in patients diagnosed with in-stent restenosis (ISR) after percutaneous coronary intervention in the Egyptians. METHODS: Polymorphisms in ADRß2 and CDKN1B were determined using PCR-restriction fragment length polymorphism in 200 Egyptian patients who underwent coronary angioplasty and stent placement of whom 100 patients developed ISR. RESULTS: We found that the GG genotype of ADRß2 and CC genotype of CDKN1B were more likely to develop restenosis after stenting (odds ratio = 3.7 and 3.2; P = 0.001, respectively). Our study considered that male sex, diabetes, obesity, bare-metal stents type of implanted stents, longer stents, GG genotype of ADRß2, and CC genotype of CDK1B were significant independent predictors for ISR. CONCLUSION: our results indicate that ADRß2 (rs1042713) and CDKN1B (rs36228499) could be associated with the development of ISR in Egyptians.

Benchmark dose and the adverse effects of exposure to pendimethalin at low dose in female rats.

Pendimethalin (PND) is a dinitroaniline herbicide widely used to control broadleaf and annual grasses. Although the acute oral toxicity of PND is >5 g/kg b.wt. in humans (LD50 for rats >5000 g/kg b.wt.), it has been classified as a possible human carcinogen. It is still used in agriculture so agricultural workers and their families, as well as consumers, can be exposed to this herbicide. The present study is the first report investigating the dose-response effect using the benchmark dose (BMD) and the adverse effects of exposure to PND at low dose via apoptosis responses linked to the expression of tumour necrosis factor-α (TNF-α), FAS and BAX proteins; oxidative stress; and DNA and liver damage in female rats. The rats were exposed to PND via drinking water at doses equivalent to no-observed-adverse-effect level (NOAEL = 100 mg/kg b.wt.), 200 and 400 mg/kg b.wt. for 28 days. PND caused the overexpression of TNF-α, FAS and BAX; increased the levels of serum liver biomarkers; and increased oxidative stress in the liver and erythrocytes. Furthermore, it induced DNA and liver damage in a dose-dependent manner. The BMD showed that serum alkaline phosphatase (ALP) and total antioxidant capacity (78.4 and 30.1 mg/kg b.wt./day, respectively), lipid peroxidation in liver tissue (30.9 mg/kg b.wt./day), catalase in erythrocytes (14.0 mg/kg b.wt./day) and FAS expression in liver tissue (6.89 mg/kg b.wt./day) were highly sensitive biomarkers of PND toxicity. Our findings suggest the generation of reactive oxygen species as a possible mechanism of PND-induced gene overexpression of tumour necrosis factor-α (TNF-α), FAS and BAX proteins, oxidative stress and DNA and liver damage in female rats.

Relationship between Fragmented QRS and Microvascular Dysfunction in Masked Hypertension.

Aim: The aim of this study was to investigate the presence of fQRS and its association with subclinical systolic and microvascular dysfunction in patients with masked hypertension (MH). Methods: The study population consisted of 95 (mean age 48.9 ± 11.3, 61% males) subjects with MH and 80 age- and gender-matched healthy individuals who served as a control group. Coronary flow reserve (CFR) using transthoracic echocardiography and for left ventricular global longitudinal strain (LVGLS) using speckle-tracking strain imaging were performed. Patients with MH were stratified into two groups according to the presence of fQRS on surface electrocardiogram. Results: Fragmented QRS was more common among MH patients compared with controls (38.9% vs. 6.25%, p < 0.003). CFR was significantly lower in patients with fQRS compared with those without fQRS and controls (p < 0.001). Likewise, LVGLS values were lower in MH patients with fQRS (p < 0.001) compared with subjects without fQRS and controls. Fragmented fQRS was significantly correlated with systolic blood pressure, CFR, and LVGLS. Multivariate analysis showed that the presence of fQRS, number of leads, and CFR were independent predictors of subclinical systolic dysfunction. With ROC cure analysis, number of leads with fQRS ≥4 was the optimal value for predicting the presence of subclinical systolic dysfunction in subjects with MH. Conclusions: Fragmented QRS is more frequent among subjects with MH compared with controls. The presence of fQRS is related with pronounced subclinical left ventricular systolic dysfunction. Furthermore, CFR was significantly reduced in subjects with MH, a finding supposed that microvascular dysfunction to be a mechanistic link.

Effect of Presence of Ramus Intermedius Artery on Location of Culprit Lesions in Acute Left Circumflex Coronary Artery Occlusion.

BACKGROUND AND AIM: Coronary artery anatomy frequently affects location of atherosclerotic plaques and subsequent culprit lesions. We sought to clarify whether presence or absence of Ramus Intermedius coronary artery (RI) would affect location of culprit lesions in acute left circumflex (LCX) coronary artery occlusion. METHODS: The study included 180 patients, 100 with a diagnosis of non-ST elevation myocardial infarction (NSTEMI) and 80 with ST elevation myocardial infarction (STEMI). All culprit lesions were located in the LCX coronary artery. RI group included 45 patients and the No RI group included 135 patients. RESULTS: Culprit LCX lesions were similarly located at a comparable distance from LCX ostium in both groups and the presence of RI was not associated with significantly more proximally located culprit LCX lesions (34.7 ± 15.2 mm compared to 30.8 ± 17.9 mm respectively, p > 0.05). The frequency distribution of culprit lesions' distance from LCX ostium showed no significant difference between both groups in any of the segments studied (10 mm each). There was no significant difference between both groups regarding markers of myocardial necrosis size as cardiac biomarkers (peak cardiac troponin-T 1077.4 ± 361.2 pg/dl vs 926 ± 462.2 pg/dl respectively, p = 0.13), (peak creatine kinase-MB 232.2 ± 81 ng/dl vs 194.7 ± 99.2 ng/dl respectively, p = 0.07) or left ventricular ejection fraction (EF 46.3 ± 6.3% vs 48.3 ± 8.3% respectively, p = 0.76). CONCLUSION: Presence of RI coronary artery, as an additional flow divider, may not be associated with more proximal culprit lesions, compared to its absence, in cases of acute LCX coronary artery occlusion. Possible underlying pathophysiologic mechanisms remain to be clarified.

Presence of Microvascular Dysfunction and CHA2DS2-VASc Score in Patients with ST-Segment Myocardial Infarction after Primary Percutaneous Coronary Intervention.

OBJECTIVE: We aimed to investigate the relation between CHA2DS2-VASc score and microvascular dysfunction (MVD) assessed by the index of microvascular resistance (IMR) immediately after primary percutaneous intervention (PPCI) for patients with ST-segment elevation myocardial infarction (STEMI). SUBJECTS AND METHODS: The study included 115 consecutive patients with STEMI who underwent successful PPCI. Angiographic results of reperfusion were inspected to evaluate the association of high CHA2DS2-VASc score and IMR. Also, we assessed echocardiographic changes with respect to CHA2DS2-VASc score. RESULTS: Subjects were stratified into 2 groups based on IMR

What is the association between left ventricular diastolic dysfunction and 6-minute walk test in hypertensive patients?

Heart failure (HF) is a major health problem. Hypertension is an important cause of HF. Most hypertensive patients have some degree of left ventricular (LV) diastolic dysfunction. The 6-minute walk test (6MWT) provides objective data about the exercise tolerance. We aimed to find the association between the degree of LV diastolic dysfunction and the functional capacity assessed by 6MWT in hypertensive patients. The study included 200 asymptomatic hypertensive patients. All patients had undergone full history taking, complete clinical examination, electrocardiography, echocardiography for assessment of LV dimensions, systolic and diastolic dysfunction, and 6MWT. Patients were classified into two groups according to the presence or absence of LV diastolic dysfunction. Clinical and echocardiographic data were comparable between the two groups. Regarding 6MWT, at the end of the test, patients with diastolic dysfunction had significantly higher systolic (P = .0088) and diastolic (P = .019) blood pressure and higher Borg score for dyspnea (P < .00001). The distant walked and percentage of the distance to predicted value were significantly lower in patients with diastolic dysfunction (P = .0322 and .0002, respectively). Incidence of abnormal 6MWT was significantly higher in patients with diastolic dysfunction (P = .00041). Compared to patients with grades I and II, patients with grade III diastolic dysfunction had significantly higher Borg score (P = .013), lower distance walked (P = .039), and lower percentage of distance to predicted vale (P = .009). Independent predictors for abnormal 6MWT were as follows: E/E' ≥15 (P = .0022), E'/A' <1 (P = .0081), and deceleration time of E-wave <160 (P = .013). The presence of LV diastolic dysfunction in hypertensive patients has a bad effect on 6MWT. The degree of LV diastolic dysfunction was correlated with 6MWT results. It may be important to investigate LV diastolic function in asymptomatic hypertensive patients.

Longitudinal function and ventricular dyssynchrony are restored in children with pulmonary stenosis after percutaneous balloon pulmonary valvuloplasty.

The aim of this study was to evaluate the impact of balloon pulmonary valvuloplasty on longitudinal ventricular dysfunction and cardiac dyssynchrony in children with congenital moderately severe pulmonary stenosis (PS). Forty-eight children with congenital moderately severe valvular pulmonary stenosis and 36 age-matched normal children were included. Successful percutaneous balloon pulmonary valvuloplasty was performed for children with PS. Longitudinal Cardiac function and myocardial synchrony was assessed by echocardiography with tissue Doppler imaging (TDI). Mitral annular plane excursion (MAPSE), tricuspid annular plane excursion (TAPSE), left ventricular systolic wave (LVs), right ventricular systolic wave (RVs) and myocardial synchrony was assessed by echocardiography with TDI. TAPSE, RVs, TAPSE/MAPSE ratio and RVs/LVs ratio were significantly lower in children with PS compared to control subjects: (P < 0.001, P < 0.001, P < 0.001 and P < 0.001). All these parameters were significantly improved after balloon valvuloplasty in children with PS. Intra& inter-ventricular dyssynchrony were significantly increased in PS patients than in control group, (P < 0.03, <0.001 and 0.02 respectively). All these variables were significantly reduced after pulmonary valvuloplasty. In children with valvular PS, balloon valvuloplasty restored longitudinal function and cardiac Synchrony. This gives good insights for the importance of early intervention in children with PS to prevent the progression for cardiac deformation.

Association of aortic stiffness to brain natriuretic peptide in children before and after device closure of patent ductus arteriosus.

OBJECTIVES: We evaluated the influence of device closure for patent ductus arteriosus (PDA) on the aortic stiffness index (ASI) and brain natriuretic peptide (BNP) and their association with cardiac function. PATIENTS AND METHODS: ASI and echocardiography assessment before and after treatment (16 ± 9 months) in 48 children with PDA (mean age 10 ± 4.5) and 52 control children (mean age 9.7 ± 4.6). BNP level was measured pre-closure for all children, and was measured six months after closure only for children with PDA. RESULTS: ASI was higher in PDA patients than in controls (P < 0.001). ASI correlated with age (P < 0.05), LVEF% (P < 0.01), E/E' (<0.03), pulmonary artery pressure (P < 0.001), and BNP (P < 0.001). ASI and BNP significantly decreased after closure (P < 0.001). ASI and BNP were independent predictors for post-closure systolic dysfunction (P < 0.001and <0.005, respectively). Receiver operating curve (ROC) analysis showed that ASI â©¾ 13.5, BNP level ⩾75 pg/ml and basal mean pulmonary artery pressure (PAP) â©¾ 23 were powerful predictors for post-closure systolic function. CONCLUSION: ASI is significantly associated with BNP and basal PAP in children with PDA. After device closure, aortic distensibility improved significantly and was associated with significant improvement in both systolic and diastolic functions. ASI can be used for monitoring the course of patients with PDA, and may give opportunities for early intervention.

Risk assessment of pesticides and heavy metals contaminants in vegetables: a novel bioassay method using Daphnia magna Straus.

Cucumber and potato samples of known levels of pesticides and heavy metal residues, as respectively measured by gas chromatography and atomic absorption, were subjected to a bioassay method using Daphnia magna in order to assess the potential of the toxic hazard of their contaminants. Based on the estimated lethal time for 50% mortality (LT50) in daphnids, we suggested a classification to categorize toxic hazards in six definite ratings. Either samples of cucumbers (from conventional, greenhouse and organic farming) or potatoes (from conventional and organic farming) were evaluated for toxic hazard of the mixtures of pesticide residues and heavy metals, as well as mixtures of both. Accordingly, a 53.7% of cucumber samples were ranked as "Highly Toxic: HT"; a 18.5% "Moderately Toxic: MT); a 9.3% "Slightly Toxic: ST"; and a 18.5% "Practically Non-Toxic: NT". For potato samples, the ranking pattern to different classes was: Extremely Toxic: ET (LT50=<1h) for 11.1%; Very Toxic: VT (LT50=1-<3h) for 50.0%; HT (LT50=3-<12h) for 13.9%; MT (LT50=12-<24h) for 11.1%; ST (LT50=24-48 h) for 0.0%; and NT (LT50= >48 h) for 13.9% of the samples bioassayed.

Monitoring of pesticides and heavy metals in cucumber fruits produced from different farming systems.

A total of 216kg of cucumber samples, representing three different types of farming production [e.g., conventional (C), greenhouse (G) and organic (O)], were collected from different locations in Giza governorate (Egypt), and subjected to pesticide residue and heavy metal analyses. Residues of some organochlorine pesticides (OCPs), such as hexachlorobenzene (HCB), heptachlor, aldrin, endrin, dieldrin and o,p'-DDT, as well as organophosphorus pesticides (OPPs), such as chlorpyrifos-methyl, thiometon and phorate were found in a number of samples at concentrations exceeding their MRLs. Lindane was detected in 33.3%, 50.0% and 25.0% of samples from C, G and O cucumber, respectively, without violation. The insecticide methamidophos showed high frequency in the analyzed samples of C, G and O cucumber accounting to 66.7%, 41.7% and 50.0%, respectively, without violation. The majority of the analyzed samples contained detectable concentrations of Zn, Cu, Mn, Fe, Cd, Pb, Cr, Ni and Co. Only, Pb and Cd were found in a number of samples at concentrations exceeding their MLs. Contamination among the three types of cucumber either by pesticides or heavy metals varied from a season to another. Generally, the greenhouse cucumber contained the highest value of total pesticide residues (1.016mgkg(-1)), followed by organic (0.442mgkg(-1)) and then conventional (0.415mgkg(-1)) cucumbers. Heavy metal contamination in the three cucumber types accounted to 4.968, 5.350 and 6.248mgkg(-1), respectively. The study shed light to the problem of multi toxicants in a food commodity such as cucumber; a common element in the daily human diet.

Evaluation of some pollutant levels in conventionally and organically farmed potato tubers and their risks to human health.

A total of 144 kg of potato tuber samples, representing two different types of farming production [e.g., conventional (C) and organic (O)], were collected from different locations in Giza governorate (Egypt), and subjected to pesticide residue and heavy metal analyses. Residues of some organochlorine pesticides (OCPs), such as HCB and heptachlor as well as some organophosphorus pesticides (OPPs), such as methamidophos, thiometon, profenofos, phorate and pirimiphos-methyl were found in a number of samples at concentration levels exceeding their MRLs. The majority of the analyzed samples contained detectable concentrations of Zn, Cu, Mn, Fe, Cd, Pb, Cr, Ni and Co. Specifically, Pb and Fe were found in a number of samples at concentrations exceeding their MLs. Contamination among the two types of potatoes varied from a season to another and contamination of C potatoes was nearly 2 times that of O potatoes either by pesticides or heavy metals. Estimation of dietary intake of pesticides and heavy metals by potatoes revealed that only phorate residues either in conventional or organic potatoes may pose risks to human health. None of the studied heavy metals showed to cause dietary intake risks to human health. The study shed light to the problem of multi toxicants in potatoes.