Identification and antibacterial evaluation of endophytic actinobacteria from Luffa cylindrica.

The emergence of antibiotic-resistant bacteria has limited treatment options and led to the untreatable infections, thereby necessitating the discovery of new antibiotics to battel against bacteria. Natural products from endophytic actinobacteria (EA) serve as a reservoir for discovery of new antibiotics. Therefore, the current study focused on the isolation and antibacterial properties of EA isolated from Luffa cylindrica. Six strains were identified using morphological characterization, SEM analyses and 16S rRNA gene sequencing from the roots and leaves of the plant. They were taxonomically classified as Streptomycetaceae family. This is the first report on EA form L. cylindrica. The strains produced a chain of oval, cubed or cylindrical shaped spores with spiny or smooth surfaces. Three strains; KUMS-B3, KUMS-B4 and KUMS-B6 were reported as endophytes for the first time. Fifty percent of isolates were isolated from leaves samples using YECD medium. Our results showed that the sampling time and seasons may affect the bacterial diversity. All six strains had antibacterial activity against at least one of the tested bacteria S. aureus, P. aeruginosa, and E. coli. Among the strains, KUMS-B6 isolate, closely related to S. praecox, exhibited the highest antibacterial activity against both gram-positive and negative bacteria. KUMS-B6, KUMS-B5 and KUMS-B4 isolates strongly inhibited the growth of P. aeruginosa. Interestingly, the strains, isolated from leaves exhibited stronger antagonist activities compared to those isolated from the roots. The study revealed that the isolated strains from Luffa produce a plethora of bioactive substances that are potential source of new drug candidates for the treatment of infections.

Left atrial deformation analysis as a predictor of severity of coronary artery disease.

BACKGROUND: Two-dimensional (2D) speckle-tracking strain imaging is a novel method for assessment of regional myocardial deformation that uses tracking of acoustic speckles or kernels rather than Doppler myocardial velocities. It has been suggested that Left atrial (LA) strain as measured by 2D speckle tracking can be used to evaluate dynamic LA function. OBJECTIVE: To study the relation between left atrial deformation and the severity of coronary artery stenosis in patients with stable coronary artery disease (CAD). STUDY DESIGN: 30 patients with stable coronary artery disease (SCAD) with coronary artery stenosis (>50%) who were admitted for elective coronary angiography at Ain Shams University hospitals and AlAzhar University hospitals were included in the study. Measurements of conventional echocardiographic parameters as well as LA strain and strain rate parameters were obtained, Syntax (SX) score was calculated for all patients. RESULTS: Patients were categorized into 3 groups: low Syntax score of <23 (Group I), moderate syntax score 23-32 (Group II) and high syntax score of ≥33 (Group III). Peak atrial longitudinal strain (PALS) (Group I: 29.80 ±â€¯4.48, Group II: 22.44 ±â€¯1.42, Group III: 19.53 ±â€¯4.46; p < 0.001) and Peak atrial contraction strain (PACS) (Group I: 13.43 ±â€¯4.05, Group II: 10.84 ±â€¯2.47, Group III: 7.19 ±â€¯0.71; p < 0.022) were significantly lower in high syntax group. Significant negative correlation was found between SX score level and LA strain parameters (PALS and PACS) (r = 0.861; p < 0.001). CONCLUSION: Left atrial deformation analysis by 2D Speckle tracking Doppler Echocardiography can predict the severity of coronary affection in patients with stable CAD.

Right ventricular function in patients presenting with non-ST-segment elevation myocardial infarction undergoing an invasive approach.

BACKGROUND: Right ventricular involvement in ST segment elevation myocardial infarction (STEMI) entails an increased morbidity and mortality. However, very scarce data is present on its affection in the setting of non-ST segment elevation myocardial infarction (NSTEMI). AIM: To assess the affection of right ventricular function in patients presenting with NSTEMI undergoing an invasive procedure. SUBJECTS AND METHODS: One hundred and fifty patients admitted with a first NSTEMI and eligible for reperfusion therapy via invasive percutaneous coronary intervention. These patients were divided in two groups; group A including patients with normal RV function, and group B including patients with impaired RV function as diagnosed by tricuspid annular plane systolic excursion (TAPSE) cutoff value < 17 mm. All patients underwent angioplasty and were followed up in-hospital and for 3 months. RESULTS: RV dysfunction occurred in ninety-five (61.3%) patients of the study population. Significant improvement occurred to TAPSE after 3 months in comparison to TAPSE at baseline (15.45 ±â€¯3.21 versus 17.09 ±â€¯4.17 mm). Those with impaired RV function showed improvement of TAPSE after three months as compared to baseline (13.62 ±â€¯2.58 vs 17.16 ±â€¯3.64 p = 0.008). Multivariate analysis determined the independent predictors of RV dysfunction as RVEDD > 26 mm, RVFAC < 35%, RAA > 20 cm2, and TAPSE < 17 mm. CONCLUSION: RV dysfunction is not uncommon in NSTEMI when using the definition of TAPSE < 17 mm. Following up RV function by TAPSE, showed significant improvement after 3 months with successful PCI as compared to baseline. We recommend assessing and following up RV function in all patients admitted with a NSTEMI.

Clinical role of serum Copeptin in acute coronary syndrome.

OBJECTIVE: To assess the role of Copeptin in diagnosis of acute myocardial infarction in troponin-blind period. SUBJECTS AND METHODS: This study was conducted on 40 patients who presented to emergency department complaining of chest pain and were highly suspicious to have acute cardiac ischemia, in addition to 10 subjects serving as a healthy control group. Blood samples were collected for determination of CK-MB, cTnI and Copeptin. These were measured twice (in patients' group); at 3 h and then at 6-9 h from admission time. RESULTS: The first sample revealed a non-significant difference between UA group and AMI group as regards CKMB and troponin, however, high significant difference was found as regards Copeptin (Z = 5.29, P < 0.001). Moreover, ROC curve analysis of serum Copeptin for discriminating AMI group from UA group in the first sample showed diagnostic sensitivity and specificity of 100%. IN CONCLUSION: Determination of copeptin in early diagnosis of AMI has diagnostic value being superior to a conventional cTn-I within the first three hours after acute chest pain.

Mitral leaflet separation index. An easy two dimensional echocardiography technique for assessment of mitral valve area before and after percutaneous balloon mitral valvuloplasty.

AIM: To evaluate the reliability of the mitral leaflet separation (MLS) index against the traditional echocardiographic methods in measuring mitral valve area (MVA) pre and post percutaneous balloon mitral valvuloplasty (PBMV). METHODS: Ninety patients suffering symptomatic moderate to severe MS underwent PBMV at Ain Shams University Hospital in cardiology department. Seventy of the patients were females representing 77.8% and 20 were males representing 22.2%. Their age ranged from 22 to 56 years. All patients were subjected to full transthoracic echocardiography (TTE) examination pre and post PBMV. MLS index was introduced as a comparative parameter with traditional echocardiographic methods for assessment of MVA, measuring average of distance between tips of MV leaflets in parasternal long axis and four chamber two dimensional echocardiographic views. RESULTS: MVA increased from 0.95 ±â€¯0.28 to 2.21 ±â€¯0.41 cm2 (P=0.001) using 2D planimetry; and increased from 0.93 ±â€¯0.23 to 2.21 ±â€¯0.46 cm2 (P= 0.0011) by pressure half time method (PHT). MLS index was correlated with MVA by 2D planimetry pre and post PBMV (r=0.453) and (r=0.668) respectively (p=0.0001) and strongly correlated with MVA using PHT post PBMV (r=0.768) (p=0.0001). Post PBMV 14 patients suffered significant mitral regurgitation 3 of them were transferred to surgery. MLS index above 11.75 mm and below 9.15 mm had excellent positive predictive value for detecting mild and severe MS respectively. CONCLUSION: The MLS index it is a simple and effective method for assessment of the MVA, it has an excellent correlation with MVA with an excellent sensitivity and specificity for the prediction of effective MVA. The MLS index cannot evaluate outcome of PBMV because it is an anatomical parameter and not flow dependent thus does not correlate with grades of mitral regurgitation.

Assessment of left ventricular systolic function by tissue Doppler imaging in controlled versus uncontrolled type 2 diabetic patients.

AIM: To detect and quantify early subtle left ventricular (LV) systolic dysfunction using Tissue Doppler Imaging in type 2 diabetic patients with apparently normal LV ejection fraction. METHODS: Ninety age and sex matched subjects were enrolled in the study, sixty of them were suffering from type 2 diabetes mellitus (DM) whom were divided according to HbAlc into 2 groups, 30 uncontrolled diabetic patients with HbAlc > 8% and 30 controlled diabetic patients with HbAlc < 8% and a third group of 30 normal subjects served as controls. We excluded patients with inadequate Doppler signal, all structural heart diseases, systemic disorders with cardiac involvement and patients with false positive HbAlc. Assessment of diastolic function was done by Pulsed Doppler through mitral flow and by propagation flow velocity. Assessment of left ventricular systolic function was done by conventional echocardiography by 2D Simpson method and by Tissue Doppler Imaging (TDI) through detection of mitral annular peak systolic velocities. RESULTS: Left ventricular diastolic function was compared between the studied groups and showed that the mean peak early mitral inflow velocity E wave and the color M-mode flow propagation velocity of early diastolic flow (Vp) were significantly lower, and the mean peak late mitral inflow velocity A wave was significantly higher in uncontrolled diabetics versus controlled diabetic patients and control group with highly significant statistical difference (p < 0.001). Assessment of global systolic function by conventional Simpson's modified biplane method didn't show significant difference between uncontrolled diabetic patients, controlled diabetic patients and normal individuals. However, evaluation of systolic function by Tissue Doppler Imaging showed that the mean peak longitudinal systolic velocity was significantly decreased in uncontrolled diabetic patients when compared to controlled diabetic patients and normal individuals, with highly significant statistical difference (p < 0.001). A cut-off value for systolic dysfunction detected by TDI in uncontrolled diabetic patients was calculated. The peak systolic velocities < 7 cm/s for medial mitral annulus and < 8.2 cm/s for lateral mitral annulus indicated systolic dysfunction in diabetic patients with sensitivity and specificity of 96% and 67% respectively for medial mitral annulus while 98% and 71% respectively for lateral annulus. CONCLUSION: TDI is a simple and effective method for detection of subtle LV systolic dysfunction in type 2 uncontrolled diabetic patients.

Pooled analysis of percutaneous mitral valvuloplasty in Egypt.

BACKGROUND: Till now, no pooled analysis summarizing the Egyptian experience in percutaneous mitral valvuloplasty (PMV) exists. OBJECTIVES AND METHODS: To pool the data of PMV procedures and perform a new analysis regarding the immediate outcome and follow-up results as well as to compare the results of different techniques. RESULTS: Patients (2,256) with mitral stenosis of rheumatic origin were included, 292 males and 1,964 females. Double balloon (DB) was used in 1,148 patients (51%), Inoue balloon (IB) in 914 patients (40.5%), metallic commissurotome (MC) in 142 patients (6%), Multi-Track in 33 patients (1.5%), and single balloon in 19 patients (1%). The mitral valve area (MVA) increased from 0.94 +/- 0.18 cm2 to 1.92 +/- 0.36 cm2; mean pressure gradient dropped from 15.94 +/- 5.46 mmHg to 5.85 +/- 2.6 mmHg. The most common complication was the occurrence of a new mitral regurgitation (MR) and/or increase in its grade (36%). Inadequate dilatation occurred in 192 patients (8.5%). Follow-up data (for 5.7 +/- 5.9 months) showed that the immediate results of PMV on MVA persisted through the follow-up period (1.78 +/- 0.35 cm2). Multi-Track system resulted in the largest increase in MVA and also resulted in the largest immediate increase in the grade of MR. CONCLUSIONS: This study confirms the success of PMV and its results during follow-up. The Multi-Track system, and the DB resulted in the largest MVA, the IB and the single balloon resulted in the least increase in MR. The most common complication of PMV is the increase in the degree of MR.

Percutaneous mitral valvotomy versus closed surgical commissurotomy. Up to 15 years of follow-up of a prospective randomized study.

BACKGROUND: Immediate and intermediate term results of percutaneous mitral valvotomy (PMV) are comparable to closed surgical commissurotomy (CSC). We aimed at exploring this relation in the long term. METHODS: Previously, we randomized 40 consecutive patients with moderate to severe mitral stenosis [defined as mitral valve area (MVA) less than 1.5 cm²] to undergo either PMV (PMV group = 20 patients) or CSC (CSC group = 20 patients). For all patients, full echocardiographic assessment was performed before the procedure/operation. Patients assigned to PMV underwent the double balloon technique. Echocardiographic assessment was done following both procedures before discharge and repeated 1 and 6 months later. Echocardiographic follow-up was performed, thereafter, on a yearly basis for up to 15 years, with a mean follow-up period of 99 ± 12 months. RESULTS: Immediate echocardiographic results showed no statistically significant difference between the 2 groups regarding the final MVA or mean diastolic gradient across the mitral valve. Two patients dropped out from the CSC group and one from the PMV group. MVA was 1.8 ± 0.3 cm² versus 1.8 ± 0.4 cm² (p > 0.05) and mean diastolic pressure gradient across the mitral valve was 7 ± 4 mmHg versus 6.6 ± 4 mmHg (p > 0.05) in the PMV and CSC groups, respectively. Mitral restenosis occurred in 5 (26.3%) patients in the PMV group versus 5 (27.8%) patients in the CSC group (p > 0.05). Kaplan-Meier curves for restenosis-free survival showed no difference between the 2 groups. CONCLUSION: PMV achieves comparable results to CSC both in the short and long term.

Relationship between cardiovascular risk as predicted by established risk scores and coronary artery plaque composition as detected by virtual histology intravascular ultrasound analysis: the PREDICT pilot study.

AIMS: Identification of subclinical high-risk plaques is potentially important because they may have greater likelihood for rupture and thrombosis. The aim of this study was to assess the relationship between in vivo coronary artery plaque composition using intravascular ultrasound virtual histology (IVUS-VH) and cardiovascular risk as predicted by clinical risk scores in patients with non-obstructive stable coronary artery disease. METHODS AND RESULTS: Forty patients undergoing elective coronary angiography revealing <50% coronary artery stenoses were prospectively included. Of these, 38 (29 men; mean age 65+/-9 years) underwent a satisfactory IVUS-VH investigation of the affected vessel. For each patient, the 10-year risk of cardiovascular events was calculated using the Framingham and the SCORE-Deutschland risk prediction algorithms, and compared to the VH-derived plaque composition at the site of the minimal lumen area (MLA). For both algorithms, patients at low estimated risk of events showed more fibrous tissue percentages than patients at high risk (67.4+/-9.7% versus 53.2+/-10.4% for the SCORE algorithm, and 65.6+/-13.4% versus 51.5+/-9.4% for the Framingham algorithm, p=0.002 and p=0.004, respectively). Plaques of patients with higher risk showed a non-significantly higher necrotic core percentage. For the SCORE algorithm, dense calcium percentage was higher in patients with high risk compared to patients with low risk (13.9+/-10.4% versus 4.9+/-4.9%, p=0.008). The prevalence of IVUS-derived thin cap fibro-atheromas at the MLA site was higher in patients at high risk (80% of lesions in patients at high risk using the SCORE algorithm and 92% of lesions in patients at high risk using the Framingham algorithm), whereas patients at low risk had more stable plaque phenotypes (p=0.002 and 0.003 for the SCORE and Framingham algorithms, respectively). CONCLUSIONS: In vivo plaque composition and morphology assessed by IVUS-VH were related to the cardiovascular risk predicted by established risk prediction algorithms in patients with non-obstructive coronary artery disease, suggesting a link between the higher risk for future events and the VH-derived plaque morphology.