Role of MDCT renal angiography in determining the anatomical eligibility for renal sympathetic denervation in resistant hypertensive patients

Objective: Aim of this study was to assess role of Multidetector computed tomography (MDCT) Renal Angiography in determining the anatomical eligibility for renal sympathetic denervation in resistant hypertensive patients. Subjects and methods: This study included 30 patients, referred from hypertension unit in Zagazig University Hospital, with refractory systemic hypertension [an office blood pressure (BP) >140/90 mmHg despite treatment with at least three drugs, including a diuretic in adequate doses]. All cases were performed using a 128-slice MDCT scanner. All data were transferred to an imaging workstation for reconstruction and analysis. Axial source images were post-processed to produce multiplanar reformation, curved planar reformation, maximum intensity projection and volume rendering images. Results: Most patients (46.7%) had an A1/A1 type renal artery (RA). 66.7% were completely eligible (CE), 23.3% were partially eligible (PE), and 10% were non eligible (NE). Regarding intraobserver agreement; concordance between two readings by the same radiologist was in 96.7%, while discordance was in 3.3%. Regarding interobserver agreement; concordance between two radiologists was in 93.3% while discordance was in 6.7%. Conclusion: MDCT renal angiography gives valuable knowledge to the interventional radiologist and cardiologist before renal artery denervation (RDN) to increase the success rate. Keywords: MDCT renal angiography, Eligibility, Resistant hypertension, Renal sympathetic denervatio

How to predict the presence of silent ischemia in asymptomatic type 2 diabetic patients? Role of myocardial performance index

Clinical Research. Presentation type: Oral Presentation. Introduction: Coronary artery disease (CAD) is an important cause of morbidity and mortality in diabetic patients. Silent myocardial ischemia (SMI) is common in diabetic patients and is associated with poorer prognosis. Myocardial performance index ”Tei index” that reflects both left ventricular (LV) systolic and diastolic function. The aim of our study was to test the value of Tei index in prediction of SMI in asymptomatic type 2 diabetic patients. Methodology: Asymptomatic patients with type 2 diabetes were included in our study. We excluded patients with known CAD, previous revascularization, low ejection fraction or abnormal ECG from the study. All patients had undergone history taking and clinical examination, ECG, echocardiography with measuring of Tei index and Holter monitoring for detecting silent ischemia. Results: 200 patients were recruited. We divided our patients into two groups: Group I: 64 patients with SMI, Group II: 136 patients without SMI. There was no significant difference between the two groups regarding clinical and conventional echocardiographic data. Tei index was significantly higher in patients with silent ischemia (p < 0.00001). Sensitivity, specificity, positive, and negative predictive values of Tei index ⩾0.6 in prediction of Holter detected silent ischemia were 85.9 %, 90 %, 78.6 %, and 88.6 % respectively. We found a significant positive correlation between Tei index and number of ischemic episodes (r = 0.366, p = 0.0029). Conclusion: Measuring Tei index is helpful in predicting the presence of silent ischemia in asymptomatic type 2 diabetic patients

55. Can we assess the success of balloon pulmonary valvuloplasty by ECG

The gold standard for diagnosis of pulmonary stenosis (PS) is by echocardiography. P wave dispersion (PWD) indicates the spreading of the sinus stimulus in the atria. Aim of the work: Study the effect of PS and its treatment by BPV on electrocardiographic (ECG) parameters as PWD and P wave amplitude. Patient & Methods: Patients with moderate or severe valvular PS was enrolled in the study. PWD and maximum P amplitude (max P amplitude) on ECG were measured. The peak systolic pressure gradients (SPG) over the pulmonary valve were obtained. All cases were underwent BPV. Reassessment of SPG and ECG parameters were done immediately and one month later. Results: Forty two patients were recruited .Their age ranged from 3 to 38 years. PWD before balloon had mean ± SD (0.06 ± 0.017). It decreased significantly to (0.04 ± 0.017) and (0.04 ± 0.013) immediately and One month after balloon respectively (p value 0.001 ). The max P amplitude had mean ± SD before balloon (0.08 ± .027) and it decreased significantly to (0.07  ± 0.025) 1 month later (p value 0.013). There was significant correlation between SPG and PWD (p value <0.05). There was significant correlation between the drop in SPG after BPV and the change in max p amplitude (p value 0.041). However, there was non significant correlation between the drop in SPG and the change in PWD. Conclusion: PWD and max P amplitude decrease significantly with BPV. The study demonstrated for the first time very simple ECG parameters; PWD and P amplitude that may predict the success of BPV on the short term

Effect of the Nile Aquifer Lithological Characteristics on Groundwater Chemistry in Assiut Governorate, Egypt

The chemical composition of groundwater is affected by many features, including the impact caused by surrounding rocks. The Nile aquifer is surrounded by the calcareous structural plateau along the Assiut governorate on both sides. This paper aims at studying the effect of surrounding rocks on the chemical composition of groundwater in the Nile aquifer along the Assiut governorate. Fifty-five samples were taken from drinking water stations and irrigation wells in 2015, and then analyzed chemically in water and soil fertility laboratory located in the irrigation ministry in Assiut. Aquachem software package was used to determine the groundwater type and rock source deduction. Piper-trilinear diagram was plotted to show the hydrochemical facies. Furthermore, Gibbs diagram was applied to determine the correlation between water composition and aquifer lithological characteristics. The results revealed that nearly all of the groundwater samples drop in the water-rock interaction field. The results of rock source deduction show that the ratio of Cl to the sum of anions is less than 0.8 for all samples, concluding that the rock weathering is dominant. According to the criterion of TDS values, 78% of all the samples indicated that the carbonate weathering is prevalent; in turn, the ratio of Mg to Ca plus Mg shows that limestone-dolomite weathering is predominant. These results confirm that the calcareous structural plateau surrounding the Nile aquifer along the Assiut governorate has an effect on the groundwater chemistry by interacting between groundwater and limestone rocks which are the main component of the calcareous plateau