Clinical and echocardiographic evaluation of patients undergoing total leaflets preservation during mitral valve replacement; Does it make a difference?

Background: The effect of anterior and posterior leaflet preservation on left ventricular function after mitral valve replacement is still the subject of ongoing research. The objective of this study is to analyze the early outcomes of total leaflets preservation compared to posterior and non-leaflet preservation during mitral valve surgery on cardiac function and dimensions measured by echocardiography and on the clinical outcomes.Methods: This prospective cohort study recruited 155 patients who had mitral valve replacement (MVR) from April 2016 to March 2018 at Assiut University Hospital. Patients were divided into three groups according to the technique of leaflets preservation; Group I (no leaflet preservation-N-MVR), Group II (total leaflet preservation- T-MVR) and Group III (posterior leaflet preservation-P-MVR). Patients who underwent redo mitral valve replacement (MVR) or those with endocarditis and had combined coronary artery bypass grafting with the MVR were excluded from the study.Results: There were nine early deaths (6%); eight patients were in Group I (N-MVR). Causes of mortality were massive intracranial hemorrhage (n= 2) and left ventricular failure (n=6). One patient died in Group III (P-MVR) from intracranial hemorrhage (1.3%). Hospital stay was significantly longer in N-MVR group compared to T-MVR and P-MVR (10.6±2.13 days in N-MVR group; p= 0.03 and 0.011 respectively). Postoperative low cardiac output occurred in all patients in N-MVR group. Left ventricular function (ejection fraction= 61.28±6.02%) and dimensions (end-diastolic diameter= 5.18±0.69 mm, end-systolic diameter= 3.58±0.78 mm) improved significantly in total leaflets preservation group.Conclusion: Leaflet preservation during mitral valve replacement was associated with improved clinical and echocardiographic outcomes. Non-leaflets preservation increased the risk of postoperative complications and length of hospital stay. Leaflet preservation is recommended as the standard approach during mitral valve replacement

Obtained Carbon Nano-onions from Underwater Arc Discharge Without the Complex Purification Procedures

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Cytokine profile of obese asthma phenotype

Background: The incidence of asthma and obesity is increasing worldwide. Understanding the causal directions between asthma and obesity could have important therapeutic implications. However, the mechanism connecting the two is not well defined.Objective: This study was undertaken to compare pulmonary function tests (PFTs), C-reactive protein (CRP) and inflammatory cytokines in obesity and asthma in Egyptian adolescents and to investigate whether obese asthmatics have a specific inflammatory phenotype than lean asthmatics.Methods: Fifty asthmatic and 30 control subjects were enrolled in the study and divided into 2 sub-groups: obese and non-obese. Serum levels of CRP, leptin, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-5, body mass index (BMI) and PFTs were done for asthmatics and controls.Results: Serum levels of IL-6, TNF-α and leptin in obese individuals whether asthmatic or not showed significant increase compared to lean ones (P < 0.01). Body mass index (BMI) showed positive linear correlations with serum levels of IL-6, TNF-α, leptin and CRP. Serum IL-5 showed significantly higher levels in all asthmatics versus all controls (P < 0.01). Also serum IL-5 showed non-significant difference between lean and obese asthmatics and it showed significant negative correlations with FEV1/FVC % and PEF.Conclusion: Serum levels ofIL-6, TNF-α and leptin could be considered surrogate markers for obesity, whereas serum IL-5 is considered a marker of airway inflammation in bronchial asthma. Thus obesity and asthma have been shown to coexist together but systemic and airway inflammation appears to operate independent of each other.Keywords: Asthma, cytokines, obesity, phenotyp

The role of cytological smears in identification of bacterial infection and abnormalities in vaginal epithelium cells among apparently healthy married Sudanese Women

Background: Vaginal infection represents a major health problem in most part of the world. Many factors have been identified as important causative agents that responsible for the development of vaginal precancerous and cancerous lesions. In Sudan, infection has been identified as a major cause. Aim: To determine the role of cytological smears in identification of bacterial infection and abnormalities in vaginal epithelium cells among apparently health married Sudanese Women. Methods: In this study 100 apparently healthy women were selected. Cytological materials were obtained by scraping the surface of the vagina. The obtained materials were applied with Pap Staining Method. Results: A total of one hundred samples of vaginal smears were included in this study, the age of the participant ranged from 20 to 70 years. Infection: Out of 100 samples 26 samples (26 %) had a bacterial infection, 3 samples (3%) had Actinomyces infection, and 71 samples (71%) were negative. Out of 100 samples 6 samples (6%) had acute inflammation, 5 samples (5%) had chronic inflammation and 89 samples (89%) were negative. Out of 100 samples 22 samples (22%) had inflammatory changes and 84 samples (78%) were negative. Conclusion: Bacterial vaginosis appears to be the predominant cause of vaginitis. The conventional cytology for exfoliative cells from female genitalia by using PAP stain is routine, specific, and sensitive, technique easy and not expensive so it is ideal technique for screening

Reproductive biology of greasy grouper, Epinephelus tauvina and coral hind grouper Cephalopholis miniata (Family: Serranidae) in the southern Red Sea, Shalatien, Egypt

Groupers are the main component of commercial fisheries in the Red Sea. The reproductive biology of Epinephelus tauvina and Cephalopholis miniata collected at the Shalatien landing site in the southern Egyptian Red Sea were investigated from January to December 2017. A total of 212 specimens of E. tauvina with a total length range of 23.6 to 70.3 cm and 243 specimens of C. miniata with a total length range of 17.4 to 42.1 cm were examined. Females of E. tauvina and C. miniata accounted for 61.7 and 61.9% of the total fish sampled, showing a 1:1.61 and 1:1.63 male-to-female sex ratio, respectively. The monthly distribution of maturity stages and gonadosomatic index values showed that the spawning season for both sexes was extended from April to October for E. tauvina and from April to September for C. miniata. The lengths at first sexual maturity of the males and females of E. tauvina were estimated at 49 and 48.1 cm, respectively, while those for C. miniata were estimated at 23.2 and 22.7 cm, respectively. All our results can help in the proper management of these valuable resources

Association Between Hemoglobin A1C and the Severity of Acute Ischemic Stroke in Sudanese Patients in Omdurman Military Hospital

Background: Hemoglobin A1C (HbA1c) levels are known to be linked to a higher risk of stroke. However, no research data is available on the impact of HbA1C on the severity of acute ischemic stroke in Sudan. Methods: This study is a descriptive, cross-sectional hospital-based study of 40 cases of acute ischemic stroke. Ischemic stroke was confirmed using computed tomography (CT) scan at admission; all subjects’ blood HbA1C levels were also measured. Participants were divided into two subgroups based on HbA1C at admission, good glycemic control (GGC) (<7 HbA1C) and poor glycemic control (PGC) (>7 HbA1C), and neurological impairment was assessed using the National Institutes of Health Stroke Scale (NIHSS). Results: The age distribution of the participants was 45-85 years, with an average age of 63.5±9.2 years with the highest frequency (67.5%) in the age group of 55-75 years. PGC had a statistically significant high HbA1C value of 8.9±1.3 (P=0.000), when compared to GGC subgroups 5.1±0. The association between stroke severity and HbA1C levels on admission in this study was statistically significant (P value=0.005), on admission (78.6%) PGC had moderate to severe stroke (> 18.8 NIHSS) versus (33.3%) that of the GGC (>10.4NIHSS). The frequency of elevated HbA1C levels in patients with acute ischemic stroke was 70% in this study. Conclusion: PGC was shown to be linked to the occurrence of stroke and to its severity

Effect of levothyroxine plus liothyronine combination therapy on hypothyroid patients quality of life

BackgroundLiothyronine combination with Levothyroxine(T4-T3) has been tried to improve the quality of life among hypothyroid patients on levothyroxine immunotherapy and normal thyroxine stimulating hormone levels. However, the efficacy of such a combination is unknown. The current review aimed to assess the effects of T4-T3 combination therapy on quality of life.AimsThe current review aimed to compare levothyroxine mono-therapy versus T4-T3 combination therapy on quality of life among hypothyroid patients.Methods The Pub Med and Google Scholar databases were systematically searched for relevant articles. Articles published in the English language from the first available article up to March 2020 were approached. The terms hypothyroidism, levothyroxine, and liothyronine were used. Out of hundred and eight articles retrieved, only six fulfilled the inclusion and exclusion criteria.Results In majority of randomized control trials (4 out of 6 RCTs), T4/T3combination therapy fail to show superiority over the standard levothyroxine mono-therapy.ConclusionLevothyroxine remain the standard of care in hypothyroid patient

Longitudinal changes in peri-papillary retinal nerve fiber layer thickness in patients with unilateral branch retinal vein occlusion

Background: Associations between retinal venous occlusion (RVO), elevated intraocular pressure, and glaucoma have been reported. Further investigations into structural alterations in the fellow eyes of individuals with unilateral RVO have revealed that the peripapillary retinal nerve fiber layer is thinner than in healthy eyes, suggesting that there may be systemic risk factors common to both RVO and glaucoma. We aimed to evaluate changes in peripapillary retinal nerve fiber layer thickness (pRNFLT) among individuals with unilateral branch retinal vein occlusion (BRVO). Methods: This prospective observational study recruited 30 individuals (60 eyes) with newly diagnosed unilateral BRVO and macular edema, and a control group of 30 healthy individuals (30 eyes) with no abnormalities on fundus examination or concurrent systemic comorbidities. After baseline measurements, the participants were reassessed at 6, 12, and 24 months by measuring global and sectoral pRNFLT using spectral-domain optical coherence tomography. Results: The mean age and sex distributions were comparable between the patient and control groups (both P > 0.05). When compared to fellow eyes, global and sectoral pRNFLT in eyes with BRVO were significantly higher at baseline (all P < 0.05). Over time, pRNFLT decreased dramatically, and by the conclusion of the two-year follow-up, there was a significant reduction from baseline in the affected eyes (all P < 0.05). Likewise, affected eyes experienced a significant improvement in best-corrected distance visual acuity and central macular thickness over the two-year follow-up (both P Less than or equal to 0.001). Comparing the global and all-sector pRNFLT of fellow eyes in the patient group with those of normal eyes in the control group, there were no significant differences at any visit, except in the temporal sector, which revealed a significant reduction in pRNFLT at 24 months in the fellow eyes of patients with unilateral BRVO (P = 0.02).   Conclusions: Patients with unilateral BRVO experienced a significant reduction in pRNFLT in the affected eyes and, to a lesser extent, in the fellow eyes, compared with that of the control arm, suggesting that they are prone to retinal nerve fiber layer damage. The reduction in pRNFLT in the normal fellow eyes of patients with BRVO may be attributed to age or concurrent systemic comorbidities. Further studies with long follow-up periods are required to shed light on the etiology of functional and structural changes in both the retinal nerve fiber layer and ganglion cell complex in the normal and affected eyes of patients with unilateral BRVO