Prognostic utility of negative stress/rest myocardial SPECT studies among patients with different clinical categories of chronic kidney disease: Data from an Egyptian cohort

AbstractPrognostic value of negative myocardial SPECT study is well established. However, patients with chronic kidney disease (CKD) are a special group showing increased risk of cardiac events. We thought to investigate the prognostic value of negative SPECT study among patients on regular hemodialysis compared to other clinical categories of CKD.Methods186 consecutive patients with CKD and negative SPECT study were enrolled. 93 (50%) were on hemodialysis with an eGFR<30mL/min/1.73m2 (Group I); 25 (13.4%) had uncomplicated renal transplantation with eGFR between 45 and 90mL/min/1.73m2 (Group II) and 68 (36.6%) with CKD on conservative management and no prior history of hemodialysis (eGFR between 30 and 60mL/min/1.73m2), Group (III). End points (CD, STEMI/NSTEMI, need for revascularization and hospitalized HF) were traced at 6months, one year and 2years.ResultsTotal events in all groups were 5 (2.70%) at 6months, and 18 (9.70%) and 36 (19.30%) at one year and 2years respectively. At one year 16 (17.20%) cardiac events happened in Group I compared to one (4.0%) and one (1.50%) event(s) in Groups II and III respectively (p values 0.001). At 2years, 29 (31.20%) cardiac events happened in Group I while 2 (8.0%) and 5 (7.30%) happened in Groups II and III respectively (p values 0.01, 0.001 respectively). eGFR and duration of hemodialysis were the independent predictors of cardiac events.ConclusionDespite negative MPI study, patients on hemodialysis showed higher event (including CD, STEMI/NSTEMI and revascularization) rate at one and 2years of follow-up compared to other clinical categories of CKD

Evaluation of Some Prognostic Biomarkers in Human Papillomavirus-Related Multiphenotypic Sinonasal Carcinoma

Background: Human papillomavirus (HPV)-related multi phenotypic sinonasal carcinoma (HMSC) is a recently described tumor subtype with an unknown prognosis, often misdiagnosed with other sinonasal carcinomas, and associated with high-risk HPV (HR-HPV). The present study aimed to evaluate the expression of vascular endothelial growth factor (VEGF), Bcl-2-associated X protein (BAX), epidermal growth factor receptors (EGFR), ProEx™C, and human telomerase reverse transcriptase (hTERT) and assess their association with survival and clinicopathological characteristics.Methods: Between 2017 and 2022, 40 HMSC patients underwent surgical resection at the School of Medicine, Zagazig University Hospitals (Zagazig, Egypt). Tissue samples were examined for the presence of HR-HPV; absence of myeloblastosis (MYB), MYB proto-oncogene like 1 (MYBL1), and nuclear factor I/B (NFIB) fusions and the presence of myoepithelial proteins (calponin, S100, SMA), squamous differentiation markers (p63, p40, calponin), VEGF, BAX, ProEx™C, and hTERT by immunohistochemistry. All patients were followed up for about 54 months until death or the last known survival data. Data were analyzed using the Chi square test and Kaplan-Meier method.Results: The expression of VEGF, hTERT, and ProEx™C was significantly associated with age, advanced tumor stages, lymph node metastasis, tumor size, mortality, relapse, poor disease-free survival (DFS), and overall survival (OS) (P<0.001). BAX expression was significantly associated with tumor size, age, poor DFS, and relapse (P=0.01, P<0.001, P=0.035, and P=0.002, respectively). Conclusion: HMSC is strongly associated with HR-HPV. The expression of VEGF, EGFR, BAX, hTERT, and ProEx™C is associated with aggressive malignant behavior, poor survival, and poor prognosis, making them novel prognostic biomarkers for targeted therapeutics in HMSC

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

The dilemma of ischemic heart failure; how FDG-PET can guide therapy and improve outcomes? Case report

Patients with ischemic LV dysfunction are at increasing risk of adverse cardiac events including sudden cardiac death. Proper revascularization of viable ischemic myocardium (compared to medical treatment alone) is associated with improvement of LV systolic function, less cardiac morbidities & mortalities and better functional capacity and well-being. Many diagnostic tools are used in clinical practice for assessment of myocardial viability. Dobutamine stress Echocardiography (DSE) is the most widely used technique, while delayed enhancement cardiac magnetic resonance (DE-CMR) and Flourine-18-fluorodeoxy-glucose positron emission tomography (18F-FDG PET) are considered the standard of care for assessment of myocardial viability. Our case report illustrates how FDG PET myocardial viability assessment can guide therapy and improve outcomes in a difficult clinical and angiographic situation

Extracardiac mediastinal uptake incidentally seen during myocardial SPECT studies; are all neoplastic?

Incidentally seen non-cardiac findings during myocardial single photon emission computed tomography (SPECT) imaging are not uncommon. These findings may be an indirect but important indication for a variety of non-cardiac disorders that may occasionally mimic cardiac symptoms. Some of these disorders are gastric diseases, liver and gallbladder diseases, spleen disorders, sternal and vertebral pathologies, and pulmonary diseases. Many reports emphasized the value of reviewing raw data in the process of reporting SPECT studies, a rule that is easily forgotten by nuclear medicine specialists. This systematic way of reviewing raw data is not only used for quality control purposes, but also for better detection of non-cardiac incidental findings

Powerful Antioxidants and Cytotoxic Activities of the Methanol Extracts from Eight Soybean Cultivars

In the present study, the chemical composition and total phenolic (TPC) and total flavonoid contents (TFC) of eight soybean cultivars (Giza 21, Giza 22, Giza 35, Giza 111, Giza 82, Giza 83, Crawford, and Holliday) were estimated. Moreover, antioxidant activity and in vitro cytotoxic activities against HepG-2 and MCF-7 were evaluated. Giza 21, Giza 111, and Crawford cultivars recorded higher than 40% crude protein. The analysis revealed that TPC values in seed extracts ranged from 10.5 mg GAE/g extract in Giza 35 to 6.4 mg GAE/g extract in Giza 22. TFC varied from 1.20 mg QE/g extract in Giza 111 to 0.55 mg QE/g extract in Crawford. Giza 35 exhibited the highest content of genistein and daidzein and the highest free radical scavenging activity (61.833%). The results of the MTT assay demonstrated that the soybean methanolic extracts inhibited the proliferation of HepG-2 and MCF-7 cells in a dose-dependent manner. Giza 35 exhibited the highest cytotoxic activity. In conclusion, Giza 35 cultivar recorded the highest TPC and TFC values and antioxidant and cytotoxic activities. Therefore, this cultivar can be used as a source for the production of pharmaceutical and medicinal products rather than as a nutritional source of protein

Effects of Selenium Supplementation on Rumen Microbiota, Rumen Fermentation, and Apparent Nutrient Digestibility of Ruminant Animals: A Review

Enzymes excreted by rumen microbiome facilitate the conversion of ingested plant materials into major nutrients (e.g., volatile fatty acids (VFA) and microbial proteins) required for animal growth. Diet, animal age, and health affect the structure of the rumen microbial community. Pathogenic organisms in the rumen negatively affect fermentation processes in favor of energy loss and animal deprivation of nutrients in ingested feed. Drawing from the ban on antibiotic use during the last decade, the livestock industry has been focused on increasing rumen microbial nutrient supply to ruminants through the use of natural supplements that are capable of promoting the activity of beneficial rumen microflora. Selenium (Se) is a trace mineral commonly used as a supplement to regulate animal metabolism. However, a clear understanding of its effects on rumen microbial composition and rumen fermentation is not available. This review summarized the available literature for the effects of Se on specific rumen microorganisms along with consequences for rumen fermentation and digestibility. Some positive effects on total VFA, the molar proportion of propionate, acetate to propionate ratio, ruminal NH3-N, pH, enzymatic activity, ruminal microbiome composition, and digestibility were recorded. Because Se nanoparticles (SeNPs) were more effective than other forms of Se, more studies are needed to compare the effectiveness of synthetic SeNPs and lactic acid bacteria enriched with sodium selenite as a biological source of SeNPs and probiotics. Future studies also need to evaluate the effect of dietary Se on methane emissions

Effects of Selenium Supplementation on Rumen Microbiota, Rumen Fermentation, and Apparent Nutrient Digestibility of Ruminant Animals: A Review

Enzymes excreted by rumen microbiome facilitate the conversion of ingested plant materials into major nutrients (e.g., volatile fatty acids (VFA) and microbial proteins) required for animal growth. Diet, animal age, and health affect the structure of the rumen microbial community. Pathogenic organisms in the rumen negatively affect fermentation processes in favor of energy loss and animal deprivation of nutrients in ingested feed. Drawing from the ban on antibiotic use during the last decade, the livestock industry has been focused on increasing rumen microbial nutrient supply to ruminants through the use of natural supplements that are capable of promoting the activity of beneficial rumen microflora. Selenium (Se) is a trace mineral commonly used as a supplement to regulate animal metabolism. However, a clear understanding of its effects on rumen microbial composition and rumen fermentation is not available. This review summarized the available literature for the effects of Se on specific rumen microorganisms along with consequences for rumen fermentation and digestibility. Some positive effects on total VFA, the molar proportion of propionate, acetate to propionate ratio, ruminal NH3-N, pH, enzymatic activity, ruminal microbiome composition, and digestibility were recorded. Because Se nanoparticles (SeNPs) were more effective than other forms of Se, more studies are needed to compare the effectiveness of synthetic SeNPs and lactic acid bacteria enriched with sodium selenite as a biological source of SeNPs and probiotics. Future studies also need to evaluate the effect of dietary Se on methane emissions