Perioperative glycemic control in diabetic patients undergoing coronary artery bypass graft surgery

Background: The concept of perioperative glycemic control in cardiac surgery patients was conducted in many studies, however, it remains unclear how tight the glycemic control should be. Our aim is to study the effect of perioperative tight glycemic control versus moderate glycemic control on the outcome of diabetic patients undergoing coronary artery bypass graft (CABG) surgery. Methods: This study is a randomized prospective study conducted on 135 diabetic patients planned for CABG surgery. Patients were divided into 2 groups: group A subjected to tight glycemic control during operation to maintain blood glucose level between 110 and 149 mg/dl and group B subjected to conventional moderate glycemic control to achieve blood glucose level between 150 and 180 mg/dl using continuous insulin infusion started before anesthesia induction and continued till the patient is extubated in ICU. Both groups were followed up till 1 month after operation regarding operative mortality and postoperative outcome. Results: No significant difference between both groups in mortality, however there was statistical significant relationship between tight glycemic control group and lowered incidence of postoperative atrial fibrillation, sternal wound infection, need for inotropic support and reduced time spent on mechanical ventilation. We noticed reduction in incidence of acute renal failure in tight glycemic control with no difference between both groups in neurological insults, renal dysfunction and perioperative myocardial infarction. Conclusion: Tight glycemic control improved perioperative outcome in diabetic CABG patients. Maintaining perioperative blood glucose level between 110 and 149 mg/dl is safe and should be recommended as a routine practice in diabetic patients undergoing CABG surgery

Thymectomy in non thymomatous myasthenia gravis: Impact of pathology on outcome and role of survivin in pathogenesis

Background: Myasthenia gravis is an autoimmune disorder characterized by production of acetylcholine receptor antibodies. These antibodies are mainly produced by thymic B-lymphocytes. Our aim was to detect the correlation between thymic pathology and outcome of myasthenia gravis. Moreover, we tried to detect the involvement of survivin as an apoptosis inhibitor in pathogenesis of myasthenia. Methods: This study was a prospective study conducted on 36 non thymomatous myasthenic patients subjected to thymectomy. Patients were followed for 6 months after operation. Moreover, 36 control normal thymic specimens were obtained from patients operated for open heart surgery. Resected thymic tissue was sent for histopathological examination and immunohistochemical staining by survivin to examine its role in pathogenesis of myasthenia. Results: Patients were divided into group A with hyperplastic thymus and group B with atrophic thymus. Nine patients had no improvement after surgery and the remaining had variable degrees of clinical improvement. Pathology of thymus did not affect clinical outcome with significant improvement in both groups. Decreased duration of symptoms before surgery and female sex are statistically associated with more improvement of patients' symptoms. Positive expression of survivin was detected in germinal centers of all hyperplastic and atrophic thymuses. All the control thymuses were negative for survivin expression. Conclusion: Thymectomy for myasthenia gravis is an effective and beneficial procedure even in patients with atrophic thymus. Survivin is expressed in all myasthenic thymuses confirming its role in pathogenesis of myasthenia gravis