Incidence and impact of totally occluded culprit coronary artery in patients with non-ST segment elevation myocardial infarction acute coronary syndrome

Background

Significance of totally occluded culprit coronary artery in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI) is underestimated.

Purpose

The aim of this study was to evaluate the incidence and impact of totally occluded culprit artery on in-hospital and 6 months follow-up outcomes of NSTEMI acute coronary syndrome (ACS) patients.

Methods

We collected retrospectively data of 500 NSTEMI patients who presented to our hospital from June 2016 to June 2017. All patients underwent PCI within 72 h of presentation. We excluded patients with cardiogenic shock, prior CABG, and STEMI. Patients were divided into two groups according to pre-procedural culprit vessel thrombolysis in myocardial infarction (TIMI) flow. Group 1, TIMI flow 0 total coronary occlusion, included 112 patients (22.4%). Group 2, TIMI flow 1–3 non-total occlusion, included 388 patients (77.6%).

Results

Group 1 patients had significantly higher incidence of smoking (p=0.01), significantly higher level of cardiac enzymes (p<0.001), significantly more collaterals (p<0.001), and significantly more LCX and RCA as the culprit vessel (p<0.01), while group 2 patients had significantly higher incidence of diabetes (p=0.02) and significantly more LAD as the culprit vessel. There were no significant differences between the two groups regarding the major adverse cardiac and cerebrovascular events (MACCE) in-hospital (5.3% in totally occluded group vs. 1% in non-totally occluded group, p=0.07), but group 1 patients had significantly higher incidence of in-hospital arrhythmia (8.9% in group 1 vs. 1% in group 2, p=0.007). After 6 months follow-up, there were no significant differences regarding MACCE between the 2 groups after 6 months follow-up (5.4% in group 1 vs. 4.6% of group 2, P=0.24).

Conclusion

22.4% of NSTEMI patients have a totally occluded culprit artery. The presence of an occluded culprit artery did not significantly affect the clinical outcomes of NSTEMI patients either in-hospital or after 6 months follow-up but was associated with significantly higher incidence of in-hospital arrhythmia.

Funding Acknowledgement

Type of funding sources: None.

A Chromosome-Length Assembly of the Hawaiian Monk Seal (Neomonachus schauinslandi): A History of “Genetic Purging” and Genomic Stability

The Hawaiian monk seal (HMS) is the single extant species of tropical earless seals of the genus Neomonachus. The species survived a severe bottleneck in the late 19th century and experienced subsequent population declines until becoming the subject of a NOAA-led species recovery effort beginning in 1976 when the population was fewer than 1000 animals. Like other recovering species, the Hawaiian monk seal has been reported to have reduced genetic heterogeneity due to the bottleneck and subsequent inbreeding. Here, we report a chromosomal reference assembly for a male animal produced using a variety of methods. The final assembly consisted of 16 autosomes, an X, and portions of the Y chromosomes. We compared variants in this animal to other HMS and to a frequently sequenced human sample, confirming about 12% of the variation seen in man. To confirm that the reference animal was representative of the HMS, we compared his sequence to that of 10 other individuals and noted similarly low variation in all. Variation in the major histocompatibility (MHC) genes was nearly absent compared to the orthologous human loci. Demographic analysis predicts that Hawaiian monk seals have had a long history of small populations preceding the bottleneck, and their current low levels of heterozygosity may indicate specialization to a stable environment. When we compared our reference assembly to that of other species, we observed significant conservation of chromosomal architecture with other pinnipeds, especially other phocids. This reference should be a useful tool for future evolutionary studies as well as the long-term management of this species.

Evaluation of biocompatibility of veneered Bio HPP and veneered lithium disilicate crowns in anterior zone (Randomized controlled clinical trial)

Objective: Evaluation of the biocompatibility of Bio-High Performance Polymer (Bio HPP) crowns veneered with Visio-Ling versus e.max crowns veneered with e.max veneering system. Material and Methods: 42 full-coverage crowns were fabricated for maxillary anterior teeth. A swap was obtained using a sterile paper cone to determine bacterial count and type. Pocket depth (PD) was determined using a William Periodontal probe. Measurements were repeated after 3, 6, 9 and 12 months respectively. Patients were randomly divided into: Group A fabricated from IPS e.max crowns and Group B fabricated from Bio HPP crowns. The preparations were standardized with an equi-gingival, finish line. Fisher’s test was used to compare between the two groups. The significance level was set at P 0.05. Statistical analysis was performed with Windows, Version 23.0. (IBM SPSS Statistics) Armonk, NY: IBM Corp. Results: Bio HPP and e.max showed no statistically significant difference in bleeding on probing and PD except after 9and 12 months; Bio HPP showed statistically significantly higher PD than e.max (P-value = 0.027, Effect size = 0.245) and (P-value = 0.011, Effect size = 0.310), respectively. Fisher’s test showed there was no statistically significant difference between total bacterial counts and the type of the two materials. Conclusion: Both e.max and Bio HPP crowns revealed successful biological behavior. No significant difference between the materials regarding the bacterial count and type as well as the pocket depth, however after 9 and 12 months, Bio HPP showed a higher significant difference PD than e.max. Keywords  Biocompatibility;   Bio HPP; e.max; Pocket depth; Bacteria.

Antihypertensive efficacy and safety of a standardized herbal medicinal product of Hibiscus sabdariffa and Olea europaea extracts (NW Roselle): A phase-II, randomized, double-blind, captopril-controlled clinical trial

Hypertension is a public health concern that needs immediate attention upon diagnosis. The demand for natural alternatives is on the rise; Hibiscus sabdariffa and Olea europaea are traditionally used for hypertension management in Egypt. In this study, we aimed to investigate the antihypertensive efficacy and safety of two doses of an herbal product of Hibiscus sabdariffa calyxes and Olea europaea leaves (NW Roselle) in Egyptian patients with grade 1 essential hypertension. We equally randomized 134 patients to receive captopril 25 mg, low-dose NW Roselle, or high-dose NW Roselle BID for 8 weeks. No significant decrease was found in systolic blood pressure or diastolic blood pressure when we compared low-dose NW Roselle and high-dose NW Roselle to captopril (p > .05). In all groups, mean reduction in BP at 8 weeks was significant; 16.4/9.9 mmHg (p < .0001), 15.4/9.6 mmHg (p < .0001), and 14.9/9.4 mmHg (p < .0001) with captopril, low-dose NW Roselle, and high-dose NW Roselle respectively. In addition, low-dose NW Roselle induced a significant reduction in the mean level of triglycerides (17.56 mg/dL; p = .038). In conclusion, NW Roselle had comparable antihypertensive efficacy and safety to captopril in Egyptian patients with grade 1 essential hypertension.

P1059ACOULD INFERIOR VENA CAVA DIAMETER REFLECT THE VOLUME STATUS OF THE PATIENT WITH INTERMITTENT HEMODIALYSIS ?

Background and Aims

In 1960, Clyde shields (1st chronic hemodialysis patient) developed severe hypertension under treatment.His physician “Dr.scribner” decided to treat this complication using ultrafiltration to deplete the extracellular volume which was thought to be responsible for the increased blood pressure.It was successful, blood pressure decreased to normal and Clyde remained alive for 11 years.from these coming the rationale of dry body weight and its value in improving dialysis patient and improving his survival and decreasing his suffering.

Several different techniques have been used to derive more standard methods of assessment dry weight, however optimal methods for adjusting fluid volume status and ideal dry weight remain uncertain.

AIM

To assess value of using IVC diameter and collapsibility index in modification of dry body weight in hemodialysis patient.

Method

A single center study included 98 patients hemodialysis patient unit in our center. all patients were subjected to assessment of IVC diameter before and after one hour of the first hemodialysis session of the week using ultrasound. We choose muscle cramps as an indicator for hypovolemia . Patients were allocated in two groups. Group 1 : patients with muscle cramps (hypotension) at last hour of session& Group 2 :without muscle cramps (normotensive or hypotensive) at last hour of session. Patients with other causes of muscle cramps rather than hypovolumia were excluded (e.g. hypocalcaemia, l-carnitine deficiency ,etc) .

Results

Patients with muscle cramps in last hour of session were 8 patients with average ivc diameter 0.7 cm & collapsibility more than 80%.Patients without muscle cramps in last hour of session were 84 patient with average ivc diameter 1.3 cm & collapsibility more than 50%.

On interpretation of the eight patient :one patient had bilateral lower limb edema 2ry to local cause (varicose vein) not as a part of overload, three patient had uncontrolled blood pressure cannot tolerate more UF and was hypovolemic but on need to increase antihypertensive medication, two Patients had improved nutritional status with increased lean body mass, one patient had prepare for transplantation and during coarse of preparation NCCT chest showed bilateral diffuse ground glass opacities (overload versus interstitial lung disease). There was marked improvement, however NCCT still revealed ground glass opacities, in spite of patient become hypovolemic (clinically and confirmed by IVC diameter ), so patient investigated for the cause of interstitial lung disease and unfortunately diagnosed by further investigation as latent TB.

Conclusions

Using of ultrasound in assessment of IVC diameter is a promising method for estimating dry body weight in hemodialysis patient because it is simple, quick ,non-invasive and helpful especially in debatable cases.

Conclusion

Using of ultrasound in assessment of IVC diameter is a promising method for estimating dry body weight in hemodialysis patient because it is simple, quick ,non-invasive and helpful especially in debatable cases.

Midline nasofrontal dermoids in children: A review of 29 cases managed at Mansoura University Hospitals

OBJECTIVES

Nasal dermoids are congenital anomalies constituting 3.7-12.6% of dermoids in the head and neck. Most of lesions are superficial but there is always a risk that it may end blindly within the deep structures of the nose or extend intracranially. Complete excision, regardless of extension, is essential and must be balanced against cosmoses. This study reviews the clinical characteristics and imaging findings as well as the appropriate surgical approach adopted for 29 cases managed at Mansoura University Hospitals.

METHODS

A retrospective analysis was performed in 29 patients admitted for management of nasal dermoid between Jan 2001 and Jan 2015 at the Otolaryngology department of our tertiary referral university hospital. Recorded data included patient's demographics, complaint, lesion's site, pre-operative radiological findings, surgical technique, intra-operative findings, and post-operative squeal.

RESULTS

This series included 12 (41%) female and 17 (59%) male children, with a mean age of 2.5 years. Twenty seven children presented with a nasofrontal swelling of which 20 had an apparent sinus. Other presentations included a swelling in the inner canthum (1), nasal tip and columella (1). Nine (31%) patients had a history of infection and two patients gave a positive history of meningitis. Intracranial extradural extension was identified in 10 patients (34.5%) during preoperative imaging. Surgical modalities included local excision and direct closure (12), open rhinoplasty (7), bicoronal excision and craniotomy (10). In 9 cases, the tract was adherent to the dura but was carefully dissected and in one case resection required excision of a segment of dura and reconstruction. In a follow up period of 1-8 years, recurrence was detected in one case and the cosmetic results were satisfactory.

CONCLUSIONS

Those lesions are rare and require early precise surgical planning to achieve complete en bloc excision. This study reports a low morbidity associated with management of nasal dermoids with intracranial extension.

Value of subcutaneous drainage system in obese females undergoing cesarean section using pfannenstiel incision

OBJECTIVE

To determine whether closed subcutaneous drainage systems were efficacious in reducing the rate of wound breakdown of Pfannenstiel incision after cesarean section (CS) in obese females.

DESIGN

Prospective controlled clinical trial.

PARTICIPANTS

118 obese pregnant females with a body mass index >32 undergoing CS were divided into two groups: group I (n = 78) with closed subcutaneous drainage system and group II (n = 40) without drainage system. Incision closure technique was standardized. Prophylactic antibiotics were given routinely to both groups.

OUTCOME MEASURES

Primary outcomes were the incidence of wound breakdown in both groups together with rate of hematoma formation and occurrence of fever. Secondary outcomes were amount of fluid drained, need for redressing.

RESULTS

Wound breakdown occurred in 9 cases in group I (11.5%), while it happened in 5 cases in group II (12.5%) (p > 0.05). Relative risk was 0.92 (95% CI 0.26-3.75). Hematoma formation was observed in only 1 case in the nondrainage group (group II). Fever was observed in 18 cases in group I (23.1%) in the first 24 h postoperative while in group II, 13 cases developed fever (32.5%) (p > 0.05). The need for redressing within the first 24 h was only in 2.5% of cases in group I while it was 17.9% in group II (p < 0.05).

CONCLUSION

We found no significant benefit in using a subcutaneous drain as a prophylactic measure against wound breakdown in obese pregnant females undergoing CS as long as they received a prophylactic antibiotic.

In-vitro high-resolution ultrasonography of benign and malignant lymph nodes. A sonographic-pathologic correlation

RATIONALE AND OBJECTIVES

The authors assess the value of combining high-resolution ultrasonography (HRUS) findings in a scoring scale for distinguishing malignant from reactive lymphadenopathy and explain the pathologic causes of altered nodal sonographic architecture.

MATERIALS AND METHODS

Sixty-one nodes obtained from 32 consecutive patients were prospectively scanned with 7.5-MHz ultrasound probes in a waterbath. Three sonographic features--long-to-short axis ratio (L/S), hilar width, and cortical width--were graded on a 5-level scoring scale (0-4). Nodes scored > or = 3 were considered malignant and < or = 2 benign. Subsequently, all nodes were microsectioned in a plane matching the sonograms, allowing direct sonographic-pathologic correlation.

RESULTS

Eighty-two percent of nodes were correctly characterized using the above cut-off point (sensitivity: 87%, specificity: 74%). Eighty-three percent of nodes scored 4 were malignant and 95% scored 0 were benign. Eighty-two percent of nodes with L/S < 2, 81% with no hilus, and 70% with eccentric cortical widening were malignant, whereas 72% with L/S > or = 2, 86% with a wide hilus, and 91% with a narrow cortex were benign. Sonographic-pathologic correlation showed that tumor infiltration results in rounded nodal shape, loss of hilar echogenicity and cortical widening, whereas reactive disease tends to preserve nodal architecture.

CONCLUSION

Morphologic changes detectable using HRUS help distinguish benign from malignant lymph nodes.

Histopathological study of the bilharzial affection on the bladder and ureter

This study was carried out on 68 cases (50 bilharzial stricture lower ureter, eight vesico-ureteral reflux cases and ten control). In cases of reflux associated with bilharziasis heavy ova-deposition was obvious all through the ureteral wall especially per-ureteral sheath. Also heavy deposition in the bladder wall involved the detrusor and trigonal muscle with fibrosis and obliteration of Waldeyer's space and atrophy and fasciculation of detrusor and trigonal muscle. This implies ureteral rigidity, impaired mobility and compression against a firm detrusor buttress.