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Background Impaired glucose tolerance and even prediabetic states have a crucial role as risk factors among several different risk factors in acute myocardial infarction (AMI). Some recent studies have shown that poor diabetes management, diagnosed by glycated hemoglobin (HbA1C), has poor prognostic value regarding future cardiovascular events, whereas other studies recommend that it is the blood glucose level at admission that predicts short-term mortality after AMI and not the HbA1C level. Aim The target of this research is to detect the correlation between the level of HbA1C and risk factors in the patients with AMI and its value regarding the severity of coronary lesions and prognosis. Patients and methods A total of 80 consecutive patients presenting with ST elevation MI to the National Heart Institute and treated with primary percutaneous coronary intervention represented the target population. Patients were classified inconsistent with HbA1C level into three groups: group 1: HbA1C less than 5.7%, group 2: HbA1C 5.7–6.4%, and group 3: more than 6.4%. Comparison among the three groups was done regarding the risk factors, troponin level, blood glucose level, lipid profile, kidney function, number of affected vessels, length of the stented area, type of MI, EF, morbidity, and mortality. Results Our results showed that regarding risk factors, diabetes and hypertension were significantly more common in group 3 as compared with the other two groups. Patients in group 3 also had significant elevated admission blood glucose. No other significant difference was noted among the three groups. Conclusion Our result suggests that in spite diabetes being a major risk factor for atherosclerotic coronary artery disease, HbA1C level has no correlation with severity and short-term prognosis.

The oscillatory patterns of electroencephalography (EEG), during resting states, are informative and helpful in understanding the functional states of brain network and their contribution to behavioral performances. The aim of this study is to characterize the functional brain network alterations in patients with amnestic mild cognitive impairment (aMCI). To this end, rsEEG signals were recorded before and after a cognitive task. Functional connectivity metrics were calculated using debiased weighted phase lag index (DWPLI). Topological features of the functional connectivity network were analyzed using both the classical graph approach and minimum spanning tree (MST) algorithm. Subsequently, the network and connectivity values together with Mini-Mental State Examination cognitive test were used as features to classify the participants. Results showed that: (1) across the pre-task condition, in the theta band, the aMCI group had a significantly lower global mean DWPLI than the control group; the functional connectivity patterns were different in the left hemisphere between two groups; the aMCI group showed significantly higher average clustering coefficient and the remarkably lower global efficiency than the control. (2) Analysis of graph measures under post-task resting state, unveiled that for the percentage change of post-task vs. pre-task in beta EEG, a significant increase in tree hierarchy was observed in aMCI group (2.41%) than in normal control (−3.89%); (3) Furthermore, the classification analysis of combined measures of functional connectivity, brain topology, and MMSE test showed improved accuracy compared to the single method, for which the connectivity patterns and graph metrics were used as separate inputs. The classification accuracy obtained for the case of post-task resting state was 87.2%, while the one achieved under pre-task resting state was found to be 77.7%. Therefore, the functional network alterations in aMCI patients were more prominent during the post-task resting state. This study suggests that the disintegration observed in MCI functional network during the resting states, preceding and following a task, might be possible biomarkers of cognitive dysfunction in aMCI patients.

OBJECTIVES:. To compare the performance of Sequential Organ Failure Assessment, systemic inflammatory response syndrome, Red Flag Sepsis, and National Institute of Clinical Excellence sepsis risk stratification tools in the identification of patients at greatest risk of mortality from sepsis in nonintensive care environments. DESIGN:. Secondary analysis of three annual 24-hour point-prevalence study periods. SETTING:. The general wards and emergency departments of 14 acute hospitals across Wales. Studies were conducted on the third Wednesday of October in 2017, 2018, and 2019. PATIENTS:. We screened all patients presenting to the emergency department and on the general wards. MEASUREMENTS AND MAIN RESULTS:. We recruited 1,271 patients, of which 724 (56.9%) had systemic inflammatory response syndrome greater than or equal to 2, 679 (53.4%) had Sequential Organ Failure Assessment greater than or equal to 2, and 977 (76.9%) had Red Flag Sepsis. When stratified according to National Institute of Clinical Excellence guidelines, 450 patients (35.4%) were in the “High risk” category in comparison with 665 (52.3%) in “Moderate to High risk” and 156 (12.3%) in “Low risk” category. In a planned sensitivity analysis, we found that none of the tools accurately predicted mortality at 90 days, and Sequential Organ Failure Assessment and National Institute of Clinical Excellence tools showed only moderate discriminatory power for mortality at 7 and 14 days. Furthermore, we could not find any significant correlation with any of the tools at any of the mortality time points. CONCLUSIONS:. Our data suggest that the sepsis risk stratification tools currently utilized in emergency departments and on the general wards do not predict mortality adequately. This is illustrated by the disparity in mortality risk of the populations captured by each instrument, as well as the weak concordance between them. We propose that future studies on the development of sepsis identification tools should focus on identifying predicator values of both the short- and long-term outcomes of sepsis.

Background and Aims: The use of dexamethasone as an adjuvant to local anesthetic rarely has been described. Some studies have demonstrated the analgesic effect of local spinal and systemic corticosteroids in combination with bupivacaine. It works by decreasing inflammation and blocking transmission of nociceptive C-fibers and by stopping the ectopic discharge of the nerve. The aim of this randomized controlled trial was to compare the efficacy of epidural levobupivacaine alone versus a combination of levobupivacaine with dexamethasone for labor analgesia. Material and Methods: This prospective double-blind trial included the 60 primigravidas during vaginal delivery with a cervical dilatation ≥4 cm and 50% effacement randomly assigned to one of two groups – Group A (n=30): epidural levobupivacaine 0.125% in normal saline in a total volume of 15 mL and Group B (n=30): epidural levobupivacaine 0.125% in normal saline combined with dexamethasone 4 mg in a total volume of 15 mL. At first request of analgesia, 10 mL of 0.125% levobupivacaine was administrated through epidural catheter. Further analgesia was provided with 8 mL of 0.125% levobupivacaine hourly. Primary outcome measure was the duration of epidural analgesia. Secondary outcome measures include pain score by Visual Analog Scale score before the block and 15 min following it, the total amount of levobupivacaine used, Apgar score and umbilical vein blood gas analysis, maternal satisfaction, and side effects recorded. Results and Conclusion: The duration of epidural analgesia was significantly longer (P < 0.05) upon adding dexamethasone to levobupivacaine. Total epidural levobupivacaine consumption was significantly lower (P = 0.05) in Group B. There were no statistical differences between the two groups regarding hemodynamics, pain score, neonatal outcome, and complications. Epidural dexamethasone plus levobupivacaine prolongs the duration of epidural analgesia during management of labor pain with hemodynamic stability and limited maternal and neonatal adverse effects.

Endothelial progenitor cells (EPCs) CD34 are bone marrow-derived cells that decrease in chronic kidney disease (CKD) patients especially when they reach end-stage renal disease and may be a risk marker of cardiovascular (CV) diseases. The aim of our study is to investigate the endothelial progenitor cell CD 34 numbers in children with CKD on regular hemodialysis (HD) and detect their association with vascular stiffness. We recruited 25 children on regular HD, who were selected from the HD unit of Al-Zahraa Hospital, Al-Azhar University. Another group of 25 age and sex matched healthy children served as as controls. We investigated the number of EPC number (CD34) using flow cytometry, intima-media thickness (IMT), and the peak systolic velocity (PSV) of the main arteries including the (aorta, carotid, and femoral) arteries using Doppler ultrasound, this is in the same line with the routine and traditional investigations of the CV risk in the study groups. Children on regular HD have significantly lower EPC numbers (CD34 numbers) compared to their controls, the median and the inter equatorial range of CD34 was 57 (17–122) and five (3–6), respectively (P 0.001). Significant positive correlations were found between CD 34 and triglycerides serum level (r = 0.817, P = 0.001), also between CD34 with IMT and PSV of the aorta (r = 0.685, P = 0.000: r = 0.457, P = 0.022), respectively. CD34 is 88% sensitive and specific for the detection of CV risk in children on regular HD. EPC CD34 exhibited a higher predictive value for CV risk in children on regular HD. Reduced EPC numbers contribute to accelerated atherosclerosis.

Background and Aim: Many techniques to prevent spinal induced hypotension in cesarean section have been advocated; but no one technique proved to be totally effective. The aim of this cohort interventional study was to investigate the efficacy of application of multimodal approach to decrease the incidence of hypotension (defined as mean arterial blood pressure ⩽60 mmHg) following spinal anesthesia in parturients undergoing elective or urgent cesarean section. Patients and Methods: In this prospective cohort interventional study, 159 American Society of Anesthesiologists (ASA) classification I–II parturients undergoing elective or urgent cesarean section were enrolled. All patients received maternal care bundle which consisted of; fixed low dose of bupivacaine (7.5 mg + fentanyl 25 μg), coloading with 15 ml/kg lactated Ringer’s, placement of the patient in the supine wedged position, administration of 9 mg ephedrine sulphate IV after intrathecal injection and placement of graduated compression stockings (GCS) in the elevated leg position >45° and maintaining leg elevation at 20° following application of GCS. Demographic data, spinal anesthetic technique variables, fluid intake and urine output were documented. Mean arterial blood pressure, heart rate and oxygen saturation were recorded at baseline T0 (before spinal anesthesia administration), T1 (5 min following intrathecal injection of local anesthetics), T2 (15 min), T3 (30 min) and at T4 (end of procedure prior to PACU transfer). Total dose of ephedrine and any complication was documented. Results: Incidence of hypotension after 5 min (T1) was 17.6%, at 15 min (T2) was 3.8% and at 30 min (T3) was 5%. Conclusions: The application of a maternal care bundle had significantly decreased the incidence of spinal induced hypotension in parturient undergoing elective or urgent Cesarean delivery.

Background: Paraoxonase (PON1) is an A-esterase capable of hydrolyzing the active metabolites (oxons) of many organophosphorus (OP) insecticides. Human PON1 displays two polymorphisms in the coding region (Q192R and L55M) and several polymorphisms in the promoter and the 3′-UTR regions. Animal studies have shown that PON1 is an important determinant of OP toxicity though a direct satisfactory verification in humans is still lacking. Aim: To investigate the impact of polymorphisms in the PON1 coding region (Q192R and L55M) on individual sensitivity to OP poisoning. Subjects and methods: This study enrolled 42 subjects (21 females and 21 males, age range 1.5–53 years) diagnosed of acute OP poisoning. They were classified into 4 grades according to manifestations. All subjects were genotyped for the PON1 gene polymorphisms; Q192R and L55M using RFLP-PCR, then genotype frequencies were compared between different OP grades. Results: Genotype frequency distribution of PON1 L55M polymorphism among different OP poisoning grades revealed no significant difference (p > 0.05) between the four grades. In contrast, frequency distribution of PON1 Q192R polymorphism showed a highly significant (p

Background: Leptin (LEP) is an anti-obesity hormone that regulates food intake, energy expenditure, and glucose metabolism. The genetic variants in LEP and the LEP receptor (LEPR) gene may play an important role in the pathogenesis of type 2 diabetes mellitus (T2DM) and obesity. The current study aimed to investigate the association of serum LEP levels, and LEP polymorphisms in LEP (rs7799039, 2548 G/A) with T2DM in Egyptian patients. Methods: A total of 205 subjects were included in the present case-control study, consisting of 100 T2DM patients and 105 healthy controls. The anthropometric, psychometric, and biochemical measurements were taken from all the subjects. The genotyping of LEP gene variants was carried out by polymerase chain reaction TaqMan technology. Serum LEP levels were measured by the ELISA technique. Results: T2DM patients had significantly elevated levels of glycated haemoglobin (HbA1c), fasting blood sugar (FBS), postprandial blood sugar (PPBS), international normalisation ratio (INR), creatinine, urea, cholesterol, triglyceride (TG), and low-density lipoproteins (LDL) and significantly decreased high-density lipoprotein (HDL) compared to healthy subjects. serum LEP levels were significantly decreased p (<0.001) as compared to the control group. LEP gene SNP rs7799039 was associated with an increased diabetic risk with A allele being more frequent in T2DM patients than control subjects. The distribution of the AA genotype and GA genotype of LEP SNP rs7799039 was higher in the diabetic group than control one. In addition, AA + GA genotype carriers had significantly elevated HbA1c, FBS, PPBS, TG, and LDL levels and on the contrary, decreased serum LEP levels compared to GG homozygotes. Conclusion: The genetic polymorphism rs7799039 showed a highly significant correlation with blood LEP. The co-dominant and dominant models of the LEP genetic polymorphism (rs7799039, 2548 G/A) were shown to have a significant correlation with complicated and uncomplicated diabetes individuals, but we have found that serum LEP levels were inversely related with control and diabetes patients. A positive significant association was found between LEP genetic polymorphism (rs7799039, 2548 G/A) and serum LEP in patients and controls. LEP levels and its rs7799039 genetic variant may play a vital role in increasing T2DM susceptibility. KEY MESSAGE: The present study revealed a positive significant association between the leptin (LEP) genetic polymorphism rs7799039, fasting blood sugar, and post-prandial blood sugar. LEP levels might be utilised to predict T2DM. The AA genotype of LEP rs7799039, 2548G/A (co-dominant model) raises the risk of diabetes compared to the GA genotype, and the A alle is considered a risk factor OR = 1.66. A positive significant association was found between LEP genetic polymorphism (rs7799039, 2548G/A) and serum LEP in patients and controls. [ABSTRACT FROM AUTHOR]

Background Impaired glucose tolerance and even prediabetic states have a crucial role as risk factors among several different risk factors in acute myocardial infarction (AMI). Some recent studies have shown that poor diabetes management, diagnosed by glycated hemoglobin (HbA1C), has poor prognostic value regarding future cardiovascular events, whereas other studies recommend that it is the blood glucose level at admission that predicts short-term mortality after AMI and not the HbA1C level. Aim The target of this research is to detect the correlation between the level of HbA1C and risk factors in the patients with AMI and its value regarding the severity of coronary lesions and prognosis. Patients and methods A total of 80 consecutive patients presenting with ST elevation MI to the National Heart Institute and treated with primary percutaneous coronary intervention represented the target population. Patients were classified inconsistent with HbA1C level into three groups: group 1: HbA1C less than 5.7%, group 2: HbA1C 5.7-6.4%, and group 3: more than 6.4%. Comparison among the three groups was done regarding the risk factors, troponin level, blood glucose level, lipid profile, kidney function, number of affected vessels, length of the stented area, type of MI, EF, morbidity, and mortality. Results Our results showed that regarding risk factors, diabetes and hypertension were significantly more common in group 3 as compared with the other two groups. Patients in group 3 also had significant elevated admission blood glucose. No other significant difference was noted among the three groups. Conclusion Our result suggests that in spite diabetes being a major risk factor for atherosclerotic coronary artery disease, HbA1C level has no correlation with severity and short-term prognosis. [ABSTRACT FROM AUTHOR]

Objective: Recent research has focused on the use of N-methyl-D-aspartate (NMDA) receptor antagonists for pain management. Several drugs are known to have this action, including ketamine, which exerts its main analgesic effect through NMDA receptor antagonism. This study aimed to evaluate the effect of low-dose ketamine infusion on opioid exposure for patients undergoing myomectomy surgery under general anaesthesia. Methods: A total of 70 women were included in this prospective double-blind trial study. The patients included in this study were American Society of Anaesthesiologists physical status I–II, aged between 18 and 50 years and scheduled for laparotomy myomectomy surgery. Patients were randomised to receive either a bolus of 0.2 mg kg-1 of ketamine followed by a continuous infusion of 0.2 mg kg-1 hr-1 during the operation or a placebo of normal saline. Both groups also received morphine as needed for pain relief. The primary outcome was the total amount of morphine used during the intraoperative and postoperative periods. Intraoperative and postoperative mean blood pressure, heart rate and postoperative visual analogue scale for pain were assessed. Results: Total mean morphine consumption was significantly lower in the ketamine group than in the control group (26±3.5 mg vs. 34.7±3.3 mg, respectively, p<0.05). However, there were no statistical differences between the groups regarding haemodynamics, postoperative pain score and complications. Conclusion: The use of ketamine in low infusion doses intraoperatively during an elective myomectomy procedure produced an opioid-sparing effect by reducing perioperative morphine consumption without significant side effects. [ABSTRACT FROM AUTHOR]

Novel tetrahydrobenzo[b]thienopyrole derivatives are synthesized from 2-amino-3-cyano-4,5,6,7-tetrahydrobenzo[ b]thiophene (1) through its reaction with a-chloroacetone to give the corresponding N-alkyl derivative 3. Compound 3 undergoes ready cyclization in sodium ethoxide solution to give the tetrahydrobenzo[b]thienopyrrole 4. The latter compound 4 is used as the key starting material for the synthesis of thiophene, thieno[2,3-b]pyridine and pyran derivatives. The cytotoxicity of the synthesized products towards the human cancer cell lines namely gastric cancer (NUGC), colon cancer (DLD-1), liver cancer (HA22T and HEPG-2), breast cancer (MCF-7), nasopharyngeal carcinoma (HONE-1) and normal fibroblast (WI-38) cell lines are measured. Compounds 4, 7a, 7b, 8a, 8b, 10c, 10d, 10f, 12a, 12b, 14b and 15b exhibit the optimal cytotoxic effect against cancer cell lines. Compounds 7b and 14b show the maximum inhibitory effect and these are much higher than the reference CHS-828 (pyridyl cyanoguanidine). On the other hand, the anti-proliferative evaluations of these compounds with high potency against the cancer cell lines L1210, Molt4/C8, CEM, K562, K562/4 and HCT116 show that compounds 7b and 8b give IC50's against Molt4/C8 and CEM cell lines higher than that of the reference, doxorubicin. [ABSTRACT FROM AUTHOR]

Background: Paraoxonase (PON1) is an A-esterase capable of hydrolyzing the active metabolites (oxons) of many organophosphorus (OP) insecticides. Human PON1 displays two polymorphisms in the coding region (Q192R and L55M) and several polymorphisms in the promoter and the 3'-UTR regions. Animal studies have shown that PON1 is an important determinant of OP toxicity though a direct satisfactory verification in humans is still lacking. Aim: To investigate the impact of polymorphisms in the PON1 coding region (Q192R and L55M) on individual sensitivity to OP poisoning. Subjects and methods: This study enrolled 42 subjects (21 females and 21 males, age range 1.5- 53 years) diagnosed of acute OP poisoning. They were classified into 4 grades according to manifestations. All subjects were genotyped for the PON1 gene polymorphisms; Q192R and L55M using RFLP-PCR, then genotype frequencies were compared between different OP grades. Results: Genotype frequency distribution of PON1 L55M polymorphism among different OP poisoning grades revealed no significant difference (p>0.05) between the four grades. In contrast, frequency distribution of PON1 Q192R polymorphism showed a highly significant (p< 0.001) difference between different grades of OP poisoning, with QQ genotype predominating in grade 4 with a frequency of 66.7%, followed by QR genotype (33.3%), while the RR and QR genotypes were similarly distributed in grade 1 with a frequency of 50% for each. Conclusion: The current results suggest a possible association between QQ genotype and poor OP poisoning prognosis. [ABSTRACT FROM AUTHOR]

Background and Aims: The use of dexamethasone as an adjuvant to local anesthetic rarely has been described. Some studies have demonstrated the analgesic effect of local spinal and systemic corticosteroids in combination with bupivacaine. It works by decreasing inflammation and blocking transmission of nociceptive C-fibers and by stopping the ectopic discharge of the nerve. The aim of this randomized controlled trial was to compare the efficacy of epidural levobupivacaine alone versus a combination of levobupivacaine with dexamethasone for labor analgesia., Material and Methods: This prospective double-blind trial included the 60 primigravidas during vaginal delivery with a cervical dilatation ≥4 cm and 50% effacement randomly assigned to one of two groups - Group A ( n =30): epidural levobupivacaine 0.125% in normal saline in a total volume of 15 mL and Group B ( n =30): epidural levobupivacaine 0.125% in normal saline combined with dexamethasone 4 mg in a total volume of 15 mL. At first request of analgesia, 10 mL of 0.125% levobupivacaine was administrated through epidural catheter. Further analgesia was provided with 8 mL of 0.125% levobupivacaine hourly. Primary outcome measure was the duration of epidural analgesia. Secondary outcome measures include pain score by Visual Analog Scale score before the block and 15 min following it, the total amount of levobupivacaine used, Apgar score and umbilical vein blood gas analysis, maternal satisfaction, and side effects recorded., Results and Conclusion: The duration of epidural analgesia was significantly longer ( P < 0.05) upon adding dexamethasone to levobupivacaine. Total epidural levobupivacaine consumption was significantly lower ( P = 0.05) in Group B. There were no statistical differences between the two groups regarding hemodynamics, pain score, neonatal outcome, and complications. Epidural dexamethasone plus levobupivacaine prolongs the duration of epidural analgesia during management of labor pain with hemodynamic stability and limited maternal and neonatal adverse effects., Competing Interests: There are no conflicts of interest.