Incremental value of live/real time three‐dimensional transesophageal echocardiography over the two‐dimensional technique in the assessment of a tuberculoma involving the left atrium and appendage

Intracardiac tuberculomas are extremely rare, and cardiac involvement in tuberculosis accounts for only 0.5% of extrapulmonary tuberculosis. We report for the first time incremental value of live/real time three‐dimensional transesophageal echocardiography over two‐dimensional transesophageal echocardiography in the assessment of a tuberculoma involving the left atrium and left atrial appendage.     

Outcomes of Carotid Revascularization in Patients with Contralateral Carotid Artery Occlusion

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Escherichia coli tetracycline efflux determinants in relation to tetracycline residues in chicken

ObjectiveTo screen for Escherichia coli (E. coli) resistant to tetracycline, followed by identification of tet efflux genes by polymerase chain reaction (PCR). In addition, detection of tetracycline residues in chicken livers and kidneys were conducted using high performance liquid chromatography-tandem quadrupole mass spectrometry (HPLC-MS-MS).MethodsStrains of E. coli were isolated from samples of chicken colon and screened for tetracycline resistance. Tetracycline genes conferring resistance (Tc^r) were detected by polymerase chain reaction (PCR). Most of the isolates were resistant to tetracycline (97.9%).ResultsPCR analysis indicated that Tc^r E. coli R-plasmids contained tet(A), tet(B) and a combination of both efflux genes. None of the isolates contained other efflux tet genes tet (C, D, E and Y). High performance liquid chromatography-tandem quadrupole mass spectrometry (HPLC-MS-MS), a sensitive technique, was used to detect residues of chlortetracycline (CTC), oxytetracycline (OTC), doxycycline (DC) in chicken livers and kidneys. The samples containing tetracycline residues were at 0.13-0.65 pg/μL levels.ConclusionsTetracycline and other antibiotics are commonly used in the poultry and meat production industry for prevention of microbial infections. Multiple antibiotic resistant bacteria in Oman have increased to alarming levels, threatening public health, domestic and may have adverse effect on environment.     

CXC ligand 13 in rheumatoid arthritis and its relation to secondary Sjögren’s syndrome

Aim of the workThe aim of the present study was to measure the level of the chemokine CXC ligand 13 protein (CXCL13) in the plasma and unstimulated saliva of rheumatoid arthritis (RA) patients in order to find out its role in the disease activity and its relation to secondary Sjögren’s syndrome (sSS).Patients and methodsThe study was conducted on thirty rheumatoid arthritis patients attending the Outpatient Clinic of Rheumatology and Rehabilitation department of Ain shams University Hospitals. The patients’ group had been classified into group (1) which included fifteen RA patients associated with sSS diagnosed according to the American–European Consensus Group Classification Criteria and group (2) which included fifteen RA patients not associated with sSS. Ten healthy subjects were included as a control group. Patients were subjected to full history taking, clinical examination, and laboratory detection of CXCL13 level in the plasma and saliva of patients as well as the control groups using ELISA technique. Assessment of disease activity in RA patients was done using the disease activity score (DAS28).ResultsPlasma levels of CXCL13 were significantly higher in RA patients than control group (p < 0.001). Plasma levels of CXCL13 were significantly correlated with the RA disease activity (r = 0.677, p < 0.001) and disease duration (r = 0.406, p < 0.05), while the salivary levels were higher in those with sSS and correlated with sSS disease duration (r = 0.536, p < 0.05). A highly significant correlation was found between salivary CXCL13 and severity of sSS (r = 0.816, p < 0.001). Salivary levels of CXCL13 above 110 pg/ml may diagnose sSS with sensitivity 80% and specificity 84%.ConclusionThe results of this preliminary study point out the importance of CXCL13 as a marker for RA disease activity, its role in diagnosing sSS, and estimation of sSS severity.     

Value of carotid intimal–medial thickness as independent predictor of endothelial dysfunction in uremic patients

Background and aim of the workCardiovascular mortality and morbidity are significantly higher among uremic patients. Although the carotid intimal–medial thickness (C-IMT) as a predictor of endothelial dysfunction (ED) has a prognostic value that has been well demonstrated as an independent predictor of future cardiovascular events, its value in uremic patients need to be re-assisted in our locality. The aim of the work is to investigate a correlation between the brachial artery reactivity test (BART) and the carotid intimal–medial thickening (C-IMT) and their value as independent predictors of endothelial dysfunction in uremic patients.Subjects and methodsThe study involved 70 uremic patients, 40 men and 30 women, 36–56 years old, 40 of them on regular hemodialysis (HD) and 30 on conservative therapy, in addition to 30 healthy persons as a control group. They were selected from the General Medicine and Nephrology Departments, Al-Azhar Assiut University and Assiut University Hospitals over a period of 2 years. All of them were subjected to detailed history, thorough clinical examination, laboratory investigations including complete blood picture, renal function tests (urine analysis, blood urea, and serum creatinine), lipid profile, serum calcium and serum phosphorus, parathyroid hormone (PTH), fasting blood glucose, electrocardiography (ECG), high resolution B-mode ultra-sonography for C-IMT evaluation and brachial artery reactivity test (BART), and abdominal ultra-sonography.ResultsThe results of the present study showed: (1) uremic patients are at an increased risk for carotid atherosclerotic lesions, with significant increase in C-IMT than controls with more significant increase in HD patients. (2) Uremic patients are characterized by impaired endothelium dependent dilatation of the brachial artery (highly significant reduction in flow-mediated dilatation (FMD%)), an abnormality related to the renal failure severity and to the hemodialysis doses. The endothelial dysfunction in the brachial artery was more pronounced in HD patients than in patients on conservative therapy. (3) Significant positive correlation between increased C-IMT and reduction of the brachial FMD%. (4) Significant relation between C-IMT and plaque prevalence and HD duration, while no relations recorded between brachial FMD with HD duration.Conclusion(1) The study confirmed that carotid IMT and brachial artery FMD can be used in interventional studies in which cardiovascular risk is modified and increased in the uremic patients. (2) There was negative correlation between brachial FMD and C-IMT in the uremic patients.