Effect of balloon mitral valvoplasty during pregnancy on childhood development

In order to study the long-term effects of balloon mitral valvoplasty (BMV) on childhood development, we followed up closely 20 mothers with severe mitral stenosis who were treated with BMV during pregnancy. Their offspring aged 63 +/- 39 (range 6-98) months were also regularly assessed using standard developmental charts and relevant laboratory tests. They were all found to have maintained normal growth, development, and speech for their appropriate ages. Developmental milestones were normal for their ages and comparable with those of their siblings. The laboratory tests revealed no abnormalities. Two losses occurred during the early course of follow-up, at the ages of 4 and 37 weeks, respectively. One of the pregnant patients suffered a stillbirth.     

Modeling of reflectometric and ellipsometric spectra from the skin in the terahertz and submillimeter waves region

The human skin is modeled as a stack of homogeneous layers in the terahertz and submillimeter waves regions with some anisotropy due to the helical sweat glands and other elongated entities. A dielectric model for the skin is presented, valid for a wider frequency range (up to the terahertz region) taking into account the dispersive nature of the effective conductivity. Polarized reflectivity and generalized ellipsometric parameters are calculated versus angle and wavelength. Recent studies have claimed that the helical sweat ducts act as an array of low-Q helical antennae and are dominant in shaping the spectral response in the sub-terahertz region. We found that water absorption, dispersion and multiple interference effects play the major role in shaping the spectrum without the need for the assumption of the sweat ducts acting as low-Q helical antennae. High sensitivities to the water content are found particularly in the ellipsometric parameters at large incidence angles. Hence a new methodology is proposed to detect skin cancer using variable angle ellipsometry or polarized reflectometry. The parameter found with the highest sensitivity to water content is cos Δ(pp) with Δ(pp) being the phase of the on-diagonal reflection matrix ratio between p-to-p polarization.     

The Effect of Extra Virgin Olive Oil and Soybean on DNA,Cytogenicity and Some Antioxidant Enzymes in Rats

We investigated the effect of extra virgin (EV) olive oil and genetically modified (GM) soybean on DNA, cytogenicity and some antioxidant enzymes in rodents. Forty adult male albino rats were used in this study and divided into four groups. The control group of rodents was fed basal ration only. The second group was given basal ration mixed with EV olive oil (30%). The third group was fed basal ration mixed with GM (15%), and the fourth group survived on a combination of EV olive oil, GM and the basal ration for 65 consecutive days. On day 65, blood samples were collected from each rat for antioxidant enzyme analysis. In the group fed on basal ration mixed with GM soyabean (15%), there was a significant increase in serum level of lipid peroxidation, while glutathione transferase decreased significantly. Interestingly, GM soyabean increased not only the percentage of micronucleated polychromatic erythrocytes (MPCE), but also the ratio of polychromatic erythrocytes to normochromatic erythrocytes (PEC/NEC); however, the amount of DNA and NCE were significantly decreased. Importantly, the combination of EV olive oil and GM soyabean significantly altered the tested parameters towards normal levels. This may suggest an important role for EV olive oil on rodents’ organs and warrants further investigation in humans.     

Resting heart rate in patients with ischemic heart disease in Saudi Arabia and Egypt

Aim

To assess the level of resting heart rate (RHR) in an outpatient population presenting with stable coronary artery disease (CAD) as well as to measure its association with current therapeutic management strategies for cardiovascular events.

Materials and methods

A multi-center cross-sectional survey was carried out in Saudi Arabia and Egypt over a three month period (between January 2007 and April 2007). 2049 patients with CAD without clinical heart failure (HF) were included in this study through “cluster sampling”. RHR was measured by manual palpitation.

Results

Mean age of CAD patients was 56.7 ± 10.4 and the mean RHR was 78.9 ± 13.9 b/m. 1686 patients (83.1%) were on β-blockers for whom the RHR was 78.5 ± 14.0 b/m (95.5% had RHR ⩾ 60 b/m, which is higher than recommended by the guidelines). 1094 (73.5%) of patients on β-blockers were on a lower dose, probably to avoid the complications associated with such a class. Among those not on β-blockers (16.9%), RHR was 80.9 ± 13.0 b/m.Moreover, 98 patients (4.8%) were on calcium channel blocker (diltiazem or verapamil) but not on β-blockers, for whom the RHR was 80.9 ± 12.0 b/m. Finally, 163 patients (8.0%) were on both β-blockers and the calcium channel blocker, and their RHR was 79.0 ± 14.4 b/m.

Conclusion

Optimal target RHR has not been achieved in a significant number of screened patients. Achievements of such targets are known to decrease mortality and to improve survival.Abbreviations: RHR, resting heart rate; CAD, coronary artery disease; NYHA, New York Heart Association Classification; HF, heart failure     

An assessment of the clinical utility of transperineal urethrosphincteric block (TUSB) in outpatient rigid cystoscopy: a single-blind,randomized study

Background and objectives  Pain control in outpatient rigid cystoscopy is often achieved via the application of intraurethral lidocaine jelly. This clinical trial was designed to test the effectiveness and safety of a new method to provide local anesthesia, transperineal urethrosphincteric block (TUSB), prior to rigid cystoscopy. Methods  Male patients posted for outpatient rigid cystoscopy were randomized to receive TUSB (group A) using 10–20 ml of 1% lidocaine, intraurethral 30 ml of 2% lidocaine jelly (group B) or intraurethral 30 ml of neutral jelly (group C) as a method of pain control. Following the procedure, plasma concentrations of lidocaine were measured in group A patients. Outcome assessments included mean urethral and sphincteric numerated pain scores (0–10), overall discomfort level (0–4) and plasma lidocaine levels. Results  One hundred and fifty patients were recruited, 50 in each group. When the three groups were compared, the ratio of group A patients with sphincteric pain score ≥2 was significantly the least. Also, the ratio of group A patients with discomfort level ≥2 was significantly less than the same ratio in either group B or C. Plasma lidocaine concentrations were within nontoxic levels and never exceeded 2.83 μg/ml in 39 subjects. Conclusion  This study demonstrates that TUSB is an effective and safe method in significantly relieving the pain associated with outpatient rigid cystoscopy. TUSB may offer urologists and anesthetists an alternative way to achieve pain control besides intraurethral lidocaine jelly during rigid cystoscopy.     

Long-Term outcome of mitral balloon valvotomy in pregnant women

BACKGROUND AND AIM OF THE STUDY: The study aim was to examine the long-term outcome (nine years) of mitral balloon valvotomy in pregnant patients with severe mitral stenosis. METHODS: Twenty-three patients with severe, symptomatic (NYHA class III/IV) mitral stenosis underwent mitral balloon valvotomy using an Inoue balloon technique during the second trimester of their pregnancy; mean follow up in 19 patients was 5.1 +/- 2.8 years (range: 1 to 9 years). RESULTS: The procedure was successful in all patients. Immediately after valvotomy, the Doppler-derived mitral valve area increased from 0.90 +/- 0.18 to 1.97 +/- 0.36 cm2 (p <0.0001), and the transmitral mean gradient decreased from 15.7 +/- 4.7 to 5.5 +/- 1.6 mmHg (p <0.0001). Four patients had mild worsening of mitral regurgitation, and six developed insignificant interatrial communication immediately after valvotomy. There was no other morbidity or mortality. Patients showed a significant improvement in mean NYHA class, from 3.0 +/- 0.1 to 1.0 +/- 0.02 (p <0.001). Twenty-two patients had normal deliveries; one cesarean section in week 36 resulted in stillbirth. No developmental abnormalities were seen in the babies. At long-term follow up of mothers, the mitral valve area was 1.8 +/- 0.52 cm2; restenosis developed in three patients (16%). One baby died at one week from sudden infant death syndrome, and one at eight months, from pneumonia. All other children showed normal growth, development and speech for their age. CONCLUSION: Mitral balloon valvotomy using the Inoue balloon technique can provide satisfactory immediate relief and long-term outcome in pregnant patients with severe mitral stenosis.     

Arrhythmogenic right ventricular dysplasia

Right ventricular dysplasia (RVD) is a disease entity of unknown cause that is characterised by partial or total replacement of RV-muscle by adipose or fibrous tissue. It is a well-recognized cause of arrhythmia and premature sudden death, but usually underdiagnosed. Several noninvasive and invasive diagnostic modalities have been used, however, all may not be positive in a given case. Drug therapy with class 1c, beta-blocker, and amiodarone in variable combination produce varying success rates in preventing recurrent ventricular tachycardia. Failure of the above measures calls for insertion of implantable cardioverter defibrillator. The attention of emergency physicians is drown to this disease as they are the first medical personnel to be presented with this disease as an emergency. Hence their recognition of RVD will ensure early and proper management.