Isotopically Enriched Geogenic δ81 Br and δ37 Cl: Primary Evidence for the Ascending Brine Model.

Mass balance calculations and hydrodynamics of groundwater flow suggest that the solutes in brines of the coastal sabkha aquifer from the Emirate of Abu Dhabi are derived largely from ascending geologic brines into the sabkha from the underlying formations. Solute interpretation for the ascending brine model (ABM) was based on two independent but secondary lines of evidence (solute ratios and solute fluxes). In the current study, direct primary evidence for this ABM was provided through analyses of δ81 Br, δ37 Cl, and 87 Sr/86 Sr. Different solute histories of geologic brine and sea water provide an "isotopic fingerprint" that can uniquely distinguish between the two possible sources. Samples from the coastal sabkha aquifer of Abu Dhabi were determined to have a mean δ81 Br of 1.17‰ that is statistically equal, at the 95% confidence level, to the mean of 1.11‰ observed in the underlying geologic brine and statistically different than sea water. Similarly, the δ37 Cl in sabkha brine has a mean of 0.25‰ and is statistically equal to a mean of 0.21‰ in the underlying geologic brines at the 95% confidence level and statistically different from sea water. Also, dissolved strontium isotope data are consistent with the ABM and even with the complex set of processes in the sabkha, the variance in strontium isotope results is similar to the geologic brine. These observations provide primary direct evidence consistent that the major source of these solutes (and presumably others in the aquifer) is from discharging geologic brines, not from adjacent sea water.

Treatment of severe mitral regurgitation that mimics a para-ring mitral regurgitation after failed annuloplasty ring with MitraClip: A case report.

BACKGROUND: Progressive remodelling of the left ventricle with lateral and apical displacement of one or both papillary muscles can lead to recurrence of severe mitral regurgitation (MR) in the presence of the mitral valve (MV) ring. The MitraClip (Abbott, USA) is the only option in cases with annuloplasty rings too large for implantation of a Sapien prosthesis in high surgical-risk patients. We present a case where the MR jet was directed toward a para-ring hole, and the MitraClip system was used successfully to treat this severe MR. CASE SUMMARY: An 80-year-old woman underwent coronary artery bypass surgery plus MV repair with C-shaped ring 6 years ago. In the past year, she experienced severe shortness of breath; her ejection fraction dropped to 15%. A transesophageal echocardiogram revealed that severe MR started at the level of MV leaflets and then passed to the left atrium beside the MV ring. Live 3D showed the severe MR coming through the oval-shaped hole beside the C-shaped MV repair ring. MitraClip implantation was decided, the two leaflets were grasped successfully, the clip was fully closed, and only trace MR remained at the MV leaflets with no flow to the para-ring hole. The patient was extubated after 12 hours and discharged home after 2 days. Follow-up transthoracic echocardiography after 6 months showed the clip in place and trace residual MR. CONCLUSION: Implantation of MitraClip in the presence of MV repair ring is feasible and safe. The para-ring defect can be left if the origin of MR from the MV coaptation line is treated successfully with MitraClip. Symptomatic improvement with no rehospitalization was documented in this case.

Percutaneous closure of ruptured noncoronary sinus of Valsalva to right atrium causing severe right heart failure, a case report.

In all young and middle-aged patients presenting with symptoms of acute heart failure and new heart murmurs, sinus of Valsalva aneurysm (SVA) rupture should be considered in the differential diagnosis. Most of SVAs rupture into the right side of the heart. Percutaneous closure is a less invasive alternative to surgery. A 25-year-old man presented with shortness of breath New York Heart Association class III of nine months' duration with a progressive course. He had a continuous murmur with maximum intensity over the left sternal border and propagated all over the pericardium. Chest radiographs revealed moderate congestion. Transthoracic and transesophageal echocardiograms with 3D imaging revealed a shunt between the ruptured noncoronary SVA and the right atrium. Percutaneous closure decided; the wire passed from superior vena caca through the ruptured sinus to the aorta. The distal disc of the device deployed in the aorta and the proximal disc in the right atrium. The ruptured aneurysm closed with no more flow to the right atrium. The patient was discharged from the hospital after two days. In conclusion, device closure of ruptured coronary sinus to the right atrium is feasible and safe. Surgery should be reserved for patients with failed device closure. .

Impact Of TP53 Gene Promoter Methylation On Chronic Lymphocytic Leukemia Pathogenesis And Progression.

BACKGROUND: Chronic lymphocytic leukemia (CLL) is a malignant lymphoid disorder that results from the overgrowth of mature-looking lymphoid cells in the blood and lymphatic tissue. Various clinical presentations have been attributed to the disease as a result of the different underlying genetic and epigenetic alterations. The current study has been initiated to study the role of an epigenetic alteration affecting the promoter of the TP53gene on CLL pathogenesis and progression. METHODS: The current study involved 54 newly diagnosed patients presenting with CLL as well as 30 normal individuals as controls. After obtaining verbal consent, data collection was done and the blood collected from all enrolled individuals for hematological investigations as well as for molecular categorization of TP53 methylation status. Methylation-specific polymerase chain reaction (MS-PCR) technique was used to define the methylation status of the TP53 gene promoter that encompasses DNA extraction, bisulfite conversion, conventional PCR amplification, running on agarose gel and documentation. Finally, statistical analysis was done to assess any correlation of the TP53 epigenetic alteration to the disease etiology and the progression. RESULTS: In the current study, all controls and 42 of 54 patients show unmethylated TP53 gene promoter; on the other hand, the methylated promoter was detected among 12 patients with a p-value of 0.001. TP53 gene promoter methylation significantly linked to reduced platelet count (p-value of 0.047) and advanced stage at presentation (p-value of 0.076). No significant differences were seen among both methylated and unmethylated TP53 promoters in relation to the age of the affected individuals, total white blood cell counts and hemoglobin level of the affected individuals. CONCLUSION: The current study revealed a significant correlation of TP53 gene promoter methylation to chronic lymphocytic leukemia pathogenesis and lower platelet counts.

Treatment of severe aortic stenosis and left ventricular outflow tract mass with transcutaneous aortic valve implantation: a case report.

BACKGROUND: Percutaneous implantation of aortic valve for severe aortic stenosis (AS) in the presence of pedunculated mobile left ventricular outflow tract (LVOT) mass not reported before. In this case report, we address the feasibility of this procedure. CASE SUMMARY: An 80-year-old patient who presented with presyncope, transthoracic echocardiogram (TTE), and transoesophageal echocardiography (TOE) revealed severe calcific AS and LVOT mass measuring 2.1*1.5 cm. The patient was turned down for surgery. It was decided that transcatheter aortic valve implantation (TAVI) be performed because the valve compresses the mass against the proximal part of the interventricular septum. The mass peduncle was 1.4 cm, and it was 4 mm away from the annulus. This meant the valve was needed to be deployed 18 mm below the annulus to cover the mass completely. Gentle manipulation and direct valve deployment without preballoon dilation to decrease the possibility of fragment embolization were necessary. Self-expandable core valve deployed as low as possible, after initial deployment, the distance of LVOT covered by the valve measured by TOE 1.66 cm, the whole mass was covered, then the valve was fully deployed. The patient was extubated in the catheterization room; there was no clinical evidence of embolization. The patient was discharged home after 2 days. A follow-up TTE after 6 months showed a well-functioning valve and the LVOT mass then disappeared. DISCUSSION: Pedunculated LVOT mass should be resected surgically. In high-risk surgical patients, direct TAVI to compress the mass is feasible in experienced canters. The safety issues need more research and more cases to judge. Transoesophageal echocardiography during the procedure is mandatory to guide the valve position.

Retroperitoneal Varix ligation with sclerotherapy: a prospective randomized comparative study.

INTRODUCTION: The aim of this article is to compare the results of high varix ligation with and without sclerotherapy. MATERIAL AND METHODS: Between November 2014 and December 2015, sixty patients with varicocele were included in this study. Patients were divided into two equal groups; group I (underwent high varix ligation), and group II (underwent high varix ligation with a retrograde injection of 2 mL of 5% ethanolamine oleate in the lower end of the bisected gonadal vein). The operative time, intra- and postoperative complications, postoperative pain, improvement of semen parameters, incidence of recurrence and achieving of unassisted pregnancy were recorded for both groups. RESULTS: The age range was 19-34 years in group I and 21-37 years in group II. The operative time was shorter in group I (34.6 ±7.81 min) than group II (43.3 ±8.5 min) (P <0.001), which was statistically significant.Improvement of semen parameters and the occurrence of spontaneous pregnancy were insignificant between both groups. No intraoperative complications occurred. The postoperative complications were statistically insignificant in both groups. CONCLUSIONS: Combined varix ligation with retrograde sclerotherapy does not offer significant advantages over high varix ligation alone with a longer operative time and prolonged post-operative pain.

Plasma ghrelin and leptin in patients with inflammatory bowel disease and its association with nutritional status.

BACKGROUND/AIMS: Ghrelin and leptin are thought to play a role in the loss of appetite in active inflammatory bowel disease (IBD). This study seeks to probe into the association of these markers with regards to IBD and the nutritional status of these patients. A case-control study was conducted between May 2015 and March 2016 at King Khalid University Hospital (KKUH). Thirty-one patients with IBD (both active and non-active) and forty-one healthy controls (both non-fasting and fasting) were recruited. PATIENTS AND METHODS: Plasma ghrelin and leptin levels were determined using an enzyme immunoassay (EIA) technique. The nutritional status was determined through the standardized Mini-Nutritional Assessment (MNA) questionnaire. RESULTS: The difference in the plasma ghrelin between active (263.7 pg/mL) and non-active (108 pg/mL) cases was significant (P= 0.02). The difference in mean plasma leptin level between active cases (229.4 pg/mL) vs. non-active cases (359.7 pg/mL) was insignificant (P= 0.4). In fasting (2028.6 pg/mL) and non-fasting controls (438.8 pg/mL), the mean plasma ghrelin values was significantly different (P< 0.01). In contrast, the plasma leptin level difference between fasting (727.3 pg/mL) and non-fasting (577 pg/mL) controls was insignificant (P= 0.14). There is a statistically significant association in mean ghrelin levels between the case group and the control group (P< 0.01). With regards to nutritional status, the mean MNA score of active cases compared to fasting controls was 18.8 ± 5 vs. 20.8 ± 3.8, respectively (P< 0.01) Conclusion: Ghrelin levels were lower in the active IBD cases compared to the inactive ones, signifying an underlying pathology as etiology to this phenomenon. Furthermore, ghrelin levels were significantly lower in both case groups compared to the controls. These findings, along with the disparity in the MNA scores, insinuate a possible link between hormone levels and the loss of appetite from which these patients suffer.

Iron status parameters in preeclamptic women.

BACKGROUND: Evidence of increased oxidative stress due to endothelial dysfunction in preeclampsia has been well established. Increase in the oxidative stress is catalyzed in the presence of free transitional metals. Therefore, the relationship of iron status with preeclampsia was under investigation. OBJECTIVE: The objective of the study was to compare red blood cell (RBC) count, hemoglobin (Hb) concentration, hematocrit (Hct), RBC indices, and iron status parameters in preeclamptic and healthy pregnant women. METHOD: Blood samples were collected from 40 pregnant females diagnosed as preeclampsia and 80 normal pregnant females at the Department of Obstetrics and Gynecology at King Abdulaziz Medical City, Riyadh, Saudi Arabia between February 2009 and January 2010. We recorded RBC count, Hb concentration, Hct, RBC indices, serum iron and ferritin levels in both the groups. RESULT: Mean serum iron in preeclampsia group was 23.48 ± 9.05, while 12.2 ± 5.21 in normal group (p <0.05). Similarly, mean serum ferritin concentration in preeclamptic and normal pregnant women were 32.56 ± 11.72 and 19.89 ± 8.86, respectively (p < 0.05). No significant differences were found among RBC count, Hb concentration, Hct, and RBC indices in both the groups. CONCLUSION: We recommend that any pregnant female with higher serum iron and ferritin concentrations should be further investigated for preeclampsia.