Sofosbuvir/ledipasvir in treatment of hcv infected egyptian patients with decompensated liver cirrhosis child pugh class [B]

Background: The main goal of anti-HCV therapy in patients with decompensated [Child-Pugh B] cirrhosis, not on a transplant waiting list is to achieve improvement in liver function and survival. Several studies have demonstrated acceptably high sustained virological response [SVR] rates, equivalent in Child-Pugh B patients, in individuals with decompensated cirrhosis, together with an effect of therapeutic viral clearance on liver function, with significant improvements in bilirubin, albumin and international normalized ratio values and, as a result, in model for end stage liver disease [MELD] and Child-Pugh scores in one-third to half of patients. Similar results were reported in real-world studies

Aim of the work: Assessment of the safety and efficacy of sofosbuvir/ ledipasvir in infected naïve and experienced HCV Egyptian patients with decompensated liver disease

Patients and Method: This study was conducted on 100 patients with HCV related decompensated liver disease who presented to the hepatology outpatient clinic in El Agouza Police hospital and were evaluated according to the inclusion and exclusion criteria

Results: Among the 100 enrolled patients; there was male predominance being 72 males [72%] and 28 females [28%]. Their age ranged between 34 and 65 years [mean 52.7 ±8.2 years]. Age was significantly higher in patients who did not achieve SVR. Among the 100 studied cases 6 patients stopped treatment; 3 of them developed HCC, 1 developed precoma, 1 died and 1 lost follow up. SGOT, SGPT, ALP, total and direct bilirubin, serum urea and creatinine and AFP showed significant improvement at the end of treatment and 3 months after end of treatment. As regards Child and MELD scores among the studied cases, Child and MELD significantly decreased in the whole sample

Conclusion: Ledipasvir/sofosbuvir is effective and safe in the treatment of HCV decompensated patients Child Pugh B. MELD and Child scores significantly improved with HCV treatment in decompensated patients

Recommendations: Longer follow up with assessment of the need for liver transplantation or HCC development is important. Larger number of patients is required

Correlation between hepatitis C viral load and hepatitis C Core antigenaemia among Egyptians

Hepatitis C virus [HCV] infection is widespread in Egypt. This study compared HCV RNA with HCVcAg for the detection and quantification of viraemia among a sample of Egyptians. Sera from 80 suspected HCV-positive individuals were tested simultaneously for HCV-RNA load using real-time polymerase chain reaction [PCR] and HCVcAg level using ELISA. Of the 80 samples, 25% were HCV-RNA-negative. HCVcAg was detected in all samples: range 0.4-2462 ng/mL, mean 460 [SD 506] ng/mL. The sensitivity and specificity of HCVcAg were 96.7% and 90.9%, respectively. There was a significant correlation between serum HCV-RNA and HCVcAg levels [r = 0.4, P < 0.0001]. HCV-RNA remains the gold standard for diagnosis of active HCV infection but HCVcAg can be used where PCR is not available

Some predicative changes in aggressive behavior of some essive behavior of some vocational learning student and preparatory student

Problem: the problem of the current study grew out of the growing phenomenon of increasingly aggressive behavior Through researcher visits to some junior high schools, asking specialists and their The educational process and found that aggressive behavior is one of the most important behavioral problems faced by Her children in general at this stage. Importance of the study: useful in knowing the size and direction of the relationship between aggressive behavior and all of frustration Anxiety and self-image and methods of treatment of parental social Majarap

Actions: the researcher in this study will be used in the descriptive approach of comparative knowledge of degree Aggressive behavior among students of secondary vocational education and its relationship to some psychological variables And social and compared by students preparatory education teacher of the year

Sample: The study sample consisted of 600 students divided into 300 students from grades Three secondary public education and 300 students from three secondary vocational education classes, The researcher used a set of standards, a measure of aggressive behavior and the measure of frustration The measure of self-concept and anxiety scale and the scale of parental treatment methods as perceived by children The measure of social Majarap

Results: The results of the study on a set of variables that frustration, anxiety and Majarap And treatment of parental and self-concept where there are significant differences between the behavior and all Aladowne From the previous variables

Assessment of liver biopsies in obese patients: a histological and immunohistochemical study

Obesity is a multifactorial condition that involves complex interactions of metabolic, physiological, social, and behavioral factors. Obese individuals have an increased incidence of nonalcoholic fatty liver disease [NAFLD], which is one of the most common causes of chronic liver disease. However, the histological course of NAFLD remains undescribed. The aim of this study was to determine the histological course of NAFLD in obese patients. Twenty biopsies [10 from male and 10 from female patients] were obtained from obese patients and processed for histological and immunohistochemical studies. Liver biopsies from obese patients showed single or multiple fat droplets within the cytoplasm of liver cells. Ballooning of hepatocytes containing Mallory bodies showing positive immunohistochemical reactions was observed. Moreover, inflammatory cells were detected in hepatic lobules, together with hepatic cell necrosis. These changes were associated with periportal fibrosis. In patients for whom the diagnosis of NAFLD has already been made clinically, liver biopsy is performed to make the distinction between simple steatosis and steatohepatitis and also to determine the severity of liver damage within the broad spectrum of steatohepatitis. Further studies are required to determine the natural history of NAFLD and the role of liver biopsy in monitoring therapeutic responses

Immunoexpression of gelatinase and apolipoprotein E in induced glomerulosclerosis in adult male albino rat

Introduction: The abnormal expressions of gelatinase are implicated in the pathogenesis of extracellular matrix accumulation in glomerulosclerosis [GS]. Apolipoprotein E [apoE] is an important plasma protein in cholesterol that plays a key role in the progression of GS

Aim: The aim of this work was to study the immunoexpression of gelatinases and apoE in experimentally induced GS

Materials and methods: Twenty male rats were divided into two equal groups: a control group and a GS model group [each n=10]. The GS was induced by an injection of adriamycin [5 mg/kg]. At the end of 4 weeks, the 10 rats in each group were killed and kidney specimens were processed for [histological and immunohistochemical study] biochemical studies

Results: Serum total protein and serum albumin in the GS group were reduced compared with those of the control group [P<0.01]. Compared with the control group, the values of 24-h urine total protein, 24-h urine excretion for albumin, blood urea nitrogen, serum creatinine, and GS index in the GS group were significantly increased [P<0.01]. In the GS group, there was glomerular hypercellularity and hypertrophy with focal obliteration of some capillaries. Interstitial fibrosis and inflammation were detected. The immunostaining for gelatinase was decreased, whereas apoE, transforming growth factor-beta1, and alpha-smooth muscle actin were increased

Conclusion: In induced GS, an increased expression of apoE was associated with decreased expression of gelatinase and this led to accumulation of extracellular material in glomeruli

Effect of chickpea substitute in the quality characteristics of biscuits and cake

Chickpea [Cicer arietinum L.] is considered the fifth valuable legume in terms of worldwide economic stand point. lt is planted in southern and western area of Asia and Mediterranean. This study was undertaken to study the effect of supplementation of wheat flour with different percentages of chickpea [5, 10, 15, 20, 30%] on the chemical composition, physical and organoleptic properties of biscuits and cakes. Cake and biscuits were prepared using different percentage of chickpea flour. Substitute the wheat flour in their formula. Chemical composition, physical measurements as well as sensory evaluation were carried out on the tested samples. The results showed that chickpea flour is a good source of protein [22.82%], crude fiber [2.90%] and ash [3.33%]. Also, chickpea is rich in potassium, magnesium and iron. Supplementation of wheat flour with chickpea flours in biscuits results in increasing protein, lipid, fiber and ash. The specific volume were in the range of [38.83 - 44.13cc/gm], specific lightness were in the range of [41-25 cc/gm.] and spread factor ranged between [100-114.21%] for control samples and biscuits that contain 30% of the chick pea flour. This biscuit which contain chickpea flour at all the supplement ratio were accepted by the panelist. The cake prepared with supplementation of wheat flour with chickpea flours at different percentage [5, 10, 15, 20, 30%] had a higher protein, lipid, crude fiber and ash content with less percentage of carbohydrates. lncreasing the ratio of chickpea flours in cake has led to a slight increase in volume and specific gravity. Sensory evaluation of the cake was accepted at all the different supplementation ratios of chickpea with the higher score for the cake samples that contain chickpea flours at ratio 10 -15%. Generally prepared cake and biscuits samples with chickpea flour as a supplement to wheat flour in their formula lead to increasing protein, crude fiber and mineral content with improving the physical properties and organoleptic characteristics

Prevalence of hepatitis D in hepatitis B virus carriers in volunteer blood donors at Minia governorate

Background: There are many hundred carries for hepatitis B virus [HBV] and hepatitis D virus [HDV] is a defective virus that requires hepatitis B surface antigen [HBs Ag] for replication and transmission. Coinfection of HBV and HDV are usually acute, self limited infections. In contrast, a super infection causes a generally sever and acute hepatitis that most often results in chronic hepatitis D, with the suppression of HBV replication but persistence of HDV replication

The aim of the work: detection of infection with HDV among HBsAg positive blood donors in Regional Blood Transfusion Center in Minia governorate

Patients and methods: We evaluated ten thousand volunteer blood donors in Minia regional blood transfusion center in the period from October 2009 to May 2010. Blood screening for HBsAg was done using plasma of the blood donors. Any blood sample was seropositive for HBsAg, was subjected to detection of antibodies to hepatitis delta antigen [anti-HD] in plasma samples and confirmed the diagnosis of hepatitis B DNA by doing PCR test to all positive [anti-HD] cases. Also detection of HCV by MEIAs was done

Results: Out of the 10000 samples, 200 samples were reactive to HBsAg. Out of the 200 blood samples, 21[10.5%] were anti-HD positive. 21 positive anti- HD samples were HBV DNA positive [100%] and 2% were positive to HCV while

Spontaneous viral clearance of chronic HCV infection in Upper Egypt: a community-based study with a 10 year follow-up

Hepatitis C virus [HCV] infection is a global blood-borne disease with the highest prevalence in Egypt. The natural course of HCV infections in highly variable. The reason why the infection persists in some patients and resolves spontaneously in others is not known. The aim of this study was to detect the frequency of spontaneous clearance of chronic HCV infection in Upper Egypt and to determine the predictors of persistence of HCV infection. In 1997, a community-based study was performed in Sallam village in Upper Egypt. Out of the 329 patients who had the start of the study and those who had received specific treatment for HCV infection. These patients were followed up every six months prospectively starting from 2004 till 2007 by clinical, ultrasonographic, and laboratory examinations [liver functions, complete blood count, prothrombin time and concentration]. Serum HCV-RNA was tested for at the end of the follow up period. After a 10-year follow-up, spontaneous clearance of chronic HCV infection was detected in 35 [17.5%] out of 200 patients. Most of clinical and laboratory abnormalities were detected in patients with HCV-RNA persistence than those who had cleared HCV-RNA. By ultrasonographic examination, normal liver echopattern was found in 30 [85.7%] cases with HCV-RNA clearance and in75 [45.5%] patients who had HCV-RNA persistence. Evidence of liver cirrhosis was found only in 9 cases with HCV-RNA persistence [5.5%]. Old age [>60 years] was the strongest predictor of persistence of HCV infection followed by obesity and history of blood transfusion. Spontaneous clearance of chronic HCV infection could occur without any specific antiviral therapy in 17.5% of patients. Older age was the strongest predictor of persistence of HCV infection followed by obesity and infection by blood transfusion

Relationship between HCV infection and Insulin resistance in non-obese non-diabetic patients

Hepatitis C is a major cause of liver-related morbidity and mortality and represents a major public health problem in Egypt and worldwide. There is growing evidence as regard to the association between hepatitis C virus [HCV] infection and type 2 diabetes mellitus. However, the mutual link and related virological implication have not been fully clarified. Insulin resistance [IR] plays a primary role in the development of type 2 DM. This is supported by the results of prospective longitudinal studies showing that IR is the best predictor of the development of type 2 DM, preceding its onset by 10-20 years. To assess the correlation between HCV morbidity and Insulin resistance [IR] detected by HOMA test in none diabetic none obese HCV patients. The study participants were subcategorized into two groups,Group [I]: included 867 healthy subjects [negative HCV RNA] as a control group. Group [II]: included 277 patients with chronic HCV as a study group. The 2 groups were subjected to thorough history taking, full clinical examination, Anthropometric study,ultrasonographic examination and laboratory investigations including liver functions, viral markers, and qualitative PCR for HCV RNA ,lipid profile, glucose profile and HOMA test. This study revealed higher insulin resistance in the HCV study group than the control group

Detection of visceral adiposity by ultrasonography and its relation to insulin resistance in HCV patients

Hepatitis C is a major cause of liver-related morbidity and mortality and represents a major public health problem in Egypt and worldwide, Ultrasonography is a simple non-invasive method for detection of visceral fat, which is directly, correlated with insulin resistance [IR] as well as development of type 2 diabetes mellitus. To assess the validity of detection of visceral adipose tissue area with Ultrasonography and its correlation with IR in HCV patients. The study participants were subcategorized into two groups, Group [I]: included 867 healthy subjects with negative [HCV] RNA as a control group. Group [II]: included 277 patients with chronic HCV as a study group. The 2 groups were subjected to thorough history taking, full clinical examination, Anthropometric study,ultrasonographic examination and laboratory investigations including liver functions, viral markers, and qualitative PCR for HCV RNA ,lipid profile and glucose profile. This study revealed that Ultrasonography is a simple, non-invasive, safe method in detection of visceral adiposity, which is correlated significantly with IR in chronic HCV patients

impact of preemptive phosphodiesterase III inhibition on left ventricular diastolic performance after valve replacement for aortic stenosis

Left ventricular diastolic dysfunction [LVDD] in aortic stenosis is an important independent risk factor for early and late postoperative mortality. We hypothesized that enoximone or milrinone, administered after releasing the aortic cross-clamp improved the diastolic function of the left ventricle as assessed by transesophageal echocardiography [TEE] in patients with aortic stenosis undergoing aortic valve replacement. Forty-five adult patients with valvular aortic stenosis and preserved systolic function scheduled for primary aortic valve replacement were randomly assigned to one of three equal groups; in group M [milrinone group, n = 15] patients received milrinone with a loading dose of 50 microg/kg followed by an infusion of 0.5 microg/kg/min for 6 hours. In group E [enoximone group, n = 15] patients were given enoximone after release of aortic cross-clamp, with an initial bolus of 0.5 mg/kg followed by a continuous infusion of 2.5 microg/kg/min for 6 hours, and in group C [control group, n = 15] patients received saline bolus and infusion at the same time and interval as the first two groups. Hemodynamic parameters and transesophageal echocardiographic assessment of left ventricular end-diastolic area [EDA], transmitral inflow velocity, and tissue doppler imaging [TDI] of the mitral annulus parameters were assessed pre-bypass [Tl], post-bypass [12] after administration of the test drug and separation from CPB, and at the end of the operation after chest closure [T3]. Cardiac index showed a statistically significant increase [p < 0.05], while the systemic vascular resistance showed statistically significant decrease [p < 0.05] in T2 and T3 compared to Tl in the three groups. Cardiac index was significantly higher [p < 0.05] and the systemic vascular resistance was significantly lower [p < 0.05] in T2 and T3 in both the milrinone and enoximone groups compared to the control group at the same intervals. Left ventricular end-diastolic area showed a decrease in all groups which was statistically significant [p < 0.05] comparing T2 and T3 to Tl but without intergroup difference. Peak E-wave velocity, peak A-wave velocity and E/A ratio of the transmitral flow were comparable in the three groups. E-wave deceleration time was significantly decreased [p < 0.05] in T2 and T3 in the three groups. Tissue Doppler analysis of the peak early mitral annular velocity revealed no significant difference between the three groups. The administration of milrinone or enoximone after release of aortic cross-clamp in valve replacement for aortic stenosis did not improve ventricular diastolic function and failed to show increase in the indices of compliance and relaxation compared to the control

Investigation of the vasodilator effect of the new synthesized compound 2-alkylthio-4-ethyl-4-methyl-4,5dihydro-lh imidazolin-5-one oxime [Oxime] on the ischaemic rat hind limb by using laser doppler flowmetry technique

The potential vasodilator effect of the novel compound 2-alkylthio-4-ethyl-4-methyl-4,5 dihydro-lH-imidazolin-5-one oxime [oxime] was investigated in a model of hind limb ischaemia induced in rats by unilateral ligation of the right femoral artery using Laser Doppler Flowmetry. The effect of oxime was compared with that of isoprenaline or L-arginine. Test drugs and oxime were injected systemically into the femoral vein or applied locally on the planter surface of the rat hind paw. Serum level of nitrite [NO[2] and nitrate [NO[3] were measured by ELISA. Immediately after operative induction of right hind limb ischaemia, blood flow ratio [Right/Left limb ratio: BFR] decreased to 0.33-0.39 in different groups. The intravenous [i.v.] administration of oxime increased BFR in a dose-dependent manner. Compared with pre-drug BFR, oxime administered at doses of 0.064, 0.128 or 0.256 mg/kg increased BFR by 78.8, 228.9 and 605.9%, respectively. Meanwhile, L-arginine given i.v. at 100 mg/kg increased BFR by 460%. Isoprenaline given i.v. at 1 micro g/kg increased BFR by 174.3%, while isoprenaline combined with oxime [0.064 mg/kg] increased BFR by 302.7%. Similarly, after topical application of oxime, BFR increased by 13.5, 161.1 and 333.3%, respectively. L-arginine given at 1000 mg/kg increased BFR by 389.7%. Isoprenaline given at 10 micro g/kg increased BFR by 131.6%, while isoprenaline administered in combination with oxime [0.064 mg/kg] increased BFR by 208.3%. The concentration of NO in serum was significantly increased after systemic or topical administration of either 0.128 and 0.256 mg/kg oxime or 100 and 1000 mg/kg L-arginine, respectively. It is concluded that systemic or topical oxime results in marked enhancement of blood flow in the rat ischaemic hind limb. This effect of oxime is likely to be mediated through the release of NO

Therapeutic drug monitoring of gentamicin: evaluation of five nomograms for initial dosing at Al-Amiri Hospital in Kuwait

To compare five published nomograms [Thomson guidelines, Mawer nomogram, rule of eights, Hull-Sarubbi table and Dettli method] for calculating the initial gentamicin dosage regimen in a Kuwaiti population. Based on measured peak and trough gentamicin concentrations, the elimination rate constant and volume of distribution of gentamicin were calculated for each patient [n = 56], using a modified two-point Sawchuk-Zaske method. The calculated individual set of pharmacokinetic parameters and the initial dose regimen recommended by each of the five methods were used to predict the steady-state peak and trough of gentamicin concentrations. The Thomson guidelines produced consistent results in predicting gentamicin concentrations within the target ranges of peak plus trough, peak only and trough only [63, 75 and 75%, respectively]. The Mawer nomogram, Hull-Sa-rubbi table and Dettli methods achieved similar percentages of patients [46-50%] within the target ranges [5-10 mg l[-1] for peak and 0.5-2 for trough], whereas empirical dosing and the rule of eights showed the lowest percentages of patients within the peak plus trough target range [25 and 37%, respectively]. However, with respect to the underdosing target range [predicted concentration <5 mg l[-1]], the Thomson guidelines showed that 21% of patients were underdosed. The results show that a large number of patients [37-63%] were outside the target ranges in all initial gentamicin dosing methods evaluated in this study. Therefore, serum concentration measurement can be advised to assist in the optimization of gentamicin dose selection

Vascular complications occurring after diagnostic cardiac catheterization and percutaneous coronary interventions. incidence and management

This study was conducted on 48 patients [32 males and 16 females] with access site complications requiring vascular surgical consultation to evaluate the incidence and surgical management of arterial injuries resulting from diagnostic cardiac catheterization and percutaneous coronary interventions. The total number of patients underwent cardiac catheterization and percutaneous coronary interventions [PCI] were 822. The work was done at the Chest Hospital in the state of Kuwait during a 2-year period from December 1, 2004 to November 30, 2006. Thirty nine patients [81.2%] were ischaemic heart disease, thirty five [72.9%] were hypertensive, thirty [62.5%] were smokers, eleven [22.9%] were diabetics, twenty two [45.8%] were hyperlipidaemic and nineteen [39.5%] had a previous myocardial infarction. The reported complications were:- femoral artery pseudo aneurysm in 24 patients [50%], acute arterial thrombosis in 9 patients [18.7%], haematoma at the groin in 7 patients [14.5%], retroperitoneal haematoma in 2 patients [4.1%], intraperitoneal haemorrhage in one patient [2%], bleeding from the catheter puncture site in 3 patients [6.2%] and arteriovenous fistula [A/V fistula] in two patients [4.1%]. All patients were carefully evaluated by history taking and physical examination in addition to urgent routine laboratory investigations. Duplex study was performed in thirty one patients [64.5%], twenty four patients [50%] with femoral artery pseudo aneurysm and seven patients [14.5%] with groin haematoma. Abdominal ultrasound was carried out in three patients [6.2%], in two of them a massive retroperitoneal haematoma was documented while in the 3[rd] patient an intraperitoneal haemorrhage was detected. Blood transfusion needed urgently in 8 patients [16.6%] for patient's resuscitation before surgery due to massive blood loss. Of total 48 complications following diagnostic cardiac catheterization and PCI: fourteen patients [29.1%] underwent successful ultrasound guided pseudo aneurysm compression and 34 patients required surgical interventions. These surgical interventions were performed under local anaesthesia in 31 patients [91.1%], and under general anaesthesia in 3 patients [8.8%]. Of ten patients [20.8%] with femoral artery pseudo aneurysm [not responding to ultrasound guided compression], 7 patients [14.5%] of them underwent primary arterial repair, in the remaining three patients [6.2%] saphenous vein patches were used. Groin haematomas were evacuated in 7 patients [14.5%]. In 3 patients [6.2%] with severe catheter site bleeding primary repair was performed. In 9 patients [18.7%] with acute lower limb ischaemia, successful thrombectomy was performed in 5 patients [10.4%]. In 2 patients [4.1%] thrombectomy was performed and the arteriotomy closed with saphenous vein patches. While in the remaining 2 patients femoro-popliteal synthetic bypass graft was performed. In 2 patients [4.1%] with A/V fistulas direct repair of femoral artery and vein were performed. In 3 patients [6.2%] with massive retroperitoneal haematoma and intraperitoneal haemorrhage, ileo-femoral bypass grafting was performed due to exsanguinating arterial perforation and extensive intimal dissections. All patients were followed up at 1-, 3, 5-, 9- and 12 months after surgery as regard to the lower limb vascularity and graft patency which was determined by Doppler study. During the period of follow up no mortality occurred. But wound infection was documented in two patients [4.1%] after evacuation of groin haematoma. Diagnostic cardiac catheterization and PCI are associated with a low but significant risk of access site complications which is higher during PCI than with diagnostic procedures. Early recognition and management is very important to minimize the risk of these complications

Outcome of carotid endarterectomy in cases of symptomatic severe carotid artery stenosis

This study was conducted on 23 patients with symptomatic severe carotid artery stenosis [70-99%] to know the outcome and evaluate the results and efficacy of the standard carotid endarterectomy. The work was done at Mubarak Al-Kabeer hospital in the state of Kuwait during a 2-year period from December 11, 2004 to December 10, 2006. All patients were evaluated clinically by history taking, physical examination as well as routine laboratory tests including full blood count, renal functions, liver functions, and serum electrolytes in addition to x-ray chest, ECG and echocardiography. Carotid duplex, Magnetic resonance or CT-angiography, computed tomography brain scans were carried out in all patients. Carotid angiography was performed in 4 cases [17.3%] where there was a doubt or misinterpretation between the results of carotid duplex and carotid MRA or CT angio. The indications for carotid endarterectomy [CEA] were: internal carotid artery [ICA] stenosis of 70% or more associated with: nondisabling stroke in 10 patients [43.4%], and recurrent transient ischaemic attacks [TIAs] in 13 patients [56.2%]. In 17 patients [73.9%] CEA was performed under local anaesthesia, while in 6 patients [26%] it was performed under general anaesthesia. Temporary Carotid shunts were used in 7 patients [30.4%] to ensure blood supply to the brain during the procedure. The arteriotomy was closed with a PTFE patch in 13 patients [56.2%] due to small diameter of ICA. In the remaining 10 patients [43.4%] primary closure was done. Post-operative follow-up of the patients was done at 1, 3, 6, 9, and 12 months and every 4 months thereafter based on repeated clinical examination carotid duplex and MRA for carotids and circle of Willis. During the period of follow up there was no mortality. There were two cases [8.6%] of ipsilateral stroke. The first case [4.3%] had nondisabling stroke and the 2nd [4.3%] had major stroke. Wound haematoma occurred in one patient only [4.3%]. Restenosis [stenosis of the lumen diameter of ICA 50% or more] was found at carotid duplex scanning in one patient [4.3%] and occurred 3 months after surgery. CEA is now the method of choice in the treatment of symptomatic severe carotid artery stenosis [70-99%]. It is easy and effective procedure for the prevention and / or minimization of the incidence of subsequent stroke

effect of intraoperative repair of mild-to-moderate and moderate ischemic mitral valve regurgitation on the postoperative results of coronary artery bypass graft surgery

Patients undergoing bypass grafting [CABG] often present with mitral regurgitation [MR]. While surgical strategy for patients with either trace or severe MR is well established, the need for a valve procedure with mild-to-moderate and moderate mitral regurgitation is still controversial. This study aims at evaluating the impact of intraoperative repair of mild-to-moderate or moderate ischemic mitral valve regurgitation on the early postoperative results of Coronary Artery Bypass Graft Surgery. Our prospective comparative study was done in the Department of Cardiothoracic Surgery of Kasr El Aini University French Teaching Hospitals as well as private hospitals after approval of the local ethical committee. The study included 60 consecutive CABG patients: 13 women [21.6%] and 47 men [78.3%] with a mean age of 59 +/- 3.5 years [range 39-66 years] which were operated upon between 2004 and 2006. Patients were divided into two adequately-matched groups: group A [no 30] included patients who carried out mitral repair concomitant with CABG; and group B [no 30] which included patients who were submitted to CABG only. Data was collected prospectively in the 1st. group patients and retrospectively in the 2nd. group patients. Preoperative patient characteristics, as well as the general operative techniques used, were comparable between patients of both groups. Preoperative Clinical and Echocardiographic examination in all patients proved the presence of mild to moderate or moderate ischemic mitral regurgitation [NYHA Clinical grades 1-2 or grade 2]. Similar Comorbidity conditions were present in both groups. Follow-up was done by clinical and echocardiographic examination for 1st. postoperative year to assess early and short-term results and identify independent predictors for early and short-term postoperative risk. A single patient [3.3%] died in group A patients; versus 4 patients [13.3%] in group B. [p< 0.01]. Better clinical improvement [NYHA step-up for milder sypmtoms]; and functional results [earlier return to work]; together with more echocardiographic improvement [LVEDD, LVESD, LA diameter, LVEF%, and surface area of the MR jet] occurred in group A versus group B patients. Morbidity occurred more in 6 [20%] of group B patients; versus 4 patients [13.3%] in group A with no statistical significance. Independent predictors of poor postoperative outcome of CABG surgery were: female sex; preoperative LVEF dysfunction, frequent preoperative infarctions, poor NYHA Class; prior cerebrovascular accident and incomplete revascularization. We found that intraoperative repair of mild-to-moderate or moderate ischemic MR during coronary artery bypass graft surgery led to a better intraoperative and postoperative outcome compared to those in whom CABG surgery was done alone. Being associated with acceptably-less mortality and morbidity complications in the immediate and early postoperative periods we justify its safe use in this context