ABSTRACT Objectives To study the relation between coronary artery disease (CAD) and peripheral ar... more ABSTRACT Objectives To study the relation between coronary artery disease (CAD) and peripheral arterial disease (PAD) with osteoporosis in postmenopausal women.Patients and methodsA 100 postmenopausal women were studied for evidence of osteoporosis by measurement of lumbar spine and femoral neck bone mineral density (BMD) and calculation of T score. From these cases; two groups were selected, group I included 30 cases with osteoporosis and group II included a matching 30 cases without osteoporosis or osteopenia as control group. Both groups were studied for prevalence of CAD using noninvasive tests including ECG, echocardiography and CT angiography, and prevalence of PAD using noninvasive tests including ankle brachial index (ABI) and color duplex study (CDS) of lower limb arteries.ResultsUsing CT angiogram, 17 cases (56.7%) had CAD in group I versus 6 cases (20%) in group II (p = 0.003). Prevalence of three vessel disease was significantly higher in group I than in group II (23.3% vs 3.3%, p = 0.022). In group I, there was a significant positive correlation between patients’ age with prevalence and severity of CAD in group I; and a significant negative correlation between T score with prevalence and severity of CAD. Presence of significant stenosis or occlusion in CDS of lower limb arteries was found in 6 cases (20%) in group I versus one case (3.3%) in group II (p = 0.044).Conclusion Because of the increased prevalence of CAD and PAD in postmenopausal women with osteoporosis the severity of CAD and PAD in osteoporotic postmenopausal women is positively correlated to the severity of osteoporosis. Thus, in osteoporotic postmenopausal women, cardiovascular status evaluation should be done in order to identify candidate patients for preventive and therapeutic cardiovascular interventions.
Maximal coronary conductance with adenosine in anaemic fetal sheep is twice that of non-anaemic f... more Maximal coronary conductance with adenosine in anaemic fetal sheep is twice that of non-anaemic fetuses. To investigate whether this increase in conductance persists into adulthood we studied twin sheep as fetuses and again as adults. Nine anaemic fetuses (118 days gestation) underwent isovolaemic haemorrhage for 18.0 +/- 4.6 days (means +/- S.D.) during which time the haematocrit was reduced from 39.9 +/- 5.2 % to 16.3 +/- 3.4 % and oxygen content from 8.6 +/- 1.3 to 2.3 +/- 0.2 ml dl-1. At 138 days the anaemic fetuses were transfused; at delivery the haematocrit was 29.3 +/- 6.8 % compared to nine control fetuses in which the haematocrit was 38.5 +/- 4.3 %. The weight at delivery was 3.5 +/- 0.36 kg in the anaemic fetuses vs. 4.2 +/- 0.83 kg in controls. Twenty-eight weeks later, we placed an occluder on the descending thoracic aorta and inferior vena cava, a flow probe around the proximal left circumflex coronary artery, and catheters in the left atrial appendage, jugular and carotid vessels. Maximal coronary conductance was determined in the adults by recording coronary blood flow as driving pressure was altered by inflating the occluders while adenosine was infused into the left atrium. Right atrial, left atrial, systolic and mean arterial pressures, systemic vascular resistance and haematocrit were not different between 'in utero anaemic' and control adults. The adults that were anaemic in utero weighed less than the controls 39.4 +/- 4.6 kg vs. 45.0 +/- 5.6 kg. Maximal conductance was greater in the adults that were anaemic in utero: 11.2 +/- 4.0 ml min(-1) (100 g)(-1) mmHg-1 as compared to 6.1 +/- 1.8 ml min(-1) (100 g)(-1) mmHg(-1) in the controls. Vascular reactivity of the mesenteric arteries was not different. These data suggest that coronary conductance can be modified in utero by anaemia (high flow and hypoxaemia) and that the remodelled coronary tree persists to adulthood.
Abstract The aim of this study was to identify pregnant women at risk of preeclampsia (PE) before... more Abstract The aim of this study was to identify pregnant women at risk of preeclampsia (PE) before clinical manifestations appeared using a panel of serum markers. We recruited 240 consecutive women who presented for antenatal care. We investigated whether serum levels of placental growth factor (PlGF), its inhibitor, soluble fms-like tyrosine kinase-1 (sFlt-1), measured at 13-16 weeks gestation and the expression of fms-like tyrosine kinase-1 (Flt-1) in the maternal neutrophils measured by flow cytometry could be predictive of the subsequent development of PE. Serum PlGF levels were found to be significantly lower among women who developed PE than patients with gestational hypertension or patients in the control group (p < 0.001). In contrast, serum sFlt1 levels were most elevated in patients who developed PE versus those with gestational hypertension or the control group (p < 0.001). Serum levels of neutrophil-Flt-1, however, were lower in women who developed PE than in those with gestational hypertension or those in the control group (p < 0.001). Increased serum levels of sFlt-1, decreased levels of neutrophil-Flt-1, and decreased levels of PlGF may predict women at risk of developing PE later in pregnancy.
Abstract OBJECTIVE: To evaluate the role of therapeutic amnioinfusion using a pediatric feeding t... more Abstract OBJECTIVE: To evaluate the role of therapeutic amnioinfusion using a pediatric feeding tube in cases of intrapartum fetal distress. METHODS: A randomized clinical trial including 438 women admitted in labor at Assiut University Hospital with nonreassuring fetal heart rate tracing. Using sealed opaque envelopes, the women were randomized to 2 groups. In the amnioinfusion group they underwent transcervical amnioinfusion (1000 mL of warmed sterile saline solution) in addition to conventional treatment. In the control group they received conventional treatment only. The primary outcome was cesarean section rate for fetal distress. The secondary outcomes were neonatal and maternal complications. RESULTS: The amnioinfusion group showed a significant reduction in the rate of cesarean section for fetal distress (relative risk [RR], 0.7; 95% confidence interval [CI], 0.6-0.83), and a 30% reduction in abnormal fetal heart rate patterns (RR, 0.7; 95% CI, 0.6-0.83). Significantly fewer...
This study was designed to evaluate the maternal effects ofepidural analgesia by different local ... more This study was designed to evaluate the maternal effects ofepidural analgesia by different local anesthetics and their impact on placental and fetal blood flow. Depending on the type of local anesthetics used, sixty full-term parturients were randomly allocated into 3 equal groups in a randomized blind study; Group (1) received Bupivacaine (0.125%), Group (2) received Ropivacaine (0.2%) and, Group (3) received Levobupivacaine (0.125%). Epidural fentanyl (100 microg) was added to all groups. Safety was assessed by recording the mothers' characters and vital signs as well as the fetal Doppler indices while efficacy was assessed by measuring severity of pain, onset and duration of analgesia, and the motor blockade. Doppler velocimetry studies for fetus included monitoring of Umbilical Artery Pulsitility Indices (UAPI) and Middle Cerebral Artery Pulsitility Indices (MCAPI). Parturient in all groups were comparable. Pulse rate and arterial blood pressure were significantly decreased ...
ABSTRACT Objectives To study the relation between coronary artery disease (CAD) and peripheral ar... more ABSTRACT Objectives To study the relation between coronary artery disease (CAD) and peripheral arterial disease (PAD) with osteoporosis in postmenopausal women.Patients and methodsA 100 postmenopausal women were studied for evidence of osteoporosis by measurement of lumbar spine and femoral neck bone mineral density (BMD) and calculation of T score. From these cases; two groups were selected, group I included 30 cases with osteoporosis and group II included a matching 30 cases without osteoporosis or osteopenia as control group. Both groups were studied for prevalence of CAD using noninvasive tests including ECG, echocardiography and CT angiography, and prevalence of PAD using noninvasive tests including ankle brachial index (ABI) and color duplex study (CDS) of lower limb arteries.ResultsUsing CT angiogram, 17 cases (56.7%) had CAD in group I versus 6 cases (20%) in group II (p = 0.003). Prevalence of three vessel disease was significantly higher in group I than in group II (23.3% vs 3.3%, p = 0.022). In group I, there was a significant positive correlation between patients’ age with prevalence and severity of CAD in group I; and a significant negative correlation between T score with prevalence and severity of CAD. Presence of significant stenosis or occlusion in CDS of lower limb arteries was found in 6 cases (20%) in group I versus one case (3.3%) in group II (p = 0.044).Conclusion Because of the increased prevalence of CAD and PAD in postmenopausal women with osteoporosis the severity of CAD and PAD in osteoporotic postmenopausal women is positively correlated to the severity of osteoporosis. Thus, in osteoporotic postmenopausal women, cardiovascular status evaluation should be done in order to identify candidate patients for preventive and therapeutic cardiovascular interventions.
Maximal coronary conductance with adenosine in anaemic fetal sheep is twice that of non-anaemic f... more Maximal coronary conductance with adenosine in anaemic fetal sheep is twice that of non-anaemic fetuses. To investigate whether this increase in conductance persists into adulthood we studied twin sheep as fetuses and again as adults. Nine anaemic fetuses (118 days gestation) underwent isovolaemic haemorrhage for 18.0 +/- 4.6 days (means +/- S.D.) during which time the haematocrit was reduced from 39.9 +/- 5.2 % to 16.3 +/- 3.4 % and oxygen content from 8.6 +/- 1.3 to 2.3 +/- 0.2 ml dl-1. At 138 days the anaemic fetuses were transfused; at delivery the haematocrit was 29.3 +/- 6.8 % compared to nine control fetuses in which the haematocrit was 38.5 +/- 4.3 %. The weight at delivery was 3.5 +/- 0.36 kg in the anaemic fetuses vs. 4.2 +/- 0.83 kg in controls. Twenty-eight weeks later, we placed an occluder on the descending thoracic aorta and inferior vena cava, a flow probe around the proximal left circumflex coronary artery, and catheters in the left atrial appendage, jugular and carotid vessels. Maximal coronary conductance was determined in the adults by recording coronary blood flow as driving pressure was altered by inflating the occluders while adenosine was infused into the left atrium. Right atrial, left atrial, systolic and mean arterial pressures, systemic vascular resistance and haematocrit were not different between 'in utero anaemic' and control adults. The adults that were anaemic in utero weighed less than the controls 39.4 +/- 4.6 kg vs. 45.0 +/- 5.6 kg. Maximal conductance was greater in the adults that were anaemic in utero: 11.2 +/- 4.0 ml min(-1) (100 g)(-1) mmHg-1 as compared to 6.1 +/- 1.8 ml min(-1) (100 g)(-1) mmHg(-1) in the controls. Vascular reactivity of the mesenteric arteries was not different. These data suggest that coronary conductance can be modified in utero by anaemia (high flow and hypoxaemia) and that the remodelled coronary tree persists to adulthood.
Abstract The aim of this study was to identify pregnant women at risk of preeclampsia (PE) before... more Abstract The aim of this study was to identify pregnant women at risk of preeclampsia (PE) before clinical manifestations appeared using a panel of serum markers. We recruited 240 consecutive women who presented for antenatal care. We investigated whether serum levels of placental growth factor (PlGF), its inhibitor, soluble fms-like tyrosine kinase-1 (sFlt-1), measured at 13-16 weeks gestation and the expression of fms-like tyrosine kinase-1 (Flt-1) in the maternal neutrophils measured by flow cytometry could be predictive of the subsequent development of PE. Serum PlGF levels were found to be significantly lower among women who developed PE than patients with gestational hypertension or patients in the control group (p < 0.001). In contrast, serum sFlt1 levels were most elevated in patients who developed PE versus those with gestational hypertension or the control group (p < 0.001). Serum levels of neutrophil-Flt-1, however, were lower in women who developed PE than in those with gestational hypertension or those in the control group (p < 0.001). Increased serum levels of sFlt-1, decreased levels of neutrophil-Flt-1, and decreased levels of PlGF may predict women at risk of developing PE later in pregnancy.
Abstract OBJECTIVE: To evaluate the role of therapeutic amnioinfusion using a pediatric feeding t... more Abstract OBJECTIVE: To evaluate the role of therapeutic amnioinfusion using a pediatric feeding tube in cases of intrapartum fetal distress. METHODS: A randomized clinical trial including 438 women admitted in labor at Assiut University Hospital with nonreassuring fetal heart rate tracing. Using sealed opaque envelopes, the women were randomized to 2 groups. In the amnioinfusion group they underwent transcervical amnioinfusion (1000 mL of warmed sterile saline solution) in addition to conventional treatment. In the control group they received conventional treatment only. The primary outcome was cesarean section rate for fetal distress. The secondary outcomes were neonatal and maternal complications. RESULTS: The amnioinfusion group showed a significant reduction in the rate of cesarean section for fetal distress (relative risk [RR], 0.7; 95% confidence interval [CI], 0.6-0.83), and a 30% reduction in abnormal fetal heart rate patterns (RR, 0.7; 95% CI, 0.6-0.83). Significantly fewer...
This study was designed to evaluate the maternal effects ofepidural analgesia by different local ... more This study was designed to evaluate the maternal effects ofepidural analgesia by different local anesthetics and their impact on placental and fetal blood flow. Depending on the type of local anesthetics used, sixty full-term parturients were randomly allocated into 3 equal groups in a randomized blind study; Group (1) received Bupivacaine (0.125%), Group (2) received Ropivacaine (0.2%) and, Group (3) received Levobupivacaine (0.125%). Epidural fentanyl (100 microg) was added to all groups. Safety was assessed by recording the mothers' characters and vital signs as well as the fetal Doppler indices while efficacy was assessed by measuring severity of pain, onset and duration of analgesia, and the motor blockade. Doppler velocimetry studies for fetus included monitoring of Umbilical Artery Pulsitility Indices (UAPI) and Middle Cerebral Artery Pulsitility Indices (MCAPI). Parturient in all groups were comparable. Pulse rate and arterial blood pressure were significantly decreased ...
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