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1.  Emergency surgical approach to device emboli due to migration of the atrial septal defect occluder 
Archives of Medical Science : AMS  2014;10(3):464-469.
Introduction
Atrial septal defect (ASD) transcatheter occlusion techniques are now established as the preferred method and have become an alternative to surgery under extracorporeal circulation. In this study, we aimed to present our emergency surgical approach to cases of device embolization due to migration of the atrial septal defect occluder.
Material and methods
Between June 2009 and June 2011, 6 patients underwent emergency operations due to device emboli secondary to migration of the transcatheter atrial septal defect occluder during the early period. Mean age was 25.5 years (15–45) and 3 of the patients were female (50%). The diagnosis was made via transthoracic echocardiography (TTE) preoperatively.
Results
All of these 6 patients underwent emergency operations. Mean postoperative intensive care unit (ICU) stay was 2.2 days and mean hospital stay was 6 days. No early or late postoperative mortality was seen. Mean postoperative follow-up time was 19.3 months (range: 5–28 months). Early- and late-period TTE examinations showed no residual interatrial shunting. One patient developed a right atrial thrombus in the postoperative 22nd month as a complication of long-term follow-up. He was treated with anticoagulant therapy for 6 months with complete resolution at the TTE.
Conclusions
Transcatheter occlusion of secundum type ASD provides prominent clinical improvement, as well as a regression in dimensions of cardiac chambers. Nevertheless, this technique has drawbacks such as distal migration and residual shunts. Consequently, we think that unfavorable anatomy and device diameter are major issues in device migration. Oversizing also increases the migration risk.
doi:10.5114/aoms.2014.43741
PMCID: PMC4107253  PMID: 25097575
Amplatzer septal occluder; embolization; migration; secundum type atrial septal defect
2.  Effects of captopril on factors affecting gastric mucosal integrity in aspirin-induced gastric lesions in Sprague-Dawley rats 
Archives of Medical Science : AMS  2012;9(6):1132-1137.
Introduction
Captopril is an angiotensin-converting enzyme inhibitor, which is used as an antihypertensive agent and has shown antioxidant properties. This study aims at determining the effects of captopril on factors affecting gastric mucosal integrity in aspirin-induced gastric lesions.
Material and methods
Eighteen male Sprague-Dawley (200-250 g) rats that were given aspirin (40 mg/100 g body weight) were divided into three groups: the control, captopril (1 mg/100 g body weight daily) and ranitidine (2.5 mg/100 g body weight twice daily) groups. Ranitidine and captopril were given orally for 28 days. Rats in all groups were sacrificed and the parameters measured.
Results
Captopril reduced gastric acidity, and increased gastric glutathione (GSH) and prostaglandin E2 (PGE2) significantly in comparison to the control group. Captopril also reduced malondialdehyde (MDA) and gastric lesions insignificantly compared to the control group. Ranitidine healed the lesions significantly compared to the control group. There was no difference between ranitidine and captopril on the severity of lesions, gastric acidity, MDA and GSH. Captopril increased PGE2 compared to ranitidine (p < 0.05).
Conclusions
Captopril has desirable effects on the factors affecting gastric mucosal integrity (acidity, PGE2 and GSH) and is comparable to ranitidine in ulcer healing.
doi:10.5114/aoms.2012.31252
PMCID: PMC3902702  PMID: 24482662
captopril; ranitidine; aspirin; gastric lesions
3.  Mean platelet volume is elevated in patients with patent foramen ovale 
Archives of Medical Science : AMS  2013;9(6):1055-1061.
Introduction
Platelets play a major role in thromboembolic events. Increased mean platelet volume (MPV) indicates higher platelet reactivity and also a tendency to thrombosis. Patent foramen ovale (PFO), persistence of the fetal anatomic shunt between right and left atria, is strongly associated with cryptogenic stroke. The aim of this study is to determine the relationship between MPV and PFO and if such an association exists, whether higher MPV levels may require antiplatelet therapy before a thromboembolic event happens, together with a literature review.
Material and methods
Thirty patients (15 women, 15 men), free of any cerebrovascular events, were diagnosed with PFO by transesophageal echocardiography (TEE), enrolled as the study group. Thirty consecutive patients (16 women and 14 men), who were diagnosed as normal in TEE, were enrolled as the control group. These two groups were compared according to MPV and anatomical features of the right atrium.
Results
There was no significant difference between study and control groups in clinical features and also no difference was observed in platelet counts; however, MPV in the PFO group was significantly higher than the control group (8.38 ±0.93 fl and 7.45 ±0.68 fl respectively).
Conclusions
Our results indicate that elevated MPV may be detected in patients with PFO. This might be one of the explanations for the relationship between PFO and cryptogenic stroke; however, larger cohorts are warranted in order to define further mechanisms.
doi:10.5114/aoms.2013.38687
PMCID: PMC3902705  PMID: 24482650
echocardiography; mean platelet volume; patent foramen ovale; stroke
4.  Effect of 1α-25-dihydroxyvitamin D3 on intimal hyperplasia developing in vascular anastomoses: a rabbit model 
Introduction
A common problem encountered in routine daily practice of cardiovascular surgery is migration of smooth muscle cells leading to intimal hyperplasia developing at vascular anastomosis sites which then causes luminal narrowing. The aim of this study was to investigate the antiproliferative effect of 1,25 (OH)2D3 on intimal hyperplasia.
Material and methods
Twenty-one male white New Zealand rabbits weighing 2-3 kg were selected. There were 3 groups of animals each consisting of 7 rabbits. Group 1 was the control group. Group 2 was the sham group and group 3 consisted of rabbits receiving 1,25 (OH)2D3. The right carotid arteries of the subjects in groups 2 and 3 were transected and re-anastomosed. A daily dose of 25 ng 1,25 (OH)2D3 per 100 g body weight was administered for 14 days to rabbits in group 3. Rabbits in group 2 were not subject to any pharmaceutical agent. All the subjects were sacrificed at the end of the 28th postoperative day. Their right carotid arteries were resected and then investigated histopathologically.
Results
Intimal thickness and intimal area were measured as significantly lower in group 1 when compared with the other groups (p = 0.004). In group 3, the ratios of thickness of tunica intima/thickness of tunica media and area of tunica intima/area of tunica media were significantly lower than those of group 2 (p = 0.015, p = 0.003).
Conclusions
1,25 (OH)2D3, the active metabolite of vitamin D, reduces the intimal hyperplasia developing after vascular anastomoses.
doi:10.5114/aoms.2012.30786
PMCID: PMC3701962  PMID: 23847659
carotid artery; vitamin D; intimal hyperplasia
5.  Fetuin-A levels in obesity: differences in relation to metabolic syndrome and correlation with clinical and laboratory variables 
Introduction
Fetuin-A is an important player in the enhancement of insulin resistance. There are very limited data available concerning the relationships between fetuin-A, weight status and features of the metabolic syndrome (Met S) in obese Egyptian subjects, and especially in children. The aim of the study was to evaluate fetuin-A serum level in subjects with obesity and its possible association with other laboratory and clinical variables.
Material and methods
A total of 140 obese subjects and 50 controls aged 10-40 years were recruited. Demographic, anthropometric and biochemical features were collected according to a standard protocol. Serum fetuin-A levels were measured using ELISA and the modified Third Report of the National Cholesterol Education Program (NCEP-ATP III) criteria were adopted to diagnose Met S.
Results
A higher level of serum fetuin-A was detected in obese subjects. Met S cases were also significantly associated with higher serum fetuin-A. Fetuin-A correlated significantly with BMI (r = 0.437), systolic (r = 0.228) and diastolic blood pressure (r = 0.295), waist circumference (r = 0.332), insulin resistance calculated by the homeostasis model (HOMA-IR) (r = 0.295) and high-density lipoprotein (HDL) (r = 0.362).
Conclusions
Fetuin-A levels were higher in adults and children with obesity and Met S. They were related to insulin resistance and to features of the Met S in cross-sectional analyses. Our study demonstrates a novel association between human fetuin-A and the Met S among obese subject. Therefore, fetuin-A might be a new promising link between obesity and its comorbidities.
doi:10.5114/aoms.2012.31616
PMCID: PMC3506238  PMID: 23185191
fetuin A; obesity; metabolic syndrome; insulin resistance
6.  The effects of palm vitamin E on stress hormone levels and gastric lesions in stress-induced rats 
Introduction
This study examines the effects of palm vitamin E (PVE) or α-tocopherol (α-TF) supplementation on adrenocorticotropin hormone (ACTH), corticosterone and gastric lesions in rats exposed to water-immersion restraint stress (WIRS).
Material and methods
Sixty male Sprague-Dawley rats (200-250 g) were divided into three groups. Group I: 20 rats as a control group were given a normal diet. Group II: 20 rats received oral supplementation of PVE at 60 mg/kg body weight. Group III: 20 rats received oral supplementation of α-TF at 60 mg/kg body weight. After the treatment period of 28 days, each group was further subdivided into two groups: 10 rats not exposed to stress, and the other 10 rats subjected to WIRS for 3.5 h. Blood samples were taken to measure the ACTH and corticosterone levels. The rats were then sacrificed and the stomach excised and opened along the greater curvature and examined for lesions.
Results
Rats exposed to WIRS had lesions in their stomach mucosa. Our findings showed that dietary supplementation of PVE or α-TF was able to reduce gastric lesions significantly in comparison to the stressed controls. The WIRS increased plasma ACTH and corticosterone significantly. Palm vitamin E and α-TF treatments reduced these parameters significantly compared to the stressed controls.
Conclusions
Supplementation with either PVE or α-TF reduces the formation of gastric lesions, probably by inhibiting the elevation of ACTH and corticosterone levels induced by stress.
doi:10.5114/aoms.2012.27276
PMCID: PMC3309432  PMID: 22457670
palm vitamin E; α-tocopherol; water-immersion restraint stress; adrenocorticotropic hormone; corticosterone; gastric lesions
7.  Interleukin-18 expression and the response to treatment in patients with psoriasis 
Introduction
The aim of the study was to demonstrate interleukin-18 (IL-18) expression in keratinocytes from psoriatic lesions in comparison to keratinocytes from uninvolved skin and to study the change of expression after therapeutic interventions.
Material and methods
This study included 16 patients of different clinical subtypes of psoriasis. Interleukin-18 gene expression analysis was performed using real time quantitative PCR. Three biopsies were obtained from each patient. Two were taken from the lesional psoriatic skin and from uninvolved skin before starting treatment. A third lesional skin biopsy was taken at the end of 2 months of treatment. The treatment was in the form of topical steroids or oral systemic methotrexate.
Results
Of all 16 studied patients, significantly increased IL-18 expression was noted in keratinocytes from psoriatic lesions before and after treatment when compared to keratinocytes from uninvolved skin (p = 0.001 and p = 0.002 respectively). The IL-18 expression in the skin lesions after treatment was significantly lower than lesional skin before treatment (p = 0.023). In psoriatic skin lesions of all studied patients IL-18 expression was significantly correlated with disease duration (r = 0.40 and p = 0.01) and clinical severity of psoriasis (r = 0.72 and p = 0.001).
Conclusions
Increased IL-18 expression in keratinocytes from psoriatic lesions of our patients and its correlation with disease duration and severity supported the concept of psoriasis as a T cell mediated autoimmune disease. This could establish therapeutic and preventive approaches for psoriasis that ultimately lead to improved outcomes for patients.
doi:10.5114/aoms.2011.24144
PMCID: PMC3258774  PMID: 22291810
psoriasis; interleukins; real-time PCR; effect of therapy
8.  Avoiding the under-diagnosis of low bone mineral density in Egyptian children with chronic medical conditions affecting bone health 
Introduction
The International Society for Clinical Densitometry recommended that the lumbar spine and total body less head (TBLH) are the most accurate and reproducible skeletal sites for performing areal bone mineral density (BMD) measurements. Our objective is to evaluate the role of measurement of femoral neck BMD in avoiding the under-diagnosis of low BMD being a risk for fractures in subjects with chronic medical conditions that might affect bone health.
Material and methods
Subjects with chronic medical conditions that might affect bone health were studied (n = 468) and 36 healthy children were recruited as control subjects. Physical examinations, height, weight measurements and BMI were calculated. Dual-energy radiographic absorptiometry of the lumbar spine and femoral neck were measured.
Results
Bone mineral density z scores in both sites were significantly reduced in chronic patients, compared with control subjects. Prevalence of very low BMD z scores (–2 or more) using lumbar DXA, femoral DXA, and either of the sites were 1.38%, 3.37%, and 3.96%, respectively, while low BMD Z scores (–1 to less than –2) were 9.52%, 18.05% and 21.14% respectively.
Conclusions
We identified a significant decrease in both lumbar and femoral BMDs in studied children. Sometimes femoral BMD is decreased while lumbar BMD is still within the normal range. For this reason we recommend that, when technically feasible and there is no facility to measure TBLH, all those patients should have lumbar spine and femoral neck bone mineral density measurements to avoid under-diagnosis of low BMD being a risk for fractures.
doi:10.5114/aoms.2011.24142
PMCID: PMC3258785  PMID: 22291808
osteoporosis; bone density; chronic diseases
9.  A long-term study of bone mineral density in patients with phenylketonuria under diet therapy 
Introduction
Dietary control of classic phenylketonuria (PKU) needs restriction of natural proteins; adequate protein intake is achieved by adding low phenylalanine (phe) formulae. The adequacy of this diet for normal bone mineralization had not been sufficiently evaluated. Our aim was to evaluate and follow up bone mineral density (BMD) in children and adolescents with PKU within a 2-year time interval to assess the adequacy of a phenylalanine restricted diet for bone mineralization and to search for a possible relationship between BMD, dietary control and blood phenylalanine (phe) concentrations.
Material and methods
Thirty-two patients with classic PKU (3-19 years) were evaluated for their bone mineral status using dual energy X-ray absorptiometry (DEXA) both at the beginning (baseline) and the end (follow-up) of the study.
Results
Low BMD was detected in 31.25% at the start and in 6.25% of patients after 2 years follows-up. No relationship was found between BMD and the duration of diet compliance and phe level as well.
Conclusions
In this study the low BMD detected in our patients was both at baseline and follow-up independent of diet restriction. A yearly DEXA would be highly beneficial for early detection and treatment, thus preventing osteoporosis and decreasing the risk of fractures. We also suggest the importance of searching for new emerging therapies such as enzyme substitution or gene therapy as low protein diet compliance was not enough to maintain normal bone mineral density.
doi:10.5114/aoms.2011.23417
PMCID: PMC3258737  PMID: 22295034
phenylketonuria; osteoporosis; bone mineral density; diet
10.  Frequency of Firmicutes and Bacteroidetes in gut microbiota in obese and normal weight Egyptian children and adults 
Introduction
Obesity and associated metabolic disorders are a worldwide epidemic. Recent evidence suggests that the microbial community in the human intestine may play an important role in the pathogenesis of obesity. The aim of this study was to assess the differences in the composition of the intestinal microbiota between obese and normal weight Egyptian children and adults.
Material and methods
The study included 79 subjects among whom 51 were obese (23 children and 28 adults), and 28 were subjects of normal weight (17 children and 11 adults). Faecal samples were collected from all subjects. Total DNA was extracted from collected stool samples and submitted to conventional PCR for detection of Firmicutes and Bacteroidetes. All the studied group was subjected to clinical and anthropometric evaluation. Laboratory assessment of fasting glucose, high-sensitivity C-reactive protein (hsCRP) and lipid profile was performed.
Results
The proportions of the phyla Firmicutes and Bacteroidetes were statistically significantly increased in the obese group compared to the normal weight group (p < 0.001, p = 0.003 respectively). The study also found a statistically significant positive trend for higher hsCRP in subjects with positive Firmicutes (p = 0.004). However, no associations were found between positive Bacteroidetes and hsCRP.
Conclusions
The results of this study indicate that obesity in Egyptian children and adults is associated with compositional changes in faecal microbiota with increase in the phyla Firmicutes and Bacteroidetes. This could be considered when developing strategies to control obesity and its associated diseases by modifying the gut microbiota.
doi:10.5114/aoms.2011.23418
PMCID: PMC3258740  PMID: 22295035
obesity; gut microbiota; Firmicutes; Bacteroidetes; high-sensitivity C-reactive protein
11.  Relationship between blood pressure levels and bone mineral density in postmenopausal Turkish women 
Introduction
We investigated the association between bone mineral density (BMD) detected by dual-energy X-ray absorptiometric (DXA) method and blood pressure (BP) in a large sample of postmenopausal women.
Material and methods
The current study was based on a retrospective analysis of 586 postmenopausal women with a mean age of 60.8 ±8.8 years, who were screened for osteopenia or osteoporosis by DXA. Patients with hypertension (HT, n= 306) were compared with normotensive (NT, n = 290) individuals. Bone mineral density results for the femur neck and spine were classified into 3 groups according to World Health Organization criteria: normal (T score > –1.0 SD), osteopenia (T score –1.0 to –2.5 SD) and osteoporosis (T score < –2.5 SD). Patients with osteopenia or osteoporosis (T score < –1.0 SD) were grouped as having low bone mass (LBM).
Results
There were no significant differences in femur T score, femur BMD, femur Z score, spinal T score, spinal BMD and spinal Z score between hypertensive and normotensive groups. The group of patients with low bone mass calculated from femur T scores had higher age, systolic BP, duration of hypertension and duration of menopause, but lower BMI. Similarly, patients with low spine BMD had higher age and duration of menopause, but lower BMI. Linear regression analysis showed a significant correlation between systolic BP and femur BMD and T score values. Furthermore, logistic regression analysis revealed that hypertension is an independent predictor of spinal osteopenia and osteoporosis.
Conclusions
The presence of hypertension is an independent predictor of spinal low bone density in Turkish women after menopause.
doi:10.5114/aoms.2011.22077
PMCID: PMC3258724  PMID: 22291766
blood pressure; bone mineral density; dual-energy X-ray absorptiometric
12.  Interleukin-18 expression and the response to treatment in patients with psoriasis 
Introduction
The aim of the study was to demonstrate Interleukin-18 (IL-18) expression in keratinocytes from psoriatic lesions in comparison to keratinocytes from uninvolved skin and to study the change of expression after therapeutic interventions.
Material and methods
This study included 16 patients of different clinical subtypes of psoriasis. IL-18 gene expression analysis was performed using real-time quantitative PCR. Three biopsies were obtained from each patient. Two were taken from the lesional psoriatic skin and from uninvolved skin before starting treatment. A third lesional skin biopsy was taken at the end of two months' treatment course. The treatment was in the form of topical steroids or oral systemic methotrexate.
Results
Of all 16 studied patients significantly increased IL-18 expression was noted in keratinocytes from psoriatic lesions before and after treatment when compared to keratinocytes from uninvolved skin (P = 0.001 and 0.002 respectively). The IL-18 expression in the skin lesions after treatment was significantly lower than lesional skin before treatment (P = 0.023). In psoriatic skin lesions of all studied patients IL-18 expression was significantly correlated with disease duration (r = 0.40 and P = 0.01) and clinical severity of psoriasis (r = 0.72 and P = 0.001).
Conclusions
Increased IL-18 expression in keratinocytes from psoriatic lesions of our patients and its correlation with disease duration and severity supported the concept which views psoriasis as a T-cell-mediated autoimmune disease. This could establish therapeutic and preventive approaches for psoriasis that ultimately lead to improved outcomes for patients.
doi:10.5114/aoms.2010.19309
PMCID: PMC3302712  PMID: 22427774
psoriasis; interleukins; real-time PCR; effect of therapy
13.  The effects of L-thyroxin replacement therapy on bone minerals and body composition in hypothyroid children 
Introduction
Prolonged treatment with levothyroxine 4 (L-T4) is a well known risk factor for osteoporosis. Patients on L-T4 replacement occasionally have a subnormal TSH, which carries a risk of development of bone loss. Thyroid hormones directly affect bone cells, stimulating osteoclastic and osteoblastic activity with a predominance of bone resorption and decrease of bone mineral density (BMD).
Material and methods
The study included 35 hypothyroid patients with mean age 11.57 ±5.06, while 26 age- and sex-matched children served as controls. Dual energy X-ray absorptiometry (DXA) was done to detect the bone mineral density (BMD), bone mineral content (BMC) and Z score in lumbar and femur neck regions. Body composition was also studied by DXA. Calcium, phosphorus, osteocalcin as a bone formation marker, osteoprotegerin as an indicator of osteoclast activity and urinary deoxypyridinoline as a bone collagen breakdown marker were assessed.
Results
No significant differences were detected in lumbar Z score (−0.12 ±0.66) and femur Z score (−0.17 ±0.58) compared to controls (−0.33 ±0.74 and −0.21 ±0.53 respectively). Bone mineral density and BMC were not significantly different from controls. No significant difference was detected between cases and controls in body composition. A positive correlation was detected between BMD and age (r=0.857, p<0.01), and with the period of treatment (r=0.766, p<0.01). A positive correlation was found between BMD and total body fat (r=0.693, p<0.01), and with abdominal fat (r=0.667, p<0.01).
Conclusions
Levothyroxine 4 treatment in hypothyroid children does not alter bone metabolism and body composition.
doi:10.5114/aoms.2010.14264
PMCID: PMC3282520  PMID: 22371779
bone density; bone mineral; dual energy X-ray absorptiometry; hypothyroid; levothyroxine 4; children

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