Background: The apolipoprotein A1 level is recognized as a better indicator of cardiovascular disease than other cholesterol measures. Objectives: To assess the serum level of ApoA1 in acute stroke patients and correlate it with the degree of vessel stenosis, stroke severity, prognosis, and functional outcome. Patients and methods: We prospectively included 60 patients with first-ever cerebrovascular ischemic stroke, and they were matched with 30 healthy individuals matched in age and sex. Patients' neurological status was assessed via National Institute of Health and Stroke Scale (NIHSS). A venous blood sample was taken within the first 24 h of stroke onset and assayed for ApoA1 level by Human ApoA1 ELISA kit. Results: ApoA1 level could be used to discriminate between cases and controls at a level of 6.2 μg/ml, with 94.9% sensitivity and 86.6% specificity. Furthermore, there is an inverse relationship between the level of ApoA1 and the clinical outcome expressed by NIHSS score and their prognosis after 3 months. Finally, there is an inverse relationship between ApoA1 level and the degree of stenosis whether intracranial or extracranial. Conclusion: ApoA1 level can be used as a predictor of ischemic stroke and as a prognostic tool for those patients with ischemic stroke.
Ketanserin is a selective 5-hydroxytryptamine (5-HT2) antagonist with vasodilator properties in the systemic and pulmonary circulation. Ketanserin also can inhibit serotonin-induced coronary artery vasoconstriction during percutaneous transluminal coronary angioplasty (PTCA). The in vivo effect of ketanserin on the coronary arteries of patients with stable angina has not previously been reported. The effects of intravenous ketanserin on cardiac haemodynamics and coronary artery diameter were measured in 10 patients with stable angina undergoing diagnostic cardiac catheterisation. Ketanserin (10 mg, i.v.) was associated with significant reductions in systemic and pulmonary arterial pressure (p < 0.05) and total systemic (SVR) and pulmonary (PVR) vascular resistance (p < 0.05). No significant change in mean coronary artery diameter or coronary artery stenotic index was evident after ketanserin. Vasodepressor responses in the systemic and pulmonary arterial circulation were observed after ketanserin injection. We assume these responses to be a direct effect of ketanserin, although non-drug-induced changes over time cannot be excluded. No significant effect on coronary artery diameter was observed, presumably because circulating serotonin levels are low in patients with stable anginal symptoms.
Background
Assessment of multiple sclerosis (MS) patients during the era of the coronavirus disease 2019 (COVID-19) pandemic was confronted with the overwhelmed healthcare facilities in Egypt and fear of the patients to get infected while attending the follow-up visits. This study aimed to assess the value of telephone-based assessments in the follow-up of MS patients. It includes one hundred and five patients who participated in the study and completed 3 telephone-based assessments which are the Hauser Ambulation index, Multiple Sclerosis Neuropsychology Questionnaire (MSNQ), and Symptoms of Multiple Sclerosis Scale (SMSS).
Results
The Hauser Ambulation index was significantly correlated with the latest Expanded Disability Status Scale (EDSS) score done within 1 month from the telephone call (r=0.738, P<0.001). The analysis of MSNQ scores showed that one-third of the study population had evidence of cognitive and/or neuropsychological impairment. Post hoc analysis regarding the cognitive and psychological impairment component of SMSS revealed that the patients who answered “Never” had significantly lower MSNQ scores compared to those who answered “Sometimes” (P=0.016), “Often” (P=0.022), and “Always” (P=0.001). The comparison of the EDSS scores of the patients regarding the sensory-motor impairment component of SMSS showed a non-significant difference.
Conclusion
The Hauser Ambulation index may be a reliable telephone-based tool for the assessment of physical disability. The MSNQ and the cognitive and psychological impairment component of SMSS can be used for the assessment of cognitive and psychological impairment among patients with MS.
Background
Acute stroke management is well-established in developed countries with no gender difference. Yet, in developing countries there are reports on gender disparity in medical services including stroke services. Egypt, a developing low–middle-income country, heavily populated, in the Middle East is a good example to answer whether acute ischemic stroke service is provided equally to males and females or there is disparity in risk factors, onset to door (OTD), door to needle (DTN), and outcome. The current study was prospective observational analytical hospital-based study, on acute ischemic stroke cases admitted to Nasr city insurance hospital stroke unit between September 2020 and September 2022.
Results
350 cases were included, 257 males and 93 females. Hypertension was the commonest risk factor 66% males and 81% females P = 0.011, atrial fibrillation was predominant in females P < 0.001, smoking was predominant in males P < 0.001. Median OTD in hours was 8.0 among both genders with minimum zero and maximum 96 h in males compared to minimum 1 and maximum 120 h in females, DTN was around 30 min with no significant difference. Median NIHSS on which rtPA was administered was 12.5 (6–13) in females compared to 10 (6–12) in males. Males who did not receive rtPA had a better mRS on discharge and on 90 days P = 0.01, 0.009, respectively, while there was no significant difference on discharge and 90 days between both genders on receiving rtPA.
Conclusions
No gender disparity was found in DTN, discharge outcome, and 90 days among rtPA recipients. Females tended to have higher NIHSS and relatively delayed presentation to ER with less favorable outcome at discharge and 90 days in case of not receiving rtPA. Encouraging earlier arrival and conducting awareness campaigns for risk factors management is warranted.
Both technical and technological advances over the past few years have made laparoscopic splenectomy (LS) more feasible and acceptable. Intraoperative bleeding is the main complication and cause of conversion during LS. Different hemostatic techniques are used for vascular control. In this study, we evaluate LigaSure vessel sealing system as the sole instrument in addition to the lateral approach for achieving a safe vascular control.Eleven patients with hematological disorders of the spleen were enrolled in this 2 year study for LS at Ain Shams University Hospitals. Eight patients had idiopathic thrombocytopenic purpura (ITP), two patients with hereditary spherocytosis and one patient with Evan's syndrome.In all patients the LigaSure vessel sealing system with lateral approach was used to achieve safe vascular control. The patients were 6 females and 5 males, their age ranging between 17-23 years (Median= 20 yrs). The intraoperative blood loss, need for blood transfusion, operative time, post-operative complications and hospital stay as well as the cost were evaluated.Nine cases were successfully performed laparoscopically with two conversions due to hilar bleeding. In all but two patients (converted patients) the intra-operative blood loss was less than 100ml (range 50-100ml) with no need for blood transfusion.The operative time range was 70-100 minutes (median 85 minutes). There were no mortalities in our series. The average hospital stay was 4 days (range 3-5 days), and apart from minor wound infection, no post operative complications were recorded.Stapleless LS using LigaSure vessel sealing system with the lateral approach is a safe procedure to carry out laparoscopic splenectomy.
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