Chronic kidney disease's impact on revascularization and subsequent major adverse cardiovascular events in patients with chronic coronary syndrome

OBJECTIVE

To determine the impact of CKD on the completeness of revascularization and major adverse cardiovascular events (MACE) in patients with chronic coronary syndrome (CCS).

PATIENTS AND METHODS

The study enrolled 400 CCS patients who underwent revascularization by PCI. They were separated into two categories according to their eGFR levels: the control group: 200 patients with eGFR ≥60mL/min/1.73m2, and the CKD Group: 200 patients with eGFR< 60ml/min/1.73m.2 Patients were reclassified according to revascularization into complete and incomplete revascularization groups with one-year follow-up to assess the MACE.

RESULTS

CKD patients were significantly older (65.78 ± 6.41 vs. 56.70 ± 9.20 years, P=<0.001). They had higher syntax scores (P = 0.005), CIN (P = 0.001), all-cause mortality (P = 0.02), MACE (P = 0.037), and heart failure (P = 0.014). After reclassification according to revascularization. GFR was significantly reduced among patients with incomplete revascularization (51.08 ± 28.15 vs. 65.67 ± 26.62, respectively, P =<0.001). Repeated revascularization (P < 0.001), STEMI (P = 0.003), stent thrombosis (P = 0.015), MACE (P < 0.001), stroke (P < 0.001), and all-cause mortality (P < 0.001) were more prevalent among patients with incomplete revascularization. Multivariate regression analysis revealed eGFR (P = 0.001) and Syntax score (SS) (P=<0.001) as independent predictors of incomplete revascularization. The optimal eGFR cutoff value for predicting partial revascularization is 49.50mL/min/1.73m2, with 58.8% sensitivity and 69.3 % specificity.

CONCLUSION

Chronic kidney disease is associated with a higher syntax score and incomplete revascularization prevalence in CCS patients. Additionally, incomplete revascularization is associated with an increased incidence of major adverse cardiac events. In patients with CCS, CKD predicts partial revascularization and subsequent MACE.

CYP24A1, AHR, CPEB4, TRIP13, and PIK3CA genes expression in colorectal cancer patients: novel diagnostic biomarkers

OBJECTIVE

This study aimed to investigate the CYP24A1, AHR, CPEB4, TRIP13, and PIK3CA mRNA expression in the blood of colorectal cancer patients in Egypt. This was performed to elucidate if there's a link between this gene expression and other clinicopathological characteristics of the tumor.

PATIENTS AND METHODS

A case-control study including 50 colorectal cancer patients and 50 healthy controls was conducted. Real-time polymerase chain reaction (rt-PCR) was utilized to assess the expression of CYP24A1, AHR, CPEB4, TRIP13, and PIK3CA mRNA in blood samples.

RESULTS

Patients with colorectal cancer had significantly higher levels of mRNA for the genes CYP24A1, AHR, CPEB4, TRIP13, and PIK3CA (p<0.001, p=0.021, p<0.001, and p<0.001, respectively) compared to controls. Remarkedly, the gene expression of AHR, TRIP13, and PIK3CA genes did not exhibit a significant correlation with the tumor stages (p=0.379, p=0.095, and p=0.526, respectively). However, there was a strong correlation between CYP24A1 and CPEB4 gene expression and tumor stages (p<0.001 and p=0.002, respectively).

CONCLUSIONS

Therefore, we can conclude that increased mRNA levels of CYP24A1, AHR, CPEB4, TRIP13, and PIK3CA in blood samples withdrawn from colorectal cancer patients could be a biomarker for the disease.

Elucidation of the role of α-lipoic acid and vitamin C in methotrexate-induced hepatoxicity in mice

OBJECTIVE

Although methotrexate (MTX) is used to treat several malignancies and chronic inflammatory diseases, its clinical use is constrained because of its negative side effects, the most prevalent of which are hepatotoxicity and nephrotoxicity. So, this study aims to determine whether α-lipoic acid (ALA) and vitamin C can protect mice against the liver damage that methotrexate causes.

MATERIALS AND METHODS

A total of 49 male mice were divided into seven groups at random. Group I received sodium bicarbonate, while groups II to VII received an intraperitoneal injection of MTX (20 mg/kg) on the tenth day, following ten days of pretreatment with ALA (60 mg/Kg), ALA (120 mg/Kg), vitamin C (100 mg/Kg), vitamin C (200 mg/Kg), ALA (60 mg/Kg), and vitamin C (100 mg/kg).

RESULTS

When compared to mice in group I, mice in group II (the control group) had significantly higher levels of the enzymes malondialdehyde (MDA), alanine transaminase (ALT), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) and significantly lower (p <0.05) levels of the enzymes superoxide dismutase (SOD) and glutathione (GSH). As compared to the control group, pretreatment groups with ALA and vitamin C showed a dose-dependent substantial rise (p <0.05) in GSH and SOD levels, a dose-dependent notable decrease (p <0.05) in MDA, ALT, ALP, and LDH levels, and better liver histological architecture. In order to increase the antioxidant capacity, pretreatment with ALA and vitamin C may be able to prevent MTX-induced hepatotoxicity.

CONCLUSIONS

These results imply that ALA and vitamin C are useful in the treatment of MTX-induced liver damage.

The predictive value of speckle tracking during dobutamine stress echocardiography in patients with chronic stable angina

Objective

Methods

Results

Conclusion

Modelling incremental benefits on complications rates when targeting lower HbA1c levels in people with Type 2 diabetes and cardiovascular disease

AIM

Glucose-lowering interventions in Type 2 diabetes mellitus have demonstrated reductions in microvascular complications and modest reductions in macrovascular complications. However, the degree to which targeting different HbA_1c reductions might reduce risk is unclear.

METHODS

Participant-level data for Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) participants with established cardiovascular disease were used in a Type 2 diabetes-specific simulation model to quantify the likely impact of different HbA_1c decrements on complication rates. Ten-year micro- and macrovascular rates were estimated with HbA_1c levels fixed at 86, 75, 64, 53 and 42 mmol/mol (10%, 9%, 8%, 7% and 6%) while holding other risk factors constant at their baseline levels. Cumulative relative risk reductions for each outcome were derived for each HbA_1c decrement.

RESULTS

Of 5717 participants studied, 72.0% were men and 74.2% White European, with a mean (sd) age of 66.2 (7.9) years, systolic blood pressure 134 (16.9) mmHg, LDL-cholesterol 2.3 (0.9) mmol/l, HDL-cholesterol 1.13 (0.3) mmol/l and median Type 2 diabetes duration 9.6 (5.1-15.6) years. Ten-year cumulative relative risk reductions for modelled HbA_1c values of 75, 64, 53 and 42 mmol/mol, relative to 86 mmol/mol, were 4.6%, 9.3%, 15.1% and 20.2% for myocardial infarction; 6.0%, 12.8%, 19.6% and 25.8% for stroke; 14.4%, 26.6%, 37.1% and 46.4% for diabetes-related ulcer; 21.5%, 39.0%, 52.3% and 63.1% for amputation; and 13.6%, 25.4%, 36.0% and 44.7 for single-eye blindness.

CONCLUSIONS

These simulated complication rates might help inform the degree to which complications might be reduced by targeting particular HbA_1c reductions in Type 2 diabetes.

Diagnostic performance of using one- or two-HbA1c cut-point strategies to detect undiagnosed type 2 diabetes and impaired glucose regulation within a multi-ethnic population

INTRODUCTION

We compared test performance and cost per case for strategies detecting diabetes on the oral glucose tolerance test (OGTT) using either (a) glycated haemoglobin (HbA1c) ≥ 6.5% (48 mmol/mol) or (b) two HbA1c thresholds where the first cut-point 'rules out' and the second 'rules in' diabetes. HbA1c values in between the thresholds require confirmatory glucose testing for diagnosis.

MATERIALS AND METHODS

We conducted an analysis of adults aged 40-75 years from the Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) cohort (Leicester, UK), from 2002 to 2008, who underwent oral glucose tolerance testing (OGTT) and HbA1c testing.

RESULTS

From 8696 individuals (mean age 57.3 years, 73% white Europeans (WE) and 27% South Asians (SA)), HbA1c ≥ 6.5% produced sensitivity of 62.1% for detecting diabetes in WE and 78.9% in SA. Using two selected thresholds, HbA1c ≤ 5.8% (rule-in, 40 mmol/mol) and HbA1c ≥ 6.8% (rule-out, 51 mmol/mol) produced high sensitivity/specificity (> 91.0%) for detecting diabetes, however, 28.8% of the cohort with HbA1c 5.9%-6.7% required a subsequent glucose test. The two cut-point threshold produced a lower cost per case of diabetes detected in WE, compared to HbA1c ≥ 6.5% of £38.53 (1.89 to 86.81) per case, but was more expensive in SA by £84.50 (69.72 to 100.92) per case. Using a risk score to determine HbA1c testing, the same costs per case became £63.33 (23.33 to 113.26) in WE and £69.21 (55.60 to 82.41) in SA.

CONCLUSION

Using a two-threshold strategy may have some benefits over a single cut-point; however, 28.8% of individuals required two blood tests.

A simple strategy for screening for glucose intolerance, using glycated haemoglobin, in individuals admitted with acute coronary syndrome

Glucose intolerance is common but often remains undiagnosed and untreated in people with acute coronary syndrome. The best approach to screening for glucose intolerance post-acute coronary syndrome remains debated. The World Health Organization has recently advocated the use of HbA(1c) in diagnosing Type 2 diabetes. A screening strategy using HbA(1c) as the preferred test would be pragmatic and improve early detection and management of glucose intolerance in acute coronary care practice. In this commentary, we discuss the relevant literature and guidelines in this area and propose a simple and pragmatic algorithm based on the use of HbA(1c) to screen for glucose intolerance during and after admission with acute coronary syndrome.

The potential impact of using glycated haemoglobin as the preferred diagnostic tool for detecting Type 2 diabetes mellitus

AIMS

There are calls to simplify the diagnosis of Type 2 diabetes mellitus (T2DM) to reduce the burden of undiagnosed disease. Glycated haemoglobin (HbA(1c)) is therefore being considered as a preferred diagnostic tool to replace the need for an oral glucose tolerance test (OGTT), considered by many as cumbersome and inconvenient. The aim of this study was to examine the potential impact of the preferred use of HbA(1c) as a diagnostic tool on the prevalence and phenotype of T2DM.

METHODS

Analysis of the Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) cohort for previously undiagnosed individuals between 40 and 75 years of age who had OGTT, repeated if within the diabetes range, and HbA(1c) results. We compared the prevalence and phenotype of subjects with T2DM based on either HbA(1c)> or =6.5% or OGTT using 1999 World Health Organization criteria.

RESULTS

From the total population of 8696, we detected 291 (3.3%) with T2DM from using an OGTT, and 502 (5.8%) had HbA(1c)> or =6.5%. Of those diagnosed with T2DM by OGTT, 93 (1.2%) had HbA(1c) <6.5% and therefore would not have been classified as having T2DM using proposed criteria. Using HbA(1c) criteria resulted in 304 (3.5%) additional cases of T2DM, approximately doubling the prevalence. Of these 304 additional people, 172 (56.7%) had impaired glucose tolerance/impaired fasting glycaemia according to 1999 World Health Organization criteria. Using HbA(1c) criteria there was an increase of 2.2- and 1.4-fold in south Asians and white Europeans detected, respectively.

CONCLUSIONS

Within this multi-ethnic cohort, we found that introducing HbA(1c)> or =6.5% as the preferred diagnostic test to diagnose T2DM significantly increased numbers detected with T2DM; however, some people were no longer detected as having T2DM.

Crystal habit modifications of ibuprofen and their physicomechanical characteristics

Ibuprofen was crystallized from methanol, ethanol, isopropanol, and hexane at similar conditions. Marked differences in crystal habit of the samples obtained from these solvents were observed. The samples crystallized from methanol and ethanol had a polyhedral crystal habit, while those from hexane were needlelike. Those from isopropanol were elongated crystals. X-ray powder diffraction (XPD) and diferential scanning calorimetry (DSC) studies confirmed that these samples were structurally similar, therefore, polymorphic modifications were ruled out. The results showed that crystal habit modification had a great influence on the mechanical properties (compressibility, flow rate, and bulk density) of ibuprofen crystals. Samples obtained from methanol and ethanol exhibited the highest bulk density and the best flow rate, while those from hexane showed the lowest bulk density and the worst flow rate. The samples obtained from ethanol exhibited the best compression force/hardness profiles, and those obtained from hexane produced the softest tablets.

Relationship between the changes in maternal serum placental leucine aminopeptidase (P-LAP) activity and umbilical artery waveforms in normal pregnancy

The relation between placental leucine aminopeptidase (P-LAP) activity in maternal sera and umbilical artery waveforms (systolic/diastolic ratio, S/D) obtained by pulsed Doppler has been examined by cross-sectional study in 26 normal pregnancies during weeks 26-38. A negative correlation was seen to exist suggesting that P-LAP may have a role in the regulation of uteroplacental blood flow.

The relationship between birth weight, and arm and chest circumference in Egypt

This paper is concerned with the prediction of birth weight using simple anthropometric indices, namely mid-arm and chest circumferences. Such indices are important tools in the identification of low birth weight infants in areas where scales are not widely available or where they are likely to be not robust enough to withstand rough treatment. This paper reports data from a study in Assiut, Egypt. The aim was to identify which of the two indices was the better predictor or whether measurements on both arm and chest circumference were required. The results show that chest circumference is the better predictor of birth weight, partly perhaps because its measurement is more replicable. Cut-off points for the identification of low birth weight infants are then identified.

Foreign body granulomas in normal ovaries

In 100 consecutive cases in which grossly normal ovaries were removed at the time of pelvic surgery, 9% were found to contain crystalline foreign particles. An additional 9% contained cortical granulomas. In four of six cases, computer-assisted x-ray analysis of the crystalline foreign particles was successful and revealed magnesium and silicon.

Effect of oral contraception on serum bile acid

Eighteen normal women, 20 with active urinary schistosomiasis, and 25 with past histories of viral hepatitis were given a contraceptive pill containing 0.05 mg ethinyl estradiol and 0.5 mg levonorgestrel for six consecutive cycles. Serum bile acid levels were measured by enzyme immunoassay method before and after 3 and 6 months of use. Simultaneously, conventional liver function tests (serum bilirubin, transaminases, alkaline phosphatase and albumin) were done. Serum bile acid concentration was not significantly changed by the contraceptive use in any group. The concentration of cholylglycine (the main bile acid measured) did not correlate with the values of any of the other tests. Pretreatment values of serum cholylglycine were significantly lower in the past-hepatitis group. The difference was maintained during treatment.

Lipases production by Bacillus circulans under mesophilic and osmophilic conditions. Factors affecting lipases production

A facultative osmophilic bacterium able to produce lipases (isolated from bee honey) was identified as Bacillus circulans. Factors affecting lipases production by such isolate were studied. Dox's liquid medium supplied with 2 and/or 30% sucrose was used as a basal medium, under static culture condition, for such a purpose. Results have showed that the optimal sucrose concentration at which the isolate produced its maximal yield of lipases was 30% after an incubation period of 24 hours at 40 degrees C, and this was corresponding to an incubation period of 48 hours at 40 degrees C in presence of 2% sucrose. The optimal pH value was 7 in the first case while, 6.5 in the second. Furthermore production of extracellular lipases by such isolate was achieved in presence and absence of tributyrin as a carbon source instead of sucrose when supplied to Dox's liquid medium. Also the production of extracellular lipases by such isolate was not enhanced in presence of tributyrin as a supplement to Dox's liquid medium when supplied with 2 and/or 30% sucrose as carbon sources. This might suggest that the extracellular lipases of such isolate is constitutive in nature.

Production of L-asparaginase by Streptomyces karnatakensis and Streptomyces venezuelae

Production of L-asparaginase by two soil isolates, identified as S. karnatakensis and S. venezuelae, was investigated under different environmental and nutritional conditions. The presence of carbon sources, other than starch, in the growth medium or amino acids, other than L-asparagine-inhibited the enzyme biosynthesis. L-aspartic inhibited growth and enzyme production, due to a feedback mechanism, and/or lowering the pH value. Both organisms were stimulated to produce more enzyme with increasing concentrations of starch and L-asparagine, however, the optimum starch and L-asparagine concentration depended on the tolerance of the organism to low and high pH, respectively. Aeration stimulated growth, but not enzyme production, and both organisms produced more enzyme in static cultures than in shaken cultures.

Activity of L-asparaginase in cells of Streptomyces karnatakensis

Eight isolates capable of producing varying quantities of L-asparaginase and all identified as members of the genus Streptomyces were isolated from the soil and a suitable technique for the assay of intracellular L-asparaginase in actinomycetes was developed. The most potent L-asparaginase producer was identified as a strain of Streptomyces karnatakensis. Static cultures of S. karnatakensis showed maximum enzyme activity with almost maximum growth while shaken cultures exhibited their activity after 48 hours of growth. This phenomenon is discussed in terms of possible feedback mechanism and/or the biosynthesis of certain pigments. L-asparaginase of S. karnatakensis proved to be mostly intracellular and the presence of L-asparagine in the culture medium though, stimulating yet not essential for the enyzme biosynthesis. Cells grown on L-asparagine showed amidase activity with other amides but at a reduced rate.

Identity and lipase productivity of a mesophilic actinomycete isolated from Egyptian soil

1. A mesophilic lipolytic actinomycete was isolated from Egyptian soil and was identified as a strain of Streptomyces flavogriseus. 2. Lipase(s) produced by S. flavogriseus is (at least partly) constitutive in its (their) nature and can be produced in the absence of lipids, however, its production is stimulated in their presence. 3. S. flavogriseus was unable to grow at 40 degrees C or higher temperatures. However, lipase(s) produced at lower temperatures (e.g. 20, 25, 30 and 35 degrees C) were more active at 45 and 55 degrees C. This is probably due to the presence of a heat sensitive lipase inhibitor in the culture filtrate. 4. Optimum conditions for lipase(s) production by S. flavoriseus are pH 6.8, incubation for 48-72 hours at 35 degrees C with 0.8% castor oil as the carbon source in Dox liquid medium supplemented with 0.3% yeast extract. 5. Factors supporting good growth were not always the same as those stimulating lipase(s) production.

L-asparaginase-producing Streptomyces from the soil of Kuwait

Five actinomycete isolates (all belonged to the genus Streptomyces), capable of producing detectable amounts of L-asparaginase, were isolated from the soil of Kuwait after enrichment. The three most potent enzyme producers were identified as different strains of Streptomyces collinus. Factors affecting enzyme production by the strongest strain were examined. Synthetic media with asparagine as a nitrogen source stimulated more enzyme production than natural media. Starch and asparagine at final concentrations of 1 and 0.8%, respectively, were optimum for enzyme production. An initial pH of 8.5 for the growth medium and an incubation temperature of 28-30 degrees C in a static culture for 6 days stimulated enzyme production by the examined strain of Streptomyces collinus.

Lipase productivity of a lipolytic strain of Thermoactinomyces vulgaris

An attempt was made to evaluate the lipase productivity by Thermoactinomyces vulgaris with various nutritional and environmental factors. Results suggest optimum conditions for production, viz. age of inoculum 18 hours, 55 degrees C, pH 6.8, 0.2% yeast extract, specific substrates, and shaken cultures incubated for 24--36 hours. Lipases are induced by corn oil in presence of yeast extract or of certain substitutes; starch could replace these at 55 degrees C. A suggestion is given of a regulatory system of lipase synthesis, involving the supply of starch to initiate growth, allowing induction of lipase by the inductive substrate.

Identity and lipase activity of an isolate of Thermoactinomyces vulgaris

An actinomycete with thermophilic nature and strong lipolytic activity was isolated by enrichment from an Egyptian soil. It proved to be Thermoactinomyces vulgaris. Variabilities justifying Adansonian systematics were reported and discussed. The potential relation of an occasional drop in successfully resumed activity to an auto-inhibition phenomenon has been notified. Optimum conditions for the activity of the extracellular lipase(s), including stability, suggest the practical importance of the enzyme(s) in the growth filtrates.

Biological studies on a strain of Escherichia coli B resistant to chlorpromazine

A strain of Escherichia coli B resistant to chlorpromazine was developed from the sensitive strain. Cells of the resistant strain were different from those of the sensitive strain. Thus, the permeability of the resistant cells (measured by the uptake of 14C-glutamic acid) was not interfered with by Cpz. Moreover, the resistant cells were able to cause detoxification or partial detoxification of the drug.