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Background: Concomitant repair of moderate secondary tricuspid regurgitation (STR) during mitral valve surgery is still subject of controverse. This research aims to study the early and mid-term postoperative influence of tricuspid repair on the clinical outcomes and right ventricular functions. Methods: This is a retrospective cohort study of 92 patients with moderate STR who underwent tricuspid valve repair between October 2014 and December 2017, in the cardiothoracic surgery department, Menoufia University Hospital. Patients were assessed clinically and by echocardiography at one month and after 24 months postoperatively for the degree of tricuspid regurgitation (TR), right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: In this study, mean age of patients was 58.33 ± 4.06 years. We had a significant improvement in the grade of TR from preoperative period to follow up data observed at 1-month postoperative and 2-years follow-up (P = 0.0001). After one month postoperatively, no TR was detected in 74 cases (80.4%), and in 71 (84.5%) after two years. Mean right ventricular diameter decreased significantly from 23 ± 3.32 mm preoperatively to 21.9 ± 3 mm at 2-years postoperatively. An increase of TAPSE was from 19.96 ± 3.7 mm preoperatively to 20.3 ± 3.9 mm at 1-month postoperative (p = 0.55) and there was significant increase in late postoperative value. Conclusion: We highly recommend repair for moderate TR during mitral valve surgery to avoid progression of TR. Tricuspid repair was able to reduce the grade of regurgitation after two years of surgery and improved right ventricular functions.

Background: Mitral valve diseases are commonly associated with pulmonary hypertension. The aim of this study was to evaluate the effect of preoperative administration of sildenafil on the outcome after mitral valve replacement in patients with pulmonary hypertension. Methods: This prospective randomized study was carried out on 67 patients who had a mitral valve replacement and associated high systolic pulmonary artery pressure more than 50 mmHg. Patients were randomized into three groups: group A (n= 20) received preoperative sildenafil for one week, group B (n=22) received sildenafil for one month, and group C (n= 25) did not receive sildenafil. All patients had transthoracic echocardiography preoperatively, one week and one month postoperatively. Results: There was no difference in preoperative and operative variables among groups. Dobutamine support was required in 15 patients (60%) in group C vs. 6 patients (30%) in group A and 5 patients (22.5%) in group B (p= 0.012). Duration of mechanical ventilation was significantly longer in group C (389.2 ± 48.79 minutes) compared to group A and B (295.5 ± 17.01 and 281.4 ± 39.44 minutes, respectively, p

Background: Bilateral internal mammary artery (BIMA) use may improve long-term outcomes after coronary artery bypass grafting (CABG); however, the risk of infection is high. Skeletonization of the internal mammary may decrease the risk of infection, especially in patients with diabetes. Our study aimed at evaluation of sternal healing in diabetic patients with different techniques of bilateral internal mammary artery harvesting. Methods: This prospective randomized study included 200 diabetic patients who underwent CABG using BIMA between 2017 and 2019. We divided patients into two groups; Group A had skeletonization of both internal mammary arteries, and Group B had pedicled left mammary and skeletonized right mammary. Patients were observed for three months, post-operatively for any sternal wound problems. Results: There was no significant difference regarding the baseline variables. Type I diabetes mellitus was present in 25% in group A (n= 24) and 13.64% in group B (n= 12) (p= 0.324). There was no difference in harvest time between groups (83 ±4 vs. 81 ±3 minutes in group A vs. B, respectively. P= 0.1). The mean number of grafts was 3± 0.5 in Group A and 3± 0.6 in Group B (p= 0.8). Postoperative drainage was 402.9 ± 174.1 ml in Group A vs. 387.2 ± 153.6 ml in Group B (p= 0.474). The duration of ICU stay did not differ significantly between groups (2± 0.7 in Group A vs. 2± 0.5 in Group B; p= 0.8). Deep sternal wound infection occurred in 4.17% in group A (n= 4) and 4.55% in group B (n= 4) (p= 0.705). Superficial wound infection occurred in eight patients in group A (8.33%) and eight patients in group B (9.1%) (p= 0.59). No patient had sternal dehiscence in group A vs. four patients in group B (4.55%) (p= 0.39). Conclusion: We did not find differences between bilateral mammary artery harvest with skeletonization of both arteries versus skeletonization of the right mammary only on sternal healing nor wound infection in diabetic patients undergoing CABG. A larger study is recommended.

Supplemental Digital Content is available in the text, Immunoglobulins are 2nd or 3rd-line treatments in dermatomyositis (DM) or polymyositis (PM) refractory to high-dose corticosteroids and immunosuppressants. Immunoglobulins (2 g/kg/mo) are usually administered intravenously (IVIg) once a month and the patients stay at hospital for a few days. Recently, subcutaneous injections (SCIg) were proposed 2 to 3 times per week, in some dysimmune diseases. SCIg are administered at home preferably by the patient or by a nurse. We investigated the needs and attitudes of DM and PM patients with experience of IVIg and SCIg. Seven patients (6 PM and 1 DM) from a single center participated in a focus group (N = 6) or underwent in-depth interview (N = 1). Six had the experience of both IVIg at hospital and SCIg at home; 1 has received only IVIg at hospital. Verbatim was recorded and transcribed for further content analysis and computer-aided textual analysis. Clinical profiles and stories were heterogeneous. At diagnosis, muscle weakness, severe pain, and fatigue were at the forefront of patients’ complaints impairing daily life. Patients reported considerable improvement with immunoglobulins. SCIg were described as easy, less disruptive for daily life, well tolerated, and less time-consuming. SCIg self-administration at home restored the feeling of autonomy and control. Interviews of DM and PM patients revealed that recovering autonomy and control was a central advantage of home-based SCIg that were efficient, well tolerated, and perceived as a good compromise between treatment burden and efficacy.

Grégoire Jacques Noël Cozon,1 Pierre Clerson,2 Annaïk Dokhan,3 Yann Fardini,2 Taylor Pindi Sala,4 Jean-Charles Crave4 1Department of Clinical Immunology and Rheumatology, Edouard Herriot Hospital, Lyon, France; 2Soladis Clinical Studies, Roubaix, France; 3KPL, Paris, France; 4Octapharma France, Boulogne, France Purpose: Patients with primary immunodeficiency (PID) often receive immunoglobulin replacement therapy (IgRT). Physicians and patients have the choice between various methods of administration. For subcutaneous immunoglobulin infusions, patients may use an automated pump (P) or push the plunger of a syringe (rapid push [RP]). P infusions are performed once a week and last around 1 hour. RP decreases the duration of administration, but requires more frequent infusions.Patients and methods: Eight out of 30 patients (coming from a single center) who had participated in the cross-over, randomized, open-label trial comparing P and RP participated in a focus group or underwent in-depth interviews. Patients had a long history of home-based subcutaneous immunoglobulin using P. The trial suggested that RP had slightly greater interference on daily life than P, but similar efficacy and better cost-effectiveness. When asked about the delivery method they had preferred, around one-third of patients pointed out RP rather than P. In-depth interviews may reveal unforeseen reasons for patients’ preferences. Results: Interviews underlined the complexity of the relationship that the patients maintain with their disease and IgRT. Even if they recognized the genetic nature of the disease and claimed PID was a part of them, patients tried not to be overwhelmed by the disease. IgRT by P was well integrated in patients’ routine. By contrast, RP too frequently reminded the patients of their disease. In addition, some patients pointed out the difficulty of pushing the plunger due to the viscosity of the product. Coming back too frequently, RP was not perceived as time saving over a week. Long-lasting use of P could partly explain patients’ reasonable reluctance to change to RP.Conclusion: In-depth interviews of PID patients highlighted unforeseen reasons for patients’ preference that the physician needs to explore during the shared medical decision-making process. Keywords: in-depth interviews, primary immunodeficiency, patients’ expectations, preference, immunoglobulins, immunoglobulins replacement therapy, pump, rapid push, syringe

Background Cefpodoxime is a broad spectrum third generation cephalosporin with antibacterial activity similar to parenteral cephalosporins. Active against Gram-negative and -positive bacteria, empirical treatment with cefpodoxime is recommended for a wide range of community-acquired infections. We assessed the efficacy of cefpodoxime for the treatment of upper respiratory tract infections (URTI) in Egyptian adults, and evaluated its safety in daily practice. Methods This prospective, observational, multicentre study recruited adult patients, presenting with acute maxillary sinusitis and tonsilopharyngitis, prescribed 200 mg/day cefpodoxime for 5–10 days by their physicians decision. Effectiveness, defined as the proportion of patients exhibiting a complete recovery of clinical symptoms for acute sinusitis and tonsilopharyngitis, was assessed. Safety was evaluated by measuring the prevalence and severity of adverse events (AEs). Results A total of 1425 adult patients were recruited from 134 centers across Egypt. Significant reductions in URTI-related signs and symptoms were observed in subjects prescribed cefpodoxime for a mean 5.87 ± 1.73 days. An 83.3% cure rate and a 16.2% improvement rate were noted for both acute maxillary sinusitis and tonsilopharyngitis patients. Superior outcomes were observed in patients with acute tonsilopharyngitis compared to the acute maxillary sinusitis cohort (86.3% and 77.4%, respectively; p Conclusions High cure rates for acute maxillary sinusitis and acute tonsilopharyngitis, and a favorable safety and tolerability profile were noted following treatment with cefpodoxime. Thus, cefpodoxime seems to be effective as empirical treatment in adult Egyptian patients with acute UTRIs.

Objective The presence of a chest tube is a factor significantly associated with postoperative pain and functional limitation in patients submitted to pulmonary resection. Our aim was to study if early removal of the chest tube is the better way that can effectively release pain, and improve pulmonary functions without increasing the risk of postoperative complications. Methods A prospective observational study was carried out on 88 patients who underwent lung resection by posterolateral thoracotomy. A single chest tube was inserted. Criteria for chest tubes removal were when air leak resolved and the fluid drainage was 350 ml/day or less provided that the drained fluid was macroscopically non-chylous and non-hemorrhagic. Static and dynamic pain scores and forced expiratory volume in the first second (FEV1) were assessed 2 h before and after the chest tube removal. The pain level was assessed by the numeric rating scale (NRS). Two measurements for FEV1 were performed both before and after the chest tube removal, and the best value measured at each time was recorded and used for the analysis. Postoperative complications were reported. Results The mean static and dynamic pain scores were decreased significantly after chest tube removal. The mean value of FEV1/Liters and FEV1% of predicted also showed statistically significant improvement after chest tube removal. 8 (9%) of patients developed pleural effusion. 5 (5.7%) of patients developed pneumothorax. Empyema was reported in 3 (3.4%) of patients. Conclusion Early removal of chest tube may have beneficial effect on control of post-thoracotomy pain, improvement of pulmonary functions and decreasing the risk of complications after lung resection.

Objectives Pulmonary Tuberculosis (TB) is a disease that is often treated medically. However, medical treatment usually fails in the management of tuberculosis – related hemoptysis. In this study, we aimed to assess the role of surgery in the treatment of hemoptysis due to pulmonary TB. Methods Fifty two patients presented by hemoptysis and underwent pulmonary resection were enrolled in this study. Patients were divided into two groups according to the timing of surgical procedures: Group A (n = 22) included patients who underwent surgery within two days of presentation which was major to massive hemoptysis causing hemodynamic instability. Group B (n = 30) included patients who underwent surgery within 4 days after presentation with hemoptysis which was persistent and minor. Results There was no significant difference in the demographic data between both groups. Major and massive hemoptysis were the common presentation of group A, whereas minor hemoptysis was the main presentation in group B. Tuberculous cavities were the most common lung lesions in both groups (40.9% in group A, versus 40% in group B). Lobectomy was the main surgical procedure performed in both groups (50% in group A, versus 56.7% in group B). Regarding the complications, Bronchopleural fistula occurred in one case in each group after pneumonectomy. Recurrent hemoptysis occurred in only one case in group A. There was one case (4.5%) of mortality in group A. Conclusion Early pulmonary resection in patients with hemoptysis is an effective and safe method to insure good outcome. Limited resections are associated with higher incidence of recurrence.

Objective The aim of this study was to explore the fate of moderate ischemic mitral regurgitation (IMR) following isolated coronary artery bypass grafting (CABG). Background IMR is a frequently encountered problem seen in patients with coronary artery disease. A much-debated question is whether surgical revascularization alone will correct moderate (2+) IMR in such patients. Patients and methods The study group included 20 patients with moderate IMR associated with coronary artery disease undergoing isolated CABG. All patients had an ejection fraction of more than 30%. The patients were clinically and echocardiographically evaluated preoperatively, 1 week postoperatively and at 3- and 6-month intervals. Results CABG alone reduced the degree of IMR in 12 (60%) patients, did not improve it in five (25%) patients, and increased its degree to 3–4 + in three (15%) patients at 6-month follow-up echocardiography. Our study showed improved functional capacity of the patients. A significant reduction in the New York Heart Association functional class was observed. The mean preoperative value for New York Heart Association was 2.45 ± 0.51 versus 2.05 ± 0.88 postoperatively (P = 0.042). Some important variables showed a role in the progression of IMR. These were: left ventricular end-systolic dimension, left ventricular end-diastolic dimension, preoperative ejection fraction%, and failure to graft the diseased right coronary system. Conclusion The presence of moderate IMR in patients undergoing revascularization alone does not add additional burden to the operative risk nor does it affect the short-term outcome of these patients.

Objectives The aim of this study was to demonstrate whether transcatheter aortic valve implantation (TAVI) improves mortality and morbidity compared with surgical aortic valve replacement in high-risk patients who require intervention for aortic valve stenosis (AS). Many patients with severe AS and coexisting conditions are not candidates for surgical replacement of the aortic valve. Recently, TAVI has been suggested as a less invasive treatment for high-risk patients with AS. Patients and methods Fifty patients with severe AS for aortic valve intervention were classified as follows: group A, as TAVI group, included 25 patients who underwent aortic valve replacement by transcatheter femoral approach, and group B, as surgical aortic valve replacement group, included 25 patients who underwent aortic valve replacement by median sternotomy. Results Intraoperatively, procedure duration was 101.8 ± 10.6 and 191.2 ± 7.5 min in group A and B, respectively (P Conclusion In high-risk patients with severe AS, transcatheter and surgical procedures for aortic valve replacement were comparable for survival at 3 months, although there were important differences in periprocedural outcomes.

Objective To evaluate the risk factors affecting the early outcome of surgical treatment of infective endocarditis (IE). Background IE represents a series of clinical conditions with high in-hospital mortality, so early diagnosis and treatment can improve outcomes. Diagnosis depends on constant history and classic manifestations like sustained bacteremia or fungemia or active valvulitis. IE is a medical-surgical disease in which surgical treatment is a part of the therapeutic process rather than a result of the failure of medical treatment. Patients and methods A prospective cohort study was conducted on 50 consecutive patients diagnosed with definite IE and underwent cardiac surgery after being admitted to the Cardiothoracic Surgical Department, National Heart Institute, Giza, Egypt, during the period from December 2015 till March 2017. Preoperative, intraoperative, and postoperative data as potential predictors of mortality were tested. Results Our results showed that rheumatic heart disease was the most common underlying cardiac disease. Native valve endocarditis was present in 31 (62%) and prosthetic valve endocarditis in 19 (38%) patients. Mean Euro SCORE II was 5.71%. The hospital mortality was 22%, whereas the 6-month mortality was 10%. Congestive heart failure, embolization, and periannular extension of infection are the most powerful predictors of hospital mortality and also 6-month mortality. Conclusion Surgery for IE continues to be challenging. Euro SCORE II has a good discrimination ability to predict in-hospital mortality in IE surgery. Satisfactory results can be obtained with valve repair in IE.

Objective This study aims to compare the efficacy of mitral valve surgery with left atrial maze versus isolated mitral valve surgery. Background Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, especially with mitral valve disease. It represents a significant health burden especially with the associated thromboembolic complications. Several surgical approaches have been developed. The most effective one is Cox-Maze III procedure using cut-and-sew technique. Recently, surgical ablation has been transformed into an easier and faster procedure using radiofrequency, microwave, and cryothermal energy. Patients and methods This is a prospective cohort study conducted after the approval of the Human Ethics Committee of Faculty of Medicine, Menoufia University. A total of 100 patients with permanent AF and concomitant mitral valve disease have been recruited. The patients were allocated into two equal groups. Group A included mitral valve surgery and left atrial maze procedure, whereas group B included mitral valve surgery without left atrial maze. Results Group A had significant longer bypass and clamp times than group B (P Conclusion Left atrial maze with mitral valve surgery results in a better outcome in terms of myocardial function and dimensions. In addition, sinus rhythm restoration has the potential benefit of reducing the incidence of thromboembolic complications.

Objective The objective of this study was to evaluate tricuspid valve (TV) ring annuloplasty for moderate functional tricuspid regurgitation (FTR) in patients undergoing mitral valve (MV) surgery. Background TV ring annuloplasty during MV surgery for severe FTR is recommended but for moderate FTR is controversial. Patients and methods Eighty patients with moderate FTR who were listed for MV surgery were classified into group A, the TV annuloplasty group which included 34 patients who underwent MV surgery and TV annuloplasty and group B, the TV nonrepair group, 46 patients who underwent MV surgery alone. Results At 1-month follow-up, in group A: no, mild, and severe FTR were detected in 70.6, 26.5, and 2.9% of patients, respectively, whereas in group B, no, mild, moderate, and severe FTR were detected in 26.1, 58.7, 13, and 2.9% of patients, respectively (P = 0.001). Pulmonary artery pressure (PAP) in groups A and B was 27.2 ± 5.1 and 31.7 ± 6.8 mmHg, respectively (P = 0.001). At 6-month follow-up, in group A no, mild, and severe FTR were detected in 64.7, 32.4, and 2.9% of patients, respectively, whereas in group B, no, mild, moderate, and severe FTR were detected in 32.6, 50, 15.2, and 2.2% of patients, respectively (P = 0.01). PAP in groups A and B was 27.6 ± 5.1 and 32.2 ± 7.1 mmHg, respectively (P = 0.003). Conclusion Intervention for moderate FTR is recommended during MV surgery to avoid persistence or progression of the TR especially in patients with high PAP.

In this study, border disease virus (BDV) infection was suspected in a goat herd in Riyadh province, KSA. The outbreak was unusual in that the typical clinical signs of border disease, i.e., tremor and/or fleece changes were not present; manifestations of disease were restricted to abortion and the birth of small weak kids. The diagnosis was confirmed by virus detection from dead-born fetuses, seroprevalence and pathology. Impression smears from internal organs of aborted feti with suspected border disease (BD) were stained with the direct fluorescent antibody technique and examined by fluorescent microscopy, as well as prepared samples were assessed by antigen ELISA, where the two assays indicated the existence of BDV antigen. In addition; the serological investigation performed to determine the prevalence of (BDV) antibodies using ELISA revealed concurrent infection of BDV among this goat herd. Histopathological changes were confined to the brain, spinal cord and liver. Lesions were especially pronounced in the white matter of the cerebrum and the cerebellum. This is the first study that shows the presence of BDV and serologically positive animals to BDV in KSA. Further studies are needed in order to determine the prevalence of the disease in the other goat and sheep populations and the strains of the virus may be present in KSA.

Purpose To compare higher spatial resolution 3D late gadolinium enhancement (LGE) cardiovascular magnetic resonance (Cardiac MR) with 2D LGE in patients with prior myocardial infarction. Materials and Methods Fourteen patients were studied using high spatial resolution 3D LGE (1.3 × 1.3 × 5.0 mm3) and conventional 2D LGE (2 × 2 × 8 mm3) scans. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured. Total infarct volume, peri-infarct volume measured in a limited slab, and papillary muscle scar volume were compared using Bland–Altman analysis. Image quality was graded. Results 3D LGE had higher scar SNR (P < 0.001), higher myocardial SNR (P = 0.001), higher papillary scar-blood CNR (P = 0.01), and greater sharpness (P = 0.01). The scar volumes agreed (14.5 ± 8.2 for 2D, vs. 13.2 ± 8.8 for 3D), with bias ± 2 standard deviations (SDs) of 0.5 ± 6.8 mL, P = 0.59 R = 0.91. The peri-infarct volumes correlated but less strongly than scar (P = 0.40, R = 0.77). For patients with more heterogeneous scar, larger peri-infarct volumes were measured by 3D (1.9 ± 1.1 mL for 2D vs. 2.4 ± 1.6 mL for 3D, P = 0.15, in the matched region). Papillary scar, present in 6/14 (42%) patients, was more confidently identified on 3D LGE. Conclusion Higher spatial resolution 3D LGE provides sharper images and higher SNR, but less myocardial nulling. Scar volumes agree well, with peri-infarct volumes correlating less well. 3D LGE may be superior in visualization of papillary muscle scar. J. Magn. Reson. Imaging 2009;30:794–800. © 2009 Wiley-Liss, Inc.

Background Malignant pleural effusions continue to be a common problem in patients with metastatic disease, leading to a significant reduction in quality of life with progressive dyspnea, dry cough, chest pain and reduced physical activity. This study was conducted to compare the efficacy, safety, and outcome of Talc Powder Pleurodesis (TPP) with Povidone-iodine Pleurodesis (PIP) through a chest drain as a palliative preventive treatment of recurrent malignant pleural effusion. Methods A total of 39 neoplastic patients with recurrent malignant pleural effusion were enrolled in a prospective randomized trial. Twenty-one patients received Talc pleurodesis (group A), and eighteen patients (group B) received Povidone-iodine pleurodesis. The continuous variables were expressed as mean values ± standard deviation (SD) and compared using the unpaired t-test. The discrete variables were expressed as percentage and compared using the chi-square test (χ2) test. p-values of less than 0.05 were considered significant. Results Our study included 11 males and 28 females, the mean age was (71.0 ± 5.0) years for group A and (70.9 ± 5.1) years for group B (non-significant). Post-procedure analgesic requirements were recorded in both groups. Four patients in each group had fever (>38°C) within 48 hours of the procedure. Both groups achieved good symptomatic relief. There were no in-hospital deaths. The mean post-procedure hospital stay was (4.7 ± 1.2) days for group A and (4.2 ± 1.0) for group B (non-significant). At follow-up recurrence of significant pleural effusion requiring intervention was noted in four and five patients in group A and group B, respectively (non-significant difference). Conclusion Povidone-iodine pleurodesis can be considered as a good alternative to Talc pleurodesis for recurrent malignant pleural effusion. The drug is available, cost effective, safe and can be administered through an intercostal drain and repeated if necessary.

Objectives The aim of the study was to study the different types of valve-sparing aortic root reconstruction techniques to assess the short-term results with respect to improvement of patient's functional status, left ventricular dimensions and functions, and durability of competent aortic valve and to detect predictors of failure of aortic repair. Background The focus on valve-sparing operations and the concomitant re-evaluation of the functional anatomy of the aortic root have demonstrated that aortic root deformation often coexists with architecturally and morphologically normal valve leaflets. Thus, sparing and realigning the leaflets and reconstructing the aortic root have the potential for avoiding prosthetic valve disease. Materials and methods This was a prospective analytical study conducted on 50 consecutive patients with aortic root aneurysm and dissection associated with significant aortic regurgitation. These patients were operated upon using aortic valve reimplantation technique and studied for aortic valve competence. Results Follow-up echocardiography was performed within 30 days postoperative, after 6 months, 1 year, and then yearly. Moderate aortic incompetence was found in four patients (P = 0.001) at 1 year, with 100% freedom from reintervention for valve-related problems. Conclusion Valve-sparing aortic root reimplantation (Tirone-David technique) is effective in correcting aortic insufficiency due to aortic root diseases, with good results with respect to durability of aortic repair.

Background Little is known about diet quality with a reduced-energy, low-fat, partial meal replacement plan, especially in individuals with type 2 diabetes. The Action for Health in Diabetes (Look AHEAD) trial implemented a partial meal replacement plan in the Intensive Lifestyle Intervention. Objective To compare dietary intake and percent meeting fat-related and food group dietary recommendations in Intensive Lifestyle Intervention and Diabetes Support and Education groups at 12 months. Design A randomized controlled trial comparing Intensive Lifestyle Intervention with Diabetes Support and Education at 0 and 12 months. Participants/setting From 16 US sites, the first 50% of participants (aged 45 to 76 years, overweight or obese, with type 2 diabetes) were invited to complete dietary assessments. Complete 0- and 12-month dietary assessments (collected between 2001 and 2004) were available for 2,397 participants (46.6% of total participants), with 1,186 randomized to Diabetes Support and Education group and 1,211 randomized to Intensive Lifestyle Intervention group. Main outcome measures A food frequency questionnaire assessed intake: energy; percent energy from protein, fat, carbohydrate, polyunsaturated fatty acids, and saturated fats; trans -fatty acids; cholesterol; fiber; weekly meal replacements; and daily servings from food groups from the Food Guide Pyramid. Statistical analyses performed Mixed-factor analyses of covariance, using Proc MIXED with a repeated statement, with age, sex, race/ethnicity, education, and income controlled. Unadjusted χ 2 tests compared percent meeting fat-related and food group recommendations at 12 months. Results At 12 months, Intensive Lifestyle Intervention participants had a significantly lower fat and cholesterol intake and greater fiber intake than Diabetes Support and Education participants. Intensive Lifestyle Intervention participants consumed more servings per day of fruits; vegetables; and milk, yogurt, and cheese; and fewer servings per day of fats, oils, and sweets than Diabetes Support and Education participants. A greater percentage of Intensive Lifestyle Intervention participants than Diabetes Support and Education participants met fat-related and most food group recommendations. Within Intensive Lifestyle Intervention, a greater percentage of participants consuming two or more meal replacements per day than participants consuming less than one meal replacement per day met most fat-related and food group recommendations. Conclusions The partial meal replacement plan consumed by Intensive Lifestyle Intervention participants was related to superior diet quality.

Look AHEAD (Action for Health in Diabetes) was a randomized clinical trial designed to examine the long-term health effects of weight loss in overweight and obese individuals with type 2 diabetes. The primary result was that the incidence of cardiovascular events over a median follow-up of 9.6 years was not reduced in the Intensive Lifestyle Group relative to the control group. This finding is discussed, with emphasis on its implications for design of trials and clinical treatment of obese persons with type 2 diabetes.

Recent data suggest that some imidazoline derivatives can lower plasma glucose in experimental animal models of diabetes. We studied the activity of an imidazoline S-22068, in rat model of non-insulin-dependent diabetes mellitus (NIDDM) produced with a low dose of streptozotocin (35 mg kg(-1), i.v.) in the adult. The respective increase over basal value in glucose (deltaG) and insulin (deltaI), and the rate of glucose disappearance (K), were measured during a 30 min intravenous glucose tolerance test. After an intraperitoneal injection of S-22068 (24 mg kg(-1)), deltaG (mM min(-1)) was decreased (91.67+/-5.83 vs 120.5+/-3.65; P

Objectives To evaluate and compare the early hemodynamic results and echocardiographic data after rheumatic mitral valve replacement (MVR) in patients with mild and severe pulmonary hypertension (PH). Background Development of PH in association with valvular dysfunction is a marker of advanced disease. Some authors have reported no greater risk in patients with severe PH compared with those with a mild degree of PH, whereas others reported that severe PH is associated with a greater operative risk and a poorer long-term prognosis. It is desirable to reassess the outcome in these patients with newer anesthetic agents, improved valve prostheses, myocardial protection, and postoperative care. Patients and methods Between September 2013 and May 2015, this multicenter prospective observational study included 40 patients who presented with rheumatic mitral stenosis indicated for elective MVR divided into two equal groups: group A, with a mean pulmonary artery pressure (mPAP) equal to 26-40 mmHg, and group B, with mPAP more than 55 mmHg. All patients underwent conventional surgical MVR using cardiopulmonary bypass. Early hemodynamic improvement was observed with follow-up transthoracic echo performed 1 week and 3 months postoperatively Results Our study included 17 male and 23 female patients with a mean age of 32.40 years; all of them underwent conventional MVR with cardiopulmonary bypass. Throughout our study, we detected a statistically significant difference between both groups regarding the duration of postoperative mechanical ventilation and improvement in mPAP in both groups. There was a single case of morbidity in group B with no cases of mortality for 3 months postoperatively in both groups. Conclusion MVR is safe and effective even in patients with severe PH.

Objectives Evaluation of early outcomes of surgical aortic valve replacement (AVR) for patients with isolated severe aortic stenosis (AS) associated with left ventricular (LV) dysfunction and low transvalvular gradient. Background AS is the most common valvular heart disease in elderly people, with an incidence of 2-7% in the population above 65 years. Sudden death may be the first presentation for severe AS. AVR is the effective treatment for AS. Benefits versus mortality of surgical AVR is still controversial in patients who presented with severe AS associated with LV dysfunction and low gradient. Materials and methods Between October 2012 and January 2015, this multicenter prospective observational study included 20 consecutive patients who presented with isolated severe AS (valve area Results Our study included 14 male and six female patients with a mean age of 64.75 years and a mean EUROSCORE II of 1.62. All participants underwent conventional AVR with a cardiopulmonary bypass mean time of 113.3 min and a mean cross-clamp time of 69.6 min. The postoperative course involved a mean ICU stay of 3.6 days but, unfortunately, with two (10%) cases requiring reopening and mortality occurring in two (10%) cases. Among the 18 survivors, we detect statistically significant improvements in LV dimensions and systolic function in the postoperative follow-up Echo after 6 months. Conclusion Despite the high mortality rate (10%), surgical AVR is still the gold standard management for severe AS even in the risky subgroup of patients with LV dysfunction and low gradient, due to its effect in the LV function improvement.

Objective The aim of the study was to evaluate the use of vertical thoracotomy as a thoracic approach. Background A carefully planned thoracic incision should provide effortless and excellent exposure, preservation of the underlying anatomy and function, and a cosmetically acceptable result. Materials and methods We conducted a prospective, cohort study in which 30 consecutive patients were exposed to two types of thoracotomies performed by the surgeons of the cardiothoracic surgery Department in Menoufia University Hospital from October 2012 to October 2014. The patients were classified randomly into two groups: group A (n = 15) in which vertical thoracotomy was performed and group B (n = 15) in which standard posterolateral thoracotomy was performed. Operative data were collected from all patients in both groups as regards indication of operation, type of operation, intraoperative complications such as bleeding, need of extension of the incision, total operative time, and time of opening and closure of the thoracotomy. Results Results showed that vertical thoracotomy can be used for a wide range of procedures in different age groups and in both sexes. Shoulder joint movement was significantly better when vertical thoracotomy was used (P = 0.044), and cosmetic results are better. Conclusion Vertical thoracotomy offers specific advantages of minimum trauma and maximum preservation of chest wall function with a cosmetically acceptable scar.

Objectives The aim of this study was to investigate the overall outcome of adult patients undergoing redo-mitral valve replacement as emergency cases against elective cases. Background Patients with mechanical prosthetic heart valves are at risk of reoperation. The reported risk of mortality may be as low as 5.4-11% for elective reoperation, but as high as 38-61.5% for emergency procedures. Patients and methods Forty patients who had undergone previous mitral valve replacement were admitted for redo-mitral valve replacement during the period between May 2011 and May 2013 at the National Heart Institute. They were divided into two groups: group A: 20 patients were admitted from the ER as emergency cases; group B: 20 patients were admitted from outpatient clinics as elective cases. A mechanical valve was inserted with horizontal mattress pledgeted nonabsorbable sutures. Sutures were placed from left atrium to left ventricle. Tricuspid valve incompetence, if present, was corrected by tricuspid valve repair (De-Vega suture). Results The hospital mortality was 20%. There was no effect regarding age, sex, cardiac rhythm, number of previous operations, type of the previous prosthesis, and interval from last implantation. Taking into consideration that mortality was higher in the emergency group, the New York Heart Association (NYHA) functional class, left ventricular end systolic diameter, left ventricular end diastolic diameter, redo-cardiac surgery sternotomy, and adhesiolysis carry a significant risk of catastrophic bleeding, especially with the rush accompanying hemodynamic instability. Infective cardiac tamponade, permanent pacemaker, residual infective endocarditis, the need for dialysis, and cerebrovascular accidents were not statistically significant. Conclusion When significant valve dysfunction is first noted, reoperation should be undertaken to minimize the operative risk to avoid mortality and postoperative morbidities.

Esophageal atresia (EA) with or without tracheoesophageal fistula (TOF) is one of the most correctable fetal anomalies if diagnosed antenatally by serial ultrasound. We retrospectively evaluated antenatal diagnoses by ultrasound of EA with or without TOF at our institution in Saudi Arabia. We examined the records of mothers and infants with EA with or without TOF who were booked early and delivered at our institution during 1994 to 1998. Fetal diagnosis was based on level II serial ultrasound using a high-resolution ultrasound machine (n=78). In the 5-year period there were 58 491 live births with 1345 congenital abnormalities (2.3%) and 78 cases of EA with or without TOF (0.13%) diagnosed antenatally. The survival rate was 68% for women with vaginal deliveries and 60% for women with caesarean deliveries so caesarean delivery did not improve outcome. The Apgar score was 7 or greater at 5 minutes in 65 cases (83.5%) which emphasizes the problems such patients develop after delivery. Death was caused by anomalies other than EA that were incompatible with life or in the post-operative period by septicemia renal failure or cot death. Our study suggests that early antenatal booking serial ultrasound and early antenatal diagnosis improves outcome in EA with or without TOF. (authors)

To find evidence of diffuse fibrosis in dilated cardiomyopathy (DCM) patients by comparing measurements on clinical late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) studies between DCM and healthy subjects.LGE-CMR and the Look-Locker images from 20 DCM patients and 17 healthy controls were analyzed. Blood signal-to-noise ratio (SNR), myocardium SNR, and blood-to-myocardium contrast-to-noise ratio (CNR) were measured on the LGE-CMR images. The optimal inversion time (TI) to null blood and myocardium was determined on the Look-Locker images. The postcontrast T(1) was estimated using a phantom study that correlated optimal TI and heart rate to T(1).The blood SNR was lower, myocardium SNR was higher, and the blood-to-myocardium CNR was lower (6.6 +/- 0.7 vs. 10.3 +/- 0.9, P = 0.004) on DCM LGE-CMR images as compared to controls. The blood-myocardium optimal TI difference (DeltaTI) was lower (38 +/- 2 msec vs. 55 +/- 3 msec, P0.001) in DCM, and the estimated blood-myocardium T(1) difference (DeltaT(1)) (116 +/- 6 msec vs. 152 +/- 8 msec, P = 0.001) was also lower.DCM patients have reduced blood-myocardium DeltaTI and DeltaT(1), and lower CNR as compared to controls, suggesting the presence of diffuse fibrosis. This may impact the interpretation of LGE data.

Objectives The aim of this study was to evaluate surgical results in patients with moderate tricuspid regurge undergoing mitral valve surgery either with or without concomitant tricuspid repair 6 months after surgery. Background Moderate tricuspid regurge has a variable natural history, as it may regress after mitral valve surgery without tricuspid repair, or may progress; hence, the decision to repair moderate tricuspid regurge in concomitant tricuspid repair with mitral valve surgery remains controversial. Patients and methods This study was conducted from January 2010 to June 2013. A total of 50 patients underwent mitral valve replacement for the first time with concomitant moderate tricuspid valve regurge. They were divided into two groups: group A (26 patients) who underwent mitral valve replacement alone, and group B (24 patients) who underwent mitral valve replacement and tricuspid valve repair using De Vega annuloplasty technique. Results The result showed that the tricuspid regurgitation improved postoperatively, irrespective of whether the repair was performed or not. However, statistical differences between group A and group B were significant. Conclusion Concomitant tricuspid valve repair with mitral valve surgery offered better early postoperative tricuspid valve function in patients with moderate tricuspid regurge, who underwent mitral valve surgery for chronic mitral valve disease.

Objectives The aim of the study was to achieve arterial myocardial revascularization using the 'Y-graft or T-graft' techniques and to measure intraoperative graft flow by transit-time flowmetry. Background Composite grafting techniques for coronary artery bypass grafts have been widely used. However, it remains unclear whether this technique provides similar blood flow to the left coronary artery. In this study, we evaluated composite grafting techniques by intraoperative measurement graft flow by transit-time flowmetry. Materials and methods Fifty patients who underwent coronary artery bypass grafting during a time period of 24 months were enrolled in this prospective study. All patients received sequential grafting using both internal thoracic arteries and left radial artery joined as a composite Y or T graft. Intraoperative left internal mammary artery (LIMA) flow was measured by transit-time flowmetry. Results This study provided evidence that the LIMA limb of a composite Y or T graft had intraoperative increase in mean flow, and there was statistical significance ( P Conclusion LIMA has the potential to provide sufficient blood flow to revascularize left coronary system.

Objectives The goal of this study was to determine whether the surgical management of moderate chronic ischemic mitral regurgitation (IMR) is to revascularize only or to revascularize and perform mitral valve repair as well. Background Ischaemic mitral regurgitation is a frequent complication of left ventricular global or regional pathological remodeling due to chronic coronary artery disease. Although there are numerous possible treatment modalities, the management of patients with moderate chronic IMR remains uncertain. Patients and methods Forty patients referred for coronary artery bypass grafting with moderate IMR and an ejection fraction more than 30% were randomized to receive coronary revascularization plus mitral valve repair (20 patients) or revascularization only (20 patients). Survivors were clinically and echocardiographically assessed early postoperatively and at 3 months' follow-up. Results There was no significant difference between the two groups as regards preoperative and demographic data. The operative time, ventilation time, and ICU stay were significantly higher in the repair group. Use of cardiac supports, complications, in-hospital mortality, and ward stay were not statistically significantly different. Postoperative and follow-up echocardiographic data showed no statistically significant difference in left atrial dimension, left ventricular dimension, and function between the two groups. Although the grade of mitral regurgitation showed improvement in both groups, there was significantly higher improvement in the repair group compared with the revascularization-only group. Conclusion Adding mitral repair to coronary revascularization in patients with moderate IMR may improve mitral regurgitation severity without additional risk. Improvement in functional capacity and left ventricular reverse remodeling was observed in both procedures.

Background Paravertebral block (PVB) is an effective analgesic technique for post-thoracotomy pain, whereas there is no clear proof on how it can be more effective. We aimed to assess if the pleural integrity has a significant effect on thoracic PVB analgesia. Methods Data of patients who underwent thoracotomy and paravertebral catheterization in Menoufia University Hospitals, between November 2010 and December 2014 were retrospectively collected. Patients were classified into two groups; group A, where the parietal pleura was disrupted, and group B, where there was no pleural tear. Pain scores and pulmonary functions were compared between both groups. Also the frequency of PVB analgesia and the need for supplementary drugs taken as well as the use of rescue pain medications were assessed in both groups. Results 132 patients were analyzed; group A (n = 68) patients with pleural disruption and group B (n = 64) patients with intact pleural. There was no statistical significant difference regarding age, sex, body mass index, American Society of Anesthesiologists score (ASA), diagnosis, and operative details. Pain scores were significantly lower in group B, where no pleural tear. Pulmonary functions significantly improved among intact pleura group. Significant increases in the frequency of PVB analgesia, supplementary drugs taken in postoperative period and in the use of rescue drugs were observed in patients with pleural disruption. Complications were higher in pleural disruption group. Conclusion Preservation of integrity of the parietal pleura is essential for the quality thoracic PVB.