Abstract Aim and Objectives The aim of this study is to compare between clopidogrel and ticagrelor loading doses used prior to primary PCI in patients presenting with acute STEMI (ST-elevation Myocardial Infarction) on myocardial perfusion and in-hospital MACE (major adverse cardiac events). Patients and Methods The study included 170 patients who presented with acute STEMI to the cardiology department of Ain Shams university hospitals and underwent primary PCI. They were divided into 2 groups where the1st group 85 patients received clopidogrel loading dose (600mg) and the 2nd group 85 patients received ticagrelor loading dose (180mg). Post interventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded. Results The majority of patients in both groups had the LAD as the culprit vessel for their presentation (71.8% in the clopidogrel group and 50.6% in ticagrelor group). In the clopidogrel group there were 4 patients with TIMI I flow and MBG I, 13 with TIMI II flow and MBG II and 68 with TIMI III flow and MBG III. Meanwhile in the ticagrelor group there was 2 patients with TIMI I flow and MBG I, s with TIMI II flow and MBG II and 81 with TIMI III flow and MBG III. There was no statistical significance between the two groups regarding in-hospital death of all causes and stroke after primary PCI. Conclusion Ticagrelor loading before primary PCI resulted in improved TIMI flow, MBG but did not decrease incidence of in-hospital MACE.
Background:The effect of male age on male fertility is a debatable subject.Men never stop producing sperms, but there is a decline in sperm quality as a man ages.According to the World Health Organization (WHO) starting around the age of 35, semen parameters worsen.The sperm quality parameters naturally change with age: count, motility, morphology, DNA fragmentation, and genetic mutations.Paternal age is among the factors affecting a couple's chance of conceiving and their pregnancy outcomes.Pregnancy Rate, time to conception, miscarriage risk, adverse pregnancy outcomes, and Offspring health risks are all affected by male age.Some studies have shown that paternal age does not affect pregnancy outcomes using conventional in vitro fertilization (IVF) techniques, while others report decreased pregnancy and live birth rates with increased male age.Objective: to discuss the effect of male aging on fertility and pregnancy outcome and also on the results of assisted reproduction. Conclusion:Male Age has a significant role in his fertility potential and would affect pregnancy prognosis as well as ART results.
Background: To a large extent, the heart's functions are influenced by the autonomic nervous system involving hemodynamics, properties of cardiac conduction, heart rate (HR), as well as cardiac myocytes cell functions, and cardiac arrhythmogenesis.In the present study, heart rate variability (HRV) was evaluated in patients receiving radiofrequency catheter ablation for supraventricular tachycardias to determine if there was a correlation between the amount of radiofrequency current used and the HRV change.Patient and Methods: For this one-arm clinical trial, 60 patients with drug-resistant supraventricular tachycardias were recruited; they underwent radiofrequency ablation and were followed up for 6 months after the procedure.Results: Compared with pre-ablation data, at the follow-up evaluation after radiofrequency ablation, HRV were found to be shorter.Results from a 24-hour Holter monitor showed an increase in mean HR, whereas HRV parameters such as time domain indices (SDNN, rMSSD) and frequency domain index, which reflect the attenuation of parasympathetic tone, were reduced in the follow-up at 1 month and 6 months post-ablation.30 patients, or 50%, had a high sinus rate 6 months after ablation.Compared to patients without AV nodal modification or postero-septal accessory pathway ablation, HRV changes were more pronounced in those with these procedures.Conclusion: Six months following radiofrequency ablation, cardiac autonomic dysfunction was still evident when measured by alterations in time domain and frequency domain HR variability measures.Perhaps one cause of parasympathetic denervation is its role in post-ablation sinus rate.
Objective: The ability to cryopreserve small numbers of spermatozoa retrieved by testicular sperm extraction (TESE) in males having nonobstructive azoospermia avoids the requirement for repeated surgery and promotes the preservation of fertility. The same applies to men with cryptozoospermia who may show few sperms only after concentrating their semen samples. Many techniques were proposed for freezing rare motile spermatozoa. In this pilot study we propose a new simple and safe technique that requires no specific commercial tools.Methodology: A new method is suggested for cryopreserving rare human spermatozoa using the culture dish slice. Results: Four cases were included in this pilot study. A total of 20 motile ejaculate sperms and 20 motile testicular sperms were frozen using the culture dish slice technique. Sperm retrieval, retrieval of motility and retrieval of usable sperms for ICSI were (100%, 25% and 70% respectively) for ejaculate sperms and (100%, 10% and 60% respectively) for testicular sperms. Conclusion: The culture dish slice technique would represent an easy, non-expensive method for rare sperm cryopreservation that necessitates no special commercial devices.
Abstract Background lesions at the bifurcation of coronary arteries pose a substantial difficulty due to their intricate anatomical structure and the increased risk of complications during or after the procedures. Drug-coated balloons (DCBs) have recently been recognized as a promising therapeutic strategy for managing bifurcation lesions. Objective to compare the use of drug-coated balloons versus ordinary balloons in provisional stenting of coronary artery bifurcation lesions and its impact on the procedural success rate & short-term MACE Patients and Methods The current study is a prospective, longitudinal cohort, interventional two arm study that included a total of 66 patients. 40 in Control group (group A) and 26 in case group (group B). every patient is assigned to a particular group based on the operator’s preference. In both groups provisional stenting was employed, with dilation of the side branch using a standard balloon in group “A” and a drug-coated balloon in group “B”. The evaluation of the outcomes of the indexed procedure and a six-month follow-up were conducted to monitor the incidence of Major Adverse Cardiac Events (MACE). Results The mean age of patients assigned to the Group A was 57.18 ± 9.84 years, while patients assigned to the Group B had a mean age of 55.50 ± 7.74years, both groups were similar in demographic data, baseline clinical characteristics and Echocardiographic Data. The study’s primary endpoint was the occurrence of major adverse cardiac events (MACEs), at a 6-month follow-up. A significant difference was observed between the case and control groups in terms of MACE after 6 months. The incidence of MACE was 23.7% (9 out of 38 patients who continued the study after 2 cases of in- hospital mortality) in the control group, compared to only 3.9% (1 out of 26 patients) in the case group, with a p-value of 0.039. the secondary endpoints of the study, which encompassed the attainment of lesion success and procedure success, did not show a statistically significant difference between the case and control groups despite the observed variation in the complication rat Conclusion The application of drug-coated balloons in provisional stenting for coronary artery bifurcation lesions demonstrated superiority over conventional balloons in terms of short-term major adverse cardiac events (MACE), and exhibited non-inferiority in relation to lesion or procedural success.
Background: Cerebrovascular stroke is a major cause of morbidity and disability. Many etiologies may contribute to its presence. Some patients have none of the identifiable risk factors yet face the consequences of stroke or transit ischemic attack. This type of stroke is known as embolic stroke of undetermined source (ESUS). It has a high rate of recurrence due to the presence of an unknown uncorrected etiology. Paroxysmal atrial fibrillation remains a hidden bottom of an iceberg, representing a major hidden etiology of ESUS. We aimed to determine the prevalence of paroxysmal atrial fibrillation in patients with ESUS using 72-h Holter monitoring. Methods: Patients diagnosed with ESUS underwent 72-h Holter monitoring within the 1st week of the incident stroke. Holter monitors determined whether atrial fibrillation (more than 3 s) is present or not. Results: This study included 200 patients with stroke of an undetermined source who underwent 72-h Holter monitoring within 1 week of the incident stroke. The patients' ages ranged between 22 and 77 years (mean age 48.46 ± 12.74 years); 136 were males and body mass index (BMI) ranged from 21 to 35 kg/m2, with a mean BMI of 24.78 ± 2.99 kg/m2. Their left atrial anteroposterior diameter in the parasternal long-axis view ranged from 26 mm to 47 mm, with a mean diameter of 36.08 ± 5.23 mm. Thirty-two out of the 200 patients were diagnosed with paroxysmal atrial fibrillation, representing 16%. There was a statistically significant association between the presence of paroxysmal atrial fibrillation and both age (P = 0.009) and left atrial diameter (P = 0.001). There was an associated finding that needs further investigation regarding the significant association between supraventricular ectopic beats and the presence of atrial fibrillation or stroke. Conclusion: Paroxysmal atrial fibrillation is an important hidden etiology of embolic stroke of undetermined etiology that can be detected early using 72-h Holter monitoring within 1 week of the incident stroke.
Background: Diabetes mellitus is recognized as an independent risk factor for the development of Coronary No Reflow. Ticagrelor has a faster onset of action and a stronger antiplatelet effect as compared to clopidogrel. The aim of this study is to compare between ticagrelor and clopidogrel loading doses before primary percutaneous coronary intervention (PCI) in Type II diabetic patients presenting with anterior wall ST-Segment Elevation Myocardial Infarction (STEMI) and their different effect on myocardial perfusion and in-hospital Major Adverse Cardiac Events. Methods: The study included 170 patients with Type II diabetes, who presented with acute anterior wall STEMI who underwent primary PCI. They were randomized into two groups, the1st group 85 patients received clopidogrel loading dose (600 mg) and the 2nd group 85 patients received ticagrelor loading dose (180 mg). Postinterventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded as well as in-hospital outcomes. Results: In the clopidogrel group, 80% of the patients had TIMI III flow score, 15.3% had TIMI II flow score and 2.4% had TIMI I and TIMI 0 flow score. In the ticagrelor group, 95% of the patients had TIMI III flow score, 2.4% had TIMI II flow score and 1.2% had TIMI I and TIMI 0 flow score (P = 0.01). Regarding MBG, in the clopidogrel group, 64.7% of the patients had MBG III, 13% had MBG II flow score, 2.3% had MBG 1, and 20% had MBG 0. In the ticagrelor group, 93% of the patients had MBG III, 1.1% had MBG II flow score, 1.1% had MBG 1, and 4.8% had MBG 0 (P = 0.007). In the clopidogrel group there were 3.5% in-hospital mortality, while in ticagrelor 2.4% in-hospital mortality (2.4%) (P = 0.47). In the Clopidogrel group, in-hospital MACE was 5.8% versus 3.5% in the ticagrelor group (P = 0.65). In the Clopidogrel group, in-hospital bleeding was 3.5% versus 4.7% in the ticagrelor group (P = 0.7). Conclusion: Ticagrelor loading before primary PCI resulted in improved TIMI flow and MBG in Type II diabetic patients presenting with anterior wall myocardial infarction.
Abstract Aim and objectives The aim of this study was to assess the relationship between vitamin D deficiency and extent of success of cardioversion in patients with lone atrial fibrillation (AF). Patients and Methods This observational cross-sectional study included 50 patients (18-60 years old) who presented to the cardiology department of Ain Shams university hospitals with lone atrial fibrillation with structurally normal heart for cardioversion after fulfilling the inclusion criteria, considering that failure of cardioversion was defined as failure of restoration to normal sinus rhythm after applying the cardioversion protocol that is being used in our cardiology department in Ain Shams University hospitals. Serum vitamin D level on admission was sampled for all patients before cardioversion, and cardioversion was assessed after then whether success or failure. Cardioversion success was restoration of normal sinus rhythm and that the patient was discharged in sinus rhythm. Cardioversion protocol that was being used was applied as Loading dose of Intravenous (IV) Amiodarone of 300 mg diluted in 250 ml 5% dextrose over 30-60 minutes, then follow up dose of 900 mg IV over 24 hours diluted in 500-1000 ml of normal saline, then if failed, application of biphasic synchronized direct current electrical cardioversion at 200 joules at anteriorlateral electrode positions. Results The success rate of cardioversion was 80% (40 out of 50) in all the patients presented, and the failure rate was 20% (10 out of 50). In the success group, majority of patients 23 (57.5%) had sufficient Vitamin D levels (≥30 ng/ml), 15 patients (37.5%) had insufficient vitamin D levels (21-29 ng/ml) and 2 patients (5%) had deficient vitamin D levels (≤20 ng/ml). Meanwhile, in the failure group, the majority of patients 8 (80%) had deficient vitamin D levels (≤20 ng/ml), 1 patient (10%) had insufficient vitamin D level (21-29 ng/ml), and 1 patient (10%) had sufficient vitamin D level (≥30 ng/ml).This difference was statistically significant with a P value of < 0.01. Vitamin D level measured (25-OH vitamin D) had values of mean ± SD of 29.41 ± 4.89 ng/ml in the success group vs 19.22 ± 4.68 ng/ml in the failure group, which was statistically significant with a P value of <0.01. A-P (antero-posterior) LAD (left atrial diameter) measured in parasternal long axis view during routine pre-cardioversion work-up study by echocardiography that has been done, had values of mean ± SD of 37.60 ± 3.20 mm in the success group vs 37.80 ± 2.86 mm in the failure group, which was statistically non- significant with a P value of 0.858. There was not a statistically significant difference between the 2 groups regarding age, sex, BMI, smoking, duration of AF(duration of onset of symptoms), number of previous trials of cardioversion, previous antiarrythmic drugs that have been administered and heart rate at time of cardioversion. Conclusion Failure rate of cardioversion was found to be higher in patients with vitamin D deficiency in comparison to patients with sufficient and insufficient vitamin D levels. Abbreviations AF: Atrial Fibrillation; A-P: Antero-posterior; BMI: Body mass index; LAD: Left atrial diameter; SD: Standard deviation
This chapter includes clinical cases, background, evidence-based practical management options, preventive measures, key-point summaries of ART in men with Klinefelter syndrome (KS) and answers to questions patients ask. Testicular sperm retrieval and ICSI may be the only fertility option for the majority of KS patients. The most important preoperative step is to discontinue supplemental testosterone 6 months before performing microscopic testicular sperm extraction. In some mosaic KS patients, there may be severe oligozoospermia instead of azoospermia. As the condition is likely to progress, early diagnosis and cryopreservation of sperm should be considered even if fertility is not desired at that stage. Genetic counseling is important in cases of ART with KS, as parents worry about the risk of having a baby with the same issue or other genetic problems and enquire whether they should have preimplantation genetic testing.
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