Publications by authors named "Ahmed Aly"

80 Publications

Pre-surgical Prediction of Ischemic Mitral Regurgitation Recurrence Using In Vivo Mitral Valve Leaflet Strains.

Ann Biomed Eng 2021 Apr 9. Epub 2021 Apr 9.

James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA.

Ischemic mitral regurgitation (IMR) is a prevalent cardiac disease associated with substantial morbidity and mortality. Contemporary surgical treatments continue to have limited long-term success, in part due to the complex and multi-factorial nature of IMR. There is thus a need to better understand IMR etiology to guide optimal patient specific treatments. Herein, we applied our finite element-based shape-matching technique to non-invasively estimate peak systolic leaflet strains in human mitral valves (MVs) from in-vivo 3D echocardiographic images taken immediately prior to and post-annuloplasty repair. From a total of 21 MVs, we found statistically significant differences in pre-surgical MV size, shape, and deformation patterns between the with and without IMR recurrence patient groups at 6 months post-surgery. Recurrent MVs had significantly less compressive circumferential strains in the anterior commissure region compared to the recurrent MVs (p = 0.0223) and were significantly larger. A logistic regression analysis revealed that average pre-surgical circumferential leaflet strain in the Carpentier A1 region independently predicted 6-month recurrence of IMR (optimal cutoff value - 18%, p = 0.0362). Collectively, these results suggest greater disease progression in the recurrent group and underscore the highly patient-specific nature of IMR. Importantly, the ability to identify such factors pre-surgically could be used to guide optimal treatment methods to reduce post-surgical IMR recurrence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10439-021-02772-5DOI Listing
April 2021

Clinical and Radiological Characteristics of Acute Cerebrovascular Diseases Among Egyptian Patients With COVID-19 in Upper Egypt.

Front Neurol 2021 22;12:635856. Epub 2021 Mar 22.

Department of Neuropsychiatry, Faculty of Medicine, Aswan University Hospital, Aswan, Egypt.

There is little information on the acute cerebrovascular complications of coronavirus disease 2019 (COVID-19) in Egypt. The aim of this study was to estimate the proportion of acute cerebrovascular disease (CVD) among COVID-19 patients and evaluate their clinical and radiological characteristics in comparison with non-COVID-19 CVD. In a retrospective study, COVID-19 patients whom presented with CVD in Assiut and Aswan University Hospitals were compared with non-COVID-19, CVD patients, admitted to Qena University Hospital, prior to the pandemic. The following data were collected: clinical history and presentation, risk factors, comorbidities, brain imaging (MRI or CT), chest CT, and some laboratory investigations. Fifty-five (12.5%) of the 439 patients with COVID-19 had acute CVD. Of them, 42 (9.6%) had ischemic stroke while 13 patients (2.9%) had hemorrhagic CVD. In the 250 cases of the non-COVID-19 group, 180 had ischemic stroke and 70 had hemorrhagic stroke. A large proportion of patients with COVID-19 who presented with ischemic stroke had large vessel occlusion (LVO), which was significantly higher than in non-COVID-19 patients with CVD (40 vs. 7.2%, < 0.001). Comorbidities were recorded in 44 (80%) cases. In COVID-19 ischemic stroke patients, risk factors [hypertension and ischemic heart disease (IHD)] and comorbidities (hepatic and renal) were significantly higher than those in non-COVID-19 patients. In addition, 23.5% had hemorrhagic CVD, and six patients with LVO developed hemorrhagic transformation. Acute CVD among patients with COVID-19 was common in our study. LVO was the commonest. Hypertension, IHD, and anemia are the most common risk factors and could contribute to the worsening of clinical presentation. Comorbidities were common among patients with CVD, although a large number had elevated liver enzymes and creatinine that were partially due to COVID-19 infection itself. The current results begin to characterize the spectrum of CVD associated with COVID-19 in patients in Upper Egypt. The ID number of this study is IRB no: 17300470.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2021.635856DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019810PMC
March 2021

Rare, post-periodontitis spondylodiscitis caused by in a patient with multiple sclerosis: challenge of diagnosis and treatment.

BMJ Case Rep 2021 Mar 18;14(3). Epub 2021 Mar 18.

The Centre for Spinal Studies and Surgery, Queen's Medical Centre Nottingham, University Hospital NHS Trust, Nottingham, UK.

is part of the commensal flora of the oral cavity, frequently associated with periodontal infections. We describe the case of a 49-year-old woman, on immunsuppressive therapy for multiple sclerosis, who presented with a 3-month history of debilitating back pain. She had a recent episode of periodontitis, and was under regular dental review. Her MRI scan demonstrated findings suggestive of L2-L3 spondylodiscitis. Her CT-guided biopsy yielded negative cultures and the patient failed two courses of empirical antibiotic treatment. With clinical and radiological disease progression, she underwent a percutaneous disc washout and biopsy, which subsequently grew Treatment with clindamycin and metronidazole was commenced orally for 6 weeks. She improved gradually, and at 1 year follow-up was asymptomatic. The diagnosis of spondylodiscitis caused by is challenging. The perseverance on identification by surgical biopsy, minimally invasive washout and targeted antibiotics are the mainstay of effective treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2020-239664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978293PMC
March 2021

Effects of monosodium glutamate on testicular structural and functional alterations induced by quinine therapy in rat: An experimental study.

Int J Reprod Biomed 2021 Feb 21;19(2):167-180. Epub 2021 Feb 21.

Beykoz Institute of Life Sciences and Biotechnology, Bezmialem Vakif University, Istanbul 34820, Turkey.

Background: Quinine (QU) as an anti-malarial drug induces alterations in testicular tissue. Toxic effects of monosodium glutamate (MSG) on the male reproductive system have been recognized.

Objective: To investigate the impact of MSG administration on the intensity of gonadotoxicity of QU.

Materials And Methods: Sixty eight-wk old Wistar rats weighing 180-200 gr were divided into six groups (n = 10/each): the first group as a control; the second and third groups received low and high doses of MSG (2 & 4 gr/kg i.p.), respectively, for 28 days; the fourth group received QU for seven days (25 mg/kg); and in the fifth and sixth groups, QU was gavaged following the MSG administration (MSG + QU) from day 22 to day 28. Serum testosterone and malondialdehyde (MDA) levels were measured. Testes samples were prepared for tissue MDA levels, histomorphometry, and immunohistochemistry of p53. Sperm analysis was performed on cauda epididymis.

Results: Serum and tissue MDA levels were increased in treated groups compared to the control group. This increment was higher in the MSG + QU groups. The testosterone levels were reduced significantly (p 0.0001) in all treated groups. In addition, histomorphometric indices and tubular epithelium population were reduced significantly (p 0.0001) in QU, MSG + QU, and consequently in high-dose MSG, QU, MSG + QU groups. All spermatogenic indices were reduced in the treated groups, particularly in the MSG + QU groups. Sperm motility and viability indices were reduced significantly (p = 0.003) in the MSG + QU groups. Finally, the overexpression of p53 was observed in the MSG + QU groups.

Conclusion: The administration of MSG before and during QU therapy may intensify testicular tissue alterations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18502/ijrm.v19i2.8475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922298PMC
February 2021

Novel thienopyrimidine analogues as potential metabotropic glutamate receptors inhibitors and anticancer activity: Synthesis, In-vitro, In-silico, and SAR approaches.

Bioorg Chem 2021 Apr 16;109:104729. Epub 2021 Feb 16.

Biochemistry and Molecular Biology Department, Faculty of Pharmacy, Helwan University, P.O. Box 11795, Cairo, Egypt; Center of Scientific Excellence "Helwan Structural Biology Research, (HSBR)", Helwan University, Cairo 11795, Egypt.

There is a continuous need in drug development approach for synthetic anticancer analogues with new therapeutic targets to diminish chemotherapeutic resistance of cancer cells. This study presents new group of synthetic thienopyrimidine analogues (1-9) aims as mGluR-1 inhibitors with anticancer activity. In-vitro antiproliferative assessment was carried out using viability assay against cancer cell lines (MCF-7, A-549 and PC-3) compared to WI-38 normal cell line. Analogues showed variable anticancer activity with IC ranging from 6.60 to 121 µg/mL with compound 7b is the most potent analogue against the three cancer cell lines (MCF-7; 6.57 ± 0.200, A-549; 6.31 ± 0.400, PC-3;7.39 ± 0.500 µg/mL) compared to Doxorubicin, 5-Flurouracil and Riluzole controls. Selected compounds were tested as mGluR-1 inhibitors in MCF-7 cell line and results revealed compound 7b induced significant reduction in extracellular glutamate release (IC; 4.96 ± 0.700 µM) compared to other analogues and next to Riluzole (IC; 2.80 ± 0.500 µM) of the same suggested mode of action. Furthermore, both cell cycle and apoptosis assays confirmed the potency of compound 7b for early apoptosis of MCF-7 at G/M phase and apoptotic positive cell shift to (91.4%) compared to untreated control (19.6%) and Raptinal positive control (51.4%). On gene expression level, compound 7b induced over-expression of extrinsic (FasL, TNF-α and Casp-8), intrinsic (Cyt-C, Casp-3, Bax) apoptotic genes with down-regulation of anti-apoptotic Bcl-2 gene with boosted Bax/Bcl-2 ratio to 2.6-fold increase. Molecular docking and dynamic studies confirmed the biological potency through strong binding and stability modes of 7b where it was faster in reaching the equilibrium point and achieving the stability than Riluzole over 20 ns MD. These results suggest compound 7b as a promising mGluR inhibitory scaffold with anticancer activity that deserves further optimization and in-depth In-vivo and clinical investigations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bioorg.2021.104729DOI Listing
April 2021

Surveillance Study of Acute Neurological Manifestations among 439 Egyptian Patients with COVID-19 in Assiut and Aswan University Hospitals.

Neuroepidemiology 2021 Feb 25:1-10. Epub 2021 Feb 25.

Department of Neuropsychiatry, Assiut University Hospital, Faculty of Medicine, Aswan, Egypt.

Background: COVID-19 can be accompanied by acute neurological complications of both central and peripheral nervous systems (CNS and PNS). In this study, we estimate the frequency of such complications among hospital inpatients with COVID-19 in Assiut and Aswan university hospitals.

Materials And Methods: We screened all patients with suspected COVID-19 admitted from 1 June to 10 August 2020 to the university hospitals of Assiut and Aswan in Upper Egypt. Clinical and laboratory tests, CT/MRI of the chest and brain, and neurophysiology study were performed for each patient if indicated.

Results: 439 patients had confirmed/probable COVID-19; neurological manifestations occurred in 222. Of these, 117 had acute neurological disease and the remainder had nonspecific neuropsychiatric symptoms such as headache, vertigo, and depression. The CNS was affected in 75 patients: 55 had stroke and the others had convulsions (5), encephalitis (6), hypoxic encephalopathy (4), cord myelopathy (2), relapse of multiple sclerosis (2), and meningoencephalitis (1). The PNS was affected in 42 patients: the majority had anosmia and ageusia (31) and the others had Guillain-Barré syndrome (4), peripheral neuropathy (3), myasthenia gravis (MG, 2), or myositis (2). Fever, respiratory symptoms, and headache were the most common general symptoms. Hypertension, diabetes mellitus, and ischemic heart disease were the most common comorbidities in patients with CNS affection.

Conclusion: In COVID-19, both the CNS and PNS are affected. Stroke was the most common complication for CNS, and anosmia and/or ageusia were common for PNS diseases. However, there were 6 cases of encephalitis, 2 cases of spinal cord myelopathy, 2 cases of MG, and 2 cases of myositis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000513647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018217PMC
February 2021

Fournier's gangrene with dapagliflozin in a rural hospital: a case report.

BMJ Case Rep 2021 Feb 1;14(2). Epub 2021 Feb 1.

Clinical Pharmacy Department, Winchester District Memorial Hospital, Winchester, Ontario, Canada.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, which are used for treatment of type 2 diabetes, are associated with risk of urogenital infections. FDA issued a black box warning about multiple case reports of Fournier's gangrene (FG) observed in patients taking SGLT2 inhibitors. FG is a type of necrotising fasciitis that occurs in the anogenital area. We report a case of a 71-year-old woman with type 2 diabetes on dapagliflozin, presenting with foul-smelling discharge and a large abscess in the perianal area. Her risk factors for FG included her advanced age, obesity, diabetes and trauma to the site. During her stay, dapagliflozin was discontinued and she received procedural debridement, wound care and broad-spectrum intravenous antibiotics. Due to possible association between FG and SGLT2 inhibitors, patients presenting with signs and symptoms of FG who are taking SGLT2 inhibitors should be examined for infection in the urogenital area and treated promptly.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2020-237784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852914PMC
February 2021

Trends and Outcomes of Transcatheter Valve Implantation in Patients With Prior Mediastinal Radiation.

Am J Cardiol 2021 03 14;143:167-168. Epub 2021 Jan 14.

Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, TX. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjcard.2021.01.003DOI Listing
March 2021

COVID-19 lockdown presented a chance to evaluate emergency referrals to paediatric neurosurgical unit: a prospective cohort study.

Childs Nerv Syst 2021 03 6;37(3):729-732. Epub 2021 Jan 6.

Paediatric Neurosurgery Department, Alder Hey Children's Hospital, Liverpool, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00381-020-04985-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787122PMC
March 2021

Dynamic Annular Modeling of the Unrepaired Complete Atrioventricular Canal Annulus.

Ann Thorac Surg 2020 Dec 23. Epub 2020 Dec 23.

Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address:

Background: Repair of complete atrioventricular canal (CAVC) is often complicated by atrioventricular valve regurgitation, particularly of the left-sided valve. Understanding the three-dimensional (3D) structure of the atrioventricular canal annulus prior to repair may help to inform optimized repair. However, the 3D shape and movement of the CAVC annulus has yet to be quantified nor has it been rigorously compared to a normal mitral valve annulus.

Methods: The complete annuli of 43 patients with CAVC were modeled in 4 cardiac phases using transthoracic 3D echocardiograms and custom code. The annular structure was compared to the annuli of 20 normal pediatric mitral valves using 3D metrics and statistical shape analysis (Procrustes analysis).

Results: The unrepaired CAVC annulus varied in shape significantly throughout the cardiac cycle. Procrustes analysis visually demonstrated that the average normalized CAVC annular shape is more planar than the normal mitral annulus. Quantitatively, the annular height to valve width ratio of the native left CAVC atrioventricular valve was significantly lower than that of a normal mitral valve in all systolic phases(p<0.001).

Conclusions: The left half of the CAVC annulus is more planar than that of a normal mitral valve with an annular height to valve width ratio similar to dysfunctional mitral valves. Given the known importance of annular shape to mitral valve function, further exploration of the association of 3D structure to valve function in CAVC is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2020.12.013DOI Listing
December 2020

Quality and microstructure of freeze-dried yoghurt fortified with additives as protective agents.

Heliyon 2020 Oct 9;6(10):e05196. Epub 2020 Oct 9.

Department of Dairy Science, Faculty of Agriculture, Benha University, Benha 13518, Egypt.

The effect of freeze drying of yoghurt and addition of some additives on the physico-chemical, microbiological, texture, microstructure, and sensory quality of yoghurt was studied. Freeze drying of yoghurt had light effects on the viability of and no effect on viability of subsp. and rehydrated yoghurt. Addition of modified starch had a considerable protection effect on during freeze drying process. Addition of whey protein concentrate produced different surface structures and caused porous and loos structure. The microstructure of the freeze-dried yoghurt fortified with spirulina powder showed a coarse and a compact less porous structure in comparison with the freeze-dried yoghurt samples fortified with whey protein concentrate. All Additives significantly decreased adhesiveness and significantly increased cohesiveness, springiness, gumminess, and chewiness in both fresh and rehydrated yoghurts.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.heliyon.2020.e05196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7560582PMC
October 2020

Administration of Nicotine Exacerbates the Quinine-induced Structural and Functional Alterations of Testicular Tissue in Adult Rats: An Experimental Study.

Urol J 2020 Jul 28;18(1):103-110. Epub 2020 Jul 28.

Department of Gastroenterology-Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands.

Purpose: In this study the role of nicotine (NCT) administration on the intensity of rat testicular tissue alterations induced by quinine (QU) was evaluated.

Materials And Methods: Forty adult Wistar rats were divided into four groups. Control (CON), NCT administrated (4 mg/kg) (NCT), QU treated (25 mg/kg for 7 days) (QU), and nicotine with quinine received (NCT+QU). After 28 days, serum testosterone and malondialdehyde (MDA) levels were measured. Testes and epididymides samples were prepared for determining tissue MDA levels, histomorphometry, microscopic indices of spermatogenesis, immunohistochemistry of p53 and sperm analysis.

Results: Testosterone levels were decreased significantly (P = .0004) in treated groups compared to CON group. Serum MDA levels were increased significantly (P = .0004) in NCT and QU groups compared to CON group. Tissue MDA levels were increased significantly (P = .0012) in NCT+QU group in comparison to CON group. These parameters were changed significantly in NCT+QU group compared to QU group. Seminiferous tubules diameter decreased significantly (P < .0001) in treated groups compared to CON group and in NCT+QU group compared to QU group. The height of germinal epithelium decreased significantly (P = .0001) in NCT and NCT+QU groups compared to CON and QU groups. The number of Sertoli cells, spermatocytes, and spermatids decreased significantly in treated groups compared to CON group. The number of spermatogonia decreased significantly (P = .0017) in NCT and NCT+QU groups compared to CON group. The number of Sertoli cells, spermatogonia, and spermatocytes decreased significantly in NCT+QU group compared to QU group. All indices of spermatogenesis decreased in treated groups compared to CON group. The lowest mean of these indices was observed in NCT+QU group. The sperm viability decreased significantly (P < .0001) in treated groups compared to CON group. Sperm count and motility decreased significantly in NCT and NCT+QU groups compared to CON group. All experimental groups showed the over-expression of p53 compared to CON group.

Conclusion: The administration of nicotine could be involved in the exacerbation of testicular tissue alterations related to quinine therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.22037/uj.v16i7.5884DOI Listing
July 2020

Intraoperative post-annuloplasty three-dimensional valve analysis does not predict recurrent ischemic mitral regurgitation.

J Cardiothorac Surg 2020 Jul 2;15(1):161. Epub 2020 Jul 2.

Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, PA, USA.

Background: High ischemic mitral regurgitation (IMR) recurrence rates continue to plague IMR repair with undersized ring annuloplasty. We have previously shown that pre-repair three-dimensional echocardiography (3DE) analysis is highly predictive of IMR recurrence. The objective of this study was to determine the quantitative change in 3DE annular and leaflet tethering parameters immediately after repair and to determine if intraoperative post-repair 3DE parameters would be able to predict IMR recurrence 6 months after repair.

Methods: Intraoperative pre- and post-repair transesophageal real-time 3DE was performed in 35 patients undergoing undersized ring annuloplasty for IMR. An advanced modeling algorhythm was used to assess 3D annular geometry and regional leaflet tethering. IMR recurrence (≥ grade 2) was assessed with transthoracic echocardiography 6 months after repair.

Results: Annuloplasty significantly reduced septolateral diameter, commissural width, annular area, and tethering volume and significantly increased all segmental tethering angles (except A2). Intraoperative post-repair annular geometry and leaflet tethering did not differ significantly between patients with recurrent IMR (n = 9) and patients with non-recurrent IMR (n = 26). No intraoperative post-repair predictors of IMR recurrence could be identified.

Conclusions: Undersized ring annuloplasty changes mitral geometry acutely, exacerbates leaflet tethering, and generally fixes IMR acutely, but it does not always fix the delicate underlying chronic problem of continued left ventricular dilatation and remodeling. This may explain why pre-repair 3D valve geometry (which reflects chronic left ventricular remodeling) is highly predictive of recurrent IMR, whereas immediate post-repair 3D valve geometry (which does not completely reflect chronic left ventricular remodeling anymore) is not.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13019-020-01138-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333337PMC
July 2020

A Case-Control Study: The Impact of Unintentional Discrepancies and Pharmacist Discharge Prescription Review on 30-Day Hospital Readmission.

J Prim Care Community Health 2020 Jan-Dec;11:2150132720932012

Winchester District Memorial Hospital (WDMH), Winchester, Ontario, Canada.

Medication discrepancies on hospital discharge are common and occur despite the use of technology to generate electronically created discharge (e-discharge) prescriptions, justifying pharmacist involvement. No published studies have focused on medication discrepancies as a risk factor for readmission. The aim was to explore the relationship between medication discrepancies on discharge and readmission rates, and how both are affected by pharmacist intervention. The primary objective was to establish the relationship between medication discrepancies on the e-discharge prescription and hospital readmissions within 30 days of discharge. Secondary objectives were to determine the 30-day readmission rate with and without pharmacist involvement, and risk factors for 30-day readmission. This was a matched case-control study where cases and controls consisted of patients readmitted and not readmitted to hospital within 30 days of discharge from the general medicine service, respectively. Case patients were defined as patients who had been readmitted to the hospital within 30 days of discharge from the general medicine unit. Control patients were defined as patients who had not been readmitted to the hospital within 30 days of discharge. Chi-square statistics was used to analyze the association between the presence of medication discrepancy at discharge and 30-day readmission. Multivariate logistic regression was used to further analyze the associations to determine which risk factors best relate to 30-day readmission. Between January 1, 2017 and December 31, 2017, a total of 401 e-discharge prescriptions were reviewed, and 194 cases were readmitted within 30 days of discharge. Similar proportions of patients were readmitted compared with not readmitted regardless of whether discrepancies were identified on the e-discharge prescriptions, and there was no relationship identified between medication discrepancies and readmission within 30 days (odds ratio [OR] = 1.04; = .854). The readmission rate with and without pharmacist involvement was similar between the case group (50%) and control group (48.0%). The proportion of discharge prescriptions with discrepancies was 48.8% in the group that had pharmacist involvement and 47.0% in the group that had no pharmacist involvement. Additionally, a LACE score of 12 or greater was identified as a statistically significant risk factor for readmission (OR = 2.13; < .001). Pharmacist review of the e-discharge prescription did not affect the readmission rate. A LACE score of 12 or greater was associated with a higher risk of readmission. Future studies are needed to identify patient groups at high risk of readmission and to determine pharmacist interventions that could reduce readmission rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2150132720932012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270941PMC
June 2020

[Paraspinous Sagittal Shift (PSSS): a novel approach for transmuscular quadratus lumborum block for hip surgery analgesia - four case reports].

Rev Bras Anestesiol 2020 Mar - Apr;70(2):178-183. Epub 2020 May 12.

Alexandria University, Faculty of Medicine, Department of Anesthesia and Surgical Intensive Care, Alexandria, Egypt.

Background: Effective pain management is essential for successful rehabilitation and enhanced recovery after joint arthroplasty. The Quadratus Lumborum Block (QLB) has mostly been described for abdominal surgery, but has also recently been applied to hip surgery patients.

Methods: In the following cases series, we suggest a modification of the TQL block described as Paraspinous Sagittal Shift QL block. We hypothesize that this approach may allow better LA spread to the lumbar nerve roots. Such technique involves a craniocaudal approach of LA injection between the QL and PM muscles behind the Anterior Thoracolumbar Fascia (ATLF) at the level of L4. Cases were provided with combined GA and PSSS modification of QL block via a single shot or catheter technique.

Results: Sensory distribution of the block in the four patients studied was found to cover the area between the T11-12 and L4-5 dermatomes. Spread of the injectate was confirmed via an A-P fluoroscopy imaging of the lumbosacral spine after injection of a mixture of LA and a contrast in the plane between the QL and PM muscles in two cases.

Conclusions: The PSSS technique for TQL block may be beneficial as a part of multimodal analgesia for hip surgeries. This technique may be a safe alternative to psoas compartment block; however, future comparative studies are recommended. The PSSS technique for TQL block also may provide an easy access for catheter insertion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjan.2020.01.003DOI Listing
May 2020

Diffeomorphic Medial Modeling.

Inf Process Med Imaging 2019 Jun 22;11492:208-220. Epub 2019 May 22.

Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.

Deformable shape modeling approaches that describe objects in terms of their geometry (e.g., [10]) yield rich geometrical features that can be useful for analyzing the shape of sheet-like biological structures, such as the myocardium. We present a novel shape analysis approach that combines the benefits of medial shape modeling and diffeomorphometry. Our algorithm is formulated as a problem of matching shapes using diffeomorphic flows under constraints that approximately preserve medial axis geometry during deformation. As the result, correspondence between the medial axes of similar shapes is maintained. The approach is evaluated in the context of modeling the shape of the left ventricular wall from 3D echocardiography images.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/978-3-030-20351-1_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222280PMC
June 2019

Synthesis and Antimicrobial Activity of Novel 1, 2, 4-Triazolopyrimidofuro- quinazolinones from Natural Furochromones (Visnagenone and Khellinone).

Med Chem 2020 Apr 6. Epub 2020 Apr 6.

Photochemistry Department (Heterocyclic Unit), National Research Center, 12622 Dokki, Giza. Egypt.

Background: Previous and recent scientific research has shown that triazolopyrimidine and furochromones have a wide range of pharmacological activities in the treatment of numerous diseases, including anticancer, antiviral, anti-depressant, antimicrobial, anti-inflammatory, and analgesic activities.

Objective: Preparation of new drugs used as antimicrobial activities derived from a natural furochromones as (1- hydrazinyl or methylthio),-furopyrimidoquinazolinone, 1, 2, 4-triazolopyrimidofuroquinazolin-5-one, and quinazolinepyrimidofuro- quinazoline-8, 10-dione and study of their biological activity as antimicrobial.

Method: A series of novel N'-furopyrimidoquinazoline-hydrazide; 1, 2, 4-triazolopyrimidofuroquinazolin-5-one; furopyrimidoquinazolin-3-one and quinazoline-pyrimidofuroquinazoline-8, 10-dione derivatives were synthesized from substituted (methylthio)-furopyrimidoquinazolinone (3a-b) and 1-hydrazinyl-furopyrimidoquinazolinone (4a-b) as the starting material.

Results: All compounds were synthesized in good yields (71-95%) in a gradually efficient system under the mild condition and some of the procedures were used a microwave oven. The new compounds have been confirmed by means of different spectroscopic ways such as IR, 1D and 2D -NMR techniques and mass spectrum. The in vitro to antimicrobial activities were evaluated for the prepared compounds using many types of bacteria (Gram positive and Gram negative) and fungi.

Conclusion: 1, 2, 4-triazolopyrimidofuroquinazolin-5-one derivatives (10a-f, 8a-b, 7a-b and 6a-d) showed the most efficient antimicrobial activities compared with the cefotaxime sodium and nystatin as standard drugs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1573406416666200406130047DOI Listing
April 2020

A Case of Fournier's Gangrene in a Patient Taking Canagliflozin for the Treatment of Type II Diabetes Mellitus.

Am J Case Rep 2020 Feb 24;21:e920115. Epub 2020 Feb 24.

Department of Clinical Pharmacy, Winchester District Memorial Hospital, Winchester, Ontario, Canada.

BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a class of antihyperglycemic medications associated with an increased risk of urinary and genital infections due to their glycosuric effects. In 2018, the FDA issued a safety alert warning that multiple cases of Fournier's Gangrene (FG), a severe genital infection, had been reported in patients taking SGLT2 inhibitors. CASE REPORT We present a case of 72-year-old male with type II diabetes mellitus who developed FG while taking the SGLT2 inhibitor canagliflozin. Besides diabetes and canagliflozin use, his other risk factors were his age, gender, and remote history of radiotherapy for prostate cancer. He presented to the Emergency Department (ED) multiple times complaining of rectal pain and was admitted for a possible diagnosis of prostatitis. During his stay, he developed leukocytosis, his pain worsened, and examination of the perianal area was consistent with FG. He was treated with multiple surgical debridement procedures and broad-spectrum antibiotics; the source of infection was determined to be a perianal abscess. He stayed in the hospital for 1 month and was discharged home with outpatient wound care and vacuum dressing changes. Canagliflozin was discontinued during the hospital stay. CONCLUSIONS Due to the possible association of FG with SGLT2 inhibitors, patients who present with signs and symptoms consistent with FG should be examined for possible FG and treated promptly.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12659/AJCR.920115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061930PMC
February 2020

Erector spinae versus paravertebral plane blocks in modified radical mastectomy: Randomised comparative study of the technique success rate among novice anaesthesiologists.

Indian J Anaesth 2020 Jan 7;64(1):49-54. Epub 2020 Jan 7.

Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt.

Background And Aims: Regional analgesia may play a role in pain management during breast surgery. Ultrasound approach to paravertebral block may be challenging. This study compared success rates of ultrasound-guided erector spinae plane block (ESPB) versus parasagittal in-plane thoracic paravertebral block among senior anaesthesia residents in modified radical mastectomy.

Methods: One hundred and two female patients undergoing modified radical mastectomy were randomly categorized into PARA group receiving sagittal in-plane paravertebral block and ESPB group receiving erector spinae plane block. The block in the 1 six cases in each group was done by an experienced consultant as a demonstration for three anaesthesia residents not experienced in either block. Primary endpoint was assessing success rate of the blocks. Secondary endpoint was the haemodynamic response to skin incision and postoperative analgesia.

Results: All patients were females undergoing modified radical mastectomy. Success rate among residents was 100% in ESPB versus 77.8% in PARA group ( = 0.002). Duration to perform the block was less in ESPB group (4.39 ± 1.2 min) than PARA group (8.18 ± 2.42 min) ( < 0.0001). Guidance frequency by consultants was significantly higher in PARA than ESPB group. Time to 1 analgesic requirement and morphine consumption postoperatively were insignificant between the groups. There was no significant difference regarding haemodynamics.

Conclusion: ESPB may be a simple and safe alternative to parasagittal in-plane paravertebral block to provide postoperative analgesia in modified radical mastectomy especially in novice practitioners. It provides equivalent profile of postoperative analgesia with less time to perform the block.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ija.IJA_536_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6967376PMC
January 2020

Synthetic DNA Vaccines Adjuvanted with pIL-33 Drive Liver-Localized T Cells and Provide Protection from Challenge in a Mouse Model.

Vaccines (Basel) 2020 Jan 10;8(1). Epub 2020 Jan 10.

Beykoz Institute of Life Sciences and Biotechnology, Bezmialem Vakif University, Istanbul 34820, Turkey.

The need for a malaria vaccine is indisputable. A single vaccine for pre-erythrocytic stages targeting the major sporozoite antigen circumsporozoite protein (CSP) has had partial success. Additionally, CD8+ T cells targeting liver-stage (LS) antigens induced by live attenuated sporozoite vaccines were associated with protection in human challenge experiments. To further evaluate protection mediated by LS antigens, we focused on exported pre-erythrocytic proteins (exported protein 1 (EXP1), profilin (PFN), exported protein 2 (EXP2), inhibitor of cysteine proteases (ICP), transmembrane protein 21 (TMP21), and upregulated in infective sporozoites-3 (UIS3)) expressed in all species and designed optimized, synthetic DNA (synDNA) immunogens. SynDNA antigen cocktails were tested with and without the molecular adjuvant plasmid IL-33. Immunized animals developed robust T cell responses including induction of antigen-specific liver-localized CD8+ T cells, which were enhanced by the co-delivery of plasmid IL-33. In total, 100% of mice in adjuvanted groups and 71%-88% in non-adjuvanted groups were protected from blood-stage disease following sporozoite challenge. This study supports the potential of synDNA LS antigens as vaccine components for malaria parasite infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/vaccines8010021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7157753PMC
January 2020

Non-iatrogenic spontaneous acute spinal subdural haematoma after transforaminal lumbar interbody fusion.

Br J Neurosurg 2020 Jan 10:1-3. Epub 2020 Jan 10.

The Centre for Spinal Studies and Surgery, Nottingham University Hospitals, Nottingham, UK.

Reporting a rare case of a non-iatrogenic spontaneously resolved spinal subdural haematoma (SSDH) following revision of transforaminal lumbar interbody fusion (TLIF) and its possible explanation. Case report of a 40-year-old man with a history of persistent lower back and left lower extremity radicular pain, secondary to recurrent disc prolapse, lumbar spondylosis with foraminal stenosis. He underwent an L5/S1 transforaminal interbody fusion a right sided approach (through previous lumbar microdiscectomy incision). On post-operative day two, the patient developed headache and photophobia that were discovered to be secondary to an acute thoracolumbar subdural haematoma with no objective neurological deficit. After close observation of his neurological status and conservative management of the subdural haematoma, the patient fully recovered from his symptoms and remained problem-free at 2-year follow-up. Although the occurrence of acute spinal subdural haematoma after spinal surgery is a rare complication following spinal surgery, its appropriate management relies on early recognition if significant morbidity is to be avoided.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02688697.2019.1710823DOI Listing
January 2020

Highly Sensitive and Rapid Characterization of the Development of Synchronized Blood Stage Malaria Parasites Via Magneto-Optical Hemozoin Quantification.

Biomolecules 2019 10 7;9(10). Epub 2019 Oct 7.

Beykoz Institute of Life Sciences and Biotechnology, Bezmialem Vakif University, Istanbul 34093, Turkey.

The rotating-crystal magneto-optical diagnostic (RMOD) technique was developed as a sensitive and rapid platform for malaria diagnosis. Herein, we report a detailed in vivo assessment of the synchronized lentum strain blood-stage infections by the RMOD method and comparing the results to the unsynchronized 17X-NL (non-lethal) infections. Furthermore, we assess the hemozoin production and clearance dynamics in chloroquine-treated compared to untreated self-resolving infections by RMOD. The findings of the study suggest that the RMOD signal is directly proportional to the hemozoin content and closely follows the actual parasitemia level. The lack of long-term accumulation of hemozoin in peripheral blood implies a dynamic equilibrium between the hemozoin production rate of the parasites and the immune system's clearing mechanism. Using parasites with synchronous blood stage cycle, which resemble human malaria parasite infections with and , we are demonstrating that the RMOD detects both hemozoin production and clearance rates with high sensitivity and temporal resolution. Thus, RMOD technique offers a quantitative tool to follow the maturation of the malaria parasites even on sub-cycle timescales.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/biom9100579DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843464PMC
October 2019

Semi-automated Image Segmentation of the Midsystolic Left Ventricular Mitral Valve Complex in Ischemic Mitral Regurgitation.

Stat Atlases Comput Models Heart 2019 14;11395:142-151. Epub 2019 Feb 14.

Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Ischemic mitral regurgitation (IMR) is primarily a left ventricular disease in which the mitral valve is dysfunctional due to ventricular remodeling after myocardial infarction. Current automated methods have focused on analyzing the mitral valve and left ventricle independently. While these methods have allowed for valuable insights into mechanisms of IMR, they do not fully integrate pathological features of the left ventricle and mitral valve. Thus, there is an unmet need to develop an automated segmentation algorithm for the left ventricular mitral valve complex, in order to allow for a more comprehensive study of this disease. The objective of this study is to generate and evaluate segmentations of the left ventricular mitral valve complex in pre-operative 3D transesophageal echocardiography using multi-atlas label fusion. These patient-specific segmentations could enable future statistical shape analysis for clinical outcome prediction and surgical risk stratification. In this study, we demonstrate a preliminary segmentation pipeline that achieves an average Dice coefficient of 0.78 0.06.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/978-3-030-12029-0_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6774645PMC
February 2019

Impact of Chronic Thrombocytopenia on Outcomes After Transcatheter Valvular Intervention and Cardiac Devices Implantation (From a National Inpatient Sample).

Am J Cardiol 2019 11 22;124(10):1601-1607. Epub 2019 Aug 22.

Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan.

To evaluate the impact of chronic thrombocytopenia (cTCP) on outcomes of transcatheter valvular procedures such as aortic valve implantation (TAVI), MitraClip, permanent pacemaker (PPM), implantable-cardioverter defibrillator (ICD), cardiac resynchronization therapy (CRT), left atrial appendage closure, and pericardiocentesis. Impact of cTCP on clinical outcomes following TAVI, Mitraclip, PPM, ICD, CRT, left atrial appendage closure, and pericardiocentesis procedures is not well described. Utilizing the National Inpatient Sample and (ICD-9-CM) procedural codes, we evaluated patients (age ≥18 years) who underwent these procedures, from January 1, 2009 to December 31, 2014, with or without cTCP as a chronic condition variable indicator. Propensity score matching model implemented to derive 2 matched groups. Propensity score matching created 47,292 and 47,351 hospitalizations matched pairs with and without cTCP, respectively. Patients with cTCP were older (mean age, 74.27 vs 72.26 years; absolute standardized differences [ASD] = 15.6) and less likely to be female (36.76% vs 43.74%, ASD = -14.31). They experienced higher in-hospital mortality (3.0% vs 2.0%; odds ratio [OR], 1.53; 95% confidence interval [CI], 1.27 to 1.83) and higher odds of vascular injury requiring surgery (2.63% vs 1.10%; OR, 2.43; 95% CI, 1.93 to 3.05). Postoperative hematoma and bleeding were 2-fold higher (4.57% vs 2.24%; OR, 2.08; 95% CI, 1.77 to 2.45) and 3-fold higher (6.34% vs 2.45%; OR, 2.69; 95% CI, 2.31 to 3.13) respectively among cTCP patients. They had greater health-care cost ($47,163 vs $35,763, p <0.0001) and longer hospital stay (mean 9.26 days vs 6.84 days, p <0.0001). In conclusion, cTCP patients had higher risk of complications after TAVI, MitraClip, PPM, ICD, CRT, left atrial appendage closure, and pericardiocentesis, including a 1.5-fold increased risk of in-hospital mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjcard.2019.08.012DOI Listing
November 2019

Phenotypic Analysis of Rodent Malaria Parasite Asexual and Sexual Blood Stages and Mosquito Stages.

J Vis Exp 2019 05 30(147). Epub 2019 May 30.

School of Public Health and Tropical Medicine, Department of Tropical Medicine, Tulane University.

Recent advances in genetics and systems biology technologies have promoted our understanding of the biology of malaria parasites on the molecular level. However, effective malaria parasite targets for vaccine and chemotherapy development are still limited. This is largely due to the unavailability of relevant and practical in vivo infection models for human Plasmodium species, most notably for P. falciparum and P. vivax. Therefore, rodent malaria species have been extensively used as practical alternative in vivo models for malaria vaccine, drug targeting, immune response, and functional characterization studies of conserved Plasmodiumspp. genes. Indeed, rodent malaria models have proven to be invaluable, especially for exploring mosquito transmission and liver stage biology, and were indispensable for immunological studies. However, there are discrepancies in the methods used to evaluate the phenotypes of transgenic and wild-type asexual and sexual blood-stage parasites. Examples of these discrepancies are the choice of an intravenous vs. intraperitoneal infection of rodents with blood-stage parasites and the evaluation of male gamete exflagellation. Herein, we detail standardized experimental methods to evaluate the phenotypes of asexual and sexual blood stages in transgenic parasites expressing reporter-gene or wild-type rodent malaria parasite species. We also detail the methods to evaluate the phenotypes of malaria parasite mosquito stages (gametes, ookinetes, oocysts, and sporozoites) inside Anopheles mosquito vectors. These methods are detailed and simplified here for the lethal and non-lethal strains of P. berghei and P. yoelii but can also be applied with some adjustments to P. chabaudi and P. vinckei rodent malaria species.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3791/55688DOI Listing
May 2019

The impact of power plant emission variability and fuel switching on the air quality of Kuwait.

Sci Total Environ 2019 Jul 31;672:593-603. Epub 2019 Mar 31.

Center for Energy and Environmental Resources, The University of Texas at Austin, 10100 Burnet Road, Building 133, M.S. R7100, Austin, TX 78758, United States.

Power plant emissions have a significant impact on air quality, and a frequent assumption made in estimating impacts is to assume annual or monthly average emission rates. This study investigates the impact, on predicted ambient concentrations, of assuming annual average emissions, compared to resolving emissions on an hourly basis (base case). A case study of emissions from power plants in Kuwait, for the year 2014, is presented. In Kuwait, power plants operate on a mix of natural gas, gas oil, crude oil, and heavy fuel oil, and the type of fuel used varies on an hourly basis. Because of this fuel variability, a fuel switching strategy was also simulated in this work, replacing high sulfur fuels with natural gas during hours with high predicted SO concentrations. Emissions estimates were combined with an air quality dispersion model to simulate the temporal variability and spatial dispersion of sulfur dioxide (SO) and nitrogen dioxide (NO) in Kuwait, for a one-year episode. The results indicate that emission averaging and fuel switching operations result in lower area-wide annual maximum SO concentrations compared to the base case (1747 μg/m, 1063 μg/m, 616 μg/m for base case, annual average emissions and fuel switching scenarios, respectively). The number of receptor sites recording daily exceedances of the SO standard for annual average emissions were one seventh of those predicted for hourly averaged emissions and 92% lower for the fuel switching scenario. For NO, while the overall number of exceedances of air quality criteria was much lower than for SO, the numbers of exceedances were also predicted to be lower using annual averaged emissions compared to the base case. These results document the importance of using emission estimates that capture hourly variability over annually averaged emissions, particularly in locations such as Kuwait where multiple fuels are used in power production.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.scitotenv.2019.03.441DOI Listing
July 2019

Dynamic Three-Dimensional Geometry of the Tricuspid Valve Annulus in Hypoplastic Left Heart Syndrome with a Fontan Circulation.

J Am Soc Echocardiogr 2019 05 28;32(5):655-666.e13. Epub 2019 Feb 28.

Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address:

Background: Tricuspid regurgitation (TR) is a significant contributor to morbidity and mortality in patients with hypoplastic left heart syndrome. The goal of this study was to characterize the dynamic annular motion of the tricuspid valve in patients with HLHS with a Fontan circulation and assess the relation to tricuspid valve function.

Methods: Tricuspid annuli of 48 patients with HLHS with a Fontan circulation were modeled at end-diastole, mid-systole, end-systole, and mid-diastole using transthoracic three-dimensional echocardiography and custom code in 3D Slicer. The angle of the anterior papillary muscle (APM) relative to the annular plane in each systolic phase was also measured.

Results: Imaging was performed 5.0 years (interquartile range, 2-11 years) after Fontan operation. The tricuspid annulus varies in shape significantly throughout the cardiac cycle, changing in sphericity (P < .001) but not in annular height or bending angle. In univariate modeling, patients with significant TR had larger changes in septolateral diameter, lateral quadrant area, and posterior quadrant area (P < .05 for all) as well as lower (more laterally directed) APM angles (P < .001) than patients with mild or less TR. In multivariate modeling, a 1 mm/(body surface area) increase in the maximum change in septolateral diameter was associated with a 1.7-fold increase in having moderate or greater TR, while a 10° decrease in APM angle at mid-systole was associated with an almost 2.5-fold increase in moderate or greater TR (P ≤ .01 for all).

Conclusions: The tricuspid annulus in patients with HLHS with a Fontan circulation changes in shape significantly throughout the cardiac cycle but remains relatively planar. Increased change in septolateral diameter and decreased APM angle are strongly associated with the presence of TR. These findings may inform annuloplasty methods and subvalvular interventions in these complex patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.echo.2019.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502661PMC
May 2019

Dynamic Three-Dimensional Geometry of the Tricuspid Valve Annulus in Hypoplastic Left Heart Syndrome with a Fontan Circulation.

J Am Soc Echocardiogr 2019 05 28;32(5):655-666.e13. Epub 2019 Feb 28.

Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address:

Background: Tricuspid regurgitation (TR) is a significant contributor to morbidity and mortality in patients with hypoplastic left heart syndrome. The goal of this study was to characterize the dynamic annular motion of the tricuspid valve in patients with HLHS with a Fontan circulation and assess the relation to tricuspid valve function.

Methods: Tricuspid annuli of 48 patients with HLHS with a Fontan circulation were modeled at end-diastole, mid-systole, end-systole, and mid-diastole using transthoracic three-dimensional echocardiography and custom code in 3D Slicer. The angle of the anterior papillary muscle (APM) relative to the annular plane in each systolic phase was also measured.

Results: Imaging was performed 5.0 years (interquartile range, 2-11 years) after Fontan operation. The tricuspid annulus varies in shape significantly throughout the cardiac cycle, changing in sphericity (P < .001) but not in annular height or bending angle. In univariate modeling, patients with significant TR had larger changes in septolateral diameter, lateral quadrant area, and posterior quadrant area (P < .05 for all) as well as lower (more laterally directed) APM angles (P < .001) than patients with mild or less TR. In multivariate modeling, a 1 mm/(body surface area) increase in the maximum change in septolateral diameter was associated with a 1.7-fold increase in having moderate or greater TR, while a 10° decrease in APM angle at mid-systole was associated with an almost 2.5-fold increase in moderate or greater TR (P ≤ .01 for all).

Conclusions: The tricuspid annulus in patients with HLHS with a Fontan circulation changes in shape significantly throughout the cardiac cycle but remains relatively planar. Increased change in septolateral diameter and decreased APM angle are strongly associated with the presence of TR. These findings may inform annuloplasty methods and subvalvular interventions in these complex patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.echo.2019.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502661PMC
May 2019