Pre-infarction angina (PIA) has been suggested to have a protective role in ST elevation myocardial infarction (STEMI), limiting necrosis extent and guaranteeing greater myocardial functional recovery. Objectives: To study the differences in angiographic and echocardiographic findings, between STEMI patients with and without PIA undergoing primary percutaneous coronary intervention (PPCI) and to assess the in-hospital and mid-term (6-months) clinical outcomes between both patients groups. Material and Methods: We prospectively enrolled 238 consecutive patients with first acute myocardial infarction. Patients were divided into 2 groups; those with or without PIA. Left ventricular ejection fraction (LVEF), LV systolic and diastolic volumes, Wall motion score index and degree of mitral regurgitation (MR) were measured by echocardiography on admission and after 90 days. Coronary angiography was assessed regarding; number of diseased vessels, the culprit artery, TIMI flow pre and post procedure, TIMI frame count, collateral circulation and thrombus grading. Major adverse cardiac events (MACE) were reported in-hospital and up to 6 months follow-up. Results: Of the 238 patients included, 42 (17%) had PIA and 196 (83%) had no PIA. No significant difference was encountered regarding baseline LV volumes, LVEF and WMSI assessed be echocardiography in both groups (PIA Vs non PIA groups: EDV 85.5±17 Vs 90.8±27 ml/m 2, p = 0.2, ESV 44.3±13 Vs 45.6±16 ml/m 2, p = 0.6, EF 48.6±9% Vs 46.4±8 , P = 0.1, WMSI 1.35±0.22 Vs 1.35±0.18, p = 0.9, respectively). However, at 90 days echocardiographic follow-up, significant increase in LV volumes and further impairment of LV systolic function was noticed in non PIA group (PIA Vs non PIA groups: EDV 81.8±27 Vs 103±49 ml/m 2, p = 0.008, ESV 42.1±16 Vs 49.7±22 ml/m 2, p = 0.04, EF 50±15% Vs 43.6±17% , P = 0.02 respectively) ) with significant improvement of WMSI among patients with PIA (1.13±0.35 in PIA group Vs 1.31±0.5 in non PIA group, p = 0.03). Angiographically, baseline TIMI flow was significantly better among PIA group (p 0.0001), while final TIMI flow and TIMI frame count were not significantly different (p = 0.2 for both), Nevertheless, TIMI frame count tended to be significantly better in PIA among patients presenting by anterior STEMI (p = 0.09). PIA group was associated with lower grades of thrombus burden than non PIA group (p = 0.002) and better collateral circulation (p = 0.001). During follow up, mortality, TLR,TVR were more but not significantly different in non PIA( p = 0.5, 0.5 and 0.9 respectively), but there was a significant increase in develepment of heart failure in non PIA group ( 2 (4%) patients in PIA Vs 43 (22%) patients in non PIA group, p = 0.02) Conclusion: PIA seems to be associated with smaller infarct size, better regional and global left ventricular function recovery, better angiographic findings and less incidence of heart failure.

Pre-infarction angina (PIA) has been suggested to have a protective role in ST elevation myocardial infarction (STEMI), limiting necrosis extent and guaranteeing greater myocardial functional recovery. Objectives: To study the differences in angiographic and echocardiographic findings, between STEMI patients with and without PIA undergoing primary percutaneous coronary intervention (PPCI) and to assess the in-hospital and mid-term (6-months) clinical outcomes between both patients groups. Material and Methods: We prospectively enrolled 238 consecutive patients with first acute myocardial infarction. Patients were divided into 2 groups; those with or without PIA. Left ventricular ejection fraction (LVEF), LV systolic and diastolic volumes, Wall motion score index and degree of mitral regurgitation (MR) were measured by echocardiography on admission and after 90 days. Coronary angiography was assessed regarding; number of diseased vessels, the culprit artery, TIMI flow pre and post procedure, TIMI frame count, collateral circulation and thrombus grading. Major adverse cardiac events (MACE) were reported in-hospital and up to 6 months follow-up. Results: Of the 238 patients included, 42 (17%) had PIA and 196 (83%) had no PIA. No significant difference was encountered regarding baseline LV volumes, LVEF and WMSI assessed be echocardiography in both groups (PIA Vs non PIA groups: EDV 85.5±17 Vs 90.8±27 ml/m 2, p = 0.2, ESV 44.3±13 Vs 45.6±16 ml/m 2, p = 0.6, EF 48.6±9% Vs 46.4±8 , P = 0.1, WMSI 1.35±0.22 Vs 1.35±0.18, p = 0.9, respectively). However, at 90 days echocardiographic follow-up, significant increase in LV volumes and further impairment of LV systolic function was noticed in non PIA group (PIA Vs non PIA groups: EDV 81.8±27 Vs 103±49 ml/m 2, p = 0.008, ESV 42.1±16 Vs 49.7±22 ml/m 2, p = 0.04, EF 50±15% Vs 43.6±17% , P = 0.02 respectively) ) with significant improvement of WMSI among patients with PIA (1.13±0.35 in PIA group Vs 1.31±0.5 in non PIA group, p = 0.03). Angiographically, baseline TIMI flow was significantly better among PIA group (p 0.0001), while final TIMI flow and TIMI frame count were not significantly different (p = 0.2 for both), Nevertheless, TIMI frame count tended to be significantly better in PIA among patients presenting by anterior STEMI (p = 0.09). PIA group was associated with lower grades of thrombus burden than non PIA group (p = 0.002) and better collateral circulation (p = 0.001). During follow up, mortality, TLR,TVR were more but not significantly different in non PIA( p = 0.5, 0.5 and 0.9 respectively), but there was a significant increase in develepment of heart failure in non PIA group ( 2 (4%) patients in PIA Vs 43 (22%) patients in non PIA group, p = 0.02) Conclusion: PIA seems to be associated with smaller infarct size, better regional and global left ventricular function recovery, better angiographic findings and less incidence of heart failure.

Background: Arthritic hip in children is a sequel of many hip disorders either being congenital, developmental or traumatic. Several surgical options are present for management. A lot of debate is present for hip arthrodesis vs arthroplasty. Both aim at eliminating pain. Patients and Methods: Prospective follow up of 17 patients (15 males and 2 females) 14 - 19 years old with arthritic hip. underwent hip fusion using either Cobra or locked anatomical distal femur plate. Hip was fused in 20-30° flexions with neither rotation nor abduction-adduction. Average at age surgery was 16.5 years. All patients were prevented from weight bearing on affected side for 1.5 months post operatively. Patients were evaluated postoperatively by serial x-rays immediate post-operative, 1.5 months, 3 months, 6 months and 12 months for the first-year then every 6 months starting from second year. Harris Hip Score is used for evaluating pain and hip function preoperative and post-operative at 3 months and 6 months post-operative. Results: The average follow-up was 1.5 years. 88.2 %showed union of hip fusion at 1.5 months while 11.8 % showed delayed union at 2.5 months post-operative. Only one case showed aseptic loosening of the screws at 9 months post-operative and metal removal performed. 76.5% of the cases showed increase in Harris Hip score by24-32. Two cases raised by40 points while remaining 2 cases got15 points improvements. Conclusion: Hip arthrodesis is still a good salvage surgical treatment for different conditions of arthritic hip in children for eliminating pain. It can be converted into Total hip replacement (THR) in late adulthood for possible avoidance of serial replacement revision surgeries due to wear process.

Introduction; Upper limb bony defects is yet a debatable dilemma. Limb shortening, amputation, biological reconstruction and prothetic replacement are all options. Patients and Methods; Between 2-2003 and 1-2015, 45 cases with bone defects of the upper limb were reconstructed by free VFG at H&ULRM unit, Assiut University. Defects were > 6 cm, following trauma or tumour resection. Minimum FU was 12 months. Tumour group, 24 patients. (14 males, 10 females). Average age 19.8 years (5 to 35). The tumor involved humerus, (18), radius, (6). Post-traumatic group, 21 patients, 16 males and 5 females. The average age was 33 years (3 to 64). The average defect was 10 cm (6 to 14.5). The humerus in 7 patients, the humerus & the proximal radius and ulna in 2 patients, the humerus & the proximal ulna in 1 patient, the radius alone in 11 patients and distal radial epiphysis, carpals, and ulnar 4 metacarpals in 1 patient. Results; The graft union in group-I (tumour) was 83.3% after the primary procedure and 16.7% after a secondary procedure. In group-II (post-traumatic) was 95.2% after the primary procedure and 4.8% after a secondary procedure.The overall incidence of hypertrophy was 22.2% (10 out of 45 patients in both groups).. Conclusion; Biological reconstruction of upper limb bony defects (exceeding 6 cm), using VFG is considered a successful reconstructive way with good long lasting results.

Type-1 diabetes mellitus is a chronic autoimmune disorder in which genetic and epigenetic factors contributed equally to its pathogenesis. Histone deacetylase (HDAC) inhibitors such as Sodium butyrate (NaB) had been reported to protect beta-cell damages and improve the glucose homeostasis by the modulation of p38/ ERK MAPK pathway. The aim of this work is to evaluate the role of NaB on ultrastructure of pancreatic beta- cells and PI3/Akt pathway. 30 juvenile male albino rats (5-6 weeks) were divided into 6 groups: Group I: Untreated control .Group II: NaB control, received 500 mg/kg/day NaB i.p. for 3 weeks. Group III: 3 days diabetic control received STZ (60 mg/kg) i.p. Group IV: 3 weeks diabetic control received STZ (60 mg/kg) i.p .Group V: pre-treatment with NaB for 3 weeks prior to diabetes induction .Group VI: post-treatment with NaB for 3 weeks after diabetes induction. Plasma glucose, insulin levels, glucose tolerance were evaluated. Light, electron microscopy and immunohistochemistry was performed using ki67, caspase 3, insulin and acetylated histone H3.NaB treatment resulted in a significant improvement in plasma glucose level, plasma insulin level / expression and ameliorated the diabetes-induced histological alternations. Decrease in number of apoptotic cells had been demonstrated. Additionally, it inhibited the HDAC activity and increased the acetylation of histone H3 and expression of phosphorylated Akt. Conclusion: These findings provide evidence that NaB might be useful for the treatment of juvenile diabetes.

Type-1 diabetes mellitus is a chronic autoimmune disorder in which genetic and epigenetic factors contributed equally to its pathogenesis. Histone deacetylase (HDAC) inhibitors such as Sodium butyrate (NaB) had been reported to protect beta-cell damages and improve the glucose homeostasis by the modulation of p38/ ERK MAPK pathway. The aim of this work is to evaluate the role of NaB on ultrastructure of pancreatic beta- cells and PI3/Akt pathway. 30 juvenile male albino rats (5-6 weeks) were divided into 6 groups: Group I: Untreated control .Group II: NaB control, received 500 mg/kg/day NaB i.p. for 3 weeks. Group III: 3 days diabetic control received STZ (60 mg/kg) i.p. Group IV: 3 weeks diabetic control received STZ (60 mg/kg) i.p .Group V: pre-treatment with NaB for 3 weeks prior to diabetes induction .Group VI: post-treatment with NaB for 3 weeks after diabetes induction. Plasma glucose, insulin levels, glucose tolerance were evaluated. Light, electron microscopy and immunohistochemistry was performed using ki67, caspase 3, insulin and acetylated histone H3.NaB treatment resulted in a significant improvement in plasma glucose level, plasma insulin level / expression and ameliorated the diabetes-induced histological alternations. Decrease in number of apoptotic cells had been demonstrated. Additionally, it inhibited the HDAC activity and increased the acetylation of histone H3 and expression of phosphorylated Akt. Conclusion: These findings provide evidence that NaB might be useful for the treatment of juvenile diabetes.

Type-1 diabetes mellitus is a chronic autoimmune disorder in which genetic and epigenetic factors contributed equally to its pathogenesis. Histone deacetylase (HDAC) inhibitors such as Sodium butyrate (NaB) had been reported to protect beta-cell damages and improve the glucose homeostasis by the modulation of p38/ ERK MAPK pathway. The aim of this work is to evaluate the role of NaB on ultrastructure of pancreatic beta- cells and PI3/Akt pathway. 30 juvenile male albino rats (5-6 weeks) were divided into 6 groups: Group I: Untreated control .Group II: NaB control, received 500 mg/kg/day NaB i.p. for 3 weeks. Group III: 3 days diabetic control received STZ (60 mg/kg) i.p. Group IV: 3 weeks diabetic control received STZ (60 mg/kg) i.p .Group V: pre-treatment with NaB for 3 weeks prior to diabetes induction .Group VI: post-treatment with NaB for 3 weeks after diabetes induction. Plasma glucose, insulin levels, glucose tolerance were evaluated. Light, electron microscopy and immunohistochemistry was performed using ki67, caspase 3, insulin and acetylated histone H3.NaB treatment resulted in a significant improvement in plasma glucose level, plasma insulin level / expression and ameliorated the diabetes-induced histological alternations. Decrease in number of apoptotic cells had been demonstrated. Additionally, it inhibited the HDAC activity and increased the acetylation of histone H3 and expression of phosphorylated Akt. Conclusion: These findings provide evidence that NaB might be useful for the treatment of juvenile diabetes.

Type-1 diabetes mellitus is a chronic autoimmune disorder in which genetic and epigenetic factors contributed equally to its pathogenesis. Histone deacetylase (HDAC) inhibitors such as Sodium butyrate (NaB) had been reported to protect beta-cell damages and improve the glucose homeostasis by the modulation of p38/ ERK MAPK pathway. The aim of this work is to evaluate the role of NaB on ultrastructure of pancreatic beta- cells and PI3/Akt pathway. 30 juvenile male albino rats (5-6 weeks) were divided into 6 groups: Group I: Untreated control .Group II: NaB control, received 500 mg/kg/day NaB i.p. for 3 weeks. Group III: 3 days diabetic control received STZ (60 mg/kg) i.p. Group IV: 3 weeks diabetic control received STZ (60 mg/kg) i.p .Group V: pre-treatment with NaB for 3 weeks prior to diabetes induction .Group VI: post-treatment with NaB for 3 weeks after diabetes induction. Plasma glucose, insulin levels, glucose tolerance were evaluated. Light, electron microscopy and immunohistochemistry was performed using ki67, caspase 3, insulin and acetylated histone H3.NaB treatment resulted in a significant improvement in plasma glucose level, plasma insulin level / expression and ameliorated the diabetes-induced histological alternations. Decrease in number of apoptotic cells had been demonstrated. Additionally, it inhibited the HDAC activity and increased the acetylation of histone H3 and expression of phosphorylated Akt. Conclusion: These findings provide evidence that NaB might be useful for the treatment of juvenile diabetes.

Type-1 diabetes mellitus is a chronic autoimmune disorder in which genetic and epigenetic factors contributed equally to its pathogenesis. Histone deacetylase (HDAC) inhibitors such as Sodium butyrate (NaB) had been reported to protect beta-cell damages and improve the glucose homeostasis by the modulation of p38/ ERK MAPK pathway. The aim of this work is to evaluate the role of NaB on ultrastructure of pancreatic beta- cells and PI3/Akt pathway. 30 juvenile male albino rats (5-6 weeks) were divided into 6 groups: Group I: Untreated control .Group II: NaB control, received 500 mg/kg/day NaB i.p. for 3 weeks. Group III: 3 days diabetic control received STZ (60 mg/kg) i.p. Group IV: 3 weeks diabetic control received STZ (60 mg/kg) i.p .Group V: pre-treatment with NaB for 3 weeks prior to diabetes induction .Group VI: post-treatment with NaB for 3 weeks after diabetes induction. Plasma glucose, insulin levels, glucose tolerance were evaluated. Light, electron microscopy and immunohistochemistry was performed using ki67, caspase 3, insulin and acetylated histone H3.NaB treatment resulted in a significant improvement in plasma glucose level, plasma insulin level / expression and ameliorated the diabetes-induced histological alternations. Decrease in number of apoptotic cells had been demonstrated. Additionally, it inhibited the HDAC activity and increased the acetylation of histone H3 and expression of phosphorylated Akt. Conclusion: These findings provide evidence that NaB might be useful for the treatment of juvenile diabetes.

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