This study was conducted with the purpose of analyzing the effects of hemodialysis on voice characteristics of patients with chronic renal failure. Design: A total of 66 patients were participated in the study, including 26 males and 40 females ranging in age from 19 to 68 years. Patients underwent evaluation of their voice directly before and after hemodialysis using computerized speech lab (CSL) (4300, Kay Elemetrics Corp.) and Aerophone II Model 6800 Kay Elemetrics Corp. The vocal acoustic parameters studied include average pitch, jitter, shimmer and noise-to-harmonic ratio. The aerodynamic parameters include vital capacity, maximum phonation time, phonation quotient, mean flow rate, sub glottic pressure and glottal efficiency. The data were analyzed using the paired t-test for the total sample, the male and female subgroups and also for the patient underwent ultrafiltration with hemodialysis. Results: In the total sample and in the female subgroup, there is a significant difference in phonation quotient after hemodialysis. The male subgroup showed no significant differences in all acoustic and aerodynamic parameters after hemodialysis. The group with positive ultrafiltration showed significant differences in both vital capacity and phonation quotient after hemodialysis. Conclusion: There was no effect of hemodialysis on acoustic characteristics of voice; however, there was a decrease in vital capacity and phonation quotient after hemodialysis especially with ultrafiltration.Recommendation: Further studies that include auditory perceptual assessment of voice and stroboscopic examination of the vocal folds may help in detecting subtle changes that may occur after hemodialysis.

Background: Patients with end stage renal failure (ESRF) have an increased risk of premature cardiovascular disease which is a leading cause of death. Circulating biomarkers play a major role in the early detection of cardiovascular disease in those patients. N-terminal-pro-BNP is a cardiac biomarker which is frequently elevated in patients with CKD. However, because NT-pro BNP clearance may depend on renal function, the significance of an elevated level in patients with chronic kidney disease (CKD) without cardiac symptoms is uncertain. The use of myocardial perfusion imaging (MPI) for patients with renal disease may be useful for diagnosing CAD and providing powerful information about the risk of future cardiac events. This study aimed to explore the prevalence of different cardiac events in CKD patients according to the grade of kidney damage , to explore the degree of elevation of N-terminal-pro-BNP in asymptomatic cardiac patients with varying degree of CKD; to clarify the relationship between the elevation of this biomarker and the occurrence of cardiac events in CKD patients and to study the usefulness of MPI by Single photon computed tomography (SPECT) as a diagnostic a diagnostic tool for cardiac events in patients with varying degree of CKD regardless hemodialysis. Subjects and methods: This case –control observational retrospective study was conducted on 40 CRF patients with varying degree of CKD, 13 –85 years old (mean age 47±17.3 years), recruited from the renal and dialysis unit, department of Internal Medicine, Assuit University Hospitals, Egypt from 2009-2010.In addition to 40 age and sex matched healthy persons as a control group .The patients were classified into two groups: 20 non-dialysis CRF patients on conservative treatment and 20 patients on hemodialysis. All are subjected to thorough history taking, full clinical examination, and anthropometric measurements. We measured serum levels of CRP and N-terminal-pro-BNP in all subjects. MPI by SPECT was done in some selected cases. Results: NT-pro BNP levels were elevated in all patients with significant higher levels in ESRD patients on HD. Whereas, the levels of NT-pro BNP were more significantly elevated with Hypertension, Anemia, Hypoalbuminemia, advanced LVH and LV dysfunction , their levels were not significantly elevated with gender ,advanced age and increased BMI. In CKD patients with varying degree, highly significant positive correlations between NT-pro BNP levels and LV mass and LV mass index were found; however, there was a highly significant negative correlation between their levels and systolic function tested by TTE. CRP levels were elevated in all studied patients with significant higher levels in ESRD patients on HD. perfusion defects have been seen in majority of CKD patients. Half of them showed a moderate degree hypoperfusion while one-fourth of cases had severer pattern. Multiple vessel affection was a characteristic feature. Significantly higher NT-pro BNP levels were seen in patients had moderate and severe degrees of hypoperfusion. A highly significant negative correlation between systolic function (EF) evaluated by MPI and NT-pro BNP levels. Majority of Patients with grade II-III CKD under SPECT had mild to moderate degrees of hypoperfusion with good systolic function and a characteristic two vessel affection. However, half of Patients with grade IV-V CKD under SPECT had a severe degree of hypoperfusion with an impaired systolic function .Two and multi-vessel affections are characteristic in Patients with grade IV-V CKD in equal percent. Nevertheless, there was a significant positive correlation between EF evaluated by MPI and TTE. Conclusion: In essence, MPI SPECT provides effective risk stratification across the entire spectrum of renal function in CKD patients. Moderate to severe degrees of hypoperfusion with multiple vessel affections were characteristic patterns especially in CKD patients on dialysis. N-terminal-pro-BNP level elevation in asymptomatic patients with CKD reflects underlying ischemic heart disease and hypertrophy independent of renal function in a population with anticipated high cardiac morbidity. Thus, N-terminal-pro-BNP can be a good parameter for predicting the severity of coronary vessels involvement and in evaluating cardiac risk in patients with ESRD especially those on HD besides other diagnostic tools. Severer degrees of hypoperfusion were associated with Higher NT-pro BNP levels. Moreover, there wa highly significant negative correlation between systolic function evaluated by MPI and NT-pro BNP levels.

Background: Patients with end stage renal failure (ESRF) have an increased risk of premature cardiovascular disease which is a leading cause of death. Circulating biomarkers play a major role in the early detection of cardiovascular disease in those patients. N-terminal-pro-BNP is a cardiac biomarker which is frequently elevated in patients with CKD. However, because NT-pro BNP clearance may depend on renal function, the significance of an elevated level in patients with chronic kidney disease (CKD) without cardiac symptoms is uncertain. The use of myocardial perfusion imaging (MPI) for patients with renal disease may be useful for diagnosing CAD and providing powerful information about the risk of future cardiac events. This study aimed to explore the prevalence of different cardiac events in CKD patients according to the grade of kidney damage , to explore the degree of elevation of N-terminal-pro-BNP in asymptomatic cardiac patients with varying degree of CKD; to clarify the relationship between the elevation of this biomarker and the occurrence of cardiac events in CKD patients and to study the usefulness of MPI by Single photon computed tomography (SPECT) as a diagnostic a diagnostic tool for cardiac events in patients with varying degree of CKD regardless hemodialysis. Subjects and methods: This case –control observational retrospective study was conducted on 40 CRF patients with varying degree of CKD, 13 –85 years old (mean age 47±17.3 years), recruited from the renal and dialysis unit, department of Internal Medicine, Assuit University Hospitals, Egypt from 2009-2010.In addition to 40 age and sex matched healthy persons as a control group .The patients were classified into two groups: 20 non-dialysis CRF patients on conservative treatment and 20 patients on hemodialysis. All are subjected to thorough history taking, full clinical examination, and anthropometric measurements. We measured serum levels of CRP and N-terminal-pro-BNP in all subjects. MPI by SPECT was done in some selected cases. Results: NT-pro BNP levels were elevated in all patients with significant higher levels in ESRD patients on HD. Whereas, the levels of NT-pro BNP were more significantly elevated with Hypertension, Anemia, Hypoalbuminemia, advanced LVH and LV dysfunction , their levels were not significantly elevated with gender ,advanced age and increased BMI. In CKD patients with varying degree, highly significant positive correlations between NT-pro BNP levels and LV mass and LV mass index were found; however, there was a highly significant negative correlation between their levels and systolic function tested by TTE. CRP levels were elevated in all studied patients with significant higher levels in ESRD patients on HD. perfusion defects have been seen in majority of CKD patients. Half of them showed a moderate degree hypoperfusion while one-fourth of cases had severer pattern. Multiple vessel affection was a characteristic feature. Significantly higher NT-pro BNP levels were seen in patients had moderate and severe degrees of hypoperfusion. A highly significant negative correlation between systolic function (EF) evaluated by MPI and NT-pro BNP levels. Majority of Patients with grade II-III CKD under SPECT had mild to moderate degrees of hypoperfusion with good systolic function and a characteristic two vessel affection. However, half of Patients with grade IV-V CKD under SPECT had a severe degree of hypoperfusion with an impaired systolic function .Two and multi-vessel affections are characteristic in Patients with grade IV-V CKD in equal percent. Nevertheless, there was a significant positive correlation between EF evaluated by MPI and TTE. Conclusion: In essence, MPI SPECT provides effective risk stratification across the entire spectrum of renal function in CKD patients. Moderate to severe degrees of hypoperfusion with multiple vessel affections were characteristic patterns especially in CKD patients on dialysis. N-terminal-pro-BNP level elevation in asymptomatic patients with CKD reflects underlying ischemic heart disease and hypertrophy independent of renal function in a population with anticipated high cardiac morbidity. Thus, N-terminal-pro-BNP can be a good parameter for predicting the severity of coronary vessels involvement and in evaluating cardiac risk in patients with ESRD especially those on HD besides other diagnostic tools. Severer degrees of hypoperfusion were associated with Higher NT-pro BNP levels. Moreover, there wa highly significant negative correlation between systolic function evaluated by MPI and NT-pro BNP levels.

Background: Patients with end stage renal failure (ESRF) have an increased risk of premature cardiovascular disease which is a leading cause of death. Circulating biomarkers play a major role in the early detection of cardiovascular disease in those patients. N-terminal-pro-BNP is a cardiac biomarker which is frequently elevated in patients with CKD. However, because NT-pro BNP clearance may depend on renal function, the significance of an elevated level in patients with chronic kidney disease (CKD) without cardiac symptoms is uncertain. The use of myocardial perfusion imaging (MPI) for patients with renal disease may be useful for diagnosing CAD and providing powerful information about the risk of future cardiac events. This study aimed to explore the prevalence of different cardiac events in CKD patients according to the grade of kidney damage , to explore the degree of elevation of N-terminal-pro-BNP in asymptomatic cardiac patients with varying degree of CKD; to clarify the relationship between the elevation of this biomarker and the occurrence of cardiac events in CKD patients and to study the usefulness of MPI by Single photon computed tomography (SPECT) as a diagnostic a diagnostic tool for cardiac events in patients with varying degree of CKD regardless hemodialysis. Subjects and methods: This case –control observational retrospective study was conducted on 40 CRF patients with varying degree of CKD, 13 –85 years old (mean age 47±17.3 years), recruited from the renal and dialysis unit, department of Internal Medicine, Assuit University Hospitals, Egypt from 2009-2010.In addition to 40 age and sex matched healthy persons as a control group .The patients were classified into two groups: 20 non-dialysis CRF patients on conservative treatment and 20 patients on hemodialysis. All are subjected to thorough history taking, full clinical examination, and anthropometric measurements. We measured serum levels of CRP and N-terminal-pro-BNP in all subjects. MPI by SPECT was done in some selected cases. Results: NT-pro BNP levels were elevated in all patients with significant higher levels in ESRD patients on HD. Whereas, the levels of NT-pro BNP were more significantly elevated with Hypertension, Anemia, Hypoalbuminemia, advanced LVH and LV dysfunction , their levels were not significantly elevated with gender ,advanced age and increased BMI. In CKD patients with varying degree, highly significant positive correlations between NT-pro BNP levels and LV mass and LV mass index were found; however, there was a highly significant negative correlation between their levels and systolic function tested by TTE. CRP levels were elevated in all studied patients with significant higher levels in ESRD patients on HD. perfusion defects have been seen in majority of CKD patients. Half of them showed a moderate degree hypoperfusion while one-fourth of cases had severer pattern. Multiple vessel affection was a characteristic feature. Significantly higher NT-pro BNP levels were seen in patients had moderate and severe degrees of hypoperfusion. A highly significant negative correlation between systolic function (EF) evaluated by MPI and NT-pro BNP levels. Majority of Patients with grade II-III CKD under SPECT had mild to moderate degrees of hypoperfusion with good systolic function and a characteristic two vessel affection. However, half of Patients with grade IV-V CKD under SPECT had a severe degree of hypoperfusion with an impaired systolic function .Two and multi-vessel affections are characteristic in Patients with grade IV-V CKD in equal percent. Nevertheless, there was a significant positive correlation between EF evaluated by MPI and TTE. Conclusion: In essence, MPI SPECT provides effective risk stratification across the entire spectrum of renal function in CKD patients. Moderate to severe degrees of hypoperfusion with multiple vessel affections were characteristic patterns especially in CKD patients on dialysis. N-terminal-pro-BNP level elevation in asymptomatic patients with CKD reflects underlying ischemic heart disease and hypertrophy independent of renal function in a population with anticipated high cardiac morbidity. Thus, N-terminal-pro-BNP can be a good parameter for predicting the severity of coronary vessels involvement and in evaluating cardiac risk in patients with ESRD especially those on HD besides other diagnostic tools. Severer degrees of hypoperfusion were associated with Higher NT-pro BNP levels. Moreover, there wa highly significant negative correlation between systolic function evaluated by MPI and NT-pro BNP levels.

Background: While prevalence of Hepatitis B virus (HBV) in patients with end-stage renal failure (ESRF) who are undergoing dialysis has decreased significantly during the past few decades, it still remains a distinct clinical problem. The immunosuppressive nature of renal disease often leads to chronicity of the HBV infection and an opportunity for nosocomial spread of the infection among dialysis patients. Egypt is among the countries with intermediate endemicity of HBsAg (range, 2%–7%). Large-scale geographic heterogeneity in HBV prevalence has been reported worldwide and HBV prevalence is especially heterogeneous in Egypt. Objectives: To assess the prevalence of occult HBV infection (OBI) in hemodialysis patients with or without chronic hepatitis C (HCV) from Minia and Assuit, Upper Egypt, using HBV DNA assays. Patient and Methods: Sera from 145 hemodialysis patients with negative HbsAg were investigated for HBV DNA using real-time polymerase chain reaction (RT-PCR). Only serum samples with repeatedly detectable HBV DNA were considered positive. Patients were divided into 2 groups: HCV RNA positive and HCV RNA negative, based on the results of a third generation enzyme linked immunosorbent assay (ELISA) anti-HCV test and HCV RNA PCR. Results: HBV DNA was detected in 6 of the 145 patients (4.1%) and HBcAb was detected in 29/145 patients (20%). There were no statistically significant differences in the age, duration of hemodialysis, biochemical parameters, serological markers of HBV, or HBV DNA between patients with and without HCV infection. Conclusions: Four percent of the hemodialysis patients had OBI. There was no significant difference in the prevalence of OBI between hemodialysis patients with or without HCV co-infection.

Introduction: Dilated cardiomyopathy (DCM) is characterized by ventricular dilatation and impaired systolic cardiac function. Anesthetic management, of patients with cardiomyopathy with reduced systolic function, is challenging and may be associated with high mortality. Objective: The purpose of this study was to evaluate the hemodynamic effects of combined spinal epidural anesthesia (CSEA) in patients with dilated cardiomyopathy, underwent vascular surgery in the lower half of the body, in addition to assess the safety of this anesthetic technique in the early postoperative period. Method: After approval by local research ethics committee of the Faculty of Medicine, and informed written consent obtained from all patients, 24 patients having dilated cardiomyopathy, subjected to vascular surgery in the lower half of the body under CSEA. The effects of CSEA on hemodynamics; IBP, HR and CVP (measured at base line and then every 10 min), in addition to cardiac complications during the hospital stay period were studied. Results: patients had significant decrease in MAP in all readings after the base line one with maximal decrease at 70 min (-14.7%), while HR increased significantly in all readings after the base line one except the last reading with maximal increase at 50 min (13.1 %). CVP showed insignificant changes in all readings except at 90 & 100 min which showed significant increase (p 0.05). Four patients developed ECG changes in the postoperative period, while no significant changes in EF. Conclusion: combined spinal epidural anesthesia (CSEA) may be an alternative to general anesthesia in patients with dilated cardiomyopathy undergoing vascular surgery in the lower half of the body, as our patients had a largely un eventful postoperative recovery with good pain control.

Introduction: Dilated cardiomyopathy (DCM) is characterized by ventricular dilatation and impaired systolic cardiac function. Anesthetic management, of patients with cardiomyopathy with reduced systolic function, is challenging and may be associated with high mortality. Objective: The purpose of this study was to evaluate the hemodynamic effects of combined spinal epidural anesthesia (CSEA) in patients with dilated cardiomyopathy, underwent vascular surgery in the lower half of the body, in addition to assess the safety of this anesthetic technique in the early postoperative period. Method: After approval by local research ethics committee of the Faculty of Medicine, and informed written consent obtained from all patients, 24 patients having dilated cardiomyopathy, subjected to vascular surgery in the lower half of the body under CSEA. The effects of CSEA on hemodynamics; IBP, HR and CVP (measured at base line and then every 10 min), in addition to cardiac complications during the hospital stay period were studied. Results: patients had significant decrease in MAP in all readings after the base line one with maximal decrease at 70 min (-14.7%), while HR increased significantly in all readings after the base line one except the last reading with maximal increase at 50 min (13.1 %). CVP showed insignificant changes in all readings except at 90 & 100 min which showed significant increase (p 0.05). Four patients developed ECG changes in the postoperative period, while no significant changes in EF. Conclusion: combined spinal epidural anesthesia (CSEA) may be an alternative to general anesthesia in patients with dilated cardiomyopathy undergoing vascular surgery in the lower half of the body, as our patients had a largely un eventful postoperative recovery with good pain control.

Introduction: Dilated cardiomyopathy (DCM) is characterized by ventricular dilatation and impaired systolic cardiac function. Anesthetic management, of patients with cardiomyopathy with reduced systolic function, is challenging and may be associated with high mortality. Objective: The purpose of this study was to evaluate the hemodynamic effects of combined spinal epidural anesthesia (CSEA) in patients with dilated cardiomyopathy, underwent vascular surgery in the lower half of the body, in addition to assess the safety of this anesthetic technique in the early postoperative period. Method: After approval by local research ethics committee of the Faculty of Medicine, and informed written consent obtained from all patients, 24 patients having dilated cardiomyopathy, subjected to vascular surgery in the lower half of the body under CSEA. The effects of CSEA on hemodynamics; IBP, HR and CVP (measured at base line and then every 10 min), in addition to cardiac complications during the hospital stay period were studied. Results: patients had significant decrease in MAP in all readings after the base line one with maximal decrease at 70 min (-14.7%), while HR increased significantly in all readings after the base line one except the last reading with maximal increase at 50 min (13.1 %). CVP showed insignificant changes in all readings except at 90 & 100 min which showed significant increase (p 0.05). Four patients developed ECG changes in the postoperative period, while no significant changes in EF. Conclusion: combined spinal epidural anesthesia (CSEA) may be an alternative to general anesthesia in patients with dilated cardiomyopathy undergoing vascular surgery in the lower half of the body, as our patients had a largely un eventful postoperative recovery with good pain control.