Background: Atherosclerosis is modulated by inflammation and oxidative stress, which play pivotal roles in the pathogenesis of coronary artery disease (CAD), especially in young patients without traditional risk factors for atherosclerosis. In this study, we aimed to study the role of some inflammatory and oxidative stress markers in triggering ST segment elevation myocardial infarction in Egyptian young patients and the potential correlation to the severity of coronary artery lesions in the Egyptian population.
Methods: This case-control study recruited 115 premature STEMI patients (aged <45 years) and 55 age-matched healthy controls. Serum CRP, TNF-a, IL-10, and oxidative stress biomarkers [reduced glutathione, total antioxidants, L-ascorbic acid, nitric oxide (NO), and lipid peroxides] were assayed using commercially available kits and correlated with the coronary artery lesion severity, assessed by the SYNTAX score (SS). The ROC curve assessed the biomarker potential of CRP, TNF-a, IL-10, and the TNF-a/IL-10 ratio to discriminate patients from healthy controls.
Results: In our study, we found that serum CRP (38.7 ± 1.9 versus 0.8 ± 0.04 mg/L; P < 0.001), TNF-a (68.4 ± 4.7 pg/mL versus 10.8 ± 0.7 pg/mL; P < 0.001), IL-10 (11.9 ± 0.8 pg/mL versus 8.7 ± 0.4 pg/mL; P = 0.001), and TNF-a/IL-10 ratio (6.8 ± 0.5 versus 1.7 ± 0.2; P < 0.001) were significantly higher in patients compared to healthy controls. Regarding oxidative stress markers, serum T-AOC levels (25.5 ± 0.9 versus 14.9 ± 0.4 U/mL; P < 0.001), NO (10.5 ± 0.3 versus 8.1 ± 0.3 nmol/mL; P < 0.001), serum LPO levels (15.8 ± 0.4 versus 4.1 ±0.2 mmol/L; P < 0.001) and lower GSH levels (3.8 ± 0.1 mg/mL versus 5.2 ± 0.2; P < 0.001) were significantly different in patients versus controls. CRP, TNF-a, and NO levels have been significantly correlated with the severity of CAD as assessed by the SYNTAX score.
Conclusion: Inflammation and oxidative stress are pathogenically implicated in premature STEMI and correlated with the severity of CAD lesions. The investigated biomarkers can be utilized in risk stratification and are theranostically targetable.
Peritalar dislocation is treated first by a trial of closed reduction. If closed reduction fails, no further attempts should be done because soft-tissue entrapment is the cause of irreducibility. 4 Urgent intervention is mandatory to prevent skin necrosis that is caused by pressure of the dislocated talar head. After reduction, the joint usually is stable because of the fitting of the shape of the articular surfaces. Presence of instability after reduction indicates severe soft-tissue and ligamentous injury that needs repair and secured immobilization by cast or external fixator.
The incidence of Slipped capital femoral epiphysis (SCFE) after management of femoral neck fracture in pediatrics is very rare. In this case report, a nine-year-old female child sustained left sided femur neck fracture after a motor car accident. The fracture was fixed by two cannulated screws and healing with mild varus occurred after six weeks. However, progressive slippage of femoral epiphysis was observed. This was treated by subtrochanteric valgus osteotomy and fixed by tension band and Wagner technique. Better radiological and functional outcomes were obtained at the short term follow up.
Osteogenesis imperfecta (OI) patients usually sustain repeated fractures from trivial trauma and also have skeletal deformities that affect walking. The bone fragility and repeated fractures produce deformities of the long bones especially in femur and tibia. However, neck of femur (NOF) fractures in OI are rarely described.
A 11-year-old male patient known to have OI (Sillence type IV) sustained a NOF fracture after a fall. He also had proximal femoral anterolateral bowing proximally and over an intramedullary (IM) rod inserted 4 years back. He was treated by corrective osteotomy and stabilisation with an IM telescoping nail for the deformed femur and the Wagner technique for the NOF fracture. One year after operation, the patient had recovered satisfactory functional outcome with union of the NOF fracture and correction of the femoral deformity.
The method of the Wagner technique can achieve stable fixation for femoral neck fractures and introduces the least interference with concurrent telescoping nail insertion.
Developmental dysplasia of the hip (DDH) is one of the most common hip anomalies encountered in pediatric patients. Stabilization of the femoral head into the acetabulum is crucial for normal hip joint development. When surgical intervention is decided, open reduction is needed to remove any obstacle that hinders hip reduction. Capsulorraphy is an essential step for minimizing instability of the hip after reduction. The classic T-shaped capsular incision is done by two incisions: vertical limb parallel to femoral neck axis and a transverse one parallel to the inguinal ligament 5 mm distally to proximal capsular attachment. The cumbersomeness of this technique was noticed in suturing of the resulted two flabs from this incision. So, the suggested U-shaped incision makes suturing of the capsule easier with multiple stitches.
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