Background: Apoptosis is a physiological programmed cell death necessary for   development and cellular homeostasis. Dysregulation of apoptosis pathways leads to a number of diseases such as cancer, autoimmune and immunodeficiency diseases, and neuro-degenerative disorders.  

Patients and methods: The current study included 56 patients (29 males and 27 females), undergoing corrective heart surgery operations, categorized into 3 groups: group A included 23 patients with atrial septal defect (ASD); group B included 15 patients with ventricular septal defect (VSD); and group C included 15 patients with fallot tetralogy. Biochemical assays of apoptotic (P53  and caspase 3) and antiapoptotic markers (Bcl-2) using  colorimetric and ELISA assay kits were performed to all included patients twice, preoperative and 24 hours postoperative.

 Results: No statistical significant difference was found in the preoperative levels of Bcl-2, Caspase-3 and P53 between the three groups. While significant difference was found when comparing the preoperative and postoperative levels of the previous markers in the same group and between groups (p˂0.05 for all).

Conclusion: Both apoptotic and antiapoptotic pathways are activated during congenital heart corrective surgeries. Degree of markers increase is directly related to duration of anesthesia exposure.

Background: Cardiac surgeries induce many inflammatory responses with remarkable clinical implications. Tryptophan (Trp) is a precursor for serotonin, melatonin and kynurenine (Kyn). Plasma kynurenic acid (Kyna) and Kyn concentrations are thought to be related to the severity of inflammation. Plasma Trp/Kyn ratio is used to measure inflammatory cytokine activity.Methods: We performed the current longitudinal study in a tertiary care center and included 62 patients divided into two groups; group A (on-pump CABG patients) and group B (off-pump CABG patients). Plasma Trp and Kyn were measured using the high-performance liquid chromatography (HPLC) technique. Serum interlukin-6 (IL-6) and white blood cells (WBCs) were measured using ELISA and routine blood count, respectively.Results: The present study revealed that the intraoperative levels of plasma Kyn, IL-6 and WBCs were significantly increased while the plasma Trp/Kyn ratio was significantly decreased in both the groups; however, the changes were more significant in the on-pump CABG group. Moreover, the levels in both the groups returned to preoperative levels 72 h postoperative. Our study has shown that WBCs is positively correlated with IL-6, but has negative correlation with Trp/Kyn ratio.Conclusions: Kyn and Trp/Kyn ratio might be utilized as markers of the severity of inflammation in major surgery. In addition, off-pump CABG might be more preferable than on-pump CABG regarding stress and release of inflammatory markers.

Background: A cyclic relationship exists, between; arginine, citrulline, and ornithine. Arginase is a specific enzyme that plays a role in this relationship. These basic amino acids have a role in the induction of nitric oxide (NO) and as anti-inflammatory and antioxidant. This study aimed to elucidate the role of surgical injuries and anesthesia on plasma levels of the above-mentioned amino acids and NO and to determine whether the changes in these levels can be correlated to the duration of surgery and anesthesia exposure.
Materials and Methods: The study included: group A (41 patients) who underwent coronary bypasses and group B (17 patients) who underwent lung cancer surgery. An amino acid analyzer was used for the detection of amino acids, while NO was estimated by a Spectrophotometric method.
Results: The study revealed a significant decrease in the intra-operative levels of arginine, citrulline, ornithine, and NO compared to their pre-operative levels in both groups.
Conclusion: Depletion of these basic amino acids is possibly multifunctional and can be associated with an increase in arginase, surgical trauma, anesthesia, and stress.