Abstract: Objectives: The purpose of the study is to evaluate whether NLR adds additional information about presence and severity of coronary artery disease in patients referred for coronary angiography for various reasons.Background: White blood cell count is known to be an independent predictor of cardiovascular events and all-cause mortality [ ].The neutrophil-to-lymphocyte ratio (NLR) has been proposed as a prognostic marker and seemed to be related to a pro-inflammatory state imposing worse clinical outcomes in patients with cardiovascular disease [ ].Patients and methods: This prospective cohort study included 101 patients who were referred to Assiut University Hospital for coronary angiography for various reasons including chronic stable angina, unstable angina, and myocardial infarction. NLR is calculated by taking the absolute neutrophil count and dividing it by the absolute lymphocyte count. Coronary artery disease (CAD) severity was determined by an interventional cardiologist unaware of the study aims. The association between NLR and CAD severity was assessed by logistic regression.Results: Our patients divided into 3 groups according to the value of NLR (2, 2-3, and >3). NLR was independently associated with CAD severity and contributed significantly to the regression models. Patients with NLR >3 had more advanced obstructive CAD (OR = 3.56, CI 95% 1.76-3.42, p = 0.001). They were further divided according to the severity of coronary artery stenosis into three categories, i.e. 0-30%, 30-70% and more than 70% (groups 1-3). NLR increase as the severity of coronary artery stenosis increases, the mean NLR was 2.37+1.27 (p=0.007) and in patients who had severe lesions the mean neutrophil count was 2.55+0.98 (p=0.008).Conclusion: NLR is a simple marker which can be derived from a routine complete blood count test was significantly and independently related to presence and severity of coronary atherosclerosis.

Abstract: Objectives: The purpose of the study is to evaluate whether NLR adds additional information about presence and severity of coronary artery disease in patients referred for coronary angiography for various reasons.Background: White blood cell count is known to be an independent predictor of cardiovascular events and all-cause mortality [ ].The neutrophil-to-lymphocyte ratio (NLR) has been proposed as a prognostic marker and seemed to be related to a pro-inflammatory state imposing worse clinical outcomes in patients with cardiovascular disease [ ].Patients and methods: This prospective cohort study included 101 patients who were referred to Assiut University Hospital for coronary angiography for various reasons including chronic stable angina, unstable angina, and myocardial infarction. NLR is calculated by taking the absolute neutrophil count and dividing it by the absolute lymphocyte count. Coronary artery disease (CAD) severity was determined by an interventional cardiologist unaware of the study aims. The association between NLR and CAD severity was assessed by logistic regression.Results: Our patients divided into 3 groups according to the value of NLR (2, 2-3, and >3). NLR was independently associated with CAD severity and contributed significantly to the regression models. Patients with NLR >3 had more advanced obstructive CAD (OR = 3.56, CI 95% 1.76-3.42, p = 0.001). They were further divided according to the severity of coronary artery stenosis into three categories, i.e. 0-30%, 30-70% and more than 70% (groups 1-3). NLR increase as the severity of coronary artery stenosis increases, the mean NLR was 2.37+1.27 (p=0.007) and in patients who had severe lesions the mean neutrophil count was 2.55+0.98 (p=0.008).Conclusion: NLR is a simple marker which can be derived from a routine complete blood count test was significantly and independently related to presence and severity of coronary atherosclerosis.

Abstract: Objectives: The purpose of the study is to evaluate whether NLR adds additional information about presence and severity of coronary artery disease in patients referred for coronary angiography for various reasons.Background: White blood cell count is known to be an independent predictor of cardiovascular events and all-cause mortality [ ].The neutrophil-to-lymphocyte ratio (NLR) has been proposed as a prognostic marker and seemed to be related to a pro-inflammatory state imposing worse clinical outcomes in patients with cardiovascular disease [ ].Patients and methods: This prospective cohort study included 101 patients who were referred to Assiut University Hospital for coronary angiography for various reasons including chronic stable angina, unstable angina, and myocardial infarction. NLR is calculated by taking the absolute neutrophil count and dividing it by the absolute lymphocyte count. Coronary artery disease (CAD) severity was determined by an interventional cardiologist unaware of the study aims. The association between NLR and CAD severity was assessed by logistic regression.Results: Our patients divided into 3 groups according to the value of NLR (2, 2-3, and >3). NLR was independently associated with CAD severity and contributed significantly to the regression models. Patients with NLR >3 had more advanced obstructive CAD (OR = 3.56, CI 95% 1.76-3.42, p = 0.001). They were further divided according to the severity of coronary artery stenosis into three categories, i.e. 0-30%, 30-70% and more than 70% (groups 1-3). NLR increase as the severity of coronary artery stenosis increases, the mean NLR was 2.37+1.27 (p=0.007) and in patients who had severe lesions the mean neutrophil count was 2.55+0.98 (p=0.008).Conclusion: NLR is a simple marker which can be derived from a routine complete blood count test was significantly and independently related to presence and severity of coronary atherosclerosis.

Background: Primary PCI (PPCI) with noreflow (NR) has been previously associated with worse outcomes. Objectives: We aimed to identify the prevalence of NR in patients with ST elevation myocardial infarction (STEMI) undergoing PPCI in the current era and its predictors with short term outcome. Methods: This prospective study enrolled 310 consecutive STEMI patients underwent PPCI. Patients were divided into 2 groups: patients with normal flow and others with NR whose (final TIMI flow 3 in the absence of coronary dissection or spasm) compared for demographic, procedural characteristics, ST resolution and short term outcomes. Results: 293 patients were finally included. NR was observed in 91 (31.06%) patients. The occurrence of NR was associated with higher mortality (25.3% vs. 3%, P=0.003) compared to patients with normal flow. Multivariate logistic regression analysis showed that high thrombus burden (thrombus grade ≥4), reference luminal diameter ≥3 mm, symptoms to first medical contact time ≥4h, anterior infarctions and syntax score ≥19 were independent predictors of NR. Using thrombus aspiration was found to be protective against NR only in patients with high thrombus burden which was associated with mortality reduction. Conclusion: In the contemporary era of PPCI, NR is more likely to occur in patients with high thrombus burden presenting late and is still associated with marked increases in adverse outcomes. Thrombus aspiration can prevent NR in patients with high thrombus burden.

Background: Primary PCI (PPCI) with noreflow (NR) has been previously associated with worse outcomes. Objectives: We aimed to identify the prevalence of NR in patients with ST elevation myocardial infarction (STEMI) undergoing PPCI in the current era and its predictors with short term outcome. Methods: This prospective study enrolled 310 consecutive STEMI patients underwent PPCI. Patients were divided into 2 groups: patients with normal flow and others with NR whose (final TIMI flow <3 in the absence of coronary dissection or spasm) compared for demographic, procedural characteristics, ST resolution and short term outcomes. Results: 293 patients were finally included. NR was observed in 91 (31.06%) patients. The occurrence of NR was associated with higher mortality (25.3% vs. 3%, P=0.003) compared to patients with normal flow. Multivariate logistic regression analysis showed that high thrombus burden (thrombus grade ≥4), reference luminal diameter ≥3 mm, symptoms to first medical contact time ≥4h, anterior infarctions and syntax score ≥19 were independent predictors of NR. Using thrombus aspiration was found to be protective against NR only in patients with high thrombus burden which was associated with mortality reduction. Conclusion: In the contemporary era of PPCI, NR is more likely to occur in patients with high thrombus burden presenting late and is still associated with marked increases in adverse outcomes. Thrombus aspiration can prevent NR in patients with high thrombus burden.

Background: Primary PCI (PPCI) with noreflow (NR) has been previously associated with worse outcomes. Objectives: We aimed to identify the prevalence of NR in patients with ST elevation myocardial infarction (STEMI) undergoing PPCI in the current era and its predictors with short term outcome. Methods: This prospective study enrolled 310 consecutive STEMI patients underwent PPCI. Patients were divided into 2 groups: patients with normal flow and others with NR whose (final TIMI flow 3 in the absence of coronary dissection or spasm) compared for demographic, procedural characteristics, ST resolution and short term outcomes. Results: 293 patients were finally included. NR was observed in 91 (31.06%) patients. The occurrence of NR was associated with higher mortality (25.3% vs. 3%, P=0.003) compared to patients with normal flow. Multivariate logistic regression analysis showed that high thrombus burden (thrombus grade ≥4), reference luminal diameter ≥3 mm, symptoms to first medical contact time ≥4h, anterior infarctions and syntax score ≥19 were independent predictors of NR. Using thrombus aspiration was found to be protective against NR only in patients with high thrombus burden which was associated with mortality reduction. Conclusion: In the contemporary era of PPCI, NR is more likely to occur in patients with high thrombus burden presenting late and is still associated with marked increases in adverse outcomes. Thrombus aspiration can prevent NR in patients with high thrombus burden.

Background: Primary PCI (PPCI) with noreflow (NR) has been previously associated with worse outcomes. Objectives: We aimed to identify the prevalence of NR in patients with ST elevation myocardial infarction (STEMI) undergoing PPCI in the current era and its predictors with short term outcome. Methods: This prospective study enrolled 310 consecutive STEMI patients underwent PPCI. Patients were divided into 2 groups: patients with normal flow and others with NR whose (final TIMI flow 3 in the absence of coronary dissection or spasm) compared for demographic, procedural characteristics, ST resolution and short term outcomes. Results: 293 patients were finally included. NR was observed in 91 (31.06%) patients. The occurrence of NR was associated with higher mortality (25.3% vs. 3%, P=0.003) compared to patients with normal flow. Multivariate logistic regression analysis showed that high thrombus burden (thrombus grade ≥4), reference luminal diameter ≥3 mm, symptoms to first medical contact time ≥4h, anterior infarctions and syntax score ≥19 were independent predictors of NR. Using thrombus aspiration was found to be protective against NR only in patients with high thrombus burden which was associated with mortality reduction. Conclusion: In the contemporary era of PPCI, NR is more likely to occur in patients with high thrombus burden presenting late and is still associated with marked increases in adverse outcomes. Thrombus aspiration can prevent NR in patients with high thrombus burden.

Background: The inflammatory basis of diabetes mellitus directed the researchers’ attention to the immune system for better management and prevention of complications. Metoclopramide (MCA; the only US Food and Drug Administration-approved for gastroparesis) has the ability to restore immune function through increasing prolactin secretion. This study aimed to test the effect of BSA/MCA nanoparticles (NPs) on modulating immune response. Methods: BSA/MCA NPs were fabricated by desolvation and evaluated in vitro via measuring loading efficiency, particle size, and surface charge. The selected formula was further evaluated via differential scanning calorimetry and release behavior. Then, NPs were injected into rats (25 mg MCA/kg/week) for 3 weeks to be evaluated histopathologically and immunologically via measuring proinflammatory cytokines, such as IL1β, IL6, and TNFα, in addition to measuring regulatory T-cell frequency. Results: MCA was successfully loaded on BSA, achieving high encapsulation efficiency reaching 63±2%, particles size of 120–130 nm with good polydispersity, and a negative surface charge indicating that entire positively charged drug was encapsulated inside NPs. Differential scanning calorimetry thermography of selected NPs showed an obvious interaction between components and cross-linking of BSA molecules using glutaraldehyde, resulting in sustained release of MCA (around 50% within 3 days). MCA NPs significantly restored the immune response via decreasing proinflammatory cytokines and increasing regulatory T-cell frequency when compared to control and free MCA (drug not loaded in NPs)-treated groups. Histopathological examination of this MCA NPs-treated group did not show the characteristic lesions of diabetes, and apoptosis nearly disappeared. Conclusion: BSA/MCA NPs could be considered a new modality for treatment of gastroparesis, in addition to management of diabetes itself and preventing its complications via an MCA-immunomodulatory effect.

Background: The inflammatory basis of diabetes mellitus directed the researchers’ attention to the immune system for better management and prevention of complications. Metoclopramide (MCA; the only US Food and Drug Administration-approved for gastroparesis) has the ability to restore immune function through increasing prolactin secretion. This study aimed to test the effect of BSA/MCA nanoparticles (NPs) on modulating immune response. Methods: BSA/MCA NPs were fabricated by desolvation and evaluated in vitro via measuring loading efficiency, particle size, and surface charge. The selected formula was further evaluated via differential scanning calorimetry and release behavior. Then, NPs were injected into rats (25 mg MCA/kg/week) for 3 weeks to be evaluated histopathologically and immunologically via measuring proinflammatory cytokines, such as IL1β, IL6, and TNFα, in addition to measuring regulatory T-cell frequency. Results: MCA was successfully loaded on BSA, achieving high encapsulation efficiency reaching 63±2%, particles size of 120–130 nm with good polydispersity, and a negative surface charge indicating that entire positively charged drug was encapsulated inside NPs. Differential scanning calorimetry thermography of selected NPs showed an obvious interaction between components and cross-linking of BSA molecules using glutaraldehyde, resulting in sustained release of MCA (around 50% within 3 days). MCA NPs significantly restored the immune response via decreasing proinflammatory cytokines and increasing regulatory T-cell frequency when compared to control and free MCA (drug not loaded in NPs)-treated groups. Histopathological examination of this MCA NPs-treated group did not show the characteristic lesions of diabetes, and apoptosis nearly disappeared. Conclusion: BSA/MCA NPs could be considered a new modality for treatment of gastroparesis, in addition to management of diabetes itself and preventing its complications via an MCA-immunomodulatory effect.

Background: The inflammatory basis of diabetes mellitus directed the researchers’ attention to the immune system for better management and prevention of complications. Metoclopramide (MCA; the only US Food and Drug Administration-approved for gastroparesis) has the ability to restore immune function through increasing prolactin secretion. This study aimed to test the effect of BSA/MCA nanoparticles (NPs) on modulating immune response. Methods: BSA/MCA NPs were fabricated by desolvation and evaluated in vitro via measuring loading efficiency, particle size, and surface charge. The selected formula was further evaluated via differential scanning calorimetry and release behavior. Then, NPs were injected into rats (25 mg MCA/kg/week) for 3 weeks to be evaluated histopathologically and immunologically via measuring proinflammatory cytokines, such as IL1β, IL6, and TNFα, in addition to measuring regulatory T-cell frequency. Results: MCA was successfully loaded on BSA, achieving high encapsulation efficiency reaching 63±2%, particles size of 120–130 nm with good polydispersity, and a negative surface charge indicating that entire positively charged drug was encapsulated inside NPs. Differential scanning calorimetry thermography of selected NPs showed an obvious interaction between components and cross-linking of BSA molecules using glutaraldehyde, resulting in sustained release of MCA (around 50% within 3 days). MCA NPs significantly restored the immune response via decreasing proinflammatory cytokines and increasing regulatory T-cell frequency when compared to control and free MCA (drug not loaded in NPs)-treated groups. Histopathological examination of this MCA NPs-treated group did not show the characteristic lesions of diabetes, and apoptosis nearly disappeared. Conclusion: BSA/MCA NPs could be considered a new modality for treatment of gastroparesis, in addition to management of diabetes itself and preventing its complications via an MCA-immunomodulatory effect.