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   Table of Contents - Current issue
Coverpage
July-September 2018
Volume 1 | Issue 2
Page Nos. 41-86

Online since Wednesday, September 26, 2018

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ORIGINAL ARTICLES  

The cardioprotective role of melatonin against myocardial injury in patients undergoing coronary artery bypass grafting surgery p. 41
Karrar H Dwaich, Fadhil G Al-Amran, Bassim I Al-Sheibani, Nasser Ghaly Yousif, Najah R Hadi
DOI:10.4103/VIT.VIT_12_18  
BACKGROUND: Myocardial ischemia/reperfusion injury associated with coronary artery bypass graft (CABG) surgery characterizes as a clinically critical problem. The incidence of oxidative stress, inflammation, and apoptosis are induced throughout the reperfusion of the cardiac muscles following ischemia. The present study aims to examine the protective role of melatonin in ameliorating the degree of myocardial injury in patients undergoing bypass surgery, and whether this effect is dose related. PATIENTS AND METHODS: A total of 45 patients who were undergoing CABG in (Al-Najaf Cardiac Center, Al-Najaf, Iraq) were enrolled in this study between January 2015 and November 2015. Patients were randomly allocated into three study groups: placebo-controlled group (C), low-dose melatonin treatment group, 10 mg capsule once daily (M1) and high-dose melatonin treatment group 20 mg capsule once daily (M2). RESULTS: Compared to the control group, there was a significant increase in the plasma level of melatonin associated with a significant reduction in plasma levels of high sensitive C-reactive protein, creatine kinase isoenzyme muscle/brain, and cardiac troponin-I, in the melatonin groups (Group M1 and M2) compared to the control group, (P < 0.05) in melatonin-treated groups. Comparing the two melatonin study groups, the changes in the parameters mentioned above were more significant in the M2 group compared to the M1 group (P < 0.05). CONCLUSION: These findings suggested that melatonin administration can ameliorate the degree of myocardial injury, dose-dependent effects.
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Aortic pulse wave velocity and augmentation index@75 measured by oscillometric pulse wave analysis in Gujarati nonhypertensives p. 50
Jayesh Dalpatbhai Solanki, Hemant B Mehta, Chinmay J Shah
DOI:10.4103/VIT.VIT_10_18  
BACKGROUND: Augmentation indexes (AIxs) and pulse wave velocity (PWV) are arterial stiffness parameters. They can be studied by pulse wave analysis (PWA) noninvasively. Before use, AIx and PWV need normative baseline study to find the predictors. MATERIALS AND METHODS: We conducted a cross-sectional study in 801 nonhypertensives, aged 15–65 (divided into five subgroups) years. PWA was accomplished by Mobil-o-Graph (IEM, Germany) based on oscillometric principle and cardiovascular parameters reported were further analyzed. Value of P < 0.05 was taken as statistical significance. RESULTS: There were five age-based subgroups from 15 to 65 years, showing an increase in AIx@75 and PWV with age. Females had significantly higher AIx in male in age groups (31.4 vs. 25.8, 34.95 vs. 27.21, 32.62 vs. 27.61, 34.32 vs. 26.36, 37.09 vs. 29.63; P < 0.05 for all), but PWV was higher in males than females in young age group (15–24 years-4.94 vs. 4.71, 25–34 years-5.28 vs. 5.12, 35–44 years-6.00 vs. 5.84; P < 0.05 in all) and in females than males in older age group (45–54 years-6.88 vs. 6.78,55–65 years-8.13 vs. 8.03). Major positive significant predictors of PWV were age, Body Mass Index, and systolic blood pressure; and of AIx@75 were age, height (negative), heart rate, and pulse pressure. AIx@75 and PWV showed a positive correlation with each other across all age group in either sex except for 55–65 years and 25–34 years age groups. CONCLUSIONS: Oscillometric measurement of PWV and AIx@75 is feasible in our population. They are dependent on each other and age, totally not dependent on blood pressure and have difference in predictors. This baseline data can be used as a reference for future studies.
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Response of internal mammary artery wall to L-carnitine in patients undergoing coronary artery bypass p. 56
Najah R Hadi, Fadhil Al-Amran, Mahamed Al-Turfy, Saad Rasool Shaker, Nasser Ghaly Yousif, Hayder A Al-Aubaidy
DOI:10.4103/VIT.VIT_11_18  
BACKGROUND: This study attempts to highlight the vasodilatation effects of L-carnitine on the left internal mammary artery (LIMA) in patients undergoing coronary artery bypass graft (CABG) surgery. PATIENTS AND METHODS: A total of 45 male patients (age 55–60 years), and body weight (70–75 kg) were included in this study. Participants were planned to undertake elective CABG surgery, and they were randomly allocated into two study groups as follows: Control group included 15 patients received placebo capsule (lactose capsules), twice daily for 3 successive days before CABG surgery. L-carnitine-treated group included the remaining 30 participants received L-carnitine capsules, 500 mg twice daily for 3 days before CABG surgery. RESULTS: The two groups were comparable according to their age and comorbidities. There was significant increase in the plasma levels of endothelial nitric oxide synthase (eNOS) and matrix Gla-protein (MGP) among the L-carnitine group as compared with the control group (P < 0.001, P = 0.011, respectively). At the same time, tissue eNOS levels and tissue MGP levels were significantly higher (P = 0.078, P < 0.001, respectively) in the L-carnitine group as compared with the control group. Plasma levels of angiotensin II (ANGII) and endothelin-1 (ET-1) levels were significantly lower (P < 0.001) in the L-carnitine group. Tissue levels of ANGII and ET-1 were significantly lower (P = 0.039, P < 0.001, respectively). CONCLUSIONS: We can conclude that L-carnitine has potent vasodilatation effects on LIMA during CABG surgery as evidenced by the increase in plasma and tissue levels of eNOS and MGP, associated with a decrease in plasma and tissue levels of ANGII and ET-1.
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Oscillometric pulse wave analysis in newly diagnosed never treated Gujarati hypertensives p. 62
Jayesh Dalpatbhai Solanki, Hemant B Mehta, Chinmay J Shah
DOI:10.4103/VIT.VIT_14_18  
INTRODUCTION: Hypertension is on a high with preponderance of undiagnosed and untreated at-risk individuals. Pulse wave analysis (PWA) provides noninvasive assessment of arterial stiffness and central hemodynamic parameters. It provides more discrete and direct inference about cardiovascular aging that is expected to be exaggerated with systemic hypertension. MATERIALS AND METHODS: A case–control study was conducted in 116 newly diagnosed, never treated, apparently healthy hypertensives and 116 matched nonhypertensive controls. Oscillometric PWA was accomplished by Mobil-o-Graph (IEM, Germany) to derive cardiovascular parameters that were further analyzed. P < 0.05 was considered statistically significant. RESULTS: Cases showed significantly higher brachial arterial parameters (blood pressure [BP], heart rate, and rate pressure product); arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification); and central hemodynamics (central BP, cardiac output, and stroke work) than age-, gender-, and height-matched controls. Major study parameters correlated with BP, heart rate, and age, but in multiple regressions, they were independent of most of these parameters. CONCLUSIONS: Oscillometric PWA is feasible in our population. It revealed beyond brachial BP abnormal profile suggestive of early cardiovascular aging in new and never treated hypertensives. It also suggests further work to consolidate and explore these results.
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Critical role of Ghrelin in downregulation of the inflammatory response after renal injury p. 68
Teba Jasim Mohammed, Najah R Hadi, Israa Al-Yasiri, Nasser Ghaly Yousif, Abdullah Jasim, Fadhil Alamran, Ying Liu
DOI:10.4103/VIT.VIT_13_18  
BACKGROUND: The impairment of blood flow to the kidney causes renal injury occurs by ischemia/reperfusion (I/R) in surgical procedures, in which the kidneys remain without blood supply for sometime. This is observed during kidney transplantation, vascular surgery of aorta and renal arteries, and in partial nephrectomy. Ghrelin is an orexigenic growth hormone secretagogue of a 28 amino acid peptide derived mainly from ghrelinergic cells in the gastrointestinal tract. It plays an important physiological role in regulating of energy homeostasis and appetite stimulant. In this study, we aimed to assess the ability of ghrelin to exert potential protective effects on the kidney I/R and subsequent kidney dysfunctions in the rat through the modulation of pro-inflammatory cytokines. MATERIALS AND METHODS: A total of 28 rats were used in this experiment and the I/R was induced in a rat model by unilateral renal artery clamping for 30 min and reperfusion for 3 h, and ghrelin (40 μg/kg/rat) or vehicle was injected through intraperitoneal before ischemia and at reperfusion time immediately. Ghrelin administration could exert a protective role in the kidney against injury by significantly reducing serum and tissue levels of pro-inflammatory markers (tumor necrosis factor-alpha, high mobility group box protein 1, and interleukin 1 beta), decreasing the serum levels of (urea and creatinine), and reduction of the severity score of renal damage. CONCLUSIONS: We conclude that ghrelin has renoprotective effects through modulation of inflammation.
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Comparison of therapeutic effects between open surgery and endovascular therapy for juxtarenal aortic occlusion p. 74
Yongquan Gu, Lixing Qi, Alan Dardik, Xixiang Gao, Lianrui Guo, Zhu Tong, Jianming Guo, Jian Zhang, Zhonghao Wang
DOI:10.4103/VIT.VIT_16_18  
OBJECTIVE: To compare the effectiveness of surgical bypass and endovascular therapy for juxtarenal abdominal aortic occlusion. METHODS: Data of 37 patients treated with open arterial bypass surgery or endovascular therapy for juxtarenal abdominal aortic occlusion in the last 10 years were retrospectively analyzed. RESULTS: Of the 37 cases, 32 were male and five were female; the mean age was 58.5 years; the mean disease history was 8.2 months. Open surgery was performed in 18 cases and endovascular treatment was done in 19 cases. No significant differences in either technical success rate or perioperative symptom improvement rate were found between the open surgery and endovascular therapy groups. There w as much more blood loss, hospital stay time, and fewer hospitalization expenses in the open group than the endo group. In the open group, the mean follow-up time was 60.5 months and graft patency rate was 94.4%; in the endo group, the mean follow-up was 52.5 months but the patency rate was 82.4% (P = 0.009). CONCLUSIONS: Both open surgery and endovascular treatment are effective for juxtarenal aortic occlusion. In comparison, open surgery has lower cost with better long-term eff icacy, while endovascular therapy has less invasiveness with faster postoperative recovery. O perative approach should be made according to the patient's clinical conditions.
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REVIEW ARTICLE Top

Exercise oximetry in arterial claudication p. 80
Pierre Abraham, Tianyu Ma, Huifei Chen, Lianrui Guo, Yongquan Gu, Samir Henni
DOI:10.4103/VIT.VIT_15_18  
Transcutaneous oxygen pressure measurement (TcPO2) is well known as a useful tool for the evaluation of critical limb ischemia, but it is rarely used during exercise (Ex-TcPO2). We have used exercise oximetry, in Angers, as a noninvasive vascular investigation for about >15 years to detect regional blood flow impairment at the proximal and distal levels simultaneously and on both sides. The use of a chest electrode is required to calculate the Delta from rest of oxygen pressure index (DROP) and account for eventual systemic exercise-induced hypoxemia. The DROP index that we proposed in our first publication in 2003, because of its mathematical formula, is independent of the absolute oxygen pressure starting values which result in improved reliability of Ex-TcPO2 as compared to the regional perfusion index. The present review is of specific interest at a time when the technique is rapidly spreading in France and Abroad.
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