NO (106.1 ± 66.7 vs. 41.5± 6 pg/mL, P< 0.05; 113.5± 65.8 vs. 20.8± 3.8 µmol/l, P< 0.001, respectively

Objective: To analyze immediate and midterm results of percutaneous mitral valvotomy (PMV) in patients ≤ 18 year, a single centre experience of Sohag university hospital. Methods: Between May 2010 and May 2012, 64 procedures of Inoue technique mitral valvotomy were performed on 64 patients. The mean age was 15.8 ± 2.2 years; 75% were females. Results: Success was obtained in 96.8% of patients. Immediate complications were severe mitral regurgitation (3.1%), cardiac tamponade (1.6%) and embolic stroke in (1.6%). Late follow-up was obtained in 93.7% of the patients (at 6 and 24 months). Restenosis developed in 3 patients. Most of the patients had no symptoms at discharge but most of them had NYHA class I to II at 6 months to 2 years follow up. No patients died. Patients who operated early with MVA around 1.4 had best outcome. Conclusion: PMV represents a safe therapeutic option in young patients with mitral valve stenosis. In these patients, recurrence of symptoms and restenosis occurs at an earlier stage than in elderly. Earlier intervention carries better outcome and decreases restenosis rate.

Homocysteine (Hcy) is an amino acid, which is a product of methionine demethylation and a precursor to cysteine biosynthesis. Elevations in plasma Hcy (homocysteinemia) are frequently found in increased risk of atherosclerotic, coronary artery disease (CAD), venous thrombosis and stroke. Hcy injuries the endothelium and may have a role in microvascular complication of type 2 diabetes mellitus (T2DM). Two common mutations in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene (MTHFR C677T and A1298C) result in elevated Hcy levels. The aim of the present study was to investigate the relationship between plasma Hcy levels and diabetic nephropathy (DN). Serum Hcy levels, MTHFR genotype, and a panel of variables were evaluated in a sample of 75 T2DM patients with DN, 55 patients without nephropathy and also 95 non-diabetic control Egyptian subjects. Its common genetic polymorphisms (MTHFR C677T and A1298C) were determined for these patients and control subjects together with their correlation with changes in Hcy levels. Biochemical variables (including 24 hours albuminuria, GFR and serum total Hcy, lipogram and HbA 1c beside blood urea and serum creatinine) and lifestyle characteristics were investigated. MTHFR genotype was studied by PCR-RFLP analysis, and total Hcy levels were measured by ELISA. The plasma Hcy levels were significantly higher in the diabetic nephropathy (19.8± 2.3 µmol/L) than uncomplicated type 2 diabetic patients (12.7± 2.1 µmol/L, P<0.05) and also, the control subjects (11.8±1.8µmol/L, P<0.05). There were no differences between uncomplicated diabetic patients and control subjects with respect to Hcy levels. C677T and T677T were highly prevalent among DN patients, with frequencies of 0.40 and 0.36 respectively. C677T, but not A1298C, SNP, is a risk factor for DN, presumably through elevating serum Hcy level.

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Objectives: Disturbance in the Low-density lipoprotein cholesterol (LDL-C), Highdensity lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglyceride (TG) and serum total homocysteine are predisposing factors in myocardial infarction. Design and methods: The study group consisted of 56 patients 35 male (aged 47.8±4.8 years), and 21 females (aged 46±4.3 years). The entry criterion for the patient group has a history of typical or atypical chest pain, unequivocal changes in the electrocardiogram. The control group consisted of 30 normal volunteers, 16 male (aged 48.4±5.2 years) and 14 females (aged 45.1±4.9 years). Measurement of serum total homocysteine was performed by enzyme linked immune sorbant assay (ELISA). Measurement of TC, TG, and HDL-C were performed using spectrophotometer. LDL-C was calculated. Results: Patients with myocardial infarction were found to have higher serum total homocysteine levels (23.93±2.99 mol/L in male and 25.82±3.82 mol/L in female) than controls (10.45±2.73 mol/L and 12.92±0.9 mol/L in both male and female respectively) (for each comparison; p < 0.001). Serum total homocysteine levels were significantly correlated with high Triglycerides and low HDL-C. Conclusions: The above mentioned findings suggest the potential usefulness of Triglycerides, HDL-C and serum total homocysteine as risk factors in myocardial infarction patients. These findings should be used in the future studies on the etiology and pathogenesis of myocardial infarction and to ascertain which patients are at risk for subsequent cardiovascular events and who will benefit from revascularization. Abbreviation: LDL-C (Low density lipoprotein-cholesterol), HDL-C (High density lipoprotein-cholesterol), MI (Myocardial infarction), TG (Triglycerides) and Hcy (homocysteine)