The pregnant mother is subjected to major changes in her anatomy and physiology to can feed and accommodate the growing baby. Such changes initiate subsequently after gestation have an influence on body organs. It is essential to discriminate between normal physiological changes and pathological changes. The anesthetist is considered a substantial part in the management of risky pregnancies, and must be a member of the multidisciplinary team who is assigned to concern for seriously ill parturient. Considerations must be taken to physiological modifications during treatment. The aim of this work is to highlight the risk factors and etiology of obstetric emergencies and how to manage them based on recent updates and guidelines.

Background: Cardiovascular disease is the leading cause of death. Importantly, it remains the foremost cause of preventable death globally.Atherosclerotic renal artery stenosis (ARAS) is the most common primary disease of the renal arteries and it is associated with two major clinical syndromes; ischemic renal disease and hypertension. Objective: To determine the incidence and predictors of renal artery stenosis in the multivessel coronary artery disease patients. Patients and Methods:The study included 100 patients undergone coronary angiography at Matrouh Specialized Cardiac Surgery and Interventional Catheterization Center and proved to have multivessel coronary artery disease during the period from January 2014 to April 2016. They were 74 males and 26 females. Their age ranged between 50-70 years with a mean of 57.28 ± 6.74 years. Results:The study showed that 16 patients (16%) had renal artery stenosis. All patients with renal artery stenosis had unilateral RAS and no patients had bilateral RAS. Significant renal artery stenosis (> 50% diameter stenosis) was found in 10 patients (10%) and nonsignificant RAS was found in 6 patients (6%). The left renal artery was singly involved in 6 patients (6%) and the right renal artery was singly involved in 10 patients (10%). There was no significant relationship between the number of coronary arteries affected and incidence of significant renal artery stenosis. Also there was no significant relationship between the level of serum creatinine and incidence of significant renal artery stenosis. Conclusion: Renal angiography was a reliable method to assess renal artery stenosis and may be more important in hypertensive patients with multivessel coronary artery disease.

No abstract

Objectives: To assess the relation between left atrial systolic strain and CHA 2 DS 2-VASc score in patients with non valvular atrial fibrillation and to assess whether it can be used in guiding the decision for oral anticoagulation. Methods: The study included 100 patients with non-valvular persistent AF (group I) compared to 100 individuals with sinus rhythm of matching age and gender (group II). Standard two-dimensional echocardiography, PW Doppler and TDI derived velocity and strains were used to assess LA function then its correlation with CHA 2 DS 2-VASc score in group I was evaluated. Results: The prevalence of DM (P<0.001), HTN (P=0.001), prior stroke (P<0.001), heart failure (P < 0.001) and peripheral vascular disease (P < 0.001) was increased in patients in group I. Group I showed significant increase in LA diameters (anterio-posterior, transverse and longitudinal) P ˂ 0.001, LA volumes (maximal and minimal P < 0.001 and mitral E/e" ratio P ˂ 0.05. The correlation between LA emptying fraction and CHA 2 DS 2-VASc score was negative and significant (P < 0.05). Systolic LA strain was significantly reduced in patients with AF (P < 0.001) and it was negatively correlated to CHA 2 DS 2-VASc score but without statistical significance. There was no significant difference of LA systolic strain between the CHA 2 DS 2-VASc score of < 2 points and ≥ 2 points (P = 0.52). Systolic LA strain ≤ 17.44 was shown to have the best diagnostic accuracy (sensitivity = 42.11 %; specificity = 62.07%) in predicting CHA 2 DS 2-VASc ≥ 2. Conclusion: LA systolic strain is significantly reduced in AF patients and negatively correlated to CHA 2 DS 2-VASc score and no significant difference between LA systolic strain in patients with CHA 2 DS 2-VASc score of < 2 points and ≥ 2 points so LA strain may be a tool that helps in guiding the decision for oral anticoagulation.

Background: Coronary catheterization is usually performed via the trans-femoral approach. Trans-radial access offers advantages in comparison with trans-femoral access, especially under conditions of aggressive anticoagulation and antiplatelet treatment in which bleeding complications at the femoral puncture site can result in increased morbidity and duration of hospitalization, Aim and objectives: the aim of the study was to compare 30 days outcome between radial and femoral approaches in patients presenting with ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI), Subjects and methods: this was a Prospective, randomized, open-label, double-arm, single center study, that was conducted on 120 STEMI patients; subdivided randomly into 2 groups. Group A (60 patients) had Primary PCI through femoral access; Group B (60 patients) had Primary PCI through radial access, Results: Hospitalization time in group (I) was ranged between 3-8 days with mean± S.D. 5.35±1.686 days while in group (II) was ranged between 5-10 days with mean± S.D. 7.32±1.751 days. There were statistically significant differences between groups, and Complications in group (I) showed that 9(15.0%) had access site complication, 4(6.7%) had hematoma, 2(3.3%) had Pseudoaneurysm and 7(11.7%) had Radial artery spasm while in group (II) 6(10.0%) had Access site complication. There was no statistically significant difference between groups, Conclusion: trans-radial approach is an equally effective approach as trans-femoral approach similar success and complication rates.