Mahmoud Elnil

Anomalous right coronary artery (RCA) arising from the left sinus of Valsalva presents a challenge during angiography, often leading to failed engagement, prolonged procedure time, and delayed reperfusion. This case highlights an innovative technique in which a standard guide catheter was manually modified to mimic a Leya catheter when the dedicated device was unavailable, allowing timely revascularization. A 47-year-old man presented with chest pain and elevated troponin, consistent with non-ST-elevation myocardial infarction. Angiography showed an anomalous RCA taking off anterior and superior to the left main coronary artery. Several standard diagnostic and guiding catheters failed to engage the vessel; the procedure was then switched from radial to femoral access, and an Amplatz Left 1 (AL1) guide catheter was manually modified by applying a 45–60° right-angled twist at the tip to reproduce the curvature of a Leya catheter. This modification allowed stable engagement of the RCA and successful percutaneous coronary intervention. In patients with anomalous RCA where standard catheters fail, manual modification of a guide catheter to achieve optimal engagement can be a useful alternative when a dedicated design is unavailable. Femoral access is preferred in difficult cases, especially with anomalous RCA, as it provides greater stability and facilitates successful engagement.

Background: Biliary atresia (BA) is a leading cause of end-stage liver disease and the most common indication of liver transplantation in children. Several reports attributed BA to both prenatal and perinatal aetiologies, including a viral infection-induced auto-immune response that targets the bile ducts. Cytomegalovirus (CMV) remains the most common virus being linked to BA. This meta-analysis estimates to what extent CMV infection is detected in patients with BA. Methods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE/PubMed, WHO-Virtual Health Library (VHL), ScienceDirect, and Google Scholar were used for the systematic search. Random effects model was used to estimate the pooled prevalence estimate with the corresponding 95% confidence interval (CI) using StatsDirect statistical software. Heterogeneity among the included studies was estimated using the I ² statistics. Publication bias was determined based on Begg’s test, Egger’s test, and examination of the funnel plot. Subgroup analyses and meta-regression were used to explore the moderators of heterogeneity between studies. Results: A total of 13 studies that fulfilled the eligibility criteria were included in the meta-analysis. The pooled overall prevalence of CMV infection in patients with BA was 24.5% (95% CI 11.9 %– 33.9%). In subgroup and meta-regression analyses, the prevalence of CMV infection in patients with BA was correlated with the geographical areas (p = .001) but not with the study year (p = .153). Conclusions: The available data demonstrate that the detection of CMV infection is common in infants with BA. There is still a need for large studies with appropriate controls to examine various aspects of the association between CMV infection and BA. Abbreviations: BA = biliary atresia, CMV = cytomegalovirus .

The rapid progression of Coronavirus disease 2019 (COVID-19) and its increasing burden on health systems necessitate the identification of parameters of severe infection to help in monitoring, prognoses and development of treatment algorithms. This review aims to investigate the association of lymphocyte count, CRP, LDH, and D-Dimer with the severe form of COVID-19. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE/PubMed, WHO-Virtual Health Library (VHL), and ScienceDirect were used for the systematic search. Random effects model was used to estimate the pooled standardized mean differences (SMD) with the corresponding 95% confidence interval (CI), using OpenMeta Analyst software. A total of 11 studies, with 2437 COVID-19 patients, which fulfilled the eligibility criteria were included in the meta-analysis. The analysis revealed that lymphocyte count was significantly lower in patients with the severe form of COVID-19 (SMD = - 1.025, P value <.001). Also, the analysis of SMD showed that patients with severe COVID-19 have a significantly higher serum levels of CRP (SMD = 3.363, P value <.001), D-Dimer (SMD = 1.073, P value <.001), and LDH (SMD = 3.345, P value <.001). Low lymphocyte count and high levels of CRP, LDH, and D-Dimer are associated with severe COVID-19. These laboratory markers could be used as clinical indicators of worsening illness and poor prognosis of COVID-19.