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Objectives: Coronary artery anomalies (CAAs) are uncommon congenital abnormalities with a prevalence ranging from 0.2–2%. CAAs can be asymptomatic or less commonly present with life-threatening symptoms. This study aimed to investigate the prevalence and spectrum of CAAs in patients who underwent coronary computed tomography angiography (CCTA) in Oman. Methods: This retrospective study was conducted at the National Heart Centre, Muscat, Oman between September 2012 and August 2018. All consecutive patients who had undergone CCTA were included. Results: A total of 4,445 patients were included in this study. Of these, 59 patients (1.3%) were diagnosed with CAAs with a mean age of 52.6 years (range: 12–80 years) and an equal gender distribution. Among the patients with CAAs, the majority (69.5%) had anomalous origins from the opposite or non-coronary sinus. Right coronary artery arising from the left coronary sinus was the most common type (33.9%). Fewer patients (18.6%) had left circumflex arising from the right coronary sinus (RCS). Seven patients (11.9%) had left main arising from the RCS. Other CAAs were in the dual left anterior descending artery (8.5%), high coronary artery take-off (6.8%), single coronary ostia (6.8%) and coronary artery fistula (6.8%). Conclusion: The prevalence of CAAs was 1.3% which is similar to the literature

Contrast-induced nephropathy (CIN) is of concern after the use of radiocontrast media for coronary angiography (CAG) and percutaneous coronary intervention (PCI). We studied the incidence of CIN and its risk factors in patients undergoing CAG. In this prospective study, we included all patients with normal renal parameters undergoing CAG with nonionic radiocontrast media. We excluded patients with known chronic kidney disease, baseline creatinine more than 1.5 mg/dL, significant hypotension, anemia, and patients with acute myocardial infarction undergoing emergency PCI. Serum creatinine was done at baseline and serially for seven days after the procedure. Appropriate statistical tests were used to analyze the results and P <0.05 was considered statistically significant. The study population (n = 500, 348 males and 152 females) had a mean age of 56.6 ± 12.5 years. Twelve patients (2.4%) developed CIN and were equally distributed irrespective of the age, diabetes, or PCI procedure. CIN was observed to be more common in patients with hypertension than in those without hypertension (P = 0.0158). The total volume of contrast administered to CIN group (175 ± 59.3) was not significant as compared to that of non-CIN (159.1 ± 56) group (P = 0.334). None of the patients in our study required renal replacement therapy, and there was no mortality. CIN is observed in 2.4% of patients undergoing CAG and had a self-limiting course. Hypertension is the only observed risk factor, and further large-scale studies are necessary to delineate the novel risk factors for CIN in the general population with normal kidney function.

Fluorescein angiography (FA) is an important tool for the diagnosis and management of diabetic retinopathy. However, the safety of fluorescein sodium on renal functions is not fully understood. One hundred type 2 diabetes patients, within the Ophthalmology Outpatient Clinic at Alexandria Main University Hospital, Egypt, were enrolled in this prospective observational study to determine the safety of FA on renal function. Serum creatinine and cystatin C were measured pre- and 2 days post-FA. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) was measured pre- and 4 hours post-FA. Renal injury was defined as a 25% increase in serum creatinine, cystatin C, or uNGAL. The study included 71 females and 29 males, with a mean age of 55.73 ± 7.29 years. Baseline serum cystatin C and uNGAL were 0.89 ± 0.34 mg/L and 21.7 ± 2.39 ng/mL, respectively. Serum cystatin C and uNGAL significantly increased after FA to 0.95 ± 0.36 and 27 ± 2.81, respectively (P <0.001). Eleven patients (11%) experienced more than a 25% rise in serum cystatin C from baseline, whereas 40 patients (40%) experienced more than a 25% increase in uNGAL levels after FA. However, the mean serum creatinine level did not change significantly after FA (P = 0.061). Only one patient experienced more than a 25% rise in serum creatinine from baseline. FA showed a significant increase in early sensitive acute kidney injury biomarkers (as serum cystatin C and uNGAL) in substantial number of patients, suggesting but still not proving, a potential harmful effect of FA on kidney functions. These findings were not demonstrated using ordinary serum creatinine.

It is essential to ascertain the state of health and renal function of potential kidney donors before organ removal. In this regard, one of the primary steps is to estimate the donor’s glomerular filtration rate (GFR). For this purpose, the modification of diet in renal disease (MDRD) and the Cockcroft–Gault (CG) formulas has been used. However, these two formulas produce different results and finding new techniques with greater accuracy is required. Measuring the renal volume from computed tomography (CT) scan may be a valuable index to assess the renal function. This study was conducted to investigate the correlation between renal volume and the GFR values in potential living kidney donors referred to the multislice imaging center at Alzahra Hospital during 2014. The study comprised 66 subjects whose GFR was calculated using the two aforementioned formulas. Their kidney volumes were measured by using 64-slice CT angiography and the correlation between renal volume and GFR values were analyzed using the Statistical Package for the Social Science software. There was no correlation between the volume of the left and right kidneys and the MDRD-based estimates of GFR (P = 0.772, r = 0.036, P = 0.251, r = 0.143, respectively). A direct linear correlation was found between the volume of the left and right kidneys and the CG-based GFR values (P = 0.001, r = 0.397, P <0.001, r = 0.465, respectively). The kidney volume derived from multislice CT scan can help predict the GFR value in kidney donors with normal renal function. The limitations of our study include the small sample size and the medium resolution of 64-slice multislice scanners. Further studies with larger sample size and using higher resolution scanners are warranted to determine the accuracy of this method in potential kidney donors.

Background : Peripheral arterial disease (PAD) represents systematic atherosclerosis of great vessels. PAD affects approximately 10-20 % of patients older than 60 years and is associated with high mortality and morbidity rate debilitating individuals’ life. Objectives : To compare the results of Gadolinium enhanced MR-Angiography and surgery in patients suspected to have peripheral arterial disease. Materials and Methods: In this prospective cohort study, 30 consecutive patients matching the inclusion criteria were enrolled and MR-Angiography was performed prior to surgery for each one. Results : 22 patients were male (73.3 %) and the mean age was 60.3 ± 10.6 years in our study group. The most common artery for cut off and run off was superior femoral artery in both assessments. Proximal section of each artery was the most common anatomical section for cut off and run off. There was a same report of cut off artery by MR-Angiography and surgery (kappa coefficient of agreement was 0.96, P value < 0.001) and positive predictive value was 0.97 (95% CI: 0.83-0.99). Conclusions : According to our findings MR-angiography is an appropriate alternative imaging modality for patients suspected to have peripheral arterial disease and it facilitates the early diagnosis proposed by the clinical findings. Also beneficial characteristics of this method such as low exposure to ionizing radiation, repeatability, and low risk of contrast agent-induced nephropathy make it a modality of choice in patients with renal impairment.-

Contrast-induced nephropathy is the third most common cause of acute renal failure in hospitalized patients. The purpose of this study was to compare three supportive treatments for prevention of contrast-induced nephropathy in high-risk patients undergoing coronary angiography. In this randomized clinical trial study, 150 patients with at least one risk factor, such as, congestive heart failure, history of diabetes mellitus, age > 65 years or renal failure were randomly assigned to three equal groups: First group (Sodium (Na) bicarbonate infusion), second group [(N-Acetylcysteine (NAC) + Sodium Chloride (Nacl)], third group (Nacl). Angiography was performed with 350 mgI/mL of Iohexol (Omnipaque). Serum creatinine (Cr), blood blood urea nitrogen (BUN), and urine pH were measured at the start of angiography and 48 hours later. The three groups had no significant difference in demographic characteristics or other risk factors before intervention (P > 0.05). Forty eight hours after exposure, the Cr level increased significantly in the Nacl group (P = 0.039), while these changes were not significant in the other groups (P > 0.05). The incidence of contrast-induced nephropathy was not statistically significant between all the groups (P = 0.944). Although the Cr clearance had no statistically significant difference, it was lower in the NaCl group. Therefore, Na bicarbonate may be the treatment of choice in the prevention of contrast-induced nephropathy, because of less prescribed fluid volume and a lesser time required for infusion of the fluid.