The effect of living at high altitude on carotid intima-media thickness in the elderly: a comparative study.

BACKGROUND: Previous studies have shown that high altitude may have a protective effect on cardiovascular diseases. However, the effects of high altitude on carotid atherosclerosis have been less evidenced. PURPOSE: To compare the effect of altitude on atherosclerosis by using carotid artery ultrasonography (CAU) findings. MATERIAL AND METHODS: A total of 180 patients aged >60 years, who had proper recorded data of ultrasonography and blood tests, and who resided in the same city for at least five years were included. Patients with anemia, hyperlipidemia, diabetes mellitus, hypertension, and those who did not meet the inclusion criteria were excluded. Patients were divided into two groups: high altitude group (HAG) and sea level group (SLG). CAU findings of each patient-including common carotid artery intima-media thickness (CIMT) ≥1 mm and < 1 mm, internal carotid artery (ICA) stenosis rate, and plaque types-were recorded and compared between the two groups. Blood test parameters and lipid profiles were additionally recorded. RESULTS: Prevalence of patients with CIMT ≥1 mm was significantly higher in the SLG (SLG: 50%, HAG: 15.6%; P < 0.001). Carotid stenosis was found to be significantly different in both groups (HAG: 9.96% ± 23.27%, SLG: 29.83% ± 23.30%; P < 0.001). RBC, HGB, HDL values, and HDL/LDL ratio were found to be significantly higher in the HAG (P < 0.001) whereas LDL, TG, and TC values were significantly higher in the SLG (P < 0.001). CONCLUSIONS: People who reside at high altitudes have significantly lower rate of carotid stenosis, lower CIMT values, and less atherogenic lipid profile values, all of which indicate protective effect of high altitude on atherosclerosis.

Seeing the Unseen: Evaluating Testicular Vascularity in Neonates by Using the Superb Microvascular Imaging Ultrasound Technique.

OBJECTIVES: To evaluate testicular vascularity in neonates by using the novel Superb Microvascular Imaging (SMI; Toshiba Medical Systems Corporation, Tokyo, Japan) ultrasound (US) technique and to compare this technique to conventional Doppler US techniques. METHODS: A total of 140 healthy neonates between 2 and 60 days old who were admitted for routine screening were included in the study. However, in 9 cases, the Doppler study could not be completed. In the remaining 131 cases, color Doppler imaging (CDI), power Doppler imaging (PDI), Advanced Dynamic Flow (ADF; Toshiba Medical Systems), and monochrome SMI (mSMI) techniques were performed on a single representative testicle. Real-time cine images were captured for 5 to 10 seconds for each technique by using a high-frequency (7.2-14-MHz) linear transducer. The images were evaluated by 3 observers using a grading system to quantify the degree of vascularity and artifact interference. RESULTS: A total of 131 testicles (74 right and 57 left) were evaluated, and vascularity was shown in 110 (84%) testicles with CDI, 109 (83%) with PDI, 94 (72%) with ADF, and 128 (98%) with mSMI by the consensus of all observers. The Doppler techniques were ranked from highest to lowest in the following order based on the degree of vascularity detected: mSMI > PDI > CDI > ADF (P < .001). Based on the presence of artifacts, the Doppler techniques were ranked as follows from high to low: ADF > CDI > PDI > mSMI (P < .001). CONCLUSIONS: Superb Microvascular Imaging is a promising US technique that appears to detect testis vascularity better than conventional Doppler US techniques; however, further research is needed to support the results of this study.

Factors Affecting Carotid Artery Stenosis in the Elderly Living at High Altitudes.

BACKGROUND: Factors affecting carotid artery stenosis have been generally investigated. However, considering the protective effect of altitude, studies on elderly individuals at high altitudes are few. Our aim is to investigate the systematic adaptive changes caused by high-altitude exposure through the causes of carotid artery stenosis. MATERIALS AND METHODS: Carotid Doppler ultrasound was performed on 250 patients over the age of 50 years. The patients' age, gender, height, weight, smoking history, place of residence, and presence of comorbidities were questioned. Those with diabetes, hypertension, hyperlipidemia, and coronary disease were excluded from the study. Those who did not reside at high altitudes were excluded from the study. One hundred and thirty-five patients were included in the study. Carotid artery Doppler findings and biochemical parameters were recorded. Factors affecting stenosis in the carotid arteries were compared. RESULTS: In our study, the factors affecting carotid stenosis were determined to be age, gender, presence of plaque, plaque type, and mean carotid intima-media thickness (CIMT). The mean CIMT of the patients was calculated as 0.71±0.14 mm. The mean CIMT measurement level was significantly higher in patients with plaque in the carotid artery (p<0.05). According to receiver operating characteristic curves, CIMT values higher than 0.72 mm increase plaque and stenosis formation in the common carotid artery (CCA) and internal carotid artery (ICA) in elderly people living at high altitudes (p<0.05, area under the curve [AUC]: 0.71-0.83). CONCLUSIONS: The most important factors affecting carotid stenosis in individuals living at high altitudes are age, gender, CIMT, plaque, and plaque type. When soft plaques were detected, the risk of stenosis was found to be higher than in calcific plaques. Additionally, the number of factors affecting stenosis was greater on the left (ICA). This suggests that the left carotid system is more vulnerable. It can be said that in elderly individuals living at high altitudes, a CIMT higher than 0.72 mm is a cutoff value in the presence of plaque and stenosis in the carotid arteries.

Prognostic Value of Chest-Computed Tomography in Patients with COVID-19.

Background: The diagnostic value for chest CT has been widely established in patients with COVID-19. However, there is a lack of satisfactory data about the prognostic value of chest CTs. This study investigated the prognostic value of chest CTs in COVID-19 patients. Materials and Methods: A total of 521 symptomatic patients hospitalized with COVID-19 were included retrospectively. Clinical, laboratory, and chest CT characteristics were compared between survivors and non-survivors. Concerning chest CT, for each subject, a semi-quantitative CT severity scoring system was applied. Results: Most patients showed typical CT features based on the likelihood of COVID-19. The global CT score was significantly higher in non-survivors (median (IQR), 1 (0−6) vs. 10 (5−13), p < 0.001). A cut-off value of 5.5 for the global CT score predicted in-hospital mortality with 74% sensitivity and 73% specificity. Global CT score, age, C-reactive protein, and diabetes were independent predictors of in-hospital mortality. The global CT score was significantly correlated with the C-reactive protein, D-dimer, pro-brain natriuretic peptide, and procalcitonin levels. Conclusion: The global CT score could provide valuable prognostic data in symptomatic patients with COVID-19.

Difficult Management of Giant Gallstone Ileus of a Post-cardiopulmonary Resuscitation Patient: A Case Report.

Gallstone ileus is a rare form of mechanical intestinal obstruction. It is associated with high mortality and morbidity in the elderly population. The treatment of gallstone ileus includes more than one surgical option and it is appropriate to determine the surgical technique according to the general condition of the patient. In our case report, we present an 83-year-old patient who was admitted to the emergency room due to nausea and vomiting, was diagnosed with gallstone ileus, and had a cardiac arrest just before surgery. The patient management and the following surgical approach are also explained in detail.

Left-sided Poland's syndrome associated with dextrocardia.

Poland's syndrome is a rare congenital anomaly accompanied by the absence of the pectoralis major, and the ipsilateral upper-limb and chest wall deformities. Hypoplasia of the breast, agenesis of the ipsilateral rib cartilage, athelia, and ipsilateral developmental finger anomalies such as syndactyly can also be seen. In the literature, only 56 cases of dextrocardia and left-sided Poland's syndrome have been described. Herein, a case of left-sided Poland's syndrome coexisting with dextrocardia and nasal hemangioma was presented.