Angina and Arrhythmia Symptoms Following Multiple Bee Stings: Kounis Syndrome.

Kounis syndrome (KS) is an acute coronary syndrome including coronary spasm, acute myocardial infarction, and stent thrombosis preceded by an anaphylactic, anaphylactoid, allergic, or hypersensitivity injury. In this case presentation, we discussed Type I and Type II KS. Case 1 was a 72-y-old man who presented to the emergency department with allergic symptoms and chest pain that developed after multiple bee stings. Electrocardiography showed ST depression in the lateral leads. Case 2 was a 42-y-old woman who presented to the emergency department with complaints of chest pain, dizziness, and presyncope that developed after multiple bee stings. Mobitz Type II Block with right bundle branch block was observed in 42 beats·min-1 in the electrocardiography. Both patients were first treated for allergic reaction. Although early percutaneous coronary intervention was performed for graft thrombosis in Case 1, a permanent pacemaker was inserted in Case 2. The patients were discharged without any complications. Increasing physician awareness towards the existence of KS can prevent fatal outcomes with early diagnosis and treatment.

Farmers' Risk Perception on Climate Change: Transhumance vs. Semi-Intensive Sheep Production Systems in Türkiye.

Sheep farmers' perceptions of climate change and its impacts and the adaptation strategies they consider to address these risks are of great importance in ensuring the resilience of farming practice. This study focused on sheep farmers' perception of climate change and the risks and actions taken to mitigate these impacts. A total of 68 surveys were carried out among sheep farmers (39 transhumance and 29 semi-intensive farmers) by two different representative production systems in Türkiye. Variables regarding the socio-economic profile, climate change impacts, and adaptation strategies were identified and analyzed. Principal component analysis and a Pearson Chi-square test were used to evaluate the data. Both farmers' groups accepted and perceived climate change, showing good awareness and perception. The farmers' attitudes towards adaptation to climate change were associated with production systems. Transhumance farmers had limited adaptation and coping strategies compared to semi-intensive farmers. Transhumance farmers focused mainly on selling livestock (mostly to cope with degraded natural grassland/feed deficiency) as an adaptive strategy. In contrast, semi-intensive farmers focused on modifying their farm management and feed operations, such as changing the feed ratio and supplement use, improving water and feed storage, and considering crop feed production. The knowledge obtained from this study could be helpful for farmers and policymakers who develop long-term small ruminant production strategies that consider the effects of climate change and adapt them to different farming systems in the Türkiye.

The Relationship Between Primary Knee Osteoarthritis and Aortic Stiffness, Distensibility, and Valve Calcifications: A Case-Control Study.

OBJECTIVE: The purpose of our study was to evaluate aortic stiffness and distensibility changes and the presence of aortic and mitral valve calcifications in patients with primary knee osteoarthritis (OA), using 2-dimensional and Doppler transthoracic echocardiography. METHODS: This case-control study included 115 participants with OA and a control group between May 2019 and November 2019. The Kellgren-Lawrence classification was used for the diagnosis and classification of knee OA, based on radiological images. We compared the demographic data, 2-dimensional and Doppler transthoracic echocardiography results, and laboratory findings between the OA patient group and the control group. RESULTS: There was a significant difference between aortic strain, aortic distensibility, aortic stiffness, and C-reactive protein values between the OA patient group and the control group (p < 0.001 for all). Post hoc analyses revealed that aortic strain and aortic distensibility values were significantly lower, and aortic stiffness values were significantly higher in the grade 4 OA group than those of other groups (p < 0.05 for all). In addition, the C-reactive protein values of the grades 3 and 4 patients were significantly higher than those of other groups (p < 0.05 for all). No significant difference was observed between the groups in terms of aortic and mitral valve calcifications (p > 0.05 for all). CONCLUSION: Aortic strain and distensibility values were lower in the advanced grades of primary knee OA, whereas aortic stiffness values and the frequency of valve calcifications were higher.

Neopterin as a novel marker; well correlated with mortality and morbidity in patients with advanced systolic heart failure.

Objective: The aim of this study is research relation of serum neopterin level with mortality and morbidity due to systolic HF and also its role in diagnosis of patients with systolic HF. Material and methods: Eighty-one patients with systolic heart failure (HF group) and eighty-one age- and gender-matched healthy subjects (the control group) were enrolled in the study. Echocardiographic examination was performed accordingly. At the beginning of the study, serum B type natriuretic peptide (BNP), neopterin, and high sensitive C-reactive protein (hs-CRP) were measured accordingly. The subjects were followed for one year then after. Mortality rate and number of hospitalisation due to HF were recorded. Results: Age and gender distribution over the groups were statistically similar (p > .05). LVEF of the control and HF groups were 62 ± 3 and 27 ± 3%, respectively (p < .001). Average neopterin value of HF group was significantly higher than that of the control group (p < .001). Both hs-CRP and BNP values were well correlated to neopterin values (p = .667 and .778, respectively). There was a significant correlation between number of hospitalisation and neopterin values among patients in HF group (p = .008). Also among HF group, neopterin value of patients died within first year of follow-up (n = 29) was higher than that of patients survived beyond first year (n = 52 and p = .011). Conclusions: Neopterin is a biomarker reflecting ongoing inflammatory process in deteriorating heart. High level of serum neopterin concentrations was associated with mortality and morbidity in systolic HF.

Frequency of genetic polymorphism for adrenergic receptor beta and cytochrome p450 2D6 enzyme, and effects on tolerability of beta-blocker therapy in heart failure with reduced ejection fraction patients: The Beta GenTURK study.

OBJECTIVE: The present objective was to determine frequency of Arginine389Glycine (Arg389Gly) and Cytochrome p450 2D6*10 (Cyp2D6*10) polymorphism in cases of heart failure-reduced ejection fraction (HFREF), and to evaluate the influence of the polymorphisms in response to beta-blocker (BB) therapy. METHODS: A total of 206 HFREF patients and 90 healthy controls were prospectively enrolled. Genotypes for Arg389Gly and Cyp2D6*10 polymorphisms of the healthy controls and 162 of the 206 heart failure (HF) patients were measured, identified by polymerase-chain-reaction- and restriction-fragment-length-polymorphism analysis. HFREF patients and healthy controls were compared regarding Arg389Gly polymorphism. The HFREF patients were separated into 2 subgroups based on achievement of maximal target dose (MTD) of BB. RESULTS: When comparing frequency of genotype distribution for Arg389Gly polymorphism in HFREF patients to the healthy controls, a statistically significant association was observed with CC genotype and Glisin-Glisin (GG) genotype (p<0.001, odds ratio [OR]=16, confidence interval [CI]: 3.8-67.9 and p<0.001, OR=0.3, CI: 0.2-0.6). Frequency of genotypes for Arg389Gly and Cyp2D6*10 polymorphism were similar in patients who could or could not achieve BB MTD (p=0.13 and p=0.60, respectively). CONCLUSION: The frequency of Arg389Gly polymorphism in patients with HFREF in the present Turkish population differed from that of the healthy controls. However, neither Arg389Gly polymorphism nor Cyp2D6*10 polymorphism was associated with dose tolerability of BB therapy.

Coronary artery fistula presenting as unstable angina pectoris in patients with antiphospholipid syndrome.

The cardiovascular system is one of the primary targets in patients with antiphospholipid syndrome. The valves are the most frequently affected. Atherosclerosis and coronary thrombosis are also seen. The risk of acute coronary syndrome is 10 times higher in patients with APS. We present an APS patient case who was hospitalized with acute coronary syndrome and who was later found to have coronary artery fistula.