ST-segment elevation myocardial infarction without culprit lesion-a case report picturing the challenging interplay of epicardial atherosclerosis and coronary artery spasm.

Background: Approximately 5-15% of patients with acute coronary syndrome have myocardial infarction with unobstructed coronary arteries (MINOCA). Guidelines recommend invasive assessments to identify underlying causes for MINOCA such as coronary artery spasm (CAS), spontaneous coronary dissection, or microvascular disease as well as non-invasive assessments in search of myocarditis, takotsubo syndrome, or cardiomyopathies. Case summary: A 54-year-old male patient presented with ST-segment elevation myocardial infarction (STEMI). Upon arrival, ST-segment elevation and symptoms had ceased. Emergency coronary angiography showed diffuse epicardial atherosclerosis with stenoses in the distal left anterior descending coronary artery (LAD) and second diagonal branch (D2); however, no epicardial occlusion was seen. Left ventriculography showed no clear wall motion abnormalities. Based on these findings, intracoronary acetylcholine (ACh) testing in search of CAS was performed. At 200 µg ACh intracoronary ST-segment elevation and chest pain recurred. Angiography showed occlusive epicardial spasm in the LAD and D2. Based on studies where the tendency of epicardial CAS was linked with the presence of epicardial atherosclerosis, the decision was made to perform PCI in the LAD and D2. ACh re-challenge after intracoronary nitroglycerine revealed only very mild symptoms, no demonstrable epicardial CAS, and no ST-segment elevation anymore. Cardiac enzymes reached their peak on day one [creatine kinase max 262 U/L (norm < 190 U/L), maximum of high-sensitivity troponin T 269 pg/mL (n < 14 pg/mL)]. Discussion: There is a broad spectrum of patients with STEMI without culprit lesion regarding the extent of epicardial disease. In cases with an unclear culprit lesion, other causes for the acute presentation such as CAS should be investigated in an ad hoc fashion. The interplay of epicardial atherosclerosis and CAS should receive more attention in future trials.

Investigation of the in vitro and in vivo therapeutic activity of Tarantula cubensis extract (Theranekron ® ) on Leishmania major.

BACKGROUND OBJECTIVES: Cutaneous leishmaniasis (CL) is a vector-borne parasitic disease caused by several species of the protozoan parasite Leishmania. The need for new anti-leishmanial drugs for the treatment of CL is highlighted by factors such as high cost, toxicity, potential for resistance and limited long-term use of existing anti-leishmanial drugs. The aim of this study was to investigate the therapeutic effect of Tarantula cubensis alcoholic extract (TCE), which has been shown to have wound-healing, anti-inflammatory, regenerative, resolving and epithelialising effects, on L. major promastigotes in vitro and in vivo in an experimental mouse model of CL. METHODS: The effect of TCE on L. major promastigotes in vitro was investigated after determination of non-cytotoxic concentrations of TCE using the XTT method. To establish a CL model, L. major amastigotes were injected into the paws of BALB/c mice. Lesion size and histopathological evaluation were used to assess the effect of treatment. RESULTS: TCE was found to be effective against L. major promastigotes at 24 h and 48 h at concentrations of 250 µg/mL, 125 µg/mL and 62.5 µg/mL ( P <0.05). TCE was found to be more effective than meglumine antimonate in treating CL in the experimentally induced CL model in BALB/c mice. INTERPRETATION CONCLUSION: The results suggest that TCE holds promising potential therapeutic agent for the treatment of CL. However, further extensive investigations are required to substantiate and expand understanding in this area.

Investigation of Head Lice and Intestinal Parasites in Primary and Secondary School in Sivas.

Objective: The purpose of this study was to investigate the prevalence of intestinal parasites and head lice in primary school-aged children and to determine a possible relationship between the co-occurrence of ecto-endoparasites. Methods: The study were conducted in three schools in the center of Sivas: Sivas Karsiyaka Primary School, Kilavuz IMKB Primary School, and Karsiyaka 27 June Middle School. The presence of head lice and intestinal parasites was investigated in a total of 563 children aged 6 to 17, with 294 girls and 269 boys. Classroom teachers and students were provided with information about intestinal parasites, head lice, and methods of transmission and prevention, and a questionnaire was administered. During the head lice examination, students were inspected with a comb, and samples with nits were examined under a microscope in the laboratory. Cellophane tape and stool samples obtained from the participants were examined on the same day using the native-lugol, flotation, and trichrome staining methods under a light microscope (x10, x40, x100). Results: Five hundred sixty-three children were evaluated for head lice and 15 (2.6%) were found to be positive. During the examination, only nits were found in 11 students (1.9%), and both adult lice and nymphs were seen in 4 students (0.7%). Head lice were found positive in 2 out of 269 boys (0.7%), while 13 out of 294 girls (4.2%) positive (p<0.05). As a result of stool examination in children, Entamoeba coli was found in 11 (1.95%), Giardia intestinalis in 4 (0.71%), Blastocystis sp. in 14 (2.48%), Enterobius vermicularis in 8 (1.42%) and Taenia spp. in 2 (0.35%). Head lice infestation and Taenia spp. were found to coexist in 2 (0.35%) children. Conclusion: In conclusion, although there has been a noticeable decrease in head lice and intestinal parasites among primary school-aged children in Sivas province, these conditions are still present, as evidenced by previous studies conducted in our region.

Increased trace amine-associated receptor 1 (TAAR1) expression is associated with a positive survival rate in patients with breast cancer.

PURPOSE: A correlation between breast cancer and thyroid disorders has been described in previous studies. Degraded thyroid hormones are referred to as trace amines. These endogenous amines have the ability to bind to the G-protein-coupled receptor TAAR1 (trace amine-associated receptor) and thereby activate it. TAAR1 is able to modulate the serotonergic and dopaminergic system in the brain and has so far been studied in the neurological field. The following study represents the first investigation of the regulation of TAAR1 in primary breast cancer (no metastases, M0). METHODS: Immunohistochemical analyses were carried out to detect TAAR1 expression in formalin fixed paraffin embedded breast cancer samples. Survival times of primary breast cancer patients (M0) with and without TAAR1 expression in their tumours were compared by Kaplan-Meier curves, and correlations between ordinal variables were determined with Spearman's rank correlation coefficient. RESULTS: The investigation showed a correlation between TAAR1 expression and tumour differentiation grade. A well differentiated tumour grade (G1) was associated with higher TAAR1 expression and HER2 and HER4 positivity predicted higher TAAR1 expression. A TAAR1 overexpression (IRS ≥ 6) was associated with significantly longer overall survival (OS) (p = 0.02) than that of reduced TAAR1 expression (IRS < 6) during a maximum follow-up of 14 years, demonstrating that TAAR1 has a favourable effect on OS of early breast cancer patients. CONCLUSIONS: We conclude that TAAR1 seems to be an independent predictor for breast cancer survival. Modulation of TAAR1 may represent a novel targeting strategy for breast cancer prevention and therapy.