Biochemical parameters and clinical outcomes of carbon monoxide poisoning in special groups: children, pregnant women, and the elderly.

OBJECTIVE: Carbon monoxide (CO), a toxic gas, poses a significant threat to human health. Children, pregnant women, and elderly individuals are particularly vulnerable to this toxicity. This study aims to evaluate the demographic and clinical characteristics of pediatric, pregnant, and geriatric patients. PATIENTS AND METHODS: The study included pediatric, pregnant, and geriatric patients with a confirmed diagnosis of CO poisoning, excluding those with complete file data and those with carboxyhemoglobin (COHb) levels below 5% (for children and pregnant patients) and 10% (for elderly patients). Patients aged < 18 years, > 65 years, and pregnant patients admitted to the adult and pediatric emergency departments were included in the study; statistical analyses were conducted using SPSS Inc., with a p-value of < 0.05 considered statistically significant. RESULTS: For pediatric patients, a statistically significant difference was observed between the two groups in terms of their main complaints, which were primarily attributed to neurological and general symptoms. A positive correlation was found between follow-up time and several factors, including white blood cell (WBC) count and troponin, lactate, lactate dehydrogenase (LDH), and COHb levels. For pregnant patients, no in-hospital mortality was observed in the patients included in this study. A significant negative correlation was identified between age and both COHb and hemoglobin (Hb) levels. A strong positive correlation was found between the COHb levels and hospital follow-up time. For elderly patients, no significant differences were found between the two treatment modalities. Notably, higher COHb levels on admission were associated with a more fatal in-hospital course, with COHb levels > 40% of all patients requiring intubation. CONCLUSIONS: Vulnerable populations are at increased risk of exposure to CO, and the study results emphasize the necessity of heightened awareness and preventive measures to safeguard these individuals from CO poisoning.

How reliable is assessment of true vocal cord-arytenoid unit mobility in patients affected by laryngeal cancer? a multi-institutional study on 366 patients from the ARYFIX collaborative group.

PURPOSE: In clinical practice the assessment of the "vocal cord-arytenoid unit" (VCAU) mobility is crucial in the staging, prognosis, and choice of treatment of laryngeal squamous cell carcinoma (LSCC). The aim of the present study was to measure repeatability and reliability of clinical assessment of VCAU mobility and radiologic analysis of posterior laryngeal extension. METHODS: In this multi-institutional retrospective study, patients with LSCC-induced impairment of VCAU mobility who received curative treatment were included; pre-treatment endoscopy and contrast-enhanced imaging were collected and evaluated by raters. According to their evaluations, concordance, number of assigned categories, and inter- and intra-rater agreement were calculated. RESULTS: Twenty-two otorhinolaryngologists evaluated 366 videolaryngoscopies (total evaluations: 2170) and 6 radiologists evaluated 237 imaging studies (total evaluations: 477). The concordance of clinical rating was excellent in only 22.7% of cases. Overall, inter- and intra-rater agreement was weak. Supraglottic cancers and transoral endoscopy were associated with the lowest inter-observer reliability values. Radiologic inter-rater agreement was low and did not vary with imaging technique. Intra-rater reliability of radiologic evaluation was optimal. CONCLUSIONS: The current methods to assess VCAU mobility and posterior extension of LSCC are flawed by weak inter-observer agreement and reliability. Radiologic evaluation was characterized by very high intra-rater agreement, but weak inter-observer reliability. The relevance of VCAU mobility assessment in laryngeal oncology should be re-weighted. Patients affected by LSCC requiring imaging should be referred to dedicated radiologists with experience in head and neck oncology.

Increased gallstone formation after sleeve gastrectomy and the preventive role of ursodeoxycholic acid.

BACKGROUND AND STUDY AIMS: To investigate the incidence of gallstone formation, and the use of Ursodeoxycholic Acid (UDCA), weight loss and serum lipid profile changes following obesity surgery. PATIENTS AND METHODS: Patients who underwent bariatric surgery due to obesity were retrospectively reviewed and divided into 2 groups for their prophylactic UDCA use. Patients who had a previous gallbladder pathology and ones who did not have a preoperative ultrasonography (US) were excluded. The patients who have returned to our clinic for a control ultrasound between 6 and 18 months following the surgery were included in this study, but only if they did not have any gall bladder pathology demonstrated with an US prior to surgery. Body mass index (BMI) and lipid profile measurements were also recorded. RESULTS: Of the 108 patients who had undergone obesity surgery, it is reported that 42 (38.9%) were given UDCA as a preventative medication, and 66 (61.1%) were not prescribed any preventative medications. During the ultrasound controls in the postoperative period between 6 and 18 months after surgery, gallbladder stones were seen in 42 patients (38.9%) and biliary sludge development was detected in 5 patients (4.6%). A total of 47 patients (43.5%) developed gallbladder pathology. Fewer patients who took UDCA developed gallstones when compared with the patients who did not take UDCA (10% vs 33%). Also, there is a correlation between BMI loss rate and the frequency of gallstone development. Though the decrease in triglyceride (TG) levels was higher in patients with gallstone development, this decrease was not statistically significant. CONCLUSIONS: Stone or sludge development in the gallbladder due to rapid weight loss after obesity surgery is quite common. However, we observed that the gallstone development decreased significantly with the prophylactic use of UDCA in patients who had undergone obesity surgery.

Cerebellar cognitive-affective syndrome preceding ataxia associated with complex extrapyramidal features in a Turkish SCA48 family.

SCA48 is a novel spinocerebellar ataxia (SCA) originally and recently characterized by prominent cerebellar cognitive-affective syndrome (CCAS) and late-onset ataxia caused by mutations on the STUB1 gene. Here, we report the first SCA48 case from Turkey with novel clinical features and diffusion tensor imaging (DTI) findings, used for the first time to evaluate a SCA48 patient. A 65-year-old female patient with slowly progressive cerebellar ataxia, cognitive impairment, behavioral changes, and a vertical family history was evaluated. Following the exclusion of repeat expansion ataxias, whole exome sequencing (WES) was performed. Brain magnetic resonance imaging (MRI), including DTI, and single-photon emission computed tomography (SPECT) were used to study the primarily affected tracts and regions. WES revealed the previously reported heterozygous truncating mutation in ubiquitin ligase domain of STUB1 (ENST00000219548:c.823_824delCT, ENSP00000219548:p.L275Dfs*16) leading to a frameshift. Patient's cognitive status was compatible with CCAS. Novel clinical features different from the original report include later onset chorea, dystonia, general slowness of movements, apraxia, and palilalia, some of which have been recently reported in two families with different STUB1 mutations. CCAS is a prominent and often early feature of SCA48 which may be followed years after the onset of the disease by other complex neurological signs and symptoms. DTI may be helpful for demonstrating the cerebello-frontal tracts, involved in CCAS-associated SCA48, the differential diagnosis of which may be challenging especially in its early years.

Shorter time to begin of QRS fragmentation predicts non-response to cardiac resynchronization therapy in non-ischemic heart failure patients. / El inicio rápido de la fragmentación del QRS predice la no respuesta a la terapia de resincronización cardíaca en pacientes con insuficiencia cardíaca no isquémica.

OBJECTIVE: Cardiac resynchronization therapy (CRT) is an effective option in the treatment of patients with heart failure and wide QRS. Presence of fragmented QRS (f-QRS) on 12-lead electrocardiogram (ECG) has been shown to be associated with non-response to CRT. The aim of this study was to evaluate whether onset of fragmentation (Q-f interval) is important for CRT response. METHODS: This is a single-center retrospective analysis of prospectively collected data of 38 non-ischemic dilated cardiomyopathy patients (18 men, mean age 63±12 years) with f-QRS on 12-lead ECG who underwent CRT. Duration of fragmentation, ratio of f-QRS duration to the total QRS duration (f-QRS/t-QRS ratio) and time interval from Q wave to the onset of QRS fragmentation (Q-f interval) were measured. RESULTS: The baseline clinical, echocardiographic findings of patients with responders (24 patients, 63%) and non-responders showed no statistically significant difference, except for longer f-QRS duration, increased ratio of f-QRS duration to the total QRS duration (f-QRS/t-QRS ratio) and shorter time interval from Q wave to the onset of QRS fragmentation (Q-f interval) in patients not responding to CRT. In multivariate analysis, Q-f interval was determined as an independent predictor of response to CRT (OR 1.240, 95% CI: 1.049-1.467, P=.012). In ROC curve analysis, the best cut-off value for Q-f interval to predict responders was 32.5ms with a sensitivity and specificity of 83.3% and 85.7%, respectively (AUC 0.899, 95% CI: 0.797-1.000, P=.001). CONCLUSIONS: Shorter time from onset of QRS to beginning of fragmentation is a simple ECG marker to predict non-responsive patients to CRT.

Association of pyrin mutations and autoinflammation with complex phenotype hidradenitis suppurativa: a case-control study.

BACKGROUND: Hidradenitis suppurativa (HS) is a rare, debilitating neutrophilic dermatosis characterized by chronic inflammation of hair follicles. Many inflammatory conditions may accompany HS. OBJECTIVES: To investigate the association of variants of the MEFV gene with a complex HS phenotype. METHODS: Firstly, we identified the clinical characteristics of 119 patients with HS with a complex phenotype (Hurley stage III disease and/or additional inflammatory symptoms). Then, we searched for MEFV variants among these patients. The odds ratios (ORs) for pathogenic MEFV mutations were calculated using data from these patients with HS and 191 healthy controls. RESULTS: The male/female ratio was higher, and the mean age of onset was earlier, in our complex HS group compared with patients with HS in general. Five of the patients with HS (4·2%) had a diagnosis of familial Mediterranean fever (FMF) with a standardized morbidity ratio of 45 [95% confidence interval (CI) 16·50-99·84, P < 0·001] when compared with the frequency of FMF in the general Turkish population. Of the patients with complex HS, 38% were positive for pathogenic variants of MEFV. The OR for carrying a pathogenic MEFV allele was 2·80 (95% CI 1·31-5·97, P < 0·001). CONCLUSIONS: The frequency of MEFV mutations in the group of patients with complex HS was higher than that in healthy controls, suggesting that MEFV mutations may contribute to the pathogenesis of HS. Understanding the role of autoinflammation in HS is of fundamental importance for the development of novel therapies.

A practical approach to ichthyoses with systemic manifestations.

Inherited ichthyoses are rare disorders in terms of patient numbers, but abundant in terms of clinical-genetic subtypes. These disorders are often associated with severe systemic manifestations, in addition to significant medical, cosmetic and social problems. There are 17 subtypes of syndromic ichthyosis identified so far and most patients with these syndromes are living in countries with high consanguinity rates. Frequently, clinicians cannot make a definitive diagnosis and patients are not managed properly owing to the rarity and complexity of these disorders. These difficulties make this group of ichthyosis and the patients living with them 'orphan'. After skin and skin appendages, nervous system is the most frequently involved system in ichthyosis syndromes. Thus, association of ichthyosis with neurological symptoms provides an important clue for diagnosis. In this article, we aim to increase clinicians' comprehension of ichthyosis syndromes by providing a symptomatology-based approach based on this observation. Additionally, we provide a review of ichthyosis syndromes, with special emphasis on neurological symptoms, hoping to attract interest to this complicated field.

The role of neutrophil to lymphocyte ratio as a predictor of diastolic dysfunction in hypertensive patients.

OBJECTIVE: Neutrophil to lymphocyte ratio (NLR) is a novel parameter for cardiovascular research area. The higher values of NLR have been found to be associated with worse clinical outcomes in atherosclerotic heart disease, heart failure, heart valve disease and other various cardiovascular disorders. Although the relationship between NLR and almost all cardiovascular disorders have been investigated, the association between NLR and diastolic dysfunction remains unclear. We herein evaluated the association between NLR and diastolic dysfunction. PATIENTS AND METHODS: The study population consisted of 41 hypertensive patients with any grade of diastolic dysfunction and 41 hypertensive patients without diastolic dysfunction determined by echocardiographic evaluation constituted the control group. RESULTS: Mean NLR value was found to be 2.07 ± 0.82 in the diastolic dysfunction group while the control group had a mean value of 1.69 ± 0.60 (p = 0.020). The patients with diastolic dysfunction had significantly higher values of NLR. When grades of diastolic dysfunction were evaluated, NLR was 1.80 ± 0.82, 2.32 ± 0.73 and 2.75 ± 0.45 in patients with grade 1, grade 2 and grade 3 diastolic dysfunction, respectively. The patients with higher grade of diastolic dysfunction had higher values of NLR (p = 0.001). None of the other hematologic parameters differed significantly in patients with diastolic dysfunction when compared to controls. CONCLUSIONS: Patients with diastolic dysfunction had higher values of NLR compared to subjects without diastolic dysfunction. Furthermore higher grades of diastolic dysfunction were associated with higher levels of NLR. Further studies are needed to search the possible use of NLR as a marker for prognostic stratification in diastolic dysfunction which is associated with worse cardiovascular outcomes.

Apical hypertrophic cardiomyopathy--case report and review of the literature.

Hypertrophic cardiomyopathy is a well-known clinical entity. Hypertrophy engraving the left ventricular apex, so called, apical hypertrophic cardiomyopathy (characterized by the giant negative T waves at ECG and a "spade-like" view of left ventricle) is very rare variant of the pathology. In this report, we present a 51-year-old patient with apical hypertrophic cardiomyopathy together with a brief review of the literature. It was concluded that in patients presenting to the clinic with typical or atypical chest pain or dyspnea, in whom ECG indicating negative giant T waves, before an early invasive strategy, the diagnosis of ApHCM should be kept in mind and an echocardiography should be performed to confirm the diagnosis. Additionally; not only the ApHCM can easily mimic the life threatening condition of acute coronary syndrome but also these two may be seen simultaneously but independently in the same patient. For this reason before making the final diagnosis the physicians always exclude the conditions, which may lead to acute coronary syndromes.

Rhinocerebral mucormycosis: experience in 14 patients.

OBJECTIVE: Mucormycosis is an opportunist, often lethal fungal infection which occurs in immunocompromised patients. We present our experience in 14 patients with this condition. PATIENTS AND METHODS: A retrospective chart review was conducted for 14 patients treated for rhinocerebral mucormycosis. RESULTS: Nine patients had diabetes mellitus and six had a haematological malignancy. Nine patients had cutaneous and/or palatal necrosis. Eleven patients were treated with amphotericin B and five with liposomal amphotericin B. Endoscopic sinus surgery was performed in five patients with disease limited to the sinonasal cavity; nine patients underwent more extensive surgery. Five patients with disease limited to the sinonasal cavity survived, while nine patients with widely disseminated disease died. Five of the nine diabetic patients died, as did five of the six patients with haematological malignancy. CONCLUSION: Patients with rhinocerebral mucormycosis spreading outside the sinonasal cavity have a poor prognosis.

Electron microscopy of contractile bands and quality characteristics in high-voltage electrical stimulation broiler breast meat.

In this study, 20 broilers were used to examine the effect of high-voltage electrical stimulation (HVES) on meat quality and the microstructure of the pectoralis muscle. After slaughter, carcasses were randomly distributed into 2 treatment groups (n = 10). In the first group, carcasses were electrically stimulated (500 V, 100 Hz) for 60 s. Carcasses in the second group (nonelectrical stimulation) were used as a control. Meat quality was evaluated by the rate of pH, water-holding capacity, cooking loss, color (L*, a*, b*), shear force, and sarcomere length. As a result, HVES increased the rate of muscle pH decline (P < 0.001). High-voltage electrical stimulation had no effect on water-holding capacity and cooking loss values. Only L* (lightness) values were improved during the storage time (P < 0.01). Tenderness (P < 0.001) and sarcomere length (P < 0.05) values were significantly increased at 2 and 5 d postmortem. In addition, microstructure examination demonstrated that the stimulated muscles had longer sarcomeres; however, the A-, I-, and Z-bands and the mitochondrial membrane structure were intact in HVES and nonelectrically stimulated carcasses. The results showed that HVES is a useful method for improving the tenderness of broiler breast meat.

An adult case of giant bronchogenic cyst mimicking tension pneumothorax.

Bronchogenic cysts are usually discovered only incidentally in the adult. A giant bronchogenic cyst in a 19-year-old woman presenting with pain and shortness of breath was mistaken for tension pneumothorax and initially treated with tube thoracostomy. Giant bullae were diagnosed by computed tomography. Bullae resection was undertaken, but the remaining lung tissue required pneumonectomy. Pathologic examination of the specimen confirmed bronchogenic cyst.

Effects of metabolic syndrome on early mortality and morbidity in coronary artery bypass graft patients.

Metabolic syndrome is a well-known cardiovascular risk factor closely related to increased insulin resistance. This study assessed the effects of metabolic syndrome on early post-operative mortality and morbidity in 100 coronary artery bypass graft (CABG) patients: 50 patients with and 50 without metabolic syndrome. A total of 17 patients were excluded from the analysis as they did not attend follow-up, leaving 51 males (61.4%) and 32 (38.6%) females of mean +/- SD age 60.02 +/- 9.76 years for analysis. Diabetes, hypertension and a high body mass index were significantly more common in patients with metabolic syndrome. A statistically significant relationship was found between metabolic syndrome and surgical wound infection. Non-significant positive correlations were found between metabolic syndrome and post-operative atrial fibrillation, surgical revision due to haemorrhage, ventricular tachycardia and ventricular fibrillation, and prolonged intubation. In conclusion, metabolic syndrome did not affect mortality, but did increase the risk of post-operative surgical wound infection.

Reconstruction of orbital floor fractures using autologous nasal septal bone graft.

We describe herein a new technique for reconstruction of the orbital floor, using autologous nasal septal bone and report the surgical results achieved in maxillofacial trauma patients.Prior to its clinical surgical application, a cadaver practice was carried out on 5 formalin-fixed adult human cadavers to establish the feasibility and efficacy of the method. Fifteen patients with orbital floor fractures, operated between 2005 and 2008, using this technique, were included in the current study.Cadaveric practice revealed that an adequate and appropriate size of septal bone graft can be harvested for reconstruction of the orbital floor. All patients except one had satisfactory clinical and radiologic late results. One patient experienced persistent enophthalmos, possibly due to delayed repair and associated displaced zygomatic bone fracture.Autologous nasal septal bone as an orbital floor bone graft has many advantages, including low donor site morbidity, adequacy and appropriateness of size, and similarity of its bicortical morphology and histologic nature compared with the orbital floor bone. Our clinical results strongly support that this technique can become a satisfactory alternative to existing reconstruction methods.

[Thienopyridines in the treatment and prevention of cardiovascular diseases. III. therapeutic application of clopidogrel as monotherapy (without acetylsalicylic acid)].

In a series of articles the authors consider clinical pharmacology and experience of clinical application of blockers of platelet P2Y12 receptors, most well known representatives of which ticlopidine and clopidogrel according to chemical structure belong to thienopyridine derivatives. In the third communication we consider data of randomized studies in which efficacy and safety of clopidogrel monotherapy has been assessed in comparison with acetylsalicylic acid (ASA), ticlopidine, warfarin, as well as ASA in combination with extended release form of dipyridamole in various cardio-vascular diseases. Results of these studies indicate that efficacy of monotherapy with clopidogrel is comparable with that of ASA, ticlopidine, warfarin, and ASA in combination with extended release form of dipyridamole. Clopidogrel significantly more rarely causes ulcerogenic and other hemorrhagic complications than ticlopidine, but is substantially more expensive. Therefore prescribing of clopidogrel as monotherapy is justified only in those cases when ASA and ticlopidine are contraindicated or induce pronounced side effects.

[Thienopyridines in the treatment and prevention of cardiovascular diseases. Part IV. therapeutic application of clopidogrel in combination with acetylsalicylic acid in acute coronary syndromes and percutaneous coronary interventions].

In a series of articles the authors consider clinical pharmacology and experience of clinical application of blockers of platelet P2Y12 receptors, most well known representatives of which ticlopidine and clopidogrel according to chemical structure belong to thienopyridine derivatives. In the forth communication we consider data of randomized studies in which efficacy and safety of clopidogrel in combination with has acetylsalicylic acid (ASA) been assessed in comparison with (ASA) in various acute coronary syndromes (ACS), as well as before, during, and after percutaneous coronary interventions (PCI). In ACS it is recommended to start therapy with clopidogrel with 300 mg loading dose with subsequent transition to maintenance dose 75 mg/day. Preliminary therapy with clopidogrel (in combination with ASA) before emergent or elective PCI significantly decreases risk of development of unfavorable clinical outcomes. In PCI loading dose of clopidogrel is 300-600 mg while duration of maintenance therapy (75 mg/day) depends on the type of used coronary stent. After implantation of bare stent duration of therapy with clopidogrel should be not less than 1 month (ideally no less that 12 months) and after implantation of drug-eluting stent - not less than 12 months.

[Thienopyridines in the treatment and prevention of cardiovascular diseases. Part II. Clinical pharmacology of clopidogrel].

In a series of articles the authors consider clinical pharmacology and experience of clinical application of blockers of platelet P2Y12 receptors, most well known representatives of which ticlopidine and clopidogrel according to chemical structure belong to thienopyridine derivatives. In the second communication we describe in detail clinical pharmacokinetics and pharmacodynamics of the most often used thienopyridine derivative - clopidogrel. We discuss results of randomized studies and clinical observations which have shown that pharmacokinetics of clopidogrel might vary substantially in dependence of polymorphisms of genes responsible for synthesis of P2Y12 receptors of platelets or cytochromic isoenzymes P-450 CYP of liver with participation of which formation of active metabolite of clopidogrel occurs. Contrary to practically healthy people in patients with various forms of ischemic heart disease (IHD) concomitant therapy, for instance some statins and calcium antagonists, can affect clopidogrel pharmacokinetics. Pharmacodynamics of clopidogrel in patients with IHD with acute coronary syndrome or diabetes mellitus or before percutaneous coronary interventions (PCI) also differs from that in healthy people, because in these patients hyperaggregation of platelets takes place initially and antiaggregatory action of clopidogrel is less expressed. In 10-30% of patients with IHD partial or complete resistance to antiaggregation action of clopidogrel is detected, which according to some observations is combined with elevated risk of thrombotic cardiac complications after PCI. Possible causes of resistance to clopidogrel and ways of its overcoming are discussed.