A rare cause and an even rarer treatment of hypertension in a 5-year-old boy: Mid-aortic syndrome.

Renal artery stenosis is one of the common vascular diseases that cause hypertension in children. However, renal artery aneurysms and abdominal aortic aneurysms, which may be components of mid-aortic syndrome, are rarely associated with renal artery stenosis. Despite its rarity, early diagnosis and treatment are critical to prevent fatal complications. Currently, non-surgical invasive techniques are considered the first choice for treatment, but in some cases, surgery is inevitable. Here, we present a 5-year-old boy with a mid-aortic syndrome. The patient presented with a history of severe headache and epistaxis 5-6 times a day and was diagnosed with hypertension. A 9 × 9 mm saccular aneurysm on the anterior surface of the abdominal aorta at the level of the left renal artery ostium, and a 12 mm aneurysm in the left renal artery after a stenotic segment at the hilum level was detected in the doppler USG and contrast-enhanced imaging techniques. The patient was operated on electively. We used a PTFE patch to repair the abdominal aorta and, saphenous vein which was taken from his father to repair the renal artery. The patient recovered well and was discharged on the 18th day.

A Prospective Study on Activities of Daily Living, Comfort, Body Image, and Cardiac Symptoms in Coronary Artery Bypass Patients.

BACKGROUND: A coronary artery bypass graft procedure reduces mortality for cardiovascular patients, but those undergoing it often face negative body perception, loss of daily activities, and lingering symptoms, hindering full functional recovery and comfort. AIM: To compare the comfort level, activities of daily living, and body image based on certain characteristics of patients at baseline, (ii) Evaluate changes over time in levels of discomfort, activities of daily living, body image, and cardiac symptoms before and after CABG surgery within three months. METHOD: This descriptive prospective cohort study comprised 50 patients scheduled for coronary artery bypass surgery. The study examined cardiac symptoms, comfort levels, daily activities, and multidimensional body-self relationships as its outcomes. RESULTS: A Friedman test revealed that patients' body image, comfort levels, activities of daily living, and each heart symptom were significantly influenced by the time of day. According to this study, patients most frequently reported experiencing exhaustion, depression, and worry as cardiac symptoms. Only the comfort level exhibited a high correlation with each heart symptom, as indicated by Spearman's rho analysis. CONCLUSION: The body image, comfort level, activities of daily living, and cardiac symptoms of patients changed over time. Therefore, regular assessments of these symptoms during the pre- and post-operative periods could offer valuable insights into patients' needs. This information can be instrumental in developing interventions that address patients' well-being and may positively impact patient outcomes.

The prevalence of poor sleep quality and its association with the risk of obstructive sleep apnea and restless legs syndrome in diabetic patients treated with cyanoacrylate glue for varicose veins.

PURPOSE: This study aimed to assess the prevalence of poor sleep quality and to describe its predictors in diabetic patients having chronic venous insufficiency and varicose veins treated with cyanoacrylate glue. METHODS: This single-center, prospective cohort study was conducted between March 2018 and March 2021. A total of 103 patients with diabetes mellitus and chronic venous insufficiency (CEAP classification at stages C3-C6) treated with cyanoacrylate glue for varicose veins were recruited. A questionnaire form, Pittsburg Sleep Quality Index, Berlin Questionnaire, and Diagnostic Criteria for Restless Legs Syndrome were used for data collection. A Doppler USG assessment was performed in the first clinical examination. RESULTS: Almost half of the participants had had diabetes mellitus for 10 years or more, and 52% had good glucose control. Among the study sample, 61% were poor sleepers, 47% of the participants were RLS positive, and 51% had a high risk of sleep apnea. RLS, HbA1c, and dressing at home had positive associations with poor sleep quality (p < 0.05) on the fifth day after the peripheral embolization. One month after the operation, participants had better sleep quality; however, there were no statistically significant differences between the assessments of RLS and the risk of OSA compared to the fifth day after the operation (p > 0.05). CONCLUSIONS: This prospective study showed that restless legs syndrome, a high level of HbA1c, and dressed injection area of the skin are associated with poor sleep quality in patients with diabetes having chronic venous insufficiency and varicose veins treated with cyanoacrylate glue. Additionally, participants had better sleep quality 1 month after the peripheral embolization compared to the fifth day after the operation.

Relationships between sleep, quality of life and anxiety in patients undergoing cardiac surgeries.

OBJECTIVE: the objective of this study is to examine the relationships between sleep, quality of life and anxiety in patients undergoing cardiac surgeries during the preoperative period, at discharge, two weeks after discharge and three months after discharge. METHOD: this study had a prospective, descriptive and correlational design and was conducted in a single center. The sample consisted of 68 patients who had undergone cardiac surgeries. The data were collected using an Information Form, the State-Trait Anxiety Inventory, the Richard-Campbell Sleep Questionnaire and the Nottingham Health Profile. RESULTS: the patients' sleep quality increased from moderate to good at each measurement moment after the surgeries, when compared to sleep quality measured at their first hospitalization. While the state anxiety scores decreased at discharge and 2 weeks after the initial hospitalization, they increased to a moderate level 3 months after discharge. There was no significant relationship between anxiety levels and sleep quality at any measurement moment. Additionally, the patients' quality of life was significantly improved 2 weeks and 3 months after discharge. CONCLUSION: The results of this study showed that the sleep quality of patients who had undergone cardiac surgeries was improved during the postoperative period, and that this improvement exerted a positive effect on their quality of life.

Assessment of Aspirin and Clopidogrel Resistance in Patients Undergoing Cardiovascular Surgery: A Single-Center Cross-Sectional Study

Objective: We aimed to investigate antiplatelet drug resistance utilizing light transmission-lumiaggregometry (LT-LA) and the Platelet Function Analyzer-100 (PFA-100) in patients undergoing cardiovascular surgery. Materials and Methods: The study included 60 patients diagnosed with stable coronary artery disease and peripheral vascular diseases that required surgery. Participants were divided into three groups: patients receiving aspirin (ASA) (n=21), patients receiving clopidogrel (CLO) (n=19), and patients receiving dual therapy (ASA+CLO) (n=20). Aggregation and secretion tests by LT-LA and closure time by the PFA-100 were used to measure antiplatelet drug resistance. Results: Based on the adenosine diphosphate (ADP)-induced aggregation test, 43% of patients were resistant to ASA, 22% to CLO, and 15% to dual therapy. Diabetes, hypertension, and hyperlipidemia were the most commonly identified comorbid disorders. In patients with comorbid risk factors, the median value of platelet aggregation response to ADP was significantly higher in the ASA group than in the CLO and dual therapy groups (p=0.0001). In patients receiving ASA monotherapy, the maximum amplitude of aggregation response to platelet agonists was ≥70% in 43% of patients for ADP and 28% for collagen by LT-LA. Elevated ADP (≥0.29 nmol) and collagen (≥0.41 nmol)-induced adenosine triphosphate release were found by LT-LA in 66% of patients utilizing an ADP agonist and 80% of patients using a collagen agonist undergoing ASA therapy. Closure times obtained with the PFA-100 were normal in 28% of patients using collagen-ADP cartridges and 62% of patients using collagen-epinephrine (CEPI) cartridges who received ASA. Recurrent thrombosis and bleeding were observed in 12 (20%) patients with cardiovascular disease. Three of these individuals (25%) showed ASA resistance with normal responses to ADP-induced aggregation (≥70%) and secretion (≥0.29 nmol), as well as normal CEPI closure times. Conclusion: Our findings suggest that antiplatelet drug monitoring by LT-LA and PFA-100 may be useful for high-risk and complicated cardiovascular patients.

Pericardiectomy after constrictive pericarditis associated with second dose of BNT162b2 vaccine: A case report.

Constrictive pericarditis is quite rare complication of messenger ribonucleic acid-based severe acute respiratory syndrome-Coronavirus 2 (SARS-CoV-2) vaccine. It is a severe clinical picture with clinical symptoms of right ventricular failure. Initial physical examination, laboratory work-up, and chest X-ray may yield non-specific findings. Echocardiography, computed tomography, and cardiac catheterization are other diagnostic tools. Surgery with pericardiectomy is the definitive treatment option. Herein, we report a case of pericardiectomy after constrictive pericarditis associated with the second dose of BNT162b2 vaccine.

Evaluation of the effect of enriched hydrogen saline solution on distant organ (lung) damage in skeletal muscle ischemia reperfusion in rats.

INTRODUCTION: Ischemia-reperfusion (IR) injury is a major concern that frequently occurs during vascular surgeries. Hydrogen-rich saline (HRS) solution exhibits antioxidant and anti-inflammatory properties. This study aimed to examine the effects of HRS applied before ischemia in the lungs of rats using a lower extremity IR model. MATERIAL AND METHODS: After approval was obtained from the ethics committee, 18 male Wistar albino rats weighing 250-280 g were randomly divided into three groups: control (C), IR and IR-HRS. In the IR and IR-HRS groups, an atraumatic microvascular clamp was used to clamp the infrarenal abdominal aorta, and skeletal muscle ischemia was induced. After 120 min, the clamp was removed, and reperfusion was achieved for 120 min. In the IR-HRS group, HRS was administered intraperitoneally 30 min before the procedure. Lung tissue samples were examined under a light microscope and stained with hematoxylin-eosin (H&E). Malondialdehyde (MDA) levels, total sulfhydryl (SH) levels, and histopathological parameters were evaluated in the tissue samples. RESULTS: MDA and total SH levels were significantly higher in the IR group than in the control group (p < 0.0001 and p = 0.001, respectively). MDA and total SH levels were significantly lower in the IR-HRS group than in the IR group (p < 0.0001 and p = 0.013, respectively). A histopathological examination revealed that neutrophil infiltration/aggregation, alveolar wall thickness, and total lung injury score were significantly higher in the IR group than in the control group (p < 0.0001, p = 0.001, and p < 0.0001, respectively). Similarly, alveolar wall thickness and total lung injury scores were significantly higher in the IR-HRS group than in the control group (p = 0.009 and p = 0.004, respectively). A statistically significant decrease was observed in neutrophil infiltration/aggregation and total lung injury scores in the IR-HRS group compared to those in the IR group (p = 0.023 and p = 0.022, respectively). CONCLUSION: HRS at a dose of 20 mg/kg, administered intraperitoneally 30 min before ischemia in rats, reduced lipid peroxidation and oxidative stress, while also reducing IR damage in lung histopathology. We believe that HRS administered to rats prior to IR exerts a lung-protective effect.

Microstructural, Biomechanical, and In Vitro Studies of Ti-Nb-Zr Alloys Fabricated by Powder Metallurgy.

This study investigated the microstructures, mechanical performances, corrosion resistances, and in vitro studies of porous Ti-xNb-10Zr (x: 10 and 20; at. %) alloys. The alloys were fabricated by powder metallurgy with two categories of porosities, i.e., 21-25% and 50-56%, respectively. The space holder technique was employed to generate the high porosities. Microstructural analysis was performed by using various methods including scanning electron microscopy, energy dispersive spectroscopy, electron backscatter diffraction, and x-ray diffraction. Corrosion resistance was assessed via electrochemical polarisation tests, while mechanical behavior was determined by uniaxial compressive tests. In vitro studies, such as cell viability and proliferation, adhesion potential, and genotoxicity, were examined by performing an MTT assay, fibronectin adsorption, and plasmid-DNA interaction assay. Experimental results showed that the alloys had a dual-phase microstructure composed of finely dispersed acicular hcp α-Ti needles in the bcc ß-Ti matrix. The ultimate compressive strength ranged from 1019 MPa to 767 MPa for alloys with 21-25% porosities and from 173 MPa to 78 MPa for alloys with 50-56% porosities. Noted that adding a space holder agent played a more critical role in the mechanical behaviors of the alloys compared to adding niobium. The pores were largely open and exhibited irregular shapes, with uniform size distribution, allowing for cell ingrowth. Histological analysis showed that the alloys studied met the biocompatibility criteria required for orthopaedic biomaterial use.

Evaluation of physical activity level and exercise capacity in patients with varicose veins and chronic venous insufficiency.

OBJECTIVE: The clinical indication of chronic venous insufficiency (CVI) is related to functional performance and the benefits of physical activity in patients with CVI are known. Despite its importance, the literature is limited in this regard. This study aimed to determine exercise capacity and physical activity level in patients with varicose veins and CVI. METHODS: Volunteers who came to the polyclinic with leg pain complaints were enrolled in the study. Individual sociodemographic and clinical information was recorded. Individuals' pain severity was assessed by the visual analog scale (VAS) and exercise capacity was assessed by 6-minute walk test (6MWT). International Physical Activity Questionnaire (IPAQ) was used to assess the level of physical activity. RESULTS: The study group consisted of 51 individuals who were diagnosed with varicose veins and CVI. The control group consisted of 51 individuals without varicose veins and CVI diagnosis. In the study group, the VAS during activity was significantly higher compared to the control group. The 6MWT distance, distance %, IPAQ total score and IPAQ walking score of the control group were significantly higher in comparison with the study group (p<0.05). CONCLUSIONS: We believe that our findings will lead the planning of interventions to increase the level of physical activity in CVI patients.

Protective effect of erdosteine on erythrocyte deformability in a rat model of lower limb ischemia/reperfusion injury

Background/aim: The protective effect of erdosteine on local and distant organ injury due to ischemia/reperfusion has been well documented but its effect on erythrocyte deformability needs further investigation. Our aim was to investigate the effect of erdosteine on erythrocyte deformability in the infrarenal aorta of rats undergoing ischemia/reperfusion. Materials and methods: Our study was conducted with 18 Wistar albino rats. Rats were divided into 3 groups: a randomized control group (group 'control', n = 6), an ischemia/reperfusion group without erdosteine (group 'ischemia/reperfusion', n = 6), and an ischemia/reperfusion group with erdosteine at 150 mg kg−1, intraperitoneally (group 'ischemia/reperfusion - erdosteine', n = 6). Packs of erythrocytes were prepared from heparinized blood samples and deformability measurements were conducted. Results: Comparisons of the control and ischemia/reperfusion - erdosteine groups revealed similar results (P = 0.051). The values of the ischemia/reperfusion group were significantly higher than those of the control and ischemia/reperfusion - erdosteine groups (P < 0.0001 and P = 0.024, respectively). Relative resistance, a marker of erythrocyte deformability, was increased significantly by ischemia/reperfusion compared to the control and ischemia/reperfusion - erdosteine groups (P < 0.05). Conclusion: We detected unfavorable effects of ischemia/reperfusion on erythrocyte deformability, which may lead to disturbance in blood flow and hence tissue perfusion in the infrarenal rat aorta. We also found that erdosteine had beneficial effects by reversing undesirable effects of ischemia/reperfusion. However, these promising results should be further supported by more detailed studies with larger volumes.

Effects of alprostadil and iloprost on renal, lung, and skeletal muscle injury following hindlimb ischemia-reperfusion injury in rats.

OBJECTIVES: To evaluate the effects of alprostadil (prostaglandin [PGE1] analog) and iloprost (prostacyclin [PGI2] analog) on renal, lung, and skeletal muscle tissues after ischemia reperfusion (I/R) injury in an experimental rat model. MATERIALS AND METHODS: Wistar albino rats underwent 2 hours of ischemia via infrarenal aorta clamping with subsequent 2 hours of reperfusion. Alprostadil and iloprost were given starting simultaneously with the reperfusion period. Effects of agents on renal, lung, and skeletal muscle (gastrocnemius) tissue specimens were examined. RESULTS: Renal medullary congestion, cytoplasmic swelling, and mean tubular dilatation scores were significantly lower in the alprostadil-treated group than those found in the I/R-only group (P<0.0001, P=0.015, and P<0.01, respectively). Polymorphonuclear leukocyte infiltration, pulmonary partial destruction, consolidation, alveolar edema, and hemorrhage scores were significantly lower in alprostadil- and iloprost-treated groups (P=0.017 and P=0.001; P<0.01 and P<0.0001). Polymorphonuclear leukocyte infiltration scores in skeletal muscle tissue were significantly lower in the iloprost-treated group than the scores found in the nontreated I/R group (P<0.0001). CONCLUSION: Alprostadil and iloprost significantly reduce lung tissue I/R injury. Alprostadil has more prominent protective effects against renal I/R injury, while iloprost is superior in terms of protecting the skeletal muscle tissue against I/R injury.