A multidisciplinary approach of outdoor aeroallergen selection for Skin Prick Testing in the geographical area of Greater Istanbul.

SUMMARY: Background. Aeroallergen selection for skin prick testing and the interpretation of results need to be in line with allergenic sources of a specific geographic area. Objective. To identify aeroallergens for a skin test panel for the specific geographical area of Istanbul in a multidisciplinary approach based on aerobiological parameters, cross-reactivity patterns and clinical symptoms. Methods. Aerobiological parameters, cross reactivity patterns and the European Standard Skin Prick Test Panel determined allergen selection. Atopic adult patients (n = 60) compiled a questionnaire and were skin prick tested with 29 aeroallergens. Aerobiological sampling followed the requirements of the European Aerobiology Society. Results were statistically analyzed. Results. 65% of patients had positive skin reactions. Sensitization to at least one grass allergen was 30%. Key grass allergens were timothy grass (Phleum pratense L.) 25.8% and Johnson grass (Sorghum halepense (L.) Pers.) 22.6%; correlations between grass-sensitizations were significant at p (minor) 0.01 and so was the correlation of Pooideae sensitization with symptoms and medication. Sensitization to at least one woody plant was 23%; to ash (Fraxinus excelsior L.) 8.1%; hazelnut (Corylus avellana L.), olive (Olea europaea L.) and mulberry (Morus alba L.) 6.5%; juniper (Juniperus ashei J.Buchholz) 4.8%. Correlations between Fagales allergen sensitizations were significant. Sensitization to at least one weed was 22%, sensitization to dock (Rumex crispus L.) 12.9%, ragweed (Ambrosia artemisiifolia L.), and mugwort (Artemisia vulgaris L.) 4.8%. Sensitization rates correlated significantly with the length of the Main Pollen Season. Conclusions. The European Standard Panel is suitable for the geographical area of Greater Istanbul, if it comprises Johnson grass and ash. Ragweed has become clinically relevant in this region. Mulberry and dock were exclusively associated to polysensitized individuals suggesting pan-allergen involvement.

Sleep disorders in cirrhotics; how can we detect ?

BACKGROUND & AIMS: Sleep disorders (SDs) are common in cirrhotics and are often associated with hepatic encephalopathy. SDs negatively affect patients' daily activities and work efficiency. For this reason, early diagnosis is important. The methods used for diagnosis of SDs are not practical and need longer periods of application and evaluation. In this study, we aimed to investigate sleep disorders and related clinical parameters in cirrhosis and also wanted to investigate the using of Sleep Timing and Sleep Quality Screening questionnaire (STSQS), a simple form with a short application time, for diagnosis of SDs and its correlation with Pittsburg Sleep Quality Index (PSQI) form. METHODS: Cirrhotic patients and age-matched healthy volunteers were enrolled. Patients were excluded from this study if they had neuropsychiatric disease or used excessive alcohol or drugs known to affect sleep. Both groups completed validated Turkish form of PSQI and STSQS. SD was defined as PSQI score (0-21) of >5 or STSQS ≥5. RESULTS: One hundred and thirty-one cirrhotic patients and 18 healthy volunteers were enrolled. SDs in cirrhotics and control group were detected 56.5% and 27.8% by PSQI, 49.6% and 16.7% by STSQS respectively. SDs are the most frequent in the Child C patients, and the least frequent in the Child A patients (P > 0.05). No correlation was found between the MELD score and SDs. SDs were more common in cirrhotic patients with hypoalbuminaemia and low haemoglobin levels. In addition, the patients with decompensated cirrhosis had more frequently SDs than the patients with compensated cirrhosis. In the patient group, sleep latency and total sleep time, sleep parameters were correlated with SDs. STSQS had statistical significant correlation with PSQI for diagnosis of SDs. CONCLUSION: SDs are common in cirrhotics and STSQS could be an appropriate and practical method for diagnosis of SDS in these patients. We can use it in cirrhotic patients at outpatient clinics.

Examining the effects of coronary artery disease- and mitochondrial biogenesis-related genes' and microRNAs' expression levels on metabolic disorders in epicardial adipose tissue.

BACKGROUND AND AIMS: Epicardial adipose tissue (EAT) surrounds the heart and coronary arteries and is important for comprehending the pathogenesis of coronary artery disease (CAD). We aimed to evaluate the expressions of mitochondrial biogenesis- and CAD-related genes and miRNAs in EAT by comparing them to visceral adipose tissue (VAT) in CAD, diabetes, and obesity subgroups. METHODS: In this study, a total of 93 individuals were recruited, and EAT samples (63 CAD; 30 non-CAD) and VAT samples from 65 individuals (46 CAD; 19 non-CAD) were collected. For further analysis, the study population was divided according to obesity and diabetes status. PRKAA1, PPARGC1A, SIRT1, RELA, TNFA, and miR-155-5p, let-7g-5p, miR-1247-5p, miR-326 expression levels were examined. RESULTS: PRKAA1 and let-7g-5p were differentially expressed in EAT compared to VAT. TNFA expression was upregulated significantly in both tissues of CAD patients. In EAT, PRKAA1, PPARGC1A, and SIRT1 were downregulated with diabetes. Moreover, PPARGC1A expression is decreased under the condition of obesity in both tissues. EAT expressions of miR-1247-5p and miR-326 were downregulated with obesity, while miR-155-5p is decreased only in the VAT of obese. Also, miRNAs and genes were correlated with biochemical parameters and each other in EAT and VAT (p < 0.050). CONCLUSIONS: The findings demonstrating distinct let-7g-5p and AMPKα1 mRNA expression between EAT and VAT underscores the importance of tissue-specific regulation in different clinical outcomes. In addition, the differential expressions of investigated genes and miRNAs highlight their responsiveness to obesity, DM, and CAD in adipose tissues.

High-risk left main coronary artery bypass surgery supported by the Impella Recover LP 2.5 assist device: an alternative insertion technique.

Patients with high-risk coronary lesions such as left main stenosis and a severely depressed left ventricular ejection fraction are at risk of death and morbidity-related complications during coronary artery bypass surgery. Several alternative methods have been developed for managing this problem, but it is still challenging, even for highly experienced and well-equipped cardiac surgery centers. We report the case of a successful coronary artery bypass surgery supported by the Impella Recover LP 2.5 assist device and using an alternative insertion technique for the ascending aorta in a patient with high-risk coronary lesions, such as left main disease.

Revascularization in patients with severe left ventricular impairment who have ischemic heart disease.

OBJECTIVE: To assess the effect of coronary bypass grafting on left ventricular (LV) function, exercise capacity and symptom profile in patients with LV impairment and retrospectively evaluate the role of the different factors affecting LV. METHODS: A total of 45 patients (33 men, 12 women, mean age 63.49 +/- 7.38 years) with LV ejection fraction of less than 0.32 were admitted to the Istanbul University, Cardiology Institute, Istanbul, Turkey between January 2001 to June 2003 for coronary bypass operation. Preoperative and postoperative wall motion, functional class (New York Heart Association) and risk factors were analyzed. RESULTS: We had one perioperative mortality (2.2%) and 2 early postoperative mortality (4.4%) due to poor cardiac function. There was a significant increase in the mean LV ejection fraction from 26.64 +/- 5.17 to 32.98 +/- 6.38 (p<0.001) postoperatively. In this group the mean New York Heart Association grade improved from 2.07 +/- 0.76 to 1.5 +/- 0.79 (p<0.001). Preoperative functional class, congestive heart failure, arrhythmia, age, pre/postoperative complications were the main predictors of poor outcome following surgical revascularization for ischemic cardiomyopathy. CONCLUSION: In patients with severe LV impairment with myocardial hibernation, coronary artery bypass grafting improves both global and regional LV function and symptom profile. We therefore, recommend a coronary artery bypass grafting as an alternative to orthotopic heart transplantation whenever myocardial viability are documented.

Postoperative mechanical circulatory support with Biomedicus centrifugal pump.

Despite advances in surgical techniques, myocardial protection, and management protocols, approximately 1% of patients undergoing open heart operations still need mechanical circulatory support for severe cardiac dysfunction. The Biomedicus centrifugal pump, available in most cardiovascular centers, is a highly effective and relatively inexpensive system compared to other more sophisticated devices for the same purpose. Of 10 patients aged 5 to 61 years who were supported for 22 to 168 hours with a Biomedicus centrifugal pump, 7 (70%) were weaned from support, there was one hospital death, and 6 patients were discharged from hospital. Two sudden deaths occurred in the first 8 months after discharge. Four patients (40%) were still alive after follow-up of 11-55 months, with no restriction in their daily activities. The centrifugal pump is a very cost-effective support system with survival rates comparable to those of more sophisticated devices in short-term ventricular assistance.