Last utterances of patients in Covid Intensive Care Units: A qualitative study.

BACKGROUND: Nurses who provide patient care in COVID-19 intensive care have witnessed that patients experience problems such as fear of death, loneliness, helplessness, uncertainty, anxiety, etc. OBJECTIVE: In this study, it was aimed to examine the messages written by the patients who receive treatment in the COVID-19 Intensive Care Unit (ICU) through letters and their feelings and thoughts which they wanted to convey to their families. METHOD: This study employed a qualitative research design. The sample of the study consisted of 52 patients admitted to the ICU. The data of the study were obtained by examining the letters written by the patients who received treatment in the COVID-19 ICU between April 2021 and June 2021. The researchers collected the research data through document analysis, one of the qualitative research methods. FINDINGS: The messages that patients in the ICU wanted to convey to their families were identified as having two main themes: "emotions in the experience of illness" and "views on death." The "views on death" theme included sub-themes such as fear of death, the meaning of life, acceptance of death and Saying halal for the rights over each other, and wills. The "emotions in the experience of illness" theme included sub-themes of love, hope/ hopelessness, loneliness, and longing. CONCLUSION: It is assumed that patients have the risk of encountering a variety of problems during their stay in ICU due to COVID-19 and that providing good physical and psychosocial care will improve the coping mechanisms of patients.

Analyses of the Turkish National Intravenous Thrombolysis Registry.

BACKGROUND: The relatively late approval of use of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke in Turkey has resulted in obvious underuse of this treatment. Here we present the analyses of the nationwide registry, which was created to prompt wider use of intravenous thrombolysis, as well as to monitor safe implementation of the treatment in our country. METHODS: Patients were registered prospectively in our database between 2006 and 2013. Admission and 24-hour National Institutes of Health Stroke Scale and 3-month modified Rankin Scale scores were recorded. A "high-volume center" was defined as a center treating 10 or more patients with rt-PA per year. RESULTS: A total of 1133 patients were enrolled into the registry by 38 centers in 18 cities. A nearly 4-fold increase in the study population and in the number of participating centers was observed over the 6 years of the study. The mean baseline NIHSS score was 14.5 ± 5.7, and the prevalence of symptomatic hemorrhage was 4.9%. Mortality at 3 months decreased from 22% to 11% in the 6 years of enrollment, and 65% of cases were functionally independent. Age older than 70 years, an NIHSS score higher than 14 upon hospital admission, and intracranial hemorrhage were independently associated with mortality, and being treated in a high-volume center was related to good outcome. CONCLUSIONS: We observed a decreasing trend in mortality and an acceptable prevalence of symptomatic hemorrhage over 6 years with continuous addition of new centers to the registry. The first results of this prospective study are encouraging and will stimulate our efforts at increasing the use of intravenous thrombolysis in Turkey.

Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers.

BACKGROUND AND PURPOSE: Successful recanalization after endovascular stroke therapy (EVT) did not translate into a good clinical outcome in randomized trials. The goal of the study was to identify the predictors of a good outcome after mechanical thrombectomy with stent retrievers. METHODS: A retrospective analysis of a prospectively collected database included consecutive patients treated with stent retrievers. We evaluated the influence of risk factors for stroke, baseline NIHSS score, Alberta Stroke Program Early CT (ASPECT) score, recanalization rate, onset-to-recanalization and onset-to-groin puncture time, and glucose levels at admission on good outcomes. The number of stent passes during procedure and symptomatic hemorrhage rate were also recorded. A modified Rankin Scale (mRS) score of 0-2 at 90 days was considered as a good outcome. RESULTS: From January 2011 to 2014, 70 consecutive patients with an acute ischemic stroke underwent EVT with stent retrievers. The absence of a medical history of diabetes was associated with good outcomes. Apart from diabetes, the baseline demographic and clinical characteristics of patients were similar between subjects with poor outcome versus those with good outcomes. Median time from onset to recanalization was significantly shorter in patients with good outcomes 245 (IQR: 216-313 min) compared with poor outcome patients (315 (IQR: 240-360 min); P = 0.023). Symptomatic intracranial hemorrhage was observed in eight (21.6%) of 37 patients with poor outcomes and no symptomatic hemorrhage was seen in patients with good outcomes (P = 0.006). In multivariate stepwise logistic regression analysis, a favorable ASPECT score (ASPECT > 7) and successful recanalization after EVT were predictors of good outcomes. Every 10-year increase was associated with a 3.60-fold decrease in the probability of a good outcome at 3 months. The probability of a good outcome decreases by 1.43-fold for each 20 mg/dL increase in the blood glucose at admission. CONCLUSION: To achieve a good outcome after EVT with stent retrievers, quick and complete recanalization and better strategies for patient selection are warranted. We need randomized trials to identify the significance of tight blood glucose control in clinical outcome during or after EVT.

Unveiling the Shadows: Childhood Traumas and the Dynamics of Seeking Psychological Help and Self-Stigmatization Among Prisoners.

BACKGROUND: Compared with the general population, prison inmates show a higher prevalence of mental disorders, particularly among those with childhood traumas. Despite childhood traumas being robust indicators of poor mental health, there is limited research on their relationship with prisoners' attitudes toward seeking psychological help. This study investigates the impact of childhood traumas on prisoners' attitudes toward help-seeking and self-stigmatization. METHODS: This cross-sectional, explanatory study was conducted with 250 persons in prison. Data were collected using a sociodemographic information form, the Childhood Trauma Questionnaire, the Attitudes Toward Seeking Psychological Help Scale, and the Self-Stigma of Seeking Help Scale. Statistical analysis was performed using Spearman correlation test and multiple linear regression analysis with SPSS Version 28. RESULTS: A significant link was found between childhood traumas and self-stigmatization in seeking psychological help. Positive attitudes toward help-seeking were significantly associated with increased self-stigmatization. Childhood traumas were significantly related to single-parent families, conflicted intrafamilial relationships, entering prison at the age of 19 years or older, mental health issues, and behavioral disorders. Moreover, a meaningful association was observed between self-stigmatization in help-seeking and being from a single-parent family with a low socioeconomic status. CONCLUSION: In conclusion, imprisoned persons with childhood traumas exhibit higher levels of self-stigmatization in seeking psychological help, contributing to negative attitudes. Recommendations for adequate access to mental health services in prisons include fostering a culture of psychological help, enhancing mental health literacy, providing trauma-informed care, and developing comprehensive strategies. In addition, the suggestion is made for the development of societal reintegration programs.

Early haemodynamic changes in cerebral blood flow after cardiac resychronisation therapy.

OBJECTIVE: Cardiac resynchronisation therapy (CRT) has emerged as a new treatment strategy for a subgroup of patients with heart failure. In this study, we aimed to evaluate acute effects of CRT on cerebral blood flow. MATERIAL AND METHODS: Twenty-two (six female and 16 male) patients (mean age 60.8±5.3 years) with idiopathic dilated cardiomyopathy were enrolled in the study. Blood flow in the common carotid artery (CCA), internal carotid artery (ICA), and vertebral arteries (VA) was evaluated by Colour Doppler ultrasound. All measurements were performed at a constant heart rate of 90beats/min for excluding the influence of variant heart rates. RESULTS: Flow velocities, flow volume, resistivity and pulsatility indices which were correlated with cardiac output (CO) significantly increased after CRT. The only parameter affecting the change in mean velocity and flow volume in VA was the change in the CO (ß=1.1, p=0.02 and ß=1.2, p=0.04, respectively). The change in peak systolic velocity after CRT in VA and the change in mean velocity and volume in ICA were affected by the change in the CO (ß=1.2, p=0.007; ß=0.8, p=0.08 and ß=0.6, p=0.03, respectively). The change in total cerebral blood flow was also affected by the change in CO (ß=1.3, p=0.003). CONCLUSION: CRT increases the carotid and vertebral artery blood flow velocities, flow volumes and therefore improves cerebral blood flow. This improvement in the cerebral blood flow after CRT is largely due to the increase in the cardiac output.

Nursing Students' Attitudes Toward Seeking Psychological Help Associated to Self-Stigma and Perceived Social Stigma.

Introduction: Nursing students often experience stress due to their educational demands and developmental stage. This study focuses on nursing students to investigate the relationship between their attitudes toward seeking psychological help and their levels of perceived self-stigma and social stigma. Methods: This was a descriptive correlational study, in which 791 nursing students participated through convenience sampling between April and May 2022. Data were collected using the Attitude Towards Seeking Psychological Help Scale-R (ASPH-R), the Stigma Scale for Receiving Psychological Help (SSRPH), and the Self-Stigma of Seeking Help (SSOSH). The data were analyzed using Pearson correlation and multiple linear regression analysis. The article adheres to the STROBE checklist in its organization and presentation. Results: Positive attitudes towards seeking psychological help were negatively correlated with self-stigma (r=-0.39, P<0.01) and social stigma perceptions (r=-0.17, P<0.01), while negative attitudes were positively correlated with self-stigma (r=0.50, P<0.01) and social stigma (r=0.47, P<0.01). Variables of sex, age, self-stigma, and social stigma significantly contributed to explaining attitudes towards seeking psychological help. Conclusion: Social stigma and particularly self-stigma significantly influence nursing students' attitudes towards seeking psychological help. Therefore, it is recommended that authorities develop psychoeducational interventions aimed at enhancing nursing students' mental health awareness and reducing self-stigma.

Successful treatment of amiodarone-induced hepatic injury with n-acetylcysteine: A case report.

Intravenous amiodarone treatment may cause hepatic toxicity. N-acetylcysteine (NAC) is a powerful antioxidant, reduces the level of free radicals by increasing glutathione levels, and is used in acetaminophen intoxication. An 83-year-old female Caucasian patient who had congestive heart failure and implantable cardioverter-defibrillator was admitted to the hospital with palpitations and confusion. After analysis of ICD device, ventricular tachycardia, ventricular fibrillation runs of patient and intervention of ICD device with electric shocks were noticed. Intravenous 1200 mg amiodarone infusion was administered as treatment. Later, her transaminase levels increased dramatically. Hepatic injury due to intravenous administration of amiodarone was diagnosed and 1200 mg/day intravenous NAC was given. After 72 h of NAC treatment, hepatic enzymes were found to be recovering. After parenteral amiodarone administration, patients must be monitored for acute hepatotoxicity. This article accentuates the benefits of NAC treatment in drug-induced liver injury.

High levels of high sensitivity C-reactive protein predict the progression of chronic rheumatic mitral stenosis.

BACKGROUND: High sensitive C-Reactive Protein (hs-CRP) predicts morbidity and mortality in various clinical conditions. The effect of hsCRP on progression of chronic rheumatic mitral stenosis (CRMS) has not been demonstrated. METHODS AND RESULTS: A total of 132 patients with CRMS (95 female, 37 male) and 145 control (100 female, 45 male) were included in the study. Baseline clinical, echocardiographic, hematologic and hs-CRP measurements were collected prospectively. Mean mitral valve area (MVA) was 1.4 +/- 0.3 cm(2), mean wilkins valve score value was 8.9 +/- 1.7, left atrial diameter was 5.0 +/- 0.7 cm, left atrial area was 37.2 +/- 12.6 cm(2), and systolic pulmonary arterial pressure (SPAP) was 44 +/- 11 mmHg in patients with CRMS. The mean levels of hs-CRP value, fibrinogen, and mean platelet volume (MPV) were significantly higher in CRMS group compared to control group. The levels of hsCRP were found to be positively correlated with mean Wilkins valve score value, SPAP, presence of atrial fibrillation (AF), left atrial diameter, left atrial area, presence of LASEC(+), fibrinogen, and MPV and inversely correlated with MVA in patients with CRMS. Linear regression analysis revealed that the hsCRP level independently affects mean Wilkins valve score value, left atrial area (LAA), LASEC(+) and AF in the patients with CRMS. CONCLUSIONS: These results suggest that increased hsCRP levels are associated with CRMS severity. These association may be important when treating patients with CRMS.

The prevalence of aspirin resistance in patients with metabolic syndrome.

OBJECTIVES: Aspirin is recommended for primary prevention in patients with metabolic syndrome (MetS). In this study, we evaluated aspirin resistance in MetS patients. STUDY DESIGN: The study included 32 patients (23 males, 9 females; mean age 60.7+/-11.4 years) with the diagnosis of MetS, according to the criteria of the International Diabetes Federation. Aspirin resistance was determined by the PFA-100 analysis (Platelet Function Analyzer). The results were compared with a control group of 30 patients (16 males, 14 females; mean age 61.6+/-7.3 years) without MetS. All the patients were taking aspirin at the time of the PFA-100 analysis. RESULTS: Overall, 21 patients (33.9%) were aspirin nonresponders. The prevalence of aspirin resistance was 46.9% in the MetS group, and 20% in the control group. The difference between the two groups was statistically significant (p=0.033). Compared to aspirin responders, fasting blood glucose level was higher (102.0+/-14.6 mg/dl vs. 95.3+/-9.9 mg/dl; p=0.036) and waist circumference tended to be greater in nonresponders (97.4+/-14.1 cm vs. 89.7+/-15.0 cm; p=0.053). Multivariate logistic regression analysis showed that MetS (OR 0.28, 95% CI 0.09-0.88; p=0.029), fasting blood glucose (OR 0.95, 95% CI 0.91-0.99; p=0.045), uric acid (OR 0.46, 95% CI 0.28-0.76; p=0.002), gamma-glutamyl transferase (OR 1.04, 95% CI 1.00-1.08; p=0.043), high-sensitivity C-reactive protein (OR 1.07, 95% CI 1.01-1.12; p=0.015) levels and platelet count (OR 0.99, 95% CI 0.98-0.99; p=0.034) significantly affected aspirin resistance. CONCLUSION: Our results show that a significant proportion of MetS patients will not benefit from aspirin use due to high aspirin resistance.

Hyperdense internal carotid artery sign: a CT sign of acute ischemia.

BACKGROUND AND PURPOSE: The hyperdense middle cerebral artery sign (HMCAS) is a well-established marker of early ischemia on noncontrast computed tomography of the brain (NCCT). Recently the MCA dot sign has been described and proposed to indicate thrombosis of the M2 or M3 middle cerebral artery branches. The purpose of this study was to define the hyperdense ICA sign (HICAS) and determine its prevalence, diagnostic and prognostic value, and its reliability as a marker for ischemia. METHODS: Noncontrast computed tomography scans of 71 patients with acute ischemic stroke were analyzed for the presence of a HICAS, HMCAS, or MCA dot sign. For the validation of HICA and HMCA signs on NCCT, 32 of 71 patients who underwent gold standard CT angiography (CTA) before thrombolytic therapy were included in the analysis. The presence of a HICAS was correlated with initial neurological severity and the short and long-term outcomes. RESULTS: A HICAS was found in 24% of patients on NCCT. In patients with a HICAS, mean age was 63+/-17.4 and mean time from symptom onset to CT was 103 minutes. Interobserver agreement was excellent for the HICAS. The HICAS has high specificity (100%) and positive predictive value (100%) in predicting the presence of distal internal carotid artery thrombus on CTA. Patients with a HICAS had a more severe initial neurological deficit and worse prognosis than patients without a HICAS. CONCLUSIONS: The HICAS is a reliable and a highly specific marker of thromboembolic occlusion of the distal ICA and is associated with severe initial neurological deficit and worse outcome despite thrombolytic therapy.

Brain lateralization and sudden death: its role in the neurogenic heart syndrome.

Sudden cardiac death is the leading cause of mortality, accounting for approximately 50% of all cardiovascular deaths and 12% deaths. Although sudden deaths are commonly seen in patients with structural and ischemic heart diseases, some patients lack any evidence of coronary atherosclerosis or structural heart abnormalities. In these patients mental stress and abnormal neurological conditions can produce cardiovascular autonomic disturbances leading to life-threatening arrhythmias and sudden death. Emotional, physiological and physical stress is associated with increased rates of cerebrovascular events and sudden deaths. Human studies in healthy individuals showed lateralization of cardiovascular autonomic function exists in the forebrain, particularly the insular cortex. Considerable evidence exists regarding the role of forebrain lateralization in cardiovascular autonomic regulation in patients with ischemic and hemorrhagic stroke. Particularly insular cortex involvement is associated with more pronounced autonomic imbalance leading to life threatening arrhythmias and sudden death. Left-handers may have a lower risk of sudden death compared with right-handers. Future studies should focus on the association of handedness with cardiovascular autonomic networks and sudden death in different neurological diseases. Identification of patients at risk for neurogenic sudden death by clinical characteristics and noninvasive diagnostic tools may help implement prophylactic and therapeutic interventions that may reduce the mortality rate.

Cerebrovascular events on awakening, patent foramen ovale and obstructive sleep apnea syndrome.

Patent foramen ovale is a defect in the interatrial septum associated with cryptogenic stroke. The presumed mechanism of cryptogenic stroke due to a patent foramen ovale is the migration of thrombus from the venous side of the circulation to the left atrium with subsequent systematic embolism, called paradoxical embolization. Provacative maneuvers and pre-existing cardiopulmonary disease can cause elevation in right atrial pressure leading to right-to-left shunting through a patent foramen ovale. We report two patients with patent foramen ovale waking up with cryptogenic vascular events and found to have an obstructive sleep apnea syndrome. During nocturnal sleep, obstructive sleep apnea can cause right atrium pressure elevation resulting in right-to-left shunting through patent foramen ovale. The possibility of patent foramen ovale and an obstructive sleep apnea syndrome may be considered in patients with cryptogenic strokes-on-awakening. Further studies are needed to support our observation.

Effects of cigarette smoking on heart rate variability and plasma N-terminal pro-B-type natriuretic peptide in healthy subjects: is there the relationship between both markers?

BACKGROUND: Cigarette smoking increased the risk of acute cardiac events related with endothelial dysfunction and increased sympathetic activity. Impaired autonomic nervous activity is recognized as a considerable symptom of cardiac dysfunction and is strongly associated with increased risk overall mortality. METHODS: A total of 75 healthy habitual smokers (40 female, 35 male, mean age 36.5 +/- 8.5 years), and 73 non-smokers subjects (45 female, 28 male, mean age 34.6 +/- 7.2 years) were studied. LF and LF/HF ratio were significantly higher in smokers than in non-smokers. On the contrary, SDNN, SDANN, RMSSD, and HF values were lower in smokers compared to those in non-smokers. Not the duration of smoking but the number of cigarettes smoked per day was correlated with the HRV parameters and NT-pro BNP. Furthermore, the average levels of NT-pro BNP were found to be positively correlated with LF, LF/HF and inversely correlated with SDNN, SDANN, RMSSD and HF. RESULTS: As a result, smoking impaires sympathovagal balance and decreases the heart rate variability in healthy subjects. And even a one cigarette smoking leads to overt sympathetic excitation. Furthermore, smoking results in an increase in NT-proBNP levels and the changes in adrenergic nervous system and NT-proBNP levels are well correlated. CONCLUSION: These findings could contribute to the higher rate of cardiovascular events in smokers.

Sympathetic overactivity in patients with pulmonary stenosis and improvement after percutaneous balloon valvuloplasty.

OBJECTIVE: Percutaneous balloon valvulotomy (PBV) is the procedure of choice for the treatment of valvular pulmonary stenosis (PS) with similar results comparable to surgical valvotomy but less invasive. METHODS AND RESULTS: Twenty-seven consecutive patients with PS being evaluated for PBV were enrolled in the study. Peak instantaneous transvalvular gradient, right ventricle (RV) diameter, mean atrial pressures, RV systolic pressure (RVSP), pro-brain natriuretic peptide (proBNP) levels significantly decreased immediately after PBV. Regarding heart rate variability (HRV) parameters, mean HR (heart rate), LF (low frequency) day and night, LF/HF day and night significantly decreased and standard deviation of all NN intervals (SDNN), root mean square of successive differences (RMSSD), P number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50), HF (High frequency) day and night significantly increased 1 day after PBV and these changes were shown to be preserved at the first month. The increase in SDNN was correlated with the decrease in right atrial pressure (RAP) (r =-0.5, P = 0.04); the increase in standard deviation of the 5-minute mean RR intervals (SDANN) was correlated with the decrease in proBNP (r =-0.4, P = 0.03). CONCLUSIONS: Sympathetic overactivity and increased proBNP levels were associated with the symptomatic status of patients with PS. Associated with a decrease in atrial pressures and proBNP levels, PBV yielded a decrease in adrenergic overactivity in the patients with PS.

[High levels of high-sensitivity C-reactive protein and impaired autonomic activity in smokers]. / Sigara içenlerde artmis yüksek duyarlikli C-reaktif protein düzeyleri ve bozulmus otonomik aktivite.

OBJECTIVES: We investigated the relationship between high sensitivity C-reactive protein (hs-CRP) activity and autonomic nervous activity using heart rate variability in smokers. STUDY DESIGN: The study consisted of 136 healthy subjects, including 66 smokers (35 women, 31 men; mean age 36 years) and 70 nonsmokers (43 women, 27 men; mean age 34 years). Serum samples were collected from all the subjects. Three-channel, 24-hr Holter monitoring was performed to derive the mean heart rate, standard deviation of normal NN intervals (SDNN), standard deviation of 5-minute mean NN intervals (SDANN), root mean square differences of successive NN intervals (RMSSD), high- (HF) and low- (LF) frequency power components, and the LF/HF ratio. RESULTS: In smokers, the mean duration of smoking was 13.6+/-8.2 years (range 3 to 45 years), and the mean number of cigarettes consumed per day was 16.3+/-7.1 (range 5 to 40). Smokers exhibited significantly higher mean heart rate, hs-CRP and fibrinogen levels, mean platelet volume, white blood cell count, LF, and LF/HF ratio, with significantly lower SDNN, SDANN, RMSSD, and HF values. In smokers, hs-CRP was correlated with the number of cigarettes consumed per day, duration of smoking, fibrinogen level, mean platelet volume, white blood cell count, LF, and LF/HF ratio, and inversely correlated with HF, SDNN, and SDANN. Even smoking a single cigarette resulted in an acute, 0.07-fold increase in the hs-CRP level (p<0.0001). In linear regression analysis, both the number of cigarettes consumed per day (beta=0.52, p=0.011) and duration of smoking (beta=0.073, p<0.0001) had an independent effect on the hs-CRP level. CONCLUSION: Smoking both impairs the sympathovagal balance and increases the hs-CRP activity in otherwise healthy smokers, the combination of which would probably contribute to a higher rate of cardiovascular events.

A case of pulmonary alveolar microlithiasis with cardiac constriction secondary to severe adjacent pleural involvement.

Pulmonary alveolar microlithiasis (PAM) is a rare disorder of uncertain etiology and pathogenesis that is characterized by tiny calcium phosphate depositions in lung alveoli. Ectopic organ involvement has been reported infrequently. We hereby present a patient with PAM complicated by severe pleural calcification that has caused a constrictive cardiac physiology, a heretofore unknown occurrence/association. Based on our observations in this particular case, we suggest that a non-invasive echocardiographic examination may be well worth in the investigation of PAM patients in whom symptom onset at an early age has occurred, particularly if severe pleural calcification adjacent to the heart is present.

P-wave durations in patients experiencing atrial fibrillation during exercise testing.

Augmented sympathoadrenal activity during exercise may contribute to occurrence of various arrhythmias including atrial fibrillation (AF). The prolongation of intraatrial and interatrial conduction times and inhomogeneous propagation of sinus impulses are well-known characteristics of the atrium prone to fibrillate and are evaluated by maximum P-wave duration (P max), P-wave dispersion (PWD). To show the increased P max and PWD values in patients experiencing AF during exercise testing and the role of beta blockade on treatment of exercise-induced AF, 22 of these patients were compared with a control group consisting of 41 patients without AF attacks. P max (p = 0.001) and PWD (p = 0.001) values were significantly higher in patients with AF compared to those without AF. The development of AF during exercise testing was found to be positively correlated with P max (r = 0.87, p < 0.001), PWD (r = 0.83, p = 0.001), and work load (r = 0.34, p = 0.002) and negatively correlated with ejection fraction (r = -0.26, p=0.02). After the treatment with beta-blocking agents for 2 weeks, the decrease in P max and PWD values was accompanied by a much lower prevalence of exercise-induced AF. Consequently, the patients with AF had greater P max and PWD values compared to control subjects, and these simple parameters were well correlated with the occurrence of AF during exercise testing. Furthermore, treatment of these patients with beta blockers would appear to decrease the recurrence of exercise-induced AF and to be associated with a decrease in P-wave durations.

Coagulation, fibrinolytic system activation and endothelial dysfunction in patients with mitral stenosis and sinus rhythm.

Anticoagulation treatment can prevent systemic embolism in patients with mitral stenosis (MS) and atrial fibrillation (AF), but this treatment is under debate if patients are in sinus rhythm. The authors aimed to determine the hemostatic changes in patients with MS and sinus rhythm. Forty-six patients (28 in sinus rhythm and 18 in AF) with mitral stenosis were enrolled in this study. They studied systemic venous fibrinogen, D-dimer, antithrombin-III, tissue plasminogen activator (tPA), plasminogen activator inhibitor-I (PAI-I), von Willebrand factor (vWF), and platelet factor 4 (PF 4) in these patients. The patients were first classified according to their rhythm as sinusal and AF, and then according to the presence of left atrial spontaneous echo contrast (LASEC). Fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly greater in patients with MS and sinus rhythm or atrial fibrillation compared to the control group (p < 0.05). Whether the rhythm was sinus or AF, fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly higher in patients with LASEC than in the control group (p < 0.05). Only PF 4 was higher in the AF group than in those with sinus rhythm (p < 0.05). As to plasminogen activator and PAI-I levels, only tissue plasminogen activator levels were found to be higher in the AF group than in those with sinus rhythm and the control group (p < 0.05). In patients with mitral stenosis and sinus rhythm, if LASEC is present, coagulation activation, platelet activation, and endothelial dysfunction are similar in patients with AF, and anticoagulation should be considered in these patients.

Does stroke etiology play a role in predicting outcome of acute stroke patients who underwent endovascular treatment with stent retrievers?

AIMS: The goal of the study was to identify whether the stroke etiology play a role in the recanalization and outcome of patients who underwent mechanical thrombectomy with stent retrievers. METHODS AND RESULTS: A retrospective analysis of a prospectively collected database included consecutive patients treated with stent retrievers. We included patients with cardioembolic stroke and large vessel atherosclerotic disease and compared risk factors for stroke, baseline NIHSS and Alberta Stroke Program Early CT scores (ASPECTS), stroke outcome, recanalization rate, onset-to-recanalization, onset-to-groin puncture time and the procedural time between two groups. Male sex was statistically more common in patients with large vessel atherosclerotic disease. Mean time from symptom onset- to the achievement of recanalization in patients with LVAD was 242±72.4 compared with cardioembolic stroke patients (301±70.7; p=0.014). Time for groin puncture to recanalization was longer in patients with cardioembolic stroke compared to LVAD group (97.5±44.3 vs 58.2±21.8; p=0.002). Time for microcatheter to successful recanalization or procedural termination was longer in patients with cardioembolic stroke compared to LVAD group (63.6±30.2 vs 34.2±19.4; p<0.001) with cardioembolic stroke had significantly worse long-term outcome (mRS 3-6) compared to those with LVAD (60.6% vs 26.3%; p=0.036). CONCLUSION: Stroke etiology may play a role in the outcome of acute stroke patients who underwent endovascular stroke therapy. Cardioembolic strokes may be more resistant to endovascular acute stroke treatment.

Myocardial injury due to lightning strike--a case report.

Lightning strike is a natural phenomenon with potentially devastating effects and represents one of the leading causes of cardiac arrest and death from environmental phenomena. Almost every organ system may be impaired as lightning passes through the human body taking the shortest pathways between the contact points. In this paper, the authors report a 38-year-old man who was injured by lightning, a typical example of ;;side splash,'' and had transient electrocardiographic changes.