Association between admission mean platelet volume and coronary patency after thrombolytic therapy for acute myocardial infarction.

OBJECTIVES: High levels of mean platelet volume (MPV) have been shown to be a predictor of poor clinical outcome among survivors of myocardial infarction. We evaluated the association between admission MPV and infarct-related artery (IRA) patency in patients treated with thrombolytic therapy for acute myocardial infarction (AMI). STUDY DESIGN: We retrospectively evaluated 133 consecutive patients with ST-elevation AMI, who received thrombolytic therapy within 12 hours of chest pain. Sixty-five patients received streptokinase and 68 patients received recombinant tissue-type plasminogen activator, based on the discretion of the physician. Blood samples were taken before thrombolytic therapy and MPV was measured. Coronary angiography was performed within a mean of two days after thrombolytic therapy and the flow in the IRA was assessed with the TIMI flow grade and corrected TIMI frame count (CTFC). RESULTS: After thrombolytic therapy, TIMI 3 flow was achieved in 62 patients (46.6%), whereas 71 patients (53.4%) had insufficient TIMI flow. Patients with insufficient TIMI flow had a significantly higher mean admission MPV (9.8+/-1.5 fl vs. 8.6+/-1.4 fl; p<0.001) and were more likely to have been given streptokinase (p=0.02). The two groups were similar with respect to the type of IRA and the number of diseased vessels (p>0.05). There was a weak correlation between MPV and CTFC (p=0.01). Multivariate analysis showed MPV (OR 1.871, 95% CI 1.402-2.498; p<0.001) and the type of thrombolytic agent (OR 2.915; 95% CI 1.333-6.374; p=0.007) as independent predictors of insufficient TIMI flow. The receiver operating characteristic analysis yielded a cutoff value of 8.885 fl for MPV to predict insufficient TIMI flow, with sensitivity and specificity being 70.4% and 66.1%, respectively. CONCLUSION: Our findings show that a higher admission MPV is associated with an increased risk for insufficient TIMI flow in the IRA after thrombolytic therapy for AMI.

Left atrial appendage aneurysm secondary to eccentric severe ischemic mitral regurgitation.

Dilatation primarily confined to the left atrial appendage (LAA) is an unusual condition in nonrheumatic mitral valve disease. We report a case of 56-year-old male with a giant LAA secondary to ischemic severe mitral regurgitation without significant dilatation of the left atrial main chamber. The mitral regurgitation jet was directed toward the LAA, which we thought as the cause of disproportionate LAA enlargement.

Penetrating atherosclerotic aortic ulcer mimicking acute inferior myocardial infarction.

Penetrating atherosclerotic ulcers (PAU), aortic dissection, and intramural hematoma are the three most important diseases involving the aorta which are classified as acute aortic syndromes. Penetrating atherosclerotic aortic ulceration is characterized by ulceration of atheromatous plaque disrupting the internal elastic lamina. These aortic ulcers may penetrate through the media to cause aortic pseudoaneurysms or less often through the adventitia to cause transmural aortic rupture. We described a case of penetrating atherosclerotic ulcer of ascending aorta mimicking ST elevation myocardial infarction. To our knowledge, this is the first case reported in the literature of such a complication from PAU.

Validation of Turkish version of the Scleroderma Health Assessment Questionnaire.

OBJECTIVES: The Scleroderma Health Assessment Questionnaire (SHAQ) is a functional scale which consists of five scleroderma-specific items (overall disease severity, Raynaud's phenomenon, digital ulcers, respiratory and intestinal involvement) in addition to Health Assessment Questionnaire Disability Index (HAQ-DI). The objective of this study was to perform an adaptation and validation of a Turkish version of the SHAQ. METHOD: We validated psychometric properties of the scale with 70 consecutive systemic sclerosis (SSc) patients, who fulfilled the 2013 ACR/EULAR classification criteria for SSc. We evaluated test-retest reliability with the intraclass correlation coefficient (ICC), discriminant validity by stratifying patients according to organ involvements and disease subtypes, and convergent validity by testing the correlation between SHAQ and related components of Short Form 36 version 2 (SF-36v2). Internal consistency of the questionnaire was evaluated by Cronbach's alpha coefficient. RESULTS: The SHAQ-global, visual analogue scales (VAS) of pulmonary, digital ulcer, and Raynaud's phenomenon were significantly correlated with the physical component score of the SF-36v2 (r = - 0.274, r = - 0.295, r = - 0.326, r = - 0.308, p < 0.05, respectively) for the convergent validity. The instruments could not discriminate between disease subtypes, except the digital ulcer VAS which was significantly higher in patients with dcSSc (1.00 ± 0.93 vs 0.55 ± 0.88, p = 0.026) for the discriminant validity. The HAQ-DI, SHAQ-global, digital ulcer VAS, and pulmonary VAS showed moderate correlation with an increase in the number of the organs involved (r = 0.319, r = 0.329, r = 0.341, r = 0.278, p < 0.05, respectively). We demonstrated high reproducibility for HAQ-DI (ICC = 0.962, 95% confidence interval = 0.934-0.978) and the other items of SHAQ. The overall internal consistency of the SHAQ was satisfactory (Cronbach's alpha = 0.953). CONCLUSIONS: The Turkish version of the SHAQ met the requirements of validity and reproducibility.

Flying saucer located at the basal septum.

Left ventricular thrombus formation is a frequent complication in patients with ischemic heart disease and is associated with a high risk of systemic embolization. Generally, thrombi localize at the apical segment. However, thrombus localized at the basal septum has not been reported yet. In this case, we discuss a flying saucer shaped mass located at the basal septum, which was later diagnosed as thrombus after anticoagulant therapy.

Isolated pulmonic valve endocarditis in an adult patient with ventricular septal defect and infundibular pulmonary stenosis.

Ventricular septal defect associated with infundibular pulmonary stenosis is a relatively uncommon congenital cardiac defect. We report the first case of a patient with perimembranous small ventricular septal defect and infundibular stenosis suffered from pulmonary valve endocarditis and septic pulmonary embolism.

Examination of anthropometric characteristics of police academy students / Examen de las características antropométricas de los estudiantes de la academia de policía

SUMMARY: Anthropometric data, which is highly correlated with health and high level of physical capacity, is very important for police officer. The aim of this study was to examine the anthropometric data of police college students and compare in terms of gender. Fifty-two police college students (32 females and 20 males) participated in the present study. Index calculations were made by applying anthropometric test measurements to all participants. The data included anthropometric (length measurements, width measurements, circumference measurement) and index [Body Mass Index (BMI), Cormic Index (C-Index), Body Adiposity Index (BAI), Ponderal Index (PI), Conicity Index (Con-Index) Waist-to-Height Ratio (WHtR)] parameters. The Independent Sample T-Test was used to analyze the difference in groups. A statistically significant difference was found in all parameters except leg length in length measurements (p<0.05). The mean of all width measurements except shoulder width of females was higher than that of male participants. Differences were obtained in all variables except hand and hip-width (p<0.05). In circumference measurements, there was a difference between the groups in the measurement values of the relaxed arm, maximum arm, wrist, shoulder, chest, and hip circumferences (p<0.05). The BAI, PI, WHtR, and Con-Index values were significantly different between groups (p<0.05). In conclusion, the length, width, circumference, and kinanthropometric indexes of male and female police candidates differ. Although male have higher mean values in length and circumference measurements, female have a higher mean for width measurements. Females have higher mean values in general in terms of index values and they are inincreased risk group in terms of WHtR index. It can be recommended for all participants, especially females, to participate in regular physical activity after they start working.

RESUMEN: Los datos antropométricos que están fuertemente correlacionados con la salud y el alto nivel de capacidad física, son muy importantes para el oficial de policía. El objetivo de este estudio fue examinar los datos antropométricos de estudiantes universitarios de policía y compararlos en relación al género. En el estudio participaron 52 estudiantes universitarios de policía (32 mujeres y 20 hombres). Los cálculos de los índices a los participantes se realizaron aplicando mediciones de pruebas antropométricas. Los datos antropométricos incluyeron (medidas de longitud, ancho y circunferencia) además de índice [Índice de masa corporal (IMC), Índice córmico (Índice C), Índice de adiposidad corporal (IAC), Índice ponderal (IP), Índice de conicidad (Con-Índice) y Relación cintura-altura (WHtR)]. Se utilizó la prueba T para muestras independientes para analizar la diferencia entre los grupos. Se encontró una diferencia estadísticamente significativa en todos los parámetros excepto en la longitud de las piernas (p<0,05). La media de todas las medidas de ancho excepto el ancho de los hombros de las mujeres fue mayor que la de los hombres. Se obtuvieron diferencias en todas las variables excepto en el ancho de manos y caderas (p<0,05). En las medidas de circunferencia, hubo diferencia entre los grupos en el brazo relajado, brazo máximo, muñeca, hombro, pecho y cadera (p<0,05). Los valores de BAI, IPI, WHtR y Con-Index fueron significativamente diferentes entre los grupos (p<0,05). En conclusión, los índices de largo, ancho, circunferencia y cineantropométricos de los candidatos a policías difieren entre hombres y mujeres. Aunque los hombres tienen valores medios más altos en las medidas de longitud y circunferencia, las mujeres tienen una media más alta en las medidas de ancho. Las mujeres tienen valores medios más altos en general, en términos de valores de índice, y se encuentran en un grupo de mayor riesgo en términos de índice WHtR. Se puede recomendar a todos los candidatos y candidatas a policía, especialmente a las mujeres, que participen en actividades físicas regularmente después de comenzar a trabajar.

Acute coronary syndrome due to complete bare metal stent fracture in the right coronary artery.

Stent fracture (SF) was suggested to be an unusual cause of restenosis after drug eluting-stent implantation. However, angiographically visible complete SF after bare metal stent (BMS) implantation is extremely rare. Here we report a case of SF of a BMS representing with acute coronary syndrome (ACS). To our knowledge, this is the first report of early fracture of a BMS in the right coronary artery, resulting in ACS.

Assessment of coronary veins in patients with isolated coronary artery ectasia by antegrade coronary venous angiography.

BACKGROUND: Coronary artery ectasia (CAE) is characterized by an abnormal dilatation of the coronary arteries. The most common cause of CAE is atherosclerosis but other possible etiologies include congenital abnormalities and inflammatory and connective tissue disease. Earlier studies have documented the association of CAE with the presence of aneurysms in other vascular beds. However, cardiac venous system in patients with isolated CAE has not been studied earlier. In this study, we aimed to assess coronary venous vessels by antegrade coronary venous angiography in patients with isolated CAE. METHODS: Twenty-four patients with isolated CAE without significant stenosis and 21 age-matched and sex-matched controls without CAE were included in this study. The anatomy of the coronary venous system was imaged in a left anterior oblique view at an angle of 45° by antegrade coronary angiography. RESULTS: Patients with isolated CAE had significantly larger coronary veins compared with control individuals with angiographically normal coronary arteries (coronary sinus ostium: 10.1 ± 1.0 vs. 8.5 ± 2.2 mm, respectively, P=0.003; coronary sinus mid level: 7.9 ± 1.4 vs. 6.5 ± 1.6, respectively, P=0.003; great cardiac vein: 5.6 ± 1.0 vs. 4.3 ± 0.8, respectively, P=0.001; middle cardiac vein: 3.9 ± 1.3 vs. 3.7 ± 1.4, respectively, P=0.52; posterior or lateral vein: 3.2 ± 1.1 vs. 2.4 ± 0.7, respectively, P=0.016). CONCLUSION: We have shown for the first time a significant dilatation in the coronary veins in patients with isolated CAE, suggesting the presence of a more extensive vascular destruction in the coronary circulation.

Impact of metabolic syndrome on coronary patency after thrombolytic therapy for acute myocardial infarction.

OBJECTIVES: The metabolic syndrome (MS) is highly prevalent in patients with acute myocardial infarction. It has been shown that MS is associated with poor in-hospital outcome and long-term survival in patients with acute myocardial infarction. We aimed to investigate the effect of MS on the infarct-related artery patency in patients treated with thrombolytic therapy for acute myocardial infarction. METHODS: We retrospectively analyzed 116 patients who were admitted to our clinics with acute ST elevation myocardial infarction and received thrombolytic therapy within 12 h of chest pain. MS was diagnosed according to National Cholesterol Education Program Adult Treatment Panel III criteria. The flow in the infarct-related artery was analyzed according to the thrombolysis in myocardial infarction (TIMI) flow grade and corrected TIMI frame count. RESULTS: MS was present in 55.2% of patients. The proportion of patients with MS who achieved TIMI grade 3 f low after thrombolysis was significantly lower than that of patients without MS (41.5 vs. 58.5%, P < 0.001). Moreover, corrected TIMI frame counts were significantly higher inpatients with MS (58.3+/-34.8 vs. 44.7+/-28.1, P =0.02). On multivariate logistic regression analysis MS was the only independent predictor of TIMI flow less than 3 (P =0.03,odds ratio = 3.545, 95% confidence interval: 1.064-11.808). CONCLUSION: We have shown for the first time that patients with MS have lower rates of TIMI grade 3 flow and higher corrected TIMI frame counts after thrombolytic therapy for acute myocardial infarction.