Behçet's disease and risk of vascular events.

PURPOSE OF REVIEW: We discuss the relationship between several factors and the risk of vascular events in patients with Behçet's disease. RECENT FINDINGS: Behçet's disease, a systemic, chronic relapsing vasculitis, is mainly seen in the Mediterranean area and is typically characterized by recurrent oro-genital ulcers, ocular inflammation, and skin manifestations, including articular, vascular, gastroenteric, and neurological involvement. It is a chronic inflammatory disease with relapses and remissions. The prognosis varies. Behçet's disease can cause venous or arterial lesions. Vascular involvement contributes to the mortality and morbidity associated with Behçet's disease. SUMMARY: The cause of thrombosis or vascular events in Behçet's disease remains incompletely understood; several factors have been studied with conflicting results. Vasculitis is considered to underlie several clinical manifestations of Behçet's disease.

The relation between monocyte to HDL ratio and no-reflow phenomenon in the patients with acute ST-segment elevation myocardial infarction.

BACKGROUND: No-reflow phenomenon is a prognostic value in ST-segment elevation myocardial infarction (STEMI). Monocyte to high density lipoprotein ratio (MHR) has recently emerged as a marker of inflammation and oxidative stress in the cardiovascular disease. PURPOSE: In this study, we aimed to investigate the relation between MHR and no-reflow phenomenon in patients with STEMI undergoing primary percutaneous coronary intervention (pPCI). MATERIAL AND METHODS: A total of 600 patients with STEMI (470 men; mean age, 62 ± 12 years) admitted within 12 hours from symptom onset were included into this study. Patients were classified into 2 groups based on postintervention Thrombolysis in Myocardial Infarction (TIMI) flow grade: no-reflow-TIMI flow grade 0, 1, or 2 (group 1); angiographic success-TIMI flow grade 3 (group 2). RESULTS: According to admission whole-blood cell count results, the patients in the no-reflow group had significantly higher monocyte count and MHR values when compared with those of the reflow patients. After multivariate backward logistic regression, MHR remained independent predictors of no reflow after pPCI. Adjusted odds ratios were calculated as 1.09 for MHR (P< .001; confidence interval [CI], 1.07-1.12). Receiver operating characteristic curve analysis suggested that the optimum MHR level cutoff point for patients with no-reflow was 22.5, with a sensitivity and specificity of 70.2% and 73.3%, respectively (area under curve, 0.768; 95% CI, 0.725-0.811). CONCLUSION: In conclusion, MHR levels are one of the independent predictors of no reflow in patients with STEMI after pPCI.

The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events.

A full blood count is a routine, inexpensive and easy test that provides information about formed blood contents. The platelet-lymphocyte ratio (PLR) is a novel inflammatory marker, which may be used in many diseases for predicting inflammation and mortality. The PLR can be easily calculated and is widely available but it may be affected by several inflammatory conditions. Recent studies show that a high PLR reflects inflammation, atherosclerosis and platelet activation. More research is needed to determine how the PLR may be used in clinical practice.

Endocan, a novel marker of endothelial dysfunction in patients with essential hypertension: comparative effects of amlodipine and valsartan.

Vascular inflammation plays an important role in the pathophysiology of hypertension and high levels of endocan may reflect ongoing vascular inflammation in hypertensive patients. In the present hypothesis-generating study, we aimed at investigating the comparative effects of amlodipine and valsartan on endocan levels in newly diagnosed hypertensive patients. The study population consisted of 37 untreated hypertensive patients who were randomized to the two treatment arms. After baseline assessment, each patient was randomly allocated to either 10 mg daily of amlodipine (n = 18, 7 males) or 160 mg daily of valsartan (n = 19, 3 males) and treated for a 3-month period. Sphygmomanometric blood pressure (BP) and serum endocan were measured before and every 2 weeks during drug treatment. There was no statistically significant difference between the two treatment arms as far as baseline socio-demographic and clinical characteristics are concerned. After a 3-month treatment period, systolic and diastolic BP values significantly reduced by antihypertensive treatment (p < 0.001). Furthermore, endocan levels were significantly decreased in both treatment arms (p < 0.05). However, amlodipine caused a greater percent decrease in circulating endocan levels compared with valsartan at the end of the treatment period. Both drugs reduced high sensitivity C-reactive protein values. However, the statistical significant difference vs baseline was achieved only in the group treated with amlodipine. No correlation was found between endocan plasma levels and BP reduction. The results of this hypothesis-generating study suggest that amlodipine and valsartan decrease endocan levels in newly diagnosed hypertensive patients. The effects, which are more evident with amlodipine, may contribute to the anti-inflammatory effects exerted by the two drugs on the vascular target.

Reaction of human macrophages on protein corona covered TiO2 nanoparticles.

The cytokine secretion of primary cells of human macrophages during the interaction of TiO2 nanoparticles (with an average primary size of 100-120 nm) is investigated down to concentration levels suggested to be relevant for in vivo conditions. We find that high TiO2 concentrations induce the cytokines Interleukin IL-1ß, IL-6, and IL-10 secretion, while at low concentrations only IL-6 secretion is observed. To obtain further evidence on in vivo conditions we investigated the development and structure of the protein corona of the nanoparticles. We demonstrated that the surface of TiO2 particles attract preferably secondary modified proteins which then induce cytokine secretion of macrophages. Our results indicate that concentration of corona covered TiO2 particles below 1 µg/ml induce IL-6 secretion which is reported to be responsible for the development of autoimmune diseases as well as for the secretion of acute phase proteins. FROM THE CLINICAL EDITOR: This study investigates the effects of protein corona covered titanium dioxide nanoparticles on human macrophages, concluding that concentration of such particles below 1 µg/ml induces IL-6 secretion, which may be responsible for the development of autoimmune diseases as well as for the secretion of acute phase proteins. This finding has important implications on future applications of such nanoparticles.

Increased frequency of mitral valve prolapse in patients with deviated nasal septum.

Any abnormality of collagen may affect the tissues with higher collagen content, e.g., joints, heart valves, and great arteries. Mitral valve prolapse (MVP) is a characteristic of generalized collagen abnormality. Nasal septum (NS) is constituted by osseous and cartilaginous septums that are highly rich in collagen. We evaluated the co-existence of deviation of NS (DNS) in patients with MVP. We retrospectively evaluated the recordings of echocardiographic and nasal examinations of subjects with MVP and DNS. We analyzed the features of MVP and anatomical classification of DNS among subjects. Totally, 74 patients with DNS and 38 subjects with normal nasal passage were enrolled to the study. Presence of MVP was significantly higher in patients with DNS compared to normal subjects (63 vs 26%, p < 0.001). Prolapse of anterior, posterior and both leaflets was higher in patients with DNS. Thickness of anterior mitral leaflet was significantly increased in patients with DNS (3.57 ± 0.68 vs 4.59 ± 1.1 mm, p < 0.001) compared to normal subjects. Type I, II, and III, IV DNS were higher in frequency in patients with MVP while type V and VI were higher in normal subjects. DNS is highly co-existent with MVP and increased thickness of mitral anterior leaflet. Generalized abnormality of collagen which is the main component of mitral valves and nasal septum may be accounted for co-existence of MVP and DNS. Also co-existence of them may exaggerate the symptoms of patients with MVP due to limited airflow through the nasal passage.

Hyperbilirubinemia and urinary tract infection: the effect of indirect hyperbilirubinemia on the in vitro growth of uropathogen Escherichia coli in newborn urine.

High serum bilirubin is antioxidant and cytoprotective. We evaluated if urine samples of hyperbilirubinemic newborns impede uropathogenic Escherichia coli growth. Bag-urine samples of hyperbilirubinemic newborns (study group) were cultured at presentation and during remission. Urine sample were obtained only once from healthy newborns (control group). Escherichia coli [2 × 104 colony-forming unit (cfu)/mL] was inoculated into the sterile urine samples and colony counts were determined after 24 h. Bilirubin levels at presentation and remission were also recorded. Escherichia coli colony counts of the control versus study groups and of the presentation versus remission samples in the study group were compared. There were 13 study and 17 control cases. Escherichia coli colony counts were not different in the study group at presentation versus remission (5.4 ± 0.7 vs. 5.5 ± 0.8 log10, respectively; p = 0.659). Escherichia coli colony count of the control group (5.2 ± 0.6 log10) was also not different from the study group. In conclusion, the urine of hyperbilirubinemic newborns did not affect the growth rate of uropathogenic E. coli.

Atrial fibrillation presented with syncope in a jet pilot during daily briefing on squadron.

INTRODUCTION: Syncope may be the initial clinical presentation of atrial fibrillation (AF) and has a great potential for incapacitation during flight. Herein is presented the case of a jet pilot who had paroxysmal palpitations accompanied with presyncope which progressed to syncope and was found to be associated with AF. CASE REPORT: A 23-yr-old male jet pilot had a sudden syncope at the fifth minute of his presentation during the daily flight briefing. After he regained consciousness, he was transferred to the intensive care unit of the military hospital. His medical history revealed two episodes of syncope which resulted in spontaneous recovery and were not reported to the flight surgeon. He had no abnormal findings on his physical examination except heart rate, which was irregular and 110 bpm with a rapid ventricular response. His diagnosis was AF. Laboratory tests, including thyroid hormones, CBC, transthoracic echocardiography, ultrasonography of the abdomen, chest X-rays, and also a tilt table test, were normal. He had completely normal findings on 24-h ECG Holter monitoring except rare ventricular extrasystoles and had a negative treadmill stress test. AF spontaneously converted to sinus rhythm during the follow-up in the intensive care unit. He was temporarily grounded and returned to flying duties after a 3-mo follow-up period without any recurrent arrhythmia. DISCUSSION: Syncope has various mechanisms and etiologies, and also a benign prognosis on the ground. However, not only vasovagal syncope, but also AF may be among the frequent causes of syncope in aviators and pilots, as was the case in the current study.

Radiofrequency catheter ablation of ventricular tachycardia in a military parachuter.

BACKGROUND: Premature ventricular contractions (PVCs) presenting as isolated complexes are insignificant, but if they present as salvos they are considered indicators of high risk for potentially fatal arrhythmias. CASE REPORT: We present the case of a 39-yr-old male military parachuter with PVCs and ventricular tachycardia that were incidentally detected on ECG and treated with radiofrequency catheter ablation (RFCA). He had no significant past medical history. Physical examination and biochemical tests were normal. Transthoracic echocardiography showed no structural heart disease. Due to frequent ventricular extrasystoles (VES) detected on his ECG, 24-h Holter monitoring was conducted and revealed VES, including 13,351 isolated PVCs, 1427 episodes of bigeminy, 397 of trigeminy, 30 couplets, and 4 salvo periods. After beta-blocker and calcium channel blocker treatment for 1 mo, his repeat 24-h Holter monitoring showed 18,414 isolated PVCs, 819 episodes of bigeminy, 181 of trigeminy, and 6 couplet VES, but no episodes of salvos. Electrophysiological studies (EPS) were performed and the baseline measurements were: basic cycle length: 890 ms; atrium His interval: 78 ms; and ventricular His interval: 54 ms. VES were found to orginate from the right ventricular outflow tract and were terminated by RFCA. Medical treatment was stopped. Repeat Holter showed no VES. The parachuter was qualified for full duties. DISCUSSION: As the patient is an aircrew member and further usage of antiarrhythmic agents will interfere with his flying status, instead of initiating a drug therapy again, we performed EPS and RFCA as an effective and dependable method in order to treat and to determine his fitness.

Atrial fibrillation in two jet pilots during aircrew periodical medical examination.

BACKGROUND: Atrial fibrillation (AF) unfavorably affects cardiac output and may cause acute incapacitation in flight due to loss of the atrial systole, which mainly contributes to the diastolic filling of the ventricles. Although it is the most common type of arrhythmia, it is rare in pilots and not compatible with aviation. CASE REPORTS: We present two AF cases incidentally detected in two jet pilots. The first case was a 39-yr-old male jet pilot with a lone AF. Since there was no structural abnormality or thrombus in the left atrial appendage on transesophageal echocardiography (TEE), the patient was converted to sinus rhythm via direct current cardioversion (DCC). The pilot returned to flying duties after a follow-up period without any recurrent arrhythmia. The second case was a 23-yr-old male jet pilot who had suffered six attacks of paroxysmal AF. Conversion to sinus rhythm was provided by DCC at once and the second via pharmacological cardioversion. Also, spontaneous conversion to sinus was observed during two attacks of AF during the follow-up period. There were no abnormalities on physical examination, echocardiography, and laboratory tests. Although the cardiac ablation procedure was applied, the patient couldn't be treated successfully. Thereafter the pilot was treated with sotalol and warfarin and was permanently disqualified from flying duties. DISCUSSION: Arrhythmia is among the frequent causes for aviators to be disqualified from flying duties. AF particularly should not be overlooked due to its potential for sudden incapacitation during flight via acute hypotension or thromboembolic events.