To show the effect of intermittent fasting during ramadan on endothelial dysfunction via TIMI frame count.

BACKGROUND: Fasting and coronary functions are prestige fields for the study. There are a limited number of studies on these topics. The effect of Ramadan fasting on endothelial dysfunction, which can be manifested by loss of nitric oxide bioavailability, has been demonstrated via flow-mediated vasomotion in patients with the slow coronary flow in a small number of studies. To our knowledge, there is no study showing the relationship between TIMI frame count and Ramadan fasting. AIMS: We aimed to prove that Ramadan fasting can improve endothelial dysfunction which can be documented via the TIMI frame count method in angiography. METHOD: This retrospective study included 67 patients diagnosed with the coronary slow flow by coronary angiographic before Ramadan. All of them were evaluated again via TIMI frame count within a period of 1 to 3 months after Ramadan. We tested our hypothesis that fasting may improve endothelial dysfunction and it was proved by the TIMI frame count method in our study. RESULTS: TIMI frame counts measured angiographically from LAD, Cx, and RCA and they were significantly lower than the counts before fasting. All coronary frame count parameters showed significant improvement after Ramadan compared with the baseline values before the Ramadan fasting period (P < 0.001). CONCLUSION: Our results revealed that fasting and lifestyle changes during Ramadan may be beneficial for the improvement of endothelial dysfunctions in patients with the slow coronary flow and this can be showed easily using TIMI frame count. This is a practical and easy method for showing coronary functions.

Renal Frame Count and High Blood Pressure.

OBJECTIVE: The aim of the present study was to demonstrate the relationship between hypertension stages according to JNC-8 classification and mean renal frame count (RFC), which is an indicator of renal perfusion. METHODS: In this retrospective study, 100 hypertensive patients without obstructive renal artery disease, who had been evaluated with renal artery angiography for hypertension, were allocated into 2 groups (Stage 1 and Stage 2 hypertension). During coronary angiography, the patients were evaluated by selective renal angiography using 6F Judkins catheter. Cineangiographic images were evaluated by the same clinician and mean RFC was estimated for both renal arteries. Injections during renal angiography were performed with power injector and same amount of radiopaque media with same speed was used for all patients. RESULTS: There was no significant difference between the groups in terms of age, sex, duration of hypertension, and laboratory markers. Stage 2 hypertensive patients (Group 2) had a significantly higher mean RFC than Stage 1 hypertensive patients (Group 1) (p<0.001). The mean RFC of both kidneys in Group 2 was significantly higher than that of Group 1 (p<0.001 and p=0.023, respectively). CONCLUSIONS: This study showed that the mean RFC increased with increases in hypertension levels and it could be used as an indicator of renal perfusion, which is an indirect marker of renal function. If renal artery flow gets slower, blood pressure levels increase and there is a proportional relationship between these two variables (mean RFC and blood pressure levels). This study also demonstrated that there was a statistically significant correlation between mean RFC and JNC-8 hypertension stages.

A new method for left carotid angiography: use right judkins 4 guiding (6f) catheter with 2 side holes.

OBJECTIVE: To introduce a rapid and simple technique to engage and localize through left common carotid (LCCA) artery during selective carotid angiography using the same type of catheter (6F Medtronic™/launcher Judkins Right Guide Catheter, 4.0 Tip,2 Side holes, U.S.A.). METHODS: Patients were divided into two groups as new method and conventional method group including 295 and 292 prior to carotid angiography, respectively. The primary endpoints of this study included an analysis of total procedure time, time required for cannulation of left common carotid artery, fluoroscopy time and selective imaging success for left common carotid artery, feasibility, safety, amount of radio opaque agent and radiation exposure. RESULTS: Our novel method applied using a single catheter shortened total procedure time (5.41 ± 1.56 min. vs. 7.52 ± 2.48 min., respectively, p<0.001), fluoroscopy time (98 ± 9 sec. vs. 210 ± 19 sec., respectively, p<0.001), duration of left carotid artery cannulation (15 ± 1.2 sec vs. 42 ± 1.9 sec, respectively, p< 0.001). Use of our method reduced radiation exposure (120 ± 17 mGy vs. 217 ± 11 mGy, respectively, p<0.001), amount of contrast agent (44.99 ± 12.84 ml vs. 59.89 ± 18.93 ml, respectively, p<0.001). Aortic arch angiography was not needed in the first group compared with the conventional method group (0% vs. 29%, respectively, p<0.001). Also a higher success was achieved in cannulation of left common carotid artery using an identical catheter compared with application of conventional methods requiring use of different types of catheter (100% vs. 60%, respectively, p<0.001). No major complication and mortality was found due to use of both methods. However, a statistically insignificant elevation in minor complication was encountered in the patient group who underwent coronary angiography by the conventional method (3% vs. 7%, respectively, p<0.064). CONCLUSIONS: This new method is more easily applicable with a shorter duration for cannulation and localization of LCCA, safer for the patients with use of a limited amount of radio-opaque agent and finally cost-effective by requiring only one type of catheter and a limited.

Plasma galectin-3 as a biomarker for clinical staging of heart failure: a cross-sectional evaluation of 100 cases.

OBJECTIVES: To evaluate the plasma galectin-3 concentration associated with the severity of HF and its use as a biomarker for clinical staging of heart failure (HF). METHODS: This was a cross-sectional study, in which 100 HF cases diagnosed by clinical parameters and echocardiography were included and subgrouped into NYHA classes (I-IV) based on clinical severity and functional limitations. Plasma galectin-3 was measured with respect to these subgroups. RESULTS: The median plasma galectin-3 concentration in pg/mL was 82.7 (95% confidence interval: 64.5-112.7), 267.2 (214.3-293.5), 694.8 (626.4-902.4), and 1530.4 (1443.1-2384.4) in NYHA class I, II, III, and IV subgroups, respectively (p <0.05). The proposed galectin-3 concentrations in mild, moderate, and severe HF were 100-460, 460-1170, and >1170 pg/mL, respectively. Galectin-3 was negatively correlated with LV Ejection fraction (EF) by Simpson's biplane method (r=-0.634, p<0.001). Pro BNP showed that the level of plasma galectin-3 was positively correlated with the level of plasma NT pro BNP (r = 0.878, p <0.001). CONCLUSIONS: The plasma galectin-3 concentration showed progressive increase with increasing severity of HF; therefore, it may be used in clinical staging of the disease.

Preoperative platelettolymphocyte ratio as a prognostic factor in geriatric patients with proximal femoral fractures.

INTRODUCTION: The aim of this study was to investigate whether the platelet to lymphocyte ratio is a prognostic factor in geriatric patients who underwent surgery for proximal femoral fractures. MATERIALS AND METHODS: Clinical and laboratory data of 288 patients who underwent surgery for proximal femoral fracture were analysed. The patients were divided into six groups on the basis of sex (male and female) and survival duration after the operation (death within the first 6 months, death between the 6 and 12 months, survival for more than 12 months). Pre-operative platelet/lymphocyte ratios of these groups were compared. RESULTS: Of 288 patients, 187 were female and 101 were male. There was no significant difference between the groups with regard to age (p = 0.123 female groups) (p = 0.207 male groups). Although the preoperative platelet to lymphocyte ratio was higher in patients who died within 12 months than in those who survived beyond that, this platelet/lymphocyte ratio was statistically significant in females who died in the first 6 months (p = 0.038). CONCLUSION: A high preoperative platelet to lymphocyte ratio may be associated with high risk of mortality in patients who were operated for proximal femoral fracture.

Reconstruction of lower extremity primary malignant and metastatic bone tumours with modular endoprosthesis.

INTRODUCTION: This study is aimed to assess the functional results of cases with lower extremity malignant and metastatic bone tumours that were treated with modular tumour resection prostheses. MATERIALS AND METHODS: 49 patients were retrospectively examined. 27 (55.1%) patients had a primary bone tumour, and 22 (44.9%) had a metastatic bone tumour. Although most tumours located in the proximal femur were metastatic, tumours located around the knee were mostly primary malignant bone tumours. The functional assessments of our patients were made according to the Musculoskeletal Tumour Society (MSTS) scoring system. The Student's t-test and the Chi-square test were used for statistical analyses. RESULTS: 30 (61.2%) of the patients were men, and 19 (38.8%) were women. The average age was 46.2 ± 1.9 years. Tumours were located in the proximal femur in 27 (55.1%) patients, distal femur in 16 (32.7%) patients and proximal tibia in 6 (12.2%) patients. 14 (28.6%) patients had a pathological fracture on admission. The average follow-up period of our patients was 27.4 ± 3.4 months, and the average MSTS score was 74.3 ± 13%. Complications developed at any time in 34.7% of the patients, and the most common symptoms were aseptic loosening (8.2%) and prosthesis infection (8.2%). Local relapse was found in one (2%) patient. The 5-year survival rate was 68.3% in patients with a primary tumour and 30% in patients with a metastatic tumour. CONCLUSION: Although endoprosthesis reconstruction had advantages of giving very good functional results in the early phases, it was found to cause mechanical complications, especially in patients with primary bone tumours during the mid and late phases.

Transfusion-related acute lung injury following coronary artery bypass graft surgery.

Blood transfusion is sometimes a necessary procedure during or following coronary artery bypass graft (CABG) surgery. However, transfusion-related acute lung injury (TRALI)/possible TRALI is a rare and fatal complication and characterized by acute hypoxemia and non-cardiogenic pulmonary edema that occurs within 6 hours following a transfusion. Anti-leukocyte antibodies or, possibly, other bioactive substances cause inflammation and capillary endothelial destruction in susceptible recipients' lungs. Prompt diagnosis and mechanical ventilatory support are important. A successful treatment of two male patients following CABG surgery, compatible with TRALI/possible TRALI, is presented here.