Evaluation of the neuroprotective efficiency of sodium hydrosulfide in neonatal rats with the induced hypoxic-ischemic encephalopathy model.

AIMS: Hypoxic ischemic encephalopathy is one of the main causes of neonatal deaths. The objective of this study was to evaluate the neuroprotective effect of antioxidant and anti-inflammatory properties of sodium hydrosulfide (NaHS) in neonatal rats with hypoxic ischemic encephalopathy, as well as its effect on neuronal apoptosis through histopathological and biochemical tests. METHODS: Forty-seven-day­old rats with induced hypoxia­ischemia (HI) were randomly separated into four groups. Half an hour after the induction of hypoxic-ischemia, serum physiological (SF), 50 µmol/kg NaHS, or 100 µmol/kg NaHS were intraperitoneally given to the rats. RESULTS: Apoptotic cells in the brain tissue of rats in HI + NaHS 50 µmol/kg, and HI + NaHS 100 µmol/kg groups decreased compared to HI group (p = 0.00). While HI + NaHS 50 µmol/kg and HI + NaHS 100 µmol/kg groups yielded no difference in TNF-α, IL-6, and iNOS levels as compared to the HI group, an increase in NGF was detected in the 50 µmol/kg and 100 µmol/kg NaHS groups (p = 0.34, p = 0.24, p = 0.26, p = 0.026, p = 0.017). When TOS, TAS and OSI levels were compared, an increase in TAS and OSI and a decrease in TOS were observed in the treatment groups as compared to HI group. CONCLUSIONS: NaHS given to hypoxic-ischemic encephalopathy model significantly decreased apoptosis in neurons and had a neuroprotective efficacy with an increase in NGF levels (Tab. 1, Fig. 3, Ref. 25).

Efficacy of palivizumab prophylaxis on the frequency of RSV-associated lower respiratory tract infections in preterm infants: determination of the ideal target population for prophylaxis.

Respiratory syncytial virus (RSV) prophylaxis in high-risk infants is an effective intervention for the prevention of severe disease. The aim of this study was to determine the ideal target preterm population that might benefit from palivizumab prophylaxis by establishing the main risk factors for acute RSV-related infections. Former premature infants born with a gestational age ≤37 weeks and ≤1 year of age at the beginning of the RSV season and admitted with respiratory infection were included. RSV status was evaluated by RSV strip test in all infants. RSV-positive and -negative infants were compared in terms of demographic features, risk factors, requirement of hospitalisation and palivizumab administration. A total of 202 preterm infants under 1 year of age were enrolled. The RSV test was positive in 34 (16.8%) infants. Maternal age was significantly lower in RSV-positive infants compared with RSV-negative infants (p = 0.03). RSV-positive infants were found to be significantly discharged during the RSV season (p = 0.03). RSV-positive infants required significantly higher rates of hospitalisation and need for mechanical ventilation. Of the RSV-positive infants, 28 (82%) had a gestational age ≥29 weeks. Seventeen (77%) RSV-positive infants that required hospitalisation were ≥29 weeks of gestation. All infants with a gestational age ≥29 weeks and without palivizumab prophylaxis developed RSV infection. Palivizumab prophylaxis should be implemented into guidelines to cover preterm infants with a gestational age >29 weeks. Palivizumab prophylaxis should also be considered in high-risk infants ≤6 months of age during the RSV season.

Maternal/neonatal vitamin D deficiency: a new risk factor for necrotizing enterocolitis in preterm infants?

OBJECTIVE: The objective of the study was to investigate the possible association between maternal/neonatal 25-hydroxy vitamin D (25-OHD) levels and development of necrotizing enterocolitis (NEC). STUDY DESIGN: One hundred and forty-five preterm infants ⩽36 weeks of gestation were enrolled. 25-OHD levels were determined in maternal/neonatal blood samples that were obtained at the time of admission to the neonatal intensive care unit. RESULTS: Of the 145 enrolled patients, 26 (18%) developed NEC. Maternal/neonatal 25-OHD levels in the NEC group were significantly lower than those of the no-NEC group (P=0.001 and 0.004, respectively). In univariate logistic regression analysis, both maternal/neonatal vitamin D levels were a significant predictor of NEC (odds ratio (OR): 0.92 and 0.89; P<0.001 and P<0.005, respectively). However, multivariate logistic regression analysis revealed that only maternal vitamin D level was a significant predictor of NEC (OR: 0.86, P<0.0009). CONCLUSION: This is the first study to propose a possible association between maternal/neonatal 25-OHD levels and subsequent development of NEC in preterm infants.

Diagnostic value of ischaemia-modified albumin for predicting myocardial ischaemia during myocardial perfusion scintigraphy.

During acute ischaemia the N-terminal site of albumin is altered, reducing its binding capacity; the modified protein is termed ischaemia-modified albumin (IMA). IMA is a sensitive marker of acute myocardial ischaemia but its diagnostic value in chronic angina pectoris patients is unclear. We investigated changes in blood levels of IMA during myocardial perfusion scintigraphy in patients with chronic angina pectoris in a study including 26 male and 20 female patients, with mean age 60 years. Technetium 99m perfusion imaging detected myocardial ischaemia in 26 patients. Coronary angiography was carried out in these 26 ischaemic patients. Mean IMA values at rest and peak exercise were significantly higher in the ischaemic than the nonischaemic group. All IMA values were considered negative for cardiac ischaemia. Peak exercise IMA was significantly lower than the pre-exercise level only in the non-ischaemic group. IMA measurements during myocardial perfusion scintigraphy are not helpful in the diagnosis of myocardial ischaemia in patients with stable angina pectoris.

P-wave dispersion is increased in pregnancy due to shortening of minimum duration of P: does this have clinical significance?

Most pregnant women complain of palpitation, and various kinds of arrhythmias can be observed during pregnancy. We investigated P-wave and QT dispersion during pregnancy. Healthy pregnant women (n=162) and healthy age-matched, non-pregnant women (n=150) were included. We performed electrocardiography and transthoracic echocardiography and determined serum oestradiol levels in both groups, and performed Holter monitoring in the pregnant group only. Resting heart rate, P-wave dispersion, left ventricular diastolic diameter, left atrial diameter and serum oestradiol levels in the pregnant group were significantly higher than in the control group. Minimum P-wave duration was shorter in the control group than in the pregnant group; however, there was no statistically significant difference in maximum P wavelength and corrected QT dispersion between the groups. No atrial fibrillation was detected in the pregnant group during Holter monitoring. Shortening of the minimum P-wave duration leads to increased P-wave dispersion during pregnancy. In contrast to other pathologies with increased P-wave dispersion, paroxysmal atrial fibrillation is absent in pregnant women; this may be a result of the stable maximum P wavelength that is present during pregnancy.

Echocardiographical characteristics of healthy young subjects with physiological mitral regurgitation.

We aimed to analyse the echocardiographical characteristics of healthy subjects and determine the causal mechanism of the development of physiological mitral regurgitation (PMR). A total of 130 healthy subjects were divided into two groups according to whether or not PMR was detected. There were no statistical differences between the two groups in terms of the mean values of the systolic and diastolic left ventricular internal diameters and the left atrial diameter. The mean values of the length and thickness of the anterior mitral valve (AMV) and the mitral annular diameter (MAD) from subjects in group 1 (with PMR) were statistically different from those of group 2 (without PMR). In conclusion, the AMV was slightly longer and thicker and the MAD was smaller in subjects with PMR than in subjects without PMR. The changes observed in the AMV and the mitral annulus may play a causal role in the development of PMR.

A retrospective comparison of bovine pericardium and polytetrafluoroethylene patch for closure of ventricular septal defects.

This retrospective study compared the immediate post-operative (first month) and mid-term (up to 5 years post-operation) results of 22 patients with isolated ventricular septal defects who underwent surgical correction with bovine pericardium with 57 similar patients who received a polytetrafluoroethylene (PTFE) patch. There were no cases of early (in the first month) mortality in either group and the 3-month post-operative echocardiographical studies showed no evidence of calcification or aneurysm formation around the patch. Recurrent ventricular septal defects due to dehiscence of the patch occurred in the early follow-up period in four patients who had the PTFE patch but this was not statistically significant. Annual echocardiographical examination revealed some calcification in both groups. We conclude that although there are no significant differences between the two materials in outcome after ventricular septal defects closure, we prefer bovine pericardium because of its handling characteristics, elasticity and the lower risk of endocarditis.

Assessment of interventricular septal motion using colour tissue Doppler imaging in adult patients with atrial septal defect.

We aimed to characterize changes in interventricular septum (IVS) motion and any relationship between them and the pulmonary-to-systemic flow ratio (Qp/Qs) in adult patients with atrial septal defect (ASD). Patients and controls were studied using colour tissue Doppler imaging (TDI). The septum length (SL) and distance from the colour change point (CCP) on the IVS to the aortic valve (the CCP distance) were measured on parasternal long axis views. Values normalized for body surface area, and the CCP distance to SL ratio, were calculated. Qp/Qs values were correlated with CCP distance, normalized CCP distance and CCP distance:SL ratio. Statistically significant differences in CCP distance, normalized CCP distance and CCP distance:SL ratio were found between the two groups. In the ASD group, there was no correlation between Qp/Qs and the echocardiographic measurements. The point between the motions in two different directions from the IVS shifted toward the apex in ASD patients compared with controls, and may be a mechanism involved in paradoxical septal motion.

Aortic elasticity in patients with ankylosing spondylitis.

OBJECTIVE: Ankylosing spondylitis (AS) is a chronic inflammatory disease which may show cardiac involvement. The effect of AS on aortic elasticity has not been previously defined. The aim of this study was to determine whether there was any change in aortic elasticity in AS. METHODS AND RESULTS: Thirty-five AS patients without cardiovascular involvement and 30 healthy subjects were enrolled into the study. Aortic strain, distensibility index and stiffness index beta were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry. The mean aortic strain and distensibility indexes in the AS group were lower than those in the control group. The mean aortic stiffness index in the AS group was higher than that in the control group (p < 0.05). No correlation between the means and the duration was observed in the AS group. CONCLUSION: We found that in AS patients without cardiac involvement, aortic elasticity was decreased and this decrease was not correlated with the duration of AS.

Wellens' syndrome: a case report.

The pattern of clinical findings and electrocardiography (ECG) changes known as Wellens' syndrome is associated with significant stenosis of the proximal left anterior descending coronary artery. Cases can be classified according to the ECG pattern into type 1 (biphasic T waves) or type 2 (deeply inverted T waves, especially in leads V2 and V3). We present here an unusual case of Wellens' syndrome in which the ECG pattern changed from type 2 to type 1 during observation, and in which the coronary lesion was in the middle rather than the proximal part of the left anterior descending artery.

Role of homocysteine for thromboembolic complication in patients with non-valvular atrial fibrilation.

Thromboembolism is the most important complication in patients with atrial fibrilation (AF). Homocysteine is a toxic amino acid that has been recently accepted as a risk factor for atherosclerosis and stroke. The aim of the present study is to show whether there is a relation between hyperhomocysteinemia and thromboembolic complications in patients with non-valvular AF. We admitted 38 patients with non-valvular AF. The patients were divided into two groups: group A (n = 20; mean age, 75.7 +/- 10.4 years; three males/17 females), and group B (n = 18; mean age, 68.0 +/- 10.6 years; 11 males/seven females). While group A consisted of the patients with AF and stroke, group B was composed of the patients with AF but without stroke. The patients having sinus rhythm (15 subjects) were used as the reference group to obtain the cut-off value. Homocysteine was measured by the immunoassay method. The means of the homocysteine levels were 12.4 +/- 3.3 micromol/l in group A, 8.3 +/- 2.3 micromol/l in group B and 9.3 +/- 1.8 micromol/l in the reference group. The cut-off value was 10.6 micromol/l. Group A had a statistically higher homocysteine level than not only group B, but also the reference group (P < 0.05). While 60% of group A (n = 12) had the elevated homocysteine level, the rate was only 22% for group B (n = 4). In conclusion, hyperhomocysteinemia may be one of the explanations for the increased rate of thromboembolic complications in older patients with AF.

[Estimate of the artery responsible for acute inferior myocardial infarct attack using arterial electrocardiograph tracings]. / Akut inferior miyokard infarktüsünde infarktan sorumlu arteri elektrokardiyografik olarak tahmin edebilme.

OBJECTIVE: The aim of the study was to determine IRA (infarct-related artery) by analysis of the initial ECG (electrocardiogram) in patients with acute inferior wall myocardial infarction. METHODS: Forty patients (36 male, 4 female) admitted to coronary care unit with the diagnosis of acute inferior wall myocardial infarction were included in the study. The mean age of patients was 62.2 year (29-85 years). The coronary angiography was performed in all patients at the first week of admission. To determine the relationship between IRA and R/S ratio, ST segment depression in lead aVL, statistical analysis was performed. RESULTS: IRA was the right coronary artery (RCA) in 20 cases, circumflex artery (Cx) in 15 cases, RCA + Cx in 5 cases. R/S ratio was bigger than one in patients with Cx lesion and R/S ratio was smaller than one in patients with RCA lesion. The degree of the ST segment depression was equal or smaller than 2 mm in patients with Cx lesion and greater than 2 mm in patients with RCA lesion (p < 0.05). There was no correlation between IRA and precordial reciprocal electrocardiographic changes. Diagnosis of right ventricular infarction was established in 75% of patients with RCA lesion, 26% of patients with Cx lesion and 100% of patients with RCA + Cx lesions. CONCLUSION: We concluded that it was possible to predict IRA after examining the initial ECG changes such as R/S ratio, ST segment depression. This prediction can shorten the time required to perform primary percutaneous transluminal coronary angioplasty. Non-invasive prediction of IRA was useful for suggestion of clinical course in patients with high complication risk, such as patients with RCA lesion.

The assessment of internal mammary artery grafts by colour Doppler in coronary artery surgery.

BACKGROUND: Various studies in progress on the flow and diameter parameters based assessment and suitability of internal mammary artery by preoperative colour Doppler examination in coronary artery surgery. Postoperative visualisation of these grafts is also in evolution. Due to its noninvasive approach, colour Doppler sonography is taking its place in the follow-up of coronary artery bypass procedure. The aim of this study was to show the effectiveness and feasibility of colour Doppler in the routine postoperative follow-up evaluation. METHODS: In GATA Haydarpasa Education Hospital, coronary artery bypass grafting was performed by anastomosing left internal mammary artery to left anterior descending artery and saphenous veins to remaining lesions of the coronary arteries in 36 male patients between the ages of 42 to 66 (mean 54.8) in 1995. Left internal mammary artery and unused right internal mammary artery were imaged by colour Doppler six to eight weeks after the operations in all cases. Coronary angiography was also performed in two cases 4 months postoperatively. RESULTS: Colour Doppler sonography findings showed that the diameter of left internal mammary artery was larger (p=0.03) and mean flow value was greater than intact right internal mammary artery (p=0.02). CONCLUSIONS: These results shows that colour Doppler sonography should be applied as a noninvasive method, in the follow-up of internal mammary artery grafts after coronary artery revascularisation.