Admission Tpe interval predicts reperfusion success in STEMI patients treated with fibrinolytic agents.

OBJECTIVE: Myocardial infarction is a leading cause of morbidity and mortality. Fibrinolytic administration is still a life-saving choice in ST-segment elevated myocardial infarction (STEMI), but the rate of successful reperfusion can be inconsistent. Failed reperfusion adds additional clinical risks to rescue percutaneous coronary intervention for STEMI patients. The interval between the peak of the T wave and the end of the T wave (Tpe) and the ratio of Tpe and a corrected measurement of the time from the start of the Q wave to the end of the T wave (Tpe/QTc ratio) are relatively new electrocardiogram (ECG) indices and have not yet been tested in STEMI patients treated with fibrinolytic agents. METHODS: A total of 177 STEMI patients (mean age: 60.5±11.1 years; 138 men and 39 women) were enrolled in this retrospective study to evaluate ECG parameters. The Tpe interval and the Tpe/QTc ratio at baseline and at the 90th minute following the administration of fibrinolytic therapy were analyzed. The clinical and ECG findings of successful and failed reperfusion groups were compared. RESULTS: Successful reperfusion was achieved in 119 patients (67.2%). The average Tpe interval on the admission ECG was shorter (91.7 vs. 100.9 milliseconds [ms]) (p<0.001) and shortened more in the successful reperfusion group (9.3 vs. 4.5 ms) (p<0.001). A cut-off value of 89.0 ms for the Tpe interval on the admission ECG was found to be related to reperfusion success with a sensitivity of 90.9%. CONCLUSION: The Tpe interval was a predictor for reperfusion success in STEMI patients treated with fibrinolytic agents.

Migraine and subclinical atherosclerosis: endothelial dysfunction biomarkers and carotid intima-media thickness: a case-control study.

BACKGROUND: Migraine is a common neurovascular disease associated with vascular risks, especially in young adult females, but the mechanism underlying these associations remains unknown. This study evaluated the relationships between plasma endothelial dysfunction biomarkers and carotid intima-media thickness (IMT) in young adult females with migraine. METHODS: This case-control study included 148 female patients (age range: 18-50 years). Migraine was diagnosed according to the International Headache Society-IIIb criteria. Endothelial dysfunction biomarkers, such as von Willebrand factor (vWF), C-reactive protein (CRP), homocysteine, total nitrate/nitrite concentration, and thiobarbituric acid-reactive substances (TBARS), were evaluated in plasma. Carotid IMT was measured by a radiologist with sonography. RESULTS: The CRP, TBARS, vWF, and IMT levels were increased in the migraine compared with the control group (p < 0.001, p = 0.02, p < 0.001, and p < 0.001, respectively). After adjusting for confounders, multiple linear regression analysis revealed that systolic arterial blood pressure, CRP, vWF, TBARS, and right and left internal carotid artery (ICA) IMT were independently positively correlated with migraine (p < 0.01, p = 0.004, p = 0.023, p = 0.024, p = 0.032, and p = 0.048, respectively). Multiple logistic regression analysis revealed that right ICA IMT was independently associated with ergotamine and triptan and left ICA IMT was independently associated with ergotamine (p = 0.013, p = 0.026, and p = 0.017, respectively). In addition, significant correlations were found between LDL lipoprotein and carotid IMT in the migraine group (p < 0.05). CONCLUSIONS: Carotid IMT enhancement and elevated TBARS, vWF, and CRP levels in migraine subjects during a migraine attack could be regarded as consequences of migraine attack pathophysiology. The independent associations between triptan and ergotamine consumption and enhanced carotid IMT suggest that repeated use of these vasoconstrictive antimigraine agents may have additional effects on carotid IMT.

A Rare and Unexpected Side-Effect of Cannabis Use: Abdominal Pain due to Acute Pancreatitis.

Acute pancreatitis is a frequently encountered disorder in patients presenting to emergency units. Biliary system disorders, alcohol consumption, infections, and drugs are among the causes of acute pancreatitis. However, it is sometimes difficult to determine the etiology of this disorder, particularly if the patient does not wish to disclose his consumption of cannabis, the use of which is illegal.