Investigation on the relationship between serum periostin, MMP-7, TGF-ß, and IL-18 levels and the clinical course and prognosis of COVID-19.

OBJECTIVE: Cytokines are involved in the inflammatory/anti-inflammatory balance and have been shown to play an important role in the course of COVID-19. This study aimed to evaluate the relationship of periostin, transforming growth factor-beta (TGF-ß), interleukin-18 (IL-18), and matrix metalloproteinase 7 (MMP-7) levels with clinical course and mortality in patients with early COVID-19 pneumonia. PATIENTS AND METHODS: A total of 150 hospitalized patients were diagnosed with COVID-19 between June and October 2021, and a control group of 30 healthy individuals were included in our study. The COVID-19 patients were divided into those who developed macrophage activation syndrome (MAS) in Group 1 and those who did not in Group 2. Serum periostin, MMP-7, TGF-ß, and IL-18 levels were measured from blood samples obtained at admission using enzyme-linked immunosorbent assay (ELISA). RESULTS: Periostin, MMP-7, and IL-18 levels were significantly higher in COVID-19 patients compared to the control group (p<0.001 for all). Periostin and MMP-7 levels were also significantly higher in Group 1 than in Group 2 (p<0.001 for both). Periostin, MMP-7, IL-18, and TGF-ß levels were significantly higher in non-surviving patients compared to survivors (p=0.04, p<0.001, p<0.001, and p<0.001, respectively). In the receiver operating characteristic (ROC) curve analysis, MMP-7 was found to have high sensitivity (90%) at a predictive value of 2.66 ng/mL. CONCLUSIONS: It is still not possible to predict which patients with early COVID-19 pneumonia will go on to develop MAS despite receiving standard treatment. The results of our study suggest that elevation of periostin and MMP-7 levels in the early period may predict the development of macrophage activation syndrome.

Long-term follow-up of young denim sandblasters in Turkey.

BACKGROUND: Denim sandblasting-induced silicosis is a recently identified occupational disease. AIMS: In this study, we aimed to evaluate pulmonary and radiological changes in the long-term follow-up of former denim sandblasters. METHODS: Ninety former denim sandblasters were followed from 2007 to 2018. Chest X-rays were evaluated according to the International Labour Organization (ILO) classification. Baseline and final data were compared. Silicosis prevalence, radiological progression and pulmonary dysfunction were evaluated. RESULTS: All of the sandblasters were men. Their mean age was 34 ± 5 years, mean follow-up time was 9 ± 2 years (mean time since initial exposure: 17 ± 2 years) and mean duration of exposure was 34 ± 25 months. Rates of radiological progression and decline in pulmonary during follow-up were 63% and 39%, respectively. During follow-up, all patients were diagnosed with silicosis. All workers who were ILO category 0 at baseline (n = 26, 29%) progressed to higher categories. The number of patients in Category 2 doubled and the number of patients in Category 3 increased by 2.5-fold. Eleven patients developed new large opacities and the number of patients with category C opacity increased from 4 to 13. Exposure time was an independent determinant of radiological progression (OR: 1.0, P = 0.036) and decline in pulmonary function (OR: 1.3, P = 0.019). CONCLUSIONS: The prevalence of silicosis in denim sandblasters increases steadily even after exposure is discontinued. Radiological progression was observed in a higher proportion of workers than a decline in lung function. Duration of exposure was the major determinant of disease progression in our study.

Female workers' silicosis diagnosis delayed due to gender bias.

After excluding alternative explanations, a silicosis diagnosis is based on the combination of appropriate silica exposure history and compatible clinical, radiological and occasionally pathological findings. Not taking appropriate occupational history by a physician may cause a misdiagnosis or underdiagnosis of silicosis. Herein, we present a female worker in a small-scale sandblasting factory who worked as a controller. Her silicosis diagnosis was established 10 years after her first symptoms, and she underwent invasive procedures due to a lack of inquiry about her occupational history. Gender bias may be one of the reasons that her occupational history was not taken.

Epidemiology and cost of burns in emergency department during Syrian civil war.

BACKGROUND: We aimed to emphasize the importance of regional hospitals' capacities and emergency services for burn patients in war and disaster situations, in addition to assessing the costs and clinical situations of seriously burned patients who have come to the emergency service due to the bomb and heater burst during the Syrian civil war. METHODS: In this study, we analyzed these 217 burn patients and analyzed these patients' data for retrospective analysis. RESULTS: Burn patients were more often seen during the winter months. The majority of the patients were children, young adults and male (1‒16 age, 95 % burn, 44 %,17‒40 age 94 % burn, 44 %, ≥ 41‒65 age, 28 % burn, 12 %). The most common body surface burns ≥ 20 % body surface in surviving patients n = 184, 78 % were determined. 14 of the burned patients died within the first 24 hours. The total cost of the burned patients in the emergency unit was observed to be 33.4 ± 25.9 Turkish Lira (10.2‒6813.2). CONCLUSION: The present study showed that burn patients need much longer treatment time. The need for trained personnel in case of mass disasters and warfare, the identification of burn intensive care units and hospitals to be referred is important (Tab. 2, Fig. 4, Ref. 23).

Effects of radiological extent on neutrophil/lymphocyte ratio in pulmonary sarcoidosis.

OBJECTIVE: Determining the severity of sarcoidosis is based on the clinical and radiological findings of the disease and the changes in pulmonary function test results. On the other hand; studies are ongoing for objective and easy markers in this respect. Neutrophil/lymphocyte ratio (NLR) is shown as a good prognostic marker for inflammation due to tissue damage in recent clinical trials. In this study, we aimed to identify the possible relationship between NLR and radiological extent of sarcoidosis. PATIENTS AND METHODS: Data of 122 patients included in the study were evaluated retrospectively in terms of age, gender, complete blood count parameters, erythrocyte sedimentation rate (ESR) and radiological findings at the time of diagnosis. RESULTS: Mean NLR and ESR were significantly different between radiological stages according to chest radiography and also total HRCT score (THS) groups according to parenchymal involvement in thorax tomography (p <0.05). Mean NLR was found to be 1.28 in stage 0, 1.65 in stage 1, 2.88 in stage 2,5.47 in stage 3 and 8.48 in stage 4; 1.63 in THS group 1, 2.01 in group 2, 3.47 in group 3 and 5.46 in group 4. There were statistically significant positive correlations between NLR and WBC, NLR and THS, NLR and ESR, THS and ESR, ESR and platelet, WBC and #neutrophil, WBC and #lymphocyte. CONCLUSIONS: Our findings suggest that NLR might be used as a prognostic marker in pulmonary sarcoidosis.

Do Atmospheric Changes and the Synodic Lunar Cycle Affect the Development of Spontaneous Pneumothorax?

BACKGROUND: Pneumothorax is defined as air in pleural space. The etiology of spontaneous pneumothorax (SP) is still under investigation and, despite many studies, remains uncertain. The aim of this study was to investigate the effects of the lunar cycle and daily weather changes on SP development. METHODS: The data of patients admitted to our clinic with SP were analysed retrospectively. The daily atmospheric pressure, relative ratio of humidity and temperature in degrees Celsius of each day were obtained. The mean values for each day, from the first to the 29th day, of the synodic lunar cycle (SLC) were calculated for the five-year study period. The attacks were allocated to the appropriate day of an ideal 29-day SLC, irrespective of the calendar date. RESULTS: A total of 131 patients who were admitted to our hospital with SP (130 males and 1 female with an average age of 32.4±12.2) were included in this study. The number of patients with SP showed a statistically significant correlation with mean atmospheric pressure (p=0.005), relative humidity (p=0.007) and outdoor temperature (p=0.02) but not with the SLC. CONCLUSIONS: SP is significantly influenced by weather-related factors. Changes in atmospheric pressure, humidity and outdoor temperature had obvious effects on the development of SP. However, the SLC had no effect on SP.

The diagnosis of common variable immunodeficiency in adults should not be missed: A delayed diagnosis can be devastating

No disponible

A potential protective role for thiamine in glucose-driven oxidative stress.

The relationship between glucose repression and the oxidative stress response was investigated in Schizosaccharomyces pombe wild type cells (972h(-)) and glucose repression resistant mutant type cells (ird11). We aimed to reveal the mechanism of simultaneous resistance to glucose repression and oxidative stress in ird11 mutants. Compared to the wild type, the expression of the sty1 gene was not altered in the ird11 mutant under normal growth conditions, but decreased after exposure to H2O2. This effect was clearly explained by the immunoblotting results, which showed elevated levels of a much more stable phosphorylated form of Sty1 mitogen-activated protein kinase in the ird11 mutant. Increased ght3 gene expression levels were also found, which may play a role in protecting the ird11 mutant from the deleterious effects of oxidative stress. In addition, decreased expression levels of glycolytic enzyme enolase- and thiamine synthesis/transport-related genes were detected. This might have resulted from the flux redirection toward mitochondrial respiration, which would enhance NADPH generation to prevent the high reactive oxygen species accumulation that is generated by respiration. Some evidence supported a flux shift toward fermentation as well as respiration. We conclude that a defect in the glucose-sensing signaling pathway in ird11 mutants likely causes erroneous low glucose-sensing signaling and high ATP production. This most likely occurs because high glucose availability in the medium induces an impairment in the respiratory chain and fermentation balance in these cells, which might explain the glucose repression and oxidative stress resistance in ird11 compared to the wild type.

Effects of glucose sensing/signaling on oxidative stress response in glucose repression mutants of Schizosaccharomyces pombe.

The resistant to glucose repression mutants of Schizosaccharomyces pombe (ird5, ird13, and ird14) have a high tolerance to oxidative stress induced by H2O2. In all ird mutants, the increased expression level of the fbp1 gene can be interpreted as a lack of glucose repression in these mutants. To investigate the mechanisms of the oxidative stress response in ird mutants, we analyzed the transcription of stress response-related genes, sod1, ctt1, atf1, pap1, and sty1, under stressed and non-stressed conditions. We then analyzed the phosphorylation state of the Sty1-MAP kinase in ird mutants. Our findings support the concept of an adaptive response to oxidative stress in these mutants. In addition, these results imply that either glucose signaling mechanisms leading to glucose repression and glucose utilization as an energy source are regulated apart from each other or, like Saccharomyces cerevisiae, S. pombe might have additional glucose detection systems.

[Imaging following valve replacement]. / Bildgebung nach Klappenersatz.

Patients who undergo heart valve replacement require lifelong cardiac follow-up care. Although the primary pathology of the patient is treated by valve replacement, the risk of postoperative complications and structural failure of the implanted device requires regular check-ups where imaging plays an important role. Immediately after surgery reference values regarding prosthetic and cardiac function for further check-ups are obtained. Transthoracic and transesophageal echocardiography are the imaging modalities of choice for standard examination and follow-up due to their availability and low costs. However, when it comes to identification of complications they are often insufficient. Magnetic resonance imaging (MRI) and computed tomography (CT) play an increasingly important role as complementary modalities for the detection and monitoring of complications after valve replacement. The following article gives an overview of the current non-invasive examination methods and the use in the investigation of postoperative complications.

Influencia del método de remoción de caries en la fuerza de adhesión a dentina afectada / Influence of caries removal method on bond strength to dentin affected

La técnica de adhesión en dentina es una técnica poco predecible y se agudiza aun más cuando la dentina ha sido afectada por caries ya que las alteraciones histológicas disminuyen la posibilidad de esta unión; no obstante la variación en la técnica de remoción del tejido cariado pudiera influir de manera independiente en la unión. El objetivo de esta investigación es determinar la influencia del método de remoción del tejido cariado en la resistencia adhesiva en micro tracción (µTBS) de resina compuesta unida a dentina humana afectada por caries. Se utilizaron 15 molares humanos afectados por caries y de manera aleatoria simple se dividieron en tres grupos (G1,G2,G3), luego se realizó un corte con disco de diamante (KG Sorensen® /Brasil) perpendicular al eje mayor del diente exponiendo la mayor cantidad de dentina afectada, el G1 fue sometido a remoción con Aire abrasivo de oxido de aluminio de 50 µm a una presión de 40 PSI (Microjato®, Bio-art /Brasil), al G2 se le eliminó la caries con fresa redonda de carburo N° 6 a baja velocidad (KG Sorensen® /Brasil)y al G3 se le eliminó con el método Químico/Mecánico (PAPACARIE ® /Brasil y Cucharita para dentina), la eliminación fue corroborada con fluorescencia laser (DIAGNOdent®, Kavo /Germany), posteriormente se aplicó la técnica de grabado total siguiendo las indicaciones del fabricante para adhesivo Excite ®( Ivoclar Vivadent Inc. /USA), y se restauraron 6 mm oclusales con resina compuesta Brilliant Enamel New Line® (Coltène-Whaledent /Germany.), luego se seccionaron con una sierra de precisión ISOMET 1000® (Buehler /USA) y se obtuvieron muestras de 1x1x10 mm , a continuación las muestras se prepararon para la prueba de micro tracción en la máquina de prueba universales AGS-J (Shimadzu /Japan) a una velocidad de desplazamiento de 0,5mm por min. Los datos fueron recolectados en hoja de cálculo Excel y analizados con un ANOVA de 1 Vía, en un nivel (µBts), el valor de p quedo preestablecido en p?0,05

The dentin adhesion technique is a quite unpredictable one and it is enhanced when the dentin has been affected because histological alterations reduce the chance for this union; however, the variation in the removal technique of caries-affected tissue could have an independent influence on the union. Aim: to determine the influence of the method of caries-affected tissue removal on the adhesive resistance in micro-tensile (µTBS) of composite bonded to human dentin affected by caries. Methods: 15 human molars affected by caries were randomly assigned into three groups (G1, G2, and G3). Then, one cut with a diamond disc (KG Sorensen® /Brasil) was performed perpendicular to the major axis of the teeth exposing the larger amount on affected dentin. G1 condition was removal with abrasive air of aluminum oxide of 50 µm at a 40 PSI (Microjato®, Bio-art /Brasil) pressure. G2 had caries removal with carbide round drill N° 6 at a low speed (KG Sorensen® /Brasil). Finally, for G3 caries was removed with the Chemical/Mechanical method (PAPACARIE ® /Brasil and spoon excavator). The elimination was corroborated by laser fluorescence (DIAGNODENT®, Kavo /Germany); later, the total etching technique was performed by following the manufacturer instructions for Excite ® (Ivoclar Vivadent Inc. /USA) and 6 oclusal mm were restored with composite Brilliant Enamel New Line® (Coltène-Whaledent /Germany.), then they were cut with a precision saw ISOMET 1000® (Buehler /USA) and 1x1x10 mm samples were obtained. The samples were prepared for the micro traction test in the universal testing machine AGS-J (Shimadzu /Japan) a speed of 0,5mm per minute. Data were recorded in Microsoft Excel and a one way ANOVA was performed for one level (µBts), the p value was established at p?0,05. Results: the mean µBts in MPa for each group and the standard deviation (±SD) was as follows: G1= 21,7 (8,6) G2=19,70 (10,5) G3=22,2 (9,7)

Extract from mistletoe, Viscum album L., reduces Hsp27 and 14-3-3 protein expression and induces apoptosis in C6 rat glioma cells.

Extracts of mistletoe (Viscum album) are intensively used in complementary medicine, but their mechanisms are not fully understood in most cases, and the effects on metabolism have not been investigated in detail. However, some biologically active natural products are well known to provoke unexpected cellular responses. They reduce overexpression of heat shock proteins (Hsps) in cancer cells. The aim of the current study was to determine whether methanolic extract of V. album, which possesses antioxidant activity, has an effect on expression levels of Hsp27 and 14-3-3 proteins in a C6 glioma cell line. For the first time, the apoptosis-inducing effect of this extract was also determined via caspase-3 activation in the cells. Overexpression of Hsps was induced by heat shock at 42°C for 1 h. Expression levels of Hsp27 and 14-3-3 proteins were determined using Western blot analysis. The apoptosis-inducing effect was also evaluated via caspase-3 activation in C6 glioma cells. Pretreatment of the cells with a nontoxic dose (100 µg/mL) of V. album extract before heat shock significantly reduced expression levels of Hsp27 (73%) and 14-3-3ß (124%), 14-3-3γ (23%), and 14-3-3ζ (84%) proteins. Pretreatment with the extract before heat shock increased apoptosis via caspase-3 activation (60%) in C6 glioma cells. This result suggested that the methanolic extract of V. album downregulates expression of Hsp27 and 14-3-3 chaperone proteins and induces apoptosis, which warrants further exploration as a potential bioactive compound for cancer therapy.

Multicenter longitudinal study of B-lymphocyte depletion in refractory systemic lupus erythematosus: the LESIMAB study.

OBJECTIVE: This study aimed to investigate the effectiveness and safety of single and repeated courses of rituximab in patients with refractory lupus. METHODS: LESIMAB is a multicenter, retrospective, longitudinal study of lupus patients who have not responded to standard therapy and have been treated with rituximab. Response rates at six months and at follow-up were defined as efficacy outcomes. Complete response was defined as a SELENA-SLEDAI score ≤ two and a SELENA-SLEDAI Flare Index of zero. Partial response was defined as a reduction in the SELENA-SLEDAI score of ≥four points with no new or worsening of symptoms. Adverse events were collected. RESULTS: Seventy-three (62.9%) of 116 patients achieved a response at six months (complete in 22 and partial in 51). Ninety-seven (77.6%) of 128 patients achieved a response after a mean follow-up of 20.0 ± 15.2 months (complete in 50 and partial in 47). High baseline SLEDAI score, previous treatment with ≥100 mg/day prednisone, and no history of severe hematologic flare were associated with response after the first treatment course. The median time to response was 6.5 months (95% CI, 5.0-8.0). Thirty-seven patients (38.1%) relapsed after the first infusion. The flare was severe in seven cases and mild to moderate in 29 cases. Serious infection rate was 12.6/100 patient-years. A schedule of four weekly doses was associated with more serious infections. Six patients died: two of infection and four of lupus complications. CONCLUSION: Rituximab can be an effective treatment option for patients who have refractory lupus with severe or life-threatening disease with an acceptable tolerance profile.

Changes in liquid emptying in migraine patients: diagnosed with liquid phase gastric emptying scintigraphy.

Gastric stasis is suspected mostly to be encountered during acute migraine attack. The aim of this study is to evaluate the liquid phase gastric emptying and motility in migraine patients in ictal and interictal periods in comparison to normal subjects with gastric emptying scintigraphy. Seven women with migraine and age, sex matched controls who applied to the Neurology Department from May 2009 to May 2010 were compared. Gastric emptying study with a standard liquid was performed one time in the non-migraineur group and two times in the migraineur group. Non-migraineur controls and migraineurs were compared. The mean T1/2 was longer in ictal period in migraineurs. The T1/2 of migraineurs interictally and the control groups were similar. The T1/2 of migraineurs ictally and migraineurs interictally were also compared. We also considered the percentage of the radioactive material remaining in the stomach. There were no significant differences between non-migraineurs and migraineurs interictally. However, increased amount of radioactive material remaining in the stomach was observed in migraineurs ictally. We concluded that the liquid emptying was delayed in spontaneous migraine attacks in migraine without aura, however in the interictal period the emptying of liquids did not differ between migraineurs and non-migraineurs.

Influencia de la variabilidad diurna en el tamaño del infarto agudo de miocardio / No disponible

Objetivo: Evaluar si el tamaño del infarto agudo de miocardio (IAM) presenta variabilidad circadiana. Diseño: Estudio prospectivo observacional. Ámbito: Unidad coronaria de 12 camas. Pacientes: Enfermos consecutivos con diagnóstico de IAM con elevación del segmento ST sometidos a intervención coronaria percutánea primaria. Intervenciones: Se dividió a los pacientes en 2 grupos, dependiendo del horario de inicio de los síntomas del IAM (grupo A: 0-12 h; grupo B: 12-24 h). Variables de interés principales: Edad, sexo, factores de riesgo cardiovascular, anatomía coronaria, fracción de eyección del ventrículo izquierdo, localización del infarto, tiempo de inicio de los síntomas y reperfusión, presencia de insuficiencia cardiaca al ingreso, pico de troponina I. Resultados: Se incluyeron un total de 108 pacientes con diagnóstico de IAM con elevación del segmento ST. Los pacientes del grupo A presentaron concentración de troponina I mayor con respecto al grupo B (70,85±16,38 frente a 60,90±22,92 ng/ml, p=0,003). En el análisis multivariado el inicio del IAM entre las 0-12 h se mostró como un predictor independiente del tamaño del infarto (OR: 1,133, IC del 95% 1.012-1,267; p=0,01). Conclusiones: El inicio del IAM entre las 0-12 h resulta en un tamaño necrótico final significativamente mayor que cuando se inicia en cualquier otro momento del día (AU)

Objective: To evaluate whether the size of acute myocardial infarction (AMI) shows circadian variability. Design: An observational, prospective study. Setting: A 12-bed coronary care unit. Patients: Consecutive patients diagnosed with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Interventions: The patients were divided into two groups according to the time of onset of AMI symptoms (Group A: 0-12hours, Group B: 12-24 hours). Main variables of interest: Age, sex, cardiovascular risk factors, coronary anatomy, left ventricular ejection fraction, infarct location, time from onset of symptoms to reperfusion, presence of heart failure upon admission, and peak troponin I value. Results: A total of 108 patients with a diagnosis of STEMI were included. Patients in group A showed a higher troponin I concentration compared to group B (troponin I: 70.85±16.38 versus 60.90±22.92ng / ml, p=0.003). In the multivariate analysis the onset of AMI between 0-12 hours was identified as an independent predictor of infarct size (OR: 1.133, 95%CI 1.012-1.267, p=0.01). Conclusions: An onset of AMI between 0-12 hours results in a significantly larger final size of necrosis compared with any other time of presentation (AU)

[Influence of diurnal variation in the size of acute myocardial infarction]. / Influencia de la variabilidad diurna en el tamaño del infarto agudo de miocardio.

OBJECTIVE: To evaluate whether the size of acute myocardial infarction (AMI) shows circadian variability. DESIGN: An observational, prospective study. SETTING: A 12-bed coronary care unit. PATIENTS: Consecutive patients diagnosed with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. INTERVENTIONS: The patients were divided into two groups according to the time of onset of AMI symptoms (Group A: 0-12hours, Group B: 12-24hours). MAIN VARIABLES OF INTEREST: Age, sex, cardiovascular risk factors, coronary anatomy, left ventricular ejection fraction, infarct location, time from onset of symptoms to reperfusion, presence of heart failure upon admission, and peak troponin I value. RESULTS: A total of 108 patients with a diagnosis of STEMI were included. Patients in group A showed a higher troponin I concentration compared to group B (troponin I: 70.85±16.38 versus 60.90±22.92ng / ml, p=0.003). In the multivariate analysis the onset of AMI between 0-12hours was identified as an independent predictor of infarct size (OR: 1.133, 95%CI 1.012-1.267, p=0.01). CONCLUSIONS: An onset of AMI between 0-12hours results in a significantly larger final size of necrosis compared with any other time of presentation.

Características diferenciales de los pacientes con síndrome coronario agudo sin elevación del segmento ST con respecto a los que tienen elevación transitoria del segmento ST / Differential characteristics of patients with acute coronary syndrome without

ObjetivoEvaluar características diferenciales de los pacientes con síndrome coronario agudo (SCA) sin elevación del segmento ST en comparación con elevación transitoria del segmento ST.DiseñoEstudio prospectivo observacional.ÁmbitoUnidad coronaria de 12 camas.PacientesEnfermos consecutivos de SCA sin elevación persistente del segmento ST.Principales variables de interésLa población se dividió en 2 grupos, en función de la presencia de elevación transitoria del segmento ST. Las variables de interés fueron: edad, factores de riesgos cardiovasculares, concentraciones de troponina I y glucemia al ingreso, anatomía coronaria, fracción de eyección del ventrículo izquierdo, mortalidad intrahospitalaria y fármacos intrahospitalarios.ResultadosLos pacientes identificados con SCA y elevación transitoria del segmento ST eran significativamente más jóvenes, fumadores y con predominio del sexo masculino. A su vez, presentaban una elevación pico de troponina I menor, mayor fracción de eyección y principalmente enfermedad coronaria de un vaso.ConclusionesLos pacientes con SCA con elevación transitoria del segmento ST presentan diferencias en cuanto al tipo de población, daño miocárdico y resultados angiográficos con respecto a los pacientes con SCA sin elevación del segmento ST. Son necesarias más investigaciones para esclarecer si dichas diferencias implicarían un manejo terapéutico diferente (AU)

AbstractObjective: To evaluate different characteristics of patients with acute coronary syndrome (ACS)without ST-segment elevation compared with transient St-segment elevation.Design: An observational, prospective study.Setting: A 12-bed coronary care unit.Patients: Consecutive patients of ACS without persistent ST-segment elevation.Main variables of interest: The population was divided intro 2 groups according to the presenceof transient ST-segment elevation. Variables of interest were age, cardiovascular risk factors,troponin I and glucose concentrations on admission, coronary anatomy, left ventricular ejectionfraction, inhospital mortality and drugs.Results: Patients identified as ACS with transient ST-segment elevation were significantly younger,smokers and predominantly male. At the same time, they showed a minor peak elevationof troponin I, a higher ejection fraction and, mainly single-vessel coronary disease.Conclusions: Patients with ACS with transient ST-segment elevation differ in the type of population,myocardial damage and coronary angiographic results with respect to patients with ACSwithout ST-segment elevation. More research is needed to clarify whether these differencesimply a different therapeutic approach (AU)

El ligando soluble CD40 en pacientes con síndrome coronario agudo consumidores de cocaína / Soluble CD40 ligand in acute coronary syndrome in cocaine users

Objetivo: El ligando soluble CD40 (sCD40L) es una molécula que se expresa en el proceso de activación plaquetaria. Analizamos la concentración sérica de dicha molécula en pacientes consumidores de cocaína con síndrome coronario agudo (SCA).Método: Se realizó un análisis retrospectivo de 40 pacientes con SCA y test de cocaína positiva en orina, quienes se compararon con 40 pacientes con este diagnóstico y sinconsumo de cocaína. Resultados: Los valores del sCD40L en los pacientes con SCA y cocaína negativa fueron más bajos que los consumidores de cocaína (110 ± 41,1 frente a 135,7 ± 65,3pg/ml; p = 0,03). En el análisis multivariable y tras ajustar por la edad y los factores deriesgo coronario, los pacientes con SCA y cocaína positiva se relacionaron de forma independiente con niveles séricos más elevados de sCD40L. Conclusiones: El sCD40L está implicado en el proceso proinflamatorio-trombótico de los pacientes consumidores de cocaína y SCA (AU)

Background and objectives: The soluble CD40 ligand (sCD40L) expressed on platelets is released in the activation process. We analyzed the sCD40L serum concentration in cocaine users with acute coronary syndrome (ACS).Patients and methods: Retrospective comparison of sCD40L serum concentration between 40 patients with ACS and apositive test for cocaine in urine and 40 ACS patients with a negative cocaine test.Results: The mean (SD) sCD40L serum concentration in the patients with ACS and a negative cocaine test was lower(110 [41.1] pg/mL) than in patients who were not cocaine users (65.3 pg/mL) (P=.03). In the multivariable analysis, after adjustment for age and coronary risk in these patients with ACS, a positive cocaine test remained associated withs CD40L concentration. Conclusions: The sCD40L plays a part in the proinflammatory thrombotic process in cocaine users who develop ACS (AU)

[Differential characteristics of patients with acute coronary syndrome without ST-segment elevation compared to those with transient ST-segment elevation]. / Características diferenciales de los pacientes con síndrome coronario agudo sin elevación del segmento ST con respecto a los que tienen elevación transitoria del segmento ST.

OBJECTIVE: To evaluate different characteristics of patients with acute coronary syndrome (ACS) without ST-segment elevation compared with transient St-segment elevation. DESIGN: An observational, prospective study. SETTING: A 12-bed coronary care unit. PATIENTS: Consecutive patients of ACS without persistent ST-segment elevation. MAIN VARIABLES OF INTEREST: The population was divided intro 2 groups according to the presence of transient ST-segment elevation. Variables of interest were age, cardiovascular risk factors, troponin I and glucose concentrations on admission, coronary anatomy, left ventricular ejection fraction, inhospital mortality and drugs. RESULTS: Patients identified as ACS with transient ST-segment elevation were significantly younger, smokers and predominantly male. At the same time, they showed a minor peak elevation of troponin I, a higher ejection fraction and, mainly single-vessel coronary disease. CONCLUSIONS: Patients with ACS with transient ST-segment elevation differ in the type of population, myocardial damage and coronary angiographic results with respect to patients with ACS without ST-segment elevation. More research is needed to clarify whether these differences imply a different therapeutic approach.