The effect of kangaroo care on maternal attachment in preterm infants.

AIM: The study was conducted to determine the effect of kangaroo care on maternal attachment in preterm infants in Turkish mothers. SUBJECTS AND METHODS: The study was conducted a quasi-experimental research design between October 2015 and February 2016 in the neonatal intensive care units (NICU) of two state hospitals located in the east and west of Turkey. The study population consisted of preterm infants hospitalized in the NICU at the time of the research and met the study-group selection criteria. The study population was divided into two groups as an experimental and control group. Kangaroo care (n = 30) was provided to the infants in the experimental group by their mothers. No intervention was applied to the infants in the control group (n = 30) other than the routine practice. Data were collected by the researcher using the 'Introductory Information Form' and the 'Maternal Attachment Inventory'. Data analysis was performed with SPSS (Statistical Package for Social Sciences) 18 software package. The data were analyzed using percentile distributions, mean, standard deviation, t-test, and Chi-square test. Official permissions and ethical approval were obtained to conduct the study. RESULTS: It was determined that the experimental and control group included in the study were similar in terms of the characteristics of the baby and the mother (P> 0.05). In the study, the mean maternal attachment scale score (MAS) of the group in which the kangaroo care was provided was higher than the control group with a statistically significant difference between the groups (P < 0.05). CONCLUSION: As a result of the study, it was concluded that kangaroo care positively affects maternal attachment and it is suggested that further studies should be conducted to evaluate the effect of kangaroo care on mother-infant attachment in Turkey.

Giant thrombus on apical wall of left ventricle due to HIT syndrome after anterior MI.

Heparin-induced thrombocytopenia (HIT) is the most important and the most frequent drug-induced, immune-mediated type of thrombocytopenia. It is associated with significant mortality and morbidity if unrecognized. We describe a patient with a giant thrombus on the apical wall of the left ventricle that occurred due to HIT syndrome after anterior myocardial infarction.

Noncompaction cardiomyopathy and dextroversion of the heart.

The prevalence of patients with noncompaction is reported to be 0.014% on echocardiographic examination. The estimated incidence of dextroversion (dextrocardia with isolated reversal of the heart with normally positioned visceral organs) is 1:2,800, while the real incidence of dextroversion and left ventricular noncompaction is still not known; to our knowledge only two cases have been reported in the literature. Noncompaction can generally be diagnosed using echocardiography; however, in the case reported here cardiac magnetic resonance imaging was important for the definitive diagnosis of dextroversion and noncompaction, because no adequate echocardiographic images could be obtained.

Left atriotomy versus right atriotomy trans-septal approach for left atrial myxoma.

The biatrial approach has been the classic means of access for left atrial myxoma resection. Increased surgical experience led cardiac surgeons to favour the uniatrial approach to reduce incisions and achieve adequate exposure. In this study, two unilateral surgical approaches were compared in 18 consecutive left atrial myxoma cases. Patients were divided into two groups according to the surgical approach: left atriotomy (group 1, n = 9) and right atriotomy trans-septal approach (group 2, n = 9). Comparison criteria included pre- and post-operative functional capacity, cardiac rhythm, left ventricular ejection fraction, pulmonary artery pressure, left atrial dimensions, cardiopulmonary bypass time, aortic cross-clamp time, drainage over 48 h post-operatively, units of blood transfused, extubation time and length of stay in the intensive care unit and hospital. No significant between-group difference was observed in any criteria except aortic cross-clamp time, which was significantly longer in group 2 than in group 1. No recurrence of myxoma occurred in either group for the 15 patients followed up. Right atrial trans-septal incision appears to be as safe and effective as the left atriotomy approach for left atrial myxoma resection.

What should be the primary treatment in atrial fibrillation: ventricular rate control or sinus rhythm control with long-term anticoagulation?

Recent trials have favoured ventricular rate control in atrial fibrillation (AF) management, however the present study investigated whether the restoration and maintenance of sinus rhythm with long-term anticoagulation therapy was superior in terms of embolic events and death in 534 patients with an AF duration > 48 h. Patients were randomized and received sinus rhythm control with either aspirin (group 1) or warfarin (group 2), or they were given ventricular rate control (group 3). Cardioversion to sinus rhythm was attempted in 425 patients and was successful in 387 (91.1%) of them. After 3 years' follow-up there were 12, two and 15 embolic events in groups 1, 2 and 3 respectively (significant difference between groups 1 and 2, and 2 and 3) and overall mortalities were four, two and 12, respectively (significant difference between groups 2 and 3). It is concluded that patients with an AF duration > 48 h might benefit considerably from sinus rhythm restoration and long-term warfarin therapy in terms of embolic events and mortality.

Heat stress limits infarct size in the isolated perfused rabbit heart.

OBJECTIVE: Heat stress, with the expression of heat stress proteins, has been shown to protect the rabbit heart in vitro against global ischaemia/reperfusion injury, though no benefit is apparent in an in vivo rabbit model of infarct size. The aim of this study was therefore to investigate this discrepancy and to discover whether heating itself has any effect which could negate the protection derived from myocardial stress protein synthesis. METHODS: (1) To ascertain whether heat stress could limit infarct size in the absence of blood, isolated buffer perfused hearts, with or without prior heat stress, were subjected to 45 min of regional ischaemia and 120 min reperfusion, and the resulting infarct size was expressed as a percentage of the risk area (I/R%). (2) The observations were repeated in an isolated blood perfused heart model in which a support rabbit (heat stressed or control) was used to perfuse the isolated heart. RESULTS: In the buffer perfused heart, prior heat stress reduced I/R from 70.8(SEM 4.4)%, n = 10, in controls to 51.5(5.7)%, n = 12 (p < 0.05). In hearts perfused by support rabbits, prior heat stress reduced I/R [from 34.7(3.7)%, n = 16, to 23.5(3.3)%, n = 15 (p < 0.05)] only when the perfusing rabbit was a control (not heat stressed). If the perfusing rabbit had been heated, I/R was greater in both heat stressed and control hearts [51.9(7.0)% and 44.9(3.3)%, p < 0.05 v control support rabbit]. CONCLUSIONS: Heat stress limits infarct size in this rabbit model. However it appears to have additional adverse effects, probably on the blood, which may override any benefit associated with myocardial stress protein synthesis.

Ruptured aneurysm of the sinus of Valsalva into the left ventricle: a case report and review of the literature.

This report describes a case of right coronary sinus of Valsalva aneurysm which ruptured into the left ventricle. The diagnosis was made with two-dimensional transthoracic echocardiography which showed an abnormal structure extending from the aortic root into the left ventricle adjacent to the interventricular septum. Subsequent examinations with transesophageal echocardiography and aortic root angiography and surgical findings confirmed the diagnosis of transthoracic echocardiography. The patient underwent aortic valve replacement. At follow-up 12 months later, the patient was without symptoms and repeated echocardiographic examinations showed no recurrence.

A cardiac papillary fibroelastoma with chordal location.

Papillary fibroelastomas, which were initially incidental findings at autopsy and surgery, are now being recognized with increasing frequency with the widespread use of echocardiography. Because of their embolic potential, an aggressive treatment approach is generally accepted. We report a papillary fibroelastoma located at the chorda of the anterior mitral leaflet that underwent conservative follow-up for 8 years without any complications. Because most of the cardiac papillary fibroelastoma cases reported are incidental findings, the question of whether symptomless fibroelastomas must be removed or other factors contribute to the embolic nature of the selected cases remains a challenge for the future.

Mobile atheromatous plaque of the aortic arch diagnosed by transthoracic echocardiography prior to coronary artery bypass surgery. Which one would you choose: scepticism or wishful thinking?

A routine pre-operative chest X-ray of a patient admitted to our institution for an elective coronary artery bypass operation revealed a mildly dilated mediastinal silhouette, which led the cardiovascular surgery resident to schedule emergency transthoracic echocardiography (TTE), with a special note asking for detailed evaluation of the ascending aorta and aortic arch. TTE revealed a mobile atheroma at the aortic arch, which obliged the cardiac surgery team to modify their strategy to combined hemi-arcus aortae replacement and coronary artery bypass grafting (CABG). Although with transoesophageal echocardiography (TEE) a small portion of the ascending aorta may be obscured by the trachea, TEE provides higher resolution images than TTE. Therefore one can conclude that TEE is the imaging modality of choice for detecting aortic atheromatous plaques but in patients with low risk for stroke and aortic atheromas, a detailed TTE may be sufficient for the pre-operative assessment.

Post-infarction ventricular septal defect: triggered by Valsalva manoeuvre?

Post-infarction ventricular septal defect (VSD) is a fatal mechanical complication of myocardial infarction. Although the incidence has decreased to less than 1% after the extensive use of reperfusion strategies, post-infarction VSD still carries a high mortality risk. Management is controversial, whether to wait for surgery after a stabilisation period or to perform emergency surgery when diagnosed. We report on a case of post-infarction VSD that was detected with severe haemodynamic instability, beginning immediately after the patient's Valsalva manoeuvre on the sixth day of a non-reperfused inferior myocardial infarction. In the early period, the post-infarction VSD was repaired via a trans-aneurismal approach.

Continuous versus separate isokinetic test protocol: the effect of estradiol on the reproducibility of concentric and eccentric isokinetic measurements in knee muscles.

OBJECTIVE: To investigate the effects of estradiol on the reliability of concentric and eccentric isokinetic measurements of knee muscles and to compare the reproducibility of measurements in a continuous test protocol and a separate test protocol. DESIGN: Repeated measurements. SETTING: A university exercise physiology laboratory. PARTICIPANTS: Twenty healthy sedentary women volunteers, aged 19 to 37 years, who had regular menstrual cycles (ranging from 27 to 35 days). Subjects were randomly divided into two groups: continuous test group (n = 10) and separate test group (n = 10) and tested at the menstrual phase (days 1 to 3) and preovulatory phase (days 12 to 14) in both legs. METHODS: Continuous reciprocal flexion-extension contractions were used in the continuous test group, and separated flexion and extension contractions were used in the separate test group. Four different test protocols were designed to determine the effects of test mode and number of contractions on the isokinetic measurements: Group A, 4 reciprocal flexion-extension repetitions at each angular velocity of 60 degrees/sec and 180 degrees/sec in one leg in the continuous test group; Group B, 4 and 20 reciprocal flexion-extension repetitions at 60 degrees/sec and 180 degrees/sec, respectively, in the contralateral leg in the same group; Group C, 4 repetitions in extensors and flexors at each angular velocity of 60 degrees/sec and 180 degrees/sec with a 5-minute rest between the two muscle groups in one leg in the separate test group; and Group D, 4 repetitions at 60 degrees/sec and 20 repetitions at 180 degrees/sec for extensors and flexors with a 5-minute rest between the two muscle groups in the contralateral leg in the same group. Blood samples were analyzed for sex hormones, creatine kinase, and lactate dehydrogenase before the tests at the menstrual phase and the preovulatory phase. In addition subjective assessment of muscle soreness was made at each blood sampling. RESULTS: Concentric and eccentric peak torque, average power, total work, and endurance ratio at both angular velocities were not significantly different in the two phases of the cycle by paired observation t test for each of the four groups. Except for concentric and eccentric endurance ratios of quadriceps and hamstrings, and concentric peak torque and average power of hamstrings at 180 degrees/sec in Group D, intraclass correlation coefficients of tested variables showed correlations that were moderate to excellent (p < .05) between two phases. In addition, there were no significant correlations between estradiol and the tested variables. Resting serum creatine kinase and lactate dehydrogenase activities and the score of muscle soreness were at the baseline and not significantly different prior to the tests performed at preovulatory and menstrual phases. CONCLUSIONS: The results suggest that: (1) reproducibility of isokinetic tests during the menstrual cycle is not influenced by sex hormone fluctuations, particularly estradiol; (2) when compared with the separate test protocol used in this study, the continuous test protocol is more appropriate to measure peak torque, average power, total work, and endurance ratio for both muscle groups of the knee even if the number of contractions is changed. However, these conclusions are specific to sedentary individuals; to make more valid conclusions, further studies with different subject groups are needed.

Effects of age on the reciprocal peak torque ratios during knee muscle contractions in elite soccer players.

To investigate the effects of age on the reciprocal peak torque ratios during knee muscle contractions, 25 elite male soccer players, aged 22.3 +/- 3.8 yr (18-28), volunteered for the present study. The players were grouped as adult (> 21 years, n = 13) and young players (< or = 21 years, n = 12). Maximal concentric (CON) and eccentric (ECC) isokinetic thigh muscle strength was measured at angular velocities of 30 degrees, 180 degrees, 240 degrees and 300 degrees/s. ECC and CON peak torques of knee flexors (hamstring, HAM) and CON peak torques of knee extensors (quadriceps, QUA) in the dominant knee were greater (P < 0.05) in adult players than in young players at 180, 240 and 300 degrees/s. ECC HAM/CON QUA peak torque ratio at 300 degrees/s was greater (P < 0.05) for adult players compared to young players in the dominant knee but not in the nondominant knee. Furthermore, conventional HAM/QUA peak torque ratios of the dominant knee at all angular velocities for ECC contraction were higher (P < 0.05) in adult players than in young players. In conclusion, the findings of the present study indicate that the reciprocal torque ratio is influenced by age in the dominant knee of elite soccer players. Because there was no effect of age for the nondominant leg, the findings of the present study are more likely to be the result of the training background of the players than their age.

Exercise-induced oxidative stress and muscle performance in healthy women: role of vitamin E supplementation and endogenous oestradiol.

The purpose of this study was to investigate the individual and combined antioxidant effects of menstrual cycle phase-related alterations in blood serum oestradiol concentrations and of dietary vitamin E supplementation on exercise-induced oxidative stress and muscle performance. A group of 18 sedentary women, aged 19-35 years, were given supplements of 300 mg alpha-tocopherol (n = 10) or placebo (n = 8) daily during the course of two menstrual cycles. The subjects exercised the knee isokinetically to exhaustion after cycling submaximally at 50% maximal oxygen uptake during the menstrual and preovulatory phases of their menstrual cycles. Blood samples were taken before and after the exercise, to evaluate haematocrit, plasma lactic acid and malondialdehyde concentrations, erythrocyte antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities and apolipoprotein B containing lipoprotein (non-high density lipoprotein, HDL, fraction) oxidation. Serum vitamin E, follicle stimulating hormone, luteinizing hormone and oestradiol concentrations were measured in pre-exercise blood samples. Neither vitamin E supplementation nor oestradiol concentrations influenced SOD and GPx activities or the susceptibility of the non-HDL fraction to oxidation while at rest. Plasma malondialdehyde concentration was unaffected by exercise, however significant reductions in erythrocyte SOD and GPx activities and increased susceptibility of the non-HDL fraction to oxidation were noted after exercise. Exercise-induced changes were reduced when oestradiol concentration was high in the preovulatory phase, independent of the serum vitamin E concentrations. In addition, both pre- (r = 0.58, P < 0.05) and post-exercise (r = 0.73, P < 0.001) GPx activities in placebo administered subjects were positively correlated with oestradiol concentrations. In conclusion, these findings suggest a better protective role of oestradiol against oxidative injury, compared to vitamin E. Exhausting muscle performance was, however, not influenced by vitamin E supplementation and/or cycle-phase related changes in oestradiol concentrations.

Tuberculous meningitis in adults--experience from Turkey.

BACKGROUND: The annual incidence of tuberculous meningitis (TM) is unknown. TM is a disease that still often results in residual sequelae, and has a mortality rate ranging between 15 and 51%. Experience of countries such as Turkey where drug-resistant tuberculosis and TM are prevalent is important. METHODS: Clinical and laboratory findings of 42 patients with TM, followed between 1991 and 2002, were evaluated retrospectively. RESULTS: Twenty-eight female and 14 male patients were included in this study. The mean age of the patients was 33.9 +/- 13.2 years (range, 16-60 years). Fourteen had a history of pulmonary tuberculosis; 12 reported close contact with a person with active pulmonary tuberculosis; three were diagnosed with active pulmonary tuberculosis; two, with HIV infection; two, with Pott's disease; and one, with systemic lupus erythematosus. On admission, 17 patients were diagnosed with stage I; 15, with stage II; and 10, with stage III disease. Hemiparesis (35.7%), cranial nerve palsy (30.9%), and altered consciousness (26.9%) were the most common neurological deficits. Prolonged duration of pre-existing symptoms and female gender were found as significant risk factors in those who develop neurological sequelae (p < 0.01 and p < 0.05, respectively). Cranial computerised tomography revealed various pathological findings in all but five patients. Sulcus effacement was the most common radiological finding. Enlargement of ventricles, focal cerebral oedema/shunt, calcification of meninges, tubercle, and infarction were other common abnormal radiological findings. CONCLUSIONS: Prolonged duration of pre-existing symptoms and female gender are predictors of neurological sequelae of TM. Early identification of such patients and prompt initiation of anti-tuberculosis therapy may improve their outcome.