Is elevated triglyceride high density lipoprotein cholesterol ratio a risk factor that causes acute coronary syndrome to appear earlier?

BACKGROUND: The purpose of this study was to assess the relationship between the triglyceride/high density lipoprotein cholesterol ratio and the risk of acute myocardial infarction in young adults. PATIENTS AND METHODS: A total of 621 patients, who underwent coronary angiography (CAG) due to Myocardial Infarction (MI) at our hospital were included in this study. Demographic characteristics, risk factor profile, laboratory test results, electrocardiographic and CAG findings were assessed in the selected groups. RESULTS: Total cholesterol, triglyceride/high density lipoprotein cholesterol (Tg/HDL) ratio, Tg levels, were higher in younger patients with MI, while glucose and high-density lipoprotein levels were lower. Using propensity score matching in the matched population comparing young patients to the older ones, serum triglyceride levels [179 (145-231) vs 148 (101-197)] and triglyceride to high density lipoprotein cholesterol ratio [5.8 (4.1-9.1) vs 3.0 (1.8-4.6)] were significantly higher, whereas high density lipoprotein levels were observed dramatically lower (32.6 ± 8.2 vs 41.7 ± 8.8). CONCLUSION: This study demonstrated that Tg/HDL ratio may be an important predictor for an acute coronary syndrome in the young adult population. Tg/HDL ratio can be used to prevent MI in young adults (Tab. 3, Fig. 1, Ref. 32.).

Parathyroid hormone is associated with heart failure with preserved ejection fraction.

BACKGROUND: Parathyroid hormone (PTH) is a novel promising biomarker that can predict hospitalization, functional status and mortality in patients who suffered heart failure with preserved ejection fraction (HFpEF). OBJECTIVE: We aimed to investigate the association of serum PTH levels and measures of disease severity (NYHA functional class, NT-proBNP, CRP, EF, Troponin I) in patients with HFpEF. METHODS: A total of consecutive 58 outpatients with HFpEF and 30 controls were prospectively studied. All patients underwent laboratory tests, including NT-proBNP and PTH analyses. RESULTS: PTH, NT-proBNP, troponin I, and CRP levels were significantly higher in patients with HFpEF when compared with control group (54.61 ± 31.02 vs 40.40 ± 14.22 pg/ml, p < 0.05; 126.05 ± 162.94 vs 44.57 ± 14.95 pg/ml, p < 0.01; 0.011 ± 0.013 vs 0.004 ± 0.001 ug/L, p < 0.01; 4.65 ± 4.24 vs 1.63 ± 0.97 mg/L, p < 0.01, respectively). Left atrium was found to be more enlarged in HFpEF patients (LAVI = 36 ± 18 vs 28 ± 11 ml/m², p < 0.01). Most indices of left ventricular diastolic function were more severely impaired compared to controls (p < 0.05). There was no correlation between PTH and CRP, troponin I, LVMI, LV volumes, LV diameters, E/E', age, and BMI in both groups (p = NS). There was strong positive correlation between PTH and NT-proBNP levels in all study participants (r = 0.359; p < 0.01). CONCLUSION: PTH together with other markers of heart failure may provide valuable information both in the diagnosis and staging of heart failure syndromes (Tab. 4, Fig. 1, Ref. 40).

Subclinical left ventricular systolic dysfunction in diabetic patients and its association with retinopathy: A 2D speckle tracking echocardiography study.

AIM: It is important to diagnose diabetic cardiomyopathy in the early stages to prevent development of evident heart failure in the future. The primary objective of this study was to evaluate the presence of subclinical left ventricular (LV) dysfunction with two-dimensional (2D) speckle tracking echocardiography (STE) and the secondary objective was to compare retinopathy-positive and -negative diabetic patients. PATIENTS AND METHODS: A total of 82 patients with type II diabetes mellitus (DM) and 90 gender-matched healthy controls were included. Retinopathy was present in 55 patients in the study group. All study participants underwent conventional 2D echocardiography and STE. RESULTS: All diabetic patients had preserved LV ejection fraction (LV-EF ≥ 50). Compared with the control group, diabetic patients had a larger left atrium (47.3 ± 19.9 mm vs. 36.9 ± 17.8 mm, p < 0.001) and a higher E/Em ratio (12.0 ± 2.9 vs. 10.5 ± 3.7, p = 0.004). The LV-EF, LV end diastolic and end systolic volumes, E/A ratios, deceleration times, and tissue Doppler parameters were compared between groups. The study group was observed to have statistically significant lower four-chamber (4C; 17.7 ± 3.0 % vs. 19.3 ± 3.5 %, p = 0.002), three-chamber (3C; 17.5 ± 3.0 % vs. 19.2 ± 3.4 %, p = 0.001), and two-chamber (2C; 18.5 ± 3.5 % vs. 20.1 ± 2.4 %, p = 0.001) peak longitudinal strain values compared with the control group. Moreover, LV global strain values were found to be significantly lower in the DM group than in the control group (17.9 ± 2.7 % vs. 21.1 ± 3.2 %, p < 0.001). By contrast, basal rotation (4.9 ± 3.3° vs.2.8 ± 4.5°, p = 0.001), apical rotation (15.3 ± 6.7° vs. 12.1 ± 5.3°, p = 0.001) and LV twist (20.2 ± 7.2° vs. 16.9 ± 6.5°, p = 0.002) in the DM group were significantly increased compared with those of controls. CONCLUSION: The STE procedure can be a useful novel technique in the determination of subclinical LV dysfunction in diabetic patients. Diabetic patients have lower longitudinal myocardial mechanics, and circumferential and rotational mechanics are impaired. There was no significant association between diabetic retinopathy and LV function.

Takotsubo cardiomyopathy after bisoprolol withdrawal and open appendectomy.

Takotsubo cardiomyopathy (TTC) is an acute cardiac syndrome characterized by transient regional wall motion abnormalities of the left ventricular apex or midventricle. Patients often present with chest pain or dyspnea, ST-segment elevation, and minor elevation of cardiac enzyme levels. TTC has been associated with severe emotional or physical stress such as severe burns, spinal cord injury, subarachnoid hemorrhage, multiple traumas, and surgery. We report a case of TTC in a 45-year-old woman who had undergone appendectomy 2 days before presenting to our institution.

Case series of a rare complication of CABG. Fistula between the internal mammary artery and pulmonary vasculature.

BACKGROUND: There are few reports in the literature on the development of a fistulous connection between the left internal mammary artery (LIMA) and the pulmonary vasculature (PV) after coronary artery bypass grafting (CABG). This type of fistula may cause angina after CABG. Various mechanisms in the pathophysiology of this rare condition have been proposed. METHODS: We evaluated 537 consecutive patients with CABG surgery who underwent coronary angiography at our institution between January 2011 and March 2012. The post-CABG angiograms were evaluated for LIMA-PV fistula formation. Presence of a LIMA-PV fistula was defined as opacification of the PV or parenchyma after injection of radiopaque contrast medium into the LIMA. RESULTS: We found that 5 of 537 patients (0.93 %) had a LIMA-PV fistula on post-CABG coronary angiograms. The mean age of patients with a LIMA-PV fistula was 61.4 years (range, 51-72 years) and all patients were male. Coronary angiography was performed in the setting of myocardial infarction for 2 patients with a LIMA-PV fistula, and stable angina pectoris was the indication for coronary angiography in the remaining 3 patients. The mean diagnosis time of LIMA-PV fistula after CABG was 3.4 years (range, 1-9 years). None of the patients had a history of redo-CABG, perioperative mediastinitis, or pneumonia. CONCLUSION: LIMA-PV fistulas may occur more frequently than reported on post-CABG angiogram findings. Angina in post-CABG patients may be associated with a LIMA-PV fistula, and selective cannulation of the LIMA with careful evaluation of the angiographic images may provide proper diagnosis and treatment of this entity.

Clinical analysis of emergency peripartum hysterectomies in a tertiary center.

OBJECTIVE: To investigate the incidence, indications, complications, and risk factors associated with increased mortality and morbidity of emergency peripartum hysterectomy (EPH). MATERIALS AND METHODS: The authors retrospectively analyzed 48 cases of EPH performed within six-year interval at Ondokuz Mayis University Hospital. EPH was defined as the operation performed for life-threatening hemorrhage which could not be controlled with conservative treatment modalities within 24 hours of a delivery. RESULTS: The incidence of EPH was 5.03 per 1,000 deliveries. The most common indication for EPH was abnormal placental adherence (n = 22, 45.8%), followed by uter- ine atony (n = 19, 39.6%). All the patients with placenta accreta had a history of repeat cesarian section (CS) and placenta previa.Total hysterectomy was performed in almost all of the patients (n = 47, 97.9%). All women required blood transfusions. Maternal morbidity was significant, with bladder injury (31.3%) and disseminated intravascular coagulation (18.7%) among the most common complications. There were one maternal (2.1%) and five neonatal deaths (10.4%). CONCLUSION: Since most of the EPH cases are associated with prior cesarean delivery, decision of the first CS should be made for true obstetrical indications.If conservative treatments fail to control massive obstetrical bleeding, blood products and an experienced obstetrician should be ready to perform EPH to decrease the maternal mor- bidity and mortality.

Epidemiology and risk factors of infections among patients with extracorporeal membrane oxygenation in a tertiary heart center.

OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is an important treatment strategy for severe acute respiratory and/or cardiac failure. Despite advancements in device technology and intensive care, mortality rates, and complications remain high. Patients undergoing ECMO are at an increased risk of infection due to factors such as immunosuppression, the presence of cannulas, and variable antibiotic pharmacokinetics. Unfortunately, an acquired infection in these patients can lead to increased morbidity, longer hospital stays, and even mortality. The purpose of this study was to examine the prevalence, profiles, and sites of ECMO-related infections, as well as underlying risk factors associated with these infections. PATIENTS AND METHODS: We retrospectively analyzed clinical data from 73 patients who received veno-arterial (VA) and/or venovenous (VV) ECMO support due to severe but potentially reversible cardiac and/or pulmonary failure lasting ≥24 hours. We involved patients with no suspicion of pre-existing infection before ECMO insertion from January 2015 to February 2023, classifying them into either infected or non-infected based on available evidence. The estimated probability for infection according to ECMO-day was established. Significance was set at p<0.05. The primary interesting outcome is the infection probability. RESULTS: Mean age was 52.2±14.8 years in all groups, and 55 (75.3%) were male. Median hospital stay was 6 (2-16) days and duration of ICU was 5 (2-10) days in all groups. The duration of ICU stay was significantly higher in the infected group compared to the non-infected group [10 days (5-15) vs. 3 days (2-7)], p<0.001, respectively. 66 patients (90.4%) received VA ECMO and 18 of them (94.7%) were infected. In all groups, the ECMO wean ratio was 28.8%. Death before 48 hours occurred in 28 patients (38.4%). 26% of patients under ECMO support consisted of the infected group and had 68 episodes per 1,000 ECMO days. Of these, the most frequent infection site was lower respiratory tract infection (47.3%). The most common pathogen among these was K. pneumonia. 39.7% of patients received no antibiotics. The probability of infection was 19% for 1.5 (mean-1SD) ECMO days, approximately 41% for 4 ECMO days, and 52% for (mean+1SD) 6.5 ECMO days. CONCLUSIONS: Nosocomial infections, which are commonly observed during ECMO procedures, are considered a significant concern. The respiratory system is frequently affected by such infections. Even though the use of antibiotics for prophylaxis remains debatable, it is predicted that there will be an inclination towards the regular application of prophylactic measures and the development of standardized protocols based on solid evidence obtained from prospective research studies in the future.

Prognostic role of intermountain risk score (IMRS) in intensive care unit patients with a diagnosis of COVID-19.

OBJECTIVE: In this study, we aimed to assess the predictive value of Intermountain Risk Score (IMRS) in intensive care unit (ICU) patients with COVID-19. PATIENTS AND METHODS: Our retrospective study included the data of 194 patients who were admitted to the COVID-19 ICU of a tertiary care center. COVID-19 diagnoses were made by a positive result from a real-time reverse-transcriptase (RT) polymerase chain reaction (PCR) assay of nasal and pharyngeal swab specimens. Patients who had negative RT-PCR results or who were not admitted to ICU and patients under 18 years old were excluded from the study. Complete blood count, biochemistry panel, and blood gas analysis results were gathered and compiled. RESULTS: 194 ICU patients with COVID-19 (PCR positive) were included in the study. The patients were divided into two groups according to IMRS (if IMRS was <15 in women and <17 in men, patients were included in the non-high-risk group, while patients with IMRS ≥15 in women and ≥17 in men were defined as a high-risk group). Multivariate regression analysis was performed to predict in-hospital mortality. The IMRS [OR: 1.17 (1.08-1.27) p<0.001)] was found to predict in-hospital mortality. CONCLUSIONS: In this study, we showed that the IMRS score at admission can predict in-hospital mortality in intensive care unit patients with a diagnosis of COVID-19.

Molecular epidemiology of the Bacillus anthracis isolates collected throughout Turkey from 1983 to 2011.

The main perspective of this study was to determine cross-transmissions amongst anthrax cases and provide detailed information regarding the genotypes of Bacillus anthracis isolates circulating in Turkey. A total of 251 B. anthracis isolates were obtained from human (93 isolates), animal (155 isolates), and environmental (three isolates) samples in various provinces of Turkey. All isolates were susceptible to quinolones, vancomycin, tigecycline, and linezolid, but not to ceftriaxone. Excluding human isolates, one of the animal isolates was found to be resistant to penicillin, erythromycin, and doxycycline. Multiple-locus variable-number tandem repeats analysis including 8 loci (MLVA8) revealed 12 genotypes, in which genotype 43 was observed at the highest frequency (41.8 %), followed by genotype 35 (25.5 %) and genotype 27 (10.4 %). Major subtype A3.a was the predominant cluster, including 86.8 % of the isolates. The MLVA25 analysis for the 251 isolates yielded 62 different genotypes, 33 of which had only one isolate, while the remaining 29 genotypes had 2 to 43 isolates, with a total of 218 isolates (86.9 %). These findings indicate very high cross-transmission rates within anthrax cases in Turkey. The genotypes diagnosed in Turkey are populated in the A major cluster. Penicillin prescribed as the first-choice antibiotic for the treatment of anthrax is still effective.

Determination of melamine in milk and dairy products by high performance liquid chromatography.

A simple, precise, accurate, and validated reverse-phase HPLC method was developed for the determination of melamine in milk (pasteurized and UHT milk) and dairy products (powdered infant formula, fruit yogurt, soft cheese, and milk powder). Following extraction with acetonitrile:water (50:50, vol/vol), samples were purified by filter (0.45 µm), separated on a Nucleosil C8 column (4.6 mm × 250 mm, 3 µm) with acetonitrile:10 mmol/L sodium L-octane sulfonate (pH 3.1; 15:85, vol/vol) as mobile phase at a flow rate of 1 mL/min, and determined by a photodiode array detector. A linear calibration curve was obtained in the concentration range from 0.05 to 5 mg/kg. Milk and dairy products were fortified with melamine at 4 levels producing average recovery yields of 95 to 109%. The limits of detection and quantification of melamine were 35 to 110 and 105 to 340 µg/kg, respectively. The method was then used to analyze 300 samples of milk and dairy products purchased from major retailers in Turkey. Melamine was not found in infant formulas and pasteurized UHT milk, whereas 2% of cheese, 8% of milk powder, and 44% of yogurt samples contained melamine at the 121, 694±146, and 294±98 µg/kg levels, respectively. These findings were below the limits set by the Codex Alimentarius Commission and European Union legislation. This is the first study to confirm the existence of melamine in milk and dairy products in Turkey. Consumption of foods containing these low levels of melamine does not constitute a health risk for consumers.

Pulsed-field gel electrophoresis characterization of Bordetella pertussis clinical isolates circulating in Turkey in 2001-2009.

Our purpose was to evaluate the natural epidemiological history of circulating Bordetella pertussis clinical isolates in Turkey, comparing isolates by means of pulsed-field gel electrophoresis (PFGE) profiles according to years, geographic regions, vaccination status, and demographic characteristics. We analyzed genotypically a collection of 92 clinical isolates recovered during the period 2001-2009 at the National Pertussis Reference Laboratory by PFGE. A total of 61 genotypes were identified among the 92 isolates. Fifteen of 61 genotypes were a cluster including 46 isolates, and the remaining 46 genotypes were unique. The clustering rate was 50% (46/92). The size of the cluster varied from 2 to 14 clinical isolates. There was no association between clustering rates and age, gender, or quarterly season. The clustering rate was significantly higher in 2006. When the isolates were grouped according to similarity coefficient higher than 85%, 89 (96.7%) of the 92 isolates were clonally related. There was one major group including 65.2% of the isolates mainly observed. This is the first study on the molecular characterization of B. pertussis isolates in Turkey. We consider that this study lays a good foundation for further monitoring of the circulating B. pertussis clinical isolates in Turkey.

Neuropathic arthropathy progressing with multiple joint involvement in the upper extremity due to syringomyelia and type I Arnold-Chiari malformation.

Neuropathic arthropathy (NA), known as Charcot neuroarthropathy, is a chronic, degenerative arthropathy and is associated with decreased sensory innervation. Numerous causes of this arthropathy have been described. Neuropathic joint, although first described by Charcot in tabes dorsalis in 1868, has subsequently been observed in a variety of conditions including syringomyelia, diabetes mellitus and peripheral nerve disorders. Syringomyelia is characterized by slow progression. The shoulders and elbows are the most frequently involved joints in syringomyelia. Involvement of the hand is a quite rarely seen in the cases of NA caused by syringomyelia. In this article, we reported a case of NA secondary to syringomyelia. The characteristics of this presented case is the presence of Arnold-Chiari malformation accompanying with syringomyelia and involvement of the shoulder, elbow and hand (multiple joint involvement).

Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain.

BACKGROUND: Different methods and propofol formulations have been used to decrease propofol injection pain, but it remains an unresolved problem. We aimed to investigate the effect of i.v. acetaminophen pretreatment on the propofol injection pain. METHODS: One hundred and fifty ASA I-II patients undergoing general anaesthesia were randomly allocated into three groups. A 20-gauge catheter was inserted into a superficial radial vein of the left hand, and after the occlusion of venous drainage, Groups I, II, and III were pretreated with 40 mg of lidocaine in saline, 50 mg of i.v. acetaminophen, and 5 ml of saline, respectively. The occlusion was released after 2 min and one-fourth of the total propofol dose was injected into the vein over a period of 5 s. During the injection of both pretreatment solution and propofol, patients' pain was assessed and recorded as 0-3, corresponding to no, mild, moderate or severe pain, respectively. Chi2 and Kruskal-Wallis tests were used for the statistical analysis. For all analyses, differences were considered to be significant at P<0.05. RESULTS: Patient characteristics were similar among the groups. Incidence of pain on injection of propofol in control, i.v. acetaminophen, and lidocaine groups was 64%, 22% and 8%, respectively (P<0.05). CONCLUSIONS: Pretreatment with i.v. acetaminophen seems to be effective in attenuating pain during i.v. injection of propofol.

Comparison of dexmedetomidine-propofol vs. fentanyl-propofol for laryngeal mask insertion.

BACKGROUND AND OBJECTIVES: There have been many studies to find the optimum anaesthetics to provide excellent conditions for laryngeal mask insertion. We compared the effects of dexmedetomidine administered before propofol, on laryngeal mask insertion with fentanyl combined with propofol. METHODS: In all, 52 patients, ASA I-II, scheduled to have minor urological procedures were randomized into two groups. Group F received 1 microg kg(-1) fentanyl (in 10 mL normal saline) and Group D received 1 microg kg(-1) dexmedetomidine (in 10 mL normal saline). We used 1.5 mg kg(-1) propofol for induction and 50% N2O and 1.5% sevoflurane in oxygen for maintenance. We observed jaw mobility (1: fully relaxed; 2: mild resistance; 3: tight but opens; 4: closed), coughing or movement (1: none; 2: one or two coughs; 3: three or more coughs; 4: bucking/movement) and other events such as spontaneous ventilation, breath holding, expiratory stridor and lacrimation. In each category, scores <2 were acceptable for laryngeal mask insertion. RESULTS: More patients developed apnoea and their apnoea times were longer in Group F than Group D (P < 0.001). Respiratory rates increased in Group D (P < 0.001). Adverse events during laryngeal mask insertion were similar. The reductions in systolic and mean blood pressures were greater in Group F (systolic: P < 0.05, mean: P < 0.01). Emergence times were shorter in Group F than in Group D (P < 0.001). CONCLUSION: Dexmedetomidine, when used before propofol induction provides successful laryngeal mask insertion comparable to fentanyl, while preserving respiratory functions more than fentanyl.