Atherosclerosis burden and coronary artery lesion complexity in acute coronary syndrome patients

Background: Syntax score (SS) is a prognostic marker in patients with acute coronary sydromes (ACS). Carotid intima media thickness (CIMT) and cardio ankle vascular index (CAVI) are well known surrogate marker of atherosclerosis burden. But association between atherosclerosis burden and coronary artery disease (CAD) complexity in ACS patients has not been investigated yet. Methods and Results: Consecutive patients with first time diagnosis of ACS (n = 172) were enrolled. SS, a marker of CAD complexity, was assessed by dedicated computer software. CIMT was examined by B-mode ultrasound. CAVI was assessed by VaSera VS-1000 cavi instrument. SS for low, intermediate and high tertiles of CIMT value were 10.1 ± 8.2 vs 11.4 ± ± 7.9 and 15.2 ± 8.8; p = 0.02). SS for normal, borderline and abnormal CAVI values were 4 ± 3.7 vs 11.1 ± 7.2 and 14.1 ± 9.1, respectively p = 0.009). Also, there was independent association between SS and CIMT (95% coinfidence interval [CI] 2.1–19, p = 0.014) and CAVI (95% CI 15–29, p = 0.021]. Neither traditional cardiovascular risk factor nor thrombolysis in myocardial infarction (TIMI) risk score was independent determinant of SS. Conclusions: We have shown that patients with higher atherosclerosis burden have more complex coronary artery lesions. Also these patients may be identified early by using surrogate markers of atherosclerosis. Its clinical significance requires further research

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Conservative Treatment of Spontaneous Rectus Sheath Hematomas: Single Center Experience and Literature Review

Introduction. Spontaneous rectus sheath hematoma (SRSH) is characterized by bleeding within the rectus abdominis muscle sheath, one of the rare causes of acute abdominal pain. Early diagnosis is imperative in SRSH to prevent complications and the treatment is usually conservative. We intended to present in this study our experience with SRSH patients with respect to diagnostic evaluation and management of their disease. Materials and Methods. In this retrospective study, 14 patients who had received treatment for SRSH in our clinic between January 2012 and December 2017 were assessed in terms of demographic and clinical characteristics, comorbidities, laboratory parameters, diagnostic approach methods, treatment practices, length of hospital stay, and patient outcomes. Results. The patients consisted of 10 (71.4%) females and 4 males (28.6%). The age of the patients ranged between 47 and 93 with a mean age of 66.5 ± 12.1. Anticoagulant treatments were being administered to 5 (35.7%) patients, antiplatelet treatments to 4 (28.5%) patients, and both anticoagulant and antiplatelet treatments to 4 (28.5%) patients. The most common triggering factor was severe cough and the most common initial symptom acute abdominal pain (71.4%). In physical examinations, the entire patients had generalized abdominal tenderness, 10 (71.4%) voluntary guarding and 7 (50%) a right lower quadrant mass. The diagnosis was confirmed by abdominal ultrasonography and computed tomography. Based on the computed tomography findings, the disease was classified as Type 2 found in 9 (64.3%) patients, Type 1 in 3 (21.4%) patients, and Type 3 in 2 (14.2%) patients. All the patients were treated conservatively. They were hospitalized for 1 to 23 days. There was no mortality. All the patients were followed up between 3 months and 2 years and no recurrence was recorded. Conclusion. Considering the presence of SRSH particularly in older female patients who use anticoagulant drugs and have newly developed an abdominal pain and a palpable mass after coughing spells is the key to make an early and correct diagnosis and to prevent possible morbidity and mortality with an appropriate treatment method

Increased Carotid Intima-Media Thickness is Associated With Higher SYNTAX Score

The main purpose of this study was to investigate the relation between carotid intima-media thickness (CIMT) and coronary artery disease (CAD) complexity. Consecutive patients (n = 360) with CAD confirmed by coronary angiography were enrolled. Mean CIMT and the overall SYNTAX score (SXscore) were 0.87 +/- 0.12 mm and 15 +/- 9, respectively. In univariate analysis, there was a significant correlation between the overall SXscore and CIMT (r = .42, P < .001), age (r = .23, P < .001), hypertension (r = .27, P = 0.001), diabetes (r = 0.11, P = 0.02), smoking (r = .24, P = .01), dyslipidemia (r = .2, P = 0.03), and beta-blocker use (r = .19, P < .001). In multivariate analysis, CIMT (beta = .34, P < .001) and age (beta = .11, P < .019) were independently associated with SXscore. We have demonstrated a significant relation between CIMT and SXscore. Although this study is correlative and no causative conclusions can be drawn, our findings suggest that increased CIMT could reflect complex coronary artery lesions

A rare cause of acute pancreatitis ın children: Duodenal duplication cyst

Duodenum duplikasyon kistleri sindirim sistemin ender görülen anomalileridir. Çocukluk döneminde daha fazla görülmektedirler ve en sık görülen komplikasyonları obstrüksiyon, pankreatit ve kanamadır. Bu yazıda, akut pankreatit tablosu ile başvuran, görüntüleme yöntemleriyle kist tespit edilen, kistin cerrahi olarak çıkarılması sonrası histopatolojik inceleme ile duplikasyon kisti tanısı konulan üç yaşındaki erkek olgu sunulmuştur. Çocuklarda akut pankreatitin ender bir nedeni olarak duodenum duplikasyon kisti akılda tutulmalıdır.Duodenal duplication cysts are rare anomalies of the gastrointestinal system. They are more common in childhood. The most frequent complications are obstruction, pancreatitis and bleeding. In this article, we present a case of a 3-year-old male patient presenting with a manifestation of acute pancreatitis, with cyst detected using imaging techniques, and diagnosed with duplication cyst at histopathological examination following surgical cyst excision. Duodenal duplication cysts should be considered as a rare cause of acute pancreatitis in children

Relationship of aortic knob width with cardio-ankle vascular stiffness index and its value in diagnosis of subclinical atherosclerosis in hypertensive patients: a study on diagnostic accuracy

Conclusion: Observation of aortic knob on chest X-ray in hypertensive patients may provide important predictive information of subclinical atherosclerosis. (Anadolu Kardiyol Derg 2012; 12: 102-6

Atherosclerosis burden and coronary artery lesion complexity in acute coronary syndrome patients

Conclusions: We have shown that patients with higher atherosclerosis burden have more complex coronary artery lesions. Also these patients may be identified early by using surrogate markers of atherosclerosis. Its clinical significance requires further research. (Cardiol J 2012; 19, 3: 295-300