What is the diagnosis?

Paced right bundle branch block pattern in an elderly woma

What is the diagnosis?

Paced right bundle branch block pattern in an elderly woma

Carotid endarterectomy compared with carotid artery stenting for extracranial carotid artery stenosis: a retrospective single-centre study

Aim: One of the main risk factors for an ischemic stroke is significant carotid artery stenosis, and extracranial severe carotid artery stenosis accounts for 20% of ischemic strokes. Prior to the development of carotid artery stenting (CAS), the only effective and reliable treatment for carotid artery stenosis was carotid endarterectomy (CEA). This study compares the results of CAS and CEA in patients with significant carotid artery stenosis. Methods: Between 2018 and 2022, hospital records of all patients who underwent carotid artery revascularization at the institution were retrospectively analyzed. Patients were divided into two groups depending on whether CEA or CAS was performed for carotid revascularization. Propensity score matching was performed to reduce bias by equating the baseline clinical characteristics of the groups. To compare 30-day, 1-year, and long-term outcomes, rates of transient ischemic attack (TIA), myocardial infarction, stroke, all-cause mortality, and composite endpoints were analyzed. Results: After PSM, 76 patients each in the CEA and CAS groups were compared. The mean age was 69.80 years ± 11.35 years and 121 (80%) were male. The patients were followed up for a mean of 33 months ± 6 months. The incidence of TIA in the perioperative period [9 (12%) vs. 4 (5%); P < 0.05], TIA and composite endpoint at 1-year period [11 (15%) vs. 2 (3%); P < 0.05 and 27 (36%) vs. 16 (21%); P < 0.05, respectively] were significantly higher in the CAS group than in the CEA group. No difference was observed between the groups in the long-term. Conclusions: There was no noticeable difference between the CEA and CAS groups in the examination of cases with severe carotid artery stenosis in terms of 1-month, and 1-year results (apart from TIA and composite endpoints), or long-term outcomes. Extracranial carotid artery stenosis can be treated safely and effectively also by CAS

Acute kidney injury: current concepts and new insights

BACKGROUND: Acute kidney injury, which was previously named as acute renal failure, is a complex clinical disorder and continues to be associated with poor outcomes. It is frequently seen in hospitalized patients, especially in critically ill patients. The primary causes of acute kidney injury are divided into three categories: prerenal, intrinsic renal and postrenal. The definition and staging of acute kidney injury are mainly based on the risk, injury, failure, loss, end-stage kidney disease (RIFLE) criteria and the acute kidney injury network (AKIN) criteria, which have previously been defined. However the clinical utility of these criteria is still uncertain. Several biomarkers such as Cystatin C and neutrophil gelatinase-associated lipocalin have been suggested for the diagnosis, severity classification and most importantly, the modification of outcome in acute kidney injury. METHODS: Current literature on the definition, biomarkers, management and epidemiology of acute kidney injury was reviewed by searching keywords in Medline and PubMed databases. RESULTS: The epidemiology, pathophysiology and diagnosis of acute kidney injury were discussed. The clinical implications of novel biomarkers and management of acute kidney injury were also discussed. CONCLUSIONS: The current definitions of acute kidney injury are based on the RIFLE, AKIN and KDIGO criteria. Although these criteria have been widely validated, some of limitations are still remain. Since acute kidney injury is common and harmful, all preventive measures should be taken to avoid its occurrence. Currently, there is no a definitive role for novel biomarker

Predictive Value of Mean Platelet Volume in Saphenous Vein Graft Disease

Abstract Objective: To determine whether mean platelet volume (MPV), platelet distribution width (PDW), and platelet count could be used as determinants of mortality following coronary artery bypass graft (CABG) surgery and patency of saphenous vein grafts (SVG). Methods: The records of 128 patients who underwent emergency or elective coronary angiography after CABG surgery, and who died at an early stage were retrospectively reviewed. Patients were divided into three groups as early death, no SVG disease (SVGD), and SVGD group. MPV, PDW, and platelet count were evaluated at different times. Results: MPV was significantly higher in the stenotic group than in the nonstenotic group (9.7±1.8 fl and 8.2±0.9 fl, P<0.05). The postoperative MPV ratio was found to be higher in the stenotic group when compared to the preoperative period (9.6±1.8 fl and 7.8±0.9 fl, P<0.05). MPV values were also found to be higher in patients who died during the early stage than in surviving patients (9.4±1.9 fl and 8.0±1.0 fl, P<0.05). There was no statistically significant difference regarding platelet count and PDW ratios between the early deaths group and surviving patients. An MPV value higher than 10.6 predicted SVGD with 85% sensitivity and 45% specificity; and an MPV higher than 7.9 predicted early death with 80% sensitivity and 68% specificity were observed. Conclusion: MPV may be a useful indicator for the prediction of SVGD and mortality following CABG surgery