Treatment strategies in the left main coronary artery disease associated with acute coronary syndromes

AbstractSignificant left main coronary artery (LMCA) stenosis is not rare and reported 3 to 10% of patients undergoing coronary angiography. Unprotected LMCA intervention is a still clinical challenge and surgery is still going to be a traditional management method in many cardiac centers. With a presentation of drug eluting stent (DES), extensive use of IVUS and skilled operators, number of such interventions increased rapidly which lead to change in recommendation in the guidelines regarding LMCA procedures in the stable angina (Class 2a recommendation for ostial and shaft lesion and class 2b recommendation for distal bifurcation lesion). However, there was not clear consensus about the management of unprotected LMCA lesion associated with acute myocardial infarction (MI) with a LMCA culprit lesion itself or distinct culprit lesion of other major coronary arteries. Surgery could be preferred as an obligatory management strategy even in the high risk patients. With this review, we aimed to demonstrate treatment strategies of LMCA disease associated with acute coronary syndrome, particularly acute myocardial infarction (MI). In addition, we presented a short case series with LMCA lesion and ST elevated acute MI in which culprit lesion placed either in the left anterior descending artery or circumflex artery. We reviewed the current medical literature and propose simple algorithm for management

What is the optimal length of stay in hospital for ST elevation myocardial infarction treated with primary percutaneous coronary intervention?

Backgound: The aim of this study was to evaluate the safety and practicality of very early (within 48 h) discharge with long-term follow-up results, and to define an optimal length of stay in hospital for patients with ST elevation myocardial infarction (STEMI) according to their demographic characteristics and risk assessment. Methods: A total of 267 patients with STEMI successfully treated with primary coronary intervention were retrospectively analyzed. Patients was divided into four groups according to length of hospitalization: 24 hours, 48 hours, 72 hours, and more than 72 hours. The groups were compared in terms of the patients’ demographic and clinical characteristics, short- and long-term follow-up results, mortality, revascularization and major adverse cardiac events (MACE). Results: More than two thirds of the patients were discharged within 48 hours (68.9%). No difference was observed between groups in terms of one month and one year MACE and one year restenosis. However, one month restenosis was slightly higher in the fourth group. At the end of the first year, there had been only four deaths, and these were in the third and fourth groups. There were no deaths among patients discharged within 48 hours. Killip class, left ventricular ejection fraction, multi-vessel disease and diabetes were the major determinants of length of stay in hospital. Conclusions: Very early discharge is safe and feasible and does not increase the mortality rate. Uncomplicated STEMI patients with single vessel disease could be discharged after 24 hours. Patients with multi-vessel disease classified in the low risk group could be discharged after 48 hours. (Cardiol J 2011; 18, 4: 378–384

Zawał serca z uniesieniem odcinka ST spowodowany zwolnieniem przepływu wieńcowego po zażyciu marihuany

Slow coronary flow (SCF) is an angiographic finding defined as the slow movement of contrast throughout the coronary lumen in the absence of epicardial coronary stenosis. It has been reported that SCF can on rare occasions cause ST elevated myocardial infarction (MI). Recent studies have shown that cannabis consumption can increase the risk of coronary heart disease and can trigger acute coronary syndromes, especially in young individuals without common risk factors. Here, we present a case of inferior MI in a patient who had consumed cannabis regularly over a long period and whose coronary angiography revealed SCF. Kardiol Pol 2010; 68, 11: 1266-126

Risk Syndromes and Scales Determining Risk in Schizophrenia and Other Psychoses

Schizophrenia is a chronic disorder leading to lifelong deterioration of social and vocational functioning. Prodromal period, designates the time interval starting with emerging nonspecific signs and deficits and extending up to presentation of distinct and ongoing schizophrenic symptoms, is observed in most of schizophrenia patients. In schizophrenia, poor premorbid adjustment leads to a worse prognosis and thus early detection and intervention is required in prodromal period. To this end, under the heading of risk factors for schizophrenia and psychosis, classification and scales to determine the risk are being utilized. Most frequently used scales are; Bonn Scale for the Assessment of Basic Symptoms (BSABS), Comprehensive Assessment of At-Risk Mental States (CAARMS), Structured Interview for Psychosis-Risk Syndromes (SIPS). Through the light of these latest developments, recent edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) added psychosis risk syndrome or attenuated psychosis syndrome to indicate risk of transition to psychosis. These approaches revealed that the risk of progression to psychosis was not reliably correlated with fulfilled criteria, but abscence of criteria credibly predicted the unlikelihood of psychosis emergence. Evidently, concomitant premorbid features and prodromal symptoms significantly increase the risk of progression to psychosis and schizophrenia in comparison to normal population. Nevertheless, specification and elaboration of risk criteria will enhance reliability of risk determination. [Archives Medical Review Journal 2015; 24(4.000): 494-508

The Relationship of Self Esteem and Humor Styles in First Class Medical Students: A Cross-Sectional Study

Purpose: Self-esteem and humor styles are significant factors for being a healthy person. The aim of this study was to investigate the relation ship between self-esteem and humor styles in medical students. Material and Methods: Two hundred three medical students (107 males, 96 females) were included this study. Self-esteem was measured with the Rosenberg Self Esteem Scale and humor style was measured with Humor Styles Questionnaire. Results: The rate of students who have mild or high self-esteem levels was 89.7%. In Humor Styles Questionnaire, the average scores of affiliative and self-enhancing humor were significantly higher than the average scores of aggressive and self-defeating humor. Male students were using humor, especially aggressive and self-defeating humor styles more commonly than female students. A positive correlation was found between self-esteem and affiliative and self-enhancing humor styles. Conclusion: The present study revealed a positive correlation between self-esteem and positive humor styles. There is a need to develop educational models that would bolster self-esteem and positive humor in medical students. [Cukurova Med J 2015; 40(4.000): 782-793

Smoking Cessation through Acceptance and Commitment Therapy: A Case Report

WOS: 000363969000029Smoking is one of the most common addictions with devastating biopsychosocial consequences. Both medical treatment and pschotherapy are utilized in smoking cessation. Acceptance and commitment therapy holds the notion that smoking cessation rates are determined not so much by the negative affect and withdrawal symptoms per se, but by the avoidant and inflexible responding style. Acceptance and commitment therapy, through targeting the avoidance of internal stimuli and concomitant inflexible responding pattern, has yielded successful results. This article presents application of acceptance and commitment therapy step by step to a chronic smoker who quitted smoking at the end of therapy sessions

Smoking Cessation through Acceptance and Commitment Therapy: A Case Report

Smoking is one of the most common addictions with devastating biopsychosocial consequences. Both medical treatment and pschotherapy are utilized in smoking cessation. Acceptance and commitment therapy holds the notion that smoking cessation rates are determined not so much by the negative affect and withdrawal symptoms per se, but by the avoidant and inflexible responding style. Acceptance and commitment therapy, through targeting the avoidance of internal stimuli and concomitant inflexible responding pattern, has yielded successful results.This article presents application of acceptance and commitment therapy step by step to a chronic smoker who quitted smoking at the end of therapy sessions. [Cukurova Med J 2015; 40(4.000): 841-846

Scimitar syndrome and pregnancy, complicated with severe preeclampsia

Scimitar syndrome (pulmonary venolobar syndrome) is a rare anomaly of venous return to the heart, most commonly consisting of partial or total anomalous pulmonary venous return from the right lung. This is the report of a case of a 29-year-old woman at 31 weeks of gestation of pregnancy who was previously diagnosed with scimitar syndrome. MR angiography and PET-CT results which were obtained before pregnancy demonstrated vascular malformation in the inferior part of the right lung. No specific treatment was planned throughout the pregnancy due to the absence of any symptoms. The patient's first physical examination was unremarkable except mild hypertension. In her follow-up, severe preeclampsia was developed and the patient had undergone a cesarean section of a live birth at 34 weeks and 2 days of gestation. This is the first case of scimitar syndrome with pregnancy in which the cardiac status of the patient deteriorated coincidentally due to the development of another manifestation such as severe preeclampsia besides the syndrome itself

Static magnetic field induced epigenetic changes in wheat callus

AYDIN, Murat/0000-0003-1091-0609; Dumlupinar, Rahmi/0000-0002-9701-9896; Elibol Cakmak, Zeynep/0000-0002-6772-5570WOS: 000383710900007PubMed: 27513309Deoxyribonucleic acid (DNA) is always damaged by endogenous and exogenous factors. Magnetic field (MF) is one of these exogenous factors. When repair mechanisms are not sufficient, mainly because of imbalance in damage or mistakes in repair mechanisms, methylation of DNA results in polymorphism-related abnormalities. In this study, low intensity static magnetic field-induced DNA damage and methylation in wheat calli were investigated by using Random Amplified Polymorphic DNA and Coupled Restriction Enzyme Digestion-Random Amplification techniques. Calli were derived from mature embryos of wheat. Both 7- and 14-day-old wheat calli were exposed to 7mT (millitesla) static MF for 24, 48, 72, 96, or 120h of incubation period. The highest change in polymorphism rate was obtained in calli exposed to 7mT MF for 120h in both 7- and 14-day-old calli. Increase in MF duration caused DNA hypermethylation in both 7- and 14-day-old calli. Polymorphism and DNA methylation ratio were higher in 7-day-old calli. The highest methylation level with a value of 25.1% was found in 7-day-old calli exposed to MF for 120h. Results suggested that low intensity static magnetic field may trigger genomic instability and DNA methylation. Bioelectromagnetics. 37:504-511, 2016. (c) 2016 Wiley Periodicals, Inc.Ataturk UniversityAtaturk University [2013-391]Grant sponsor: Ataturk University, Scientific Research Projects Fund (BAP); grant number: 2013-391