Should we wait until severe pulmonary hypertension develops? Efficacy of percutaneous mitral balloon valvuloplasty in patients with severe pulmonary hypertension: A subgroup analysis of our experience

Background: The primary goal of this study is to evaluate the immediate and long-term ef­fects of percutaneous mitral balloon valvuloplasty (PBMV) on patients with rheumatic mitral stenosis (MS) complicated with severe pulmonary hypertension (PH). Methods: The study population consisted of 85 patients with MS complicated with severe PH (systolic pulmonary pressure > 75 mm Hg). PBMV was performed with Inoue balloon technique. Clinical and echocardiographic follow-up was scheduled at 6 months and 1 year and yearly thereafter. Results: Mitral valve area (MVA) was increased (pre-PBMV MVA was 1.03 ± 0.21 cm2, post-PBMV MVA 1.89 ± 0.34 cm2, p < 0.001) significantly. The mean and the maximum transmitral pressure gradient significantly decreased (pre-PBMV mean transmitral gradient was 18.47 ± 6.59 mm Hg, post-PBMV 6.84 ± 3.84 mm Hg, p < 0.001, pre-PBMV maximum transmitral pressure gradient was 27.6 ± 8.38 mm Hg, post-PBMV 12.68 ± 4.74 mm Hg, p < 0.001). Systolic pulmonary artery pressure (SPAP) significantly decreased (pre-PBMV 89.9 ± 23.38 mm Hg, post-PBMV 54.5 ± 14.6 mm Hg, p < 0.001). Two patients underwent surgery due to rupture of anterior mitral leaflet. There was no peri-procedural mortality. The procedure time was 29.12 ± 11.37 min. Follow-up duration was 108.2 ± 31.4 months. One patient died due to heart failure. One patient underwent re-PBMV and 7 patients mitral valve replacement. At the last follow-up, MVA still remained high (1.52 ± 0.34 cm2) and mean transmitral pressure gradient was low (9.2 ± 5.7 mm Hg). SPAP was 56.5 ± 20.8 mm Hg which was the same as after PBMV. Conclusions: PBMV in patients with MS with severe PH is an effective therapy with low procedure time. However, it is recommended to perform PBMV before developing severe PH

ACUTE EFFECTS OF SYNTHETIC CANNABINOIDS ON VENTRICULAR REPOLARIZATION

Objective: The usage of synthetic cannabinoids (SCs) has increased both in Turkey and all worldwide. Here, we evaluate if SCs cause ventricular repolarization abnormalities using initial and after 12th-hour electrocardiograms in patients with acute intoxication of SCs. We examined changes in the QTc and cTp-e parameters to demonstrate ventricular repolarization effects of the usage of SCs. Material and Methods: We used a prospective study design. Twenty patients were included who visited the emergency department, complaining of clouding of consciousness after using SCs. The QT, QTc and Tp-e intervals and several other electrocardiographic parameters were measured at baseline and 12 hours after the usage of SCs. Results: The QRS duration was significantly decreased (102.1±15.5 ms vs 95.0±10.7 ms; p=0.022). We noted a significant decrease in cQT measurements at the end of the 12th hour (426.6±47.2 ms vs 390.4±42.9 ms; p=0.002). Similarly, the Tp-e and cTp-e values decreased significantly when SCs lost its acute effect (93.4±21.1 ms vs 77.4±21.0 ms; p=0.014, 105.3±28.5 ms vs 88.1±21.5 ms; p=0.01). Conclusions: The usage of SCs affects ventricular repolarization heterogeneity based on QTc and Tp-e intervals

Antioxidative protection of dietary bilberry, chokeberry and Lactobacillus plantarum HEAL19 in mice subjected to intestinal oxidative stress by ischemia-reperfusion

<p>Abstract</p> <p>Background</p> <p>Ischemia-reperfusion (I/R) in the intestines is an inflammatory condition which activates leukocytes and reactive oxygen species (ROS) and leads to lipid peroxidation and DNA damage. Bilberry and chokeberry fruits are rich sources of polyphenols which may act as antioxidants and prevent lipid peroxidation. Lactic acid bacteria (LAB) may improve microbial status in the intestines and increase the metabolic activity towards polyphenolic degradation. The aim of the study was to clarify antioxidative effects of bilberry and chokeberry fruits alone and with addition of a LAB-strain, <it>Lactobacillus plantarum </it>HEAL19, in an I/R-model in mice.</p> <p>Methods</p> <p>Male BALB/cJ mice were fed the experimental diets for 10 days. Diets consisted of standard chow supplemented with either bilberry (<it>Vaccinium myrtillus</it>) or chokeberry (<it>Aronia × prunifolia</it>) powder alone or in combination with the LAB-strain <it>Lactobacillus plantarum </it>HEAL19. I/R-injury was induced by holding superior mesenteric artery clamped for 30 minutes followed by reperfusion for 240 minutes. Thereafter, colonic and caecal tissues and contents were collected. Malondialdehyde (MDA) was used as indicator of lipid peroxidation and was measured by a calorimetric assay, lactobacilli were cultured on Rogosa agar plates and <it>Enterobacteriaceae </it>on VRBG agar plates, anthocyanins and phenolic acids were analysed by HPLC-DAD-ESI-MSn.</p> <p>Results</p> <p>MDA was significantly decreased in the colon of groups fed bilberry alone (p = 0.030) and in combination with <it>L. plantarum </it>HEAL19 (p = 0.021) compared to the IR-control but not in chokeberry-fed groups. Supplementation with bilberry or chokeberry alone reduced the total number of lactobacilli on the mucosa. Higher concentrations of anthocyanins were found in the colon than in the caecum content of mice. A more varied composition of different anthocyanins was also observed in the colon content compared to the caecum of bilberry-fed mice. Phenolic acids formed by microbial degradation of the dietary polyphenols in the gut could be detected. More phenolic metabolites were found in the intestines of bilberry-fed mice than in the chokeberry-fed ones.</p> <p>Conclusions</p> <p>Bilberry alone and in combination with <it>L. plantarum </it>HEAL19 exerts a better protection against lipid peroxidation than chokeberry. These dietary supplements may be used to prevent or suppress oxidative stress.</p

Hyperbaric oxygen therapy for carbon monoxide poisoning

Carbon monoxide poisoning is a life-threatening poisoning. In this case report neurological findings developed in carbon monoxide poisoning and the importance of multidisciplinary approach are discussed. The patient, 16-year-old male, was found unconscious following a 1-hour exposure to gas water heater poisoning and brought to our hospital after being intubated at the scene of the accident. After treatment for bicarbonate deficit, hepatamine infusion was started and hyperbaric oxygen treatment was performed. The patient was connected to mechanical ventilator in our department. The treatment were performed for cerebral edema. And hyperbaric oxygen treatment continued for 12 days. The patient was disconnected from the ventilator on the 36 th day of the follow-up. Medical history and clinical examination are very important in the diagnosis of carbon monoxide poisoning. The patient should be followed up with laboratory examinations and imaging methods such as magnetic resonance imaging in order not to overlook neurological sequelae or any organ injury. Additionally hyperbaric oxygen treatment performed in acute period and goal-directed therapy decrease mortality and morbidity

Left Main Coronary Artery Hypoplasia in Elderly

Congenital anomalies of the coronary artery causing coronary occlusive disease may be of many different types. A 67-year-old woman with no coronary risk factors was referred for coronary angiography with few months’ history of angina. The patient underwent coronary angiography due to ischemic cardiac symptoms with nondiagnostic exercising test. In coronary angiography, the left main coronary artery was arising from normal anatomical position; however, left anterior descending artery and circumflex artery were hypoplastic. The treatment of patient was discussed in cardiology-cardiovascular surgery council and coronary surgery was found inappropriate due to the hypoplasia of the left coronary system entirely

Urine iodine excretion &#305;n patients with euthyroid noduler disease

<b>Background and Objectives:</b> Different nutritional and environmental factors are responsible for the pathogenesis of goiter, but iodine deficiency is the most important factor. However, little is known about the natural course of benign thyroid nodules in euthyroid patients over time. Few studies have used ultrasonographic evaluation to address this issue, especially in iodine-deficient areas. In this study, we present the long-term follow-up of benign thyroid nodules in a iodine-deficient area. <b>Design and Setting:</b> Cross-sectional study at a tertiary referral center. <b> 0 Patients and Methods:</b> This study included 62 randomly selected patients with benign euthyroid nodule. Thyroid volume and nodules were measured with sonography. Iodine intake was estimated by patient diet history and by measuring iodine excretion in spot urine samples. Patients were followed one year. <b>Results:</b> Patients were divided into three groups according to level of urine iodine excretion: Group 1: &lt;50&#956;g/L (severe iodine deficiency group), Group 2: 50-100&#956;g/L (mild iodine deficiency group), Group 3: &gt;100 g/L (iodine sufficient group). The presence of additional disease (hypertension, diabetes mellitus, coronary heart disease, chronic renal failure and a history of any medication for chronic disorder) and smoking rates were significantly higher in first group compared to the second and third group. Among groups, no significant difference was observed in either right or left thyroid lobe volume after one year. A clinically significant increase in nodule volume was observed in the first group, while there was a significant decrease in the second and third group. <b>Conclusion:</b> In this study, iodine deficiency was associated with an increase in thyroid nodule volumes. Smoking rates were higher in iodine deficient groups. It is thought that smoking impairs iodine intake or absorption consistent with a previous report

Anaphylaxis induced by intravenous non-steroidal anti-inflammatory drug in an asthma patient

WOS: 000404541200042

Long-term monitoring of Graves' disease in children and adolescents: a single-center experience

Background/aim: Graves' disease (GD) is more severe, requires a more complex treatment, and has a lower probability of achieving remission in children than in adults. 'there is no consensus on the appropriate duration of antithyroid drug (ATD) treatment. Surgical or radioactive iodine (RAI) treatments are not definitive and generally result in permanent hypothyroidism. This study's goal was examining the effectiveness of ATD treatment in children and adolescents with GD and determining the risk factors of remission and relapse

The assessment of peripapillary retinal nerve fiber layer and macular ganglion cell layer changes in obese children: a cross-sectional study using optical coherence tomography

To investigate the relationship between the obesity and optical coherence tomography (OCT) parameters