Relationship between carotid intima-media thickness and coronary angiographic findings: a prospective study

<p>Abstract</p> <p>Background</p> <p>Since cardiovascular diseases are associated with high mortality and generally undiagnosed before the onset of clinical findings, there is a need for a reliable tool for early diagnosis. Carotid intima-media thickness (CIMT) is a non-invasive marker of coronary artery disease (CAD) and is widely used in practice as an inexpensive, reliable, and reproducible method. In the current study, we aimed to investigate prospectively the relationship of CIMT with the presence and extent of significant coronary artery narrowing in patients evaluated by coronary angiography for stable angina pectoris.</p> <p>Methods</p> <p>One hundred consecutive patients with stable angina pectoris and documented ischemia on a stress test were included in the study. The patients were divided into two groups according to the result of the coronary angiography: group 1 (39 patients) without a noncritical coronary lesion, and group 2 (61 patients) having at least one lesion more than 50% within the main branches of the coronary arteries. All of the patients underwent carotid Doppler ultrasound examination for measurement of the CIMT by a radiologist blinded to the angiographic data.</p> <p>Results</p> <p>The mean CIMT was 0.78 ± 0.21 mm in Group 1, while it was 1.48 ± 0.28 mm in Group 2 (p = 0.001). The mean CIMT in patients with single vessel disease, multi-vessel disease, and left main coronary artery disease were significantly higher compared to Group 1 (1.2 ± 0.34 mm, p = 0.02; 1.6 ± 0.32 mm, p = 0.001; and 1.8 ± 0.31 mm, p = 0.0001, respectively). Logistic regression analysis identified CIMT (OR 4.3, p < 0.001) and hypertension (OR 2.4, p = 0.04) as the most important factors for predicting CAD.</p> <p>Conclusions</p> <p>The findings of this study show that increase in CIMT is associated with the presence and extent of CAD. In conclusion, we demonstrated the usefulness of carotid intima-media thickness in predicting coronary artery disease but large-scale studies are required to define its role in clinical practice.</p

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Rare Complications of COVID-19 Pneumonia: Pneumomediastinum and Atrial Fibrillation

Objective: Coronavirus disease 2019 (COVID-19) is considered as systemic disease involving many vital organs in addition to the lungs, including the heart, liver, and kidneys. Pneumomediastinum associated with COVID-19 pneumonia is a rare condition usually seen in patients with underlying lung pathology, infections, or mechanical intubation. We presented a case of late diagnosis of pneumomediastinum and atrial fibrillation in COVID-19 patient undergoing Noninvasive mechanical ventilation (NIMV). Case: A 66-years-old male patient with a history of COVID-19 pneumonia and 19 days hospital follow up and a NIMV treatment was admitted to our emergency department with palpitations and dyspnea. Thoracic CT and electrocardiography revealed, scattered ground glass areas, pneumomediastinum and high-velocity atrial fibrillation, respectively. Conclusion: We recommend regular checks with imaging methods and ECG during follow-up in patients with COVID-19. Clinicians should remember that ventilator-related lung damage may be seen in COVID-19 patients undergoing NIMV.WOS:00070904020002

Epithelioid Myofibroblastoma in an Old-Male Breast: A Case Report with MRI Findings

Myofibroblastoma of the breast (MFB) is a very rare benign stromal tumor. In recent years, increase in mammographic screenings has resulted in increased diagnosis of MFB. Most cases are old males and postmenopausal women. MFB may be confused as malignant, clinically, morphologically, or by imaging. Immunohistochemistry is essential for final diagnosis in these cases. We report a case of a pathologically diagnosed MFB in an 80-year-old male patient who had coexisting prostate cancer and describe its imaging characteristics, especially magnetic resonance imaging (MRI). In this paper, histopathological and MRI findings of the MFB were discussed

Stab Injury of the Thoracic Aorta: Computed Tomography Findings

Stab injury of the thoracic aorta is a rare condition with high mortality rate. Patients must be evaluated carefully, and the diagnosis usually should be confirmed by radiological modalities. In this case, we report a 37-year-old man presented with a penetrating stab injury to the upper back and the thoracic aorta, and the diagnostic role of computed tomography is discussed

Metabolomic profiling in ankylosing spondylitis using time-of-flight mass spectrometry

Background & aims: Ankylosing spondylitis (AS) is an inflammatory disease associated with destructive changes in the skeleton and joints. The exact molecular mechanism of the disease has not been fully elucidated. This study aimed to determine metabolic differences between active AS patients and healthy controls to understand the molecular mechanism of AS

CT and MRI Findings of Hepatic Involvement in Rendu-Osler-Weber Disease

Rendu-Osler-Weber disease is a rare autosomal dominant disorder. Hepatic involvement manifests itself as vascular, parenchymal, and biliary lesions with characteristic telangiectasias and vascular shunts. In a 37-year-old female patient, dynamic contrast-enhanced upper abdominal CT and MRI were performed. CT and MRI revealed dilated celiac trunk and hepatic artery. On early arterial phase, dilated hepatic veins showed significant enhancement. On arterial and portal venous phases, liver showed significantly heterogeneous contrast enhancement and showed homogenous enhancement in the hepatic parenchymal phase. On the magnetic resonance cholangiopancreatography, irregular biliary ducts with strictures and dilatation were seen

Targeted drug delivery and vaccinology approaches using virus-like particles for cancer

Nanotechnology has the potential to make significant alterations in the treatment of diseases such as cancer through targeted drug delivery nanoparticles. Virus-like particles (VLPs) are composed of the capsid proteins that do not carry the viral genome and are also noninfectious. VLPs are self-assembling competent protein structures with identical or highly related structures to their corresponding native viruses. VLPs that have precise 3D nanostructures exhibit a notable diversity in shapes and structures. They can be produced in large quantities through biological amplification and growth. External protein inserts can be displayed through genetic methods or chemical modifications. Functionalized VLPs when used as delivery systems have the ability to target with specificity and can attract macrophages for the destruction of cancer cells. The capability to target tumors for the delivery of therapeutic agents is an important goal of the design approaches of VLPs. Against the current problems in cancer therapies, delivery systems using VLPs are an arising and promising field with the potential to exhibit solutions. Cancer therapies require specific targeting of the diagnostic element or the drug to tumor cells without binding to or affecting healthy cells and tissues. Specialization of the VLPs provides an opportunity for using them as site-specific drug delivery systems in cancer therapy while reducing the systemic toxicity and the overall damage to healthy cells. With fewer side effects, immunotherapy is also a promising alternative for cancer treatment by primarily activating the host's immune system. Cancer vaccines are aimed at inducing an immune response in the host, thereby generating a defensive mechanism against tumor cells. VLPs can be used as a vaccine without the requirement of any adjuvant due to their naturally optimized particle size and their repetitive structural order. Therefore, the aim of this review is to provide basic information about VLPs and describe previous research on VLPs used as drug and vaccine delivery systems and their applications in different types of cancer

Relationship between carotid intima-media thickness and coronary angiographic findings: a prospective study

Background: Since cardiovascular diseases are associated with high mortality and generally undiagnosed before the onset of clinical findings, there is a need for a reliable tool for early diagnosis. Carotid intima-media thickness (CIMT) is a non-invasive marker of coronary artery disease (CAD) and is widely used in practice as an inexpensive, reliable, and reproducible method. In the current study, we aimed to investigate prospectively the relationship of CIMT with the presence and extent of significant coronary artery narrowing in patients evaluated by coronary angiography for stable angina pectoris