Evaluation of the Tpeak-Tend Interval as an Arrhythmogenicity Index in Graves' Disease

Introduction.Graves’ disease is the most common cause of hyperthyroidism. The mortality rate increases by 20% in hyperthyroid patients; cardiac problems are the leading cause of death and arrhythmia is the most common cardiac complication. Our study aimed to evaluate the corrected QT interval (QTc), the Tpeak-Tend interval (Tp-e), and the Tp-e/QTc ratio to predict arrhythmia risk in patients with Graves’ disease. Methods. The study included 64 patients with Graves’ disease and 57 euthyroid controls. The 12-lead electrocardiograms of the individuals under study were evaluated. The QTc interval, the Tp-e interval, and the Tp-e/QTc ratio of all participants were determined and statistically evaluated with thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4) values. Results. Tp-e (p < 0.001) and QTc (p < 0.05) were significantly prolonged in the group of patients with Graves’ disease as compared to the control group. Heart rate was higher in patients with Graves’ disease as well (p < 0.05). Correlation analysis in patients with hyperthyroidism demonstrated that Tp-e (r=0.372, p=0.002), QTc (r=0.291, p=0.020), and fT3 levels were significantly and positively correlated. Similarly, Tp-e (r=0.271, p=0.030), QTc (r=0.259, p=0.039), and fT4 levels were significantly and positively correlated. Conclusions. We observed a significant prolongation of the Tp-e and QTc intervals with the increase in fT3 and fT4 levels. On the other hand, our study demonstrated that the sensitivity and specificity of Tp-e in the prediction of hyperthyroidism were 70.3% and 70.1%, respectively (AUC=0.724 (CI: 0.629-0.818)), the optimal cut-off value=83.5 ms). The Tp-e interval, which has recently been used as one of the arrhythmogenicity indices, may be an indicator of arrhythmia risk in patients with Graves’ disease

Abnormal gel flotation in a patient with apperant pneumonia diagnosis: a case report

Introduction: Serum blood collection tubes with separator gel are widely used by many laboratories for chemistry analyses. We describe a case of a primary blood collection tube filled with blood sample and a floating separator gel. Materials and methods: The blood sample was collected from a 51 years old female in intensive care unit with the diagnosis of pneumonia into a BD Vacutainer SST tube (Becton Dickinson, NJ, USA) containing serum separator gel and conveyed to the core laboratory of Marmara University Hospital within 30 minutes from collection. Sample was immediately centrifuged at room temperature at 1500 x g for 10 minutes. Results: The analyses revealed a highly increased total protein concentration of 145 g/L (reference interval 64-83 g/L). The nephelometric analyses showed an elevated serum IgG concentration of 108 g/L (reference interval 6.5-16 g/L) and IgG lambda monoclonal band was determined by serum immunofixation electrophoresis. Conclusion: Limitation of the separator gel tubes in patients with a high plasma density and its possible effects on test results and laboratory costs should be remembered. The clinical diagnosis stated in the information system should also reveal known comorbid conditions besides the apparent admission reason. This information would avoid resampling, additional testing, and communication efforts with the clinicians

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Obstructions to the existence of displaceable Lagrangian submanifolds

We utilize Floer theory and an index relation relating the Maslov index, Morse index and Conley-Zehnder index for a periodic orbit of the flow of a specific Hamiltonian function to state and prove some nonexistence results for certain displaceable Lagrangian submanifolds. We start with results under the assumption that the symplectic manifold (M,w) is closed and symplectically aspherical and then generalize to the case when (M,w) is weakly exact. The specific Lagrangian submanifolds in consideration are split hyperbolic submanifolds, spheres, products of spheres, Cayley projective plane and quaternionic projective spaces

Congenital Muscular Dystrophy due to Novel Compound Heterozygote Mutations in POMGNT1 Gene

Muscular dystrophy-dystroglycanopathy is a heterogeneous group of inherited muscular dystrophies caused by glycosylation defects associated with different mutations. The main finding of the disease is disruption of the binding of cellular alpha-dystroglycan to its extracellular matrix ligands. O-mannose beta-1,2-N-acetylglucosaminyltransferase 1 is one of the pathogenic genes involved in glycosylation defects of alpha-dystroglycan. Herein, we report a patient diagnosed with muscular dystrophy-dystroglycanopathy 3 with the determination of a compound heterozygote novel mutation on O-mannose beta-1,2-N-acetylglucosaminyltransferase 1 gene, which was not reported before in literature