Loküle perikart efüzyonunun sağ parasternal perikardiyosentez ile başarılı tedavisi

A 46-year-old woman with a previous diagnosis of inoperable stage IV small cell lung cancer presented to the emergency department with shortness of breath. Physical examination showed apale woman who appeared malnourished. Her vital signs were as follows: pulse rate 115 beats/min,respiration rate 22 breaths/min, body temperature 37.5°C, and blood pressure 95/65 mm Hg. Breathsounds were diminished on the left base and widespread coarse crackles were heard over the leftlung. Other system examination fi ndings were within normal limits. A 12-lead electrocardiogramshowed sinus tachycardia and lower voltage without marked ST changes. A chest X-ray showedinfi ltrates on the left upper zones, and a large left-sided pleural effusion (Figure 1A). Transthoracicechocardiograpy (TTE) showed a large loculated pericardial effusion measuring 3.2 cm inmaximal width on the right side of the heart with cardiac tamponade, which was also confi rmedby multislice computed tomography (Figure 1B). Due to the increased risk of general anesthesia

Drug Eluting Stents versus Bare Metal Stents in ST-Segment Elevation Myocardial Infarction

WOS: 000464326000010Objective: The aim of this study was to compare the effectiveness and safety of drug eluting stents (DES) with bare metal stents (BMS) in patients presented with ST-segment elevation myocardial infarction (STEMI) in a real world setting. Methods: One thousand five hundred ninety six STEMI patients treated with primary percutaneous coronary intervention from January 2013 to March 2016 were enrolled to study. One thousand one hundred ninety four of them received BMS while 402 of them received DES. Patients were analyzed for major adverse cardiac events (MACE) and stent thrombosis (ST). Results: There was no difference at 30 days in relation of MACE, all cause death, reMI, TVR, TLR and ST. The cumulative incidence of MACE was significantly higher in DES group (9,2% vs. 7,0%, p = 0.02) at 1 year. Stent thrombosis and re-MI incidence were significantly higher in DES group (4,2% vs. 2,6%, p = 0.028, 6,9% vs. 4,8%, p = 0.015) respectively at 1 year. There was no statistically significant difference in relation of all cause death, TVR and TLR at 1 year. The statistically differences between groups vanished at 2 year and the groups looked similar. Male gender (HR, 1.40; 95% CI, 1.00 to 1.94; p = 0.043) and presence of DM (HR, 1.73; 95% CI, 1.29 to 2.32; p<0,001) were found to be independent predictors of 2-year MACE. Conclusions: Our study showed effectiveness and safety of DES in STEMI. Despite increased incidence of MACE, re-MI and ST in 1-year, DES was found to be non-inferior to BMS at 2-year follow up

Zakkum zehirlenmesine bağlı olarak gelişen mobitz tip II atriyoventriküler bloklu olgunun digoksin-spesifik fab antikoru ile başarılı tedavisi

Nerium oleander is a popular ornamental plant grown in many tropical and subtropical countries and in the Mediterranean region. It is dangerous because it has been shown to contain several types of cardiac glycosides, and hence can cause cardiac arrhythmias resembling digoxin in their toxicologic manifestations. We report a patient present- ing to our hospital with Mobitz type II atrioventricular block after drinking herbal tea prepared from oleander leaves. Three hours after admission, a 200-mg empiric dose of digoxin-specific Fab antibody fragments was administered intravenously over 30 minutes. A 12-lead electrocardiogram (ECG) revealed sinus rhythm at the end of infusion. After 72 hours, the patient was discharged without any symptoms.Zakkum (Nerium oleander) tropikal, subtropikal ve Akdeniz bölgesinde yetişen popüler bir süs bitkisidir. Çe- şitli kalp glikozidleri içerdiği gösterilmiştir ve tehlikeli ola- bilmektedir. Bu yüzden zakkum zehirlenmesi, digoksinin toksik bulgularını taklit eden aritmilere neden olabilmekte- dir. Yazımızda zakkum yapraklarından yaptığı çayı içtikten sonra Mobitz tip II atriyoventriküler blok ile başvuran bir hasta sunuldu. Başvurusundan üç saat sonra, 200 mg’lık ampirik dozda digoksin-spesifik antikoru 30 dakikalık in- füzyon şeklinde uygulandı. İnfüzyonun bitiminde, 12 deri- vasyonlu elektrokardiyogramda (EKG) sinüs ritmi izlendi. Hasta, 72 saat sonra herhangi bir semptomu olmadan ta- burcu edildi

More About the Effect of Dynamic Potassium Change in STEMI

Keskin, Muhammed/0000-0002-4938-0097; kaya, adnan/0000-0002-9225-8353WOS: 000453470000013PubMed: 30231627

ST-segment elevasyonlu miyokard infarktüsünde başvuru kan üre azotu ile hastane içi ve uzun dönem mortalite arasındaki ilişki

Objective: The aim of this study was to investigate the association of blood urine nitrogen (BUN) levels with all-causemortality in ST-segment elevation myocardial infarction (STEMI).Method: This study included 3778 patients with STEMI treated with primary percutaneous coronary intervention. Anadmission BUN of 17.5 mg/dL was identified through a ROC analysis as an optimal cutoff value to predict the inhospitalmortality with 68% sensitivity and 66% specificity (AUC: 0.75; 95% CI:0.72-0.88; p 0.001).Results: The patients were followed up for a mean period of 330.14 months. Patients with higher BUN levels had 5.3-times higher in-hospital (OR: 6.0, 95% CI: 4.4-8.3) and 5-times higher long-term (HR: 5.3, 95% CI: 4.2-6.8) mortalityrates than patients with lower BUN levels.Conclusions: This study demonstrated that elevated BUN level was independently associated with increased in-hospitaland long-term mortality. BUN test is a simple, inexpensive, and easily bedside applicable method. Hence, it can be usedto detect high-risk patients in the setting of STEMI.Keywords: Blood urine nitrogen; ST-segment elevation myocardial infarction; primary percutaneous coronaryintervention; mortalityAmaç: Çalışmanın amacı kan üre azotu (KÜA) seviyesi ile ST-elevasyonlu miyokard infarktüsündeki (STEMİ) tümnedenli mortalite arasındaki ilişkiyi araştırmaktı.Yöntem: Bu çalışma primer perkütan koroner girişim yapılan 3378 STEMİ hastalarını içermekteydi. Hastane içimortalitede başvuru KÜA seviyesi eşik değeri ROC analizinde 17.5 mg/dL olarak ve sensivite %68, spesifite %66olarak saptanmıştır (AUC: 0.75; 95% CI:0.72-0.88; p 0.001).Bulgular: Hastalar ortalama olarak 330.14 ay izlenmiştir. Yüksek KÜA seviyesine sahip hastalarda düşük KÜAseviyesine sahip hastalara göre hastane içi mortalite 5.3 kat (OR: 6.0, 95% CI: 4.4-8.3), uzun dönem mortalite 5 kat(HR: 5.3, 95% CI: 4.2-6.8) yüksek olarak saptanmıştır.Sonuç: Bu çalışmada yüksek KÜA seviyesi bağımsız olarak hastane içi ve uzun dönem mortalite ile ilişkili olarakbulunmuştur. KÜA testi basit, ucuz ve kolaylıkla uygulanabilen bir yöntemdir. Bu yüzden, STEMİ geçiren yüksek risklihastaları saptamada kullanılabilir

More About the Effect of Dynamic Potassium Change in STEMI

Keskin, Muhammed/0000-0002-4938-0097; kaya, adnan/0000-0002-9225-8353WOS: 000453470000013PubMed: 30231627

The association of blood urea nitrogen levels with mortality in acute pulmonary embolism

WOS: 000440509302772

Association of SYNTAX Score With Abdominal Aortic Intima-Media Thickness in Non-ST Elevation Myocardial Infarction

Keskin, Muhammed/0000-0002-4938-0097; Cinar, Tufan/0000-0001-8188-5020WOS: 000470864700015PubMed: 30270633

Effect of Dynamic Potassium Change on In-Hospital Mortality, Ventricular Arrhythmias, and Long-Term Mortality in STEMI

Keskin, Muhammed/0000-0002-4938-0097; kaya, adnan/0000-0002-9225-8353WOS: 000453470000010PubMed: 29962233We evaluated the effect of serum potassium (K) deviation on in-hospital and long-term clinical outcomes in patients with ST-segment elevation myocardial infarction who were normokalemic at admission. A total of 2773 patients with an admission serum K level of 3.5 to 4.5 mEq/L were retrospectively analyzed. The patients were categorized into 3 groups according to their K deviation: normokalemia-to-hypokalemia, normokalemia-to-normokalemia, and normokalemia-to-hyperkalemia. In-hospital mortality, long-term mortality, and ventricular arrhythmias rates were compared among the groups. In a hierarchical multivariable regression analysis, the in-hospital mortality risk was higher in normokalemia-to-hypokalemia (odds ratio [OR] 3.03; 95% confidence interval [CI], 1.72-6.82) and normokalemia-to-hyperkalemia groups (OR 2.81; 95% CI, 1.93-4.48) compared with the normokalemia-to-normokalemia group. In a Cox regression analysis, long-term mortality risk was also higher in normokalemia-to-hypokalemia (hazard ratio [HR] 3.78; 95% CI, 2.07-7.17) and normokalemia-to-hyperkalemia groups (HR, 2.97; 95% CI, 2.10-4.19) compared with the normokalemia-to-normokalemia group. Ventricular arrhythmia risk was also higher in normokalemia-to-hypokalemia group (OR 2.98; 95% CI, 1.41-5.75) compared with normokalemia-to-normokalemia group. The current study showed an increased in-hospital ventricular arrhythmia and mortality and long-term mortality rates with the deviation of serum K levels from normal ranges

Relationship between endothelial dysfunction and microalbuminuria in familial Mediterranean fever

OBJECTIVE: The aim of our study is to investigate the relationship between microalbuminuria and flow-mediated dilatation in familial Mediterranean fever (FMF) patients. MATERIAL AND METHODS: In our study, there were two groups consisting of 54 patients who were out of the attack period (43 of whom had no microalbuminuria and 11 of whom had microalbuminuria) and 40 healthy controls (M/F: 12/28). RESULTS: There was no statistically difference between patient and control groups’age (25.06±8.07, 22.89±6.00 years, respectively). Flow-mediated dilatation (FMD) percentages were significantly different between the three groups (p=0.01). It was observed that there was a correlation between microalbuminuria and FMD percentage. CONCLUSION: Endothelial dysfunction and renal damage occurred as a result of low-grade chronic inflammation. Microalbuminuria, which is the indicator of renal damage and endothelial dysfunction, and FMD show that endothelial functions can be used in the following of early detection of renal damage and endothelial functions in FMF patients