Pacemaker lead endocarditis with hiccups (Kalayci)

Background: Lead-related infections that might develop after pacemaker implantation associated with high mortality and morbidity rates are challenging to manage and pose high-cost. Patients with lead-related infections usually present with fever, chills and fatigue and the treatment can be challenging unless the implant system is extracted. Case presentation: A 66-year old male patient who underwent dual chamber pacemaker and implantable cardioverter defibrillator was admitted to the emergency service with a six-week history of complaints of hiccups and fever. After a detailed investigation, lead-related infective endocarditis was the diagnosis. The patient was initiated on antibiotic therapy and lead extraction was performed. Conclusions: Patients with signs of infection who underwent pacemaker implantation may present with atypical symptoms such as hiccup. In these cases, imaging, particularly echocardiography, should be performed as soon as possible and the localization of the pacemaker leads and signs of infective endocarditis should be investigated. &nbsp

The relationship of age-adjusted Charlson comorbidity index and diurnal variation of blood pressure

WOS: 000454914000002PubMed: 29504835Backgrounds: Charlson Comorbidity index (CCI) is a scoring system to predict prognosis and mortality. It exhibits better utility when combined with age, age-adjusted Charlson Comorbidity Index (ACCI). The aim of this study was to evaluate the relationship between ACCI and diurnal variation of blood pressure parameters in hypertensive patients and normotensive patients. Methods: We enrolled 236 patients. All patients underwent a 24-h ambulatory blood pressure monitoring (ABPM) for evaluation of dipper or non-dipper pattern. We searched the correlation between ACCI and dipper or non-dipper pattern and other ABPM parameters. To further investigate the role of these parameters in predicting survival, a multivariate analysis using the Cox proportional hazard model was performed. Results: 167 patients were in the hypertensive group (87 patients in non-dipper status) and 69 patients were in the normotensive group (41 patients in non-dipper status) of all study patients. We found a significant difference and negative correlation between AACI and 24-h diastolic blood pressure (DBP), awake DBP, awake mean blood pressure (MBP) and 24-h MBP and awake systolic blood pressure(SBP). Night decrease ratio of blood pressure had also a negative correlation with ACCI (p = 0.003, r = -0.233). However, we found a relationship with non-dipper pattern and ACCI in the hypertensive patients (p = 0.050). In multivariate Cox analysis sleep MBP was found related to mortality like ACCI (p = 0.023, HR = 1.086, %95 CI 1.012-1.165) Conclusion: ACCI was statistically significantly higher in non-dipper hypertensive patients than dipper hypertensive patients while ACCI had a negative correlation with blood pressure. Sleep MBP may predict mortality

Association of parathyroid hormone and vitamin D with untreated hypertension: Is it different in white-coat or sustained hypertension?

<div><p>Background</p><p>Previous reports about the relationship between a high parathyroid hormone (PTH) and low vitamin D levels with blood pressure in different hypertension groups are conflicting.</p><p>Objective</p><p>We studied serum PTH and vitamin D levels in white-coat (WCHT) and sustained hypertension (SHT) patients who had not been on antihypertensive treatment. We also investigated the association between serum PTH and vitamin D levels with respect to blood pressure in SHT and WCHT patients.</p><p>Methods</p><p>We included 52 SHT patients (54.06 ± 9.2 years, 32 newly diagnosed and 20 previously diagnosed with SHT who had not been treated with antihypertensive medication for 3 months or more), 48 WCHT patients (53.64 ± 9.5 years), and 50 normotensive (NT) healthy controls (53.44 ± 8.4 years) in our study. In addition to routine tests, PTH and vitamin D levels were measured.</p><p>Results</p><p>Serum PTH levels were significantly higher in SHT patients not taking antihypertensive medications than in WCHT patients and NT controls (p = 0.004). Although PTH levels were higher in WCHT than in NT groups, the difference was not statistically significant. In SHT patients, PTH levels showed a positive correlation with office systolic (r = 0.363, p = 0.008), office diastolic (r = 0.282, p = 0.038), home systolic (r = 0.390, p = 0.004), and home diastolic blood pressures (r = 0.397, p = 0.003). Serum vitamin D levels were similar in SHT, WCHT and NT groups. Vitamin D levels were not associated with blood pressures in the entire study group. Furthermore, no significant relation was found between vitamin D and PTH levels in SHT and WCHT groups.</p><p>Conclusion</p><p>PTH levels are significantly higher in untreated SHT patients than WCHT patients and NT subjects. However, vitamin D levels are similar in SHT, WCHT and NT groups. There is a significant association between PTH levels and blood pressures suggesting PTH has a role in increase of blood pressure in SHT.</p></div

Effects of special exercise programs on functional movement screen scores and injury prevention in preprofessional young football players

To increase movement capacity and to reduce injury risk in young soccer players by implementing a special functional exercise program based on functional movement screen (FMS) and correctives. 67 young male athletes 14-19 years of age from a Super League Football Club Academy participated in the study. Functional movement patterns were evaluated with FMS assessment protocol. Deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability push-up, and rotatory stability were examined in FMS. Considering the FMS scores the number of intervention and control groups were defined as 24 and 43, respectively. Intervention program was composed of 1 hr twice a week sessions in total of 12 weeks with 4 weeks of mobility, 4 weeks of stability, and 4 weeks of integration exercises. At the end of 12-week intervention and control groups were re-evaluated with FMS protocol. Contact and noncontact sports injuries recorded during one season. In intervention group there was statistically significant difference in increase in total FMS scores (P<0.01), deep squat (P= 0.001), hurdle step (P<0.05), inline lunge (P<0.01), and trunk stability push-up (P<0.01). In control group total FMS, deep squat, and trunk stability push-up scores increased with a statistical difference (P<0.01, P<0.05, P= 0.01, respectively). The incidence of noncontact injury in control group was higher than intervention group (P<0.05). Periodic movement screening and proper corrections with functional training is valuable in order to create better movement capacity to build better physical performance and more effective injury prevention

Discontinuation of Eculizumab treatment after hematological remission in patients with atypical and drug-induced hemolytic uremic syndrome

Introduction. The aim was to evaluate the effect of therapeutic plasma exchange (TPE) and eculizumab on hematological and renal survival in atypical hemolytic uremic syndrome (aHUS), and additionally, to examine the reliability of discontinuation of eculizumab treatment

Relation between parathyroid hormone levels and blood pressures in sustained hypertensive patients.

<p>Relation between parathyroid hormone levels and blood pressures in sustained hypertensive patients.</p

Comparison of clinical features of the study groups.

<p>Comparison of clinical features of the study groups.</p

Multiple linear regression showing the association of home blood pressures with clinical and laboratory parameters in the entire study group.

<p>Multiple linear regression showing the association of home blood pressures with clinical and laboratory parameters in the entire study group.</p

Bivariate correlates of log-transformed parathyroid hormone levels in sustained and white-coat hypertension.

<p>Bivariate correlates of log-transformed parathyroid hormone levels in sustained and white-coat hypertension.</p

Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A retrospective cohort study

WOS: 000375550000011PubMed ID: 26987514Introduction: Most of the ACL reconstruction is done with isometric single-bundle technique. Traditionally, surgeons were trained to use the transtibial technique (TT) for drilling the femoral tunnel. Our study compared the early postoperative period functional and clinical outcomes of patients who had ACL reconstruction with TT and patients who had ACL reconstruction with anatomical single-bundle technique (AT). Material method: Fifty-five patients who had ACL reconstruction and adequate follow-up between January 2010-December 2013 were included the study. Patients were grouped by their surgery technique. 28 patients included into anatomical single-bundle ACL reconstruction surgery group (group 1) and 27 patients were included into transtibial AC reconstruction group (group 2). Average age of patients in group 1 and group 2 was 28.3 +/- 6, and 27.9 +/- 6.4, respectively. Lachman and Pivot-shift tests were performed to patients. Laxity was measured by KT-1000 arthrometer test with 15, 20 and 30 pound power. All patients' muscle strength between both extremities were evaluated with Cybex II (Humac) at 60 degrees/sec, 240 degrees/sec frequencies with flexion and extension peak torque. The maximum force values of non-operated knee and the operated knee were compared to each other. Groups were evaluated by using International Knee Documentation Committee (IKDC) knee ligament healing Standard form, IKDC activity scale, modified Lysholm and Cincinnati evaluation forms. Return to work and exercise time of patients were compared. Functional and clinical outcomes of two groups were compared. NCSS 2007 and PASS 2008 Statistical Software programs were used for statistical analysis. Result: There was no statistically significant difference between Lachman and Pivot-shift results (p > 0.01). Positive value of Pivot-shift test and incidence of anterior translation in Lachman test were higher in the patients who had TT. Lysholm activity level of patients who had TT, 33.3% (n = 9) were excellent, 51.9% (n = 14) were good and 14.8% (n = 4) were moderate; patients who had AT, 57.1% (n = 16) were excellent, 39.3% (n = 11) were good and 3.6% (n = 1) was good level. There was no statistically significant difference between Lysholm Activity level of the patients (p 0.05). Conclusion: Single-bundle anatomic ACL reconstruction was better than the TT in term of clinical, functional, and laboratory results. We believe that AT ACL reconstruction will increase in use and traditional method which is TT ACL reconstruction surgery will decrease in the long term. Theoretically, anatomic relocation of the ACL can provide better knee kinematics