A rare cause of dyspnea: Left atrial angiosarcoma

WOS: 000482646600012PubMed ID: 3137565

Resistant hypertension in elderly: a clinical manifestation of heart failure with preserved ejection fraction? retrospective single-center analysis

Background: Resistant hypertension (RHT) is defined as high blood pressure despite three antihypertensive medications one being a diuretic. RHT is a common clinical problem and as a subgroup has not been studied widely. The present study has investigated patient demographics and if the RHT might be a clinical presentation of heart failure with preserved ejection fraction (HFPEF) in elderly. Method: The outpatient data between January and June 2015 of Izmir Kemalpasa State hospital’s hypertension specialty clinic has been reviewed retrospectively. The patients with pseudo-RHT are excluded. Among 957 patients, 68 patients have been identified as true RHT with a left ventricle ejection fraction ≥50%. HFPEF is defined according to the latest guideline. Instead of a common cut-off level for NT-proBNP, age and gender-related cut-off levels have been used. Results: The mean age was 63.24 ± 12.05 years. Among 68 patients, 49 were female. While only 3 patients in younger group (8.8%) had elevated levels of NT-proBNP, 22 of older RHT patients (64.7%) had high levels. NT-proBNP levels were disproportionally high in elderly (p < 0.001) and high levels in RHT patients were related to a larger left atrial diameter (p < 0.001). Conclusion: The underlying mechanism might be different in RHT according to age. Hypervolemia might be the key factor in older RHT patients but not in younger patients. The current study suggests RHT in elderly can be a clinical presentation of HFPEF, and they should be investigated and treated accordingly. Because of single-center results and limited patients, further studies are needed

Rubella seroprevalence among healthy individuals in Izmir, Turkey

WOS: 000295837200022PubMed ID: 21860258In order to assess immunity to rubella in Izmir, Turkey, a total of 600 persons of 1-70 y of age were selected with cluster sampling. Of the 597 subjects, 120(20.1%) was susceptible to the rubella according to their serum antibody levels. Of children 1 to 6 y of age, 50.9% was found to be serologically susceptible to rubella. Rubella protection rates showed a age-related increase, reaching maximum in the 15-19 age group, in which 98.1% of these subjects had antibody titer above the full protective level. Of the 126 females in the reproductive age group, only 4(3.1%) were found to be serologically susceptible to rubella. Logistic regression analysis showed that among the several independent variables, only age (p < 0.001) was significantly associated with rubella protective antibody levels. Epidemiological studies should continue as the epidemiological characteristics of the disease may change depending on the uptake of MMR vaccination

Low pertussis antibody levels in maternal and umbilical cord blood samples in Turkey

WOS: 000415748800001PubMed ID: 29090869Pertussis continues to cause significant mortality and morbidity in many countries despite high vaccine coverage, especially among young infants. The aim of the study was to determine pertussis antibody levels in paired maternal and cord blood samples, to evaluate the placental transfer of these antibodies, and to assess whether newborn infants have adequate antibody levels against pertussis. Antibody titers to pertussis toxin (anti-PT) and filamentous hemagglutinin (anti-FHA) were measured by in-house enzyme linked immunosorbent assay (ELISA) in 251 paired maternal delivery and cord blood samples. Geometric mean concentrations (GMCs) of pertussis antibodies and cord: maternal GMC ratios were calculated. GMCs of maternal anti-PT and anti-FHA antibodies at delivery were 4.12 and 9.89 EU/ml, respectively. Cord GMCs were 133% and 131% of maternal delivery values for PT and FHA, respectively; demonstrating effective placental transfer. However, cord pertussis antibodies were at a low concentration; 5.49 EU/ml for PT and 12.73 EU/ml for FHA. Only 34.6% of infants had protective anti-PT levels (>= 10 EU/ml) at birth. Anti-pertussis antibody concentrations were extremely low in pregnant women in Turkey where childhood pertussis vaccination coverage has been high for a long time. Despite effective placental antibody transfer, umbilical cord pertussis antibody concentrations are similarly low. A majority of young infants are vulnerable to pertussis infection until the onset of primary vaccinations. These data support the need for pertussis vaccination during pregnancy to prevent infant infection in Turkey

Comparison of the Effects of Epidural Levobupivacaine with Tramadol or Morphine Addition on Postoperative Analgesia following Major Abdominal Surgery

WOS: 000475857600003PubMed ID: 31380509Objective: The study was designed to compare the postoperative analgesic efficacy of epidural tramadol or epidural morphine as adjuvant to levobupivacaine in major abdominal surgery. Methods: Patients in ASA I-II group aged between 18 and 65 years were included in study. Epidural catheter was introduced. Patients were randomised into three groups to receive levobupivacaine (Group L), levobupivacaine+morphine (Group LM) and levobupivacaine+tramadol (Group LT). General anaesthesia was administered to all patients. The solution intended for Group L contained 25 mg 0.5% levobupivacaine+15 mL saline, that for Group LM contained 25 mg 0.5% levobupivacaine+14.5 mL salin+100 mu g morphine and that for Group LT contained 25 mg 0.5% levobupivacaine+13 mL salin+100 mg tramadol, which was administered via epidural catheter as loading dose 30 min before the end of the operation. Patient-controlled analgesia device was connected to the epidural catheter to provide postoperative analgesia. Bolus dose was adjusted to 12 mg levobupivacaine in Group L, 12 mg levobupivacaine + 1.2 mg morphine in Group LM and 12 mg levobupivacaine+12 mg tramadol in Group LT. Lock-out period was adjusted to 15 min in three groups. Quality of analgesia was evaluated using Visual Analogue Scale; administered and demand doses of levobupivacaine, morphine and tramadol were compared at 30 min, 1, 2, 6, 12 and 24 h postoperatively. Results: Visual Analogue Scale scores were significantly higher in Group L than Groups LM and LT. Nausea and vomiting observed in Group L were lesser than those in Groups LM and LT. Conclusion: Continuous epidural analgesia using levobupivacaine combined with morphine or tramadol is an effective method for managing postoperative analgesia in major abdominal surgery