Management of Cardiac Tamponade: A Comperative Study between Echo-Guided Pericardiocentesis and Surgery—A Report of 100 Patients

Background. Cardiac tamponade (CT) represents a life-threatening condition, and the optimal method of draining accumulated pericardial fluid remains controversial. We have reviewed 100 patients with CT at our institution over a five-year period and compared the results of echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis with regard to functional outcomes. Methods. The study group consisted of 100 patients with CT attending Yuzuncu Yil University from January 2005 to January 2010 who underwent one of the 3 treatment options (echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis). CT was defined by clinical and echocardiographic criteria. Data on medical history, characteristics of the pericardial fluid, treatment strategy, and follow-up data were collected. Results. Echo-guided pericardiocentesis was performed in 38 (38%) patients (Group A), primary surgical treatment was preformed in 36 (36%) patients (Group B), and surgical treatment following pericardiocentesis was performed in 26 (26%) patients (Group C). Idiopathic and malignant diseases were primary cause of tamponade (28% and 28%, resp.), followed by tuberculosis (14%). Total complication rates, 30-day mortality, and total mortality rates were highest in Group C. Recurrence of tamponade before 90 days was highest in Group A. Conclusions. According to our results, minimal invasive procedure echo-guided pericardiocentesis should be the first choice because of lower complication and mortality rates especially in idiopathic cases and in patients with hemodynamic instability. Surgical approach might be performed for traumatic cases, purulent, recurrent, or malign effusions with higher complication and mortality rates

Comparison of the frailty among older adults between the nursing home living versus own home living

Introduction: This study aims to evaluate elder people according to their living place and gender in terms of frailty with the FRAIL Scale.Methods: An observational cross sectional study was conducted between December 2019 and March 2020 with 113 patients aged ≥ 65 years who were admitted to a family health center in Istanbul. Patients registered at the nursing home address and patients living at their home address were assigned to the groups by the simple randomization method. A questionnaire including the demographic data and the FRAIL Scale which would evaluate the frailty was performed face-to-face. The Chi-square test was used for the statistical analysis.Results: It was observed that 51.3% of 113 individuals over 65 years in the study were male (n = 24), and the mean age was 73.13 ± 6.52 years. Frailty was found to be 21.2% (n = 24), according to the mean score of the FRAIL Scale (1.24 ± 1.26). The frailty rate (29.8%) of own home living elderly was found to be higher than the nursing home living elderly (12.5%) (p = 0.049). The frailty rate of own home living men (27.6%) was higher than the nursing home living men (3.4%) (p = 0.038). In FRAIL scale components, fatigue 19.5% (n = 22), resistance 38.9% (n = 44), ambulation 36.3% (n = 41), disease 10.6% (n = 12), weight loss 18.6% (n = 21) of the scale component were included in the fragility measurement. In the analysis of the answers, the internal consistency of the scale was moderate level (Cronbach alpha = 0.552).Conclusions: According to this study, one out of every five elderly was frail. Based on the fact that the elderly especially own home living men, are more fragile, and nursing home living women are seen at an older age, the results drew attention to the importance of nursing homes in the course of frailty in the future.Keywords: Nursing home, frailty, elderly, reliabilit

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Background. Cardiac tamponade (CT) represents a life-threatening condition, and the optimal method of draining accumulated pericardial fluid remains controversial. We have reviewed 100 patients with CT at our institution over a five-year period and compared the results of echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis with regard to functional outcomes. Methods. The study group consisted of 100 patients with CT attending Yuzuncu Yil University from January 2005 to January 2010 who underwent one of the 3 treatment options (echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis). CT was defined by clinical and echocardiographic criteria. Data on medical history, characteristics of the pericardial fluid, treatment strategy, and followup data were collected. Results. Echo-guided pericardiocentesis was performed in 38 (38%) patients (Group A), primary surgical treatment was preformed in 36 (36%) patients (Group B), and surgical treatment following pericardiocentesis was performed in 26 (26%) patients (Group C). Idiopathic and malignant diseases were primary cause of tamponade (28% and 28%, resp.), followed by tuberculosis (14%). Total complication rates, 30-day mortality, and total mortality rates were highest in Group C. Recurrence of tamponade before 90 days was highest in Group A. Conclusions. According to our results, minimal invasive procedure echo-guided pericardiocentesis should be the first choice because of lower complication and mortality rates especially in idiopathic cases and in patients with hemodynamic instability. Surgical approach might be performed for traumatic cases, purulent, recurrent, or malign effusions with higher complication and mortality rates

Increased P-wave dispersion in patients with newly diagnosed lichen planus

OBJECTIVE: Lichen planus is a chronic inflammatory autoimmune mucocutaneous disease. Recent research has emphasized the strong association between inflammation and both P-wave dispersion and dyslipidemia. The difference between the maximum and minimum P-wave durations on an electrocardiogram is defined as P-wave dispersion. The prolongation of P-wave dispersion has been demonstrated to be an independent risk factor for developing atrial fibrillation. The aim of this study was to investigate P-wave dispersion in patients with lichen planus. METHODS: Fifty-eight patients with lichen planus and 37 age- and gender-matched healthy controls were included in this study. We obtained electrocardiographic recordings from all participants and used them to calculate the P-wave variables. We also assessed the levels of highly sensitive C-reactive protein, which is an inflammatory marker, and the lipid levels for each group. The results were reported as the means ± standard deviations and percentages. RESULTS: The P-wave dispersion was significantly higher in lichen planus patients than in the control group. Additionally, highly sensitive C-reactive protein, LDL cholesterol, and triglyceride levels were significantly higher in lichen planus patients compared to the controls. There was a significant positive correlation between highly sensitive C-reactive protein and P-wave dispersion (r = 0.549,

Predictors of mortality in patients with prosthetic valve infective endocarditis: A nation-wide multicenter study

Background: Our aim was to investigate the clinical and prognostic features of the patients with prosthetic valve endocarditis (PVE) in a multicenter nation-wide study.Methods: The present nation-wide study consisted of 75 consecutive patients with PVE treatedat 13 major hospitals in Turkey from 2005 to 2012.Results: The patients who died during follow-up were significantly older than the survivors and had higher C-reactive protein (CRP), creatinine, poor NYHA functional class and large vegetations. High creatinine level (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.14–6.13), poor functional status (OR 24.5; 95% CI 3.1–196.5) and high CRP (OR 1.02; 95% CI1.00–1.03) measured on admission were independent risk associates for in-hospital mortality.Conclusions: High creatinine level, poor functional status and high CRP measured on admission were independent risk associates for in-hospital mortality, whereas a NYHA class ofIII/IV and high CRP reflected independent risk for stroke/mortality end point

The relation of platelet–lymphocyte ratio and coronary collateral circulation in patients with non-ST segment elevation myocardial infarction

Introduction : Recently, platelet-to-lymphocyte ratio (PLR) has emerged as a significant inflammatory marker and a novel predictor of major adverse consequences in cardiovascular disease. Aim : In this study, we aimed to explore the relationship between PLR and coronary collateral circulation (CCC) in patients with non-ST elevation myocardial infarction (NSTEMI). Material and methods : Clinical and laboratory data of 386 patients who underwent coronary angiography were evaluated retrospectively. The patients were classified into 2 groups as follows: poor CCC (group 1: Rentrop grades 0–1) and good CCC (group 2: Rentrop grades 2–3). The PLR was calculated from the complete blood count. Results : The PLR values of the patients with poor CCC were significantly higher than those of patients with good CCC (153.9 ±26.6 vs. 129.8 ±23.5, p < 0.001). In the multiple logistic regression tests, PLR (odds ratio: 1.51, 95% confidence interval: 1.27–1.74; p < 0.001) and hs-CRP (odds ratio: 1.56, 95% CI: 1.03–2.11; p < 0.001) were found to be independent predictors of poor CCC. The receiver operating characteristic (ROC) curve analysis yielded a cutoff value of 140.5 for PLR to predict poor CCC with 79% sensitivity and 71% specificity, with the area under the ROC curve being 0.792 (95% CI: 0.721–0.864). Conclusions : Our study revealed that high PLR is independently associated with poor coronary collateral circulation in patients with NSTEMI

classification tree method

Most current statistical strategies for determining risk factors for hypertension (HT) among certain populations have proved inconclusive. In this study, the classification tree method, which is more practical and easy to understand than other statistical methods, was used to determine the risk for HT among outpatients in a clinic in Denizli province, western Turkey, between January 2002 and July 2004. The effects of 14 risk factors (body mass index, waist-to-hip ratio, age, serum total cholesterol, serum triglycerides, sex, HT in first-degree relatives, diabetes mellitus, smoking, stress factors, alcohol consumption, dyslipidemia in first-degree relatives, dyslipidemia [previously diagnosed], and saturated fat consumption) on HT were evaluated in this population. in all, 1761 adults at the outpatient clinic were recruited for lipid and HT measurements. The classification tree method revealed 7 main risk factors (body mass index, waist-to-hip ratio, sex, serum triglycerides, serum total cholesterol, HT in first-degree relatives, and saturated fat consumption) for HT. The findings of the present study suggest that the classification tree is a valuable statistical method for evaluating multiple risk factors for HT

Função endotelial vascular em pacientes com fluxo coronário lento e os efeitos do nebivolol Vascular endothelial function in patients with coronary slow flow and the effects of nebivolol

FUNDAMENTO: A função endotelial braquial tem sido associada ao fluxo lento coronário (FLC). O aumento do fluxo sanguíneo para a artéria braquial faz com que o endotélio libere óxido nítrico (ON), com subsequente vasodilatação. Além de sua atividade com betabloqueador, o nebivolol provoca vasodilatação, aumentando a liberação endotelial de ON. OBJETIVO: Avaliar os efeitos do nebivolol na função endotelial vascular em pacientes com FLC. MÉTODOS: 46 pacientes com FLC e 23 indivíduos com artérias coronárias epicárdicas normais foram examinados com ecocardiografia transtorácica e ultrassonografia da artéria braquial. Os pacientes foram reavaliados dois meses após o tratamento com aspirina ou aspirina e nebivolol. RESULTADOS: Os pacientes com FLC apresentaram maior índice de massa corporal (26,5 ± 3,3 vs. 23,8 ± 2,8, p BACKGROUND: Brachial endothelial function has been associated with coronary slow flow (CSF). Increasing blood flow to brachial artery provokes endothelium to release nitric oxide (NO) with subsequent vasodilatation. Besides its &#946;1-blocker activity, nebivolol causes vasodilatation by increasing endothelial NO release. OBJECTIVE: To assess the effects of nebivolol on vascular endothelial function in patients with CSF. METHODS: Forty-six patients with CSF and 23 individuals with normal epicardial coronary arteries were examined with transthoracic echocardiography and brachial artery ultrasonography. The patients were reevaluated two months after treatment with aspirin or aspirin plus nebivolol. RESULTS: Patients with CSF had higher body mass index (26.5 ± 3.3 vs. 23.8 ± 2.8, p < 0.001), mitral inflow isovolumetric relaxation time (IVRT) (114.9 ± 18.0 vs. 95.0 ± 22.0 msec, p < 0.001) and lower left ventricular ejection fraction (LVEF) (63.5 ± 3.1% vs. 65.4 ± 2.2, p = 0.009), HDL-cholesterol (39.4 ± 8.5 vs. 45.8 ± 7.7 mg/dL, p = 0.003) and brachial flow-mediated dilatation (FMD) (6.1 ± 3.9% vs. 17.6 ± 4.5%, p < 0.001). There were significant correlations between FMD and the presence of CSF (r = 0.800, p < 0.001) and HDL-cholesterol (r = 0.349, p = 0.003). Among Patients with CSF, although pretreatment mean FMD values were similar (6.1 ± 4.3% vs. 6.0 ± ,6%, p = 0.917) compared to aspirin alone group, posttreatment FMD was significantly higher in patients treated with aspirin plus nebivolol (6.0 ± 3.5% vs. 8.0 ± 2.9%, p = 0.047). Treatment with nebivolol was associated with a significant increase in FMD (6.0 ± 3.6 to 8.0 ± 2.9 %, p = 0.030) whereas treatment with aspirin alone was not. CONCLUSION: Endothelial function may be impaired in both coronary and brachial arteries in patients with CSF and nebivolol may be effective in the improvement of endothelial function in patients with CSF