Off-pump versus on-pump coronary artery bypass grafting in acute coronary syndrome: a clinical analysis

<p>Abstract</p> <p>Background</p> <p>Although off-pump coronary artery bypass (OPCAB) surgery has many beneficial effects compared with on-pump surgery, switch to on-pump surgery has significantly higher risks of operative mortality. Benefits of OPCAB over on-pump surgery strategies concerning myocardial revascularization are still debatable. We have aimed to develop an "algorithm of off-pump surgical strategy" on preventing conversion to on-pump. This clinical study reports our clinical outcome of OPCAB in patients with acute coronary syndrome.</p> <p>Methods</p> <p>Between January 2006 and December 2008, 198 patients with acute coronary syndrome were enrolled in the study. Decision of OPCAB (142 patients) or on-pump surgery (56 patients) was made according to patients' present clinical status and our surgical background. Cardiac enzymes, duration of the surgery, graft numbers, stay in intensive care unit were recorded.</p> <p>Results</p> <p>OPCAP group has shorter operation time (82.78 min versus 164.22 min, p < 0.001), lesser necessity for intra-aortic balloon pumping (3.5% versus 12.5%, p = 0.053), shorter duration of intensive care unit stay (p < 0.05) and hospital stay (p < 0.001) compared to on-pump patients. EuroSCORE level was lower in OPCAP group (p < 0.001). None of the patients of OPCAB group required conversion to on-pump technique.</p> <p>Conclusions</p> <p>The patients who admitted to the hospital with acute coronary syndrome within "golden hours" (within 6 hours after onset) had a greater chance for OPCAB surgery. This study proves that EuroSCORE is likely to be an important factor in deciding which surgical technique to use, but a further investigation is needed to verify. According to our findings, a careful evaluation of coronary angiography, hemodynamic status, quality of target coronary vessel and timing of surgery are important for OPCAB surgery to avoid conversion to on-pump. By a careful systematic evaluation of the patients as explained with this article, it can be prevent or reduce conversion to on-pump surgery during OPCAB surgery.</p

Genotyping of Mycobacterium tuberculosis clinical isolates in two cities of Turkey: Description of a new family of genotypes that is phylogeographically specific for Asia Minor

BACKGROUND: Population-based bacterial genetics using repeated DNA loci is an efficient approach to study the biodiversity and phylogeographical structure of human pathogens, such as Mycobacterium tuberculosis, the agent of tuberculosis. Indeed large genetic diversity databases are available for this pathogen and are regularly updated. No population-based polymorphism data were yet available for M. tuberculosis in Turkey, at the crossroads of Eurasia. RESULTS: A total of 245 DNAs from Mycobacterium tuberculosis clinical isolates from tuberculosis patients residing in Turkey (Malatya n = 147 or Ankara n = 98) were genotyped by spoligotyping, a high-throughput genotyping method based on the polymorphism of the Direct Repeat locus. Thirty-three spoligotyping-defined clusters including 206 patients and 39 unique patterns were found. The ST41 cluster, as designated according to the international SpolDB3 database project, represented one fourth and when gathered to three genotypes, ST53, ST50 and ST284, one half of all the isolates. Out of 34 clinical isolates harboring ST41 which were further genotyped by IS6110 and by MIRU-VNTR typing, a typical 2-copy IS6110-RFLP pattern and a "215125113322" MIRU-VNTR pattern were observed among 21 clinical isolates. Further search in various databases confirms the likely Turkish-phylogeographical specificity of this clonal complex. CONCLUSION: We described a new phylogeographically-specific clone of M. tuberculosis, designated LAM7-TUR. Further investigations to assess its frequency within all regions of Turkey and its phylogeographical origin and phylogenetic position within the global M. tuberculosis phylogenetic tree will shed new light on its endemicity in Asia Minor

The Relationship of Markers With Carotid Artery Stenosis and Lesion Hardness: Superiority of C-Reactive Protein and Uric Acid

Background : Atherosclerosis is a disease that cholesterol plaque builds up inside arteries. The process of atherosclerosis starts when certain substances such as cholesterol, fats, and cellular waste products accumulate in the walls of arteries, and the immune system responds to these substances, triggering inflammation. Over time, this inflammation can cause the plaque to grow and harden, narrowing the artery and reducing blood flow. Carotid artery disease (CAD) is a conclusion of plaques in carotid artery. CAD can increase the risk of stroke, a potentially life-threatening condition that occurs when blood flow to the brain is interrupted. Objectives: The objectives of this study were to detect the association between carotid artery stenosis and inflammatory markers. Methods: This study was designed prospectively and included 109 and 100 patients having mild carotid stenosis and severe carotid stenosis, respectively. Further, 101 patients were included in the control group. The carotid ultrasonography was evaluated in all patients. After classifying the plaques into(severe stenosis) categories, they were also grouped into echogenicity plaques, namely, echolucent (soft) and echogenic (hard) plaques. Results: The uric acid (UA) values of the mild and severe stenosis groups were higher than that of the control group (P<0.01). The mean C-reactive protein (CRP) value was the highest in the severe stenosis group, and the lowest CRP value was found in the control group (P<0.01). A one-unit increase in UA could increase the risk by 2.203 times. The CRP value was higher in the soft lesion group without calcification than in the hard lesion group with calcification. Conclusion: Our findings demonstrated that age, UA, and CRP values were identified as predictors independent of each other in the development of carotid stenosis. Regarding plaque classification, our results identified CRP, mean platelet volume (MPV), white blood cell, and lymphocyte values as negative predictors. The findings of our study indicate that CRP and UA are valuable in predicting the severity of stenosis and the formation of soft plaque

Distribution of Spoligotyping Defined Genotypic Lineages among Drug-Resistant Mycobacterium tuberculosis Complex Clinical Isolates in Ankara, Turkey

Background: Investigation of genetic heterogeneity and spoligotype-defined lineages of drug-resistant Mycobacterium tuberculosis clinical isolates collected during a three-year period in two university hospitals and National Tuberculosis Reference and Research Laboratory in Ankara, Turkey. Methods and Findings: A total of 95 drug-resistant M. tuberculosis isolates collected from three different centers were included in this study. Susceptibility testing of the isolates to four major antituberculous drugs was performed using proportion method on Löwenstein–Jensen medium and BACTEC 460-TB system. All clinical isolates were typed by using spoligotyping and IS6110-restriction fragment length polymorphism (RFLP) methods. Seventy-three of the 95 (76.8%) drug resistant M. tuberculosis isolates were isoniazid-resistant, 45 (47.4%) were rifampicin-resistant, 32 (33.7%) were streptomycinresistant and 31 (32.6%) were ethambutol-resistant. The proportion of multidrug-resistant isolates (MDR) was 42.1%. By using spoligotyping, 35 distinct patterns were observed; 75 clinical isolates were grouped in 15 clusters (clustering rate of 79%) and 20 isolates displayed unique patterns. Five of these 20 unique patterns corresponded to orphan patterns in th

Advancement In Poct Molecular Testing: The Multiplex Pcr Poct Devices For Infectious Diseases

Rapid and accurate diagnostic tests are very important for the global control of infectious diseases. The point of care diagnosis has become a promising strategy in recent years. Different kind of point of care testing devices has been introduced into the market in the last decade. These devices must provide a low-cost, robust, sensitive, specific, and practical analysis in order to replace the conventional clinical laboratory diagnostic test algorithms when needed. The successful implementation of point of care diagnostics has a potential to increase the strength of infectious diseases surveillance programs. Finally, the rapid progress in point of care diagnosis can stimulate a shift from a centralized diagnostic model to a decentralized patient-centered approach.PubMe

Rapid Determination of Rifampin Resistance in Clinical Isolates of Mycobacterium Tuberculosis by Real-Time Pcr

Real-time PCR was used to determine rifampin resistance in clinical isolates of Mycobacterium tuberculosis. Ninety-six rifampin-resistant isolates and 23 rifampin-susceptible isolates were included in the study. A 305-bp region covering the 81-bp "rifampin resistance-determining region" of rpoB was amplified. Two hybridization probe pairs that covered the most frequent mutation sites in rpoB, codon regions 526 to 531 and 513 to 516, were used. The results obtained by real-time PCR were compared to those obtained by the proportion method. For detection of rifampin resistance, the real-time PCR assay yielded a sensitivity of 92.7% and a specificity of 100%. Real-time PCR is a very rapid method, and it can be especially helpful for the reporting of resistant clinical isolates in a very short period of time.WoSScopu

Single shot "3-in-1" femoral nerve blockade with 0.25% or 0.375% levobupivacaine provides similar postoperative analgesia for total knee replacement

WOS: 000275833900012Aim: To compare postoperative analgesia provided by single shot "3-in-1" femoral nerve blockade using 0.25% or 0.375% levobupivacaine in preceding with spinal anesthesia for unilateral total knee replacement surgery. Materials and methods: Forty consenting patients undergoing unilateral total knee arthroplasty were included in this prospective randomized study. Spinal anesthesia was achieved with 15 mg plain bupivacaine at the L3-4 or L4-5 interspace. After resolution of the spinal anesthesia, patients were randomized into 2 groups: "3-in-1" femoral nerve blocks were performed using 30 m L of 0.25% levobupivacaine (Group 1, n = 20) or 0.375% levobupivacaine (Group 2, n = 20). Pain was assessed by visual analogue scale (VAS). The total morphine consumption and the side effect profile were compared during the postoperative period. Results: There were no significant differences between the 2 study groups with respect to characteristics or intraoperative variables. Furthermore, sensory block periods and time to first pain sensation, VAS, and morphine consumption for 24 h (Group 1: 19.7 +/- 9.2, Group 2:20.6 +/- 12.1 mg) were similar. Pain scales and range of motion during rehabilitation period and side effects were also comparable. Conclusion: Our results indicate that the augmenting concentration did not influence the clinical outcome when single shot "3-in-1" femoral nerve block was performed with 0.25% or 0.375% levobupivacaine in total knee arthroplasty

Postoperatif analjezide % 0,25 veya % 0,375 levobupivakain ile tek doz 3’e 1 femoral sinir blokajı total diz protezi operasyonunda benzer analjezi sağlar

Amaç: Bu çalışmada tek taraflı total diz protezi cerrahisinde spinal anesteziyi takiben % 0,25 veya % 0,375 levobupivakain kullanılarak yapılan 3 e 1 femoral sinir bloğunun etkinliğinin karşılaştırılması amaçlandı. Yöntem ve gereç: Çalışmaya tek taraflı elektif diz cerrahisi geçirmesi planlanan onamı alınmış kırk hasta dahil edildi. Spinal anestezi 15 mg düz bupivakain kullanılarak L3-4 veya L4-5 seviyesinden gerçekleştirildi. Spinal anestezinin ortadan kalkmasından sonra hastalar randomize olarak iki gruba ayrıldı: 3 e 1 femoral blok 30 mL % 0,25 levobupivakain (Grup 1, n = 20) veya % 0,375 levobupivakain (Grup 2, n = 20) kullanılarak gerçekleştirildi. Ağrı Vizüel Analog Skala (VAS) ile değerlendirildi. Postoperatif dönemde total morfin tüketimi ve yan etkiler belirlendi. Bulgular:Her iki grup arasında hasta özellikleri veya intraoperatif değişimler açısından belirgin bir farklılık saptanmadı. Bundan öte, duyu bloğu süresi, ilk ağrı duyumu, VAS ve ilk 24 saatlik morfin tüketimi (Grup 1: 19,7 ± 9,2, Grup 2: 20,6 ± 12,1 mg) benzerdi. Ağrı skalaları, rehabilitasyon sırasındaki hareket genişliği ve yan etkiler benzerdi. Sonuç: Bulgularımız % 0,25 veya % 0,375 levobupivakain kullanılarak yapılan tek doz 3 ü 1 yerde femoral sinir blokajında konsantrasyon artışının klinik sonucu etkilemediğini gösterdi.Aim: To compare postoperative analgesia provided by single shot &amp;#8220;3-in-1&amp;#8221; femoral nerve blockade using 0.25% or 0.375% levobupivacaine in preceding with spinal anesthesia for unilateral total knee replacement surgery. Materials and methods: Forty consenting patients undergoing unilateral total knee arthroplasty were included in this prospective randomized study. Spinal anesthesia was achieved with 15 mg plain bupivacaine at the L3-4 or L4-5 interspace. After resolution of the spinal anesthesia, patients were randomized into 2 groups: &amp;#8220;3-in-1&amp;#8221; femoral nerve blocks were performed using 30 mL of 0.25% levobupivacaine (Group 1, n = 20) or 0.375% levobupivacaine (Group 2, n = 20). Pain was assessed by visual analogue scale (VAS). The total morphine consumption and the side effect profile were compared during the postoperative period. Results: There were no significant differences between the 2 study groups with respect to characteristics or intraoperative variables. Furthermore, sensory block periods and time to first pain sensation, VAS, and morphine consumption for 24 h (Group 1: 19.7 &plusmn; 9.2, Group 2: 20.6 &plusmn; 12.1 mg) were similar. Pain scales and range of motion during rehabilitation period and side effects were also comparable. Conclusion: Our results indicate that the augmenting concentration did not influence the clinical outcome when single shot &amp;#8220;3-in-1&amp;#8221; femoral nerve block was performed with 0.25% or 0.375% levobupivacaine in total knee arthroplasty

Rapid Detection of Rifampin Resistance in Mycobacterium Tuberculosis Isolates by Heteroduplex Analysis and Determination of Rifamycin Cross-Resistance in Rifampin-Resistant Isolates

Direct heteroduplex analysis and a universal heteroduplex generator assay were performed to detect rifampin resistance rapidly in Turkish Mycobacterium tuberculosis isolates. Cross-resistance to rifapentine, rifabutin, and rifalazil was investigated. A relationship between specific mutations and resistance patterns, which can guide the choice of an appropriate therapeutic regimen for tuberculosis patients, was identified.Wo