Association of dipping pattern of blood pressure and atherosclerotic burden of coronary arteries in hypertensive patients

Aim    The aim of this study was to determine the association between the dipping pattern of BP and coronary artery disease in hypertensive patients.Material and methods    A total of 356 hypertensive patients were included in the study. The results of ambulatory BP monitoring, echocardiography, and coronary computerised tomographic angiography were evaluated retrospectively. The patients were divided into two groups on the basis of their ambulatory BP monitoring: 1) patients with the dipping pattern of BP; 2) patients with the non-dipping pattern (NDP).Results    Among the 356 patients, 145 were male (40.7 %). The smoking status was higher in patients with NDP (p=0.023). The statin usage in patients with the dipping pattern was higher in patients with NDP (p=0.027). There were no significant differences in the echocardiographic findings. 58.6 % of the patients without plaque formation had the dipping pattern of BP (p<0.05), however 84.4 % of patients with >50 % plaque formation had the NDP of BP (p<0.001).Conclusion    The NDP of BP might be related to the increased atherosclerotic process in coronary arteries, and pa-tients with NDP might have an increased atherosclerotic burden for coronary arteries when compared with patients with a dipping pattern.

Response of (Vitis vinifera L.) cv. Fantasy Seedless to water deficit treatments: Phenolic compounds and physiological activities

This paper describes an investigation on the effects of deficit irrigation treatments on phenolic compounds and physiological activities of Fantasy Seedless table grape variety. Research was conducted in Viticultural Research Institute of Manisa, located in Aegean Region of Turkey, during two consecutive years (2016–2017). Three irrigation treatments were assayed; namely full irrigation (T-F), deficit irrigations (T-35 and T-65). In T-F, soil water deficit in the 90 cm within the one week intervals was completed to the field capacity. T-35 and T-65 treatments received 35% and 65% of water applied to T-F. Sub-surface drip irrigation system was used in the research and soil water content was measured by MobiCheck probe while vine water status was monitored through midday leaf water potential before the irrigations. Results showed that water deficit treatments (T-35 and T-65) affected berry composition particularly individual phenolics [Gallic acid, (+)(−) Catechine, (−)-Epigallocatechin gallate, (−)-Epicatechin gallate, Caftaric acid, Chlorogenic acid, Caffeic acid, p-Coumeric acid, Ferulic acid, Sinapic acid, Trans-Resveratrol, Myricetin, Quercetin hydrate, Kaempferol, Oenin Chloride, Delphinidin Chloride, Cyanidin Chloride, Malvidin Chloride] differently. The highest Catechine content in the samples was obtained from T-65, T-35 and T-F treatments, respectively. Furthermore it was determined that DI treatments did not change the Myricetin and Quercetin hydrate contents in 2017. On the other hand minimum Ψmd value was observed from the T-35 treatment in both years. Last of all, our findings show a strong relationship between the amount of water and berry composition values especially individual phenolics which are benefical to health.

Subclinical left ventricular systolic dysfunction in diabetic patients and its association with retinopathy: A 2D speckle tracking echocardiography study

AIM

It is important to diagnose diabetic cardiomyopathy in the early stages to prevent development of evident heart failure in the future. The primary objective of this study was to evaluate the presence of subclinical left ventricular (LV) dysfunction with two-dimensional (2D) speckle tracking echocardiography (STE) and the secondary objective was to compare retinopathy-positive and -negative diabetic patients.

PATIENTS AND METHODS

A total of 82 patients with type II diabetes mellitus (DM) and 90 gender-matched healthy controls were included. Retinopathy was present in 55 patients in the study group. All study participants underwent conventional 2D echocardiography and STE.

RESULTS

All diabetic patients had preserved LV ejection fraction (LV-EF ≥ 50). Compared with the control group, diabetic patients had a larger left atrium (47.3 ± 19.9 mm vs. 36.9 ± 17.8 mm, p < 0.001) and a higher E/Em ratio (12.0 ± 2.9 vs. 10.5 ± 3.7, p = 0.004). The LV-EF, LV end diastolic and end systolic volumes, E/A ratios, deceleration times, and tissue Doppler parameters were compared between groups. The study group was observed to have statistically significant lower four-chamber (4C; 17.7 ± 3.0 % vs. 19.3 ± 3.5 %, p = 0.002), three-chamber (3C; 17.5 ± 3.0 % vs. 19.2 ± 3.4 %, p = 0.001), and two-chamber (2C; 18.5 ± 3.5 % vs. 20.1 ± 2.4 %, p = 0.001) peak longitudinal strain values compared with the control group. Moreover, LV global strain values were found to be significantly lower in the DM group than in the control group (17.9 ± 2.7 % vs. 21.1 ± 3.2 %, p < 0.001). By contrast, basal rotation (4.9 ± 3.3° vs.2.8 ± 4.5°, p = 0.001), apical rotation (15.3 ± 6.7° vs. 12.1 ± 5.3°, p = 0.001) and LV twist (20.2 ± 7.2° vs. 16.9 ± 6.5°, p = 0.002) in the DM group were significantly increased compared with those of controls.

CONCLUSION

The STE procedure can be a useful novel technique in the determination of subclinical LV dysfunction in diabetic patients. Diabetic patients have lower longitudinal myocardial mechanics, and circumferential and rotational mechanics are impaired. There was no significant association between diabetic retinopathy and LV function.

Management and outcomes of coronary artery perforations during percutaneous treatment of acute coronary syndromes

BACKGROUND

Coronary artery perforation (CAP) is an infrequent and life-threatening complication of percutaneous coronary intervention (PCI), requiring prompt intervention. There is insufficient data about the prognosis and management of CAP in patients with acute coronary syndrome (ACS). The aim of this study was to investigate the management of CAP in patients with ACS.

METHODS

The results of 25 patients with CAP were retrospectively analyzed.

RESULTS

Of the 25 patients, 14 patients (56%) had ACS. According to the Ellis classification, the grade of perforation was type-I in 8 (32%) patients, type-II in 6 (24%) patients and type-III in 11 (44%) patients. Prolonged balloon inflation was performed to 20 (80%) cases of CAP. It successfully sealed the perforation in three cases of type-I, five cases of type-II CAP and in seven cases of type-III CAP. Seven patients underwent covered stent implantation. Emergent CABG was required in two patients with type-III CAP. In-hospital mortality was not observed in the patients.

CONCLUSION

The outcomes of CAP in patients with ACS were similar to patients with stable coronary disease. The continuation of anti-platelet agents after the successful management of CAP may be encouraged in these patients.

The relationship between the neutrophil-lymphocyte ratio and the coronary collateral circulation in patients with chronic total occlusion

OBJECTIVES

Previous studies showed the association between the major adverse cardiovascular outcomes and both higher neutrophil and lower lymphocyte counts. We aimed to investigate whether there is an association between the neutrophil-lymphocyte ratio (NLR) value and the development of coronary collateral circulation (CCC) in patients with coronary chronic total occlusion (CTO).

METHODS

A total of 274 patients with CTO were included in this study. Patients were then classified according to their Rentrop collateral grades as either poor (Rentrop grades 0-1) or good (Rentrop grades 2-3). Clinical information and analyses of blood samples were obtained from a review of the patients' charts.

RESULTS

Although there was no difference between the two groups with regard to cardiovascular risk profiles, the NLR values were significantly higher in the patients who had poorly developed CCC (2.6 ± 0.5 vs 2.2 ± 0.4, p<0.001). NLR, high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBC), age, diabetes, fasting glucose levels and body mass index were found to have univariate association with poorly developed CCC (p<0.1). In a multivariate logistic regression model, NLR (odds ratio 1.88, 95% confidence interval (CI) 1.37-2.74; p<0.001), high-sensitivity C-reactive protein and WBC were found to be the independent predictors of poor CCC. In receiver operator characteristic curve analysis, the optimal cut-off value of NLR to predict poor CCC was found as 2.17, with 77% sensitivity and 65% specificity.

CONCLUSION

NLR, as a novel cardiovascular risk marker, is an important, simple and inexpensive method which can be used by the cardiologist as a screening inflammation tool to estimate the development of CCC in patients with CTO.

Cilostazol decreases total atrial conduction time in patients with peripheral artery disease

Objective:

Total atrial conduction time (TACT) is the most important parameter in predicting the development of new-onset atrial fibrillation. We investigated the effect of cilostazol therapy on TACT in patients with peripheral artery disease.

Methods:

Thirty patients with peripheral artery disease were treated with cilostazol (200 mg/day) for 6 months. The baseline echocardiographic total atrial conduction time parameter was compared with the 6-month follow-up.

Results:

The TACT duration was decreased in all patients compared with the baseline after therapy (121.8 ± 19.3 vs. 109.1 ± 15.9 milliseconds, p<0.001). However, left atrial (LA) diameter was not changed with the therapy. The reduction of TACT duration was correlated with the increase in mitral E wave velocity/mitral A wave velocity ratio (r=-0.48, p<0.003).

Conclusion:

Our results showed that 200 mg cilostazol treatment decreased TACT duration in patients with peripheral artery disease, which may also prevent the development and/or recurrence of atrial fibrillation (AF).

A mysterious case of fatal embolism after the repair of tetralogy of Fallot: secondary to arrhythmia?

Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. The most important late complications observed after repair of TOF are atrio-ventricular arrhythmias and sudden cardiac death. We present a rare case of fatal embolism and sudden cardiac death in a 36-year-old patient, 30 years after the operation for TOF.

Primary giant leiomyoma of the ovary--case report

Primary leiomyoma of the ovary, which is of unknown origin, is an extremely rare tumor of ovary. We report a rare case of giant primary ovarian leiomyoma with an unusual presentation, ascites, elevated CA125 and discuss the preoperative imaging findings. A 45-year-old woman was referred for evaluation of an adnexal mass of 8 x 9 cm with ascites and elevated CA125 levels. Preoperative imaging studies were in accordance with fibroma/thecoma. At laparotomy total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Histological and immunhistochemical examination revealed primary ovarian leiomyoma.

The serum levels of soluble interleukin-2 receptor levels in patients with obstructive jaundice

BACKGROUND/AIMS

Increased susceptibility to infection in patients with obstructive jaundice is well recognized. Depression of reticuloendothlial system phagocytic function and suppression of cellular immunity suggested by in vivo studies have been postulated as the cause. It has been shown that increased serum soluble interleukin-2 receptor (sIL-2R) levels are the marker of immune system activation, especially T cell activation. The purpose of this study was to evaluate cellular immune system activation by measuring serum sIL-2R levels in 18 patients with obstructive jaundice (11 with choledocholithiasis, 7 with malignant obstructive jaundice), 10 patients with liver cirrhosis and 10 healthy subjects.

MATERIAL AND METHODS

Serum sIL-2R levels were measured by using ELISA (Boehringer Manheim). Lymphocyte subgroups were determined by flowcytometry. Serum immungolubulins (IgG, IgA, IgM) and autoantibodies such as antinuclear antibody, rheumatoid factor, anti-thyroglobulin and anti-microsomal antibody were measured.

RESULTS

The levels of serum sIL-2R were found to be 47.1-121.2 (mean 77.3, SD +/- 20.1) pmol/l in healthy subjects, 82.8-199.2 (mean 150.9 +/- 32.2) pmol/L in patients with liver cirrhosis and 32.6-172.5 (mean 121.7 +/- 40.6) pmol/L in patients with obstructive jaundice. Serum sIL-2R levels were significantly higher in patients with liver cirrhosis or obstructive jaundice than in healthy subjects (p < 0.01 and p < 0.05 respectively). There is a significant difference in levels between patients with choledocholithiasis and with malignant obstructive jaundice (p < 0.01). Serum sIL-2R levels were measured higher in patients with liver cirrhosis than those in patients with obstructive jaundice (p < 0.059).

CONCLUSIONS

In patients with obstructive jaundice, and to a lesser extent in those with liver cirrhosis, in vivo activation of immune system may be considered possible.

The role of high-dose intravenous methylprednisolone in the treatment of varicella associated thrombocytopenic purpura

Two children with varicella associated thrombocytopenia are presented. Case 1, evidencing no mucosal or parenchymal bleeding was administered prednisone 2 mg/kg/day therapy after having been put under observation for a period of one week without medical treatment. There was an increase in the platelet count during the period of therapy culminating in a return to normal on the eighth day. Case 2, who was in poor clinical condition at presentation, was treated with high-dose intravenous methylprednisolone (HIVMP) 30 mg/kg/day, resulting in the platelet count returning to a normal level (180,000/mm3) on the second day of therapy. HIVMP therapy is recommended in the treatment of life-threatening cases of thrombocytopenia because of its rapid action, limited side-effects, and its low cost.

Effects of cortisol and growth hormone on the metabolism of liver and bone in children with malnutrition

A protein-energy deficit produces stress in the organism affecting all systems. Proportional to the degree of disease, cortisol and GH are mostly responsible for some of these effects. To investigate the effects on liver and bone, cortisol, GH, AST, ALT, ALP activities and Ca(T) and P(i) in serum were measured in 21 marasmus, nine kwashiorkor and 34 control children. In the marasmus group, we found a positive correlation between cortisol and AST, ALT and Ca(T) and a negative correlation between cortisol and ALP. In the kwashiorkor group there were positive correlations between the same parameters, although, they were of a lesser degree. Furthermore, in the kwashiorkor group we established a positive correlation between GH and ALP. Cortisol stimulates transaminases directly and suppresses ALP activity, thus indirectly increasing Ca(T), whereas GH has no direct effect on these enzymes. As the disease progresses and as liver functions deteriorate, AST, ALT and ALP increase in serum.