Simultaneous Thrombosis of the Left Anterior Descending Artery and the Right Coronary Artery in a 34-Year-Old Crystal Methamphetamine Abuser

This case report underscores that crystal methamphetamine abuse is an important cause of multivessel coronary thrombosis and raises doubts about the therapeutic options. The patient was a 34-year-old smoker and crystal methamphetamine abuser with no significant medical history, who presented with retrosternal chest pain associated with cold sweats. Twelve-lead electrocardiogram revealed diffuse ST-segment elevation in I, II, AVL, AVF, and V 2-6 leads. He underwent urgent coronary angiography and it showed Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow in coronary arteries and presence of a thrombus in the left anterior descending artery (LAD) and the right coronary artery (RCA). The patient underwent medical therapy with antiplatelet agents and anticoagulants. Repeat coronary angiography after three months of dual therapy with warfarin and aspirin did not show any thrombus or any significant lesion in the RCA and the LAD having TIMI grade 3 flow.

Acute myocardial infarction in a 35-year-old man with coronary artery aneurysm most probably caused by Kawasaki disease

We present a 35-year-old man with history of Kawasaki disease who referred with myocardial infarction, and angiography, revealing aneurysm of left main and left anterior descending coronary arteries. The patient underwent percutaneous coronary intervention and thrombectomy and was discharged after 6 d. Coronary artery sequels of Kawasaki disease should be considered as one of the underlying causes of acute myocardial infarction in young adults.

Pentraxin 3 Is Highly Specific for Predicting Anatomical Complexity of Coronary Artery Stenosis as Determined by the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Score

BACKGROUND AND OBJECTIVES: The aim of this study was to examine the hypothesis that pentraxin 3 (PTX3) can have a diagnostic value for predicting anatomical complexity of coronary artery stenosis as measured by the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score. SUBJECTS AND METHODS: We investigated the association of systemic arterial PTX3 with SYNTAX score among 500 patients with ischemic heart disease assigned to medical treatment (251), percutaneous coronary intervention (PCI) (197), or coronary artery bypass graft (CABG) (52). RESULTS: The clinical judgment of the cardiologists was near-perfectly concordant with the SYNTAX score. Mean {99% confidence intervals (CIs)} SYNTAX scores were 5.8 (5.1-6.6), 18.4 (17.1-19.8), and 33.2 (32.8-33.6) in patients assigned to medical therapy, PCI, and CABG, respectively. The AROC (95% CIs) for discriminating between patients with and without a high SYNTAX score (>23) was 0.920 (0.895-0.946) for systemic arterial levels of PTX3. As the systemic arterial level of PTX3 increased, the SYNTAX scores also increased almost in a curvilinear fashion, with the value corresponding to the SYNTAX score of 23 being 0.29 ng . dL-1. This cutpoint achieved a sensitivity of 0.66 (0.57-0.74), a specificity of 0.94 (0.91-0.96), a positive predictive value of 0.79 (0.70-0.87), and a negative predictive value of 0.89 (0.85-0.92). CONCLUSION: We observed that systemic arterial levels of PTX3 were associated with the SYNTAX score in a curvilinear fashion. The discriminatory power of systemic arterial levels of PTX3 for a high SYNTAX score was excellent. The interesting finding of this study was the near perfect concordance between the decisions made by the cardiologists based on their clinical judgment and the SYNTAX score. The systemic arterial PTX3 level of 0.29 ng . dL-1 was highly specific for diagnosing complex coronary artery stenosis.

Bedside-Friendly Prediction for Presence of Post-Myocardial lnfarction Systolic Dysfunction Using Multimarker Panel: Integrating Salivary Diagnostics into Clinical Practice

BACKGROUND AND OBJECTIVES: We investigated if a combination of plasma or salivary interleukin-2 (IL-2), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), transforming growth factor-beta (TGF-beta), and troponin can improve estimation of the pretest probability of the left ventricular systolic dysfunction (LVSD). SUBJECTS AND METHODS: Eighty patients with newly-diagnosed myocardial infarction (MI) were echocardiographically examined for LVSD (ejection fraction < or =40%). Measurements included traditional MI risk factors, plasma and salivary concentrations of troponin, IL-2, IL-6, TNF-alpha, and TGF-beta. With the LVSD as the outcome variable, we developed logistic regression models, starting with a basic model incorporating traditional risk factors and consecutively adding salivary and plasma biomarkers. Models were compared using several criteria, including (but not limited to) C statistic (discrimination) and net reclassification improvement index (NRI). RESULTS: Apart from troponin, plasma, and salivary values of the biomarkers were correlated: spearman's rho was 0.19 (p=0.088) for troponin, 0.36 (p=0.001) for IL-2, 0.74 (p<0.001) for IL-6, 0.61 (p<0.001) for TNF-alpha, and 0.65 (p<0.001) for TGF-beta. The predictive performances of the basic model for estimating the pretest probability of the presence of LVSD considerably improved when cytokines were added (salivary added: C-statistic from 0.77 to 0.82 and NRI 77%; plasma added: C-statistic to 0.80 and NRI 134%). CONCLUSION: Multiple biomarkers added diagnostic value to the standard risk factors for predicting the presence of post-MI LVSD.

relationship between salivary beta-2 microglobulin and uremia intensity in men with chronic renal failure

This study defines the relationship between salivary beta-2 microglobulin [beta 2-M] and intensity of uremia in male patients diagnosed with chronic renal failure [CRF]. In total of 42 males were enrolled in a case-control study. There were 21 cases of CRF and 21 control cases. We collected 10cc of saliva plus 5 cc of blood from all patients to determine beta 2-M, blood urea nitrogen [BUN] and creatinine [Cr] levels. There was a correlation between the level of serum BUN and salivary urea in controls and patients, which was statistically significant for controls [p=0.028].The correlation between serum and salivary Cr was 0.195 in controls [p=0.398] and 0.598 in patients [p=0.006], which was statistically significant in patients. The correlation between serum and saliva was 0.133 [p=0.566] in controls and 0.078 [p=0.737] in patients, which was not statistically significant. The correlation between serum BUN and beta 2-M was 0.168 [p=0.469] in the control group and 0.629 [p=0.002] in patients, which was statistically significant in patients. The correlation between serum Cr and beta 2-M was 0.110 [p=0.635] in the control group and 0.678 [p=0.001] in patients, which was statistically significant in patients. The correlation between serum BUN and salivary beta 2-M was 0.093 [p=0.0690] in controls and 0.152 [p=0.152] in patients, which was not statistically significant. The correlation between serum Cr and salivary beta 2-M was 0.072 [p=0.070] in the control group and 0.286 [p=0.209] in patients, which was not statistically significant in either group. The results of the study indicated that salivary beta 2-M cannot be used as a non-invasive indicator to detect the severity of renal failure

Long acting propranolol and HSP-70 rich tumor lysate reduce tumor growth and enhance immune response against fibrosarcoma in Balb/c mice

Noradrenaline [NA], the principal neurotransmitter released from sympathetic nerve terminals, influences T-cell maturation, not only directly in developing T cells, but also indirectly, by acting on the thymic nonlymphoid cells. In vitro and in vivo studies have demonstrated the anti-proliferative, anti-migratory, antiangiogenic and cytotoxic properties of propranolol, beta-AR blocker, against various cancers. To evaluate the effect of propranolol on efficacy of HSP-70 rich lysate vaccine in immunotherapy of fibrosarcoma. Mouse fibrosarcoma WEHI-164 cells were used to immunize tumor-bearing mice with or without propranolol and HSP-70. Splenocytes proliferation, cytotoxic activity of the splenocytes, naturally occurring CD4+ CD25[high] T-reg cells and IFN-gamma and IL-4 secretion as well as tumor size, were assessed to describe the anti-tumor immune response. A significant increase in the level of IFN- gamma in the mice vaccinated with WEHI-164 cells enriched with HSP-70 and co-treated with propranolol was observed compared to controls. However, HSP enrichment or propranolol treatment alone did not enhance the immune response as measured by the level of IFN-gamma. Likewise, a decrease in tumor growth in the test group [p<0.01] and a significant increase in CTL activity [p<0.05] was observed. HSP enriched vaccine shows anti-tumor activity, probably due to the modulation of immune responses

Six-year follow up of imatinib therapy for newly diagnosed chronic myeloid leukemia in Iranian patients

The present study reported a six-year follow up of patients with chronic myeloid leukemia who were on imatinib therapy. We performed a retrospective study on a total of 417 patients diagnosed with chronic-phase, Philadelphia-positive [Ph+] chronic myeloid leukemia within six months before study entry. Patients were eligible for the study if they were between 18 and 70 years of age. Enrolled patients were treated at an initial dose of 400 mg of imatinib. The mean age of 417 patients was 40.9 +/- 14.5 years; 220 [52%] were men and 197 [47.2%] were women. Complete hematologic response at three months occurred in 99% of patients, 221 [53%] before four weeks and 196 [47%] after four weeks. Adverse events occurred in 17 [4.1%] of patients, relapse in 46 [11%] and death in 31 [7.4%] of our studied population. At 72 months, the estimated rate of overall survival rate was 89%.Our findings showed the efficacy and safety of imatinib mesylate among Iranian patients with chronic myeloid leukemia by hematological and molecular response