A Relação entre o Índice de Imuno-Inflamação Sistêmica e Isquemia com Artérias Coronárias Não Obstrutivas em Pacientes Submetidos à Angiografia Coronária / The Relationship between the Systemic Immune-Inflammation Index and Ischemia with Non-Obstructive Coronary Arteries in Patients Undergoing Coronary Angiography

Resumo Fundamento: A isquemia com artéria coronária não obstrutiva (INOCA) é uma doença cardíaca isquêmica que inclui principalmente disfunção microvascular coronariana e/ou vasoespasmo coronariano epicárdico devido à disfunção vascular coronariana subjacente e pode ser observada mais comumente em pacientes do sexo feminino. O índice de inflamação imunológica sistêmica (SII, relação plaquetas × neutrófilos/linfócitos) é um novo marcador que prediz resultados clínicos adversos na doença arterial coronariana (DAC). Objetivo: Este estudo tem como objetivo investigar a relação entre INOCA e SII, um novo marcador associado à inflamação. Métodos: Um total de 424 pacientes (212 pacientes com INOCA e 212 controles normais) foram incluídos no estudo. Amostras de sangue venoso periférico foram recebidas de toda a população do estudo antes da angiografia coronária para medir o SII e outros parâmetros hematológicos. Em nosso estudo o valor de p<0,05' foi considerado estatisticamente significativo. Resultados: O valor de corte ideal do SII para prever o INOCA foi 153,8, com sensibilidade de 44,8% e especificidade de 78,77% (Área sob a curva [AUC]: 0,651 [IC 95%: 0,603-0,696, p=0,0265]). Suas curvas ROC foram comparadas para avaliar se o SII tinha um efeito preditivo adicional valor sobre os componentes. O valor da AUC do SII foi significativamente maior do que o do linfócito (AUC: 0,607 [IC 95%: 0,559-0,654, p = 0,0273]), neutrófilos (AUC: 0,559 [IC 95%: 0,511-0,607, p = 0,028]) e plaquetas (AUC: 0,590 [IC 95%: 0,541-0,637, p = 0,0276]) em pacientes INOCA. Conclusões: Verificou-se que um nível elevado de SII estava independentemente associado à existência de INOCA. O valor do SII pode ser usado como um indicador para adicionar aos métodos tradicionais e caros comumente usados na previsão do INOCA.

Abstract Background: Ischemia with the non-obstructive coronary artery (INOCA) is an ischemic heart disease that mostly includes coronary microvascular dysfunction and/or epicardial coronary vasospasm due to underlying coronary vascular dysfunction and can be seen more commonly in female patients. The systemic immune-inflammation index (SII, platelet × neutrophil/lymphocyte ratio) is a new marker that predicts adverse clinical outcomes in coronary artery disease (CAD). Objective: This study aims to investigate the relationship between INOCA and SII, a new marker associated with inflammation. Methods: A total of 424 patients (212 patients with INOCA and 212 normal controls) were included in the study. Peripheral venous blood samples were received from the entire study population prior to coronary angiography to measure SII and other hematological parameters. In our study, the value of p<0.05' was considered statistically significant. Results: The optimal cut-off value of SII for predicting INOCA was 153.8 with a sensitivity of 44.8% and a specificity of 78.77% (Area under the curve [AUC]: 0.651 [95% CI: 0.603-0.696, p=0.0265]). Their ROC curves were compared to assess whether SII had an additional predictive value over components. The AUC value of SII was found to be significantly higher than that of lymphocyte (AUC: 0.607 [95% CI: 0.559-0.654, p = 0.0273]), neutrophil (AUC: 0.559 [95%CI: 0.511-0.607, p=0.028]) and platelet (AUC: 0.590 [95% CI: 0.541-0.637, p = 0.0276]) in INOCA patients. Conclusions: A high SII level was found to be independently associated with the existence of INOCA. The SII value can be used as an indicator to add to the traditional expensive methods commonly used in INOCA prediction.

Albumin-Bilirubin Score: A Novel Mortality Predictor in Valvular Surgery

ABSTRACT Introduction: The heart and liver are two organs that are closely related. The Albumin-Bilirubin (ALBI) score is a developed scoring system for assessing liver function. The aims of this study were to examine the correlation between preoperative ALBI score and pulmonary artery pressure and to investigate its ability to predict heart valve surgery mortality outcomes. Methods: The data of 872 patients who underwent isolated and combined heart valve surgery from 2014 to 2021 were retrospectively screened. In the preoperative period, 152 patients with laboratory tests including albumin and total bilirubin were found and analyzed retrospectively. Thirteen of these patients were excluded from the study. The remaining 139 patients were included in the analysis. Baseline demographic data, echocardiography data, performance status, laboratory data, operative data, and postoperative status were collected. The optimal cutoff value of preoperative ALBI score was calculated. Results: The cutoff for ALBI scores was calculated as -2.44 to predict in-hospital mortality (sensitivity = 75.0%, specificity = 70%). Based on the cutoff value, 90 patients had a low ALBI score (≤ -2.44, 64.7%) and 49 patients had a high ALBI score (> -2.44, 35.3%). High ALBI score was associated with an increased incidence of acute kidney injury and in-hospital mortality, and a positive correlation was found between ALBI score and pulmonary artery pressure. Conclusion: In patients with valvular surgery, high ALBI score was an independent prognostic factor of in-hospital mortality and acute kidney injury. It is easily measurable and a cost-effective way to predict mortality.

Central vs. Peripheral Cannulation During Reoperations: A Propensity Score Matching Analysis

ABSTRACT Introduction: The aim of this study is to compare the postoperative outcomes and early mortality of peripheral and central cannulation techniques in cardiac reoperations using propensity score matching analysis. Methods: In this retrospective cohort, patients who underwent cardiac reoperations with median resternotomy were analyzed in terms of propensity score matching. Between November 2010 and September 2020, 257 patients underwent cardiac reoperations via central (Group 1) or peripheral (Group 2) cannulation. A 1:1 propensity score matching was performed to balance the influence of potential confounding factors to compare postoperative data and mortality rate. Results: There were no significant differences when comparing the matched groups regarding early mortality (P=0.51), major cardiac injury (P=0.99), prolonged ventilation (P=0.16), and postoperative stroke (P=0.99). The development of acute renal failure (P=0.02) was statistically less frequent in Group 1. Conclusions: Performing cardiopulmonary bypass via peripheral cannulation increases acute renal failure in cardiac reoperations. In contrast, peripheral or central cannulation have similar early mortality rate in cardiac reoperations.

Fate of the Patent False Lumen of the Descending Aorta After Surgical Treatment for Acute Type 1 Aortic Dissection

ABSTRACT Introduction: This study aimed to investigate the factors affecting false lumen patency in the descending thoracic aorta among patients who underwent surgery for acute type 1 aortic dissection. Methods: A total of 112 patients with acute type 1 aortic dissection, with the flap below the diaphragm level, underwent surgery between January 2010 and September 2019. Of these, 60 patients who were followed up for ≥ 12 months and whose computed tomography scans were available were included in this study. The patients were divided into two groups: group I, consists of patent false lumen (n=36), and group II, consists of thrombosed false lumen (n=24). Demographic data, operative techniques, postoperative descending aortic diameters, reintervention, and late mortality were compared between the two groups. Results: The mean follow-up period of all patients was 37.6±26.1 months (range: 12-104). The diameter increase in the proximal and distal descending aorta was significantly higher in the patent false lumen group (5.3±3.7 mm vs. 3.25±2.34 mm; P=0.015; 3.1±2.52 mm vs. 1.9±1.55 mm; P=0.038, respectively). No significant difference in terms of hypertension was found between the two groups during the follow-up period (21 patients, 58.3% vs. 8 patients, 33.3%; P=0.058). A total of 29 patients (48.3%) were found to be hypertensive in the postoperative period. Conclusion: After surgical treatment for acute type 1 aortic dissection, patients should be monitored closely, regardless of whether the false lumen is patent or thrombosed. Mortality and reintervention can be seen in patients with patent false lumen during follow-up.

Early Mortality Predictors in İnfective Endocarditis Patients: A Single-Center Surgical Experience

ABSTRACT Introduction: Infective endocarditis is a disease that progresses with morbidity and mortality, afecting 3-10 out of 100,000 people per year. We conducted this study to review the early outcomes of surgical treatment of infective endocarditis. Methods: In this retrospective study, 122 patients who underwent cardiac surgery for infective endocarditis in our clinic between November 2009 and December 2020 were evaluated. Patients were divided into two groups according to in-hospital mortality. Demographic, echocardiographic, laboratory, operative, and postoperative data of the groups were compared. Results: Between November 3, 2009, and December 7, 2020, 122 patients were operated for infective endocarditis in our hospital. Emergency surgery was performed in nine (7.3%) patients. In-hospital mortality occurred in 23 (18.9%) patients, and 99 (81.1%) patients were discharged. In-hospital mortality was related with older age, presence of periannular abscess, New York Heart Association class 3 or 4 symptoms, low albumin level, high alanine aminotransferase level, and longer cross-clamping time (P<0.05 for all). Conclusion: The presence of paravalvular abscess was the most important prognostic factor in patients operated for infective endocarditis.

Clinical, virological, imaging and pathological findings in a SARS CoV-2antibody positive cat

This paper reports a presumptive severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) infection in a cat. A cat with respiratory disease living with three individuals with coronavirus disease 2019 showed bilateral ground-glass opacities in the lung on X-ray and computed tomography. The clinical swabs were negative for SARS-CoV-2 RNA, but the serum was positive for SARS-CoV-2 antibodies. Interstitial pneumonia and prominent type 2 pneumocyte hyperplasia were noted on histopathology. Respiratory tissues were negative for SARS-CoV-2 RNA or antigen, but the cat was positive for feline parvovirus DNA. In conclusion, the respiratory disease and associated pathology in this cat could have been due to exposure to SARS-CoV-2.

Thyroid Papillary Carcinoma in Paediatric and Adolescent Patients: Evaluation of Surgical Treatment in a Single Centre

ABSTRACT Aim: Thyroid cancers are the most commonly determined cancers in the paediatric age group. Although the rates of lymph node and distant metastases are greater at the time of diagnosis in comparison with adult thyroid cancers, with the appropriate treatment protocols, the prognosis is excellent. In this paper, we present the clinical characteristics of thyroid papillary carcinoma determined in children and adolescents in our clinic, the surgical techniques applied and the clinical results evaluated in consideration of the relevant literature. Methods: A retrospective evaluation of 12 patient records in the paediatric and adolescent age group from a total of 250 who underwent surgery for a diagnosis of thyroid papillary carcinoma at Ankara Oncology Training and Research Hospital between 2000 and 2007. Results: The prevalence of thyroid and papillary carcinoma in childhood and adolescence was determined as 4.8%. The patients were all female with a mean age of 17.9 years (range, 11-21 years). At the time of diagnosis, lymph node metastases were identified in seven cases (58.3%) and lung metastases in four cases (33.3%). Total thyroidectomy was performed on all patients and for those with lymph node metastasis; a modified radical neck dissection was also applied. Post-operatively, all patients were administered radioactive iodine therapy followed by levothyroxine therapy. During the mean follow-up period of 123 months, apart from persistent tumour in some patients, no recurrence was noted in other patients. Conclusion: As thyroid papillary carcinoma in childhood and adolescence is characterized by lymph node and distant metastases, even if the tumour is limited to the thyroid, because of frequent recurrence after treatment, total thyroidectomy and, where necessary, modified neck dissection are recommended for all patients rather than more conservative treatment protocols.

The effects of mobile phone exposure on mast cells in rat dura mater / Efectos de la exposición del teléfono móvil en los mastocitos de la duramadre de ratas

Mobile phone use has increased rapidly. The central nervous system has been shown to be adversely affected by its electromagnetic field (EMF) resulting in headache and sleep disturbances. How the cells make up the CNS and are affected by EMF is unclear. However, because of their central role in inflammation through diverse stimuli including radiation, this study aimed to investigate the effects of electromagnetic fields induced by mobile phones on mast cells in rat dura mater. A total of 18 adult, female, SpragueDawley rats were divided into two groups. The choice of female rats for his study was based on recent surveys demonstrating that mobile phone use is more frequent and prolonged among females. The study group was exposed to 900 MHz electromagnetic field (1 h/day for 45 days). In the end of the study, duramater tissue was extracted and stained using Toluidine blue. Mast cells were counted and results were analysed using Student t test. Mean mast cell number was 202.33±9.82 and 456.78±35.01 in the control and study groups, respectively (p<0.05). Analysis of serum electrolyte and immunoglobulin E levels showed no statistically significant difference between the two groups (p>0.05). The study showed that mobile phone exposure increased mast cell number and degranulation in rat dura mater. Further studies are required to evaluate the clinical implications of these findings.

El uso del teléfono móvil ha aumentado rápidamente. Se ha demostrado que el sistema nervioso central (SNC) se ve afectado de manera adversa debido al campo electromagnético (CEM) que produce dolor de cabeza y trastornos del sueño. No está claro cómo se ve afectada la composición celular del SNC por el CEM. Sin embargo, debido a su función principal en la inflamación a través de diversos estímulos que incluyen la radiación, este estudio tuvo como objetivo investigar los efectos de los campos electromagnéticos inducidos por los teléfonos móviles en los mastocitos de la duramadre de ratas. Un total de 18 ratas Sprague-Dawley adultas, hembras, se dividieron en dos grupos. Se usaron ratas hembras para este estudio en base a investigaciones recientes que han demostrado que el uso de teléfonos móviles es más frecuente y prolongado en las mujeres. Los grupos de estudio fueron expuestos a un campo electromagnético de 900 MHz (1 h / día durante 45 días). Al término del estudio, fue extirpado el tejido de la duramadre y teñido con azul de toluidina. Se contaron los mastocitos y se analizaron los resultados utilizando la prueba t de Student. La cantidad media de células cebadas fue de 202,33 ± 9.82 y 456,78 ± 35,01 en los grupos control y estudio, respectivamente (p <0,05). El análisis del electrolito sérico y los niveles de inmunoglobulina E no mostraron diferencias estadísticamente significativas entre los dos grupos (p> 0,05). El estudio mostró que la exposición a teléfonos móviles aumentó el número de mastocitos y la desgranulación en la duramadre de las ratas. Se requieren estudios adicionales para evaluar las implicaciones clínicas de estos hallazgos.

Validity and Reliability of Cognitive Attentional Syndrome-1 Questionnaire

OBJECTIVE: This study aimed to evaluate the reliability and validity of the Turkish version of Cognitive Attentional Syndrome-1 (CAS-1) questionnaire. METHODS: 221 participants were included in the study who do not meet any psychiatric diagnosis. Participants were applied SCID I and II and filled CAS-1 scale, Meta-Cognitions Questionnaire-30 (MCQ-30), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Generalized Anxiety Disorder-7 (GAD-7) Scale, and Penn State Worry Questionnaire (PSWQ). Testing the reliability Cronbach’s alpha, item analysis and Item and total score correlation coefficients were applied. For testing structural validity, Confirmatory Factor Analysis was used, and for testing the content validity, the relationship between each item of CAS-1 and MCQ-30, BDI, BAI, GAD-7, PSWQ was examined. RESULTS: The correlation reliability coefficients were statistically significant except for using alcohol/drugs as a coping mechanism. Cronbach Alpha reliability coefficient of 16 items was 0.771 whereas, this ratio was 0.772 for the first eight items (CAS) and 0.685 for the last eight items (Metacognitive Beliefs) which showed that the internal consistency of CAS-1 was high. Structural and Content Validity of the scale was significant. CONCLUSION: The Turkish version of the CAS-1 was a reliable and valid measure to evaluate CAS in a Turkish population.

Squamous Cell CarcInoma of Gallbladder: A Case Report.

Although gallbladder cancers are rarely seen, the mortality rates are high. Pure squamous cell cancer, which is one of the most rarely seen cancer types in the gallbladder, originates from the squamous metaplasia which forms following chronic irritation in the mucosa. The majority of cases are generally at the inoperable stage when diagnosed as they have been followed up for long-term cholelithiasis. The case is here presented of a 59-year old female who underwent surgical and medical treatment for a bladder tumour 10 years previously and although gallbladder stones were determined at that time, as she was asymptomatic, surgery was not recommended, then with the progression of time, gallbladder squamous cell carcinoma developed.

Paraganglioma of Carotid Body: A Case Report.

Paraganglioma occur from the paraganglionic stems of the autonomic nervous system. They develop from the carotid body and are known as carotid body tumours. These are sporadic, rare vascular lesions showing genetic transfer. Although they are generally benign and have a slow course, because of invasion to adjacent neurovascular tissues or pressure, early diagnosis and treatment is of importance. Diagnosis is made from a detailed history and physical examination and is confirmed with angiography. The treatment method selected in the majority of cases is surgery. In this paper, the case is presented of a 73-year old female who underwent surgery in our clinic for a diagnosis of carotid body paraganglioma.

Recurrent Eccrine Porocarcinoma: A Case Report.

Eccrine porocarcinoma is a very rarely seen malignant skin tumour which originates from the intra-epithelial section of the eccrine sweat glands. They are generally seen in the elderly and are most often located in the lower extremities. This tumour which has a poor prognosis and displays different biological behaviour, often has a tendency to recurrence and metastasis is seen in the skin and lymph nodes. The basis of treatment is surgical excision and if there is lymph node involvement, regional lymph node dissection must be applied. The case is here presented of a 67-year old patient with eccrine porocarcinoma which developed in the inguinal region and showed recurrence.

Apelin Levels In Isolated Coronary Artery Ectasia

BACKGROUND AND OBJECTIVES: The etiopathogenesis of coronary artery ectasia (CAE) is not known completely. In most of the cases, CAE is associated with atherosclerosis; however, isolated CAE has a nonatherosclerotic mechanism. The association between atherosclerotic coronary artery disease and apelin has been examined in previous studies. However, the role of plasma apelin in isolated coronary artery ectasia has not been studied. In this study, we investigated the relationship between plasma apelin levels and isolated coronary artery ectasia. SUBJECTS AND METHODS: The study population included a total of 54 patients. Twenty-six patients had isolated CAE (53.6+/-8.1 years); 28 patients with normal coronary arteries (51.6+/-8.8 years) and with similar risk factors and demographic characteristics served as the control group. Apelin levels were measured using an enzyme-linked immunoassay kit. RESULTS: Apelin level in the CAE group was significantly lower (apelin=0.181+/-0.159 ng/mL) than that in the control group (apelin=0.646+/-0.578 ng/mL) (p=0.033). Glucose, creatinine, total cholesterol, triglyceride, low density lipoprotein cholesterol, and high density lipoprotein cholesterol levels were not significantly different between the two groups. CONCLUSION: In this study, we showed that patients with isolated CAE have decreased plasma apelin levels compared with the control group. Based on the data, a relationship between plasma apelin and isolated CAE was determined.

A Rare Coronary Anomaly: Atypical Double Right Coronary Artery With an Acute Inferior Myocardial Infarction

Coronary artery anomalies are uncommon and often asymptomatic. A double right coronary artery (RCA) is an extremely rare coronary artery anomaly, and only a few cases of double RCA have been reported. We report on an atherosclerotic double RCA that appeared after primary percutaneous intervention in a patient with an acute inferior myocardial infarction. This is the second case in the literature in which coronary arteries can be accepted as a double RCA, which were hidden by a total atherosclerotic occlusion in the proximal part of the RCA.

Unreported Coronary Artery Anomaly: Association of Right Coronary Artery and Circumflex Coronary Artery with Single Ostium Originate from High Left Anterior Aorta

No abstract available.

Infant with a Sudden, Large, Post-Extubation Subglottic Cyst

Acquired subglottic cyst in infancy is almost always associated with episodes of early life intubation. Most cases typically presented late, usually days to months after extubation. We report a case of a subglottic cyst with different presentation than the norm. This case highlights that subglottic cyst can present acutely, and rapidly enlarging soon after the airway extubation. As the management of a large subglottic cyst can be challenging, a close observation for early diagnosis and intervention are recommended post extubation in the high-risk cases, such as in the premature infant.