Pyruvate kinase deficiency in 29 Turkish patients with two novel intronic variants.

Pyruvate kinase (PK) is a key enzyme of anaerobic glycolysis. The genetic heterogeneity of PK deficiency (PKD) is high, and over 400 unique variants have been identified. Twenty-nine patients who had been diagnosed as PKD genetically in seven distinct paediatric haematology departments were evaluated. Fifteen of 23 patients (65.2%) had low PK levels. The PK:hexokinase ratio had 100% sensitivity for PKD diagnosis, superior to PK enzyme assay. Two novel intronic variants (c.695-1G>A and c.694+43C>T) have been described. PKD should be suspected in patients with chronic non-spherocytic haemolytic anaemia, even if enzyme levels are falsely normal. Total PKLR gene sequencing is necessary for the characterization of patients with PKD and for genetic counselling.

Antioxidant Capacity, Sugar Content, and Tandem HPLC-DAD-ESI/MS Profiling of Phenolic Compounds from Aronia melanocarpa Fruits and Leaves (Nero and Viking Cultivars).

This study examined the phenolic profile, sugar composition, and antioxidant capacities of chokeberry fruits and leaves obtained from four different Turkiye provinces. A total of 21 phenolics including phenolic acid and its derivatives, flavanols, anthocyanins, and flavonols were determined in the fruits, while the leaves had 19 phenolics, including phenolic acid and its derivatives, flavanols, and flavonols. The total amount of phenolic compounds was the highest in both fruits and leaves in the samples from the Bursa province. Cis 5-O-p-coumaroylquinic acid and secoxyloganin were quantified for the first time in both fruits and leaves. In summary, it was found that different geographical locations significantly affected the phenolics, sugar contents, and antioxidant activities of the fruits and leaves.

Correction: Kelebek et al. Exploring the Impact of Infusion Parameters and In Vitro Digestion on the Phenolic Profile and Antioxidant Capacity of Guayusa (Ilex guayusa Loes.) Tea Using Liquid Chromatography, Diode Array Detection, and Electrospray Ionization Tandem Mass Spectrometry. Foods 2024, 13, 694.

In the original publication [...].

COVID-19 disease in children and adolescents following allogeneic hematopoietic stem cell transplantation: A report from the Turkish pediatric bone marrow transplantation study group.

BACKGROUND: Data on the risk factors and outcomes for pediatric patients with SARS-CoV-2 infection (COVID-19) following hematopoietic stem cell transplantation (HSCT) are limited. OBJECTIVES: The study aimed to analyze the clinical signs, risk factors, and outcomes for ICU admission and mortality in a large pediatric cohort who underwent allogeneic HSCT prior to COVID-19 infection. METHOD: In this nationwide study, we retrospectively reviewed the data of 184 pediatric HSCT recipients who had COVID-19 between March 2020 and August 2022. RESULTS: The median time from HSCT to COVID-19 infection was 209.0 days (IQR, 111.7-340.8; range, 0-3845 days). The most common clinical manifestation was fever (58.7%). While most patients (78.8%) had asymptomatic/mild disease, the disease severity was moderate in 9.2% and severe and critical in 4.4% and 7.6%, respectively. The overall mortality was 10.9% (n: 20). Deaths were attributable to COVID-19 in nine (4.9%) patients. Multivariate analysis revealed that lower respiratory tract disease (LRTD) (OR, 23.20, p: .001) and lymphopenia at diagnosis (OR, 5.21, p: .006) were risk factors for ICU admission and that HSCT from a mismatched donor (OR, 54.04, p: .028), multisystem inflammatory syndrome in children (MIS-C) (OR, 31.07, p: .003), and LRTD (OR, 10.11, p: .035) were associated with a higher risk for COVID-19-related mortality. CONCLUSION: While COVID-19 is mostly asymptomatic or mild in pediatric transplant recipients, it can cause ICU admission in those with LRTD or lymphopenia at diagnosis and may be more fatal in those who are transplanted from a mismatched donor and those who develop MIS-C or LRTD.

Exploring the Impact of Infusion Parameters and In Vitro Digestion on the Phenolic Profile and Antioxidant Capacity of Guayusa (Ilex guayusa Loes.) Tea Using Liquid Chromatography, Diode Array Detection, and Electrospray Ionization Tandem Mass Spectrometry.

Guayusa tea is derived from the leaves of the Ilex guayusa Loes. plant, which is native to the Amazon rainforest. Beyond its pleasant sensory properties, Guayusa tea is rich in antioxidants, phenolics, and minerals. In this study, the effects of infusion time, temperature, and solvent conditions on the color, antioxidant capacity, total phenolic content, phenolic profile, and antimicrobial activity of Guayusa (Ilex guayusa Loes.) tea were investigated. Guayusa tea samples were prepared using two different solvents, ethanol and water, with 4, 6, and 8-h infusions at 60 and 70 °C. Liquid chromatography, diode array detection, and electrospray ionization tandem mass spectrometry (LC-DAD-ESI-MS/MS) were used to determine a comprehensive profile of phenolic compounds and to detect differences due to infusion conditions. Moreover, after the Guayusa tea infusion with the highest bioactive properties was determined, the effects of in vitro gastrointestinal digestion on the total phenolic content, antioxidant capacity, and phenolic compounds of the Guayusa tea infusion were measured. Phenolic profile analysis identified 29 compounds, among which chlorogenic acid and its derivatives were predominant. The increase in infusion time was correlated with an elevation in total phenolic content. Significant differences were observed between water and ethanol infusions of Guayusa in terms of phenolics and antioxidants. The total amount of phenolic compounds in the samples prepared with both solvents was found to increase after oral intake, depending on the digestion stage; meanwhile, the amounts of flavonoid compounds and di-O-caffeoylquinic acid derivatives decreased during digestion.

Busulfan-Based and Treosulfan-Based Myeloablative Conditioning for Allogeneic Transplantation in Children with Thalassemia Major: a Single-Center Experience From Southern Turkey.

OBJECTIVES: Allogeneic hematopoietic stem cell transplant is the only curative treatment for patients with transfusion-dependent thalassemia major. In recent years, a number of novel approaches have improved patient outcomes and quality of life by minimizing the toxicity of conditioning regimens. The objective of this study was to compare the role of treosulfan- and busulfan-based conditioning in transfusion-dependent thalassemia. MATERIALS AND METHODS: Data were collected retrospectively on 121 children with beta thalassemia major who underwent hematopoietic stem cell transplant using treosulfan-based (n = 37) or busulfan-based (n = 84) conditioning regimens between 2012 and 2022. RESULTS: Two-year overall survival was 87.5% in the busulfan-based conditioning group and 91.1% in the treosulfan-based conditioning group.The group given the busulfan regimen compared with treosulfan regimen had significantly increased number of side effects (58.3% vs 21.6%, respectively; P < .001). When the busulfan-based regimen by level was evaluated, we observed no significant differences between the frequency of side effects according to drug serum levels. In addition, no significant differences were shown between the 2 regimen groups for cumulative incidence of acute and chronic graft-versus-host disease. CONCLUSIONS: The safety and effectiveness of a treosulfan-based myeloablative conditioning regimen has been confirmed by ourretrospective investigation of pediatric patients with beta thalassemia.

Optimization of complex coacervation parameters for the production of encapsulated black garlic using response surface methodology.

The purpose of this study was to optimize black garlic encapsulation parameters (core/coating ratio, extract concentration, and coacervate/maltodextrin [MD] ratio) using central composite design of the response surface methodology based on encapsulation efficiency (EE) (%). The optimum parameters were determined as 4.0 for the coating material/core ratio, 50% for the extract concentration, and 6.0 for the MD/coacervate ratio depending on the EE (%). The antioxidant activity values were determined as 101 and 134 µmol Trolox/100 g dry weight (DW) for the 2,2-diphenyl-1-picrylhydrazyl and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) methods, respectively, whereas the total phenolic content was 49 mg gallic acid equivalent/100 g DW for the encapsulated black garlic samples. S-Allyl-l-cysteine (SAC), γ-l-glutamyl-SAC (GSAC), γ-l-glutamyl-(S)-trans-1-propenyl-l-cysteine, and allicin were the organosulfur (OS) compounds determined in the samples. The SAC concentration of the encapsulated black garlic samples was determined as 22.36 mg/g, whereas the GSAC content was found at a lower concentration (0.33 mg/g) compared to SAC. The allicin content was quantified to be 0.31 mg/g. The encapsulated samples were also characterized by scanning electron microscopy (SEM) and Fourier transform infrared (FT-IR) spectroscopy. The FT-IR analysis revealed specific functional groups, including hydroxyl, carbonyl, and glycosidic linkage. The interaction between lentil protein isolate and pectin was strong enough to encourage capsule formation as visualized in the SEM images. This study shows the potential of black garlic coacervates as a functional ingredient for the food industry due to their stability, solubility, and preservation of OS and antioxidant compounds.

Effects of a supervised therapeutic exercise program on musculoskeletal health and gait in patients with haemophilia: A pilot study.

INTRODUCTION: Episodes of bleeding in patients with haemophilia (PwH) are associated with haemophilic arthropathy, limitations in physical performance, reduced quality of life (QoL), and gait disorders. AIM: This non-randomized, controlled, interventional, prospective, single-centre pilot study aimed to assess the effects of an 8-week supervised therapeutic exercise program on musculoskeletal health, gait kinematic parameters (GKP), functional capacity, and QoL in adult PwH. METHODS: Nineteen PwH were allocated to an exercise group (n = 10) or a control group (n = 9). The patients in the exercise group followed an 8-week supervised therapeutic exercise program. The Haemophilia Joint Health Score (HJHS), a two-dimensional video-based gait kinematic analysis (2D-GKA), the 6-min walking test (6MWT), and the Haemophilia Quality of Life Questionnaire for Adults (Haem-A-Qol) were used as the outcome measures at baseline, after the exercise program (at the 8th week), and at the 6th-month follow-up. RESULTS: A significant improvement was observed in the exercise group in the HJHS-Total and Haem-A-Qol Total scores and the 6MWT value after the exercise program. Moreover, the 2D-GKA revealed improvement in most of the GKP (knee extension during the midstance and late swing phases, ankle dorsiflexion during the midstance phase, and ankle plantar flexion during the preswing phase). However, the gain obtained by the exercise program was not maintained at the 6th-month follow-up for the HJHS-Total and Hem-A-QoL-Total scores and GKP. CONCLUSION: The 8-week supervised therapeutic exercise program was successful in achieving improvement in joint health, GKP, functional capacity, and QoL in PwH.

The effects of manual therapy and exercises on pain, muscle strength, joint health, functionality and quality of life in haemophilic arthropathy of the elbow joint: A randomized controlled pilot study.

INTRODUCTION: Effective physiotherapy interventions are required for haemophilic arthropathy (HA) of the elbow due to its biomechanical differences and contribution to upper limb functionality. AIM: To investigate the effects of manual therapy & exercises on bleeding frequency, pain, range of motion (ROM), strength, joint health, functionality and quality of life (QoL) in HA of the elbow. METHODS: Seventeen participants with HA of the elbow were randomized as Manual Therapy & Exercises Group (MTEG = 9) and Home Exercises Group (HEG = 8). Soft tissue mobilization, joint traction (grade I-II) and Mulligan's mobilization with movement as manual therapy, and stretching/strengthening exercises were applied to MTEG, while HEG had only same exercises as home programme. The interventions lasted 3 days/weekly for 5 weeks. Bleeding frequency was evaluated with patients' records; pain with Numeric Pain Scale; ROM with goniometer; strength with digital dynamometer; joint health with HJHS; functionality with Quick-Disability of Arm, Shoulder and Hand questionnaire; and QoL with Oxford Elbow Score. RESULTS: Bleeding frequency and activity pain were decreased, while elbow ROMs and flexor strength were increased in MTEG (P Ë‚ 0.05). Also significantly improvements were seen in joint health, functionality and QoL in MTEG. HEG showed improvements in activity pain, QoL and some ROMs. MTEG had better results in ROMs, joint health and functionality (P Ë‚ 0.05). CONCLUSION: Manual therapy & exercises may be used without causing bleeding and pain to increase the functionality, joint health and QoL, and is superior to home exercise for joint health and functionality. Home exercises may be ameliorated in pain, QoL and some ROMs.

The effects of manual therapy on musculoskeletal system, functional level, joint health and kinesiophobia in young adults with severe haemophilia: A randomized pilot study.

INTRODUCTION: The effects of manual therapy (MT) on joint health and functional level in haemophilic arthropathy (HA) have relatively under-explored. AIM: To investigate the effects of MT in HA of lower limb joints on musculoskeletal system, functional level, Functional Independence Score in Hemophilia (FISH), Hemophilia Joint Health Score (HJHS) and kinesiophobia. METHODS: Seventeen patients were randomized to the control group (CG = 9) and manual therapy group (MTG = 8). The number of haemarthrosis (NoH) was recorded from the diaries. Range of motion (ROM), strength and pain intensity were measured using goniometer, digital dynamometer and visual analogue scale, respectively. Joint health was evaluated with HJHS, functional independence with FISH, and kinesiophobia with Tampa Scale. Functional Reach (FR), Timed Up-Go (TUG) and 5-Times Sit-to-Stand (5*STS) tests were used to evaluate functional level. Home exercises were given to both groups. Additionally, myofascial release techniques and mobilizations were applied to MTG. Interventions were applied 3 d/weekly for 5 weeks. Assessments were performed at baseline and after treatment. RESULTS: ROM, strength, activity pain, HJHS and FISH were improved in MTG (p˂0.05). Ankle NoH, 5*STS and FR were developed in both groups (p˂0.05), but kinesiophobia, TUG and knee NoH were not significant. Although improvements were observed in favour of MTG in HJHS, FR, activity pain and ankle strength/ROM (p˂0.05), no significant difference was found in FISH, kinesiophobia, TUG, 5*STS, resting pain and knee strength. CONCLUSION: Reduction in ankle NoH indicated that both interventions were safe. The use of MT in HA of lower limb joints was an effective physiotherapy approach to improve functional level, joint health and functional independence.

A Case With Wiskott-Aldrich Syndrome and Ascending Aorta Aneurysm.

Wiskott-Aldrich syndrome (WAS) is a rare X-linked primary immunodeficiency disorder that is characterized by a triad of microthrombocytopenia, severe immunodeficiency, and eczema. We report the case of a 7-year-old male patient with chronic thrombocytopenia that was diagnosed as WAS after dilatation of the ascending aorta was noticed. WAS is rare, and it is a disease that requires high suspicion for diagnosis. We recommend periodic echocardiography and magnetic resonance imaging examinations to evaluate aortic aneurysms in children with WAS and that surgical intervention should not be delayed when aneurysm is detected.

Prognostic significance of myocardial energy expenditure and myocardial efficiency in patients with heart failure with reduced ejection fraction.

In heart failure with reduced ejection fraction (HFrEF) patients, myocardial blood flow (MBF), myocardial energy expenditure (MEE), myocardial efficiency has been poorly evaluated because of the necessity of invasive procedures in the determination of these parameters. Transthoracic echocardiography (TTE) can provide reliable data for MEE, MBF (via coronary sinus (CS) flows). Also, myocardial efficiency can be evaluated by the MEE to MBF ratio. We aim to assess MBF, MEE and energy efficiency and the prognostic value of these parameters in HFrEF. In this prospective study, a total of 80 patients with HFrEF due to either ischemic or non-ischemic etiology and 20 healthy control subjects were included. Median follow-up duration was 901 (27-1004) days. MBF was calculated via coronary sinus blood flow. MEE was measured from circumferential end-systolic stress, stroke volume and left ventricular ejection time. MEE to MBF ratio was determined as MEf. Primary composite end-point (CEP) was cardiovascular mortality, heart transplantation or mechanical circulatory support. MEE and MEf were lower and MBF per minute was higher in HF group compared to control subjects whereas MBF per 100 g left ventricular mass was not different. MEE and MEf have significantly negative correlation with troponin I, BNP, uric acid and positive correlation with epicardial fat thickness. In Cox regression analysis, per one calorie decrease of MEE was associated 4.3 times increased risk [HR 4.396 (95% CI 1.230-15.716)] and per one percent decrease of MEf was associated 3.3 times increased risk of CEP [HR 3.343 (95% CI 1.025-10.905)]. Our study demonstrated that while MEE and MEf diminished in HFrEF, MBF preserved with the symptomatic progression of HF. MEE and MEf were found to be associated with important prognostic markers and independent predictors of CEP in HFrEF. Evaluation of MEE, MBF and MEf with echocardiography may provide an additional data regarding prognostic assessment of HFrEF population.

Ischemia-modified albumin levels in patients with acute decompensated heart failure treated with dobutamine or levosimendan: IMA-HF study.

OBJECTIVE: Ischemia-modified albumin (IMA) is a sensitive biomarker of myocardial ischemia. However, data on IMA levels in acute heart failure (HF) are still lacking. In this study, we aimed to evaluate serum IMA levels in acute decompensated HF and the effects of dobutamine and levosimendan treatments on IMA levels. METHODS: This was a prospective, multicenter study that included 70 patients hospitalized with acute decompensated HF and left ventricular ejection fraction < 35%. Blood samples for IMA measurements were obtained on admission and 24-48 h after the initiation of HF therapy. Twenty-nine patients were treated with standard HF therapy, 18 received levosimendan, and 23 received dobutamine in addition to standard of care. A single serum specimen was also collected from 32 healthy individuals each. IMA concentrations were measured by the albumin cobalt binding colorimetric assay, and the results were given in absorbance units (AU). Independent and paired sample t-tests, Mann-Whitney U test, and Wilcoxon signed-rank test were used for the analysis. RESULTS: In patients with acute decompensated HF, the serum concentration of IMA was significantly higher than those of healthy subjects (0.894 ± 0.23 AU vs. 0.379 ± 0.08 AU, p < 0.001). Overall, the IMA levels significantly decreased after 24-48 h of HF therapy (0.894 ± 0.23 AU and 0.832 ± 0.18 AU, p = 0.013). Furthermore, the IMA levels were also found to significantly decrease with standard HF therapy (1.041 ± 0.28 vs. 0.884 ± 0.15 AU, p = 0.041), with levosimendan (0.771 ± 0.18 vs. 0.728 ± 0.18 AU, p = 0.046) and also with dobutamine (0.892 ± 0.18 vs. 0.820 ± 0.13 AU, p = 0.035). CONCLUSION: Patients with acute decompensated HF had elevated IMA levels, and appropriate HF therapy significantly reduced the serum IMA levels. Dobutamine or levosimendan did not increase the IMA levels, suggesting a lower potential in inducing myocardial ischemia when used in recommended doses.

Long-term follow-up of iatrogenic atrial septal defect: after percutaneous mitral balloon valvuloplasty.

During percutaneous mitral balloon valvuloplasty, the Inoue method leaves patients with an iatrogenic atrial septal defect. In this study, we evaluated the factors affecting the development of iatrogenic atrial septal defect and searched for the possible influence of this defect on long-term outcomes.We reviewed the medical records of 267 patients who had undergone successful percutaneous mitral balloon valvuloplasty for symptomatic moderate or severe mitral stenosis from January 2000 through March 2004. Sixty-three of the 267 patients were enrolled in a face-to-face follow-up study. We noted their clinical and demographic characteristics. All included patients were asked for the endpoints of repeat percutaneous mitral balloon valvuloplasty or mitral valve surgery, cerebrovascular accident or transient ischemic attack, and the need of intervention for the iatrogenic atrial septal defect. They underwent standard 2-dimensional and Doppler echocardiographic examination. The presence of iatrogenic atrial septal defect was evaluated via the color-Doppler technique in the subcostal view and via contrast echocardiography.Patients were subclassified in accordance with the presence (n = 15) or absence (n = 48) of echocardiographically proven persistent iatrogenic atrial septal defect. When we compared the 2 groups, there were no significant differences in baseline demographic characteristics or in pre- and postprocedural echocardiographic data.We conclude that the presence of persistent iatrogenic atrial septal defects might not be predicted from echocardiographic or demographic data in patients undergoing percutaneous mitral balloon valvuloplasty. Fortunately, these defects are small in size and low in shunt ratio. They appear not to be associated with serious long-term outcomes.

Acute and long-term follow-up results of percutaneous mitral balloon valvuloplasty: a single-center study.

OBJECTIVE: Percutaneous mitral balloon valvuloplasty (PMBV) is the method of choice in treatment of patients with hemodynamically significant mitral stenosis. We aimed to analyze acute and long-term clinical and echocardiographic consequences of PMBV. METHODS: In this retrospective cohort study; 311 patients who underwent PMBV in our Cardiology Clinic at Türkiye Yüksek Ihtisas Education and Research Hospital between January 2000 and March 2004 were evaluated for acute procedural outcomes and primary endpoints (death, rePMBV, mitral valve replacement (MVR)). All 311 patients were contacted by phone call or letter at least five years after the procedure. Of the 311 patients, 87 who defined NYHA class II-IV symptoms were invited for a control visit and detailed echocardiographic evaluation. Sixty-three patients out of 87 who completed follow-up were enrolled for long-term consequences. Those 63 patients were subclassified into two groups as those without any negative event (n=26) (Group 1) and those with mitral valve area (MVA) (<1.5 cm(2)), rePMBV or referral to MVR (n=37) (Group 2) on follow up to 6.4±1.6 years. RESULTS: In the analysis of 311 patients, acute post procedural success, which was defined as mitral valve area (MVA) ≥1.5 cm(2) without severe mitral regurgitation, was 94% and was only associated with preprocedural MVA (p=0.008). In the logistic regression analysis, preprocedural MVA was the only independent parameter, associated with acute procedural success (Expß=0.004, 95%CI 0.0001-0.234, p=0.008). In the long-term follow up of 63 patients, the patients with uneventful course (Group 1) had significantly higher MVA (p<0.001), lower mean (p=0.001) and peak (p<0.001) transmitral gradients immediately after the procedure when we compared to the patients in Group 2. It was also noticed that patients with at least 60% improvement in MVA experienced composite end point much less frequently compared to those with less than 60% improvement in MVA (5% vs. 30.4%, p=0.009). Kaplan-Meier analysis yielded significantly diverging cumulative survival curves for those with and without at least 60% improvement in MVA (p=0.003). CONCLUSION: Concerning long-term follow up data of patients undergoing PMBV in a single center, it seems only acute postprocedural MVA was significantly associated with long-term consequences.

Serum creatinine is independently associated with angiographic extent of coronary artery disease in patients with stable angina pectoris.

OBJECTIVE: Renal dysfunction has been shown to be linked to high risk for cardiovascular events. Even milder forms of creatinine elevation are associated with poor cardiovascular outcomes. We designed a retrospective study and searched the association of angiographic extent of coronary artery disease and creatinine levels in patients without overt renal dysfunction. METHODS: We retrospectively reviewed 892 consecutive patients with typical stable angina pectoris (311 female with mean age of 62 ± 10 years, 581 male with mean age of 56 ± 11 years) at Türkiye Yüksek Ihtisas Hospital and creatinine level ≤ 3 mg/dl without history of hemodialysis. Patients without overt renal disease were divided into 3 groups according to level of creatinine (Group A: Cr level <1.2 mg/dl, Group B: Cr level ≥ 1.2 and <1.5 mg/dl and Group C: Cr level ≥ 1.5 -≤ 3 mg/dl). Additionally after evaluation of coronary angiograms, patients were also classified according to those with high stenosis (stenosis score ≥ 16) and high extension scores (extension score >50%) versus low stenosis and low extension scores. Logistic regression analysis was performed to establish the clinical predictors of high total stenosis and high extension scores. RESULTS: Each group of patients according to level of creatinine showed marked difference in terms of angiographic extent of coronary artery disease (p<0.001). Those in the highest creatinine group (≥ 1.5 mg/dl, but not above 3 mg/dl) had the highest total stenosis (17 ± 6, p<0.001) and extension (78 ± 25, p<0.001) scores irrespective of age and gender. Creatinine was shown to be significantly correlated with both stenosis and extension scores. Age (OR:1.035, 95% CI:1.016-1.054, p<0.0001), being male (OR:1.746, 95% CI: 1.135-2.685, p=0.011), presence of hypertension (OR:1.507, 95%CI: 1.005-2.25 p=0.047), presence of diabetes mellitus (OR: 1.865, 95%: 1.250-2.783, p=0.002), previous history of myocardial infarction (OR: 1.624, 95%CI: 1.094-2.413, p=0.016), wall motion score index (OR:1.203, 95%CI: 1.108-1.305, p<0.0001) and creatinine (OR:4.037, 95%CI: 2.530-6.443, p<0.0001) level were found to be independent predictors of high total stenosis score. Furthermore, age (OR:1.042, 95%CI: 1.026-1.059, p<0.0001), being male (OR:2.587, 95%CI: 1.794-3.731, p<0.0001), presence of hypertension (OR:1.536, 95% CI:1.100-2.147, p=0.012), previous myocardial infarction (OR:6.183, 95%CI: 4.340-8.807, p<0.0001), total cholesterol/HDL ratio (OR:1.215, 95%CI: 1.114-1.327, p<0.0001) and creatinine (OR:3.814, 95%CI: 2.149-6.768, p<0.0001) were found to be independent predictors of high extension score. CONCLUSION: Serum creatinine seems to denote severity of angiographic extent of coronary artery disease in patients with typical chest pain.

[Acute results of percutaneous mitral balloon valvuloplasty]. / Perkütan mitral balon valvüloplastinin kisa dönem sonuçlari

OBJECTIVES: We aimed to analyze acute clinical, echocardiographic, and hemodynamic results and long-term event-free survival of percutaneous mitral balloon valvuloplasty (PMBV) in the treatment of hemodynamically significant mitral stenosis (MS). STUDY DESIGN: We retrospectively reviewed 577 patients (454 females, 123 males; mean age 38±11 years) who underwent PMBV for moderate or severe MS. Acute procedural success was defined as the achievement of mitral valve area (MVA) >1.5 cm2 and absence of grade 3-4 mitral regurgitation. In addition, 489 patients were interrogated by phone calls for event-free survival (death, redo PMBV, mitral valve replacement) after at least one year (mean 54 months) of the procedure. RESULTS: The procedure was successful in 547 patients (94.8%) and unsuccessful in 30 patients (5.2%). Among baseline echocardiographic and hemodynamic parameters, MVA was significantly lower (p=0.0001) and moderate/severe tricuspid regurgitation was significantly more common (p=0.031) in patients with failure. The mean Wilkins scores were similar in the two groups (p>0.05). Failure was related to suboptimal valve opening (MVA <1.5 cm2) in 20 patients (66.7%), and grade 3-4 mitral regurgitation in 10 patients (33.3%). There were no in-hospital death, cardiac tamponade, or cerebrovascular accident. Acute complications included iatrogenic atrial septal defect (n=51, 8.8%) and groin hematoma (n=4, 0.7%). Inquiry for long-term outcomes showed that four patients had died, while 21 patients and six patients had undergone mitral valve replacement and redo PMBV, respectively. CONCLUSION: Our data suggest that PMBV is a safe and effective treatment option in MS and preprocedural MVA and tricuspid regurgitation are associated with acute failure of the procedure.

Coronary collaterals in obese patients: impact of metabolic syndrome.

Obesity is a growing pandemic. Among obese patients with significant coronary artery stenosis, development of coronary collaterals was investigated. Consecutive 104 obese patients with stable angina pectoris were enrolled. Coronary collaterals were assessed according to the Cohen and Rentrop grading system and classified into 2 as those with poor collaterals (grade 0-1, Group 1) and those with good collaterals (grade 2-3, Group 2). Group 1 had higher body mass index, shorter duration of angina pectoris than Group 2. Poor collaterals were present in 82.3% and 59.5% of patients with and without (P = .019) metabolic syndrome, respectively. Metabolic syndrome score (sum of each component) was found to be negatively correlated with Rentrop score (r = -691; P < .001). After controlling for symptom duration and body mass index, metabolic syndrome kept independent association with poor collaterals among obese patients (P = .043, B = 1.8). Metabolic syndrome appears to influence the development of coronary collaterals among obese patients with stable coronary artery disease.

Fate of internal mammary artery grafted to left anterior descending artery is influenced by native vessel stenosis and viable myocardium.

In this study, factors leading to the failure of internal mammary artery grafting was investigated among patients with coronary bypass. In all, 1323 patients were evaluated. It was found that lower grade diameter stenosis in the native vessel during postoperative angiogram and wall motion score index independently affected the fate of internal mammary artery as a graft. Grafting with internal mammary artery to native vessels with lower grade stenosis and to myocardium with poor wall score might not be a rational approach.

Role of mean platelet volume in triagging acute coronary syndromes.

BACKGROUND: Acute coronary syndromes, characterized by the rupture of unstable plaque and the subsequent thrombotic process involving platelets, have been increasing in relative frequency. The central role of platelet activation has long been noticed in this pathophysiology; hence, many therapies have been directed against it. In this study, we have aimed to search prospectively the value of mean platelet volume (MPV), which is a simple and accurate measure of the functional status of platelets, in patients hospitalized with diagnosis of acute coronary syndromes (ACS). MATERIALS AND METHODS: A total of 216 consecutive patients (156 male, 60 female) hospitalized with the diagnosis of non-ST segment elevation (NSTE) ACS within the first 24 h of their chest pain were enrolled. One hundred and twenty patients, matched according to sex and age, with stable coronary heart disease (CHD) (85 male, 35 female) were enrolled as a control group. Patients were classified into two group: those with unstable angina (USAP, n = 105) and those with non-ST segment elevation myocardial infarction (NSTEMI, n = 111). RESULTS: MPVs were 10.4 +/- 0.6 fL, 10 +/- 0.7 fL, 8.9 +/- 0.7 fL consecutively for NSTEMI, USAP and stable CHD with significant differences. Patients with ischemic attacks in the first day of hospitalization accompanied by >0.05 mV ST segment shift had significantly higher MPV compared to those without such attacks (P = 0.001). Multivariable logistic regression analysis yielded that MPV (P = 0.016), platelet count (P < 0.001), and the presence of >0.05 mV ST segment depression at admission (P = 0.002) were independent predictors of development of NSTEMI in patients presenting with NSTE ACS. CONCLUSION: In patients presenting with NSTE ACS, higher MPV, though there are overlaps among subgroups, indicates not only more risk of having NSTEMI but also ischemic complications.