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Increasing the extensity of latent tuberculosis infection (LTBI) treatment which is one of the important parameters of tuberculosis (TB) control and completing the treatment in success are important. The purpose of this study is to evaluate LTBI treatment indications and treatment outcomes of patients who received LTBI treatment in İstanbul between 2016 and 2018.The treatment outcomes of people who started LTBI treatment registered in TB dispensaries in Istanbul between 2016 and 2018 were analyzed retrospectively according to the variables of the age groups, gender, dispensary subgroups, and prevention treatment indications. Data collected from the health institutions were evaluated.26.920 patients received LTBI treatment in all Istanbul TB dispensaries between 2016 and 2018. The evaluation of LTBI treatment indications; contact 15.696, Tuberculin skin test (TST) positivity 2224, immunosuppression 8746, TST conversion 58, sequelae lesion 15, and other indications are identified as 181. The groups which diagnosed with TB disease, mortality, transfer, other, and still in treatment are excluded from the analysis of LTBI treatment outcomes. A total of 25.253 patients were analyzed. 65 percent of the patients had completed LTBI treatment. Variables effective for treatment outcomes are analyzed with logistic regression. Treatment discontinuation was statistically significantly lower in 2017 (odds ratio [OR]: 0.906 confidence interval [CI] [95%] [0.849-0.968]) and 2018 (OR: 0.635 CI [95%] [0.594-0.679]) compared to 2016. Treatment lost to follow-up was statistically significantly lower in those receiving LTBI treatment with the indication of tuberculin skin test positivity (OR: 0.541 CI [95%] [0.487-0.600]) and the indication of immunosuppression (OR: 0.284 CI [95%] [0.142-0.569]) compared to those who received LTBI treatment due to contact. When the treatment results are evaluated according to the TB incidence of the region where the dispensaries are located, treatment lost to follow-up was higher in 101-200 per 100,000 incidence group (OR: 1.201 CI [95%] [1.123-1.285]) and incidence of 201-370 per 100,000 (OR: 1.461 CI [95%] [1.358-1.572]). Treatment lost to follow-up was higher in dispensaries on the European side (OR: 1.293 CI [95%] [1.203-1389]) and the 0-35 age group (OR: 1.248 CI [95%] [1.168-1.333]).In conclusion, the treatment completion rate should be improved for an effective LTBI treatment which is one of the important parameters of targeted TB elimination. Particularly people under the age of 35 years and regions with high-TB incidence should receive special care and close follow-up.

Saribas, Suat/0000-0002-4549-3887; Demirci, Mehmet/0000-0001-9670-2426 WOS:000576827800018 PubMed ID: 32616395 Background: The antigen 85 complex (85B) is secreted in large quantities from growing mycobacteria and the presence of bacterial mRNA is an indicator of cell viability. The quantitative detection of 85B mRNA expression levels can be used to assess the success of anti-tuberculosis treatment outcomes to detect viable mycobacteria cells. Therefore, we evaluated the levels of 85B mRNA of Mycobacterium tuberculosis strains in patients with pulmonary tuberculosis. Methods: Thirty patients with primary tuberculosis were included in this study. The sputum specimens of patients were collected on days 0, 15, and 30 days and were cultured and evaluated by 85B mRNA-based RT-qPCR. Results: Overall, 23 of the studied tuberculosis strains were susceptible to the primary anti-tuberculosis antibiotics used in this study, 7 were resistant. By the 30th day of treatment, 85B mRNA was detected in only one of the susceptible strains, but in all 7 of the resistant strains, though the relative gene expression varied between the strains. This difference between the susceptible and resistant strains at day 30 was statistically significant (p < 0.05). Conclusion: 85B mRNA expression levels could be used to follow up on primary tuberculosis cases. 85B mRNA seems to be a good diagnostic marker for monitoring anti-tuberculosis treatment outcomes. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. Istanbul University Scientific Research Projects Coordination UnitIstanbul University [27154] This work was supported by Istanbul University Scientific Research Projects Coordination Unit, Project number 27154.

Introduction To evaluate tuberculosis screening and efficacy of prophylaxis in contacts of patients with pulmonary tuberculosis. Patients and methods A total of 7453 contacts of 1909 patients with pulmonary tuberculosis treated at four tuberculosis dispensaries located in Istanbul, between 2005 and 2009 were included in this retrospective screening-based study. Data on demographics, smear positivity, PPD positivity, rate and onset of secondary tuberculosis and prophylaxis were recorded in contacts. Result Overall 184 (2.5%) secondary cases of tuberculosis were identified within a mean 2.9 (1-5) years of follow-up. The rate for secondary tuberculosis was 3.1% (163/5335) in smear positive and 1.0% (20/2118) in smear negative contacts. With and without prophylaxis rates for secondary tuberculosis after 6 months of index case was identified in 0.7% (6/912) and 2.0% (9/455) of contacts aged 0-15 years, in 0.9% (3/339) and 2.8% (51/1826) of contacts aged 16-35 years and in 0% (0/215) and 0.9% (14/1507) of contacts aged ≥ 36 years, respectively. Conclusion In conclusion, our findings indicate high risk of being infected and diseased in smear positive contacts along with efficacy of prophylactic therapy among contacts not only in the childhood but also in adults, particularly in contacts aged 16-35 years.

Aims: The objective of the study is to determine the demographics and the in-hospital outcome of diabetic and non-diabetic patients treated with percutaneous coronary interventions (PCI) in Europe, to report the type of equipment and technology used for PCI procedures in diabetics and to clarify whether the treatment of diabetic patients complies with current European Society of Cardiology (ESC) guidelines. Methods and results: A total of 14,458 patients treated with PCI were enrolled from 29 member countries of the ESC between June 2005 and January 2006. Data were collected on patient characteristics and treatment, using new Cardiology Audit and Registration Data standards. In total, 3,603 patients (24.9%) were diabetic. Diabetics were older, more often female and had a higher body mass index than non-diabetics. Diabetics had higher rates of hypercholesterolaemia and hypertension, while current smokers were more frequent in the non-diabetics. Diabetics also had significantly higher rates of previous cardiovascular events. Clopidogrel was administered only in 48.1% of diabetic patients before PCI, while IIb/IIIa inhibitors were 22.9% during PCI. At discharge, there was a major adjustment of treatment with increases in the use of Beta-blocker (80.4%), angiotensin converting enzyme inhibitor (ACEI, 71.3%) and statins (89.8%) compared with on admission (Beta-blocker 60.9%, ACEI 55.0%, statin 63.1%). Inhospital mortality was higher in diabetics (1.8% vs 1.2%) although the in-hospital MACCE rate was not significantly different (3.6% vs 3.0%, p=0.09). Conclusions: Diabetic patients treated with PCI were older with more comorbidity. According to ESC guideline, the under-usage of clopidogrel, GP IIb/IIIa inhibitors should be improved. PCI is now taken as a good opportunity to adjust the use of appropriate medication. © Europa Edition. All rights reserved.

Background and objective: Istanbul has the highest incidence of tuberculosis (TB) in Turkey. It is also the largest city, with considerable differences in quality of life across its urban regions. The aim of this study is to investigate the relationship between (i) the diverse quality of life across specific urban regions, (ii) TB incidence rates, inclusive of demographic and clinical characteristics of TB patients, and (iii) adverse treatment outcomes. Methods: This retrospective study included 23,845 new TB patients (recorded in the National TB Registry between 2006 and 2010) in Istanbul. Thirty-nine urban districts of Istanbul were ranked into five groups on the basis of an urban quality of life index. Patient data were matched with these groups, and further categorized according to âageâ, âsexâ, âcountry of birthâ and âantibiotics resistanceâ. Adverse treatment outcomes and TB incidence rates were extracted from official records. Logistic regression, clustered analyses, 95% CI and p values (STATA) were reported to describe the association between variables. Results: Six per cent of total cases had âat least one adverse treatment outcomeâ (default 3.8%, failure 0.5%, death 1.7% in total cases). âAn adverse treatment outcomeâ was found to be associated with age OR (CI 95%) (1.02 (1.01â1.03)); âmale sexâ 1.65 (1.28â2.12); âother country of birthâ 4.82 (3.05â7.62); 100,000 per âover 60â insidence goups 1.61 (1.32-1.97), the lowest quality of life index 0.65 (0.47-0.83). Conclusions: Patients with high tuberculosis risk factors living in high incidence regions need to be closely monitored. Patients living in lower ranking regions are more likely to have âpoor treatment outcomesâ. Resumo: Contexto e objetivo: Istambul tem a mais elevada incidência de tuberculose (TB) na Turquia. à igualmente a sua maior cidade, com diferenças consideráveis na qualidade de vida ao longo das suas regiões urbanas. O objetivo deste estudo é investigar a relação entre i) as diversas qualidades de vida ao longo de regiões urbanas específicas, ii) taxas de incidência de TB, incluindo as características demográficas e clínicas dos doentes, e iii) resultados adversos do tratamento. Métodos: Este estudo retrospetivo incluiu 23.845 novos doentes com TB (registados no Registo Nacional de TB, entre 2006-2010) em Istambul. Os trinta e nove distritos urbanos de Istambul foram classificados em 5 grupos com base no índice de qualidade de vida urbano. Os dados dos doentes foram correspondidos com estes grupos e subsequentemente divididos por categorias de acordo com a «idade», «sexo», «país de nascimento» e «resistência a antibióticos». Os resultados adversos ao tratamento e as taxas de incidência de TB foram retiradas dos registos oficiais. Regressão logística, análises agregadas, valores de CI e p de 95% (STATA) foram usados para descrever a associação entre variáveis. Resultados: Seis por cento do total de casos tiveram pelo menos um resultado adverso do tratamento (padrão 3,8%; insuficiência 0,5%; morte 1,7% do total de casos). «Um resultado adverso do tratamento» foi considerado como estando associado à idade (CI 95%) (1,02 [1,01-1,03]); «sexo masculino» 1,65 (1,28-2,12); «outro país de nascimento» 4,82 (3,05-7,62); 100.000 por grupos de incidência com «idade superior a 60 anos» 1,61 (1,32-1,97), o índice de qualidade de vida mais baixo 0,65 (0,47-0,83). Conclusões: Os doentes com altos fatores de risco de tuberculose em regiões de elevada incidência precisam de ser monitorizados de forma mais assídua. Os doentes que vivam em regiões de classificação inferior têm maior probabilidade de ter «maus resultados do tratamento». Keywords: Adverse outcome, Tuberculosis, Tuberculosis incidence, Tuberculosis risk factors, Urban quality of life, Palavras-chave: Resultado adverso, Tuberculose, Incidência da tuberculose, Fatores de risco da tuberculose, Qualidade de vida urbana

Idiopathic hypereosinophilic syndrome (IHES) is an uncommon systemic disease which is characterised by blood eosinophilia and multiple clinical presentations. Cardiac involvement is the major cause of mortality and morbidity. Here we describe a 59-year-old man with symptoms of progressive dyspnea on exertion, and productive cough as an unusual case of Löffler endomyocarditis with a mass on the aortic valve which showed regression with treatment.

Plasma isoniazid and rifampin concentrations, but not pyrazinamide and ethambutol concentrations, were decreased by about 50% ( P < 0.05) in diabetic pulmonary tuberculosis patients. The prevalences of subnormal plasma isoniazid, rifampin, pyrazinamide, and ethambutol concentrations were 49% or 100% ( P < 0.01), 66% or 100% ( P < 0.05), 30% or 50% ( P = 0.198), and 32% or 21% ( P = 0.742) in nondiabetic or diabetic tuberculosis patients, respectively. These data show that plasma concentrations of isoniazid and rifampin were greatly reduced in diabetic tuberculosis patients.

Radiation-induced heart disease must be considered in any patient with cardiac symptomatology who had prior mediastinal irradiation. Radiation can affect all the structures in the heart, including the pericardium, the myocardium, the valves and the conduction system. In addition to these pathologies, coronary artery disease following mediastinal radiotherapy is the most actual cardiac pathology as it may cause cardiac emergencies requiring interventional cardiological or surgical interventions. Case A 36-year-old man was admitted to the clinic with unstable angina pectoris of one month duration. The patient had no coronary artery disease risk factor. The history of the patient revealed that he had mediastinal radiotherapy due to Hodgkin's disease at 10-year of age. Coronary arteriography showed total occlusion of the left anterior descending artery and 70% stenosis of the proximal right coronary artery. Both arteries are dilated with placement of two stents. Control coronary arteriography at the end of the first year showed patency of both stents and the patient is free of symptoms. Previous radiotherapy to the mediastinum should be considered as a risk factor for the development of premature coronary artery disease. Percutaneous transluminal coronary angioplasty with stent placement or surgical revascularization are the preferred methods of treatment. Preoperative assessment of internal thoracic arteries should be considered prior to surgery. As the radiation therapy is currently the standard treatment for a number of mediastinal malignancies, routine screening of these patients and optimal cardiac prevention during radiotherapy are the only ways to minimize the incidence of radiation-induced heart disease.

BACKGROUND The excellent results obtained from internal thoracic artery for myocardial revascularization have led surgeons to simultaneous use of other arterial conduits, particularly the right internal thoracic artery. However, some controversy still exists regarding the optimal target coronary artery for this graft; different strategies have been proposed for bilateral internal thoracic artery grafting. PATIENTS AND METHODS 59 patients with right internal thoracic artery grafts were monitored using coronary arteriography in order to compare the patency of this graft on the left anterior descending and the right coronary arteries. The right internal thoracic artery was grafted to left anterior descending artery in 39 patients (group 1) and to right coronary artery in 20 patients (group 2). RESULTS The mean period of follow-up was 64.07 months (range: 37 to 185 months). Overall, 8 of the 59 grafts (13.6%) were occluded at the arteriography. In group 1, 1 of 39 (2.6%) grafts and in group 2, 7 of 20 (35%) grafts are found to be occluded. These results are considered statistically significant (p < 0.001). COMMENT The results show that the patency of the right internal thoracic artery is significantly better on the left anterior descending artery than on the right coronary artery in the mid-to-long term, and patency does not differ from the left internal thoracic artery on the left anterior descending artery.

Objective To document the pharmacokinetics and serum concentrations of first-line anti-tuberculosis drugs in adult Turkish patients with pulmonary tuberculosis (PTB). Design Consenting 21 adult patients (aged 38 ± 4 years, 10 female and 11 male) with newly diagnosed active PTB participated in the study. Blood samples were collected 1, 2, 4, 6 and 24 h after simultaneous isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA) and ethambutol (EMB) ingestion. Serum concentration-time profiles, maximum serum concentrations, time to achieve maximum serum concentrations, the half-life and the areas under the serum concentration-time curve for each of the four drugs were determined. Results Wide variations in pharmacokinetic parameters were observed among patients. In respectively 8 (38%), 17 (81%), 3 (14%) and 1 (5%) patients, the maximum INH, RMP, PZA and EMB serum concentrations were below the accepted therapeutic concentrations. Conclusion Our data show that the serum concentrations of anti-tuberculosis drugs varied considerably in the study patients. Therapeutic drug monitoring is necessary to identify patients with subtherapeutic INH and RMP serum concentrations.

The aim of this study is to evaluate the treatment outcomes and identify factors associated with adverse tuberculosis treatment outcomes for bacteriologically confirmed pulmonary tuberculosis. Treatment outcomes of pulmonary tuberculosis were evaluated retrospectively among 11,186 smear- and/or culture-positive patients treated between 2006 and 2009 in Istanbul, Turkey. Adverse treatment outcomes were identified in 1,010 (9.0%) patients including death (1.8%), treatment default (6.1%), and treatment failure (1.1%). Factors associated with adverse treatment outcomes included being born abroad (odds ratios [OR], 5.38; 95% confidence intervals [CI], 3.67-7.91), history of tuberculosis treatment (OR, 3.77; 95% CI, 3.26-4.36), age > 65 years (OR, 2.79; 95% CI, 2.21-3.53), and male gender (OR, 1.91; 95% CI, 1.59-2.27). Death was most strongly associated with age > 65 years (OR, 45.1; 95% CI, 27.0-75.6), followed by treatment default with history of interrupted treatment (OR, 11.6; 95% CI, 8.94-15.1), and treatment failure with prior history of treatment failure (OR, 17.1; 95% CI, 6.97-41.6). Multidrug resistance was strongly associated with adverse treatment outcomes (OR, 10.8; 95% CI, 8.02-14.6). Age > 65 years, male sex, being born abroad, and history of treatment failure were found to be risk factors for adverse treatment outcomes. Hence, patients with any of these characteristics should be carefully monitored and treated aggressively.

WOS: 000318154600011, PubMed: 23425772, Objective We conducted a clinical trial to examine the effect of omega-3 fatty acids in patients with cardiac syndrome X (CSX). We aimed to evaluate the potential impact of omega-3 fatty acids on endothelial function, oxidative stress, and symptom relief in the CSX. Methods and results Eighteen patients with CSX were enrolled according to a double-blind, randomized, placebo-controlled design. Patients were randomized to omega-3 fatty acids (1440 mg/day, n = 8) or placebo (n = 10) for 4 months. We assessed plasma levels of malondialdehyde (MDA), endothelium-dependent vasodilatation [flow-mediated dilatation (FMD)], endothelium-independent vasodilatation [nitroglycerin-mediated dilatation (NMD)], and status of symptom [score with Seattle Angina Questionnaire (SAQ)] before and after the treatment. After 4 months, patients who were treated with omega-3 fatty acids showed significant increases in the FMD (from 47 +/- 48 to 104 +/- 23%, P, Turkish Society of Cardiology [2006-3]; Kocak Farma Pharmaceutical Company, Istanbul, Turkey, This study was supported by a Research Fund of the Turkish Society of Cardiology (fund number 2006-3) and Kocak Farma Pharmaceutical Company, Istanbul, Turkey.

Introduction: Lung diseases caused by biomass exposure cause a significant health hazard particularly amongst women. The present study was designed to investigate biomass exposure in women suffering from lung disease. Materials and Methods: A total of 100 women {[} mean (SD) age: 55.13 (17.65) years] hospitalized for chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, tuberculosis or interstitial lung disease were included in this study conducted between September 2008-March 2009 in three chest disease clinics at Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital. Data collection on biomass exposure was based on application of hospital-based survey questionnaire including items on occupation, level of education, place of birth (location, region), exposure to biomass fuel fumes for heating and cooking purposes (animal dung, wood, charcoal, dried plant) and years of exposure with animal dung, wood, charcoal, dried plant. Results: COPD in 22\% patients, lung carcinoma in 12\%, bronchitis in 8\%, tuberculosis in 26\%, and interstitial lung disease in 17\% were the diagnosis for hospitalization. The most identified occupation was housewifery 86\%. Active, former and nonsmokers composed 6\%, 22\% and 72\% of the population. Birth place was village in 67\% patients while districts in 9\%. According to regional distribution, the most common place of birth was Central Anatolia region in (29\%). Exposure to biomass fuels was identified in all of patients including wood (92\%), animal dung (30\%), charcoal (23\%), and dry plant (23\%). Mean (SD) years of exposure was identified to be 52.6 (17.9) years for wood, 40.8 (17.9) years for animal dung, 48.1 (20.8) years for dry plant and 38.5 (21.4) years for charcoal. The most common type of biomass exposure was wood in village (97\%), city (79\%) and county (89\%). Conclusion: Findings indicating impact of biomass exposure in women seem to emphasize the need for analytic epidemiologic studies assessment measuring biomass exposure levels-particularly for women and young children.

Introduction Non-tuberculosis mycobacterium is especially seen in AIDS and non-immunosuppressant patients. This study was designed to evaluate data relating to non-tuberculosis mycobacterium content in patients' sputum for the clinical importance. Patients and methods During 2009-2010 at Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital clinics, 75 patients [30 women (40%) and 45 men (69%); mean age (SD): 48.7 (15.9) years] with non-tuberculosis mycobacterium were determined by the rapid test and NAP test in Mycobacteria Growth Indicator Tube (MGIT), which had atypical growth in 51.864 Lowenstein-Jensen. Identification was done with Hsp65PCRREA methods in 32 (43%) cases. Treatment management, radiology, bacteriology, co-morbidity, treatment outcomes were evaluated from medical records, calling patients and from tuberculosis dispensaries. Results In 9 (28%) patients Mycobacterium abscessus, in 8 (25%) patients Mycobacterium avium complex (MAC), in 5 (16%) patients Mycobacterium kansasii was found with identification Hsp65PCRREA methods. In 18 (24%) of 75 cases with American Thoracic Society definition and treatment criteria, treatment was administered using major and minor drugs. Standard tuberculosis treatment was administered in 25 (33%) of the 75 cases. In 8 of 25 (32%) cases identification of non-tuberculosis mycobacterium was evident. In 32 of 75 cases follow up was performed with no treatment. One positive atypical growth culture was identified in 23 (72%) of 32 patients. Treatment was administered in 43 cases while 25 (58%) of 43 were cured, 3 (7%) of 43 were default and 3 (7%) died. Drug resistance was the outcome in 36 cases. While 31 (86%) had any drug resistance, 27 (75%) had HR drug resistance. Past history of tuberculosis treatment was evident in 20 (40%) cases. Respiratory and non-respiratory diseases were identified equally in 18 (38%) cases. Radiological consolidation in 28 (65%), and cavity in 16 (37%) cases were determined. Conclusion In order to carry out the right treatment and epidemiologic evaluation, it is important to identify non-tuberculosis mycobacterium by culture methods.

Therapeutic drug monitoring ensures optimal dosing while aiming to reduce toxicity. However, due to the high costs and complexity of testing, therapeutic drug monitoring is not routinely used in the treatment of individuals with active tuberculosis, despite the efficacy demonstrated in several randomized trials. This study reviewed data spanning five years regarding the frequency of finding low drug levels in patients with tuberculosis, the dosing adjustments that were required to achieve adequate levels and the factors associated with low drug levels.BACKGROUND: Therapeutic drug monitoring (TDM) is used to optimize dosing that maximizes therapeutic benefit while minimizing toxicity. In the treatment of active tuberculosis (TB), TDM is not routine, yet low levels of anti-TB drugs can be associated with poorer treatment outcomes.METHODS: In a retrospective case control study, patients with active TB in whom TDM was performed were considered cases and compared with controls who did not undergo TDM, and matched according to year of diagnosis and the results of direct smear microscopy. Medical records were reviewed to abstract demographic, clinical, radiographic and microbiological data including time until smear and culture conversion.RESULTS: In total, 20 patients were identified in whom TDM was performed, of whom 17 (87%) had at least one low drug concentration. Overall, 27 of 45 (60%) initial drug concentrations were low and resulted in an increased drug dosage. Low drug levels were found in 13 of 15 (87%) isoniazid, four of five (80%) rifabutin and eight of 12 (67%) rifampin measurements, but in only two of 13 (15%) pyrazinamide measurements. Within cases only, the 17 patients with low serum drug levels were significantly more likely to have comorbid illnesses, be smear positive, have lower serum albumin levels and had nonsignificantly longer time to culture conversion, compared with the three cases in whom all drug levels were within therapeutic ranges.CONCLUSIONS: TB drug levels were frequently below clinically acceptable levels in patients with active TB, particularly in those with HIV infection or other comorbidities. TDM is potentially useful for the treatment of active TB, but is currently underused.

Summary Ross syndrome is a rare disorder first described in 1958 with partial autonomic dysfunction. It has three basic components including unilateral or bilateral segmental anhidrosis, Adie's tonic pupils and areflexia or hyporeflexia of deep tendon reflexes. The most disturbing symptom in the patients is segmental compensatory hyperhidrosis and often the hypohidrosis or anhidrosis is not even noticed. While the pathogenesis of Ross syndrome is unclear, degenerative changes or damage to the peripheral autonomic nerve system or dorsal root ganglia have been suggested as possible causes. About 50 cases have been reported, usually by neurologists and ophthalmologists, and less often by dermatologists. We present a 26-year-old patient who displayed the classic triad of this syndrome, emphasizing that the presenting complaint may be hyperhidrosis and that multidisciplinary evaluation in neurology and ophthalmology is essential.

We investigated the association of matrix metalloproteinase-3 (MMP-3) and paraoxonase 1 (PON1) 55/192 polymorphisms with coronary artery disease (CAD) and the number of diseased vessels in patients with CAD.One hundred thirty-nine CAD patients and 119 healthy control subjects were included in the study. Genotypes for PON1 55/192 and MMP-3 5A/6A polymorphisms were determined by restriction fragment length polymorphism.Although distributions of the RR genotype of PON1 192 and the 5A5A genotype of MMP-3 were more frequent in patients, frequencies of the QQ genotype of PON1 192, the MM genotype of PON1 55, and the 6A6A genotype of MMP-3 were significantly lower in patients compared with healthy control subjects. The combined genotypes of RR/LL and/or 5A5A are increased the risk of CAD when compared with subjects who possess neither the MMP-3 5A5A nor the PON1 RR/LL genotype. While the MMP-3 5A/6A genetic variants were not associated with the number of diseased vessels, PON1 55/192 variants were associated with the number of diseased vessels.The combined PON1 55/192 and MMP-3 5A/6A genetic variants are associated with CAD; PON1 seems to be connected with the number of diseased vessels, and hypertension and hyperlipidemia are related with PON1 192 and MMP-3 in CAD patients.

Objective: To report our experience with use of thrombolysis with streptokinase during cardiopulmonary resuscitation of patients with cardiac arrest due to myocardial infarction. Design: A case series. Methods: Thrombolytic therapy (streptokinase) was administered during cardiopulmonary resuscitation of 4 patients with suspected myocardial infarction as the cause of cardiac arrest. Results: 3 of the 4 patients survived and were discharged from the hospital without any major complications or neurological sequela. Conclusion: Thrombolysis with streptokinase during cardiopulmonary resuscitation of patients with suspected acute myocardial infarction is associated with reduced mortality and favorable neurological outcome.

The aim of this prospective cross-sectional study was to investigate the hypertrophic effects of endogenous subclinical hyperthyroidism on myocardium and early development of left ventricular hypertrophy (LVH) in essential hypertensive patients accompanied by endogenous subclinical hyperthyroidism. A total of 31 consecutive patients with stage I hypertension were included in the study. Sixteen of them also had endogenous subclinical hyperthyroidism that they were unaware before. The patients and the controls formed out of ten healthy subjects all underwent an investigation of thyroid functions and cardiologic evaluation. The mean wall thickness of the left ventricle in the stage I hypertensive group with endogenous subclinical hyperthyroidism (group I) was significantly increased as compared with both hypertensive patients without thyroid disease (group II) and the control subjects. The mean left ventricle mass was also significantly higher in group I than group II. Both of the patients' groups had an increased prevalence of LVH as compared with the controls. In this study, hypertensive patients with subclinical hyperthyroidism presented more increase in left ventricular mass, suggesting that subclinical hyperthyroidism may contribute to left ventricular hypertrophy forming a natural progression to hypertension. The hypertensive population should always be screened for endogenous subclinical hyperthyroidism, and should be examined for the criteria of left ventricular hypertrophy by echocardiography in early stages.

Bidirectional flow in patients with normal coronary arteries is an indicator of intercoronary continuity, a rare variant of coronary circulation, distinct from collaterals. The case of an 18 year old Turkish male with bicuspid aorta and intercoronary artery is reported and different aspects of this interesting entity are emphasized.

The aims of the present study are to evaluate clinical, angiographic, and procedural determinants of creatine kinase (CK) elevation following successful coronary stent implantation, and to assess the relationship between postprocedural CK release and subsequent target vessel revascularization.Study population was composed of 400 consecutive patients who underwent successful coronary stent implantation. Forty-six patients (11.5%) had CK enzyme levels2 times the upper limit of normal. This group was compared to 100 patients with no CK release after stenting.Baseline, angiographic and procedural characteristics did not differ between patients with and without postprocedural CK elevation. The significant predictors of CK elevation by multiple logistic regression analysis are unstable angina (p0.001, OR=5.62 with 95% CI of 2.35-13.45), multiple stenting (p=0.04, OR=2.55 with 95% CI of1.02-6.40) and side branch occlusion (p=0.03,OR=12.20 with 95% CI of 1.22-121.71). By multivariate analysis, postprocedural CK release was found to be a significant determinant of subsequent target vessel revascularization (p=0.032,OR=3.84 with 95% CI of 1.12-13.18).Our results indicate that side branch occlusion, implantation of1 stents per lesion and coronary stenting in unstable angina pectoris are strong predictors of postprocedural CK release. There is a significant relationship between postprocedural CK elevation and subsequent target vessel revascularization.

The aim of the present study was to assess the procedural safety and in-hospital and long-term effectiveness of heparin-coated Jostents after failed thrombolysis in acute myocardial infarction. We prospectively analyzed the acute and long-term clinical and angiographic outcomes of 35 consecutive patients treated with heparin-coated Jostents for thrombolytic failure. Rescue coronary stenting was successful in 34 of 35 patients (97%). Thrombolysis in Myocardial Infarction flow grade 3 was obtained in 31 patients (88.5%). The only patient with procedural failure died from cardiogenic shock a day after the procedure. One patient (2.8%) underwent an emergency coronary bypass operation because of angiographic evidence of stent thrombosis with re-infarction. During in-hospital follow-up, 2 patients (5.7%) underwent an elective coronary bypass operation after successful stent implantation of the infarct-related artery because of existing severe multivessel coronary artery disease. Minor bleeding complications at the vascular access site occurred in 3 (8.6%) patients. No cerebrovascular or any other major bleeding complication occurred. One patient (2.1%) underwent repeat coronary angioplasty for restenosis and an elective coronary artery bypass operation was performed in one patient (2.8%) during the 294 +/- 150 days follow-up. The rate of target vessel revascularization was 14.3% and the event-free survival rate was 80%. Twenty-six patients (90%) had angiographic follow-up at six months, and stent restenosis was found in 5 (19.2%). This study demonstrates that heparin-coated Jostents are sale, with low in-hospital and long-term mortality rates for the treatment of failed thrombolysis in acute myocardial infarction. The angiographic restenosis and target vessel revascularization rates of this registry are also acceptable.

Insulin is known to stimulate proliferation and migration of vascular smooth muscle cells. As the predominant mechanism of restenosis after stent implantation is neointimal tissue proliferation, one can expect a relationship between hyperinsulinemia and restenosis in these patients. The aim of this study was to determine whether hyperinsulinemia during oral glucose tolerance test is a predictor of the development of restenosis after stent implantation in nondiabetic patients. We prospectively studied 52 nondiabetic patients with effort angina who underwent elective stent implantation for single-vessel coronary artery disease. In order to increase the statistical power of the study, numerous exclusion criteria were applied. All patients were subjected to a 75 g oral glucose tolerance test a day before the stent implantation and underwent follow-up angiography 6 months later. Plasma insulin levels in fasting (6.77 +/- 1.57 vs. 5.36 +/- 1.35 micro U/ml; P = 0.005), at 30 min (102.48 +/- 10.6 vs. 47.74 +/- 12.75 micro U/ml; P = 0.001), 1 hr after (120.23 +/- 14.1 vs. 63.08 +/- 12.62 micro /ml; P = 0.001), 2 hr after (63.58 +/- 8.64 vs. 34.88 +/- 6.82 micro /ml; P = 0.001), and 3 hr after (25.71 +/- 5.65 vs. 23.02 +/- 4.61 micro /ml; P = 0.04) loading were significantly higher in patients with stent restenosis than in patients without stent restenosis. Insulin area and insulin area/glucose area were also significantly higher in patients with stent restenosis than in patients without (219.5 +/- 23.8 vs. 118.9 +/- 21.8, P = 0.001, and 0.62 +/- 0.09 vs. 0.33 +/- 0.06, P = 0.001, respectively). By multiple logistic regression analysis, insulin area during oral glucose tolerance test was found to be an independent predictor of stent restenosis (OR = 1.12; 95% CI = 1.01-1.25; P = 0.031). In conclusion, nondiabetic patients with hyperinsulinemia during oral glucose tolerance test have a high risk for restenosis after stent implantation, and performing this simple test before intervention may be useful for the prediction of stent restenosis.