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We present a 73-year-old male patient with an unusual complication of a broken coronary stent catheter during percutaneous coronary angioplasty, which was successfully retrieved by balloon trapping and pulling-back method, along with literature review of similar cases.

Number of transplantations increase every day, and thus anaesthetists encounter patients who were transplanted after transplantation more often. Like liver transplant, immunosuppression and various anaesthetic problems are important for patients after other transplantations, too. This article presents our infraclavicular block experience along with literature in a case with a patient who has Behcet\s disease, an immunosuppressive disease, and was transplanted with a liver. [Cukurova Med J 2014; 39(3.000): 658-661]

Focal cemento-osseous dysplasia (FCOD) is a benign fibro-osseous lesion which changes cancellous bone tissue with each fibrous tissue and cementum-like material, or both together. The teeth that are related to the lesion are vital, and FCOD is generally asymptomatic. FCOD is, usually, found during routine radiographic examination. The etiology and pathogenesis of FCOD are unknown. This lesion is evaluated to be a reactive or a dysplastic process in the periapical tissues. Radiologic images of FCOD change depending on the amount of mineralization. Radiological appearance of FCOD is either only complete radiolocent or only complete radio-opaque or mixed radiolucent, radio-opaque together. In this case report an FCOD is presented, which is located between the first premolar and the second molar on the left side mandible of a 60-year-old female patient. The lesion caused perforation and expansion of alveolar bone. The diagnosis, treatment and 1 year follow-up after surgery are reported.

Patients in intensive care units (ICU) are at increased risk of corneal abrasions and infectious keratitis due to poor eyelid closure, decreased blink reflex, and increased exposure to pathogenic microorganisms. The aim of this retrospective study was to evaluate the ocular surface problems in patients who stayed in ICU more than 7 days and were consulted by an ophthalmologist. There were 26 men and 14 women with a mean age of 40.1 ± 18.15 years (range 17–74 years). Conjunctiva hyperemia, mucopurulent or purulent secretion, corneal staining, and corneal filaments were observed in 56.25%, 36.25%, 15%, and 5% of the eyes, respectively. Keratitis was observed in 4 patients (10%) who were treated successfully with topical antibiotics. Mean Schirmers test results were 7.6 ± 5.7 mm/5 min (median 6.5 mm/5 min) in the right, and 7.9 ± 6.3 mm/5 min (median 7 mm/5 min) in the left eyes. Schirmers test results were

Background and Objectives: In this study, we aimed to investigate the prognostic value of the C-reactive protein to albumin ratio (CAR) for all-cause mortality in patients with chronic heart failure with reduced ejection fraction (HFrEF). Materials and Methods: In total, 404 chronic HFrEF patients were included in this observational and retrospective study. The CAR value of each patient included in this analysis was calculated. We stratified the study population into tertiles (T1, T2, and T3) according to CAR values. The primary outcome of the analysis was to determine all-cause mortality. Results: The median follow-up period in our study was 30 months. In the follow-up, 162 (40%) patients died. The median value of CAR was higher in patients who did not survive during the follow-up [6.7 (IQR = 1.6–20.4) vs. 0.6 (IQR = 0.1–2.6), p < 0.001]. In addition, patients in the T3 tertile (patients with the highest CAR) had a higher rate of all-cause mortality [n = 90 cases (66.2%), p < 0.001]. Multivariate Cox regression analysis revealed that CAR was an independent predictor of mortality in patients with HFrEF (hazard ratio: 1.852, 95% confidence interval: 1.124–2.581, p = 0.005). In a receiver operating characteristic curve analysis, the optimal cut-off value of CAR was >2.78, with a sensitivity of 66.7% and specificity of 76%. Furthermore, older age, elevated N-terminal pro-brain natriuretic peptide levels, and absence of a cardiac device were also independently associated with all-cause death in HFrEF patients after 2.5 years of follow-up. Conclusions: The present study revealed that CAR independently predicts long-term mortality in chronic HFrEF patients. CAR may be used to predict mortality among these patients as a simple and easily obtainable inflammatory marker.

Studies reported conflicting results on the effect of renin-angiotensin-aldosterone system (RAAS) blocker use on acute kidney injury (AKI) in patients undergoing elective coronary angiography but association in elderly patients with ST-elevation myocardial infarction (STEMI) is not known. Also, there are limited data on the effect of inflammatory markers on AKI. We aimed to investigate the effects of RAAS blocker pretreatment and inflammatory markers on AKI in this population. A total of 471 patients were compared according to presence of RAAS blocker pretreatment at admission. Conventional and inverse probability weighed conditional logistic regression were used to determine independent predictors of AKI. Mean age of the study group was 75.4 ± 7.1 years and 29.1% of the patients were female. AKI was observed in 17.2% of the study population. Weighted conditional multivariable logistic regression analysis revealed that AKI was associated with baseline creatinine levels and C-reactive protein/albumin ratio (CAR) (OR 2.08, 95% CI = 1.13–3.82, p = .02 and OR 1.19, 95% CI = 1.01–1.41, p = .04, respectively). No significant association was found between RAAS blocker pretreatment and AKI. CAR and elevated baseline creatinine levels were independent predictors of AKI in this patient group.

Objectives:Right heart catheterization (RHC) is a gold standard method for diagnosis, also monitors the level of the disease, the prognosis, and the response to the therapy in patients with pulmonary arterial hypertension (PAH). Cardiac power output (CPO) is the product of flow and pressure. Aim of this study was to evaluate right ventricular cardiac power output (RVCPO) in PAH patients as a prognostic factor. Materials and methods: Demographic characteristics, functional class, RHC findings, echocardiographic data, PAH-specific medical treatment usage of 105 treatment-naïve, newly diagnosed Group 1 PAH patients between September 2009 and June 2019 were reviewed. RVCPO (Watt) was calculated as a product of cardiac output (CO) and mean pulmonary artery pressure (mPAP), divided by a constant of 451. Results: RVCPO was lower in high-risk patients (0,25 ± 0,02 W for high risk, 0,42 ± 0,15 W for low risk, and 0,44 ± 0,10 W for intermediate-risk; p=0.04) in comparison with low and intermediate-risk patients. RVCPO showed very high correlation with mPAP while a low positive correlation with CO, and PVR. 0,44 W for RVCPO was found the most accurate predictor value for mortality in low and intermediate-risk patients by ROC analysis. Conclusion: RVCPO could be a promising hemodynamic parameter that represents cardiac pumping ability with PAH patients. RVCPO tends to increase with low and intermediate risk while decrease with high-risk and associated with mortality above 0,44 W with low and intermediate-risk patients. We suggest that RVCPO could be a beneficial hemodynamic tool to discriminate the patients at-risk among the low and intermediate-risk groups.

Introduction:To explore the prognostic importance for admission of C-reactive protein (CRP)/albumin ratio (CAR) in elderly patients aged 80 years over who presented with non-ST elevation myocardial infarction (non-STEMI).Methods:This retrospective, observational research was related to the clinical data of 528 elderly non-STEMI patients. The study population was categorized based on CAR tertiles as T1, T2, and T3 groups. The CAR was obtained by dividing CRP to albumin level. The main outcome of the research was the in-hospital mortality.Results:The in-hospital mortality rate during index hospitalization was 5% (n=27 patients). Cases included in the T3 tertile had significantly higher incidence of cardiopulmonary arrest, cardiac mortality, and all-cause mortality during the index hospitalization [(15% vs 4% vs 0.5%), (10% vs 1% vs 0%), and (13% vs 2% vs 0%), respectively, p1 on admission, revascularization, and CAR (odds ratio: 1.47, 95% confidence intervals: 1.23-1.75, p1.12 predicted in-hospital mortality with a sensitivity of 85% and specificity of 77% (area under the curve: 0.813, p

Objective: In a subgroup of patients with inferior myocardial infarction (MI), both the right coronary artery (RCA) and circumflex coronary artery (Cx) show potentially culprit lesions, and angiography may be insufficient to determine which artery is responsible for the clinical presentation. Although many electrocardiographic (ECG) algorithms have been proposed for identifying the infarct-related artery in patients with inferior MI, it is unclear whether the current algorithms have the discriminative power to identify the real culprit artery in these patients. Methods: The patients with the diagnosis of acute inferior MI and underwent coronary angiography were enrolled in the study. The prediction of the infarct-related artery was attempted from the admission ECG using published algorithms and criteria. For the angiographic definition of the infarct-related artery, multiple criteria were used. Results: Total 417 inferior MI cases were enrolled during the study period; the final patient population comprised of 318 patients. Forty-five patients (14.2%) had both RCA and Cx lesions on coronary angiography. Although several criteria and algorithms are able to identify the infarct-related artery in the general inferior MI population, they lose their strength in patients with both RCA and Cx lesions. Only the Aslanger-Bozbeyoğlu criterion emerges as a more powerful diagnostic test with a sensitivity, specificity, and c-statistic of 80%, 48%, and 0.650, respectively for the whole population (p

Objective: The aim of this study was to investigate the prognostic value of the serum vitamin D (Vit-D) level on admission in patients with acute pulmonary embolism (APE) to determine in-hospital mortality. Methods: Ninety-nine patients who were diagnosed with APE between January 2015 and January 2018 and had a record of an admission serum Vit-D level were enrolled in the study. The serum Vit-D level was measured using an immune-based assay in all cases. The primary outcome of the study was in-hospital all-cause mortality. Results: The study population was divided into 2 groups according to the median value of serum Vit-D level: Vit-D level ≤7.36 ng/mL in 49 patients and Vit-D level >7.36 ng/mL in 50 patients. The patients with a serum Vit-D level ≤7.36 ng/mL had a higher of incidence of in-hospital death compared with those whose serum Vit-D level was >7.36 ng/mL (6 [12.2%] vs. 1 [2%]; p=0.048). In Cox regression analysis, the serum Vit-D level (Hazard ratio: 0.82, 95% confidence interval: 0.68-0.98; p=0.043) was found to be independently associated with in-hospital mortality. The optimal value of serum Vit-D level for the prediction of in-hospital mortality was ≤6.47 ng/mL, with a sensitivity of 71.4% and a specificity 86.9% (area under the curve: 0.81, 95% CI: 0.72–0.88; p=0.004). Conclusion: The findings demonstrated that the serum Vit-D level on admission may be an independent predictor for in-hospital mortality in patients with APE.

Objective: Certain bleeding risk scores have been proposed to predict major bleeding (MB) events in patients with acute pulmonary embolism (APE) during anticoagulation therapy. Since patients who undergo thrombolytic treatment are usually excluded from such studies, it is unknown whether these scores may provide an adequate prognostic value for in-hospital major MB. Consequently, we evaluated some well-known bleeding scores to predict in-hospital MB in patients with APE who were treated with thrombolytic therapy. Materials and Methods: A total of 99 consecutive patients with APE who underwent thrombolytic therapy from June 2011 to August 2015 were included in the retrospective study. For each patient, we estimated the bleeding risk using the Kuijer, Riete, Atria, Has-Bled, and PRECISE-DAPT scores. Results: In total, 22 MB events occurred in 99 (19%) patients following admission. A receiver operating characteristic curve analysis showed that the PRECISE-DAPT score might have an adequate prognostic value for MB (area under curve [AUC] value, 0.770). Meanwhile, the other abovementioned risk scores had poor predictive values (AUC values, 0.612–0.658) for MB. Conclusion: Despite being developed and validated to determine MB in patients receiving dual antiplatelet treatment, the PRECISE-DAPT score may be useful in estimating the risk of MB in patients with APE who underwent thrombolytic therapy.

Background: Atrial fibrillation (AF) is associated with increased morbidity in myocardial infarction (MI), especially thromboembolic risk increases. The PRECISE-DAPT (The PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti-Platelet Therapy) score was created to predict the bleeding risk of dual antiplatelet therapy. The purpose of this study was to evaluate the association between new-onset AF and the PRECISE-DAPT score in ST-segment-elevation myocardial infarction (STEMI). Methods: This retrospective study enrolled patients who developed STEMI within 12 hours of the onset of symptoms and underwent primary percutaneous coronary intervention. The study population was divided into 2 groups of PRECISE-DAPT scores of 25 or greater and PRECISE-DAPT scores of below 25 and their baseline characteristics, as well as laboratory and echocardiography results, were compared. In-hospital new AF and related events were compared between the 2 PRECISE-DAPT score groups. Results: From February 2015 to December 2017, this study enrolled 2234 patients with STEMI at a mean age of 54.4 years. The new-onset AF incidence rate was higher in the higher PRECISE-DAPT group than in the lower PRECISE-DAPT group (62 [28.7 %] vs 58 [2.9%]; P

Background: High-intensity statin (HIS) therapy is widely recommended for secondary prevention after an acute myocardial infarction (AMI). The 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidemia guidelines have lowered the target low-density lipoprotein cholesterol (LDL-C) level, which necessitates a more frequent use of nonstatin therapies. Objectives: The objectives of the study were to investigate the rate of LDL-C target attainment for secondary prevention in AMI patients. Methods: This retrospective investigation included 1360 patients diagnosed with AMI in a tertiary heart center. Lipid parameters were collected within 24 h of admission and within 1 year after discharge. The medications used were retrieved from medical records, and the lowest LDL-C levels after statin treatment were used to assess the effectiveness of the therapy. LDL-C target attainment was defined according to the 2016 ESC/EAS dyslipidemia guidelines as an LDL-C level of < 70 mg/dL and a ≥ 50% reduction from baseline. In addition, the rate of LDL-C target attainment according to the 2019 ESC/EAS guidelines was defined as an LDL-C level of < 55 mg/dL and a ≥ 50% reduction from baseline. Results: In total, 502 (36.9%) and 247 (18.2%) patients reached the LDL-C targets according to the 2016 and 2019 ESC/EAS guidelines, respectively. The admission LDL-C levels were significantly lower and HIS treatment was used more frequently in patients who subsequently attained the LDL-C goal. Remarkably, 461 (34%) patients failed to reach the LDL-C goals despite HIS treatment. Only 27 (1.9%) patients were prescribed ezetimibe. Conclusion: The rate of LDL-C goal attainment in AMI patients was low, which indicates the need for combination statin and non-statin lipid-lowering therapies.

Background: Although ST-segment elevation (STE) has been used synonymously with acute coronary occlusion (ACO), current STE criteria miss nearly one-third of ACO and result in a substantial amount of false catheterization laboratory activations. As many other electrocardiographic (ECG) findings can reliably indicate ACO, we sought whether a new ACO/non-ACO myocardial infarction (MI) paradigm would result in better identification of the patients who need acute reperfusion therapy. Methods: A total of 3000 patients were enrolled in STEMI, non-STEMI and control groups. All ECGs were reviewed by two cardiologists, blinded to any outcomes, for the current STEMI criteria and other subtle signs. A combined ACO endpoint was composed of peak troponin level, troponin rise within the first 24 h and angiographic appearance. The dead or alive status was checked from hospital records and from the electronic national database. Results: In non-STEMI group, 28.2% of the patients were re-classified by the ECG reviewers as having ACO. This subgroup had a higher frequency of ACO, myocardial damage, and both in-hospital and long-term mortality compared to non-STEMI group. A prospective ACOMI/non-ACOMI approach to the ECG had superior diagnostic accuracy compared to the STE/non-STEMI approach in the prediction of ACO and long-term mortality. In Cox-regression analysis early intervention in patients with non-ACO-predicting ECGs was associated with a higher long-term mortality. Conclusions: We believe that it is time for a new paradigm shift from the STEMI/non-STEMI to the ACOMI/non-ACOMI in the acute management of MI. (DIFOCCULT study; ClinicalTrials.gov number, NCT04022668.)

Düşük yoğunluk değerine, yüksek ısı ve korozyon direncine sahip olan polipropilen gittikçe yapı malzemeleri sektörü için daha cazip hale gelmektedir. Bununla birlikte polipropilenin tek başına kullanımı yapı malzemesinin mekanik dayanımını düşürmesi bakımından bazı dezavantajlar içerir. Polipropilenin yapı malzemeleri içerisindeki uygulamalarında bu dezavantajın ortadan kaldırılması için polipropilen kompozitleri tercih edilmektedir. Bu çalışmada, CaCO3 takviyeli polipropilen içeren betonun tanımlanan kalite ölçütleri sırası ile termal iletkenlik, elektrik direnci, 3, 7, 28 gün basınç dayanımları, 28 günlük yarmada çekme dayanımı ve su emme oranı olarak belirlenmiştir. Deneylerde ince agrega yerine %0, %10, %20, %30 ve %40 oranlarında CaCO3 takviyeli polipropilen kullanılmıştır. Dolgulu CaCO3/PP takviyeli beton özellikleri kontrol betonu ile kıyaslandığında %34.5 daha düşük 28 günlük basınç dayanımına, %24.7 oranında daha düşük termal iletkenliğe, %50.7 daha yüksek elektrik direncine sahiptir.

Düşük yoğunluk değerine, yüksek ısı ve korozyon direncine sahip olan polipropilen gittikçe yapı malzemeleri sektörü için daha cazip hale gelmektedir. Bununla birlikte polipropilenin tek başına kullanımı yapı malzemesinin mekanik dayanımını düşürmesi bakımından bazı dezavantajlar içerir. Polipropilenin yapı malzemeleri içerisindeki uygulamalarında bu dezavantajın ortadan kaldırılması için polipropilen kompozitleri tercih edilmektedir. Bu çalışmada, CaCO3 takviyeli polipropilen içeren betonun tanımlanan kalite ölçütleri sırası ile termal iletkenlik, elektrik direnci, 3, 7, 28 gün basınç dayanımları, 28 günlük yarmada çekme dayanımı ve su emme oranı olarak belirlenmiştir. Deneylerde ince agrega yerine %0, %10, %20, %30 ve %40 oranlarında CaCO3 takviyeli polipropilen kullanılmıştır. Dolgulu CaCO3/PP takviyeli beton özellikleri kontrol betonu ile kıyaslandığında %34.5 daha düşük 28 günlük basınç dayanımına, %24.7 oranında daha düşük termal iletkenliğe, %50.7 daha yüksek elektrik direncine sahiptir.

This paper proposes a Response Surface Methodology (RSM) based Genetic Algorithm (GA) using MATLAB® to assess and optimize the thermal and fluidity of high strength concrete (HSC). The overall heat transfer coefficient, slump-spread flow and T50 time was defined as thermal and fluidity properties of high strength concrete. In addition to above mentioned properties, a 28-day compressive strength of HSC was also determined. Water to binder ratio, fine aggregate to total aggregate ratio and the percentage of super-plasticizer content was determined as effective factors on thermal and fluidity properties of HSC. GA based multi-objective optimization method was carried out by obtaining quadratic models using RSM. Having excessive or low ratio of water to binder provides lower overall heat transfer coefficient. Moreover, T50 time of high strength concrete decreased with the increasing of water to binder ratio and the percentage of superplasticizer content. Results show that RSM based GA is effective in determining optimal mixture ratios of HSC.

Objective: The aims of the present study were to examine, first, overall mortality in the Turkish Adult Risk Factor (TARF) 2015 survey, and second, distribution of cumulative mortality and temporal losses to follow-up in the 7 geographic regions of Turkey over 25 years. Methods: Information on mode of death was obtained from first-degree relatives and/or primary health center personnel. Information regarding survivors was based on history, examination of the cardiovascular system, and Minnesota coding of electrocardiograms. Results: Of the 1304 participants to be screened, 58 were lost to follow-up, 787 were examined, and 39 participants had died. In 420 subjects, verbal reporting alone was used to determine health status. Deaths were attributed to coronary heart disease in 16 subjects, and cerebrovascular event and cancer in 8 cases each. However, evidence suggested underlying autoimmune activation in 85% of cases. Cumulative 25-year assessment of the entire cohort, comprising 863 deaths over a mean follow-up of 20.5 years, corresponded to a rate of 11.4 per 1000 person-years. A significantly lower mortality rate was found in the Southeast. The 1992 participants lost to follow-up represented a rate of 22.5 per 1000 person-years. Conclusion: The generally high overall mortality in Turkey is similar among geographic regions, with the exception of a lower rate in Southeastern Anatolia. One of every 45 surviving participants is lost to follow-up each year.

Organ nakil sayıları her geçen gün artmakta olup bu durum anestezistlerin nakil olan hastalar ile nakil sonrası daha sık karşılaşmasına neden olmaktadır. Karaciğer naklinde olduğu şekilde diğer nakiller sonrasında da immünsüpresyon ve çeşitli anestezik problemler hastalar için önem taşımaktadır. Bu makalede immünsüpresif bir hastalık olan Behçet hastalığı ve karaciğer nakli olmuş bir olguda infraklaviküler blok deneyimimiz literatür eşliğinde sunulmuştur.

In this study, a fuzzy multi-response standard ready-mixed concrete (SRMC) optimization problem is addressed. This problem includes two conflicting quality optimization objectives. One of these objectives is to minimize the production cost. The other objective is to assign the optimal parameter set of SRMC’s ingredient to each activity. To solve this problem, a hybrid fuzzy multi-response optimization and artificial neural network (ANN) algorithm is developed. The ANN algorithm is integrated into the multi-response SRMC optimization framework to predict and improve the quality of SRMC. The results show that fuzzy multi-response optimization model is more effective than crisp multi-response optimization model according to final production cost. However, the ANN model also gave more accurate results than the fuzzy model considering the regression analysis results.

ABSTRACT BACKGROUND: Bispectral index (BIS) monitoring can positively affect cognitive performance through decreasing the use of sedative agents. We aimed to evaluate the effect of BIS monitoring on early cognitive performance among patients undergoing sedation for colonoscopy. DESIGN AND SETTING: Randomized, controlled trial in a university hospital. METHODS: 100 patients were randomized into two groups. In the monitored group (n = 50), the depth of anesthesia was monitored using the BIS, and BIS scores were maintained between 60 and 80. In the usual care group (n = 50), BIS monitoring was not performed. To determine the patients’ baseline cognitive performance levels, the mini-mental state examination (MMSE), Trieger dot test (TDT) and clock drawing test (CDT) were used. The patients’ post-procedure cognitive performance levels were determined when they were classified as ready for discharge. RESULTS: The total volume (mg) of propofol used [median (range) IQR] in the sedation procedure was lower in the monitored group [100 (50-200) 100-140] than in the usual care group [150 (75-200) 100-200] (P < 0.001). The discharge scores [mean (SD)] using MMSE and CDT were higher in the monitored group [26 (3) and 3 (1), respectively] than in the usual care group [23 (3) and 2 (1), respectively] (P = 0.002 and P = 0.002, respectively). The discharge scores using TDT [mean (SD)] were lower in the monitored group [11 (7)] than in the usual care group [15 (11)] (P = 0.033). CONCLUSION: BIS monitoring among sedated patients was associated with lower propofol use and smaller decline in cognitive performance. CLINICAL TRIAL REGISTRATION: This trial was registered in the Australian New Zealand Clinical Trial Registry (ACTRN12617000134325).