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SARS-COV-2 virus that causes COVID-19 binds to the host cell with angiotensin converting enzyme-2 causing acute respiratory distress syndrome (ARDS) and severe mortality and morbidity. There are studies in the literature conducted on the importance of serum angiotensin converting enzyme (ACE) and ACE-2 enzymes in ARDS pathogenesis. Serum ACE levels are higher in children and adolescents than in adults, and COVID-19 has a milder progression. All these reasons suggest that there may be a relationship between serum ACE levels and COVID-19 prognosis.The serum ACE levels were determined at the time of hospitalization due to COVID-19 diagnosis in this single-centered, prospective study. According to discharge status, patients were divided into three groups as "Discharge with Healing", "Intensive Care Need" and "Mortality", and the effect of serum ACE levels on disease prognosis was investigated.The present study comprised a total of 103 patients, of whom 42.7% (n = 44) were female, and 57.3% (n = 59) were male. The mean age was 59.48 ± 16.47; 91.3% (n = 94) of them were discharged with healing, 5.8% (n = 6) needed intensive care, and 2.9% (n = 3) resulted in mortality. No differences were detected in terms of serum ACE levels between the groups.No relationships were detected between serum ACE levels at the time of hospitalization and COVID-19 prognosis.

Introduction. Usage of the Perclose ProGlide® (PP: Abbott Laboratories, Chicago, IL, USA) closure device is becoming increasingly prevalent during percutaneous endovascular aortic repair (EVAR) and transcatheter aortic valve implantation (TAVI). The respective conditions treated via these procedures, abdominal aortic aneurysm and aortic valve stenosis, share risk factors but are two different physiopathological problems. Aim. Our aim was to compare the complication and success rates of PP closure device use in patients undergoing EVAR and TAVI. Materials and Methods. A total of 74 patients, including 58 undergoing TAVI and 16 undergoing EVAR, were analysed in our study. Results. Of the TAVI patients treated using the PP closure device, two (3.4%) had access to site-related bleeding complications and two (3.4%) experienced device failure. Of the EVAR patients who received the PP closure device, three (18.8%) had bleeding complications and three (18.8%) experienced device failure. Conclusion. Due to the underlying diffuse aortic wall pathology, the success rate of PP closure device use was lower and the complication rate of PP closure device was higher in the EVAR group versus the TAVI group.

Subclinical hypothyroidism is the most common thyroid dysfunction in the general population. The relationship between overt thyroid dysfunction and hypertension is generally understood. Besides high blood pressure, non-dipper hypertension is known to increase cardiovascular risk. Our aim is to investigate daily blood pressure changes and the frequency of non-dipping patterns in patients with subclinical hypothyroidism.Forty-nine patients without hypertension with subclinical hypothyroidism were compared with 50 healthy sex- and age-matched controls using ambulatory blood pressure monitoring.Thyroid-stimulating hormone (TSH) levels were significantly higher in the subclinic hypothyroidism group, and there was no difference between free triiodothyronine (FT3) and free thyroxine (FT4) levels which could be predicted as a result of the study design. Levels of mean diastolic, daytime diastolic, nighttime diastolic and nighttime systolic blood pressure were significantly higher in the subclinic hypothyroidism group (p = 0.001 for mean, daytime and nighttime diastolic and p = 0.01 for nighttime systolic). Diastolic non-dipping occurred more frequently in the subclinic hypothyroidism group [subclinical hypothyroidism group 24 patients (49%), control group 13 patients (26%), p = 0.01]. On multivariate analysis, subclinical hypothyroidism was independently associated with diastolic non-dipping (95% confidence interval 1.162-8.053, odds ratio 1.182, p = 0.024).Our study found that both the frequency of diastolic non-dipping pattern and diastolic blood pressure increase with subclinical hypothyroidism. Therfore, it would appear that searching for non-dipping pattern can add valuable information for patients with subclinical hypothyroidism.

Myocardial injury after non-cardiac surgery (MINS) is closely related to increased cardiovascular mortality.To evaluate the relationship between MINS and interarm systolic blood pressure difference (IASBPD), which has previously been shown to correlate with the frequency of cardiovascular events and arterial arteriosclerotic processes.This observational, single-centre cohort study included 240 consecutive noncardiac surgery patients aged ≥ 45 years. Simultaneous blood pressure recordings were taken preoperatively and IASBPD was calculated. Patients' electrocardiography recordings and high sensitivity cardiac troponin T (hscTnT) levels were obtained for a period of three days postoperatively.Postoperatively, 27 (11.3%) patients were found to have MINS when hscTnT ≥ 14 ng/L was taken as a cut-off value. IASBPD10 mm Hg was found in 44 (18.3%) patients. When IASBPD was accepted to be a continuous variable, there was a higher IASBPD value in the MINS group (9.4 ± 5.0 vs. 4.5 ± 3.8, p0.000). When patients were grouped as those having IASBPD10 mm Hg and those not, exaggerate IASBPD was found to be more frequent in patients developing MINS (16 [59.3%] vs. 28 [13.1%], respectively, p0.000). Multiple logistic regression analysis found IASBPD10 mm Hg to be independently associated with the development of MINS (OR: 30.82; CI: 9.14-103.98; p0.000). Receiver operating char-acteristic curve analysis showed that the optimal IASBPD cut-off value for predicting MINS was 11.5 mm Hg, with a sensitivity of 61.0% and specificity of 89.1% (AUC = 0.79; 95% CI 0.71-0.87).Increased IASBPD is closely related to development of MINS. The preoperative measurement of blood pressure from both arms may be an important and easy to use clinical tool in determining cardiovascular risk.

We herein report the case of a preeclampsia patient with comorbid peripartum cardiomyopathy (PPCMP). A 22-year-old woman in the 26th week of gestation was admitted with acute pulmonary edema. Hypertension and proteinuria were detected, and echocardiography showed an ejection fraction of 33%. It is remarkable that PPCMP particularly that associated with preeclampsia was observed in the early gestational period. In conclusion, while dyspnea and pretibial edema are often noted during normal pregnancies, the potential for PPCMP should be considered if these symptoms are excessive and/or comorbid paroxysmal nocturnal dyspnea and orthopnea are present, even in patients with preeclampsia.

The use of conducted electrical weapons (CEWs) by legal security forces and in civil society is rapidly increasing. While they are generally considered safe devices, and fatal complications are rare, it is possible to see a small number of complications. In the present case, we describe the detection of acute inferior myocardial infarction in a patient who experienced chest pain after being exposed to a CEW. In such cases, multiple factors should be considered, and the choice of treatment and follow-up should be decided accordingly.

The improvement of health care service has a great effect on patient satisfaction. During the service delivery, the health care organization attempts to answer the reasonable expectations of patients. The expectations relate to many service dimensions, among them the phone system, appointment availability and waiting times. The research questions of this study are: can the implementation of quality initiatives improve patient satisfaction with the phone system, appointment availability and waiting times and do patients from diverse cultural backgrounds exhibit different levels of satisfaction? The study was undertaken in a public clinic, with a culturally diverse clientele, including 194 patients. The authors use a combination of the longitudinal and cross-sectional research design to test the propositional model. The findings show that the implementation of the quality initiative significantly improved patient satisfaction with the appointment availability and waiting time. On the other hand, the implementation of the quality initiative did not improve patient satisfaction with the phone system. Some culturally diverse patients exhibited different levels of expectations of the care provider and quality in terms of patient satisfaction with the appointment availability.

The rate of technological advances over the past five to ten years has resulted in shortened product life cycles, making it necessary to engage in a continuous and rapid introduction of new products. The ability to anticipate and respond to market pressures makes the timely introduction of new products a crucial competency within many industries. While technological advances have driven the need for a reduced time to market, they also have provided tools to aid in the reduction of product development cycle time. This paper examines how the use of the Internet and Intranet in the new product introduction process can reduce time to market by facilitating increased levels of communication within a company and between a company and its customers, based on literature searches as well as interviews.

Although many practitioners believe there is value in total quality management (TQM) initiatives, it sounds fair to demand empirical evidence of its positive role in improving patient satisfaction in the health care industry. The authors study found evidence that TQM made a difference in improving patient satisfaction in a US government clinic.