Trace metals and 210Po (210Pb) concentrations in mussels (Mytilus galloprovincialis) consumed at western Anatolia.

The mussels (Mytilus galloprovincialis) have been evaluated for their bioavailability as biomonitors of trace and toxic elements in coastal water of western Anatolia. The levels of Fe, Cu, Zn, Pb, Br and Sr in the edible part of mussels were determined using X-ray fluorescence method during the period of September 1999-July 2000. Distribution of 210Po and 210Pb activities were measured by radiometric methods and their ratios were calculated. The activity concentrations of 210Po and 210Pb were found to vary between 52 +/- 6-1,344 +/- 108 and 6 +/- 2-167 +/- 10 Bqkg(-1) dry wt, respectively. The highest values for 210Po and 210Pb were measured in Foca mussels and also observed the highest Fe, Zn and Br concentrations in the same species. 210Po/210Pb activity ratio were derived as between 3.1 and 25.0.     

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

Background

Invasive pulmonary aspergillosis (IPA) is an infection often occurring in neutropenic patients and has high mortality rates. In recent years, it has been reported that the incidence of IPA has also increased in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study is to investigate the clinical and demographic characteristics and treatment responses of IPA in patients with COPD.

Methods

Seventy-one patients with a positive culture of Aspergillus from lower respiratory tract samples were examined retrospectively. Eleven (15.4%) of these patients, affected with grade 3 or 4 COPD, had IPA.

Results

Aspergillus hyphae were detected in lung biopsy in three (27.3%) out of 11 patients and defined as proven IPA; a pathological sample was not taken in the other eight (72.7%) patients, and these were defined as probable IPA. Aspergillus isolates were identified as six cases of Aspergillusfumigatus and three of Aspergillusniger in nine patients, while two isolates were not identified at species level. While five patients required intensive care unit admission, four of them received mechanical ventilation. The most common finding on chest X-ray and computed tomography (CT) (respectively 63.6%, 72.7%) was infiltration. Amphotericin B was the initial drug of choice in all patients and five patients were discharged with oral voriconazole after amphotericin B therapy. Six patients (54.5%) died before treatment was completed.

Conclusions

IPA should be taken into account in the differential diagnosis particularly in patients with severe and very severe COPD presenting with dyspnea exacerbation, poor clinical status, and a new pulmonary infiltrate under treatment with broad-spectrum antibiotics and steroids.

     

Combined risk stratification with computerized tomography /echocardiography and biomarkers in patients with normotensive pulmonary embolism

Background

Right ventricular dysfunction (RVD) detected by computerized tomography (CT)/echocardiography or elevated biomarkers is associated with a poor prognosis for pulmonary embolism (PE). However, these prognostic factors have not previously been concomitantly elucidated in the same patient group.

Methods

This prospective study included 108 consecutive patients with normotensive PE confirmed by CT pulmonary angiography (CTPA). On admission, patient serum NT-proBNP and troponin T (Tn-T) levels were measured, and echocardiography was performed within 24 hours after diagnosis of PE. Receiver operating characteristic (ROC) analysis was performed to determine the optimal echocardiographic end-diastolic diameters of the right ventricle, the ratio of the right ventricle to left ventricle (RV/LV ratio) on CTPA, and NT-proBNP and Tn-T cut-off levels with regard to prognosis.

Results

All-cause 30-day mortality was 13% and PE-related mortality was 5.6%. RVD was defined as a right/left ventricular dimension ratio ≥ 1.1 on CTPA and RV > 30 mm on echocardiography by ROC analysis. A cut-off level of NT-proBNP ≤ 90 pmol/ml had a high positive predictive value of 98% for survival, whereas NT-proBNP > 300 and Tn-T ≥ 0.027 had a negative predictive value, for all-cause deaths, of 95% and 96%, respectively. PE mortality in patients with NT-proBNP > 300 and Tn-T ≥ 0.027 reached 64%. In univariable analysis, the combination of Tn-T ≥ 0.027 ng/ml with a echocardiographic RVD were the most significant predictors of overall mortality and PE-related death [HR: 14 (95% CI: 4.6–42,) and HR: 37.6 (95% CI: 4.4–324)], respectively. In multivariable Cox's regression analysis, NT-proBNP > 300 and Tn-T ≥ 0.027 HR: 26.5 (95% CI: 4.1-169.9, p < 0.001) were the best combination to predict all-cause of mortality.

Conclusions

The combination of NT-proBNP and Tn-T clearly appears to be a better risk stratification predictor than biomarkers plus RVD on CT/ echocardiography in patients with normotensive PE.     

A rare cause of hemoptysis: factitious disorder

Hemoptysis is an important symptom that requires broad evaluation, including invasive procedures. Nevertheless, in a considerable number of patients, the cause of hemoptysis may not be adequately determined despite extensive investigations. Factitious hemoptysis is a manifiestation of Munchausen syndrome that describes a group of patients who intentionally produce or feign symptoms or disabilities. Although the disorder is rare, it is believed to be under recognized and under reported. Therefore, there is an urgent need for increased awareness of the disease in order to avoid unnecessary, expensive and sometimes dangerous medical treatment and manipulations. We report a case of Munchausen hemoptysis as a reminder that factitious origins should be added in the differential diagnosis of hemoptysis of unclear etiology.     

The evaluation of antimuscarinic-induced convulsions in fasted rats after food intake

The present study was performed to evaluate convulsions after food intake in fasted rats pretreated with scopolamine or atropine and to determine whether these convulsions respond to drugs found effective in fasted mice. Scopolamine (2.4 mg/kg) and atropine (2.4 mg/kg) were given intraperitoneally (i.p.) to rats fasted for 52h. Both drugs induced convulsions after animals were allowed to eat ad lib. Another group of fasted rats pretreated with saline, MK-801 (0.1mg/kg), clonidine (0.1mg/kg), chlorpromazine (2 and 4 mg/kg), valproate (200mg/kg), diazepam (1.5 and 2mg/kg) or gabapentin (50mg/kg) were treated i.p. with saline or scopolamine (2.4 mg/kg) and were allowed to eat ad lib. Clonidine, MK-801, chlorpromazine (4 mg/kg) and diazepam (2 mg/kg) reduced the incidence of scopolamine-induced convulsions in fasted rats. Gabapentin could only prolong the onset of convulsions. Neither treatment was effective against myoclonus of hindlimbs. Present results showed that fasted rats also develop antimuscarinic-induced convulsions which do not completely respond to treatments found effective in convulsions of fasted mice.     

Effects of passive smoking on lung function in children

BACKGROUND: Passive smoking can have significant effects on lung function with reductions in forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and forced mid-expiratory flow rate (FEF25-75%) of between 5 and 10%. METHODS: Fifty non-smoking children aged 6-15 years, who had no history of asthma or atopy and no parental history of atopy, were assessed with respect to their lung functions (FEV1, FEV1/FVC, FEF25-75%). RESULTS: Thirty-three of these children were being exposed to environmental tobacco smoke inside their homes, while 17 children were not exposed. In the 'passive smoker' group the FEV1, FEV1/FVC and FEF25-75% values were found to be significantly lower than the non-smoker control group's values (P = 0.0080, 0.0228 and 0.0003, respectively). The decrease in FEF25-75% was significantly correlated inversely with the number of cigarettes smoked per day (P = 0.0261). CONCLUSION: There is sufficient evidence to support the notion that environmental tobacco smoke is a serious health burden for children. Considering that recent studies suggest that up to 70% of children grow up in homes with at least one smoker, every effort should be made to reduce these children's exposure to environmental tobacco smoke and to give them a chance to grow up in a more healthy environment.     

Increased intestinal permeability as a cause of fluctuating postprandial blood glucose levels in Type 1 diabetic patients

BACKGROUND: In diabetic patients, postprandial glucose levels, which have a major impact on metabolic control, are determined by the rate of nutrient delivery into the intestine, absorption of nutrients from the small intestine, and the metabolism of the absorbed nutrients by the liver. The present study addresses whether Type 1 diabetic patients have increased intestinal permeability and intestinal permeability predicts postprandial glucose variability. MATERIAL AND METHODS: Thirty Type 1 diabetic patients together with 15 sex- and age-matched healthy controls were enrolled in the study. After an overnight fasting all patients and controls received 100 micro Ci 51Cr of EDTA as a radioactive tracer and the percentage of the isotope excreted in a 24-h urinary specimen was the permeability measure. Instant blood glucose was measured just before the test, and the patients performed and recorded self-monitoring of fasting and 2nd-hour postprandial blood glucose levels during the following week. RESULTS: We found that intestinal permeability is increased in Type 1 diabetic patients compared with age- and sex-matched healthy controls. Increased intestinal permeability is related at least in part to the instant blood glucose level and the presence of diabetic autonomic neuropathy. CONCLUSION: Increased intestinal permeability leads to higher variation in postprandial blood glucose levels, thereby worsening metabolic control.     

Comparison of right ventricular functions by tissue Doppler imaging in patients with obstructive sleep apnea syndrome with or without hypertension

Objective To evaluate the right ventricular function in patients with obstructive sleep apnea syndrome (OSAS) independent from systemic hypertension (HT) and to determine the association between OSAS severity and right ventricular dysfunction. Methods The study population included 77 consecutive subjects; 20 of these patients had OSAS, 20 of them had HT, but did not have OSAS, 16 patients, who constituted the study group, had both disorders, and 21 subjects without any of these two disorders represented the control group. Right ventricular function was assessed by echocardiography: standard two-dimensional, M-Mode, and conventional Doppler as well as tissue Doppler imaging. None of the patients had a previous history of cardiac disease. The diagnosis of OSAS was based on an apnea- hipopnea index of 5 or higher in polysomnography. Results Tricuspid inflow velocities and tissue Doppler derived tricuspid annular diastolic velocities were significantly different in the patient groups (OSAS, HT, OSAS + HT) compared to the control group. Tricuspid annular plane systolic excursion (TAPSE) (18.3 ± 3.2, 18.4 ± 2.5, 20.1 ± 2.1, and 20.7 ± 2.5 mm, respectively, P = 0.024) and peak systolic myocardial velocity at tricuspid lateral annulus (S-vel) (12.2 ± 1.5, 10.9 ± 0.9, 11.2 ± 1.1, and 13.1 ± 2.1 cm/s, respectively, P < 0.001) were significantly lower in patient groups compared to those of the study group. Tissue Doppler derived myocardial performance index (MPI) of the right ventricle was significantly impaired in the patient groups compared to the control group (0.34 ± 0.06, 0.44 ± 0.06, 0.45 ± 0.07, and 0.41 ± 0.06, respectively, P < 0.001). With regard to these right ventricular functional parameters, there was no significant difference between OSAS and the other patient groups (HT and OSAS + HT). There were significant correlations both between OSAS severity and the right ventricular functions, and between diastolic and systolic parameters of the right ventricle (r = −0.45, P < 0.05). Conclusion Both right ventricular systolic and diastolic functions are impaired in patients having OSAS with or without HT. Right ventricular MPI was found to be the parameter most closely related with OSAS severity and the right ventricular subclinical dysfunction.     

Mad honey poisoning-related asystole

Mad honey poisoning is well known in the eastern Black Sea region of Turkey. The cause of the poisoning is the toxin grayanotoxin, found in honey obtained from the nectar of Rhododendron species on the mountains in the region. A 60-year-old man was brought to the emergency department with dizziness and syncope after eating a few spoonfuls of honey. While the patient was being treated, bradycardia and asystole developed. The patient was given 0.5 mg of atropine, and asystole began and ended. The patient was transferred to the catheter laboratory and a temporary pacemaker was implanted. Mad honey poisoning related asystole has not been previously reported, and the rapid response to atropine is significant.