Hemorheological changes with strontium ranelate treatment do not seem to be related to its claimed prothrombotic effects

Strontium ranelate is claimed to be related with increased risk of thromboembolic events. No explanation of this increased incidence of thromboembolism has been identified. However, growing evidence has clearly demonstrated the involvement of blood rheology in any thrombotic process. The aim of this study was to assess hemorheological changes with strontium ranelate treatment in elderly women with osteoporosis. This study was designed in a prospective manner. Twenty-two elderly women diagnosed with osteoporosis were included. During a 2-month treatment period, participants received strontium ranelate 2 g/day. Hemorheological parameters including erythrocyte deformability, erythrocyte aggregation and plasma viscosity were measured before and after 2 months therapy with strontium ranelate. The median age of the patients was 70.0 (range = 65-80) years. After 60 days of treatment, there was no statistically significant change in hemorheological parameters. None of the subjects developed clinical venous thromboembolic event (VTE) during the 2-month period of strontium ranelate treatment. Our study demonstrated that in elderly women, treatment of osteoporosis with strontium ranelate did not change hemorheological parameters over 2 months of time. However, its long-term effects on hemorheologic parameters should be evaluated further with a larger sample.     

Coexistence of osteoporosis (OP) and coronary artery disease (CAD) in the elderly: it is not just a by chance event

Cardiovascular disease (CVD) and OP are common age-related conditions. In both cross-sectional and longitudinal epidemiologic studies, low bone mass has been related to increased frequency of CVD. But available data in geriatric population is limited. In this study we aimed to seek the possible relationship between CAD and low bone mineral density (BMD) in a large number of geriatric patients. A total of 2235 patients aged 65 years or more were included in this cross-sectional study. All patients underwent a complete geriatric assessment and evaluated for CAD and cardiovascular risk factors. BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine (L1-L4) and femoral neck. BMD results were classified into three groups; normal (T-score: ≥-1.0×S.D.), osteopenia (T-score between -1.0 and -2.5×S.D.), and OP (T-score: ≤-2.5×S.D.). CAD was present in 397 (29.7%) of 1335 patients with OP, in 199 (27.4%) of 726 patients with osteopenia and in 34 (19.5%) of 174 patients with normal BMD. Multivariate regression analysis revealed that presence of OP or osteopenia increased the prevalence of CAD as an independent correlate (OR=1.643; 95% CI=1.068-2.528, p=0.030). This study highlights the need for careful evaluation of elderly patients with low BMD for possible CAD.     

Hospital acquired infections (HAI) in the elderly: comparison with the younger patients

The aim of this retrospective study is to determine the frequency, type, microbiological characteristics and outcome of HAIs in the elderly (age ≥ 65) and to compare the data with younger patients in a Turkish Training and Research Hospital. From January 2008 to December 2009, the infection control team analyzed HAIs among 60,585 hospitalized patients (20,109 aged ≥ 65 and 40,747 aged between 18 and 64 years) with a total number of 419,017 patient days. A total of 825 HAIs episodes were detected in 607 patients, of which 395 episodes were in 301 elderly patients. The incidence of HAIs per 1000 patient days was 2.49 in the elderly and 1.64 in the younger patients’ group (p < 0.001). The most common site of infection in the elderly patients was the urinary tract, whereas in non-elderly group this was the lower respiratory tract. The incidence density of urinary tract infections, respiratory tract infections, surgical site, skin and soft tissue infections, primary bacteremia, and prosthesis infections were significantly higher in the elderly group (p < 0.05). Gram-negative species were the most frequently isolated agents in both groups. There were no significant differences between the groups in the frequency of isolated pathogens or antibiotic susceptibility patterns. Overall, the fatality rate was found 16.8%. The elderly patients were more likely to have crude mortality rates (22% vs. 12%; p < 0.01). The death was most often related to pneumonia, primary bacteremia or intravascular catheter infections in both groups.     

Agreement of keratometric readings measured using rotating Scheimpflug imaging,auto-refractokeratometer,and biograph in eyes with keratoconus

International Ophthalmology - To determine agreement in keratometric readings obtained using rotating Scheimpflug imaging with Pentacam, biograph with Lenstar LS900, and Topcon KR-8100P...     

Ultrasonographic Maturation of Native Arteriovenous Fistulae: A Follow-Up Study

Background/aims. Ideal time needed for arteriovenous fistula (AVF) maturation is still controversial. In this study, we aimed to investigate the natural course of AVF maturation and also investigated the factors affecting AVF maturation. Methods. We studied 31 (21M/10F, mean age 55.8 ± 16.2) chronic renal failure patients. We evaluated the patients with color Doppler ultrasound examination before the fistula operation, at the first day, and at the first, second, third, and sixth months. Radial artery (RA) diameter, flow velocity, flow, resistance index, fistula vein diameter, flow velocity, and flow were measured. Results. Patency rates at the first post-operative day and the sixth month were 87.1% and 67.1%, respectively. Cephalic vein flow was 451.2 ± 248.6 mL/min at the first month and 528.6 ± 316.5 mL/min at the sixth month. Baseline RA diameter was lower in failing fistulas than that of patent fistulas. Failing fistulas were more common in women. Conclusion. Blood flow was enough for hemodialysis at the end of the first month. However, fistula maturation had continued until the end of the study; women and patients with low RA diameter are particularly prone to fistula failure. Therefore, especially in these patients, AVF must be created at least three or four months before the predicted hemodialysis initiation time.     

Comparison of carpal tunnel injection techniques: A cadaver study

The purpose of the study was to evaluate the accuracy of injections into the carpal tunnel using three different portals in cadavers, and to define safe guidelines. In this study, 150 wrists of 75 cadavers (54 male, 21 female) were included. To compare three injection sites, 50 wrists of 25 cadavers were used for each technique; we used 23 gauge needles, and acrylic dye. The first injection technique: the needle was inserted 1cm proximal to the wrist crease and directed distally by roughly 45 in an ulnar direction through the flexor carpi radialis tendon. The second injection technique: the needle was inserted into the carpal tunnel from a point just ulnar to the palmaris longus tendon and 1cm proximal to the wrist crease. The third injection technique: the needle was inserted just distal to the distal skin crease of the wrist in line with the fourth ray. The first injection technique gave the highest accuracy rate, and this was also the safest injection site. Median nerve injuries caused by injection was seen mostly with the second technique. Although a steroid injection may provide symptomatic relief in patients with carpal tunnel syndrome, the median nerve and other structures in the carpal tunnel are at risk of injury. Because of that, the injection should be given using the correct technique by physicians skilled in carpal tunnel surgery.     

Effect of plasma NO<Subscript>x</Subscript> values on cardiac function in obese hypertensive and normotensive pediatric patients

Background

Hypertension (HT) is a major comorbidity of obesity that is associated with an increased risk of cardiovascular disease and higher mortality. The aim of our study was to evaluate cardiac function in obese hypertensive (OHT) and obese normotensive (ONT) pediatric patients and determine the effects of plasma nitric oxide (NO_x) values on cardiac function, while demonstrating the role of plasma NO_x in HT in obese pediatric patients.

Methods

The study population consisted of 62 patients (27 boys, 35 girls), aged 13–18 years and 21 age-matched healthy controls. All subjects enrolled in the study underwent echocardiography (Echo) evaluation and ambulatory blood pressure monitoring for HT. Plasma NO_x and biochemical values were studied in both patient groups separately.

Results

Plasma NO_x levels were found to be lower in the OHT group than in the ONT and control groups (p?<?0.001) and to be negatively correlated with left ventricular mass index values (p?<?0.05). Both the OHT and ONT groups had concentric hypertrophy of the heart.

Conclusions

Plasma NO_x plays an essential role in obesity-induced HT. Concentric hypertrophy of the left ventricle was found in both the OHT and ONT groups, indicating structural deformation of the heart.