Effect of intravenous zoledronic acid infusion on electrocardiographic parameters in patients with osteoporosis

Summary

We evaluated the effects of zoledronic acid (ZA) therapy on electrocardiographic (ECG) parameters for the first time in the literature. Measurements were performed on ECGs obtained before and after ZA infusion on the same day as well as 1 month after the infusion. ZA infusion did not have any short- or long-term effect on any parameter that might be associated with the tendency for atrial fibrillation or ventricular arrhythmias.

Introduction

The aim of the present study was to evaluate the early and late effects of ZA therapy on ECG parameters which might be associated with the tendency for atrial and ventricular arrhythmias.

Methods

Consecutive patients with osteoporosis who were admitted to our clinic between December 2013 and December 2014 and who were scheduled to receive ZA infusion constituted our study population. Twelve-lead surface ECGs were obtained from all patients before and after ZA infusion on the same day as well as 1 month after the infusion. All ECG parameters were measured and compared with each other for each patient.

Results

Data of 100 patients were used in the analysis (9 male; 70.5 ± 11.6 years of age). There were no significant differences between repeated measurements regarding pmax, pmin, and p dispersion values. QT max and QT min values were significantly increased after infusion; however, there were no significant changes in QT dispersion, Tp-e interval, and Tp-e dispersion values.

Conclusions

ZA infusion did not affect P wave dispersion both at the immediate post-infusion period and 1 month after infusion. QT values were significantly increased early after ZA infusion; however, there were no significant differences in parameters reflecting disparity of ventricular recovery times and transmural dispersion of ventricular repolarization. Based on these observations, it may be suggested that ZA infusion did not have any short- or long-term effect on any parameter that might be associated with the tendency for atrial fibrillation or ventricular arrhythmias.

     

The Effect of Psychological Support for the Relatives of Intensive Care Unit Patients on Cadaveric Organ Donation Rate

We searched to see whether psychological support for relatives of intensive care unit patients helps them to donate organs of their brain-dead relatives. After receiving ethics committee permission, first-degree relatives of 200 general intensive care unit patients were enrolled in the study. The participants were divided into 2 groups randomly: an interview group (n = 100) and a control group (n = 100). Participants were asked to complete a questionnaire. Interviews with the psychologist and patients' relatives in the interview group were therapeutic in nature and were conducted according to the relatives' psychosocial needs in an unstructured format. In the control group, the psychologist and patients' relatives were not interviewed. The study utilized demographic data, the questionnaire for relatives of patients to mention their attitude on organ donation and the reasons for this choice, and the Participant Information Form to record demographic data and relatives' degree of relationship with the patient. There was no statistically significant difference between the 2 groups when compared according to sex ratio, patient age, and duration of patients' hospital stay. Whereas in the interview group, 75% agreed to allow their relatives to be organ donors, only 32% in the control group agreed (P < .0001). Of the 200 patients enrolled in the study, 93 lost their lives: 50 from the interview group and 43 from the control group. Among the relatives whose patients had lost their lives, 78% belonging to the interview group accepted to donate the organs of their patients, whereas in the control group 13.9% accepted (P < .0001). We hope that psychological support for the relatives of the potential brain-dead donor to cope with the psychological problems to be faced can improve the rate of organ donation.     

Treatment of renal stones with flexible ureteroscopy in preschool age children

The aim of the study is to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in preschool age (<7 years) children. From September 2005 to May 2013, a total of 65 children (31 boys and 34 girls) with 72 renal stones were treated using RIRS. Patients were considered stone-free when the absence of residual fragments was observed on imaging studies. In the presence of residual calculi >4 mm, a second-stage RIRS was performed. The pre-operative, operative and post-operative data of the patients were retrospectively analyzed. A total of 65 patients with a mean age of 4.31 ± 1.99 years (6 months–7 years) were included in the present study. The mean stone size was 14.66 ± 6.12 mm (7–30 mm). The mean operative time was 46.47 ± 18.27 min. In 5 (7.69 %) patients, the initial procedure failed to reach the renal collecting system and ended with the insertion of a pigtail stent. The stone-free rates were 83.07 and 92.3 % after the first and second procedures, respectively. Complications were observed in 18 (27.7 %) patients and classified according to the Clavien system. Post-operative hematuria (Clavien I) occurred in 6 (9.2 %) patients, post-operative urinary tract infection with fever (Clavien II) was observed in 10 (15.4 %) patients, and ureteral wall injury (Clavien III) was noted in 2 (3 %) patients. RIRS is an effective and safe procedure that can be used to manage renal stones in preschool age children.     

A case of mitral stenosis complicated with seronegative Brucella endocarditis

Brucellosis is a multisystemic disease. The most common cause of death from the disease is endocarditis. The aortic valve is most commonly affected. The disease rarely involves the mitral valve. A 30 year-old woman presented with complaints of chills and fever up to 38 degrees C at night, fatigue, palpitations, and dyspnea for the previous 3 weeks. Cardiac auscultation revealed a diastolic murmur in the mitral area. Her temperature was 38.3 degrees C. On echocardiographic examination, the mitral valve area was 0.62 cm (2) and an isoechoic mass thought to be a vegetation was detected on the anterior mitral leaflet. A diagnosis of infective endocarditis was made and vancomycin administration was commenced. Brucella melitensis was isolated in all three blood samples, however, the patient remained seronegative with Brucella agglutination titers of up to 1/160. The antibiotic therapy was then shifted to doxycycline (200 mg/day), rifampicin (600 mg/day), and ciprofloxacin (1000 mg/day). After 30 days of treatment, surgery was performed for the severely stenotic mitral valve and to remove the vegetation. The operation was successful. The postoperative period was uneventful. On the follow-up she had no complaints. In cases with Brucella endocarditis, after diagnosis, antibiotic therapy must be started immediately and when the clinical condition improves, surgical intervention should be performed when indicated.     

Left Main Coronary Artery Obstruction by Dislodged Native-Valve Calculus after Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement can be an effective, reliable treatment for severe aortic stenosis in surgically high-risk or ineligible patients. However, various sequelae like coronary artery obstruction can occur, not only in the long term, but also immediately after the procedure. We present the case of a 78-year-old woman whose left main coronary artery became obstructed with calculus 2 hours after the transfemoral implantation of an Edwards Sapien XT aortic valve. Despite percutaneous coronary intervention in that artery, the patient died. This case reminds us that early recognition of acute coronary obstruction and prompt intervention are crucial in patients with aortic stenosis who have undergone transcatheter aortic valve replacement.     

Increase in QRS amplitudes is better than N-terminal pro-B-type natriuretic peptide to predict clinical improvement in decompensated heart failure

Background

We aimed to investigate the correlation between ECG QRS voltage changes, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and clinical improvement in decompensated heart failure (DHF).

Methods and results

DHF patients (n = 56) with a mean age of 67.5 ± 12.6 years showed limb QRS amplitude increase and NT-proBNP level decrease with clinical improvement (p < 0.001). Significant correlation was found between percent changes (Δ%) in body weight and Δ% in QRS voltages of aVR, aVF, DII, ΣQRSI + II and ΣQRS (all limb-leads) (r = − 0.40; r = − 0.35; r = − 0.32; r = − 0.30; r = − 0.30 respectively, p < 0.05). No correlation was found between Δ% in NT-proBNP and body weight (r = − 0.23, p = 0.09). Δ% NT-proBNP was correlated with Δ% QRS voltage only in aVR (r = − 0.312, p = 0.019). In ROC analysis, ≥ 0.5 mm increase in aVR QRS voltage was found to predict ≥ 5 kg weight loss with a sensitivity of 74% and specificity of 62% (p = 0.013, AUC: 0.699).

Conclusions

Increase in QRS voltages especially in aVR was found to be more sensitive than NT-proBNP to predict clinical improvement in DHF.     

Efficacy of zoledronic acid treatment in Paget disease of bone

Summary

Clinical trials have shown that zoledronic acid was more effective than other bisphosphonates in the treatment of Paget disease. We retrospectively reviewed remission and relapse statuses of 12 patients with Paget disease. Remission was achieved in all patients after treatment. We recommend zoledronic acid in the first-line treatment of Paget disease.

Introduction

Paget disease is a disease of bone of unknown etiology with increased bone turnover that results in defective bone microarchitecture and bone deformity. Bisphosphonates are used in symptomatic Paget disease of bone. Clinical trials have shown that zoledronic acid was more effective than other bisphosphonates in the treatment of Paget disease.

Methods

In this study, we retrospectively reviewed the remission and relapse statuses of 12 patients with Paget disease of bone who were seen as outpatients between October 2011 and October 2013.We evaluated alkaline phosphates, osteocalcin, and deoxypyridinoline levels measured before and at 6th, 12th, and 18th months of treatment.

Results

Pretreatment and posttreatment values for alkaline phosphates, deoxypyridinoline, and osteocalcin were as follows: 473?±?256 U/L, 14.99?±?7.63 mmol/L, 21.09?±?3.18 ng/ml, and 82?±?13 U/L, 5.14?±?1.11 mmol/L, and 8.57?±?4.31 ng/ml. Remission was achieved in all patients after treatment. The levels indicated that remission continued at 12th and 18th months of treatment. There was statistically significant difference between pretreatment and posttreatment values. No statistically significant difference between the levels measured at 6th, 12th, and 18th months of treatment was detected.

Conclusion

We recommend zoledronic acid in the first-line treatment of Paget disease of bone in achieving and maintaining remission.