Ponderal index of large-for-gestational age infants: comparison between infants of diabetic and non-diabetic mothers

Ponderal index (PI) is a weight-height related parameter that is mainly used to assess the pattern of fetal growth in small-for-gestational age infants. We aimed to use PI for large-for-gestational age (LGA) infants who were born to diabetic or non-diabetic mothers, in order to predict the fetal growth pattern. One hundred sixty-six LGA infants born at the Department of Obstetrics, Hacettepe University Hospital, Ankara, Turkey were included in the study. The PI was calculated by using the following formula: PI = weight (g) x 100/(height, cm)3. Sixty-seven (40%) of these infants were born to diabetic mothers. Maternal age, maternal weight and maternal weight gain during pregnancy were similar in the diabetic and non-diabetic groups. Mean birthweight, height and head circumference were similar in both groups, but median PI of infants of diabetic mothers was significantly higher than of infants of non-diabetic mothers (3.02 and 2.89, respectively, p < 0.05). Fetal growth was different between LGA infants of diabetic and non-diabetic mothers, and PI provided useful information on the proportionality of fetal growth in LGA infants.     

In Vitro Generation of Atrioventricular Heart Valve Neoscaffolds

Tissue engineering of cardiovascular structures represents a novel approach to improve clinical strategies in heart valve disease treatment. The aim of this study was to engineer decellularized atrioventricular heart valve neoscaffolds with an intact ultrastructure and to reseed them with umbilical cord‐derived endothelial cells under physiological conditions in a bioreactor environment. Mitral (n = 38) and tricuspid (n = 36) valves were harvested from 40 hearts of German Landrace swine from a selected abattoir. Decellularization of atrioventricular heart valves was achieved by a detergent‐based cell extraction protocol. Evaluation of the decellularization method was conducted with light microscopy and quantitative analysis of collagen and elastin content. The presence of residual DNA within the decellularized atrioventricular heart valves was determined with spectrophotometric quantification. The described decellularization regime produced full removal of native cells while maintaining the mechanical stability and the quantitative composition of the atrioventricular heart valve neoscaffolds. The surface of the xenogeneic matrix could be successfully reseeded with in vitro‐expanded human umbilical cord‐derived endothelial cells under physiological flow conditions. After complete decellularization with the detergent‐based protocol described here, physiological reseeding of the xenogeneic neoscaffolds resulted in the formation of a confluent layer of human umbilical cord‐derived endothelial cells. These results warrant further research toward the generation of atrioventricular heart valve neoscaffolds on the basis of decellularized xenogeneic tissue.     

The impact of individual room on rehospitalization and health service utilization in preterms after discharge

Abstract Aim: To compare individual room implemented family-centred care to classical designed neonatal intensive care unit and find out its effect on rehospitalization and application to health services in preterm infants after discharge. Methods: Mothers whose infants were born before 34 gestational weeks and hospitalized for at least one week in the NICU were enrolled in the study. Mothers who were hospitalized with their preterm infants in individual rooms (Group I) were compared with mothers who were not hospitalized with their preterm infants (Group II). After the third postdischarge month, groups were compared for their rates of phone consultations to physician/hospital, acute care applications, rehospitalization and parent's perception of child's vulnerability. Results: Although demographic and medical information did not indicate any differences between the groups, the mean number of acute care visits (p = 0.046), the median number of phone consultations (p = 0.001) and rehospitalization rate (12.9% vs. 34.5%, p < 0.05) were significantly higher in Group II. The anatomical problems, such as inguinal hernia and retinopathy of prematurity, were the main recorded causes in Group I whereas problems related to prematurity like feeding difficulties were dominating in Group II. Conclusion: The availability of individual rooms that allows maternal presence and participation during the hospitalization of the mother's preterm infant, is correlated with lower rates of rehospitalization and healthcare applications.     

Increased frequency of ultrasonographic findings suggestive of renal stones in patients with ankylosing spondylitis

OBJECTIVE: To determine the frequency of hypercalciuria and renal stones in ankylosing spondylitis (AS) sufferers. METHODS: This study involved 83 consecutive AS patients (21 female, 62 male; mean age 36.7 yr), 72 consecutive Behcet's disease (BD) patients (29 female, 43 male; mean age 37.7 yr) as disease control and 92 healthy control (HC) (26 female, 66 male; mean age 32.9 yr.) Twenty-four hour urine analyses for urinary calcium and uric acid levels were performed in each patient. Likewise, blood samples for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), parathyroid hormone (PTH), calcium and uric acid evaluation were taken. Renal ultrasonography to evaluate the presence of renal stone was performed in patients with AS, as well as in the BD patients and HC individuals after a fasting period of 12 hours. RESULTS: 20 of the 80 (25%) patients with AS were diagnosed with renal stones. Only 4/72 (5.5%) BD patients, and 3/98 (3.3%) HC individuals had renal stones by ultrasonography. AS patients had a significantly higher frequency of renal stones compared with BD (p < 0.001) and HC (p < 0.0001). AS patients with renal stones were much older and their disease duration was much longer in comparison with AS patients without renal stones. Ultrasonographic and laboratory findings did not correlate. The number of AS patients with hypercalciuria who had renal stones was higher than that of AS patients who did not have renal stones (p < 0.01). There was a negative correlation between acute phase response and spinal mobility. CONCLUSION: Renal stone prevalence was found to increase in AS patients. The likelihood of renal stone formation was also found to increase with the extension of the disease duration of AS sufferers.     

Left ventricular thrombosis is associated with increased mean platelet volume in patients with dilated cardiomyopathy and sinus rhythm

OBJECTIVE: Dilated cardiomyopathy has been associated with left ventricular thrombosis, which leads to substantial morbidity and mortality as a site for peripheral emboli. There are some studies on patients with dilated cardiomyopathy showing altered haemostasis and platelet behaviour despite sinus rhythm. Mean platelet volume, which is the most accurate and simple estimate of platelet reactivity, may be associated with the development of left ventricular thrombosis. METHODS AND RESULTS: We prospectively enrolled 48 consecutive patients with dilated cardiomyopathy and sinus rhythm with left ventricular thrombosis and compared them with an age-sex-matched control group having dilated cardiomyopathy without left ventricular thrombosis. We found that in patients with left ventricular thrombosis mean platelet volume is significantly higher than those without (9.5 +/- 0.8 vs. 8.7 +/- 0.6, p < 0.001). CONCLUSIONS: Mean platelet volume is increased in patients with dilated cardiomyopathy and sinus rhythm having left ventricular thrombosis. This might be reflecting a causal relationship, which in turn requires further study to establish the role of antiplatelet agents both in prevention and in treatment.     

Lipid profile of patients with aortic stenosis might be predictive of rate of progression

Background

Aortic stenosis is one of the most commonly encountered valvular pathology requiring surgery in developed countries. There are similarities between risk factors for coronary atherosclerosis and the development of aortic stenosis. We designed a retrospective study, evaluated the lipid profile and previous echocardiographic recordings of patients with aortic stenosis, and searched the association of rate of progression and lipid profile.

Methods and results

The annual rates of progression in the peak and mean aortic gradients were 8.5 ± 3.2 and 6.7 ± 2.2 mm Hg/year, respectively. We classified the annual rate of progression of peak aortic gradient into 2 groups, group 1 with <10 mm Hg (“slow progressors”) and group 2 with ≥10 mm Hg annual rate of progression (“fast progressors”). The annual rate of progression in group 1 was significantly higher than that in group 2, both in peak and mean aortic gradients (12 ± 2 mm Hg and 6.4 ± 1.6 mm Hg; 9 ± 1.3 mm Hg and 5.2 ± 1.1 mmHg; P <.001 for both). There was a highly significant difference between group 1 and group 2 for total cholesterol/high-density lipoprotein (HDL) cholesterol level ratio (7.1 ± 1.4 vs 5.2 ± 1.3, P <.001). There was a significant correlation between annual rate of progression in peak gradient and total cholesterol/HDL cholesterol level ratio (r = 0.399, P = .009). Smoking (P = .024, Beta = 0.26), presence of coronary heart disease (P = .011, Beta = 0.31), and total cholesterol/HDL cholesterol level ratio (P = .004, Beta = 1.98) were independently predictive of fast progression of the peak aortic gradient in the regression analysis.

Conclusion

In a small group of patients from Turkey with aortic stenosis, there seems to be an association between the rate of progression and total cholesterol/HDL cholesterol level ratio, with fast progression occurring in the group with higher ratios.     

The effect of dobutamine stress on left ventricular outflow tract gradients in hypertensive patients with basal septal hypertrophy

Basal septal hypertrophy (BSH), a cause of left ventricular outflow tract (LVOT) obstruction, is thought to occur by increased ventricular dynamics. The aim of the study was to evaluate the effect of pharmacologic stress on LVOT gradients in a group of hypertensive patients with BSH. Dobutamine stress was used in 24 hypertensive patients (mean age 56 +/-8 years; 11 women) with BSH and 20 normal controls (mean age 54 +/-9 years; 7 women). Ejection fraction and myocardial mass, basal septal dimension, and LVOT diameter were measured with 2-dimensional echocardiography. LVOT velocities and transmitral velocities before and at peak dobutamine infusion were determined by continuous wave Doppler and pulsed Doppler, respectively. There were no differences in mean ejection fraction and myocardial mass between BSH patients (58 +/-3%, 204 +/-24 g) and normals (56 +/-4%, 201 +/-32 g). The basal septum was thicker in patients (1.55 +/-0.2 cm) than in normals (1.03 +/-0.1 cm, p<0.001). Maximum LVOT velocities were similar in BSH (1.2 +/-0.4 m/sec) and normals (1.1 +/-0.2 m/sec) at rest. At peak stress, maximum LVOT velocities were higher in BSH (3.3 +/-0.6 m/sec) than normals (1.7 +/-0.4 m/sec, p<0.001). LV rate-pressure product at peak stress was higher in BSH (23,326 +/-4,388) than normals (17,592 +/-2,409, p<0.001). LV isovolumetric relaxation time was prolonged, and the E/A ratio was decreased in the patients at rest (130 +/-14 msec and 0.72 +/-0.18, respectively, p<0.001). At peak stress, diastolic function did not significantly change in two groups. The correlations between LVOT velocity change by stress and mean LVOT diameter (r=-0.668, p<0.001) and mean BS thickness (r=0.610; p<0.001) were significant in the whole group. High velocities appeared on LVOT at peak pharmacologic stress in the hypertensive patients with BSH compared with control group. This suggests dynamic ventricular ejection by stress may contribute to hypertrophy of the basal segment, which is the closest part of septum to increased afterload.     

Effectiveness of triple-site triggered atrial pacing for prevention of atrial fibrillation after coronary artery bypass graft surgery

BACKGROUND: Recently, several temporary multisite pacing methods have been developed for prevention of postoperative atrial fibrillation (AF). HYPOTHESIS: In this study, we evaluated the effect of triple-site temporary triggered pacing in the AAT mode on the development of AF in patients undergoing coronary artery bypass graft (CABG) at high risk for developing postoperative AF. METHODS: A total of 70 patients undergoing CABG were randomly assigned either to pacing group (study group, n = 35 patients) or to no pacing group (control group, n = 35 patients). The external pacemaker was programmed to pace at the atrial triggered mode at a lower rate of 40 beats/min for 4 days. RESULTS: Atrial fibrillation, defined as lasting > 30 s, occurred in 4 patients (11.4%) in the study group and in 16 patients (45.7%) in the control group (p = 0.003). Sustained AF, defined as AF lasting > 10 min, also was observed less frequently in the study group than in the control group (11.6 vs. 37.1%, p = 0.024). Triple-site triggered atrial pacing was observed to reduce the incidence of AF by 75% and the incidence of sustained AF by 69%. CONCLUSIONS: We believe that multiple-site temporary pacing in the triggered mode is an effective way of preventing postoperative AF. This technique may be used especially in patients at high risk of developing AF.     

Persisting fever in a patient with brucella endocarditis: occult splenic abscess

Brucella endocarditis, despite its high mortality rate with combined medical and surgical treatment, has a low occurrence rate in cases of brucellosis and has been endemic in regions surrounding Turkey. Rarely, patients with infective endocarditis with common microorganisms develop a splenic abscess. A patient is reported on with brucella endocarditis and persistent fever. An occult splenic abscess was found. This is the second reported case in the literature of brucella endocarditis with splenic abscess.