Effect of glucometabolic disorders on the formation of coronary collaterals in occlusive coronary artery disease

OBJECTIVE: The primary aim of this study was to assess the effect of glucometabolic disorders on coronary collateral vessels in patients with occlusive coronary artery disease. METHODS AND RESULTS: Hundred and ninety-five consecutive patients with at least single-vessel occlusion were enrolled in this study prospectively. The standard oral glucose tolerance test was performed according to the criteria of the World Health Organization. Collateral circulation was graded according to the Rentrop classification.The mean Rentrop scores in normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes were 1.40 +/- 1.02, 1.05 +/- 0.84, 1.00 +/- 0.98, respectively (P = 0.043).The percentage of patients without collateral circulation (Rentrop-0) was greatest in the diabetic group (44.4%), while the percentage was 21.8% in the IGT group and 22.0% in the NGT group. Ninety-five patients with at least one totally occluded coronary artery were analysed as a subgroup. In the totally occluded artery subgroup postprandial glycaemia was the only parameter that was associated with the Rentrop score in the univariate analysis (r = -0.34, P = 0.002) CONCLUSIONS: In conclusion, our study results, which are in agreement with previous results, indicate that not only diabetic glucose tolerance but also impaired glucose tolerance has an adverse impact on the development of coronary collaterals.     

Risk factors and type of dementia: vascular or Alzheimer?

The most efficient strategy for combating Alzheimer's disease (AD) is to prevent the onset of clinically significant symptoms. Determining the clinical characteristics, risk factors, and indices of cognitive reserve would help in achieving this goal. The aim of this study was to determine the risk factors for AD and vascular dementia (VD) in the elderly and to highlight the importance of risk factor modification in the early diagnosis. Consecutive 1436 patients (mean age=72.7+/-6.9 years, 34.2% male) were enrolled in the study. After a comprehensive geriatric and cognitive assessment, patients were grouped as AD group (n=203), VD group (n=73) and normal cognitive status (NCS) group (n=1160). Thirty-three possibly related factors including demographic characteristics, co-existing diseases and laboratory parameters were examined. The results revealed that female sex, advanced age, depression, and intake of vitamin supplements were independent related factors for AD; whereas depression and low-density lipoprotein-cholesterol (LDL-C) were independent related factors for VD. For every geriatric patient admitted for any reason, cognitive assessment should be performed, risk factors should be determined and the patients at high risk should be followed up carefully.     

Appropriate utilization of hospital beds in internal medicine: evaluation in a tertiary care hospital

AIM: To assess the appropriateness of utilization of beds in the internal medicine department of a university hospital. METHODS: The appropriateness of hospital stay was evaluated using the Appropriateness Evaluation Protocol. A random sample of 402 days of stay was assessed. RESULTS: One hundred and thirty-nine days of stay (34.6%) were classified as inappropriate. The inappropriate stays were mostly secondary to hospital-related factors. The two major factors for inappropriate stays were 'inappropriate timing/delay in diagnostic procedures/consultations' (27%) and 'delay in obtaining test results' (27%). None of the factors including age, gender, residence and inpatient period was significantly related to inappropriate stay in univariate analysis. CONCLUSION: This study indicated that a significant portion of stays were inappropriate. Efforts to decrease particularly hospital-related factors associated with inappropriate stay are needed.     

Remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy: comparison of adjuvant propofol and ketamine

OBJECTIVE:

Laryngoscopy and stimuli inside the trachea cause an intense sympatho-adrenal response. Remifentanil seems to be the optimal opioid for rigid bronchoscopy due to its potent and short-acting properties. The purpose of this study was to compare bolus propofol and ketamine as an adjuvant to remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy.

MATERIALS AND METHODS:

Forty children under 12 years of age who had been scheduled for a rigid bronchoscopy were included in this study. After midazolam premedication, a 1 µg/kg/min remifentanil infusion was started, and patients were randomly allocated to receive either propofol (Group P) or ketamine (Group K) as well as mivacurium for muscle relaxation. Anesthesia was maintained with a 1 µg/kg/min remifentanil infusion and bolus doses of propofol or ketamine. After the rigid bronchoscopy, 0.05 µg/kg/min of remifentanil was maintained until extubation. Hemodynamic parameters, emergence characteristics, and adverse events were evaluated.

RESULTS:

The demographic variables were comparable between the two groups. The decrease in mean arterial pressure from baseline values to the lowest values during rigid bronchoscopy was greater in Group P (p = 0.049), while the reduction in the other parameters and the incidence of adverse events were comparable between the two groups. The need for assisted or controlled mask ventilation after extubation was higher in Group K.

CONCLUSION:

Remifentanil-based total intravenous anesthesia with propofol or ketamine as an adjuvant drug along with controlled ventilation is a viable technique for pediatric rigid bronchoscopy. Ketamine does not provide a definite advantage over propofol with respect to hemodynamic stability during rigid bronchoscopy, while propofol seems more suitable during the recovery period.