Allergic myocardial infarction in childhood: Kounis syndrome

Kounis Syndrome was first described by Kounis as “allergic angina syndrome” progressing to “allergic myocardial infarction”. This report describes the first children in the literature presented with Kounis syndrome.     

Oxidative Stress Status Increase in Patients with Nonischemic Heart Failure

Objective

It was the aim of this study to investigate the serum oxidative stress level in nonischemic patients with heart failure (HF).

Subjects and Methods

The study included 37 patients who presented to the Department of Cardiology, Suleyman Demirel University, Isparta, Turkey, with a diagnosis of asymptomatic HF (New York Heart Association class I-II). The patients had a left ventricular (LV) ejection fraction (EF) of ≤40% and normal coronary arteries or nonsignificant stenosis (stenosis <40%). In addition, 30 age- and sex-matched normal patients were selected as the control group. Clinical and laboratory characteristics presumed to be associated with oxidative stress were evaluated.

Results

Demographic characteristics were comparable. However, creatinine and potassium levels were higher in the HF than in the control group. Total oxidative status [2.42 μmol H₂O₂ Eq/l (range 0.74–5.86) vs. 1.81 μmol H₂O₂ Eq/l (range 0.42–3.45); p < 0.01], oxidative stress index [2.24 (range 0.63–5.33) vs. 1.53 (range 0.28–2.51); p < 0.01] and uric acid (6.1 ± 1.8 vs. 4.4 ± 1.1 mg/dl; p < 0.01) levels were significantly higher in the HF than in the control group. The total antioxidant capacity was similar in both groups [1.22 mmol Trolox Eq/l (range 0.61–1.99) vs. 1.18 mmol Trolox Eq/l (range 0.82–1.80); p = 0.77]. The γ-glutamyltransferase levels were also comparable in both groups [32 U/l (range 11–106) vs. 23 U/l (range 11–72); p = 0.10].

Conclusion

The oxidative stress levels were higher in HF patients, and hence, oxidative stress may play an important role in poor prognosis of HF. Therefore, antioxidant treatment might be reasonable.Key Words: Heart failure, Oxidative stress index, Total oxidative stress, Uric acid     

Are parents aware of their schoolchildren's headaches?

BACKGROUND: The objective of this study is to determine parents' awareness of their children's headaches and to evaluate some of the factors that affect this awareness. METHODS: The subjects of the study are 2601 children who were diagnosed with headache. Data on the children and the parents was collected using a detailed data form. The diagnosis of headache in children was made on the basis of the criteria of the International Headache Society (IHS). If the parents of a child diagnosed with headache reported that their child had headache, the parent was evaluated to be aware of his/her child's headache. In the statistical analyses, chi-square and binary logistic regression were used. RESULTS: Almost 74% of parents were aware of their children's headache. It was found that migraine type headache, female gender, being the first child of the family, travel sickness of children, the presence of headache history in one of the family members; the number of family members and mother's age are factors that affect the awareness level of parents. It was also revealed that parents who do not work outside are more aware of their children's headache and that educational and financial status do not have any effect on the degree of awareness. CONCLUSIONS: In a city like Mersin, which is economically well developed when compared with the rest of the country, one quarter of the parents are not aware of their children's headache.     

Correlation between maternal thyroid function tests and endothelin in preeclampsia-eclampsia.

OBJECTIVE: To investigate the relationship between results of maternal thyroid function tests and endothelin levels in preeclamptic or eclamptic women. METHODS: Thyroid hormones, TSH, and endothelin were measured in plasma or serum from 37 proteinuric, preeclamptic or eclamptic women and 20 normotensive, nonlaboring, pregnant women. Subjects were subdivided into four groups according to hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and birth weights of infants with respect to gestational age. RESULTS: A significant decrease in concentrations of total thyroxine (T4) (13.76+/-1.84 microg/dL versus 10.00+/-1.48 microg/dL, P < .05), total triiodothyronine (T3) (180.58+/-30.84 ng/dL versus 141.16+/-27.31 ng/dL, P < .01), free T4 (1.45+/-0.27 ng/dL versus 1.10+/-0.21 ng/dL, P < .01) and free T3 (3.32+/-0.56 pg/mL versus 2.41+/-0.60 pg/mL, P < .01) and a significant increase in TSH (1.55+/-0.89 microIU/mL versus 2.96 +/-1.07 microIU/mL, P < .05) and endothelin (2.31+/-0.61 pg/mL versus 6.11+/-1.41 pg/mL, P < .001) levels were observed in the preeclamptic-eclamptic group compared with the normotensive group. Also, women without HELLP syndrome and without small-for-gestational-age infants had elevated levels of thyroid hormones and decreased levels of TSH and endothelin compared with other subgroups, but stastical significance was reached only in total T4 (P < .05), TSH (P < .05), and endothelin (P < .001). Birth weights of infants born to preeclamptic or eclamptic women correlated positively with total T4 (P < .01) and total T3 (P < .01) and negatively with TSH (P < .01) levels. A more significant negative correlation was found in preeclamptic-eclamptics (P < .001) between birth weight and endothelin levels than in control subjects (P < .05). Endothelin levels in preeclamptic or eclamptic women correlated negatively with total T4 (P < .01), total T3 (P < .05), free T4 (P < .05), and free T3 (P < .05) and positively with TSH levels (P < .01) compared with control subjects. CONCLUSION: Moderate decreases in thyroid hormones with concomitant increases in TSH levels in maternal serum correlated with severity of preeclampsia or eclampsia and high levels of endothelin. Changes in results of thyroid function tests induced by preeclampsia or eclampsia might be consequences of the dysfunction in the hypothalamic-pituitary-thyroid axis, secondary to the disease itself.     

Aminoguanidine prevents ototoxicity induced by cisplatin in rats

Cisplatin (CDDP) is one of the most potent antineoplastic drugs, but its therapeutic use is limited by side effects such as ototoxicity. This study tested the effect of aminoguanidine (AG), a specific inhibitor of inducible nitric oxide synthase, on CDDP ototoxicity. Female Wistar albino rats were randomly assigned to 4 groups: saline controls (n = 7), CDDP (n = 7), CDDP plus AG (n = 7), and AG (n = 7). Rats in the CDDP group received a single injection of cisplatin (16 mg/kg, ip). Rats in the CDDP plus AG group received aminoguanidine (20 mg/kg, ip) twice daily on the day before and on 5 consecutive days after a single injection of CDDP (16 mg/kg, ip). Rats in the AG group received aminoguanidine (20 mg/ kg, ip) twice daily for 6 days. Distortion product otoacoustic emissions (DPOAEs) were elicited from the control and experimental animals utilizing a standard commercial otoacoustic emissions apparatus. DPOAEs were measured in the rats on day 0, prior to any drug administration, and on day 5. The initial baseline distortion product diagrams (DPgram) and input/output (I/O) function measurements gave similar results in all 4 groups. On day 5, there was significant deterioration of the DPgrams and I/O functions in the CDDP group; no significant changes of DPgrams and I/O functions were observed on day 5 in the other 3 groups. The median amplitudes of DPgrams and I/O functions revealed significant differences between the CDDP group and the other 3 groups. These results suggest that AG had a preventive effect against CDDP ototoxicity. In summary, this study indicates that AG prevents the cochlear dysfunction and hearing loss induced in rats by a single dose of CDDP.     

Detection of HCV-RNA in cerumen of chronically HCV-infected patients

OBJECTIVES/HYPOTHESIS: Viral hepatitis C is a worldwide public health problem. Hepatitis C virus is mainly transmitted by parenteral or percutaneous route. Nonparenteral transmission, such as through sexual activity, household contact, and vertical or perinatal exposure to body fluids or secretions, can occur, which has been studied before. Cerumen, however, has not been investigated for its ability to transmit hepatitis C virus. The aim of this study is to evaluate the importance of cerumen in transmission of hepatitis C virus infection. STUDY DESIGN: This study was performed on 35 patients with confirmed chronic hepatitis C virus infection. METHODS: Thirty-five cerumen specimens collected from the patients with hepatitis C virus RNA in their sera were prospectively analyzed for the presence of hepatitis C virus RNA by polymerase chain reaction. RESULTS: None of the 35 cerumen specimens were positive for hepatitis C virus RNA. CONCLUSION: This study showed that cerumen has no risk for transmission of hepatitis C virus infection, even in patients with high hepatitis C virus RNA serum levels; however, standard infection control precautions should be applied carefully in all examinations and surgical operations of the ears.     

Activated protein C resistance in Turkish women with severe preeclampsia

The purpose of this study was to investigate the occurrence rate of APC resistance (APC-R) with severe preeclampsia in Turkish women. Thirty-two consecutive women having severe preeclampsia were included in the study. Thirty-two healthy pregnant women served as the control group. APC-R assays were performed in the third trimester of pregnancy, and 3 and 9 months after delivery. APC-R was demonstrated in the third trimester, 3 months and 9 months after delivery in 27 (84.4%), 23 (71.9%) and 5 (15.6%) of 32 preeclamptic patients, respectively. APC-R rates were significantly higher in preeclamptic group than in normal pregnant women in the third trimester of pregnancy (p < 0.05). Decreased mean APC activity and also increased APC-R rate was still persisting in preeclamptic group for 3 months after delivery. Nine months after delivery, the mean APC activity and also APC-R rates approached to the normal pregnant women; however, there was a significant difference between both groups (p < 0.05). Our results indicate that acquired APC-R may be a contributory factor in the pathogenesis of preeclampsia.     

Long-term pulmonary function in survivors of childhood Hodgkin disease and non-Hodgkin lymphoma

BACKGROUND: The aim of our study was to evaluate the long-term effects of chemotherapy and/or radiotherapy on lung function in 75 childhood Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL) survivors several years after treatment. PATIENTS AND METHODS: We studied 37 HD and 38 NHL survivors. These patients were divided into two groups according to the treatment protocols applied. Group I consisted of 23 patients who were treated with both chemotherapy and thoracic irradiation and Group II consisted of 52 patients who were treated with chemotherapy and no thoracic irradiation. A detailed history of smoking habits, respiratory symptoms, and diseases was recorded. Complete physical examinations and pulmonary function tests [PFT, including spirometry, lung volume, and diffusion capacity for carbon monoxide (DLCO)] were performed on all subjects. RESULTS: No patients reported acute or chronic respiratory symptoms or diseases. Pulmonary function abnormality (reduced lung volume and diffusion capacity) was found in 13% of patients at a median 5 years after diagnosis. The percentage of predicted normal value of forced expiratory volume in the 1st sec (FEV(1)), residual volume (RV), and DLCO were significantly lower in Group I than these values for Group II. There were no significant differences in PFT parameters between patients with HD and NHL (P > 0.05). It appears that the risk of reduced lung function was greater the younger the patient in therapy. CONCLUSION: Chemotherapy or chemo-radiotherapy-induced pulmonary sequalae in childhood may remain asymptomatic for many years.     

A rare cause of respiratory distress in infants: tracheal compression due to anomalous course of innominate artery

Incomplete vascular ring is a rare congenital vascular anomaly causing tracheal compression. A case of anomalous innominate artery causing tracheal compression and low grade tracheomalacia with remarkable dyspnea and intermittent apnea in a five-month-old infant is reported. Chest X-ray revealed enlarged upper mediastinum. Patent foramen ovale and thymus hyperplasia were detected on echocardiographic examination. Angiography demonstrated left aortic arch with normal arterial branching pattern. Thorax computerized tomography (CT) revealed tracheal compression of more than 50% at innominate artery level and aberrant position of the hyperplastic thymus. Operation was planned for subtotal thymectomy and relocation of innominate artery in order to relieve tracheal obstruction. Postoperative thorax CT demonstrated satisfactory relief of tracheal compression. Patient was discharged from hospital on sixth postoperative day in good condition. On clinical follow-up he is completely asymptomatic without any signs of dyspnea or intermittent reflex apnea. In severely symptomatic cases, surgical treatment offers excellent results.