Percutaneous mitral valvuloplasty in the adult. Apropos of 5 cases

The results of percutaneous mitral valvuloplasty in 5 adult patients with mitral stenosis are presented. The average age was 55 years (37-72 years); 4 patients were in functional Class III and 1 in Class IV. The three oldest patients were in atrial fibrillation, and 2 of them had severe valvular and subvalvular lesions. Valvuloplasty was carried out with a "Trefoil" balloon (3 X 12 mm; effective cross sectional area at maximal inflation: 3.8 cm2). The procedure was successful in 4 patients. In the other patient, it was not possible to position the balloon across the stenotic valve. After valvuloplasty, the mean mitral gradient decreased (14 +/- 5 to 6 +/- 2 mmHg, p less than 0.05) without a significant change in cardiac index (2.9 +/- 0.5 vs 2.7 +/- 0.4 l/mn/m2; NS): this indicated an increased mitral valve surface area (1.1 +/- 0.2 to 1.8 +/- 0.05 cm2, p less than 0.05). In parallel, echocardiographic measurements of mitral valve surface area increased from 0.9 +/- 0.2 to 1.8 +/- 0.3 cm2, p less than 0.05, and Doppler pressure halt time fell from 220 +/- 50 to 116 +/- 13 ms, p less than 0.05. There were no operative complications and, in particular, no resulting angiographic mitral regurgitation. These preliminary results suggest that percutaneous mitral valvuloplasty may be a valuable alternative therapeutic procedure to surgery in selected patients.     

Hemodynamic and angiographic results following surgical correction of mitral insufficiency. Apropos of 51 repeated catheterizations

The benefits of surgical correction of mitral incompetence were assessed in 51 patients by comparing pre and postoperative catheter and quantitative angiographic results. The mean age of the patients was 43.5 +/- 12.3 years. The mitral lesions were elongation or ruptured chordae (27 cases), valvular perforation due to endocarditis (1 case) and the usual rheumatic disease in 23 cases. Hemodynamic investigation was carried out on average 2 months before operation and 29 +/- 22 months after surgery. The following angiographic parameters were measured : indexed end diastolic and end systolic volumes (EDV and ESV), ejection fraction (EF), myocardial mass (MM) and its ratio to EDV (hypertrophy coefficient : HC) and the geometry of the ventricle as assessed by diastolic and systolic coefficients of excentricity (DE and SE). Surgery comprised 13 mitral valvuloplasties and 38 valve replacements. Patients who suffered perioperative myocardial infarction or who had a residual valvular lesion were excluded from the study. After surgery, the hemodynamic state was considerably improved with a significant decrease in pulmonary capillary pressures (11 +/- 5 compared to 17 +/- 6 mmHg, p less than 0.09) and mean pulmonary artery pressures (19 +/- 7 compared to 27 +/- 11, p less than 0.01) and increase in cardiac index (2.8 +/- 0.7 compared to 2.3 +/- 0.6 l/min/m2, p less than 0.01). There was an associated decrease in ventricular volumes (EDV : 115 +/- 44 compared to 165 +/- 43, p less than 0.01) (ESV : 60 +/- 39 compared to 77 +/- 22, p less than 0.001). The reduction in myocardial mass was less spectacular (129 +/- 40 compared to 148 +/- 32, p less than 0.01) with a resulting increase in the HC (1.10 +/- 0.26 compared to 0.88 +/- 0.17, p less than 0.001). The geometry of the LV was less spherical in diastole (DE 0.76 +/- 0.08 compared to 0.70 +/- 0.08, p less than 0.001) and in systole (SE = 0.83 +/- 0.06 compared to 0.77 +/- 0.08, p less than 0.001). The EF fell slightly but this was not statistically significant (0.51 +/- 0.13 compared to 0.53 +/- 0.09 NS). The surgical result of 14 patients with PCP greater than or equal to 13 mmHg was considered hemodynamically incomplete, and this was confirmed by a lower cardiac index than in the remaining 37 patients (2.4 +/- 0.5 compared to 3.0 +/- 0.7, p less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)     

What do Australian patients with inflammatory arthritis value in treatment? A discrete choice experiment

Clinical Rheumatology - The purpose of this study was to develop an understanding of treatment preferences in patients with inflammatory arthritis (IA) [rheumatoid arthritis (RA), ankylosing...     

Results of intravitreal triamcinolone acetonide in patients with macular edema secondary to branch retinal vein occlusion

Background Macular edema is one of the most common causes of visual loss in patients with retinal vein oclusions. Intravitreal corticosteroids and intravitreal anti-vascular endothelial growth factors are modalities of treatment for macular edema secondary to branch retinal vein occlusion (BRVO). Objective To present the results of intravitreal triamcinolone acetonide therapy in patients with macular edema secondary to BRVO. Setting A retrospective clinical interventional study included 32 patients with macular edema secondary to BRVO. Method The records of 32 eyes of 32 patients who received 4 mg/0.1 mL injection of intravitreal triamcinlone for macular edema secondary to BRVO were evaluated. Patients with visual acuity <0.40 logMAR (logarithm of the minimum angle of resolution), central macular thickness (CMT) >260 μm and no neovascularization at baseline were included. Patients with diabetes mellitus, a history of intravitreal anti vascular endothelial growth factor injection, grid laser photocoagulation and ischemic BRVO were excluded. The re-injections were performed in cases with increased CMT >100 μm or vision loss of five or more letters. Results The mean follow-up was 12 ± 1.9 months. The visual acuity increased from 0.58 ± 0.16 at baseline to 0.25 ± 0.11 logMAR (P < 0.001). The CMT decreased from 490 ± 107 μm at baseline to 266 ± 90 μm at 12 months (P < 0.001). Both cataract and glaucoma developed in 18.75 % patients. Conclusion Intravitreal triamcinolone, due to absence of systemic side effects, can be used with confidence for treatment macular edema secondary to BRVO. However the main disadvantages of intravitreal triamcinolone injection are elevation of intraocular pressure and formation of cataract.     

Nasopharyngeal carriage of Streptococcus pneumoniae in healthy Turkish children after the addition of PCV7 to the national vaccine schedule

The aim of this study was to determine serotype distribution and investigate antimicrobial resistance patterns of Streptococcus pneumoniae in healthy Turkish children in the era of community-wide pneumococcal conjugate vaccine (PCV7). The study was conducted on 1,101 healthy children less than 18 years of age. Specimens were collected with nasopharyngeal swabs between April 2011 and June 2011. Penicillin and ceftriaxone susceptibilities were determined by E-test according to the 2008 Clinical Laboratory Standards Institute, and serotypes of the isolates were determined by Quellung reaction. The nasopharyngeal pneumococcal carriage rate was 21.9 % (241/1,101). Using the meningitis criteria of minimum inhibitory concentration values, 73 % of the isolates were resistant to penicillin and 47.7 % of them were resistant to ceftriaxone. Half of all pneumococcal isolates were serotyped as 19F (15.2 %), 6A (15.2 %), 23F (10.3 %), and 6B (9.3 %) and surprisingly, no serotype 19A was isolated. Serotype coverage rates of PCV7 and non-PCV7 were 46.2 and 53.8 %, respectively. The most common penicillin- and ceftriaxone-resistant serotypes were 6A, 6B, 14, 19F, and 23F. Penicillin- and ceftriaxone-resistant isolates were more prevalent in serotypes covered by PCV7 than the non-PCV7 serotypes. Conclusion: After the community-wide PCV7 vaccination, more non-PCV7 serotypes were isolated from the carriers compared to the time before PCV7 was used especially the serotype 6A, and the antimicrobial resistance of pneumococci was significantly increased.     

Periodontal status of ectopic canines after orthodontic treatment

Objective: To evaluate the periodontal health and tooth vitality of palatally impacted and buccal ectopic maxillary canines after completion of orthodontic treatment.Materials and Methods:Fifteen patients who had unilateral, palatally impacted canines and 15 patients who had unilateral, buccal ectopic canines comprised the subjects of the study. Clinical and radiographic data was collected by recalling the patients in both groups after a mean period of 3.82 ± 1.54 years following completion of their orthodontic treatment. In both groups, the contralateral, normally placed canines served as controls.Results:Palatally impacted canines had greater pocket depths, higher gingival levels, higher electric pulp testing scores, and reduced bone levels compared to their contralaterals. Buccal ectopic canines had increased plaque and gingival bleeding index, greater pocket depths, reduced attached gingival width, higher gingival levels, increased clinical crown lengths, and higher electric pulp testing scores compared to their contralaterals. Buccal ectopic canines had lower electric pulp testing scores and higher bone levels compared to palatally impacted canines.Conclusion:All ectopic canines had increased plaque and gingival bleeding index, greater pocket depths, reduced attached gingival width, higher gingival levels, increased crown lengths, higher electric pulp testing scores, and reduced bone levels compared to their contralaterals.     

The neutralization effect of montelukast on SARS-CoV-2 is shown by multiscale in silico simulations and combined in vitro studies

Small molecule inhibitors have previously been investigated in different studies as possible therapeutics in the treatment of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In the current drug repurposing study, we identified the leukotriene (D4) receptor antagonist montelukast as a novel agent that simultaneously targets two important drug targets of SARS-CoV-2. We initially demonstrated the dual inhibition profile of montelukast through multiscale molecular modeling studies. Next, we characterized its effect on both targets by different in vitro experiments including the enzyme (main protease) inhibition-based assay, surface plasmon resonance (SPR) spectroscopy, pseudovirus neutralization on HEK293T/hACE2+TMPRSS2, and virus neutralization assay using xCELLigence MP real-time cell analyzer. Our integrated in silico and in vitro results confirmed the dual potential effect of montelukast both on the main protease enzyme inhibition and virus entry into the host cell (spike/ACE2). The virus neutralization assay results showed that SARS-CoV-2 virus activity was delayed with montelukast for 20 h on the infected cells. The rapid use of new small molecules in the pandemic is very important today. Montelukast, whose pharmacokinetic and pharmacodynamic properties are very well characterized and has been widely used in the treatment of asthma since 1998, should urgently be completed in clinical phase studies and, if its effect is proved in clinical phase studies, it should be used against coronavirus disease 2019 (COVID-19).     

Treatment of three hereditary leiomyomatosis patients with cryotherapy

Hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome is an autosomal dominant disorder characterized by cutaneous leiomyomas (CLM), uterine leiomyomas, and the increased risk of renal cell carcinoma. Piloleiomyomas develop from the arrectorpili muscle and are usually painful. For 22% of the affected patients, the pain is reported to impair their life quality. Since there are few case reports about cryotherapy for cutaneous leiomyomas in the literature, we have decided to present three patients who had painful cutaneous leiomyomas treated with cryotherapy.