Myocardial perfusion is preserved in patients with psoriasis without clinically evident cardiovascular disease

Background  Psoriasis is associated with a premature atherosclerosis due to the chronic inflammatory process. To evaluate the effect of disease process on myocardial perfusion, we planned to perform 99mTc-MIBI myocardial perfusion single photon emission computed tomography (SPECT) in patients with psoriasis.
Methods  The study group consisted of 28 psoriasis patients (17 men, 11 women), aged 18-76 years, and mean age 41.2 ± 14.1 years. The patients were selected among those who were older than 18 years and longer than 10 years of disease duration with more than two times of systemic treatment. All patients underwent 99mTc-MIBI myocardial perfusion SPECT with the same day protocol.
Results  We detected various risk factors including smoking habits in 7, family history of cardiovascular disease in 4, hypertension in 1, hyperlipidemia in 9 patients. We completed myocardial perfusion SPECT for each patient and found normal perfusion pattern in SPECT images.
Conclusion  We detected that myocardial perfusion is preserved in the patients with psoriasis. The majority of acute heart attacks are caused by noncritical coronary stenosis and this may be an explanation for increased cardiovascular risk in these patients despite normal coronary perfusion.     

Changes in platelet count and indices in pulmonary tuberculosis.

BACKGROUND: Recent studies show that platelets have important roles in the immune system. Little is known about the clinical significance of platelet indices. Changes in platelet indices, including platelet distribution width (PDW), mean platelet volume (MPV) and plateletcrit, in pulmonary tuberculosis were investigated. METHODS: Platelet indices were quantified in 82 patients with active tuberculosis and 87 patients with inactive or non-tuberculous disease (controls). Radiological extent of the disease was assessed. RESULTS: There were significantly higher PDW (40.9+/-23.5% vs. 27.0+/-14.5%), MPV (10.05+/-2.36 vs. 8.83+/-1.47 fL) and plateletcrit (0.330+/-0166% vs. 0.266+/-0.128%) values in the active tuberculosis group, which decreased significantly with anti-tuberculous therapy. Erythrocyte sedimentation rate and plateletcrit showed significant correlation (r=0.54 and r=0.66) with radiological extent of tuberculosis, while PDW and MPV correlations with radiological extent of tuberculosis were also significant but weaker (r=0.31 and r=0.23). In a subpopulation of controls with pneumonia, which leads to acute phase reaction, PDW, MPV and plateletcrit values were significantly lower than in the tuberculosis group. CONCLUSIONS: We suggest that PDW, MPV and plateletcrit change in tuberculosis and that these changes may not reflect only acute phase reaction and disease activity. The potential role of platelet indices in tuberculosis immunopathogenesis remains to be investigated.     

MicroRNA Expression Analysis in Patients with Primary Myelofibrosis,Polycythemia vera and Essential Thrombocythemia

MicroRNAs (miRNA) are small non-coding RNA molecules that play critical roles in cell differentiation, proliferation and apoptosis and thus regulate haematopoietic stem cells and committed progenitor cells. We analyzed expressions of miRNAs associated with hematopoietic transformation of myeloid, erythroid and megakaryocytic progenitor cells during haematopoiesis (mir155, mir181a, mir221, mir222, mir223, mir451), in patients with primary myelofibrosis (PMF) (n = 22), polycythemia vera (PV) (n = 33), essential thrombocythemia (ET) (n = 49) and in healthy controls (n = 40) by quantitate/real time polymerase chain reaction. RT-PCR testing was negative for BCR–ABL1 fusion gene in all the patients. Mir155 was expressed in higher levels in all 3 disorders (p < 0.05). Mir221 was higher especially in ET and PMF group (p < 0.05). Mir222 expression was lower in PV patients (p < 0.05) and higher in ET and PMF patients compared to control group. Mir223 expression was higher in ET and PMF group than control group (p > 0.05). Mir451 levels were lower in all three groups compared to control group (p < 0.05). There was no difference in expression levels of mir181a between groups. JAK2V617F positivity, co-morbidities, drugs, and gender did not affect miRNA expressions. This study holds promise for the future application of these molecules for differential diagnosis and as therapeutic targets in Philadelphia chromosome negative myeloproliferative neoplasms.     

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in various lung diseases

Objective:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of lung disease, and its use is increasing worldwide. It has been used as a means of diagnosing lung cancer in its initial stages, and there are data supporting its use for the diagnosis of benign lung disease. The aim of this study was to share our experience with EBUS-TBNA and discuss its diagnostic value.

Methods:

We retrospectively analyzed the results related to 159 patients who underwent EBUS-TBNA at our pulmonary medicine clinic between 2010 and 2013. We recorded the location and size of lymph nodes seen during EBUS. Lymph nodes that appeared to be affected on EBUS were sampled at least twice. We recorded the diagnostic results of EBUS-TBNA and (for cases in which EBUS-TBNA yielded an inconclusive diagnosis) the final diagnoses after further investigation and follow-up.

Results:

We evaluated 159 patients, of whom 89 (56%) were male and 70 (44%) were female. The mean age was 54.6 ± 14.2 years among the male patients and 51.9 ± 11.3 years among the female patients. Of the 159 patients evaluated, 115 (84%) were correctly diagnosed by EBUS. The diagnostic accuracy of EBUS-TBNA was 83% for benign granulomatous diseases and 77% for malignant diseases.

Conclusions:

The diagnostic value of EBUS-TBNA is also high for benign pathologies, such as sarcoidosis and tuberculosis. In patients with mediastinal disorders, the use of EBUS-TBNA should be encouraged, primarily because it markedly reduces the need for mediastinoscopy.     

Serum gamma-glutamyl transferase activity increased in patients with coronary artery ectasia

BACKGROUND: Serum gamma-glutamyl transferase (GGT) activity, an enzyme responsible for the extracellular catabolism of antioxidant glutathione, may directly take part in atherogenesis and evolve as a potential biochemical risk indicator of cardiovascular morbidity and mortality. An important characteristic of coronary artery ectasia (CAE) is the fact that in 85% of the cases, atherosclerotic coronary disease accompanies it. The relation between CAE and serum GGT activity has not been studied so far. Hence, we decided to investigate the serum GGT level in patients with CAE. METHODS: We measured serum GGT activity in 88 consecutive patients (48 males) with isolated CAE and 86 patients with coronary artery disease (CAD) and 84 controls. CAE was defined as being without any stenotic lesions with a visual assessment of the coronary arteries showing a luminal dilatation 1.5-fold or more of the adjacent normal coronary segments. Four subgroups were created in accordance with the CAE extension in coronary arteries. RESULTS: There were no statistically significant differences in serum GGT activity among CAE and CAD groups. Serum GGT activity was found significantly increased in patients in both CAE and CAD groups, compared with those in control group (P<0.001, P<0.001, respectively). According to the CAE severity, there were no statistically significant differences in CAE among these subgroups. CONCLUSION: We have shown for the first time that patients with CAE have higher serum GGT activity compared with controls with normal coronary angiograms. Hence, serum GGT activity can be used as a follow-up marker in patients with CAE.     

Adenosine‐Induced Ventricular Arrhythmias in Patients with Supraventricular Tachycardias

Background: Adenosine is widely used for the diagnosis and the termination of supraventricular arrhythmias. There are many case reports and few series about the proarrhythmic potential of adenosine. We sought to evaluate the proarrhythmic potential of adenosine used to terminate the supraventricular arrhythmias. Methods: The records of all patients that received adenosine for the termination of supraventricular tachycardia were reviewed retrospectively and those with a continuous electrocardiographic (ECG) recording during adenosine administration were included to the study. Results: Our search identified 52 supraventricular episodes of 46 patients with a continuous ECG recording during adenosine administration. Following adenosine administration, premature ventricular contraction (PVC) or ventricular tachycardia (VT) developed in 22 (47.8%) patients and in 26 (50%) tachycardia episodes. No patient had a sustained VT. Nonsustained VT developed in eight (17.4%) patients. All VT episodes were polymorphic, short, and self‐terminating. When the basal and demographic properties of patients with PVC or VT and those without PVT or VT were compared, there was no significant difference. Conclusions: Adenosine is a quite safe and effective drug for the termination of narrow QRS complex tachycardia but it often induces nonsustained VT or PVC that are clinically insignificant in the absence of other accompanying heart disease.