Serum uric acid and slow coronary flow in cardiac syndrome X

Objective

It has been recently shown that cardiac syndrome X (CSX) patients with slow coronary flow (SCF) have a worse long-term prognosis than those with normal coronary flow. Increased uric acid levels were shown to be associated with atherosclerosis, oxidative stress, and endothelial dysfunction. The purpose of the study was to investigate the relationship between coronary flow assessed with TIMI frame count (TFC) and serum uric acid (SUA) levels in patients with CSX.

Methods

The study population consisted of 113 consecutive patients with typical cardiac CSX and 41 controls without cardiac CSX. Frequencies of risk factors as well as biochemical and hematological data were recorded for all participants. Coronary blood flow was evaluated by TFC. All patients with a TFC greater than two standard deviations from the published normal range for any one of the three vessels were accepted as having slow coronary flow (SCF group), while those whose TFC values fell within the standard deviation of the published normal range for all of the three vessels were considered to have normal coronary flow.

Results

Of the 113 CSX patients enrolled, 40 (35.4%) had SCF. The mean TFC value was strongly positively correlated with SUA level, but weakly correlated with male sex, hypertension, diabetes, smoking, serum creatinine level, and hemoglobin. Multivariate regression analysis showed that only the SUA level was independently associated with SCF. The cut-off value for uric acid obtained by the ROC curve analysis was 4.55 mg/dl for the prediction of SCF (sensitivity, 77.5%; specificity, 73.6%).

Conclusion

The SUA level is independently associated with SCF in patients with CSX.     

Effects of Apple Consumption on Plasma and Erythrocyte Antioxidant Parameters in Elderly Subjects

The effects of apple consumption on plasma and erythrocyte antioxidant parameters of elderly subjects were investigated in this study. Fifteen elderly subjects (mean age 71.86 ± 4.17) participated in the study. They consumed an apple a day for 1 month. Before and after this period, fasting blood samples were obtained, and oxidant (malondialdehyde [MDA]) and antioxidant (superoxide dismutase [SOD], glutathione peroxidase [GSH-Px], catalase [CAT], and antioxidant potential [AOP]) parameters were studied. MDA and AOP levels were studied in plasma, and SOD, GSH-Px, and CAT activities and MDA levels were measured in the erythrocytes. In the erythrocytes, GSH-Px and SOD activities were found to be higher (p < .001 and p < .01), but MDA levels were lower in the second samples relative to the first ones. In the plasma, AOP value was found to be higher in the second samples relative to first ones (p < .001). No differences were found, however, between the routine blood parameters such as total cholesterol, low-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol, high-density-lipoprotein cholesterol, and triglyceride levels. The results show that consumption of apple leads to significant increases in the activities of some antioxidant enzymes and in the antioxidant potential values of the blood, and that decreases oxidation reactions in the body in significant amount. It is quite possible that reduced peroxidation processes owing to consumption of this fruit may play a part in some of their beneficial effects in the elderly subjects.     

Does enthesopathy relate to M694V gene mutation in patients with Familial Mediterranean fever?

Familial Mediterranean fever (FMF) is a systemic hereditary autoinflammatory disorder. The present study aimed to investigate the relationship of enthesitis to FMF and to search the potential association between enthesitis and MEFV gene missense variations in patients with FMF. The study consisted of 72 FMF patients (mean age 29.12?±?11.47 years, 32 females), 29 patients with ankylosing spondylitis (AS) (mean age 34.14?±?11.73 years, 16 females), and 34 healthy volunteers (mean age 23.06?±?6.41 years, 8 females). FMF patients were classified according to the kind of MEFV gene mutation. Doppler ultrasound was used to determine enthesitis based on the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) scoring system. OMERACT score was significantly different between FMF patients and control group (p?<?0.001 in all patients, p?=?0.009 in men, and p?=?0.002 in women). However, it was not significantly different between FMF and AS patients in both sexes. OMERACT score did not differ between FMF patients with and without M694V gene mutation. The best cutoff point of OMERACT score to predict enthesitis was found as ≥0.5 with sensitivity of 29 %, specificity of 100 %, positive predictive value of 100 %, and negative predictive value of 40 %.     

Cystic lymphangiomatosis with severe intra‐abdominal bleeding in a newborn: Case report

We report the case of a newborn girl with intestinal cystic lymphangiomatosis who presented with abdominal distension and intra‐abdominal bleeding following a prenatal ultrasound diagnosis of intestinal anomaly. Postnatal abdominal ultrasound revealed disseminated submucosal and intramural cystic dilatations of various sizes in the bowel and intestinal lymphangiomatosis was diagnosed. The presence of severe bleeding diathesis and widespread disease led to conservative treatment. The patient died on postnatal day 7 and postmortem examination confirmed cystic lymphangiomatosis. Detection of intestinal hyperechogenicity and/or dilatation in prenatal ultrasonography and the persistence of these findings during pregnancy are suggestive for pathologies such as meconium ileus, meconium peritonitis, and intestinal atresia. Although rare, intestinal lymphangiomatosis should be kept in mind in patients whose prenatal sonographic findings persist until birth. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2013     

Prenatal and Postnatal Attachment Among Turkish Mothers Diagnosed with a Mental Health Disorder

The presence of a mental disorder in the mother is one of the key factors affecting attachment. The present study aimed to evaluate prenatal and postnatal attachment among mothers diagnosed with a mental health disorder by comparing them to a healthy group. The patient group included women who received follow-up care in a psychiatric clinic (74 pregnant and 75 postpartum), and the healthy group consisted of women who attended a follow-up polyclinic (118 pregnant and 82 postpartum). Data were collected using questionnaire forms, including the Prenatal Attachment Inventory and the Maternal Attachment Scale. Mothers diagnosed with a mental health disorder were determined to have lower attachment scores than the healthy group, both during the prenatal and postnatal periods. The literature suggests that mothers diagnosed with a mental health disorder showed low maternal attachment scores during pregnancy and/or the postnatal period. Psychiatric nurses should be involved in initiatives that may increase the prenatal and maternal attachment.     

Self-expanding covered metallic stent treatment of esophagojejunostomy fistulas

Purpose

The purpose of this study is to analyze the outcomes of the self-expanding covered metallic stent (SECMS) therapy in the management of the postoperative anastomotic leaks that seen after total gastrectomy–esophagojejunostomy (EJ) operations.

Materials and methods

Contrast radiography and endoscopy revealed EJ fistulas in 14 patients. SECMSs were implanted both fluoroscopically and endoscopically to seal fistulas. Postoperative fistula diagnosis times, postoperative covered stent implantation times, primary success rates, clinical success rates, postinterventional oral feeding beginning times, reduction of the drainage from the surgical drains, procedure-related mortality–morbidity, and mortality related with factors other than the procedure were noted.

Results

Technical success rate was 100 %. Clinical success rate was 79 %. Reduction of the fluid from surgical drains was observed in all patients. There were no procedure-related mortality. Recurrent fistula was observed in two patients (14 %) at the third and fifth day after the intervention. In one patient (7 %), stent dislocation was observed at the 10th day after the intervention. Non procedure-related mortality was 21 %. No anastomotic stricture, no in-stent stenosis was observed during the follow up period(11.09 ± 3.21 months).

Conclusion

From the above results we concluded that SECMS treatment for EJ fistulas is a safe, effective and technically easy procedure.     

Explaining variation in perceived team effectiveness: results from eleven quality improvement collaboratives

Aims and objectives. Explore effectiveness of 11 collaboratives focusing on 11 different topics, as perceived by local improvement teams and to explore associations with collaborative‐, organisational‐ and team‐level factors. Background. Evidence underlying the effectiveness of quality improvement collaboratives is inconclusive and few studies investigated determinants of implementation success. Moreover, most evaluation studies on quality improvement collaboratives are based on one specific topic or quality problem, making it hard to compare across collaboratives addressing different topics. Design. A multiple‐case cross‐sectional study. Methods. Quality improvement teams in 11 quality improvement collaboratives focusing on 11 different topics. Team members received a postal questionnaire at the end of each collaborative. Of the 283 improvement teams, 151 project leaders and 362 team members returned the questionnaire. Results. Analysis of variance revealed that teams varied widely on perceived effectiveness. Especially, members in the Prevention of Malnutrition and Prevention of Medication Errors collaboratives perceived a higher effectiveness than other groups. Multilevel regression analyses showed that educational level of professionals, innovation attributes, organisational support, innovative culture and commitment to change were all significant predictors of perceived effectiveness. In total, 27·9% of the individual‐level variance, 57·6% of the team‐level variance and 80% of the collaborative‐level variance could be explained. Conclusion. The innovation’s attributes, organisational support, an innovative team culture and professionals’ commitment to change are instrumental to perceived effectiveness. The results support the notion that a layered approach is necessary to achieve improvements in quality of care and provides further insight in the determinants of success of quality improvement collaboratives. Relevance to clinical practice. Understanding which factors enhance the impact of quality improvement initiatives can help professionals to achieve breakthrough improvement in care delivery to patients on a wide variety of quality problems.