Effect of tirofiban on C-reactive protein in non-ST-elevation myocardial infarction

Objectives

C-reactive protein (CRP) is a prototypic marker of inflammation. The effect of tirofiban on CRP levels in patients with non-ST-elevation myocardial infarction (NSTEMI) was investigated.

Methods

The present study was prospective and randomized. Patients with NSTEMI received aspirin, clopidogrel, statin, and unfractionated heparin. Patients with NSTEMI were enrolled into either the tirofiban + heparin group (group 1: n = 25) or the heparin group (group 2: n = 32). Levels of CRP were determined at baseline and after 48 and 72 hours. Heparin and tirofiban were discontinued after 48 hours.

Results

Levels CRP of were similar in two groups at baseline; they increased significantly at 48 hours and 72 hours in the control group but not in the tirofiban group. The differences on and after treatment were statistically significant. In group 1, CRP elevation was attenuated after tirofiban infusion compared with group 2.

Conclusions

Products of platelet activation may aid neutrophil accumulation and enhance inflammation. Activated leukocytes and platelets potentate each others' effects. Tirofiban strongly inhibits the platelet aggregation. The decreased platelet aggregation can suppress the inflammatory protein, chemokine, and adhesion molecule expression. After the tirofiban infusion, CRP elevation was atteunated in patients with NSTEMI.     

Coronary artery bypass grafting is associated with a significant worsening of QT dynamicity and heart rate variability

BACKGROUND: Imbalance in autonomic nervous system and impaired myocardial repolarization has been shown to increase the risk for arrhythmias in patients with coronary artery disease. This study evaluated the effects of coronary artery bypass grafting (CABG) on heart rate variability and QT interval dynamicity in subjects with coronary artery disease undergoing elective CABG surgery. METHODS: The study group consisted of 68 consecutive patients (mean age +/-SD: 61 +/- 9 years) with coronary artery disease who underwent elective CABG. Twenty-four-hour Holter monitoring was performed 2-5 days before cardiac surgery and was repeated 10 days after CABG. ELATEC holter software was used to calculate heart rate variability and QT dynamicity parameters. All subjects had a complete history, laboratory examination and transthoracic echocardiography. RESULTS: All patients had beta-blocking agent medication pre- and postoperatively. Standard deviation of all NN intervals for a selected time period, square root of the mean of the sum of the squares of differences between adjacent RR intervals, the proportion of differences in successive NN intervals greater than 50 ms, normalized low-frequency power, and normalized high-frequency power were significantly decreased after CABG surgery, whereas low-frequency/high-frequency ratio was significantly increased after CABG. QT/RR slopes over 24 h were significantly increased after CABG surgery for QT end and QT apex (QTapex/RR: 0.16 +/- 0.13 vs. 0.28 +/- 0.19, p < 0.001; QTend/RR: 0.18 +/- 0.13 vs. 0.36 +/- 0.23, p < 0.001). CONCLUSION: This prospective study showed for the first time that CABG was associated with a significant worsening of heart rate variability and QT dynamicity parameters in the postoperative period.     

Volume control associated with better cardiac function in long-term peritoneal dialysis patients.

BACKGROUND: This study was undertaken to investigate the effect of long-term blood pressure (BP) reduction, achieved with salt restriction and strict volume control, on frequency and regression of left ventricular hypertrophy (LVH) in long-term peritoneal dialysis (PD) patients. METHODS: 56 patients who had been treated for more than 2 years under our care were enrolled. After echocardiographic (Echo) evaluation, 46 patients were included in the follow-up study. In our unit, we aim to keep patients' BP below 130/85 mmHg and cardiothoracic index below 0.50. To reach these targets, moderate salt restriction is advised, and if necessary, hypertonic PD solutions are used. Echo was performed at the beginning of the study (after a mean period of 36 months on PD) and at the end of the prospective follow-up period (24 months later). RESULTS: At the time of the first Echo, LVH was detected in only 8 (21%) patients. Residual urine volume was significantly decreased compared to data taken when they first started PD (658 +/- 795 vs 236 +/- 307 mL/day). Mean left ventricular mass index (LVMI) was 107 +/- 26.5 g/m2. LVMI was significantly decreased at the end of the follow-up in patients who had LVH at baseline. No LVH developed in patients who had normal LVMI at baseline. CONCLUSION: Our results indicate that control of hypertension is possible when extracellular fluid volume is kept under control using hypertonic PD solutions in case of recruitment in addition to salt restriction in long-term PD patients. Sustained normovolemia is associated with low incidence and regression of LVH.     

Severe jaundice due to coexistence of Dubin-Johnson syndrome and hereditary spherocytosis: a case report

Dubin-Johnson syndrome is a chronic, benign, intermittent jaundice, mostly of conjugated hyperbilirubinemia. The level of bilirubin is not expected to be more than 20 mg/dl in this syndrome. In this article, we report a patient who was evaluated for hyperbilirubinemia and liver function test abnormalities and diagnosed with Dubin-Johnson syndrome coexisting with hereditary spherocytosis. We suggest that other diseases should be investigated if patients with Dubin-Johnson syndrome present with severe hyperbilirubinemia. Dubin-Johnson syndrome accompanied by hemolytic diseases might also have high coproporphyrin levels (as in Rotor's syndrome) than expected in pure Dubin-Johnson syndrome.     

Evaluation of drug resistance in pulmonary tuberculosis patients at Sureyyapasa Chest Diseases Hospital, Istanbul, Turkey.

SETTING: Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey. OBJECTIVE: To determine levels of Mycobacterium tuberculosis resistance to first-line drugs in patients with pulmonary tuberculosis (PTB). DESIGN: Between 1 January and 31 December 2005, all hospitalised PTB patients with culture-positive M. tuberculosis specimens and corresponding drug susceptibility tests (DST) for isoniazid (INH), rifampicin (RMP), streptomycin (SM) and ethambutol, routinely performed for every tuberculosis (TB) case at our centre, were included. RESULTS: Of a total of 1513 cases, 1277 (84.4%) were new and 236 (15.6%) were previously treated cases. Of the 1513 isolates, 290 (19%) isolates were resistant to at least one of the drugs tested. Resistance among new and previously treated cases was respectively 16.3% (209 of 1277) and 34.3% (81/236). Any SM resistance and any INH resistance were the most common drug resistance in new cases, while any RMP resistance was the most common drug resistance in previously treated cases. Multidrug resistance was detected in 3.2% (n = 41) of new cases and in 13.5% (n = 32) of previously treated cases. CONCLUSION: Planning for TB control requires an assessment of the number and distribution of drug-resistant cases, with laboratories providing accurate and reliable results.     

Takayasu disease with prominent pulmonary artery involvement: confusion with pulmonary disease leading to delayed diagnosis

Pulmonary artery involvement as the initial predominant clinical manifestation in Takayasu arteritis (TA) is rare. We describe a young adult female who presented with life-threatening complications of proximal pulmonary arterial involvement of Takayasu arteritis. In our case, atypical presentation of TA with pulmonary symptoms due to pulmonary artery involvement resulted in an erroneous initial diagnosis of sarcoidosis and then tuberculosis. The frequency of such a clinical form could be underestimated given the difficulties involved in its diagnosis and because its features are similar to those of pulmonary disease.     

The relationship between ascending aortic diameter with left atrial functions and left ventricular mass index in a population with normal left ventricular systolic function

Aim

Ascending aortic dilatation is a common clinical issue. In the present study, we aimed to evaluate the relationship between ascending aortic diameter with left ventricular (LV) and left atrial (LA) functions, and LV mass index (LVMI) in a population with normal LV systolic function.

Methods

A total of 127 healthy participants with normal LV systolic function took part in the study. Echocardiographic measurements were obtained from each subject.

Results

The mean age of the participants was 43 ± 14.1 years and 76 (59.8%) were female. The mean aortic diameter of the participants was 32.2 ± 4.7 mm. A negative correlation was found between aortic diameter and LV systolic function (LVEF r = -.516, p < .001; Gls r = -.370). In addition, there was a strong positive correlation between aortic diameter with LV wall thicknesses, LVMI (r = .745, p < .001), and systolic and diastolic diameters. The relationship between aortic diameter and diastolic parameters was evaluated, a negative correlation with Mitral E, Em, E/A ratio, and a positive correlation with MPI, Mitral A, Am, E/Em ratio were found.

Conclusion

A strong correlation between ascending aortic diameter with LV and LA functions, and LVMI in individuals with normal LV systolic function.     

Effect of I-deprenyl and gliclazide on oxidant stress/antioxidant status and dna damage in a diabetic rat model

BACKGROUND: This study investigates the possible effect of monoamine oxidase inhibitor (MAOI), selegyline (l-deprenyl), in combination with oral antidiabetic-gliclazide (OAD), in preventing oxidative stress in streptozotocin-induced diabetes model in male Swiss Albino rats by measuring oxidant stress/ DNA damage and antioxidant levels. METHODS: Diabetic rats were divided into four groups (n = 10) as (1) diabetic untreated (DM), (2) deprenyl treated (DM + D), (3) gliclazide treated (DM + O), and (4) gliclazide and deprenyl treated (DM + O + D). Controls were divided into two groups (n = 8) (1) untreated (C), and (2) deprenyl treated (C + D). Gliclazide 5 mg/kg and/or MAOI 0.25 mg/kg daily were given orally by gavage for 4 weeks. At the end of the 12th week, catalase and superoxide dismutase (SOD) levels in erythrocyte lysates (EL); total antioxidant status (TAS), 8-hydroxy-deoxyguanosine (8-OHdG), malondialdehyde (MDA), and vitamin A and E levels in plasma, MDA, and MAO in liver homogenates were determined. RESULTS: Diabetic rats showed a decrease in EL-SOD, plasma TAS, and vitamin E, and an increase in plasma 8-OHdG, plasma, and liver MDA levels (p < 0.05). Gliclazide and/or deprenyl decreased 8OHdG levels and increased antioxidant levels and survival when compared with untreated diabetic rats (p < 0.05). The lowest 8-OHdG levels were determined in the DM +O + D group. CONCLUSIONS: The combined treatment of deprenyl and gliclazide may contribute to the control of the physiopathological mechanisms underlying both the process of aging and type 2 diabetes by reducing oxidant stress and DNA damage, improving antioxidant status, and increasing survival, and may have implications for further clinical studies.