Perspectives on endocarditis and rheumatic heart disease / Detecting and stratifying hypertension 959 relative efficacies is controversial in rheumatic heart disease, in part because of differing and mixed lesions and pathologies, technical challenges, and recurrent events.This meta-analysis compared mitral valve repair and replacement surgery for rheumatic mitral valve disease.Methods: We searched Medline, Embase, Cochrane and Scopus databases from January 1980 to June 2016 for original studies reporting outcomes of both mitral valve repair and replacement in rheumatic heart disease.Two authors independently assessed studies for inclusion, followed by data extraction and analysis. Results:The search yielded 933 articles, with 100 full-texts reviewed after initial screening and 17 studies were included for analysis, totaling 1982 mitral valve repairs and 3426 replacements.Pooled rates and odds ratio (95% confidence interval) for operative mortality of repair versus replacement was 3.2% vs 4.3%, 0.68 (0.50-0.92; p=0.01).Pooled odds ratios (95% confidence interval) were for longterm mortality 0.41 (0.30-0.56; p<0.001); valve related mortality 0.23 (0.14-0.37; p<0.001); re-operation 3.02 (1.72-5.31;p<0.001); and bleeding 0.26 (0.11-0.63; p=0.003).There was a trend towards lower thrombo-embolism 0.42 (0.17-1.03; p=0.06) and no significant difference in endocarditis (p=0.76)rates during followup.Conclusion: Mitral valve repair is associated with reduction in operative and longterm mortality and bleeding, so is recommended to be performed in rheumatic mitral valve disease where feasible, although it does have higher rates of reoperations during follow-up.

OBJECTIVE:We aimed to investigate whether there is an association between male pattern baldness and angiographic coronary artery disease (CAD) severity and collateral development, which has not been reported previously.METHODS:Coronary arteriograms, CAD risk factors, lipid parameters and presence and severity of baldness in 511 male patients were prospectively evaluated. Baldness was classified into five groups. Severity of CAD was evaluated with the Gensini scoring system and collateral development with Rentrop scores.RESULTS:Although subjects with a higher Gensini score had more frequent and severe baldness, they were older than the group with lower Gensini scores. Bald patients had a higher Gensini score when compared with their non-bald counterparts. In univariate analysis, age more than 60, body mass index more than 30, smoking and baldness were predictors of high Gensini scores. In multivariate analysis, only age more than 60, body mass index more than 30 and smoking were independent predictors of a high Gensini score. There were no differences in terms of presence and severity of baldness in subjects with and without adequate collateral development.CONCLUSIONS:There was no relation between presence, severity and age of occurrence of male pattern baldness and Gensini and Rentrop scores, which are important measures of presence and severity of CAD.

Agomelatine is a potent agonist at melatonergic 1 and 2 (MT1 and MT2) receptors and an antagonist at serotonin-2C (5HT-2C) receptors. It was suggested that psychotropic effects of agomelatine is associated with its melatonergic and serotonergic effects. In this study, we aimed to evaluate the effects of agomelatine alone or in combination with ritanserin (5HT-2A/2C antagonist) on memory and learning. Male Balb-C mice (25–30 g) were used, and all drugs and saline were administrated by intraperitoneal (i.p.) route 30 min prior to evaluating retention time. Whilst agomelatine was administered at the doses of 1, 10 and 30 mg/kg, ritanserin was administered at the doses of 0.1, 1 and 10 mg/kg. To evaluate memory function, passive avoidance test was used. On the first day, acquisition time and on the second day (after 24h), retention time of mice were recorded. To evaluate the synergistic activity, only the least doses of agomelatine and ritanserine were used, that is, 1 and 0.1 mg/kg, respectively. Scopolamine (1 mg/kg) was used as a reference drug, so it was combined with drug groups. Our results show that 5HT-2A/2C receptor antagonist ritanserin (1 and 4 mg/kg, i.p.) and agomelatine (10 and 30 mg/kg, i.p.) improve memory deficit induced by scopolamine, whilst a synergistic interaction is observed between ritanserin and agomelatine (0.1 mg/kg and 1 mg/kg, i.p., respectively) when they were administered at their ineffective doses. According to our findings, we concluded that agomelatine improves memory deficit and thus improves the effect of agomelatine arises from its 5HT-2C receptor antagonist activity.

The aim of this study was to determine whether inappropriate peripheral vasomotion have a significant role in the pathogenesis of neurally mediated syncope (NCS).A normal person's blood pressure will not decrease dramatically while standing, because the body will compensate for this posture with increase in heart rate and constriction of the blood vessels in the legs. The Ankle- Brachial Index (ABI) is the ratio of the blood pressure in the lower legs to the blood pressure in the arms. We have studied 66 patients between the years 2012–2013 at our institution.Thirty three patients (21 female/12 male, mean age:28±11 years) who experienced syncope in positive tilt table test and 33 healthy control (7 female/23 male, mean age:31±12 years ) (negative tilt table test) were included into the study. The ABI was calculated by dividing the mean of the dorsalis pedis and posterior tibial pressures in each leg by the mean of the four brachial pressures. The ABI was calculated as the ratio between the brachial and ankle systolic blood pressure for each leg separately. The lowest leg ABI was used in the analyses. All subjects were assesment before HUTT and after HUTT. Compared to the controls, patients showed significant difference lower basal values of ABI, (1.1±0.1 vs, 1.2±0.1; p<0.04; respectively) but end of tilt table test ABI was not significant difference (1.1±0,1, 1.1±0.1vs, p>=0.05;respectively). In the present study, We tested the hypothesis that subjects with a tilt-induced syncope,especially if occurring after nitrate administration, may present an abnormal vascular reaction.

PURPOSE OF THE STUDY To evaluate whether or not children with displaced proximal humerus fractures are more likely to have attention deficit and hyperactivity disorder (ADHD). PATIENTS AND METHOD Between January 2010 and February 2013, we retrospectively evaluated 42 children with proximal humerus fractures. Requirements for inclusion were an open epiphyseal plate and a non-pathological fracture of the proximal humerus. Fractures were classified according to Salter-Harris, Neer and Horwitz. Following orthopaedic examination, all of the children were consulted to child psychiatry department of our hospital. Orthopaedic examination included a detailed physical examination; the assessment of the overall shoulder functions using the Constant score. Diagnostic and Statistical Manual of Mental Disorders, Text Revisions (DSM-IV-TR) were used for psychiatric examination. RESULTS 9 of the 42 children with proximal humerus fractures consulted to child psychiatry were put ADHD diagnoses (21 %). Of the remaining 33 children without ADHD diagnosis, 5 children were operated; percentage of surgery was 15%. We found statistically significant difference between the rates of ADHD diagnosed children with proximal humerus fractures and ADHD diagnoses in normal population (p<0.01). There was also statistically significant difference between operation rates of children with or without ADHD diagnosis (55 % vs. 15 %) (p<0,01). CONCLUSIONS ADHD can be accepted as a risk factor for sustaining high energy trauma and rate of ADHD children who were operated was significantly more than normal children. This might be due to more displaced, open fractures or polytrauma - higher energy trauma- they sustained. Deciding on the treatment method, surgery may be treatment of choice in certain children with severely displaced, irreducable, fractures or polytrauma with accompanying ADHD due to the potential difficulties during follow up period.

OBJECTIVES:To investigate the rate of allergic diseases including asthma, allergic rhinitis and eczema in children and adolescents diagnosed with obsessive-compulsive disorder (OCD) (n:26) and/or Tourette syndrome (TS) (n:32) [OCD plus TS, n:13] compared to control subjects (n:35) [total, n:80].PATIENTS AND METHODS:The symptoms of any allergic disease were assessed using the ISAAC questionnaire form. Allergy diagnoses were made by a pediatric allergy specialist. Skin prick tests were applied, and IgE levels and eosinophil counts were measured.RESULTS:While only one-fifth of the control subjects had allergic diseases, more than half of the children with TS and/or OCD had comorbid allergic diseases. Positive skin prick tests were greater in OCD patients compared to control subjects. There were no significant differences between the groups in terms of eosinophil counts or IgE levels. Among the allergic diseases, while allergic rhinitis was diagnosed at significantly higher rates in TS patients, eczema was significantly higher in OCD patients compared to control subjects.CONCLUSIONS:This preliminary study shows an association between allergic diseases and TS and/or OCD. The results revealing differences in associations between types of allergic disease (rhinitis or eczema) and neuropsychiatric disorder (tic disorder or OCD) need to be investigated in further studies with higher numbers of participants, and immune markers should be examined.

The incidence of systemic embolization with mechanical valves is 1% per year [1]. Most cases present as cerebrovascular events. As the incidence of mechanical valve surgery has increased in recent years, systemic thromboembolism has become an important problem. Although coronary embolism due to mechanical valve thrombosis is encountered rarely, it is an important and serious complication. We report here a case of embolic myocardial infarction caused by a thrombus of a mechanical mitral valve.

Although persistent left superior vena cava (PLSVC) is rare, it is the most common thoracic venous anomaly. The prevalence of PLSVC is 0.3 % in a general population and 10 % in patients with congenital heart disease. Diagnosis of PLSVC is usually incidental during cardiovascular imaging or surgery. Although PLSVC is usually not associated with any negative hemodynamic effect, it is important to be aware of its existence, since it may cause problems in central venous catheterization, pacemaker implantation and cardiopulmonary bypass. The overall proportion of absent right superior vena cava in patients with PLSVC is approximately 20 %. If PLSVC is associated with absence of the right superior vena cava, the coronary sinus may become gigantic due to excessive inflow. Herein, we report a case of PLSVC complicated by the absence of a right superior vena cava resulting in a giant coronary sinus.

Reliable non-invasive new indices reflecting severity of rheumatic valve disease would be highly beneficial. Recently, presence of fragmented QRS (fQRS) in ECG was accepted as a marker of myocardial fibrosis. fQRS is defined as the presence of RSR' patterns such as additional R wave (R'), notching in the R wave or the S wave in 2 contiguous leads. Purpose of our study was to establish frequency of fQRS in isolated rheumatic mitral stenosis compared with control group. We studied 193 patients with mitral stenosis and age/gender matched 97 healthy subjects. Patients were categorized according to the New York Heart Association (NYHA) functional class. Severity of mitral stenosis, left ventricular ejection fraction, and pulmonary artery pressure were obtained by means of echocardiography. fQRS was defined on routine 12-lead ECG. fQRS was more frequent in subjects with mitral stenosis than in control group (p < 0.001). fQRS was associated with low ejection fraction, pulmonary hypertension, poor functional NYHA class, increased mean mitral valve gradient and decreased mitral valve area (R = 0.1, p = 0.02; R = 0.1, p = 0.001; R = 0.1, p = 0.01; R = 0.1, p = 0.04; and R = -0.1, p = 0.009, respectively). Mitral valve area was the only independent predictor of fQRS in multiple logistic regression analysis. In conclusion, fQRS is predictive of severe mitral stenosis, lower ejection fraction, increased pulmonary artery pressure, and poor functional class. fQRS might be considered as a novel indicator of mitral stenosis severity and associated complications.

Myopathy effecting mainly skeletal muscles of the limbs are frequently seen in hyperthyroidism. Rarely bulbar muscles may also be involved, causing dysphagia, nasal speech, and aspiration. We report a 70-year-old woman with severe dysphagia and aspiration pneumonia. Clinical examination and laboratory tests showed an underlying Graves' disease. Her dysphagia improved dramatically by antithyroid therapy. Considering its excellent response to medical therapy, hyperthyroidism--being a very rare factor - is well-worth to remember for the unexplained dysphagia cases.