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  • ISSN: 2378-9344
    Volume 2, Issue 3
    Research Article
    Seyhan Yilmaz*
    Purpose: We aimed in this study to examine the presence and frequency of genetic polymorphisms in individuals less than 55 years of age with significant peripheral arterial disease in the femoropopliteal arterial system and to report on their association with the disease.
    Material and methods: This cross-sectional study undertaken between 2013 and 2014 included a total of 32 peripheral arterial disease patients (30 male, mean age 47.34±4,62 years) were included. less than 55 years of age who had significant femoropopliteal stenosis / occlusion (> 50%) as documented by a computed tomography arteriography and who had a complete set of thrombophilia marker and genetic risk factor analysis results.
    Results: A total of 32 patients were investigated for genetic risk factors and thrombophilia markers. Of the 32 patients 7 (21.8%) had factor V Leiden mutation (7 heterozygous), 2 (6.2%) had prothrombin gene mutation, and 13 (40.6%) had methylenetetrahydrofolate reductase C677T gene mutation (3 homozygous and 10 heterozygous). Three patients had both legs involved, while 18 and 11 patients had involvement on the right and left side only, respectively.
    Conclusion: Due to the presence of an association between risk factors for hereditary thrombophilia and thrombotic and occlusive events, which lead to increased failure rates in operations and interventions for peripheral arterial disease, we believe that thrombophilic markers and genetic risk factors should certainly be assessed particularly in younger patients and/or patients undergoing revascularization procedures to improve success and patency rates and to minimize thrombotic and occlusive complications.
    Karsten Keller*, Meike Coldewey, Martin Geyer, Johannes Beule, Jorn Oliver Balzer, and Wolfgang Dippold
    Aim: Right ventricular dysfunction (RVD) and cardiac troponin are important tools for accurate risk stratification in acute pulmonary embolism (PE). We aimed to investigate the impact of age on the effectiveness of cardiac Troponin I (cTnI) for predicting RVD and adverse outcomes in normotensive PE.
    Methods: A retrospective analysis of normotensive PE patients (2006-2011) was performed. Patients were subdivided in age groups of <70 years and =70 years, and their data was compared with the Mann-Whitney-U test. A logistic regression model for the association between cTnI>0.1 ng/ml and RVD was constructed. Age-dependent ROC curves with AUC and cut-off values were calculated for cTnI to predict RVD and cTnI to predict adverse outcomes as a combination of in-hospital death, pneumonia (on the basis of lung infarction) and RVD.
    Results: A total of 129 normotensive PE patients (59.7% women) were subdivided into groups of <70 years and =70 years (61 vs. 68 patients). The mean cTnI values of the <70 years and =70 years groups were similar (0.12±0.29 vs. 0.16±0.34 ng/ml, P=0.127). RVD was more frequent in the older group (82.4% vs. 55.7%, P=0.00106). In the logistic regression model, cTnI >0.1 ng/ml was associated with RVD (OR 4.00, CI95%: 1.23-13.04, P=0.0213). The AUC for cTnI predicting RVD was 0.76 in the younger age group and 0.84 in the older age group. The AUC for cTnI predicting adverse outcomes was 0.66 in the younger age group and 0.81 in the older age group. The cTnI cut-off values (0.005 vs. 0.015 ng/ml) for the identification of RVD and adverse outcomes (0.0050 vs. 0.0150 ng/ml) were slightly lower in younger than in older patients.
    Conclusions: The effectiveness of cTnI at predicting RVD as well as adverse outcomes is better in normotensive PE patients aged 70 years and older than in those younger than 70 years.
    Manuel Podrecca*, Jose C Martins, Krisztina Feher and Jean-Marie Colet
    Hypertensive disorders during pregnancy are a leading cause of maternal and fetal mortality worldwide. During a first pregnancy, some women may develop gestational hypertension, representing a major risk to the mother and child especially when associated with preeclampsia. This pathological condition arises from a defect in placentation that is the starting point of hypertension in pregnancy. The impact of hypertension and/or pregnancy on the metabolome of rats was assessed by 1H-NMR spectroscopy. This approach revealed specific metabolic patterns in urine, plasma and tissue samples associated with hypertension and/or pregnancy. In particular, alterations in the contents of fatty acids, amino acids and glycoprotein's in plasma samples and tissue extracts were indicative of the development of a "metabolic syndrome". Also, changes in urinary creatinine already reported by other authors as potential biomarkers of an alteration in glomerular filtration due to hypertension were confirmed in our study. Finally, changes in sarcosine were also noticed, which could be seen as indicative of the invasion of cytotrophoblast during the development of the placenta. These results support the use of 1H-NMR-based metabonomics as a promising tool to provide new information on metabolic changes associated with the physiopathology of hypertension and pregnancy in rats.
    Short Communication
    Evilane do Carmo Patricio1, Regina Amelia Lopes Pessoa de Aguiar2, Henrique Vitor Leite2, Victor Hugo de Melo2, Antônio Carlos Vieira Cabral3 and Augusto Henriques Fulgencio Brandao4*
    Background: Highly Active Antiretroviral Therapy (HAART) represented a breakthrough towards vertical transmission of HIV. Despite several reports of important collateral effects, the use of HAART quickly widespread due to its incontestable benefit to the fetus regarding the risk of infection. Endothelial dysfunction and abnormal placentation have been pointed out as one of the consequences of HAART and also as pathophysiological events of many disorders in pregnancy, such as Preeclampsia (PE). The association between PE, HIV and HAART presented conflicted data in literature.
    Objectives: to evaluate possible differences in endothelial function and placental invasion between HIV-positive pregnant women receiving prophylactic HAART and HIV-negative healthy pregnant women from 16+0 to 19+6 weeks of pregnancy.
    Patients and Methods: in this cross-sectional study, a total of 20 HIV-positive pregnant women and 40 HIV-negative pregnant women were submitted to Flow-mediated dilation (FMD) of brachial artery and dopplerfluxometry of uterine arteries, in order obtain its pulsatility index (UtA-PI).
    Results: there were no statistical differences between the results of FMD (6,53 ± 3,61 X 4,98 ± 3,17, p=0,13) and UtA-PI (1,08 ± 0,29 X 1,06 ± 0,23, p=0,91) between HIV-positive group an HIV-negative group.
    Conclusions: our findings suggest adequate placentation and absence of endothelial dysfunction in the first half of pregnancy in HIV positive women using prophylactic HAART.
    Case Report
    T. Joseph Watson*, W. Kurtis Childers and Joseph Campbell
    We present a case of a fifty-five year old male with acute thrombosis of the celiac trunk secondary to alcohol-induced pancreatitis. He was treated emergently with open thrombectomy and post-operatively has been maintained on oral anticoagulation. Although it is an uncommon abdominal emergency, acute thrombosis of the celiac axis carries a high risk of morbidity and mortality if not aggressively treated and should be included in the differential of any patient with a history of chronic pancreatitis that presents with sudden deterioration.
    Ugur Gocen*, Atakan Atalay and Vecih Keklik
    Situs inversus totalis is a rare autosomal recessive congenital anomaly. There are very few reports in the published literature of abdominal aortic aneurysm in patient with situs inversus totalis, all of whom underwent open aneurysm repair. DeBakey type III acute aortic dissection is life threatening condition with organ malperfusion. A 74-year-old male, referred our department with back pain and dyspnea. Contrast-enhanced computed tomography (CT) suggested DeBakey type III aortic dissection and situs inversus totalis. Thoracic endovascular aneurysm repair (TEVAR) were successfully performed. Postoperative control CT showed succesfull treatment of the DeBakey type III dissection with TEVAR in a situs inversus totalis patient. His postoperative course was uneventful. With situs inversus totalis, which is the first case in the literature that DeBakey type 3 dissection is treated with TEVAR. TEVAR is applicable in Situs inversus totalis patients.
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