5 research outputs found
Medical Malpractice Stress Syndrome and Defensive Medicine in Obstetricians and Gynecologists in Turkey
No full textConclusion: Defensive medicine is common among Turkish OB/GYNs, driven by malpractice fears. The study highlights the need for improved support systems, better legal protections, and educational interventions to address defensive practices and reduce malpractice-related stress
The usefulness of fQRS and QRS distortion for predicting reperfusion success and infarct-related artery patency in patients who underwent thrombolytic therapy
No full textBackgroundThe aim of this study is to determine whether the presence of fragmented QRS (fQRS) and QRS distortion on admission ECG can be used to predict the success of treatment before beginning thrombolytic therapy (TT).Patients and methodsTwo hundred and three eligible patients with acute ST elevation myocardial infarction who received TT consecutively between 1 January 2009 and 1 July 2013 were enrolled. The presence of fQRS and QRS distortion was analyzed at admission ECG. The electrocardiographic criteria of reperfusion were defined as 50% or more of ST resolution (STR), whereas the angiographic criteria of reperfusion were defined as thrombolysis in myocardial infarction 2/3 flow in the infarct-related artery.ResultsfQRS was detected in 63 (31%) patients. Compared with patients with non-fQRS, STR was lower (46.117.7 vs. 73.6 +/- 20.9, respectively; P0.05). However, there was no relationship between QRS distortion and failed thrombolysis.ConclusionfQRS was detected in just 31% of the patients, but we found that it can be used to predict thrombolytic failure. Patients who have this simple marker on admission ECG may be directed to percutaneous interventions as a first-line therapy without any delay. (C) 2015 Wolters Kluwer Health, Inc. All rights reserved
Exercise Prevents Glucocorticoid-Induced Myocardial 4-Hydroxynonenal Production
No full textPurpose Long-term administration of glucocorticoids (GCs) increases myocardial oxidative stress. 4-Hydroxynonenal (4-HNE) protein adducts, a marker of oxidative damage, have been associated with several cardiovascular diseases, including atherosclerosis, cardiac hypertrophy, cardiomyopathy, and ischemia-reperfusion injury. Exercise training has been shown to have a protective effect on the heart by lowering the level of oxidative stress in cardiomyocytes. Therefore, we aimed to investigate the effect of long-term dexamethasone treatment and exercise training on myocardial 4-HNE levels.Methods Twenty-four female Wistar albino rats were assigned to sedentary control-saline treated (C, n = 8), sedentary-dexamethasone treated (D, n = 8), and exercise training-dexamethasone treated (DE, n = 8) groups. Daily dexamethasone was injected for 28 days at a 1 mg kg(-1) dose, while C animals were injected with the same volume of saline subcutaneously. DE animals underwent an exercise training protocol of 60 min/day, 5 days a week, at 25 m/min(-1) (0% grade) for 28 days. Left ventricular 4-HNE, Hsp72 levels, and pHsp25/Hsp25 ratio were determined by Western blot.Results The administration of dexamethasone led to a significant elevation in 4-HNE levels in the myocardium of adult rats (p 0.05; DE vs. C). Exercise training induced a threefold increase in myocardial Hsp72 expression (p < 0.001; DE vs. C and D) and attenuated the dexamethasone-induced increase in Hsp25 phosphorylation (p < 0.05; C vs. D) (p < 0.001; DE vs. D).Conclusion Our results indicate that long-term administration of dexamethasone is associated with an increase in cardiac 4-HNE levels, which is hindered by the addition of exercise training
A strong and reliable indicator for early postoperative major cardiac events after elective orthopedic surgery: Aortic arch calcification
No full textBackground: Cardiovascular events after orthopedic surgery may result in mortality. Therefore, predictors of early cardiovascular events after elective orthopedic surgery are required. Aim: The aim of this study is to investigate the relationship between aortic arch calcification and 30-day major adverse cardiac events following elective orthopedic surgery. Methods: Patients who had undergone orthopedic surgery were screened. Preoperative detailed anamnesis was taken. Echocardiography and standard chest x-ray were performed. Patients were followed in terms of perioperative 30-days major cardiac events and were classified into two groups according to development of perioperative major adverse cardiac events. Aortic arch calcification was evaluated by two cardiologists, blinded to study findings and was graded as 0 to 3 on chest x-ray. Results: A total of 1060 patients were approached for the study participation. Of these 714 were included in the study (mean age: 70.43, 65% female). Cardiovascular events occurred in 33 patients. As compared to the patients without cardiac events, the prevalence of aortic arch calcification, coronary artery disease, hypertension, and smoking were higher in patients with cardiac events. In addition, Lee index, left ventricular end systolic, end-diastolic and left atrial diameter were significantly higher, GFR values were significantly lower in the group with cardiac events. Multivariate regression analysis showed that smoking (OR 5.031, 95% CI 1.602 to 15.794), presence of hypertension (OR 5.133, 95% CI 1.297 to 20.308) and aortic arch calcification (OR 6.920, 95% CI 3.890 to 12.310) are independent predictors of major cardiac events within 30-day of elective orthopedic surgery. Conclusions: Presence of aortic arch calcification is associated with development of major cardiac events within 30-days after elective orthopedic surgery. (C) 2018 Elsevier Inc. All rights reserved
Navigating Heart Failure: Unveiling Sex Disparities in Guideline-Directed Medical Therapy Combinations
No full textMajor heart failure (HF) trials remain insufficient in terms of assessing the differences in clinical characteristics, biomarkers, treatment efficacy, and safety because of the underrepresentation of women. The study aimed to present sex-related disparities in HF management, including differences in demographics, co-morbidities, cardiac biomarkers, prescribed medications, and treatment outcomes. The study utilized anonymized data from and December 31, 2022. The cohort analysis included 2,501,231 adult patients with HF. Specific therapeutic combinations were analyzed using a Cox regression model to obtain relative risk reduction for all-cause death. The primary end point was all-cause mortality. In the cohort, 48.7% (n = 1,218,911) were male, whereas 51.3% (n = 1,282,320) were female. Female patients exhibited a higher median age (71 vs 68 years) and manifested higher prevalence of diabetes mellitus, anemia, atrial fibrillation, anxiety, and ischemic stroke. Male patients demonstrated higher rates of previous myocardial infarction, dyslipidemia, chronic obstructive pulmonary disease, and chronic kidney disease. Higher concentrations of natriuretic peptides were observed in female patients. Renin-angiotensin aldosterone inhibitor, b blockers, mineralocorticoid receptor antagonists, sodium/glucose cotransporter 2 inhibitor (SGLT2i), and ivabradine were more commonly prescribed in male patients, whereas loop diuretics, digoxin, and ferric carboxymaltose were more frequent in female patients. Male patients had higher rates of cardiac resynchronization therapy and implantable cardioverter defibrillator implantation rates. All-cause mortality and hospitalization rates were higher in male patients. Compared with monotherapy, all combinations, including SGLT2i, showed a beneficial effect on all-cause mortality in both female and male patients with HF. In hospitalized patients with HF, the addition of digoxin to renin-angiotensin aldosterone inhibitor, mineralocorticoid receptor antagonists, and b blockers was superior to monotherapy regarding all-cause mortality in female patients with HF compared with male patients with HF. In conclusion, this study highlights that sex-specific responses to HF medication combinations compared with monotherapy and differences in co-morbidities underscore the importance of tailored management strategies. Digoxin showed a contrasting effect on allcause mortality between both sexes after hospitalization, whereas SGLT2i exhibited a consistent beneficial effect in both sexes when added to all combinations. (c) 2024 Elsevier Inc. All rights reserved. (Am J Cardiol 2024;216:27-34
