RESUMEN
BACKGROUND: Penile Mondor's disease (PMD) is thrombophlebitis of the superficial dorsal vein of the penis. Following the occurrence of thrombotic events in the affected veins, the lumen often becomes occluded with fibrin and inflammatory cells. A hyper-coagulative state is one of the underlying causes although most cases of PMD are idiopathic. Coronavirus disease-2019 infection (COVID-19) is associated with frequent thrombotic events. Inflammation and thrombosis play a central role in the course and outcome of COVID-19, which can predispose to both venous and arterial thromboembolism. In this report, we present a 33-year-old male patient diagnosed with PMD during the subacute phase of COVID-19 infection while on prophylactic antithrombotic treatment. CASE PRESENTATION: A 33-year-old male patient was diagnosed as PMD which occurred during the subacute phase of COVID-19 infection, while he was on active treatment of COVID-19 by prophylactic antithrombotic Rivaroxaban 15 mg therapy and curative antiviral medication. There was no recent sexual intercourse or trauma to the genitals. His PCR test for COVID-19 had become negative, and antibody test was positive at the time of his PMD's onset. Rivaroxaban was replaced by Enoxaparin (8000 IU/0.8 ml.), a low molecular weight heparin administered subcutaneously and twice daily. On the third day of this medication, all coagulative measurements returned to normal. PMD disappeared in the second week. CONCLUSION: Low-dose Rivaroxaban 15 mg is not safe for some COVID-19-associated thromboembolism prophylaxis, and careful follow-up is critical due to the possibility of a wide range of pathologic thrombotic manifestations in COVID-19 infection.
RESUMEN
OBJECTIVES: This study was designed to evaluate clinical, laboratory, microbiological, and echocardiographic characteristics of infective endocarditis (IE) at a tertiary care center in Turkey and to identify predictors of in-hospital mortality. STUDY DESIGN: Based on a systematic retrospective review of clinical records covering 1997 to 2007, we analyzed data and outcomes of 68 patients (40 males, 28 females; mean age 51+/-20 years) with definite or possible IE according to the modified Duke criteria. RESULTS: Native valve endocarditis (NVE) was seen in 28 patients (41.2%), and prosthetic valve endocarditis (PVE) was seen in 38 patients (55.9%). Pacemaker endocarditis (PE) was observed in only two patients (2.9%). Nineteen patients (27.9%) had nosocomial IE. The most frequent predisposing factor for NVE was rheumatic heart disease (n=11; 39.3%). Echocardiography failed to show any signs of involvement in five patients (13.2%) with PVE. The most common causative microorganisms of NVE, PVE, and PE were staphylococci (n=28; 41.2%). At least one complication developed in 46 patients (67.7%), congestive heart failure being the most common (n=38; 55.9%). Forty-one patients (60.3%) underwent combined medical and surgical treatment. In-hospital mortality occurred in 17 patients (25%). Mortality rates were 37.5%, 30%, and 14.3% for early and late PVE and NVE, respectively. Mortality was significantly higher with nosocomial IE (57.9%) compared to 12.2% in the remaining patients. In multivariate analysis, septic shock (p=0.011) and nosocomial infection (p=0.032) were independently associated with in-hospital mortality. CONCLUSION: Compared to the European series, IE in our cohort occurred in a relatively younger population, with rheumatic heart disease as the most common underlying heart disease. The rates of PVE, nosocomial IE, and surgical treatment were about the same.
Asunto(s)
Infección Hospitalaria/mortalidad , Endocarditis/mortalidad , Prótesis Valvulares Cardíacas/efectos adversos , Marcapaso Artificial/efectos adversos , Infecciones Relacionadas con Prótesis/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva/análisis , Infección Hospitalaria/etiología , Infección Hospitalaria/terapia , Ecocardiografía , Ecocardiografía Transesofágica , Endocarditis/complicaciones , Endocarditis/etiología , Endocarditis/terapia , Femenino , Mortalidad Hospitalaria , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/terapia , Estudios Retrospectivos , Cardiopatía Reumática/complicaciones , Factores de Riesgo , Choque Séptico/complicaciones , Choque Séptico/mortalidad , Turquía/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Our aim was to determine whether the common variants within the coding sequence of ABCA1 gene affects low plasma high-density lipoprotein cholesterol (HDL-C) levels in Turkish patients with coronary artery disease (CAD). The study group was composed of 552 CAD patients, of which 251 had HDL-C levels < or =40 mg/dL, and 301 had HDL-C levels >40 mg/dL. METHODS: PCR-RFLP was used to determine the A2589G and G3456C DNA polymorphisms of the ABCA1 gene. The study group was analyzed for potential clinical predictors of low HDL-C. RESULTS: The GG variant of the ABCA1 gene A2589G polymorphism was found in 3.6% patients within the HDL-C < or =40 mg/dL group and in 4% of HDL-C levels >40 mg/dL group. Frequency distributions of the A2589G genotypes were not found to differ significantly among groups. The CC genotype of the G3456C polymorphism was found in 6.8% of HDL-C < or =40 mg/dL group and in 11.6% individuals of the HDL-C levels >40 mg/dL group. Frequency distributions of the G3456G genotypes were not significantly different among groups. The A2589G genotypes were not found to be effective over the analyzed lipid parameters. Among G3456C genotypes, in CAD patients with HDL-C < or =40 mg/dL the low-density lipoprotein (LDL-C) levels were elevated, whereas HDL-C levels decreased in CC genotype carriers compared to GG and GC. CONCLUSIONS: No significant association was found between cardiovascular endpoints and ABCA1 gene A2589G and G3456C genotypes in this study population.
Asunto(s)
Transportadoras de Casetes de Unión a ATP/genética , HDL-Colesterol/sangre , Enfermedad de la Arteria Coronaria , Polimorfismo Genético , Transportador 1 de Casete de Unión a ATP , Transportadoras de Casetes de Unión a ATP/metabolismo , Anciano , LDL-Colesterol/sangre , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/genética , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , TurquíaRESUMEN
BACKGROUND: Coronary slow flow (CSF) is characterized by delayed opacification of epicardial arteries in the absence of occlusive disease. In the present study, we aimed to investigate the relation between coronary flow rate, plasma endothelin-1 (ET-1) concentrations, and clinical characteristics in patients with normal coronary arteries. METHODS: The study population included 77 patients with angiographically normal coronary arteries who underwent coronary angiography on suspicion of ischemic heart disease due to typical chest pain or ischemic findings on treadmill exercise test or myocardial scintigraphy. Based on the Thrombolysis In Myocardial Infarction frame count (TFC), patients were grouped into those with normal coronary flow and those with slow coronary flow. RESULTS: Forty-eight (61.5%) patients were found to have CSF. Plasma ET-1 concentrations were significantly higher with the presence of CSF (P=.03). There were significant differences between plasma ET-1 concentrations, and mean TFC, TFC for left anterior descending coronary artery (LAD), TFC for left circumflex coronary artery (CX), and TFC for right coronary artery separately in patients with and without CSF (P=.033, P<.001, P<.001, P<.001, and P<.001, respectively). Mean TFC, TFC for LAD, and TFC for CX, and ET-1 concentrations were significantly higher in smokers than in nonsmokers (P<.001, P<.001, P=.004, and P=.033, respectively). However, logistic regression analysis suggested that ET-1 concentration was not an independent determinant of CSF. CONCLUSIONS: Although there is a significant relation between ET-1 concentrations and coronary flow rate, ET-1 concentrations are not sufficient to determine the presence of CSF. Smoking is strongly associated with CSF, TFC, and increased ET-1 concentrations.
Asunto(s)
Velocidad del Flujo Sanguíneo/fisiología , Circulación Coronaria/fisiología , Vasos Coronarios/fisiología , Endotelina-1/sangre , Isquemia Miocárdica/fisiopatología , Biomarcadores/sangre , Angiografía Coronaria , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/sangre , Isquemia Miocárdica/diagnóstico por imagen , Pronóstico , Estudios Retrospectivos , Factores de RiesgoRESUMEN
PURPOSE: Metabolic syndrome is a cluster of cardiovascular disease risk factors. We assessed the impact of these medical disorders on the outcome of percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Data from 430 consecutive PCNL procedures were retrospectively reviewed. The presence of serum lipid abnormalities (SLA), hypertension (HT), diabetes (DM), and obesity was investigated. Patients were determined to have the metabolic syndrome according to the definition of the International Diabetes Federation. Success rate, need for auxiliary procedures, and major complication rates of PCNL were analyzed separately for patients with or without DM, SLA, HT, obesity, and the metabolic syndrome, and were compared. RESULTS: SLA, HT, and DM were observed in 123 (28.6%), 108 (25.1%), and 44 (10.2%) patients, respectively. Body mass index was >30 kg/m2 in 74 (17.2%) patients. Metabolic syndrome was diagnosed in 41 (9.5%) patients. An overall success rate of 96.3% for PCNL was achieved. Success rates were not significantly (P > 0.05) influenced by the presence of SLA, HT, DM, obesity, or the metabolic syndrome. Major complications were encountered in 49 (11.4%) patients and were 2.5 to 2.7 times more common in patients with DM, HT, and the metabolic syndrome. In patients with DM, auxiliary treatment alternatives were necessary in 20.5%, while they were indicated in 10.9% of patients without DM (P = 0.046). Presence of the metabolic syndrome was also associated with an increased necessity for auxiliary treatments after PCNL (P = 0.048). CONCLUSIONS: Our results indicate that the metabolic syndrome and its components (DM and HT) significantly augment auxiliary treatment and complication rates after PCNL.
Asunto(s)
Cálculos Renales/cirugía , Síndrome Metabólico/complicaciones , Nefrostomía Percutánea , Adolescente , Adulto , Anciano , Índice de Masa Corporal , Niño , Complicaciones de la Diabetes , Femenino , Humanos , Hipertensión/sangre , Cálculos Renales/complicaciones , Lípidos/sangre , Masculino , Persona de Mediana Edad , Nefrostomía Percutánea/efectos adversos , Resultado del TratamientoRESUMEN
Anemia is associated with higher rates of cardiovascular events in patients with heart failure, acute myocardial infarction, and in patients undergoing coronary artery bypass graft surgery. Although studies have focused on fatal coronary events in anemic patients following percutaneous coronary intervention (PCI), data is lacking regarding nonfatal coronary events. The aim of our study was to analyze the incidence of anemia in patients who developed nonfatal events after successful PCI, and to make a comparison with event-free patients. Forty-nine consecutive patients with and 51 without nonfatal coronary events (nonfatal myocardial infarction, coronary artery bypass grafting, or repeat PCI) during the 1-year follow-up after the index PCI procedure were included in the study. Anemia was defined using World Health Organization (WHO) criteria as a hematocrit value at initial presentation <39% for men and <36% for women. Baseline hematocrit levels were measured before the procedure. Baseline clinical, lesion, and procedural characteristics were comparable in both groups. Anemia was present in 33.8% of men and 30.4% of women. The incidence of anemia in patients with nonfatal coronary events was 46.9% and 15.7% in the event-free group, which was significantly different (P = 0.001). Anemia was found to be an independent risk factor for nonfatal coronary events in PCI patients (odds ratio: 2.24, 95% confidence interval: 1.05-4.79; P = 0.036). In conclusion, anemia is an important risk factor for predicting nonfatal coronary events after PCI. Although previous studies have shown its impact on fatal events, this study has demonstrated that anemia also has a role in nonfatal thrombotic coronary events and restenosis.