Sadik Duran

Cardiac emergencies caused by honey ingestion: a single centre experience

An unusual type of food poisoning is commonly seen in the Black Sea coast of Turkey attributable to andromedotoxin containing toxic honey ingestion. This study is a retrospective case series of 19 patients admitted to an emergency department in 2002, poisoned by “mad” honey. All of the patients had the complaints of nausea, vomiting, sweating, dizziness, and weakness, several hours after ingesting “mad” honey. Physical examination showed hypotension in 15 patients, sinus bradycardia in 15, and complete atrioventricular block (AVB) in four patients on admission. Two patients with bradycardia and two with AVB fell and injured their heads. Three of them presented with local haematoma. One patient had a 6 cm cut on his head without any neurological deficit and his cranial computed tomography imaging was normal. Hypotension and conduction disorders resolved with atropine treatment, resulting in complete recovery within 24 hours.

Pregnancy-associated plasma protein A in dialysis patients.

Abstract Background: Pregnancy-associated plasma protein A (PAPP-A) was recently described as a new marker of cardiovascular events and of inflammation in uremic patients. The aim of this study was to determine levels of PAPP-A in chronic dialysis patients and its possible relationships with renal osteodystrophy. Methods: A total of 99 adult chronic hemodialysis patients, 14 peritoneal dialysis patients and 41 control subjects were included in the study. Serum PAPP-A, intact parathormone (iPTH), calcium, phosphorus and alkaline phosphatase (ALP) were measured. The correlations between PAPP-A and iPTH, calcium, phosphorus and ALP were determined. Results: PAPP-A levels were significantly higher in peritoneal dialysis [4.5 (3.2–6.7) mU/L, median (interquartile range)], and hemodialysis patients [4.7 (3.8–6.5) mU/L] in comparison to control subjects [3.4 (3.0–5.0) mU/L] (p<0.05). In hemodialysis patients, post-dialysis PAPP-A levels [6.2 (4.7–9.4) mU/L] were significantly higher than pre-dialysis levels [4.7 (3.8–6.5) mU/L] (p<0.05). There was a weak but statistically significant positive correlation between serum PAPP-A and iPTH (r=0.216; p=0.041) and ALP (r=0.205; p=0.044) in the hemodialysis group. Correlation between the duration of dialysis therapy and PAPP-A levels was also significant (r=0.267; p=0.008) in the hemodialysis group. Conclusions: PAPP-A levels are elevated in acute coronary syndromes and are closely related to inflammation and oxidative stress. We conclude that PAPP-A levels are increased in dialysis patients and may reflect a greater degree of chronic inflammation than osteodystrophy in uremic patients. Clin Chem Lab Med 2007;45:63–6.

Pregnancy-associated plasma protein-A and asthma.

Pregnancy-associated plasma protein-A (PAPP-A) is potentially a proatherosclerotic metalloproteinase and a new inflammatory marker. Investigators sought to evaluate the significance of PAPP-A in patients with asthma. Blood samples were collected from 35 patients and 20 control subjects. Serum PAPP-A was determined by enzyme-linked immunosorbent assay. PAPP-A levels of patients with asthma (8.1±5.0 mU/L) were higher than those of the control group (4.9±2.1 mU/L) (P < .01). A significant correlation was noted between serum PAPP-A concentration and asthma severity (r=.581;P < .01). Investigators concluded that PAPP-A may contribute to airway smooth muscle hyperplasia as an insulin-like growth factor-dependent insulin-like growth factor-binding protein-4 protease in patients with asthma.

In vivo effect of losartan on platelet aggregation in patients with hypertension

The angiotensin II receptor, losartan, has been found to inhibit platelet aggregability to some extent in in vitro experiments. There have been conflicting results about the in vivo effects of losartan. We sought to clarify the in vivo effect of losartan on platelet aggregation. Forty patients with grade I essential hypertension were treated with losartan for 3 weeks. Platelet aggregation tests with adenosine diphosphate (ADP) and ristocetin were analyzed and compared before and at the end of the study. Losartan effectively decreased systolic (SBP) and diastolic (DBP) blood pressure. Mean SBP before and after treatment was 159.6 ± 12.8 and 149.2 ± 17.3 mmHg, respectively. Mean DBP decreased from 93.7 ± 8.2 to 87.7 ± 10.3 mmHg after treatment. The results of the platelet aggregation tests with ADP and ristocetin were not significantly different when both rate and amplitude of maximal aggregation were included. Peak platelet aggregation with ADP regarding the lowest light transmission in the aggregometer was 59.8% ± 24.3% before and 58.3% ± 18.1% after the treatment. The same variables with ristocetin were 66.8% ± 21.6% and 60.8% ± 23.3%, respectively. In vivo effects of losartan on platelet aggregation with ADP and ristocetin were insignificant.

HLA-DR B1 and DQ B1 polymorphisms in patients with coronary artery ectasia

Objectives — The purpose of our study was to evaluate the significance of polymorphisms in HLA class II genes in coronary artery ectasia (CAE) patients. Methods and results — Twenty-six patients with CAE without associated cardiac defects were enrolled in the study.CAE was defined as luminal dilation of 1.5- to 2.0-fold of normal limits. Ninetyfive healthy subjects who were donors for different organ transplantations, were chosen as control group. Physical examination, electrocardiography and chest X-ray were completely normal in these cases. Both the patients and the control group were screened and compared for their HLA class II genotypes. HLA-DR B1*13, DR16, DQ2 and DQ5 genotypes were significantly more frequent in the patient group.When the known risk factors of coronary heart disease were compared in the patients carrying these genotypes with the non-carrying group, no significant differences were encountered. Conclusions — HLA-DR B1*13, DR16, DQ2 and DQ5 may be associated with the pathogenesis and increase the risk of CAE.

Do Turkish adults really have lower serum levels of high-density lipoprotein cholesterol?

Background — Coronary heart disease is the leading cause of death in Turkey.The Turkish Heart Study and TEKHARF study have been carried out at various times and in different parts of Turkey and have suggested that the Turkish population has a low high-density lipoprotein-cholesterol (HDLC) level. However, in our daily practice, mean HDL-C levels were not as low as previously reported. Here, we investigated the lipid profile, especially the HDL-C level, in the population of the Duzce region of northwest Turkey. Methods — Serum triglyceride, total cholesterol, and HDL-C levels were measured in 674 healthy volunteers (398 women and 276 men);low-density lipoprotein cholesterol (LDL-C) levels were calculated using the Friedewald equation. Results — The mean serum HDL-C level was 46.1 ± 9.8 mg/dl in men and 53.2 ± 10.7 mg/dl in women;these values are higher than expected based on the Turkish Heart Study.The mean serum total cholesterol level was 196.7 ± 43.2 mg/dL in men and 198.4 ± 43.9 mg/dL in women;the mean LDL-C level was 119.6 ± 34.9 mg/dL in men and 118.7 ± 34.1 mg/dL in women;and the mean serum triglyceride level was 151.4 ± 80.9 mg/dL in men and 132.1 ± 68.9 mg/dL in women. Conclusions — Our finding that the HDL-C level in this population was higher than the previously reported levels in Turkey indicates that HDL-C levels may not be as low as previously thought.We believe that lower HDL-C levels that were previously reported might be due to the difference between techniques of analysis, nutritional status, and percent of subjects who were fasting in the day of analysis or improper subject inclusion which did not reflect the Turkish population causing selection bias.

Images in Emergency Medicine: Acute severe coronary spasm associated with 5-fluorouracil chemotherapy

Cardiotoxicity is an uncommon adverse effect of 5-FU treatment. Prevalence of 5- fluorouracil (FU) - induced cardiotoxicity is 2–18%, and represents an interesting clinical challenge.1 A 62 …