Aim: To evaluate the value of a more closed perioperative ECG follow-up in the investigation and forecasting of cardiovascular events during and after hospital admission.
Methods: We included in the study 30 asymptomatic patients from cardiac point of view (14 women, 16 men, mean age 63 years), who underwent total hip arthroplasty. ECGs were performed on the day before surgery, on the day of surgery, after the intervention, and on the 3rd day. We looked for the correlations between ECG changes and clinical events.
Results: The commonest postoperative new ECG changes were QTc prolongation (14 patients -46,6%) and sinus tachycardia (8 patients - 26,6%). There were no major cardiac events during hospitalization, and we found possible correlations in two cases between perioperative ST-T changes and postdischarge clinical events: one exitus and one case of ischemic heart disease.
Conclusions: Our data do not support the efficacy of a more closed, routine ECG follow-up in the studied, low risk patient population, but new perioperative ST-T changes always have to be taken into account.
Hematological conditions can lead to serious disturbances in blood rheology, being frequently associated with increased systemic inflammation and increased risk of bleeding. The imbalance between coagulation and thrombolytic factors in patients with acute coronary syndromes may lead to undesirable outcomes, and the success of emergency coronary angioplasty or by-pass grafting may be altered by increased bleeding in coagulopathies such as hemophilia. This paper intends to review the present knowledge in the field of acute coronary syndromes in subjects with hematological and onco-hematological disorders such as thrombotic thrombocytopenic purpura, immune thrombocytopenic purpura, von Willebrand disease, hemophilia, polycythemia vera, erythrocyte disorders, myelodysplastic syndrome, leukemia, lymphoma or myeloma.
In Western countries, chronic lymphocytic leukemia (CLL) is one of the most diagnosed leukemia types among elderly patients. CLL is described as an indolent lymphoproliferative disorder, characterized by the presence of a high number of small, mature B-cells in the peripheral blood smear, with a particular immunophenotype (CD5, CD19, CD23 positive and CD20 dim positive) and accumulation in the bone marrow and lymphoid tissue (e.g., lymph nodes, spleen). The experience of the past decades showed that CLL is clinically very heterogeneous; while some patients present a chronic clinical evolution, with a prolonged survival, in which the treatment can be delayed, others suffer from a more aggressive form, which must be treated early and is associated with many relapses. This observation led to several genomic studies that have mapped the genetic modifications involved in the disease conformations, including del(13q14), del(11q), or trisomy 12. On the other hand, certain genetic mutations such as del(17p13)–p53, NOTCH1 mutation, or ZAP70/CD38 increased expression are associated with worse clinical outcome. In order to apply the right treatment strategy, the RAI and BINET staging systems should be considered, which are based on clinical and laboratory assessment, on genetic mutations that may influence the resistance to chemotherapy, as well as the patient’s age and comorbidities. The aim of this manuscript was to present the therapeutic approaches of CLL, in order to attempt to answer the following question: to treat, or not to treat? This clinical update focuses on the managements of CLL patients in the 21st century.
Acute myeloid leukemia (AML) is a cancerous disease affecting the myeloid line of the bone marrow cells. FLT3, also known as CD135, is a proto-oncogene, which, if mutated, leads to different types of cancer. The protein it encodes presents tyrosine-kinase activity, and its intratandem mutation, FLT3-ITD, leads to uncontrolled proliferation of myeloblasts and worse outcomes in AML patients. There are currently several pharmacological agents that can inhibit the effect of either the proteins with tyrosine-kinase activity or the mutated FLT3 gene. We present the case of a 68-year-old patient, smoker, with a history of arterial hypertension, chronic obstructive pulmonary disease, presenting with headache unresponsive to antalgics, dyspnea after physical exertion, and epistaxis, with onset 2 months prior to his presentation. The patient was diagnosed with AML with positive FTL3 mutation for which conventional induction therapy was initiated. Within the next days, the patient presented several complications related to the disease itself or caused by the treatment, which eventually led to his death.
Objectives. The aim of this study is to evaluate the efficacy of immediate weight-bearing versus two weeks delayed weight-bearing following anterior cruciate reconstruction.
Methods. We conducted a prospective observational study on the efficiency of immediate or delayed weight-bearing following anterior cruciate reconstruction. 30 patients undergoing anterior cruciate ligament reconstruction were included in the study. The patients in the first group were allowed the maximum endurance level of weight-bearing on the operated leg from the first postoperative day, resuming normal walking as soon as possible. Patients in group II were barely allowed the loading of the affected limb after 2 weeks postoperatively. Patient assessment was performed preoperatively, immediately after the procedure and postoperatively at 6 weeks, 3 and 6 months.
Results. The average pre- and postoperative values of the arthometric assessment show a statistically significant improvement of joint stability in both groups of patients. There were no significant differences in the development of joint mobility averages between the two groups. Following the evolution of functional test average values, there is a gradual function improvement in both groups of patients. The assessment results at 6 weeks and three months postoperatively shows that patients in the first group are significantly better in comparison with the results of patients in group II. The final evaluation showed no significant differences between the two groups of patients.
Conclusions. The final assessment revealed no statistically significant difference in reported or objectively measured function. We believe that the weight-bearing exercises and the non–weight-bearing exercises are equally effective and safe in the post-ligamentoplasty recovery.
We determined the elemental profile of 16 edible mushroom species from the Făget Forest, near Cluj-Napoca, and of 12 species from the Apuseni Mountains. One-way ANOVA showed no difference in the elemental content of mushrooms when the two regions were compared. Some species accumulated high amounts of trace elements, i.e. Boletus edulis (Ag, S, Zn), Macrolepiota procera (Cu), Lactarius volemus (Co), Russula emetica (Mn), Armillariella mellea, and Chantarellus cibarius (Cr). The cadmium content was the highest in the case of Leccinum scabrum and Boletus edulis. These two species presented elevated risk levels for all age-groups when they are consumed regularly.
The Corncrake is a strictly protected species in Hungary and a qualifying species of many Natura 2000 sites. Despite its Least concern global conservation status, it receives much attention and was elected as “Bird of the Year” by MME BirdLife Hungary in 2016. In this paper, we estimate its population trends and analyse the suitability of the protected area system and agri-environment schemes for the species. We compiled information on major threatening factors and conservation measures applied for the species. We reviewed international publications on the ecology and conservation management of the species to extract information for practical conservation. We estimated that 500–2000 pairs of Corncrakes breed in Hungary. Although their breeding sites are well covered by protected areas, Natura 2000 sites (42%) and High Nature Value Areas (67%), their population has declined by 55% over the last 20 years. We found that most of the major threatening factors are addressed by conservation management, and appropriate measures are applied in most cases. Recent research findings and recommendations by the BirdLife International Corncrake Conservation Team suggest that mowing of grasslands around nesting places should be delayed until 1–15 August either in the entire field or at least on 2 hectares around nests. Prescriptions of agri-environment schemes should also be adjusted to the above requirements and more farmers should be encouraged to enrol in Corncrake conservation programmes. We strongly suggest that more emphasis should be devoted to combat important threats for the most important breeding sites such as aridification and flooding.
In the Golyófogó Valley near Albertirsa natural erosion created near vertical walls in the loess deposited in the last glacial period, offering natural nesting sites for the European Bee-eater. Later the deeply cut coach roads, the pits of loess extraction and the construction works of the motorway nearby created further man-made banks. Hence by the 1970-ies a well-established colony bred here, but by the beginning of the 21st century, disturbance and the demise of vertical banks led to a serious reduction in the number of breeding pairs. The purchase of 5-hectare loess grassland plot and the adjacent loess bank, and later its reconstruction led to an unprecedented growth in the number of Bee-eaters. From 2010 the number of breeding pairs exceeded 200 every year. Not only the Bee-eater colony, but also the natural vegetation and the botanical values of the area are managed to maintain the population of rare and protected element of the local flora and fauna.
QT interval prolongation on the electrocardiogram is considered a precursory sign for imminent, potentially lethal ventricular arrhythmias. Beside the inherited condition of long QT syndrome, numerous drugs, certain electrolyte disturbances and early transmural ischemia have been identified to induce reversible prolongation of the QT interval, collectively called as acquired long QT syndrome. Herein we describe a case of a patient with transient QT prolongation and Takotsubo cardiomyopathy, a rather infrequent cause of long QT development. Serial changes of the repolarization pattern were documented to demonstrate progression and resolution of the abnormal QT interval.