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Background: The aim of this study was to provide insight into the real-life clinical presentation and outcomes of the elderly presenting with acute myocardial infarction from the Turkish Myocardial Infarction registry database. Methods: TURKMI was a nationwide, multicenter, observational, 15-day snapshot registry conducted to address the management of acute myocardial infarction patients admitted to percutaneous intervention-capable hospitals. The present analysis included the comparison of consecutively enrolled acute myocardial infarction patients aged ≥75 and

Methemoglobinemia is a complication that develops when ferrous hemoglobin is oxidized to a ferric state. It may be congenital due to structural hemoglobin defects or acquired through causes such as exposure to local anesthetic drugs or intake of toxins. Methemoglobinemia is characterized by cyanosis when the blood level exceeds 10%, and at higher levels it may cause tissue hypoxemia, coma, cardiovascular collapse, or even death. The primary mechanism used to reduce the methemoglobin level in the body is the nicotinamide adenine dinucleotide phosphate-cytochrome b5 reductase pathway. This case report is a presentation of the diagnosis and treatment of prilocaine-induced methemoglobinemia in 2 recently circumcised infants admitted to the pediatric emergency department.

Hereditary angioedema (HAE) is an autosomal dominant disorder, mostly due to C1 esterase inhibitor (C1-INH) deficiency, known by recurring angioedema attacks that are nonpruritic, not accompanying with urticaria, and involve the dermis, intestinal submucosa, and upper respiratory system. The angioedema attacks are not responsive to epinephrine, glucocorticoids, or antihistamine treatments. Whereas HAE patients formerly had a few therapeutic options accessible such as anabolic androgens and antifibrinolytics. Nowadays in many parts of the world there has been remarkable progress in HAE treatment for the last two decades and clinically confirmed medications are presented for prophylactic and attack treatment. Alternatives in attack therapy contain two plasma-derived C1-INH concentrates, a recombinant C1-INH product, a kallikrein inhibitor, and a bradykinin β2 receptor antagonist. Options in prophylactic therapy include other than two plasma-derived C1-INH concentrates, subcutaneous C1-INH replacement and newest subcutaneous plasma kallikrein inhibitor Lanadelumab. In spite of these progresses, HAE patients still run into some challenges of an arduous disorder that can yield to devastating angioedema attacks related with important expenses for patients and the public. Better education of HAE patients and implementation of the self-management policy for 'on-demand' therapy will recuperate patients' life quality and negative effects of the disease. Herein the existing and promising therapeutic options are reviewed in the HAE management.

The novel coronavirus infection (SARS-CoV-2 infection), which appeared in the Wuhan region of China in late 2019, spread rapidly in a short time. A few months later, it was accepted as pandemic by the WHO (World Health Organization) and became an important threat to public health. The death rate in cases occurring in China was around 2%. Although it is thought that pregnancy is not a risk factor in the course of COVID-19 disease, it is often seen in which the cases were in the third trimester. It is striking that the maternal and neonatal implications of these infected cases during the late pregnancy period were quite good. Further studies examining more cases in the first and second trimesters, in order to determine long-term results and to clarify the risk of vertical transmission are needed.

At the end of 2019, the pandemic, which originated in China, has become a major concern all over the world. A new coronavirus, severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), has been defined as the reason for a cluster of unknown pneumonia. Thus far, no precise therapy or vaccine has been shown to be effective against SARS-CoV-2 infection. Mild cases can be treated by supportive care although symptomatic treatment is not enough for critically ill patients. However, extracorporeal membrane oxygenation, convalescent (immune) plasma (CIP) and certain specific antiviral drugs for this disease are still being investigated for improving the survival rate of cases with SARS-CoV-2 infection whose condition continued to deteriorate. The use of passive immunization, for the prophylaxis and therapy of human contagious diseases, has been gone back to the 20th century. Human whole blood is also a source of antibodies. CIP consists of collecting blood plasma from someone who has recovered from a specific infection. Recent literature data show that human CIP may be an alternative option for managing coronavirus disease 2019 (COVID-19) and will be accessible when adequate numbers of individuals have improved. However, such donors should have a high titer of neutralizing immunoglobulin-containing plasma. CIP can be administered to improve the survival rate for COVID-19, together with other drugs and preventive measures, when specific management is not obtainable. On the other hand, randomized clinical trials are still necessary to assess the safety and efficiency of CIP in the therapy of COVID-19. In this article, we want to address the special role of CIP therapy in various infectious diseases from yesterday to today, including COVID-19.

Family of coronavirus has significant human and animal pathogens. In the end of December 2019, a new coronavirus was recognized as the reason of a group of pneumonia cases of unidentified etiology in Wuhan, a city in the Hubei Province of China. It has rapidly become widespread, resulting in an epidemic throughout China, followed by a pandemia, increasing number of cases in various countries throughout the world. Coronavirus disease 2019 (COVID-19) is spread through large droplets produced during coughing and sneezing by symptomatic patients as well as asymptomatic individuals before starting of their symptoms. The incubation period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is assumed to be 14 days succeeding exposure, mostly around 4 to 5 days. Individuals of all ages can acquire SARS-CoV-2 infection, although middle age and older individuals are the majority. The usual clinical characteristics involve fever, dry cough, fatigue, sore throat, rhinorrhea, conjunctivitis headache, myalgia, dyspnea, nausea, vomiting and diarrhea. Hence, there are no unique clinical features that yet dependably differentiate COVID-19 disease from other upper/lower airway viral infections. In a subgroup of cases, by the end of the first week COVID-19 disease can develop to pneumonia, pulmonary failure and death. Aim is here to discuss the COVID-19 disease beginning from virology, epidemiology and continuing with clinical manifestations, diagnosis, its complications and to finish with available therapeutic options and conclusion.

Hereditary angioedema (HAE) is a rare, inherited disease mostly associated with mutations in the SERPING1 gene (serpin family G member 1), which encodes the C1 inhibitor (C1-INH) protein. Regulation can lead to plasma deficiency and ensuing repeated attacks of severe angioedema. This disease was first described clinically and genetically in 1888 by William Osler, who named it 'hereditary angioneurotic edema (HANE).' It took 75 years until Donaldson and Evans identified the fundamental role of C1-INH in the pathophysiology of so-called HANE by Osler. Significant progress has been made in the research of this genetic disease when the role of neural factors was documented as being too small to lead to edema, the name was changed as HAE. Therefore, the name of more than 490 different mutations have been reported in the region of the C1-INH gene (SERPING1) until mid-2018. It is now known that C1-INH deficiency overstimulates the plasma contact (kallikrein-kinin) system, which eventually results in the overproduction of bradykinin. By binding to the bradykinin B2 receptor, bradykinin increases vascular permeability (vasodilation) and causes contraction of nonvascular smooth muscle, and acts as a main/major mediator in the pathophysiology of HAE. Reports since 2000 have described a new type of HAE with 'normal' CI-INH levels, primarily in Caucasians. A number of abnormalities in the genes encoding for factor XII, angiopoietin-1, and plasminogen have been identified in this novel disease entity. The establishment of treatment modalities for HAE with normal C1-INH is also expected.

Takotsubo cardiomyopathy (TTC) is characterized by transient systolic dysfunction of the left ventricle and changes of electrocardiographic or cardiac markers, resembling an acute coronary syndrome. Although the etiology of TTC is still unknown, a wide variability in the psychological and physical triggers for TTC is present. In this article, we describe the case of 69-year-old female with a history of epilepsy and who presented in the emergency room with a new-onset generalized tonic–clonic seizure activity. After finding out that her biochemistry results indicated severe hyponatremia, a diagnosis of TTC was established through echocardiography and angiography.

Primary immunodeficiency diseases (PIDD) are inherited disorders resulting from defects in diverse elements of the human immune system. Currently, more than 330 PIDDs have been described, and the molecular (genetic) bases for more than 320 of them are known. PIDD can be divided into nine different groups, including antibody (humoral) deficiencies, innate/intrinsic deficiencies, phagocytic system deficiencies, complement component deficiencies, combined (T and B cells) immunodeficiencies, syndromic combined immunodeficiencies, immune dysregulation disorders, autoinflammatory diseases and phenocopies of PIDD. In the PIDD group, primary antibody deficiencies are the most common group, and approximately 50% of patients with PIDD fall into this group of deficiencies. Congenital primary immunodeficiencies typically appear early in life, although late onset is gradually more identified. Affected patients usually present clinically with recurrent/ severe infections, or clinical pictures resembling various autoimmune or other diseases. An early diagnosis of congenital immunodeficiencies is necessary for transfer to specialized medical centers, and prompt commencement of the optimal treatment, including transplantation and enhanced outcomes. In this review, a general approach is described for the investigation of the most common groups of PIDD, outlining the most appropriate laboratory investigations when the clinician comes across typical clinical pictures and/or infections suggesting immunodeficiency.

NCI-2020-0012

Objectives: Blood pressure (BP) variability is associated with hypertensive (HT) target organ damage and cardiovascular events. The aim of this study was to investigate the relation between neutrophil to lymphocyte ratio (NLR) and BP variabil- ity in hypertensive and normotensive subjects. Study design: In this cross-sectional study, 150 subjects (63 male, mean age 52.1+-5.2 years) were enrolled. In all patients, blood samples and 24-hour ambulatory blood pressure (BP) monitoring were obtained. According to 24-hour ambulatory BP results, participants were divided into four investigation categories. Group 1= Normotensive dipper (ND), Group 2= Normotensive non-dipper (NN), Group 3= HT dipper (HD), Group 4= HT non-dipper (HN). Results: Highest NLR values were determined in the HN group (p=0.005 vs. ND, p=0.046 vs. NN and p0.05, for all). NLR was correlated with night systolic blood pressure (SBP) (r=0.178, p=0.031), night diastolic blood pressure (DBP) (r=0.176, p=0.032) and BP variation rate (r=- 0.246, p=0.003). Multiple linear regression analysis showed BP variation rate to be an independent predictor of high NLR value (β=0.186, 95% CI=0.918-0.982, p=0.044). In ROC anal- ysis, a level of NLR>2.7 predicted non-dipper HT with 83% sensitivity and 65% specificity (ROC area under curve: 0.653, 95% CI=0.565-0.741, p=0.001). Conclusion: In the present study, we found that NLR levels were significantly correlated with BP variability. The measure- ment of NLR may be used to indicate increased risk of HT- related adverse cardiovascular events.