Autologous bone marrow cell transplantation (BMCs-Tx) is a promising novel option for treatment of cardiovascular disease. We analysed in a randomized controlled study the influence of the intracoronary autologous freshly isolated BMCs-Tx on the mobilization of bone marrow–derived circulating progenitor cells (BM-CPCs) in patients with acute myocardial infarction (AMI). Sixty-two patients with AMI were randomized to either freshly isolated BMCs-Tx or to a control group without cell therapy. Peripheral blood (PB) concentrations of CD34/45+- and CD133/45+-circulating progenitor cells were measured by flow cytometry in 42 AMI patients with cell therapy as well as in 20 AMI patients without cell therapy as a control group on days 1, 3, 5, 7, 8 and 3, 6 as well as 12 months after AMI. Global ejection fraction (EF) and the size of infarct area were determined by left ventriculography. We observed in patients with freshly isolated BMCs-Tx at 3 and 12 months follow up a significant reduction of infarct size and increase of global EF as well as infarct wall movement velocity. The mobilization of CD34/45+ and CD133/45+ BM-CPCs significantly increased with a peak on day 7 as compared to baseline after AMI in both groups (CD34/45+: P < 0.001, CD133/45+: P < 0.001). Moreover, this significant mobilization of BM-CPCs existed 3, 6 and 12 months after cell therapy compared to day 1 after AMI. In control group, there were no significant differences of CD34/45+ and CD133/45+ BM-CPCs mobilization between day 1 and 3, 6 and 12 months after AMI. Intracoronary transplantation of autologous freshly isolated BMCs by use of point of care system in patients with AMI may enhance and prolong the mobilization of CD34/45+ and CD133/45+ BM-CPCs in PB and this might increase the regenerative potency after AMI.

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Background: White coat hypertension (WCH) is a condition in which people exhibit an elevation in blood pressure (BP) in a clinical setting, although they do not show such elevation in other settings. This study aims to provide new insight into determining the prevalence of WCH amongst patients with or without any cardiovascular risk. Method: This is a cross-sectional study of convenience sampling study design where 300 patients were involved based on their consultation to a Tertiary Healthcare Unit between November 2021 to March 2022 in Erbil city. Patients were classified according to the ESC into different categories of BP patterns by comparing the first BP reading that was taken at clinic with their average AMBP readings which were taken at home. Results: A total of 300 patients were included in the study where 58% of the population was male and 42% of the population was female. Of the population, 16% had WCH, 12.3% had sustained HTN, 59.3% were considered to be normotensive (NT), and 12.3% among them were categorized as masked hypertension. From the total of 47 patients that were diagnosed with WCH, 55.3% were male and 44.7% were female patients. The overall average Systolic Blood Pressure in WCH was 125.79±15.30 mmHg, and in Hypertensives it was 147.70±17.15 mm Hg with a P-value of <0.001. The Mean Arterial Pressure in WCH was 94.63±8.87 mmHg and in Hypertensives it was 112.16±13.62 mmHg with a P-value of <0.001. The average Pulse Pressure in WCH was 75.27±9.42 mmHg, and in Hypertensives it was 76.35±9.11 mmHg with a P-value of 0.001. Conclusion: WHC is significantly prevalent in Erbil city; therefore AMBP monitoring should be performed for those with certain indications to limit the prescription of unnecessary long-term medications with possibly significant side effects to patients with WHC.

Background: Sick sinus syndrome (SSS), also known as sinus node dysfunction (SND), is a disorder of the sinoatrial (SA) node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. Sick Sinus Syndrome is a highly relevant clinical entity, being responsible for the implantation of the majority of electronic pacemakers worldwide. Case Summary: An 80-year-old patient with a recent diagnosis of atrial fibrillation after a syncopal attack, presented to our clinic complaining of new onset lightheadedness. Following a pre-syncopal attack in our clinic, extensive analysis was performed and showed no underlying causes for the light headedness. A 24-hour Holter monitoring was performed and demonstrated signs of sick sinus syndrome with unusually prolonged sinus pauses without an escape rhythm. Urgent correction with permanent dual chamber pacemaker was performed with an uneventful postoperative recovery. Discussion: In sick sinus syndrome, cessation of sinus rhythm (sinus arrest) for short intervals without an escape rhythm, or longer periods of pause with replacement of sinus rhythm by an atrial or junctional rhythm are commonly seen. However, recurrent prolonged ventricular asystolic episodes are infrequently encountered and an extremely rare cause of syncope. It is known that triggers like anaesthesia, certain drugs or epilepsy can unmask sinus node dysfunction, which then manifests as significant atrial dysrhythmias and “rarely” asystole but long asystolic episodes of such duration were never reported in the absence of any trigger in patients with sick sinus syndrome. Permanent pacemaker placement is the recommended treatment for sick sinus syndrome.