BACKGROUND: Frailty is one of the key syndromes in geriatric medicine and an important factor for post-transplant outcomes. We aimed to describe the prevalence of frailty and examine the correlates of frailty and depressive symptoms in older kidney transplant recipients (KTRs). METHODS: This cross-sectional study involved 112 kidney transplant recipients (KTRs) aged 70 and above. Frailty syndrome was assessed using the Fried frailty criteria, and patients were categorized as frail, pre-frail, or non-frail based on five frailty components: muscle weakness, slow walking speed, low physical activity, self-reported exhaustion, and unintentional weight loss. Depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS). The relationship between frailty and depressive symptoms was evaluated using multinomial logistic regression, with the three frailty categories as the dependent variable and the severity of depressive symptoms as the independent variable, while controlling for age, gender, renal graft function, and time since transplant surgery. RESULTS: The participants had a mean age of 73.3 ± 3.3 years, and 49% were female. The prevalence of frailty syndrome was 25% (n = 28), pre-frailty was 46% (n = 52), and 29% (n = 32) of the KTRs were non-frail. The mean score for depressive symptoms was 3.1 ± 2.4 points, with 18% scoring above the clinical depression cutoff. Depressive symptoms were positively correlated with frailty (r = .46, p < .001). Among the frailty components, self-reported exhaustion (r = .43, p < .001), slow walking speed (r = .26, p < .01), and low physical activity (r = .44, p < .001) were significantly positively correlated with depressive symptoms, while muscle strength (p = .068) and unintentional weight loss (p = .050) were not. A multinomial logistic regression adjusted for covariates indicated that, compared to being non-frail, each additional point on the GDS increased the odds of being pre-frail by 39% (odds ratio [OR] = 1.39, 95% confidence interval [CI] 1.01-1.96) and roughly doubled the odds of being frail (OR = 2.01, 95% CI 1.39-2.89). CONCLUSION: There is a strong association between frailty and depression in KTRs aged 70 years and older. Targeted detection has opened up a new avenue for collaboration between geriatricians and transplant nephrologists.

• MeSH
• Depression * epidemiology   psychology   diagnosis   MeSH
• Geriatric Assessment methods   MeSH
• Geriatrics methods   trends   MeSH
• Frailty * epidemiology   diagnosis   psychology   MeSH
• Frail Elderly psychology   MeSH
• Humans MeSH
• Nephrologists trends   MeSH
• Prevalence MeSH
• Transplant Recipients psychology   MeSH
• Cross-Sectional Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Kidney Transplantation * psychology   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

OBJECTIVE: Injection of the tibiotalar (TT) joint is commonly performed in clinical practice under ultrasound (US) guidance using an anteromedial approach. However, in some patients, this approach may be technically challenging due to post-traumatic and/or degenerative bony changes. Therefore, the aim of this cadaveric investigation was to demonstrate the feasibility of the ultrasound-guided (USG) injection of the ankle joint via the anterolateral sulcus (ALS) by confirming the dye placement/distribution inside the articular space. Likewise, the safety of the procedure has also been evaluated by measuring the distance between the needle and the intermediate dorsal cutaneous nerve of the foot. DESIGN: A descriptive laboratory study with eight embalmed cadaveric ankles using the Fix for Life (F4L) method was performed at the setting of an academic institution. The interventional technique and the related anatomical findings were illustrated. During the injection, the needle was advanced into the TT joint through the ALS under US guidance, i.e., in-plane anterior-to-posterior approach. With the objective to confirm its correct placement, the needle was kept in situ and-to demonstrate the location of the dye inside the articular space-all eight ankles were injected with 3 mL of green color dye. Thereafter, a layer-by-layer anatomical dissection was performed on all four cadavers. RESULTS: The position of the needle's tip within the ALS was confirmed in all specimens. Accurate placement of the dye inside the articular space of the ankle was confirmed in seven of the eight cadaveric ankles, with 87.5% of accuracy. Herewith, unintentional spilling of the dye within the superficial soft tissues was reported in two of the eight ankles (25.0%). The mean distance between the needle and the intermediate dorsal cutaneous nerve of the foot, measured in all eight procedures, was 3 cm. CONCLUSION: USG injection of the ALS using the in-plane, anterior-to-posterior approach can accurately place the injectate inside the articular space. CLINICAL RELEVANCE: This cadaveric investigation described the accuracy and potential pitfalls of USG injection of the ankle via the anterolateral approach which represents an alternative technique in patients with reduced accessibility of the anteromedial recess due to degenerative and/or post-traumatic bony changes.

• MeSH
• Ankle Joint * diagnostic imaging   MeSH
• Injections, Intra-Articular methods   MeSH
• Ultrasonography, Interventional methods   MeSH
• Humans MeSH
• Cadaver MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Injections around the Achilles tendon (AT) are commonly performed in clinical practice to manage non-insertional Achilles tendinopathy, but the presence/distribution of the injectate with relation to its sheath has not been assessed specifically. Accordingly, the aim of this cadaveric investigation was to demonstrate the feasibility of Achilles paratenon injection under ultrasound guidance - by confirming the exact needle positioning as well as the dye distribution inside the paratenon lumen. METHODS: A descriptive laboratory study with three human cadaveric specimens (one fresh cadaver and two cadavers embalmed using the Fix for Life (F4L) method) was performed in a tertiary-care academic institution. The interventional technique and the related anatomical findings were illustrated. During the injection, the needle was advanced inside the Achilles paratenon under ultrasound guidance i.e. in-plane medial-to-lateral approach. With the objective to confirm its correct placement, the needle was kept in situ on the right AT of the fresh cadaver. Likewise, to demonstrate the location of the dye inside the lumen of Achilles paratenon, the other five ATs - four on the embalmed cadavers and one on the fresh cadaver - were injected with 5 mL of green color dye. After removal of the needle, a layer-by-layer anatomical dissection was performed on all three cadavers. RESULTS: On the right AT of the fresh cadaver, the position of the needle's tip within the Achilles paratenon was confirmed. Accurate placement of the dye inside the paratenon lumen was confirmed in four (80%) ATs, one of the fresh and three of the embalmed cadavers. No spread inside the crural fascia compartment or between the AT and the Kager's fat pad was observed. Herewith, unintentional spilling of the dye within the superficial soft tissues of the posterior leg was reported in the left AT of one of the two embalmed cadavers (20%). CONCLUSIONS: Ultrasound-guided injection using the in-plane, medial-to-lateral approach can accurately target the lumen of Achilles paratenon.

• MeSH
• Achilles Tendon * diagnostic imaging   anatomy & histology   MeSH
• Injections MeSH
• Ultrasonography, Interventional * MeSH
• Humans MeSH
• Cadaver * MeSH
• Aged MeSH
• Feasibility Studies MeSH
• Tendinopathy diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH

OBJECTIVE: Unintentional injuries are the leading cause of hospitalization and death among children. Compared to environmental factors, less attention in injury preventive efforts has been paid to how individual characteristics relate to the risk of injury. Using a large prospective cohort, the current study assessed the longitudinal impact of early-life temperament on the cumulative number of injuries until mid-adolescence. METHODS: The data came from the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ). Temperament was evaluated by mothers when children were 3 years old (N = 3,545). The main outcome was the pediatrician-reported sum of child's injuries from age 3 to 15 (seven timepoints). Latent profile analysis (LPA) was used to determine classes based on temperamental dimensions and then extended to a mixture model with a distal count outcome. The covariates included maternal conflict and attachment, sex, family structure, and maternal education. RESULTS: The LPA determined the existence of three classes: shy children (8.1% of the sample; lowest activity/highest shyness), outgoing children (50.8%; highest activity/lowest shyness), and average: children (41.1%; middle values). Results from a mixture model showed that the outgoing temperament was associated with the highest longitudinal risk for injuries, as both average children (IRR = 0.89 [0.80, 0.99]), and the shy children (IRR = 0.80 [0.68, 0.95]) had lower risk. CONCLUSIONS: Early childhood temperamental differences can have long-term effects on injury risk. Highly active children showed the highest risk for future injuries, suggesting that these characteristics make them more likely to be involved in novel and potentially dangerous situations.

• MeSH
• Child MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Mothers * MeSH
• Adolescent MeSH
• Child, Preschool MeSH
• Prospective Studies MeSH
• Risk Factors MeSH
• Pregnancy MeSH
• Temperament * MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Child, Preschool MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Syndrom křehkosti je klinický syndrom, ve kterém jsou přítomny tři nebo více z následujících kritérií: neúmyslný úbytek hmotnosti 4,5 kg (10 liber) za poslední rok, pacientem udávaná vyčerpanost, slabá svalová síla úchopu, pomalá rychlost chůze a snížená fyzická aktivita. Prevalence křehkosti u kardiochirurgických pacientů je podle dostupných studií od 4,1 % do 46 %. Je spojený s výskytem sarkopenie a osteoporózy. Pro diagnostiku v kardiochirurgii je vhodný nástroj Edmonton Frail Scale, který je vyvinut pro negeriatrické specialisty a poskytuje informace ohledně závislosti pacienta na okolí, znalost zvládání běžných denních aktivit a úrovně fyzické zdatnosti. Existuje široká škála dalších nástrojů k hodnocení. Syndrom křehkosti je nezávislý rizikový faktor zvýšené morbidity, mortality a prodloužené doby hospitalizace po kardiochirurgické operaci. Tito pacienti mají vysoké riziko neúspěchu zvoleného terapeutického postupu. Základem péče o rizikové pacienty je screening a prevence vzniku syndromu křehkosti. Dá se mu předejít dostatečnou fyzickou aktivitou, zdravým životním stylem a pravidelným kognitivním tréninkem.

Frailty syndrome is a clinical syndrome in which three or more of the following criteria are present: an unintentional weight loss of 4.5 kg (10 lb) in the past year, patient-reported exhaustion, poor muscle grip strength, slow walking speed, and reduced physical activity. The prevalence of frailty in cardiac surgery patients ranges from 4.1% to 46% according to available studies. It is associated with the occurrence of sarcopenia and osteoporosis. The Edmonton Frail Scale tool, developed for non-geriatric specialists, is useful for diagnosis in cardiac surgery and provides information regarding the patient's dependence on the environment, knowledge of coping with normal daily activities and level of physical fitness. A wide range of other assessment tools are available. Frailty syndrome is an independent risk factor for increased morbidity, mortality, and prolonged hospital stay after cardiac surgery. These patients have a high risk of failure of the chosen therapeutic approach. Screening and prevention of frailty syndrome is the cornerstone of care for patients at risk. It can be prevented by sufficient physical activity, a healthy lifestyle, and regular cognitive training. Klíčová slova: Kardiochirurgie Prehabilitace Rehabilitace Sarkopenie Syndrom křehkosti Keywords: Cardiac surgery Frailty syndrome Prehabilitation Rehabilitation Sarcopenia

• MeSH
• Cardiac Surgical Procedures rehabilitation   MeSH
• Frailty * diagnosis   complications   prevention & control   MeSH
• Humans MeSH
• Osteoporosis etiology   MeSH
• Motor Activity physiology   MeSH
• Sarcopenia diagnosis   epidemiology   etiology   MeSH
• Check Tag
• Humans MeSH

Cyberhate is one of the online risks that adolescents can experience online. It is considered a content risk when it is unintentionally encountered and a conduct risk when the user actively searches for it. Previous research has not differentiated between these experiences, although they can concern different groups of adolescents and be connected to distinctive risk factors. To address this, our study first focuses on both unintentional and intentional exposure and investigates the individual-level risk factors that differentiate them. Second, we compare each exposed group of adolescents with those who were not exposed to cyberhate. We used survey data from a representative sample of adolescents (N = 6,033, aged 12-16 years, 50.3 percent girls) from eight European countries-Czechia, Finland, Flanders, France, Italy, Poland, Romania, and Slovakia-and conducted multinomial logistic regression. Our findings show that adolescents with higher sensation seeking, proactive normative beliefs about aggression (NBA), and who report cyberhate perpetration, are at higher risk of intentionally searching for cyberhate contents compared with those who are unintentionally exposed. In comparison with unexposed adolescents, reporting other risky experiences was a risk factor for both types of exposure. Furthermore, NBA worked differently-reactive NBA was a risk factor for intentional exposure, but proactive NBA did not play a role and even decreased the chance of unintentional exposure. Digital skills increased both types of exposure. Our findings stress the need to differentiate between intentional and unintentional cyberhate exposure and to examine proactive and reactive NBA separately.

• MeSH
• Aggression * MeSH
• Humans MeSH
• Adolescent MeSH
• Surveys and Questionnaires MeSH
• Risk Factors MeSH
• Check Tag
• Humans MeSH
• Adolescent MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Europe MeSH
• Finland MeSH

Východiská: Hodnotenie faktorov pádov v primárnej starostlivosti má určité deficity. Menej pozornosti sa jej venuje v primárnej starostlivosti. Pričom výsledky ich skúmania môžu byť motiváciou k tvorbe a implementácii preventívnych programov, ktoré majú svoje limity a obmedzenia. U starších dospelých sú pády hlavnou príčinou neúmyselných zranení s vysokými nákladmi na starostlivosť. Zhoršujú kvalitu života a nadobúdajú charakter dlhodobého rizika poškodenia zdravia. Včasná identifikácia faktorov vnútorného a vonkajšieho prostredia je metódou účinnej prevencie pádu v každom vekovej skupine. Cieľ: Skúmať rizika pádu v závislosti od vybraných faktorov: pohlavie, vek, komorbidity (≥ 2 diagnózy) a medikácia (≥ 5 indikačných skupín liekov), poruchy chôdze, ťažkosti pri pohybe poruchy vyprázdňovania, zmyslové poruchy, mentálne zdravie. Určiť, ktoré faktory sú rizikové a nerizikové. Poukázať na význam identifikácie faktorov pádu počas preventívnej prehliadky. Súbor a metódy: Súbor tvorilo 937 respondentov vo veku 50 do 95 rokov, ktorí absolvovali preventívnu prehliadku v jednej ambulancii všeobecného lekára pre dospelých v roku 2021. Do súboru bolo zaradených 420 mužov (45 %) s priemerným vekom 62,71 rokov a 517 žien (55 %) s priemerným vekom 65,39 rokov. Priemerný vek všetkých 937 respondentov bol 64,19 rokov. Použili sme Skríningový test (ST) a Morse Fall Scale (MFS), ktorý sa skladá zo šiestich subškál: história pádu, sekundárna diagnóza, pomôcky pri chôdzi, intravenózna terapia, chôdza a duševný stav. Celkové skóre MFS rozdelilo starších dospelých do skupiny bez rizika pádu (0 bodov), s nízkym rizikom (< 25 bodov), stredným riziko (25 – 45 bodov) a vysokým rizikom pádu (> 45 bodov). Na určenie korelačnej závislosti medzi premennými sme použili metódu regresnej korelačnej analýzy Za štatisticky významný sme považovali faktor, kde p hodnota bola < 0,05. Výsledky: Celý súbor respondentov vykazoval skóre stredného rizika pádu (MFS skóre 29,9 ± 19,8; min. 0, max. 105). Pádová anamnéza bola negatívna u 886 respondentov. Pozitívnu pádovú anamnézu malo 51 (5,4 %) starších dospelých. Padli v priemere 1,4 krát za posledné tri mesiace. V súbore respondentov (n=937) faktorom rizika pádu je vek < 75 rokov (p=0,002), komorbidita a medikácia (p=0,000), poruchy chôdze, rovnováhy a hybnosti (p=0,000)a poruchy vyprázdňovania. Zmyslové poruchy a mentálne poruchy neboli v našom súbore štatisticky významnými faktormi pádu. Záver: Pády majú za následok hospitalizáciu a zhoršenie kvality života pacienta. Spôsobujú zvýšenú morbiditu, mortalitu a vyššie finančné náklady na liečbu. Prevencia pádov v ambulantnej starostlivosti je s ohľadom na bezpečnosť pacienta nevyhnutnosťou. Súčasťou preventívnych opatrení je edukácia zdravotníckych pracovníkov o manažmente rizikových faktorov pádu v komunite starších dospelých.

Backround: The assessment of factors of falls in primary care has some deficits. Less intention is paid to it in primary care, though the results of the research can be a motivation for the creation and implementation of preventive programs which have their limits and imitations. Falls are a leading cause of unintentional injuries with high cost of care for older adults. They worsen the quality of life and become a long-term risk of health damage. Early identification of the factors of internal and external environment is a method of effective fall prevention in every age group. Objective: To examine the risk of fall in regard with specific factors like: gender, age, comorbidities (≥2 diagnoses) and medication (≥ 5 groups of drugs), gait disorders, difficulty in movement, voiding disorders, sensory disorders, mental health, to determine which factors are risky and non-risky, to point out the importance of identification of fall factors during a preventive examination. Participants and methods: The set of respondents consisted of 937 people aged 50 -95 years who underwent preventive examinations at the same general practitioner’s for adults in 2021. The set of respondents included 420 men (45 %) with an average age of 62.41 4/202360Suplementum years and 517 women (55 %) with an average age of 65.39 years. The average age of all respondents was 64. 19 years. We used the Screening Test (ST) and The Morse Fall Scale (MFS) which consists of six subscales: fall history, secondary diagnosis, walking aids, therapy, walking and mental status. The total MFS score divided older adults into groups of no-fall risk (0 points), low risk (< 25 points), moderate risk (25 - 45 points), and high-fall risk (>45 points). To determine the correlation dependance between the variables we used the methods of regressive correlation analysis. The factor where the p value was < 0.05 was considered to be statistically significant. Results: The entire set of respondents showed a moderate fall risk score (MFS score 29.9 ±19.8; min. 0, max. 105). The fall history was negative for 886 respondents. 51 (5.4 %) older adults had a positive fall history. They fell 1.4 times on average in the last three months. In th group of respondents (n=937) the fall risk factor is age < 75 years (p = 0.002), comorbidity and medication (p = 0.000), gait, balance and mobility disorders (p=0.000) and voiding disorders. Sensory disorders and mental disorders were not statistically significant fall factors in the group. Conclusion: Falls result in hospitalization and deterioration of the patient’s quality of life. They cause increased morbidity, mortality and higher financial cost of treatment. Prevention of falls in ambulatory care is a necessity with regard to patient safety. The education of healthcare workers about the management of fall risk factors in the community of older adults is a part of preventive measures.

• MeSH
• Ambulatory Care MeSH
• Surveys and Questionnaires MeSH
• Risk Factors MeSH
• Aged MeSH
• Accidental Falls MeSH
• Check Tag
• Aged MeSH

Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by perception and psychomotor disorder and has a negative impact on morbidity in the form of maladaptive behavior, which can last weeks after anesthesia. Patients with developed ED present with psychomotor anxiety, agitation, and are at higher risk of unintentional extraction of an intravenous cannula, self-harm and nausea and vomiting. The described incidence of ED varies between 25-80%, with a higher prevalence among children younger than 6 years of age. We aimed to determine the incidence of ED in pediatric patients (>1 month) after general anesthesia in the post-anesthesia care unit (PACU), using Paediatric Anaesthesia Emergence Delirium (PAED) score, Watcha score and Richmond agitation and sedation scale (RASS). The incidence of ED was the highest in the PAED score with cutoff ≥10 points (89.0%, n = 1088). When using PAED score >12 points, ED incidence was 19.3% (n = 236). The lowest incidence was described by Watcha and RASS scores, 18.8% (n = 230) vs. 18.1% (n = 221), respectively. The threshold for PAED ≥10 points seems to give false-positive results, whereas the threshold >12 points is more accurate. RASS scale, although intended primarily for estimation of the depth of sedation, seems to have a good predictive value for ED.

• Publication type
• Journal Article MeSH

Výrazem křehkost - frailty - je vyjadřován stav zranitelnosti organismu charakterizovaný vyčerpáním jeho kompenzačních rezerv. Z klinického pohledu je křehkost definována nezáměrným hmotnostním úbytkem, pomalou chůzí, svalovou slabostí, únavností prezentovanou samotným nemocným a nízkou fyzickou aktivitou. Postihuje ve většině případů nemocné vyššího věku a vyskytnout se může i u mladších multimorbidních nemocných. Důsledkem frailty je zvýšený výskyt komplikací doprovázejících i jinak běžné zdravotní problémy, častá nutnost hospitalizací a jejich delší trvání, progresivní ztráta soběstačnosti a zvyšující se mortalita. V rámci intervence a současně prevence syndromu křehkosti je nutno podpořit stav výživy a mobilitu pacienta, věnovat pozornost vodnímu, minerálovému a vitaminovému hospodářství, zejména deficitu vitaminu D, léčit chronické infekty a chronickou bolest a poskytovat nemocnému psychosociální podporu.

Frailty is an expression describing overall vulnerability of the organism characterized as depletion of its compensatory reserves. From clinical point of view frailty is defined as unintentional loss of weight, slow walking, muscle weakness, fatigue presented by patient himself and low physical activity. It affects the elderly in most cases and can occur in younger multimorbid patients as well. The consequence of frailty is an increased incidence of complications accompanying otherwise common health problems, frequent need for hospitalizations and their longer duration, progressive loss of self-sufficiency and increasing mortality. As a part of the intervention and at the same time prevention of frailty syndrome it is necessary to the support the nutritional status and mobility of the patient, pay attention to fluid, mineral and vitamin management, especially vitamin D deficiency, treat chronic infection and pain and to provide psychosocial support.

• MeSH
• Infections etiology   physiopathology   therapy   MeSH
• Frailty * diagnosis   etiology   complications   physiopathology   pathology   prevention & control   psychology   MeSH
• Humans MeSH
• Multimorbidity MeSH
• Musculoskeletal System pathology   MeSH
• Vitamin D Deficiency therapy   MeSH
• Proteins administration & dosage   MeSH
• Vitamin D administration & dosage   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Úvod: Solitární koronární tepna (single coronary artery, SCA) bez přidruženého vrozeného srdečního onemocnění představuje vzácnou vrozenou anomálii. Ve většině případů, asymptomatických a zjištěných zcela náhodně, může být SCA příčinou ischemie, městnavého srdečního selhání a náhlé srdeční smrti. Kazuistika: Čtyřiačtyřicetiletá žena byla přivezena na naše oddělení akutních příjmů s typickou bolestí na hrudi. Po vyšetření byla u ní stanovena diagnóza infarktu myokardu zadní stěny s elevací úseku ST. Pacientka následně podstoupila perkutánní koronární intervenci. Selektivní kanylaci pravé koronární tepny (right coronary artery, RCA) nebylo možno provést. Angiografické vyšetření levé koronární tepny prokázalo kritickou stenózu (99%) středního segmentu levé přední sestupné větve (RIA). Byla provedena perkutánní transluminální koronární angioplastika se zavedením stentu do středního segmentu RIA. Dva týdny po intervenci byla provedena tomografická koronární angiografie (coronary computed tomography angiography, CCTA), která potvrdila absenci pravé koronární tepny i stenózu RIA. Závěr: Jednou z nejvzácnějších anomálií je solitární levá koronární tepna při vrozené absenci RCA. U některých pacientů je tato anomálie spojena s rozvojem ischemie; přitom může být život ohrožující. Pro stanovení diagnózy a stratifikaci rizika se přednostně používá metoda CCTA. Přestože si jsme vědomi mezer v našich znalostech o těchto anomáliích, mohou si některé případy vyžádat intervenci, aby se předešlo náhlé srdeční smrti a zvýšila se kvalita života.

Introduction: Single coronary artery (SCA) with no associated congenital heart disease is a rare congenital anomaly. SCA may cause ischemia, congestive heart failure, and accidental cardiac death in most cases, which are asymptomatic and unintentional. Case report: A 44-year-old woman came to our emergency room with a typical chest pain. After work up in ER, the patient was diagnosed with inferior ST-elevation myocardial infarction. Then the patient underwent percutaneous coronary intervention. Selective cannulation of the right coronary artery (RCA) was not possible. We found critical stenosis 99% at the mid-left anterior descending artery (LAD) from left coronary artery angiography. Percutaneous transluminal coronary angioplasty with stent was done in mid LAD. Coronary computed tomography angiography (CCTA) was done two weeks after the PCI procedure. From CCTA, it was confi rmed the absence of RCA and no coronary stenosis. Conclusion: One of the rarest coronary artery anomalies is left SCA with congenital absence of the RCA. It is associated with ischemia in some patients and may be life-threatening. For diagnosis and risk stratifi cation, CCTA is the preferred method. Despite our current understanding of such anomalies’ shortcomings, action may be warranted in some cases to prevent sudden death and increase the quality of life.

• MeSH
• Anomalous Left Coronary Artery * diagnostic imaging   complications   MeSH
• Chest Pain MeSH
• Computed Tomography Angiography MeSH
• Adult MeSH
• ST Elevation Myocardial Infarction diagnostic imaging   complications   MeSH
• Comorbidity MeSH
• Middle Aged MeSH
• Humans MeSH
• Incidental Findings MeSH
• Rare Diseases MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH