Social cognition and neurocognition in first-episode bipolar disorder and psychosis: The effect of negative and attenuated positive symptoms

BACKGROUND

Schizophrenia and bipolar disorder are associated with neurocognitive and social-cognitive impairments. To date very few studies investigated social cognition in first-episode bipolar disorder (FEBD). Our main aim was to investigate the differences in social cognition and neurocognition between FEBD and first-episode psychosis (FEP). Another aim was to investigate neurocognitive correlates of negative symptoms and attenuated psychotic symptoms in FEBD.

METHODS

This study included 55 FEBD, 64 FEP and 43 healthy controls. A comprehensive neuropsychological battery assessing social cognition, processing speed, verbal and visual memory, working memory, sustained attention, and executive functions was administered to all participants.

RESULTS

Both FEBD and FEP were associated with widespread deficits in all neurocognitive domains and social cognition. Both FEP (d = -1.19) and FEBP (d = -0.88) were also impaired in social cognition. In FEP, effect sizes (Cohen's d) of neurocognitive deficits ranged from -0.71 to -1.56. FEBD was also associated with relatively milder but similar neurocognitive deficits (d = -0.61 to-1.17). FEBD group performed significantly better than FEP group in verbal and visual memory, processing speed, and executive function domains (d = -0.40 to-0.52). Negative symptoms and social functioning were associated with neuropsychological impairment in both groups. The severity of attenuated psychotic symptoms was associated with poorer verbal memory in FEBD (r = -0.39, p < 0.01).

LIMITATIONS

The cross-sectional nature of the current study is the main limitation.

CONCLUSIONS

Neurocognitive and social-cognitive deficits are evident in both FEBD and FEP. In FEBD, more severe memory deficits might be markers of clinical overlap and shared neurobiological vulnerability with psychotic disorders.

Tranexamic Acid and Tourniquet: Which Combination Reduces Blood Loss Most Effectively?

BACKGROUND

Blood loss during and after total knee arthroplasty (TKA) can lead to substantial morbidity and the need for blood transfusions. There are several methods to minimize blood loss and decrease transfusion rates in patients undergoing TKA. Tranexamic acid, an antifibrinolytic agent with known efficacy for achieving these goals, is combined with tourniquets to reduce bleeding in arthroplasty surgeries. Our study investigated the effects of various combinations of tranexamic acid and tourniquet use on bleeding in knee arthroplasty in 558 patients.

AIM

We aimed to determine the method that would provide the least blood loss and transfusion need in knee arthroplasty surgery.

METHODS

Between January 2018 and December 2022, 558 patients aged between 55 and 85 years underwent TKA surgery for grade 4 gonarthrosis in our clinic, and their decrease in hemoglobin value and whether they were transfused or not were analyzed. The patients were divided into four groups based on use of tranexamic acid and tourniquet. Demographic variables and patient data (body mass index, INR values, and preoperative hemoglobin values) were recorded.

RESULTS

There were 558 patients with a mean age of 68.19 (67 ± 6.949) years. In group 1, tranexamic acid was not used in 128 patients and tourniquet was used only during cementation; in group 2, in 132 patients, tranexamic acid was not used and tourniquet was used throughout the surgery; in group 3, in 158 patients, tranexamic acid was used and tourniquet was used throughout the surgery; in group 4, in 140 patients, tranexamic acid was used and tourniquet was used only during cementation. The decrease in hemoglobin value and transfusion rate was lowest in group 3 and highest in group 1. Besides, there was a greater decrease in hemoglobin value in group 2 than in group 4 and the transfusion rate was similar.

CONCLUSIONS

This clinical study showed that using tranexamic acid and a tourniquet throughout surgery significantly reduced the decrease in hemoglobin value and the need for transfusion.

Neurocognition and social cognition in youth and young adults at ultra-high-risk for psychosis and bipolar disorder

BACKGROUND

Schizophrenia and bipolar disorder are associated with significant deficits in neurocognition and social cognition. Unlike the studies in chronic stages of these disorders, very limited information is available regarding neurocognitive and social-cognitive impairment before the onset of bipolar disorder. Our main aim was to investigate the differences in neurocognition and social cognition between individuals at ultra-high risk for psychosis (UHR-P) and bipolar disorder (UHR-BD).

METHODS

This study included 152 help-seeking individuals identified as UHR-P (n = 78) and UHR-BD (n = 74), who were compared with a healthy control group (n = 43). A comprehensive neuropsychological battery was administered to all participants.

RESULTS

UHR-P was associated with widespread deficits in all neurocognitive and social-cognitive domains. Effect sizes (Cohen's d) of these deficits ranged from -0.57 to -1.34. UHR-BD was associated with significant deficits in processing speed, executive functions, sustained attention and social cognition (d = -0.48 to-0.70, p < 0.05). UHR-P performed significantly worse than UHR-BD in social cognition, processing speed, verbal memory and executive function domains (d = -0.39 to-0.64, p < 0.05). Negative symptoms were associated with impaired social cognition in the UHR-P group and verbal memory deficits in the UHR-BD group. Cognitive impairment was associated with functional impairment in both groups.

CONCLUSIONS

While UHR-P is associated with more widespread cognitive impairment, deficits in processing speed, executive functions, sustained attention and social cognition might be common features of both UHR groups. In early intervention services, cognition should be considered as a target for assessment and intervention not only for individuals at high risk for psychosis but also for bipolar disorder.

The Effectiveness of Biological Agents on Chronic Rhinosinusitis with Nasal Polyposis in Patients with Comorbid Asthma: A Multicenter Real-Life Study from Türkiye

Background and Objectives: Real-life data on the efficacy of biologic agents (BAs) on asthma-comorbid CRSwNP are needed. Our primary goal is to investigate the effects of BAs on CRSwNP symptoms, as well as endoscopic and tomography scores. Our secondary goal is to show a reduction in the frequency of acute sinusitis exacerbations and the need for surgery. Materials and Methods: We conducted a multicenter, retrospective, real-life study. We screened the patients with asthma-comorbid CRSwNP treated with omalizumab or mepolizumab. A total of 69 patients (40 F/29 M; omalizumab n = 55, mepolizumab n = 14) were enrolled. We compared the visual analog scale (VAS), sinonasal outcome test-22 (SNOT-22), nasal congestion score (NCS), Lund-Mackay computed tomography score (LMS), and total endoscopic polyp scores (TPS) before and after BAs. We evaluated the endoscopic sinus surgery (ESS) and acute exacerbations of chronic rhinosinusitis (AECRS) frequencies separately, according to the BAs. Results: The overall median (min-max) age was 43 (21-69) years. The median (min-max) of biologic therapy duration was 35 (4-113) months for omalizumab and 13.5 (6-32) for mepolizumab. Significant improvements were seen in VAS, SNOT-22, and NCS with omalizumab and mepolizumab. A significant decrease was observed in TPS with omalizumab [95% CI: 0-4] (p < 0.001), but not with mepolizumab [95% CI: -0.5-2] (p = 0.335). The frequency of ESS and AECRS were significantly reduced with omalizumab [95% CI: 2-3] (p < 0.001) and [95% CI: 2-5] (p < 0.001); and mepolizumab [95% CI: 0-2] (p = 0.002) and [95% CI: 2-8.5] (p < 0.001), respectively. There was no significant difference in LMS with either of the BAs. Conclusions: Omalizumab and mepolizumab can provide a significant improvement in the sinonasal symptom scores. BAs are promising agents for CRSwNP patients with frequent exacerbations and multiple surgeries.

Hypersensitivity Reactions to Taxanes: A Multicenter Study for Outcomes and Safety of Rapid Drug Desensitization

PURPOSE

Taxanes can cause hypersensitivity reactions (HSRs), which pose a significant challenge in the treatment of malignancies. Patients who are eligible for rapid drug desensitization (RDD) can continue treatment; however, some patients experience breakthrough reactions (BTRs). Data about risk factors for BTRs during RDDs in patients with HSRs to taxanes are limited.

METHODS

This was a multicenter, retrospective study of patients with immediate-HSRs to taxanes. Initial HSRs were classified as grade 1, 2, or 3 based on severity. Prick/intradermal skin tests were performed with implicated taxanes. A 12-step protocol was used during RDD.

RESULTS

The study comprised 75 patients (F/M: 63/12, mean age 49.92 ± 11.72 years, 43 HSRs to paclitaxel, 32 HSRs to docetaxel). The majority of reactions (86.7%) occurred during the first or second exposure. The prevalence of drug allergy history was higher in patients with paclitaxel HSR than in those with docetaxel HSR, although it was not statistically significant (23.3% vs. 6.3%). The initial HSRs were mostly grade 2 (n = 50, 66.7%) or grade 3 (n = 22, 29.3%). Skin tests with implicated taxanes were done on 48 patients, and the rate of positive response in patients with grade 1, 2, and 3 initial HSRs were 50%, 17.6%, and 16.7%, respectively. . A total of 255 RDDs were completely performed, although BTRs occurred in 27 (grade 1, 55.6%; grade 2, 40.7%; grade 3, 3.7%). There were no statistically significant correlations between the risk of BTR and age, drug cycle, gender, positivity of skin test or atopy. The step reduction was successfully done on 9 eligible patients with mild or moderate HSRs during the 12-step RDDs.

CONCLUSIONS

Our experience demonstrates a 100% success rate in completing the 255 RDDs for taxanes, affirming the safety and efficacy of the RDD within the study population.

Assessment of Optic Nerve Sheath Diameter in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography: A Prospective, Randomized, Controlled Double-Blinded Comparison of Propofol and Ketofol Anesthesia

BACKGROUND

ERCP is an endoscopic procedure for the diagnosis and treatment of biliopancreatic system diseases. An increase in intra-abdominal pressure due to the insufflation of air to the intestinal lumen may be transmitted to ICP through the course of ERCP. In this prospective, randomized, controlled double-blinded study, we aimed to assess the ICP change using ultrasonography measurement of ONSD in patients undergoing ERCP comparing the effects of propofol and ketofol anesthesia.

MATERIAL/METHODS

One hundred and nine patients undergoing ERCP under propofol or ketofol anesthesia were enrolled in the study. Ultrasonography measurement of ONSD was performed before (T0) and immediately after induction of anesthesia (T1), during sphincterotomy (T2), at the end of procedure (T3), and after the patient is fully awake (T4).

RESULTS

Comparison of ONSD values and ONSD alteration between groups showed no statistically significant difference (P > 0.05). Both groups showed significantly greater changes from T0 to T2 compared with values from T0 to T1, T3, and T4, respectively (P = 0,000). T0 to T3 alteration was also significantly greater than T0 to T1 and T4 change in both groups (P = 0,000).

CONCLUSIONS

ERCP procedure increases intracranial pressure most prominently during sphincterotomy both under propofol or ketofol anesthesia. Further studies are needed to investigate the impact of this phenomenon on adverse clinical outcomes.

Chanarin-Dorfman Syndrome diagnosed at the stage of liver transplantation: A rare lipid storage disease

Chanarin-Dorfman Syndrome (CDS) is a rare lipid storage disease with ichthyosis, hepatomegaly, myopathy, neuropathy, deafness, and ocular findings. Here, we aim to present an elderly CDS case and highlight the new endocrinological findings. A 66-year-old male patient with cirrhosis was hospitalized for liver transplantation. We suspected Chanarin-Dorfman Syndrome with ichthyosis, fatty liver, and syndromic facial features with bilateral ectropion, deafness, and malocclusion. We showed the lipid droplets in neutrophils called patognomonic Jordans' anomaly. Homozygous c.47+1 G>A mutation in the ABHD5 (NM_016006.6) gene were detected by clinical exome sequencing. Out of <160 CDS cases in the literature, this is the second eldest CDS patient and first with adrenal insufficiency, parathyroid lipoadenoma and atrophic pancreas. Clinicians should be aware of CDS as a rare cause of fatty liver. We recommend a blood smear and genetic analyses in patients with severe ichtiosis, ectropion, deafness and multiple endocrinolgic disorders.

Antioxidant and anti-inflammatory potential of crocin on the doxorubicin mediated hepatotoxicity in Wistar rats

Doxorubicin (DXR) is widely used in cancer treatment. However, it has not yet been possible to prevent the side effects of DXR. The aim of this study was to investigate the hepatoprotective effect of crocin against DXR used in cancer treatment. For this reason; forty Wistar rats (male-250-300 g) were allocated into four groups (n = 10/group): Control, Crocin, DXR and DXR+Crocin. Control and Crocin groups were administered saline and crocin (40 mg/kg, i.p) for 15 days, respectively. DXR group, cumulative dose 12 mg/kg DXR, was administered for 12 days via 48 h intervals in six injections (2 mg/kg each, i.p). DXR+Crocin group, crocin (40 mg/kg-i.p) was administered for 15 days, and DXR was given as in the DXR group. The results revealed that serum liver markers (alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP) increased significantly after DXR administration but recovered after crocin therapy. In addition, lipid peroxidation (MDA), and inflammatory cytokine (TNF-α) increased after DXR application and the antioxidative defense system (GSH, SOD, CAT) significantly decreased and re-achieved by crocin treatment. Our results conclude that crocin treatment was related to ameliorated hepatocellular architecture and reduced hepatic oxidative stress and inflammation in rats with DXR-induced hepatotoxicity.

Oxidative stress, apoptosis, inflammation, and proliferation modulator function of visnagin provide gonadoprotective activity in testicular ischemia-reperfusion injury

OBJECTIVE: Visnagin (Vis) is a compound found in the flowers and seeds of the Ammi visnaga plant with promising antioxidant and anti-inflammatory properties. We aimed to investigate the dose-dependent gonadoprotective effects of visnagin in rats while considering oxidative stress, apoptosis, and inflammation-related protein expression levels. MATERIALS AND METHODS: Twenty-eight adult rats were divided into four groups of seven animals each; control, ischemia/reperfusion (I/R), I/R+30Vis, and I/R+60Vis. Animals in control received no surgical application and were sacrificed at the end of the experiment. The rats in I/R, I/R + Vis30, and I/R + Vis60 were exposed to testicular ischemia and the animals in I/R + Vis30, and I/R + Vis60 groups received either 30 or 60 mg/kg visnagin intraperitoneal. At the end of the experiment, testis tissues were used for the measurement of oxidative stress, apoptosis, and inflammation. RESULTS: Our microscopic examinations indicated that I/R resulted in testicular degenerations and morphological alterations, which were improved in visnagin-treated animals. The biochemical analyses demonstrated that oxidative stress in the I/R group increased significantly (p<0.05) compared to the control group. The immunohistochemical examinations showed that pro-apoptotic Bax and Caspase 3 expressions, and pro-inflammatory tumor necrosis factor-alpha (TNF-α) levels were significantly up-regulated (p<0.05) but proliferating nuclear antigen (PCNA) levels in I/R group was significantly (p<0.001) down-regulated compared to the control group. CONCLUSIONS: Ischemia leading to testicular torsion is a reproductive health-affecting problem, and current surgical treatment methods might be insufficient to recover the testis due to the accumulation of reactive oxygen species (ROS). Our observations indicate that visnagin is a potential co-modality along with the surgical interventions for the recovery of ischemia encountered testis, but we believe the requirement of more detailed studies to explore the underlying signaling pathways and the strength of visnagin against testicular ischemia-reperfusion injury.

Graphical Abstract

https://www.europeanreview.org/wp/wp-content/uploads/GRAB.jpg.

Evaluation of the relationship between trochlear and patellar morphology and patellar chondromalacia with magnetic resonance imaging

It was aimed to investigate the relationship between magnetic resonance imaging (MRI) measurements of trochlear and patellar morphology and grade 3-4 patellar chondromalacia. Grade 3-4 patellar chondromalacia group, and an age- and sex-matched control group with normal patellar joint cartilage were comprised. For trochlear morphology evaluation in MRI; sulcus angle, trochlear angle, lateral trochlear inclination angle and medial trochlear inclination angle were measured. For patellar morphology evaluation; patella trochlear ratio, insall-salvati ratio, modified Insall- Salvati ratio and Blackburne-Peel ratio were measured. Obtained measurements were statistically analyzed according to demographic characteristics. One hundred and twenty-five patients with chondromalacia and 125 controls participated. The sulcus angle and the trochlear angle were significantly higher in the patellar chondromalacia group (p<0.05). The lateral trochlear inclination angle was significantly less in the patellar chondromalacia group (p=0.011). There was no significant difference between the groups in terms of medial trochlear inclination angle (p=0.520). There was no significant difference between the groups in terms of patella-trochlear ratio (p=0.617). Insall-Salvati ratio was significantly higher in the patellar chondromalacia group (p=0.003). Modified Insall-Salvati ratio was significantly lower in the patellar chondromalacia group (p=0.001). The rate of Blackburne-Peel was significantly higher in the patellar chondromalacia group (p=0.004). Measurements of sulcus angle, trochlear angle, lateral trochlear inclination angle, Insall-Salvati ratio, modified Insall-Salvati ratio, Blackburne-Peel ratio have diagnostic value for grade 3-4 chondromalacia.

A novel predictor in patients undergoing heart valve surgery: systemic inflammation response index: a single center cross-sectional study

OBJECTIVE

Inflammation plays a pivotal role in heart valve disease (HVD). This study aimed at evaluating the prognostic value of systemic inflammation response index (SIRI) after valve replacement surgery.

SUBJECTS AND METHODS

The study enrolled 90 patients who underwent valve replacement surgery. SIRI was calculated using laboratory data on admission. Receiver operating characteristic (ROC) analysis was used to calculate the optimal cutoff values of SIRI for predicting mortality. Univariable and multivariable COX analysis was used to assess the relationship of SIRI with clinical outcomes.

RESULTS

5-year mortality rate was higher in SIRI ≥1.55 group than SIRI <1.55 group [16 (38.1%) vs. 9 (18.8%)]. In receiver operating characteristic analysis, the optimal cutoff values for SIRI were 1.55 (area under the curve 0.654, p: 0.025). Univariable analysis revealed that SIRI [OR: 1.41, 95%CI (1.13-1.75), p<0.001] was an independent predictor of 5-years mortality. Multivariable analysis revealed that glomerular filtration rate (GFR) [OR: 0.98, 95%CI (0.97-0.99)] was an independent predictor of 5-years mortality.

CONCLUSIONS

Although SIRI is a preferable parameter for the detection of long-term mortality, it failed to predict in-hospital and 1-year mortality. Larger multi-center studies are needed to investigate effect of SIRI on prognosis.

Prognostic importance of nutritional assessment in patients with acute ischemic stroke undergoing endovascular thrombectomy

OBJECTIVE

The prevalence of malnutrition in patients with acute ischemic stroke (AIS) can range from 8% to 34%. It has been shown that prognostic nutritional index (PNI) and control nutritional status (CONUT) scores can provide an opportunity to make prognostic predictions in some disease groups. Previous studies have shown a close relationship between malnutrition scores and stroke prognosis. We evaluated the effect of nutritional scores on in-hospital and long-term mortality in AIS patients undergoing endovascular therapy (EVT).

PATIENTS AND METHODS

219 patients who underwent EVT for the AIS were included in this retrospective design and cross-sectional study. The primary endpoint of the study was accepted as all-cause death including in-hospital death, 1-year death, and 3-years death.

RESULTS

A total of 57 patients died in the hospital. In-hospital mortality rate was higher in the high CONUT group [36 (49.3%), 10 (13.7%), 11 (15.1%), p<0.001]. A total of 78 patients died within one year, and 1-year mortality was higher in the high CONUT group [43 (58.9%), 21 (28.8), 14 (19.2), p<0.001]. At the end of the 3-year follow-up, 90 patients had died, and the 3-year mortality rate was significantly higher in groups with a high CONUT score than in those with a low CONUT score (p<0.001).

CONCLUSIONS

A higher CONUT score, calculated easily by simple scoring with parameters studied from peripheral blood before the EVT procedure, is an independent predictor of in-hospital, 1-year, and 3-years all-cause mortality.

Global longitudinal strain score predicts all cause death in patients with chronic total occlusion with preserved ejection fraction

OBJECTIVE

Change in LVEF is one of the most important indicators of prognosis in CTO cases. Studies in patients with CTO have shown improvement in LVEF approximately at 3 and 6 months after successful PCI. It has been shown that LV global longitudinal strain (GLS) starts to improve even 1 day after CTO-PCI. We aimed at investigating the effect of subclinical echocardiographic involvement on all-cause mortality in the group with CTO and preserved ejection fraction by evaluating the LV GLS score.

PATIENTS AND METHODS

Patients with LVEF ≥ 50% were considered to have preserved ejection fraction and were included in the study. The endpoint of the study was all-cause death. For this retrospective study, 1,171 patients with coronary angiography who had had CTO in any of their vessels were screened.

RESULTS

A total of 86 consecutive patients were reviewed in the study. The optimum GLS score cut-off value (≥ 14.18) for predicting mortality was determined using receiver operating characteristic (ROC) curve analysis (AUC: 0.897, sensitivity 87.5%, specificity 81.5% p<0.001). At a mean follow-up of 49 months, a significant difference was found between the two groups in all-cause mortality determined by the GLS score [2 (3.4%) vs. 14 (51.9%), p<0.001]. A significant difference in mortality was observed between the group with a low GLS score and the group with a high GLS score, according to Kaplan-Meier analysis. The effect of GLS score in predicting all-cause mortality was demonstrated in multivariate cox regression analysis (Low GLS score; OR: 6.36 95%CI (1.039-39.013), p=0.045). Cox regression multivariate analysis and the effect of GLS score in predicting mortality were observed [Low GLS score; OR: 6.368 95%CI (1.039-39.013), p=0.045].

CONCLUSIONS

As a predictor, GLS may be a valuable marker of cardiac subclinical dysfunction for all caused mortality in CTO patients.

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Predictive value of lymphocyte to monocyte ratio for cardiac syndrome X

OBJECTIVE

Cardiac syndrome X (CSX) is typically described with ischemia in stress tests in addition to angina-like chest pain and without stenosis in coronary angiography. We aimed at determining the relationship between LMR and CSX.

PATIENTS AND METHODS

We retrospectively collected patients with CSX between January 2016 and December 2019. Patients with typical angina-like chest pain, normal 12-lead electrocardiography at rest, a positive response to the exercise test (> 0.1 mV ST-segment depression at 80 ms after the J point in two or more contiguous leads) or ischemia on myocardial perfusion scintigraphy and normal coronary angiography were included in the study as CSX patients.

RESULTS

This study consisted of 116 patients with CSX and 153 control groups. The mean age of the patients with CSX was 52.7±9.7 years, and the mean age of the control group was 53.7±10.6 years (p= 0.416). The patients with CSX were more likely to have higher monocyte counts and LMR. According to the Pearson correlation test, the CRP value negatively correlated with the LMR. In multivariate logistic regression analysis, LMR remained a significant predictor of CSX. In ROC analysis, LMR < 4.1 had 64% sensitivity and 50% specificity (ROC area under curve: 0.587, 95% CI: 0.519-0.655, p=0.015) in accurately predicting a CSX diagnosis.

CONCLUSIONS

We showed that lower LMR levels were associated with the presence of CSX.

Awareness and knowledge of pneumococcal vaccination in cardiology outpatient clinics and impact of physicians' recommendation on vaccination rates

Funding Acknowledgements

Type of funding sources: None.

Background

Although there is not enough data on pneumococcal vaccination status in patients with cardiovascular disease and or risk factors in our country, it is known that vaccination rates are quite low in the current data.

Purpose

We aimed to evaluate the awareness of pneumococcal vaccination (PCV13, PPSV23) in general cardiology outpatient clinics and impact of physician’s recommendation (with educational brochures) on vaccination rate.

Methods

Awareness of vaccination, before COVID-19 pandemic, was measured in patients admitting to cardiology outpatient clinics from 40 center of our country by a questionnaire contained 19 questions. The demographics (including gender, age, educational level, awareness vaccination level) and comorbidities were obtained. The vaccination rates were calculated within 3-months follow-up from the admitting of patient to cardiology clinics.

Results

The 403 (18.2%) of patients with previous pneumococcal vaccination were excluded from the study. The mean age of study population (n=1808) was 61.9±12.1 years and 55.4% were male. The 58.7% had coronary artery disease, hypertension (74.1%) was the most common risk factor and 32.7% of the patients had never been vaccinated although they had information about vaccination before. The 98.5% were referred to family medicine (n=1412, 78.1%) or vaccination outpatient clinics (n=370, 20.5%) and the vaccination rate was 62.1% during the follow-up period. The differences between vaccinated and not-vaccinated patients are presented in Table 1.

The physician’s recommendation was positively correlated with vaccination intention and behavior in our participants. Multivariate logistic regression analysis showed a significant between vaccination and female sex [OR=1.55 (95% CI=1.25–1.92), p&lt;0.001], higher education level [OR=1.49 (95% CI=1.15-1.92), p=0.002] patients’ knowledge [OR=1.93 (95% CI=1.56-2.40), p&lt;0.001], and their physician’s recommendation [OR=5.12 (95% CI=1.92-13.68), p=0.001].

Conclusion

To our knowledge this is the first report about the awareness pneumococcal vaccination rates and impact of physician’s recommendation in patients with cardiovascular disease by high study population. These findings suggest providing information on the benefits of vaccination by physician’s and educational advice was significantly associated with an increase vaccination rate and have a key role.

Hematuria frequency and association with abnormal urological findings in medical check-up patients

Aims and Background

Hematuria is one of the most common findings in urology. The management of hematuria detected in routine medical check-ups is also important in this respect. The aim of this study was to determine the frequency of hematuria in patients undergoing medical check-ups and evaluate its association with abnormal urological findings in laboratory tests and imaging.

Patients and Methods

Asymptomatic patients who presented to the check-up clinic between January 1 and December 31, 2020, were included. All patients underwent a complete laboratory workup and total abdominal ultrasound (TAUS). The distribution of hematuria by sex and age and the relationship between hematuria and abnormal urological findings in the laboratory tests and TAUS were calculated.

Results

The mean age of the 2,077 check-up patients was 45.8 ± 12.8 years. The female to male ratio was 1.07:1, and there was no significant difference in age between the sexes (P = 0.655). Microscopic hematuria was detected in 15.9% of the patients. The frequency of hematuria was 10.8% in men and 20.7% in women (P < 0.001). Men with hematuria were significantly older than men without hematuria (P = 0.033), whereas hematuria was not associated with age in women (P = 0.521). When its relationship between abnormal urological findings was evaluated, hematuria had a sensitivity of 21.70% (95% confidence interval [CI]: 18.84, 24.86) and a specificity of 87.11% (95% CI: 85.23, 88.79).

Conclusion

The frequency of hematuria in check-up patients was remarkable, at 15.9%. Hematuria in women is more common and unrelated to age, unlike in men. Hematuria had a high specificity but low sensitivity for urological abnormal findings.

A novel intermediate coronary artery stenosis severity method: Fluoroscopy-Assisted Measurement of Coronary Volume Ratio (The FLAME FFR Trial)

OBJECTIVE

The fluoroscopy-assisted coronary volume measurement (FLASH) algorithm, based on contrast passage time and vessel size, is a simple and non-invasive method of assessing coronary blood volume. The present study evaluated the diagnostic performance of FLASH flow ratio-derived fractional flow reserve (FFRFLAME) compared to wire-based FFR (FFRWB).

PATIENTS AND METHODS

FFRFLAME was defined as the ratio of FLASH at baseline to maximal hyperemia. Forty-eight patients with one intermediate coronary lesion (30-70% by angiographic visual estimation) were enrolled in this cross-sectional study. FFRFLAME and FFRWB measurements were collected in each patient. Intravenous administration of adenosine was used to achieve maximal hyperemia. The Pearson correlation coefficient and receiver operating characteristic analysis were performed to determine the predictive accuracy of FFRFLAME.

RESULTS

The average age of the patients was 58 years, and 43% (21 of 48) were female. The predominant vessel assessed was the left anterior descending artery system (87.5%). The mean FFRWB was 0.91 ± 0.05 at baseline and 0.83 ± 0.07 at the hyperaemic level, with 27% (13 of 48) of patients having an FFRWB of ≤0.80. For each patient, the mean FFRFLAME was 0.668 ± 0.17. The mean FFRFLAME was 0.85 ± 0.16 for patients having an FFRWB of ≤0.80. A strong relationship existed between FFRFLAME and FFRWB (Pearson's r = - 0.765 p<0.001). The optimal cutoff value of the functional significance of coronary artery stenosis for FFRFLAME was determined to be > 0.84 (AUC: 0.899, 84% sensitivity and 97% specificity) when the FFRWB cutoff value for significant lesions was ≤ 0.80.

CONCLUSIONS

FFRFLAME, applied to coronary angiography without the need for an invasive pressure wire, can be a beneficial index for appropriate lesion selection in coronary artery diseases.

Evaluation of rheumatoid arthritis and connective tissue disease-related interstitial lung disease with pulmonary physiologic test, HRCT, and patient-based measures of dyspnea and functional disability

OBJECTIVES

We aim to investigate the relationship between pulmonary function and imaging parameters with symptom-related patient-reported outcome measures (PROs).

METHOD

We included 65 patients of rheumatoid arthritis (RA) and connective tissue disease (CTD) with and without interstitial lung disease (ILD) into this cross-sectional study. We evaluated the relationship between FVC, DLco, and PROs and compared to HRCT findings. PROs included visual analogue scale for breathing, modified Borg scale, medical research council dyspnea scale, St. George's respiratory questionnaire (SGRQ), Leicester cough questionnaire, and Short Form 36 quality of life (SF-36 QoL).

RESULTS

The mean age was 57.4 ± 9.7 and 61.9% (39/65) of patients had an established ILD. In RA-ILD group, SGRQ score was higher (p < 0.001) and SF-36 physical functioning score was lower (p = 0.02) than CTD-ILD group. In RA group, there was a significant correlation between FVC and SF-36 role functioning/physical score (r = 0.724, p = 0.012). In CTD group, SF-36 general health score was correlated with both FVC (r = 0.441, p = 0.045) and DLco (r = 0.485, p = 0.035), and also SF-36 physical functioning score was correlated with FVC (r = 0.441, p = 0.040). PROs were found to be similar between ILD and non-ILD patients. SF-36 QoL total and SGRQ outcomes were worse in non-ILD group.

CONCLUSIONS

We concluded that PROs could be used to evaluate health-related quality of life (HRQoL) in RA- or CTD-related ILD. The physical health determinants of HRQoL are measurably worse in RA-ILD patients than in CTD patients. But, PROs may not be very helpful in differentiating patients with cough and/or shortness of breath due to ILD or non-ILD causes in RA/CTD.

KEY POINTS

• HRQoL may be affected differently among specific subtypes of ILD. • PROs can be used to evaluate dyspnea and function of patients with RA- or CTD-related ILD but are not distinguished from patients with cough and/or shortness of breath due to non-ILD causes in RA/CTD.

Does inflammation play a role in the pathophysiology of tinnitus?

Objective

The present study aimed to investigate the potential of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and mean platelet volume (MPV) as prognostic markers in tinnitus patients at inflammatory process.

Methods

This study consisted of 216 subjects (124 males and 92 females), Routine laboratory CBC test results were calculated in this study. All the patients were divided into three groups according to their hearing thresholds: a high frequency hearing loss-tinnitus group (HFHL-TN) consisted of 55 subjects, an hearing loss in all frequencies tinnitus group (AFHL-TN) consisted of 53 subjects and a normal hearing-tinnitus group (NH-TN) consisted of 51 subjects. The control group (CNT) included 57 age-and sex-matched healthy subjects.

Results

NLR, PLR and MPV were observed in the HFHL-TN group when compared to AFHL-TN, NH-TN and CNT group (P < 0.001). An increase in NLR was observed in the AFHL-TN group compared with the CNT group (P = 0.004). The PLR value of the HFHL-TN group was significantly higher than that of the AFHL-TN (P = 0.028) and NH-TN,CNTgroup (P < 0001). The PLR value of the HFHL-TN group was significantly higher than that of the AFHL-TN (p=0.028) and NH-TN, CNT group (P < 0001). MPV values in HFHL-TN group was slightly higher AFHL-TN group and significantly higher than NH-TN (P = 0.025) and CNT (P < 0.001) group.

Conclusion

Our results confirm that elevated NLR, PLR and MPV values has been suggested to be a useful inflammatuar prognostic biomarker of tinnitus patients.

Performance of integrated pulmonary index for pulmonary embolism in dyspneic patients

OBJECTIVES

The aim of this study was to evaluate the diagnostic capacity of integrated pulmonary index (IPI) in predicting the pulmonary embolism (PE) in patients admitted to emergency departments (ED) with dyspnea.

BACKGROUND

The acute dyspnea is one of the most common chief complaints in EDs. PE is a potentially fatal disease and the delay in specific therapy increases the worst outcomes.

METHODS

This study is a prospective methodological study, in which we evaluated the diagnostic performance of the IPI in predicting PE in patients admitted to ED with dyspnea. ROC analysis was used for estimating the accuracy of IPI and OCRS.

RESULTS

Of the 144 patients included in the study, there were 20 (13.9 %) PE patients. In the ROC analysis, the best cut-off point for IPI was ≤ 2. For this cut-off point, the sensitivity and specificity of IPI were 100.0 % and 96.0 %, respectively. Besides, the accuracy of IPI was 96.5 % with a +LR of 24.8 and a -LR of 0.0.

CONCLUSION

IPI was a potential candidate for evaluating the respiratory status, and a limiting tool to prevent unnecessary diagnostic tests and save time in determining the treatment course in dyspneic patients at ED (Tab. 5, Fig. 3, Ref. 34).

COSMIC RADIATION EXPOSURE CALCULATIONS FOR INTERNATIONAL AND DOMESTIC FLIGHTS DEPARTS FROM ISTANBUL AND ANKARA

In this study, cosmic radiation doses were calculated for domestic and international flights departing from Istanbul and furthermore for domestic flights departing from Ankara using a software program called CARI-7A and also a mathematical method approach. Main parameters for calculating cosmic radiation are vertical cut-off rigidity, flight duration, latitude-longitude and altitude of the flight. Our calculation results agree with the measurements for domestic and international flights departing from Istanbul and Ankara.

Sevoflurane induced diffuse alveolar haemorrhage in a young patient after orthopedic surgery: A case report

We present a very rare case of Sevoflurane Induced Diffuse Alveolar Haemorrhage in a young male patient with a closed tibial fracture after direct trauma to the right cruris. The patient was operated for tibial fracture, but diffuse alveolar haemorrhage developed after sevoflurane inhalation in the postoperative period following general anesthesia. Diffuse alveolar haemorrhage (DAH) is associated with inhalation injury from halogenated gases and reported as a unique entity in the literature that practicing clinicians should be aware of and consider in post-operative cases of acute respiratory distress. As DAH usually presents with symptoms the presence of hemoptysis, anemia, dyspnoea and radiological alveolar infiltrates, rapid detection of the aetiology and initiation of cause-directed treatment are of great importance on survival.

Screening for hepatic fibrosis and steatosis in Turkish patients with type 2 diabetes mellitus: A transient elastography study

BACKGROUND/AIMS

Non-alcoholic fatty liver disease is highly prevalent in patients with type 2 diabetes mellitus (T2DM). The aim of the present study was to investigate the potential usefulness of transient elastography (TE), which is a technique that allows measuring both fibrosis and liver fat content simultaneously, as a screening tool for hepatic involvement in Turkish patients with T2DM.

MATERIALS AND METHODS

We obtained liver stiffness measurements (LSMs, as a measure of fibrosis) and controlled attenuation parameter (CAP, as a marker of steatosis) in 124 (46 males and 78 females; mean body mass index (BMI): 33.2±6.6 kg/m2) Turkish patients with T2DM. The prevalence rates of overweight, obesity, and metabolic syndrome in our sample were 28.2%, 64.5%, and 77.4%, respectively. Probe-specific LSM cut-off values were used to define advanced fibrosis (>F3) and cirrhosis (F4) (M probe: F3=9.6-11.4 kPa, F4 >11.5 kPa and XL probe: F3=9.3-10.9 kPa, F4 >11.0 kPa). Mild, moderate, and severe steatosis were defined as CAP 222-232 dB/m, CAP 233-289 dB/m, and CAP >290 dB/m, respectively.

RESULTS

Advanced fibrosis and cirrhosis were identified in 21 (16.9%) and 10 (8.0%) patients, respectively. TE-defined hepatic steatosis (CAP>222 dB/m) was detected in 117 (94.3%) patients. Mild, moderate, and severe steatosis were identified in 0, 29, and 88 patients, respectively.

CONCLUSION

TE is a useful non-invasive imaging modality to screen for liver involvement in Turkish patients with T2DM. High rates of TE-defined fibrosis and steatosis in our sample reflect the presence of an elevated mean BMI.

Blind mole rat (Spalax leucodon) masseter muscle: structure, homology, diversification and nomenclature

BACKGROUND

It is well known that rodents are defined by a unique masticatory apparatus. The present study describes the design and structure of the masseter muscle of the blind mole rat (Spalax leucodon). The blind mole rat, which emer- ged 5.3-3.4 million years ago during the Late Pliocene period, is a subterranean, hypoxia-tolerant and cancer-resistant rodent. Yet, despite these impressive cha- racteristics, no information exists on their masticatory musculature.

MATERIALS AND METHODS

Fifteen adult blind mole rats were used in this study. Dissections were performed to investigate the anatomical characteristics of the masseter muscle.

RESULTS

The muscle was comprised of three different parts: the superficial mas- seter, the deep masseter and the zygomaticomandibularis muscle. The superficial masseter originated from the facial fossa at the ventral side of the infraorbital foramen. The deep masseter was separated into anterior and posterior parts. The anterior part of the zygomaticomandibularis muscle arose from the snout and passed through the infraorbital foramen to connect on the mandible.

CONCLUSIONS

The construction of the deep masseter and zygomaticomandibularis muscles were of the Myomorpha type. Further studies are needed to reveal features such as muscle biomechanics, muscle types.

Results of Real-time Multiplex Polymerase Chain Reaction Assay in Renal Transplant Recipients With Sterile Pyuria

Urinary tract infections are a major cause of morbidity and hospitalization after renal transplantation. Patients treated with immunosuppressive drugs suffer not only from common uropathogens but also from opportunistic infections caused by unusual uropathogens. Sterile pyuria is associated with numerous infectious agents including viruses, fungi, and atypical or fastidious organisms. The objective of this study was to investigate the pathogens using real-time multiplex polymerase chain reaction (rtMPCR) assay in sterile pyuria of renal transplant recipients. In this prospective controlled study, pathogen detection was performed with rtMPCR assay on October 2016 in 60 patients with sterile pyuria who had undergone kidney transplantation. A total of 40 renal transplant patients were determined as the control group. Male-to-female ratio was same. The mean age of the subjects with sterile pyuria was 45.7 ± 12.1 (25-74). The mean duration after transplantation was 28.8 ± 3.97 (3-102) months. Pathogens were detected with rtMPCR in 61.7% of sterile pyuria group. This rate was significantly higher compared with the control group (P < .001). Two or more different pathogens were found in 13 (21.7%) patients in sterile pyuria group. The pathogens found included cytomegalovirus in 10 patients (19%), Gardnerella vaginalis and obligate anaerobes in 20 patients (38%), Ureaplasma spp in 17 patients (33%), Candida spp in 2 patients (4%), Mycoplasma hominis in one patient (2%), herpes simplex virus-2 in one patient (2%), and Trichomonas vaginalis in one patient (2%). Sterile pyuria may indicate the presence of genitourinary pathogens that cannot be detected with conventional urine culture method in renal transplantation patients. rtMPCR is an accurate and convenient method for detection of multiple potential pathogens of sterile pyuria in renal transplant patients.

Role of diffusion-weighted MR imaging in predicting the grade of nonfunctional pancreatic neuroendocrine tumors

PURPOSE

The purpose of this study was to describe the magnetic resonance imaging (MRI) findings including diffusion-weighted MRI of nonfunctional pancreatic neuroendocrine tumors (PanNETs) and their hepatic metastases, and investigate the relationships between MRI features and histopathological findings for each grade of PanNETs.

MATERIALS AND METHODS

A total of 30 patients were included. There were 14 men and 16 women with a mean age of 61.60±11 (SD) years (range: 31-81years). PanNET lesions were analyzed qualitatively (signal intensities, contrast enhancement, lesion margins, presence of metastasis and characteristics of metastases) and quantitatively (signal intensity ratios, contrast enhancement indices and normalized apparent diffusion coefficient [ADC]). The relationships between MRI findings and histopathological findings were evaluated.

RESULTS

Among 30 nonfunctional PanNETs, 11 were high-grade tumors, 10 were intermediate and 9 were low-grade tumors. All high grade PanNETs showed low to intermediate signal on T2-weighted images and ill-defined borders. All intermediate grade PanNETs had intermediate and 6 low grade PanNETs have high signal on T2-weighted images. Patients with hepatic metastases from high grade PanNETs had cystic component in 8/10 (80%) and wash-out in 7/10 (70%) whereas intermediate grade PanNETs had none (P<0.05). The normalized ADC values of high grade PanNETs was lower than those of intermediate and low grade PanNETs (P<0.05).

CONCLUSION

The presence of cystic component or contrast wash-out in hepatic metastases correlates with high grade PanNETs. The pre-operative MRI combined with DWI has an important role in grading and surgical planning of PanNETs.

Effect of aquaporin 1 and 4 on masticatory muscles degeneration as a result of aging

OBJECTIVE

The changes in the mouth structures due to aging cause some structural and functional changes by affecting masticatory muscles over time. The aim of this study was to evaluate the aging-related histopathologic changes and immunohistochemically assessed aquaporin 1 and 4 expressions on masseter and temporal muscles.

MATERIAL AND METHODS

14 Balb/c white mice (50-80 g) were used in this study. Group I consisted of young animals (2-month-individuals) (n = 7) and Group II consisted of older animals (18-month-old) (n = 7). After routine histological follow-ups were made, tissues were stained immunohistochemically for aquaporin 1 and aquaporin 4 as well as with hematoxylin-eosin.

RESULTS

It was seen that while the masseter and temporalis muscle tissues showed a high immunoreactivity (+++) for aquaporin 1 and 4 in young mice, they showed a weak immunoreactivity (+) for aquaporin 1 and 4 in old mice (p = 0.001). In the H-score assessment, aquaporin 1 and 4 immunoreactivity was significantly higher in young mice than in old mice (p = 0.002).

CONCLUSIONS

Consequently, it was shown that degeneration of the masticatory muscles increased with aging and there was a decrease in intra- and intercellular exchange of substances because of changing aquaporin 1 and aquaporin 4 expressions (Tab. 2, Fig. 4, Ref. 20).

Comparison of type I collagens and MMP-2 proteins in temporomandibular joint of young and old mice

BACKGROUND

The effects of ageing on the histopathological changes of tem-poromandibular joint (TMJ) and the existence and age related alterations of immunochemical expressions of type I collagen and matrix metalloproteinase-2 (MMP-2) proteins was aimed to be displayed.

MATERIALS AND METHODS

In this study, 14 Balb/C type white mice (50- -80 g) were included. Groups were organised as group 1 - 2-month-old young animals (n = 7) and group 2 - 18-month-old old animals (n = 7). Of the paraffin embedded tissues 4-5 μm thick sections were taken and immunohisto-chemical stainings of haematoxylin-eosin, type-1 collagen and MMP-2 were performed.

RESULTS

Collagen bundles showed sagittal and oblique localisations in the young mice, which were comprised of compact collagen bundle layers positioned alterna-tely. While collagen bundle fragmentation was observed in the disks of old mice, some disk regions showed ruptures. In the old mice a decrease in blood vessels, structural impairments and dilatation in arterioles and venules were detected. In the TMJ tissues of the young mice type I collagen and MMP-2 expressions were increased, while they were decreased in old mice. In the MMP-2 H-score evaluation young mice showed significant increase compared to the old mice.

CONCLUSIONS

Occurrence of degenerations in the collagen structure of TMJ and decimation in the matrix metalloproteases were observed with age. (Folia Morphol 2018; 77, 2: 329-334).

Impact of myocardial blush grade on Tpe interval and Tpe/QT ratio after successful primary percutaneous coronary intervention in patients with ST elevation myocardial infarction

INTRODUCTION

Myocardial perfusion, when assessed by myocardial blush grade (MBG) is an independent predictor of major adverse cardiac outcomes. The terminal part of repolarization, measured as the interval from the peak to the end of the T wave (Tpe), is a relatively novel indicator of ventricular arrhythmias. The relations between MBG and Tpe interval have not been examined before. We aimed to evaluate the relationship between MBG and Tpe and Tpe/QT ratio after successful primary percutaneous coronary intervention (PCI) in acute ST-segment elevation myocardial infarction (STEMI).

PATIENTS AND METHODS

In this study, 149 consecutive patients with STEMI and underwent primary PCI were included. The Tpe interval was defined as the interval from the peak of T wave to end of T wave, and measurements were performed from precordial leads on ECGs at admission and 90 minutes after revascularization. Patients with no myocardial blush were graded as MBG 0, those with minimal myocardial blush were graded as MBG 1, those with moderate myocardial blush were graded as MBG 2 and patients with normal myocardial blush were graded as MBG 3.

RESULTS

Comparisons were made between the MBG 0-1, MBG 2 and MBG 3 groups. In all groups, post-procedural Tpe interval were significantly shorter than pre-procedural Tpe intervals (for all groups p<0.001). Post-procedural Tpe interval in MBG 3 group was significantly shorter than MBG 0-1 and MBG 2 groups (Tpe=81±11 ms in MBG 0-1 group, 81±11 ms in MBG 2 group and 72±10 ms in MBG 3 group; p<0.001, for all groups). Post-procedural Tpe/QT ratios decreased in all three MBG groups (p<0.001, for all groups). Tpe/QT ratios were smaller with the increasing MBG (p<0.001).

CONCLUSIONS

Tpe interval and Tpe/QT ratio are closely associated with MBG after successful primary percutaneous coronary intervention in STEMI.

Predicting ADR from PDR and individual adenoma-to-polyp-detection-rate ratio for screening and surveillance colonoscopies: A new approach to quality assessment

BACKGROUND AND AIMS

Adenoma detection rate (ADR) has been established as a quality indicator for screening colonoscopy. Because ADR is cumbersome to obtain in routine practice, polyp detection rate (PDR), polypectomy rate (PR) and adenoma-to-polyp-detection-rate-ratio (APDRR) have been proposed to estimate ADR. This study aimed to evaluate APDRR in order to estimate ADR (ADR_est) in different settings.

METHODS

Average risk screening and surveillance colonoscopies from a community-based private practice and a tertiary academic hospital setting were retrospectively evaluated. APDRR was calculated as averaged group APDRR for all study procedures (APDRR) and for the first half of study procedures of each gastroenterologist (APDRR_ag) or individually for each gastroenterologist on the basis of his or her first 25, 50 and 100 colonoscopies (APDRR_ind). ADR_est was determined from PDR by using APDRR, APDRR_ag, and APDRR_ind, respectively.

RESULTS

A total of 2717 individuals were analyzed. Using APDRR, significant correlations between ADR and ADR_est were observed for the entire (0.944, p < 0.001), proximal (0.854, p < 0.001), and distal (0.977, p < 0.001) colon. These correlations were lost when APDRR_ag was used to estimate each gastroenterologist's ADR for the second half of his or her included colonoscopies. However, ADR and ADR_est correlated significantly with a root-mean-square-error of 6.8% and 5.8% when APDRR_ind on the basis of each gastroenterologist's first 50 and 100 colonoscopies was used for subsequent colonoscopies.

CONCLUSIONS

ADR for subsequent colonoscopies of an individual endoscopist can be reliably estimated from PDR by using an individually calculated APDRR. Prospective studies are needed to verify this promising approach in different practice settings.

Effects of early contrast-enhanced computed tomography on clinical course and complications in patients with acute pancreatitis

PURPOSE

To investigate the effect of an early contrast-enhanced computed tomography (CECT) on clinical course and complications of acute pancreatitis (AP).

MATERIAL AND METHODS

58 patients with AP who had at least one CECT examination were analyzed retrospectively. Laboratory as well as clinical data, and results from the assessment of disease severity (CT severity index (CTSI) and its modified (MCTSI) version) were analyzed. The primary endpoint was the development of severe complications, defined as death, respiratory failure, acute renal failure, and the need for invasive interventions. Patients were divided into two groups: an early group (CECT within the first 48 h after the onset of symptoms, n = 32) and a late group (CECT > 48 h after the onset of symptoms, n = 26). Multivariate regression analysis was performed to identify risk factors for severe complications.

RESULTS

There were no statistically significant differences between both groups concerning baseline characteristics, CTSI, and MCTSI. Complications occurred more often in the early CECT group (p = 0.008). Multivariate logistic regression analysis identified an early CECT and a severe MCTSI as independent risk factors for the occurrence of severe complications (p = 0.02 and p = 0.002, respectively).

CONCLUSION

CECT performed within the first 48 h after the onset of symptoms is associated with an unfavorable outcome in AP.

Fragmented QRS is associated with cirrhotic cardiomyopathy in patients with decompensated cirrhosis

BACKGROUND AND AIM

It has been reported that the fragmented QRS (fQRS) is related to left ventricular systolic dysfunction and diastolic dysfunction. The aim of this study was to determine the frequency of fragmented QRS (fQRS) in patients with decompensated cirrhosis and to evaluate the relationship between the presence of fQRS and systolic and diastolic dysfunction.

METHOD

PThe study included consecutive 189 patients with decompensated cirrhosis. fQRS pattern was described as presence of RSR' manifested as existence of additional R wave and notching in either R or S waves in ECG recordings. Conventional echocardiography and tissue doppler echocardiography were performed in all patients.

RESULTS

The prevalence of fQRS was 31% (59/189) in patients with decompensated cirrhosis. The patients with fQRS had worse diastolic and systolic functions in comparison to the patients without fQRS. In addition, multivariate analysis revealed that the presence of an fQRS, Na levels < 125 mEq/L, the Child-Pugh score and the MELD score were independent predictive factors for mortality (respectively, p < 0.001, p < 0.001, p < 0.001 and p < 0.001).

CONCLUSIONS

In conclusion,this study showed a relationship between the presence of an fQRS and cardiac dysfunction. In addition, the fQRS appeared to act as an independent predictor of mortality in patients with decompensated cirrhosis. These data suggest that the fQRS may represent a novel noninvasive marker for cardiac involvement and for predicting mortality in patients with decompensated cirrhosis.

Association between the neutrophil to lymphocyte ratio and prehypertension

OBJECTIVES

To explore the neutrophil-lymphocyte ratio (NLR) in patients with prehypertension (PHT).

BACKGROUND

Inflammation plays an important role in the development of cardiovascular diseases. A pathophysiological link also exists between inflammation and PHT. NLR is a simple marker for the assessment of inflammatory status. There is a lack of data regarding the association between NLR and pre-hypertensive state.

METHODS

The present cross-sectional study included 33 newly diagnosed PHT patients and 35 normotensive control subjects. Prehypertension was defined as a systolic blood pressure (BP) of 120-139 mm Hg and/or a diastolic BP of 80-89 mm Hg.

RESULTS

Patients were divided into tertiles based on NLR values: 1.17 (0.9-1.42) in tertile 1; 1.57 (1.43-1.78) in tertile 2; and 2.40 (1.82-4.5) in tertile 3. The frequency of PHT was significantly higher for patients in the upper NLR tertile compared to the middle and lower NLR tertiles (21 (91.3%), 7 (30.4%), and 5 (22.7%), respectively; p<0.001). Systolic BP and diastolic BP were significantly higher among patients in the upper NLR tertile than among those in the other NLR tertiles.

CONCLUSION

An association exists between PHT and NLR. NLR measurement, as well as monocyte count, may be used to indicate increased risk of prehypertension (Tab. 2, Ref. 48).

[First data concerning the medical supply of patients with non-alcoholic fatty liver disease in Germany - a survey in university hospital centers of hepatology]

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) currently is one oft the most common reasons for chronic liver injury in the western world. In the European and American population the prevalence is up to 30 %. The medical supply of German patients with NAFLD is variable and has not been analyzed to date.

METHODS

We sent questionnaires to all university liver centers in Germany (11 questions) concerning the medical supply of patients with NAFLD. Questions included the rate of patients with fatty liver disease in the outpatient clinics, metabolic comorbidities and the kind of assignment. Besides that, individual clinical standards were documented. We compared longitudinal changes between 2008 and 2013.

RESULTS

The return rate of questionnaires was 65 % (n = 20). Analysis showed that the portion of NAFLD patients in the university outpatient clinics had increased between 2008 and 2013 with the predominant part of patients being assigned from external practitioners and not from internal departments of the hospital. Only few patients were assigned by diabetologists or endocrinologists, but on the other hand most liver outpatient clinics investigated their NAFLD patients for metabolic disorders. Cooperation between liver outpatient clinics and other medical services was moderate and was rated average, joint conferences were held rarely. Follow-up visits of patients with NAFLD take place regularly in all centers, however based on different criterions. A consistent algorithm concerning risk assessment and invasive workup does not exist.

CONCLUSION

The awareness concerning patients with NAFLD seems to have grown in recent years. Nevertheless, the medical supply of these patients is quite heterogenous and consistent standards do not exist. Therefore, a common guidline is urgently required.