The effect of renin-angiotensin blockers on COVID-19 related mortality: A tertiary center's experience

Background: The first reports on coronaviruse disease 2019 (COVID-19) revealed an exaggerated mortality rate in hypertensive patients. In this regard, concerns about angiotensin-converting enzyme (ACE) inhibitors’ and angiotensin-receptor blockers’ (ARBs) have been aroused. Our aim in this study was to evaluate the potential bad outcome effect of hypertension and anti-hypertensive therapy on COVID-19. Methods: 183 patients with polymerase-chain-reaction (PCR)-proven COVID-19, who were admitted to our hospital and consulted to cardiology department between 15th of March and 15th of April 2020 were included. Data were recruited from hospital records. Results: Thirty-two out of 183 patients with COVID-19 died in hospital. Hypertension incidence was not statistically different between patients who survived and died (76 [50.3%] vs 19 [59.4%, p = 0.352]). Although the usage rate of ACEI were similar among groups, ARB usage rate was significantly higher in patients who died than survived (11 [34.4%] vs 23 [15.2%], p = 0.011). Binary regression analysis showed an association between ARBs and mortality (OR: 0.032, 95% CI 1.045–2.623, p = 0.032). Conclusion: Our study confirmed previous concerns regarding a potential harmful effects of ARBs on COVID-19 related mortality.Kontext: První zprávy o onemocnění koronavirem v roce 2019 (coronavirus disease 2019, COVID-19) ukazovaly na zvýšenou mortalitu jedinců s hypertenzí, což vyvolalo obavy ohledně užívání inhibitorů angiotenzin konvertujícího enzymu (ACEI) a blokátorů receptoru AT1 pro angiotenzin II (ARB). Cílem naší studie bylo posoudit možnost nepříznivého vlivu onemocnění covid-19 na závažnost hypertenze a účinnost antihypertenzní léčby. Metody: Do studie bylo zařazeno 183 pacientů s onemocněním covid-19 prokázaným PCR testem, kteří byli v období od 15. března do 15. dubna 2020 přijati do naší nemocnice a následně odesláni na kardiologickou kliniku. Údaje byly získány z nemocničních záznamů. Výsledky: Celkem 32 ze 183 pacientů s onemocněním covid-19 zemřelo v nemocnici. Incidence hypertenze se mezi pacienty, kteří přežili a zemřeli, statisticky významně nelišila (76 [50,3 %] vs. 19 [59,4 %]; p = 0,352). I když podíly pacientů užívajících inhibitory ACE byly v obou skupinách podobné, léčiva ze skupiny ARB užívalo statisticky významně více pacientů, kteří zemřeli, než těch, kteří přežili (11 [34,4 %] vs. 23 [15,2 %]; p = 0,011). Binární regresní analýza prokázala souvislost mezi užíváním ARB a mortalitou (OR: 0,032; 95% CI 1,045–2,623; p = 0,032). Závěr: Naše studie potvrdila původní obavy týkající se možných škodlivých účinků lékové skupiny ARB na mortalitu v souvislosti v onemocněním covid-19

Hepatoprotective effects of B-1,3-(D)-Glucan on bortezomib-induced liver damage in rats

The aim of this study was to evaluate the effects of beta -1,3-(D)-glucan as an antioxidant and tissue protective agent and study the biochemical, histopathologic, and immunohistochemical effects of first therapeutic proteasome inhibitor bortezomib on the liver for treating relapsed multiple myeloma. The experiment included 36 adult male rats, which were divided into four treatment groups: control (healthy); bortezomib-treated; beta-1,3-D-glucan-treated; and bortezomib + beta-1,3-(D)-glucan-treated. Each group was subdivided into two subgroups based on time of sacrifice (48 or 72 h). After the experiments, superoxide dismutase (SOD) activity and lipid peroxidation (LPO) amounts were determined, and immunohistochemical and histopathological changes were examined in all rat liver tissues. beta -1,3-(D)-Glucan treatment normalized changes of LPO and stimulated an over activity of endogenous SOD. The results of the histopathologic parameters showed that treatment with beta -1,3-(D)-Glucan in the bortezomib group ameliorated the development of non-specific reactive hepatitis (NSRH) and Kupffer cell activation via NF-kB. Administration of beta -1,3-(D)-Glucan is effective in reversing tissue damage induced by bortezomib in rat livers.Bu çalışmanın amacı, relaps multiple miyelom tedavi etmek için kullanılan ilk terapötik proteazom inhibitörü olan bortezomibin karaciğer üzerine immunohistokimyasal, histopatolojik ve biyokimyasal etkilerini araştırmak ve bir antioksidant ve doku koruyucu ajan olarak B-1,3-(D)-glukanın etkilerini değerlendirmekdi. Deney; kontrol (sağlıklı), bortezomib ile tedavi, B-1,3-(D)-glukan ile tedavi ve bortezomib + B-1,3-(D)-glukan ile tedavi olmak üzere dört tedavi grubuna bölünen 36 yetişkin erkek sıçan içerdi. Her bir grup sakrifikasyon zamanına (48 veya 72 saat) göre iki alt gruba ayrıldı. Deneylerin bitiminden sonra, süperoksit dismutaz (SOD) aktivitesi ve lipid peroksidasyon (LPO) miktarları ölçüldü ve tüm sıçan karaciğer dokularında immünohistokimyasal ve histopatolojik değişiklikler incelendi. B-1,3-(D)-glukan ile tedavi LPO değişikliğini normalize etti ve endojen SOD aktivitesi aşırı uyardı. Histopatolojik parametrelerin sonuçları, bortezomib grubunda B-1,3-(D)-glukan ile tedavi NF-kB yoluyla Kupffer hücre aktivasyonunu ve non-spesifik reaktif hepatit (NSRH) gelişimini regüle ettiğini gösterdi. B-1,3-(D)-glukan uygulaması, sıçan karaciğerinde bortezomibin neden olduğu geri döndürülebilir doku hasarında efektifdir

Survival results according to Oncotype Dx recurrence score in patients with hormone receptor positive HER-2 negative early-stage breast cancer: first multicenter Oncotype Dx recurrence score survival data of Turkey

BackgroundThe Oncotype Dx recurrence score (ODx-RS) guides the adjuvant chemotherapy decision-making process for patients with early-stage hormone receptor-positive, HER-2 receptor-negative breast cancer. This study aimed to evaluate survival and its correlation with ODx-RS in pT1-2, N0-N1mic patients treated with adjuvant therapy based on tumor board decisions.Patients and methodsEstrogen-positive HER-2 negative early-stage breast cancer patients (pT1-2 N0, N1mic) with known ODx-RS, operated on between 2010 and 2014, were included in this study. The primary aim was to evaluate 5-year disease-free survival (DFS) rates according to ODX-RS.ResultsA total of 203 eligible patients were included in the study, with a median age of 48 (range 26-75) and median follow-up of 84 (range 23-138) months. ROC curve analysis for all patients revealed a recurrence cut-off age of 45 years, prompting evaluation by grouping patients as ≤45 years vs. >45 years. No significant difference in five-year DFS rates was observed between the endocrine-only (ET) and chemo-endocrine (CE) groups. However, among the ET group, DFS was higher in patients over 45 years compared to those aged ≤45 years. When stratifying by ODx-RS as 0-17 and ≥18, DFS was significantly higher in the former group within the ET group. However, such differences were not seen in the CE group. In the ET group, an ODx-RS ≥18 and menopausal status were identified as independent factors affecting survival, with only an ODx-RS ≥18 impacting DFS in patients aged ≤45 years. The ROC curve analysis for this subgroup found the ODx-RS cut-off to be 18.ConclusionThis first multicenter Oncotype Dx survival analysis in Turkey demonstrates the importance of Oncotype Dx recurrence score and age in determining treatment strategies for early-stage breast cancer patients. As a different aproach to the literature, our findings suggest that the addition of chemotherapy to endocrine therapy in young patients (≤45 years) with Oncotype Dx recurrence scores of ≥18 improves DFS