Total serum protein predicted mortality in patients with st-elevation myocardial ınfarction who underwent primary percutaneous coronary ıntervention: Results of 8-year follow-up

Objectives: ST-elevation myocardial infarction (STEMI) is globally one of the leading causes of mortality. Determining modifiable mortality predictors to improve outcomes is critical. Total serum protein (TSP) is a composite indicator of immunity, nutrition, and inflammation and it plays a vital role in biological pathways contributing to cardiovascular diseases. TSP level has not been evaluated in patients with STEMI in the prediction of mortality previously. Materials and Methods: The patients diagnosed with STEMI between March 2007 and May 2009 were included in the study. TSP was obtained at admission to the hospital. Follow-up period of the study was 8 years and primary endpoint was all-cause mortality. Participants were separated according to the presence of mortality and clinical parameters compared between these two groups. Results: The mean age of the total 99 patients was 61±12.4 years and 82 (82.8%) of them were male. While left ventricular ejection fraction (LVEF) (p=0.001), serum albumin (p=0.014), and TSP (p<0.001) were lower, serum creatinine was higher (p=0.003) in the mortality group. Diabetes mellitus (p=0.007), increased age (p=0.027), LVEF (p=0.006), serum creatinine level (p=0.023), and TSP (hazard ratio: 0.159, 95% confidence interval: 0.062-0.408, p<0.001) predicted mortality independently. Conclusion: TSP level predicted all-cause mortality independently in STEMI patients who underwent primary percutaneous coronary intervention during 8-year follow-u

Relation of apolipoprotein E gene polymorphism with the severity of coronary artery disease in patients with stable ischemic heart diseas

Aim: Atherosclerosis begins from an early age and manifests in later years as Coronary artery disease (CAD). This inflammatory process is aggravated by age, smoking, hypercholesterolemia, hypertension, diabetes mellitus, and genetic factors. We aimed to investigate which isoform of APOE is related to extensive coronary lesions in patients with stable coronary heart disease. Materials and Methods: This study was carried on single center. One hundred and ten patients diagnosed with stable coronary artery disease by coronary angiogram were enrolled consecutively. Syntax score was calculated by a tool of website calculator (www. syntax.com). According to the Syntax score, patients were split into three groups. APOE genotyping was performed through blood samples. Patients split into three groups according to the APOE genotypes: E4 (3/4 and 4/4 genotypes), E3(3/3 genotype), E2 (2/2 and 2/3 genotypes). APOE groups were compared according to baseline characteristics and syntax scores. (%82.6) değil (82.6%) olacak. Lütfen İngilizce kurala göre düzeltiniz. Tüm sayısal değerlerde virgülleri de nokta yapmayı unutmayınız. Results: Coronary angiography and APOE genotypes of 98 patients were analyzed. 81 of patients (%82.6) had E3E3 allele; 6 of patients (%6.1) had E2E3 allele; 10 patients (%10.2) had E3E4 allele and 1 patient (%1) had E2E4 allele. Due to the contrast effect of E2 and E4 on CAD, we excluded patients with E2E4 allele from the study. Firstly, we assessed distribution of APOE genotype E2 (E2E3), E3 (E3E3 and E3E4), E4 (E3E4) within 3 groups of syntax scores. Total of 6 patients of E2 allele was at low syntax score group. 83 patients of E3 allele were at the low-risk group of syntax score. 10 patients of E3 allele were at the mid group and 4 patients were at the high-risk group of syntax score. 7 patients of E4 allele subjects were at the low-risk and 1 patient was at the high-risk group of syntax score. Compared to syntax score groups and APOE genotypes, E2 alleles were in lower syntax score group versus E3 (P=0.046) and E4 (P=0.003) alleles. However E4 alleles were in higher syntax score group versus E3 alleles (P= 0.034). The Syntax score was seemed to be lower in the E2 allele group versus E4 and E2 groups (P=0.013). Conclusion: we reported the first study that E2 allele was related with less and E4 allele was more extensity and severity of CAD in patients with stable ischemic coronary diseas

Serum uric acid level independently predicted metabolic syndrome in non-diabetic hypertensive patients

Background: Arterial hypertension may accompany metabolic syndrome (MetS) which is strongly associated with cardiovascular diseases. Determining high-risk groups concerning MetS development is crucial to prevent this undesirable clinic. Serum uric acid level was demonstrated to be associated with development of hypertension and MetS in normal population. It was aimed to investigate the role of serum uric acid for the prediction of MetS in non-diabetic hypertensive individuals. Material and methods: Patients who were diagnosed with arterial hypertension between January 2021 and June 2021 were included in the study. Diabetes mellitus was determined as an exclusion criteria. Metabolic syndrome was considered as the clustering of high blood pressure, elevated glucose level, abnormal cholesterol levels, and abdominal obesity conditions according to the National Cholesterol Education Program (NCEP) definition. Patients were divided into two groups by the presence of MetS. Results: The mean age of 107 non-diabetic hypertensive patients was 48.5 ± 8.6 years and 50 (46.7%) of them were female. A total of 56 patients (52%) had MetS. Waist circumference (101.2 ± 11.3 vs. 106.7 ± 10.1 cm, p = 0.020), body mass index (30.6 ± 4.9 vs. 32.8 ± 4.1, p = 0.016), E/e’ ratio [9.2 (7.3–11.1) vs. 10.6 (9.1–13.4), p = 0.003], EAT [5.9 (4.8–8) vs. 7.9 (6–9.6), p = 0.006], and serum uric acid level (4.75 ± 1.10 vs. 5.82 ± 1.21 mg/dL, p &lt; 0.001) were higher in MetS (+) group. Multivariable regression demonstrated that serum uric acid [(odds ratio) OR = 2.217, 95% confidence interval (CI): 1.300–3.783, p = 0.003] and body mass index (OR = 1.214, 95% CI: 1.032–1.428, p = 0.019) were independent predictors of MetS presence. Conclusion: Serum uric acid level predicted MetS presence in non-diabetic hypertensive individuals independently. This practical blood parameter can be used to evaluate those who are at risk of MetS development.

Comparison of subclinical neuronal injury by measuringneuron-specific enolase in patients with severeaortic stenosis treated with transcatheter aortic valvereplacement or sutureless aortic valve replacement

Aim: Severe aortic valve stenosis (SAVS) which causes angina pectoris, syncope, arrhythmias, and sudden cardiac death, may be treated with transcatheter aortic valve replacement (TAVR) or sutureless aortic valve replacement (SU-AVR). We aimed to predict subclinical neuronal injury (SNI) by measuring neuron-specific enolase (NSE) in patients who underwent the TAVR and the SU-AVR. Materials and Methods: This clinical trial was carried out between January 2015 and January 2017. A total of 53 patients who had severe aortic valve stenosis (SAVS) and underwent TAVR and SU-AVR were included. The Serum NSE level was measured just before and 24 hours after the procedure. Demographic variables, neurologic assessment findings, clinical and echocardiographic data, carotid ultrasounds reports, and laboratory findings were recorded. Results: A total of 53 patients were included the study. The mean age was 78.4±8.6 and 20 were man (37.7%). The mean age of the TAVR group was significantly higher than the SU-AVR group (82.9±4.7 vs 71.5±8.7, p<0.001). The NSE level was significantly higher in the SUAVR group compared to the TAVR group after the procedure (21.15±10.25 vs 35.32±12.64, p<0.001). Differences between before and after the procedure the National Institutes of Health Stroke Scale (NIHSS), demographic and echocardiographic variables were similar between the two groups. Conclusion: Serum NSE level was significantly higher in the SU-AVR group than the TAVR group Therefore, we may consider the SNI rate is higher as well. In patients who are at higher risk for neurological damage or have neurologic disease, TAVR may be a better treatment option instead of SUAVR

Metastatik safra yolu kanseri olan yaşlı hastalarda optimal tedavi yaklaşımları ve prognostik faktörler

Introduction: There is a lack of evidence of the outcomes in elderly patients advanced stage biliary tract cancer due to the patients aged over 65 years are less than 25% in many prospective trials. We designed a retrospective multicenter study to evaluate the factors affecting treatment and survival in elderly patients with advanced-stage biliary tract cancer. Materials and methods: A total of 116 patients with advanced stage biliary tract cancer aged ≥65 years were included, and the treatment responses, survival, and toxicity rates were evaluated with respect to age groups Results: There was no significant difference between age and response to treatment, survival, or toxicity. The median progression-free survival and overall survival were 5.3, and 11.8 months respectively. Multivariate analysis indicated that ECOG PS (p<0.001 CI95% 1.5-3.7) and PNI (p<0.001 CI 95% 0.14-0.41) were significant independent prognostic factors for PFS. The independent prognostic factors for OS were choice of frontline regimen, NLR and PNI (p=0.007 CI 95% 0.71 – 0.94, p=0.006 CI 95% 1.2 – 3.1, p=0.001 CI 95% 0.35 – 0.91, respectively). Discussion: This study confirms the general prognostic relevance of inflammatory parameters and the importance of frontline treatment in elderly patients with advanced-stage biliary tract tumors. Additionally, getting older does not indicate that treatment will be avoided or that they will have a worse prognosis and suffer from more toxicities.Giriş: 65 yaş üzeri hastaların klinik çalışmaların %25’inden daha azını oluşturması nedeniyle biliyer sistem kanseri olan ileri yaş hastaların yönetimi konusunda kanıt eksiği bulunmaktadır. Bu amaçla, metastatik safra yolu kanseri tanılı yaşlı hastalarda tedaviyi ve sağkalımı etkileyen faktörleri değerlendirmek için retrospektif çok merkezli bir çalışma tasarladık. Gereç ve yöntemler: Çalışmaya 65 yaş ve üzeri, ileri evre safra yolu kanseri tanısı almış, 116 hasta dahil edildi ve yaş gruplarına göre tedavi yanıtları, sağkalım ve toksisite oranları değerlendirildi. Bulgular: Median yaşa göre gruplandırılıdğında; yaş ile tedaviye yanıt, sağkalım, toksisite arasında anlamlı bir fark bulunmadı. Tüm populasyonda medyan progresyonsuz sağkalım (PSK) ve genel sağkalım (GSK) sırasıyla 5.3, 11.8 aydı. Multivariate analizde, PSK için bağımsız prognostik faktörler preformans durumu(ECOG PS) (p<0.001 CI95% 1.5-3.7) ve Prognostik nutrisyonel indek (PNI) (p<0.001 CI 95% 0.14-0.41) olarak bulundu. GSK için ise bağımsız prognostik faktörler, birinci sıra tedavi seçimi, Notrofil Lenfosit oranı (p=0,007 CI %95 0,71 – 0,94) ve PNI (p=0,001 CI %95 0,35 – 0,91) olarak bulundu. Tartışma: Metastatik safra yolu kanseri olan yaşlı hastalarda prognozu etkileyen temel faktöreler inflamatuar parametreler ve birinci basamakta seçilen kemoterapi rejimidir. İleri yaş ile sağkalım, toksiste profili ve tedavi toleransı farklılık göstermemektedir

Kardiyak resenkronizasyon tedavisine yanıtın öngörülmesinde sistemik bağışıklık-inflamatuvar indeksinin rolü

Aim: Cardiac resynchronization therapy (CRT) is a reliable treatment modality in patients with systolic dysfunction. However, not every patient appears to benefit from CRT. The systemic immune inflammation index (SII) is closely linked to the poor prognosis of various cardiovascular disorders. However, there is no study investigating whether SII has predictive value in determining response to CRT in dilated cardiomyopathy patients. Therefore, we intend to investigate the association between SII and response to CRT. Methods: A total of 220 patients (mean age 61.2±10.8 years; 120 men) implanted with CRT were involved in this study. Echocardiographic and laboratory measurements were evaluated prior to CRT. Response to CRT was determined as a≥ 15% decrease in left ventricular end-systolic volume at one-year follow-up. Results: Patients grouped as CRT responders and non-responders. Of these, 143 (64.6%) were considered to be CRT responders, while the remaining 77 (33.4%) were non-responders. Female sex (OR: 3.823, CI: 1.568-9.324 p=0.003), QRS duration (OR: 1.224, CI: 1.158-1.335 p<0.001), and SII (OR: 0.996 CI: 0.995-0.997 p<0.001) were shown to be independent predictors of CRT response in multivariate analysis. A cut-off value of SII >825 estimated no response to CRT with 80% sensitivity and 75% specificity. Conclusions: SII was associated with unresponsiveness to CRT. Therefore, it may be used to determine optimal patient selection for CRT implantation in routine clinical practice.Amaç: Kardiyak resenkronizasyon tedavisi (KRT), sistolik disfonksiyonu olan hastalarda güvenilir bir tedavi yöntemidir. Ancak, KRT'nin faydası belli hasta grupları ile sınırlıdır. Sistemik immün inflamatuvar indeks (SII), çeşitli kardiyovasküler bozuklukların kötü prognozu ile ilişkilidir. Bununla birlikte, dilate kardiyomiyopati hastalarında SII'nin KRT'ye yanıtı belirlemede prediktif değeri olup olmadığını araştıran bir çalışma bulunmamaktadır. Bu nedenle, bu çalışmada SII ile KRT'ye yanıt arasındaki ilişkiyi araştırmak amaçlandı. Yöntemler: Bu çalışmaya KRT implante edilen toplam 220 hasta (ortalama yaş 61,2±10,8 yıl; 120 erkek) dahil edildi. KRT öncesi ekokardiyografi ve laboratuvar ölçümleri değerlendirildi. KRT'ye yanıt, bir yıllık takipte sol ventrikül sistol sonu hacminde ≥ %15 azalma olarak belirlendi. Bulgular: Hastalar, KRT'ye yanıt verenler ve yanıt vermeyenler olarak gruplandırıldı. Bunlardan 143'ü (%64,6) KRT'ye yanıt veren olarak kabul edilirken, kalan 77'si (%33,4) yanıt vermeyendi. Kadın cinsiyet (OR: 3.823, CI: 1.568-9.324 p=0.003), QRS süresi (OR: 1.224, CI: 1.158-1.335 p<0.001) ve SII (OR: 0.996 CI: 0.995-0.997 p<0.001) çok değişkenli analizde KRT yanıtının bağımsız öngörücüleri olarak bulundu. SII >825'lik bir sınır değeri, %80 duyarlılık ve %75 özgüllük ile KRT'ye yanıt olmadığını öngördürmüştür. Sonuç: Bu çalışmada SII’nin KRT'ye yanıtsızlığı öngördüğü gösterilmiştir. Bu nedenle SII rutin klinik uygulamada KRT implantasyonu için optimal hasta seçimini belirlemede kullanılabilir

Determination of the Level of Emergency Medicine Resident Physicians to Recognize the Electrocardiography Findings

Abstract Objective: The aim of this study is to determine the accuracy and reliability of the interpretation of electrocardiography (ECG) findings by emergency medicine resident physicians (EMPs) and to provide training recommendations in line with emerging deficiencies. Material and Methods: This research depended on the data from a questionnaire that we conducted among EMPs in Ankara. The survey included multiple-choice questions, selected through conceived cases presented in major textbooks or congresses. EMP ECG assessment levels were compared according to the duration of residency education and the presence of ECG education. The data were evaluated by using the Statistical Package for Social Sciences 17.0 (SPSS Inc., Chicago, IL, USA). Results: A total of 112 volunteers participated. Mean age was 29.6±4.4; also, 47 were female and 65 were male. When all of the questions were taken into account, the mean number of total correct answers was higher for those who had received ECG training than who had not received it, those who underwent more training than those who underwent less training, and those whose duration of assistantship was longer than those whose duration was shorter. Conclusion: The results of our study revealed that the evaluation of ECG is improved by increasing clinical knowledge and training. Depending on these results, we suggest that effective and practical ECG courses and training programs should be organized for EMPs. (JAEM 2014; 13: 108-11

Prognostic factors for regorafenib treatment in patients with refractory metastatic colorectal cancer: A real-life retrospective multi-center study

Regorafenib, an oral multikinase inhibitor, has improved survival in metastatic colorectal cancer (mCRC) patients who have progressed on standard therapies. Our study aimed to evaluate prognostic factors influencing regorafenib treatment and assess the optimal dosing regimen in a real-life setting. We retrospectively analysed 263 patients with mCRC from multiple medical oncology clinics in Turkey. Treatment responses and prognostic factors for survival were evaluated using univariate and multivariate analysis. Of the patients, 120 were male, and 143 were female; 28.9% of tumors were located in the rectum. RAS mutations were present in 3.0% of tumors, while BRAF, K-RAS, and N-RAS mutations were found in 3.0%, 29.7%, and 25.9% of tumor tissues, respectively. Dose escalation was preferred in 105 (39.9%) patients. The median treatment duration was 3.0 months, with an objective response rate (ORR) of 4.9%. Grade ≥ 3 treatment-related toxicity occurred in 133 patients, leading to discontinuation, interruption, and modification rates of 50.6%, 43.7%, and 79.0%, respectively. Median progression-free survival (PFS) and overall survival (OS) were 3.0 and 8.1 months, respectively. RAS/RAF mutation (hazard ratio [HR] 1.5, 95% confidence interval [CI] 1.1-2.3; P = 0.01), pretreatment carcinoembryonic antigen (CEA) levels (HR 1.6, 95% CI 1.1-2.3; P = 0.008), and toxicity-related treatment interruption or dose adjustment (HR 1.6, 95% CI 1.1-2.4; P = 0.01) were identified as independent prognostic factors for PFS. Dose escalation had no significant effect on PFS but was associated with improved OS (P < 0.001). Independent prognostic factors for OS were the initial TNM stage (HR 1.3, 95% CI 1.0-1.9; P = 0.04) and dose interruption/adjustment (HR 0.4, 95% CI 0.2-0.9; P = 0.03). Our findings demonstrate the efficacy and safety of regorafenib. Treatment line influences the response, with dose escalation being more favorable than adjustment or interruption, thus impacting survival