Comparison of the real-life clinical outcomes of warfarin with effective time in therapeutic range and NOACs: Insight from AFTER-2 Trial

BACKGROUND: We aimed to compare the long-term follow-up results of patients with atrial fibrillation (AF) who use vitamin K antagonist (VKA) with effective time in therapeutic range (TTR) and non-vitamin K antagonist oral anticoagulants (NOACs). METHODS: A total of 1140 patients were followed at 35 different centers for five years. During the follow-up period, the INR values were studied at least 4 times a year and the TTR values were calculated according to the Roosendaal method. The effective TTR level was accepted as >60% as recommended by the guidelines. There were 254 patients in the effective TTR group and 886 patients in the NOACs group. Ischemic cerebrovascular disease/ transient ischemic attack (CVD/TIA), hemorrhagic CVD, and mortality were considered primary endpoints based on one-year and five-year follow-ups. RESULTS: Ischemic CVD/TIA (3.9% vs. 6.2%; P = 0.17) and hemorrhagic CVD (0.4% vs. 0.5%, P = 0.69), the one-year mortality rate (7.1% vs. 8.1%; P = 0.59), five-year mortality rates (24% vs. 26.3%; P = 0.46) were not different between the effective TTR and NOACs groups during the follow-up respectively. The CHA2DS2-VASC score was similar between warfarin with the effective TTR group and NOACs group (3 [2–4] vs. 3 [2–4]; P = 0.17, respectively]. Additionally, survival free-time did not differ between the warfarin with effective TTR group and each NOAC in the Kaplan-Meier analysis (dabigatran, P = 0.59; rivaroxaban, P = 0.34; apixaban, P = 0.26; and edoxaban, P = 0.14). CONCLUSION: There was no significant difference in primary outcomes between the effective TTR and NOAC groups in AF patients

Evaluation of Right Ventricular Global Longitudinal Strain in COVID-19 Patients After Intensive Care Unit Discharge

Background and Aim:Using two-dimensional speckle tracking echocardiography (2D-STE), the ventricular functions of hospitalized coronavirus disease-2019 (COVID-19) patients were assessed. However, there is limited information about cardiac functions in the first year after recovery from the intensive care unit (ICU). This research aims to assess the right ventricular functions of COVID-19 patients and their changes within the first year after ICU discharge using 2D-STE.Materials and Methods:The study was conducted prospectively. The study included 68 consecutive patients and 70 control patients. Echocardiography was performed in the ICU and the first year after discharge from the hospital. Right ventricular global longitudinal strain (RVGLS) was measured using the 2D-STE method.Results:The mean age of the study group was 48.67±8.10 and 37 (54.4%) patients were males. There were no substantial differences across the groups, including age, gender, body mass index, heart rate, diabetes, dyslipidemia, and smoking (P > 0.05). A substantially significant positive correlation was detected between right ventricular dimension (RAD) (r = 0.644, P < 0.001), right ventricular diastolic dimension (RVDD) (r = 0.573, P < 0.001), ferritin (r = 0.454, P < 0.001), D-dimer (r = 0.305, P = 0.011) values and RVGLS in the in-hospital and after-discharge first-year groups. The RVGLS values of the control, in-hospital, and after-discharge first-year groups were -20.36±3.06, -16.98±3.78, and -17.58±6.45, indicating a statistically significant difference across the groups (P < 0.001). Tricuspid annular plane systolic excursion was higher in the control group (P < 0.05).Conclusion:RVGLS was found to be depressed during the in-hospital period and showed no improvement in the 1 year post discharge

The effect of coronary slow flow on ventricular repolarization parameters

Introduction: Ischemia due to microvascular dysfunction may be responsible for the heterogeneity of ventricular repolarization in coronary slow flow. To our knowledge, there is no study in which QT interval, Tp-Te interval, index of cardiac-electrophysiological balance (iCEB), and frontal QRS-T angle were evaluated together in patients with CSF. In this study, we examined for the first time the relationship between all these myocardial repolarization parameters and CSF. Materials and methods: The study group included 178 patients (99 female, mean age: 50.6 ± 8.6 years) with isolated CSF without stenotic lesions and with angiographically proven normal coronary arteries. The control group included 120 patients (71 female, mean age: 49.3 ± 9.4 years) with normal coronary angiography. QRS duration, QT interval, QTc interval, Tp-Te interval, Tp-Te/QT, Tp- Te/QTc, iCEB score, and frontal QRS-T angle were calculated from 12‑lead ECGs. Results: There was no significant difference in demographic parameters between the two groups. Compared with the control group, patients with CSF had significantly longer QTmax duration, QT dispersion, Tp-Te interval, and higher iCEB score, wider frontal QRS-T angle. Conclusion: In our study, we found that many of the ventricular repolarization parameters were adversely affected in patients with CSF. Impaired parameters may be associated with the risk of malignant ventricular arrhythmias

The prognostic value of ORBIT risk score in predicting major bleeding in patients with acute coronary syndrome

Background: The most significant adverse effect of antithrombotic medication in acute coronary syndrome (ACS) is major bleeding, which is related to increased mortality. Studies on ORBIT risk score in predicting major bleeding in ACS patients are limited. Objective: This research aimed to examine whether the ORBIT score calculated at the bedside can identify major bleeding risk in patients with ACS. Methods: This research was retrospective, observational, and conducted at a single center. Analyses of receiver operating characteristics (ROC) were utilized to define the diagnostic value of CRUSADE and ORBIT scores. The predictive performances of the two scores were compared using DeLong's method. Discrimination and reclassification performances were evaluated by the integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Results: The study included 771 patients with ACS. The mean age was 68.7 ± 8.6 years, with 35.3 % females. 31 patients had major bleeding. Twenty-three of these patients were BARC 3 A, five were BARC 3 B, and three were BARC 3 C. Bleeding history [OR (95 % CI), 2.46 (1.02-5.94), p = 0.021], hemoglobin levels [OR (95 % CI), 0.54 (0.45-0.63), p 74 years [OR (95 % CI), 1.03 (1.01-1.06), p = 0.039] were independent predictors of major bleeding. The ORBIT score was an independent predictor of major bleeding in the multivariate analysis: continuous variables [OR (95 % CI), 2.53 (2.61-3.95), p < 0.001] and risk categories [OR (95 % CI), 3.06 (1.69-5.52), p < 0.001]. Comparison of c-indexes for major bleeding events revealed a non-significant difference for the discriminative ability of the two tested scores (p = 0.07) with a continuous NRI of 6.6 % (p = 0.026) and an IDI of 4.2 % (p < 0.001). Conclusion: In ACS patients, the ORBIT score independently predicted major bleeding

The Effect of Phenyramidol on Neural Development in Early Chicken Embryo Model

AIM: To investigate the effects of Phenyramidol (Phe) on neural development in an early chicken embryo model. MATERIAL and METHODS: Sixty fertile non-pathogenic Super Nick eggs were incubated for 24 hours (h) and divided into four groups of 15 eggs each. Phe was administrated through the sub-blastoderm, and the eggs were incubated for another 24 h. All eggs were opened after 48 h of incubation, and the embryos were evaluated morphologically and histopathologically. RESULTS: in Group 1 (control group), none exhibited neural tube defects (NTDs) (0%), 1 (6.6%) was undeveloped; in Group 2 (low dosages), 1 did not develop (6.6%); in Group 3 (normal dosages), 2 (13.4%) had NTDs, 1 (6.6%) was undeveloped; in Group 4 (high dosages), 5 (33.3%) had NTDs, 2 (13.3%) were undeveloped. CONCLUSION: in light of the results, it was determined that the use of increasing doses of Phe led to defects in midline closure in early chicken embryos. This is the first report in the literature on Phe used in an early chicken embryo model

Clinical and demographic features of hidradenitis suppurativa: A multicentre study of 1221 patients with an analysis of risk factors associated with disease severity

Background Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity. Aim In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity. Methods In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed. Results The mean age of disease onset was 26.2 +/- 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 +/- 8.4 years with a delay in diagnosis of 5.8 +/- 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years. Conclusions Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity