Tp-e/QT ratio and QT dispersion with respect to blood pressure dipping pattern in prehypertension

Introduction Tp-e/QT, the ratio of the interval between the peak and the end of T wave to the QT interval, is a novel index of arrhythmogenesis. We investigate Tp-e/QT and QT dispersion (QTd) in prehypertensive and normotensive patients with different patterns of nocturnal blood pressure dipping. Patients and methods Forty-seven prehypertensive and 37 normotensive adult patients were included. Ambulatory blood pressure monitoring recording was performed and patients were considered to be dipper if nocturnal blood pressure fall was at least 10%; nondipper if it was 0-10%; and reverse-dipper if less than 0%. Tp-e, QT intervals were assessed by 12-lead ECG and Tp-e/QT was calculated using these measurements. QTd is defined as the difference between the maximum and the minimum QT interval of the 12 leads. Results Tp-e/QT was 0.22+/- 0.02 and 0.16+/- 0.01 in prehypertensives and normotensives, respectively (P< 0.001), whereas cQTd was 36.1+/- 6.8 and 27.2+/- 5.2 ms (P< 0.001). Tp-e and Tp-e/QT were the lowest in the dippers and the highest in the reverse-dippers in the prehypertensive group (Tp-e/QT dipper: 0.21+/- 0.01; nondipper: 0.24+/- 0.02; reverse-dipper: 0.25+/- 0.01; for dipper-nondipper, and dipper-reverse-dipper P< 0.05). However, in the normotensive group, dipping status had no effect on Tp-e/QT. There were no significant differences between dippers, nondippers, and reverse-dippers in terms of cQTd both in prehypertensives and in normotensives. There were no associations between left ventricular mass index and Tp-e, Tp-e/QT, and cQTd in both groups. Conclusion Tp-e, Tp-e/QT, and cQTd are increased in prehypertensives compared with normotensives. Tp-e and Tp-e/QT are associated with the dipping status in prehypertensives. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved

Role of inflammatory markers in decreasing negative appendectomy rate: A study based on computed tomography findings

BACKGROUND: This study aimed to investigate the role of inflammatory markers in decreasing negative appendectomy rate (NAR) based on their relation with findings of acute appendicitis (AA) on computed tomography (CT). METHODS: Ninety-two patients who underwent CT examination with suspected AA were included. We investigated the relation between CT findings of AA and laboratory inflammatory markers and also performed receiver operating characteristic (ROC) analysis to calculate cut-off values of inflammatory markers and CT findings of AA. Appendectomy cases were re-evaluated considering cut-off values to make the operation decision and NAR was recalculated. Chi-squared test was used to compare the actual and recalculated NAR. RESULTS: Cut-off values of appendiceal diameter, appendiceal wall thickness, and caecal wall thickness were 7.9, 2, and 2.3 mm, respectively, for the diagnosis of AA. Cut-off values of WBC , NLR, and CRP on ROC analysis were 7.47, 4.06 and 13, respectively, for the diagnosis of AA. When the actual and recalculated NAR (21.9% versus 9.1%) were compared, the difference was found to be almost significant (p=0.058). CONCLUSION: Inflammatory markers are not sufficiently powerful on their own to accurately diagnose AA. However, particularly in equivocal cases, proposed cut-off values may be helpful for accurate diagnosis and a lower NAR can be achieved

The relationship between serum uric acid levels and angiographic severity of coronary heart disease

Background: Many studies have shown that the serum uric acid (SUA) level is associated with atherosclerosis. Aim: To determine the relationship between the SUA level and the presence and severity of coronary heart disease (CHD). Methods: A total of 705 patients who underwent coronary angiography were included in this study. All patients were assessed for the presence of cardiovascular risk factors and ongoing medications. SUA levels were measured in all patients before the procedure after 12 h of fasting. The severity of CHD was assessed by the SYNTAX score. The independent association between the SUA and the severity of CHD was statistically evaluated using IBM SPSS Statistics 21 for Windows. Results: The mean age of the study population was 60.2 +/- 11.0 years. 252 were female (35.7%) and 453 were male (64.3%). Of the patients, 59.0% had significant CHD, 34.6% had diabetes mellitus, 67.7% had hypertension, 55.3% had hyperlipidaemia, and 45.4% were current smokers. The mean SYNTAX score was 10.6 +/- 12.9. According to the SYNTAX score, 289 of the patients (41%) had normal coronary arteries and non-significant CHD (controls, SYNTAX score: 0), 236 of the patients (33.5%) had mild CHD (SYNTAX score: 1-22), 97 (13.8%) had moderate CHD (SYNTAX score: 23-32), and 83 (11.8%) had severe CHD (SYNTAX score: >= 33). The mean SUA values were 5.3 +/- 1.5 mg/dL in the control group, 5.6 +/- 1.4 mg/dL in the mild CHD group, 6.2 +/- 1.6 mg/dL in the moderate CHD group, and 6.5 +/- 1.7 mg/dL in the severe CHD group. According to Spearman's rho analysis, a positive correlation between the SUA levels and the SYNTAX score was determined to be statistically significant (p < 0.001, r = 0.239; p = 0.002, r = 0.148 in men; p = 0.001, r = 0.204 in women). Conclusions: In this study, we found a positive correlation between the SUA level and the SYNTAX score. Therefore, this routine biochemical test can be used for the evaluation of the severity of CHD besides other risk factors in clinical practice. However, larger scale randomised studies are needed to show the effects of SUA on the severity of CHD

Arterial stiffness and central arterial wave reflection are associated with serum uric acid, total bilirubin, and neutrophil-to-lymphocyte ratio in patients with coronary artery disease

Objective: Total bilirubin (TB) was recently recognized as an endogenous anti-inflammatory and anti-oxidant molecule. Uric acid (UA) takes part in cardiovascular diseases by inducing oxidative stress, inflammation, and endothelial dysfunction. We assessed the relationship between serum TB levels, serum UA levels, and inflammatory status assessed by neutrophil-to-lymphocyte ratio (N/L) and arterial stiffness and arterial wave reflection in patients with a clinical diagnosis of coronary artery disease (CAD). Methods: We included 145 consecutive patients admitted with stable angina pectoris (SAP) or acute coronary syndrome (ACS). Blood samples were drawn at admission for complete blood count and biochemistry. Non-invasive pulse waveform analysis for the determination of augmentation index (AIx) and carotid-femoral pulse wave velocity (PWV) measurements were performed with the commercially available SphygmoCor system. Results: When patients were divided into tertiles of PWV and AIx, median N/L and median serum UA levels were the highest and mean TB levels were the lowest in the third tertile (p<0.001 for all). AIx and PWV were positively associated with serum UA and N/L and negatively associated with serum TB levels (p<0.001 for all). After adjustments for age, gender, heart rate, systolic blood pressure, and presence of diabetes, significant correlations persisted for N/L, UA, and TB in ACS patients (p<0.05). In the SAP group, TB was significantly negatively correlated with AIx and PWV, and UA was significantly positively correlated with PWV (p<0.05). Conclusion: N/L ratio and serum UA and TB levels might be used to risk-stratify patients with respect to arterial stiffness in CAD patients, especially in the presence of ACS

Average glandular doses and national diagnostic reference levels in mammography examinations in Turkey

In order to establish national diagnostic reference levels for mammography examinations, entrance skin air kerma, entrance skin dose and average glandular doses (AGDs) were calculated for a total of 25 624 cranio-caudal (CC) and mediolateral oblique (MLO) projections of 6309 patients for 40-49 and 50-64 age groups. The average entrance skin air kerma and entrance skin dose values for both age groups were found to be higher in MLO projections compared with CC projections. The minimum and maximum values of AGDs were determined as 0.4 and 7.9 mGy for both projections. The maximum numbers of AGDs for CC and MLO projections were calculated in the range of 1.1-1.5 and 1.6-2.0 mGy, respectively. The third quartile values of AGDs were calculated for each compressed breast thickness between 20 and 99 mm. The first national diagnostic reference levels of the country were established for each 10-mm compressed breast thickness in mammography examinations.Turkish Atomic Energy AuthorityMinistry of Energy & Natural Resources - Turke

Nötrofil lenfosit oranı daha yaygın, ciddi, kompleks koroner arter hastalığı ve miyokart perfüzyonunda bozulma ile ilişkilidir

We investigated the relation between neutrophil to lymphocyte ratio (N/L) and the extent, severity, and complexity of coronary artery disease (CAD) and myocardial perfusion. Study design: One hundred and fifty-one patients who underwent coronary angiography with stable angina pectoris (SAP) (n=93) or acute coronary syndrome (ACS) (n=58) were included in the study. Blood samples were drawn before coronary angiography. Gensini and SYNTAX scores and myocardial blush grade (MBG) were assessed. Results: Neutrophil counts were 4.4±1.4 and 5.0±1.6 in the SAP and ACS groups (p=0.018), whereas lymphocyte counts were 2.2±0.7 and 2.1±0.7, respectively (p=0.104). N/L was 2.2±1.2 in the SAP and 2.6±1.0 in the ACS (p=0.002) groups. In patients with SAP, N/L was significantly correlated with Gensini and SYNTAX scores (Gensini score r=0.32, p=0.002; SYNTAX score r=0.36, p=0.000), but there was no significant correlation between N/L and MBG. In the ACS group, N/L had a more powerful association with both Gensini and SYNTAX scores (Gensini r=0.42, p=0.001; SYNTAX r=0.51, p=0.000). N/L was negatively correlated with MBG in ACS patients (r= -0.48, p=0.000). Significant correlations persisted both in the SAP and ACS groups after correcting for age, diabetes, hyperlipidemia, and statin use; however, the associations were weaker. Cut-off N/L to predict moderate to severe CAD according to SYNTAX score was 2.26, with 72% sensitivity and 71% specificity (area under the curve [AUC]: 0.772, 95% confidence interval [CI] 0.679-0.865, p<0.001). Conclusion: N/L is associated with severe, extensive and complex CAD and may be used to predict moderate to severe involvement in patients with CAD

In spontaneous intracerebral hematoma patients, prediction of the hematoma expansion risk and mortality risk using radiological and clinical markers and a newly developed scale

Objective: In patients with spontaneous intracerebral hematoma (ICH), early-stage hematoma expansion has been associated with poor prognosis in literature. This study aimed to develop predictive parameter(s) as well as a new scale to define hematoma expansion and short-term prognosis in patients with ICH. Methods: In 46 patients with ICH, Glasgow Coma Scale (GCS) scores, non-contrast CT (NCCT) markers (hematoma volume on admission and follow-up, hypodensity, intraventricular hemorrhage, blend and island sign, BAT score), and modified Rankin Scale scores were evaluated for predicting the hematoma expansion risk and mortality risk. Furthermore, a newly developed scale called the ‘HEMRICH scale’ was constituted using the GCS score, hematoma volumes, and some NCCT markers. Results: Roc-Curve and Logistic Regression test results revealed that GCS score, initial hematoma volume value, hypodensity, intraventricular haemorrhage, BAT score, and HEMRICH scale score could be the best markers in predicting hematoma expansion risk whereas GCS score, intraventricular haemorrhage, BAT score, hematoma expansion, and HEMRICH scale score could be the best markers in predicting mortality risk (p = 0.01). Moreover, Factor analysis and Reliability test results showed that HEMRICH scale score could predict both hematoma expansion and mortality risks validly (Kaiser-Meyer-Olkin test value = 0.729) and reliably (Cronbach’s alpha = 0.564). Conclusion: It was concluded that the GCS score, intraventricular haemorrhage, and BAT score could predict both hematoma expansion risk and mortality risk in the early stage in patients with ICH. Furthermore, it was suggested that the newly produced HEMRICH scale could be a valid and reliable scale for predicting both hematoma expansion and mortality risk

Is mean platelet volume associated with the angiographic severity of coronary artery disease?

Background: Platelet activation and aggregation play key roles both in the pathogenesis of atherosclerosis and in the developmentof acute thrombotic events. Platelet volume is a marker of platelet activation and function, and is measured usingmean platelet volume (MPV).Aim: To determine the relationship between MPV and angiographic Gensini and SYNTAX scores, which give informationabout the severity and complexity of coronary artery disease (CAD).Methods: This study included 435 consecutive patients undergoing elective coronary angiography. The complete blood countand biochemical examination of blood were obtained after 12 h of fasting. The independent association between MPV andthe severity of CAD was statistically evaluated using PASW Statistics 18 for Windows.Results: Mean age of the study population was 58.4 ± 9.3 years, of whom 196 were female (45.1%) and 239 male (54.9%).Of the patients, 63.2% had CAD, 31.7% had diabetes mellitus, 61.8% had hypertension, 56.6% had hyperlipidaemia, and38.6% were smokers. Mean Gensini score was 20.7 ± 31.1. According to Gensini scores, 160 of the patients (36.8%) hadnormal coronary arteries (Gensini score: 0), 134 of the patients (30.8%) had minimal CAD (Gensini score: 1–19), and 141 ofthem (32.4%) had severe CAD (Gensini score ? 20). Mean MPV values were 8.4 ± 1.0 fL in the group that had no CAD,8.7 ± 1.0 fL in the group with minimal CAD, and 9.3 ± 1.5 fL in the group with severe CAD. According to Spearman correlationanalysis, the positive relationship found between MPV and Gensini score was statistically significant (p < 0.001,r = 0.290). Likewise, SYNTAX score was also associated with MPV (p < 0.001, r = 0.504).Conclusions: We determined a positive correlation between MPV and Gensini and SYNTAX scores. Therefore, this simplehaematology test can be used in determining cardiovascular disease burden besides other risk factors during routine clinicalpractice. For further information about this topic, large-scale studies are needed

Evaluation of the clinical effects of isotretinoin on chronic rhinosinusitis

Objectives: This study aims to evaluate the clinical effects of isotretinoin (13-cis-retinoic acid), a derivative of retinoic acid, on the clinical features of chronic rhinosinusitis. Patients and Methods: The study group included 25 chronic rhinosinusitis patients (16 females, 9 males; mean age 25.2±6.8 years; range 15 to 25 years) who were on isotretinoin for acne treatment, while the control group consisted of 25 chronic rhinosinusitis patients (15 females, 10 males; mean age 25.2±6.8 years; range 15 to 25 years) who were not on isotretinoin treatment. The patients’ symptom scores in visual analog scale (VAS), Lanza and Kennedy nasal endoscopic scores and Newman computed tomography (CT) scores were obtained in order to evaluate the their symptom, examination and radiological findings. These patients’ symptom and examination results were evaluated first day, week two and at months 3-5 and 6-10. Paranasal sinus CT results were studied first day and at months 6-10. Results: In the group of patients being administered isotretinoin, no significant change in the mean symptom and examination scores was detected during the acute phase (week 2), while there was a significant regression in the longterm (months 3-5 and 6-10). There was a significant regression in the mean CT score after isotretinoin therapy. In the control group no significant change was seen in any of the scores. The number of acute sinusitis attacks were significantly lower in the isotretinoin group than in the control group. No significant difference was found between the two groups in terms of the duration of the healing period of acute sinusitis attacks. Conclusion: We conclude that the long-term administration of isotretinoin has positive effects on the clinical results of chronic rhinosinusitis