Investigation of the predictive values of triglyceride/HDL cholesterol ratio and whole blood viscosity with regard to severe peripheral or carotid artery disease in patients scheduled for coronary bypass

Background: The incidence of atherosclerotic cardiovascular diseases, which constitute an important disease group, is expected to rise with increasing life expectancy. The aim of this study was to investigate the predictive values of triglyceride/HDL cholesterol (TG/HDL-C) ratio and whole blood viscosity on possible severe carotid or peripheral arterial disease in patients who were admitted to our clinic and scheduled for coronary artery bypass graft (CABG) surgery. Methods: This study retrospectively examined 299 patients who were admitted to our clinic and scheduled for CABG between August 1, 2015, and August 1, 2019. Patients with severe carotid or peripheral arterial disease were included in group 2; those in whom peripheral arterial disease and stenosis were not detected were included in group 1. Results: Group 1 consisted of 255 patients, mean (+/- standard deviation) age 58.1 +/- 8.9 years; the 44 patients in group 2 had a mean age of 64.1 +/- 10.6 years (P = .018). The incidence of diabetes mellitus and tobacco use were significantly higher in group 2 (P < .001 and P = .034, respectively). Triglyceride values, TG/HDL-C, and whole blood viscosity at high and low shear rates were significantly higher in group 2 (P = .017, P < .001, P < .001, and P < .001, respectively). Receiver operator characteristic analysis revealed that the cutoff value of TG/HDL-C was 3.2 with 77% sensitivity and 72% specificity; that of high-shear-rate viscosity was 16.1 with 73% sensitivity and 69% specificity; and that of low-shear-rate viscosity was 59.2 with 70% sensitivity and 63% specificity. Conclusion: It is possible to predict severe additional arterial diseases in patients scheduled for CABG with whole blood viscosity and TG/HDL-C ratios, both of which can be obtained with simple blood tests

Is there a difference between normotensive and hypertensive patients in terms of blood parameters and cardiovascular diseases?

Objectives: It has been stated in various studies that there is a difference in some blood parameters between hypertensive and normotensive patients for a long time. Mean platelet volume (MPV), and red blood cell distribution width (RDW), have been studied in hypertensive patient groups in many studies. Hypertension is a classic risk factor for ischemic stroke and myocardial ischemia, as known. In our study, we examined whether there was a difference between hypertensive patient groups and normotensive patients in terms of blood parameters such as MPV and RDW, and the incidence of stroke and myocardial infarction.Methods: Blood samples and twenty-four-hour ambulatory blood pressure monitoring (ABPM) results of 552 patients admitted to our outpatient clinic with a pre-diagnosis of hypertension were retrospectively analyzed. According to ABPM results, we divided the study participants into four groups; dippers, non-dippers, extreme dippers, and normotansives. Complete blood count and biochemical test results were found in the database of our hospital for all patients and differences between groups were investigated.Results: One hundred seventy three normotensives (Group 1) (mean age, 47.4 ± 15.4 years), 210 non-dippers (Group 2) (mean age, 53.8 ± 15.8 years), 67 extreme dippers (Group 3) (mean age, 49.1 ± 15.9 years) and 102 dippers (Group 4) (mean age, 52.2 ± 12.5 years). Daytime mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and night-time mean SBP and DBP were significantly different in groups (Group 1: 117 [90-193] mmHg and 71 [55-87] mmHg; Group 2: 137 [107-188] mmHg and 83 [107-188] mmHg; Group 3: 143 [115-193] mmHg and 88 [56-122] mmHg; and Group 4: 140.5 [116-173] mmHg and 76 [55-124] mmHg), p &lt; 0.001; respectively. MPV and RDW levels were different in all four groups (p &lt; 0.001). We found a significant difference in the rates of stroke and coronary artery disease between the four groups (p = 0.018 and p = 0.002, respectively). In the ROC curve analysis MPV had sensitivity of %77. 8 and specificity of 78. 1% for stroke when the cut-off value MPV was 9.25 (Area under curve: 0.808, 95% confidence interval: 0.726-0.889, p &lt; 0.001).Conclusions: In our study, MPV and RDW levels and the rates of stroke and cardiovascular disease were significantly higher in non-dipper patients compared to other groups

Bleeding Disorders Associated with Abnormal Platelets: Glanzmann Thrombasthenia and Bernard-Soulier Syndrome

Platelets, the smallest cells in the blood, are associated with hemostasis, bowel formation, tissue remodeling, and wound healing. Although the prevalence of inherited platelet disorders is not fully known, it is a rare disease group and is encountered in approximately between 10000 and 1000000. Glanzmann thrombasthenia (GT) and Bernard-Soulier syndrome (BSS) are more frequently observed in inherited platelet disorders. In GT, the platelet aggregation stage due to deficiency or dysfunction of the platelet GPIIb/IIIa complex cannot take place. BSS is a platelet adhesion disorder due to the absence or abnormality of GPIb/IX complex on the platelet surface. If there is bleeding after easy bruising, mucous and oral cavities, menorrhagia, tooth extraction, tonsillectomy, or other surgical interventions, inherited platelet dysfunction should be considered if the platelet count is normal while the bleeding time is long. Firstly, other causes should be investigated by making differential diagnosis of GT and BSS. In this chapter, the definition, etiology, historical process, epidemiology, genetic basis, pathophysiology, clinical findings, diagnosis, differential diagnosis, and the follow-up and treatment approach of GT and BSS will be reviewed according to the current medical literature

Predictive Values of Inflammation Indexes in Predicting Mortality in Patients with COVID 19 Hospitalized in General Intensive Care Unit

Objective: Causing a global pandemic, the coronavirus disease 2019 (COVID-19) has caused millions of people to become infected and many more to die. In this study we aimed to investigate whether routinely evaluated clinical and laboratory values ??can predict the mortality of patients with COVID-19 disease.Materials and Methods: In our study, routine laboratory parameters of 89 patients hospitalized in the general intensive care unit with the diagnosis of COVID 19 were retrospectively analyzed. The aggregate index of systemic inflammation (AISI) and other inflamatuar values were calculated from blood tests in patients with positive COVID-19 polymerase chain reaction test and with ground-glass opacity on lung tomography. Patients were divided into two groups as those who died (non-survivors) and those who were discharged (survivors)during the intensive care follow-ups. Results: In our study, in 48 patients who died during follow-up, the indexes of AISI, other inflamatuar paramaters and the biochemical parameters such as troponin I, d-dimer, ferritin and procalcitonin were significantly higher than in discharged patients. Hypertension and higher AISI and ferritin levels were statistically associated with reduced survival in Cox regression analysis (Hazard ration (HR): 3.176; 95% Confident interval (CI): 1.122-8.991, p=0.03, HR: 1.114; 95% CI: 1.060-1.348, p=0.042, HR=1.072;95% CI: 1.014-1.242, p=0.011, respectively.Conclusion: Inflammation indexes derived from blood tests and acute phase reactants such as ferritin can guide us in planning the treatment strategy and risk stratification in patients with COVID-19 in intensive care follow-ups.

The protective effects of different treatments on rat salivary glands after radiotherapy

WOS: 000387700400056PubMed ID: 27324888This study was aimed to evaluate the efficacy of treatment modalities for minimizing salivary gland damage caused by radiotherapy. Forty rats were divided into five groups. Group 1 had no irradiation or any treatment. Group 2 underwent only 15 Gy single dose radiotherapy. N-acetylcysteine, dexamethasone, hyperbaric oxygen treatment were given, respectively to the group 3, 4 and 5 for 5 days. 15 Gy single dose radiotherapy was applied to the group 3, 4 and 5 on the second day. Pyknosis, lysis, and vacuolization were examined in ductal cells and pyknosis, lysis, vacuolization, inflammation and collective duct damage in acinar cells. Dexamethasone and hyperbaric oxygen did not prove to have a positive effect on acinar and ductal cell. N-acetylcysteine-applied group had statistically significantly lower amount of damage. We determined that the decrease of ductal and acinar cell damage in parotid glands of N-acetylcysteine-applied rats was more distinct and statistically

Tip A Aort Diseksiyonlarında Operasyon Sonrası Erken Dönem Mortalite ve Morbidite Üzerine Etki Eden Faktörlerin Retrospektif İncelenmesi

Amaç: Aortik diseksiyon günümüzde hala önemli bir mortalite ve morbidite nedenidir. Tip A aort diseksiyonu nedeniyle ameliyat edilen hastalarda birçok faktör cerrahi sonuçları etkilemektedir. Bu faktörlerin yeterince belirlenmesi tedavinin başarılı olmasına etki edecektir. Yöntemler: Kliniğimizde Ocak 2006 - Aralık 2016 yılları arasında Tip A aort diseksiyonu tanısı ile opere edilen 140 hastanın preoperatif, intraoperatif, ve postoperatif verileri, hasta dosyaları ve hastane bilgi yönetim sistem kayıtlarından retrospektif olarak araştırıldı. Gruplar arası niceliksel parametreler Student t veya Mann-Whitney U testleri ile, niteliksel veriler ise Ki-Kare testi ile karşılaştırıldı. Bulgular: Hastalarda ortalama yaş 57.1±12.3 (min: 27 ile max: 84), 31’i (%22,2) kadın, 109’u (%77,8) erkekti. Hastaların çoğunluğuna izole asendan aorta replasmanı veya asendan aorta ile birlikte hemiarkus replasmanı uygulandı (%70). Beyin koruma yöntemi olarak çoğunlukla antegrad serebral perfüzyon (ASP) nadiren retrograd serebral perfüzyon (RSP) kullanıldı. Tüm hastalarda total mortalite 37 kişi (%26,4) idi. Başvuru anında sistolik tansiyonun 90 mmHg altında olması, majör nörolojik defisit varlığı, hastada geçirilmiş kardiyak cerrahi öyküsü olmasının mortaliteyi anlamlı oranda etkilediği saptanmıştır (p<0.05). Mortalite olan hastalarda perfüzyon süreleri uzun, inotrop ihtiyacı fazla, yoğun bakım yatış süreleri istatiksel olarak anlamlı derecede yüksekti (p<0.05). RSP yapılan grupta yoğun bakımda kalış süreleri ve mortalite, ASP uygulanan hastalara göre anlamlı oranda yüksekti (sırası ile p=0.02, p=0.04). Sonuç: Tip A aortik diseksiyonlarda mortalite üzerine etki eden faktörlerin daha büyük hasta serilerinde ortaya konulması ve bu faktörlere yönelik tedbirlerin alınması mortalite ve morbiditenin azaltılmasında etkili olabilir

Herpes zoster infection in early adolescence: two case reports and review of the treatment approach

Introduction: Herpes zoster is a skin infection caused by reactivation of the Varicella zoster virus that remains latent in the dorsal root ganglia, showing dermatomal spread on the skin, accompanied by a vesicular rash and itching. It is a disease of the adult age group. Although herpes zoster is more common in immunocompromised children, it is rarely seen in healthy children. Case Presentation: Two patients, 11 and 12 years old, presented with pain, itching, and rash. Patient histories indicated that they were previously healthy. Alanine aminotransferase, aspartate aminotransferase, urea, blood urea nitrogen, creatinine, and electrolyte values were within normal limits. Varicella-zoster virus (VZV) immunoglobulin (Ig) G and VZV Ig M were positive, while herpes zoster virus (HZV) Ig G and HZV Ig M were negative. Oral acyclovir treatment was started. Symptoms, treatment, and follow-up of the two cases were similar. In both patients, the lesions regressed within a week, and at the end of the second week, they recovered without complications.Conclusion: Herpes Zoster infection is rarely seen in healthy children. In this case report, we aimed to remind and discuss the clinical features during childhood

Comparison of Ultrasonography and Cystoscopy in the Evaluation of Hematuria

Objective:Every day, many patients visit hospital due to hematuria. Ultrasonography and/or cystoscopy are performed in the initial evaluation and management. In this study, we compared ultrasonography and cystoscopy in the evaluation of microscopic or macroscopic hematuria.Materials and Methods:A total of 55 patients, who presented to our clinic with the complaint of hematuria between July 2016 and October 2017, were enrolled in this study. After obtaining informed consent, the patients were directed to urinary ultrasonography and cystoscopy for the evaluation of hematuria.Results:Ultrasonography showed 45 (81.8%) normal bladder and 10 (18.2%) masses, and cystoscopy detected 39 (70.9%) normal bladder and 16 (29.1%) masses in the bladder (p=0.001). Ultrasonography was able to report only 8 (50%) of 16 masses detected via cystoscopy. Two (20%) of 10 masses reported by ultrasonography were not confirmed through cystoscopy. The sensitivity and specificity of ultrasonography in detecting and excluding masses in the bladder were calculated to be 50% and 94.9%, respectively. Ultrasonography failed to detect lesions at the posterior, dome and right side and bladder neck. The cut-off value for blood cell count in urine to refer the patient to a cystoscopy procedure was detected to be 15 with 60% sensitivity and 50% specificity.Conclusion:With low sensitivity, ultrasonography could not offer enough knowledge about the bladder masses as sufficient as cystoscopy

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