How does disease location affect acute phase reactants in ulcerative colitis?

Background: We aimed to evaluate erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell (WBC), platelet (PLT) counts and albumin levels according to disease location in ulcerative colitis.Methods: The ESR, CRP, WBC, PLT counts and albumin levels of 206 ulcerative colitis patients with endoscopic activity were retrospectively evaluated. Endoscopic activity had been assessed using Rachmilewitz endoscopic activity index. Patients were grouped according to the extent of disease by Montreal classification, and they were evaluated regarding the location and severity of disease according to the laboratory test results.Results: Among 206 patients, 88 (42.7%) had extensive colitis, 89 (43.2%) of them had left sided colitis and 29 (14%) patients had proctitis. According to the endoscopic activity index, 32.04% of the patients had mild activity, 39.32% moderate activity and 28.64% had severe activity. As the disease extent progressed from the distal to the proximal intestine, CRP, ESR, WBC and PLT counts showed a significant increase while albumin levels showed a significant decrease. In our study, the test that yielded the best results in the assessment of disease activity was CRP, which was found to be high in 80% of patients with extensive colitis, followed by ESR, PLT and WBC counts. As the involved intestine shortened, the rate of patients with abnormal laboratory tests significantly decreasedConclusion: CRP, ESR, WBC, PLT counts and albumin levels are of limited value in determining disease activity in ulcerative colitis patients, especially in those with proctiti

Fragmented QRS complexes are associated with left ventricular systolic and diastolic dysfunctions in patients with metabolic syndrome

Background: Metabolic syndrome (MetS) is found to be associated with deterioration of the left ventricular (LV) systolic and diastolic functions. One of the factors for this impairment is myocardial fibrosis. Fragmented QRS (fQRS) complexes are found to be associated with myocardial fibrosis. The aim of the study was to evaluate if the presence of fQRS on electrocardiogram (ECG) can detect pronounced impairment in the LV systolic and diastolic functions in MetS patients. Methods: The study included 111 (mean age 47 ± 9, 49.5% male) MetS patients and 96 (mean age 45 ± 9, 58.3% male) control subjects without MetS. ECG was evaluated for the presence of fQRS. Each patient underwent conventional echocardiography and tissue Doppler imaging. Results: Fragmented QRS was more common among MetS patients (26.1% vs. 14.6%, p = 0.041). MetS was associated with subclinical LV systolic and LV diastolic dysfunctions. In subgroup analyses of MetS patients, the presence of fQRS on ECG had a higher E/E’ ratio and lower E’ velocity, indicating pronounced diastolic dysfunction, as well as lower isovolumic acceleration (IVA), indicating profound subclinical LV systolic dysfunction. E/E’ ratio and IVA were independent predictors of fQRS presence in patients with MetS. Conclusions: Fragmented QRS is more common among MetS patients compared to non-MetS patients. The presence of fQRS is associated with pronounced subclinical LV systolic and diastolic dysfunctions in MetS patients

Assessment of sustained effects of levosimendan and dobutamine on left ventricular systolic functions by using novel tissue Doppler derived indices in patients with advanced heart failure

Background: Previous studies comparing levosimendan vs. dobutamine have revealed that levosimendan is better in relieving symptoms. Echocardiographic studies have been done using second measurements immediately following a dobutamine infusion or while it was still being administered. The aim of our study was assessment of sustained effects of 24 h levosimendan and dobutamine infusions on left ventricular systolic functions. Methods: A total of 61 patients with acutely decompensated heart failure with New York Heart Association (NYHA) class III or IV symptoms were randomized to receive either levosimendan or dobutamine 2:1 in an open label fashion. Before and 5 days after the initiation of infusions, functional class was assessed, N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) levels and left ventricular ejection fraction (LVEF), mitral inflow peak E and A wave velocity, and E/A ratios were measured; using tissue Doppler imaging, isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sa), early (E’) and late (A’) diastolic velocities, and E’/A’ and E/E’ ratios were measured. Results: The NYHA class improved in both groups, but improvements were prominent in the levosimendan group. NT-proBNP levels were significantly reduced in the levosimendan group. Improvements in LVEF and diastolic indices were significant in the levosimendan group. Tissue Doppler-derived systolic indices of IVV and IVA increased significantly in the levosimendan group. Conclusions: Improvements in left ventricular systolic and diastolic functions continue after a levosimendan infusion.

Evaluation of the effect of mitral stenosis severity on the left ventricular systolic function using isovolumic myocardial acceleration

Background: Isovolumic acceleration (IVA) is a new tissue Doppler parameter in the as­sessment of systolic function of both left and right ventricles. It remains unaffected with the changes in pre- and after-load within the physiological range. The aim of our study was to assess the effect of mitral stenosis degree, which is determined by echocardiography, on the left ventricular (LV) function using IVA. Methods: A total number of 62 patients with mitral stenosis (MS) and 32 healthy controls were examined. The severity of MS (mild, moderate, and severe) was determined on the basis of mitral valve area (MVA) and the mean diastolic mitral gradient findings. The peak myocardial velocities during isovolumic contraction, systole, early diastole and late diastole were measured by using tissue Doppler imaging (TDI). Results: All TDI-derived global LV basal wall systolic (peak myocardial isovolumic contra­ction velocity, peak myocardial systolic velocity and IVA), and diastolic velocities (peak early and late diastolic velocities) were significantly decreased in the patients with MS, compared to the healthy patients (p < 0.001, for all). However, IVA was not different when the degree of MS was evaluated (p = 0.114). In addition, IVA was not correlated with the MVA (r = 0.185, p = 0.150). Conclusions: Left ventricular function is impaired in patients with MS regardless of the severity of the disease.

Relation of maternal vitamin D status with gestational diabetes mellitus and perinatal outcome

Objective: To investigate the relationship between maternal vitamin D status and glucose intolerance, and its impact on pregnant women and their newborns. Methods: A cohort of pregnant women were divided into three groups: women with gestational diabetes mellitus, ones with normal results both after the 50 gr and 100 gr OGTT (CG-1) and ones having a positive result after the 50 gr OGTT screening but negative results for gestational diabetes mellitus (GDM) after the 100 gr OGTT (CG-2) Results: The newborn length in CG-1 was greater than in GDM and CG-2 (p= 0.002 and p= 0.02). Fasting blood glucose and insulin resistance (IR) were negatively correlated with length of the newborns (r=-0.3, p=0.03 and r=-0.3, p=0.01). The newborns of women with GDM had lower APGAR-1 and 5 scores than those of CG-1 and CG-2 (APGAR-1 p= 0.001 and p= 0.004, APGAR-5 p=0.005 and p=0.007, respectively). APGAR scores were correlated negatively with IR (APGAR-1 r=- 0.32, p=0.01, APGAR-5 r=-0.3, p=0.03) and positively with 25OHD levels (APGAR-1 r=0.3, p=0.01, APGAR-5 r=0.3, p=0.02). Conclusion: Vitamin D deficiency, gestational diabetes and insulin resistance are interrelated. Severe vitamin D deficiency during pregnancy is associated with poor pregnancy and neonatal outcome

Aktivna deformacija Zemljine površine utvrđena preciznim nivelmanskim premjerom u Afyon-Akşehir grabenu u Zapadnoj Anadoliji u Turskoj

In the actively deforming region of western Anatolia, crustal deformation is accommodated by destructive earthquakes and a variety of aseismic events. In this study, we investigated the 2016–2017 aseismic sequence located in the Bolvadin Fault, one of the segments of the Akşehir-Simav Fault System of western Anatolia by analysing surface deformation derived from detailed geological mapping. Our findings suggest that surface deformation in the Bolvadin Fault is accommodated by aseismic episodes. During the field studies in the Bolvadin area, progressive surface deformations, such as surface faults and earth fissures with a length of 800 meters to 3 kilometres and strike of N15°E to N70°E were mapped on a 1/5000 scale. Furthermore, a levelling network was established to calculate the vertical displacements and deformation rate along the surface deformations. Precision level measurements were undertaken in 2016 and 2017. On the routes to the NW of the Bolvadin settlement, a vertical deformation rate of 30 mm/yr was detected in the period of 2016–2017, and a large deformation rate of 40 mm/yr was detected in the same period.Aktivna deformacija Zemljine kore se u regiji Zapadne Anadolije kompenzira razornim potresima i drugim seizmičkim događajima. U ovom smo radu na temelju detaljnog geološkog kartiranja analizirali deformaciju površine kako bismo proučili niza seizmičkih događaja u razdoblju 2016.–2017. na lokaciji rasjeda Bolvadin, jednoga od segmenata rasjednoga sustava Akşehir-Simav u Zapadnoj Anadoliji. Naši rezultati ukazuju na to da se površinska deformacije kompenzira tijekom aseizmičkih epizoda. Tijekom terenskih istraživanja u području Bolvadin, progresivne su površinske deformacije, poput površinskih rasjeda ili pukotina duljina od 800 m do 3 km, pružanja N15°E do N70°E, kartirane u mjerilu 1:5 000. Nadalje, uspostavljena je nivelmanska mreža kako bi se izmjerila brzina pomaka i deformacija. Precizna nivelmanska mjerenja izvedena su 2016. i 2017. godine. Na pravcima usmjerenima SZ od naselja Bolvadin, ustanovljena je brzina vertikalne deformacije od 30 mm/god., a u istom je razdoblju izmjerena i velika brzina deformacije od 40 mm/god

A simplified acute kidney injury predictor following transcatheter aortic valve implantation: ACEF score

Background: Transcatheter aortic valve implantation (TAVI) is an effective, less invasive treatment alternative for symptomatic severe aortic stenosis (AS). Acute kidney injury (AKI) following TAVI is a common complication and is associated with worse outcomes. The age, creatinine, ejection fraction (ACEF) score is a simple scoring method, including only three parameters: age, creatinine, and ejection fraction (EF). The score was well established in predicting AKI after coronary interventions.Aims: We aimed to evaluate whether this simple scoring method, ACEF, may predict a development of AKI in patients who underwent TAVI.Methods: A total of 173 consecutive patients with symptomatic severe AS who underwent TAVI were included retrospectively. The primary endpoint of the study was the development of AKI. Study population was divided into two groups according to the presence of AKI. The ACEF score was calculated with the formula: age/EF + 1 (if baseline creatinine >2 mg/dl).Results: Twenty-nine patients developed AKI. The median (interquartile range) ACEF score was 1.36 (1.20–1.58). The ACEF score was found to be an independent predictor of AKI (P <0.001). The ACEF score ≥1.36 predicted AKI development with a sensitivity of 96.6% and specificity of 58.8%. Moreover, hypertension, hemoglobin levels, contrast volume, and aortic valve area (AVA) were found to be independent predictors of AKI.Conclusions: Our study revealed that the ACEF score was an independent predictor of AKI. A simple and objective score might be very useful in predicting AKI development in patients undergoing TAVI