Polymorphisms in the tumor necrosis factor-alpha gene in Turkish women with pre-eclampsia and eclampsia

The genetic background predisposing pregnant women to pre-eclampsia/eclampsia (PE/E) is still unknown. The aim of the current study was to investigate whether there is an association between the TNF-alpha-308 and 850 polymorphisms and PE or eclampsia. In this study, 40 cases of eclampsia, 113 cases of PE and 80 normotensive control cases were genotyped for the TNF-alpha-G-308A and C-850 polymorphisms. At position 308, the replacement of Guanine with Adenosine was denoted as TNF2. We found a significant difference between the TNF2 allele frequencies of the eclamptic, pre-eclamptic and normotensive controls. TNF2 (AA) polymorphism frequency was significantly higher among the eclamptics and pre-eclamptics (control : 5%, PE : 13.3%, E : 12.9%). A significantly different genotype distribution of C-850T polymorphism was observed between the PE/E and control groups, with the frequency of the variant TT genotype being significantly reduced in the preeclamptics (PE : 17% ; E : 17.5%) when compared with the control group (24.3%). We have demonstrated an association between TNF-alpha polymorphisms and pre-eclampsia susceptibility. However, it is not known whether C-850T polymorphism has a functional effect on the TNF-alpha gene. In addition, it was not possible to determine whether this polymorphism promotes the progression from PE to eclampsia because of no statistically significant difference between eclampsia and the controls

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 relationship between good collateral development and magnesium/phosphate ratios in chronic total occlusion

Objective: Coronary collateral formation can be triggered by many acquired factors such as ischemia and growth factors, which ultimately manifests as differences in the quality of the coronary collateral circulation (CCC) in patients. Low magnesium (Mg) levels can increase endothelial cell dysfunction and potentially increase the risk of thrombosis and atherosclerosis. However, it has been reported that high serum phosphate (P) levels are correlated with the development of atherosclerosis and mortality. In this article, we aimed to reveal the relationship between CCC quality and Mg/P ratio in chronic total occlusion (CTO). Methods: A total of 269 patients with detected CTO in coronary angiography between March 2014 and June 2018 were included in the study. The patients were divided into two groups as group I (127 patients) and group II (142 patients) according to the Rentrop classification. The study is a retrospective, observational study. Results: In the multivariable regression analysis; smoking (p=0.004), triglyceride (p<0.001) and Mg/P ratio (p<0.001) parameters were independent predictors affecting CCC in CTO. Mg/P value was statistically lower in the group I (0.49±0.17) than group II (0.62±0.12) (p<0.001). The ideal Mg/P cut-off value was 0.56 that calculated by the Youden index had 69% sensitivity, and 64% specificity for collateral development of CTO. Conclusion: Mg/P is a parameter that affects coronary collateral development. High Mg/P ratio level is associated with good collateral development in patients who had CTO

The relationship between left ventricular diastolic dysfunction and hemoglobin A1c levels in the type 2 diabetes mellitus patient population

Objectives: This study aimed to investigate the relationship between hemoglobin A1c (HbA1c) levels, which is a good marker for determining glycemic levels, and left ventricular diastolic dysfunction (LVDD) in the type 2 diabetes mellitus (DM) patient population. Patients and methods: This retrospective study was conducted with 116 type 2 DM patients (62 males, 54 females; mean age: 58.4±9.5 years; range, 18 to 65 years) between July 2019 and November 2021. The patients were divided into two groups as those without LVDD (n=55, Group 1) and those with LVDD (n=61, Group 2). Early to late diastolic transmural flow velocity (E/A) ratio, the mean ratio (E/e') of mitral inflow (E) and mitral annular (e'), HbA1c levels, other hemogram and biochemical parameters, and demographic data were recorded. Results: The HbA1c level was significantly higher in the group with LVDD (6.96±1.23 vs. 9.00±2.19, p<0.001). While the mean E/e' ratio was 9.69±2.73 in the group without LVDD, it was 16.00±1.69 in the group with LVDD, and there was a significant difference between the two groups (p<0.001). The mean E/A ratio was significantly higher in the group without LVDD (1.25±0.51 vs. 1.02±0.53, p=0.021). In regression operating characteristics analysis, a HbA1c cut-off value of 7.35 and was found to be a predictor of LVDD in the type 2 DM patient group with a sensitivity of 80% and specificity of 80% (AUC: 0.805; 95% confidence interval: 0.718-0.892; p<0.001). Conclusion: Providing close glycemic follow-up and monitoring the HbA1c level can reduce heart failure and other comorbid conditions that may develop, particularly after LVDD

AKUT SEREBROVASKÜLER OLAY GEÇİREN HASTALARDA ACEF RİSK SKORU İLE ARİTMİ GELİŞİMİ ARASINDAKİ İLİŞKİ

Giriş: Akut inmeden sonra yüksek riskli hastaların belirlenmesi, uygun kardiyak izlem ve altta yatan aritmilerin tanı ve tedavisi, kardiyak morbidite ve mortaliteyi önlemek için önemlidir. ACEF risk skoru, sadece kısa ve uzun vadeli mortalite açısından değil, aynı zamanda majör advers kardiyovasküler olaylar açısından da tatmin edici prediktif değerler ile ilişkilendirilmiştir. Bu çalışmanın amacı akut iskemik serebrovasküler olay (SVO) geçiren hastalarda ACEF risk skoru ile aritmi gelişimi arasındaki ilişkinin araştırılmasıdır. Gereç ve Yöntem: Çalışmaya, akut iskemik SVO geçiren, bazal elektrokardiyografisinde (EKG) aritmi bulunmayan ve aritmi tespiti için Holter EKG takılan ardışık 158 hasta dahil edilmiştir. Hastalar, Holter EKG’de aritmi saptanmayanlar (Grup 1) ve saptananlar (Grup 2) şeklinde iki gruba ayrılarak incelendi. ACEF skoru aşağıdaki formüle göre hesaplandı; ACEF = yaş/sol ventrikül ejeksiyon fraksiyonu+1 (kreatinin>2.0 mg/dL ise). Bulgular: Hastaların yaş ortalaması 71.6±10.6 yıldı ve grup II'deki yaş ortalaması grup I'e göre istatistiksel olarak anlamlı derecede yüksekti (72.8±10.1'e karşı 68.8±11.2 yıl, p=0.025). Hastaların 110'unda (%69.6) Holter EKG'de aritmi saptandı. En sık görülen aritmi tipi ventriküler ekstrasistoller (%32.7) idi. Ortalama ACEF skoru 1.43±0.49 olarak bulundu. ACEF risk skoru grup II'de grup I'e göre istatistiksel olarak anlamlı derecede daha yüksekti (1.497±0.511'e karşı 1.285±0.407, p=0.012). ACEF risk skoru değeri >1.26, %59 duyarlılık ve %56 özgüllük ile akut iskemik inmeli hastalarda aritmi için bir öngördürücü olarak saptandı (eğri altındaki ROC alanı: 0.642, %95 CI: 0.548-0.737, P =0.004 ). Sonuç: Akut iskemik SVO geçiren hastalarda yüksek ACEF risk skoru, holter EKG ile tespit edilen, altta yatan aritmi varlığı ile ilişkilidir. Bu hastalarda aritmi varlığını öngörmek için basit ve kolay ulaşılabilir ACEF risk skoru kullanılabilir