Local Bone Marrow Renin-Angiotensin System and Atherosclerosis

Local hematopoietic bone marrow (BM) renin-angiotensin system (RAS) affects the growth, production, proliferation differentiation, and function of hematopoietic cells. Angiotensin II (Ang II), the dominant effector peptide of the RAS, regulates cellular growth in a wide variety of tissues in pathobiological states. RAS, especially Ang II and Ang II type 1 receptor (AT1R), has considerable proinflammatory and proatherogenic effects on the vessel wall, causing progression of atherosclerosis. Recent investigations, by analyzing several BM chimeric mice whose BM cells were positive or negative for AT1R, disclosed that AT1R in BM cells participates in the pathogenesis of atherosclerosis. Therefore, AT1R blocking not only in vascular cells but also in the BM could be an important therapeutic approach to prevent atherosclerosis. The aim of this paper is to review the function of local BM RAS in the pathogenesis of atherosclerosis

A Comprehensive Framework Identifying Readmission Risk Factors Using The Chaid Algorithm: A Prospective Cohort Study

Objective: To identify frequency of readmission after discharge from internal-medicine wards, readmission risk factors, and reasons and costs of readmission. Design: Prospective cohort study. Setting: A tertiary-care hospital in Turkey. Participants: 2622 adult patients discharged from internal-medicine wards of the hospital between 1 February 2015 and 31 January 2016. Main outcome measures: Thirty day all-cause readmission rates, reasons and costs of readmission. To identify readmission risk factors Chi-square Automatic Interaction Detector (CHAID) analysis was conducted. Results: The same hospital readmission rate was 17.9%, while the same hospital or different-hospital readmission rate was 21.3%. Receiver operating characteristic (ROC) curve analysis showed that the predictive performance of the CHAID algorithm was high. According to the CHAID algorithm, the most significant readmission risk factor was the main diagnosis of neoplasm at the index admission. In other diagnosis groups, higher Charlson comorbidity score, higher level of education, having a regular physician, and three dimensions of Readiness for Hospital Discharge Scale were significant risk factors for readmission. The most frequent reason for readmission was neoplasm, and the total cost of readmissions was similar to$900 000. Conclusions: The CHAID algorithm for readmissions had a high predictive strength and provided details that aid physicians in decision-making. Measures must be taken from initial diagnosis to post-discharge follow-up, to minimize readmissions, especially in patients with neoplasm.WoSScopu

The Cholesterol Lowering Efficacy of Plant Stanol Ester Yoghurt in a Turkish Population: A Double-Blind, Placebo-Controlled Trial

Background We evaluated the cholesterol lowering efficacy of low-fat spoonable yoghurt with 1.9 g/d plant stanols as esters on plasma lipid profiles of Turkish subjects with mild to moderate hypercholesterolemia. Methods Using a randomised, double-blind, placebo-controlled study design, intervention (n = 35) and control (n = 35) groups consumed either 115 g low-fat yoghurt with 1.9 g/d plant stanols as esters or placebo yoghurt, respectively, for 4 weeks. Seventy subjects with untreated mild to moderate hypercholesterolemia (aged 23-65 years) were recruited. Changes in the lipid profile, including lipoproteins, apolipoproteins, and triglycerides, and anthropometric measurements were monitored at screening, baseline, and at the end of the second, third, and fourth weeks of intervention. The general linear model repeated measures procedure was used to test differences in the repeated continuous variables between study groups. Results Serum total cholesterol (4.6%), LDL cholesterol (6.3%), and non-HDL cholesterol (6.2%) concentrations were reduced significantly from baseline in the plant stanol group compared to the control group (p = 0.007, p = 0.005 and p = 0.005, respectively). A variation in the response of serum total and LDL cholesterol between the subjects in plant stanol group was obtained. No clinically significant change in anthropometrical measurements was observed during the intervention. Conclusions The spoonable low-fat yoghurt with 1.9 g/d plant stanols as esters lowered total, LDL, and non-HDL cholesterol levels in Turkish subjects with mild to moderate hypercholesterolemia. Nevertheless variation in baseline cholesterol levels, genetic predisposition of the subjects and compliance may contribute to a large individual variability.PubMedWoSScopu

The effect of CYP2C9 gene polymorphisms on blood pressure lowering response to losartan in patients with essential hypertension

Purpose: In this study, the possible effects of CYP2C9 polymorphisms on the clinical response to losartan were investigated in a group of hypertensive patients. Materials and Methods: Seventy-four patients, newly diagnosed to have essential hypertension, and were subsequently prescribed losartan by attending physicians, were prospectively recruited for the study. Blood pressure measurements at the initiation of losartan treatment and six weeks after were completed for all participants. Genetic analysis for CYP2C9 polymorphisms was performed in blood samples collected at baseline. CYP2C9 *2 and *3 variant alleles were genotyped, and polymorphic patients' treatment responses were compared with the patients' who were carrying the wild type genotype. Results: Analysis comparing the wild type genotype and CYP2C9*1*2 genotype revealed a trend toward more systolic blood pressure reduction in favor of wild-type genotype. However, there was no statistically significant difference between these two groups considering the change in diastolic blood pressure levels. Regarding the CYP2C9*1*3 genotype, there were no significant differences in systolic or diastolic blood pressure changes. Conclusion: CYP2C9*1*2 polymorphism affects the systolic blood pressure response to losartan in hypertensive patients, while the CYP2C9*1*3 genotype was not shown in associated with systolic or diastolic blood pressure responses.Hacettepe University Scientific Projects Coordination Unit [0801101009]This study was financially supported by Hacettepe University Scientific Projects Coordination Unit (Number: 0801101009)

Perceptions And Attitudes Of Patients About Adult Vaccination And Their Vaccination Status: Still A Long Way To Go?

Background Immunization is one of the most effective public health measures to prevent disease, but vaccination rates in adult populations still remain below the targets. Patient and physician attitudes about vaccination are important for adult vaccination. In this study, we aimed to determine patient attitudes and perceptions about vaccination and the vaccination coverage rates of adult patients in a university hospital in Turkey. Material/Methods A survey was conducted between October 2014 and May 2015 at the Internal Medicine Outpatient Clinics of a university hospital. Adult patients were asked to fill out a questionnaire on their perceptions and attitudes about vaccination and their vaccination status. Results We interviewed 512 patients ages 19–64 years. Eighty percent of the study population thought that adults should be vaccinated, while only 36.1% of the patients stated that vaccination was ever recommended to them in their adult life. Forty-eight percent of the patients stated that they were vaccinated at least once in their adulthood. The most commonly received vaccine was tetanus vaccine in general, while influenza vaccine was the leading vaccine among patients with chronic medical conditions. While 71.4% of the patients to whom vaccination was recommended received the vaccine, 34.9% of the patients received a vaccine without any recommendation. Conclusions Although the vaccine coverage rates among adults in this survey were low, the perceptions of patients about adult vaccination were mainly positive and of many of them positively reacted when their physician recommended a vaccine.PubMedWo

Patients' readiness for discharge: Predictors and effects on unplanned readmissions, emergency department visits and death

Urek, Duygu/0000-0001-6471-5601WOS: 000443945100011PubMed: 29573007AimTo determine the variables that affect patients' perceptions about their readiness for discharge and to elucidate the effects of these perceptions on patient outcomes such as unplanned readmission to the hospital, emergency department visits and death within 30days after discharge. BackgroundIn recent years, it has become even more important to assess patients' readiness for discharge as patients tend to be discharged more quickly. MethodsFor the determination of patients' self-assessment, the Readiness for Hospital Discharge Scale/Short Form was utilized. This 1-year prospective cohort study included 1,601 patients. Data were analysed using a chi-square test, Mann-Whitney U test, univariate logistic regression analysis and multiple logistic regression analysis. ResultsThe results of multiple logistic regression analysis revealed that age, sex, marital status, educational status, presence of someone to help at home after discharge and length of stay were predictors of patients' readiness for hospital discharge. Furthermore, being unready for discharge increased the risk of 30day unplanned readmission and 30day death. ConclusionsConsidering these predictors, patients' perceptions of readiness for discharge must be assessed before deciding to discharge them. Implications for Nursing ManagementNurse managers can consider the predictors of patients' readiness for discharge, thus the risk of unplanned readmission and death may be reduced.Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [114K404]The Scientific and Technological Research Council of Turkey (TUBITAK), Grant/Award Number: 114K40

Emergency department visits following discharge: Implications for healthcare management

KAYA, SIDIKA/0000-0002-1495-9373; Teles, Mesut/0000-0002-3255-0096WOS:000546936000001Objective: This study aimed to reveal the frequency of emergency department (ED) visits within 7 and 30 days after discharge and to identify the factors affecting these ED visits. Methods: A total of 1570 patients discharged from the internal medicine wards of a university hospital in Turkey within 1 year were included in this prospective cohort study. Multiple logistic regression analyses were used to identify the factors affecting ED visits. Results: Of the patients, 1.3% visited the ED within the first 7 days after discharge and 5.2% within 30 days. Multivariable analyses showed that the probability of an ED visit within 30 days was 1.83 (95% CI 1.09-3.08; p = 0.023) times higher for male patients and 2.15 (95% CI 1.00-4.60; p = 0.049) times higher for patients with intensive care unit (ICU) stay before discharge. The probability of an ED visit increased by 1.25 (95% CI 1.11-1.42, p < 0.001) times for every 1-point increase in the comorbidity score. The costs of ED visits within 0-7 days were lower than the costs within 8-30 days (p = 0.001). Conclusion: Innovative approaches targeting discharge planning and postdischarge care for patients with high comorbidity scores and ICU use during index hospitalization could reduce ED visits within 30 days after discharge.Scientific and Technological Research Council of Turkey (Turkiye Bilimsel ve Teknolojik Arastirma Kurumu [TUBITAK])Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [114K404]; TUBITAKTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK)The data (except ED visits data) used in this study were obtained from research project no. 114K404 supported by the Scientific and Technological Research Council of Turkey (Turkiye Bilimsel ve Teknolojik Arastirma Kurumu [TUBITAK]). The authors thank TUBITAK for providing financial support

Vital Corner of Diagnostic Challenge: Eosinophilic Granulomatosis With Polyangiitis Or COVID-19 Pneumonia?

The COVID-19 pandemic raises many alarms in the rheuma- tological era. Gianfrancesco et al reported the answer of an important question: the characteristics associated with hospital- ization for COVID-19 in people with rheumatic disease.1 The data suggested that patients with rheumatic disease on predni- sone dose of ≥10mg/day were associated with higher odds of hospitalization, and vasculitis was the fourth common rheumatic disease among all of these patients.PubMe