White blood cell count to mean platelet volume ratio: A novel and promising prognostic marker for ST-segment elevation myocardial infarction

Background: Increased white blood cell (WBC) count is associated with increased mortality in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate predictive value of admission WBC to mean platelet volume (MPV) ratio (WMR) on prognosis in patients undergoing primary percutaneous coronary intervention (pPCI) for STEMI. Methods: A total of 2,603 consecutive patients with STEMI who underwent pPCI were recruited for the study. Follow-up data were obtained from digital records, patient files or by telephone interview with patients, family members, or primary care physicians. Results: WMR has the highest area under receiver operating characteristic (ROC) curve and pairwise comparisons of the ROC curves revealed that WMR has the higher discriminative ability for long-term mortality than WBC, MPV, red blood cell distribution with (RDW), WBC-MPV combination, and platelet to lymphocyte ratio and neutrophil to lymphocyte ratio (PLR-NLR) combination in patients undergoing pPCI for STEMI (a WMR value of 1,653.47 was also found as threshold value for mortality with 75.4% sensitivity and 87.3% specificity by ROC curve analysis). Conclusions: Higher WMR value on admission was associated with worse outcomes in patients with STEMI and independently better predicted the long-term mortality than other complete blood count components, such as MPV, RDW, PLR-NLR and WBC-MPV combinations

Comparison of different diuretic regimens in heart failure

Furosemid, akut dekompanse kalp yetmezliği olan hastalarda tedavinin temel öğesidir. Ancak nasıl kullanılması gerektiği ile ilgili az sayıda veri bulunmaktadır.Akut dekompanse kalp yetmezliği tanısıyla Gazi Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalına başvuran 43 hasta çalışmaya dahil edilmiştir. Onbeş hastaya 160 mg furosemid tedavisi 16 saat infüzyon şeklinde, ondört hastaya 80 mg furosemid günde iki kez bolus şeklinde, ondört hastaya 160 mg furosemid 150 cc hipertonik salin solüsyonu (75 cc %0,9 NaCl ile 75 cc %3 NaCl karışımı) ile birlikte 30 dk infüzyon şeklinde uygulanmıştır. Bu tedavi rejimlerine 48 saat devam edilmiştir. Sonrasında doz ayarlamasına izin verilmiştir. Hastaların bazal değerlerine göre 48.saat sonundaki kreatinin değişimi, kompanse hale geldikten sonraki kreatinin değişimi, hastanede yatış süresi ve kilo kaybı değerlendirildi. Kırksekiz saat sonundaki kreatinin değişiminde üç grup arasında istatistiksel olarak fark gözlenmemiştir (infüzyon grubu 0,16 ± 0,21 mg/dl, bolus grubu 0,04 ± 0,15 mg/dl, HSS grubu 0,20 ± 0,21 mg/dl; p= 0,08). Hastalar kompanse olduktan sonra bazale göre kreatinin değişimi incelendiğinde bolus grubunda daha az bozulma izlenmiş olmasına rağmen istatistiksel olarak fark bulunmamıştır (infüzyon grubu 0,36 ± 0,42 mg/dl, bolus grubu 0,10 ± 0,28 mg/dl, HSS grubu 0,30 ± 0,42 mg/dl; p= 0,18). Kilo kaybı her üç grupta benzer şekilde sonuçlamıştır (infüzyon grubu 4,6 ± 5,2 kg, bolus grubu 4,1 ± 2,7 kg, HSS grubu 5,7 ± 3,6 kg; p= 0,66). Bunların yanında HSS grubunda anlamlı olarak hastanede yatış süresi daha kısa saptanmıştır (infüzyon grubu 6,6 ± 3,4 gün, bolus grubu 7,9 ± 4,1 gün, HSS grubu 3,7 ± 1,3 kg; p<0,01).Kalp yetmezliği hastalarında hipertonik salin solüsyonu ile furosemid tedavisinin beraber uygulanması hastanede yatış süresini kısaltmıştır. Bu tedavi protokolünün uygulanması tedavi maliyetini azaltmak için etkin bir yöntem olabilir.Furosemide is an essential component of therapy for patients with acute decompensated heart failure. But there are few data to guide their use.We assigned 43 patients with acute decompensated heart failure who refered to Cardiology Department of Gazi University Medical Faculty. Fifteen patients received 160 mg furosemide administered intravenously continuous infusion through 16 hours. Fourteen patients received 80 mg furosemide administered twice a day as a bolus intravenous treatment with twelve-hour intervals. Fourteen patients treated with 160 mg furosemide plus HSS (150 cc %1,95 NaCl) for 30 minutes. All of these treatment regimes were continued for 48 hours. At the end of this period the protocol allowed specified dose adjustments.We evaluated the changing in the serum creatinine level from baseline to 48 hours, changing in the serum creatinine level from baseline to patients after becoming compensated, length of hospitalization and loss of body weight. After treatment, there were no significiant differences in patients? serum creatinine level at the end of 48 hours (infusion group 0,16 ± 0,21 mg/dl, bolus group 0,04 ± 0,15 mg/dl, HSS group 0,20 ± 0,21 mg/dl; p= 0,08). Patients after becoming compensated, we observed a nonsignificiant lower renal impairment with bolus treatment (infusion group 0,36 ± 0,42 mg/dl, bolus group 0,10 ± 0,28 mg/dl, HSS group 0,30 ± 0,42 mg/dl; p= 0,18). There were no differences among the body weight loss of the three groups (infusion group 4,6 ± 5,2 kg, bolus group 4,1 ± 2,7 kg, HSS group 5,7 ± 3,6 kg; p= 0,66). As well as a significiantly shorter length of hospitalization was observed in patients treated with HSS (infusion group 6,6 ± 3,4 days, bolus group 7,9 ± 4,1 days, HSS group 3,7 ± 1,3 days; p< 0,01).Treatment of furosemide plus HSS shortened the length of hospital stay in patients with heart failure. This treatment modality can be an effective method to reduce the cost of treatment

Pulmonary hypertension classification based on machine learning using standart chest X-Ray: ATA Artificial Intelligence Study-1

[No Abstract Available

Impact of free thyroxine levels and other clinical factors on bare metal stent restenosis

ABSTRACT Objective Thyroid hormones have both direct and indirect effects on thermogenesis such as modulating vascular smooth muscle cell proliferation. However, the influence of more subtle changes in thyroid hormones on coronary atherosclerosis remains a matter of speculation. Smooth muscle cells play a crucial role in the pathogenesis of in-stent restenosis (ISR). However, the relationship between free thyroxine (fT4) and ISR has not been studied. In the present study, we aimed to assess the role of preprocedural serum fT4 level on the development of ISR in patients undergoing coronary bare metal stent (BMS) implantation. Materials and methods We enrolled and analyzed clinical, biochemical, and angiographic data from 705 consecutive patients without a history of primary thyroid disease [mean age 60.3 ± 9.3 years, 505 (72%) male]; all patients had undergone BMS implantation and further control coronary angiography owing to stable or unstable angina pectoris. Patients were divided into 3 tertiles based on preprocedural serum fT4 levels. Results ISR was observed in 53 (23%) patients in the lowest tertile, 82 (35%) patients in the second tertile, and 107 (46%) patients in the highest fT4 tertile (p 1.23 mg/dL had 70% sensitivity and 73% specificity (AUC: 0.75, p < 0.001) in predicting ISR. Conclusion Higher preprocedural serum fT4 is a powerful and independent predictor of BMS restenosis in patients with stable and unstable angina pectoris

Stężenie nesfatyny-1 u chorych ze zwolnionym przepływem wieńcowym

Background: Nesfatin-1 is a novel anorectic neuropeptide with potent metabolic regulatory effects. Aim: We aimed to evaluate the relationship between nesfatin-1 levels and slow coronary flow (SCF). Methods: A total of 60 consecutive patients with SCF and 60 consecutive patients with normal coronary flow (NCF) were enrolled into the study. Nesfatin-1 level was measured from blood serum samples using enzyme-linked immunosorbent assay test. Results: Serum nesfatin-1 levels were significantly lower in the SCF group compared to the NCF group (p &lt; 0.001). Low levels of nesfatin-1 were found to be significantly and independently associated with the SCF (odds ratio 0.982, 95% confidence interval 0.969–0.995, p = 0.005). Conclusions: The results of this study showed that serum nesfatin-1 level was lower in the SCF group than in the NCF group. Nesfatin-1 could play a role in the pathogenesis of SCF phenomenon with mechanisms such as inflammation and endothelial dysfunction. Further studies are needed to determine the relation between SCF and nesfatin-1.Wstęp: Nesfatyna-1 jest nowo odkrytym neuropeptydem o działaniu anorektycznym mającym silny wpływ regulacyjny na procesy metaboliczne. Cel: Celem niniejszej pracy była ocena zależności między stężeniem nesfatyny-1 a zwolnionym przepływem wieńcowym (SCF). Metody: Do badania włączono 60 kolejnych pacjentów z SCF oraz kolejnych 60 pacjentów z prawidłowym przepływem wieńcowym (NCF). Pobrano próbki krwi i zmierzono stężenia nesfatyny w surowicy, stosując metodę immunoenzymatyczną. Wyniki: Stężenie nesfatyny-1 w surowicy było istotnie wyższe w grupie SCF niż w grupie NCF (p < 0,001). Niskie stężenie nesfatyny-1 było istotnie i niezależnie związane z SCF (iloraz szans [OR]: 0,982; 95% przedział ufności [CI]: 0,969–0,995; p = 0,005). Wnioski: Podsumowując, wyniki uzyskane w badaniu wskazują, że stężenie nesfatyny-1 w surowicy było niższe w grupie SCF niż w grupie NCF. Nesfatyna-1 może mieć swój udział w patogenezie zjawiska SCF poprzez takie mechanizmy, jak zapalenie i dysfunkcja śródbłonka. Potrzebne są dalsze badania w celu ustalenia zależności między SCF a nesfatyną-1