Effect of SGLT-2 inhibitors as an add-on therapy to metformin on P wave indices and atrial electromechanics in type 2 diabetes mellitus patients

INTRODUCTION

Sodium-glucose co-transporter 2 (SGLT-2) inhibitors have been shown to reduce the risk of atrial fibrillation (AF) occurrence in patients with diabetes mellitus (DM). In this prospective study, we aimed to analyze the effect of SGLT-2 inhibitors as an add-on therapy to metformin on P wave indices and atrial electromechanics in patients with type 2 DM.

METHODS

A total of 144 patients enrolled. Electrocardiographic indices were recorded on admission and at 3rd and 6th month of the combination therapy. P wave indices and atrial electromechanical coupling intervals were measured and compared.

RESULTS

Although decrease in P wave dispersion (62.78 ± 9.59 vs. 53.62 ± 10.65; p = .002) became significant at 6th month of combination therapy, significant decreases in P wave terminal force in V₁ (37.79 ± 3.45 vs. 32.01 ± 5.74; p = .035), left atrial volume index (35.87 ± 6.57 vs. 31.33 ± 7.31; p = .042), left sided intra-atrial electromechanical delay (32.09 ± 9.17 vs. 27.61 ± 8.50; p = .016), right sided intra-atrial electromechanical delay (31.82 ± 4.92 vs. 27.65 ± 8.05; p = .042), and interatrial electromechanical delay (29.65 ± 7.52 vs. 25.96 ± 4.30; p = .044) were seen as early as 3rd month of treatment. Besides, there was no statistically significant difference between Empagliflozin and Dapagliflozin subgroups in terms of mentioned parameters.

CONCLUSION

SGLT-2 inhibitors as an add-on therapy to metformin were shown to significantly improve P wave indices and atrial electromechanics in type 2 DM patients as early as the 3rd month of treatment. It was thought that this may be one of the underlying mechanisms of the decrease in the frequency of AF with the use of SGLT2 inhibitors.

The impact of daily troponin I and D-dimer serum levels on mortality in COVID-19 pneumonia patients

BACKGROUND

Coronavirus disease 2019 (COVID-19) is an infection resulting in very high morbidity and mortality rates globally. Limited data are available on the cardiovascular manifestations in these patients. The aim of this study was to analyse the daily troponin I and D-dimer levels and their impact on the need for intensive care and on mortality rates of COVID-19-infected patients.

METHODS

Two-hundred and five patients who were hospitalised between 20 March and 5 May 2020, with a diagnosis of moderate-to-severe COVID-19 pneumonia, were analysed retrospectively. Serum troponin I and D-dimer levels were recorded for at least 10 days after admission.

RESULTS

The average age was higher in the group of patients who died compared to the group who were discharged (67.79 ± 14.9 vs 56.87 ± 18.15 years, respectively, p < 0.001). The presence of hypertension, diabetes mellitus, previous coronary bypass surgery, heart failure, chronic renal failure and chronic obstructive pulmonary disease statistically significantly affected mortality rates (p = 0.003, 0.004, 0.045, 0.02, 0.003, 0.007, respectively). The first 10 days of measurements of troponin I and D-dimer were associated with intensive care requirements and mortality (p < 0.001). Both troponin I and D-dimer were higher in the group who died compared to the patients requiring intensive care. Troponin I values of ≥ 16.05 pg/ml on the seventh day were related to the need for intensive care [area under the curve (AUC) 0.896, sensitivity 78.6%, specificity 78.3%, p < 0.001). Troponin I values ≥ 30.25 pg/ml on the ninth day were related to mortality (AUC 0.920, sensitivity 89.5%, specificity 89.3%, p < 0.001). D-dimer values ≥ 878 hg/ml on the second day were associated with intensive care need (AUC 0.896, sensitivity 78.6%, specificity 78.3%, p < 0.001). D-dimer values ≥ 1 106 hg/ml on the 10th day were associated with mortality (AUC 0.817, sensitivity 68.4%, specificity 65.2%, p < 0.001). It was observed that hospitalisation periods ≥ 9.5 days were associated with mortality (AUC 0.738, sensitivity 68.4%, specificity 65.9%, p < 0.001).

CONCLUSIONS

We showed that hospitalisations ≥ 9.5 days in duration were related to increased mortality rates. Troponin I and D-dimer follow-up values in the serum were more effective than other inflammatory markers in predicting mortality and the need for intensive care. A high troponin I value should alert the clinician in terms of clinical deterioration.

Prevalence and clinical features of pollen-food allergy syndrome in adults with seasonal allergic rhinitis

OBJECTIVE

Pollen-food allergy syndrome (PFAS) is an IgE-mediated allergic reaction to certain foods due to prior sensitization to pollen allergens. The data about the prevalence of PFAS in adults in Turkey is not sufficiently reported. Our objective was to investigate the frequency and clinical features of PFAS in adult patients with seasonal allergic rhinitis (SAR).

PATIENTS AND METHODS

A total of 222 patients with SAR were enrolled in our outpatient allergy clinic at Hacettepe University, during a ten-month period. A questionnaire was used to evaluate patients and to categorize those who experienced obvious allergy symptoms consistent with PFAS. Atopy was assessed by a standard skin prick test panel including common aeroallergen extracts.

RESULTS

Among 222 patients with a diagnosis of SAR, 31 had patient reported PFAS (31/222, 14%). Among them, 23 (74.2%) were females, and their mean age was 32.29±9.24 years. The most common symptoms were isolated oropharyngeal symptoms (58.1%), followed by urticaria (51.6%) after culprit food ingestion. The most frequent culprit foods were eggplant, walnut, kiwi, peach, and melon. The predominant sensitizing aeroallergen was grass pollen.

CONCLUSIONS

PFAS can be frequently observed in adults who are followed up for SAR. The most frequently involved foods are eggplant, walnut, kiwi, peach, and melon in Ankara Province. The symptoms of PFAS are usually localized in the oropharyngeal area and are self-limited.

O-112 Fertility awareness: Educating the teenagers in europe

The term fertility awareness has been long associated with specific methods of family planning. Within the context of reproductive health and fertility issues, fertility awareness is a level of knowledge of the society on the topics of human reproduction system, fertility life cycle, possible threats to reproductive health and the ways of its protection. Moreover, as the birth rates have been continuously falling throughout Europe and the number of European citizens with fertility issues has increased during the last 50 years, fertility and infertility have been put into the spotlight for scientists, policy-makers, non-government organizations and other stakeholders. Therefore, the level of fertility awareness should be increased among all society groups. The main objective of the Fertility Awareness Project is to digitally reach teenagers aged 15-18 in various European countries in order to check their knowledge of fertility and to raise their awareness level. Fertility Awareness Project will follow a knowledge-based, holistic, systemic approach built on two pillars: collecting information and providing information. For this purpose, a digital tool will be developed to measure/increase fertility awareness and this tool will be disseminated in 4 selected European countries among teenagers aged 15-18, aiming to reach as many respondents as possible. After the data collection, a large effort will be devoted to evaluate the results based on the application usage by the target group. Thus, the Fertility Awareness Project will provide reliable information on the levels of fertility awareness among young people in Europe and the outcome of the project will help us to advocate for actions to promote fertility education on EU and national levels.

De-novo development of fragmented QRS during a six-month follow-up period in patients with COVID-19 disease and its cardiac effects

OBJECTIVE

The aim of this study is to examine the probability of de-novo fQRS in patients with mild COVID-19 disease, as an indicator of cardiac injury.

METHODS

Data of 256 patients with normal admission electrocardiography and no comorbidities between 1.12.2020-31.12.2021, were examined retrospectively 6-month after mild COVID-19 disease. Patients were divided into two groups: fQRS+ group (n = 102) and non-fQRS group (n = 154). Relation between fQRS and other electrocardiography, echocardiographic and laboratory findings were investigated.

RESULTS

No significant difference was found between the groups among age and gender. Troponin-I and creatine kinase myocardial band values (retrospectively 9.10 ± 1.76 vs 0.74 ± 1.43, 34.05 ± 82.20 vs. 14.68 ± 4.42), COVID-19 IgG levels (45.78 ± 14.82 vs. 36.49 ± 17.68), diastolic dysfunction (39.21% vs. 15.07%), EF value (58.02 ± 1.95 vs. 64.27 ± 3.07), dyspnea (41.17% vs. 6.84%), post-COVID-19 tachycardia syndrome (19.6% vs. 2.74) were more frequent in fQRS+ group compared to non-fQRS group. The EF value was lower in the presence of fQRS in the high lateral leads (57.12 ± 1.99, 58.47 ± 1.79, p:0.018). There was a positive correlation between IgG value and endsystolic diameter, septum thickness and left atrium diameter. In multivariate analysis de-novo fQRS, dyspnea, high troponin and IgG values, diastolic dysfunction, low EF value and left atrial diameter were determined as independent risk factors for post-COVID-19 tachycardia syndrome in follow-up.

CONCLUSION

In COVID-19 disease de-novo fQRS, dyspnea, high IgG and troponin value, left atrial diameter, lower EF value, diastolic dysfunction were associated with post-COVID-19 tachycardia syndrome. The de-novo fQRS in SARS-COV-2 may be a predictor of future more important adverse cardiovascular outcomes and this should alert clinicians.

Biomass, carbon and nitrogen in single tree components of grey poplar (Populus × canescens) in an uncultivated habitat in Van, Turkey

The biomass, carbon and nitrogen storage in the single tree components (foliage, branch, crown, bark, stem and total aboveground) of the grey poplar (Populus × canescens) in its distribution in Eastern Anatolia (Van, Turkey) were determined and modelled. The biomass, carbon and nitrogen storages were not estimated at a stand level but were based on single trees. Regression models based on the tree diameter at breast height (DBH) and total tree height (H) were developed to estimate the biomass, carbon (C) storage and nitrogen (N) storage of the different tree components of a total of 28 grey poplar trees. The two main regression models in the power function were developed based only on the DBH (Model 1) and the combination of the DBH and height (D²H) (Model 2). All regression models, except for those of the foliage components, developed to estimate the biomass and C and N storages of the tree components were found to be statistically significant (p < 0.001). The partitioning of the total aboveground biomass in the bark, foliage, branches and stems was 0.7, 9, 17 and 73%, respectively. The average C concentrations of the tree components ranged from 48 (foliage) to 50% (bark, branch and stem), while the N concentrations ranged from 0.35 (stem) to 1.32% (foliage). Higher biomass and lower nitrogen concentrations of foliage compared with cultivated poplars were likely related to the natural site conditions, low soil nitrogen and/or characteristics of single tree growth.

Impact of early (3 months) dual antiplatelet treatment interruption prior to renal transplantation in patients with second-generation DES on perioperative stent thrombosis and MACEs

OBJECTIVE

Early cessation of dual antiplatelet therapy (DAPT) is related to stent thrombosis (ST). The use of second-generation everolimus- and zotarolimus-eluting stents is associated with low restenosis rates and short duration of clopidogrel usage. Non-cardiac surgery in recently stent-implanted patients is associated with major adverse cardiac events (MACEs). Chronic renal failure patients awaiting renal transplantation may also undergo coronary stent implantation prior to surgery. Here we aimed to investigate the safety of early (3 months) DAPT interruption in second-generation drug-eluting stent (DES)-implanted renal transplant recipients.

METHODS

In total, 106 previously stent-implanted chronic renal failure patients who underwent renal transplantation were retrospectively enrolled. Three groups were formed according to stent type and the duration of DAPT: early-interruption (3 months from DES implantation), lateinterruption (3-12 months from DES implantation), and bare-metal stent (BMS; at least 1 month from BMS implantation) groups.

RESULTS

Comparison among BMS, DES-early and DES-late groups indicated no difference in ST, myocardial infarction, death, and MACEs. In addition, no difference was observed in ST (p=0.998), myocardial infarction (p=0.998), death (p=0.999), and MACEs (p=0.998) between DES-early and DES-late groups.

CONCLUSION

Early (3 months) interruption of antiplatelet treatment with second-generation stents before renal transplantation seems to be safe and does not lead to increase in the occurrence of ST and MACEs.

How do voice restoration methods affect the psychological status of patients after total laryngectomy?

OBJECTIVE

This study investigated the relationship between psychological well-being and different voice rehabilitation methods in total laryngectomy patients.

METHODS

The study enrolled 96 patients who underwent total laryngectomy. The patients were divided into three groups according to the voice rehabilitation method used: esophageal speech (24 patients); a tracheoesophageal fistula and Provox 2 voice prosthesis (57 patients); or an electrolarynx (15 patients). The participants were asked to complete the Turkish version of the Voice Handicap Index-10 (VHI-10) to assess voice problems. They were also asked to complete the Turkish version of the Perceived Stress Scale (PSS), and the Hospital Anxiety and Depression Scale (HADS). The test scores of the three groups were compared statistically.

RESULTS

Patients who used esophageal speech had a mean VHI-10 score of 10.25 ± 3.22 versus 19.42 ± 5.56 and 17.60 ± 1.92 for the tracheoesophageal fistula and Provox 2 and electrolarynx groups respectively, reflecting better perception of their voice. They also had a PSS score of 11.38 ± 3.92, indicating that they felt less stressed in comparison with the tracheoesophageal fistula and Provox 2 and electrolarynx groups, which scored 18.84 ± 5.50 and 16.20 ± 3.49 respectively. The HADS scores of the groups were not different, indicating that the patients' anxiety and depression status did not vary.

CONCLUSION

Patients who used esophageal speech perceived less stress and were less handicapped by their voice.

Effect of obesity and serum leptin level on clopidogrel resistance

OBJECTIVE

Clopidogrel inhibits platelet aggregation by blockade of platelet adenosine diphosphate (ADP) P2Y12 receptor. Leptin is the obesity gene product, and its serum level increases with obesity. Platelets have leptin receptors on their surfaces. Hyperleptinemia may induce ADP-mediated platelet aggregation. It has been proposed that clopidogrel effect could be diminished with high serum leptin levels. The aim of the present trial was to further investigate the relationship between serum leptin level and clopidogrel resistance.

METHODS

A total of 100 subjects who underwent percutaneous coronary intervention were enrolled. Two groups were organized according to presence of clopidogrel resistance, and serum leptin levels were compared. Threshold for clopidogrel resistance and hyperleptinemia were accepted as ≥P2Y12 reaction unit (PRU) 240 and ≥15 ng/mL leptin, respectively. Body mass index (BMI) of 30 kg/m2 or greater was considered obese.

RESULTS

A total of 37% of patients were considered clopidogrel-resistant. Comparison of groups revealed significantly higher clopidogrel resistance (p=0.017) and PRU levels (p=0.001) in hyperleptinemic patients. No significant difference in serum leptin levels (p=0.116) was found. Increased clopidogrel resistance was observed in patients with BMI >30 kg/m2 (p=0.015).

CONCLUSION

Clopidogrel resistance is more common in obese and hyperleptinemic patients. Dosage should be individualized in these populations.

Diagonal earlobe crease associated with increased epicardial adipose tissue and carotid intima media thickness in subjects free of clinical cardiovascular disease

OBJECTIVE

Atherosclerotic coronary artery disease is a leading cause of death, worldwide. Diagonal earlobe crease (DELC) has been suggested as a simple, noninvasive marker of cardiovascular disease. Although epicardial adipose tissue (EAT) thickness and carotid intima media thickness (CIMT) are closely related to atherosclerosis, the relation between EAT, CIMT, and DELC had yet to be studied. The present objective was to analyze this association.

METHODS

Subjects were apparently healthy individuals referred to the cardiology outpatient clinic. A total of 65 subjects with DELC and 65 age- and sex-matched controls without DELC were enrolled. EAT thickness and CIMT were measured and analyzed.

RESULTS

Epicardial adipose tissue thickness was significantly higher in the DELC group (0.57±0.12 vs. 0.35±0.05; p<0.0001). CIMT was also significantly higher in DELC group (0.85±0.16 vs. 0.60±0.15; p<0.0001). Correlation analysis showed that CIMT was significantly correlated with EAT thickness (r: 0.594; p<0.0001). Linear regression analysis showed that presence of DELC was independently associated with CIMT and EAT thickness.

CONCLUSION

A significant and independent association between the presence of DELC and increased CIMT and EAT thickness was presently determined, for the first time, in subjects free of clinical cardiovascular disease.

Quality of life and related factors in degenerative lumbar spinal stenosis: A controlled study

OBJECTIVE

The purpose of this study was to compare the quality of life of patients with lumbar spinal stenosis (LSS) with that of the controls' and to investigate the factors related with the quality of life in LSS.

METHODS

Fifty-four patients with LSS were included in the study whose diagnosis were made by clinically and magnetic resonance imaging (MRI). Control group consisted of age and sex matched 54 individuals. Both of the patient and control groups were evaluated with the Short Form-36 (SF-36) health survey and Hospital Anxiety Depression Scale (HADS). The Oswestry Pain and Disability Index (ODI) was used for the assessment of the disability.

RESULTS

SF-36 scores in the LSS group was lower than that of the controls'. There was a significantly positive correlation between the SF-36 scores and walking distance in LSS group. A moderately negative correlation was found between the SF-36 and the ODI, HADS anxiety and depression scores. There was a significantly positive correlation between the ODI and the HADS anxiety and depression scores. HADS anxiety and depression scores in the patient group were significantly higher than that of the controls'.

CONCLUSIONS

As a result, quality of life was decreased in subjects with LSS. The factors related with the quality of life were the walking distance, severity of the disability and emotional status in LSS.

Validation of the Turkish Cervical Cancer and Human Papilloma Virus Awareness Questionnaire

AIM

The aim of this study was to determine the validity and reliability of the 'Cervical Cancer and Human Papilloma Virus Awareness Questionnaire' among fertility age women by adapting the scale into Turkish.

BACKGROUND

Cervical cancer is the fourth most commonly form seen among women. Death from cervical cancer ranks third among causes and is one of the most preventable forms of cancer.

METHODS

This cross-sectional study included 360 women from three family health centres between January 5 and June 25, 2014.

RESULTS

Internal consistency showed that the Kuder-Richardson 21 reliability coefficient in the first part was 0.60, Cronbach's alpha reliability coefficient was 0.61 in the second part. The Kaiser-Meyer-Olkin value of the items on the scale was 0.712. The Barlett test was significant. The confirmatory factor analysis indicated that the model matched the data adequately.

CONCLUSION

This study shows that the Turkish version of the instrument is a valid and reliable tool to evaluate knowledge, perceptions and preventive behaviours of women regarding human papilloma virus and cervical cancer.

IMPLICATIONS FOR NURSING AND POLICY MAKERS

Nurses who work in the clinical and primary care settings need to screen, detect and refer women who may be at risk from cervical cancer.

Cancer Screening of Renal Transplant Patients Undergoing Long-Term Immunosuppressive Therapy

OBJECTIVE

With this study we aimed to research the effects of immunosuppressive drugs, their cumulative doses, and viral infections on development of malign tumors in patients who have undergone treatment for 5 years.

METHODS

We examined 100 patients who underwent renal transplantation from 2004 to 2009. Patients had mycophenolate mofetil and steroid in addition to cyclosporine, sirolimus, or tacrolimus as immunosuppressive treatment. For malignancy screening, physical examination, radiologic and endoscopic screening were done, and immunosuppressive drugs and their cumulative doses, age, sex, body mass index (BMI), dialysis history, and viral infection history were investigated.

RESULTS

The mean age of patients was 42.03 ± 11.30 years. There were 1 colon cancer patient, 1 retroperitoneal liposarcoma, 1 renal oncocytoma, 3 Kaposi sarcoma patients treated with cyclosporine; in those treated with Tac there were 1 basal cell carcinoma, 1 Kaposi sarcoma, 2 thyroid carcinoma, 1 breast carcinoma, 1 bladder carcinoma, 1 renal cell carcinoma, and 1 colon carcinoma patients. The mean age of patients having carcinoma was statistically significant compared with those without cancer (P < .01). The prednisolone cumulative dose was significantly higher in carcinoma patients than in patients without carcinoma (P < .01).

RESULTS

The use of long-term chronic immunosuppressive therapy may increase the development of cancer. The risk of carcinoma increases with increasing drug dose and time period of the immunosuppressive drug. There was not a negative effect on cancer prevalence in patients with cyclosporine or tacrolimus. But the cumulative dose of steroids significantly increased malignancy occurence.

Covalent organic polymer framework with C–C bonds as a fluorescent probe for selective iron detection

Iron detection has just gone heterogeneous, thanks to the selective quenching of fluorescence by the nanoporous polymers that are tuned for optimal processability.

Monitoring of CD3(+) T-cell count in patients receiving antithymocyte globulin induction after cadaveric renal transplantation

AIM

Although antithymocyte globulin (ATG) has been used for years, its ideal dose and administration period is obscure. Herein, we sought to use the CD3(+) cell count to detect the optimal ATG dosage.

MATERIAL AND METHODS

Twenty-one patients who underwent cadaveric donor renal transplantation from January 2009 to January 2012 received a 1 mg/kg ATG initial dose at the time of the operation. Patients were randomized into 2 cohorts. Group 1 (n = 11) received ATG according to the clinical and total lymphocyte count and group 2 (n = 10), the dose was tailored according to the CD3(+) cell count. We compared the total and daily ATG dosages, ATG administration period, side effects of ATG, the number of days to a serum creatinine level <2 mg/dL, graft function at 3 months, acute rejection episodes, infection rates, costs of CD3(+) analysis, and ATG amounts.

RESULTS

Both groups showed similar gender, age, and human leukocyte antigen matching data. There was no difference in presensitizing events or panel-reactive antibody class 1 and 2 levels. The number of days to a serum creatinine level of <2 mg/dL was 11 ± 1.5 for group 1 versus 10.4 ± 0.8 for group 2 (P = .45). Between groups 1 and 2, there was a significant difference between the mean total (P = .031) and mean daily ATG dosages (P = .006). We used a total dose of 3800 mg ATG for group 1 and 2200 mg for group 2 and for the group 2 who underwent 43 CD3(+) cell counts. The expenditure per patient was 20% higher among group 1 than group 2.

CONCLUSION

Determination of appropriate ATG dosages by CD3(+) cell counts was useful, reliable, and cost effective.

Variations of the celiac trunk and hepatic arteries: a study with 64-detector computed tomographic angiography

OBJECTIVES

The aim of the present study was to evaluate variations in celiac trunk and hepatic artery with multi-detector computed tomography (MDCT).

PATIENTS AND METHODS

Totally 820 patients who underwent angiography of the abdominal aorta were evaluated. Anatomical findings were grouped according to the Michels classification.

RESULTS

Several variations and/or anomalies were noted in 33.2% of the patients (n=272). The most common abnormality was Michels type III (10.1%), followed by type V (7.3%), type II (4.7%) and others. Type X was not observed in our series. We have noted additional, previously unclassified variations in 12 cases (1.5%).

CONCLUSIONS

Preoperative knowledge of variant anatomy may assist in the selection of treatment options and surgical planning, which in turn facilitates surgical dissection and helps avoiding iatrogenic injury. MDCT angiography allows detailed visualization of the vascular anatomy.