Evaluation of electrocardiogram findings and inflammatory parameters in patients with benign paroxysmal positional vertigo

OBJECTIVE

Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular disorder characterized by brief episodes of intense vertigo, often accompanied by nausea and nystagmus. The frontal QRS-T (fQRS-T) angle, a novel indicator of ventricular depolarization and repolarization heterogeneity, has garnered attention due to its potential to reveal insights into cardiac function. This study aimed to investigate the potential relationship between the fQRS-T angle and inflammation markers in individuals with BPPV.

PATIENTS AND METHODS

The study encompassed 49 BPPV patients and 51 healthy individuals as a control group. Laboratory assessments were conducted to measure inflammation parameters. Electrocardiogram (ECG) data was analyzed, focusing on conduction parameters including fQRS-T angle, QRS duration, QT interval, and corrected QT interval.

RESULTS

The study revealed that the fQRS-T angle was significantly higher in BPPV patients compared to the control group (p<.001). Moreover, inflammation markers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and C-reactive protein-to-albumin ratio (CAR) were notably elevated in BPPV patients (p<.001, for all). The findings of the correlation analysis demonstrated a strong association between NLR and the fQRS-T angle (r=.718, p<.001). Additionally, the results of the linear regression analysis indicated that NLR positively predicted the fQRS-T angle (p<.001).

CONCLUSIONS

The study's outcomes have underscored a significant increase in the fQRS-T angle among BPPV patients, suggesting altered ventricular repolarization dynamics. The strong correlation between NLR and the fQRS-T angle raises intriguing possibilities of inflammation's potential role in influencing cardiac electrophysiology. The study contributes to the growing body of evidence suggesting that BPPV might have implications beyond its immediate vestibular manifestations.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Stasis dermatitis: A skin manifestation of poor prognosis in patients with heart failure

BACKGROUND

 The relationship between stasis dermatitis (SD), clinical factors, and heart failure (HF) outcomes in outpatients has not been previously assessed.

METHODS

 This observational cross-sectional study evaluated 324 patients admitted to the HF outpatient clinic. A total of 158 HF outpatients (100 males and 58 females) were enrolled in the study and were divided into two groups depending on whether they were diagnosed with SD within six months before attending the outpatient clinic. Forty-one patients (26 %) diagnosed with SD in the preceding six months were designated group 1, and 117 (74 %) not diagnosed were designated group 2.

RESULTS

 Diabetes mellitus (DM) (OR =5.473, p <0.001), chronic obstructive pulmonary disease (COPD) (OR =2.623, p =0.039), and increased systolic pulmonary artery pressure (SPAP) (OR =1.061, p =0.001) values were independently associated with SD in multivariate logistic regression analysis. During the follow-up of 12 ± 4 months, no significant difference was documented between group 1 and group 2 regarding the death ratio (17 % vs. 19 %, p =0.991). In the multivariate Cox proportional-hazards model with a stepwise forward method, the presence of SD diagnosis [hazard ratio (HR) =2.933, 95 % Confidence Interval (CI): 1.660-5.181, p <0.001] and coronary artery disease (CAD) (HR=2.492, 95%CI: 1.238-5.018, p= 0.011) remained independently associated with the risk of HF-related hospitalization.

CONCLUSION

SD was found, for the first time, to be independently associated with DM, COPD, and increased SPAP values and determined as an independent predictor for HF-related hospitalization.HIPPOKRATIA 2022, 26 (1):13-18.

Seasonal effects of the fatty acid composition of phospholipid and triacylglycerol in the muscle and liver of male Salmo trutta macrostigma

The seasonal effects on the fatty acid composition of triacylglycerol (TAG) and phospholipid (PL) in the muscle and liver of male Salmo trutta macrostigma were determined using the gas chromatographic (GC) method. The fatty acid (FA) compositions of total lipid, PL and TAG fractions were determined in muscle and liver tissues of S. trutta macrostigma. The phospholipids contained a higher proportion of 16:0 compared to the TAG in the muscle tissue of S. trutta macrostigma. Docosahexaenoic acid (22:6 ω-3) and eicosapentaenoic acid (20:5 ω-3) contents were high in both muscle and liver tissues. The total lipid contents in the muscle and liver were 1.07-2.45 and 3.00-4.64%, respectively. S. trutta macrostigma is a rich source of ω-3 and ω-6, polyunsaturated fatty acids (PUFA) with numerous benefits to human health.

Lymphocyte/mean platelet volume ratio, a new marker; is it effective in predicting the prognosis of COVID-19 cases?

OBJECTIVES

This study aims to determine the prognostic significance of the lymphocyte/mean platelet volume ratio (LMR) in terms of the clinical course of the disease in patients with COVID-19.

METHODS

Patients over 18 who were evaluated for COVID-19 during the period from April 1, to April 30, 2020 were retrospectively scanned. Patients with at least 1 positive PCR test result were as assigned to Group 1 while patients with negative test results were assigned to Group 2. The LMR ratio was calculated by dividing the lymphocyte value by that of MPV. The relationship between LMR, severity of patients' CT findings and 28-day mortality was evaluated.

RESULTS

A total of 938 patients were included in the study. It was observed that the lymphocyte and LMR levels were significantly different in those who died within 28 days (p < 0.001, p ≤ 0.001). In the ROC analysis for the LMR level, the area under the curve (AUC) was found to be 0.737 (95% CI 0.639‒0.834). When the cut‑off value of LMR was 0.045, the sensitivity was found to be 99.0 % and specificity was 15.2 %.

CONCLUSION

LMR can be a guide in multiple cases of care provided to critical patients, as is the case in the COVID-19 pandemic and can be used in recognizing critical patients (Tab. 5, Fig. 1, Ref. 21).

The evaluation of myocardial performance index in patients with COVID-19: An echocardiographic follow-up study

Funding Acknowledgements

Type of funding sources: None.

Introduction

The epidemic of pneumonia caused by a new coronavirus rapidly spread all over the world. World Health Organization called the condition as coronavirus disease 2019 (COVID-19). COVID-19 has become a life-threatening public health emergency internationally. COVID-19 mostly presents by respiratory tract symptoms including fever, dry cough, and dyspnea. The disease progression causes pneumonia and acute respiratory distress syndrome. Pathophisyology of cardiovascular effects of COVID-19 have not been well known yet. Myocardial dysfunction may occur in cytokine-originated immune reactions. Myocardial performance index (MPI) is a feasible parameter that reflects systolic and diastolic cardiac functions.

Purpose

We aimed to evaluate the MPI in patients with COVID-19.

Methods

The study consisted of 40 patients diagnosed with COVID-19 who had mild pneumonia and had not needed intensive care treatment. Transthoracic echocardiographic examination was performed in all patients at the acute stage of infection and after clinical recovery. The average time interval between the baseline and recovery echocardiography exam was about 28 ± 3,4 days. Blood samples were studied on day 0 and on days 7, 14, 21, and 28.  Immunofluorescence assay was used for COVID-19 antibody titers.  Respiratory secretions were sent for RT-PCR tests.

Results

The mean age was 54 ± 11 years ( male 26 (65% ) ). Statistically significant higher MPI (0.56 ± 0.09 versus 0.44 ± 0.07, p < 0.001), longer isovolumic relaxation time (112.3 ± 13.4 versus 91.8 ± 12.1ms, p < 0.001), longer deceleration time (182.1 ± 30.6 versus 161.5 ± 43.5ms, p = 0.003), shorter ejection time (279.6 ± 20.3 versus 298.8 ± 36.8ms, p < 0.001) and higher E/A ratio (1.53 ± 0.7 versus  1.22 ± 0.4, p < 0.001), were observed during acute period of  infection compared to ones after clinical recovery. Compared with basal values, no significant change in left ventricular systolic ejection fraction was observed after clinical recovery (60.3± 3.2% versus 61.7 ± 2.4%, p > 0.05). Isovolumic contraction time was similar at acute infection and after clinical recovery ( 44.3 ± 7.8 versus 40.6 ± 9.7ms, p > 0.05)

Conclusion

In conclusion, our study suggests global reversible LV dysfunction in COVID-19 patients with preserved LV systolic function based on tissue Doppler derived MPI. This could be due to isolated subclinical diastolic dysfunction. To our knowledge, this study is the first echocardiographic follow-up study that evaluated the systolic and diastolic function of the left ventricle in COVID -19 patients. The underlying mechanism and its clinical significance can be established by further studies.

Potantial clinical application of potassium binders in patients with chronic heart failure in real life clinical practice: results from TREAT HF study

Purpose

Hyperkalemia is increasingly prevalent and life-threatening condition in heart failure (HF). In clinical practice, hyperkalemia is also an important barrier to optimal application of RAASi. New potassium binders, sodium zirconium cyclosilicate and patiromer, were developed for the treatment of hyperkalemia. TREAT HF data were analyzed for the evaluation of potential clinical application of potassium binders in real life clinical care in HF patients.

Methods

TREAT HF is a network which undertakes multicenter, national, observational studies designed to evaluate HF patients' clinical characteristics and current treatment modalities. 1028 patients with the diagnosis of chronic HF, median age 64 years and median LVEF 30% who had potassium and GFR data were included in this analysis. In this patient population, 847 patients (82.6%) were receiving beta blockers, 739 (71.9%) were receiving ACE inhibitors or ARBs and 518 (50.4%) were receiving MRA. Patients with hyperkalemia (serum potassium ≥5.1 mEq/L) were considered candidate for potassium binders based on the criteria of HARMONIZE study. According to eGFR (mL/min) level, renal dysfunction was subclassified as: stage-1 (eGFR ≥90) (n=211), stage-2 (eGFR 60-&lt;90) (n=398), stage-3 (eGFR 30-&lt;60) (n=306) and stage 4–5 (eGFR &lt;30) (n=113).

Results

In study population, median potassium level was 4.5 mEq/L, median creatinin level was 1.1 mg/dL and median eGFR was 65.5 mL/min. Overall, 82.9% of patients had normal serum potassium levels (≥3.5–5 mEq/l) and 14.3% of patients (n=147) were found to have hyperkalemia (≥5.1 mEq/L) and, hypokalemia was found in 2.8% of patients (n=30). Hyperkalemia was present in 10.9% (n=23) of patients with stage-1, 12.6% (n=50) of patients with stage-2, 17.0% (n=52) of patients with stage-3 and 19.5% (n=22) of patients with stage 4–5 renal dysfunction. In patients with eGFR &lt;60 ml/min (n=419), hyperkalemia was much more prevalent than those with eGFR ≥60 ml/min (n=609) (17.6% and 11.9% respectively, p=0.011). In patients with stage 4–5 renal dysfunction who were receiving ACEI/ARB or combination of ACEI/ARB and MRA (RAASi), more patients had hyperkalemia than those not receiving RAASi therapy (23.4%, 20.0% and 12.5%, respectively).

Conclusions

This study suggested that in real life clinical practice, 14.3% of HF patients have hyperkalemia and seem to be eligible for the treatment of potassium binders. The risk of hyperkalemia increases with advanced stages of renal dysfunction and the use of RAASi, showing an increased clinical need for potassium binders in HF patients with renal dysfunction and in those receiving RAASi.

Funding Acknowledgement

Type of funding source: None

[Tenolysis of extensor and flexor tendons of the hand]

BACKGROUND

Unrestricted gliding of extensor and flexor tendons is essential for normal functioning of the hand. If tendon gliding is impaired, a restricted range of motion of finger joints and, finally, joint stiffness result.

OBJECTIVES

To answer the questions about the causes of tenodesis in the hand, which examinations are most informative, how tenolysis is technically performed, and what results can be expected.

METHODS

The reasons, examinations, surgical technique, and results of extensor and flexor tendon tenolysis are presented.

RESULTS

Based on the data in the literature tenolysis of flexor tendons leads to range of motion that is only 50-60% of the preoperative range of motion. In about 20% of patients, deterioration as serious as secondary tendon rupture is observed. Meaningful results of extensor tendon tenolysis have not yet been published.

CONCLUSIONS

Tenolysis of extensor and flexor tendons in the hand is a demanding surgical procedure, and in addition to detailed knowledge of anatomy and biomechanics, it requires sufficient experience-especially following the primary repair of tendon injuries. The earliest indication for tenolysis can occur at about 3 months, usually after 6 months, if continuous intensive hand therapy and splinting have not been successful. General and individual benefits and risks must be carefully weighed. The key to successful tenolysis is the patient's access to and unrestricted participation in competent postoperative treatment, ideally performed by a specialist in hand therapy, which may last for weeks or months.

Effects of trimetazidine on nerve regeneration in a rat sciatic nerve injury model

AIM

The aim of this study was to evaluate the efficacy of trimetazidine(TMZ) after end-to-end repair in a peripheral nerve injury model.

METHOD

We performed end-to-end primary repair of sciatic nerves in rats and showed TMZ's regenerative effect. For this objective 30 male Sprague Dawley albino rats were used. Surgery+water group, rats were assigned to a placebo group and were given water by oral gavage. Surgery+TMZ group, rats were given trimetazidine by oral gavage. All medications were given for 12 weeks. Motor function test was performed. Afterwards, electromyography (EMG) recording was done. Finally, blood samples were taken, the animals were euthanized andsciatic nerve was removed.

RESULTS

The amplitudes of compound muscle action potential (CMAP) increased significantly in the Surgery+TMZ group when compared with the group that have been given Surgery+Water. Nerve growth factor (NGF) immunoexpression in the Schwann cell was significantly increased in the Surgery+TMZ group compared with the Surgery+Water group. Moreover, fibrosis score was reduced in the Surgery+TMZ group compared to the Surgery+Water group.CONCLUSİONS: In conclusion, we demonstrated the superiority of TMZ on nerve healing in our experimental study which was evaluated with comparative groups (Tab. 3, Fig. 2, Ref. 31).

Deletion of TLS polymerases promotes homologous recombination in Arabidopsis

Unrepaired DNA damage hinders the maintenance of genome integrity because it blocks the catalytic activity of replicase. The stalled replication fork can be processed through either translesion synthesis (TLS) with specific polymerases, or replication using the undamaged template. To investigate how TLS activities are regulated and how the stalled replication fork is processed in plants, reversion frequencies and homologous recombination (HR) frequencies were analyzed using GUS-based substrates. The HR frequencies in plants deficient in DNA polymerase ζ (Pol ζ) or Rev1 were higher than that in wildtype plants under normal conditions, and were significantly increased by ultraviolet light irradiation. Heat shock protein (HSP) 90 is known to be involved in various stress responses. To examine the role of HSP90 in the regulation of damage tolerance, we analyzed reversion frequencies and HR frequencies in plants grown in the presence of a HSP inhibitor, geldanamycin (GDA). Reversion frequency was lower in GDA-treated plants than in mock-treated plants. Though the HR frequency was higher in GDA-treated wildtype plants than in mock-treated plants, no significant difference was detected in Rev1-deficient plants. In yeast, TLS polymerases interacted with each other or with a replication clump component, proliferating cell nuclear antigen (PCNA). HSP90 interacted with REV1 or REV7 in Nicotiana benthamiana cells. These results suggest that HSP90 interacts with TLS polymerase(s), which promotes error-prone TLS in plants.

A Rare Case of Fahr'S Disease Presenting as Epileptic Seizure in the Emergency Department

Fahr's disease (striato-pallido-dentate calcifications) is a rare neurodegenerative disorder characterised by bihemispherical and symmetrical calcium deposits in certain areas of the brain, particularly in the basal ganglia. We report an unusual case of Fahr's disease in a 36-year-old man who presented with generalised seizure in our emergency department. Basing on clinical, radiological, and endocrinological aspects, the patient was diagnosed as Fahr's disease associated with hypoparathyroidism. Administration of parenteral calcium and calcitriol supplementation were started in the emergency department. The clinical outcome was favourable after the treatment. The case illustrates that Fahr's disease, though rarely seen, has to be considered in a patient with convulsive state associated with calcifications of the basal ganglia. Systematically searching for dysparathyroidism in such patients is extremely important.

Opipramol Overdose Presented with Wide-Complex Tachycardia to the Emergency Department

Opipramol is an antidepressant and anxiolytic drug similar in structure to tricyclic antidepressants (TCAs) but it is primarily used for the treatment of generalized anxiety disorders. Unlike many TCAs, opipramol has no reuptake-inhibiting properties. Opipramol acts as a high affinity sigma receptor agonist. Opipramol acts as a low to moderate affinity antagonist for the dopamine-2 (D2), 5-hydroxtryptamine (5-HT2), histamine 1 (H1), histamine 2 (H2), and muscarinic acetylcholine receptors accounting for its antihistamine effects, and muscarinic anticholinergic properties. Here, we report a rare case of opipramol overdose case involving a 18-year-old woman, presenting to our emergency department (ED) with loss of consciousness and wide-complex tachycardia. A firm diagnosis of opipramol overdose was made on the basis of clinical, laboratory and electrocardiogram findings.

The Role of Oxidative Status in Initial Evaluation of Paediatric Patients with Graded Traumatic Brain Injury

Introduction

The purposes of this study were (a) to investigate the oxidative and antioxidative status in paediatric patients with varying severity of traumatic brain injury (TBI) during the early post-traumatic period; (b) to correlate injury severity with the oxidative and antioxidative status of patients; and (c) to identify early predictors of outcome in patients with TBI.

Methods

Fifty-two consecutive paediatric patients with isolated TBI and 31 age- and sex-matched healthy controls were enrolled. Patients were divided into two groups based on their Glasgow Coma Scale (GCS) scores recorded upon admission to the emergency department within the first 24 hours after injury. Twenty-three patients with moderate to severe TBI and 29 patients with mild TBI (GCS scores of >13) were included. The primary outcome variable was hospital mortality. Plasma total oxidant status (TOS), total antioxidant status (TAS), and the oxidative stress index (OSI) were assessed as predictors of early oxidative changes in serum using a novel automated measurement method.

Results

Compared to patients with mild TBI, TOS and OSI values were markedly elevated in patients with moderate to severe TBI. However, TAS levels did not show significant changes in either group of patients. Both GCS scores and Revised Trauma Scores were negatively correlated with the TOS and OSI, but neither was significantly correlated with the TAS. The TOS and OSI were significantly higher in non-survivors than in survivors. However, there was no significant difference in TAS levels between survivors and non-survivors.

Conclusion

Paediatric patients with isolated TBI are exposed to extensive oxidative stress, which varies with injury severity.

Critical Thinking Dispositions of Emergency Nurses in Turkey: A Cross-Sectional Study

Introduction

This cross-sectional descriptive study was conducted to determine the critical thinking dispositions of emergency nurses and any influencing factors related to critical thinking. The study is considered to respond to this need and contribute to the relevant literature.

Method

The study was conducted with the participation of 248 emergency nurses. The study data were collected using an information form covering characteristics of the nurses and the California Critical Thinking Disposition Inventory. The data were analyzed using independent-samples t test, independent-samples one-way variance analysis (F-test), and Pearson correlation test.

Results

The critical thinking dispositions of the emergency nurses in the study group were found to be at medium level (246.76±23.24). It was found that the female emergency nurses had higher levels of critical thinking dispositions than that of male nurses. The emergency nurses with graduate degrees had higher levels of critical thinking dispositions than that of the nurses with other educational levels. It was demonstrated that age, marital status, experience, or participation in in-service emergency training and certificate program did not affect the critical thinking dispositions of the nurses.

Conclusion

The results of the study reveal that the emergency nurses who are required to make quick and correct decisions. They need to develop their critical thinking skills and further studies should be conducted with more representative sample group.

Association between attitudes towards Internet usage and health practices in high-school students in 2 schools in Turkey: a cross-sectional study

Excessive usage of the Internet can negatively affect health and health practices especially among youth. To examine the issue among Turkish students, this study determined the association between high-school students' attitudes towards Internet usage and their health behaviour. The sample (n = 2043) was randomly drawn from all students at two high schools in Turkey: one in Anatolia and one (a vocational school) in Istanbul. Data were collected using the Structured Questionnaire, Attitude Scale towards Internet Usage (ASTIU) and Adolescent Lifestyle Profile (ALP). The mean age of the students was 16.3 years, 77.7% were male and 96.9% used the Internet; mean duration of Internet use was 18.8 h/week. Female students had more positive attitudes towards Internet usage. Mean scores for ASTIU and ALP were 72.58 (SD 17.64) and 111.34 (SD 16.61) respectively, which were average levels. There was a statistically significant but weak overall negative correlation between adolescents' attitudes towards Internet usage and their health behaviour. Our results concur with studies in different cultures which suggest some negative effects, of heavy Internet use.

Report of mecC-carrying MRSA in domestic swine

Objectives

We unexpectedly identified MRSA isolates carrying mecC (mecC-MRSA) from a Danish swine farm located in eastern Zealand. The objective of the present study was to investigate the origin of these isolates and their genetic relatedness to other mecC-MRSA isolates from Zealand.

Methods

WGS was used to infer the phylogenetic relationship between 19 identified mecC-MRSA isolates from the swine farm and 34 additional epidemiologically unrelated human isolates from the same geographical region of Denmark. Variations in the accessory genome were investigated by bioinformatics tools, and antibiotic susceptibility profiles were assessed by MIC determination.

Results

mecC-MRSA was isolated from a domestic swine farm, but not from cattle reared at the same farm. Phylogenetic analysis revealed that all mecC-MRSA isolates from both farm animals and workers formed a separate cluster, whereas human isolates from the same municipality belonged to a closely related cluster. Analysis of the accessory genome supported this relationship.

Conclusions

To the best of our knowledge, this is the first report of mecC-MRSA isolated from domestic swine. The investigation strongly indicates that transmission of mecC-MRSA has taken place on the swine farm between the farmers and swine. The close clustering of farm isolates and isolates from the same municipality suggests a local transmission of mecC-MRSA.

Effects of long-term exposure to 900 megahertz electromagnetic field on heart morphology and biochemistry of male adolescent rats

The pathological effects of exposure to an electromagnetic field (EMF) during adolescence may be greater than those in adulthood. We investigated the effects of exposure to 900 MHz EMF during adolescence on male adult rats. Twenty-four 21-day-old male rats were divided into three equal groups: control (Cont-Gr), sham (Shm-Gr) and EMF-exposed (EMF-Gr). EMF-Gr rats were placed in an EMF exposure cage (Plexiglas cage) for 1 h/day between postnatal days 21 and 59 and exposed to 900 MHz EMF. Shm-Gr rats were placed inside the Plexiglas cage under the same conditions and for the same duration, but were not exposed to EMF. All animals were sacrificed on postnatal day 60 and the hearts were extracted for microscopic and biochemical analyses. Biochemical analysis showed increased levels of malondialdehyde and superoxide dismutase, and reduced glutathione and catalase levels in EMF-Gr compared to Cont-Gr animals. Hematoxylin and eosin stained sections from EMF-Gr animals exhibited structural changes and capillary congestion in the myocardium. The percentage of apoptotic myocardial cells in EMF-Gr was higher than in either Shm-Gr or Cont-Gr animals. Transmission electron microscopy of myocardial cells of EMF-Gr animals showed altered structure of Z bands, decreased myofilaments and pronounced vacuolization. We found that exposure of male rats to 900 MHz EMF for 1 h/day during adolescence caused oxidative stress, which caused structural alteration of male adolescent rat heart tissue.

Influence of influenza vaccination on recurrent hospitalization in patients with heart failure

BACKGROUND

The current study aimed to evaluate the influence of regular annual influenza vaccinations on cardiovascular (CV) death and heart failure-related hospitalizations (HFrH) in stable outpatients with heart failure with reduced ejection fraction.

METHODS

The Turkish research team-HF (TREAT-HF) is a network undertaking multicenter, observational cohort studies in HF. This study is a subgroup analysis of TREAT-HF outpatient cohorts who completed a questionnaire on influenza vaccination status and for whom follow-up data were available. A total of 656 patients with available follow-up data for CV death and HFrH including recurrent hospitalization were included in the study. Patients were classified into two groups: those who received regular influenza vaccination (40 %) and those who did not receive vaccination.

RESULTS

During a mean follow-up of 15 ±6 months, 113 (18 %) patients had CV death and 471 (72 %) patients had at least one HFrH. The CV death rate was similar in both groups of patients (16 vs. 19 %, p = 0.37), whereas, HFrH and recurrent HFrH were significantly less frequently encountered in patients who received regular influenza vaccination than in those who did not receive vaccination (43 vs. 92 % and 16 vs. 66 %, p < 0.001, respectively). In a multivariate Cox proportional hazards model - in addition to a few clinical factors - vaccination status (HR = 0.30, 95 % CI = 0.17-0.51, p < 0.001) and graduation from university (HR = 0.35, 95 % CI = 0.17-0.72, p = 0.004) remained independently associated with the risk of recurrent HFrH.

CONCLUSION

Regular influenza vaccination does not influence CV deaths; however, it decreases HFrH including recurrent episodes of HFrH in outpatients with heart failure with reduced ejection fraction.

A cost effective parameter for predicting the troponin elevation in patients with carbon monoxide poisoning: red cell distribution width

OBJECTIVE

Carbon monoxide (CO) poisoning is very common worldwide. Despite the fact that CO is known to have cardiotoxic effects, as it has non-specific symptoms; cardiotoxicity could easily be overlooked, especially when troponin is not measured. The present study aimed to evaluate the association between troponin I levels and red cell distribution width (RDW) levels, which can be measured rapidly, easily, and affordably in the Emergency Room (ER).

PATIENTS AND METHODS

This single-center observational study included a total of 504 consecutive patients, who presented to the ER due to CO poisoning between January 2011 and June 2015. The diagnosis of CO poisoning was made according to the medical history and carboxyhemoglobin (COHb) level of >5%. Elevated troponin test levels, which measure >0.04 ng/ml for our laboratory, were accepted as positive.

RESULTS

Patients (mean age 37±14) were classified into two groups: those who had positive troponin levels (38%) and those that did not. Patients with positive troponin, who were older, had longer CO exposure time and higher creatinine, COHb and RDW levels at the index admission following CO poisoning than patients with negative troponin. In a multivariate logistic regression model with forward stepwise method, age, COHb level, CO exposure time, and RDW (HR=1.681, 95% CI: 1.472-1.934, p<0.001) remained associated with an increased risk of troponin positivity following adjustment for the variables that were statistically significant in the univariate analysis and correlated with RDW.

CONCLUSIONS

In patients presenting to the ER with CO poisoning, RDW can be helpful for the risk stratification of troponin positivity.

QTC Dispersion and P-Wave Dispersion during Migraine Attacks

The aim of this study was to investigate increase of QTc dispersion and P-wave dispersion during migraine attacks. Fifty-five patients (16–65 years of age, 49 women, six men) with migraine were included in our study. Heart rate, QTc interval, maximum and minimum QTc interval, QTc dispersion, maximum and minimum P-wave duration and P-wave dispersion were measured from 12-lead ECG recording during migraine attacks and pain-free periods. ECGs were transferred to a personal computer via a scanner and then used for magnification of x400 by Adobe Photoshop software. Maximum QTc interval (454 ± 24 ms vs. 429 ± 23 ms, P < 0.001), QTc interval (443 ± 26 ms vs. 408 ± 22 ms, P <0.001) and QTc dispersion (63 ± 18 ms vs. 43 ± 14 ms, P <0.001) were found significantly higher during migraine attacks compared with pain-free periods. Maximum P-wave duration (107 ± 11 ms vs. 100 ± 11 ms, P <0.001) and P-wave dispersion (45 ± 13 ms vs. 35 ± 13 ms, P <0.001) were found higher during migraine attacks than pain-free periods. We concluded that migraine attacks are associated with increased QTc and P-wave dispersion compared with pain-free periods.

Oxidase Activity of Ceruloplasmin and Some Acute Phase Reactant and Trace Element Concentrations in Serum of Patients with Chronic Lymphocytic Leukemia

In the present study, we aimed to investigate the parameters in serum of patients with chronic lymphocytic leukaemia (CLL) and correlate with the cancer stage. The serum concentrations of ceruloplasmin, a-1-acid glycoprotein, albuminumin, transferrin, copper, zinc, manganese, and ceruloplasmin oxidase activity were measured, and compared with those from a healthy control group. The serum from 34 patients with CLL were extracted before chemotherapy. Serum transferrin, albuminumin and Zinc concentrations were lower in patients with CLL while serum a-1-acid glycoprotein, ceruloplasmin, copper concentrations, and ceruloplasmin oxidase activity were higher in CLL patients when compared with the control group. Although serum manganese concentration was lower in CLL groups than in the control group, the difference was not statistically significant. Serum transferrin concentration was lower in the early stage group compared with the advanced stage. Serum ceruloplasmin level positively correlated with serum ceruloplasmin oxidase activity in patients from the early stage group. Serum ceruloplasmin level positively correlated with serum ceruloplasmin oxidase activity in patients with advanced stage. In conclusion, increased serum ceruloplasmin oxidase activity, ceruloplasmin, a-1-acid glycoprotein, copper levels and decreased transferrin and albuminumin, unchanged manganese levels are associated with CLL and appear to be a consequence of the disease itself.

The coexistence of eosinophilic esophagitis with allergic rhinitis

OBJECTIVE

Eosinophilic esophagitis (EoE) is diagnosed with the presence of characteristic esophageal symptoms and eosinophilic infiltration of the esophageal mucosa after other causes of eosinophilia are excluded. EoE has been reported to co-occur with some allergic diseases. In this study, we evaluated the co-existence of EoE in Ear-Nose-Throat (ENT) outpatient clinic patients with allergic rhinitis (AR).

PATIENTS AND METHODS

The study group consists of 67 AR patients (AR group) and the control group (CG) was formed with 53 cases with dyspepsia symptoms. Symptoms of AR and CG groups were compared in terms of endoscopic and histological findings. Moreover, in AR group, accompanying symptoms, immunoglobulin E (IgE), skin prick test (SPT) positivity, Helicobacter pylori (H. pylori) presence, endoscopic findings and biopsy results were compared between patients with EoE and those without.

RESULTS

Seven of the cases with AR were diagnosed with EoE. Reflux symptoms were more common in patients with EoE (71.4%). The presence of H. pylori was similar between groups. Blood IgE levels were significantly higher among EoE patients compared to those without EoE (p = 0.003). SPT positivity was present in the 85.7% of patients with EoE and 50% of the patients without EoE (p = 0.113). Allergens were more likely to be mites Dermatophagoides farinae and Dermatophagoides pteronyssinus in patients with EoE (p = 0.042 and p = 0.034 respectively).

CONCLUSIONS

The most common symptom among patients with EoE is reflux. In AR patients with EoE, serum IgE levels were higher compared to those without EoE. In AR patients with reflux symptoms, high serum IgE levels, and especially in patients whose tests are positive for allergy to mites, referral to a gastroenterologist for EoE evaluation may be recommended.

Evaluation of the effect of selective serotonin reuptake inhibitors on bone mineral density: an observational cross-sectional study

Sixty patients diagnosed with generalized anxiety disorder and treated with either paroxetine, sertraline, or citalopram for at least 12 months were enrolled in this study, and the bone mineral density (BMD) of the patients was compared with that of 40 healthy volunteers. Selective serotonin reuptake inhibitor (SSRI) therapy in generalized anxiety disorder was found to be related with decreased BMD values.

INTRODUCTION

The objectives of this study were to evaluate the effect of SSRI therapy on BMD in postmenopausal women diagnosed with generalized anxiety disorder (GAD) and to identify the effects of the duration of disease and treatment on risk factors for osteoporosis.

METHODS

Sixty patients diagnosed with GAD and treated with paroxetine, sertraline, or citalopram from the SSRI group for at least 12 months were enrolled. Social demographic features, the Hamilton Anxiety Scale (HAS) results, and the Hamilton Depression Scale (HDS) scores of all the patients were assessed. The BMD of the patients was measured by dual-energy X-ray absorptiometry (DXA) at the femoral and lumbar regions. The patients were divided into three groups which are the paroxetine, sertraline, and citalopram groups. The BMD of the patients was compared with that of 40 healthy volunteers.

RESULTS

The L2-L4, total lumbar vertebrae, femoral intertrochanteric, total femoral Z-scores, and femoral Ward's region T-scores of the treatment group were lower than the median T- and Z-scores of the control group (p < 0.05). Of the treatment groups, the femoral neck, trochanteric and intertrochanteric T- and Z-scores, total femoral T- and Z-scores, and femoral Ward's T- and Z-scores of the sertraline group were significantly lower than the BMD values measured at the identical regions in the paroxetine and citalopram groups (p < 0.05).There was a significant negative correlation between the duration of treatment and the BMD values.

CONCLUSION

SSRI therapy in GAD was found to be related with decreased BMD values. Further randomized controlled studies are warranted to determine whether SSRI use is a risk factor for osteoporosis; such studies should investigate these factors by performing BMD assessments before treatment.

Prognostic factors influencing survival in 35 patients with malignant peritoneal mesothelioma

Malignant mesothelioma is a rare but highly lethal form of cancer that affects the serosal membranes. Malignant peritoneal mesothelioma (MPM) is the second most common form of malignant mesothelioma (pleural mesothelioma is the most common). The aim of this study was to evaluate prognostic factors influencing the survival of patients with MPM. A retrospective analysis was performed on 35 patients who were admitted to our hospital between March 2005 and July 2013. The patients' demographic and clinical data, laboratory results, radiological signs, Eastern Cooperative Oncology Group (ECOG) performance status (PS), and treatment outcomes were evaluated. The mean age of the 35 patients was 59.0±14.4 years, the mean survival time was 16.2±12.9 months, and the majority of the histopathological types of MPM were epithelial (68.6%). 82.9% of the patients had been exposed to asbestos, and the mean duration of exposure was 28.3±14.5 years. The most frequent symptoms were abdominal distention/pain, weight loss, dyspnea, and chest pain. The mean interval between the onset of symptoms and the diagnosis was 4.6±3.3 months. Platinum-based combination chemotherapy in combination with supportive care was used in the treatment of 68.6% of the patients, while supportive treatment alone was used in the others. Our results revealed that patients who were >60 years old (p=0.019), who were exposed to asbestos >20 years (p=0.033), who had an ECOG PS of 3 (p=0.000) were more likely to have a poor MPM prognosis.In conclusion, increased age, duration of environmental asbestos exposure and ECOG PS are important factors that influence the prognosis of MPM patients.

Pathological effects of prenatal exposure to a 900 MHz electromagnetic field on the 21-day-old male rat kidney

We investigated the effects on kidney tissue of 900 megahertz (MHz) EMF applied during the prenatal period. Pregnant rats were exposed to 900 MHz EMF, 1 h/day, on days 13-21 of pregnancy; no procedure was performed on control group pregnant rats or on mothers or newborns after birth. On postnatal day 21, kidney tissues of male rat pups from both groups were examined by light and electron microscopy. Malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT) and glutathione levels also were investigated. Light microscopy revealed some degenerative changes in the tubule epithelium, small cystic formations in the primitive tubules and large cysts in the cortico-medullary or medullary regions in the experimental group. Electron microscopy revealed a loss of peritubular capillaries and atypical parietal layer epithelial cells in the experimental group. Biochemical analysis showed significantly increased MDA levels in the experimental group and decreased SOD and CAT levels. EMF applied during the prenatal period can caused pathological changes in kidney tissue in 21-day-old male rats owing to oxidative stress and decreased antioxidant enzyme levels.

Effects of coronary artery bypass grafting surgery on retinal vascular caliber, ocular pulse amplitude and retinal thickness measurements

Aim:

The retina and ocular vasculature are vulnerable to alterations in systemic hemodynamics, such as in open heart surgeries. Our aim was to investigate retinal vascular caliber (RVC), ocular pulse amplitude (OPA), peripapillary retinal nerve fiber layer (RNFL) and macular thickness in coronary artery bypass grafting (CABG) surgery patients.

Methods:

Twenty-six patients who had a history of CABG surgery and 26 age-sex-matched healthy participants were recruited for this prospective, cross-sectional and comparative study. The RVC, peripapillary RNFL and macular thickness measurements were taken with spectral-domain optical coherence tomography. The OPA, a surrogate of pulsatile ocular blood flow, was measured with the Pascal dynamic contour tonometer.

Results:

There were no statistically significant differences between the CABG surgery patients and the controls with regard to RVC, OPA, peripapillary RNFL thickness and macular thickness measurements (p>0.05).

Conclusions:

CABG surgery does not affect retinal structures and pulsatile ocular blood flow in the long-term follow-up.

The impact of the duration of admission to the emergency room on the mortality of intensive care patients

OBJECTIVE

There are many factors affecting the mortality of patients admitted to the intensive care unit (ICU). Among these are the patients' age, diagnosis, and concomitant pathology. The aim of this retrospective study was to investigate whether there is an adverse effect of the time between admission to the Emergency Room (ER) and admission to the ICU on the mortality of these patients.

MATERIALS AND METHODS

The medical records of the patients who were admitted to the Emergency Department (ED) of the Bolu Izzet Baysal State Hospital and subsequently were admitted to the ICU between December 2009 and August 2011 were analyzed in terms of the time of admission, the season of admission, and the waiting and the stand-by times in the ER.

RESULTS

A total of 2380 patients, who were admitted to the ED of the Bolu Izzet Baysal State Hospital and subsequently to the ICU, were included in the study. The median waiting time in the ER was 1.23 h (10 min to 10.02 h). After completion of the admission procedures, the median hospitalization time in the ER was 0.16 h (3 min to 2.58 h). There was no statistically significant difference between the patients who died after admission to the ICU and the ones who survived, in terms of the waiting and the stand-by times in the ER ( P > 0.05).

CONCLUSION

The waiting times at the ED did not affect the mortality of the ICU patients.

Three-dimensional transesophageal echocardiographic evaluation of cor triatriatum in adults

We present the cases of two adult patients with cor triatriatum due to left atrial membrane with atrioventricular septal defect and right atrial membrane. Two-dimensional and real-time three-dimensional transthoracic echocardiography were performed. These noninvasive modalities provided a comprehensive anatomic and hemodynamic evaluation of the anomaly.