Crocus heuffelianus-A New Species for the Bulgarian Flora from Series Verni (Iridaceae)

In the Pirin Mountains, at an elevation of around 1000 m, three populations of a new species of Bulgarian flora from the genus Crocus, series Verni, were discovered. The species was compared to the morphologically related C. veluchensis, and presented with diagnostic morphological and anatomical features. Despite the high degree of morphological similarity, the molecular analysis, which included sequences from all related species (C. cvijicii, C. dalmaticus, C. jablanicensis, C. rujanensis, C. sieberi subsp. atticus, and C. veluchensis), distinguished the Pirin Mountains' populations, and revealed the closest relationship to C. heuffelianus. Despite the C. heuffelianus/C. verni complex's uncertain taxonomic status, our findings on the local population, based on morphometric, anatomical, molecular, and geographic analyses, indicate its belonging to the putative allotetraploid C. heuffelianus of south-eastern Europe and the Balkans, and an expansion of its range to the southeast. Given the taxonomic uncertainty and unclear phylogenetic relationships of the taxa in the Crocus vernus complex, we considered it appropriate to accept our taxon as Crocus heuffelianus. So far, only C. tommasinianus Herb. has been found in Bulgarian flora from the Crocus series Verni, but in terms of altitude and morphological features, the species from our collection is close to the Balkan endemic C. veluchensis, which belongs to the C. sieberi aggregate. Morphologically, it differs by the dark, heart-shaped spots on the tip of the tepals, and the presence of one bract. A detailed comparative anatomical analysis between the three species of crocuses from the series Verni in Bulgaria shows discrete differences: the width of the white stripe and lacunar area are good distinguishing features, as are the number of conducting vessels.

Crocus speciosus (Iridaceae)-A New Species for the Bulgarian Flora

This is the first report on the autumn-flowering species Crocus speciosus, belonging to C. ser. Speciosi from the Bulgarian flora. The species was found in Southeastern Bulgaria, in the area between Ahtopol and Rezovo. Re-examining the Bulgarian collections, the earliest specimen was collected in 1975, was probably overlooked, and most likely determined as C. pulchellus. The nearest known localities of the species are on the territory of Türkiye. In this study, we compared C. pulchellus and C. ibrahimii using DNA sequence data from the nuclear ITS1/2 region and morphological features. Our study showed a close relationship between the specimens from Bulgaria and the recently deposited data of C. speciosus and their separation from the closely related C. pulchellus. Together with the previously cited white anthers as a key feature for determination, the molecular data confirmed a clear distinction between the samples with white anthers in the two species. The morphological data of our taxon overlapped with the description of C. ibrahimii. The molecular data strongly supported the affiliation of C. speciosus s.l., but did not support the recognition of C. ibrahimii as a separate species and it should be referred to as a subspecies of C. speciosus subsp. ibrahimii Rukšāns.

Crocus pallidus (Iridaceae)—A Neglected Species for the Bulgarian Flora and Critical Taxon in the Balkans

For a long time, the Balkan endemic species Crocus pallidus has been unconfirmed and neglected for the flora of Bulgaria. It has remained an uncertain species from the Balkans, often listed as a synonym of C. weldenii. The morphological resemblance to the albinistic forms of C. chrysanthus has led to incorrect identification in the past, resulting in uncertainty regarding the distribution of this species in Bulgaria. In this regard, a detailed morphological and anatomical study of Bulgarian natural populations was carried out. A phylogenetic comparison in the ITS region of two Bulgarian populations of C. pallidus with other related species was conducted, revealing the distinction of C. pallidus populations from the closely related C. weldenii. The recently described new endemic species from Turkey, C. thracicus, shows very similar morphological and anatomical characteristics to C. pallidus and logically continues the distribution range in Eastern Thrace, along the Black Sea coast. We have a basis for suggesting that it should be treated as a synonym of C. pallidus.

Comparison of the analytical performance of the PATHFAST high sensitivity cardiac troponin I using fresh whole blood vs. fresh plasma samples

OBJECTIVES

The PATHFAST hs-cTnI (high-sensitivity cardiac troponin) assay is the first point-of-care assay with a high-sensitivity designation that received FDA approval for diagnosis of myocardial infarction (MI). Testing from whole blood does not need centrifugation and therefore is faster and more convenient in the emergency room instead of plasma. However, there is sparse evidence whether point-of-care testing of Tn from whole blood is as reliable as from plasma samples.

METHODS

We investigated the agreement between plasma and whole blood hs-cTnI by using the PATHFAST hs-cTnI assay. Hs-cTnT measured on Cobas 602 in the central laboratory and compared to a final diagnosis of NSTEMI using serial hs-cTnT served as reference. We assessed biases, limits of agreement (±1.96 SD) and coefficients of correlation, and tested the discriminatory ability of the baseline sample of plasma and whole blood hs-cTnI and plasma hs-cTnT to discriminate non-ST-segment elevation myocardial infarction (NSTEMI).

RESULTS

A total of 224 paired fresh samples were collected simultaneously from 191 patients presenting with suspected acute coronary syndrome. There was an excellent correlation between plasma and whole blood hs-cTnI (r=0.99), and a very good inter-rater agreement (k=0.93) between elevated and normal plasma and whole blood results. Precision evaluation according to CLSI ep 15 revealed comparable coefficients of variation (CV) in whole blood and plasma. The discriminatory ability of baseline hs-cTnT, plasma and whole blood hs-cTnI was excellent (AUC 0.967, AUC 0.954 and AUC 0.953) without significant difference.

CONCLUSIONS

Whole blood can be used interchangeably with plasma for more convenient and less time and labor-consuming testing of hs-cTnI on the PATHFAST instrument.

Interpretation of myocardial injury subtypes in COVID-19 disease per fourth version of Universal Definition of Myocardial Infarction

BACKGROUND

Application of the 4th version of Universal Definition of Myocardial Infarction (UDMI) to characterize rates and prognostic relevance of myocardial injury in COVID-19 disease.

METHODS

This retrospective, single-centre observational study enrolled 104 patients hospitalized with SARS-CoV-2 infection. Kaplan-Meier analysis and multivariate Cox regression were used to identify influence of acute or chronic myocardial injury on a composite primary (mortality, incident acute respiratory distress syndrome, incident mechanical ventilation) and secondary endpoint (mortality, incident acute myocardial injury during hospitalization, incident venous thrombosis, pulmonary embolism or stroke).

RESULTS

A total of 27 (26.0%) patients presented with chronic myocardial injury, and 19 (18.3%) with acute myocardial injury. 42 patients(40.4%) developed an incident myocardial injury during hospitalization. The presence of acute or chronic myocardial injury on admission and incident myocardial injury during hospitalization were associated with higher rates of endpoints. Independent predictors for the primary endpoint were higher severity stages according to Siddiqi et al. classification system and history of dyslipidaemia. Maximal hs-cTnT and D-dimer concentrations during hospitalization showed an association (r = 0.61).

CONCLUSIONS

Objective description of myocardial injury according to the 4th UDMI in the current COVID-19 pandemic is crucial in order to discriminate patients with acute myocardial infarction and acute, chronic or incident myocardial injury.

Comparative accuracy of NT-proBNP and MR-proANP for the diagnosis of acute heart failure in dyspnoeic patients

AIMS

To compare the performance of the natriuretic peptides (NPs) NT-proBNP and MR-proANP for the diagnosis of acute heart failure (AHF) in subsets of conditions potentially confounding the interpretation of NPs.

METHODS AND RESULTS

We studied 312 patients, presenting to the emergency department with new onset of dyspnoea or worsening of chronic dyspnoea within the last 2 weeks. Performance of NPs for the diagnosis of AHF was tested and compared using C-statistics in the entire cohort and in conditions previously described to confound interpretation of NPs such as older age, renal failure, obesity, atrial fibrillation or paced rhythm, and in the NT-proBNP grey zone. AHF was diagnosed in 139 patients. In the entire cohort, the diagnostic performance of NT-proBNP was comparable with that of MR-proANP. Receiver operating characteristic analysis demonstrated that optimal diagnostic cut-offs were higher in the presence of older age, kidney failure or rhythm disorder. However, there were no statistically relevant differences between the receiver operating characteristic curves analysed in the total population and those studied in the pre-specified subsets severe kidney failure, advanced age, obesity, atrial fibrillation and paced rhythm, and grey zone NT-proBNP values. Moreover, the diagnostic performance of NT-proBNP was comparable with that of MR-proANP in the subsets.

CONCLUSIONS

The performance of NT-proBNP and MR-proANP for AHF is comparable in the total population as well as in the subsets with potentially confounding characteristics such as older age, renal dysfunction, obesity, atrial fibrillation and paced rhythm, or those with NT-proBNP values in the grey zone.

New method and device for assessment of functional capacity of upper extremity with chronic ischemia

BACKGROUND

The aim of this study is to establish an objective diagnostic method, through which the functional capacity of the upper extremity with chronic ischemia could be best assessed.

METHODS

For a 9-year period (1986-1994) 74 patients suffering Arterial Occlusive Disease (AOD) of the upper extremity with chronic ischemia were treated. Fifty five of them (74.3%) were males (an average age of 52.4 years) and 19 females (25.6%), (an average age of 42.5 years). Forty nine of them (66.2%) were in second stage according to the adapted Fontain's classification. An original method and device have been established for the investigation of the abilities of the upper extremity to make repeated movements till they get an intermittent claudication. The apparatus consists of tree modules: a mechanical device, an interface adapter and a microcomputer.

RESULTS

During the flexion of the fingers the patient overcomes the resistance of springs which is 1.82 Nm. An Ischemic Fatigue Index (IFI) is calculated--it gives the quantitative value of the functional capacity of the limb. IFI in patients in second stage of Chronic Arterial Ischemia (CAI) is from 0.14 to 0.76 during the diagnostic test and from 0.18 to 1.0 after the operative or drug treatment or Percutaneous Transluminal Angioplasty (PTA). A retrospective analysis shows that in patients who were operated on, the preoperative IFI was less than 0.50. The measurement of Arm-Arm Blood Pressure Index (AABPI) before treatment and after it in some cases shows normal values in spite of the presence of subclavian artery stenoses. The angiographies that were done could not help for the evaluation of the functional capacity of the upper extremities. The presence of pulse in 9 patients (18.4%) does not exclude a presence of occlusion.

CONCLUSIONS

IFI is a quantitative indicator for the upper extremity capacity. It shows whether the symptoms are severe enough to justify the surgery. The periodical measurement of IFI is a monitoring of the development of AOD.