Short-term effects of fibrinolytic therapy on the hemodynamic parameters of patients with intermediate- and high-risk pulmonary embolism

Objective@#We aimed to determine the effect of fibrinolytic therapy on hemodynamic parameters at 4 hours after treatment and bleeding complications in patients with intermediate- and high-risk pulmonary embolism. @*Methods@#This single-center, retrospective, cohort study included patients with intermediate- and high-risk pulmonary embolism treated with fibrinolytics. Their demographic and clinical characteristics, complications, and vital signs at the initiation of and 4 hours after fibrinolytic therapy were evaluated. The primary outcome was the change in the patients’ vital signs at 4 hours after fibrinolytic therapy, compared by the Mann-Whitney U-test. @*Results@#Seventy-nine patients were included in this study. The systolic and diastolic blood pressures of the high-risk group at 4 hours after fibrinolytic therapy were higher than those at the initiation of fibrinolytic therapy (80 mmHg vs. 99 mmHg, P = 0.029; 49 mmHg vs. 67 mmHg, P = 0.011, respectively). In the intermediate-risk group, the oxygen saturation increased (94% vs. 96%, P = 0.004) and pulse rate decreased (104 beats/min vs. 91 beats/min, P < 0.001). @*Conclusion@#Blood pressure at 4 hours after fibrinolytic therapy increased in patients with high-risk pulmonary embolism. Also, oxygen saturation and pulse rate improved in intermediate-risk patients.

Gait speed as a functional capacity indicator in patients with chronic obstructive pulmonary disease

Walking distance is generally accepted as a functional capacity determinant in chronic obstructive pulmonary disease [COPD]. However, the use of gait speed in COPD patients has not been directly investigated. Thus, the aim of our study was to assess the use of gait speed as a functional capacity indicator in COPD patients. A total 511 patients with mild-to-very severe COPD and 113 healthy controls were included. The lung functions [pulmonary function test], general health- and disease-related quality of life [Medical Outcomes Study 36-Item Short-Form of Health Survey, St George's Respiratory Questionnaire], and gait speed [6-minute walk test] were assessed. The mean gait speed values were slower in moderate [75.7 +/- 14.0 m/min], severe [64.3 +/- 16.5 m/min], and very severe [60.2 +/- 15.5 m/min] COPD patients than controls [81.3 +/- 14.3 m/min]. There were significant correlations between gait speed and age, dyspnea-leg fatigue severities, pulmonary function test results [FEV [1], FVC, FVC%, FEV[1] /FVC ratio, PEF, PEF%], and all subscores of Medical Outcomes Study 36-Item Short-Form of Health Survey and activity, impact and total subscores of St George's Respiratory Questionnaire in patients with moderate, severe, and very severe COPD. However, these correlations were higher especially in patients with severe and very severe COPD. As a conclusion, according to our results gait speed slows down with increasing COPD severity. Also, gait speed has correlations with age, clinical symptoms, pulmonary functions, and quality of life scores in COPD patients. Thus, we consider that gait speed might be used as a functional capacity indicator, especially for patients with severe and very severe COPD

Age- and body mass index-dependent relationship between correction of iron deficiency anemia and insulin resistance in non-diabetic premenopausal women

No prospective studies have evaluated the effects of correction of iron deficiency anemia on insulin resistance in non-diabetic premenopausal women. We investigated this relationship in 54 non-diabetic premenopausal women with iron deficiency anemia. All patients were treated with oral iron preparations. Insulin resistance was calculated with the Homeostasis Model Assessment formula. All patients were dichotomized by the median for age and BMI to assess how the relationship between iron deficiency anemia and insulin resistance was affected by age and BMI. Although the fasting glucose levels did not change meaningfully, statistically significant decreases were found in fasting insulin levels following anemia treatment both in the younger age [<40 years] [P=0.040] women and in the low BMI [<27 kg/m[2]] [P=0.022] subgroups but not in the older age [>/=40 years] and the high BMI [>/=27 kg/m2] subgroups. Post-treatment fasting insulin levels were positively correlated both with BMI [r=0.386, P=0.004] and post-treatment hemoglobin levels [r=0.285, P=0.036]. Regression analysis revealed that the factors affecting post-treatment insulin levels were BMI [p=0.001] and post-treatment hemoglobin levels [P=0.030]. Our results show that following the correction of iron deficiency anemia, insulin levels and HOMA scores decrease in younger and lean non-diabetic premenopausal women