Protective effect of magnesium preloading on cisplatin-induced nephrotoxicity: which dose is more suitable?

OBJECTIVE: Cisplatin is a widely used and potent cytotoxic chemotherapy agent, but its nephrotoxicity is a significant limiting side effect. Various premedication approaches have been implemented to preserve renal function, including magnesium (Mg) preloading. However, the optimal Mg dosage is still unknown. Our study aimed to assess the protective effects of different Mg doses as premedication in cisplatin-based chemoradiotherapy for patients with local/locally advanced cervical and head-neck cancers. PATIENTS AND METHODS: This retrospective, multicenter study involved premedication with saline infusion containing potassium chloride and magnesium sulfate (MgSO4) for all patients before cisplatin treatment. Patients were divided into two groups: 12 mEq MgSO4 (low-dose Mg preload group, low-Mg) and 24 mEq MgSO4 (high-dose Mg preload group, high-Mg). Renal function was evaluated using serum creatinine (sCr, mg/dl) and estimated glomerular filtration rate (eGFR, ml/min). Acute kidney injury (AKI) was defined per the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Renal outcomes and efficacy were compared between the groups. RESULTS: In the low-Mg group (n = 159), sCr levels were significantly higher compared to baseline, various weeks during treatment, and at the 1st, 3rd, 6th, and 12th months post-treatment (p < 0.001). In the high-Mg group (n = 128), no significant changes were observed during treatment and at 1st, 3rd, and 12th months post-treatment (p > 0.05). A significant reduction in mean sCr level from baseline to 6 months was noted in the high-Mg group (p < 0.001). eGFR values are generally correlated with sCr levels. AKI occurred in 21 (13.2%) and 22 (17.7%) patients in the low-Mg and high-Mg groups, respectively (p = 0.292). There was no difference in progression-free or overall survival between the groups. CONCLUSIONS: We clearly demonstrated that saline hydration with 24 mEql MgSO4 supplementation before cisplatin treatment has a better renal protective effect than 12 mEql MgSO4 without reducing efficacy, especially in patients with local/local advanced cervical and head-neck cancer receiving cisplatin with concurrent radiotherapy.

Atherogenic index of plasma and triglyceride-glucose index to predict more advanced coronary artery diseases in patients with the first diagnosis of acute coronary syndrome.

OBJECTIVE: Coronary heart disease (CHD) is the most common cause of mortality and morbidity. Acute coronary syndrome (ACS) is the most advanced form of the CHD spectrum. The triglyceride-glucose index (TGI) and atherogenic plasma index (AIP) are associated with future cardiovascular events. This study investigated the association of these parameters with the severity of CAD and prognosis in the first-diagnosed ACS patients. PATIENTS AND METHODS: Our study was designed retrospectively, including 558 patients. Patients were divided into four subgroups: high and low TGI and high and low AIP. SYNTAX scores, in-hospital mortality, major adverse cardiac events (MACE), and survival were compared at 12-month follow-up. RESULTS: More three-vessel disease and higher SYNTAX scores have been detected in the high AIP and TGI groups. More MACEs have been observed in high AIP and TGI groups than low groups. AIP and TGI were found to be independent predictors for SYNTAX ≥23. While AIP has been found to be an independent risk factor for MACE, TGI has not been detected as an independent risk factor. In addition to AIP, age, three-vessel disease, and lower EF were the independent risk factors for MACE. Survival was lower in high TGP and AIP groups. CONCLUSIONS: AIP and TGI are costless bedside parameters that can be easily calculated. These parameters can predict the severity of CAD in first-diagnosed ACS patients. Besides, AIP is an independent risk factor for MACE. AIP and TGI parameters can guide our treatment in this patient population.

Assessment of systemic immune-inflammation index as an independent surrogate biomarker of no-reflow phenomenon in acute coronary syndrome patients with coronary artery bypass grafting undergoing percutaneous coronary intervention of saphenous vein graft.

OBJECTIVE: Numerous mechanisms have been proposed for the no-reflow phenomenon (NRP) in the literature including leukocyte intravascular plugging, microembolisms, and extrinsic coagulation pathway activation. Some of the more recent studies suggested a relationship between NRP and systemic immune-inflammation index (SII) in different contexts. To this end, the objective of this study was to investigate the relationship between NRP and SII in acute coronary syndrome (ACS) patients with coronary artery bypass grafting (CABG) who underwent percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI) of saphenous vein graft (SVG). PATIENTS AND METHODS: The sample of this retrospective study consisted of 124 ACS patients with CABG who underwent PTCA/PCI of SVG. RESULTS: The incidence of NRP in the study group was 30.6% (n=38). The results of the multivariate logistic regression analysis indicated that ST-elevation myocardial infarction (STEMI) and SII were independent predictors for NRP (p<0.05). The receiver operating characteristic (ROC) curve analysis revealed that the optimal cut-off value of SII in predicting the development of NRP in patients undergoing PTCA/PCI of SVG and the sensitivity and specificity values thereof are 975, 74%, and 80%, respectively [Area under the curve (AUC): 0.84, 95% confidence interval (CI): 0.76-0.91, p-value <0.001]. CONCLUSIONS: The study findings indicated that SII, which can be easily calculated from a single complete blood count test, is an independent predictor of the development of NRP in ACS patients undergoing PTCA/PCI of the SVG.

COVID-19 survivors may exhibit deterioration in frontal plane QRS-T angle and other electrocardiogram parameters.

OBJECTIVE: COVID-19 infection is known to injure myocardial tissue and increase arrhythmic events. However, data on the subject is limited in the literature. In our study, our aim was to investigate possible arrhythmic damages in COVID-19 survivors using the frontal plane QRS-T [f(QRS)-T] angle and a few other ECG parameters. PATIENTS AND METHODS: 269 patients who recovered from COVID-19 between April 2020 and January 2021 were included into the study. Pre-admission electrocardiograms and first-month outpatient clinic control ECGs of the patients were compared. RESULTS: After COVID-19, left bundle branch block (p<0.001), right bundle branch block (p<0.001), right bundle branch block (p<0.001), and atrial fibrillation (p<0.001) rates had increased. Prolongation was detected in QRS duration (p<0.001), QT interval (p=0.014), adjusted QT interval (p=0.007) and Tpe interval (p=0.012). F(QRS)-T angle (p<0.001) and fragmented QRS rate (p<0.001) were increased. CONCLUSIONS: It was observed in our study that even if patients survived COVID-19, permanent deterioration in ECG parameters may occur.

Effects of caffeic acid phenethyl ester on cisplatin ototoxicity.

PURPOSE: To report histological and electrophysiological data in rats treated with cisplatin and caffeic acid phenethyl ester. METHODS: We randomly divided 28 Wistar rats into four groups of seven, to be treated as follows: control (saline), cisplatin, CAPE and cisplatin-CAPE. Distortion product otoacoustic emission (DPOAE) measurements were performed on day one (before drug administration) and day five under anaesthesia. All animals were killed under general anaesthesia on day five after the DPOAE measurement. The cochleae of each rat were histopathologically and immunohistochemically evaluated. RESULTS: The outer hair cells were mostly preserved in the control and CAPE groups. Moderate-to-severe and mild-to-moderate hair cell losses were detected in the cisplatin and cisplatin-CAPE groups, respectively. DPOAE assessments revealed significant deterioration in the cisplatin group (P < 0.05). The difference between the cisplatin and cisplatin-CAPE groups was statistically significant (P < 0.05). CONCLUSION: CAPE prevents cisplatin ototoxicity.

The investigation of the prognostic value of mean platelet volume in patients with sudden hearing loss.

OBJECTIVE: The study was aimed to observe the changes in mean platelet volume in patients with sudden hearing loss, taking the close relationship of vascular reasons and sudden hearing loss into account. MATERIALS AND METHODS: Patients who were admitted and treated with sudden hearing loss in the study. The control group was made up of healthy people. The hemoglobin values, mean platelet volumes, platelet counts of the groups were recorded. RESULTS: Forty sixth patients in the sudden hearing loss group and 45 patients in the control group were evaluated. No statistically significant difference between the two groups regarding mean platelet volume values and platelet counts were found. There was also no significant difference between the high mean platelet volumes and hearing loss levels. CONCLUSIONS: We think it would be beneficial to examine the mean platelet volume values in further studies with more patient series on patients with sudden hearing loss.

Relationship between hearing loss and sexual dysfunction.

OBJECTIVE: Deafness may be one of the factors that leads to a change in sexual function. This study aimed to assess sexual function, in particular erectile dysfunction, in male patients with hearing loss. MATERIALS AND METHODS: We studied two groups: (1) adult men with acquired, bilateral, sensorineural hearing loss, and (2) healthy, adult, married men demonstrated to have normal hearing levels, as the control group. Sexual function was assessed using the International Index of Erectile Functions questionnaire, and quality of life using the 36-Item Short-Form Health Survey. RESULTS: There was a statistically significant difference between the groups regarding the International Index of Erectile Functions questionnaire results (p <0.001), both for each of the five questionnaire domain scores and for the total score. CONCLUSION: Our results indicate that men with mild or moderate sensorineural hearing loss have poorer sexual health.

Intratympanic methylprednisolone injections for subjective tinnitus.

OBJECTIVES: This study aimed to determine whether intratympanically injected methylprednisolone is effective in treating subjective tinnitus refractory to medical treatment. STUDY DESIGN: Prospective, randomised, placebo-controlled, single-blinded study. METHODS: Seventy adult patients with subjective tinnitus of cochlear origin were randomly assigned to receive intratympanic injection of either methylprednisolone or saline solution. The treatment protocol comprised three intratympanic injections, one per week for three weeks. Improvement in tinnitus severity was measured by a self-rated tinnitus loudness scale and by the tinnitus severity index, at baseline and two weeks after the last injection. RESULTS: Data for 59 patients were available for analysis. There was no significant difference between the two treatment groups regarding age, sex, pure tone average, pretreatment tinnitus intensity, tinnitus laterality or tinnitus duration. There was a significant post-treatment improvement in self-rated tinnitus loudness scale results in both groups. No significant post-treatment changes in the tinnitus severity index individual and total scores were observed in either group. The most frequently encountered side effects were pain during injection, vertigo, a burning sensation around the ear and in the throat, and a bitter taste. A burning sensation and bitter taste were observed more often in the methylprednisolone group compared with the placebo group. CONCLUSION: The results of this study indicate that intratympanic methylprednisolone has no benefit, compared with placebo, for the treatment of subjective tinnitus of cochlear origin refractory to medical treatment.

The role of asymmetric dimethylarginine (ADMA) and leptin in hypertensive patients.

We investigated the role of leptin and asymmetric dimethylarginine (ADMA) in uncomplicated hypertension. We also investigated their relationship with insulin resistance and serum levels of several metabolic parameters, including homocysteine, lipoprotein(a) and malondialdehyde (MDA). A total of 34 untreated newly-diagnosed hypertensive patients (seven men and 27 women; mean age, 57.4 +/- 10.1 years) and 38 normotensive healthy subjects (20 men and 18 women; mean age, 55.9 +/- 8.7 years) were studied prospectively. Serum leptin, homocysteine, lipoprotein(a), MDA and insulin resistance (HOMA-IR) were significantly higher in hypertensive patients compared with normotensive subjects. There were no significant differences in ADMA, insulin-like growth factor-1 and insulin-like growth factor binding protein-3 between the two groups. No correlation was found between serum ADMA and leptin levels. Our findings suggest that high serum leptin and homocysteine levels, oxidative stress and insulin resistance may be important risk factors for atherosclerosis among patients with uncomplicated hypertension.

The relationship between dieting and body image, body ideal, self-perception, and body mass index in Turkish adolescents.

OBJECTIVE: The current study examined the roles of body image, ideal body weight, self-perception, and body mass index (BMI) on the dieting behavior of Turkish adolescents. METHOD: The 531 subjects who participated in the study ranged from 15 to 17 years old and were recruited from five selected high schools in Ankara. They completed the Self-Perception Profile for Adolescents (SPPA), the Body Image Satisfaction Questionnaire (BISQ), and the Dieting Status Measure (DiSM). Height and weight were measured. RESULTS: Dieting adolescents received significantly lower scores than nondieters for most of the BISQ items and for the physical appearance and global self-worth subscales of the SPPA. A thinner body ideal, the physical appearance domain of self-concept, and low global self-worth were the predicting factors of frequent dieting. However, BMI and body image dissatisfaction were not predicting factors. DISCUSSION: The results indicate that a thinner body ideal, low self-worth, and low physical self-concept have more significant effects on body dissatisfaction and dieting than being actually overweight does. Furthermore, high physical self-concept scores and body satisfaction may not necessarily preclude having a thinner body ideal and, hence, dieting in girls.

[Is there any correlation between self-perception and psychopathology in adolescence?]. / Ergenlerde kendilik algisi ile psikopatoloji arasinda baginti var mi?

OBJECTIVE: In this study, the relation between self-perception and psychopathology is examined trying to answer the question of whether the self-perception profiles of the adolescents who have admitted to an outpatient unit of a psychiatry clinic are different from those of the adolescents who have not. METHOD: The study is a cross-sectional controlled study. There are two groups one of which is the group of adolescents who have admitted to the outpatient adolescent clinic of the Social Security Hospital of Ankara and the other is the control group. Self-Perception Profile for Adolescents (SPPA) and SCL-90-R were administered to the groups. DSM-IV diagnoses were made by two clinicians via interviews with adolescents. The differences in the domains of SPPA between two groups were assessed via multivariate and then univariate analysis. RESULTS AND CONCLUSION: In the domains of SPPA, the global self-worth and the behavior in the relationships, the adolescent group who has admitted to the psychiatry clinic was found to be significantly lower than that of the adolescent group who has not.

Reliability and validity of the Turkish version of the Hamilton Depression Rating Scale.

The aim of the study was to examine the reliability and validity of the Turkish version of the Hamilton Depression Rating Scale (HDRS). Ninety-four patients with major depression/depressive mood disorders and 40 healthy controls participated in the study. The severity of depression was assessed with the HDRS, Beck Depression Inventory (BDI), and Clinical Global Impression score (CGI). The test-retest reliability coefficient of the HDRS was based on a 5-day interval was.85, with a Cronbach alpha coefficient of.75 and a split-half reliability coefficient of.76. Interrater reliability coefficients based on the independent ratings of four assessors were between.87 and.98. The correlation between the HDRS and BDI scores was.48, and between the HDRS and CGI it was.56. Principal Components Analysis yielded six factors. The correlation (-.13) between the control and patient groups indicates that the HDRS assesses depression very well.

The validity of diagnosis of melancholic depression according to different diagnostic systems.

BACKGROUND: Melancholic versus nonmelancholic depression dichotomy is perhaps the most widely accepted distinction in categorization of depression. This research aims to compare RDC, DSM-III, DSM-III-R, DSM-IV and ICD-10 melancholic/endogenous/somatic and nomelancholic/nonendogenous/nonsomatic depressive patients with regards to biological variables thyroid stimulating hormone (TSH), basal and post dexamethasone cortisol levels, age, age of onset of depression, psychosocial stressors, and severity of depression. METHODS: Sixty-five patients who had been diagnosed as having major depression according to DSM III-R, using SCID were included in this study. Patients were divided into melancholic and nonmelancholic subtypes using RDC, DSM-III, DSM III-R, DSM-IV and ICD-10 criteria and groups were compared on the basis of biological variables, as well as age, psychosocial stressors and the severity of depression. RESULTS: RDC endogenous depressives were older, more severely depressed and had higher cortisol levels then RDC nonendogenous depressives. DSM III-R melancholics were older, more severely depressed, reported fewer numbers of psychosocial stressors and had lower levels of TSH than nonmelancholics. DSM-IV melancholics were more severely depressed, had higher basal and post dexamethasone cortisol levels and lower TSH levels. The ICD 10 somatic depression group contained more severe, older depressives with lower TSH levels. CONCLUSION: The results of this research show that different criteria may identify different groups of patients as having melancholic depression. They also partly support the hypothesis that endogenous or melancholic depression have a biological basis. LIMITATIONS OF STUDY: The study involved a relatively small sample size from a single centre and the results are based on this relatively small sample.

Moclobemide and sertraline in the treatment of depressive disorders: a comparative study.

The efficacy and tolerability of moclobemide and sertraline were compared in a 13 week trial on 55 depressive patients. Patients were diagnosed according to DSM-III-R criteria using SCID (Structured Clinical Interview for DSM-III-R). The study group was composed of 48 patients with major depression and 7 with minor depression. Patients were randomized in two drug groups and raters were blind to the drugs patients used. HDRS and CGI were used to assess the change in depressive symptoms. Twenty seven patients received moclobemide and 28 patients received sertraline. The dose of moclobemide used was 300-600 mg/day and that of sertraline was 50-200 mg/day. At the end of 13 weeks mean drop in HDRS for the overall group was 14.78 and the response rate calculated as percentage of patients showing a 50% drop in HDRS score was 77.8. The response rate was 76.5% for moclobemide and 78.5% for sertraline. The difference was not significant. The side effects were assessed by using UKU Side Effects Rating Scale. The most three observed side effects were dry mouth, headache and insomnia.