A Rare Cause of Epistaxis: Nasopharyngeal Leech Infestation.

Leeches are rare cause of foreign body in airways. A 23-year-old male, experiencing epistaxis and difficulty in swallowing is presented. During nasopharyngoscopy, a moving leech was observed on the nasopharynx posterior wall in midline location, and removal of the leech was decided under general anaesthesia. The flexible nasopharyngoscopy was inserted, but removal was unsuccessful due to the leech's movements. Leeches are blood-sucking parasites, so neuromuscular blocking agent was given to prevent the movement. After administration, motion of the leech was lost and easily removed undamaged. In patients presenting with unexplained epistaxis, hemoptysis, dyspnea, and foreign body sensation in the airway, leech infestation should be included as the differential diagnosis and history of contact with stream water should be questioned. We concluded that use of low dose neuromuscular blocking agents facilitates the gentle removal, and could be necessary for successful management of removal of leech under general anaesthesia.

A complicated pregnancy: Eclampsia or COVID-19?

Pregnant women may be infected with SARS-CoV-2 virus and develop serious complications of the disease. Covid-19 causes primarily a respiratory system infection but can also affect cardiovascular, renal, gastrointestinal, and neurological systems. Cardiovascular involvement includes new onset hypertension, myocarditis, cardiomyopathy, pulmonary embolism, and pre-eclampsia like syndrome. We report a confirmed Covid-19 pregnant case presented with eclampsia to the emergency department and undergone emergent cesarean section. Following surgery, she was admitted to the intensive care unit due to hypoxemia and hypertension. After observing lymphopenia and high CRP level with hypoxemia, radiological imaging revealed typical findings for viral pneumonia and nasopharyngeal swab, which was not carried out at admission, was positive for Covid-19. On the 20th hour of follow-up, she became hypotensive requiring noradrenalin infusion. Echocardiography diagnosed cardiomyopathy with left ventricular ejection fraction of 35-40 % with high levels of NT pro-BNP, hs-troponin, and CK-MB in the patient. Covid-19 should be considered in complicated pregnancies. In complicated cases, a chest CT scan upon admission may aid in quickly detecting the presence of infection and preventing nosocomial spread of the virus. Cardiomyopathy could be found in pregnant patients with Covid-19 infection. Since cardiomyopathy can be seen in late pregnancy and early postpartum period, it is difficult to distinguish between viral and postpartum cardiomyopathy in these patients. Recognizing the infection earlier will help to anticipate the complications that might contribute to deterioration of the patients, perioperatively.

Diagnostic Accuracy of Sagittal TSE-T2W, Variable Flip Angle 3D TSET2W and High-resolution 3D Heavily T2W Sequences for the Stenosis of Two Localizations: The Cerebral Aqueduct and the Superior Medullary Velum.

OBJECTIVES: This study aimed to investigate the accuracy of conventional Sagittal Turbo spin Echo T2-weighted (Sag TSE-T2W), variable flip angle 3D TSE (VFA-3D-TSE) and high-resolution 3D heavily T2W (HR-3D-HT2W) sequences in the diagnosis of primary aqueductal stenosis (PAS) and Superior Medullary Velum Stenosis (SMV-S), and the effect of stenosis localization on diagnosis. METHODS: Seventy-seven patients were included in the study. The diagnosis accuracy of the HR-3D-HT2W, Sag TSE-T2W and VFA-3D-TSE sequences, was classified into three grades by two experienced neuroradiologists: grade 0 (the sequence has no diagnostic ability), grade 1 (the sequence diagnoses stenosis but does not show focal stenosis itself or membrane formation), and grade 2 (the sequence makes a definitive diagnosis of stenosis and shows focal stenosis itself or membrane formation). Stenosis localizations were divided into three as Cerebral Aquaduct (CA), Superior Medullary Velum (SMV) and SMV+CA. In the statistical analysis, the grades of the sequences were compared without making a differentiation based on localization. Then, the effect of localization on diagnosis was determined by comparing the grades for individual localizations. RESULTS: In the sequence comparison, grade 0 was not detected in the VFA-3D-TSE and HR-3DHT2W sequences, and these sequences diagnosed all cases. On the other hand, 25.4% of grade 0 was detected with the Sag TSE-T2W sequence (P<0.05). Grade 1 was detected by VFA-3D-TSE in 23% of the cases, while grade 1 (12.5%) was detected by HRH-3D-T2W in only one case, and the difference was statistically significant (P<0.05). When the sequences were examined according to localizations, the rate of grade 0 in the Sag TSE-T2W sequence was statistically significantly higher for the SMV localization (33.3%) compared to CA (66.7%) and SMV+CA (0%) (P<0.05). Localization had no effect on diagnosis using the other sequences. CONCLUSION: In our study, we found that the VFA-3D-TSE and HR-3D-HT2W sequences were successful in the diagnosis of PAS and SMV-S contrary to the Sag TSE-T2W sequence and especially SMV localization decreases the diagnostic accuracy of Sag TSE-T2W sequence.

Comparison of the quick SOFA score with Glasgow-Blatchford and Rockall scores in predicting severity in patients with upper gastrointestinal bleeding.

INTRODUCTION: Upper gastrointestinal bleeding is one of the common causes of mortality and morbidity. The Rockall score (RS) and Glasgow-Blatchford score (GBS) are frequently used in determining the prognosis and predicting in-hospital adverse events, such as mortality, re-bleeding, hospital stay, and blood transfusion requirements. The quick Sepsis Related Organ Failure Assessment (qSOFA) score is easy and swift to calculate. The commonly used scores and the qSOFA score were compared and why and when these scores are most useful was investigated. METHOD: 133 patients admitted to the emergency department with upper gastrointestinal bleeding over the period of a year, were evaluated in this retrospective study. The RS, GBS and qSOFA score were calculated for each patient, and their relationship with in-hospital adverse events, such as length of hospitalization, rebleeding, endoscopic treatment, blood transfusion requirements, and mortality, was investigated. RESULTS: The mean overall GBS was 9.72 ± 3.72 (0-19), while that of patients who did not survive was 14.0 ± 1.1 (13-16), with an area under the curve (AUC) of 0.901, a cutoff value of 12.5, and specificity (Spe) and sensitivity (Sen) of 1 and 0.82, respectively. The median value of the GBS, in terms of transfusion need, was 7.12 ± 4.01 (0-15). (AUC = 0.752, cut-off = 9.5, Spe = 0.79, Sen = 0.69). The median value of the qSOFA score, in terms of intensive care need, was 1.73 ± 0.7 (0-3) (AUC = 0.921, cut-off = 0.5, Spe = 0.93, Sen = 0.79). The RS median, in terms of re-bleeding, was 8.22 ± 0.97 (6-9). CONCLUSION: Early use of risk stratification scores in upper gastrointestinal bleeding is important due to the high risk of morbidity and mortality. All scoring systems were effective in predicting mortality, the need for intensive care, and re-bleeding. The GBS had a greater predictive power in terms of mortality and transfusion need, the qSOFA score for intensive care need, and the RS for re-bleeding. The simpler, more efficient, and more easily calculated qSOFA score can be used to estimate the severity of patients with upper gastrointestinal bleeding.

Melkersson-Rosenthal Syndrome Induced by COVID-19.

Melkersson-Rosenthal syndrome is a rare condition characterized by a triad of orofacial edema, facial paralysis, and fissured tongue. Histopathological examination of the disease has demonstrated areas of inflammation involving mast cells. Activated mast cells also play a part in the pathogenesis of COVID-19 infection, as they release cytokines in the lungs. We present a case of a female patient presenting with edema. We present a case of a female patient presenting with edema. Her examination revealed edema in the right lower lip, right facial paralysis, and fissured tongue. COVID-19 may be associated with which was not previously included in the etiology of the disease.

Distribution of psychogenic and vascular impotence in a tertiary health-care center's cohort: a retrospective study using penile Doppler imaging / Distribución de la impotencia psicógena y vascular en la cohorte de un centro sanitario de tercer nivel: estudio retrospectivo con imágenes Doppler peneanas

PURPOSE: In this study, we retrospectively reviewed the penile color Doppler ultrasound (PCDU) scans of the patients who had admitted to our clinic with erectile dysfunction and aimed to evaluate the contribution of penile Doppler scan results to the clinical decisions. MATERIAL-METHOD: The data of patients admitted to our outpatient clinic with complaints of erectile dysfunction (IIEF-5 score<22 or IIEF-EF score<26) between January 2005 and January 2018 were retrospectively evaluated. Patients whose testosterone level is lower than 280ng/ml or who had undergone radical prostatectomy were excluded from the analysis. RESULTS: Three thousand ninety patients were included in the study. The mean age of our patients was 55.05±13.05 years. In total, 2139 (69%) patients had normal PCDU findings, 351 (11%) patients had arterial insufficiency, 531 (17%) patients had venous insufficiency, and 69 (2%) patients had arterial insufficiency with concurrent venous leakage. When the patients were divided into 2 groups ≤40 years (Group 1) old and >40 years (Group 2) old; normal PCDU findings were found in 432 patients (84%) of the Group 1 patients and normal PCDU findings in 1707 (66%) patients of the Group 2 patients (p < 0.0001). There were arterial insufficiency findings in 24 (4.7%) and 327 (12.7%) patients of the Group 1 and 2, respectively (p = 0.002). CONCLUSION: The etiology is psychogenic in the majority of patients who present with ED complaints to the urology clinic. With age, the prevalence of psychogenic ED is decreasing but still more than organic

OBJETIVO: En este estudio, revisamos retrospectivamente las ecografías Doppler a color del pene (PCDU) de los pacientes que ingresaron en nuestra clínica con disfunción erectile, el objetivo era evaluar la contribución de los resultados de la ecografía Doppler peneana a las decisiones clínicas. MATERIAL Y MÉTODO: Los datos de los pacientes ingresados en nuestra clínica ambulatoria con quejas de disfunción eréctil (puntuación IIEF-5<22 o puntuación IIEF-EF<26) entre enero de 2005 y enero de 2018 se evaluaron retrospectivamente. Los pacientes cuyo nivel de testosterona fuera inferior a 280ng/ml o a los cuales se les hubiera realizado una prostatectomía radical se excluyeron del análisis. RESULTADOS: En el estudio se incluyó a 3.090 pacientes. La media de edad de nuestros pacientes fue de 55,05±13,05 años. En total, en 2.139 pacientes (69%) hubo hallazgos normales en la PCDU; en 351 (11%) se observó insuficiencia arterial; en 531 (17%) insuficiencia venosa y en 69 (2%) insuficiencia arterial con reflujo venoso simultáneo. Cuando los pacientes se dividieron en 2 grupos, ≤40 años (grupo 1) y >40 años (grupo 2), se encontraron hallazgos normales de la PCDU en 432 pacientes (84%) de los pacientes del grupo 1 y hallazgos normales de PCDU en 1.707 pacientes (66%) del grupo 2 (p < 0,0001). Hubo hallazgos de insuficiencia arterial en 24 (4,7%) y 327 (12,7%) pacientes de los grupos 1 y 2, respectivamente (p = 0,002). CONCLUSIÓN: La etiología es psicógena en la mayoría de los pacientes que presentan quejas de en la clínica de urología. Con la edad, la prevalencia de la DE psicógena va disminuyendo, pero todavía es más psicógena que orgánica

The synergistic effect of trehalose and low concentrations of cryoprotectants can improve post-thaw ram sperm parameters.

The objective of this study was to compare the effects of different concentrations of two different cryoprotectants (glycerol, G and ethylene glycol, EG) and trehalose (T), added to the semen extender, on post-thaw ram sperm parameters. Ejaculates, collected from 6 Merino rams, were pooled and evaluated at 37 °C. The pooled samples were divided into six equal aliquots, and diluted in Tris-based extenders containing 5% G, 3% G + 60 Mm T, 1.5% G + 100 Mm T, 5% EG, 3% EG + 60 mM T, and 1.5% EG + 100 Mm T. Subsequently, the samples were cooled to 5 °C, frozen in 0.25-ml French straws, and stored in liquid nitrogen (LN2). Frozen samples were thawed individually, at 37 °C for 25 s in a water bath, for evaluation. Sperm motility was assessed using a phase-contrast microscope with a warm stage maintained at 37 °C. Acrosome integrity (FITC/PNA-PI), sperm viability (SYBR-14/PI), mitochondrial activity (JC-1/PI), DNA damage (COMET assay) and DNA fragmentation (TUNEL test) were determined. The group of samples diluted in an extender containing 5% of glycerol (Group 5% G) displayed higher percentages of subjective motility, viability and mitochondrial activity of sperm, compared to the other groups (P < 0.05). On the other hand, Group 3% G + 60 mM T yielded the second-best results for subjective motility, viability and mitochondrial activity of sperm, when compared to the other groups. The post-thaw sperm parameters of Group 3% G + 60 Mm T did not show any statistically significant difference from those of Group 5% G. There were no statistically significant differences between the groups for acrosome integrity (P > 0.05). The results of the COMET assay showed that the use of low concentrations of cryoprotectants in combination with trehalose decreased sperm DNA damage. Accordingly, Group 1.5% G + 100 mM T and Group 3% EG + 60 mM T benefited from a significantly stronger cryoprotective effect on DNA integrity, in comparison to Group 5% G (P < 0.05). According to the results of the TUNEL test, the combined use of low concentrations of cryoprotectants with trehalose decreased sperm DNA damage, when compared to the use of 5% glycerol, but this difference was statistically insignificant (P > 0.05). In conclusion, G and EG concentrations can be reduced by adding various amounts of T (60 mM, 100 mM) to the semen extender. The addition of 5% of glycerol and 3% G + 60 mM T to the semen extender did not yield statistically different post-thaw sperm parameters, when compared for protection against cryoinjury. Post-thaw sperm parameters can be improved by the supplementation of the semen extender with 3% G + 60 mM T. Thus, we recommend the use of freezing extenders containing low cryoprotectant concentrations (3% G) combined with trehalose to avoid the high level of toxic and osmotic damage caused by 5% G.

Antioxidant effects of dexmedetomidine against hydrogen peroxide-induced DNA damage in vitro by alkaline Comet assay

Background/aim: Dexmedetomidine (DEX) is an alpha-2 adrenergic agonist that is commonly used as a sedative and anesthetic. The protective effects of DEX against oxidative damage under both in vitro and in vivo conditions have been demonstrated. It was aimed to evaluate and compare the protective effects of DEX and vitamin C (Vit C) on DNA against H2O2-induced DNA damage in human lymphocyte cell cultures in vitro by alkaline Comet assay. Materials and methods: Lymphocyte cell cultures were divided into 5 groups, as the negative control, solvent control, positive control, hydrogen peroxide (H2O2; 150 µM) + DEX (1 µM; 2.5 µM; 5 µM), and H2O2 (150 µM) + Vit C (1 µM; 2.5 µM; 5 µM), and incubated at 37 °C for 1 h. Cell viability was measured using the Trypan blue test. DNA damage was measured using the Alkali Comet Technique and the % percent tail intensity was evaluated. Statistical analysis was performed using 1-way ANOVA and the Tukey multiple comparison test. Results: It was observed that H2O2 significantly induced DNA damage in the lymphocytes and this damage was decreased significantly with Vit C and DEX. It was observed that Vit C at doses of 1 µM and 2.5 µM had a significantly stronger antioxidant effect, but there was no significant difference between the antioxidant effects of Vit C and DEX with a dose of 5 µM. The dose of 5 µM DEX was found to be the most effective in reducing oxidative DNA damage. Conclusion: There is limited data on the protective effects of DEX against oxidative DNA damage. The primary effect might be cytoprotection. The results herein showed that DEX was protective against H2O2-induced in vitro oxidative DNA damage in lymphocyte cell cultures in a dose-dependent manner. DEX might have a potential therapeutic value in the prevention of oxidative DNA damage in patients.

Distribution of psychogenic and vascular impotence in a tertiary health-care center's cohort: A retrospective study using penile Doppler imaging.

PURPOSE: In this study, we retrospectively reviewed the penile color Doppler ultrasound (PCDU) scans of the patients who had admitted to our clinic with erectile dysfunction and aimed to evaluate the contribution of penile Doppler scan results to the clinical decisions. MATERIAL-METHOD: The data of patients admitted to our outpatient clinic with complaints of erectile dysfunction (IIEF-5 score<22 or IIEF-EF score<26) between January 2005 and January 2018 were retrospectively evaluated. Patients whose testosterone level is lower than 280ng/ml or who had undergone radical prostatectomy were excluded from the analysis. RESULTS: Three thousand ninety patients were included in the study. The mean age of our patients was 55.05±13.05 years. In total, 2139 (69%) patients had normal PCDU findings, 351 (11%) patients had arterial insufficiency, 531 (17%) patients had venous insufficiency, and 69 (2%) patients had arterial insufficiency with concurrent venous leakage. When the patients were divided into 2 groups ≤40 years (Group 1) old and >40 years (Group 2) old; normal PCDU findings were found in 432 patients (84%) of the Group 1 patients and normal PCDU findings in 1707 (66%) patients of the Group 2 patients (p<0.0001). There were arterial insufficiency findings in 24 (4.7%) and 327 (12.7%) patients of the Group 1 and 2, respectively (p=0.002). CONCLUSION: The etiology is psychogenic in the majority of patients who present with ED complaints to the urology clinic. With age, the prevalence of psychogenic ED is decreasing but still more than organic.

Changing trends in the Turkish maternal deaths, with a focus on direct and indirect causes.

OBJECTIVE: Our aim is to evaluate trends in the direct and indirect causes' distribution using data from National Maternal Mortality Surveillance (2012-2015). STUDY DESIGN: A population-based retrospective review was performed on all pregnancy-associated maternal deaths in Turkey from 2012 to 2015. Causes of death were grouped into direct and indirect maternal deaths and compared in the context of distribution. Maternal mortality rate was reported. Statistics included chi-square test or Fisher's exact test for categorical variables. RESULTS: Between 2012 and 2015 there were 812 maternal deaths. The maternal mortality rate was 15.4 deaths per 100,000 live births in 2012 as compared to 13.7 in 2015. Direct maternal deaths in Turkey declined from 59.5% in 2012 to 45% in 2015 while indirect maternal deaths increased from 45% in 2012 to 55% in 2015 (p = 0.045). The leading direct causes of maternal deaths were postpartum hemorrhage. The major indirect causes of maternal deaths were circulatory system diseases. CONCLUSION: Direct maternal deaths in Turkey appear to be declining. This data will aid the management of maternal deaths.

Maternal mortality due to hemorrhage: population-based study in Turkey.

Objective: The aim of this study was to determine the epidemiological characteristics of maternal mortality due to postpartum hemorrhage, and to investigate whether national preventative measures of the Maternal Mortality Program have been successful in Turkey. Design: A population-based cohort study. Setting: Turkish National Maternal Mortality Data collected by the Turkish Ministry of Health. Participants: Women who died due to hemorrhage during pregnancy or after delivery within the initial 42 days, from 2012 to 2015, throughout Turkey (N = 812/146). Main outcome measures: The preventability and problems in each maternal death due to hemorrhage. Results: A total of 779 maternal deaths were identified during the study period. Our estimate of the Maternal Mortality Ratio (MMR) in the 3-year period was 19.7 per 100,000 live births. Of the 779 deaths, the report listed 411 as direct and 285 as indirect deaths. Direct obstetric complications were the leading causes of maternal deaths, the most common of which was maternal cardiovascular diseases (21%) and obstetric hemorrhage (20.6%). Conclusion: Improving data surveillance and implementing national guidelines for the prevention and management of major complications of pregnancy, childbirth, and puerperium is necessary to reduce MMR. The healthcare authorities of Turkey should continue to set a sustainable development goal of ≤70 maternal deaths per 100,000 live births by 2030. We believe our results may provide useful information for other developing countries that are aiming to reduce maternal mortality, as well as mobilize global efforts to improve women's health.

The diagnostic role of pentraxin-3 in the differential diagnosis of pleural effusions

Background/aim: Discrimination of pleural effusion etiology is not always easy in clinical practice. Pentraxin-3 (PTX-3) is a new acute- phase protein. The aim of this study was to investigate the role of PTX-3 in the differential diagnosis of pleural effusions. Materials and methods: This prospective study enrolled all consecutive patients from two tertiary hospitals who underwent diagnostic or therapeutic thoracentesis. In a cohort of 149 subjects with pleural effusion, including transudates and malignant (MPE), tuberculous (TPE), and parapneumonic effusion (PPE), serum and pleural effusion PTX-3 concentration measurements were performed using ELISA. Serum and pleural effusion protein, lactate dehydrogenase, C-reactive protein (CRP), and adenosine deaminase levels were also assessed. Results: Of these patients, 34 had transudates, 29 had PPE, 63 had MPE, and 23 had TPE. There was a weak correlation between pleural effusion PTX-3 level and serum CRP (P < 0.01). There was a significant difference in pleural PTX-3 levels between the exudative effusion groups (P < 0.01). The median pleural effusion PTX-3 was significantly higher in patients with PPE (11.2 ng/mL, 2­17.8) than MPE (4.7 ng/mL, 1.8­13.9) and TPE (3.1 ng/mL, 2.0­4.1). At a cut-off point of 5.89 ng/mL, PTX-3 had the best discriminatory power for PPE versus other exudative effusions (sensitivity: 86.2%, specificity: 87.7%). The exudative effusion group had a significantly different pleural effusion/serum PTX-3 ratio (P = 0.03). Conclusion: PTX-3 concentration in pleural effusion was elevated without a significant correlation with serum PTX-3 in PPE. These results may suggest that PTX-3 is a local acute-phase reactant and may allow discrimination of PPE from other exudative effusions.

A view of maternal mortalities in women conceiving through assisted reproductive techniques: A nation-based study of Turkey.

BACKGROUND: Our aim was to evaluate maternal mortality causes among Turkish women giving birth after assisted reproductive techniques (ARTs). METHODS: All maternal deaths following conception with ART pregnancies were identified through the National Maternal Mortality Surveillance System. We analyzed the system data collected between 2007 and 2014. During this period, there were 10,369,064 live births and 1788 maternal deaths resulting from both direct and indirect causes. We identified 28 maternal death cases following ART procedures. The age, gestational age at birth, number of antenatal visits, delivery route, time of death, cause of death, and neonatal outcomes were recorded. Also, any existing delay (phase 1, 2, or 3) and preventability of maternal death were assessed. RESULTS: Hypertensive disorders, pulmonary embolism, and cardiovascular disease were the leading causes of maternal death. Twelve (40%) women were over 35 years of age. Of the deaths, 15 (54%) were attributed to indirect causes. The number of unpreventable maternal deaths was 19 (67.9%), and 9 (36%) were classified as preventable after being assessed by the review commission of maternal mortality. CONCLUSION: Pregnancies conceived with ARTs should undergo a careful assessment of risk factors for hypertensive disorders, pulmonary embolism and cardiovascular diseases. Those women require closer antenatal surveillance because 1/3 of these deaths were preventable.

The value of autopsy to determine the cause of maternal deaths in Turkey

Objective: To analyze the value of autopsy reports for determining the cause of maternal deaths in Turkey. Material and Methods: In this descriptive retrospective study, the case files of 992 maternal deaths, except for accidental causes, that occurred in Turkey between 2012 and 2016 were reviewed. An autopsy examination was performed in 177 (17.8%) of the cohort. When the files were reviewed, maternal descriptive data and the cause of maternal mortality according to the autopsy reports were recorded. Results: The mean age at death was 31.5±6.6 years. No exact cause of maternal death was identified after autopsy in 44 (24.9%) of the 177 cases. An exact cause of death could be determined in 133 (75.1%); 34.5% (n=61) were due to direct causes, and 40.7% (n=72) were due to indirect causes. The leading direct causes of maternal deaths were obstetric hemorrhage (13.0%) and obstetric (pulmonary and amniotic fluid) embolism (12.4%). The main cause among the indirect causes was ruptured aortic aneurysm and/or dissection of aorta (8.5%). Among the subjects with no clinical diagnosis based on the clinical course before death (n=96), the exact cause of death could not be determined at autopsy in 19 (19.8%) cases. The exact or possible cause of death was identified at autopsy in 80.3% (n=77) cases with no clinical diagnosis. Among the cases who had antemortem diagnoses based on the clinical course (n=81), the final diagnosis at autopsy was compatible with the clinical diagnosis in 48 (59.3%) subjects. Conclusion: Maternal autopsy examination provides an exact cause of death in most cases and is still a valuable tool for understanding the cause of maternal mortality.

A novel ultrasound-based technique to establish a correlation between disease activity and local carotid stiffness parameters in rheumatoid arthritis.

AIM: Cardiovascular (CV) disease is the reason for most mortality cases in RA and cannot be explained only by the presence of traditional CV risk factors. In this study, we aimed to investigate the relationship between local carotid stiffness (CS) parameters measured by a novel ultrasound method and inflammatory disease activity in rheumatoid arthritis (RA) patients. Material and methods: The study was conducted with 70 RA patients and 35 control subjects. According to their disease activity score (DAS-28), the RA patients were classified into active RA (n = 36; DAS-28 > 3.2) and inactive RA (n = 34; DAS-28 ≤ 3.2) groups. A novel non-invasive echo-tracking system was used to measure carotid intima-media thickness (C-IMT), diameter, pulsatile strain, distensibility, and carotid pulse wave velocity (PWV) on 128 sites of the common carotid artery. Erythrocytesedimentation rate (ESR) and C-reactive protein (CRP) levels were also determined. RESULTS: Carotid PWV and IMT were significantly higher in the active RA patients (8.20±1.47 m/s and 6.88±1.50 mm, respectively) compared to the inactive group (6.06±1.21 mm and 7.32±1.19 m/s, respectively) and the control subjects (0.68±0.12 mm and 6.41±0.98, respectively). In all RA patients, a statistically significant correlation was found between carotid PWV and age (r=0.435, p<0.001), ESR (r=0.257, p=0.033), and DAS-28 (r=0.314, p=0.009). According to the multivariate logistic regression analysis, age, DAS-28, and ESR were independent predictors of CS. CONCLUSION: A strong correlation was found between disease activity and local CS parameters in patients with RA. We also demonstrated that both active and inactive RA patients showed increased PWV values compared with the control subjects. This easily applicable and previously confirmed method can be used in future to assess cardiovascular risk in broad study populations from different risk groups.

Evaluation of local carotid stiffness and inflammatory biomarkers in stable angina pectoris.

INTRODUCTION: Arterial stiffness (AS) is a well-accepted and reliable predictor of atherosclerotic diseases. Inflammation plays an important role in the development of AS. AIM: To evaluate local carotid stiffness (CS) together with fibrinogen and high-sensitivity C-reactive protein (hsCRP) levels in stable angina pectoris (SAP) patients. MATERIAL AND METHODS: The study consisted of 353 consecutive patients with SAP. All underwent coronary angiography (CAG) after the evaluation of local CS parameters and carotid intima-media thickness (IMT) from both common carotid arteries by a real-time echo-tracking system. Baseline inflammatory biomarkers, serum hsCRP and fibrinogen levels were measured. Based on CAG findings, the patients were classified into 4 groups: control subjects with normal coronary arteries (group 1, n = 86), single-vessel disease (group 2, n = 104), double-vessel disease (group 3, n = 95) and triple-vessel disease (group 4, n = 68). RESULTS: The mean carotid pulse wave velocity (PWV) in patients with angiographically confirmed coronary artery disease (CAD) was significantly higher than that in patients with normal coronary arteries (7.82 ±1.76 vs. 6.51 ±0.85 cm/s, p = 0.001). The mean carotid IMT was detected to be significantly higher in group 4 patients compared to those in group 1 (p < 0.001) and group 2 (p = 0.001). Significant correlations were observed between both inflammatory biomarkers and the number of diseased vessels and carotid PWV. Using multi-variate analysis, carotid stiffness, carotid IMT, hsCRP and fibrinogen were independently associated with the presence and extent of CAD. CONCLUSIONS: Local CS, carotid IMT, hsCRP and fibrinogen levels are significant predictors of atherosclerotic burden and they may facilitate the identification of high-risk patients for the early diagnosis and prompt treatment of CAD.

Assessment of local carotid stiffness in seronegative and seropositive rheumatoid arthritis.

OBJECTIVES: Rheumatoid arthritis (RA) is a chronic, inflammatory disease associated with increased risk of cardiovascular (CV) disease. Arterial stiffness (AS) is an independent predictor of CV events. This study aimed to analyse local carotid AS parameters in seronegative and seropositive RA patients. DESIGN: Of 347 consecutive RA patients, we selected specifically those who were free of established CV diseases and risk factors. As a result, 140 patients (126 women, 52.2 ± 10 years) and 140 healthy controls (122 women, 52.7 ± 8.0 years) were enrolled into this study. The common carotid AS was evaluated using radio frequency echo-tracking system to determine the local carotid pulse wave velocity (cPWV) and carotid intima-media thickness (cIMT). Based on rheumatoid factor (RF) and/or anti-citrullinated protein antibody (ACPA) positivity, RA patients were categorized into seronegative and seropositive subgroups. RESULTS: Carotid PWV was determined to be significantly higher in all patients and subgroups than controls (p < .001 for all). Although cIMT was similar between the patients, controls and seropositive subgroup, seronegative patients had significantly higher cIMT compared to controls (p = .035) and seropositive group (p = .010). Moreover, a significant positive correlation was found between cPWV and age (r: 0.603, p < .001), ESR (r: 0.297, p = .004), ACPA (r: 0.346, p = .001) and cIMT (r: 0.290, p = .005) in seropositive patients. CONCLUSIONS: RA per se is sufficient to cause arteriosclerosis in the absence of classical CV risk factors. However, arterial hypertrophy is only increased in seronegative patients but not in seropositive group.

Maternal mortality due to hypertensive disorders in pregnancy, childbirth, and the puerperium between 2012 and 2015 in Turkey: A nation-based study.

OBJECTIVE: To analyze maternal deaths in Turkey due to hypertensive disorders. MATERIAL AND METHODS: In this retrospective study 812 maternal deaths were analyzed. Maternal demographic features, presence of antenatal care, medical and obstetric history, mode of delivery, and use emergency antihypertensive therapy were recorded. The delay model for each case was investigated. RESULTS: Hypertensive disorders accounted for 15.5% (n=126) out of all maternal mortality. They were the third most frequent cause among all causes and the 2nd among direct causes of maternal deaths. Sixty-one (48.4%) cases were in severe preeclampsia or pre-existing hypertensive disorder with increased/superimposed proteinuria, 30.1% were in eclampsia, 9.5% cases were diagnosed as hemolysis, elevated liver enzymes, low platelet count syndrome, and 11.1% in pre-existing hypertension complicating pregnancy, childbirth, and puerperium without increased or superimposed proteinuria. The median age was 32 years, 37.3% women were ≥35 years. All deaths except for 2 cases occurred during the postpartum period. Twenty-three percent of deaths occurred in the first 48 hours postpartum, and 51.6% between 8-42 days. Intracranial hemorrhage was the major final cause of death with a rate of 41.3%. With the exception of fifteen patients with intracranial hemorrhage, emergency antihypertensive agents were not implemented in optimal dose and/or duration. A first and/or third delay was identified in 36.5% of cases. CONCLUSION: Approximately one third of maternal death due to hypertensive disorders could be prevented. The importance of acute antihypertensive treatment should be emphasized because of most frequent cause of death was intracranial hemorrhage.

Comparison of prognostic value of N-terminal pro-brain natriuretic peptide in septic and non-septic intensive care patients.

INTRODUCTION: The aim of this study is to compare the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in septic and non-septic intensive care patients. MATERIAL AND METHODS: Fifty consecutive patients admitted to the intensive care unit (ICU) were enrolled in either the septic or non-septic group according to the criteria in the International Sepsis Definitions Conference in 2001. Demographic and clinical data, procalcitonin and lactate levels at admission, and death within 28 days were registered. Five blood samples were collected from all patients for NT-proBNP measurements. RESULTS: Septic patients had higher APACHE II (19 (16.00-24.25) vs. 16 (13.00-18.25)), and SOFA (8 (5-10) vs. 6 (4-7)) scores (p <0.05). Procalcitonin levels were also higher in septic patients (3.33 (1.06-10.96) vs. 0.46 (0.26-1.01) ng/ml) and more patients required vasopressors in this group (9 (36%) vs. 2 (8%)) (p < 0.05). In the septic group, the correlation between mortality and the level of NT-proBNP was significant for each measurement, starting from the admission. In the non-septic group the correlation between mortality and the level of NT-proBNP was significant only at the 120th h. CONCLUSIONS: We concluded that the level of NT-proBNP at admission is well correlated with 28-day mortality in septic ICU patients. However, single measurement of NT-proBNP levels in non-septic patients does not correlate with the 28-day mortality. Repeated measurements and an increasing trend of the NT-proBNP levels may show a correlation with mortality in non-septic intensive care patients.

Maternal mortality cases from pulmonary embolism: A nation-wide study in Turkey.

The aim of the study was to evaluate the maternal mortality cases attributed to pulmonary embolism (PE). PE constituted 7.58% of maternal deaths in 2013. Risk factors for PE were present in 15 (88.2%) of the women. Five women (29.4%) were overweight, and 5 (29.4%) were obese. Four women (23.5%) had cardiac diseases. PE occurred in the postpartum period after caesarean delivery in 9 (52.9%) patients. Eleven (64.7%) of the maternal deaths were recognised as preventable. More deaths attributed to PE occurred in the postpartum period (n = 11) than the antepartum period (n = 5). One other maternal mortality case was after therapeutic abortion. Caesarean section, obesity and cardiac diseases were important risk factors. It can be suggested that monitoring all risk factors and timely recognition of related symptoms and signs with initiation of appropriate management have paramount importance for reducing maternal mortality rate related to pulmonary embolism. Increasing awareness of healthcare professionals as well as the public, and continuously reviewing the cases are also important tools for achieving this goal.