A Novel Index for Prompt Prediction of Severity in Patients with Unstable Angina Pectoris.

OBJECTIVES: Rapid risk stratification by emergency department (ED) physicians to evaluate patients with chest pain for predicting the short-term occurrence of major adverse cardiac event (MACE) is crucial. The aim of this study was to investigate the predictive value of platelet-lymphocyte ratio (PLR) levels and compare with the modified heart score (m-HS) and stress testing to predict the severity of high-risk patients with unstable angina pectoris (UAP) in the ED. METHODS: This study is prospective which included 316 patients with UAP and 316 control healthy subjects. The study took place from 01 April 2016, until 01 April 2017, in Medipol University. RESULT: The mean PLR levels in the UAP group were higher than those in the control group (p < 0.001). The mean PLR of the m-HS ≥4 group was higher than that in the m-HS ≤3 group (p < 0.001). The mean levels of PLR in the subgroups based on the stress testing positivity were higher than those in the stress testing negative subgroup (p < 0.001). PLR levels were positively correlated with the m-HS, stress testing, and treatment decision in this study (r = 0.559; p < 0.001; r = 0.582; p < 0.001; r = 0.789; p < 0.001, respectively). CONCLUSION: A positive correlation was determined with an increase in m-HS, treatment decision, and positive exercise testing as the PLR levels increased, indicating the severity of high risk of UAP in the ED.

Endothelial Nitric Oxide Level as a Predictor of Coronary Complexity in Patients With Unstable Angina Pectoris.

BACKGROUND: The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is an anatomic scoring system based on coronary angiography that quantifies lesion severity and complexity and predicts morbidity and mortality to guide decision making between coronary artery bypass graft surgery and percutaneous coronary intervention in patients with acute coronary syndrome. The present study aimed to compare nitric oxide levels with the SYNTAX score in terms of predicting coronary complexity and the treatment decision for unstable angina pectoris in the emergency department. METHODS: The study included 120 patients with unstable angina pectoris and 120 control group subjects. Nitric oxide levels were compared with the SYNTAX score and the treatment decision. The UAP group was divided into 2 subgroups, first based on SYNTAX score of ≤18, >18-27 or >27 and then on the treatment decision of coronary angiography, percutaneous coronary intervention, or coronary artery bypass graft surgery. RESULTS: The mean nitric oxide levels in the unstable angina pectoris group were lower than in the control group (P < 0.001). Nitric oxide levels were negatively correlated with the SYNTAX score and the treatment decision (r = -0.227, P = 0.013; r = -0.498, P < 0.001, respectively). The nitric oxide levels were decreased with SYNTAX score >27 compared with >18-27 and ≤18 (P = 0.04-0.003, respectively). Nitric oxide levels were decreased in coronary artery bypass graft surgery subgroup compared with the coronary angiography and percutaneous coronary intervention groups (P < 0.001-0.018 and P < 0.001, respectively). CONCLUSIONS: Nitric oxide may be considered as a novel biomarker in the prediction of coronary complexity in patients with unstable angina pectoris.

The intracranial number of foreign bodies as a predictor of mortality after penetrating brain injury.

INTRODUCTION: Penetrating brain injury (PBI) is the most lethal form of traumatic brain injury, which is a leading cause of mortality. PBI has a mortality rate of 23%-93% and 87%-100% with poor neurological status. Despite the use of various prognostic factors there is still a need for a specific prognostic factor for early prediction of mortality in PBI to reduce mortality and provide good outcomes with cost-effective surgical treatments. The aim of this study was to investigate the predictive value of the number of intracranial foreign bodies (FBs) on mortality in PBI in the Emergency Department. METHODS: The study included 95 patients admitted with PBI caused by barrel bomb explosion. The intracranial number of FB was examined by brain computed tomography. Logistic regression was used to assess the association of the intracranial number of FB on mortality. Correlation analyses were performed to investigate the association of Glasgow Coma Scale (GCS) with intracranial number of FB. RESULTS: The optimal cut-off value of the intracranial number of FB calculated for mortality was 2, which was effective for predicting mortality (p < .001). In patients with >2 intracranial FB, the mortality rate was statistically significantly 51-fold higher than those with ≤2 (p < .001). A statistically significant negative correlation was determined between GCS and number FB (r = -0.697; p < .001). CONCLUSION: When the intracranial number of FB was >2, mortality significantly increased in patients with PBI. The intracranial number of FBs may be considered as a novel prognostic factor for the prediction of mortality in PBI.

Association of decreased C1q/tumor necrosis factor-related protein-5 levels with metabolic and hormonal disturbance in polycystic ovary syndrome

Objective: C1q/tumor necrosis factor-related protein-5 (CTRP5) is a novel peptide hormone involved in the metabolism of energy regulation. Polycystic ovary syndrome (PCOS), which is a reproductive and metabolic disorder, is associated with insulin resistance. The aim of the current study was to compare circulating levels of CTRP5 in women with and without PCOS and to investigate possible associations between CTRP5 and metabolic-hormonal parameters. Material and Methods: The present cross-sectional study contained 80 women with PCOS and 80 age and body mass index-matched women without PCOS. Circulating levels of CTRP5 were calculated using an enzyme-linked immunosorbent assay. We also measured hormonal and metabolic parameters. Results: Patients with PCOS had lower levels of circulating CTRP5 compared with women without PCOS (6.90±2.64 vs 11.73±3.66 ng/mL, p<0.001). CTRP5 was negatively correlated with insulin resistance, free-androgen index, and body mass index in both the PCOS and control groups. Moreover, patients with PCOS who had insulin resistance showed lower circulating CTRP5 levels compared with those without insulin resistance. In both the control and PCOS groups, overweight subjects had lower circulating levels of CTRP5 compared with participants of normal weight. Logistic regression analyses indicated that subjects in the lowest tertile for CTRP5 level had higher risk for PCOS compared with those in the highest tertile of CTRP5. Conclusion: Decreased circulating levels of CTRP5 were associated with higher risk of PCOS, as well as having metabolic disturbance among women with PCOS.

A novel biochemical marker for community-acquired pneumonia: Ischemia-modified albumin.

INTRODUCTION: Community-acquired pneumonia (CAP) is a frequent cause of hospitalization and a leading cause of mortality worldwide. Early diagnosis and the initiation of appropriate antibiotic therapy are essential to reduce pneumonia-related morbidity and mortality. CRP is a well-established biomarker in many clinical settings, but has been traditionally considered not specific enough to be a useful guide in the diagnostic process of pneumonia. There is still a need for more specific and practical markers in CAP for diagnosis. The aim of this study was to investigate the diagnostic value of ischemia-modified albumin (IMA) levels in the diagnosis of CAP in the Emergency Department. METHODS: The study included 81 patients admitted with CAP and 81 control patients. Initial hour levels of IMA and CRP were measured. The IMA mean levels were compared between the study and control group. Correlation analyses were performed to investigate the association of serum IMA levels with CRP. RESULTS: Mean levels of IMA were 0.532±0.117IU/ml in the study group and 0.345±0.082IU/ml in the control group. IMA levels were significantly higher in the study group compared to the control group. The IMA level of 0.442IU/ml had sensitivity of 75.3% and specificity of 91.3% and was positively correlated with CRP levels (r=0.506; p<0.05). CONCLUSION: Blood IMA levels significantly increase in adult patients presenting with CAP. IMA may be considered as a novel biomarker in the diagnosis of CAP.

The antioxidant role of agomelatine and gallic acid on oxidative stress in STZ induced type I diabetic rat testes.

Diabetes is a multisystem disorder and its effects are observed on the reproductive system. One of the main causes of testicular tissue damage is diabetes-induced overproduction of reactive oxygen species and glycated end products. The main objectives of this study were to investigate the possible effects of agomelatine (AG) and gallic acid (GA) in suppressing oxidative stress in Type I diabetes induced testicular damage. A total of 28 adult male rats were included in the study. Diabetes was induced by intraperitoneal injection of streptozocin (STZ, 55mg/kg) to 21 rats, which were then randomly assigned to 3 groups; 1mL saline solution was given to the diabetes+saline group by oral gavage, 20mg/kg/day oral AG was given to the diabetes+AG group, and 20mg/kg/day oral GA was given to the diabetes+GA group for 4 weeks. Tumor necrosis factor α (TNFα), nitric oxide synthase 2 (NOS2), fibronectin and vascular endothelial growth factor (VEGF) were used for the investigation of inflammation, fibrosis and vascular structures. The terminal-deoxynucleoitidyl-transferase mediated nick end-labeling assay (TUNEL) was used to detect apoptosis. Testicular tissue total antioxidant capacity values were tested by biochemical analysis. AG treatment showed an improvement on biochemical parameters and histopathological appearance on the rat testes. GA showed dose-related regenerative effects on biochemical parameters. Histologically, a minimal healing effect was determined on the testes damage. In conclusion, it was observed that AG is a potentially beneficial agent for reducing testicular damage by decreasing oxidative stress level. However, GA was seen to have a poor therapeutic effect.