Predictive values of D-dimer assay, GRACE scores and TIMI scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction.

PURPOSE: To determine the predictive values of D-dimer assay, Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) risk scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction (NSTEMI). PATIENTS AND METHODS: A total of 234 patients (mean age: 57.2±11.7 years, 75.2% were males) hospitalized with NSTEMI were included. Data on D-dimer assay, GRACE and TIMI risk scores were recorded. Logistic regression analysis was conducted to determine the risk factors predicting increased mortality. RESULTS: Median D-dimer levels were 349.5 (48.0-7,210.0) ng/mL, the average TIMI score was 3.2±1.2 and the GRACE score was 90.4±27.6 with high GRACE scores (>118) in 17.5% of patients. The GRACE score was correlated positively with both the D-dimer assay (r=0.215, P=0.01) and TIMI scores (r=0.504, P=0.000). Multivariate logistic regression analysis revealed that higher creatinine levels (odds ratio =18.465, 95% confidence interval: 1.059-322.084, P=0.046) constituted the only significant predictor of increased mortality risk with no predictive values for age, D-dimer assay, ejection fraction, glucose, hemoglobin A1c, sodium, albumin or total cholesterol levels for mortality. CONCLUSION: Serum creatinine levels constituted the sole independent determinant of mortality risk, with no significant values for D-dimer assay, GRACE or TIMI scores for predicting the risk of mortality in NSTEMI patients.

First-line monotherapies of tenofovir and entecavir have comparable efficacies in hepatitis B treatment.

BACKGROUND: Hepatitis B virus (HBV) infection is a health problem worldwide. Current treatment options for chronic hepatitis B (CHB) are nucleoside or nucleotide analogues and pegylated interferons. Tenofovir and entecavir are much more commonly used as they have better efficacy, tolerability, and high genetic barriers to resistance. AIM: The aim of this study was to assess the efficacies of tenofovir and entecavir in previously untreated CHB patients in a treatment cohort. PATIENTS AND METHODS: We included CHB patients in a cohort including previously untreated HBeAg-positive and HBeAg-negative patients from 10 centers in Istanbul, Turkey. The patients were compared in terms of baseline characteristics, decrease in alanine transaminase (ALT), decrease in HBV-DNA to undetectable levels, HBeAg loss and anti-HBe development (among baseline HBeAg-positive patients), interventions to therapy because of lack of efficacy, side effects, severe side effects, and side effects that required change in treatment. RESULTS: The study included 121 patients who were administered tenofovir and 130 patients who were administered entecavir. The majority of patients were men, with mild to moderate histology in both treatment groups. The mean duration of follow-up was 18 and 20 months for tenofovir and entecavir, respectively. Patients receiving both drugs showed comparable rates of HBeAg loss, rates of undetectable HBV-DNA levels, rates of ALT normalization, ALT decrease, and decrease in HBV-DNA. Both drugs were well tolerated. CONCLUSION: This study shows that although the baseline characteristics did not match, tenofovir and entecavir sustained comparable virological efficacies. More patients discontinued entecavir during follow-up. Both drugs provided effective viral control, with few side effects.

Helicobacter pylori stool antigen test: results of a prospective study.

PURPOSE: There are now many tests and pathological examinations to detect Helicobacter pylori (Hp), but most have disadvantages such as being invasive, expensive, or unobtainable for a widespread population. The Hp stool antigen (SA) test has been advocated as a safe and cost-effective method of diagnosing Hp. Thus, we conducted a prospective study to examine the reliability of the Helicobacter pylori stool antigen (HpSA) test. METHODS: The subjects were 100 patients who underwent endoscopic manipulation at Istanbul Haseki Education and Research Hospital. Endoscopy specimens were studied by a pathologist, for routine pathological analysis and for the presence of Hp. Fecal specimens were studied using the HpSA test in the laboratory of the Department of Infectious Diseases at our hospital. The pathology results were compared with the HpSA test results, since pathological examination was the reference standard of our study. The Chi(2) test was used for statistical comparison of the values. RESULTS: According to the pathology results, Hp was present in 82 patients, whereas the HpSA test was positive in 77 patients and negative in 23 patients. The sensitivity, specificity, positive predictive value, and negative predictive value were 91%, 83%, 96%, and 65%, respectively. CONCLUSION: The HpSA test results were similar to the pathology results, with sensitivity and specificity of 91% and 83%, respectively. Thus, the HpSA test appears to be an effective method of detecting Hp in patients who are not candidates for endoscopy.