Prognostic impact of cardiohepatic syndrome in patients with ST-segment elevation myocardial infarction.

Background: Cardiohepatic syndrome (CHS) indicates a bidirectional interaction between the heart and liver. This study was designed to evaluate the impact of CHS on in-hospital and long-term mortality in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention. Materials & methods: 1541 consecutive STEMI patients were examined. CHS was defined as the elevation of at least two of three cholestatic liver enzymes: total bilirubin, alkaline phosphatase and gamma-glutamyl transferase. Results: CHS was present in 144 (9.34%) patients. Multivariate analyses revealed CHS as an independent predictor of in-hospital (odds ratio: 2.48; 95% CI: 1.42-4.34; p = 0.001) and long-term mortality (hazard ratio: 2.4; 95% CI: 1.79-3.22; p < 0.001). Conclusion: The presence of CHS is a predictor of poor prognosis in patients with STEMI and should be evaluated during the risk stratification of these patients.

Relationship between in-hospital mortality and creatinine/albumin in patients with ST-elevation myocardial infarction without standard modifiable risk factors.

Background: Diabetes, hypertension, hyperlipidemia and smoking are associated with coronary artery disease and ST-elevation myocardial infarction (STEMI). However, patients without any classic risk factors have a higher mortality rate in the post-STEMI period. The aim of this study was to investigate the relationship between in-hospital mortality and creatinine/albumin ratio in patients with STEMI without modifiable risk factors. Materials & methods: All patients included in this study with a diagnosis of STEMI and who underwent primary percutaneous intervention between 2016 and 2020 were retrospectively analyzed. Patients were included in the standard modifiable cardiovascular risk factor (SMuRF) group if at least diabetes, hypertension, smoking or hyperlipidemia was present according to risk factors. Patients without these risk factors were considered the non-SMuRF group. Results: Creatinine/albumin ratio was found to be higher in non-SMuRF patients with mortality (p < 0.001). In multivariate logistic regression analysis, ejection fraction, hemoglobin and SMuRF were found to be inversely associated with in-hospital mortality (odds ratio [OR]: 0.48, 95% CI: 0.35-0.66, p < 0.001; OR: 0.70, 95% CI: 0.56-0.88, p = 0.002; OR: 0.57, 95% CI: 0.34-0.95, p = 0.03, respectively). Conclusion: The creatinine/albumin ratio can be used as a predictor of mortality in these patients; it can help identify high-risk patients beforehand.

The association of acute--to--chronic glycemic ratio with no-reflow in patients with ST--segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

BACKGROUND: No­reflow (NR) is a strong and independent predictor of poor cardiovascular outcomes among patients with ST­segment elevation myocardial infarction (STEMI). AIMS: The aim of the study was to investigate the association of the acute­to­chronic (A/C) glycemic ratio with no­reflow (NR) in STEMI patients following primary percutaneous coronary intervention (PCI). METHODS: This retrospective study included 905 patients with STEMI. The A/C glycemic ratio was determined as admission blood glucose (ABG) divided by the estimated average glucose (eAG). We evaluated 2 primary models (full model and reduced model). The primary outcome was the presence of NR. RESULTS: The incidence of NR was 22.7% (206 cases) in the present study. We divided the study population into 3 tertiles (T1, T2, and T3) based on the ABG/eAG ratio. There was a stepwise increase of the frequency of NR from the T1 to T3 group (36 patients [12%] vs 70 patients [23%] vs 100 patients [33%]; respectively [P <0.001, for each group comparison]). In a full model, the ABG/eAG ratio (OR, 2.274; 95% CI, 1.587-3.26; P <0.001) was associated with NR. After the performance of a step-down backward variable selection method, the thrombus grade, the ABG/eAG ratio, the infarct­related artery diameter, and age remained in the reduced model. The ABG/eAG ratio (contributing 25.3% of the explainable outcome in the model) was one of the strong predictors of NR in the reduced model. CONCLUSIONS: To our knowledge, this might be the first study showing a significant relationship between the ABG/eAG ratios with NR in patients with STEMI after primary PCI.

The effects of chronic smoking on lung tissue and the role of alpha lipoic acid.

We investigated the effects of alpha lipoic acid (ALA) on blood and lung tissue exposed chronically to cigarette smoke (CS). Female Sprague-Dawley rats were divided into three groups. Group 1 was the control group (CON): fresh air was supplied twice daily and 0.1 ml physiological saline was given orally for 8 weeks. Group 2 was exposed to CS: 12 cigarettes were smoked daily at two sessions for 1 h and 0.1 ml saline was given orally for 8 weeks. Group 3 (CS + ALA) was exposed to 12 cigarettes daily in two sessions for 1 h and 100 mg/kg/day ALA was given orally for 8 weeks. DNA damage was assessed using comet analysis; oxidative damage was assessed using ischemia-modified albumin (IMA) from blood; and total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were measured in blood and lung tissue. Histopathological and immunohistochemical evaluation of hypoxia-inducible factor (HIF)-1α, and -2α, caspase-3, vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF2) were conducted using lung tissue. The oxidative markers, TOS, OSI and IMA, and the comet analysis score were increased and the TAS level was decreased in the blood of the CS group compared to the CON group. IMA levels in blood, and TOS and OSI levels in the lung were decreased significantly in the CS + ALA group compared to the CS group. We observed increased septal wall thickness, marked and diffuse inflammatory reaction, emphysema, and necrotic cell debris in bronchial and bronchiolar lumens in the CS group. HIF-1α, HIF-2α, caspase-3 and FGF2 expressions were increased, while VEGF expression decreased in the lung tissues of the CS group compared to the CON group. ALA slightly ameliorated the damage caused by chronic exposure to CS in the lungs, but further investigation is needed to determine its possible protective effects at different dosages.

The impact of sleep deprivation on hippocampal-mediated learning and memory in rats.

BACKGROUND: To examine the impact of different types of sleep deprivation on hippocampal-mediated learning and memory in rats. METHODS: Forty-eight Sprague-Dawley male rats were randomly assigned to 1 of 4 equal-size groups: (1) 12 hours of sleep per day (control). (2) total sleep deprivation (TSD), (3) rapid eye movement (REM) deprivation (RD), and (4) sleep restricted to 4 hours per day (SR). All rats were subjected to swimming training in the Morris water maze (MWM). At the end of the experiments, the rats were decapitated, and hippocampus tissue was analyzed for several neurotransmitters and receptors. RESULTS: The time spent at the target quadrant increased from 20.2 to 30.0 seconds in the control group on the third day of the experiment, whereas corresponding values increased from 20.2 to 21.8 seconds in the TSD group, 22.1 to 25.4 seconds in the RD group, and 21.2 to 32.0 sec in the SR group (p = 0.026). On the seventh day of the experiment, the values decreased to 25.0 seconds in controls, 22.5 in the RD group, and 23.6 in the SR group (p = 0.045). The TSD group demonstrated significant decreases in glutamate and serotonin levels compared with the control group. There was a significant increase in 5-HT2a receptor expression in all intervention groups compared with the controls. CONCLUSIONS: Our results of glutamate levels and 5-HT2a receptor expression in the hippocampus seem to be primarily involved in sleep and memory regulation (Tab. 2, Fig. 4, Ref. 59).

R202Q/M694V as novel MEFV gene mutations in chronic periodontitis and familial Mediterranean fever.

BACKGROUND AND OBJECTIVE: Familial Mediterranean fever (FMF) and chronic periodontitis are inflammatory diseases leading to an increase in the number of inflammasomes. To date, no published studies have reported on mutations in the Mediterranean fever (MEFV) gene in patients with chronic periodontitis, although the roles of MEFV gene mutations in FMF and FMF-associated amyloidosis (FMF-A) are well known. Therefore, the aim of this study was to evaluate the frequencies of MEFV gene mutations and serum amyloid A (SAA) and high-sensitivity C-reactive protein (hs-CRP) levels in patients with chronic periodontitis, FMF and FMF-A. MATERIAL AND METHODS: The study population included 122 patients with FMF and 128 subjects who were systemically healthy. Clinical periodontal parameters, including the plaque index, gingival index, probing pocket depth, clinical attachment level and percentage of bleeding on probing were recorded. Blood samples were obtained from patients with FMF and systemically healthy controls, and all mutations located on exons 2 and 10 of the MEFV gene were analyzed by DNA Sanger Sequencing, which is the gold standard. SAA and high-sensitive CRP levels were also assessed. RESULTS: Mean gingival index, percentage of bleeding on probing, probing pocket depth and clinical attachment level, and the levels of SAA and hs-CRP were higher in the FMF-A group than those in the FMF and control groups. The two most relevant mutations in patients with FMF were heterozygous M694V (46.2%), and heterozygous R202Q (32.7%). The frequencies of the homozygous M694V and R202Q mutations in the FMF-A group were 53.8% and 46.1%, respectively. The complex R202Q/M694V homozygous state led to an increased risk of chronic periodontitis (odds ratio: 3.6), and FMF-A (odds ratio: 7.6). CONCLUSION: This is the first study to report the R202Q mutation in patients with periodontitis. Furthermore, the MEFV gene-mediated inflammatory pathway increased serum acute phase reactants, and the changes in the R202Q and M694V could play a role in inflammatory-genetic diseases, such as FMF, FMF-associated amyloidosis and chronic periodontitis.

The evaluation of Nesfatin-1 levels in patients with OSAS associated with metabolic syndrome.

PURPOSE: The association of obstructive sleep apnea syndrome (OSAS) and metabolic syndrome (MS) has been demonstrated in studies and in recent years; the effect of OSAS on insulin resistance independent of the level of obesity is being investigated. Nesfatin-1 is a newly defined 82 amino acid protein with a precursor molecule of NUCB2 (nucleobindin 2). Nesfatin-1 is not only essential in regulation of food ingestion but also important in regulation of some brain functions, autonomic regulation, stress, mental state, and paradoxical sleep. We aimed to evaluate the relationship between OSAS and MS and the MS dependent or independent effect of Nesfatin-1 on this relationship. METHODS: Patients admitted with clinical signs of OSAS are included. Patients are divided into three groups based on Apnea-Hypopnea Index (AHI) on Polysomnography (PSG) as mild, moderate, and severe OSAS. A total of 59 patients were included the control patients. Several OSAS parameters and laboratory findings which are and are not MS dependent are compared. Nesfatin-1 levels are evaluated in all OSAS patients with and without MS. RESULTS: There were significantly more males in all groups (p = 0.007). There was no significant difference between groups in terms of Nesfatin-1 levels. Nesfatin-1 levels were significantly lower in MS group compared to non-MS group (p = 0.021). CONCLUSION: Nesfatin-1 which is known to play a role in the pathophysiology of insulin resistance can be a beneficial target in developing new therapeutic targets for treatment of patients with obesity without any toxic effects in the future.

Correlation between the serum alkaline phosphatase level and the severity of coronary artery disease.

OBJECTIVES: The serum alkaline phosphatase (ALP) level has shown to be a prognostic factor in myocardial infarction and peripheral vascular disease by its promoting effect on vascular calcification. A few recent studies also showed that elevated ALP levels were associated with mortality and unfavorable prognosis in coronary artery disease (CAD). Herein, we aimed to investigate the correlation between serum ALP levels and the severity of CAD by assessing the Gensini score. MATERIALS AND METHODS: A total of 470 patients with stable angina pectoris were evaluated retrospectively.Upon admission, their ALP levels were measured with an automated analyzer by the enzymatic method, and the severity of CAD was documented for each patient according to their Gensini score. Patients with a Gensini score greater than 40 were defined to have an advanced CAD. Serum ALP levels higher than 129 mg/dl in men and higher than 104 mg/dl in women were defined as the elevated ALP groups. RESULTS: The mean ALP level was 97.3±56.4, ranging from 15 to 485 U/l with 66.0/82.5/106.0 U/l percentile values, and elevated ALP levels were obtained in 79 cases (16.8%). In 70% of the patients (n=329), advanced CAD was diagnosed. The mean Gensini score was 85.6±29.4 in the advanced CAD group and 12.8±15.8 in the remainder of the patients. The advanced CAD group included more men, patients with diabetes mellitus, hypertension, and a reduced left ventricular ejection fraction, and patients with lower levels of high-density lipoprotein cholesterol and higher levels of creatinine, red cell distribution width, and mean platelet volume. ALP levels (105.4±60.7 vs. 78.4±38.7 U/l, P<0.001) and the frequency of patients with elevated ALP levels (22 vs. 5.0%, P<0.001) were significantly higher in the advanced CAD group. Regression analysis showed a significant correlation between increased levels of serum ALP and advanced CAD in univariate (odds ratio 1.015, 95% confidence interval 1.008-1.1291, P<0.001) and multivariate analyses (odds ratio 1.013, 95% confidence interval 1.003-1.023, P=0.01). CONCLUSION: Elevated ALP levels are associated with higher Gensini scores and a more severe form of CAD.

The periodontal status of indirectly lead-exposed apprentices working in autorepair workshops.

The aim of this study was to evaluate the periodontal health status of lead-exposed apprentices and to search the correlation between clinical periodontal parameters and either blood lead or oxidative stress/damage indices in erythrocytes. Sixty male subjects were recruited for this study (30 apprentices and 30 controls). The periodontal health status was determined with gingival index, plaque index, gingival bleeding time index, probing depth, and clinical attachment level records. Additionally, blood lead level and indices of oxidative stress (glutathione peroxidase, superoxide dismutase), catalase activities and damage (malondialdehyde concentration) in erythrocytes were determined. The results showed that lead level was significantly higher in apprentices than in controls (P < 0.05). None of the clinical periodontal parameters and oxidative stress/damage indices were significantly different between the groups (P > 0.05). Significant correlation between plaque index and catalase, probing depth and superoxide dismutase, clinical attachment level and superoxide dismutase, and clinical attachment level and malondialdehyde in apprentices group (P < 0.05), and gingival bleeding time index and glutathione peroxidase in control group were found (P < 0.05). In multiple regression analysis, there were statistically significant associations between gingival index and working status, family income and either probing depth or clinical attachment level (P < 0.05). The results of this study showed significant association between the clinical periodontal parameters and oxidative stress/damage indices in apprentices indirectly exposed to low levels of lead.

Serum sialic acid and gamma-glutamyltransferase levels in alcohol-dependent individuals.

Alcohol abuse is a very common problem all over the world. Identification of alcoholism is crucial in preventing some adverse health effects, economical and social consequences of excessive alcohol consumption. The aim of this study was to determine sialic acid (SA) and gamma-glutamyltransferase (GGT) levels in serum samples of alcoholics and to compare the diagnostic accuracy of SA with the conventional marker, GGT. The results have shown that serum SA (p<0.01) and GGT levels (p<0.001) were significantly increased in alcohol-dependent individuals as compared with healthy controls. No significant relationship was observed between SA and GGT levels in alcohol-dependent subjects and control group. Interestingly, a positive correlation was found between amount of alcohol consumption and serum SA level (r = 0.381, p<0.05). In order to evaluate the ability of SA and GGT determinations to discriminate between alcohol-dependent subjects and healthy controls, an analysis of receiver operating characteristic (ROC) curve was performed. Data suggest that GGT and SA levels in serum may be used as valuable biological markers for detecting and monitoring alcohol abuse. In view of the findings, introducing serum SA determination can be recommended as a part of diagnostic tests for identifying alcohol abuse.

Frequency of mtDNA A1555G and A7445G mutations among children with prelingual deafness in Turkey.

UNLABELLED: Considerable differences on the frequencies of the mitochondrial 12S rRNA A1555G and tRNA(Ser(UCN)) A7445G mutations have been reported in different populations. Our screening of 168 patients coming from independent Turkish families with prelingual sensorineural non-syndromic deafness revealed three deaf children with A1555G (1.8%) but no examples of A7445G. One proband with the mitochondrial A1555G mutation has also evidence for right parietal infarct on a brain imaging study, for which common thrombotic mutations were found to be negative. CONCLUSION: This study shows that the mitochondrial A1555G mutation is among the significant causes of prelingual non-syndromic deafness in the Turkish population.

Nasopharyngeal carcinoma in Turkish children: review of 33 cases.

A retrospective and prospective analysis is reported of epidemiological, clinical, and therapeutic aspects of 33 children with nasopharyngeal carcinoma who were treated in a single institution over a period of 10 years. Twenty-three male and 10 female children ranging from 9 to 17 years were referred to our center. Histopathology was WHO type 3 carcinoma in 21, WHO type 2 in 8, WHO type 1 in 1, and unclassified in 3 patients. Disease extent was T2a (n = 15), T2b (n = 2), T3 (n = 11), and T4 (n = 5); N1 (n = 5), N2 (n = 12), and N3a (n = 16). Five patients had base of skull invasion. Four patients had M1 disease on admission. Four patients were treated with irradiation only. Three patients received neoadjuvant, 4 patients received adjuvant, and 22 patients received neoadjuvant + adjuvant chemotherapy in addition to radiotherapy. Patients received 50-72 Gy to the primary tumor and involved nodes and 45-50 Gy to uninvolved regions. Chemotherapy consisted of combinations of cisplatin, fluorouracil or Adriamycin, vincristine, and cyclophosphamide. Twenty-nine patients (88%) attained locoregional control. Overall, 10 patients died with progressive disease or infectious complications, and 2 patients are still receiving therapy. Three patients are still living with multiple metastases and stable disease. Eight patients were lost to follow-up. Twelve patients are alive without relapse 3 and 63 months from diagnosis. Seven patients had 6 relapses at distant and 1 relapse at local site. The median time for first relapse was 8 months. Overall, the 5-year survival rate was 63% and disease-free survival rate was 53%. Although the locoregional control rate is high, long-term survival rates will be the real test of the impact of chemotherapy. Further studies are needed to confirm the optimal combination of effective chemotherapeutic agents and radiotherapy.

Subcutaneous sacrococcygeal myxopapillary ependymoma.

We report an 8-year-old boy with a primary subcutaneous sacrococcygeal ependymoma, a rare tumor that is thought to arise in embryologic rests. The lesion was completely removed in our patient, who has been followed without recurrence for 20 months. Our experience, together with that of the other 15 cases in the world literature, supports surgical excision as the mainstay of treatment.

Long-term pulmonary function in children with Hodgkin's disease.

We studied the long-term pulmonary function of 25 patients who were at least 5 years post-treatment for Hodgkin's disease. The mean age of the patients was 17 years (range 9.5-25 years) at the time of study. Twenty-one of the patients were male. All patients received six courses of COPP chemotherapy and, in addition, 8 of the 25 patients received radiotherapy to the mediastinum in low or moderate doses (20-30 Gy). One patient had symptoms of bronchiectasia. The chest radiographs of nine patients (36%) showed minimal abnormalities. We divided patients into two groups while evaluating their pulmonary function tests according to whether they received mantle irradiation or not. In patients who received mantle irradiation, pulmonary function tests showed a minimal decrease in FEV1. The decrease in FEV1 indicated an obstructive ventilatory defect. We concluded that our treatment protocols for paediatric Hodgkin's disease were curative, well tolerable and might minimize pulmonary functional changes.

Primary osteosarcoma presenting in axial bones in childhood.

Six cases of osteosarcoma occurring between 1971 and 1992 and involving the axial bones were reviewed. They constituted 4% of 129 osteosarcomas occurring in the skeleton in childhood during the same period at our center. The patients' ages ranged from eight to seventeen years. Four of the six patients were female. The distribution of axial bones of osteosarcoma was as follows: one case was in the vertebrae, two cases in the craniofacial bones (maxilla and mandible), two cases in the pelvis and one case in the ribs. The prognosis was very poor, with only one case of mandible osteosarcoma still alive. The other five patients died three to sixteen months after diagnosis. A combination of wide surgical resection and aggressive chemotherapy may offer the best chance for longterm survival.

p53 codon 213 (A-G) polymorphism in a Turkish population.

We studied a rare polymorphism at exon 6 (CD 213) of the p53 gene in a healthy Turkish population (n = 26) and in Turks with different types of tumors such as malignant lymphoma (n = 12), osteosarcoma (n = 5), and nasopharyngeal sarcoma (n = 4). The polymorphic allele was found in only one of the malignant lymphoma patients (4.16%). Our data revealed that CD 213 (A-G) polymorphism is very rare in the Turkish population and there is no association with the tumors.

Methotrexate-induced leukoencephalopathy. A case report.

A six-year-old girl with non-Hodgkin's lymphoma who was treated with both intravenous (IV) and intrathecal (IT) methotrexate and developed brain damage secondary to the cytostatic drug is described. This patient displayed hypertension, hypothermia/hyperthermia, lethargy, deterioration and coma as clinical findings, and bilateral, focal white matter hyperintensities in the occipital lobes were seen in her magnetic resonance imaging (MRI). Treatment-related leukoencephalopathy is one such adverse effect of IT methotrexate administration on the central nervous system and usually appears in a generalized form.