Association of atherogenic indices with myocardial damage and mortality in COVID-19.

BACKGROUND: Lipoproteins in cell membranes are related to membrane stability and play a role against microorganisms. Patients with COVID-19 often experience myocyte membrane damage. OBJECTIVE: This study aimed to search the relationship of atherogenic indices with myocardial damage and mortality in COVID-19. METHODS: This was an observational, single-center, retrospective study. The study population was grouped according to in-hospital mortality. C-reactive protein (CRP), CRP to albumin ratio (CAR), monocyte to high density lipoprotein cholesterol ratio (MHR), levels of total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDLc), and low-density lipoprotein cholesterol (LDLc) and cardiac troponin I (cTnI) were recorded. Atherogenic indices (plasma atherogenic index [AIP], atherogenic coefficient [AC], Castelli's risk indices I and II [CRI I and II], triglyceride to HDLc ratio (THR) were calculated. RESULTS: A total of 783 patients were included. The mortality rate was 15.45% (n = 121). The median age of non-survivor group (NSG) was higher than survivor group (SG) [66.0 years (Q1 -Q3: 55.0-77.5) vs 54.0 years (Q1 -Q3: 43.0-63.0)] (p < 0.001). Study parameters which were measured significantly higher in the NSG were CRP, cTnI, triglyceride, CRI-I, CRI-II, AC, AIP, ferritin, CAR, MHR and THR. LDLc, HDLc, TC and albumin were significantly lower in NSG (p<0.001). CONCLUSION: THR is positively correlated with myocardial damage and strongly predicts in-hospital mortality in COVID-19.

A prospective study of wake-up stroke patients presenting to the emergency department: a single-center cohort study.

INTRODUCTION: This study aims to prospectively examine patients with ischemic wake-up stroke (WUS) presenting to the emergency department, to investigate the risk factors affecting the mortality occurring within 28, 90, and 180 days, and to create a new scoring system for the prediction of 28-day mortality. MATERIALS AND METHOD: Patients who presented to the emergency department with WUS findings between 01.07.2019 and 30.06.2020 were prospectively analyzed. Logistic regression analysis was performed to determine the factors affecting mortality and the modified Rankin scale (mRS). RESULTS: A total of 161 patients were included. Of the patients, 22.4% died within 28 days and 40.4% within 180 days. The presence of coronary artery disease (CAD) increased the 28-day mortality risk (p = 0.009) 3.57 times, 90-day mortality risk 2.15 times (p = 0.033), and 180-day mortality risk 2.18 times (p = 0.045). In order to be used in the prediction of 28-day mortality in patients with WUS, we developed the ischemic WUS mortality score (IWUSMOS), which consists of the middle cerebral artery (45 points), internal carotid artery (60 points), basilar artery (39 points), superior cerebellar artery (66 points) occlusion, hypertension (33 points), CAD (28 points), malignancy (100 points), and arrhythmia (23 points). With this scoring system, the 28-day mortality risk was determined as 0.05% when the total score was "43" whereas the mortality risk was found to be 95.0% when the total score was "187." CONCLUSION: We propose that IWUSMOS, a new scoring system, can be used to predict the 28-day mortality risk of patients with WUS.

Turkish adaptation and validation of the Short-UPPS-P in adolescents and examination of different facets of impulsivity in adolescents with ADHD.

The short form of the Impulsive Behavior scale (S-UPPS-P) is a widely used scale to measure multiple impulsive personality traits; although it has been translated into many languages, no Turkish translation has been studied to date. Our study had two aims. First, we tested the validity and reliability of the Turkish version of the S-UPPS-P for adolescents. Second, we examined impulsive trait characteristics exhibited by adolescents with ADHD, compared to a community sample. We evaluated the psychometric properties of the Turkish S-UPPS-P scale in 384 adolescents aged 11-18 and tested correlations with ADHD symptoms by assessing 41 adolescents diagnosed with ADHD. Our results showed that with a few slight modifications the Turkish translation of the S-UPPS-P scale can validly assess impulsive trait characteristics for Turkish adolescents. The subscales of lack of premeditation, positive urgency, and negative urgency efficiently distinguished between adolescents with ADHD and control subjects. This is the first scale to evaluate the multidimensional nature of impulsivity in Turkish adolescents. This scale is capable of screening various facets of impulsivity in typically developing adolescents as well as those with ADHD, enabling us to enhance our understanding of possible risks for comorbid diseases in the latter group.

The effect of calcineurin inhibitors on anthropometric measurements in kidney transplant recipients.

BACKGROUND: This study was designed to investigate the effect of calcineurin inhibitors (CNIs), cyclosporine (CsA), and tacrolimus (Tac) on anthropometrics in kidney transplant recipients. METHODS: 111 of 128 adult kidney transplant recipients who received post-transplant CNIs were included in this retrospective study. Anthropometrics were recorded in the pre-transplant and post-transplant 4-year follow-up periods (1st, 3rd, 6th, 12th, 24th, 36th and 48th months). RESULTS: Compared to pre-transplant values, significant increases in body weight and body mass index (between 3rd and 48th months), waist and hip circumferences (between 1st and 48th months), waist-to-hip ratio (between 1st and 3rd or 6th months) and neck circumference (between 1st and 12th or 24th months) were observed in both CsA and Tac groups. A significant increase was noted in post-transplant body fat percentage values for the 3rd to 24th months in the CsA group, whereas for the 24th to 48th months in both CsA and Tac groups. Hip circumferences percentage changes from the pre-transplant period to the 1st, 12th and 24th months were significantly higher in CsA than in the Tac group. At each time point, there was no significant difference in percentage changes for other anthropometric parameters between the CsA and Tac groups. De novo diabetes mellitus developed in 8.3% of the CsA group and 19.1% of the Tac group. CONCLUSIONS: After a successful kidney transplant, anthropometric measurements increase in most recipients. Although the effect of calcineurin inhibitor type on weight gain is unclear, a regression analysis showed that CNI type was not a risk factor for the development of obesity in the 48th month. However, it is helpful to be cautious about its dyslipidemic effect in patients using CsA and the potential hazards of using Tac in patients with a diabetic predisposition.

A Nomogram Based on Myocardial Damage and Novel Inflammatory Indexes for Post-Discharge Survival Rates of COVID-19.

BACKGROUND: In the course of SARS-CoV-2 infection, early prognostic evaluation is important since clinical symptoms may worsen rapidly and may be fatal. Inflammation plays an important role in the pathogenesis of COVID-19 and can cause myocardial damage which is common in severe COVID-19 patients. Therefore, novel inflammatory indexes and myocardial damage may be predictive of prognosis in patients with COVID-19. The aim of the study was to evaluate the role of cardiac troponin I (cTnI), modified Glasgow prognostic score (mGPS), systemic immune inflammation index (SII), prognostic nutritional index (PNI), and CRP to albumin ratio (CAR) in the outcome estimation of COVID-19 and to develop a risk model predicting the survival probability of COVID-19 survivors during early post-discharge. METHODS: This was a single-center, observational, retrospective cohort study. Laboratory confirmed COVID-19 patients (n = 265) were included and grouped according to in-hospital mortality. ROC curve analysis was performed and Youden's J index was used to obtain optimal cutoff values for inflammatory indexes in discriminating survivors and non-survivors. Cox regression analysis was performed to assess the possible predictors of in-hospital mortality. A nomogram was constructed based on the Cox regression model, to calculate 7- and 14-day survival. RESULTS: The area under the ROC curve (AUC) of the variables ranged between 0.79 and 0.92 with the three highest AUC values for albumin, PNI, and cTnI (0.919, 0.918, and 0.911, respectively). Optimal threshold value for cTnI was 9.7 pg/mL. Univariate analysis showed that gender, albumin, CRP, CAR, PNI, SII, cTnI, and mGPS were significantly related to in-hospital mortality. The Cox regression analysis indicated that mGPS (p = 0.001), CRP (p = 0.026), and cTnI (p = 0.001) were significant prognostic factors. CONCLUSIONS: cTnI should not be considered merely as an indicator of myocardial damage. It also reflects the inflammatory phase and, along with other inflammatory markers, it should be included in risk models as a prognostic factor for COVID-19.

Predictors of drug survival of biologic therapies in psoriasis patients.

INTRODUCTION: We aimed to investigate the clinical, immunological, and genetic factors affecting the response to anti-TNFα (tumor necrosis factor-α) and interleukin-12/23 therapies and drug survivals. METHODS: A total of 180 patients were divided into two groups: 89 patients who used at least two biologic agents, with the initial biologic agent used less than 12 months (group A), and 91 biologic-naive patients who have been receiving a single biologic agent for more than 12 months (group B). ELISA (enzyme-linked immunosorbent assay) was used to analyze anti-drug antibodies (ADAs) in blood samples. Clinical data of the patients were retrospectively analyzed. HLA-SSO (sequence-specific oligonucleotide) Typing Kits were used for HLA-C typing. IBM SPSS v.21 was used for statistical analysis.Results: Infliximab had the longest drug survival as the first biologic agent in group A (p = .015). Etanercept had the lowest ADA count compared to the other anti-TNF agents (p = .001). HLA-Cw6 negativity, late-onset psoriasis, smoking and alcohol use were determined to be risk factors for treatment failure in group A. HLA-Cw6 was found to be associated with type I psoriasis (p = .000). CONCLUSIONS: Although our study is retrospective of a relatively low number of patients, this is a preliminary study focusing on two different patient populations based on therapy response.

The relationship between venous insufficiency and serum magnesium level

Background: Magnesium is the second most common cation in the cell. In addition to its role as a cofactor in many enzymatic pathways in physiological processes, it is necessary for the regular functioning of vascular smooth muscle cells. Magnesium deficiency has been associated with exacerbation of inflammation, which plays a role in the aetiopathogenesis of many diseases. Aim: To investigate the potential relationship between serum magnesium level and the development of chronic venous insufficiency by comparison with healthy individuals. Methods: The study included 394 patients with venous insufficiency based on physical examination findings and colour Doppler ultrasonography, and 206 controls without venous insufficiency. Venous insufficiency was defined by colour Doppler as reflux lasting 0.5 seconds or more in superficial veins, and longer than one second in femoral and popliteal veins. Clinical, haematological and biochemical parameters, including serum magnesium level and indicators of inflammation, were compared between groups. Results: A total of 600 participants were included. There was no significant difference between the groups in terms of age and gender. In total, 187 (47.46%) patients with chronic venous insufficiency and 105 (50.97%) of the control group were male (p=0.414). The median age of the patients with chronic venous insufficiency was 48 (min-max: 41-49), and the median age of the control group was 49.00 (min-max: 45.00-60.25) (p=0.064). Serum magnesium level was found to be significantly lower in the group with chronic venous insufficiency compared to the control group; 1.90 mg/dL (min-max: 1.82-2) versus 2.1 mg/dL (min-max: 2-2.2) (p<0.001), respectively. Conclusion: Low serum magnesium levels may pose a potential risk for the development of chronic venous insufficiency, which is common in the community.

Evaluation of the corpus callosum shape in patients with obstructive sleep apnea.

BACKGROUND: The aim of this study was to examine whether or not there was a difference in corpus callosum shape between patients with mild to moderate and severe obstructive sleep apnea (OSA) compared with patients who have simple snoring. METHODS: The landmark coordinate data was obtained from the mid-sagittal magnetic resonance imaging (MRI) images of 70 patients who underwent polysomnography. For comparisons, mild and moderate OSA groups were combined and analyses were performed on three groups; simple snoring/control group, mild or moderate OSA group, and severe OSA group. RESULTS: The corpus callosum shape of controls was significantly different from that of the severe OSA group. The most prominent deformities were observed in the genu and rostral body of the corpus callosum for the patients with severe OSA. No significant difference was found between mild/moderate OSA group and simple snoring group in terms of global corpus callosum shape. CONCLUSION: The data demonstrated that severe OSA patients have structural changes in the corpus callosum and deformities may vary as the severity of disease changes.

Inflammation and Nocturnal Pattern of Blood Pressure in Normotensives

Abstract Background: In most healthy individuals, blood pressure (BP) shows a circadian rhythm. Being non-dipper increases cardiovascular risk in normotensive and hypertensive individuals. Nocturnal dipping shows a correlation with the state of inflammation. Objetive: To investigate the relationship between inflammation-based indexes and nocturnal BP pattern in normotensive individuals. Method: This is a retrospective study that included patients evaluated with ambulatory BP monitoring (ABPM). A total of 131 normotensive individuals were included and grouped as dippers and non-dippers. The normality of the data was verified with a Shapiro-Wilk test. We compared ABPM variables and inflammation-based indexes derived from blood tests (monocyte to high-density lipoprotein ratio [MHR], platelet to lymphocyte ratio [PLR], neutrophil to lymphocyte ratio [NLR], and systemic immune-inflammation index [SII]) between groups. The independent samples t-test and Mann-Whitney U test were used for comparing variables with normal and non-normal distributions, respectively. The Pearson's chi-squared test was used to compare categorical variables, and Spearman's correlation coefficient was used to examine the relationships between variables. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performances of inflammation-based indexes. The level of statistical significance was 5%. Results: The study included 131 patients (mean±standard deviation [SD] age 49.2±15.1 years, 58 [76.0%] of which were women). SII was significantly higher in the non-dipper group (p=0.033). Significant negative correlations were observed between the change in systolic BP [ΔSBP] and SII (r=-0.172, p=0.049) and between ΔSBP and PLR (r=-0.179, p=0.040). Conclusion: SII is a predictor of nocturnal BP pattern in normotensives.

Relationship of magnesemia with myocardial damage and mortality in patients with COVID-19.

Magnesium (Mg) is the second most abundant intracellular cation and plays a significant role in immune system and cardiac protection. Mg deficiency contributes to chronic low-grade inflammation leading to cardiovascular diseases, and low Mg level exacerbates virus-induced inflammation. The aim of the study was to investigate whether serum magnesium level is associated with myocardial damage and prognosis of COVID-19. This was a single-center, observational retrospective study of patients with COVID-19. The study population was divided into two groups according to in-hospital mortality: a survivor group (SG) and a non-survivor group (NSG). Myocardial damage was defined as blood levels of cardiac troponin I (cTnI) above the 99th percentile upper reference limit. Magnesium, variables regarding inflammation, and myocardial damage were compared between the groups. A total of 629 patients with COVID-19 were included. Mortality rate was 11.85% (n = 82). There were 61 (74.4%) and 294 male patients (53.7%) in NSG and SG, respectively (p = 0.001). The median age of NSG was 64.5 years (min-max: 37-93) and the median age of SG was 56.0 years (min-max: 22-92) (p < 0.001). Median serum magnesium levels of NSG and SG were 1.94 mg/dL (min-max: 1.04-2.87) and 2.03 mg/dL (min-max: 1.18-2.88), respectively (p = 0.027). Median cTnI levels of NSG and SG were 25.20 pg/mL (min-max: 2.10-2240.80) and 4.50 pg/mL (min-max: 0.50-984.3), respectively (p < 0.001). The cTnI levels were lower in those patients whose serum Mg levels were higher than 1.94. Although serum magnesium level was not a predictor for in-hospital mortality, there was a significant negative correlation between magnesemia and myocardial damage.