Validation and psychometric properties of the Turkish version of Neuromuscular disease Swallowing Status Scale (NdSSS) in patients with oro-pharygo-esophageal dysphagia in neuromuscular disorders.

Objective: Dysphagia is one of the most disabling conditions arising from neuromuscular disorders(NMD). There is no specific methods to use in the evaluation of dysphagia in NMD patients. We aimed both to evaluate the applicability of the Neuromuscular Disease Swallowing Status Scale (NdSSS) for dysphagia in all phases of swallowing in various NMD patients and to investigate psychometric properties of this scale. Methods: Patients with NMD were enrolled. Functional Oral Intake Scale (FOIS), Fiberoptic Endoscopic Evaluation of Swallowing (FEES), NdSSS and High-Resolution Esophageal Manometry (HRM) were performed on all subjects within 72 hours. While the convergent and concurrent validities were used as validation method, Cohen's kappa and Cronbach's alpha coefficient were calculated for inter-rater reliability. The correlation between FOIS, PAS and HRM diagnosis according to Chicago version 3.0 (CCv3) were analyzed. Results: 115 NMD patients were included. There was good correlation between NdSSS and FOIS and PAS scores (Spearman's rank correlation coefficient (r):0.927, r:0.927 and r:-0.836, r:0.841, respectively). Also, there was a positive good correlation between NdSSS and CCv3 evaluating disorders of esophageal peristalsis (r:0.677-0.679, p=0.001). When evaluated separately, there were good correlation between NdSSS levels; and PAS (r:-0.648-0.656); and CCv3 (r:0.514-0.573) levels for ALS. For Myasthenia gravis there was a good correlation between NdSSS levels; and CCv3 (r:0.577-0.622); FOIS (r:0.508-0.521); and PAS (r:-0.504-0.519) scores. Also, for myopathy; a very good(CCv3(0.976-0.982)) and good(FOIS (0.511-0.581) and (PAS (-0.516-0.550)) correlations were defined for myopathy. Conclusion: The NdSSS was found applicable to detect both oropharyngeal and esophageal dysphagia risk in patients with NMD and is a valid and reliable swallowing screening tool that can evaluate oro-pharyngo-esophageal dysphagia in NMD patients.

Predictive factors of complications and 30-day mortality in patients undergoing percutaneous endoscopic gastrostomy: the utility of C-reactive protein to albumin ratio.

BACKGROUND AND STUDY AIMS: Percutaneous endoscopic gastrostomy (PEG) is a procedure that provides long term enteral nutrition. To investigate the predictors of PEG-related complications and 30-day mortality rates and evaluate the indicators for deciding whether to recommend elective PEG insertions, we sought to determine the complications and early mortality rates of patients who underwent PEG. PATIENTS AND METHODS: We performed a retrospective analysis of consecutive adult patients who had undergone PEG for the first time between October 2016 and January 2019. The predictors of complications and 30-day mortality were analyzed with receiver operating characteristic (ROC) and logistic regression analysis. RESULTS: This study included 309 patients. Patients were excluded from the study if they were < 18 years of age or there were missing data about them. Out of 253 patients, 33 (13%) had complications and 32 (12.6%) died within one month after PEG insertion. A higher C-reactive protein (CRP) to albumin ratio was the only independent factor predicting the complications (odds ratio (OR) : 3.17 ; 95% CI : 1.26-8.00 ; p = 0.014). The independent predictive factors for 30-day mortality after PEG placement included higher urea levels and higher CRP to albumin ratios (OR : 3.78 ; 95% CI : 1.41-10.17 ; p = 0.008) (OR : 6.67 ; 95% CI : 1.87- 23.75 ; p = 0.003). The only predictor for both complications and 30-day mortality was the CRP to albumin ratio. CONCLUSIONS: When appropriate, the PEG procedure can provide a safe and effective method for enteral feeding. The CRP to albumin ratio can be used to predict complications and early mortality after PEG insertion. Because PEG is elective, higher CRP to albumin ratios can be helpful in deciding to select patients for the procedure.

Evaluation of pentraxin-3 in familial Mediterranean fever patients during attack and attack-free periods.

INTRODUCTION: Pentraxin-3 (PTX-3) is a prototype of pentraxin proteins that have been shown to be involved in acute phase response. In this study, we aimed to investigate the relationship between PTX-3 levels and familial Mediterranean fever (FMF) disease, and to evaluate PTX-3 as a novel diagnostic marker of FMF. METHOD: Forty-three male patients diagnosed with FMF and 42 healthy individuals were included in the study. Patients with other inflammatory diseases and patients who used drugs having anti-inflammatory properties were excluded from the research. Blood samples were obtained during both attack and attack-free periods. RESULTS: Patient attack periods were confirmed by combining physical examination and elevation of acute phase reactants. Acute phase reactants were significantly higher in attack versus attack-free periods (p < 0.01), however PTX-3 levels were not significantly different between the two periods. Additionally, PTX-3 levels in FMF patients were higher than in controls in both attack (917.29 ± 725.29 vs 451.83 ± 291.95, p < 0.01) and attack-free periods (748.23 ± 487.53 vs 451.83 ± 291.95, p < 0.01). CONCLUSION: In this study, we showed that PTX-3 levels, in both FMF attack and attack-free periods, were significantly higher than in the control group. Finally, PTX-3 may be a promising biomarker for FMF diagnosis and may predict FMF attacks (Tab. 2, Fig. 2, Ref. 18).

Differences in nephrotoxicity risk and renal effects among anti-viral therapies against hepatitis B.

BACKGROUND: Results are conflicting with respect to the renal effects of anti-viral agents used for hepatitis B virus infection. AIM: To compare short and long-term renal effects in real-life settings and to determine risk factors for renal impairment during treatment. METHODS: 2221 treatment-naïve patients were enrolled. Among these, 895 (302 lamivudine, 27 telbivudine, 282 entecavir, 273 tenofovir and 11 adefovir initiated patients) had 'repeated measures' of creatinine (baseline, 1st, 6th, 12th and 24th month of treatment). Telbivudine and adefovir groups were excluded from further analysis because of the low number of patients. We calculated the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) formula at each time point. Hypophosphataemia was also recorded. Risk factors for renal impairment were analysed. RESULTS: Tenofovir caused a decline in GFR at each time point when compared to baseline levels. However, lamivudine and entecavir did not change GFR. GFR-shifting from ≥90 to 60-89 mL/min/1.73 m(2) was comparable among groups. The proportion of patients whose baseline creatinine increased more than 25% was comparable among all anti-virals. GFR showed a decline in patients who switched from entecavir to tenofovir. One patient with compensated cirrhosis needed to change from tenofovir because of renal safety. Seven and three patients developed transient hypophosphataemia in the tenofovir and lamivudine groups, respectively. CONCLUSIONS: Although tenofovir caused a decline in GFR, differences between the anti-viral agents do not appear to be so impressive. In patients with and without renal risk factors at baseline, there is no impact of anti-virals, including tenofovir.

Appreciation of trimetazidine treatment in experimental sepsis rat model.

INTRODUCTION: Our aim was to determine the efficacy of trimetazidine on experimental sepsis rat model. MATERIAL AND METHODS: Sixty rats were randomized into three groups. In Group 1, sepsis was induced. In Group 2, sepsis was induced and as a therapeutic agent trimetazidine was given. In Group 3, rats were sham operated. Serum interleukin-1 beta (IL-1ß), tumor necrosis factor alfa (TNF-α), superoxide dismutase (SOD), glutathion peroxidase (GSH-Px) and malondialdehyde (MDA) levels were determined in all groups. RESULTS: In Group 2, serum GSH-Px and SOD levels were statistically significantly higher than in Group 1 (p< 0.05) and serum MDA levels were statistically significantly lower than in group 1 (p < 0.05). Trimetazidine also significantly decreased the levels of IL-1ß and TNF-a which are the proinflammatory cytokines (p < 0.05). CONCLUSION: Trimetazidine treatment significantly improved inflammation, oxidative stress and membrane destruction in LPS-induced sepsis. As the proinflammatory cytokines are supposed to play a primary role in the pathogenesis of sepsis, we assumed that the trimetazidine treatment would give new insights into the treatment of sepsis (Tab. 1, Fig. 5, Ref. 29).