Predictive epidemiological, clinical and laboratory parameters in the diagnosis of Crimean-Congo hemorrhagic fever.

Background: The aim of this study is to determine predictive parameters that can be used in the differential diagnosis of Crimean-Congo Hemorrhagic Fever (CCHF) and other diseases with similar clinical and laboratory findings. Materials & methods: In this study, epidemiological, clinical and laboratory parameters of 107 CCHF-positive and 71 CCHF-negative patients were compared. Results: Alanine amino transferase, aspartate aminotransferase, creatine kinase, lactate dehydrogenase, red blood cell, hemoglobin and hematocrit were significantly higher in CCHF-positive patients, whereas total and direct bilirubin, alkaline phosphatase, prothrombin time, international normalization ratio, white blood cell, C-reactive protein and procalcitonin were higher in CCHF-negative patients. In binary logistic regression analysis, an increase in activated partial thromboplastin time level was identified as an independent predictor of having CCHF, while alanine amino transferase, white blood cell and C-reactive protein elevations were identified as independent predictors of not having CCHF. Conclusion: In endemic areas where PCR and serological tests are delayed, knowing the predictive parameters may be of vital importance in the early diagnosis of CCHF.

Impact of model for end-stage liver disease (MELD) score for mortality in patients undergoing coronary bypass surgery.

OBJECTIVES: The aim of the study is to evaluate the predictive value of the model for end-stage liver disease (MELD) score for mortality in stable angina pectoris patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: We retrospectively analyzed 261 consecutive patients with stable angina pectoris who underwent CABG while not being on anticoagulant therapy. The patients were divided into two groups: survivors and non-survivors. The MELD score was calculated for all patients. The all-cause mortality within postoperative 12 months was the primary end point of the study. RESULTS: The follow-up period was 12 months. The non-survivors were older (72.0±6.1 vs 62.4±8.4, p<0.001). The MELD score was significantly higher in the non-survivors group (7.5±1.2 vs 6.7±0.7, p<0.001). The MELD score (p=0.001) was an independent predictor of postoperative one-year mortality. The addition of MELD score to EuroSCORE II significantly improved the prognostic performance of the EuroSCORE II (EuroSCORE II vs EuroSCORE II plus MELD score: AUCs: 0.792 vs 0.842). CONCLUSION: Our research showed that the MELD score could be useful to predict mortality in patients who have stable coronary artery disease, and are undergoing CABG surgery (Tab. 3, Fig. 2, Ref. 25).

Combining clinical predictors to better predict for the no-reflow phenomenon.

OBJECTIVE: We aimed to determine whether the combination of a CHA2DS2-VASc score (C: Congestive Heart Failure, H: Hypertension, A2: Age ≥ 75 years, D: Diabetes mellitus, S: Stroke history, V: Vascular disease, A: Age ≥ 65 years, Sc: Sex category) and pre-percutaneous coronary intervention (PCI) thrombus load score was more sensitive at detecting the no-reflow phenomenon compared to the CHA2DS2-VASc score alone or to the thrombus load score alone in patients with acute ST-elevation myocardial infarction (STEMI) who had underwent primary PCI (PPCI). PATIENTS AND METHODS: 497 patients with acute STEMIs were divided into two groups: no-reflow group (n: 194) and control group (n: 303). The Thrombolysis In Myocardial Infarction (TIMI) flow grading and Myocardial Blush Grade (MBG) were used together to define angiographic no-reflow as TIMI flow < 3 (with any MBG grade) or TIMI flow 3 with MBG 0 or 1. Successful reperfusion was defined as TIMI flow 3 with MBG 2 or 3. RESULTS: CHA2DS2-VASc score was significantly higher in the no-reflow group than in the control group (2 [1-4] vs. 1 [0-3], p < 0.001]. Compared with the control group, the no-reflow group had a higher pre-PCI thrombus score (5 [4-5] vs. 4 [3-5], p = 0.001). Compared with the CHA2DS2-VASc score alone, the combined use of the pre-PCI thrombus score and the CHA2DS2-VASc score was associated with significant improvements in the ability to predict no-reflow (AUC) (0.65 vs. 0.60, p < 0.05). The addition of the pre-PCI thrombus score to the CHA2DS2-VASc score was related to a significant net reclassification improvement of 6.7% (p = 0.047) and an integrated discrimination improvement of 0.036 (p < 0.05). CONCLUSIONS: We have found that the combination of a CHA2DS2-VASc score and a pre-PCI thrombus load score was more sensitive in detecting the no-reflow phenomenon than only a CHA2DS2-VASc score in patients who underwent PPCIs for STEMIs.

Real-life use of digoxin in patients with non-valvular atrial fibrillation: data from the RAMSES study.

WHAT IS KNOWN AND OBJECTIVE: Although inappropriate use of digoxin has been described in various populations, a real-world evaluation of patterns of digoxin prescription has not been well studied in patients with atrial fibrillation (AF). The aim of this study was to identify prevalence, indications and appropriateness of digoxin use in the general population of patients with non-valvular AF (NVAF) in Turkey. METHODS: We included and classified patients from the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke prevention strategies in Turkey) study, a prospective registry including 6273 patients with NVAF, on the basis of digoxin use. After excluding the data of 73 patients whose medical history about digoxin use or left ventricle function was absent, 6200 patients were included for the final analysis. Digoxin use was considered inappropriate if patients did not have left ventricular systolic dysfunction or symptomatic heart failure (HF). RESULTS AND DISCUSSION: Digoxin was used in 1274 (20·5%) patients. Patients treated with digoxin were older (71·4 ± 9·8 years vs. 69·2 ± 10·9 years, P < 0·001), more likely to be female (58·8% vs. 55·9%, P = 0·019) and had more common comorbidities such as HF (40·2% vs. 17·4%), diabetes (26·4% vs. 21·1%), coronary artery disease (35·3 vs. 27·6%) and persistent/permanent AF (93·4% vs. 78·4%; P < 0·001 for each comparison). Of the 1274 patients, the indication of digoxin use was considered inappropriate in 762 (59·8%). WHAT IS NEW AND CONCLUSION: Our findings show that nearly one-fifth of the patients with NVAF were on digoxin therapy and nearly 60% of these patients were receiving digoxin with inappropriate indications in a real-world setting.

Prevalence of coronary artery anomalies in patients undergoing coronary artery angiography: a review of 16768 patients. A retrospective, single-center study.

AIM: Coronary artery anomalies (CAAs) most of the time are detected at birth. The aim of this study was to report the prevalence of CAAs by investigating coronary artery angiography (CAG) images of patients admitted to the authors' hospital, a tertiary healthcare provider. METHODS: Images of 16,768 patients who underwent CAG in our hospital were evaluated regarding CAAs. RESULTS: CAAs were detected in 120 (0.7%) cases. Anomalous origin and course of arteries were observed in 86 (0.51%) cases. Seven of these cases were diagnosed with acute coronary syndrome and 5 of them were treated with angioplasty without any complication. Absence of LMCA was revealed as the most frequent anomaly in the subgroup analysis of origin and course anomalies by being spotted in 59 (49.9 %) cases of total 120. Myocardial bridge, which constituted all intrinsic coronary anomalies in our study, was determined in 18 (0.1%) patients. All of the anomalies of coronary termination were coronary artery fistulas which were seen in 16 (0.09%) of patients and 2 of them were occluded with coil. CONCLUSION: Absence of LMCA was the most frequently encountered anomaly. Although CAAs are rare cases, they can cause difficulties in CAG interventions and surgical operations. This study presents CAA frequencies of patients who performed CAG.

[Child welfare, diseases and their treatments in the Turkish medical manuscripts (14th and 15th century)]. / Ilk Dönem (14. ve 15. Yüzyil) Türkçe Tip Yazmalarinda Cocuk Sagligi Hastaliklari ve Tedavileri.

The data of this study is the knowledge related to the children in the Turkish medical manuscripts of 14th and 15th century which constituted the basis of Ottoman Medicine. Our primary aim was to investigate the child welfare and diseases in these manuscripts. So that we searched for these issues and compared them with Avicenna medicine and Tedbir-ul Mevlüd of Saban Sifai (about child welfare and diseases) and classified them according to the contemporary medicine. In this paper, we aimed to find out and determine the medical knowledge on child welfare, diseases and the treatment in the Ottoman medicine of 14th and 15th centuries.

[The case of a patient with multiple superinfected necrosis of both legs caused by vasculitis disease]. / Fallbericht einer Patientin mit multiplen superinfizierten Nekrosen beider Ober- und Unterschenkel auf dem Boden einer Vaskulitis.

Vasculitis can lead to skin necrosis, which typically shows decayed recovery tendency and is able to lead to local as well as systemic inflammation. By repeated necrosectomy, vacuum therapy, split skin graft transplantation as well as simultaneous immunosuppression and systemic antibiotics, the cutaneous manifestations of vasculitis where cured.