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1.
Artigo em Inglês | MEDLINE | ID: mdl-38853577

RESUMO

Purpose: The COVID-19 pandemic has shown a rise in pediatric diabetes. Studies have indicated an increased likelihood of children with COVID-19 infection developing diabetes. Our objective was to assess not only for an increase in pediatric diabetes at our hospital and identify possible risk factors but also to correlate psychosocial changes resulting from the pandemic with new-onset diabetes during this time. Methods: We analyzed data from 58 children aged 1-18 years admitted to our hospital with new-onset diabetes between March 2020 and December 2021, including inflammatory biomarkers and SARS-CoV-2 antibodies (Ab), as well as results of a lifestyle questionnaire. Results: Average monthly hospital admissions for new-onset diabetes rose from 10 to 18 with the start of the pandemic. Of the 58 children in our analysis, 33% had positive SARS-CoV-2 IgG Ab, 31% had type 1 diabetes mellitus (T1DM), and 62% had type 2 diabetes mellitus (T2DM). More than half (54%) were in DKA. Those with T2DM were older, majority African American, had higher median BMI percentiles, and lower Vitamin D levels. There were no significant correlations between any psychosocial risk factors and either diabetes type or SARS-CoV2 Ab status. Conclusions: Despite the increased incidence of new-onset diabetes among children in Mississippi during the pandemic, this study was unable to demonstrate significant correlations between COVID-19 infection and new-onset diabetes. This study highlighted the correlation between increased BMI and type 2 diabetes, which speaks to the significant problem of obesity and diabetes in Mississippi and the need for further research.

2.
Psychother Psychosom Med Psychol ; 74(5): 174-182, 2024 May.
Artigo em Alemão | MEDLINE | ID: mdl-38580309

RESUMO

The mental health of refugees is influenced by a variety of pre-, peri- and postmigratory factors. It remains largely unclear how social determinants influence the utilization of psychiatric-psychotherapeutic treatment. We applied a questionnaire survey to 189 refugees from a clinical sample in a psychiatric hospital and from a control sample, which was not in treatment. The influence of social factors on psychopathology and utilization of care was analyzed by means of a CHAID algorithm. The total sample was highly stressed (54% PTSD and 41.4% depression symptoms). Patients were more severely affected in all psychometric scales as well as in traumatization and they were less able to draw on resources such as a social network or residence permit. The strongest predictor for psychotherapeutic-psychiatric treatment was social isolation in the living environment. For patients, the lack of a work permit was the strongest predictor of depression symptoms. The results point to the importance of postmigratory social determinants for the mental health of refugees. In particular, stable social relationships, together with formal factors such as work permit and residence title, should help to reduce mental distress and the need for psychiatric treatment.


Assuntos
Saúde Mental , Refugiados , Determinantes Sociais da Saúde , Isolamento Social , Humanos , Refugiados/psicologia , Masculino , Feminino , Alemanha , Adulto , Pessoa de Meia-Idade , Isolamento Social/psicologia , Inquéritos e Questionários , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto Jovem , Idoso , Depressão/psicologia
3.
Turk Gogus Kalp Damar Cerrahisi Derg ; 32(1): 17-25, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38545357

RESUMO

Background: This study aims to report the incidence of acute kidney injury following surgical reconstruction after a failed endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysms. Methods: This retrospective study included 44 patients (39 males, 5 females; mean age: 70±11.3 years; range, 35 to 84 years) who underwent emergency or elective surgical reconstruction after failed EVAR between February 2015 and January 2019. Patients were divided into two groups: acute kidney injury group and no acute kidney injury group. The primary end-point of the study was to evaluate the development of acute kidney injury following surgery. The secondary end-points included the 30-day and one-year mortality rates. Results: Surgical reconstruction of the abdominal aorta was performed electively in 29 (65.9%) patients and urgently in 15 (34.1%) patients. Acute kidney injury occurred in 12 (27.3%) patients. The interval from endovascular aneurysm repair to surgical reconstruction was statistically significantly higher in the no acute kidney injury group than in the acute kidney injury group (24.6±11.5 and 18.1±13.3 months, respectively; p=0.145). The mean abdominal aortic aneurysm diameter, neck angulation, and neck diameter were statistically significantly higher in the acute kidney injury group than in the no acute kidney injury group (p=0.001, p=0.009, and p<0.001, respectively). No statistically significant difference was observed between the acute kidney injury and no acute kidney injury groups for the overall 30-day mortality (p=0.185) and oneyear mortality (p=0.999). Conclusion: Acute kidney injury is not uncommon after the surgical reconstruction of a failed EVAR. Aneurysm-related anatomical factors may have an impact on the development of postoperative acute kidney injury. Comprehensive surgical planning should be performed for open abdominal aortic surgery after a failed EVAR.

4.
Am J Emerg Med ; 80: 51-60, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38507847

RESUMO

INTRODUCTION: ChatGPT, developed by OpenAI, represents the cutting-edge in its field with its latest model, GPT-4. Extensive research is currently being conducted in various domains, including cardiovascular diseases, using ChatGPT. Nevertheless, there is a lack of studies addressing the proficiency of GPT-4 in diagnosing conditions based on Electrocardiography (ECG) data. The goal of this study is to evaluate the diagnostic accuracy of GPT-4 when provided with ECG data, and to compare its performance with that of emergency medicine specialists and cardiologists. METHODS: This study has received approval from the Clinical Research Ethics Committee of Hitit University Medical Faculty on August 21, 2023 (decision no: 2023-91). Drawing on cases from the "150 ECG Cases" book, a total of 40 ECG cases were crafted into multiple-choice questions (comprising 20 everyday and 20 more challenging ECG questions). The participant pool included 12 emergency medicine specialists and 12 cardiology specialists. GPT-4 was administered the questions in a total of 12 separate sessions. The responses from the cardiology physicians, emergency medicine physicians, and GPT-4 were evaluated separately for each of the three groups. RESULTS: In the everyday ECG questions, GPT-4 demonstrated superior performance compared to both the emergency medicine specialists and the cardiology specialists (p < 0.001, p = 0.001). In the more challenging ECG questions, while Chat-GPT outperformed the emergency medicine specialists (p < 0.001), no significant statistical difference was found between Chat-GPT and the cardiology specialists (p = 0.190). Upon examining the accuracy of the total ECG questions, Chat-GPT was found to be more successful compared to both the Emergency Medicine Specialists and the cardiologists (p < 0.001, p = 0.001). CONCLUSION: Our study has shown that GPT-4 is more successful than emergency medicine specialists in evaluating both everyday and more challenging ECG questions. It performed better compared to cardiologists on everyday questions, but its performance aligned closely with that of the cardiologists as the difficulty of the questions increased.


Assuntos
Cardiologistas , Competência Clínica , Eletrocardiografia , Medicina de Emergência , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doenças Cardiovasculares/diagnóstico
5.
Catheter Cardiovasc Interv ; 103(4): 511-522, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38415900

RESUMO

BACKGROUND: Double kissing (DK)-crush and T-stenting and small protrusion (TAP) techniques are gaining popularity, but the comparison for both techniques is still lacking. This study sought to retrospectively evaluate the long-term outcomes of DK-crush and TAP techniques in patients with complex bifurcation lesions. METHODS: A total of 255 (male: 205 [80.3%], mean age: 59.56 ± 10.13 years) patients who underwent coronary bifurcation intervention at a single-center between January 2014 and May 2021 were included. Angiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary endpoint was target lesion failure (TLF), defined as the combination of cardiac death, target vessel myocardial infarction, or clinically driven-target lesion revascularization (TLR). The regression models were adjusted applying by the inverse probability weighted (IPW) approach to reduce treatment selection bias. RESULTS: The initial management strategy was DK-crush in 152 (59.6%) patients and TAP in 103 (40.4%) cases. The SYNTAX scores (24.58 ± 7.4 vs. 24.26 ± 6.39, p = 0.846) were similar in both groups. The number of balloon (6.32 ± 1.82 vs. 3.92 ± 1.19, p < 0.001) usage was significantly higher in the DK-crush group than in the TAP group. The rates of TLF (11.8 vs. 22.3%, p = 0.025) and clinically driven TLR (6.6 vs. 15.5%, p = 0.020) were significantly lower in the DK-crush group compared to the TAP group. The long-term TLF was significantly higher in the TAP group compared to the DK-crush group (unadjusted HR: 1.974, [95% CI: 1.044-3.732], p = 0.035 and adjusted HR [IPW]: 2.498 [95% CI: 1.232-5.061], p = 0.011). CONCLUSION: The present study showed that the DK-crush technique of bifurcation treatment was associated with lower long-term TLF and TLR rates compared to the TAP technique.


Assuntos
Angioplastia Coronária com Balão , Stents Farmacológicos , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Sistema de Registros
6.
J Gastroenterol Hepatol ; 39(6): 1040-1047, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38334062

RESUMO

BACKGROUND AND AIM: This study investigates the effectiveness of bedside ultrasonography in predicting blood transfusion requirements in patients with upper gastrointestinal bleeding (UGIB). It focuses on evaluating the inferior vena cava (IVC) diameter, IVC collapsibility index (CI), and stroke volume (SV) as ultrasonographic measures. METHODS: A hundred adult patients enrolled in this prospective clinical study. The patients were divided into two groups (group 1: only saline administered group, group 2: saline and blood administered group). IVC diameter, IVC CI, and SV were measured at the time of admission and after treatment. RESULTS: At the initial admission, group 1 exhibited an IVC CI of 20.4% and an SV of 65.0 mL, whereas group 2 displayed an IVC CI of 26.6% and an SV of 58.0 mL. Upon analyzing the relationship between the Glasgow-Blatchford score (GBS) and SV, we identified a significant negative correlation (r = -0.7350; P < 0.001). Similarly, a weak negative correlation was observed between the Rockall score (RS) and SV (r = -0.4718; P < 0.001). It is worth noting that patients with UGIB require blood transfusion if their SV falls below 62.5 mL, with an area under the curve (AUC) of 89.1% and a 95% confidence interval (CI) ranging from 82.8% to 95.4%. CONCLUSION: IVC CI and SV can be used as parameters to predict the need for blood transfusion in the ED in patients with UGIB.


Assuntos
Transfusão de Sangue , Serviço Hospitalar de Emergência , Hemorragia Gastrointestinal , Valor Preditivo dos Testes , Volume Sistólico , Veia Cava Inferior , Humanos , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/diagnóstico por imagem , Masculino , Feminino , Veia Cava Inferior/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Prospectivos , Idoso , Ultrassonografia , Adulto
7.
Environ Monit Assess ; 196(3): 287, 2024 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-38378878

RESUMO

Soil respiration (RS) is one of the largest terrestrial sources of CO2 causing global warming and may vary according to land use and vegetation type. Türkiye is in the first place in the world in terms of area of hazelnut orchards that are generally converted from natural forests. The aim of this study was the comparison of the effects of cultural practices (pruning, fertilizing, and pruning+fertilizing) on RS in hazelnut orchards and that of the adjacent natural oak forest. Every trial site had a statistically similar annual mean RS, which ranged from 0.15 to 1.55 g C m-2 day-1. The RS on the sites was different only in the spring season and was similar in the other seasons. The RS of the pruned and fertilized hazelnut orchard (Hpf) in the spring was 58% greater than the unmaintained hazelnut orchard (Hc) and oak forest and 28% greater than the only fertilized hazelnut orchard (Hf). The RS of Hpf was also greater than other sites in most monthly measurements. While the positive correlation between soil moisture and RS was on an annual basis (r = 0.44), it was higher in summer (r = 0.61) and autumn (r = 0.55) seasons. The negative correlation between soil temperature and RS in the summer and autumn seasons evolved positively in winter. The results of the study suggest that the maintenance practices applied in the hazelnut garden could increase RS in the spring when soil moisture and temperature are optimal but have no effect in other seasons or on an annual basis.


Assuntos
Corylus , Quercus , Solo , Monitoramento Ambiental , Florestas , Temperatura , Respiração , Estações do Ano , China , Dióxido de Carbono/análise
8.
Skeletal Radiol ; 53(4): 805-809, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37658863

RESUMO

Many anatomical variations have been described in the menisci, especially in the lateral meniscus. Among these, discoid meniscus is the most common variation. Others are described in the literature as double-layered meniscus, accessory meniscus, ring-shaped meniscus, and hypoplastic meniscus. Also, combined variations associated with ring-shaped meniscus have been described, and they can be confused with fragmented complex tears and cause unnecessary surgery. Increasing awareness of the imaging features of these accompanying combined variations may aid in the recognition and differentiation of this entity from meniscus tears. We report the case of a ring-shaped meniscus and accompanying intermeniscal bridge meniscus, which has not been described before in the literature, highlighting the MRI and arthroscopic imaging findings of it.


Assuntos
Artropatias , Lesões do Menisco Tibial , Humanos , Artroscopia , Estudos Retrospectivos , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/cirurgia , Articulação do Joelho , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia , Imageamento por Ressonância Magnética/métodos
9.
Acta Radiol ; 65(2): 159-166, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38146126

RESUMO

This review article highlights the potential of integrating photon-counting computed tomography (CT) and deep learning algorithms in medical imaging to enhance diagnostic accuracy, improve image quality, and reduce radiation exposure. The use of photon-counting CT provides superior image quality, reduced radiation dose, and material decomposition capabilities, while deep learning algorithms excel in automating image analysis and improving diagnostic accuracy. The integration of these technologies can lead to enhanced material decomposition and classification, spectral image analysis, predictive modeling for individualized medicine, workflow optimization, and radiation dose management. However, data requirements, computational resources, and regulatory and ethical concerns remain challenges that need to be addressed to fully realize the potential of this technology. The fusion of photon-counting CT and deep learning algorithms is poised to revolutionize medical imaging and transform patient care.


Assuntos
Aprendizado Profundo , Humanos , Tomografia Computadorizada por Raios X/métodos , Processamento de Imagem Assistida por Computador/métodos , Algoritmos , Fótons , Imagens de Fantasmas
10.
J Am Heart Assoc ; 13(1): e032262, 2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38156599

RESUMO

BACKGROUND: The optimal treatment of symptomatic paravalvular leak (PVL) remains controversial between transcatheter closure (TC) and surgery. This large-scale study aimed to retrospectively evaluate the long-term outcomes of the patients who underwent reoperation or TC of PVLs. METHODS AND RESULTS: A total of 335 (men, 209 [62.4%]; mean age, 58.15±12.77 years) patients who underwent treatment of PVL at 3 tertiary centers between January 2002 and December 2021 were included. Echocardiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary end point was defined as the all-cause death during follow-up. The regression models were adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The initial management strategy was TC in 171 (51%) patients and surgery in 164 (49%) cases. Three hundred cases (89.6%) had mitral PVL, and 35 (10.4%) had aortic PVL. The mean left ventricular ejection fraction was 52.03±10.79%. Technical (78.9 versus 76.2%; P=0.549) and procedural success (73.7 versus 65.2%; P=0.093) were similar between both groups. In both univariate and multivariable logistic regression analysis, the in-hospital mortality rate in the overall population was significantly higher (15.9 versus 4.7%) in the surgery group compared with the TC group (unadjusted odds ratio, 3.13 [95% CI, 1.75-5.88]; P=0.001; and adjusted odds ratio (inverse probability-weighted), 4.55 [95% CI, 2.27-10.0]; P<0.001). However, the long-term mortality rate in the overall population did not differ between the surgery group and the TC group (unadjusted hazard ratio [HR], 0.86 [95% CI, 0.59-1.25]; P=0.435; and adjusted HR (inverse probability-weighted), 1.11 [95% CI, 0.67-1.81]; P=0.679). CONCLUSIONS: The current data suggest that percutaneous closure of PVL was associated with lower early and comparable long-term mortality rates compared with surgery.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Masculino , Humanos , Pessoa de Meia-Idade , Idoso , Implante de Prótese de Valva Cardíaca/efeitos adversos , Estudos Retrospectivos , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda , Sistema de Registros , Cateterismo Cardíaco/efeitos adversos
11.
Diagn Interv Radiol ; 30(3): 163-174, 2024 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-38145370

RESUMO

Rapid technological advances have transformed medical education, particularly in radiology, which depends on advanced imaging and visual data. Traditional electronic learning (e-learning) platforms have long served as a cornerstone in radiology education, offering rich visual content, interactive sessions, and peer-reviewed materials. They excel in teaching intricate concepts and techniques that necessitate visual aids, such as image interpretation and procedural demonstrations. However, Chat Generative Pre-Trained Transformer (ChatGPT), an artificial intelligence (AI)-powered language model, has made its mark in radiology education. It can generate learning assessments, create lesson plans, act as a round-the-clock virtual tutor, enhance critical thinking, translate materials for broader accessibility, summarize vast amounts of information, and provide real-time feedback for any subject, including radiology. Concerns have arisen regarding ChatGPT's data accuracy, currency, and potential biases, especially in specialized fields such as radiology. However, the quality, accessibility, and currency of e-learning content can also be imperfect. To enhance the educational journey for radiology residents, the integration of ChatGPT with expert-curated e-learning resources is imperative for ensuring accuracy and reliability and addressing ethical concerns. While AI is unlikely to entirely supplant traditional radiology study methods, the synergistic combination of AI with traditional e-learning can create a holistic educational experience.


Assuntos
Inteligência Artificial , Instrução por Computador , Radiologistas , Radiologia , Humanos , Radiologia/educação , Radiologistas/educação , Inteligência Artificial/tendências , Instrução por Computador/métodos , Internato e Residência/métodos
12.
Medicine (Baltimore) ; 102(50): e36461, 2023 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-38115270

RESUMO

A retrospective study comparing traction, dead-hang, and side-bending radiographs in adolescent idiopathic scoliosis to compare the effectiveness of dead-hang radiography in structural and nonstructural curves and evaluate it in terms of postoperative correction prediction. In the surgical correction of adolescent idiopathic scoliosis, flexibility radiographs have an important role in determining fusion levels and in surgical decision-making. Supine bending radiographs are presently considered the gold standard, but their reliability, reproducibility, and standardization along with traction films, are a subject of debate. In our clinic, dead-hang radiographs are also used as an alternative flexibility film. The role of dead-hang radiography against other flexibility radiographs is unknown. A total of 33 patients with adolescent idiopathic scoliosis were evaluated with preoperative standing, lateral, supine traction, dead-hang, supine side-bending, and postoperative standing films. Flexibility and correction rates were assessed. In structural main thoracic (MT) and thoracolumbar/lumbar (TL/L) curves, dead-hang showed significantly higher flexibility compared with traction (P < .001). In MT curves > 60°, dead-hang was superior to side-bending and traction, whereas in MT curves < 50°, side-bending showed more improvement (P < .05). Side-bending showed higher flexibility in TL/L curves < 50° (P < .05). No predictive value was found in structural curves for all 3 radiographs. In nonstructural curves, side-bending films showed over-correction while traction radiographs remained below postoperative correction. Dead-hang radiographs showed very similar flexibility to postoperative correction. Dead-hang radiograph is superior to traction. In MT curves > 60°, dead hang shows greater flexibility than side-bending. Dead-hang technique, which shows equal results with side-bending except in TL/L curves < 50°, is a successful flexibility radiograph and provides predictive value for nonstructural curves in terms of postoperative correction.


Assuntos
Cifose , Escoliose , Fusão Vertebral , Humanos , Adolescente , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Estudos Retrospectivos , Reprodutibilidade dos Testes , Vértebras Lombares/cirurgia , Vértebras Torácicas/cirurgia , Tração , Radiografia
13.
Clin Imaging ; 103: 109993, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37812965

RESUMO

Artificial Intelligence is a branch of computer science that aims to create intelligent machines capable of performing tasks that typically require human intelligence. One of the branches of artificial intelligence is natural language processing, which is dedicated to studying the interaction between computers and human language. ChatGPT is a sophisticated natural language processing tool that can understand and respond to complex questions and commands in natural language. Radiology is a vital aspect of modern medicine that involves the use of imaging technologies to diagnose and treat medical conditions artificial intelligence, including ChatGPT, can be integrated into radiology workflows to improve efficiency, accuracy, and patient care. ChatGPT can streamline various radiology workflow steps, including patient registration, scheduling, patient check-in, image acquisition, interpretation, and reporting. While ChatGPT has the potential to transform radiology workflows, there are limitations to the technology that must be addressed, such as the potential for bias in artificial intelligence algorithms and ethical concerns. As technology continues to advance, ChatGPT is likely to become an increasingly important tool in the field of radiology, and in healthcare more broadly.


Assuntos
Inteligência Artificial , Radiologia , Humanos , Fluxo de Trabalho , Radiografia , Algoritmos
14.
Medicine (Baltimore) ; 102(35): e34875, 2023 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-37657013

RESUMO

BACKGROUND: Warfarin has a narrow therapeutic window. Maintaining the patient's international normalized ratio (INR) within a predefined therapeutic range is one of the main challenges of warfarin treatment. This study aimed to compare the INR values of patients followed by face-to-face and telephone applications. METHODS: This study was designed as a randomized controlled trial. Twelve patients living in a distant place were assigned to the experimental group, and 12 patients living nearby and followed-up in the outpatient clinic were assigned to the control group. A Patient Information Form and the Adherence to Refills and Medications Scale were used to collect data. RESULTS: There was no significant difference between the groups in terms of demographic and clinical characteristics except for age (P > .05). The INR values of 67% of the patients followed in the outpatient clinic and 72% of the patients followed with the application were in the therapeutic range. There was no significant difference between the groups and medication adherence was high in both groups (P > .05). CONCLUSION: In light of the findings of our study, which demonstrated that the INR levels of patients who were monitored both face-to-face and via a telephone application were within the same therapeutic range, it was concluded that the telephone application can be used to manage warfarin therapy.


Assuntos
Aplicativos Móveis , Humanos , Coeficiente Internacional Normatizado , Varfarina/uso terapêutico , Instituições de Assistência Ambulatorial , Telefone
15.
Ulus Travma Acil Cerrahi Derg ; 29(9): 996-1003, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37681726

RESUMO

BACKGROUND: Infective endocarditis is a serious heart disease that may cause several different clinical conditions and can need urgent surgical therapy. In our study, we aimed to evaluate the patients with infective endocarditis undergoing acute surgical treatment results in-hospital mortality. METHODS: A total of 107 consecutive patients with infective endocarditis undergoing acute surgical therapy were included in our retrospective study. The patients were divided into two groups according to the presence of in-hospital mortality as Group 1 without in-hospital mortality (n=89) and Group 2 with in-hospital mortality (n=18). The demographic, laboratory, and clinical parameters were evaluated in both groups. RESULTS: The mean age (50±14; 64±14, P<0.001) and the incidence of chronic renal failure (9 [10.1%]; 8 [44.4%], P=0.001) were higher in Group 2 while the ejection fraction was lower in Group 2 (50.0±9.3; 44.6±12.9, P=0.039). The incidence of positive blood culture was also higher in Group 2 (41 [46.1]; 14 [77.8], P=0.014). Aortic bioprosthesis operation (2 [2.2]; 6 [33.3], P<0.001) and mitral bioprosthesis operation (4 [4.5]; 5 [27.8], P=0.008) were higher in Group 2 as well as the incidence of septic shock was also higher in Group 2 (1 [1.1]; 3 [16.7], P=0.015). In addition, in multivariate logistic regression analyses, advanced age (odds ratio [OR]: 1.068, 95% confidence interval [CI]: 1.009-1.130, P: 0.024) and positive blood culture (OR: 4.436, 95% CI: 1.044-18.848, P: 0.044) were found to be independent predictors of in-hospital mortality. CONCLUSION: Advanced age, lower ejection fraction, high creatinine, positive blood culture, high systolic pulmonary artery pressure, and septic shock predicted in-hospital death in patients who have undergone emergent or urgent surgery due to infective endocarditis.


Assuntos
Endocardite , Choque Séptico , Humanos , Mortalidade Hospitalar , Estudos Retrospectivos , Endocardite/cirurgia , Hospitais
16.
Turk Kardiyol Dern Ars ; 51(6): 399-406, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37671522

RESUMO

OBJECTIVE: Atrial fibrillation is the most common arrhythmia following coronary artery bypass graft surgery. The relationship between impaired lung function and atrial fibrillation has been described previously. We aimed to evaluate the prognostic influence of small airway function on predicting postoperative atrial fibrillation undergoing isolated coronary artery bypass graft surgery (CABG). METHODS: We retrospectively analyzed 283 patients who underwent isolated CABG at our institution between January 2020 and August 2020. The patients were divided into 2 groups according to the development of postoperative atrial fibrillation. Demographic characteristics of the patients were recorded; spirometry was performed for each patient before surgery. Small airway function was determined by forced mid-expiratory flow (forced expiratory flow 25%-75%) values measured by spirometry. Propensity score matching was applied to ensure a balanced distribution of demographic data between the 2 groups. RESULTS: The frequency of postoperative atrial fibrillation was 30.7% in our patient population. After propensity matching, forced expiratory volume in 1 second/forced vital capacity % [80.6 (73.8-87.8) vs. 76.3 (66.7-81.6), P = 0.006] and forced expiratory flow 25%-75% (87.4 ± 14.2 vs. 75.2 ± 15.8, P = 0.001) were significantly lower in postoperative atrial fibrillation group. In multivariate analysis, white blood cell count, left ventricular ejection fraction, cross-clamp time, and forced expiratory flow 25%-75% were found to be independent predictors of postoperative atrial fibrillation development after isolated CABG. In the receiver operating characteristic curve analysis, forced expiratory flow 25%-75% with an optimal threshold value of 81% could detect the presence of postoperative atrial fibrillation with 63.8% sensitivity and 70.1% specificity. CONCLUSION: Our study demonstrated that small airway obstruction, as indicated by forced expiratory flow 25%-75% in spirometry, can be a simple predictive tool for the development of postoperative atrial fibrillation in patients undergoing isolated CABG.


Assuntos
Fibrilação Atrial , Humanos , Estudos Retrospectivos , Volume Sistólico , Função Ventricular Esquerda , Ponte de Artéria Coronária
17.
Int J Cardiovasc Imaging ; 39(10): 1897-1908, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37530971

RESUMO

Right ventricular (RV) function is a determining factor for clinical outcomes in patients undergoing tricuspid valve surgery (TVS). Our aim was to investigate the importance of the function of the right ventricular outflow tract (RVOT), which is an important anatomical region of the RV, in patients underwent TVS. 104 patients who underwent TVS were analyzed retrospectively. Patients with previous cardiac surgery, congenital heart disease, or heart failure were excluded. The parasternal short-axis view at the level of the aortic root was used to measure RVOT dimensions and RVOT fractional shortening (RVOT-FS). The effect of RVOT diameter and function on major adverse cardiac events (MACE) after TVS was investigated. In our study, MACE, consisting of pacemaker implantation, acute kidney injury, postoperative atrial fibrillation and mortality, was developed at 44 (42.3%) patients.We compared the predictive performances of RVOT end-systolic (RVOTs) diameter, RVOT end-diastolic (RVOTd) diameter, RVOT-FS and RV diameters in prediction of MACE. The model including the RVOTs had higher AUC, R2 and likelihood ratio X2 values (0.775, 0.287 and 25.0, respectively) than RVOTd (0.770, 0.279 and 24.2, respectively) and RVOT-FS (0.750, 0.215 and 18.1, respectively). RVOT diameters showed better performance in predicting MACE than RV diameters. Moreover, there was statistically significant association between RVOTs, RVOTd and MACE (p value were 0.014 and 0.027, respectively), while no association between RVOT-FS and MACE (p value was 0.177). In summary, we determined that the RVOT diameters are important predictors for the in-hospital clinical outcomes of patients who underwent TVS.

18.
Environ Sci Pollut Res Int ; 30(41): 94779-94789, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37540413

RESUMO

The use of the nano zero-valent iron (nZVI) nanoparticle-based advanced oxidation systems in conjunction with an activator such as peroxymonosulfate (PMS) to generate hydroxyl and sulfate radicals for the degradation of organic pollutants has been extensively used in recent studies. In this study, a nZVI-modified polyethersulfone (PES) membrane (nZVI@PES) was produced successfully by attaching the nZVI catalytic nanoparticles on the surface of a commercial microporous polymeric membrane material using a simple and easy filter press coating method. The presence of nZVI nanoparticles on the nZVI@PES membrane was confirmed by XRD, SEM, and EDS analyses. The nZVI@PES membrane was applied in the dead-end filtration system in the presence of the PMS activator to treat the reactive black 5 (RB5) dye solution. The effect of catalyst loading, RB5 dye concentration, PMS dosage, and pH level on the nZVI@PES membrane/PMS system was investigated. Quenching experiments were carried out to identify the reactive species responsible, and reusability tests were conducted on the membrane. The highest decolorization efficiency (96.8%) was obtained at 20 mg/L RB5 dye solution, initial pH of 3, the nZVI loading of 5 mg/cm2, and the PMS dosage of 300 mg/L at the end of a reaction time of 30 min. The formation of HO•, [Formula: see text], [Formula: see text] and, 1O2 was confirmed by quenching experiments. The results indicate that the nZVI@PES membrane/PMS system could successfully treat wastewater contaminated with an organic dye.


Assuntos
Nanopartículas , Poluentes Químicos da Água , Ferro/análise , Águas Residuárias , Ultrafiltração , Têxteis , Poluentes Químicos da Água/análise
19.
Immun Inflamm Dis ; 11(4): e836, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-37102643

RESUMO

INTRODUCTION: Behçet syndrome (BS) is a chronic, multisystemic inflammatory condition with unanswered questions regarding its pathogenesis and rational therapeutics. A microarray-based comparative transcriptomic analysis was performed to elucidate the molecular mechanisms of BS and identify any potential therapeutic targets. METHODS: Twenty-nine BS patients (B) and 15 age and sex-matched control subjects (C) were recruited. Patients were grouped as mucocutaneous (M), ocular (O), and vascular (V) according to their clinical phenotypes. GeneChip Human Genome U133 Plus 2.0 arrays were used for expression profiling on peripheral blood samples of the patients and the control subjects. Following documentation of the differentially expressed gene (DEG) sets, the data were further evaluated with bioinformatics analysis, visualization, and enrichment tools. Validation of the microarray data was performed using quantitative reverse transcriptase polymerase chain reaction. RESULTS: When p ≤ 0.05 and fold change ≥2.0 were chosen, the following numbers of DEGs were obtained; B versus C: 28, M versus C: 20, O versus C: 8, V versus C: 555, M versus O: 6, M versus V: 324, O versus V: 142. Venn diagram analysis indicated only two genes, CLEC12A and IFI27, in the intersection of M versus C ∩ O versus C ∩ V versus C. Another noteworthy gene appeared as CLC in the DEG sets. Cluster analyses successfully clustered distinct clinical phenotypes of BS. While innate immunity-related processes were enriched in the M group, adaptive immunity-specific processes were significantly enriched in the O and V groups. CONCLUSIONS: Distinct clinical phenotypes of BS patients displayed distinct expression profiles. In Turkish BS patients, expression differences regarding the genes CLEC12A, IFI27, and CLC seemed to be operative in the disease pathogenesis. Based on these findings, future research should consider the immunogenetic heterogeneity of BS clinical phenotypes. Two anti-inflammatory genes, namely CLEC12A and CLC, may be valuable as therapeutic targets and may also help design an experimental model in BS.


Assuntos
Síndrome de Behçet , Humanos , Síndrome de Behçet/genética , Biologia Computacional , Expressão Gênica , Perfilação da Expressão Gênica , Lectinas Tipo C/genética , Proteínas de Membrana/genética , Fenótipo , Receptores Mitogênicos/genética
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