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Background: An example of a sodium-glucose cotransporter-2 (SGLT-2) inhibitor is Empagliflozin. It is a new medicine for treating type 2 diabetes mellitus (T2DM), but there is increasing interest in how empagliflozin affects the heart. This study aims to examine the impact of empagliflozin treatment on ventricular repolarization parameters in T2DM patients. Methods: T2DM patients were included in a prospective study. Measurements of ventricular repolarization parameters, including QT interval, corrected QT interval (QTc), QT dispersion (QTd), Tpeak-to-Tend interval (Tp-e), and Tpeak-to-Tend interval corrected for QTc (Tp-e/QTc), were obtained before initiating empagliflozin treatment and six months following treatment initiation. Statistical analysis was performed to assess changes in these parameters. Results: In this study, 95 patients were diagnosed with T2DM out of 177 patients. Among T2DM patients, 40 were male (42%) compared to 48% males in controls (p = 0.152). The average age of the T2DM patients was 60.2 ± 9.0 years, compared to 58.2 ± 9.2 years in the control group (p = 0.374). When comparing pre- and post-treatment measurements of parameters representing ventricular repolarization (QT 408.5 ± 22.9/378.8 ± 14.1, p < 0.001; QTc 427.0 ± 20.5/404.7 ± 13.8, p < 0.001; QTd 52.1 ± 1.2/47.8 ± 1.7, p < 0.001; Tp-e 82.3 ± 8.7/67.1 ± 5.1, p < 0.001; Tp-e/QTc 0.19 ± 0.01/0.17 ± 0.01, p < 0.001 (respectively)), statistically significant improvements were observed. A statistically significant dose-dependent decline in the magnitude of change in the QTc parameter (19.4/29.6, p = 0.038) was also observed. Conclusions: According to these results, empagliflozin may decrease the risk of potential ventricular arrhythmias.
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Pulmonary arterial intimal sarcomas (PAIS) are rare malignancies with a poor prognosis. Sarcomas present with signs and symptoms mimicking pulmonary thromboembolic disease, delaying the diagnosis. We present a 29-year-old male patient diagnosed with PAIS in the right and main pulmonary arteries extending to the left pulmonary leaflet. The patient was treated with pulmonary endarterectomy and pulmonary leaflet reconstruction using the Ozaki technique.
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Neoplasias Pulmonares , Embolia Pulmonar , Sarcoma , Neoplasias Vasculares , Masculino , Humanos , Adulto , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Artéria Pulmonar/patologia , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/cirurgia , Sarcoma/patologia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Endarterectomia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologiaRESUMO
BACKGROUND: In this systematic review and meta-analysis, we aimed to investigate the correlation of D-dimer levels measured on admission with disease severity and the risk of death in patients with coronavirus disease 2019 (COVID-19) pneumonia. MATERIALS AND METHODS: We performed a comprehensive literature search from several databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in abstracting data and assessing validity. Quality assessment was performed using the Newcastle-Ottawa quality assessment scale (NOS). D-dimer levels were pooled and compared between severe/non-severe and surviving/non-surviving patient groups. Weighted mean difference (WMD), risk ratios (RRs) and 95% confidence intervals (CIs) were analyzed. RESULTS: Thirty-nine studies reported on D-dimer levels in 5750 non-severe and 2063 severe patients and 16 studies reported on D-dimer levels in 2783 surviving and 697 non-surviving cases. D-dimer levels were significantly higher in patients with severe clinical status (WMD: 0.45 mg/L, 95% CI: 0.34-0.56; p < 0.0001). Non-surviving patients had significantly higher D-dimer levels compared to surviving patients (WMD: 5.32 mg/L, 95% CI: 3.90-6.73; p < 0.0001). D-dimer levels above the upper limit of normal (ULN) was associated with higher risk of severity (RR: 1.58, 95% CI: 1.25-2.00; p < 0.0001) and mortality (RR: 1.82, 95% CI: 1.40-2.37; p < 0.0001). CONCLUSION: Increased levels of D-dimer levels measured on admission are significantly correlated with the severity of COVID-19 pneumonia and may predict mortality in hospitalized patients.
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COVID-19/diagnóstico , COVID-19/mortalidade , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , COVID-19/sangue , Hospitalização , Humanos , Prognóstico , Medição de Risco/métodosRESUMO
OBJECTIVE: We aimed to detect the malignant arrhythmic potential of COVID-19 with surface electrocardiographic (ECG) markers. MATERIAL AND METHOD: Of the ECG parameters PR, QT, QTc, QTd, TPe, and Tpe/QTc were measured in 51 COVID-19 patients and 40 in control subjects. RESULTS: Compared to control group mean QTc (410.8 ± 24.3 msec vs. 394.6 ± 20.3 msec, p < .001) and Tpe/QTc (0.19 ± 0.02 vs. 0.18 ± 0.04, p = .036) and median QTd (47.52 vs. 46.5) values were significantly higher in COVID-19 patients. Troponin levels were significantly correlated with heart rate (r = 0.387, p = .006) but not with ECG parameters. CONCLUSION: Several ventricular arrhythmia surface ECG predictors including QTc, QTd, and Tpe/QTc are increased in COVID-19 patients. Since medications used in COVID-19 patients have the potential to affect these parameters, giving importance to these ECG markers may have a significant contribution in decreasing disease-related arrhythmias.
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Arritmias Cardíacas , Tratamento Farmacológico da COVID-19 , Síndrome do QT Longo , Taquicardia Ventricular , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etiologia , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/terapia , Correlação de Dados , Eletrocardiografia/métodos , Eletrocardiografia/estatística & dados numéricos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Hospitalização/estatística & dados numéricos , Humanos , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/virologia , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/isolamento & purificação , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/prevenção & controle , Troponina/análise , Turquia/epidemiologiaRESUMO
The current study enhances the performance of solid-network triply periodic minimal surface (TPMS) cellular materials through using cell size grading along with the Taguchi method. Cell size grading is a novel technique used to control the size of pores and the surface area without changing the relative density. In this context, experimental compression testing was conducted on six distinct geometries of cell size graded TPMS structures (Diamond, Fischer-Koch S, Gyroid, IWP, Primitive, and Schoen-F-RD) manufactured with dental resin using a masked stereolithography (MSLA) printer. The findings indicated that mean total energy absorption was greater for smaller initial cell sizes (4 and 6 mm) compared to larger sizes (12 mm). Consistent patterns were also observed with respect to final cell sizes. Upon examination of the stress-strain relationships between D and I-WP, it is evident that D exhibits a higher initial peak stress point. However, subsequent to a significant decline, it exhibits a tremendous degree of volatility before recovering. Conversely, I-WP demonstrated greater stability throughout the experiments, with a notably greater maximum stress effect. A significant influence was observed from the initial cell size on stress, with larger sizes leading to a reduction in absorbed energy. The acquired results serve as an essential basis for the identification of optimized designs that may be implemented to enhance the structures' durability.
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Materiais Biocompatíveis , Teste de Materiais , Materiais Biocompatíveis/química , Estresse Mecânico , Propriedades de Superfície , Porosidade , Tamanho Celular , Fenômenos MecânicosRESUMO
This study presents the first report of congenital tuberculosis in an 8-month-old male British Shorthair cat. The case was examined using histopathological and immunohistochemical methods. The cat was referred to a private veterinary clinic with general respiratory system problems and subsequent deterioration, leading to death. The cat owner granted permission for the cat necropsy and pathological examinations at Department of Pathology, Faculty of Veterinary Medicine, Selçuk University, Konya, Türkiye. During systemic necropsy, white round foci with diameters ranging from 3.00 to 5.00 mm were observed in the lung and spleen. Tissue samples were collected from the lung, spleen, liver, heart, kidney, mediastinal lymph nodes and brain for histopathological examinations. The tissues were subjected to routine histological tissue processing and sections were stained with Hematoxylin and Eosin and Ziehl-Neelsen. Additionally, Mycobacterium spp. antibodies were used for immunohistochemical staining. Microscopic examination revealed exudative tuberculosis lesions, areas of necrosis without a fibrous capsule and karyorrhectic cells only in the lung and spleen. Acid-resistant bacteria observed by ZN staining in the lesioned areas of the lung and spleen were identified as Mycobacterium spp. using immunohistochemical staining. No positive staining was observed in other organs using ZN and immunohistochemical methods. As a result, congenital tuberculosis was diagnosed in a cat for the first time, especially in relation to lesions in the spleen.
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Introduction: Radial artery (RA) spasm is demonstrated to be one of the most common complications of transradial approach (TRA). Aim: We hypothesised that radial flow-mediated dilation (FMD) can be used as a preprocedural method to assess the likelihood of arterial spasm. Material and methods: The patients were divided into 2 groups: those with and without flow-mediated RA dilatation. A blood pressure cuff was placed on the upper part of the antecubital region of the patients in the FMD group and inflated for 10 min, allowing the pressure to rise to 30 mm Hg above the systolic blood pressure. RA diameters of the patients in both groups were measured via quantitive coronary angiography method before transradial coronary angiography. Results: A total of 165 patients were included in the study, of whom 64 (38.8%) were women. The median age of the patients was 56 years (48-63). The mean RA diameter was significantly larger in the FMD group (3.44 ±0.48 vs. 2.96 ±0.46 mm, p < 0.001), and the number of punctures required for successful transradial cannulation was found to be significantly higher in the group without FMD (1.55 ±0.7 vs. 1.20 ±0.64; p < 0.001). Linear regression analysis revealed diabetes and FMD as independent predictors of RA diameter. In the diabetic subgroup, RA diameter remained larger in the FMD group (3.00 ±0.35 vs. 2.78 ±0.26, p = 0.036). Radial puncture attempts were significantly higher in the control group compared to the FMD group (1.55 ±0.7 vs. 1.20 ±0.64; p < 0.001). Conclusions: In our study, we demonstrated that FMD created by pressure application significantly increased RA diameter and reduced puncture attempt during TRA.
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Hypoxemic arrests due to severe traumatic pulmonary injury may not respond to usual medical support. Extracorporeal life support (ECLS) can be life-saving; adequate flows are needed in this setting along with a careful choice of anticoagulation strategies to minimize bleeding. A 44 month old child, who presented with severe blunt chest trauma after being run over by a truck was resuscitated with active compressions and code medications seven times before arrival to the intensive care unit. Failure to adequately oxygenate led to an unconventional approach with cannulations of the right atrium (RA) and pulmonary artery (PA) via sternotomy. Anticoagulation regimen started after bleeding had slowed down with active transfusion of blood products and consisted of low-dose heparin and alprostadil infusions for the initial 48 hours. Heparin was adjusted per institutional guidelines thereafter. Physiologically veno-venous central approach enabled fast stabilization due to full oxygenation without recirculation. Additionally, the dual anticoagulation regimen was safe for circuit maintenance. The described method can be considered in small children with similar risks and conditions.
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Oxigenação por Membrana Extracorpórea , Choque Hemorrágico , Traumatismos Torácicos , Ferimentos não Penetrantes , Humanos , Criança , Pré-Escolar , Oxigenação por Membrana Extracorpórea/métodos , Choque Hemorrágico/etiologia , Choque Hemorrágico/terapia , Artéria Pulmonar , Traumatismos Torácicos/complicações , Traumatismos Torácicos/terapia , Estudos Retrospectivos , Ferimentos não Penetrantes/tratamento farmacológico , Heparina/uso terapêutico , Hemorragia , Anticoagulantes/uso terapêutico , CateterismoRESUMO
OBJECTIVE: This study aimed to present a new modification of the modified Kessler tendon repair technique and share results of an animal study scrutinizing mainly the biomechanical properties and comparing it to other techniques. METHODS: Eighteen New Zealand rabbits were used and divided into 3 groups: 1 experiment and 2 control groups. Four-strand modified Kessler and 6-strand Tang repairs were used for the control groups. The new modification was used in the experiment group. Two surgeries were conducted 8 weeks apart, repairing 1 Achilles tendon in the first, repairing the contralateral tendon and harvesting specimens in the second. The repair times were recorded. In addition, biomechanical tests were conducted to determine mechanical strength. RESULTS: There was a statistically significant difference between the 3 groups in load-to-failure values for the strength after repair model, with the experiment group superior to the other 2 (P = .002; P < .05). Although there was a noticeable difference between the mean loadto- failure values of each group in the healing model, we could not demonstrate a statistically significant difference(P > .05). The new modification took significantly less time than the other 2 techniques (P = .001). CONCLUSION: Our new modification was biomechanically stronger and faster than the other 2 techniques. The technique offers a new, suitable, practical option for human flexor tendon repair.
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Tendão do Calcâneo , Procedimentos de Cirurgia Plástica , Coelhos , Humanos , Animais , Tendão do Calcâneo/cirurgia , Técnicas de Sutura , Fenômenos Biomecânicos , Resistência à Tração , SuturasRESUMO
Background: The Gustave Roussy immune score (GRIm score) is a laboratory index developed to predict survival in nonsmall cell lung cancer patients undergoing immunotherapy and has shown that the pretreatment value is an independent prognostic factor for survival. In this study, we aimed to determine prognostic significance of GRIm score for pancreatic adenocarcinoma that have not been determined in the literature for pancreatic cancer before. The reason for choosing this scoring is to show that the immune scoring system works as a prognostic marker in pancreatic cancer known as immune-desert tumor via immune properties of microenvironment. Methods: Medical records of patients with histologically confirmed pancreatic ductal adenocarcinoma, who were treated and followed up between December 2007 and July 2019 at our clinic, were reviewed retrospectively. GRIm scores of each patient were calculated at the time of diagnosis. Survival analysis were performed according to risk groups. Results: A total of 138 patients were included in the study. While 111 (80.4%) patients were in the low-risk group; 27 (19.6%) were in high-risk group according to GRIm score. Median OS was 36.9 months (95% Confidence interval (CI): 25.42-48.56) in lower GRIm scores, and it was 11.1 months (95% CI: 6.83-15.44) in higher GRIm scores (P = 0.002). One-two-three-year OS rates were 85% versus 47%, 64% versus 39%, 53% versus 27% for low versus high GRIm scores, respectively. The multivariate analysis revealed that high GRIm score was an independent poor prognostic factor. Conclusion: GRIm can be used as a noninvasive, easily applicable, practical prognostic factor in pancreatic cancer patients.
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Adenocarcinoma , Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Neoplasias Pancreáticas , Humanos , Neoplasias Pancreáticas/patologia , Prognóstico , Adenocarcinoma/cirurgia , Estudos Retrospectivos , Microambiente TumoralRESUMO
While renal cell carcinomas frequently invade the renal vein and inferior vena cava, the right atrial extension or formation of bilateral pulmonary massive embolism is quite unusual. A 65-year-old male patient underwent bilateral pulmonary tumor endarterectomy and total thrombectomy of the inferior vena cava combined with left nephrectomy under total circulatory arrest with antegrade cerebral perfusion. Both mediastinal and abdominal approaches facilitated the complete removal of the caval thrombus under the guidance of transesophageal echocardiography. The patient is still under follow-up for six months without metastasis. In conclusion, pulmonary thromboembolism due to renal cell carcinoma is rare, surgical treatment is possible.
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Background: This study aims to investigate whether the coexistence of advanced renal cell carcinoma and inferior vena cava tumor thrombus could be treated with a multidisciplinary approach and teamwork and to evaluate early and mid-term results. Methods: Between January 2017 and December 2020, a total of 33 patients (28 males, 5 females; mean age: 55.8±13.2 years; range, 27 to 76 years) who underwent radical nephrectomy and thrombectomy of the inferior vena cava were retrospectively analyzed. Demographic characteristics of the patients, types of operations, postoperative data, mortality and morbidity rates were recorded. Results: Of the patients, 12% (n=4) had Stage 2 tumor thrombus, 60.6% (n=20) had Stage 3 tumor thrombus, and 27% (n=9) had Stage 4 tumor thrombus. A total of 55% (n=19) of the patients had right-sided renal cell carcinoma, while 45% (n=14) of them had a left-sided mass. Totally, 66% (n=22) of the patients underwent primary inferior vena cava repair. The thrombectomy procedure and a Dacron® patch was applied with patch plasty in 24% (n=8) of the patients, and Dacron® graft interposition was applied to the inferior vena cava in 9% (n=3) of the patients. The mean follow-up was 20.3±13.0 (range, 2 to 70) months. Deep vein thrombosis was detected in the follow-up of seven (21%) patients, and no pulmonary thromboembolism was observed during the postoperative follow-up period. The mean length of stay in the intensive care unit was 1.39±0.6 (range, 1 to 3) days. The 30-day mortality rate was 3%, due to the loss of one patient from massive pulmonary embolism intraoperatively. Conclusion: Vascular surgical procedures performed regardless of the stage of the tumor thrombus provide satisfactory mid-term results in patients with advanced renal cell cancer.
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INTRODUCTION: We aimed to evaluate the use of social media among cardiovascular surgery specialists and their respective perspectives. METHODS: In total, 173 cardiovascular surgeons were reached through an online survey. The surgeons surveyed were cardiovascular surgery specialists. The questionnaire consisted of 33 questions, including closed-ended and open-ended questions about social media. RESULTS: We found that 73.4% of the participants think that social media facilitates the communication of the patient with the doctor, and 87.9% think that social media increases the publicity of the physician. Furthermore, 80.9% of the participants believe that informing through social media creates information pollution. We found that personal use of Instagramï was more common in state hospital cardiac surgeons. The number of patients who contacted surgeons in private hospital for surgery via social media were found to be statistically significant, and it was found that this group benefitted more economically. CONCLUSION: Social media usage rates of cardiovascular surgeons were found to be high. On the other hand, it was observed that the rate of surgeons who share medical content is low. However, half the cardiovascular surgeons who participated in the study believe that their colleagues do not fully comply with the ethical rules in medical sharing.
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Mídias Sociais , Cirurgiões , Humanos , Inquéritos e QuestionáriosRESUMO
Background: Pancreatic ductal adenocarcinoma differs from other solid tumors with its unique immunosuppressive microenvironment and non-immunogenic feature. There are not many studies in the literature investigating the effect of these features on prognosis. Aims: To investigate the prognostic value of tissue-resident memory T cells, tumor microenvironment features, and tumor-associated immune cells in resected pancreatic ductal adenocarcinomas. Study Design: Retrospective cross-sectional study. Methods: Of 138 patients diagnosed with pancreatic ductal adenocarcinoma between 2011 and 2018, 81 were included in the study. Specimens from operated patients were reassessed separately as peritumoral and intratumoral areas for tissue resident memory cells and tumor microenvironmental elements (tumor infiltrating lymphocytes, tumor stroma, CD204+ macrophages, PDL1+ immune cells). Disease-free survival and overall survival were defined from the date of operation to the date of recurrence and the date of first diagnosis to the date of death, respectively. If the patient was alive, the last visit date was taken into account. Results: The median age at diagnosis was 63 (range: 40-78). The median follow-up period was 18.9 months (range: 1.4-80.4 months). Median overall survival was 23.7 months (1.4-80.4 months) and median disease-free survival was 10.8 months (1.4-74.4 months). Patients with higher intra-tumoral tissue-resident memory cell counts had a longer survival trend than those having lower values (25.6 months vs. 18 months, respectively, P = .84). According to microenvironmental evaluations, lower stromal score (defined as stroma having less desmoplasia and rich in cells) and presence of peritumoral Crohn's-like inflammatory response were associated with higher survival (29.2 months vs. 19.7 months for low vs. high stromal scores, respectively, P = .16 and 30.2 months vs. 18.1 months for the presence of Crohn's-like inflammatory response P = .13). Decreased survival was observed in tumors with increased CD204+ tumor-associated macrophages which were immunosuppressive elements of the microenvironment (12 months vs. 26.3 months for intra-tumoral assessment, P = .29). Conclusion: Tissue-resident memory T cells and other microenvironmental features may be prognostic in resectable pancreatic ductal adenocarcinomas. Further studies with larger cohorts are needed for validation.
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Adenocarcinoma , Neoplasias Pancreáticas , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Estudos Transversais , Humanos , Células T de Memória , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Prognóstico , Estudos Retrospectivos , Microambiente TumoralRESUMO
Medicines based on messenger RNA (mRNA) hold immense potential, as evidenced by their rapid deployment as COVID-19 vaccines. However, worldwide distribution of mRNA molecules has been limited by their thermostability, which is fundamentally limited by the intrinsic instability of RNA molecules to a chemical degradation reaction called in-line hydrolysis. Predicting the degradation of an RNA molecule is a key task in designing more stable RNA-based therapeutics. Here, we describe a crowdsourced machine learning competition ('Stanford OpenVaccine') on Kaggle, involving single-nucleotide resolution measurements on 6,043 diverse 102-130-nucleotide RNA constructs that were themselves solicited through crowdsourcing on the RNA design platform Eterna. The entire experiment was completed in less than 6 months, and 41% of nucleotide-level predictions from the winning model were within experimental error of the ground truth measurement. Furthermore, these models generalized to blindly predicting orthogonal degradation data on much longer mRNA molecules (504-1,588 nucleotides) with improved accuracy compared with previously published models. These results indicate that such models can represent in-line hydrolysis with excellent accuracy, supporting their use for designing stabilized messenger RNAs. The integration of two crowdsourcing platforms, one for dataset creation and another for machine learning, may be fruitful for other urgent problems that demand scientific discovery on rapid timescales.
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The main goals in the treatment of acute coronary syndrome are to prevent myocardial ischemia, damage, and possible complications. Accordingly, we evaluated the predictive value of glypican-6 (GPC6) for cardiac remodeling after myocardial infarction (MI). Baseline plasma GPC6 levels were measured in patients who underwent primary percutaneous coronary intervention (PCI) for acute MI. Left ventricular ejection fraction (LVEF) was measured at baseline and at 6 months with transthoracic echocardiography. Reduced LVEF persisted in 89 out of 276 patients after 6 months. The majority of the patients were male (n = 198, 72%) and the mean age was 57.8 ± 10.8 years. Glypican-6, N-terminal pro-brain natriuretic peptide (NT-proBNP), and high-sensitive troponin levels were significantly lower in the improved LVEF group compared with the low LVEF group (10.54 ± 4.46 vs 6.98 ± 3.34 ng/mL, P < .001; 500 pg/mL [range, 300-600 pg/mL] vs 350 pg/mL [range, 200-550 pg/mL], P = .008; 396 pg/mL [range, 159-579 pg/mL] vs 300 pg/mL [range, 100-500 pg/mL], P = .016, respectively). Logistic regression analysis revealed the SYNTAX Score 2, GPC6, and NT-proBNP as significant independent predictors of low LVEF (hazard ratio [HR]: 1.064, P = .041; HR: 1.215, P < .001; HR: 1.179, P < .001). Glypican-6 may prove to be useful for the detection of low LVEF development in patients undergoing PCI following MI.
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Glipicanas/sangue , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico , Função Ventricular Esquerda , Remodelação Ventricular , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Intervenção Coronária Percutânea/efeitos adversos , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Troponina/sangue , Disfunção Ventricular Esquerda/sangue , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
OBJECTIVE: COVID-19 can cause lung damage and may present with pneumonia in patients. In the present study, the correlation between the severity of pneumonia and electrocardiography parameters of COVID-19 were examined. METHODS: A total of 93 COVID-19 patients and a control group consisting of 62 volunteers were studied. Computed thorax tomography evaluation was performed; each lung was divided into three zones. For each affected zone, scores were given. The main computed thorax tomography patterns were described in line with the terms defined by the Fleischner Society and peer reviewed literature on viral pneumonia. We compared Computed thorax tomography of patients with corrected QT (QTc) and P wave dispersion (Pd) time. RESULTS: There is a significant difference between the patient and control groups in terms of QTc values (413.5±28.8 msec vs. 395.6±16.7 msec p<0.001). Likewise, the Pd value of the patient group is statistically significantly higher than that of the control group (50.0±9.6 ms computed thorax tomography ec vs. 41.3±5.8 msec p<0.001). In the patient group, a reverse correlation was detected between computed thorax tomography score and Pd value according to partial correlation coefficient analysis (correlation coefficient: -0.232, p=0.027). In the patient group, the correlation between computed thorax tomography score and QTc value was similarly determined according to partial correlation coefficient analysis (Correlation coefficient:0.224, p=0.017). CONCLUSIONS: COVID-19 prolongs QTc and P wave dispersion values; and as the severity of pneumonia increases, QTc value increases. However, whereas the severity of pneumonia increases, P wave dispersion value decreases.
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COVID-19 , Eletrocardiografia , Humanos , SARS-CoV-2 , TomografiaRESUMO
OBJECTIVE: COVID-19 is a disease with high mortality, and risk factors for worse clinical outcome have not been well-defined yet. The aim of this study is to delineate the prognostic importance of presence of concomitant cardiac injury on admission in patients with COVID-19. METHODS: For this multi-center retrospective study, data of consecutive patients who were treated for COVID-19 between 20 March and 20 April 2020 were collected. Clinical characteristics, laboratory findings and outcomes data were obtained from electronic medical records. In-hospital clinical outcome was compared between patients with and without cardiac injury. RESULTS: A total of 607 hospitalized patients with COVID-19 were included in the study; the median age was 62.5 ± 14.3 years, and 334 (55%) were male. Cardiac injury was detected in 150 (24.7%) of patients included in the study. Mortality rate was higher in patients with cardiac injury (42% vs. 8%; P < 0.01). The frequency of patients who required ICU (72% vs. 19%), who developed acute kidney injury (14% vs. 1%) and acute respiratory distress syndrome (71%vs. 18%) were also higher in patients with cardiac injury. In multivariate analysis, age, coronary artery disease (CAD), elevated CRP levels, and presence of cardiac injury [odds ratio (OR) 10.58, 95% confidence interval (CI) 2.42-46.27; P < 0.001) were found to be independent predictors of mortality. In subgroup analysis, including patients free of history of CAD, presence of cardiac injury on admission also predicted mortality (OR 2.52, 95% CI 1.17-5.45; P = 0.018). CONCLUSION: Cardiac injury on admission is associated with worse clinical outcome and higher mortality risk in COVID-19 patients including patients free of previous CAD diagnosis.
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COVID-19/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Cardiopatias/diagnóstico , Troponina I/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , COVID-19/sangue , COVID-19/mortalidade , COVID-19/terapia , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/terapia , Progressão da Doença , Feminino , Cardiopatias/sangue , Cardiopatias/mortalidade , Cardiopatias/terapia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Turquia , Regulação para CimaRESUMO
Messenger RNA-based medicines hold immense potential, as evidenced by their rapid deployment as COVID-19 vaccines. However, worldwide distribution of mRNA molecules has been limited by their thermostability, which is fundamentally limited by the intrinsic instability of RNA molecules to a chemical degradation reaction called in-line hydrolysis. Predicting the degradation of an RNA molecule is a key task in designing more stable RNA-based therapeutics. Here, we describe a crowdsourced machine learning competition ("Stanford OpenVaccine") on Kaggle, involving single-nucleotide resolution measurements on 6043 102-130-nucleotide diverse RNA constructs that were themselves solicited through crowdsourcing on the RNA design platform Eterna. The entire experiment was completed in less than 6 months, and 41% of nucleotide-level predictions from the winning model were within experimental error of the ground truth measurement. Furthermore, these models generalized to blindly predicting orthogonal degradation data on much longer mRNA molecules (504-1588 nucleotides) with improved accuracy compared to previously published models. Top teams integrated natural language processing architectures and data augmentation techniques with predictions from previous dynamic programming models for RNA secondary structure. These results indicate that such models are capable of representing in-line hydrolysis with excellent accuracy, supporting their use for designing stabilized messenger RNAs. The integration of two crowdsourcing platforms, one for data set creation and another for machine learning, may be fruitful for other urgent problems that demand scientific discovery on rapid timescales.
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No-reflow (NR) is one of the major complications of primary percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We aim to assess the value of multilayer longitudinal strain parameter to predict NR in patients with NSTEMI and preserved ejection fraction. 230 consecutive patients who were admitted to the emergency department and diagnosed with NSTEMI were prospectively included in this study. Echocardiography was performed 1 h before angiography. Specific analysis for endocardial, mid-myocardial and epicardial layers were performed by two-dimensional (2D) speckle tracking echocardiography (STE) for multilayer longitudinal strain. NR was described as flow grade of ≤ TIMI 2 when mechanical occlusions like dissection, intimal tear, arterial spasm and thromboembolism during angiography were excluded. 49 of 168 patients admitted to the study had NR. No significant differences were observed between the groups regarding age and gender. Multilayer longitudinal strain imaging (endocard, midmyocard and epicard) revealed lower strain values particularly in endocardial layer in patients with NR (GLS-endocard: - 14.14 ± 1.39/- 17.41 ± 2.34, p < 0.001; GLS-midmyocard: - 14.81 ± 1.40/17.81 ± 2.22, p < 0.001; GLS-epicard: - 16.14 ± 1.38/18.22 ± 2.00, p < 0.001). GLS-endocard, GLS-midmyocard, GLS-epicard and ST depression were found to be statistically significant independents parameters respectively to predict NR phenomenon (GLS-endocard: OR: 2.193, p < 0.001; GLS-midmyocard: OR: 1.510, p: 0.016; GLS-epicard: OR: 1.372, p: 0.035; ST depression: OR: 3.694, p: 0.014). We revealed that left ventricular strain study with speckle tracking echocardiography predicts NR formation. This noninvasive method may be useful for detecting NR formation in patients with NSTEMI.