Relationship between platelet/hemoglobin and radial thrombus in patients with coronary angiography via radial access.

Aim: To predict the development of radial artery thrombus (RAT) in patients with radial approach coronary angiography of platelet-to-hemoglobin ratio (PHR). Materials & methods: This study was designed to evaluate the relationship between RAT and PHR. A total of 1156 patients who had coronary angiography via the transradial approach between 2021 and 2022 in the authors' center were included in the study. Results: Radial thrombus was detected in 52 (4.5%) patients. PHR was higher in the group with thrombus and was statistically significant. In the regression model, PHR was an independent predictor of the development of radial thrombus (p = 0.007). Conclusion: High PHR may be an independent predictor of the development of radial thrombus.

Cardiac Parameters Better Predict ICU Admission and Short-Term Mortality in Hospitalized Patients With COVID-19.

Background COVID-19 is a multisystemic disease that affects many organs, and the use of some parameters is recommended both during hospitalization and follow-up. In this study, we investigated the relationship between blood (liver and kidney function tests, lactate, and D-dimer), infection (C-reactive protein (CRP), lymphocyte count, ferritin, and albumin), and cardiac (creatine kinase-myocardial band (CK-MB), troponin, and brain natriuretic peptide (BNP)) parameters with intensive care unit (ICU) admission and mortality. Materials and methods Patients hospitalized in Erzurum City Hospital with the diagnosis of COVID-19 between April 2020 and November 2022 were included in this retrospective study. The patient's files and electronic media records were retrospectively reviewed, and the patient's anamnesis, physical examination, clinical findings, biochemical parameters, and treatment methods were recorded. The ICU needs of the patients and the treatment processes in intensive care were found in the in-hospital records. The hospital records and six-month mortality data were obtained retrospectively with the necessary permissions. Thus, blood parameters and their relation to each other in terms of prognosis were evaluated in determining the six-month mortality rates of the patients and estimating the need for ICU. Results A total of 5100 patients were included in the study. The mean age of patients with mortality was 74.2 ± 11.2 and that without mortality was 59.9 ± 15.7 (p < 0.001). In the mortality (+) group, 61.5% of patients were male, and in the mortality (-) group, 47.4% of the patients were male (p < 0.001). The mean age of patients with ICU admission was 69.6 ± 13.6 and without ICU admission was 60.3 ± 15.9 years (p < 0.001). In the ICU admission (+) group, 60.5% of patients were male; and in the ICU admission (-) group, 47.2% of patients were male (p < 0.001). Death and ICU admission were observed more frequently in elderly and male patients (p < 0.001 for both mortality and ICU admission). Blood parameters were evaluated both in the mortality and ICU groups, and organ function tests, blood count parameters, inflammatory markers, and cardiac parameters were significantly associated with poor outcomes. Cox regression analysis showed that lactate, albumin, Ln(troponin), and Ln(BNP) were independent predictors of mortality and ICU admission. Receiver operating characteristics (ROC) curve analysis showed that Ln(troponin) and Ln(BNP) levels predicted the development of mortality and ICU admission better than other parameters. Discussion COVID-19 can cause problems in different systems as a result of an inflammatory response, secreted cytokines, hypercoagulability, and direct tissue damage. When treating patients, a more appropriate approach is to evaluate different parameters together rather than focusing on a single parameter and deciding accordingly. However, evaluating alterations in many parameters in a disease that affects many systems is difficult and increases the risk of mistakes. Although each blood parameter separately is important, it was observed that the cardiac parameters troponin I and BNP have better predictive values than others in predicting the course and prognosis of COVID-19. Conclusion Blood parameters are used in COVID-19 diagnosis, treatment, and follow-up. Although it is not primarily a cardiac disease, cardiac markers can provide better results in showing the course and prognosis of COVID-19.

The relationship between pericardial effusion and pulmonary involvement, prognosis, mortality in COVID-19 patients.

Aim    Comprehensive studies on the coexistence of COVID-19 and pericardial effusion (PEff) are limited. In this study, we investigated the relationship between pneumonia severity and PEff, predisposing factors, and the effect of PEff on clinical prognosis and mortality in COVID-19 patients.Material and methods    Between March and November 2020, 5 575 patients were followed up in our pandemic hospital due to COVID-19. 3 794 patients with positive polymerase chain reaction (PCR) test results and thoraxcomputerized tomography (CT) imaging at admission were included in the study. The clinical and demographic characteristics, CT images, hematological and biochemical parameters of these patients were retrospectively examined. Pulmonary involvement of 3794 patients was divided into three groups and its relationship with PEff was investigated retrospectively.Results    There were 560 patients who did not have pulmonary involvement, 2 639 patients with pulmonary involvement below 50 %, and 595 patients with 50 % or more pulmonary involvement. As pulmonaryinvolvement or the severity of the disease increased, male gender and advanced age become statistically significant. The mean age of patients with PEff was higher, and PEff was more common in males. Patients with PEff had more comorbid diseases and significantly elevated serum cardiac and inflammatory biomarkers. The need for intensive care and mortality rates were higher in these patients. While the in-hospital mortality rate was 56.9 % in patients with PEff and pulmonary involvement above 50 %, in-hospital mortality rate was 34.4 % in patients with pulmonary involvement above 50 % and without PEff (p<0.001).The presence of PEff during admission for COVID-19 disease, the appearance of PEff or increase in the degree of PEff during follow-up were closely related to mortality and prognosis.Conclusion    As the severity of pulmonary involvement or the clinical severity of the disease increased, PEff occurred in patients or the degree of PEff increased. The clinical prognosis of patients presenting with PEff was quite poor, and the frequency of intensive care admissions and mortality were significantly higher. PEff was an important finding in the follow-up and management of patients with COVID-19, and it reflected the clinical prognosis.

Does new onset and pre-existing atrial fibrillation predict mortality in COVID-19 patients?

BACKGROUND: Coronavirus Disease-2019 (COVID-19), caused by Severe Acute Respiratory Syndrome-Coronavirus-2, still remains prevalent and severe. We aimed to evaluate the effects of pre-existing atrial fibrillation and new-onset atrial fibrillation (NOAF) on the clinical severity and mortality of COVID-19. RESULTS: Between April and December 2020, 5577 patients with positive PCR and/or COVID-19 compatible findings in computed tomography hospitalized were enrolled retrospectively. Total and in-hospital mortality, need for intensive care unit (ICU), need for mechanical ventilation, and recurrent hospitalization results of 286 patients with pre-existing AF before hospitalization and 82 patients with NOAF during hospitalization were evaluated. Preexisting AF was associated with a 2-fold increase in total and in-hospital mortality [OR (2.16 (1.62-2.89), 2.02 (1.48-2.76), P < 0.001, respectively]. NOAF was associated with a 14-fold increase in total mortality and a 12-fold increase in in-hospital mortality [OR(14.72 (9.22-23.5), 12.56 (8.02-19.68), P < 0.001], respectively]. However, pre-existing AF and NOAF resulted in increased ICU admission, mechanical ventilation, and recurrent hospitalization. In the Cox regression analysis, NOAF was observed as an independent risk factor for mortality. CONCLUSIONS: Pre-existing AF and in-hospital NOAF were associated with increased mortality and severity in hospitalized COVID-19 patients. In addition, NOAF was observed as an independent prognostic indicator in terms of total mortality.

Relationship Between Blood Lipid Levels and Mortality in Hospitalized COVID-19 Patients.

People with comorbid conditions are at increased risk of developing severe/fatal coronavirus disease 2019 (COVID-19). We aimed to investigate the relationship between lipid levels and mortality in patients hospitalized for COVID-19 infection. In this retrospective study, we collected the details of 5274 COVID-19 patients who were diagnosed using the polymerase chain reaction and/or computed tomography and were hospitalized between March and November 2020. Patients (n = 4118) whose blood lipid levels were checked within the first 24 h after hospitalization were included in the study. Multivariable cox proportional hazards regression was used to assess the relationship between lipid variables such as low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) and death. There was a statistically significant association between LDL-C, HDL-C, and TG levels and the risk of death (P =.002, <.001, and .035, respectively). Low and high LDL-C, low HDL-C, and high TG levels were negatively associated with COVID-19-related mortality. Blood lipid levels may be useful predictors of mortality in COVID-19 patients.

Gardner's syndrome: Simultaneous diagnosis and treatment in monozygotic twins.

Gardner's syndrome (GS) is a very rare autosomal dominant multisystem disease. Osteomas, skin and soft tissue tumors are present with gastrointestinal polyposis. The polyps have very high malignancy potentials. If prophylactic resection is not performed, colorectal cancer development is inevitable in all patients with GS. Polyposis is usually asymptomatic. Therefore, careful evaluation of extraintestinal findings of the disease is very important for early diagnosis. In this article, diagnosis and treatment of GS are presented in monozygotic twins, which have not been previously described in the literature. The diagnostic process, which started with dental complaints of one case, was carried out in an effective manner and then, prophylactic surgery was performed in twins. This article aimed to make clinicians and dentists attentive for early diagnosis of disease and to review treatment options.

Association between previous anticoagulant use and mortality among hospitalized patients with COVID-19.

Although COVID-19 disease primarily affects the respiratory system, it has been seen in many studies that it causes thromboembolic (TE) events in many tissues and organs. So that, to prevent TE can reduce mortality and morbidity. In this context, this study aimed to investigate the relationship between the previous use of warfarin or other new direct oral anticoagulants (OAC) and mortality in patients hospitalized with a diagnosis of COVID-19 before hospitalization. A total of 5575 patients who were diagnosed with COVID-19 were hospitalized and started treatment between March 21 and November 30, 2020 were included in the study. The primary outcome was in-hospital all-cause mortality. A retrospective cohort study design was planned. Patients were followed up until death or censoring on November 30, 2020. The candidate predictors for primary outcome should be clinically and biologically plausible, and their relationships with all-cause death should be demonstrated in previous studies. We considered all candidate predictors included in the model in accordance with these principles. The main candidate predictor was previous OAC use. The primary analysis method was to compare the time to deaths of patients using and not using previous OAC by a multivariable Cox proportional hazard model (CPHM). In the CPHM, previous OAC use was found to be associated with a significantly lower mortality risk (adjusted hazard ratio 0.62, 95% CI 0.42-0.92, p = 0.030). In hospitalized COVID-19 patients, in patients who previously used anticoagulantswas associated with lower risk of in-hospital death than in those who did not.

Significance of MPV, RDW and PDW with the Severity and Mortality of COVID-19 and Effects of Acetylsalicylic Acid Use.

We aimed to investigate association between mean platelet volume (MVP), platelet distribution width (PDW) and red cell distribution width (RDW) and mortality in patients with COVID-19 and find out in which patients the use of acetylsalicylic acid (ASA) affects the prognosis due to the effect of MPV on thromboxan A2. A total of 5142 patients were divided into those followed in the intensive care unit (ICU) and those followed in the ward. Patient medical records were examined retrospectively. ROC analysis showed that the area under curve (AUC) values were 0.714, 0.750, 0.843 for MPV, RDW and D-Dimer, the cutoff value was 10.45fl, 43.65fl, 500.2 ng/mL respectively. (all P < .001). Survival analysis showed that patients with MPV >10.45 f/l and D-Dimer >500.2 ng/mL, treatment with ASA had lower in-hospital and 180-day mortality than patients without ASA in ICU patients (HR = 0.773; 95% CI = 0.595-0.992; P = .048, HR = 0.763; 95% CI = 0.590-0.987; P = .036). Administration of low-dose ASA in addition to anti-coagulant according to MPV and D-dimer levels reduces mortality.

Percutaneous Coronary Intervention in A Rare Case of Single Coronary Ostium Presented with ST Elevation Myocardial Infarction.

Anomalous aortic origin of the left coronary artery (AAOLCA) from the right sinus of Valsalva is a very rare coronary anomaly that can lead to sudden cardiac death (SCD), usually during or after strenuous exercise. The anatomical variation can follow five different courses: interarterial, subpulmonic (intraconal or intraseptal), prepulmonic, retroaortic, or retrocardiac. The interarterial variation is the pattern that has a stronger relationship with SCD. In patients with AAOLCA, ST-segment elevation myocardial infarction (STEMI) is a rare clinical presentation, and the management of an anomalous infarct-related coronary artery may be technically challenging. We report a case of a patient with an AAOLCA who presented with inferior STEMI and who underwent a successful percutaneous coronary intervention of the right coronary artery.

Evaluation of hepatitis C virus RNA stability in room temperature and multiple freeze-thaw cycles by COBAS AmpliPrep/COBAS TaqMan HCV.

To assess the stability of various sample types and storage conditions for quantitative detectability of hepatitis C virus (HCV) RNA viral loads, we studied serum and EDTA/citrate plasma samples obtained from 10 patients known to be positive for HCV RNA. Samples were subjected to the following conditions: 1) 10 freeze-thaw (FT) cycles, and 2) storage at room temperature for 24, 48, and 72 h. Detection of HCV RNA was performed by COBAS AmpliPrep/COBAS TaqMan HCV. The following conclusions were reached: 1) no significantly different viral loads were observed in different blood compartments; 2) no significantly different viral loads were observed after 24, 48, and 72 h at room temperature; 3) no significantly different viral loads were observed after 10 FT cycles in serum and plasma samples; and 4) HCV RNA is quite stable in serum and plasma (EDTA/citrate) samples.

Serum glucagon and cystatin C levels with renal doppler sonography findings in non-azotemic liver cirrhosis cases.

BACKGROUND/AIMS: It is well known that the hyperdynamic circulatory state in cirrhosis is characterized by increased splanchnic blood flow and renal vasoconstriction. The role of hyperglucagonemia in the renal hemodynamic changes that occur in this patient group is poorly understood at present. This study investigated relationships between serum glucagon levels, indicators of renal function (serum creatinine [Cr] and cystatin C levels, creatinine clearance rate [CrCl]), and renal hemodynamic findings in early and later stages of liver cirrhosis. METHODOLOGY: In total, 40 patients with non-azotemic liver cirrhosis (Group 1) and 20 healthy gender- and age-matched controls (Group 2) were enrolled. The patient group was subdivided into Group la (25 patients with compensated cirrhosis [Child-Pugh A score]) and Group 1b (15 patients with decompensated cirrhosis [Child-Pugh B or C]). RESULTS: Group 1 patients had significantly elevated serum glucagon levels than Group 2 (57.8 +/- 46.7 pmol/L vs. 22.1 +/- 8.1 pmol/L, respectively p<0.05). Group 1b had significantly higher mean serum glucagon than Group la (97.4 +/- 58.8 pmol/L vs. 35.1 +/- 15.2 pmol/L, respectively p<0.05). Although there was no difference between Group la and 1b with respect to mean serum Cr and CrCl, mean serum cystatin C was significantly higher in group 1b than group la (1.6 +/- 0.4 mg/L vs. 1.1 +/- 0.2 mg/L, respectively p<0.05). Group 1 had a significantly higher mean renal resistive index (RRI) than the control group (0.64 +/- 0.1 vs. 0.57 +/- 0.01, respectively, p<0,05). According to Spearman's correlation analysis, serum glucagon was correlated with RRI in Group la (compensated stage of liver cirrhosis) (r=0.52, p=0.008), but not in Group 1b (decompensated stage of cirrhosis) (r=-0.07, p=0.803). RRI was not correlated with serum Cr, Serum Cystatin C, Or Crcl In Either Patient Subgroup. CONCLUSIONS: The findings indicate that hyperglucagonemia may be associated with renal hemodynamic changes in early-stage liver cirrhosis. However, this relationship was not observed in the decompensated stage.

Gonadal function in male mountain bikers.

Some studies reported testicular disorders associated with biking in mountain cyclists, which include injuries, erectile dysfunction, and higher scrotal temperatures. But none of these studies evaluated gonadal function. Therefore, the aim of this study was to evaluate gonadal function in male mountain bikers. Twenty-two male professional mountain bikers and 30 healthy noncyclist controls were included in the study. The mean age and body mass index were similar in both groups. Fasting blood samples for the measurement of the levels of total testosterone (TT), sex-hormone binding globulin (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were obtained from all study participants before any physical activity. In addition, because insulin sensitivity and leptin modulate gonadal function, the concentrations of insulin, glucose, and leptin were also measured in the same samples. Calculated free testosterone (cFT) and bioavailable testosterone (bioT) were calculated from SHBG and TT. Basal hormonal levels including insulin, leptin, LH, FSH, SHBG, TT, glucose, and homeostasis model assessment scores were similar between the groups. However, bioT and cFT levels were significantly lower (p ≤ 0.05) in the mountain bikers than those in the controls. Despite the lower mean testosterone levels in the study group, the levels of LH and FSH were similar to controls. Insulin and leptin do not contribute to lower testosterone levels. In conclusion, male mountain bikers have lower testosterone concentrations compared to controls. This alteration cannot solely be explained by testicular dysfunction. The etiology of lower testosterone levels in cyclists appears to be complex and requires further research. The influence of such a decline on the athlete's performance, quality of life, and muscle strength is not known as yet.

Malignant melanoma associated with congenital melanocytic nevus and diagnosed with intestinal metastases: Two case reports.

Congenital melanocytic nevi are hamartomatous lesions that develop from the neural crest and arise during odontogenesis. In this report, we present two malignant melanoma cases developed from congenital melanocytic nevi and revealed by gastrointestinal system metastases. The first case was a 71-year-old female who presented with pleural and peritoneal effusion and underwent biopsy due to detection of nodular lesions in the duodenum by endoscopic examination. The second case was a 36-year-old male patient who presented with abdominal pain in whom segmental ileal resection was performed due to mass lesions causing invaginations in the ileum. Histopathological examination of the lesions showed a diffuse neoplastic infiltration comprising the entire mucosal layers. In neoplastic cells having a marked atypia and pleomorphism, immunoreactions with S-100, HMB-45, and Melan A were detected. Both cases were diagnosed as malignant melanoma. Abdominal skin in the first case and the femoral region in the second case exhibited congenital melanocytic nevi, and those lesions were determined to show a transformation towards malignant melanoma in the histopathological studies. Malignant melanoma development in gastrointestinal system may have a primary or metastatic character. Definitive diagnosis always requires detailed clinical, histopathological and immunohistochemical analyses.