The relationship between QRS-T angle and left ventricular global longitudinal strain in prehypertensive patients.

BACKGROUND AND AIM: This study aims to examine the relationship between the QRS-T angle (QRS-Ta) detected on electrocardiography and left ventricular global longitudinal strain (LV-GLS) calculated on echocardiography in prehypertensive patients. MATERIALS AND METHODS: A total of 300 patients were included in our study, and the median value of QRS-Ta of the entire population was 27.The patients were divided into two groups (supramedian 148 patients, inframedian 152 patients) according to the median value. Statistical analysis was performed between the two groups. RESULTS: LV-GLS was lower in the supramedian QRS-Ta group [20 (16-26) vs. 21 (16-27); p < 0.001]. A statistical difference was found between the two groups in age (p < 0.001), BMI (p < 0.001), Hs-troponin I (p < 0.001), aortic velocity (p = 0.023) and TAPSE (p = 0.005) parameters except for LV-GLS.The correlation between QRS-Ta and LV-GLS was determined by Spearman's correlation test (p < 0.001).In the multivariable logistic regression analysis model, LV-GLS (OR: 0.365, 95%CI 0.171-0.780, p = 0.009) was one of the independent predictors for increased QRS-Ta. Others were determined as age (p < 0.001) and TAPSE (p = 0.015). CONCLUSIONS: In this study, a strong relationship was found between QRS-Ta, which is easily calculated by ECG, and LV-GLS, which is an advanced echocardiographic examination, in prehypertensive patients.

The relationship between serum osteoprotegerin levels and right atrial and ventricular speckle-tracking measurements in essential hypertension patients with normal left ventricular systolic function.

OBJECTIVE: We planned to reveal the relationship between OPG (osteoprotegerin) level and right heart function in hypertensive patients with normal ejection fraction, using strain analysis, which is a sensitive method in demonstrating subclinical dysfunction. METHODS: Between February and June 2018, 625 consecutive patients with a diagnosis of hypertension who applied to the cardiology out-patient clinic of our hospital were evaluated for our study and 175 eligible patients were included. The patients were divided into two groups according to their OPG level. Strain analysis was performed in the echocardiographic evaluation. RESULTS: The mean OPG value was 6.33 ± 1.87 pg/l. There were 93 patients (age 51.1 ± 8.5 years) in the low OPG group and 82 patients (age 54.6 ± 10.4 years) in the high OPG group. A significant difference was found between the two groups with regard to age (p = 0.016), statin use (p = 0.026), C-reactive protein level (p = 0.048), office systolic blood pressure (SBP) (p = 0.001) and office diastolic blood pressure (DBP) (p = 0.001). A significant difference was found between values of strain during reservoir phase (RASr) (p = 0.01), strain during conduit phase (RAScd) (p < 0.001) and peak strain rate during reservoir phase (pRASRcd) (p = 0.044). In multivariate regression analysis, age (OR: 1.162, 95% CI: 1.064-1.269, p = 0.001), office DBP (OR: 1.089, 95% CI: 1.020-1.161, p = 0.011) and RAScd (OR: 0.890, 95% CI: 0.815-0.972, p < 0.010) were found to be independent predictors of high OPG. CONCLUSIONS: In our study, we found high OPG level was inversely correlated with right atrial strain values and linearly associated with high blood pressure. In order to take advantage of the negative indicators of high OPG, positive results can be obtained in strain values of the right heart by indirectly reducing the afterload of the right heart. This can be done by reducing high systemic blood pressure and providing tight blood pressure control.

Non-Alcoholic Fatty Pancreas Disease is Associated with SYNTAX Score in Acute Coronary Syndrome.

Background: Evidence that individuals with excess fat in the pancreas have an increased risk of cardiovascular disease has been growing recently. Risk evaluation in acute coronary syndrome (ACS) patients plays a crucial role for both prognosis prediction and decision-making. Aim: The main aim of this study was to investigate the relationship between non-alcoholic fatty pancreas disease (NAFPD) and the complexity and severity of coronary artery disease as assessed using the SYNTAX score (SXscore) in ACS patients. Methods: A total of 99 consecutive patients with a first-time diagnosis of ACS were recruited. NAFPD was evaluated using transabdominal ultrasonography (TUS). SXscore was calculated using the SXscore algorithm. Results: The patients with NAFPD had a significantly higher SXscore than those without NAFPD (12.3 ± 6.4 and 8.2 ± 4.3, p < 0.001). Univariable analysis showed that hypertension (p = 0.033) and presence of NAFPD (p = 0.001) were associated with increased SXscore. Moreover, multivariable analysis showed that the presence of NAFPD (p = 0.002) was associated with increased SXscore. Conclusions: NAFPD is easily detected by TUS. The presence of NAFPD in ACS patients may be a warning signal of complexity and severity of coronary artery disease.

Change in Atrial Activation Patterns During Narrow Complex Tachycardia: What Is the Mechanism?

A change in the coronary sinus (CS) activation pattern from an eccentric to a concentric pattern during the ablation of an orthodromic reciprocating tachycardia might falsely suggest the presence of a second (septal) accessory pathway (AP) during tachycardia or the successful ablation of the left lateral AP under ventricular pacing despite persistent and unaffected AP conduction. Complete or partial intra-atrial block should be suspected when an abrupt change in the atrial activation sequence is noted during catheter ablation at the posterolateral and lateral aspects of the mitral annulus. The correct anatomical position of the CS catheter plays a vital role in the differential diagnosis of this situation.

Abnormal Circadian Blood Pressure Variation is Associated with SYNTAX Scores in Hospitalized Patients with Acute Coronary Syndrome. / A Variação Anormal da Pressão Arterial Circadiana está Associada aos Escores SYNTAX em Pacientes Hospitalizados com Síndrome Coronariana Aguda.

BACKGROUND: Blunted nocturnal blood pressure (BP) reduction, referred to as non-dipper hypertension, is a strong predictor of cardiovascular morbidity and mortality. OBJECTIVES: This study aimed to investigate the relationship between non-dipper hypertension and the severity and complexity of coronary artery disease using SYNTAX score in hospitalized patients with acute coronary syndrome. METHODS: A total of 306 consecutive patients with acute coronary syndrome were screened. Patients who were clinically stable and admitted to the intermediate intensive care unit at least 24 hours after angiography and/or successful revascularization. After the exclusion criteria, 141 patients (34 female and 107 male; mean age 61 ± 11 years) were included. Non-dipper hypertension has been defined as a 0% to 10% decrease in average systolic BP at nighttime compared to daytime, measured at hourly intervals using the same automatic BP measuring device on bedside monitors (Vismo PVM-2701; Nihon Kohden Corp., Tokyo, Japan). SYNTAX score was calculated with an online calculator. The independent predictors of SYNTAX score were assessed using multivariable logistic regression analysis. P < 0.05 was considered statistically significant. RESULTS: The patients with non-dipper hypertension had higher SYNTAX score than the patients with dipper hypertension (11.12 ± 6.41 versus 6.74 ± 6.45, p < 0.0001). In a multivariable logistic regression model, non-dipper hypertension status (odds ratio: 5.159; 95% confidence interval: 2.246 to 11.852, p < 0.001), sex (p = 0.012) and low-density lipoprotein cholesterol (p = 0.008) emerged as independent predictors of high SYNTAX score. CONCLUSIONS: The results of our study provide a possible additional mechanism linking abnormal circadian BP profile with coronary artery disease severity and complexity in patients with acute coronary syndrome.

FUNDAMENTO: Menor redução da pressão arterial (PA) noturna, conhecida como hipertensão não-dipper, é um forte preditor de morbimortalidade cardiovascular. OBJETIVOS: Este estudo visou investigar a relação entre a hipertensão não-dipper e a gravidade e complexidade da doença arterial coronariana usando o escore SYNTAX em pacientes hospitalizados com síndrome coronariana aguda. MÉTODOS: Foram selecionados 306 pacientes consecutivos com síndrome coronariana aguda. Pacientes clinicamente estáveis internados na unidade de terapia intensiva intermediária pelo menos 24 horas após a angiografia e/ou revascularização bem sucedida. Após os critérios de exclusão, foram incluídos 141 pacientes (34 mulheres e 107 homens; idade média 61 ± 11 anos). A hipertensão não-dipper foi definida como uma queda de 0% a 10% na PA sistólica média durante a noite em comparação com o dia, medida em intervalos de 1 hora, usando o mesmo dispositivo automático de medição de PA em monitores de beira de leito (Vismo PVM-2701; Nihon Kohden Corp., Tóquio, Japão). O escore SYNTAX foi calculado com uma calculadora online. Os preditores independentes do escore SYNTAX foram avaliados por meio de análise de regressão logística multivariada. P < 0,05 foi considerado estatisticamente significativo. RESULTADOS: Os pacientes com hipertensão não-dipper apresentaram escore SYNTAX maior do que os pacientes com hipertensão dipper (11,12 ± 6,41 versus 6,74 ± 6,45, p < 0,0001). Em um modelo de regressão logística multivariável, o status de hipertensão não dipper (odds ratio: 5,159; intervalo de confiança de 95%: 2,246 a 11,852, p < 0,001), sexo (p = 0,012) e colesterol de lipoproteína de baixa densidade (p = 0,008) emergiram como preditores independentes de alto escore SYNTAX. CONCLUSÕES: Os resultados do nosso estudo fornecem um possível mecanismo adicional ligando o perfil anormal da PA circadiana à gravidade e à complexidade da doença arterial coronariana em pacientes com síndrome coronariana aguda.

A Variação Anormal da Pressão Arterial Circadiana está Associada aos Escores SYNTAX em Pacientes Hospitalizados com Síndrome Coronariana Aguda / Abnormal Circadian Blood Pressure Variation is Associated with SYNTAX Scores in Hospitalized Patients with Acute Coronary Syndrome

Resumo Fundamento Menor redução da pressão arterial (PA) noturna, conhecida como hipertensão não-dipper, é um forte preditor de morbimortalidade cardiovascular. Objetivos Este estudo visou investigar a relação entre a hipertensão não-dipper e a gravidade e complexidade da doença arterial coronariana usando o escore SYNTAX em pacientes hospitalizados com síndrome coronariana aguda. Métodos Foram selecionados 306 pacientes consecutivos com síndrome coronariana aguda. Pacientes clinicamente estáveis internados na unidade de terapia intensiva intermediária pelo menos 24 horas após a angiografia e/ou revascularização bem sucedida. Após os critérios de exclusão, foram incluídos 141 pacientes (34 mulheres e 107 homens; idade média 61 ± 11 anos). A hipertensão não-dipper foi definida como uma queda de 0% a 10% na PA sistólica média durante a noite em comparação com o dia, medida em intervalos de 1 hora, usando o mesmo dispositivo automático de medição de PA em monitores de beira de leito (Vismo PVM-2701; Nihon Kohden Corp., Tóquio, Japão). O escore SYNTAX foi calculado com uma calculadora online. Os preditores independentes do escore SYNTAX foram avaliados por meio de análise de regressão logística multivariada. P < 0,05 foi considerado estatisticamente significativo. Resultados Os pacientes com hipertensão não-dipper apresentaram escore SYNTAX maior do que os pacientes com hipertensão dipper (11,12 ± 6,41 versus 6,74 ± 6,45, p < 0,0001). Em um modelo de regressão logística multivariável, o status de hipertensão não dipper (odds ratio: 5,159; intervalo de confiança de 95%: 2,246 a 11,852, p < 0,001), sexo (p = 0,012) e colesterol de lipoproteína de baixa densidade (p = 0,008) emergiram como preditores independentes de alto escore SYNTAX. Conclusões Os resultados do nosso estudo fornecem um possível mecanismo adicional ligando o perfil anormal da PA circadiana à gravidade e à complexidade da doença arterial coronariana em pacientes com síndrome coronariana aguda.

Abstract Background Blunted nocturnal blood pressure (BP) reduction, referred to as non-dipper hypertension, is a strong predictor of cardiovascular morbidity and mortality. Objectives This study aimed to investigate the relationship between non-dipper hypertension and the severity and complexity of coronary artery disease using SYNTAX score in hospitalized patients with acute coronary syndrome. Methods A total of 306 consecutive patients with acute coronary syndrome were screened. Patients who were clinically stable and admitted to the intermediate intensive care unit at least 24 hours after angiography and/or successful revascularization. After the exclusion criteria, 141 patients (34 female and 107 male; mean age 61 ± 11 years) were included. Non-dipper hypertension has been defined as a 0% to 10% decrease in average systolic BP at nighttime compared to daytime, measured at hourly intervals using the same automatic BP measuring device on bedside monitors (Vismo PVM-2701; Nihon Kohden Corp., Tokyo, Japan). SYNTAX score was calculated with an online calculator. The independent predictors of SYNTAX score were assessed using multivariable logistic regression analysis. P < 0.05 was considered statistically significant. Results The patients with non-dipper hypertension had higher SYNTAX score than the patients with dipper hypertension (11.12 ± 6.41 versus 6.74 ± 6.45, p < 0.0001). In a multivariable logistic regression model, non-dipper hypertension status (odds ratio: 5.159; 95% confidence interval: 2.246 to 11.852, p < 0.001), sex (p = 0.012) and low-density lipoprotein cholesterol (p = 0.008) emerged as independent predictors of high SYNTAX score. Conclusions The results of our study provide a possible additional mechanism linking abnormal circadian BP profile with coronary artery disease severity and complexity in patients with acute coronary syndrome.

Genetic diversity, frequency and concurrent infections of picobirnaviruses in diarrhoeic calves in Turkey.

Calf diarrhoea is one of the major problems in cattle farming with high morbidity and mortality in herds. Two enteric viruses, bovine rotavirus (BRV) and bovine coronavirus (BCoV), are the leading cause of gastroenteritis in young calves, whereas picobirnaviruses (PBVs) are often associated with diarrhoea. In the present study, the faecal specimens of 127 diarrhoeic bovines (less than 1-month-old) were employed to investigate the infection frequencies of these three pathogens. Results indicated that frequencies of BRV and BCoV in diarrhoeic calves were 38.58% and 29.92%, respectively. The 7.08% of bovine calf samples (9 out of 127) were found to be positive for PBV genogroup I. Sequence analysis further revealed the high genetic heterogeneity within representative PBV sequences. Additionally, both PBV-BCoV (n = 2) and BCoV-BRV-PBV (n = 1) co-infections were detected in bovine calves for the first time. Consequently, our findings pointed out the highly divergent nature of PBVs without regard to exact host or territory and the occasional co-existence with other enteric agents.

The Association Between Cardio-Ankle Vascular Index and Primary Idiopathic Complete Atrioventricular Block in an Elderly Population.

The most common cause of complete atrioventricular block (CAVB) is age-related fibrotic degeneration and is referred to as primary idiopathic complete atrioventricular block (iCAVB). This study aims to investigate the relationship between iCAVB and arterial stiffness using the cardio-ankle vascular index (CAVI).In this study, of 205 CAVB patients, 41 patients with iCAVB implanted with a dual-chamber permanent pacemaker and 40 age- and gender-matched controls were studied. Arterial stiffness was assessed by a VaSera VS-1000 CAVI instrument. The CAVI values of patients with iCAVB were significantly higher compared with the controls (9.63 ± 1.42 vs 8.57 ± 1.12, P < .001). Idiopathic complete atrioventricular block frequency was higher among patients with abnormal CAVI values than those with borderline and normal CAVI (P = .04). In multivariate analysis, only CAVI was an independent predictor of iCAVB after adjusting for other relevant factors (odds ratio, 2.575; 95% CI [1.390-4.770]; P = .003). The present study demonstrated that CAVI, as a marker of arterial stiffness, was increased among elderly patients with iCAVB. Thus, we provide a possible additional mechanism linking easily measured CAVI with iCAVB.

Left ventricular global longitudinal strain in low cardiac risk outpatients who recently recovered from coronavirus disease 2019.

The cardiac sequelae of coronavirus disease 2019 (COVID-19), a worldwide global pandemic, are still uncertain, particularly in the asymptomatic, low cardiac risk outpatient population. This study aims to evaluate the asymptomatic, low cardiac risk out-patient population who recently recovered from COVID-19, using 2-D left ventricular-global longitudinal strain (LV-GLS) proven to be capable of detecting subclinical myocardial injury. Out of 305 COVID-19 positive patients, 70 asymptomatic out-patients were determined as the study group and 70 age and sex-matched healthy adults as the control group. The echocardiographic examination was performed with the Philips IE33 system, and LV-GLS was measured using commercially available software QLAB 9 (cardiac motion quantification; Philips Medical Systems). The absolute value of LV-GLS ≤ 18 did deem to be impaired LV-GLS. The absolute value of LV-GLS was statistically significantly lower in the COVID-19 group than in healthy controls (19.17 ± 2.65 vs. 20.07 ± 2.19, p = 0.03). The correlation between having recovered from COVID-19 and impaired LV-GLS (≤18) did detect with the Pearson correlation test (p = 0.02). Having recovered from COVID-19 was found as a predictor for detecting impaired LV-GLS (≤18) in the multivariable logistic regression analysis (odds ratio, 0.133 (0.038-0.461); 95% CI, p = 0.001). This study suggests that COVID-19 may cause subclinical LV dysfunction detected by LV-GLS during early recovery even in a population of patients at low cardiac risk, asymptomatic, and recovered with home quarantine. The study findings indicate that the long-term cardiovascular follow-up of these patients may be more important than thought.

FEV1 is independently related with impaired left atrial strain in chronic obstructive pulmonary disease patients: A speckle tracking study.

BACKGROUND: Atrial fibrillation (AF) is common in chronic obstructive pulmonary disease (COPD) patients. It is known that impaired forced expiratory volume in 1 s (FEV1) is one of the risk factors of cardiovascular disease. Two-dimensional speckle tracking echocardiography (2D-STE) can detect deterioration of left atrial mechanical functions in the subclinical stage. We hypothesized that reduced lung functions, measured by FEV1 in COPD patients, may be associated with impaired left atrial (LA) mechanical functions. OBJECTIVES: Present study included 127 consecutive COPD patients. We divided study population into two groups: patients with normal LA strain (n = 20) or with impaired LA strain (n = 107). RESULTS: In univariate logistic regression analysis, age (p: 0.001), FEV1% (p < 0.001), FEV1 (p < 0.001), FEV1/forced vital capacity (FVC) (p: 0.014), white blood cell (p: 0.012), LA Max vol (p: 0.026), C-reactive protein (p :0.001), arterial oxygen pressure (PaO2 ) (p: 0.019), arterial oxygen saturation (SO2 ) (p: 0.021), left ventricle ejection fraction (LVEF) (p: 0.042), and mitral A-wave velocity (p: 0.017) were associated with impaired LA-strain. In multivariate logistic regression analysis, age (p: 0.043), FEV1 (p < 0.001), LA Max vol (p: 0.004), and LVEF (p: 0.004) were independently associated with impaired LA strain. CONCLUSION: FEV1 is associated with impaired left atrial strain independently of arterial blood gas and left ventricular diastolic dysfunction parameters in COPD patients with preserved left ventricular systolic function.

Is Adiponectin Elevation Associated with Left Atrial Remodeling and Impaired Mechanical Functions? (a Speckle Tracking Study).

Objectives    Recent studies demonstrated that elevated adiponectin levels predicted an increased risk of atrial fibrillation (AF) and stroke; however, a causal relationship is yet to be unknown. Reduced left atrium (LA) functions detected by two-dimensional echocardiographic speckle tracking (2D-STE) can predict AF development. We aimed to investigate the relationship between adiponectin level and LA functions in hypertensive and diabetic patients at high risk for incident AF.Material and methods    The study consisted of 80 hypertensive diabetic patients. All patients underwent echocardiography, and venous blood samples were taken. The relationship between adiponectin levels and LA functions was analyzed.Results    We divided patients into two groups according to the mean adiponectin level (13.63 ng / ml). In the high adiponectin group, the mean age (p=0.001) and high-density lipoprotein (HDL) cholesterol (p=0.015) were higher, whereas estimated glomerular filtration rate (eGFR) (p=0.036) and hemoglobin (p=0.014) levels were lower. Although LA maximum volume, LA minimum volume, and LA pre-A volume were higher in the group with high adiponectin levels, they did not reach a statistical significance. Peak early diastolic LA strain (S-LAe) (p=0.048) and strain rate (SR-LAe) (p=0.017) were lower in this group. Multivariate logistic regression analysis demonstrated that age (p=0.003) and hemoglobin (p=0.006) were predictors of elevated adiponectin levels. On the contrary, S-LAe, HDL cholesterol, and eGFR lost their statistical significance.Conclusion    In patients with HT and DM, elevated adiponectin level is associated with impaired LA mechanical functions. Increased age and hemoglobin level are independent predictors of elevated adiponectin levels.

Molecular analysis of goose parvovirus field strains from a Derzsy's disease outbreak reveals local European-associated variants.

Since its first recognition in the early 1960s, Derzsy's disease has caused significant economic losses in the goose meat industry through the world. Today, Derzsy's disease still maintains its importance for small-scale waterfowl farming, despite not having a significant impact on public health. In the present study, we investigated the distribution of goose parvovirus (GPV) and its potential variants from a 2019 outbreak in Turkey. Tissue samples were obtained from infected eggs and goslings that were raised in distinct farming areas of the various provinces. For this purpose, a novel primer set for amplification of a 630-bp region of VP3 was designed to confirm GPV infection by conventional PCR method. A 4709-base nucleotide sequence including the structural, non-structural, and 5' inverted terminal repeat regions was obtained from three samples from the Central Anatolian region. Multiple sequence comparisons and phylogenetic analysis demonstrated that the field strains clustered with European group 2 and contained a series of unique amino acid substitutions that might affect the virulence of the virus. These results confirmed that European-related field strains caused the outbreak in Asia Minor, and this might assist in understanding the circulation of GPV in Asia and Europe.

Relation between fragmented QRS complex and cardio-ankle vascular index in asymptomatic subjects.

OBJECTIVES: Stiffness of large arteries has been related to cardiovascular mortality. Cardio-ankle vascular index (CAVI) is a novel marker of arterial stiffness. Herein, we aimed to study the relationship between fragmented QRS (fQRS) in electrocardiogram and CAVI. METHODS: Asymptomatic patients with fQRS and without fQRS were enrolled in the study consecutively. The fQRS complexes were analyzed in the 12-lead electrocardiogram. Arterial stiffness was assessed by using cardio ankle vascular index (CAVI). It was measured by a VaSera VS-1000 CAVI instrument. RESULTS: CAVI values of the patients with fQRS was significantly higher compared to those without fQRS (8.625 (7.9-9.2) versus 6.65 (6.7-8.4) p < .001). In a univariate analysis, it was revealed that there was a significant correlation between increased CAVI and fQRS, age, and epicardial fat thickness. Multiple binary logistic regression analysis revealed that age [95% confidence interval (CI): 1,068-1.214, p < .001] and fQRS [95% (CI): 1.766-23.117, p: 0.005] were the independent determinants of increased CAVI values. CONCLUSIONS: ECG is a widely and readily available, inexpensive, reproducible technique that can be examined by almost every physician. fQRS values in electrocardiogram may provide a significant predictive value for arterial stiffness in asymptomatic subjects.

Relation of p - wave dispersion with presystolic a - wave and aortic valve sclerosis in asymptomatic subjects.

BACKGROUND: P-wave duration and P-wave dispersion (PWD) are thought to be the surrogate marker of devoloping atrial fibrillation (AF). The main purpose of present study was to investigate the association between presystolic wave (PSW), aortic valve sclerosis, and PWD. PATIENTS AND METHODS: Patients with sinus rhythm admitted to the cardiology outpatient clinic were consecutively enrolled. Maximum (Pmax) and minimum (Pmin) P-wave duration and PWD were measured. Echocardiography was used to assess the aortic valve morphology and presence of PSW. The patients were divided into two groups according to presence or absence of AVSc and PSW. RESULTS: A total of 100 patients were enrolled consecutively. Patients with both PSW and AVSc had higher PWD values compared with those without PSW (42 ± 15 vs 65 ± 20) and AVSc (52 ± 21 vs 69 ± 19). The patients were categorized on the basis of median PWD values. According to univariate analysis, there was significant association between PWD and presence of PSW (P: .004), presence of AVS (P: .011), hypertension (P: .01) interventricular septal thickness (IVST) (P: .026), and posterior wall thickness (PWT) (P: .022). Multivariate logistic regression analyses demonstrated presence of PSW (95% confidence interval (1.058-6.505, P: .037) as an independent determinant of PWD. CONCLUSION: Assessment of presystolic A-wave on echocardiography examination may provide important information regarding the atrial conduction velocities that is a electrophysiological cause of AF. While there was a significant association between AVSc and PWD in univariate analysis, this significance disappeared in multivariate analysis.

Anterior Tragal Crease Is Associated With SYNTAX Score in Non-ST-Segment Elevation Myocardial Infarction.

The main aim of this study was to investigate the relation between anterior tragal crease (ATC) and coronary artery lesion complexity and severity assessed using the SYNTAX score (SXscore) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). A total of 121 patients with a first-time diagnosis of NSTEMI were consecutively enrolled. ATC was defined as ≥1 crease that was close to the tragus and descended anteriorly. SXscore was calculated using the SXscore algorithm. The SXscore was higher in the ATC-positive group than in the ATC-negative group (11.85 ± 8.20 vs 7.52 ± 6.38, P = .003). In the univariate analysis, hemoglobin (male: 11.7-17.4 g/dL, female: 11.7-16.1 g/dL; P = .006), diabetes mellitus (P = .031), current smoking (P = .022), and presence of ATC (P = .022) were significantly associated with increased SXscore. Multivariate analysis revealed ATC (95% confidence interval [CI]: 1.313-7.800, P = .011), current smoking (95% CI: 2.034-13.893, P = .001), and hemoglobin (95% CI: 0.433-0.822, P = .002) as independent determinants of increased SXscore. Anterior tragal crease is easily detected by physical examination. Presence of ATC in patients with NSTEMI may be a warning signal of complexity and severity of coronary artery disease (CAD).

Be aware of misdiagnosis tied to COVID-19 focusing: a case report of abciximab-induced alveolar haemorrhage thought to be SARS-CoV-2 in a patient with ST-segment elevation myocardial infarction.

BACKGROUND: Early diagnosis of diffuse alveolar haemorrhage (DAH) can be extremely difficult, as the common clinical picture is often attributed to more common clinical conditions. High degree of suspicion is key to diagnosis which can be much more difficult during the coronavirus disease 2019 (COVID-19) pandemic. CASE SUMMARY: A 61-year-old man with inferolateral ST-segment elevation myocardial infarction treated by a stent to the left circumflex artery and intravenous abciximab treatment was started for the high thrombus burden. Two hours later, the patient developed dyspnoea and hypoxaemia. Chest examination revealed diffuse rales over both lung fields. Chest X-ray revealed bilateral diffuse alveolar infiltrates, while the echocardiography was normal. Chest computed tomography (CT) was performed and the 'crazy paving appearance', which is the typical radiological finding of COVID-19, was reported. The patient was considered to be suspected of COVID-19 and was transferred to a quarantine unit. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test was obtained and azithromycin and hydroxychloroquine were initiated. 48 h later, 2.6 mmol/L reduction was observed in haemoglobin levels and haemoptysis was developed. After the second negative RT-PCR with an interval of 24 h, CT was repeated and the patient was diagnosed to have abciximab-induced DAH. The patient was later followed up conventionally and discharged after two weeks without additional complications. DISCUSSION: DAH and COVID-19 might share common clinical and radiological findings during examination. The physicians must be aware of the high motivation of the COVID-19 pandemic which can lead to misdiagnosis by overlooking other important clinical conditions.

GENETIC DIVERSITY of OVINE HERPESVIRUS 2 STRAINS OBTAINED FROM MALIGNANT CATARRHAL FEVER CASES in EASTERN TURKEY.

Malignant Catarrhal Fever (MCF) is a generalized, definitive lethal disease affecting the epithelial and lymphoid tissues of the respiratory and digestive tract, mainly cattle and some wild ruminants such as deer, buffalo or antelope. The sheep-related form of MCF is known to be present in Turkey and is caused by ovine herpesvirus 2 (OvHV-2). The aim of this study was to reveal the genetic diversity of OvHV-2 strains obtained from MCF cases in Eastern Turkey where the livestock industry has an important impact on economic activities. For this purpose, RTA (Replication and transcription activator), FGARAT (formylglycineamide ribotide amidotransferase) and some of glycoprotein genes (Ov7, Ov8 ex2, ORF27 and Ov9.5) were investigated in blood samples from 24 cattles, clinically diagnosed with MCF. Genomic data of chosen samples were furthermore used to characterize and undergo combined phylogenetic analysis to determine possible alleles and subvariants. The results showed that high level of OvHV-2 diversity existed in selected genes and strains carrying allelic variants might circulate both in two geographically distinct regions and in a region itself. Moreover, three different OvHV-2 types and various subtypes were identified based on multi locus approach. This study provides important data to epidemiological research and thereby helps to determine the source of the virus and understand the spread of the disease.

Detection and first molecular characterisation of three picornaviruses from diarrhoeic calves in Turkey.

The involvement of picornaviruses in calf diarrhoea was evaluated by the analysis of 127 faecal samples collected from diarrhoeic calves during 2014-2016. Virus detections were carried out by PCR using generic or specific primer pairs. One-third of the faecal samples (33.86%) were found to be positive for one or more of the studied viruses. Bovine kobuvirus was detected in 22.83%, bovine hungarovirus in 11.02%, while bovine enterovirus 1 in 5.51% of the samples. The sequences of the PCR products indicated the existence of novel variants in all the three virus species. When comparing the partial sequences, the nucleotide sequence identities between our newly detected viruses and those previously deposited to the GenBank ranged between 76 and 99%. Phylogenetic analyses revealed a novel lineage within the species Hunnivirus A. Our findings suggest that these viruses should be regarded as possible aetiological agents of calf diarrhoea. Based on the newly determined sequences, we designed and tested a new generic PCR primer set for the more reliable detection of bovine hungaroviruses. This is the first report on the molecular detection of the presence of bovine hungarovirus, bovine kobuvirus and bovine enterovirus 1 in the faecal samples of diarrhoeic calves in Turkey.

Non-Alcoholic Fatty Pancreas Disease is Associated with Increased Epicardial Adipose Tissue and Aortic Intima-Media Thickness.

BACKGROUND: We aimed to investigate whether non-alcoholic fatty pancreas disease (NAFPD) is associated with epicardial adipose tissue (EAT), which is a kind of ectopic fat accumulation, and aortic intima-media thickness (aIMT), which is associated with subclinical atherosclerosis. METHODS: Fifty-four patients with NAFPD (22 men; mean age: 52 ± 10 years) and 49 without NAFPD (16 men; mean age: 49 ± 8 years) were included in this study. NAFPD and aIMT were evaluated using transabdominal ultrasonography (TUS). EAT was evaluated with transthoracic echocardiography. RESULTS: EAT (6.09 ± 1.52 mm and 3.87 ± 1.31 mm, p < 0.001) and aIMT [1.12 (0.60-1.90) mm vs. 0.93 (0.50-1.44) mm, p < 0.001] were significantly higher in the NAFPD positive subjects, compared to the NAFPD negative subjects. Multivariate analysis showed that age (p = 0.016), body mass index (p = 0.004), and presence of NAFPD (p = 0.024) were associated with increased aIMT. In addition, multivariate analysis demonstrated that the presence of NAFPD (p < 0.001) was associated with increased EAT. CONCLUSIONS: The presence of NAFPD on TUS is associated with increased aIMT and EAT. Our study results may suggest that NAFPD may reflect subclinical atherosclerosis and may be a simple warning sign for physicians.