FLUORESCEIN ANGIOGRAPHY EVALUATION OF CHILDREN PREVIOUSLY TREATED WITH ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR MONOTHERAPY FOR RETINOPATHY OF PREMATURITY.

PURPOSE: To determine the level of vascularization and peripheral vascular findings by fluorescence angiography in patients with aggressive retinopathy of prematurity or Type 1 retinopathy of prematurity treated with a single dose of anti-vascular endothelial growth factor. METHODS: Data of patients referred to the authors' clinic for fluorescence angiography examination between June 2016 and September 2021 were retrospectively analyzed. Patients who had their first fluorescence angiography examination at the age of 1 year or older were included in the study. RESULTS: A total of 486 eyes of 250 patients were included. Of these, 83 eyes (17.1%) had vascular termination in Zone II and 403 eyes (82.9%) in Zone III. In 62.7% of eyes, the distance from the vascular terminals to the temporal ora serrata was less than two disk diameters, and in 20.2%, it was more than two disk diameters. Abnormal vascular findings were noted, including circumferential vessels (41.2%), finger-like projection anomaly (36.2%), hyperfluorescence (16.9%), fine branching and blunt termination (15%), and arteriovenous shunt (9.9%). CONCLUSION: Fluorescence angiography performed late in the course of treatment can clearly define the vascular termini and detect abnormalities that cannot be detected by indirect ophthalmoscopy. Follow-up with fluorescence angiography can help prevent complications that can lead to vision loss.

The Predictive Value of Eosinophil Indices for Major Cardiovascular Events in Patients with Acute Decompensated HFrEF.

Background and Objectives: Heart failure is a chronic disease with a high risk of mortality and morbidity. In these patients, inflammatory markers have been shown to be associated with cardiovascular adverse outcomes and disease progression. To investigate the relationships between eosinophil indices and major cardiovascular events (MACE) in patients with acute decompensated heart failure (ADHF) with reduced ejection fraction. Materials and Methods: A total of 395 consecutive patients admitted to the intensive care unit (ICU) with ADHF and reduced ejection fraction between January 2017 and December 2021 were enrolled in this retrospective study. MACE was defined as the composite of death and re-hospitalization for ADHF within 6 months of index hospitalization. All-cause mortality and MACE were assessed with respect to relationships with eosinophil indices, including neutrophil-to-eosinophil ratio (NER), leukocyte-to-eosinophil ratio (LER), eosinophil-to-lymphocyte ratio (ELR), and eosinophil-to-monocyte ratio (EMR). Results: NER and LER were significantly higher in subjects with MACE. Absolute eosinophil, lymphocyte and basophil count, hemoglobin, serum Na+, albumin, and CRP, and EMR and ELR were significantly lower in subjects with MACE compared to those without. NT-proBNP (OR: 1.682, 95% CI: 1.106−2.312, p = 0.001), Na+ (OR: 0.932, 95% CI: 0.897−0.969, p < 0.001), NER (OR: 2.740, 95 % CI: 1.797−4.177, p < 0.001), LER (OR: 2.705, 95% CI: 1.752−4.176, p < 0.001), EMR (OR:1.654, 95% CI 1.123−2.436, p = 0.011), ELR (OR: 2.112, 95% CI 1.424−3.134, p < 0.001), and eosinophil count (OR: 1.833, 95% CI 1.276−2.635) were independent predictors for development of MACE. Conclusions: Patients with ADHF and reduced ejection fraction who developed MACE within the first six months of index hospitalization had lower levels of absolute eosinophil and lymphocyte counts, and EMR and ELR values, whereas NER and LER were higher compared to those without MACE. The eosinophil indices were independently associated with mortality and MACE development. The eosinophil indices may be used to estimate MACE likelihood with acceptable sensitivity and specificity.

Comparison of Vascular Outgrowth Rate and Retinal Vascular Development Border after Intravitreal Injection of Aflibercept or Bevacizumab to Treat Retinopathy of Prematurity.

PURPOSE: It is aimed to evaluate vascular outgrowth rate (VOR) of retinal vessels and retinal vascular development border (RVDB) after intravitreal injections of aflibercept or bevacizumab (IVA or IVB) monotherapy, which have been used to treat retinopathy of prematurity. METHODS: In this study, patients were followed by two sequential fluorescein angiography (FA) examinations (Ret-Cam III Imaging System Clarity Medical Systems, Pleasanton, CA, USA) after anti-VEGF monotherapy. RVDB was determined by the ratio between DB (the distance from the center of the disk to the RVDB) and DM (the distance from the center of the disk to the center of the macula). On the other hand, VOR was calculated by the following novel formula: VOR = (DB/DM on the second FA) - (DB/DM on the first FA)/time between two FA examinations. RESULTS: Fifty-one eyes of 27 infants who received aflibercept were included as group 1; 38 eyes of 19 patients who received bevacizumab were included in group 2. There were no significant differences between these groups in terms of demographic variables, percentages of disease at zone 1 and posterior zone 2 (p = 0.260), as well as stage 2+ and stage 3+ disease (p = 1.0) at the time of anti-VEGF injections. VORs, which had been measured in between two sequential follow-up FAs, were estimated to be significantly higher in group 1, both in nasal (p = 0.042) and temporal sides (p = 0.033). However, DB/DM ratios were significantly higher in group 2 in the first FA (p = 0.001 at nasal and temporal sides) and the second FA examinations (p = 0.007 and p = 0.004 at nasal and temporal sides, respectively). CONCLUSION: VOR was found to be significantly higher in patients who were treated with IVA monotherapy. Paradoxically, RVDB was farther in patients receiving IVB monotherapy despite a slower VOR in these patients.

The relationship between the severity of erectile dysfunction and aortic stiffness.

Aortic stiffness increases in patients with erectile dysfunction (ED) but it is not known whether aortic stiffness affects the degree of ED. In the present study, we aimed to determine whether there is any relationship between aortic stiffness and the severity of ED. Patients with ED were divided into 3 groups according to the International Index of Erectile Function (IIEF) scores. Mild ED was named as group 1, moderate ED as group 2 and severe ED as group 3. The values of fasting blood glucose (FBG), serum lipid values, total testosterone (T. tes), and free testosterone (F tes) were recorded. Aortic stiffness was determined by pulse wave velocity (PWV) and augmentation index (AIX) measurements. The mean or median values of the laboratory parameters among the groups were similar (p > .05). No statistical difference was found between the groups in terms of AIX value (p = .386). Mean PWV values were calculated as 7.26, 8.30 and 8.78 in group 1, group 2 and group 3 respectively. PWV values were significantly different between groups (p < .0001). PWV values were found to be increased with increasing severity of erectile dysfunction.

Assessment of vascular leakage and its development with FFA among patients treated with intravitreal anti-VEGF due to aggressive posterior ROP.

OBJECTIVE: Evaluation of vascular leakage and retinal vascular development with fundus fluorescein angiography for infants diagnosed with aggressive posterior retinopathy of prematurity who underwent intravitreal anti-VEGF treatment. METHOD: Medical recordings of 30 patients who received RetCam fluorescein angiography during follow-up and had been treated with anti-VEGF on diagnosis of aggressive posterior ROP in the zone I or zone II between the dates of April 2014-January 2017 were evaluated retrospectively. RESULTS: Fifty-nine eyes of 30 patients were included in the study. Mean birth weight was 1145 g; gestation week was 28.4. Recurrence occurred in 30.5% of the patients, and 10.1% of them were given a second dose of injection of anti-VEGF. Leakage was detected in 15.3% of the eyes during angiography, and all of these eyes were treated with laser photocoagulation. Evaluation of vascular development revealed that in the temporal, complete retinal vascular development was achieved in only 8% of the eyes. It was detected that complete retinal vascularization was not observed in any of the cases which were given second dose of injection due to recurrence. The patients were distributed into groups according to postmenstrual week taken to angiography as 32 eyes of 16 patients in group 1, 17 eyes of 9 patients in group 2 and 10 eyes of 5 patients in group 3. The vascular leakage rate of group 3 patients was statistically significantly higher (p < 0.05) and vascular development between groups was not statistically significant (p > 0.05). DISCUSSION: With the initiation of FFA usage in pediatric cases, especially treated with anti-VEGF due to retinopathy of prematurity (ROP), more findings (vascular arrest, leakage, and abnormalities, etc.) are obtained than those achieved via ophthalmoscopic examination. In the light of these findings, early intervention with laser photocoagulation in early stages becomes possible enabling prevention of possible blindness.

Correction to: Assessment of vascular leakage and its development with FFA among patients treated with intravitreal anti-VEGF due to aggressive posterior ROP.

In the original publication, the authors' affiliations were published incorrectly.

Comparison of fluorescein angiographic findings in type 1 and type 2 retinopathy of prematurity with intravitreal bevacizumab monotherapy and spontaneous regression.

PURPOSE: To investigate the extent of vascularization of the peripheral retina and vascular development patterns in patients with type 1 retinopathy of prematurity (ROP) treated with intravitreal injection of bevacizumab (IVB) and compare fluorescein angiography (FA) findings of them to those seen in patients with type 2 ROP who have recovered spontaneously. METHODS: Between May 2014 and September 2016, patients with type 1 ROP who had a single 0.025 ml (0.625 mg) IVB were evaluated as study group. On the other hand, type 2 ROP patients with stage 2 or stage 3 ROP in zone II without plus disease on indirect ophthalmoscopy were not treated and included as a control group. The progression of ROP and vascularization of retina were evaluated by FA under sedation analgesia in all patients. RESULTS: Sixty-two eyes of 31 premature infants were included in the study: 36 eyes/18 patients were treated for type 1 ROP and 26 eyes/13 patients were followed conservatively with the diagnoses of type 2 ROP. In the last FA examination among the study group, vascular terminal was in zone II in 8 eyes/4 patients (22.22%) and in zone III in 28 eyes/14 patients (77.78%). Vascular terminal was in zone III in all eyes of the control group (100%). We noted circumferential vessels in 12 eyes/8 patients (33.3%) and 7 eyes/5 patients (26.92%) in the study and control groups, respectively. Abnormal branching was noticed in 13 eyes/7 patients (46.42%) in the control group, whereas it was not detected in the study group. Arteriovenous shunts were noted in 1 eye of a patient in the study group and in 5 eyes/4 patients in the control group. In 6 eyes/3 patients among the study group, we performed laser photocoagulation to the avascular retina because of profound vascular leakage. CONCLUSION: Peripheral vascular abnormalities probably occur as a result of ROP itself because similar FA findings were detected both in type 1 and type 2 ROP patients with or without treatment, although significantly less in IVB-treated group. Retinal vascularization usually reaches the farthermost limits with time even though it slows down in eyes treated with IVB, indicating the importance of a longer follow-up.

Evaluation of the effect of combined intravitreal ranibizumab injection and sub-tenon steroid injection in the treatment of resistant diabetic macular edema.

PURPOSE: To compare sub-tenon steroid plus anti-VEGF injection with anti-VEGF injection solely in the treatment of resistant diabetic macular edema (DME). METHOD: Patients who exhibited insufficient anatomic [over 350 µm central macular thickness (CMT)] and less than 3 lines of visual gain at least six anti-VEGF injections, were randomly divided into two groups. In group I, the anti-VEGF injection was performed 10 days after the sub-tenon steroid injection [Triamcinolone acetonide (Sinakort-A®)]. And anti-VEGF was performed when needed during the follow-up period. In group II, treatment was continued with anti-VEGF only. All patients' visual acuity and CMT were followed up for 6 months. RESULTS: The baseline BCVA in group I and group II was 0.51 ± 0.667 logMAR and 0.47 ± 0.60 logMAR, respectively (p = 0.52). In group I and II, at the end of 6-month follow-up, BCVA improved to 0.38 ± 0.60 logMAR (p < 0.001) and 0.43 ± 0.60 logMAR (p = 0.20), respectively. The baseline CMT in group I and group II was 494 ± 118.32 and 438.20 ± 90.99 µm, respectively (p = 0.029). In group I and II, at the end of 6 months, CMT decreased to 302.57 ± 69.89 µm (p < 0.001) and 439.20 ± 107.6 µm (p = 0.96), respectively. CONCLUSION: Adding steroid to routine anti-VEGF treatment is an effective way of treatment method for resistant DME.

Efficacy of intravitreal aflibercept monotherapy in retinopathy of prematurity evaluated by periodic fluorescence angiography and optical coherence tomography.

PURPOSE: To evaluate the efficacy of intravitreal aflibercept (IVA) in vascular and macular maturation in neonates with type 1 retinopathy of prematurity (ROP) and aggressive posterior retinopathy of prematurity (APROP). MATERIALS AND METHODS: Thirty-six eyes of 18 patients with type 1 ROP or APROP in zone I or posterior zone II were enrolled in our study. At baseline, only fluorescein angiography (FA) was performed. After IVA injection, both FA and optical coherence tomography (OCT) were performed after 6.8 ± 0.8 (range 6-8) and 19 ± 0.9 (range 18-20) weeks to follow vascular and macular changes. RESULTS: Both diffuse flat neovascularization with leakage and abnormal vascular branching at the small arteriolar level were detected in all eyes (100%) at baseline FA. Regression of the disease was observed in 34 eyes (94.4%) in the first week with binocular indirect ophthalmoscopy. Early unresponsiveness in remaining two eyes of an infant required an IVA re-treatment. Late reactivation was detected only in 19.4% of eyes, none of which required treatment during 12 months of follow-up. The most common feature after IVA injection was abnormal branching at capillary level, which was noted in 100% in the first post-injection FA and 50.0% of all eyes in the second FA. Meanwhile, the end limit of vascularization was observed in zone III in 83.3% of eyes. No vascular abnormality was also detected in 27.3% of eyes. The OCT examination at a mean postmenstrual age of 43.4 weeks revealed cystoid macular changes in four eyes of two infants (11.1%), normal foveal contour in 30 eyes of 15 infants (83.3%) and matured ellipsoid zone at the foveal center in 28 eyes of 14 infants (77.8%). Macular maturation was complete in all eyes in the last OCT analyses. CONCLUSION: Intravitreal aflibercept monotherapy has been an effective treatment in type I ROP and APROP with much lower early and late re-treatment rates because of early unresponsiveness and late reactivation, respectively. In most of the eyes, rapid vascular outgrowth beyond zone III together with normal macular maturation was observed more precisely by periodic FA and OCT.

Evaluation of the effect of percutaneous mitral balloon valvuloplasty on left ventricular systolic function via strain and strain rate in patients with isolated rheumatic mitral stenosis.

BACKGROUND AND AIM OF THE STUDY: Percutaneous balloon mitral valvuloplasty (PMBV) has an established role in the treatment of rheumatic mitral stenosis. The study aim was to evaluate the effects of PMBV on left ventricular function in patients with rheumatic mitral stenosis (MS) by using strain and strain rate imaging modalities. METHODS: The study included 30 consecutive patients (21 women, nine men; mean age 44 ± 14 years) with moderate to severe MS. Left ventricular long-axis strain and strain rate color tissue Doppler imaging of the septal, lateral, inferior and anterior basal segments were performed one day before and seven days after PMBV. RESULTS: Compared with pretreatment findings, lateral systolic strain (-13.4 ± 2.9% versus -18.4 ± 3.9%; p = 0.024), inferior systolic strain (-14.7 ± 2.3% versus -17.6 ± 2.1%; p = 0.016), anterior systolic strain (-15.2 ± 2.4% versus -17.2 ± 2.2%; p = 0.02), and septal systolic strain (-15.7 ± 1.6% versus -18.1 ± 1.9%; p = 0.018) values were significantly increased after the procedure, but no significant change was observed in strain rate analysis. CONCLUSION: A rapid improvement in strain values after PMBV in patients with isolated MS showed that the LV systolic dysfunction in isolated MS is strongly associated with impaired. hemodynamic parameters. Significantly increased strain values can be added to the criteria of successful PMBV.

Choroidal thickness changes after a single administration of coffee in healthy subjects.

PURPOSE: To investigate the changes in the subfoveal choroidal thickness measured by enhanced depth imaging optical coherence tomography after a single administration of a cup of coffee in healthy subjects. METHODS: In this prospective study, 62 healthy subjects (study group) who received a cup of 100 mL Turkish coffee (57 mg caffeine/100 mL) and 54 healthy subjects (control group) who received the same amount of water were enrolled. In the study group, the participants underwent enhanced depth imaging optical coherence tomography scanning at baseline, and at 5 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 4 hours, and 6 hours after coffee drinking. The participants of the control group simultaneously underwent enhanced depth imaging optical coherence tomography scanning. Subfoveal choroidal thickness measurements were performed on both groups at another time. RESULTS: Baseline choroidal thickness was 328 ± 79 µm in the study group and 311 ± 79 µm in the control group (P = 0.381). In the study group, choroidal thickness was significantly lower at 5 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, and 4 hours after coffee drinking when compared with the baseline measurement (P < 0.001, for all); however, there were no significant differences between the measurements at 6 hours and 24 hours after coffee drinking and the baseline measurement (P = 0.113 and P = 0.342, respectively). In the control group, no significant difference was found between each choroidal thickness measurement (P > 0.05, for all). CONCLUSION: The findings of this study revealed that drinking of a cup of coffee causes a significant decrease in choroidal thickness for at least 4 hours after coffee drinking.

Investigation of Retinal Alterations in Patients Recovered from COVID-19: A Comparative Study.

AIM: : To evaluate any abnormalities on retinal examination and retinal microvascularity in patients recovered from COVID-19. MATERIALS AND METHODS: : Cross-sectional, case- control study. Patients between 18 and 65 years old with PCR-confirmed SARS-CoV-2 infection and age matched controls were included. Macular and retinal nerve fiber layer thickness, vessel density of the superficial (SCP) and the deep retinal capillary plexus (DCP) and the foveal avascular zone (FAZ) were measured and compared with controls. RESULTS: : This study included 200 eyes of 200 cases totally. Of them 105 cases were patients and 95 cases were controls. Retinal abnormalities were detected by indirect ophthalmoscopic examination in ten patients of 105 cases (10.5%). There was no statistically significant difference in the vessel density of the SCP and the DCP and the mean FAZ measurements. CONCLUSION: : There isn't any relevant difference between early post-COVID-19 patients and general population in terms of retinal microvascularity.

Factors Influencing Stereopsis Outcomes in Adults Following Strabismus Surgery.

Objectives: The aim of the study was to evaluate binocular vision after adult strabismus surgery and to investigate the predictive factors on improvement stereoacuity. Methods: Patients aged upper from 16 years who underwent strabismus surgery in our hospital reviewed retrospectively. Age, existence of amblyopia, pre-operative and postoperatively fusion ability, stereoacuity, and deviation angle were recorded. Patients were divided into two groups according to final stereoacuity; 200 sn/arc and lower: Good stereopsis (Group 1), upper 200 sn/arc: Poor stereopsis (Group 2). Characteristics were compared between groups. Results: A total of 49 patients, who were 16-56 years of age, were included in the study. The mean follow-up time was 37.8 months (range 12-72 months). Of patients, 26 had improvement in stereopsis scores after surgery (53.0%). Group 1 includes 200 sn/arc and lower (n=18, 36.7%) and Group 2 includes higher than 200 sn/arc (n=31, 63.3%). The presence of amblyopia and higher refraction error was frequent significantly in Group 2 (p=0.01 and p=0.02, respectively). The existence of fusion postoperatively was significantly frequent in Group 1 (p=0.02). Type of strabismus and the amount of deviation angle were not found in a relationship with good stereopsis. Conclusion: In adults, surgical correction of horizontal deviation improves stereoacuity. Having no amblyopia, having fusion after surgery, and low refraction error are predictive for the improvement in stereoacuity.

The Relationship Between Coronary Collateral Circulation and Serum Adropin Levels.

Objective Coronary collateral circulation (CCC) are vascular structures that limit the infarct area, protect left ventricular function, and reduce the frequency of arrhythmia and mortality during myocardial ischemia and infarction. In this study, we examined the relationship between the development of CCC and serum adropin levels, which has been shown in previous studies to regulate endothelial functions and increase endothelial nitric oxide synthesis, in patients with acute myocardial infarction. Methods This study included 41 patients with insufficient CCC and 43 patients with well-developed CCC who were hospitalized for acute myocardial infarction and underwent coronary angiography. The Cohen-Rentrop classification was used to grade the CCC. The patients were divided into two groups according to Rentrop grades: those with a 0-1 stage were considered as insufficient and those with grades of 2-3 were considered as well-developed CCC. We took blood samples to measure the adropin levels within the first 24 hours of hospitalization. Results The mean age was 59.1±11.9 years and 62 (73.8%) were male. The right coronary artery was the most frequently target vessel (n: 51, 60.7%), and the majority of the patients presented with ST-segment elevation myocardial infarction (STEMI) (n:58, 69%). The median interval between the severe chest pain and the intervention was significantly higher in patients with well-developed CCC (p=0.042). The serum adropin levels in patients with insufficient CCC were significantly lower than in those with well-developed CCC (196.3 [131.5 - 837.0] pg/mL vs. 235.5 [171.9 - 1124.2] pg/mL, p<0.001). Logistic regression analysis revealed that the circumflex artery as the target vessel, NSTEMI (non-STEMI) as the type of myocardial infarction, and serum adropin level were the independent risk factors for the prediction of poor coronary collateral vessel formation (p<0.05). Conclusions In this study, we found that in patients with acute myocardial infarction, those with well-developed CCC had higher adropin levels.

Well-Developed Coronary Collateral Circulation Is Associated With Higher Thrombus Burden in the Setting of ST-Segment Elevation Myocardial Infarction.

BACKGROUND: This study investigated the relationship between coronary collateral circulation (CCC) and intracoronary thrombus burden in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI). CCC and thrombus burden are predictive of clinical outcomes in patients with STEMI. METHODS: Patients with STEMI undergoing primary percutaneous coronary intervention were enrolled (n = 172). CCC was graded according to the Cohen-Rentrop classification. Patients were classified as insufficient (grade 0 or 1, n = 134) or well-developed (grade 2 or 3; n = 38) CCC. The Thrombolysis in Myocardial Infarction scale was used to evaluate intra-coronary thrombus burden. The low-thrombus-burden group comprised those with grades 0 to 2, and the high-thrombus-burden group comprised those with grades 3 or 4. RESULTS: Right coronary artery infarcts had a 13.830-fold higher chance of having well-developed CCC than did left anterior descending artery infarcts (P < .001). Circumflex artery infarcts had a 7.904-fold higher chance of well-developed CCC than did left anterior descending artery infarcts (P = .016). High thrombus burden was associated with a 4.393-fold higher chance for well-developed CCC than was low thrombus burden (P = .030). Low albumin levels were related to a greater chance of having well-developed CCC (P = .046). CONCLUSION: Patients with well-developed CCC have higher thrombus burden than do those with insufficient CCC. Because well-developed CCC is an indicator of more severe underlying lesions, we speculate that patients with severe lesions are more prone to experience more complicated STEMI with high thrombus burden.

Comparison of Fluorescein Angiography Findings in Stage 3 Retinopathy of Prematurity in Zone II Treated With or Without Anti-VEGF.

PURPOSE: To define late-stage fluorescein angiography (FA) findings in patients who received anti-vascular endothelial growth factor (VEGF) agents (intravitreal bevacizumab or aflibercept) as a treatment for stage 3 retinopathy of prematurity (ROP) in zone II. We also compared the findings of untreated eyes. METHOD: Infants with a history of ROP who underwent fluorescein angiography were evaluated retrospectively. The patients were divided into 2 groups: those who received anti-VEGF treatment and those who regressed spontaneously without treatment. Vascular abnormalities, such as vascular leakage, shunts at the vascular-avascular junction, periarteriolar areas with hypoperfusion, fine branching and blunt termination of the vessels and, were recorded. RESULTS: Angiography evaluations revealed leakage in the eyes of 27.69% of the infants in the anti-VEGF-treated group and in 21.7% of the untreated group (p = .638). Among the abnormal vascular findings in the peripheral retina, the ratios of fine branching and blunt termination, numbers of shunts along the vascular-avascular junction, and sizes of periarteriolar areas of hypoperfusion were significantly larger in the untreated group than in the treated group (p < .05; p < .01). The gestational ages and birth weights were significantly lower (p ≤ .05) in infants with vascular findings in both groups. CONCLUSION: Vascular abnormalities in the peripheral retina are likely due to the ROP itself. Although these abnormalities were detected by FA imaging in both treated and untreated infants with ROP, they were significantly less frequent in patients treated with anti-VEGF, indicating that anti-VEGF treatments have a partially positive effect on the retinal vascularization process.

A New Marker for Determining Cardiovascular Risk: Salusin Alpha.

Background and objective Prevention of atherosclerotic cardiovascular diseases (ASCVD) is possible with early recognition of individuals at risk. Salusin alpha is an endogenous bioactive peptide with anti-atherogenic properties. We aimed to reveal the relationship between salusin alpha levels and cardiovascular (CV) risk using the Systematic COronary Risk Estimation 2 (SCORE2) and Pooled Cohort Equation (PCE) algorithms. Methods A total of 137 asymptomatic outpatients were included in the study. The participants were divided into four quartile groups according to the distribution of salusin alpha levels: Q1 (n = 34), Q2 (n = 35), Q3 (n = 34), and Q4 (n = 34). The relationships of salusin alpha with cardiovascular risk scores and groups were investigated. Results The means of SCORE2 and PCE risk scores (11.24 ± 1.24 and 13.30 ± 1.71, respectively; p < 0.001 for both), baseline scores in the presence of SCORE2 and PCE optimal risk factors (4.82 ± 0.71 (p = 0.034); 4.20 ± 0.77 (p = 0.010)), and means of Δ SCORE2 and Δ PCE risk score (6.41 ± 0.67 and 9.10 ± 1.10, respectively; p < 0.001 for both) were significantly higher in the Q1 group. The SCORE2 "very high" cardiovascular (CV) risk group was significantly represented in the Q1 group (n = 17 (50%)), while the "low-moderate" risk group was more heavily represented in the Q4 group (n = 15 (44.1%)) (p < 0.001). The PCE "high" CV risk group was significantly represented in the Q1 group (n = 9 (26.5%)), while the "low" risk group was more intensely represented in the Q4 group (n = 20 (58.8%)) (p < 0.001). Salusin alpha had a significantly negative moderate correlation with SCORE2 and PCE risk scores. As a result of receiver operating characteristic (ROC) analysis, it was found that salusin alpha had significant diagnostic power in the prediction of CV risk groups determined by SCORE2 and PCE risk scores. Salusin alpha was observed to be a risk-reducing factor in SCORE2 and PCE CV risk groups (odds ratio (OR) (95% confidence interval (CI)): 0.989 (0.982-0.997) (p = 0.002) and OR (95% CI): 0.988 (0.978-0.998) (p = 0.009) respectively). Conclusion Salusin alpha has a negative correlation with SCORE2 and PCE risk scores. It has significant diagnostic power in the prediction of CV risk groups and is an independent variable that has a risk-reducing effect in the distribution of risk groups.

The relationship between vitamin B12 levels and electrocardiographic ventricular repolarization markers.

Introduction: Background: it has been shown that vitamin B12 deficiency, which can cause hematological and neuropsychiatric disorders, may also be associated with cardiac autonomic dysfunction, heart rate variability, endothelial dysfunction, and a decrease in myocardial deformation. Aims: the aim of our study is to evaluate the relationship between vitamin B12 levels and electrocardiographic repolarization disorders, which are indicators of arrhythmogenic predisposition in healthy individuals. Methods: our study population consisted of 214 healthy adults. Considering the distribution of vitamin B12 levels and accepting 25 % and 75 % percentiles as the cut-off values, the participants were divided into 3 groups. Laboratory, echocardiography and electrocardiography (ECG) measurements were compared between three groups. ECG measurements were performed manually and Tpeak-Tend (Tp-e), Tp-e corrected (Tp-ec), QT and QT corrected (QTc) intervals were calculated. Results: the patients in Group 1 (vitamin B12 < 253 pg/ml) were found to have significantly higher QT and QTc dispersions, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios when compared to those in Group 2 (253 pg/ml < vitamin B12 > 436 pg/ml) and Group 3 (vitamin B12 > 436 pg/ml). On the other hand, a negative significant correlation was detected between vitamin B12 levels and Tp-e, Tp-e/QT, Tp-e/QTc ratios, QT and QTc dispersions. Conclusion: a low level of vitamin B12 in healthy individuals can be a significant indicator of arrhythmogenic susceptibility. A close follow-up of these subjects in terms of arrhythmogenic predisposition can be useful.

Introducción: Fundamento: se ha demostrado que la deficiencia de vitamina B12, que puede causar trastornos hematológicos y neuropsiquiátricos, también puede estar asociada con disfunción autonómica cardíaca, variabilidad de la frecuencia cardíaca, disfunción endotelial y disminución de la deformación miocárdica. Objetivos: el objetivo de nuestro estudio es evaluar la relación entre los niveles de vitamina B12 y los trastornos de repolarización electrocardiográfica que son indicadores de predisposición arritmogénica en individuos sanos. Métodos: la población del estudio fue de 214 adultos sanos. Considerando la distribución de los niveles de vitamina B12 y aceptando los percentiles del 25 % y 75 % como valores de corte, los participantes se dividieron en 3 grupos. Se compararon las mediciones de laboratorio, ecocardiografía y electrocardiografía (ECG) entre tres grupos. Las mediciones del ECG se realizaron manualmente y se calcularon los intervalos Tpeak-Tend (Tp-e), Tp-e corregido (Tp-ec), QT y QT corregido (QTc). Resultados: se encontró que los pacientes del grupo 1 (vitamina B12 < 253 pg/ml) tenían dispersiones QT y QTc, intervalo Tp-e, cocientes Tp-e/QT y Tp-e/QTc significativamente más altos cuando se compararon con los del grupo 2 (253 pg/ml < vitamina B12 > 436 pg/ml) y el grupo 3 (vitamina B12 > 436 pg/ml). Por otro lado, se detectó una correlación significativa negativa entre los niveles de vitamina B12 y las relaciones Tp-e, Tp-e/QT, Tp-e/QTc, dispersiones QT y QTc. Conclusión: el bajo nivel de vitamina B12 en los individuos sanos puede ser un indicador significativo de susceptibilidad arritmogénica. Un seguimiento estrecho de estos sujetos en términos de predisposición arritmogénica podría ser útil.

Clinical evaluation of torpedo maculopathy in an infant population with additional genetic testing for NEXMIF mutation.

PURPOSE: To assess clinical characteristics of torpedo maculopathy (TM) lesions in an infant population with age ≤1.5 years and to investigate the role of NEXMIF mutation in the development of TM. METHODS: Retrospective analysis of medical records of 17 consecutive infants with the diagnosis of TM between 2016 January and 2019 December were done. Fundus images and a hand-held spectral-domain optical coherence tomography (Envisu 2300, Bioptigen, Morrisville, NC, USA) were used to identify clinical characteristics of TM lesions. Additional molecular testing for mutation screening for NEXMIF gene was also carried out. RESULTS: Totally 55334 infants were screened during the study period and 17 (0.03%) were identified as having TM. The mean age at the time of diagnosis was 3.94±5.08 months. All TM lesions showed variable degrees of hypopigmentation. Satellite lesion in one infant was nasally located to the main TM lesion. Absence, disruption, loss, degeneration and/or irregularity of the ellipsoid zone were common findings on OCT examination. No pathogenic or likely pathogenic variant of NEXMIF gene was detected. CONCLUSION: Fundoscopic appearance and OCT findings of lesions show similarities to those already reported previously. Contrary to popular belief, a nasally located satellite lesion was observed in one of our case.

Serum vascular endothelial growth factor, insulin-like growth factor-1 and aflibercept levels in retinopathy of prematurity.

PURPOSE: To evaluate the serum levels of vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1) after intravitreal injection of aflibercept (IVA) and the transition of aflibercept into systemic circulation in infants with severe retinopathy of prematurity (ROP). STUDY DESIGN: Prospective study. METHODS: This single-centered prospective cohort study included infants who received IVA for the treatment of type 1 ROP in zone I and posterior zone II. Blood samples were collected before IVA and at 1 day and 1, 2, 4, and 8 weeks after IVA. VEGF, IGF-1 and aflibercept levels were measured. RESULTS: Thirty eyes of 15 infants received IVA of 1 mg/0.025 mL. Serum VEGF levels decreased significantly at 1 day and 1, 2, 4, and 8 weeks after IVA compared with baseline (P < 0.05). Serum aflibercept levels decreased significantly 1, 2, 4, and 8 weeks after IVA compared with the level at 1 day after IVA (P < 0.05) and increased significantly at 1 day, 1, 2, and 4 weeks after IVA compared with the baseline level (P < 0.05). No significant difference was detected between serum IGF-1 levels any time in any infant (P > 0.05). CONCLUSION: Serum VEGF levels are suppressed for at least 8 weeks, and aflibercept could be detected in the systemic circulation at 4 weeks after injection. Clinicians should be cautious about changes in systemic VEGF levels and passage of the agent into systemic circulation after IVA in infants.