Index of cardiac-electrophysiological balance in relapsing-remitting multiple sclerosis patients treated with fingolimod.

BACKGROUND: Fingolimod is indicated for the treatment of relapsing-remitting multiple sclerosis (RRMS) and also targets cardiovascular system due to receptors on cardiomyocytes. Results of previous studies are controversial for the effect of fingolimod in terms of ventricular arrhythmias. Index of cardio-electrophysiological balance (iCEB) is a risk marker for predicting malignant ventricular arrhythmia. There is no evidence on the effect of fingolimod on iCEB in patients with relapsing-remitting multiple sclerosis (RRMS). The aim of this study was to evaluate iCEB in patients with RRMS treated with fingolimod . METHODS: A total of 86 patients with RRMS treated with fingolimod were included in the study. All patients underwent a standard 12-lead surface electrocardiogram at initiation of treatment and 6 h after treatment. Heart rate, RR interval, QRS duration, QT, QTc (heart rate corrected QT), T wave peak-to-end (Tp-e) interval, Tp-e/QT, Tp-e/QTc, iCEB (QT/QRS) and iCEBc (QTc/QRS) ratios were calculated from the electrocardiogram. QT correction for heart rate was performed using both the Bazett and Fridericia formulas. Pre-treatment and post-treatment values were compared. RESULTS: Heart rate was significantly lower after fingolimod treatment (p< 0.001). While the post-treatment values of RR and QT intervals were significantly longer (p< 0.001) and post-treatment iCEB was higher (median [Q1-Q3], 4.23 [3.95-4.50] vs 4.53 [4.18-5.14]; p< 0.001), it was found that there was no statistically significant change in iCEB and other study parameters derived using QT after correcting for heart rate using both of two formulas. CONCLUSIONS: In this study, it was found that fingolimod did not statistically significantly change any of the heart rate-corrected ventricular repolarization parameters, including iCEBc, and it is safe in terms of ventricular arrhythmia.

Ventricular repolarization indexes in patients treated with hydroxychloroquine - azithromycin combination for COVID-19.

BACKGROUND: Combination of hydroxychloroquine and azithromycin for the treatment of coronavirus disease 2019 (COVID-19) carries increased risk of corrected QT (QTc) prolongation and cardiac arrhythmias. OBJECTIVE:  To characterize the ventricular repolarization indexes which are associated with malignant ventricular arrhythmias in patients treated with hydroxychloroquine and concomitant azithromycin for COVID-19. METHOD: A total of 81 patients who had hydroxychloroquine and azithromycin combination therapy because of possible or  reverse-transcription polymertase chain reaction (RT-PCR) confirmed diagnosis of COVID-19 were included in the study. Baseline and control electrocardiograms (before and after treatment) were analyzed retrospectively. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios, which are ventricular repolarization indexes, were calculated. RESULTS: While there was no significant increase in QTc interval in patients receiving combination therapy, there was a significant increase in ventricular repolarization indexes. CONCLUSION: The increase in ventricular replarization indexes is associated with the risk of arrhythmia. In patients using QTc prolonging medication for COVID-19 treatment, QTc monitoring alone may not be sufficient to follow-up for arrhythmia. Even if there is no prolongation in QTc, an increase in ventricular repolarization indexes may be seen (Tab. 5, Ref. 37).

Relationship between the interleukin-6-174 gene and mannose-binding lectin codon 54 gene polymorphisms and condyloma acuminatum.

BACKGROUND: Several genes encoding different Th1 and Th2 cytokines may play crucial roles in host susceptibility to Condyloma acuminatum (CA). Mannose-binding lectin (MBL) is a serum lectin that mediates complement activation, and it is a member of innate immune system. MBL gene polymorphisms are considered to be associated with several infectious diseases. OBJECTIVE: In this study, we investigated the association between cytokines and MBL gene polymorphisms with CA. METHODS: Forty patients with CA and 40 healthy controls were enrolled in this study. These patients had not responded to at least a therapy modality and all patients had recurrent lesions. Polymorphism of cytokine [Th1 cytokines; tumour necrosis factor-α and interferon (IFN)-γ, Th2 cytokine; IL-6, T regulatory/suppressor cytokines; IL-10 and transforming growth factor-ß] genes studies were performed by Polymerase chain reaction sequence-specific primers method and MBL genotyping were studied by PCR-restriction fragment length polymorphism method. RESULTS: With the aid of agglomerative hierarchical cluster analysis, we categorized subjects into two main clusters (cluster 1; formed by the majority of patients with CA, cluster 2; formed by the majority of healthy controls), which were found to have significantly different distributions of IL-6 and MBL genotypes. Frequencies of IL-6 (-174) G/G (P < 0.001) and MBL AA (P < 0.001) polymorphisms were significantly greater in the cluster 1. In contrast, significantly lower frequencies of the IL-6 G/C (P = 0.046) genotype and MBL AB (P < 0.001) genotype were observed in cluster 1. CONCLUSION: These results suggest that the IL-6 G/G and MBL AA gene polymorphisms are potential risk factors and that the IL-6 G/C and MBL AB polymorphisms are a protective factor for occurrence and recurrence of CA.

Preoperative parathyroid hormone levels are correlated with parathyroid adenoma volume and bone mineral density but not serum calcium levels.

AIM: The aim of this study was to determine the relationship between biochemical parameters, parathyroid adenoma volume, and bone mineral density with respect to intact parathyroid hormone (iPTH) levels in patients with primary hyperparathyroidism. METHODS: Data were collected retrospectively from patients with primary hyperparathyroidism who were diagnosed and followed in our clinic between 2005 and 2008. Forty-eight (female/male=42/6) patients with a mean age of 52.8±13.1 years were enrolled into the study. RESULTS: Bone pain was the most common presenting feature, seen in 41.7% of patients, while 29.1% of patients were asymptomatic. The mean serum calcium and iPTH concentrations were 2.9±0.6 mmol/L and 657.1±682 ng/L, respectively. The mean total Z/T scores of dual-energy X-ray absorptiometry (DEXA) scan at the femur and lumbar spine were -0.4±1.6/-1.0±1.7 and -1.4±1.6/-2.2±1.5, respectively. Preoperative iPTH levels were correlated with serum phosphate (r=-0.412, P=0.005), alkaline phosphatase (r=0.698, P=0.0001), and femur (r=-0.402, P=0.020) and lumbar spine total Z scores (r=-0.441, P=0.013), whereas parathyroid adenoma volume was correlated with iPTH (r=0.367, P=0.036) and alkaline phosphatase (r=0.570, P=0.001). There was no correlation between iPTH, serum calcium levels and total T scores at the femur and lumbar spine. After excluding patients with 25-OHD insufficiency, there was still no correlation between serum iPTH and calcium levels. Parathyroid adenoma volume, serum iPTH and calcium levels were also not different between patients with and without 25-OHD insufficiency. CONCLUSION: These results suggest that serum iPTH level may be useful in predicting parathyroid adenoma volume and it is also well correlated with femur and lumbar spine Z scores.

Subcutaneous closed-suction drainage does not affect surgical site infection rate following elective abdominal operations: a prospective randomized clinical trial.

PURPOSE: To evaluate whether subcutaneous closed-suction drainage (SCSD) would decrease the SSI rate in elective abdominal operations. METHODS: Participants were randomly assigned to have subcutaneous drains or not following elective abdominal surgery. The fascia and incision closure technique and antimicrobial prophylaxis were standardised. In the drain cohort, SCSD was applied after fascia closure. The drain was removed on postoperative day three. Patient characteristics, body mass index (BMI) and the depth of subcutaneous fatty tissue (SCFT) were noted. The incisional SSI rates were analysed. RESULTS: There were 210 patients in the drain group and 192 in the no-drain group. There was no significant difference between groups in terms of demographics, BMI or SCFTs. The overall SSI rate was 7.7% and was 5.7% in the drain group and 9.9% in the no-drain group (p = 0.116). Neither BMI nor subcutaneous skin depth affected the SSI rate. However, subgroup analysis revealed that the SSI rate was lower in patients with drains who had undergone resection of colorectal malignancies or had lower abdominal incisions (p< 0.03). CONCLUSIONS: The overall incisional SSI rate was comparable between the drain and no-drain groups. However, subcutaneous closed-suction drainage was not found effective in preventing SSI in our study except in a subgroup of patients with colorectal malignancies and lower abdominal incisions.

Association between hepatitis B and hepatocellular carcinoma recurrence in patients undergoing liver transplantation.

BACKGROUND/AIMS: Hepatitis B virus (HBV) and hepatocellular carcinoma (HCC) recurrences affect both patient and graft survivals post-orthotopic liver transplantation (OLT) in HBV patients with HCC. We analyzed the relationship between HBV and HCC recurrence in a large cohort of HBV-OLT patients with versus without HCC. METHODS: Two hundred eighty-seven HBV patients with OLT (72 also with HCC) were included in the study. Mean follow-up in the post-OLT period was 31.7 +/- 24.7 (range, 3-119) months. RESULTS: Post-OLT HBV recurrence observed in 10.1% of patients was more prevalent among the HCC group; 23.6% versus 5.5% in patients with and without HCC, respectively. The mean interval for the development of HBV recurrence was 39.5 +/- 28.5 (range, 2-99) months. Among 72 HCC patients, 8 patients (11.1%) had recurrent HCC, and 7 of them also had HBV recurrence. The mean interval for the development of HCC recurrence was 11.2 +/- 7.85 (range, 2-23) months after OLT. OLT patients with HCC with tumors exceeding the Milan criteria had worse 1-, 3-, and 5-year survival rates than patients with HCC meeting the Milan criteria. HBV and HCC recurrence-free survivals were significantly lower in patients with HCC and HBV recurrence, respectively. In the 7 patients with both HCC and HBV recurrence, mean HBV recurrence time was 9.42 +/- 6.75 months and mean HCC recurrence time was 9.57 +/- 6.75 months. There was a strong correlation between HBV and HCC recurrence times. Cox proportional hazards regression analysis showed that only HCC recurrence was a significant independent predictor of HBV recurrence (P < .001; hazard ratio [HR] = 26.94; 95% confidence interval [CI] = 10.81-67.11). On the other hand, HBV recurrence (P = .013; HR = 5.80; 95% CI = 1.45-23.17) and nodule count (P = .014; HR = 13.08; 95% CI = 1.70-100.83) were significant predictors of HCC recurrence. CONCLUSIONS: HBV and HCC recurrences demonstrate a close relationship in patients with OLT.

The effect of distance on the postoperative follow-up of patients with breast carcinoma.

PURPOSE: To assess the effect of in or out of city residence of patients with breast carcinoma, where breast surgery unit treatment and follow-up is made postoperatively. METHOD: 234 patients operated on for breast carcinoma at the Breast Surgery Unit were retrospectively studied. Patients were divided into two groups; patients living in the major city where the Breast Surgery Centre is located and patients living in smaller cities, districts, towns and villages out of the city. The distance of patients' residences from the Breast Centre has also been determined in kilometres. The number of patients and the frequency of check-up visits were compared in both groups. RESULTS: The number of patients residing in the city centre where the Breast Unit is located was 156 (66.7%). Comparing the frequency of patients' visits for check-up during the postoperative period, there were no differences between the two groups during the first four years. However, the patients living out of the city did not visit the Breast Unit for check-ups during the fifth postoperative year. Moreover, when the patients were classified into two groups with known and unknown outcomes, it was observed that those patients with unknown outcomes lived further away from the city where the Breast Surgery Unit was located compared to those with known outcomes (p = 0.002). DISCUSSION: Living within or out of the major city centre where the Breast Surgery Unit is located does not have any effect on the frequency of follow-up visits or the number of patients applying for check ups during the first four years postoperatively. However, there were gradual decreases over the course of time in both groups and these differences became apparent during the 5th year. In addition to this, the distance was also found to be an important factor for patients with unknown outcomes in the present study. The combination of living outside the city where The Breast Unit was located and the distance may have a negative effect on follow-ups. There is a need for new, larger scale, studies with longer follow-ups to show how this difference will change over a longer time period.