Association of Preoperative Platelet-to-Lymphocyte Ratio with Atrial Fibrillation after Coronary Artery Bypass Graft Surgery.

OBJECTIVE: The aim of this study was to investigate the association between platelet-to-lymphocyte ratio (PLR) and atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery. SUBJECTS AND METHODS: A total of 125 patients were retrospectively analyzed. AF was diagnosed using standard clinical criteria, and PLR was calculated as the ratio of the platelets to lymphocytes, obtained from the blood samples that were taken in the fasting state before CABG surgery. The association of different variables with postoperative AF and PLR was calculated using univariate and multivariate analysis. The receiver operating characteristics curve was used to determine the sensitivity and specificity of PLR and the optimal cutoff value for predicting post-CABG AF. RESULTS: Of the 125 patients, 50 with AF (mean age: 67.0 ± 9.5 years, 38 males and 12 females) and 75 patients without AF (mean age: 61.1 ± 9.1 years, 58 males and 17 females) were identified, and the difference in the mean age was statistically significant (p = 0.01). PLR was also significantly higher in those with AF (152.8 ± 82.2) than those without AF (118.2 ± 32.9) (p = 0.012). Univariate analysis showed that age and PLR were associated with AF after CABG surgery (p < 0.001 and p = 0.005, respectively). Using a multivariate logistic regression model with the backward elimination method, age and PLR remained as independent predictors of AF after CABG surgery (p < 0.001 and p = 0.005, respectively). PLR levels >119.3 predicted postoperative AF with 64% sensitivity and 56% specificity (AUC: 0.634, p = 0.012). CONCLUSION: In this study, age and PLR level were independent predictors of AF after CABG surgery. Patients with an elevated preoperative PLR were at higher risk of AF after CABG surgery.

Relationship of anxiety and burnout with extrasystoles in critical care nurses in Turkey.

OBJECTIVE: To determine the relationship between levels of anxiety and burnout and prevalence of atrial extrasystoles (AESs) and ventricular extrasystoles (VESs) among critical care nurses. METHODS: The sample of study included 51 nurses who worked in the intensive care units of a university hospital located in western Turkey. Beck's Anxiety Inventory and the Maslach Burnout Inventory were used in the study. RESULTS: The mean emotional exhaustion score of the nurses was 14.68±6.10, the mean personal accomplishment score was 19.19±7.08, the mean depersonalization score was 5.31±3.84 and the mean anxiety score was 12.37±11.12. The rates of VESs and AESs detected in the critical care nurses were 21.6% and 35.3%, respectively. No relationship was found between levels of anxiety and burnout and the prevalence of AESs and VESs among the critical care nurses. A positive correlation was found between personal accomplishment scores and numbers of VESs (r= 0.693, p=0.001) and AESs (r= 0.700, p= 0.001). CONCLUSION: In the present study, there were low mean scores of burnout and anxiety among nurses working in intensive care units. No relationship was found between levels of anxiety and burnout and the prevalence of AESs and VESs among nurses who work in intensive care units. It was found that the people feeling more personal accomplishment have more VES or AES. The prevalence of AESs and VESs among the critical care nurses suffering from burnout and anxiety may be studied in the future studies.

Predictive value of platelet-to-lymphocyte ratio in severe degenerative aortic valve stenosis.

BACKGROUND: Aortic valve stenosis (AVS) is the most common cause of left ventricular outflow obstruction, and its prevalence among elderly patients causes a major public health burden. Recently, platelet-to-lymphocyte ratio (PLR) has been recognized as a novel prognostic biomarker that offers information about both aggregation and inflammation pathways. Since PLR indicates inflammation, we hypothesized that PLR may be associated with the severity of AVS due to chronic inflammation pathways that cause stiffness and calcification of the aortic valve. MATERIALS AND METHODS: We retrospectively enrolled 117 patients with severe degenerative AVS, who underwent aortic valve replacement and 117 control patients in our clinic. PLR was defined as the absolute platelet count divided by the absolute lymphocyte count. Severe AVS was defined as calcification and sclerosis of the valve with a mean pressure gradient of >40 mmHg. RESULTS: PLR was 197.03 ± 49.61 in the AVS group and 144.9 ± 40.35 in the control group, which indicated a statistically significant difference (P < 0.001). A receiver operating characteristic (ROC) curve analysis demonstrated that PLR values over 188 predicted the severity of aortic stenosis with a sensitivity of 87% and a specificity of 70% (95% confidence interval = 0.734-0.882; P < 0.001; area under ROC curve: 0.808). CONCLUSION: We suggest that the level of PLR elevation is related to the severity of degenerative AVS, and PLR should be used to monitor patients' inflammatory responses and the efficacy of treatment, which will lead us to more closely monitor this high-risk population to detect severe degenerative AVS at an early stage.

Ozone preconditioning attenuates contrast-induced nephropathy in rats.

BACKGROUND: Contrast-induced nephropathy (CIN) is an important complication of vascular interventions. Ozone therapy can induce tolerance to ischemic insults, a phenomenon known as ozone oxidative preconditioning (OOP). The aim of this study was to investigate the effects of OOP on CIN. MATERIALS AND METHODS: Thirty-two Wistar rats were randomized into four groups (n = 8). The control group had intravenous saline injection. The contrast media (CM) group had intravenous meglumine/sodium diatrizoate injection to form CIN. The ozone (O3) group received intraperitoneal ozone for 5 d before the induction of CIN. The oxygen (O2) group was given an equal amount of oxygen for 5 d before the induction of CIN. The animals were sacrificed 48 h after the administration of contrast agent or saline. Kidneys were harvested, and blood samples were obtained. Renal function tests, serum and renal tissue malondialdehyde (MDA), and nitric oxide (NO) levels and renal oxidant system parameters were determined. Histologic examination was performed for renal injury. RESULTS: Serum blood urea nitrogen (BUN), creatinine, and serum and renal MDA were increased after contrast exposure. Renal NO was decreased, and there was prominent tubular necrosis in the CM group. Serum BUN, creatinine, serum and renal MDA, and grade of tubular necrosis were decreased in the O3 group as compared with those in the CM group. The levels of serum and renal NO and renal total antioxidant system in O3 group were higher than the levels in the CM group. CONCLUSIONS: OOP attenuates experimental CIN. This effect is suggested to be mediated by reinforcement of renal antioxidant defenses and maintenance of renal NO levels.

Predictors of early death in patients with acute pulmonary embolism.

AIM: We aimed to determine the predictors of early death in the course of acute pulmonary embolism (APE). MATERIALS AND METHODS: We included 206 patients who had been admitted to our hospital between January 2011 and April 2013 with the diagnosis of APE. We derived a new model including corrected QT interval dispersion (QTcd) and P wave dispersion (Pd), echocardiographic findings, laboratory markers, and blood cell count indices to predict early death in patients with APE. RESULTS: Thirty patients (14.5%) died; 176 patients (85.5%) lived after diagnosis of APE. Logistic regression (LR) analysis found that troponin I (odds ratio [OR], 1.084 [95% confidence interval {CI}, 1.009-1.165]), creatinine (OR, 4.153 [95% CI, 1.375-12.541]), mean platelet volume (OR, 1.991 [95% CI, 1.230-3.223]), neutrophil to lymphocyte ratio (NLR) (OR, 1.079 [95% CI, 1.005-1.160]), QTcd (OR, 1.084 [95% CI, 1.043-1.127]), Pd (OR, 1.049 [95% CI, 1.004-1.096]) were associated with early death in APE. New LR model (area under the curve [AUC], 0.970) performed better than the simplified pulmonary embolism severity index (sPESI) score (AUC, 0.859) in predicting early death in APE (P=.021). The predictivity of the sPESI score significantly improved after its single combination with creatinine, QTcd, or troponin I. When the combined model was constructed together with these 6 independent variables and sPESI score, stepwise LR model automatically excluded Pd and NLR, and the AUC from the rest of the combined model was 0.976, which is significantly different from the AUC of sPESI (0.859) (P=.0031). CONCLUSIONS: Creatinine, troponin I, and QTcd significantly improves sPESI score. A new model with troponin I, creatinine, mean platelet volume, NLR, QTcd, and Pd seems to have greater prognostic power than the sPESI scoring system.

The usefulness of carvedilol and nebivolol in preventing contrast nephropathy in rats.

BACKGROUND: Oxidative stress and vasoconstriction appear to be important components of contrast nephropathy (CN) pathogenesis, and both carvedilol and nebivolol are known to have vasodilatory and antioxidant effects. AIMS: This study aimed to investigate whether carvedilol and nebivolol play preventive roles against developing CN and to compare the effects of each. MATERIALS AND METHODS: Wistar albino rats were divided into control (C, n = 6), contrast material (CM, n = 6), carvedilol (CV, n = 7), carvedilol + contrast material (CV + CM, n = 7), nebivolol (N, n = 7), and nebivolol + contrast (N + CM, n = 7) groups. Following 3 days of dehydration, 6 mL/kg diatrizoate was administered to each rat. Carvedilol was given at a dose of 2 mg/kg and nebivolol at a dose of 1 mg/kg by way of oral gavage. After scarification, total antioxidant capacity (TAC), malondialdehyde (MDA), and superoxide dismutase (SOD) were studied in renal tissue. Histopathological findings were graded as mild (+), moderate (++), and severe (+++). RESULTS AND DISCUSSION: Most of the histopathological findings and MDA levels were significantly higher in the CM group than that in the C, CVCM, and NVCM groups, whereas there was no significant difference between the C, CVCM and NVCM groups. TAC level in the CM group was significantly lower than in all other groups. There was no difference in SOD among groups. CONCLUSIONS: Carvedilol and nebivolol both prevent development of nephropathy related to CMs by decreasing oxidative stress. Neither is superior to the other.

The relation between compliance to the Mediterranean diet and the extensiveness of coronary artery disease.

OBJECTIVE: There are various studies showing the cardiovascular benefits of the Mediterranean diet (MD), but, to the best of our knowledge, this is the first study which aimed to investigate the relation between adherence to the MD and severity of coronary artery disease (CAD). METHODS: The study was a single centre, cross-sectional prospective study which included 200 consecutive patients (131 men [65.5%] and 69 women [34.5%], mean age 57±9) who were diagnosed with CAD by coronary angiography between January 2012 and April 2013. A food frequency questionnaire was administered to the patients. Compliance to the MD was evaluated by the MD score (MDS), which collects prominent diet characteristics under 10 main titles. Each patient's angiographic data was examined by a cardiologist, and Gensini scores (GS) were then calculated to evaluate the extensiveness of coronary atherosclerosis. RESULTS: Forty-four percent of patients were in the third category of body mass index (BMI) (≥30 kg/m2) and 17.5% were in the first category (BMI<25 kg/m2). Education levels were markedly low, with 78% of the patients having fewer than six years in education. Most patients had low physical activity levels (55.5%). Frequency of metabolic syndrome was prominent (79%). The median (25-75 percentiles) of GS was found to be 21.25 (7-44.75) and the MD score was 4 (3-5). A negative correlation was found between compliance to the MD and GS (r=-0.380, p<0.001). CONCLUSION: This study found that in patients with CAD, compliance with the traditional MD is related to decreased severity of coronary atherosclerosis.

Lymphocytopenia is associated with poor NYHA functional class in chronic heart failure patients with reduced ejection fraction.

OBJECTIVE: In heart failure (HF) patients, functional capacity has been demonstrated to be a marker of poor prognosis, independent of left ventricular ejection fraction (EF). Lymphocyte count is currently recognized in certain risk stratification scores for chronic HF, and severe HF is associated with lymphocytopenia. However, no data exists on the association between lymphocyte count and functional capacity in patients with stable HF. This study aimed to assess the relationship between lymphocyte count and New York Heart Association (NYHA) functional capacity in systolic HF outpatients. METHODS: The Turkish Research Team-HF (TREAT-HF) is a network which undertakes multi-center observational studies in HF. Data on 392 HF reduced ejection fraction (HFREF) patients from 8 HF centers are presented here. The patients were divided into two groups and compared: Group 1 comprised stable HFREF patients with mild symptoms (NYHA Class I-II), while Group 2 consisted of patients with NYHA Class III-IV symptoms. RESULTS: Patient mean age was 60±14 years. Lymphocyte count was lower in patients with NYHA functional classes III and IV than in patients with NYHA functional classes I and II, (0.9 [0.6-1.5]x1000 versus 1.5 [0.7-2.2]x1000, p<0.001). In multivariate logistic regression analysis, lymphocyte count (OR: 0.602, 95% CI: 0.375-0.967, p=0.036), advanced age, male gender, presence of hypertension, EF, left atrium size, systolic pulmonary artery pressure, neutrophil and basophil counts, creatinine level, and diuretic usage were associated with poor NYHA functional class in systolic HF outpatients. CONCLUSION: The present study demonstrated that in stable HFREF outpatients, lymphocytopenia was strongly associated with poor NYHA function, independent of coronary heart disease risk factors.

An epidemiological study to evaluate the use of vitamin K antagonists and new oral anticoagulants among non-valvular atrial fibrillation patients in Turkey- AFTER-2 study design.

OBJECTIVES: Atrial fibrillation (AF) is one of the most common causes of preventable ischemic stroke and is related to increased cardiovascular morbidity and mortality. There is a lack of data in Turkey on the use of new oral anticoagulants (NOACs), and time in therapeutic INR range (TTR) in vitamin K antagonist users and AF management modality. In this multi-center trial, we aimed to analyze, follow and evaluate the epidemiological data in non-valvular AF patients. STUDY DESIGN: Four thousand one hundred consecutive adult patients from 42 centers with at least one AF attack identified on electrocardiography will be included in the study. Patients with rheumatic mitral valve stenosis and prosthetic valve disease will be excluded from the study. At the end of one year, the patients will be evaluated in terms of major cardiac end points (death, transient ischemic attack, stroke, systemic thromboembolism, major bleeding and hospitalization). RESULTS: First results are expected in June 2015. Data about major cardiovascular end-points will be available in January 2016. CONCLUSION: The rates and kind of oral anticoagulant use, TTR in vitamin K antagonist users and main management modality applied in non-valvular AF patients will be determined by AFTER-2 study. In addition, the rate of major adverse events (MACEs) and the independent predictors of these MACEs will be detected (AFTER-2 Study ClinicalTrials.gov number, NCT02354456.).

Investigation of the effect of different polishing techniques on the surface roughness of denture base and repair materials.

STATEMENT OF PROBLEM: The rough surface of denture base materials may cause plaque accumulation and staining. Thus, the effectiveness of polishing techniques should be known. PURPOSE: The purpose of this study was to compare the effects of chairside polishing kits and conventional laboratory techniques on the surface roughness of denture base and repair materials. MATERIAL AND METHODS: Ninety-six specimens, 50 ±1 mm in diameter and 0.5 ±0.05 thick, were fabricated from heat-polymerized acrylic resin (HP), polyamide resin (PR), and autopolymerizing resin (AP) and submitted to grinding with a tungsten carbide bur. The specimens were divided into 4 groups according to the polishing technique used: control group without polishing, conventional laboratory polishing, polished with Acrylic Polisher HP blue kit, and polished with AcryPoint polishing kit. Surface roughness (Ra) was measured after polishing with a profilometer. Data were analyzed with a 2-way analysis of variance, and the Tukey honestly significant difference (HSD) test was performed to identify significant differences (α=.05). RESULTS: The polishing techniques significantly affected the Ra of denture base materials (P<.001). The highest mean average Ra was measured for the control group. The lowest Ra values were determined in specimens exposed to conventional laboratory polishing techniques. No significant differences were found between Acrylic Polisher HP blue and AcryPoint polishing kits (P>.05). Statistically significant differences were found in the Ra between the PR and both the HP and AP (P<.001); PR exhibited the highest Ra values. CONCLUSIONS: Conventional laboratory polishing was the most effective polishing technique. A significantly smoother surface than that of the specimens in the control group was produced with chairside silicone polishing kits.

Management of a subclavian artery thrombosis causing acute anterior wall infarction and concurrent left arm ischemia in a patient with prior coronary bypass.

We report a 57-year-old patient with acute anterior wall infarction with a history of a coronary baypass graft operation in 2007. He also had concurrent left arm cyanosis and severe pain. He had received diagnosis of pancreatic adenocarcinoma one month previously and had had his first chemotherapy in the previous week with gemcitabine and 5-fluorouracil. After the angiography, a giant thrombus was detected in the proximal left subclavian artery, deteriorating the flows of both left internal mammarian artery (LIMA) to left anterior descending (LAD) coronary artery graft, as well as the left brachial artery. The proximal subclavian artery was stented and good flow was achieved. Through the LIMA, the distal part of LAD, which was totally obstructed with probable distal thrombus embolization, was reached and a percutaneous balloon angioplasty performed. However, the no-reflow phenomenon was observed in distal LAD. A Fogarty traction of thrombus was performed successfully for the revascularization of the left arm. Approximately 30 minutes after the procedure, both angina and ST segment elevation in ECG were resolved under unfractioned heparin and nitroglycerin infusion. However, the patient died due to sepsis seven days after admission to hospital. In the literature, there are only a few previous reports on this rare clinical entity. The eitology, presentation, and the possible management strategies of this clinical entity is presented in this report.

Management of urological injuries following gynecologic and obstetric surgery: A retrospective multicenter study.

OBJECTIVE: Urinary system injuries may occur iatrogenically during some surgical procedures especially gynecological and obstetrical surgeries. Unfortunately, these injuries can lead to serious complications in patients. In this multicentric study, we aimed to review and report our experiences and results of urinary tract injuries identified during gynecological and obstetrical surgery. METHODS: We included women with urinary tract injuries during gynecological and obstetrical surgeries between January 2018 and October 2023 at four centers. Detailed data collected include patient demographics, surgical details, injury characteristics, diagnostic and treatment methods, timing of injury diagnosis and management reports of the patients. The incidence of bladder and ureter injuries was evaluated and the rate of intraoperative urological consultations was recorded. RESULTS: In a total of 328 patients with a median age of 47 years (24-90), urinary tract injuries were diagnosed, including 227 (69.2%) iatrogenic bladder injuries (IBI) and 101 (30.8%) iatrogenic ureteral injuries (IUI). These injuries were diagnosed in 299 patients (91.2%) during surgery and in 29 patients (8.8%) after the surgical procedure. We observed intraoperative detection rates of 71.9% for IBI and 28.1% for IUI. IBI (71.9%) was diagnosed significantly more frequently than IUI (28.1%) (p=0.001). Cesarean section resulted in significantly more frequent IBI, whereas tumor debulking surgeries resulted in more IUI (n=52, 56.5%) than the other types of procedures (p<0.001). CONCLUSION: Our study provides a comprehensive overview of iatrogenic urological injuries during gynecological and obstetrical surgeries. Although the bladder is the most frequently injured organ during gynecological and obstetric surgeries, early diagnosis and urological intervention are mandatory to prevent delayed complications. Surgeons must have a thorough understanding of the pelvic anatomy and appropriate surgical techniques to prevent iatrogenic injuries during surgery and ensure timely diagnosis and treatment of urinary tract injuries.

Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture.

UNLABELLED: Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. KEY WORDS: Chest pain; Coronary artery disease; Esophageal rupture; Misdiagnosis.

[Evaluation of left ventricular systolic and diastolic functions in patients with coronary slow flow phenomenon]. / Koroner yavas akim fenomeni saptanan hastalarda sol ventrikül sistolik ve diyastolik fonksiyonlarinin degerlendirilmesi.

OBJECTIVES: In this study, systolic and diastolic function parameters were measured with conventional and tissue Doppler echocardiography in coronary slow flow phenomenon (CSFP) patients and compared to those of a control group. STUDY DESIGN: Sixty patients (49 male; mean age 52.4±12.1) in whom CSFP was detected during coronary angiography study and 30 volunteers with normal coronary arteries (21 males; mean age 50.2±12.1) were included in this study. CSFP was determined using the TIMI frame count (TFC) method. TIMI frame count was calculated in each coronary artery using the TFC method. Left ventricular systolic and diastolic function was assessed by conventional echocardiography and tissue Doppler imaging. TFC correlation between diastolic function parameters was measured. RESULTS: Baseline demographic and laboratory results did not differ significantly between the groups. TIMI frame counts were greater in the CSFP group compared to controls (p<0.001). Left ventricular ejection fraction (65.93±8.06% vs 66.63±5.96%), E/A ratio (1.11±0.36 vs 1.22±0.33), and isovolumetric relaxation time (IVRT) (85±17 cm/s vs 84±13 cm/s) measured with conventional echocardiography showed no significant difference between the two groups. Em (7.0±2.1 cm/s vs 7.4±1.7 cm/s), Am (7.4±2.0 cm/s vs 7.0±1.4 cm/s) and E/Em (10±3 vs 10±1) measured with tissue Doppler echocardiography showed no significant difference between the two groups. Corrected TIMI frame count for the left descending coronary artery (cLAD) and mean TFC were not correlated with the E/A ratio, deceleration time (DT), IVRT, or E/Em ratio. CONCLUSION: Left ventricular systolic and diastolic functions were preserved in CSFP.

Assessment of left atrial morphological and functional differences in professional male football players: a prospective, case-control study.

BACKGROUND: Intensive physical activity in athletes leads to considerable changes in the morphology and physiology of the left atrium through physiological, exercise-induced remodelling. AIM: This study aimed to assess the mechanical and electrophysiological changes in professional football players using electrocardiographic and echocardiographic assessment tools. METHODS: This prospective, case-control study was performed between February and June 2022. The population consisted of elite male football players (n = 49, group F) as the study group, and healthy male non-athlete individuals of matching age (n = 50, group C) as the control group. All participants underwent electrocardiographic and echocardiographic (two-dimensional and tissue Doppler) examinations. Volumetric and functional assessment of the left atrium was identified as the study's primary outcome. RESULTS: There was no significant difference between the groups in terms of demographic and morphometric characteristics (p > 0.05). Maximum and minimum P waves and PR-interval duration were significantly higher in group F than in group C (p = 0.011, p = 0.005 and p < 0.001). Diameter, maximum and minimum volumes of the left atrium, and their corresponding indexes were significantly increased in group F (p < 0.0). Ejection fraction of the left atrium was significantly lower in group F than in group C (p = 0.001). Pulmonary acceleration time and tricuspid annular plane systolic excursion was significantly higher in the football players (p = 0.023 and p < 0.001). CONCLUSIONS: Increased diameter, maximum and minimum volumes of the left atrium, and their corresponding indexes could be demonstrated in the elite football players. The morphological and functional changes in the left atrium might be a physiological consequence of left atrial cardiac remodelling to intensive and chronic training.

The determinants of ecological footprint in the UK: The role of transportation activities, renewable energy, trade openness, and globalization.

The objective of this study is to explore the interaction between transportation energy consumption, GDP, renewable energy, trade, globalization and ecological footprint in the United Kingdom over the period 1990-2020. To achieve this aim, the study uses the autoregressive distributed lag (ARDL) approach and Fourier Toda-Yamamoto causality test. The research findings demonstrate that an increase in transportation energy consumption, renewable energy, and globalization is associated with a reduction in environmental pollution. On the contrary, GDP and trade contribute to worsening the environment. Moreover, there exists a unidirectional causal relationship from transportation energy consumption, GDP, renewable energy, trade, and globalization towards the ecological footprint. The findings of the study recommend that the policymakers should implement strategies and provide incentives to increase the deployment of renewables in the transportation sector, specifically focusing on electric vehicles (EVs) and the necessary charging infrastructure. Overall, the UK government should prioritize sustainable environmental development when planning its economic development strategies.

Are impacts of renewable energy and globalization on carbon neutrality targets asymmetric in South Africa? A reconsideration using nonlinear ARDL approach.

In this paper, we deviate from the existing literature by disentangling the independent variables into their positive and negative changes to capture asymmetric and dynamic multiplier effects of renewable energy and globalization on carbon neutrality targets within the framework of the autoregressive distributed lag (ARDL) model. In doing this, the paper uses South African data for the period 1990 to 2018 and the results show that CO2 emissions respond differently to the positive and negative shocks in renewable energy, globalization, and economic growth. The effect of a positive shock in economic growth is inelastic and positively related to CO2 emissions while a negative shock in economic growth has an elastic and negative effect on CO2 emissions. These results hold for both long-run and short-run periods. In the case of globalization, the positive shock increases CO2 emissions while the negative shock decreases CO2 emissions; although the long-run effect of a negative shock is elastic and insignificant while the short-run negative shock exerts an inelastic and significant effect on CO2 emissions. Furthermore, both the upward and downward shocks in renewable energy consumption transmit a negative effect on CO2 emissions in the long-run and short-run periods. Therefore, the paper suggests among others that to effectively decarbonize the South African economy, the use of subsidies, tax credits, tax holidays, and a host of others on green energy activities need to be enhanced as incentives for promoting cleaner energy production and consumption.

Efficacy and safety of Hyadex for treatment of vesicoureteral reflux: a multicenter experience.

OBJECTIVE: This study was performed to evaluate the efficacy and safety of dextranomer/cross-linked hyaluronic acid (Hyadex) in patients with a clinical diagnosis of vesicoureteral reflux (VUR). METHODS: In this cross-sectional multicenter observational study, Hyadex was used in four different centers for the endoscopic treatment of VUR from 2020 to 2022. The study involved 74 patients (93 renal units) who were diagnosed with VUR according to voiding cystourethrography (VCUG) findings and were considered suitable for subureteric endoscopic treatment. The follow-up time (control VCUG time) was 3 months. RESULTS: In the VCUG evaluation, grade I VUR was found in 13 renal units, grade II in 23 renal units, grade III in 42 renal units, and grade IV in 12 renal units. The success rates of Hyadex treatment according to the degree of VUR were as follows: 84.6% for grade I, 82.6% for grade II, 71.4% for grade III, and 66.0% for grade IV. No major complications were observed. CONCLUSION: Endoscopic subureteric Hyadex injection had high success rates in appropriately selected patients with VUR and may be used as the first-line treatment for children with VUR.

Selvester QRS Score is a Predictor of Mortality in Heart Failure with Preserved Ejection Fraction. / O Escore de Selvester QRS é um Preditor de Mortalidade na Insuficiência Cardíaca com Fração de Ejeção Preservada.

BACKGROUND: The Selvester QRS (S-QRS) score on a 12-lead electrocardiogram (ECG) is associated with both the amount of myocardial scar and poor prognosis in myocardial infarction patients. However, its prognostic value in heart failure (HF) with preserved ejection fraction (HFpEF) is unknown. OBJECTIVE: This study aims to investigate the predictive value of the S-QRS score for mortality in HFpEF. METHODS: 359 patients were retrospectively enrolled in this study. Electrocardiographic, echocardiographic, and laboratory features of the patients were recorded. The simplified S-QRS score was measured and recorded. The mean follow-up time of the patients was 38.1±9.5 months. Statistical significance was set at p < 0.05. RESULTS: Of 359 patients, 270 were in the survivor group, and 89 were in the deceased group. Age, Hs-CRP, troponin, pro-BNP, left atrial (LA) diameter, LA volume index, QRS duration, Tpe, and S-QRS score were statistically high in the deceased group. In multivariate logistic regression analysis, age, Hs-CRP, NT-proBNP, LA diameter, LA volume index, Tpe, and S-QRS score were shown to be independent risk factors for mortality. In the receiver-operating characteristic (ROC) analysis, the cut-off value of the S-QRS score was 5.5, the sensitivity was 80.8%, and the specificity was 77.2% (AUC:0.880, p:0.00). In Kaplan-Meier analysis, it was found that mortality was higher in the group with S-QRS score ≥ 5.5 than in the group with S-QRS score < 5.5. (Long-rank, p:0.00). CONCLUSIONS: We think that the S-QRS score can be used as a prognostic indicator of long-term mortality in patients with HFpEF.

FUNDAMENTO: O escore Selvester QRS (S-QRS) em um eletrocardiograma (ECG) de 12 derivações está associado tanto à quantidade de cicatriz miocárdica quanto ao mau prognóstico em pacientes com infarto do miocárdio. Entretanto, seu valor prognóstico na insuficiência cardíaca (IC) com fração de ejeção preservada (ICFEp) é desconhecido. OBJETIVO: Este estudo tem como objetivo investigar o valor preditivo do escore S-QRS para mortalidade na ICFEp. MÉTODOS: 359 pacientes foram incluídos retrospectivamente neste estudo. As características eletrocardiográficas, ecocardiográficas e laboratoriais dos pacientes foram registradas. O escore S-QRS simplificado foi medido e registrado. O tempo médio de seguimento dos pacientes foi de 38,1±9,5 meses. A significância estatística foi estabelecida em p < 0,05. RESULTADOS: Dos 359 pacientes, 270 estavam no grupo sobrevivente e 89 no grupo falecido. Idade, PCR-us, troponina, pro-BNP, diâmetro do átrio esquerdo (AE), índice de volume do AE, duração do QRS, Tpe e escore do S-QRS foram estatisticamente altos no grupo falecido. Na análise de regressão logística multivariada, idade, PCR-us, NT-proBNP, diâmetro do AE, índice de volume do AE, Tpe e escore S-QRS mostraram-se fatores de risco independentes para mortalidade. Na análise da característica operacional do receptor (ROC), o valor de corte do escore S-QRS foi de 5,5, a sensibilidade foi de 80,8% e a especificidade foi de 77,2% (AUC: 0,880, p:0,00). Na análise de Kaplan-Meier, verificou-se que a mortalidade foi maior no grupo com escore S-QRS ≥ 5,5 do que no grupo com escore S-QRS < 5,5. (Long-rank, p:0,00). CONCLUSÃO: Acreditamos que o escore S-QRS pode ser usado como um indicador prognóstico de mortalidade a longo prazo em pacientes com ICFEp.

Comparison of the left atrial appendage flow velocities between patients with dipper versus nondipper hypertension.

OBJECTIVE: In this study, left atrial appendage (LAA) flow velocities of dipper and nondipper hypertensive patients were compared with normal subjects. METHODS: Twenty-three patients with nondipper hypertension (NDH), 25 patients with dipper hypertension (DH), and 25 control subjects with comparable age, gender, and body mass indices were enrolled in the study. A detailed history, physical examination, and routine laboratory tests were obtained on all participants. Standard transthoracic echocardiographic examinations were performed on each subject. In addition, LAAs of all patients were visualized using transesophageal echocardiography. LAA filling and ejection velocities were measured using pulsed-wave Doppler with the sample volume placed in proximal third of the LAA. The mean LAA ejection velocity in patients with NDH (47.7 + 13.0 cm/sec) was found to be significantly lower relative to the DH (66.3 + 12.9 cm/sec) and the control group (81.7 + 8.0 cm/sec) (P < 0.001). The mean LAA filling velocity in patients with NDH (41.7 + 14.7 cm/sec) was also significantly lower relative to those observed in the DH 58.8 + 9.2 cm/sec) and the control group (67.2 + 7.9 cm/sec) (P<0.001). CONCLUSION: In NDH patients, LAA filling and ejection flow rates are decreased relative to DH patients and the control group. For patients with NDH detected using ambulatory blood pressure monitoring, more aggressive treatment approach should be considered. Maintenance of LAA function may prevent potential complications secondary to left atrial appendage dysfunction.