Is there an association between glomerular hyperfiltration and coronary flow velocity reserve in patients with gestational diabetes history?

Glomerular hyperfiltration (GHF) is an early marker of chronic kidney disease (CKD) and may predict coronary microvascular dysfunction, presenting as reduced coronary flow velocity reserve (CFVR) in patients with a history of gestational diabetes (GDM). This study aimed to assess the glomerular filtration rate (GFR) and compare CFVR in patients with a history of GDM. We screened patients referred to the Cardiology Department of Istanbul Medeniyet University for angina pectoris, excluding those with positive treadmill test results. Women with a history of GDM were categorized into three groups based on GFR levels: Group 1 (60-89 ml/min), Group 2 (90-119 ml/min), and Group 3 (≥ 120 ml/min). Coronary diastolic peak velocities were measured at baseline and after dipyridamole administration, with CFVR defined as the ratio of hyperemic to baseline diastolic peak velocities. The homeostasis model assessment of insulin resistance (HOMA-IR) and body mass index were derived from patient files. A total of 166 patients were included: 57 in Group 1, 80 in Group 2, and 29 in Group 3. HOMA-IR was higher in Group 3 compared to Group 2 (P < 0.05). Group 1 had the lowest CFVR (2.3 ± 0.3%), Group 2 had the highest (2.5 ± 0.3%), and Group 3 showed a moderate decrease in CFVR (2.4 ± 0.3%). Multivariate linear regression analysis revealed that HbA1c was independently associated with CFVR. In patients with GDM, GHF is associated with reduced CFVR, linked to metabolic parameters such as HbA1c and HOMA-IR. Interventions to improve metabolic health may prevent cardiovascular disease in these patients.

Rapid detection and interpretation of heart murmurs using phonocardiograms, transfer learning and explainable artificial intelligence.

Cardiovascular disease, which remains one of the main causes of death, can be prevented by early diagnosis of heart sounds. Certain noisy signals, known as murmurs, may be present in heart sounds. On auscultation, the degree of murmur is closely related to the patient's clinical condition. Computer-aided decision-making systems can help doctors to detect murmurs and make faster decisions. The Mel spectrograms were generated from raw phonocardiograms and then presented to the OpenL3 network for transfer learning. In this way, the signals were classified to predict the presence or absence of murmurs and their level of severity. Pitch level (healthy, low, medium, high) and Levine scale (healthy, soft, loud) were used. The results obtained without prior segmentation are very impressive. The model used was then interpreted using an Explainable Artificial Intelligence (XAI) method, Occlusion Sensitivity. This approach shows that XAI methods are necessary to know the features used internally by the artificial neural network then to explain the automatic decision taken by the model. The averaged image of the occlusion sensitivity maps can give us either an overview or a precise detail per pixel of the features used. In the field of healthcare, particularly cardiology, for rapid diagnostic and preventive purposes, this work could provide more detail on the important features of the phonocardiogram.

Can the efficacy of a medical treatment be predicted based on the type of idiopathic premature ventricular contraction?

BACKGROUND: Premature ventricular contractions (PVCs) are common arrhythmias with diverse clinical implications. This retrospective study aimed to evaluate the efficacy of medical treatments using various clinical, imaging, and electrocardiographic parameters in patients with idiopathic PVCs. METHODS: A total of 1051 patients with idiopathic PVCs were retrospectively analyzed. Patients were categorized into three groups based on treatment response: beta-blocker (BB) responders (479 patients), calcium-channel blocker (CCB) responders (335 patients), and class 1c antiarrhythmic (AA) responders (237 patients). Clinical, imaging, and electrocardiographic data were collected and analyzed to assess the factors influencing treatment response. RESULTS: Age, left ventricular ejection fraction (LVEF), PVC QRS duration, CI variability, and multiple PVC morphologies were identified as significant factors affecting treatment response. Older age and lower LVEF were associated with better response to BB treatment, whereas CCB responders showed narrower QRS complexes. BB responders also exhibited higher CI variability, possibly linked to automaticity mechanisms. Moreover, the BB responder group had a higher frequency of multiple PVC morphologies. CONCLUSION: These findings emphasize the importance of tailored treatment approaches based on individual patient characteristics.

Assessment of the reliability and usability of ChatGPT in response to spinal cord injury questions.

OBJECTIVE: The use of artificial intelligence chatbots to obtain information about patients' diseases is increasing. This study aimed to determine the reliability and usability of ChatGPT for spinal cord injury-related questions. METHODS: Three raters simultaneously evaluated a total of 47 questions on a 7-point Likert scale for reliability and usability, based on the three most frequently searched keywords in Google Trends ('general information', 'complications' and 'treatment'). RESULTS: Inter-rater Cronbach α scores indicated substantial agreement for both reliability and usability scores (α between 0.558 and 0.839, and α between 0.373 and 0.772, respectively). The highest mean reliability score was for 'complications' (mean 5.38). The lowest average was for the 'general information' section (mean 4.20). The 'treatment' had the highest mean scores for the usability (mean 5.87) and the lowest mean value was recorded in the 'general information' section (mean 4.80). CONCLUSION: The answers given by ChatGPT to questions related to spinal cord injury were reliable and useful. Nevertheless, it should be kept in mind that ChatGPT may provide incorrect or incomplete information, especially in the 'general information' section, which may mislead patients and their relatives.

The use of standing powered wheelchairs from the perspective of individuals with spinal cord injury.

PURPOSE: The aim of this study was to investigate the experiences of standing powered wheelchair (SPWC) users with spinal cord injury (SCI). MATERIALS AND METHODS: This cross-sectional study included 20 participants with SCI. SPWC daily usage time (total, in sitting position and standing position) and the frequency of using the SPWC's standing feature were recorded. Participants' level of satisfaction and comfort associated with the SPWC were assessed on a five-point Likert scale. If there was a dissatisfaction reason with the SPWC, the issues related to it were recorded. Participants were asked about their positive and adverse experiences with the use of SPWC. RESULTS: Mean age of the participants was 41.65 (± 9.35) years. Eighty percent were tetraplegic. Ninety percent of the participants stood for at least 30 minutes at least one day a week, and 55% stood for at least 30 minutes at least four days a week. The most commonly reported perceived benefits were improvement in activities of daily living, bowel movements, and blood pressure regulation, better perception of body image, and feeling better. The most frequently identified reasons for dissatisfaction with the SPWC were its big dimensions, heavy weight, and difficulty of use in indoor environment and on uneven surfaces. CONCLUSIONS: The findings show positive perceived experiences for SPWC users with SCI in terms of physical, social, and psychological aspects. Prospective controlled studies are needed to explore the benefits of SPWC use regarding secondary complications of SCI.

This paper shows that participants with spinal cord injury (SCI) report numerous perceived physical, social, and psychological benefits of using standing powered wheelchair (SPWC).Individual adjustments must be made for SPWCs. Before prescribing SPWC, the physician and physical or occupational therapist who specialises in wheelchairs should make the necessary evaluations based on the individual's abilities and needs. The necessity for special SPWC equipment and orthoses during standing should be evaluated.In SPWC users with SCI, neck discomfort may occur due to the contraction of non-postural innervated muscles such as the neck due to inadequate trunk control. In addition to the adjustable chest support in SPWC, equipment that provides additional chest support can be used for better control of the trunk. Better control of the trunk can contribute to improved neck comfort.

Concomitant amyloidosis is the primary cause of endothelial and coronary microvascular dysfunction in carpal tunnel syndrome.

Study objectives: Patients with carpal tunnel syndrome (CTS) show manifestations of arterial abnormalities, including carotid intimal thickening and increased vascular stiffness. As carpal tunnel syndrome is associated with amyloidosis, we hypothesized that previously observed abnormalities can largely be related with concomitant amyloidosis rather than CTS itself. Design: Prospective observational study. Setting: Medeniyet University Goztepe Hospital. Participants: 61 patients with CTS (of whom 32 had biopsy-proven amyloidosis) and 36 healthy controls. Interventions: Subjects underwent ultrasound examinations for the measurement of coronary flow velocity reserve (CFVR), flow-mediated vasodilatation (FMD) and carotid intimal-media thickness (CIMT). Main outcome measures: Comparison of CFVR, FMD and CIMT in CTS patients with or without amyloidosis. Results: Patients with either CTS or CTS with concomitant amyloidosis (CTS-A) had significantly lower FMD (9.7 % ± 4.0 % in CTS and 10.3 % ± 4.6 % in CTS-A groups, p < 0.05 for both) and CFVR (2.4 (2.1-2.8) in CTS and 1.8 (1.6-2.1) in CTS-A groups, p < 0.001 for both) as compared to controls, while CIMT was only increased in CTS-A group (0.70 (0.60-0.80), p < 0.001). The reduction in CFVR was solely related to an increased basal flow velocity in CTS patients while there was also a reduced hyperemic flow velocity in patients with CTS-A. Conclusion: Most arterial phenomena in CTS patients could be attributable to concomitant amyloidosis, although endothelial dysfunction was present even in patients with CTS without amyloidosis.

Neural decoding of inferior colliculus multiunit activity for sound category identification with temporal correlation and transfer learning.

Natural sounds are easily perceived and identified by humans and animals. Despite this, the neural transformations that enable sound perception remain largely unknown. It is thought that the temporal characteristics of sounds may be reflected in auditory assembly responses at the inferior colliculus (IC) and which may play an important role in identification of natural sounds. In our study, natural sounds will be predicted from multi-unit activity (MUA) signals collected in the IC. Data is obtained from an international platform publicly accessible. The temporal correlation values of the MUA signals are converted into images. We used two different segment sizes and with a denoising method, we generated four subsets for the classification. Using pre-trained convolutional neural networks (CNNs), features of the images were extracted and the type of heard sound was classified. For this, we applied transfer learning from Alexnet, Googlenet and Squeezenet CNNs. The classifiers support vector machines (SVM), k-nearest neighbour (KNN), Naive Bayes and Ensemble were used. The accuracy, sensitivity, specificity, precision and F1 score were measured as evaluation parameters. By using all the tests and removing the noise, the accuracy improved significantly. These results will allow neuroscientists to make interesting conclusions.

The use of myoelectric prosthesis in a sample of veterans with unilateral upper extremity amputation: prosthesis satisfaction and quality of life.

AIMS: To determine the relationship between clinic and prosthesis-related characteristics and psychosocial adjustment, activity restriction, satisfaction with the prosthesis and quality of life in myoelectric prosthesis users with upper limb amputation. METHODS: Thirty patients with myoelectric prosthesis users with upper limb amputation took part in this study. The patients' demographic and clinical information were recorded. Psychosocial adjustment, activity restriction and satisfaction with the prosthesis were assessed with Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R). Short-Form 36 (SF-36) was used for the quality of life. RESULTS: TAPES-R activity restriction score was significantly higher in patients with transhumeral or elbow disarticulation and with concomitant lower limb amputation (p = 0.009, p = 0.037, respectively). TAPES-R psychosocial adjustment subparameter score had significantly moderate correlation with daily prosthesis wearing time (p = 0.019 r = 0.425). A significant negative correlation was found between age at the time of the injury and SF-36 role limitation due to physical problem (p = 0.028 r = - 0.401). CONCLUSIONS: Clarifying the factors related to psychosocial adjustment, activity restriction, prosthesis satisfaction and quality of life in individuals with upper extremity amputation and producing interventions/approaches that support patients' life are meaningful and important steps. CLINICAL TRIAL REGISTER: E2-22-1416.

Is the information about lateral epicondylitis on the YouTube platform reliable and of good quality?

OBJECTIVES: This study aimed to investigate the quality and reliability of YouTube videos, as a source of lateral epicondylitis (LE). METHODS: In this cross-sectional study, 484 videos were analyzed by searching the YouTube platform with the keyword 'lateral epicondylitis.' Journal of the Medical Association (JAMA) benchmark criteria, modified DISCERN and Global Quality Scale (GQS) were used for quality and reliability assessments. RESULTS: A total of 298 videos were evaluated. High quality (GQS 4-5) was identified in 74 videos (24.8%), intermediate quality (GQS 3) in 84 videos (28.2%), and low quality (GQS 1-2) in 140 videos (47%). Of the videos, 57.7% (n = 41) uploaded by physician were of high quality. A significant difference was found between the low-intermediate-high-quality groups in terms of duration, number of views, number of likes, number of comments, likes per day, comments per day, video view ratio, JAMA score and modified DISCERN score (all p < 0.01). In videos uploaded by physicians; views, time since uploaded, JAMA score, modified DISCERN score, and GQS score were significantly higher than videos shared by trainers, health-related web sites, and independent users. The duration and viewing rates of the videos, the number of views, likes, comments, likes per day and comments per day were found to be significantly associated with JAMA, modified DISCERN, and GQS scores (p < 0.01). CONCLUSION: About half of YouTube videos for LE were low quality. Most of the high-quality videos have been shared by physicians and these videos have been longer, more viewed, more liked and commented, and more reliable. Healthcare professionals should provide high-quality, unbiased, accurate and instructive information that is accessible to everyone on the YouTube platform.

Assessment of isokinetic hip muscle strength and predictors in patients with lower limb amputation: A cross-sectional study.

Objectives: The purpose of the study was to determine isokinetic features and analyze significant predictors related to activity level of patients with lower limb amputation. Patients and methods: Forty-three male patients (mean age: 32.9±8.8 years; range, 21 to 50 years) with lower limb amputation were recruited consecutively for this cross-sectional study between March 1, 2022, and June 30, 2022. The hip flexor and extensor peak torques and total work were evaluated by an isokinetic dynamometer. The secondary outcome measure was the Amputee Mobility Predictor. A linear regression analysis was used to determine factors independently affecting Amputee Mobility Predictor scores. Results: All data of patients with unilateral amputation, except for flexor (p=0.285) and extensor (p=0.247) peak torques on the dominant side, were higher than those of patients with amputation. Dominant side extensor peak torque was statistically higher than nondominant side extensor peak torque (59.4±30.7 vs. 43.4±32.0) in patients with bilateral amputation. No difference was detected between amputated and intact sides of patients with unilateral amputation. Both flexor and extensor total work on the amputated side of the patients with below-knee amputation were higher than the patients with above-knee amputations (63.5±21.1 vs. 94.1±34.3 and 67.1±34.0 vs. 113.0±51.5, respectively). Unilateral amputation (odds ratio: 7.442) and nondominant side extensor total work (odds ratio: 0.615) were found to be significant predictors related with amputee mobility predictor scale. Conclusion: It is possible to have an idea about the possible activity level of the patients with lower limb amputation with the help of the predictors obtained in the current study.

Outcomes and predictors of stress among Turkish family caregivers of patients with acquired brain injury.

OBJECTIVE: This study examined family caregiver stress and factors predicting the stress among caregivers of patients with acquired brain injury (ABI). METHODS: Sixty caregivers of patients with ABI took part in this study. All participants completed assessments of Caregiver Strain Index, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, Nottingham Health Profile (NHP), and Satisfaction with Life Scale (SWLS). The patients with ABI were also assessed on the Functional Independence Measure, Disability Rating Scale, Rancho Los Amigos Cognitive Scale-revised, Functional Ambulation Classification Scale, and Neurobehavioral Rating Scale-revised. Relationship between caregiver's stress and clinical outcomes was analyzed, together with factors significantly associated with stress. RESULTS: Elevated levels of stress were determined in 40% of caregivers. Higher stress was seen in caregivers of patients with shorter disease duration, worse functioning, who had more depression and anxiety, poorer perceived health status particularly for pain and emotional reaction domains, and less life satisfaction. Linear regression analysis demonstrated that caregiver's stress was predicted by NHP pain domain (ß = 0.062, p = 0.016) and SWLS (ß = -0.133, p = 0.040). CONCLUSION: Caregivers with more pain and less life satisfaction are at higher risk of developing stress. In order to overcome this difficult process and improve the quality of care, it would be appropriate to reveal predictors of stress and produce appropriate interventions/approaches.

A Associação de TWEAK com Calcificação da Artéria Coronária em Pacientes com Doença Renal Crônica / The Association of TWEAK with Coronary Artery Calcification in Patients with Chronic Kidney Disease

Resumo Fundamento O receptor fraco indutor de apoptose semelhante a fator de necrose tumoral solúvel (sTWEAK) é um membro da superfamília de TNF que tem um papel crítico na proliferação e inflamação na circulação arterial. Objetivos Este estudo prospectivo tem o objetivo de mostrar a relação entre os níveis de sTWEAK e calcificação da artéria coronária (CAC) em pacientes com doença renal crônica (DRC). Métodos Este estudo prospectivo incluiu 139 pacientes consecutivos que passaram por angiografia coronariana por tomografia computadorizada, por qualquer motivo, para síndromes coronarianas agudas, de agosto de 2020 a fevereiro de 2021. Um total de 12 pacientes foi excluído do estudo devido aos critérios de exclusão. Os pacientes foram divididos em dois grupos com base em terem um escore CAC menor que 400 (n=84) ou um escore de 400 ou mais (n=43). A significância foi presumida em p-valor bilateral <0,05. Resultados À medida que o escore CAC aumentou, os níveis de sTWEAK diminuíram de forma estatisticamente significativa e detectou-se uma relação forte entre níveis de sTWEAK e escore CAC (r: -0,779, p<0,001). A análise ROC revelou que o nível de corte ideal de sTWEAK para prever o escore CAC de 400 era 761 pg/mL com uma sensibilidade de 71% e especificidade de 73% (AUC: 0,78; IC 95%: 0,70-0,85; p <0,001). Conclusões Embora os estudos em larga escala tenham demonstrado uma correlação positiva entre os níveis de TFGe e sTWEAK, alguns estudos detectaram que o aumento nos níveis de sTWEAK estão associados a mortalidade e gravidade do sistema da artéria coronária em pacientes com DRC. Nossos resultados comprovam nossa hipótese de que os níveis de sTWEAK mostram calcificação coronária em vez de outros tipos de placas ateroscleróticas.

Abstract Background The soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) is a member of the TNF superfamily that plays a critical role in proliferation and inflammation in the arterial circulation. Objectives This prospective study aimed to show the relationship between the sTWEAK levels and coronary artery calcification (CAC) in patients with chronic kidney disease (CKD). Methods This prospective study included 139 consecutive patients undergoing computed coronary angiography for any reason except for acute coronary syndromes from August 2020 to February 2021. A total of 12 patients were excluded from the study due to exclusion criteria. Patients were divided into two groups with regard to having a CAC score of less than 400 (n=84) and 400 or more (n=43). Significance was assumed at a 2-sided p<0.05. Results As the CAC score increased, sTWEAK levels presented a statistically significant decrease, and a strong relationship between sTWEAK levels and the CAC score (r: -0.779, p<0.001) was observed. The ROC analysis revealed that the optimal cut-off level of sTWEAK for predicting the CAC score of 400 was 761 pg/mL with a sensitivity of 71% and a specificity of 73% (AUC: 0.78; 95% CI:0.70-0.85; p < 0.001) Conclusions Even though the large-scale studies showed a positive correlation between eGFR and the sTWEAK levels, some studies found the increased sTWEAK levels to be associated with mortality and the severity of the coronary artery system in patients with CKD. Our results support our hypothesis that the sTWEAK level shows coronary calcification rather than other types of atherosclerotic plaques.

Evaluation of COVID-19 Patients According to the Survival Time.

BACKGROUND: Coronavirus disease 2019 (COVID-19) was first detected as a form of atypical pneumonia. COVID-19 is a highly contagious virus, and some patients may experience acute respiratory distress syndrome (ARDS) and acute respiratory failure leading to death. We aim to evaluate the clinical, imaging, and laboratory parameters according to survival time to predict mortality in fatal COVID-19 patients. METHODS: Fatal 350 and survived 150 COVID-19 patients were included in the study. Fatal patients were divided into three groups according to the median value of the survival days. Demographic characteristics and in-hospital complications were obtained from medical databases. RESULTS: Of the non-survived patients, 30% (104) died within three days, 32% (110) died within 4-10 days, and 39% (136) died within over ten days. Pneumonia on computational tomography (CT), symptom duration before hospital admission (SDBHA), intensive care unit (ICU), hypertension (HT), C-reactive protein (CRP), D-dimer, multi-organ dysfunction syndrome (MODS), cardiac and acute kidney injury, left ventricular ejection fraction (LVEF), right ventricular fractional area change (RV-FAC), and Tocilizumab/Steroid therapy were independent predictors of mortality within three days compared to between 4-10 days and over ten days mortality.  A combined diagnosis model was evaluated for the age, CT score, SDBHA, hs-TnI, and D-dimer. The combined model had a higher area under the ROC curve (0.913). CONCLUSION: This study showed that age, pneumonia on CT, SDBHA, ICU, HT, CRP, d-dimer, cardiac injury, MODS, acute kidney injury, LVEF, and RV-FAC were independently associated with short-term mortality in non-surviving COVID-19 patients in the Turkish population. Moreover, Tocilizumab/Steroid therapy was a protective and independent predictor of mortality within three days.

The Association of TWEAK with Coronary Artery Calcification in Patients with Chronic Kidney Disease. / A Associação de TWEAK com Calcificação da Artéria Coronária em Pacientes com Doença Renal Crônica.

BACKGROUND: The soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) is a member of the TNF superfamily that plays a critical role in proliferation and inflammation in the arterial circulation. OBJECTIVES: This prospective study aimed to show the relationship between the sTWEAK levels and coronary artery calcification (CAC) in patients with chronic kidney disease (CKD). METHODS: This prospective study included 139 consecutive patients undergoing computed coronary angiography for any reason except for acute coronary syndromes from August 2020 to February 2021. A total of 12 patients were excluded from the study due to exclusion criteria. Patients were divided into two groups with regard to having a CAC score of less than 400 (n=84) and 400 or more (n=43). Significance was assumed at a 2-sided p<0.05. RESULTS: As the CAC score increased, sTWEAK levels presented a statistically significant decrease, and a strong relationship between sTWEAK levels and the CAC score (r: -0.779, p<0.001) was observed. The ROC analysis revealed that the optimal cut-off level of sTWEAK for predicting the CAC score of 400 was 761 pg/mL with a sensitivity of 71% and a specificity of 73% (AUC: 0.78; 95% CI:0.70-0.85; p < 0.001). CONCLUSIONS: Even though the large-scale studies showed a positive correlation between eGFR and the sTWEAK levels, some studies found the increased sTWEAK levels to be associated with mortality and the severity of the coronary artery system in patients with CKD. Our results support our hypothesis that the sTWEAK level shows coronary calcification rather than other types of atherosclerotic plaques.

FUNDAMENTO: O receptor fraco indutor de apoptose semelhante a fator de necrose tumoral solúvel (sTWEAK) é um membro da superfamília de TNF que tem um papel crítico na proliferação e inflamação na circulação arterial. OBJETIVOS: Este estudo prospectivo tem o objetivo de mostrar a relação entre os níveis de sTWEAK e calcificação da artéria coronária (CAC) em pacientes com doença renal crônica (DRC). MÉTODOS: Este estudo prospectivo incluiu 139 pacientes consecutivos que passaram por angiografia coronariana por tomografia computadorizada, por qualquer motivo, para síndromes coronarianas agudas, de agosto de 2020 a fevereiro de 2021. Um total de 12 pacientes foi excluído do estudo devido aos critérios de exclusão. Os pacientes foram divididos em dois grupos com base em terem um escore CAC menor que 400 (n=84) ou um escore de 400 ou mais (n=43). A significância foi presumida em p-valor bilateral <0,05. RESULTADOS: À medida que o escore CAC aumentou, os níveis de sTWEAK diminuíram de forma estatisticamente significativa e detectou-se uma relação forte entre níveis de sTWEAK e escore CAC (r: -0,779, p<0,001). A análise ROC revelou que o nível de corte ideal de sTWEAK para prever o escore CAC de 400 era 761 pg/mL com uma sensibilidade de 71% e especificidade de 73% (AUC: 0,78; IC 95%: 0,70-0,85; p <0,001). CONCLUSÕES: Embora os estudos em larga escala tenham demonstrado uma correlação positiva entre os níveis de TFGe e sTWEAK, alguns estudos detectaram que o aumento nos níveis de sTWEAK estão associados a mortalidade e gravidade do sistema da artéria coronária em pacientes com DRC. Nossos resultados comprovam nossa hipótese de que os níveis de sTWEAK mostram calcificação coronária em vez de outros tipos de placas ateroscleróticas.

Evaluation of long-term antibody kinetics in healthcare workers vaccinated with inactivated COVID-19 Vero cell vaccine (CoronaVac), a propensity score-matched observational study.

OBJECTIVES: This study aimed to evaluate the long-term antibody kinetics after vaccinating with an inactivated COVID-19 Vero cell vaccine (CoronaVac) in healthcare workers (HCWs) at a single center in Turkey. METHODS: For this prospective observational study, Chemiluminescence immunoassay (CLIA) and enzyme-linked immunosorbent assay (ELISA) were used for the determination of binding antibodies (bAb) and neutralizing antibodies (nAb), respectively. Antibody kinetics were compared for the potential influencing factors, and propensity score analysis was performed to match the subcohort for age. RESULTS: Early bAb and nAb response was achieved in all 343 participants. Titers of bAbs against SARS-CoV-2 on 42 days post-vaccination (dpv) were higher in HCWs who were aged <40 years and who had a history of COVID-19. SARS-CoV-2 bAb levels in HCWs on days 42 (n = 97), 90 (n = 97), and 180 (n = 97) were 175 IU/ml (3.9-250), 107 IU/ml (2.4-250), and 66.1 IU/ml (2.57-250), respectively (p<0.001). SARS-CoV-2 bAb (p<0.001) and nAb (p<0.001) titers decreased significantly over time. There was a high negative correlation between SARS-CoV-2 antibody titers and inverse optic density of nAb responses (Pearson correlation coefficient: -0.738, p<0.001). CONCLUSIONS: When the antibody responses were compared, it was seen that the vaccine immunogenicity was better in those who had prior COVID-19 history and were aged <40 years. In the course of time, it was determined that there was a significant decrease in bAb and nAb responses after the 90th day. These results may guide approval decisions for booster COVID-19 vaccines.

Can plasma TWEAK levels predict coronary slow flow in patients with chronic kidney disease?

BACKGROUND: The tumor necrosis factor-like weak inducer of apoptosis (TWEAK) is one of the inflammatory mediators contributing to the atherosclerotic process. TWEAK has been studied in patients with chronic kidney disease (CKD), and it has demonstrated that its level declines as estimated glomerular filtration rate (eGFR) decreases. Most studies have found that the decreased TWEAK levels were seen in atherosclerosis and associated with plaque calcification. The objective of this prospective study was to clarify any relationship between coronary slow-flow (CSF) and TWEAK levels in patients with CKD under conservative treatment. METHODS: This prospective study included 93 consecutive patients with CKD (mean creatinine level was 1.8±0.4 mg/dL) undergoing invasive coronary angiography (ICA) for any reason except for acute coronary syndromes from May 2019 to March 2020. A total of 93 patients were divided into two groups concerning having CSF (n=35) or no-CSF (n=58). RESULTS: Patients with CSF had higher TWEAK levels than those without CSF (695.2± 225.2 vs. 465.8±157.6, p<0.001). As the number of coronary arteries with slow flow increased, TWEAK levels increased statistically significantly (r:0.635/ p<0.001). Receiver operating characteristic (ROC) analysis showed that TWEAK levels of 516 pg/mL could predict CSF in patients with CKD. CONCLUSIONS: Our study has shown that plasma TWEAK levels were an independent predictor for CSF in patients with CKD. In addition, our study has found that elevated TWEAK levels may not reflect the healthy arteries as it was hypothesized in the past.

The Relationship Between Urinary Symptom Severity And Functional Status In Patients With Stroke.

BACKGROUND: Lower Urinary Tract Dysfunction (LUTD) is a condition that is common in stroke patients and affects their quality of life and psychological state. AIM: To determine the factors affecting LUTD severity in stroke patients and to evaluate its relationship with functional status. METHOD: 77 stroke patients were included in our study. Demographic and stroke characteristics of all patients were recorded. Functional Ambulation Scale (FAS), Functional Independence Measure (FIM), the Core Lower Urinary Tract Symptom Score (CLSS) Questionnaire, Beck Depression Scale were administered to the patient. 33 of 77 patients had urodynamic study and these patients constituted the subgroup of the study. Patients were grouped according to type of disorder, type of detrusor and detrusor sphincter dyssynergia (DSD) using urodynamic study findings. RESULT: The mean CLSS of men was significantly higher than women (P = 0.017). A significant positive correlation was found between age and CLSS (P = 0.035 r = 0.24) and negative correlation was found between total FIM and all sub-parameter scores and mean of CLSS (P = 0.001 r = -0.467). CONCLUSION: LUTD is common in stroke patients and the presence of urinary symptoms is associated with poor functional status. No significant relationship was observed between urodynamic data except maximum flow rate and CLSS.

Lawyers' beliefs about mental illnesses and their tendency to stigmatize people with mental illnesses.

PURPOSE: This descriptive study determined lawyers' beliefs about mental illnesses and their tendency to stigmatize people with mental illnesses. DESIGN AND METHODS: The sample consisted of 181 lawyers. Data were collected using a demographic characteristics form, the Beliefs toward Mental Illness Scale (BMI), and the Stigma Scale (SS). FINDINGS: Participants felt compassion, uneasiness, curiosity, and pity for people with mental illnesses. Participants had a mean BMI and SS score of 1.99 ± 0.70 and 2.19 ± 0.61, respectively. Their BMI and SS scores were moderately and positively correlated (r = 0.554) PRACTICE IMPLICATIONS: Lawyers should be informed about mental illness by courses within the context of health education in law schools' curricula. Future studies should focus on other community leaders' beliefs about mental illness and their tendency to stigmatize people with mental illnesses.

Perception of pain in patients with adolescent cerebral palsy: self report or parent's report.

PURPOSE: To compare mothers' report on children's pain with patients' own reports and to explore the prevalence, intensity, localisation and the effect of pain on daily living activities of adolescents with CP. MATERIALS AND METHODS: A total of 75 adolescent with CP (34 females and 41 males) and their mothers were included in this cross-sectional study. Demographical and clinical characteristics were recorded. The adolescent and the mother independently completed the pain questionnaire in a face-to-face interview administrated by a physiatrist. RESULTS: The prevalance of pain in the previous week was 28% by self report and was 40% by mothers' report. No significant difference was determined between mother's report and self report (p = 0.121). There was no significant difference in the prevalence of pain, pain intensity, and the effect of pain on activities of daily living according to Gross Motor Functional Classification System levels and CP types in terms of mothers' report and self report. CONCLUSIONS: Pain is a common condition in adolescents with CP and it affects quality of life negatively. While the self-report of pain is ideal, parent's reports in various situations is important for the assessment of pain.

Is there an association between sarcoidosis and atherosclerosis?

Sarcoidosis is a multisystemic chronic inflammatory disease that the specific etiology is not known clearly. The aim of this study is, to investigate the presence of subclinical atherosclerosis and endothelial dysfunction by using carotid intima-media thickness and flow-mediated dilatation measurements, measuring the copeptin values, which is a stress marker, and interpreting the association of copeptin values with these two variables in sarcoidosis patients without conventional risk factors for coronary artery disease. Seventy-four patients (50 f, 24 m) with histopathological diagnosis of sarcoidosis and 60 healthy volunteers (35 f, 25 m) with similar sociodemographic characteristics were included in this study. CIMT, FMD, and serum copeptin levels of all participants were measured. The values of CIMT and Copeptin in sarcoidosis patients were significantly higher (p = 0.001, p < 0.001 respectively), and FMD was significantly lower (p = 0.01) than the control group. In sarcoidosis patients not significant correlation found among CIMT with copeptin (r: 0.16, p = 0.18) and FMD with copeptin (r: 0.01, p = 0.96). With the demonstration of the presence of subclinical atherosclerosis and endothelial dysfunction, we suggest; sarcoidosis patients may be followed more closely in terms of cardiovascular diseases. And new studies are needed to investigate the pathophysiology and the effects of high copeptin levels in sarcoidosis patients.