Ambient air quality assessment at the airports based on a meteorological perspective.

Natural mineral dust episodes elevate particle concentrations and eventually decrease air quality. Air pollutant emissions from aircraft, airport ground operations, and long-range dust transport are producing problems for the aviation sector. Dust transport from the Sahara Desert, one of the primary dust sources globally, significantly affects the eastern Mediterranean basin, including Türkiye. This study investigates the effect of long-range dust transport on particulate matter (PM) concentrations at Turkish airports. Three different approaches were used to analyse dust episodes in the study area. Firstly, routine reports of meteorological conditions at the airports were investigated. For this purpose, airport routine meteorological reports (Metar) and aviation-selected special weather report (Speci) codes, recorded at 11 airports from 2012 to 2021, were used to determine the dust episode days. Secondly, the hourly PM measurement dataset was analyzed from the closest air quality monitoring stations to the airports. Finally, regional atmospheric model results and backward-trajectory analysis were used to validate the dust episodes and determine the dust origin. Results showed that 163 dust episodes occurred during the study period, 17% from North Africa and 12% from the Mediterranean region.

An urban air quality assessment based on a meteorological perspective.

An integrated approach to understanding all measured pollutants with multi-discipline in different time scales and understanding the mechanisms hidden under low air quality (AQ) conditions is essential for tackling potential air pollution issues. In this study, the air pollution of Sivas province was analyzed with meteorological and PM2.5 data over six years to assess the city's AQ in terms of PM2.5 pollution and analyze the effect of meteorological factors on it. It was found that the winter period (January-February-November-December) of every year except 2019-which has missing data-is the period with the highest air pollution in the province. In addition, the days exceeding the daily PM2.5 limit values in 2016, 2017, 2020, and 2021 were also seen in the spring and summer months, which inclined the study to focus on additional pollutant sources such as long-range dust transport and road vehicles. The year 2017 has the highest values and was analyzed in detail. Pollution periods with the most increased episodes in 2018 were analyzed with the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) and Dust Regional Atmospheric Model (DREAM) models. As a result of the study, the average PM2.5 values in 2017 were 31.66 ± 19.2 µg/m3 and a correlation of -0.49 between temperature and PM2.5. As a result of model outputs, it was found that the inversion is intensely observed in the province, which is associated with an increase of PM2.5 during the episodes. Dust transport from northwestern Iraq and northeastern Syria is observed, especially on days with daily average PM2.5 values above 100 µg/m3. Additionally, planetary boundary layer (PBL) data analysis with PM pollution revealed a significant negative correlation (r = -0.61). Air pollutants, particularly PM2.5, were found to be higher during lower PBL levels.

Can stellate ganglion blockage be an alternative treatment for refractory ventricular arrhythmias: Case series.

INTRODUCTION: Ventricular tachycardia (VT) and ventricular fibrillation (VF) are life-threatening conditions which increase in frequency over the years. Electrical storm (ES) is defined as the occurrence of 3 or more continuous ventricular arrhythmia. The sympathetic nervous system has an important role in Ventricular arrythmias (VA) and is the target of treatment. Studies show that stellate ganglion blockade (SGB) can reduce cardiac sympathetic tone and is an alternative bridge therapy in VAs. PATIENT CONCERNS: Among the patients who were admitted to the hospital with the complaints of general condition disorder and palpitation. DIAGNOSIS: Patients were referred to the Cardiology department and diagnosed VA and ES. Patients who applied to the Cardiology Department with the diagnosis of VA or ES and did not benefit from antiarrhythmic drug therapy were selected and evaluated by a team of 2 anesthesiologists (cardiothoracic and pain specialists) and 2 cardiologists (1 of whom is an electrophysiology specialist). INTERVENTION: In our study, ultrasound (USG) guided left SGB was applied to 10 VA and ES patients with implantable cardiac defibrillator (ICD). The 6-month results of the patients were evaluated retrospectively. For blockage, the solution was prepared by adding 8 mg dexamethasone, 40 mg lidocaine and 10 mg bupivacaine to 10 mL with physiological saline. The success of the procedure was evaluated with the development of Horner syndrome in the left eye. OUTCOMES: Resistant VA developed in 2 of 10 patients who had left SGB due to VF/VT ES and were excluded from the study. One (1) month after the procedure it was seen that there was a statistically significant decrease in the number of shocks in 8 patients in the 6th month controls compared to the pre-procedure. The number of VES in the 1st and 6th months of the patients was also statistically significantly decreased compared to the pre-SSD (P = .01, P = .01, P = .01, respectively). CONCLUSION: Unilateral USG-guided SGB application is an effective and safe method in patients with ES and VA. Long-term results can be satisfactory in successful responders in whom SGB is performed with a combination of local anesthetic and steroid.

An investigation of the effects of sand and dust storms in the North East Sahara Desert on Turkish airports and PM10 values: 7 and 8 April, 2013 events.

Between April 7 and April 10, 2013, a cyclone with a value of 995 hPa that developed in the central Mediterranean transported dust from the Sahara Desert towards Turkey. At 13 airports in Turkey, dust haze and widespread dust were seen during different occasions in this period and caused the observation of so-called "Blowing dust events." This cyclone blew dust towards the Cappadocia airport, and the prevailing visibility decreased to 3800 m, making it the lowest value measured during the transition of this cyclone. In this study, Aviation Routine Weather Report (Metar) and Aviation Selected Special Weather Report (Speci) observations of airports in North Africa and Turkey were evaluated for the period between April 3 and April 11, 2013. With this cyclone the prevailing visibility at Benina Airport in Libya decreased to 50 m on April 6, 2013. This study aims to evaluate long-distance dust transport's effects on meteorological visibility at airports in Turkey and examine the episodic changes of PM10 values measured by air quality monitoring stations. Hybrid Single Particle Lagrangian Integrated Trajectory (HYSPLIT) model outputs were used to determine the trajectories of long-distance dust particles. Powder red, green, and blue (RGB) and Moderate Resolution Imaging Spectroradiometer (MODIS) satellite images, Cloud-Aerosol LIDAR Infrared Pathfinder Satellite Observations (CALIPSO) images, the Barcelona Supercomputing Center-Dust Regional Atmosphere Model (BSC-DREAM8b) outputs, and Global Forecast System (GFS) synoptic maps were used for analysis. In addition, PM10 values obtained from air quality monitoring stations were examined. According to the data obtained from the CALIPSO images, the dust concentration on the Eastern Mediterranean reaches up to 5 km. The episodic values obtained from certain air quality measurement stations are Adana 701, Gaziantep 629, Karaman 900, Nevsehir 1343, and Yozgat 782 µg/m3 on an hourly average.

Expanding the phenotypic landscape of Gaucher disease type 3c with a novel entity - Transient neonatal cholestasis.

Gaucher disease (GD) is the most frequent lysosomal storage disorder due to biallelic pathogenic variants in GBA gene. Only homozygous D409H variant has been associated with the cardiovascular phenotype which is also known as Gaucher disease type 3c. In this descriptive study, we presented phenotypic heterogeneity and a novel clinical finding among 13 patients with GD type 3c. Patients presented with varying degrees of cardiac valve and/or aortic calcifications (84,6%) and corneal opacities (76,9%) in addition to visceral (100%), hematological (92,3%), neurological (92,3%), and skeletal (30%) manifestations. Also, cervical dystonia (38,4%) and psychiatric disorders (46,1%) were not infrequent entities with respect to neurological involvement in GD type 3c. In this report, we highlight transient neonatal cholestasis (38,4%) as a novel finding in GD type 3c. Neonatal cholestasis is a finding associated with Gaucher type 2, but transient neonatal cholestasis has not been reported in GD patients, so far. The clinical features of GD type 3c are highly heterogeneous, from disease severity or age of onset to disease progression. Also, we concluded that phenotypic spectrum may be associated with age at onset of clinical symptoms. As, patients presenting in infancy or childhood had mainly visceral and hematological involvement and patients presenting in adolescence and adulthood had mainly cardiac, neurological involvement, and psychiatric behavioral disorders. Identifying the heterogeneous clinical course of these patients in this fatal disease, may lead a sufficient understanding of the pathophysiology which will enable targeted therapeutic interventions.

The relationship between PM10 and meteorological variables in the mega city Istanbul.

PM10, one of the air pollutants, occurs regularly in Istanbul during the winter months, namely in December, January, and February. PM10 pollutant is affected by numerous factors. Among these factors are various meteorological variables and climatological factors. This article aims to determine the relationship between PM10 and meteorological variables (wind speed, wind direction, temperature, and relative humidity) and to interpret these results. PM10 and meteorological data were examined between 2011 and 2018. To determine the relationship, multiple linear regression, Pearson's correlation coefficient (PCC), Spearman's rank correlation, Kendall Tau correlation, autocorrelation function (ACF), cross-correlation function (CCF), and visuals were determined using the R program (open-air) packages. In the study, the relationship between wind, temperature, and relative humidity with PM10 was determined, and it was observed that the PM10 concentration was maximum between January and February. PM10 concentrations have a positive relationship with relative humidity and wind direction, while a negative relationship with wind speed and temperature was observed. The correlation values for relative humidity and temperature were found to be 0.01 and - 0.15, respectively. Furthermore, the relationship between wind speed and PM10 was calculated from multiple linear regression model, and the estimated value was - 0.12 while looking at the wind direction value, it was approximately 0.03.

Uterine arcuate artery calcification as a potential marker of cardiovascular risk-a preliminary study.

OBJECTIVE: Atherosclerotic cardiovascular disease is the most common cause of death in postmenopausal women. As this is a progressive disease, it is important to identify markers at an early stage during the subclinical period. Arterial calcifications are an indicator of overall atherosclerotic disease and therefore may be used as a marker for the estimation of future atherosclerotic cardiovascular events. The aims of this study are to investigate the relationship between uterine myometrial calcification (UMC) and carotid artery intima-media thickness (CIMT) and to evaluate whether UMC can be a predictive marker for the estimation of future atherosclerotic cardiovascular risk in asymptomatic postmenopausal women. METHODS: In this cross-sectional study, we assessed 81 postmenopausal women without gynecological complaints for cardiovascular risk factors, UMC, and CIMT. Participants were divided into two risk groups according to their cardiovascular risk factors. The level of UMC was determined using a new scoring system, which was based on transvaginal ultrasonography. Demographic, clinical, and laboratory parameters, UMC scores, and measurements of CIMT were evaluated. RESULTS: A moderately positive correlation was detected between CIMT and UMC scores ( r = 0.62). There was a significant relationship between UMC scores and atherosclerotic cardiovascular risk; the risk of atherosclerosis was 15.4 times higher (OR: 15.4, 95% CI: 5.1-46.8; P = 0.001) in participants with a high UMC score (≥2). According to the multivariable logistic regression model adjusted by age and duration of menopause, the risk of cardiovascular atherosclerosis increased 27.8 fold for those with CIMT of 0.075 or greater (OR: 27.8, 95% CI: 5.3-147.1; P = 0.001) and 9.2 fold for those with a UMC score of 2 or greater (OR: 9.2, CI: 1.22-69.3; P = 0.032). CONCLUSIONS: The presence of UMC has been identified as an independent predictive factor for atherosclerotic risk. Accordingly, considering UMC as an atherosclerotic cardiovascular risk factor may provide an opportunity to identify cardiovascular disease in asymptomatic postmenopausal women. When UMC is detected, women should be assessed for cardiovascular risk.

Analysing of atmospheric conditions and their effects on air quality in Istanbul using SODAR and CEILOMETER.

In this study, first, air pollution that is caused by the air pollutants' concentration exceeding the limit value in Istanbul between 2017 and 2020 were analysed. In addition to this analysis, the effects of meteorological parameters on pollution were also examined within the same period of time. Second, for a 14-day period during which the concentration values of the air pollutants were calculated higher than the standards, therefore, were selected as an episode. In that respect, measurements of both pollutant and meteorological parameters were obtained from air quality monitoring stations. The Weather Research and Forecasting (WRF) model was used to examine the changes of meteorological parameters in the surface and upper atmospheric levels. The cross-correlation function (CCF) was performed together with both air quality monitoring station and the WRF model output data to examine the effects of temporal changes in meteorological parameters on air pollutant concentrations on a temporal scale. In addition, some meteorological parameters were obtained from remote sensing systems (SODAR and Ceilometer). Finally, with the help of the trajectory analysis model, it was determined whether the pollutant parameters were transported or not. Consequently, within a 3-year period, the most critical parameters in terms of pollution throughout the city were assessed as NO2 and PM10. Moreover, low wind speeds and high pressure values during the episode prevented the dispersion of pollutants and caused air pollution in Istanbul.

Increased Circulating Copeptin Levels Are Associated with Vaso-Occlusive Crisis and Right Ventricular Dysfunction in Sickle Cell Anemia.

OBJECTIVE: Vaso-occlusive crisis (VOC) is a common clinical manifestation of sickle cell anemia (SCA) and is associated with increased proinflammatory mediators. Copeptin is the C-terminal part of the prohormone for provasopressin and seems clinically relevant in various clinical conditions. Right ventricular (RV) dysfunction significantly appears in SCA patients due to pulmonary hypertension. This study aimed to investigate the association of copeptin levels in VOC patients and evaluate RV dysfunction. MATERIALS AND METHODS: A total of 108 patients were enrolled in the study. Twenty-eight SCA patients in steady state (30.2 ± 0.9 years), 25 SCA patients in VOC (36.8 ± 11.8 years), and 55 healthy individuals (31.9 ± 9.4 years) with HbAA genotype were included. Clinical, echocardiographic, and laboratory data were recorded. ELISA was used for the determination of serum levels of copeptin. RESULTS: VOC patients had significantly higher copeptin level compared both with controls and SCA subjects in steady state (22.6 ± 13.0 vs. 11.3 ± 5.7 pmol/L, 22.6 ± 13.0 vs. 12.4 ± 5.8 pmol/L, p = 0.009 for both). Additionally, the copeptin level was significantly higher in SCA patients with RV dysfunction than those without RV dysfunction (23.2 ± 12.2 vs. 15.3 ± 9.5 pmol/L, p = 0.024). Multiple logistic regression analysis revealed that high-sensitivity C-reactive protein and copeptin levels were found to be associated with VOC. CONCLUSION: This study showed that copeptin and hs-CRP levels were increased in patients with VOC, and it was found that RV dysfunction was more common in SCA patients with VOC than in the control group. Copeptin can be considered for use as a potential biomarker in predicting VOC crisis in SCA patients and in the early detection of patients with SCA who have the potential to develop RV dysfunction.

Influences of Elastic Foundations and Material Gradient on the Dynamic Response of Polymer Cylindrical Pipes Patterned by Carbon Nanotube Subjected to Moving Pressures.

Composite materials are frequently used in the construction of rail, tunnels, and pipelines as well as in the construction of aircraft, ships, and chemical pipelines. When such structural elements are formed from new-generation composites, such as CNT-reinforced composites, and their interaction with the ground, there is a need to renew the dynamic response calculations under moving pressures and to create new mathematical solution methods during their design. The aim of this study was to analyze the influences of elastic foundations (EFs) and material gradient on the dynamic response of infinitely long carbon nanotube (CNT)-based polymer pipes under combined static and moving pressures. The CNT-based polymer pipes resting on the EFs were exposed to the axial and moving pressures. The uniform and heterogeneous reinforcement distributions of CNTs, which varied linearly throughout the thickness of polymer pipes, were considered. After setting the problem, the fundamental equations derived to find new analytical expressions for dynamic coefficients and critical velocity, which are dynamic characteristics of cylindrical pipes reinforced by the uniform and linear distributions of CNTs, were solved in the framework of the vibration theory. Finally, numerical computations were performed to examine the effects of EFs on the critical parameters depending on the characteristics of the pipes, the speed of moving pressures, the shape of the distribution of CNTs, and the change in volume fractions.

Modeling and Solution of Large Amplitude Vibration Problem of Construction Elements Made of Nanocomposites Using Shear Deformation Theory.

The main purpose of the study is to investigate the vibration behaviors of carbon nanotube (CNT) patterned double-curved construction elements using the shear deformation theory (SDT). After the visual and mathematical models of CNT patterned double-curved construction elements are created, the large amplitude stress-strain relationships and basic dynamic equations are derived using the first order shear deformation theory (FSDT). Then, using the Galerkin method, the problem is reduced to the nonlinear vibration of nanocomposite continuous systems with quadratic and cubic nonlinearities. Applying the Grigolyuk method to the obtained nonlinear differential equation, large-amplitude frequency-amplitude dependence is obtained. The expressions for nonlinear frequencies of homogenous and inhomogeneous nanocomposite construction members such as plates, panels, spherical and hyperbolic-paraboloid (hypar) shells in the framework of FSDT are found in special cases. The accuracy of the results of the current study has been confirmed by comparing them with the reliable results reported in the literature. Original analyses are carried out to examine the effects of nonlinearity, CNT patterns and volume fraction changes on frequencies in the framework of shear deformation and classical shell theories.

Prognostic performance of copeptin among patients with acute decompensated heart failure.

BACKGROUND: In heart failure (HF), various biomarkers have been established for prognosis. However, little is known about the relevance of copeptin measurements to HF. This study aimed to explore the prognostic value of copeptin for predicting cardiovascular (CV) death or HF-related re-hospitalisation in patients with acute decompensated HF. MATERIALS AND METHODS: We prospectively enrolled 155 consecutive patients with acute signs and symptoms of HF. Plasma copeptin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured at admission. Patients were monitored for 90 days regarding the composite endpoint of CV death or acute HF-related re-hospitalisation. RESULTS: Of the 155 patients enrolled, 40 reached the endpoint, and 115 were in a stable condition during follow-up. Patients who reached an adverse endpoint showed higher NT-proBNP and copeptin levels compared to patients in stable condition. Receiver operating characteristic curve analysis revealed that the area under curve of copeptin 0.844 (95% CI, 0.753-0.935) was superior to that of NT-proBNP 0.809 (95% CI, 0.729-0.890) for the prediction of adverse events within 90 days. Meanwhile, compared to the group with lower copeptin levels (<34 pmol/L), patients with higher copeptin levels (≥34 pmol/L) were at a 10.672-times higher risk of CV death or acute HF-related re-hospitalisation. Multivariate Cox proportional hazards regression analysis revealed that increased copeptin level was a significantly independent predictor of adverse events (risk ratio, 1.051; 95% CI, 1.020-1.083; p < 0.001). CONCLUSION: Copeptin was found to be a strong, novel marker for predicting CV death or HF-related re-hospitalisation in patients with acute decompensated HF.

Frailty Significantly Associated with a Risk for Mid-term Outcomes in Elderly Chronic Coronary Syndrome Patients: a Prospective Study.

INTRODUCTION: Frailty is a condition of elderly characterized by increased vulnerability to stressful events. Frail patients are more likely to have adverse events. The purposes of this study were to define frailty in patients aged ≥ 70 years with chronic coronary syndrome (CCS) and to evaluate mortality and prognostic significance of frailty in these patients. METHODS: We included 99 patients, ≥ 70 years old (mean age 74±5.3 years), with diagnosis of CCS. They were followed-up for up to 12 months. The frailty score was evaluated according to the Canadian Study of Health and Aging (CSHA). All patients were divided as frail or non-frail. The groups were compared for their characteristics and clinical outcomes. RESULTS: Fifty patients were classified as frail, and 49 patients as non-frail. The 12-month Major Adverse Cardiac Events (MACE) rate was 69.4% in frail patients and 20% in non-frail patients. Frailty increases the risk for MACE as much as 3.48 times. Two patients died in the non-frail group and 11 patients died in the frail group. Frailty increases the risk for death as much as 6.05 times. When we compared the aforementioned risk factors by multivariate analysis, higher CSHA frailty score was associated with increased MACE and death (relative risk [RR] = 22.94, 95% confidence interval [CI] 3.33-158.19, P=0.001, for MACE; RR = 7.41, 95% CI 1.44-38.03, P=0.016, for death). CONCLUSION: Being a frail elderly CCS patient is associated with worse outcomes. Therefore, frailty score should be evaluated for elderly CCS patients as a prognostic marker.

Predictive value of plasma copeptin level for diagnosis and mortality of pulmonary embolism.

OBJECTIVE: Early diagnosis and risk stratification may provide a better prognosis in pulmonary embolism (PE). Copeptin has emerged as a valuable predictive biomarker in various cardiovascular diseases. The aim of this study was to determine the levels of copeptin in patients with acute PE and to evaluate its relationship with disease severity and PE-related death. METHODS: Fifty-four patients and 60 healthy individuals were included in this study. Copeptin concentrations and right ventricular dysfunction were analyzed. The correlation between copeptin levels and hemodynamic and echocardiographic parameters was examined. After these first measurements, patients were evaluated with PE-related mortality at the one-year follow-up. RESULTS: The copeptin levels were higher in PE patients than in the control group (8.3 ng/mL vs 3.8 ng/mL, p<0.001). Copeptin levels were found to be significantly higher in patients with PE-related death and right ventricular dysfunction (10.2 vs 7.5 ng/ml, p=0.001; 10.5 vs 7.5 ng/ml, p=0.002, respectively). When the cut-off value of copeptin was ≥5.85, its sensitivity and specificity for predicting PE were 71.9% and 85.0%, respectively (AUC=0.762, 95% CI=0.635-0.889, p<0.001). CONCLUSIONS: The copeptin measurement had moderate sensitivity and specificity in predicting the diagnosis of PE, and the copeptin level was significantly higher in patients with PE-related death at the one-year follow-up. Copeptin may be a useful new biomarker in predicting diagnosis, risk stratification, and prognosis of PE.

Predictive value of plasma copeptin level for diagnosis and mortality of pulmonary embolism

SUMMARY OBJECTIVE: Early diagnosis and risk stratification may provide a better prognosis in pulmonary embolism (PE). Copeptin has emerged as a valuable predictive biomarker in various cardiovascular diseases. The aim of this study was to determine the levels of copeptin in patients with acute PE and to evaluate its relationship with disease severity and PE-related death. METHODS: Fifty-four patients and 60 healthy individuals were included in this study. Copeptin concentrations and right ventricular dysfunction were analyzed. The correlation between copeptin levels and hemodynamic and echocardiographic parameters was examined. After these first measurements, patients were evaluated with PE-related mortality at the one-year follow-up. RESULTS: The copeptin levels were higher in PE patients than in the control group (8.3 ng/mL vs 3.8 ng/mL, p<0.001). Copeptin levels were found to be significantly higher in patients with PE-related death and right ventricular dysfunction (10.2 vs 7.5 ng/ml, p=0.001; 10.5 vs 7.5 ng/ml, p=0.002, respectively). When the cut-off value of copeptin was ≥5.85, its sensitivity and specificity for predicting PE were 71.9% and 85.0%, respectively (AUC=0.762, 95% CI=0.635-0.889, p<0.001). CONCLUSIONS: The copeptin measurement had moderate sensitivity and specificity in predicting the diagnosis of PE, and the copeptin level was significantly higher in patients with PE-related death at the one-year follow-up. Copeptin may be a useful new biomarker in predicting diagnosis, risk stratification, and prognosis of PE.

RESUMO OBJETIVO: O diagnóstico precoce e a estratificação de risco podem proporcionar um melhor prognóstico em casos de embolia pulmonar (EP). A copeptina surgiu como um valioso biomarcador preditivo de várias doenças cardiovasculares. O objetivo deste estudo é determinar os níveis de copeptina em pacientes com EP aguda e avaliar a sua relação com a severidade da doença e mortes relacionadas à EP. MÉTODOS: Um total de 54 pacientes e 60 indivíduos saudáveis foram incluídos neste estudo. As concentrações de copeptina e disfunções ventriculares direitas foram analisadas. A correlação entre os níveis de copeptina e parâmetros ecocardiográficos e hemodinâmicos foi examinada. Após essas primeiras medições, os pacientes foram avaliados em relação à mortalidade relacionada à EP após um ano. RESULTADOS: Os níveis de copeptina foram maiores em pacientes com EP do que no grupo de controle (8,3 ng/mL vs 3,8 ng/mL, p<0,001). Os níveis de copeptina eram significativamente maiores em pacientes com mortes relacionadas à EP e disfunção ventricular direita (10,2 vs 7,5 ng/ml, p=0,001; 10,5 vs 7,5 ng/ml, p=0,002, respectivamente). Com um valor de corte ≥5,85 para a copeptina, sua sensibilidade e especificidade preditivas para EP foram 71,9% e 85,0%, respectivamente (AUC=0,762, 95% IC=0,635 - 0,889, p<0,001). CONCLUSÃO: A medição da copeptina teve sensibilidade e especificidade preditivas moderadas para o diagnóstico de EP, e o nível de copeptina foi significativamente maior em pacientes com mortes relacionadas à EP após um ano. A copeptina pode ser um novo biomarcador preditivo útil para o diagnóstico, a estratificação de risco e o prognóstico de PE.

Frailty significantly associated with a risk for mid-term outcomes in elderly chronic coronary syndrome patients: a prospective study

Abstract Introduction: Frailty is a condition of elderly characterized by increased vulnerability to stressful events. Frail patients are more likely to have adverse events. The purposes of this study were to define frailty in patients aged ≥ 70 years with chronic coronary syndrome (CCS) and to evaluate mortality and prognostic significance of frailty in these patients. Methods: We included 99 patients, ≥ 70 years old (mean age 74±5.3 years), with diagnosis of CCS. They were followed-up for up to 12 months. The frailty score was evaluated according to the Canadian Study of Health and Aging (CSHA). All patients were divided as frail or non-frail. The groups were compared for their characteristics and clinical outcomes. Results: Fifty patients were classified as frail, and 49 patients as non-frail. The 12-month Major Adverse Cardiac Events (MACE) rate was 69.4% in frail patients and 20% in non-frail patients. Frailty increases the risk for MACE as much as 3.48 times. Two patients died in the non-frail group and 11 patients died in the frail group. Frailty increases the risk for death as much as 6.05 times. When we compared the aforementioned risk factors by multivariate analysis, higher CSHA frailty score was associated with increased MACE and death (relative risk [RR] = 22.94, 95% confidence interval [CI] 3.33-158.19, P=0.001, for MACE; RR = 7.41, 95% CI 1.44-38.03, P=0.016, for death). Conclusion: Being a frail elderly CCS patient is associated with worse outcomes. Therefore, frailty score should be evaluated for elderly CCS patients as a prognostic marker.

Determination of the effects of cryoablation for atrial fibrillation on esophageal functions.

OBJECTIVE: Periesophageal vagal plexus injury is a complication of cryoablation for atrial fibrillation (AF). The aim of this study is to investigate the effect of cryoablation on esophageal functions and to determine the relationship between esophageal temperature and esophageal motility. METHODS: Twenty patients with symptomatic paroxysmal AF who underwent cryoablation were included in this study. The lowest cryoballoon temperature for each pulmonary vein (PV) was recorded. Esophageal temperature was measured using an esophageal probe during each cryoapplication. Esophageal manometry was performed before the procedure and one day after the procedure for each patient in order to assess the esophageal functions. RESULTS: During the procedure, the highest esophageal temperature change was found in the left-side PVs in 13 patients (65%) and in the right-side PVs in seven patients (35%). No correlation was found between the lowest cryoballoon temperature and esophageal temperature change (r=0.22, p=0.05). It was detected that the lower esophageal sphincter pressure and esophageal contraction amplitude pressure decreased after the procedure (before: 19.7±9.3 mm Hg, after: 14.3±4.9 mm Hg, p=0.001; before: 84.5±28.3 mm Hg, after: 72.7±34.3 mm Hg, p=0.005, respectively). Five patients (25%) developed gastrointestinal symptoms after the procedure. CONCLUSION: During cryoablation, esophageal temperature measurement can be performed to reduce the probability of esophageal injury. Cryoablation affects esophageal motility, and esophageal manometry can be performed to detect esophageal motility impairments in patients with gastrointestinal symptoms.

Predictors of the paroxysmal atrial fibrillation recurrence following cryoballoon-based pulmonary vein isolation: Assessment of left atrial volume, left atrial volume index, galectin-3 level and neutrophil-to-lymphocyte ratio.

BACKGROUND: Cryoballoon-based pulmonary vein isolation (PVI) is a treatment option for atrial fibrillation (AF). Left atrial volume (LAV) and left atrial volume index (LAVi) are important parameters for long term success of PVI. Galectin-3 (Gal-3) and neutrophil to lymphocyte ratio (N/L ratio) are biomarkers to demonstrate the cardiac fibrosis and remodelling. METHODS: 50 patients with symptomatic PAF despite ≥1 antiarrhythmic drug(s), who underwent PVI were enrolled. LAV, LAVi, Gal-3 and N/L ratio were calculated before ablation and after ablation at 6 and 12 months. According to AF recurrence patients were divided into two groups, recurrent AF (n = 14) and non-recurrent AF (n = 36). RESULTS: In both groups (recurrent and non-recurrent), initial and 12 months follow-up LAV values were 41.39 ±â€¯18.13 ml and 53.24 ±â€¯22.11 ml vs 48.85 ±â€¯12.89 ml and 42.08 ±â€¯13.85 (p = 0.037). LAVi were 20.9 ±â€¯8.91 ml/m2 and 26.85 ±â€¯11.28 ml/m2 vs 25.36 ±â€¯6.21 and 21.87 ±â€¯6.66 (p = 0.05) for recurrent and non-recurrent AF groups, respectively. In both groups PVI had no significant effect on serum Gal-3 levels and N/L ratio during 12 months follow-up. The comparison between two groups at the end of 12th month showed Gal-3 values of 6.66 ±â€¯4.09 ng/ml and 6.02 ±â€¯2.95 ng/ml (p = 0.516), N/L ratio values of 2.28 ±â€¯1.07 103/µl and 1.98 ±â€¯0.66 103/µl (p = 0.674). CONCLUSION: LAV and LAVi are useful to predict the remodelling of the left atrium and AF recurrence after cryoballoon-based PVI. However, biomarkers such as Gal-3 and N/L ratio are not associated with AF recurrence.

The frequency of diastolic dysfunction in patients with sarcoidosis and it's relationship with HLA DRB1* alleles.

BACKGROUND: Impaired systolic function is common in sarcoidosis however the frequency of diastolic dysfunction (DD) and it's possible genetic basis has not been fully elucidated yet. The aim of this study is to evaluate the frequency of left ventricular DD(LVDD) and right ventricular DD(RVDD) and it's possible relationship between Human Leukocyte Antigen(HLA)-DRB1* alleles in patients with sarcoidosis. METHODS: Seventy seven patients (51 females, mean age 41.1±8.2yrs) without known sarcoid related or any other structured heart disease and 77 healthy controls with a similar age and gender (38.7±7.8yrs,51 females) were included in the case control study. DD was diagnosed with echocardiography. RVDD was defined as early(E)/late(A) ratio<1 or >2 on tricuspit valve. LVDD was defined as E/A ratio<1 or >2 on mitral valve, with isovolumetric relaxation time(IVRT)>90 miliseconds(msn) or deceleration rate of early diastolic flow(Edec)>220msn respectively. All patients were HLAtyped with the Sequence Specific Oligonucleotide Probe(SSOP) method. RESULTS: The frequencies of LVDDs and RVDDs were significantly higher in sarcoidosis patients than the controls (26.0% vs. 2.6% for LVDD; and 42.9% vs. 18.2% for RVDD)(p<0.05). No significant difference was found in patients according to the presence of RVDD and LVDD in terms of age, gender or respiratory function test parameters. Although the frequency of HLA DRB1* alleles were comparable among patients with RVDD, HLA DRB1*14 alleles were more frequent in patients with LVDD. CONCLUSIONS: Biventricular DD is common in patients with sarcoidosis without manifest cardiac involvement. HLA DRB1*14 allele seems to be related with LVDD in this study population.

Frailty significantly impairs the short term prognosis in elderly patients with heart failure.

BACKGROUND: Frailty is a condition of elderly characterized by increased vulnerability to stressful events with high risk of adverse outcomes. The purpose of this study was to evaluate the association between frailty and adverse outcomes including death and hospitalization due to heart failure in elderly patients. METHODS: We included patients aged ≥ 65 years with the diagnosis of heart failure. The clinical and laboratory data, echocardiography and ECGs were recorded. Additionally, the frailty scores of the patients were evaluated according to Canadian Study of Health and Aging. All the patients were divided as frail or non-frail. The groups were compared for their characteristics and the occurrence of clinical outcomes. RESULTS: We included 86 eligible patients. The median follow-up time was four months. The mean age was 75 ± 6.5 years. Of these 86 patients, 17 (19.7%) patients encountered an event (death and/or hospitalization). Nine patients (10.4%) died during follow-up. Thirty patients (34.9%) were considered frail. Among the demographic, clinical and laboratory data, only total protein and albumin levels were found to be lower in frail patients (total protein level: 6.8 ± 0.6 g/dL in non-frails, 6.5 ± 0.9 g/dL in frails, P = 0.05; albumin level: 3.8 ± 0.4 g/dL in non-frails, 3.4 ± 0.6 g/dL in frails, P = 0.001). In multivariate analysis, frailty was found to be strongly associated with clinical outcomes in short term. CONCLUSIONS: Being frail in an elderly heart failure patient is associated with death and/or hospitalization due to heart failure in short term. Therefore, frailty score should be evaluated for all elderly heart failure patients as a prognostic marker.