Sarcopenia, frailty prevalence, and related factors in patients with stroke: A cross-sectional analytical study from Turkey.

BACKGROUND: Sarcopenia and frailty may develop at varying rates depending on the metabolic, structural, and functional changes in the muscle structure after stroke. OBJECTIVE: To evaluate the prevalence of sarcopenia and frailty in patients with stroke and affecting clinical parameters. METHODS: This was a cross-sectional and analytical study. Twenty-six (49.1%) women and 27 men (50.9%) with stroke with an average age of 60.2 ± 10.3 (median = 62) years were included in the study. To evaluate physical performance, balance, and mobility, we used the 4-meter walk test (4-MWT), timed up and go test, chair sit and stand test, and the Berg Balance Scale (BBS). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. The SARC-F scale was used for sarcopenia. RESULTS: The average stroke duration was 21.6 ± 18.2 months. Prefrailty was present in 14 (26.4%) patients, frailty was present in 34 (64.2%) patients, and two (3.8%) patients were normal. Sarcopenia was detected in 28 (52.8%) patients. According to handgrip strength, the prevalence of low muscle strength was 17% (n= 9). In the sarcopenic group, female sex (p= 0.005) was more frequent, 4-MWT was longer (p= 0.003), chair stand test results were lower (p< 0.001), the clinical frailty scale (CFS) was higher (p< 0.001), fall risk was higher compared with the BBS (p< 0.001), there was lower HG strength (p= 0.009), lower malnutrition scores (PNI, prognostic nutritional index, p< 0.001), and lower lymphocyte counts (p= 0.037). EAT-10 scores and dysphagia presence (p= 0.026), the presence of malnutrition (p< 0.021) and Nottingham Health Profile score (p< 0.001) were higher in the sarcopenic group. CONCLUSION: Sarcopenia and frailty frequently develop in patients with chronic stroke, with low lymphocyte counts, physical performance, muscle strength, and mobility and balance scores, and it is associated with poor prognostic factors including high disease severity, dysphagia, malnutrition, risk of falling, and poor quality of life.

Examination of SARS-CoV-2 RNA in joint synovial fluid of patients with COVID-19 and acute knee arthritis.

BACKGROUND: It has not yet been fully established that there is coronavirus disease 2019 (COVID-19) involvement in the synovial fluid and it remains a topic of debate. OBJECTIVE: The aim of this study was to evaluate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in knee joint synovial fluid of patients with COVID-19. METHODS: This retrospective study was conducted with an initial screening of patients who were admitted to a tertiary pandemic hospital due to COVID-19 symptoms, and underwent treatment for COVID-19 between March and June 2020. RESULTS: A total of 2476 patients were hospitalized or received treatment for a possible diagnosis of COVID-19. While the RT-PCR test was positive in 318 patients (12.8%), 2158 (87.2%) were computed tomography positive but reverse transcription-polymerase chain reaction (RT-PCR) negative. Twelve patients were consulted due to acute joint effusion. Of five patients with knee joint effusion and a positive RT-PCR test, the synovial tissue RT-PCR test was positive in only one patient. CONCLUSION: This paper is the first to show the presence of SARS-CoV-2 in synovial fluid. This can be considered of importance for the determination and elimination of the route of transmission, thereby preventing further development and spread of the disease.

Baseline Characteristics of a Patient Cohort and Predictors of In-hospital MORtality in CORonary Care Units (MORCOR-TURK) Trial in Türkiye.

OBJECTIVE: The MORtality in CORonary Care Units in Türkiye (MORCOR-TURK) trial is a national registry evaluating predictors and rates of in-hospital mortality in coronary care unit (CCU) patients in Türkiye. This report describes the baseline demographic characteristics of patients recruited for the MORCOR-TURK trial. METHODS: The study is a multicenter, cross-sectional, prospective national registry that included 50 centers capable of 24-hour CCU service, selected from all seven geographic regions of Türkiye. All consecutive patients admitted to CCUs with cardiovascular emergencies between September 1-30, 2022, were prospectively enrolled. Baseline demographic characteristics, admission diagnoses, laboratory data, and cardiovascular risk factors were recorded. RESULTS: A total of 3,157 patients with a mean age of 65 years (range: 56-73) and 2,087 (66.1%) males were included in the analysis. Patients with arterial hypertension [1,864 patients (59%)], diabetes mellitus (DM) [1,184 (37.5%)], hyperlipidemia [1,120 (35.5%)], and smoking [1,093 (34.6%)] were noted. Non-ST elevation myocardial infarction (NSTEMI) was the leading cause of admission [1,187 patients (37.6%)], followed by ST elevation myocardial infarction (STEMI) in 742 patients (23.5%). Other frequent diagnoses included decompensated heart failure (HF) [339 patients (10.7%)] and arrhythmia [272 patients (8.6%)], respectively. Atrial fibrillation (AF) was the most common pathological rhythm [442 patients (14%)], and chest pain was the most common primary complaint [2,173 patients (68.8%)]. CONCLUSION: The most common admission diagnosis was acute coronary syndrome (ACS), particularly NSTEMI. Hypertension and DM were found to be the two leading risk factors, and AF was the most commonly seen pathological rhythm in all hospitalized patients. These findings may be useful in understanding the characteristics of patients admitted to CCUs and thus in taking precautions to decrease CCU admissions.

Fractal characteristics of the trabecular pattern of the mandible in patients with renal transplantation.

OBJECTIVE: In this study, we examined the mandibular trabecular bone structures by performing fractal dimension (FD) analysis in patients who underwent renal transplantation (RTx). METHODS: Our study is an observational study with 69 RTx patients and 35 control group patients. The mean FD values of the patient and control groups were calculated and compared. In addition, biochemical parathyroid hormone (PTH), serum calcium, phosphorus, alkaline phosphatase (ALP), and vitamin-D parameters and FD values of both groups were analyzed. RESULTS: FD values were significantly lower in the patient group than in the healthy group (p < .05). In the RTx group compared to the control group, ALP (90.71 ± 34.25-66.54 ± 16.8, respectively) (p < .001) and PTH (75.76 ± 38.01-38.17 ± 12.39, respectively) (p < .001) values were higher. There was a positive correlation between the FD values and ALP (rspearman  = .305, p = .011) and a negative correlation between FD values and vitamin-D (rspearman  = .287, p = .017) of patients with RTx. CONCLUSION: FD values were found to be lower in patients who underwent RTx compared to the control group. It should be considered that FD analysis can be a method that can be used to evaluate trabecular bone structure in patients undergoing RTx.

Different Cardio-Selective ß-Blockers and the Prevention of Exaggerated Blood Pressure Response During Exercise: A Retrospective Cross-Sectional Study.

OBJECTIVE: The aim of this study was to analyze the role of various ß-blockers in managing exercise-induced blood pressure escalations, referred to as exaggerated blood pressure response (eBPR). Despite the importance of this phenomenon, there is limited data on the efficacy of ß-blockers in controlling eBPR. METHOD: Our retrospective cohort for this study comprised 2,803 individuals who underwent treadmill tests from January 2016 to February 2018. A further subgroup analysis of 1,258 patients receiving ß-blocker treatment was performed to evaluate the influence of different ß-blockers on eBPR. RESULTS: The results demonstrated that ß-blockers play a significant role in mitigating the occurrence of eBPR (P = 0.026), irrespective of the specific type of ß-blocker. Additionally, no significant variance was observed in the development of eBPR among the different ß-blocker groups (P = 0.532 for systolic blood pressure (BP); P = 0.068 for diastolic BP). This finding remained consistent even among the 992 hypertensive patients, where no notable association was found between the type of ß-blocker and the development of eBPR (P = 0.736 for systolic BP; P = 0.349 for diastolic BP). It is noteworthy that patients using ß-blockers had unique clinical and demographic attributes. CONCLUSION: Our study suggests that ß-blockers can potentially deter the development of eBPR during physical activity, a benefit that is consistent across all types of ß-blockers. The study sheds light on prospective randomized studies on the use of eBPR as a new treatment target.

FIB-4 liver fibrosis index correlates with aortic valve sclerosis in non-alcoholic population.

AIM: Hepatic fibrosis, a progressive scarring of liver tissue, is commonly caused by non-alcoholic fatty liver disease (NAFLD), which increases the risk of cardiovascular disease. The Fibrosis-4 (FIB-4) index is a non-invasive tool used to assess liver fibrosis in patients with NAFLD. Aortic valve sclerosis (AVS), a degenerative disorder characterized by thickening and calcification of valve leaflets, is prevalent in the elderly and associated with increased cardiovascular morbidity and mortality. Recent studies have suggested that AVS may also be linked to other systemic diseases such as liver fibrosis. This study aimed to investigate the relationship between the FIB-4 index and AVS in a non-alcoholic population, with the hypothesis that the FIB-4 index could serve as a potential marker for AVS. METHOD: A total of 92 patients were included in this study. AVS was detected using transthoracic echocardiography, and patients were divided into groups according to the presence of AVS. The FIB-4 index was calculated for all patients and compared between the groups. RESULTS: A total of 17 (18.4%) patients were diagnosed AVS. Patients with AVS had higher rates of diabetes mellitus, older age, hypertension, angiotensin-converting enzyme inhibitor use, higher systolic blood pressure (BP) and diastolic BP in the office, coronary artery disease prevalence, left atrial volume index (LAVI), left ventricular mass index (LVMI), and late diastolic peak flow velocity (A) compared to those without AVS. Moreover, AVS patients had significantly higher creatinine levels and lower estimated glomerular filtration rate. Remarkably, the FIB-4 index was significantly higher in patients with AVS. In univariate and multivariate analyses, higher systolic BP in the office (OR, 1.044; 95% CI 1.002-1.080, p = .024) and higher FIB-4 index (1.46 ± .6 vs. .91 ± .46, p < .001) were independently associated with AVS. CONCLUSION: Our findings suggest that the FIB-4 index is associated with AVS in non-alcoholic individuals. Our results highlight the potential utility of the FIB-4 index as a non-invasive tool for identifying individuals at an increased risk of developing AVS.

Turkish Real Life Atrial Fibrillation in Clinical Practice: TRAFFIC Study.

BACKGROUND: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and is associated with an increased risk of thromboembolism, ischemic stroke, impaired quality of life, and mortality. The latest research that shows the prevalence and incidence of AF patients in Türkiye was the Turkish Adults' Heart Disease and Risk Factors study, which included 3,450 patients and collected data until 2006/07.The Turkish Real Life Atrial Fibrillation in Clinical Practice (TRAFFIC) study is planned to present current prevalence data, reveal the reflection of new treatment and risk approaches in our country, and develop new prediction models in terms of outcomes. METHODS: The TRAFFIC study is a national, prospective, multicenter, observational registry. The study aims to collect data from at least 1900 patients diagnosed with atrial fibrillation, with the participation of 40 centers from Türkiye. The following data will be collected from patients: baseline demographic characteristics, medical history, vital signs, symptoms of AF, ECG and echocardiographic findings, CHADS2-VASC2 and HAS-BLED (1-year risk of major bleeding) risk scores, interventional treatments, antithrombotic and antiarrhythmic medications, or other medications used by the patients. For patients who use warfarin, international normalized ratio levels will be monitored. Follow-up data will be collected at 6, 12, 18, and 24 months. Primary endpoints are defined as systemic embolism or major safety endpoints (major bleeding, clinically relevant nonmajor bleeding, and minor bleeding as defined by the International Society on Thrombosis and Hemostasis). The main secondary endpoints include major adverse cardiovascular events (systemic embolism, myocardial infarction, and cardiovascular death), all-cause mortality, and hospitalizations due to all causes or specific reasons. RESULTS: The results of the 12-month follow-up of the study are planned to be shared by the end of 2023. CONCLUSION: The TRAFFIC study will reveal the prevalence and incidence, demographic characteristics, and risk profiles of AF patients in Türkiye. Additionally, it will provide insights into how current treatments are reflected in this population. Furthermore, risk prediction modeling and risk scoring can be conducted for patients with AF.

Anxiety disorders and depression are associated with resistant hypertension.

BACKGROUND: Anxiety and depression can adversely affect the prognosis following cardiovascular diseases (CVDs) and may be associated with resistance to hypertension (HT) treatment. A better understanding of the complex biological substratum of resistant HT complicated by depression and anxiety is crucial for designing future primary care strategies. OBJECTIVES: To evaluate the relationship between anxiety and depression and resistant HT, which will help to look at resistant HT from a broader perspective and aid the development of new strategies for diagnosis and treatment. MATERIAL AND METHODS: We used a stratified random sampling method to select HT patients aged 18 and older in primary care setting. A total of 300 consecutive patients with persistent HT who were diagnosed with essential HT and uncontrolled blood pressure (BP) despite antihypertensive therapy were prospectively included in the study. Anxiety and depression were investigated, and scoring was evaluated using the Hospital Anxiety and Depression Scale (HADS). RESULTS: The study included 108 controlled and 91 uncontrolled HT patients. The HADS scales were higher in the controlled HT group compared to the uncontrolled HT group (6 (0-18) compared to 9 (0-20), p = 0.001; 5 (0-17) compared to 7 (0-16), p < 0.001, respectively). Body mass index (BMI) and C-reactive protein (CRP) were also significantly higher in the uncontrolled HT patients compared to the normotensive group. Anxiety was associated with a 2.18 times increased risk of HT and a 1.99 times increased risk of depression. Thus, anxiety and depression predicted resistant HT in both univariate and multivariate analyses. CONCLUSIONS: During the treatment of HT, efforts should be made to improve the psychological and social functions of the patients beyond the primary therapy for control of the disease. As such, we hope to draw attention to the importance of psychological factors, especially anxiety and depression, in any field of medicine related to managing resistant HT.

Presystolic wave as a predictor of interatrial block in patients with supraventricular tachycardia.

The identification of interatrial block (IAB) through electrocardiography (ECG) has been correlated with an elevated likelihood of developing atrial fibrillation (AF) and stroke. IAB is diagnosed by evaluating P-wave prolongation on a surface ECG. The presystolic wave (PSW) is an echocardiographic marker determined by pulse-wave examination of the aortic root during late diastole. As IAB and PSW share similar pathophysiological mechanisms, we speculated that PSW, as a component of the P wave, might be useful in predicting IAB. In the present study, we aimed to determine the relationship between PSW and IAB. Patients with pre-diagnosis of supraventricular tachycardia (SVT) on electrocardiography or rhythm Holter monitoring between January 2021 and December 2022 were included in the study. Surface 12-lead ECG and transthoracic echocardiography (TTE) were performed for the diagnosis of IAB and PSW. Patients were divided into two groups based on the presence of IAB, and PSW was compared between the groups. In total, 104 patients were enrolled in this study. IAB was diagnosed in 16 patients (15.3%) and PSW was detected in 33 patients (31.7%). The PSW was higher in the IAB ( +) group than in the IAB ( -) group (10 patients (71.4%) vs. 23 patients (32.4%), p = 0.008). PSW may be a useful tool for predicting IAB in patients with SVT. Further studies are needed to determine the clinical utility of PSW in the diagnosis and management of IAB.

Modified Glasgow Prognostic Score Predicted High-Grade Intracoronary Thrombus in Acute Anterior Myocardial Infarction.

High-grade intracoronary thrombus (ICT) burden leads to greater myocardial injury following anterior myocardial infarction (MI). The modified Glasgow prohgnostic score (mGPS) is a novel immune-inflammatory index, calculated by using C-reactive protein (CRP) and albumin levels, was shown to have prognostic value in heart diseases. The present study investigated the role of mGPS in predicting high grade ICT in patients with acute anterior MI admitted between February 2017 and March 2020. Blood samples were obtained at admission and mGPS was calculated. The ICT burden was evaluated visually from angiographic images. Patients were divided into 2 groups according to the ICT burden as high and low. A total of 1132 patients were enrolled: a mean age 61 ± 12.4 years and 370 males (32.7%). Serum albumin was lower, whereas mGPS and CRP were higher in high grade ICT group. CRP (odds ratio (OR): 1.404 95% CI: 1.312-1.502; P < .001), albumin (OR: .486; 95% CI: .301-.782 P < .001), and mGPS (0 vs ≥ 1) (OR: 7.391; 95% CI: 3.910-13.972; P < .001) were independent predictors of high-grade ICT burden in the left anterior descending coronary artery. The mGPS is a novel predictor of high-grade ICT burden and may be useful for risk stratification in patients with acute anterior MI.

The efficacy of liraglutide combined with intragastric balloon on weight loss.

OBJECTIVE: Intragastric balloon placement is an effective method for weight reduction. The aim of this study was to evaluate the efficacy of combining liraglutide with intragastric balloon. METHODS: Initially, demographic data of patients such as age, gender, comorbid diseases, adverse events, initial weight, height, body mass index, percent body fat, and waist-hip ratio were collected. Weight, body mass index, percent body fat, and waist-hip ratio were measured in the second, third, fourth, fifth, and sixth months. Then, intragastric balloon was removed and liraglutide was stopped. RESULTS: A total of 50 patients were included in the study, of whom 28 (56%) were in Group A (intragastric balloon) and 22 (44%) were in Group B (plus liraglutide). Weight change at the time of balloon removal was higher in Group B [median weight change 13.8 (7.8 min to 16.8 max) versus 7.9 (4.8 min to 11.8 max); p<0.01]. When the weight, percent body fat, body mass index, and waist-hip ratio changes were compared according to gender, no significant difference was observed in the groups. Comorbid diseases were hypertension in 7 patients (4 in Group A and 3 in Group B) and diabetes in 9 patients (5 in Group A and 4 in Group B). No statistical significance was found. CONCLUSION: Liraglutide has benefits in terms of weight, percent body fat, and body mass index reduction when administered with intragastric balloon.

Novel styryl-thiazole hybrids as potential anti-Alzheimer's agents.

In this study, combining the thiazole and cinnamoyl groups into the styryl-thiazole scaffold, a series of novel styryl-thiazole hybrids (6a-p) was rationally designed, synthesized, and evaluated by the multi-target-directed ligands strategy as potential candidates for the treatment of Alzheimer's disease (AD). Hybrids 6e and 6i are the most promising among the synthesized hybrids since they are able to significantly increase cell viabilities in Aß1-42-exposed-human neuroblastoma cell line (6i at the concentration of 50 µg mL-1 and 6e at the concentration of 25 µg mL-1 resulted in ∼34% and ∼30% increase in cell viabilities, respectively). Compounds 6e and 6i exhibit highly AChE inhibitory properties in the experimental AD model at 375.6 ± 18.425 mU mL-1 and 397.6 ± 32.152 mU mL-1, respectively. Moreover, these data were also confirmed by docking studies and in vitro enzyme inhibition assays. Compared to hybrid 6e and according to the results, 6i also has the highest potential against Aß1-42 aggregation with over 80% preventive activity. The in silico prediction of the physicochemical properties confirms that 6i possesses a better profile compared to 6e. Therefore, compound 6i presents a promising multi-targeted active molecular profile for treating AD considering the multifactorial nature of AD, and it is reasonable to deepen its mechanisms of action in an in vivo experimental model of AD.

Hand-held echocardiography during complex electrophysiologic procedures.

Introduction: Complex electrophysiologic (EP) procedures are time consuming and open to complications. Accurate and rapid recognition of cardiac pathologies is essential before, during, and immediately after such procedures. In this study, we aimed to compare hand-held echocardiography (HHE) with standard echocardiography (SE) to determine whether HHE can be used as a practical and reliable diagnostic tool during such procedures. Methods: One hundred consecutive patients undergoing complex EP procedures and catheter ablation were included in the study. All patients were evaluated with SE or HHE in terms of main cardiac pathologies at the beginning and immediately after the procedure. The diagnostic accuracy and evaluation time of both methods were compared at the beginning and after the procedure. The agreement between both methods was calculated. Results: At the beginning and after the procedure, opening and evaluation times with HHE were significantly shorter than with SE (P<0.001 for all). There was significant agreement between the two methods in the diagnosis of cardiac pathologies (Agreement was 95% for minimal mild aortic regurgitation (AR), 99% for moderate/ severe AR, 93% for minimal/ mild mitral regurgitation (MR), 95% for moderate/ severe MR, 100% for pericardial effusion, and 100% for left ventricular thrombus at the beginning of the procedure). Conclusion: With the use of HHE during complex EP procedures, cardiac pathologies can be diagnosed with similar accuracy as SE. In addition, HHE has a significant advantage over SE in terms of time to diagnosis.

Incorrect Application of Yilmaz-Poli (2022) Initialisation Method in dePater-Mitici 2023 paper entitled "A mathematical framework for improved weight initialization of neural networks using Lagrange multipliers".

In this letter to the editor we report on a methodological error made in the article entitled "A mathematical framework for improved weight initialization of neural networks using Lagrange multipliers" by dePater and Mitici recently appeared in this journal. The error relates to the incorrect application of a weight initialisation method we derived, published last year in this same journal.

Thermal Conductivity and Phase-Change Properties of Boron Nitride-Lead Oxide Nanoparticle-Doped Polymer Nanocomposites.

Thermally conductive phase-change materials (PCMs) were produced using the crosslinked Poly (Styrene-block-Ethylene Glycol Di Methyl Methacrylate) (PS-PEG DM) copolymer by employing boron nitride (BN)/lead oxide (PbO) nanoparticles. Differential Scanning Calorimetry (DSC) and Thermogravimetric Analysis (TGA) methods were used to research the phase transition temperatures, the phase-change enthalpies (melting enthalpy (ΔHm), and crystallization enthalpies (ΔHc)). The thermal conductivities (λ) of the PS-PEG/BN/PbO PCM nanocomposites were investigated. The λ value of PS-PEG/BN/PbO PCM nanocomposite containing BN 13 wt%, PbO 60.90 wt%, and PS-PEG 26.10 wt% was determined to be 18.874 W/(mK). The crystallization fraction (Fc) values of PS-PEG (1000), PS-PEG (1500), and PS-PEG (10,000) copolymers were 0.032, 0.034, and 0.063, respectively. XRD results of the PCM nanocomposites showed that the sharp diffraction peaks at 17.00 and 25.28 °C of the PS-PEG copolymer belonged to the PEG part. Since the PS-PEG/PbO and the PS-PEG/PbO/BN nanocomposites show remarkable thermal conductivity performance, they can be used as conductive polymer nanocomposites for effective heat dissipation in heat exchangers, power electronics, electric motors, generators, communication, and lighting equipment. At the same time, according to our results, PCM nanocomposites can be considered as heat storage materials in energy storage systems.

The relationship between epicardial adipose tissue thickness and coronary artery disease progress.

BACKGROUND: The relationship between epicardial adipose tissue and inflammatory events has been shown in many studies. Because it is an inflammatory process in coronary progression, it is aimed to examine the relationship between coronary artery disease progression and epicardial adipose tissue thickness. MATERIALS AND METHODS: Our research was conducted with 50 patients (33 men, 17 women) who underwent planned or emergency coronary angiography, by evaluating the coronary artery disease progression from the coronary angiography images together with the echocardiographic epicardial adipose tissue thickness measurement. Patients were examined in two groups according to their tissue thickness, 17 patients with less than 0.55 cm were defined as group 1 and 33 patients with ≥ 0.55 were determined as group 2. RESULTS: There was no significant difference between the groups in terms of gender, diabetes, age, hypertension. In addition, a significant relationship was found with epicardial adipose tissue thickness (> 0.5 cm), ejection fraction and smoking in the group with coronary progression. Patients without stenotic changes were found to be statistically significantly lower p < 0.005. CONCLUSION: An independent relationship was found between epicardial adipose tissue and coronary artery progression. In the light of these findings, it can be concluded that epicardial adipose tissue residue is effective in the development of coronary artery stenosis and calcific-atherosclerotic changes in the coronary arteries. In the light of the information obtained, a positive correlation was determined between epicardial adipose tissue thickness and coronary artery disease (Tab. 3, Fig. 2, Ref. 15). Text in PDF www.elis.sk Keywords: coronary artery disease, epicardial adipose tissue, progression.

Non-alcoholic faty liver disease and liver fibrosis score have an independent relationship with the presence of mitral annular calcification.

Non-alcoholic faty liver disease (NAFLD) and liver fibrosis score (FIB 4) are associated with increased mortality from cardiovascular causes. NAFLD and cardiac diseases are different manifestations of systemic metabolic syndrome. In this study, we aimed to reveal the relationship between NAFLD and FIB 4 liver fibrosis scores and mitral annular calcification (MAC). One hundred patients were included in the study. Blood samples and echocardiography measurements were obtained from each subject. The two groups were compared in terms of demographic and echocardiographic characteristics. Thirty-one men and 69 women with a mean age of 48.6 ± 13.1 years were included in the analysis. The patients were divided into two groups as those with MAC (n = 26) and those without (n = 74). The baseline demographic and laboratory data for the two groups were compared. In the group with MAC (+) age, serum creatinine levels, FIB4 and NAFLD Scores; HL, DM rates, angiotensin converting enzyme (ACE) inhibitor and statin usage rates were higher, with statistical significance. NAFLD and FIB 4 liver fibrosis scores have an independent relationship with MAC.

Rationale, Design, and Methodology of the MORCOR-TURK Trial: Predictors of In-hospital MORtality in CORonary Care Patients in Turkey.

BACKGROUND: Coronary care units are sophisticated clinics established to reduce deaths due to acute cardiovascular events. Current data on coronary care unit mortality rates and predictors of mortality in Turkey are very limited. The MORtality predictors in CORonary care units in TURKey (MORCOR-TURK) trial was designed to provide information on the mortality rates and predictors in patients followed in coronary care units in Turkey. METHODS: The MORCOR-TURK trial will be a national, observational, multicenter, and noninterventional study conducted in Turkey. The study population will include coronary care unit patients from 50 centers selected from all regions in Turkey. All consecutive patients admitted to coronary care units with cardiovascular diagnoses between 1 and 30 September 2022 will be prospectively enrolled. All data will be collected at one point in time, and the current clinical practice will be evaluated (ClinicalTrials.gov number NCT05296694). In the first step of the study, admission diagnoses, demographic characteristics, basic clinical and laboratory data, and in-hospital management will be assessed. At the end of the first step, the predictors and rates of in-hospital mortality will be documented. The second step will be in cohort design, and discharged patients will be followed up till 1 year. Predictors of short- and long-term mortality will be assessed. Moreover, a new coronary care unit mortality score will be generated with data acquired from this cohort. RESULTS: The short-term outcomes of the study are planned to be shared by early 2023. CONCLUSION: The MORCOR-TURK trial will be the largest and most comprehensive study in Turkey evaluating the rates and predictors of in-hospital mortality of patients admitted to coronary care units.

Serum fibrinopeptide A is increased in patients with acute coronary syndrome.

OBJECTIVE: Acute coronary syndrome (ACS) is one of the leading causes of mortality, globally. Atherosclerosis is an underlying factor in ACS process and coagulative cascade is activated secondary to atherosclerotic plaque rupture. Fibrinopeptide A (FPA) takes an active role in thrombus formation and is an indicator of coagulative process. We aimed to evaluate serum FPA level in patients with ACS. METHODS: Patients diagnosed with ACS and chronic coronary syndrome (CCS), with non-obstructive coronary artery disease as a control group, were included in the study. Blood samples and demographic data of all patients were obtained at admission. Obtained data were compared between ACS and control groups. RESULTS: The study consisted of 107 patients with ACS and 69 patients with CCS. ACS group was older (p<0.001) with male preponderance (p<0.001), more likely to had hypertension (p<0.001), and had a higher smoking rate (p<0.001). Serum FPA level was highest in the ST elevated myocardial infarction group (p<0.001). FPA>3.38 ng/mL predicted ACS with 89.7% sensitivity and 78% specificity (AUC: 0.825, 95% CI 0.745-0.905; p<0.001). CONCLUSION: Serum FPA may be used for the differential diagnosis of ACS. In addition, patients with increased FPA may be considered to be given more aggressive antithrombotic medication.

A case of Guillain-Barré syndrome related to COVID-19 infection.

BACKGROUND: After the first COVID-19 case, reported neurological complications are increasing day by day. METHOD: In this paper, we present a benign-course Guillain-Barré syndrome (GBS) emerging 2 weeks after COVID-19 infection in a 35-years-old male. RESULTS: Cough and fever were started 18 days ago and his PCR test was resulted positive for COVID-19 infection. After treatment and quarantine were completed, he developed sudden leg weakness following autonomic features. Cerebrospinal fluid was suggestive for GBS despite the electrodiagnostic test was not helpful because it was done in the first days. He recovered without needing any immunotherapy. CONCLUSION: Our case suggested that COVID-19 can cause atypical benign GBS forms in addition to well-known variants. Comprehensive studies are needed to describe the unknowns and determine the exact prevalence of GBS after COVID-19 infection, including mild cases that did not require hospital admission.