Monocyte-to-high-density lipoprotein ratio: an independent predictor of reverse dipper pattern in hypertensive patients.

OBJECTIVE: In healthy individuals, blood pressure (BP) levels are expected to decrease by 10-20% during sleep hours, which is defined as the dipping pattern. On the other hand, the presence of a BP rise at night in hypertensive patients is defined as a reverse dipper hypertensive pattern (RDHT). RDHT has been associated with stroke and cardiovascular mortality. Similarly, the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) has been associated with the prognosis of cardiovascular disease. We, therefore, aimed to assess the relationship between MHR and RDHT in patients with hypertension. PATIENTS AND METHODS: A total of 363 patients were enrolled in the study, all of whom had undergone 24-hour ambulatory BP monitoring. The patients were analyzed in three groups: RDHT (n: 92), dipper hypertensive (DHT) (n: 124), and normotensive controls (n: 147). Univariable and multivariable analyses were performed to identify factors that could be used to predict RDHT presence. RESULTS: The RDHT group was compared with the DHT and normotensive groups. A high MHR (p = 0.014, OR: 1.110, CIs: 1.021-1.206) and low daytime diastolic BP (p = 0.026, OR: 0.951, CIs: 0.910-0.994) were found to be independent factors that differentiated RDHT from DHT. Additionally, high MHR (p < 0.001, OR: 1.244, CIs: 1.140-1.357), body mass index (p = 0.005, OR: 1.143, CIs: 1.042-1.255), and C-reactive protein (p = 0.009, OR: 1.166, CIs: 1.039-1.308) were found to be independent factors that could differentiate patients with RDHT from controls. CONCLUSIONS: We demonstrated that MHR, a novel inflammatory marker, independently predicts RDHT. This easily applicable and inexpensive marker can be used to predict RDHT in patients with hypertension.

The relationship between the serum uric acid/creatinine ratio and prognosis in patients with transcatheter aortic valve implantation.

OBJECTIVE: Aortic valve stenosis is a common valve disease in developed countries where the elderly population is high. Aortic valve stenosis is not a simple calcification; it is a dynamic process in which uric acid plays a serious role. We investigated the role of the serum uric acid/creatinine (SUA/Cr) ratio, which is an indicator of uric acid level independent of renal function, in determining the prognosis in patients who had undergone transcatheter aortic valve implantation (TAVI). PATIENTS AND METHODS: In this retrospective cohort study, 357 patients who underwent TAVI for symptomatic severe aortic stenosis between March 2019 and March 2022 were retrospectively analyzed. After applying exclusion criteria, the remaining 269 patients were included in the study. According to the Valve Academic Research Consortium criteria, major adverse cardiac and cerebrovascular events (MACCE) defined the endpoint of the study. Therefore, patients were divided into two groups: the MACCE group and the no MACCE group. RESULTS: Serum uric acid level was significantly higher in the MACCE group (7.0 ± 2.6) than in the no MACCE group (6.0 ± 1.7) (p = 0.008). SUA/Cr ratio was significantly higher in the MACCE group (6.7 ± 2.3) than in the no MACCE group (5.9 ± 1.1) (p = 0.007). CONCLUSIONS: The serum UA/creatinine ratio is important in determining the prognosis of patients undergoing TAVI.

P wave peak time and P wave dispersion in severe COVID-19 infection.

OBJECTIVE: With this study, we aimed at evaluating the association between electrocardiographic P wave indices and the severity of COVID-19 infection indicated as intensive care unit (ICU) admission. PATIENTS AND METHODS: We included 247 patients who were hospitalized with a diagnosis of COVID-19 infection and underwent 12 lead standard Electrocardiography (ECG). P wave indices, P wave dispersion (Pdis), P wave peak time in V1 lead (PWPTV1), and D2 lead (PWPTD2) were measured using admission ECG. Comparisons were performed between ICU admitting and non-ICU admitting patients. RESULTS: 160 patients were hospitalized in normal wards, and 87 patients were admitted to ICU. Pdis, PWPTV1, and PWPTD2 were prolonged in ICU admitted patients compared with the normal ward admitted patients [40 (30-50) ms vs. 50 (40-55) ms; p<0.001, 61±9 ms vs. 68±9 ms; p<0.001, and 55±7 ms vs. 64±7 ms; p<0.001, respectively]. In multiple logistic regression analysis, PWPTV1 and PWPTD2 were independent predictors of ICU admission. A cut-off point of 67.5 ms PWPTv1 has a sensitivity of 62.1% and a specificity of 69.4% (AUC=0.710, 95% CI: 0.642-0.777, p<0.001) and a cut-off point of 62.5 ms PWPTD2 has a sensitivity of 60.9% and a specificity of 83.6% (AUC=0.819, 95% CI: 0.777-0.871, p<0.001). CONCLUSIONS: Admission ECG atrial indices Pdis and PWPT were associated with intensive care unit admission in newly diagnosed COVID-19 patients.

Strategies to support breastfeeding: a review.

BACKGROUND: Mothers need to be given support, confidence and encouragement to successful breastfeeding. The importance of breastfeeding support has been addressed in numerous studies. However, reviews to explore strategies to support breastfeeding are sparse. AIM: The study aims to explore strategies to support breastfeeding. It was also aimed to reveal how the international papers compare with the Turkish situation. METHODS: Searches of CINAHL, PubMed, ScienceDirect, Scopus, Web of Science databases, Cochrane databases, Turkish health databases were conducted for data collection. The search was limited to articles published between the years 1995 and 2011, focusing on the strategies related to the support received by mothers. Two experts independently read and analysed 38 articles. FINDINGS: Thirty-eight papers were included in this review. The findings identified strategies to support breastfeeding. These include collaboration with community and family members; confidence building; appropriate ratio of staffing levels; development of communication skills; and 'closing the gap' in inequalities in health. CONCLUSION: Mothers benefit from strategies that encourage breastfeeding, with guidance that supports their self-efficacy and feelings of being capable and empowered, and is tailored to their individual needs.

Breastfeeding support received by Turkish first-time mothers.

BACKGROUND: Research conducted to examine nurses' breastfeeding support to first-time mothers is sparse in Turkey. AIM: To identify informational, practical and emotional support that mothers had received from nurses in the early postpartum period. METHODS: A descriptive and cross-sectional study of 192 mothers who took part in the research prior to discharge from a maternity hospital in Ankara, Turkey. Mean, standard deviation and percentages were used to analyze the maternal characteristics. Chi-square test was used to analyze informational, practical and emotional support received by the mothers in relation to socio-demographic characteristics. Multiple logistic regression analyses were performed to evaluate risk factors for in-hospital formula supplementation and experiencing breastfeeding problem. RESULTS: The mothers stated that the information provided should be adequate (41%), given individually (36.3%) and taught through practice (41%). Supplementary feeding was the only statistically significant predictor of in-hospital breastfeeding problems [P<0.01, odds ratio (OR) 0.109, 95% confidence interval (CI) 0.33-0.361]. Experiencing a breastfeeding problem, not receiving practical support, and the unavailability of nurses were statistically significant predictors of supplementation respectively (P<0.01, OR 0.084, 95% CI 0.023-0.309; P<0.05, OR 0.239, 95% CI 0.071-0.809; P<0.05, OR 3.442, 95% CI 1.059-11.183, respectively). CONCLUSION: Informational, practical and emotional support offered by nurses has the potential to make a difference in reducing breastfeeding problems and in-hospital supplementation. Practical support could be enhanced through effective implementation of early maternal/infant skin-to-skin contact in a busy hospital environment.

Effect of neural blockade on somatostatin-induced inhibition of exocrine pancreatic secretion.

In vivo somatostatin inhibits exocrine pancreatic secretion. In in vitro experiments, such as the isolated perfused pancreas, somatostatin fails to inhibit exocrine pancreatic secretion. This suggests an indirect action of somatostatin, such as modulation of neural regulation. In the anesthetized rat we tested the inhibitory capacity of somatostatin in the presence of neural blockade in vivo. Neither the drugs given intravenously--phentolamine, propranolol, atropine and naloxone--nor vagotomy were able to prevent somatostatin-induced inhibition of exocrine pancreatic secretion. We conclude that somatostatin-induced inhibition of exocrine pancreatic secretion is not dependent on intact extrinsic innervation.