Acute Rejection Rates in Vascularized Composite Allografts: A Systematic Review of Case Reports.

INTRODUCTION: Vascularized Composite Allografts (VCA) are usually performed in a full major histocompatibility complex mismatch setting, with a risk of acute rejection depending on factors such as the type of immunosuppression therapy and the quality of graft preservation. In this systematic review, we present the different immunosuppression protocols used in VCA and point out relationships between acute rejection rates and possible factors that might influence it. METHODS: This systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We systematically searched Medline (PubMed), Embase, and The Cochrane Library between November 2022 and February 2023, using following Mesh Terms: Transplant, Transplantation, Hand, Face, Uterus, Penis, Abdominal Wall, Larynx, and Composite Tissue Allografts. All VCA case reports and reviews describing multiple case reports were included. RESULTS: We discovered 211 VCA cases reported. The preferred treatment was a combination of antithymocyte globulins, mycophenolate mofetil (MMF), tacrolimus, and steroids; and a combination of MMF, tacrolimus, and steroids for induction and maintenance treatment, respectively. Burn patients showed a higher acute rejection rate (P = 0.073) and were administered higher MMF doses (P = 0.020). CONCLUSIONS: In contrast to previous statements, the field of VCA is not rapidly evolving, as it has encountered challenges in addressing immune-related concerns. This is highlighted by the absence of a standardized immunosuppression regimen. Consequently, more substantial data are required to draw more conclusive results regarding the immunogenicity of VCAs and the potential superiority of one immunosuppressive treatment over another. Future efforts should be made to report the VCA surgeries comprehensively, and muti-institutional long-term prospective follow-up studies should be performed to compare the number of acute rejections with influencing factors.

Evaluation of left ventricular function in patients with mitral annular disjunction using speckle tracking echocardiography.

BACKGROUND: Mitral annular disjunction (MAD) is a structural abnormality characterized by the systolic detachment of the posterior mitral annulus and the ventricular myocardium. It is usually observed coexistent with mitral valve prolapse (MVP) and associated with a mechanical dysfunction despite preserved electrical isolation function of the mitral annulus. This study aimed to evaluate left ventricular (LV) function using speckle tracking echocardiography in MVP patients with MAD. METHODS: This study was designed as a prospective, single-center study including 103 patients with MVP and 40 age- and sex-matched control subjects. Transthoracic echocardiography and cardiac magnetic resonance imaging were performed to assess LV function and MAD presence. RESULTS: MAD (+) MVP (n = 34), MAD (-) MVP (n = 69), and control (n = 40) groups were enrolled in the study. Among the MVP patients, 34 (33%) had MAD. T-negativity in the inferior leads on electrocardiography was more frequent in the MAD (+) group than in the MAD (-) patients (4.3% vs. 20.6%, p = .014). Mitral regurgitation degree, Pickelhaube sign (17.6% vs. 1.4%, p = .005), and late gadolinium enhancement frequency (35.3% vs. 10.6%, p = .002) were significantly higher in MAD (+) patients. MAD (+) patients had significantly impaired global longitudinal strain (-23.1 ±  2.1 vs. -23.5 ± 2.3, p < .001), basal longitudinal strain (BLS) (-19.6 ±  1.5 vs. -20.5 ± 1.9, p < .001), Mid-Ventricular Longitudinal Strain (-22.2 ± 1.7 vs. -23.2 ± 2.2, p < .001) and LA strain (-24.5 ± 3.9 vs. -27.2 ± 3.6, p < .001) when compared to MAD (-) MVP patients, despite similar LV ejection fraction. All these values of MVP patients were also significantly lower than the control group. The mean MAD distance was 7.8 ± 3.2 mm in MAD (+) patients. Patients with two or more symptoms were higher in the MAD (+) group than in the MAD (-) group (4.3% vs. 44.1%, p < .001). CONCLUSION: This study demonstrated a significant decrease in longitudinal strain in MVP patients with MAD, indicating myocardial dysfunction. These findings suggest that MAD may contribute to LV dysfunction and highlight the importance of early detection in younger patients. Further research is needed to explore the functional implications and long-term outcomes of MAD.

Earthquake victims in focus: a cross-sectional examination of trauma and management in intensive care unit.

BACKGROUND: After the Kahramanmaras earthquake of February 6, 2023, the disaster of the century, a significant number of victims were admitted to intensive care units (ICUs). In this study, we aimed to share the characteristics and management of critical earthquake victims and shed light on our experiences as intensivists in future earthquakes. METHODS: The study included 62 earthquake victims in two tertiary ICUs. Demographic characteristics, laboratory findings, clinical characteristics, trauma and disease severity scores, treatments administered to patients, and the clinical course of the patients were recorded retrospectively. The patients were divided into two groups, survivors and nonsurvivors, according to 7-day mortality and into two groups according to the duration of their stay under the rubble: those who remained under the rubble for 72 hours or less and those who remained under the rubble for more than 72 hours. A receiver operating characteristic (ROC) curve analysis was used to determine the best cutoff value for the 'Circulation, Respiration, Abdomen, Motor, and Speech' (CRAMS) score. RESULTS: The median age of the 62 patients included in the study was 35.5 (23-53) years. The median length of stay under the rubble for the patients was 30.5 (12-64.5) hours. The patient was transferred to the ward with a maximum duration of 222 hours under the rubble. The limb (75.8%) was the most common location of trauma in patients admitted to the ICU. Crush syndrome developed in 96.8% of the patients. There was a positive correlation between the development of acute kidney injury (AKI) and myoglobin, serum lactate, and uric acid levels (r = 0.372, p = 0.003; r = 0.307, p = 0.016; r = 0.428, p = 0.001, respectively). The best cutoff of the CRAMS score to predict in-7-day mortality was < 4.5 with 0.94 area under the curve (AUC); application of this threshold resulted in 75% sensitivity and 96.3% specificity. CONCLUSION: Search and rescue operations should continue for at least ten days after an earthquake. The CRAMS score can be used to assess trauma severity and predict mortality in critically ill earthquake victims.

Pulmonary Physician Consultancy in Emergency Services in Turkiye (PuPCEST) - a cross-sectional multicenter study.

Pulmonology is one of the branches that frequently receive consultation requests from the emergency department. Pulmonology consultation (PC) is requested from almost all clinical branches due to the diagnosis and treatment of any respiratory condition, preoperative evaluation, or postoperative pulmonary problems. The aim of our study was to describe the profile of the pulmonology consultations received from emergency departments in Turkiye. A total of 32 centers from Turkiye (the PuPCEST Study Group) were included to the study. The demographic, clinical, laboratory and radiological data of the consulted cases were examined. The final result of the consultation and the justification of the consultation by the consulting pulmonologist were recorded. We identified 1712 patients, 64% of which applied to the emergency department by themselves and 41.4% were women. Eighty-five percent of the patients had a previously diagnosed disease. Dyspnea was the reason for consultation in 34.7% of the cases. The leading radiological finding was consolidation (13%). Exacerbation of preexisting lung disease was present in 39% of patients. The most commonly established diagnoses by pulmonologists were chronic obstructive pulmonary disease (19%) and pneumonia (12%). While 35% of the patients were discharged, 35% were interned into the chest diseases ward. The majority of patients were hospitalized and treated conservatively. It may be suggested that most of the applications would be evaluated in the pulmonology outpatient clinic which may result in a decrease in emergency department visits/consultations. Thus, improvements in the reorganization of the pulmonology outpatient clinics and follow-up visits may positively contribute emergency admission rates.

Impact of Treatment With Sacubitril/Valsartan on Erectile Dysfunction in Patients With Heart Failure With Reduced Ejection Fraction.

Sacubitril/valsartan (S/V), an angiotensin receptor-neprilysin inhibitor, has been shown to reduce the risk of cardiovascular death or heart failure hospitalization and relieve symptoms in patients with chronic heart failure with reduced ejection fraction. The objective of this study was to assess the effects of S/V on erectile dysfunction in patients with heart failure with reduced ejection fraction (HFrEF). A prospective, open-label study was conducted with 59 male patients diagnosed with HFrEF and concomitant erectile dysfunction. Patients were treated with S/V for a duration of 1 month. The International Index of Erectile Function (IIEF) questionnaire was used to assess the severity of erectile dysfunction and sexual activities at baseline and follow-up visits. Other clinical parameters, including heart rate, were also monitored. After S/V treatment, a significant improvement was observed in sexual activities at the 1-month follow-up visit. The IIEF score showed a statistically significant increase, indicating a decrease in the severity of erectile dysfunction. However, it should be noted that the numerical increase in the IIEF score did not reach clinical significance. This study suggests that S/V treatment in patients with HFrEF may lead to improvements in sexual activities and a reduction in the severity of erectile dysfunction as measured by the IIEF score.

Galectin-3 as a Biomarker to Predict Cardiorenal Syndrome in Patients with Acute Heart Failure.

Background: Galectin-3 affects cardiac tissue inflammation as an inflammatory mediator. The development of cardiorenal syndrome in heart failure patients is associated with a poor prognosis. This study aims to investigate whether serum galectin-3 levels can be used as a biomarker to predict cardiorenal syndrome in heart failure patients with reduced left ventricular ejection fraction. Methods: A total of 166 symptomatic heart failure patients [New York Heart Association (NYHA) functional class II-III] with reduced left ventricular ejection fraction (≤ 40%) were recruited prospectively. Cardiorenal syndrome type 1 was defined as an acute worsening of cardiac function leading to renal dysfunction. The patients were divided into two groups with and without cardiorenal syndrome. The galectin-3 levels of all patients were determined. The primary outcome of this study was the occurrence of cardiorenal syndrome. Results: Cardiorenal syndrome developed in 41 patients. Galectin-3 levels were found to be higher in the patients with cardiorenal syndrome (+) compared to those without cardiorenal syndrome (-) (20.7 ± 2.9 ng/mL vs. 17.8 ± 3.1 ng/mL, p < 0.001). After performing a multivariable analysis, galectin-3 levels [odds ratio (OR): 3.21, p = 0.001], NYHA functional class (OR: 1.98, p = 0.009), creatinine (OR: 3.18, p = 0.006), furosemide dose (OR: 1.21, p = 0.033), and angiotensin-converting enzyme inhibitor/angiotensin-receptor blockers usage (OR: 0.54, p = 0.029) were identified as independent predictors for the development of cardiorenal syndrome. Moreover, galectin-3 level demonstrated predictive capability for cardiorenal syndrome development (AUC = 0.761, p < 0.001). Conclusions: Serum galectin-3 level showed an association with cardiorenal syndrome development in patients with heart failure, indicating potential usefulness as a prognostic biomarker.

The Relationship between Coronary Flow Reserve and the TyG Index in Patients with Gestational Diabetes Mellitus.

Background and Objectives: Gestational diabetes mellitus (GDM) is a prevalent metabolic disorder characterized by glucose intolerance during pregnancy. The triglyceride glucose (TyG) index, a marker of insulin resistance, and coronary flow reserve (CFR), a measure of coronary microvascular function, are emerging as potential indicators of cardiovascular risk. This study aims to investigate the association between CFR and the TyG index in GDM patients. Materials and Methods: This cross-sectional study of 87 GDM patients and 36 healthy controls was conducted. The participants underwent clinical assessments, blood tests, and echocardiographic evaluations. The TyG index was calculated as ln(triglycerides × fasting glucose/2). CFR was measured using Doppler echocardiography during rest and hyperemia induced by dipyridamole. Results: The study included 87 individuals in the GDM group and 36 individuals in the control group. There was no significant difference in age between the two groups (34.1 ± 5.3 years for GDM vs. 33.1 ± 4.9 years for the control, p = 0.364). The TyG index was significantly higher in the GDM group compared to the controls (p < 0.001). CFR was lower in the GDM group (p < 0.001). A negative correlation between the TyG index and CFR was observed (r = -0.624, p < 0.001). Linear regression revealed the TyG index as an independent predictor of reduced CFR. Conclusions: The study findings reveal a significant association between the TyG index and CFR in GDM patients, suggesting their potential role in assessing cardiovascular risk.

The Relationship between the MAGGIC Score and Cardiorenal Syndrome in Patients with Acute Decompensated Heart Failure with Reduced Ejection Fraction.

Background: The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) is a scoring system that is easy to use in outpatient clinics or at the bedside, and was developed to predict the survival of heart failure patients after hospitalization. Objectives: This study aims to evaluate the relationship between the MAGGIC score and cardiorenal syndrome (CRS) in patients with acute decompensated heart failure with reduced ejection fraction (HFrEF). Methods: This retrospective, single-center study, included 706 patients with New York Heart Association II-IV who were hospitalized and discharged for acute decompensated heart failure between 2016 and 2021. CRS type 1 was defined as acute worsening of cardiac function leading to renal dysfunction. Patients were divided into two groups: those with CRS and those without. The MAGGIC score of all patients was determined. The primary outcome was the occurrence of CRS. Results: CRS developed in 132 patients. The MAGGIC score was higher in CRS (+) patients compared to CRS (-) patients (30.70 ± 8.09 vs. 23.96 ± 5.59, p < 0.001). After a multivariable analysis, MAGGIC score [odds ratio (OR): 3.92, p < 0.001], sodium (OR: 0.92, p = 0.003), N terminal pro B type natriuretic peptide (OR: 1.78, p = 0.009), hs troponin (OR: 1.28, p = 0.044), MRA (OR: 0.61, p = 0.019) and furosemide dose (OR: 1.03, p = 0.001) were found to be independent predictors of CRS development. The MAGGIC score was associated with CRS development (area under curve = 0.778). Conclusions: The MAGGIC score may be associated with CRS in HFrEF patients.

Existence of SARS-Cov-2 in the Peritoneal Fluid.

OBJECTIVE: To determine the existence of SARS-CoV-2 in the peritoneal fluid to assess the risk of exposure through surgical smoke and aerosolization threatening healthcare workers during abdominal surgery. BACKGROUND: SARS-CoV-2 is a respiratory virus and possible ways of viral transmission are respiratory droplets, close contact, and fecal-oral route. Surgeries pose risk for healthcare workers due to the close contact with patients. Aerosolized particles may be inhaled via the leaked CO2 during laparoscopic procedures and surgical smoke produced by electrocautery. METHODS: All the data of 8 patients, who were tested positive for COVID-19, were collected between August 31, 2020 and April 30, 2021. Recorded clinicopathologic data included age, symptoms, radiological and laboratory findings, antiviral treatment before surgery, type of surgery and existence of the virus in the peritoneal fluid. Nasopharyngeal swab RT-PCR was used for the diagnosis. COVID-19 existence in the peritoneal fluid was determined by RT-PCR test as well. RESULTS: All 8 COVID-19 positive patients were pregnant, and surgeries were cesarean sections. 1 of the 8 patients was febrile during surgery. Also only 1 patient had pulmonary radiological findings specifically indicating COVID-19 infection. Laboratory findings were as follows: 4 of 8 had lymphopenia and all had elevated D-dimer levels. Peritoneal and amniotic fluid samples of all patients were negative for SARS-CoV-2. CONCLUSION: SARS-CoV-2 exposure due to aerosolization or surgical fumes does not seem to be likely, provided the necessary precautions are taken.

OBJETIVO: Determinar a existência de SARS-CoV-2 no fluido peritoneal para avaliar o risco de exposição através da fumaça cirúrgica e aerossolização que ameaçam os profissionais de saúde durante a cirurgia abdominal. CONTEXTO: O SARS-CoV-2 é um vírus respiratório e as possíveis formas de transmissão viral são gotículas respiratórias, contato próximo e rota fecal-oral. As cirurgias representam risco para os profissionais de saúde devido ao contato próximo com os pacientes. As partículas aerossolizadas podem ser inaladas através do CO2 vazado durante os procedimentos laparoscópicos e a fumaça cirúrgica produzida pela eletrocauterização. MéTODOS: Todos os dados de 8 pacientes, que foram testados positivos para COVID-19, foram coletados entre 31 de agosto de 2020 e 30 de abril de 2021. Dados clinicopatológicos registrados incluíam idade, sintomas, achados radiológicos e laboratoriais, tratamento antiviral antes da cirurgia, tipo de cirurgia e existência do vírus no fluido peritoneal. O diagnóstico foi feito através do swab nasofaríngeo RT-PCR. A existência de COVID-19 no fluido peritoneal foi determinada pelo teste de RT-PCR também. RESULTADOS: Todas as 8 pacientes positivas para COVID-19 estavam grávidas, e as cirurgias eram cesarianas. 1 das 8 pacientes estava com febre durante a cirurgia. Também apenas 1 paciente tinha achados radiológicos pulmonares especificamente indicando infecção por COVID-19. Os achados laboratoriais foram os seguintes: 4 de 8 tinham linfopenia e todas apresentavam níveis elevados de D-dímero. Amostras de fluido peritoneal e líquido amniótico de todas as pacientes foram negativas para SARS-CoV-2. CONCLUSãO: A exposição ao SARS-CoV-2 devido à aerossolização ou fumaças cirúrgicas não parece ser provável, desde que sejam tomadas as precauções necessárias.

Existence of SARS-Cov-2 in the Peritoneal Fluid / Existência de SARS-Cov-2 no líquido peritoneal

Abstract Objective To determine the existence of SARS-CoV-2 in the peritoneal fluid to assess the risk of exposure through surgical smoke and aerosolization threatening healthcare workers during abdominal surgery. Background SARS-CoV-2 is a respiratory virus and possible ways of viral transmission are respiratory droplets, close contact, and fecal-oral route. Surgeries pose risk for healthcare workers due to the close contact with patients. Aerosolized particles may be inhaled via the leaked CO2 during laparoscopic procedures and surgical smoke produced by electrocautery. Methods All the data of 8 patients, who were tested positive for COVID-19, were collected between August 31, 2020 and April 30, 2021. Recorded clinicopathologic data included age, symptoms, radiological and laboratory findings, antiviral treatment before surgery, type of surgery and existence of the virus in the peritoneal fluid. Nasopharyngeal swab RT-PCR was used for the diagnosis. COVID-19 existence in the peritoneal fluid was determined by RT-PCR test as well. Results All 8 COVID-19 positive patients were pregnant, and surgeries were cesarean sections. 1 of the 8 patients was febrile during surgery. Also only 1 patient had pulmonary radiological findings specifically indicating COVID-19 infection. Laboratory findings were as follows: 4 of 8 had lymphopenia and all had elevated D-dimer levels. Peritoneal and amniotic fluid samples of all patients were negative for SARS-CoV-2. Conclusion SARS-CoV-2 exposure due to aerosolization or surgical fumes does not seem to be likely, provided the necessary precautions are taken.

Resumo Objetivo Determinar a existência de SARS-CoV-2 no fluido peritoneal para avaliar o risco de exposição através da fumaça cirúrgica e aerossolização que ameaçam os profissionais de saúde durante a cirurgia abdominal. Contexto O SARS-CoV-2 é um vírus respiratório e as possíveis formas de transmissão viral são gotículas respiratórias, contato próximo e rota fecal-oral. As cirurgias representam risco para os profissionais de saúde devido ao contato próximo com os pacientes. As partículas aerossolizadas podem ser inaladas através do CO2 vazado durante os procedimentos laparoscópicos e a fumaça cirúrgica produzida pela eletrocauterização. Métodos Todos os dados de 8 pacientes, que foram testados positivos para COVID-19, foram coletados entre 31 de agosto de 2020 e 30 de abril de 2021. Dados clinicopatológicos registrados incluíam idade, sintomas, achados radiológicos e laboratoriais, tratamento antiviral antes da cirurgia, tipo de cirurgia e existência do vírus no fluido peritoneal. O diagnóstico foi feito através do swab nasofaríngeo RT-PCR. A existência de COVID-19 no fluido peritoneal foi determinada pelo teste de RT-PCR também. Resultados Todas as 8 pacientes positivas para COVID-19 estavam grávidas, e as cirurgias eram cesarianas. 1 das 8 pacientes estava com febre durante a cirurgia. Também apenas 1 paciente tinha achados radiológicos pulmonares especificamente indicando infecção por COVID-19. Os achados laboratoriais foram os seguintes: 4 de 8 tinham linfopenia e todas apresentavam níveis elevados de D-dímero. Amostras de fluido peritoneal e líquido amniótico de todas as pacientes foram negativas para SARS-CoV-2. Conclusão A exposição ao SARS-CoV-2 devido à aerossolização ou fumaças cirúrgicas não parece ser provável, desde que sejam tomadas as precauções necessárias.

Determining the age group-based cut-off values of serum anti-Mullerian hormone concentrations to diagnose polycystic ovary syndrome.

OBJECTIVE: To determine the cut-off values of the serum anti-Müllerian hormone (AMH) concentration for different age groups (21-25, 26-30, 31-35 years) to diagnose polycystic ovary syndrome (PCOS). METHODS: In total, 187 women aged 21-35 years were included in this descriptive study. Patients diagnosed with PCOS according to the Rotterdam Criteria formed the PCOS group (n = 93), whereas those without symptoms related to PCOS formed the control group (n = 94). Follicular phase serum hormone concentrations were evaluated during the endocrinological assessment of patients with PCOS. Serum levels of estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, total testosterone, dehydroepiandrosterone sulfate, sex hormone-binding globulin, androstenedione, and AMH were measured. The free androgen index and LH/FSH ratio were calculated. Cut-off values of serum AMH concentrations for the age groups were measured using receiver operating characteristic curve analysis. RESULTS: The prevalence rates of frank, ovulatory, normoandrogenic, and non-polycystic ovary PCOS were 69.9, 10.8, 10.8, and 8.6%, respectively. Serum AMH concentrations >5.56 ng/mL were associated with PCOS in the 21-25-year-old group. The cut-off value was 4.01 ng/mL in the 26-30-year-old group, whereas it was 3.42 ng/mL in the oldest age group. The correlation between the antral follicle count (AFC) and serum AMH level was strong for each age group. CONCLUSIONS: The serum AMH concentration is a valuable parameter for assessing patients with symptoms indicative of PCOS. We recommend measuring serum AMH levels to support the diagnosis or to use them instead of the AFC for the Rotterdam criteria.

Dataset for machine learning of microstructures for 9% Cr steels.

The microstructure of steel greatly influences the mechanical properties. For 9 wt% Cr steels, which are widely used in the power generation industry, the steels have a ferritic and martensitic microstructure which can be altered by heat treating and chemical composition variations. Fully martensitic steels typically having high yield strengths but low ductility. Tempering can reduce the amount of martensite in the steel lowering the yield strength but increasing the ductility of the alloy. Alloying can alter the time required for a martensitic transformation. In authors' previously published research, the authors used machine learning methodology to predict room temperature tensile properties from scanning electron microscopy (SEM) images of the initial steel microstructures from a wide range of steel compositions. This data-in-brief supplies the raw image files and the associated tensile properties for the authors' previously published research utilized to predict tensile properties of steels [1].

The evaluation of disease awareness, caregiver burden, and workday loss in caregivers of COPD patients.

BACKGROUND: Our aim is to determine the caregiver burden of chronic obstructive lung disease (COPD) patient's caregivers, and to determine whether there is a workday loss. METHODS: 252 COPD patients and their caregivers were included. Disease information of the patients were recorded and a questionnaire was applied. Socio-demographic characteristics of the caregivers were recorded and a questionnaire consisting of 24 questions including COPD disease, treatment and loss of working days, and the Zarit Scale were used. RESULTS: 128(50.8%) of the patients according to GOLD were group-D, 97(38.5%) of the patient's relatives were working, 62(24.7%) were not able to go to work for 1-14 days, and 125(57.1%) spent outside the home from 1-14 nights, because those accompanied to patients. In univariate analysis were detected modified medical research council (mMRC) (p < 0.001), CAT (p < 0.001), the number of comorbidities of patients (p = 0.027), forced expiratory volume in 1 FEV1cc (p = 0.009), FEV1% (p < 0.001), the presence of long term oxygen therapy (LTOT), and the number of comorbidities of the patient's relatives (p = 0.06) increased the care load. In multiple linear regression analysis, age (p = 0.03), COPD assessment test (CAT) score (p = 0.001), FEV1% (<0.068) and the number of comorbidities of patients (p = 0.01) and the number of comorbidities of caregivers (p = 0.003) increased the caregiving burden. DISCUSSION: In COPD increases caregiving burden. This burden is greater in symptomatic patients and when comorbidities are present. Psychosocial and legal regulations should be investigated and solutions should be produced for the caregivers of COPD patients.

Research Burden of Interstitial Lung Diseases in Turkey - RBILD.

Introduction: The aim of our study is to investigate the etiological distribution of ILD in Turkey by stratifying the epidemiological characteristics of ILD cases, and the direct cost of initial diagnosis of the diagnosed patients. Material-Method: The study was conducted as a multicenter, prospective, cross-sectional, clinical observation study. Patients over the age of 18 and who accepted to participate to the study were included and evaluated as considered to be ILD. The findings of diagnosis, examination and treatment carried out by the centers in accordance with routine diagnostic procedures were recorded observationally. Results: In total,1070 patients were included in this study. 567 (53%) of the patients were male and 503 (47%) were female. The most frequently diagnosed disease was IPF (30.5%). Dyspnea (75.9%) was the highest incidence among the presenting symptoms. Physical examination found bibasilar inspiratory crackles in 56.2 % and radiological findings included reticular opacities and interlobular septal thickenings in 55.9 % of the cases. It was observed that clinical and radiological findings were used most frequently (74.9%) as a diagnostic tool. While the most common treatment approaches were the use of systemic steroids and antifibrotic drugs with a rate of 30.7% and 85.6%, respectively. The total median cost from the patient's admission to diagnosis was 540 Turkish Lira. Conclusion: We believe that our findings compared with data from other countries will be useful in showing the current situation of ILD in our country to discuss this problem and making plans for a solution.

Impact of Sacubitril/Valsartan on Lipid Parameters in Patients with Heart Failure with Reduced Ejection Fraction.

BACKGROUND AND OBJECTIVE: Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, has been shown to significantly reduce cardiovascular mortality, heart failure hospitalizations, and all-cause mortality in patients with heart failure with reduced ejection fraction. This study aims to investigate the long-term impact of the sacubitril/valsartan combination on lipid parameters in patients with heart failure with reduced ejection fraction. METHODS: For this single-center retrospective cross-sectional study, data of patients using sacubitril/valsartan because of heart failure with reduced ejection fraction were collected. In addition to routine controls, the patients' lipid levels were measured at 3-month intervals. The parameters that were obtained over 3 years included total cholesterol, high-density lipoprotein cholesterol, triglyceride, and N-terminal pro-B-type natriuretic peptide levels. RESULTS: A total of 192 patients with a functional capacity New York Heart Association II-V, and who were using sacubitril/valsartan because of heart failure with reduced ejection fraction, were included in this study. Independent of statin use, there was a decrease in total cholesterol levels (196.1 ± 44.8 mg/dL vs 161.5 ± 41.7 mg/dL, p < 0.001) and triglyceride levels (159.1 ± 10.4 mg/dL vs 121.4 ± 6.9 mg/dL, p < 0.001), and there was an improvement in high-density lipoprotein cholesterol levels (44.9 ± 1.9 mg/dL vs 48.2 ± 2.4 mg/dL, p < 0.001) when comparing baseline levels with third-year levels. CONCLUSIONS: Sacubitril/valsartan in patients with heart failure with reduced ejection fraction, independent of statin use, may cause a decrease in total cholesterol and triglyceride levels and an improvement in high-density lipoprotein cholesterol levels.

Prognostic significance of addition of electrocardiographic findings to the MAGGIC heart failure risk score.

BACKGROUND: The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) is a scoring system that is easy to use in outpatient or inpatient settings and was developed to predict the survival of heart failure (HF) patients after hospitalization. AIM: This study aims to determine the prognostic significance of MAGGIC risk score combined with electrocardiography (ECG) parameters in decompensated patients with heart failure with reduced left ventricular ejection fraction (HFrEF) who were hospitalized for worsening HF. METHODS: A total of 562 HF patients with New York Heart Association (NYHA) II-IV functional class who were discharged after hospitalization for decompensated HF between 2013 and 2018 in a single center were included. MAGGIC risk scores of all participating patients were calculated according to baseline characteristics gathered using data from the initial hospitalization for HF. In addition, electrocardiographic findings of all patients were examined. RESULTS: During the follow-up period (4.5 ± 1.2 years) 177 patients died. MAGGIC scores were observed to be higher in non-survivors compared to surviving patients (28.69 ± 7.01 vs. 22.82 ± 6.05, p < 0.001). After a multivariate analysis, MAGGIC score (OR:1.090, p < 0.001), development of cardio-renal syndrome (OR:2.035, p < 0.001), presence of left bundle branch block (LBBB) (OR:1.931, p < 0.001), atrial fibrillation (AF) (OR:1.817, p < 0.001), and fragmented QRS (fQRS) (OR:1.671, p = 0.002) on ECG were found to be independent predictors of mortality. While the MAGGIC score was shown to predict mortality (AUC = 0.739), its predictive power was improved when combined with AF (AUC = 0.752), LBBB (AUC = 0.745), and fQRS (AUC = 0.757) respectively, as well as in the combined final model (MAGGIC score, AF, LBBB, fQRS) (AUC = 0.787). CONCLUSIONS: Our findings showed that addition of electrocardiographic findings to the MAGGIC heart failure risk score has prognostic significance in decompensated patients with HFrEF.

Recurrent arthritis as an unexpected side effect associated with azacitidine in a patient with myelodysplastic syndrome.

INTRODUCTION: Hypomethylating agents have confirmed efficacy for myelodysplastic syndrome and acute myeloid leukemia and are widely used. Although arthralgia is common side effect associated with hypomethylating agents, arthritis has not been reported previously. CASE REPORT: We present the first recorded patient with arthritis after azacitidine treatment. The patient we presented here had severe cytopenias requiring transfusion with erythrocyte and platelet suspensions, and a complete hematological response was obtained for myelodysplastic syndrome after three cycles of azacitidine (AZA) treatment. However, interestingly, after each AZA treatment cycle, the patient had recurrent attacks of arthritis. MANAGEMENT AND OUTCOMES: The episodes of arthritis were possibly acute flares of pre-existing crystal-induced arthritis, as exhibited with azacitidine treatments and were managed effectively with nonsteroidal anti-inflammatory drugs. DISCUSSION: Because it is a rare condition, clinicians should not overlook AZA as a possible cause of arthritis exacerbations when arthritis of unknown etiology develops in patients treated with AZA.

Long-Term Follow-Up of Patients With Isolated Side Branch Coronary Artery Disease.

The data with respect to stable coronary artery disease (SCAD) are mainly confined to main vessel disease. However, there is a lack of information and long-term outcomes regarding isolated side branch disease. This study aimed to evaluate long-term major adverse cardiac and cerebrovascular events (MACCEs) in patients with isolated side branch coronary artery disease (CAD). A total of 437 patients with isolated side branch SCAD were included. After a median follow-up of 38 months, the overall MACCE and all-cause mortality rates were 14.6% and 5.9%, respectively. Among angiographic features, 68.2% of patients had diagonal artery and 82.2% had ostial lesions. In 28.8% of patients, the vessel diameter was ≥2.75 mm. According to the American College of Cardiology lesion classification, 84.2% of patients had either class B or C lesions. Age, ostial lesions, glycated hemoglobin A1c, and neutrophil levels were independent predictors of MACCE. On the other hand, side branch location, vessel diameter, and lesion complexity did not affect outcomes. Clinical risk factors seem to have a greater impact on MACCE rather than lesion morphology. Therefore, the treatment of clinical risk factors is of paramount importance in these patients.

The accuracy of three-dimensional ultrasonography in the diagnosis of Müllerian duct anomalies and its concordance with magnetic resonance imaging.

This retrospective study was performed to comparatively evaluate the diagnostic accuracies of three-dimensional ultrasonography (3D-US) and magnetic resonance imaging (MRI) for identification of Müllerian duct anomalies (MDAs). A total of 27 women with suspected MDAs underwent gynaecological examination, 2D-US, 3D-US and MRI, respectively. The MDAs were classified with respect to the European Society of Human Reproduction and Embryology-European Society for Gynaecological Endoscopy (ESHRE/ESGE) and American Society of Reproductive Medicine (ASRM) systems. Based on the ESHRE/ESGE classification, there was a discrepancy for only one patient between US and MRI. Thus, the concordance between US and MRI was 26/27 (96.3%). With respect to ASRM classification, there was a disagreement between MRI and 3D-US in three patients, thus the concordance between MRI and 3D-US was 24/27 (88.9%). To conclude, the 3D-US has a good level of agreement with MRI for recognition of MDAs.Impact StatementWhat is already known on this subject? Müllerian duct anomalies (MDAs) are relatively common malformations of the female genital tract and they may adversely affect the reproductive potential. The establishment of accurate and timely diagnosis of these malformations is critical to overcome clinical consequences of MDAs.What the results of this study add? The concordance between US and MRI for diagnosis of MDAs based on ESHRE-ESGE classification and ASRM were 96.3% and 88.9%, respectively. These results indicate that 3D US has a satisfactory level of diagnostic accuracy for MDAs and it can be used in conjunction with MRI. Minimisation of diagnostic errors is important to improve reproductive outcome and to avoid unnecessary surgical interventions.What the implications are of these findings for clinical practice and/or further research? Efforts must be spent to eliminate the discrepancies between the clinical and radiological diagnosis of MDAs. Further trials should be implemented for establishment and standardisation of radiological images for identification and classification of MDAs.

Clinical features and major bleeding predictors for 161 fatal cases of COVID-19: A retrospective observational study.

The aim of this study was to investigate the patient characteristics and laboratory parameters for COVID-19 non-survivors as well as to find risk factors for major bleeding complications. For this retrospective study, the data of patients who died with COVID-19 in our intensive care unit were collected in the period of March 20 - April 30, 2020. D-dimer, platelet count, C-reactive protein (CRP), troponin, and international normalized ratio (INR) levels were recorded on the 1st, 5th, and 10th days of hospitalization in order to investigate the possible correlation of laboratory parameter changes with in-hospital events. A total of 161 non-survivors patients with COVID-19 were included in the study.  The median age was 69.8±10.9 years, and 95 (59%) of the population were male. Lung-related complications were the most common in-hospital complications. Patients with COVID-19 had in-hospital complications such as major bleeding (39%), hemoptysis (14%), disseminated intravascular coagulation (13%), liver failure (21%), ARDS (85%), acute kidney injury (40%), and myocardial injury (70%). A multiple logistics regression analysis determined that age, hypertension, diabetes mellitus, use of acetylsalicylic acid (ASA) or low molecular weight heparin (LMWH), hemoglobin, D-dimer, INR, and acute kidney injury were independent predictors of major bleeding. Our results showed that a high proportion of COVID-19 non-survivors suffered from major bleeding complications.