Association between renin-angiotensin-aldosterone system inhibitor treatment, neutrophil-lymphocyte ratio, D-Dimer and clinical severity of COVID-19 in hospitalized patients: a multicenter, observational study.

The aim of this study was to investigate the possible relationship between worse clinical outcomes and the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in hospitalized COVID-19 patients. A total of 247 adult patients (154 males, 93 females; mean age: 51.3 ± 14.2 years) hospitalized for COVID-19 as confirmed by polymerase chain reaction (PCR) were retrospectively reviewed. Demographic and clinical characteristics and laboratory parameters were analyzed using various statistical modeling. Primary outcomes were defined as the need for intensive care unit (ICU), mechanical ventilation, or occurrence of death. Of the patients, 48 were treated in the ICU with a high flow oxygen/noninvasive mechanical ventilation (NIMV, n = 12) or mechanical ventilation (n = 36). Median length of ICU stay was 13 (range, 7-18) days. Mortality was seen in four of the ICU patients. Other patients were followed in the COVID-19 services for a median of 7 days. There was no significant correlation between the primary outcomes and use of ACEIs/ARBs (frequentist OR = 0.82, 95% confidence interval (CI) 0.29-2.34, p = 0.715 and Bayesian posterior median OR = 0.80, 95% CI 0.31-2.02) and presence of hypertension (frequentist OR = 1.23, 95% CI 0.52-2.92, p = 0.631 and Bayesian posterior median OR = 1.25, 95% CI 0.58-2.60). Neutrophil-to-lymphocyte ratio (NLR) and D-dimer levels were strongly associated with primary outcomes. In conclusion, the presence of hypertension and use of ACEIs/ARBs were not significantly associated with poor primary clinical outcomes; however, NLR and D-dimer levels were strong predictors of clinical worsening.

Worm-like thrombus in left main coronary artery after cytostatic treatment.

This paper reports a 43-year-old patient who had a large, mobile, worm-like thrombus in the left main coronary artery after receiving a chemotherapy regimen containing cisplatin, bleomycin and etoposide for a nonseminomatous testes tumor. The patient was successfully treated with thrombolytic therapy. Physicians should be aware that thrombotic events may be observed after the administration of certain chemotherapeutic agents, particularly cisplatin.

[Association of microalbuminuria and fasting insulin levels with presence and severity of coronary artery disease in non-diabetic cases]. / Diyabetik olmayan olgularda mikroalbüminüri ve açlik insülin düzeyi ile koroner arter hastaligi varligi ve siddetinin iliskisi.

OBJECTIVE: In this study, we aimed to determine the relation of presence and severity of coronary artery disease with microalbuminuria, fasting insulin levels and the classical risk factors in non-diabetic patients. METHODS: We enrolled 100 non-diabetic patients that had an indication for coronary angiography. Group 1 consisted of 55 patients with coronary artery disease, and 45 patients without coronary artery disease were included in Group 2. The study was cross-sectional and case-controlled. In all patients 24-hour microalbuminuria, serum total, high density lipoprotein (HDL), low density lipoprotein (LDL) cholesterol and lipoprotein a, triglyceride, fasting blood sugar levels were obtained. Fasting insulin levels were determined and routine urinary tests were performed. Gensini scoring was done for determination of the severity of coronary artery disease. Statistical analysis was performed using unpaired t test, Mann-Whitney U test, Chi-square test, ROC analysis and multiple logistic regression analysis. RESULTS: Microalbuminuria levels (p<0.001), fasting insulin levels (p<0.001), mean age (p=0.01), pulse pressure (p=0.014), LDL cholesterol levels (p=0.004), lipoprotein a levels (p<0.001) were significantly higher and HDL cholesterol levels were significantly lower (p=0.015) in Group 1 compared to the Group 2. Male gender was more frequent in Group 1 (p<0.001). With cut-off values defined by ROC analysis microalbuminuria (18 microgr/min, sensitivity: 91%, specificity: 45%, area under the curve: 0.790, 95% CI 2.43-15.96, p<0.001) increased probability of coronary artery disease by 6.2-fold and fasting insulin level higher than 10 microIU/ml by 11 folds at multivariate logistic regression analysis. When the cases were evaluated according to the Gensini scoring there was a significant association of coronary artery disease and microalbuminuria (r=0.52, p<0.001). CONCLUSION: We concluded that in non-diabetic cases microalbuminuria and increased fasting insulin levels were predictors of presence and the severity of coronary artery disease and can be suggested as risk factors.