[Investigation of Anti-HCV S/CO Value in Detecting Viremia in Patients with Hepatitis C Virus Infection]. / Hepatit C Virüsü Enfeksiyonu Olan Hastalarda Viremi Tespitinde Anti-HCV S/CO Degerinin Arastirilmasi.

Anti-HCV and HCV RNA tests are used in laboratory diagnosis of hepatitis C virus (HCV) infections. False positive results are frequently observed in anti-HCV tests used as screening tests in societies with low prevalence of HCV. The HCV RNA test, which is a confirmatory test, is not performed in every laboratory because it is a high-cost and high-tech test, which can lead to delay in the diagnosis and treatment of patients. In this study, it was aimed to obtain an optimal anti-HCV S/CO value in our laboratory for demonstrating true antibody positivity and viremia in patients by analyzing the relationship between anti-HCV, alanine aminotransferase (ALT) and HCV RNA using retrospective data. Between July 2014 and July 2017, 754.190 anti-HCV tests were performed. Patients aged 18 years or older who were reactive with anti-HCV and those with simultaneous HCV RNA and ALT prompts were included in the study. The second generation CMIA (Abbott, USA) method was used for anti-HCV detection. For quantitative HCV RNA analysis, viral nucleic acid extraction was performed with the QIAsymphony SP/AS (Qiagen, Germany) using the QIAsymphony DSP Virus/Pathogen Midi Kit; and PCR was performed by Rotor-Gene Q (Qiagen, Germany) using Artus HCV QS-RGQ kit. ARCHITECT c and AEROSET systems (Abbott, USA) were used for ALT measurement. HCV genotype determination (622 cases) was performed using GenoSen's HCV Genotyping 1/2/3/4 RG qualitative real time PCR kit (Corbett Research, Australia) and GEN-C 2.0 Reverse Hybridization Strip Assay (NLM Diagnostics, Italy) kit at different periods covered by our study. The optimal threshold value for the relationship between anti-HCV, ALT and HCV RNA was selected based on ROC analysis. Statistical significance was accepted as p<0.05. Of the anti-HCV test results, 10.679 were found to be reactive. 1754 data of 1290 cases with anti-HCV reactivity who were simultaneously tested for HCV RNA and ALT in the same serum were evaluated. Of these, 742 (42%) were found to be HCV RNA positive and 1012 (58%) were found to be HCV RNA negative. ALT and anti-HCV levels of those who were positive for HCV RNA were significantly higher than those with negative HCV RNA (p= 0.001). The threshold point for anti-HCV S/CO according to HCV RNA was found to be 7.13 (sensitivity of 97.4%, specificity of 50.3%, positive predictive value 58.9%, negative predictive value 96.4%), and the cut-off point for ALT was found to be 27.5 IU/L (sensitivity of 77.6%, specificity of 80.8%). For HCV RNA positivity, the area under the ROC curve for anti-HCV and ALT was significantly higher than 0.5 (p= 0.001). No statistically significant difference was found between HCV genotypes in terms of ALT and anti-HCV levels. By using our new threshold in the laboratory workflow, the need to verify with HCV RNA can be reduced, especially in some patients who have been screened for antiHCV for screening purposes. Anti-HCV values below 7.13 S/CO, considering the high negative predictive value of this threshold; a false positive result in a patient presenting for screening can be predicted without waiting for the HCV RNA result. In anti-HCV reactivities determined above 7.13, the possibility of absence of viremia should be considered due to the low positive predictive value.

The prevalence and clinical characteristics of mitral valve prolapse in a large population-based epidemiologic study: the MELEN study.

OBJECTIVE: Mitral valve prolapse (MVP) is the most common cardiac valvular abnormality in industrialized countries. Its prevalence has been estimated to be between 2% to 4%. However, some studies found the prevalence of MVP less than 1% which is significantly lower than the prevalence reported in the Framingham Heart Study. The purpose of this study was to determine the prevalence, demographic, clinical and echocardiographic characteristics of MVP in a large population-based epidemiologic study. PATIENTS AND METHODS: The final cohort included 2,228 participants. Data were obtained by a validated questionnaire, physical examination of the cardiovascular system, recording of a resting electrocardiogram, transthoracic echocardiographic examination. RESULTS: The echocardiographic prevalence of MVP was 0.36%. Baseline demographic and clinical characteristics of patients were as follows; 12.5% had hypertension, 37.5% had depression, 12.5% had migraine, 12.5% had diabetes mellitus, 12.5% had diastolic dysfunction, 25% had multi-nodular goiter, 12.5% had diffuse goiter and 25% had hyperthyroidism. During the follow-up of 36 months no major adverse events occurred in patients with MVP during the follow-up. CONCLUSIONS: This finding suggests that MVP is a benign disorder and the prevalence of MVP is lower than previously studies. There might be a relationship between MVP and goiter, and depression.

Predictors of major adverse cardiovascular events; results of population based MELEN study with prospective follow-up.

OBJECTIVE: In healthy persons, cardiovascular risk is the result of multiple interacting risk associates including demographic, clinical, genetic and environmental factors. Several non-invasive tools such as echocardiography, ultrasonography and electrocardiography as well as new biochemical markers were shown to be applicable to predict cardiovascular events. However, implementation of all of these tools has not been tested before. The aim of the study was to evaluate the independent predictors of major adverse cardiovascular events in a prospective population based study, with the use of bioempedance analysis, echocardiography, ultrasonography and ECG. PATIENTS AND METHODS: The baseline measurements were conducted on 2230 participants (1427 women, 803 men with a mean age of 49 ± 15). The follow-up was done 36 months after the baseline admission via telephone call. Major adverse event was defined as mortality or myocardial infarction or stroke. RESULTS: Follow-up data was possible in 1495 participants (65%). During the follow-up of 36 months (4485 patient years), 42 major adverse events occurred (0.03%). Among them, 16 were death (1 stroke, 2 cancer, 13 cardiac related), 12 were stroke and 14 were myocardial infarction. Age, body mass index and atrial fibrillation were independent predictors of major adverse events; AF being the most powerful (Odds ratio 10.46; 95% confidence interval [1.73-63.14]; p = 0.010). CONCLUSIONS: Age, lower body mass index and atrial fibrillation were independent predictors of major cardiovascular events in our cohort.

The impact of metabolic syndrome on carotid intima media thickness.

OBJECTIVES: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities involving several cardiovascular risk factors. Carotid intima media thickness (CIMT) is an important early screening tool to assess subclinical manifestation of cardiovascular and metabolic diseases. We aimed to investigate the impact of MetS on CIMT in a large scaled community based study. METHODS: The study was conducted on 2102 participants. Carotid intima media thickness was measured in all of the participants. The study sample was divided into 4 groups; Group 1 subjects with a body mass index (BMI) < 25.0 kg/m2 [n = 499 (MetS- = 488, MetS+ = 11)], Group 2 BMI between 25.0 and 29.9 kg/m2 [n = 693 (MetS- = 559, MetS+ = 134)], Group 3 BMI between ≥ 30 kg/m2 and 39.9 kg/m2 [n = 822 (MetS- = 375, MetS+ = 477)], and Group 4 BMI ≥ 40 kg/m2 [n = 88 (MetS- = 27, MetS+ = 61)]. RESULTS: Carotid intima media thickness was higher in the individuals with MetS compared to their normal counterparts. Furthermore, the subgroup analysis showed that CIMT values in Group 1 (0.55±0.18 vs 0.82±0.70; p < 0.001), Group 2 (0.59±0.20 vs 0.68±0.18; p < 0.001) and Group 3 (0.61±0.15 vs 0.65±0.18; p < 0.001) were significantly higher in subjects with MetS compared to their normal counterparts, whereas the values were similar in Group 4 (0.62±0.13 vs 0.65±0.17; p = 0.363). CONCLUSIONS: Carotid intima media thickness of overweight, obese and normal weight individuals without MetS were lower than their counterparts with MetS. MetS had no impact on CIMT in morbid obese individuals possibly due to established insulin resistance earlier than MetS.

Predictors of hypertension control in Turkey: the MELEN study.

BACKGROUND: Hypertension is one of the most common causes of atherosclerosis, morbidity and mortality in adults. A total of 11 million hypertensive patients were estimated in Turkey. AIM: The aim of this study was to investigate the prevalence, awareness and control of hypertension in Duzce and compare the current data with the literature. MATERIALS AND METHODS: The visits were carried out in May and June, 2010 in Yigilca town health centre on 2298 participants (1471 female, 827 male with a mean age of 50). Data were obtained by a simple form, physical examination and sampling of blood. Hypertension was defined as a blood pressure 140 mmHg and/or 90 mmHg, and/or use of antihypertensive medication. The data of patients under control were compared with the patients who were not under control. RESULTS: Hypertension was detected in 964 participants. General prevalence was 42%. Hypertension awareness ratio was 70%, use of antihypertensive medication was 39% and the ratio of patients under control was 28%. Antihypertensive drug use, age and awareness were lower in the uncontrolled group. Logistic regression analysis revealed that only antihypertensive drug use and BMI < 30 were the independent predictors of hypertension under control [Odd's ratio (OR) = 3.43; 95% confidence interval (CI) = 2.54-4.64, p < 0.001 and OR = 1.69; 95% CI = 1.23- 2.32, p = 0.01; respectively]. CONCLUSIONS: Hypertension is one of the most important public health problems in Turkey. According to the literature data the awareness of hypertension was increased significantly in the last five years. On the other hand, control ratio was increased very little compared with the previous studies.

Non-valvular atrial fibrillation in the elderly; preliminary results from the National AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) Study.

OBJECTIVE: This study aimed at the assessment of the clinical approach to atrial fibrillation (AF) in the older population and the consistency with the guidelines based on the records of the multicenter, prospective AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) study. PATIENTS AND METHODS: 2242 consecutive patients admitted to the Cardiology Outpatient Clinics of 17 different tertiary Health Care Centers with at least one AF attack determined on electrocardiographic examination, were included in the study. Among the patients included in the study, 631 individuals aged 75 years and older were analyzed. RESULTS: The mean age of the patients was determined as 80.3±4.2 years. The most frequent type of AF in geriatric population was the persistent-permanent type with a percentage of 88%. 60% of the patients with AF were female. Hypertension was the most common co-morbidity in patients with AF (76%). While in 16% of patients a history of stroke, transient ischemic attack or systemic thromboembolism was present, a history of bleeding was present in 14% of the patients. 37% of the patients were on warfarin treatment and 60% of the patients were on aspirin treatment. In 38% of the patients who were on oral anticoagulant treatment, INR level was in the effective range. CONCLUSIONS: The rate of anticoagulant use in the elderly with AF was 37% and considering the reason of this situation was the medication not being prescribed by the physician, one should pay more attention particularly in the field of treatment.

Effect of combined oral contraceptive use on platelet volume in women at reproductive age.

INVESTIGATION: Combined oral contraceptives use is associated with an increased risk of developing venous and arterial thromboembolic events. Platelet size, measured as mean platelet volume (MPV), is associated with platelet reactivity. METHODS: Ninety-five women using oral contraceptives for contraception were investigated retrospectively. The patients' blood pressure, pulse and hematological values at application and at the sixth month were evaluated retrospectively. RESULTS: There was no difference between the values of blood pressure (systolic and diastolic), pulse, hematological values (which contain leukocytes, platelets and mean platelet volume) at application and at the sixth month. CONCLUSION: We determined that using oral contraceptives for contraception did not change MPV values in young women.

The platelet indices in patients with rheumatoid arthritis: mean platelet volume reflects disease activity.

The present study was designed to investigate the interaction between platelet indices, inflammatory markers and disease activity in rheumatoid arthritis (RA) subjects. The effects of anti-TNF-alpha therapy and conventional treatment on platelet indices were also compared. We studied 97 patients with RA (19 men, 78 women: mean age 51 years) and 33 age and sex-matched healthy subjects as a control group. All RA patients were administered conventional therapy. After 3 months of therapy, 35 subjects who had high disease activity score (DAS28 > 5.1) were grouped as non-responders and were administered infliximab as a TNF-alpha blocker at the standard intravenous dose. Responders to the conventional therapy and non-responders were also compared. At baseline white blood cell (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet count and mean platelet volume (MPV) were significantly higher in patients with RA. Mean platelet volume was positively correlated with DAS28 score (r = 0.27; p = 0.007). These markers of inflammation and platelet indices were substantially decreased after therapy. The reductions were similar in responders to conventional therapy and non-responders (TNF alpha group). In conclusion, we found that MPV was correlated with inflammatory markers and disease activity in patients with RA. Both anti-TNF-alpha and conventional therapy decreases markers of inflammation and platelet indices. MPV can reflect both disease activity and response to treatment.

Correlation of plasma B-type natriuretic peptide with shunt severity in patients with atrial or ventricular septal defect.

The goal of this study was to test the utility of bedside plasma concentration of B-type natriuretic peptide (BNP) assay as a screen for large shunts in pediatric patients with atrial septal defects (ASDs) and ventricular septal defects (VSDs). Thirty-five children at a mean age of 70+/-129 weeks with ASD or VSD were included in the study. Nine patients had VSD and 26 had ASD. Plasma BNP values were compared with the Qp/Qs ratios derived from quantitative Doppler flow measurements. Mean BNP was 29+/-42 pg/ml, with a range between<5 pg/ml and 208 pg/ml. Sixteen patients had Qp/Qs values>1.5 and 19 had values<1.5. The difference of mean BNP in these patient groups was statistically significant (45+/-56 vs 14+/-17, p=0.03). BNP was positively correlated with shunt significance. Receiver operating characteristic curve analysis revealed a sensitivity of 69% and a specificity of 79% at a plasma BNP cut-off level of>or=20 pg/ml. Bedside measurement of BNP correlates with magnitude of ASD and VSD in children. BNP can provide information for the management of children with ASD or VSD. It can be used as part of the evaluation of a child with a preliminary diagnosis of a congenital defect.

Interaction between Chlamydia pneumoniae seropositivity, inflammation and risk factors for atherosclerosis in patients with severe coronary stenosis.

OBJECTIVE: To investigate whether Chlamydia pneumoniae (Cpn) seropositivity in patients with suspected coronary artery disease (CAD) (n = 81) is associated with increases in markers of inflammation, the severity of coronary atherosclerosis, and traditional risk factors for cardiovascular events. MATERIAL AND METHODS: The severity of coronary atherosclerosis was ranked by Gensini score. Inflammation and endothelial dysfunction were evaluated using white blood cell counts and levels of high-sensitivity C-reactive protein (hs-CRP), ferritin, tumour necrosis factor-alpha (TNF-alpha), interleukins 1beta and 6 (IL-1beta, IL-6), soluble intercellular adhesion molecule-1 (sICAM-1), E-selectin and oxidized LDL (oxLDL), and these were compared between Cpn-seropositive and seronegative individuals. RESULTS: IgA and IgG Cpn seropositivity were significantly associated with the presence of CAD (p = 0.005) and were independent predictive factors for the severity of coronary atherosclerosis (p = 0.005). Elevated levels of IL-6 (p = 0.027) and triglyceride (p = 0.038) and low levels of high-density lipoprotein cholesterol (HDL-C) (p = 0.038) were significantly predicted by Cpn IgA and IgG seropositivity. CONCLUSIONS: Seropositivity for Cpn is a risk factor for patients with significant angiographically documented coronary stenosis. Additionally, Cpn seropositivity was significantly associated with dyslipidemia and elevated IL-6, known risk factors for CAD. These observations indicate that Cpn infection may be one entry point to the causal or contributory pathways that lead to atherosclerosis and its clinical manifestations.

A case of myocardial infarction with sumatriptan use.

Sumatriptan is widely used in the treatment of acute attacks of cluster headache. It is a serotonin-1 (5HT-1) agonist. Several studies have reported an association between sumatriptan use and myocardial infarction, possibly due to the generalized vasoconstrictive nature of this agent. We report a 16-year-old male patient presenting with acute inferior myocardial infarction after sumatriptan use without any known risk factors of coronary artery disease.

Cardiac emergencies caused by honey ingestion: a single centre experience.

An unusual type of food poisoning is commonly seen in the Black Sea coast of Turkey attributable to andromedotoxin containing toxic honey ingestion. This study is a retrospective case series of 19 patients admitted to an emergency department in 2002, poisoned by "mad" honey. All of the patients had the complaints of nausea, vomiting, sweating, dizziness, and weakness, several hours after ingesting "mad" honey. Physical examination showed hypotension in 15 patients, sinus bradycardia in 15, and complete atrioventricular block (AVB) in four patients on admission. Two patients with bradycardia and two with AVB fell and injured their heads. Three of them presented with local haematoma. One patient had a 6 cm cut on his head without any neurological deficit and his cranial computed tomography imaging was normal. Hypotension and conduction disorders resolved with atropine treatment, resulting in complete recovery within 24 hours.

A case of coronary artery fistula draining into the pericardium causing hematoma.

A 28-yr old female patient admitted to our clinic because of dyspnea and chest pain. Her transesophageal echocardiography demonstrated a huge mass on the anterolateral wall of the left ventricle causing dysfunction of the myocardium. Coronary angiography demonstrated left anterior descending artery fistula draining into the pericardial cystic mass. Hydatic cyst was suspected and ELISA and hemagglutinin tests were both negative for Echinococcus granulosus. Magnetic resonance image of the heart showed a mass thought to be a hematoma inside the cyst. She underwent surgery. The cystic lesion with a pure hematoma inside, was excised, and the fistula between left anterior descending artery and the mass was ligated without any complications. To our knowledge, this is the first case of a pericardial hematoma due to a coronary artery fistula, in the English literature.