Prognostic significance of Tp-e interval and Tp-e/QTc ratio in patients with COVID-19.

OBJECTIVE: Ventricular arrhythmias were the most frequent manifestations in patients with COVID-19. Both the natural course of the disease and the treatment drugs used have effects on ventricular repolarization. The objective of this study was to evaluate the effects of repolarization parameters obtained from surface electrocardiography (ECG) on prognosis. PATIENTS AND METHODS: Participants were 205 consecutive patients hospitalized with COVID-19 diagnosis. The 12-lead surface ECG was obtained from each patient on admission. The ECG results were evaluated against the patients' clinical characteristics and outcomes by experienced cardiology specialists. RESULTS: The mean age was higher in the non-survivor group compared to the survivor group (57.4 ± 15.7 vs. 65.6 ± 16.6; p = 0.001). The demographical characteristics were similar between the survivor and non-survivor groups. Multivariate analyses demonstrated that age (OR: 1.041; p = 0.009), D-dimer (OR: 1.002; p = 0.031), high-sensitivity troponin I (hs-TnI) (OR: 1.010; p = 0.041), pneumonia on computed tomography (CT) (OR: 4.985; p < 0.001), the peak-to-end interval of the T wave (Tp-e) (OR: 3.421; p < 0.001), and Tp-e/QTc ratio (OR: 1.978; p = 0.013) were statistically significant independent predictors in terms of determining mortality. CONCLUSIONS: Prolonged Tp-e interval and increased Tp-e/QTc ratio on admission are decent predictors and linked with mortality. ECG is a practical study to evaluate prognosis and potential arrhythmias, as well as initiating suitable treatment.

SYNE1 related cerebellar ataxia presents with variable phenotypes in a consanguineous family from Turkey.

SYNE1 related autosomal recessive cerebellar ataxia type 1 (ARCA1) is a late-onset cerebellar ataxia with slow progression originally demonstrated in French-Canadian populations of Quebec, Canada. Nevertheless, recent studies on SYNE1 ataxia have conveyed the condition from a geographically limited pure cerebellar recessive ataxia to a complex multisystem phenotype that is relatively common on the global scale. To determine the underlying genetic cause of the ataxia phenotype in a consanguineous family from Turkey presenting with very slow progressive cerebellar symptoms including dysarthria, dysmetria, and gait ataxia, we performed SNP-based linkage analysis in the family along with whole exome sequencing (WES) in two affected siblings. We identified a homozygous variant in SYNE1 (NM_033071.3: c.13086delC; p.His4362GlnfsX2) in all four affected siblings. This variant presented herein has originally been associated with only pure ataxia in a single case. We thus present segregation and phenotypic manifestations of this variant in four affected family members and further extend the pure ataxia phenotype with upper motor neuron involvement and peripheral neuropathy. Our findings in turn established a precise molecular diagnosis in this family, demonstrating the use of WES combined with linkage analysis in families as a powerful tool for establishing a quick and precise genetic diagnosis of complex neurological phenotypes.

Violence against emergency department employees and the attitude of employees towards violence.

INTRODUCTION: This study was conducted to evaluate the occurrence of violent incidents in the workplace among the various professional groups working in the emergency department. We characterised the types of violence encountered by different occupation groups and the attitude of individuals working in different capacities. METHODS: This cross-sectional study included 323 people representing various professional groups working in two distinct emergency departments in Turkey. The participants were asked to complete questionnaires prepared in advance by the researchers. The data were analysed using the Statistical Package for the Social Sciences (Windows version 15.0). RESULTS: A total of 323 subjects including 189 (58.5%) men and 134 (41.5%) women participated in the study. Their mean (± standard deviation) age was 31.5 ± 6.5 years and 32.0 ± 6.9 years, respectively. In all, 74.0% of participants had been subjected to verbal or physical violence at any point since starting employment in a medical profession. Moreover, 50.2% of participants stated that they had been subjected to violence for more than 5 times. Among those who reported being subjected to violence, 42.7% had formally reported the incident(s). Besides, 74.3% of participants did not enjoy their profession, did not want to work in the emergency department, or would prefer employment in a non-health care field after being subjected to violence. According to the study participants, the most common cause of violence was the attitude of patients or their family members (28.7%). In addition, 79.6% (n=257) of participants stated that they did not have adequate safety protection in their working area. According to the study participants, there is a need for legal regulations to effectively deter violence and increased safety measures designed to reduce the incidence of violence in the emergency department. CONCLUSION: Violence against employees in the emergency department is a widespread problem. This situation has a strong negative effect on employee satisfaction and work performance. In order to reduce the incidence of violence in the emergency department, both patients and their families should be better informed so they have realistic expectations as an emergency patient, deterrent legal regulations should be put in place, and increased efforts should be made to provide enhanced security for emergency department personnel. These measures will reduce workplace violence and the stress experienced by emergency workers. We expect this to have a positive impact on emergency health care service delivery.

Echo-guided pericardiocentesis in patients with clinically significant pericardial effusion. Outcomes over a 10-year period.

BACKGROUND: The purpose of the present study is to evaluate current echocardiographically (echo)-guided pericardiocentesis practice with regard to procedural success, complication rate, etiological causes, and outcomes of patients with clinically significant pericardial effusion. PATIENTS AND METHODS: Patients who underwent echo-guided pericardiocentesis between January 2004 and February 2014 were identified using an institutional code for the procedure. Other complementary data were obtained by interviewing patients or their relatives (directly or by telephone) and by searching the social security death index. RESULTS: A total of 301 patients were identified. The pericardium was approached via the subcostal (85 %) or apical (15 %) route under echo guidance in all procedures. The success rate was 97 %, with an intervention-requiring complication rate of 1.3 %. No patient died from complications. The most common etiology was malignancy (n = 84, 28 %). Patients were followed-up for a median of 35 months. Median survival for patients with malignant effusion was 5.9 months compared with 54 months for those with nonmalignant effusion. CONCLUSIONS: Echo-guided pericardiocentesis has a high success and low complication rate in current practice. Among etiologies, malignancy remains the most common cause of clinically significant pericardial effusion and is associated with a poor prognosis.

Paricalcitol counteracts the increased contrast induced nephropathy caused by renin-angiotensin-aldosterone system blockade therapy in a rat model.

OBJECTIVE: The effect of vitamin D and renin-angiotensin-aldosterone system blockade medications in pathophysiology of contrast induced nephropathy (CIN) is controversial. The effects of paricalcitol (active vitamin D analogue) and losartan treatments in an experimental model of CIN were investigated in this study. MATERIALS AND METHODS: Thirty-six male Wistar albino rats were examined in five treatment groups. Placebo group (Group A; n = 4) received no active medication; control group (Group B; n = 8) received only contrast media (CM); Group C (n = 8) received paricalcitol; Group D (n = 8) received losartan and Group E (n = 8) received paricalcitol plus losartan. CIN was induced by NG-nitro-L-arginine methyl ester and indomethacin before iohexol injection. Renal histopathological findings were categorized and renal immunohistochemical examinations by caspase-3 rabbit primary antibody were performed. RESULTS: Creatinine and cystatin C levels significantly increased in the treatment groups, compared to Group A. However, creatinine levels were not significantly increased in Groups C, D and E compared to Group B. Compared to Group B, a significant increase of cystatin C levels was observed in Group D (p < 0.01). In Group E, when paricalcitol treatment was added to losartan treatment, cystatin C levels were similar to Group B (p = 1.00). In histopathological and immunohistochemical examination frequency of Grade 2/3 tubular necrosis and renal caspase 3 activity scores were significantly higher in the losartan treatment group compared to the other treatment groups. The histopathological effects related to losartan treatment were found to be reversed when paricalcitol treatment was combined. CONCLUSIONS: Our findings suggest that paricalcitol treatment counteracts increased contrast induced nephropathy caused by losartan. These findings warrant further clinical studies to investigate the benefit of paricalcitol in CIN prophylaxis.

Preventing intraperitoneal adhesions with ethyl pyruvate and hyaluronic acid/carboxymethylcellulose: a comparative study in an experimental model.

OBJECTIVE: To compare the effectiveness of ethyl pyruvate (EP) with that of hyaluronic acid+carboxymethyl cellulose (Seprafilm) for the prevention of intraperitoneal adhesions. Seprafilm has been shown to be effective in many experimental and clinical studies. STUDY DESIGN: Thirty rats were divided into three groups at random, and uterine horn abrasion was performed by laparotomy. One group received no treatment (control group), one group received a single intraperitoneal dose of EP 50mg/kg (EP group), and a 2×1-cm patch of Seprafilm was applied in the third group (Seprafilm group). All rats were killed 14 days after surgery. Macroscopic and histopathological evaluation were performed by a surgeon and a pathologist who were blinded to group allocation. Histopathologically, inflammation, fibroblastic activity, foreign body reaction, collagen proliferation, vascular proliferation, Masson-Trichrome score, matrix metalloproteinase-2 score and vascular endothelial growth factor score were studied. RESULTS: Median macroscopic intraperitoneal adhesion scores for the control, EP and Seprafilm groups were 2.8, 1.2 and 1.1, respectively. Multiple comparisons between groups showed a significant difference (p<0.05). In binary comparisons, significant differences were found between the control group and the EP group, and between the control group and the Seprafilm group (p<0.05). No significant difference was found between the adhesion scores for the EP group and the Seprafilm group (p>0.05). After histopathological evaluation, significant differences in all parameters were found between the groups (p<0.05). In the paired comparison, significant differences were found between the control group and the EP group, and between the control group and the Seprafilm group (p<0.0167), but no significant difference was found between the EP group and the Seprafilm group (p>0.0167). CONCLUSIONS: In comparison with the untreated control group, EP and Seprafilm were found to reduce the formation of intraperitoneal adhesions. No significant difference was found between EP and Seprafilm.

Malignant arrhythmia as the first manifestation of Wolff-Parkinson-White syndrome: a case with minimal preexcitation on electrocardiography / Arritmia maligna como primera manifestación del síndrome de Wolff-Parkinson-White: un caso con preexcitación mínima en la electrocardiografía

Wolff-Parkinson-White (WPW) syndrome is defined as the presence of an accessory atrioventricular pathway which is manifested as delta waves and short PR interval on electrocardiography (ECG). However, some WPW cases do not have typical findings on ECG and may remain undiagnosed unless palpitations occur. Sudden cardiac death may be the first manifestation of WPW and develops mostly secondary to degeneration of atrial fibrillation into ventricular fibrillation. In this report, we present a case of undiagnosed WPW with minimal preexcitation on ECG and who suffered an episode of malignant arrhythmia as the first manifestation of the disease.

El síndrome Wolff-Parkinson-White (WPW) se define como la presencia de una vía accesoria atrioventricular que se manifiesta como ondas delta, e intervalos cortos de PR en el electrocardiograma (ECG). Sin embargo, algunos casos de WPW no tienen resultados típicos en el ECG, y pueden permanecer sin diagnosticar a menos que se produzcan palpitaciones. La muerte cardíaca súbita puede ser la primera manifestación de WPW, y se produce principalmente de forma secundaria a la degeneración de la fibrilación auricular en fibrilación ventricular. En este reporte, presentamos un caso no diagnosticado de WPW con preexcitación mínima en el ECG, con un episodio de arritmia maligna como primera manifestación de la enfermedad.

Symptomatic bradycardia caused by premature atrial contractions originating from right atrial appendage.

Premature atrial contraction is a common form of supraventricular arrhythmias. In rare cases, severe symptoms other than palpitation may occur. In this report, we present a patient with symptomatic bradycardia which developed secondary to blocked premature atrial contractions and was successfully treated with radiofrequency ablation.

Identifying SNP targeted pathways in partial epilepsies with genome-wide association study data.

PURPOSE: In a recent genome-wide association study for partial epilepsies in the European population, a common genetic variation has been reported to affect partial epilepsy only modestly. However, in complex diseases such as partial epilepsy, multiple factors (e.g. single nucleotide polymorphisms, microRNAs, metabolic and epigenetic factors) may target different sets of genes in the same pathway, affecting its function and thus causing the disease development. In this regard, we hypothesize that the pathways are critical for elucidating the mechanisms underlying partial epilepsy. METHODS: Previously we had developed a novel methodology with the aim of identifying the disease-related pathways. We had combined evidence of genetic association with current knowledge of (i) biochemical pathways, (ii) protein-protein interaction networks, and (iii) the functional information of selected single nucleotide polymorphisms. In our present study, we apply this methodology to a data set on partial epilepsy, including 3445 cases and 6935 controls of European ancestry. RESULTS: We have identified 30 overrepresented pathways with corrected p-values smaller than 10(-12). These pathways include complement and coagulation cascades, cell cycle, focal adhesion, extra cellular matrix-receptor interaction, JAK-STAT signaling pathway, MAPK signaling pathway, proteasome, ribosome, calcium signaling and regulation of actin cytoskeleton pathways. Most of these pathways have growing scientific support in the literature as being associated with partial epilepsy. We also demonstrate that different factors affect distinct parts of the pathways, as shown here on complement and coagulation cascades pathway with a comparison of gene expression vs. genome-wide association study. CONCLUSIONS: Traditional studies on genome-wide association have not revealed strong associations in epilepsies, since these single nucleotide polymorphisms are not shared by most of the patients. Our results suggest that it is more effective to incorporate the functional effect of a single nucleotide polymorphism on the gene product, protein-protein interaction networks and functional enrichment tools into genome-wide association studies. These can then be used to determine leading molecular pathways, which cannot be detected through traditional analyses. We hope that this type of analysis brings the research community one step closer to unraveling the complex genetic structure of epilepsies.

Malignant arrhythmia as the first manifestation of Wolff-Parkinson-White syndrome: a case with minimal preexcitation on electrocardiography.

Wolff-Parkinson-White (WPW) syndrome is defined as the presence of an accessory atrioventricular pathway which is manifested as delta waves and short PR interval on electrocardiography (ECG). However, some WPW cases do not have typical findings on ECG and may remain undiagnosed unless palpitations occur. Sudden cardiac death may be the first manifestation of WPW and develops mostly secondary to degeneration of atrial fibrillation into ventricular fibrillation. In this report, we present a case of undiagnosed WPW with minimal preexcitation on ECG and who suffered an episode of malignant arrhythmia as the first manifestation of the disease.

Do the calcifications in the thyroid gland predict malignancy?

BACKGROUND: The purpose of this study was to determine the relationship between calcifications in the thyroid gland and malignant thyroid lesions. METHODS: From June 2005 - May 2010, 169 patients, who had been operated on for thyroidectomy, were evaluated. The demographic findings were analyzed with regard to ultrasonographic and histopathologic calcifications. The relationship between calcifications and malignant and benign thyroid lesions was statistically determined by SPSS 10.01 version of Z-test and Chi-square test. RESULTS: Microcalcifications were found in 54 patients (31.95 %). Macrocalcification was found in one patient (0.59 %).Malignancy was determined in 29 patients (17.16 %). The rate of malignancy in patients with calcifications was 17/55 (30.9 1%). The diagnosis was nodular colloidal goiter in 38 patients (38/55, 69.09 %) with calcifications. The rate of calcification in malignant patients was 17/29 (58.62 %). The rate of malignancy in patients without calcification was 12/114 (10.52 %). The difference between the rate of malignancy in patients with calcification and the rate of malignancy in patients without calcification was statistically significant (Z-test, p < 0.001). CONCLUSION: Microcalcifications of the thyroid gland could predict malignant thyroid disease. They should be strictly evaluated by all thyroid cancer diagnostic modalities and surgical treatment should also be considered (Tab. 4, Ref. 29).

Treatment results of the Ewing sarcoma of bone and prognostic factors.

BACKGROUND: The purpose of this study is to assess the clinical outcome of patients with ESFT of the bone treated with the European Intergroup Cooperative Ewings Sarcoma Study (EICESS)-92 treatment protocol at a single center, and to identify prognostic factors. METHODS: Ninety-eight patients younger than 18 years of age, diagnosed with ESFT of the bone between 1992 and 2005, were analyzed retrospectively. RESULTS: Eighty-seven patients were treated with the EICESS-92 protocol. The median follow-up was 105 +/- 38 months. The 5-year event-free survival (EFS) survival rate was 40%, the 5-year overall survival (OS) rate was 47%. For non-metastatic disease, the rates of 5-year EFS and OS were 45% and 51%. These rates were 18% and 27%, for metastatic disease. The 5-year EFS and OS rates were 17% and 30%, respectively for females. For males, theses rates were 45% and 48%. Of 87 patients, 52 were admitted with primary extremity lesions. Distant metastasis was detected in 48% of patients with a metaphyseal tumor. In patients with diaphyseal lesions, it was 17%. The 5-year EFS and OS were 35% and 43%, respectively. In non-metastatic disease, these measures were 43% and 50%, whereas in metastatic disease, they were 20% and 27%. In patients with a lesion originating from metaphysis, the 5-year EFS was 17%, and the 5-year OS was 29%, for patients with a diaphyseal lesion, these values were 50% and 54%. CONCLUSION: The presence of metastasis was closely related with metaphyseal tumors. The localization of tumor in the bone (i.e., diaphyseal or metaphyseal) and gender of patients seem to have prognostic importance.

Control and eradication programme of enzootic bovine leucosis (EBL) from selected dairy herds in Turkey.

Serum samples of 15,909 cattle from 31 dairy herds located in various regions of Turkey were tested for the presence of antibodies against bovine leucosis virus (BLV) using Agar Gel Immuno-diffusion technique (AGID). 48.3% (15/31) of the herds had seropositive animals and positivity rates were detected from 0.5-34.4% in these herds. In an EBL control/eradication programme all seropositive animals were culled in the infected herds. Thereafter, a total of 74,347 sera were tested for the presence of BLV specific antibodies. The serological results and detail of EBL control/eradication programme were shown in this paper.