Is There a Relationship Between Epicardial Adipose Tissue, Inflammatory Markers, and the Severity of COVID-19 Pneumonia?

Objectives: Epicardial adipose tissue (EAT) is a type of visceral adipose tissue with pro-inflammatory properties. We sought to examine the relationship between the EAT volume and attenuation measured on non-contrast chest computed tomography (CT), inflammation markers, and the severity of COVID-19 pneumonia. Methods: One hundred and twenty-five patients who are over 18 years old who applied to our hospital and were found to have COVID-19 polymerase chain reaction (+) on nasopharyngeal swab sample and COVID-19 pneumonia on chest CT were included in the study. At admission, C-reactive protein (CRP), procalcitonin, fibrinogen, leukocytes, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lactate dehydrogenase (LDH), ferritin, and d-dimer were evaluated. EAT volume and attenuation were measured on chest CT. Patients who were hospitalized and discharged from the ward were categorized as Group 1, whereas patients who required intensive care admission and/or died were classified as Group 2. The primary endpoint of our study was defined as death, hospitalization in the intensive care unit, and discharge. The relationship between disease severity and EAT and other inflammatory markers was investigated. Results: One hundred and six individuals were in Group 1 and 19 patients were in Group 2. Of the 125 individuals, 46 were women and 79 were men. The mean age was 58.5±15.9 years. Group 2 patients were older. Regarding measurements of the EAT volume and attenuation; there was no statistically significant difference between the groups determined. The patients in Group 2 had statistically substantially higher values for urea, creatinine, LDH, d-dimer, troponin T, procalcitonin, CRP, and neutrophil/lymphocyte ratio in their laboratory tests. When compared to patients in Group 1, patients in Group 2 had statistically significantly lower albumin values (p<0.001). In obese patients, EAT volume was statistically significantly higher and EAT attenuation was found to be lower. Conclusion: In our study, no relationship was found between critical COVID-19 disease and EAT volume and attenuation, which is an indicator of EAT inflammation. Inflammatory markers from routine laboratory tests can be used to predict critical COVID-19 disease. No relationship was found between obesity and critical COVID-19 disease.

Improving Risk Stratification of Patients With Chest Pain in the Emergency Department.

OBJECTIVE: The HEARTS3 score is used to predict acute coronary syndrome by evaluating the findings of chest pain patients at the end of the second hour. Additionally, the American College of Cardiology (ACC)/American Heart Association (AHA) 2014 non-ST elevation acute coronary syndrome (NSTE-ACS) management guideline suggests assessing cardiac troponin levels at the third and sixth hours as a class 1A recommendation. This study aimed to explore the value of the HEARTS3 score for the evaluation of patients with chest pain and its utility for determining whether a patient is eligible for early discharge from the emergency department. MATERIAL AND METHODS: This study was prospectively conducted between March 1, 2016 to May 31, 2016 at the ED of the Research and Training Hospital in Istanbul. A total of 136 patients were evaluated, and HEARTS3 scores were calculated at the second, third, and sixth hours. Receiver operating characteristic (ROC) curves were used to calculate the specificity, sensitivity, negative predictive value (NPV) and positive predictive value (PPV) of these scores. The primary outcome was the occurrence of major adverse cardiac events (MACEs) within 30 days. RESULTS: In total, 29 patients with MACEs and 107 patients without MACEs were identified within 30 days. Based on the ROC curve, the cutoff value for early discharge was 6. The area under curve (AUC) values were 0.943, 0.963 and 0.976 at the second, third, and sixth hours, respectively. The sensitivity of the second-hour HEARTS3 score was 96.6%, and the NPV was 98.6%. Both the sensitivity and NPV reached 100% at the sixth hour. CONCLUSION: The HEARTS3 score was considered a feasible method for the prediction of MACEs. We concluded that a patient with a HEARTS3 score less than 6 may be discharged without serial troponin and ECG examination.

Association of neutrophil-to-lymphocyte ratio with thirty-day mortality in acute peripheral arterial ischemia.

BACKGROUND: Acute peripheral arterial ischemia (APAI) is an acute ischemic condition that develops as a result of embolism or thrombosis, and its morbidity and mortality are still high today. The objective of this study is to determine the effect of preoperative Neutrophil-to-Lymphocyte ratio (NLR) on mortality in patients admitted with the diagnosis of APAI. METHODS: 178 patients who were diagnosed with acute peripheral arterial occlusion and underwent emergency embolectomy were evaluated retrospectively over a 7-year period. Patient demographics, clinical history, risk factors, comorbidity, and hemogram sub-parameters were documented. The endpoint of the patients was determined as death. RESULTS: A total of 178 patients were identified with a mean age 74.29±14.71 (range 28-111) years; among them, 105 (59%) were female. 18% patients (32/178) died within 30 days. Lower extremity involvement was present in 124 (69.7%) of the patients. A statistically significant difference was found between the mortality rates and blood parameters of the patients included in the study in terms of white blood count C-reactive protein (CRP), and age among those with normal distribution. Neutrophil, NLR, procalcitonin, lactate, aspartate aminotransferase, and urea; It was statistically significant in terms of mortality in our patients with APAI. NLR values of the deceased were determined as 7.98 ± 6.85. CONCLUSIONS: APAI patients with high NLRs had significantly higher risks of 30-day mortality. The NLR can be used as a prognostic marker in these patients and warrants further investigation.

Biochemical Factors Affecting Thrombosis Development in Permanent Tunneled Hemodialysis Catheter.

BACKGROUND: It is critical to clarify the biochemical factors associated with thrombosis development following tunneled dialysis catheter (TDC) insertion. METHODS: The study involved retrospective analysis of charts of patients hospitalized for permanent TDC placement between 2013 and 2020 in a tertiary academic center. Patients undergoing a hemodialysis schedule with permanent TDC for more than three months were included in the study. To determine predictive factors associated with thrombosis development in permanent TDC, patients were assigned to one of two groups, according to the extent of thrombosis. The groups were compared in terms of demographic characteristics, blood test values, complication and length of follow-up period. RESULTS: A total of 350 patients (204 female, 146 male) were enrolled into the study. In patients with thrombosis the mean BMI was found significantly higher (p = 0.001) and presence of diabetes mellitus was significantly common (p = 0.014). Patients with thrombosis had significantly higher D-dimer (6.5 vs. 2.4 µg/mL, p = 0.001) and procalcitonin levels (4.1 vs. 1.4 ng/mL, p = 0.001). Additionally, patients with thrombosis had a significantly higher rate of infective complications (p = 0.014). Logistic regression analysis revealed that BMI > 30 kg/m2 and infective complications increased thrombosis risk 3.842 and 3.104 times (p = 0.004 and p = 0.038, respectively). Additionally, D-dimer level > 3 µg/mL and procalcitonin level > 2 ng/mL were significantly associated with the development of thrombosis (p = 0.001 and p = 0.007). CONCLUSIONS: The present study demonstrated that the presence of infection, higher BMI > 30 kg/m2, D-dimer level > 3 µg/mL and procalcitonin level > 2 ng/mL were found to increase the incidence of thrombosis.

The Importance of D-Dimer, Ferritin, CRP and Lymphocyte Values in Determining Mortality in COVID-19 Disease in Turkey.

BACKGROUND: It is critical to determine the importance of laboratory tests on the mortality of Covid-19 disease. Our aim is to search the effect of D-dimer, C-reactive protein (CRP), ferritin, and lymphocyte count in the algorithm organized by our Ministry of Health in the diagnosis and treatment of Covid-19 on mortality. METHODS: Two hundred forty-five patients admitted to the emergency department (ED) with a diagnosis of Covid-19 pneumonia between March 15, 2020, and May 15, 2020. CRP, D-dimer, ferritin, and lymphocyte count included in the algorithm of the Ministry of Health. The relationship between demographic, clinical, and laboratory characteristics of the patients and their thirty-day mortality was examined. RESULTS: A statistically significant difference was only found in coronary artery disease between the mortality rates and underlying diseases of the patients included in the study. When the diagnostic contribution of laboratory values to the mortality estimation was evaluated, the areas under the curve were the highest for CRP 0.782 (95% Cl 0.68 - 0.88), ferritin 0.740 (95% Cl 0.60 - 0.88), and D-dimer 0.738 (95% Cl 0.58 - 0.89). CONCLUSIONS: An increased serum CRP, D-dimer, ferritin levels, and low lymphocyte count as shown by Turkish Ministry of Health in Turkey are significant predictors of COVID-19 mortality.

Acute effects of synthetic cannabinoids on ventricular repolarization parameters.

OBJECTIVE: An association between ventricular repolarization parameters (VRPs) and ventricular arrhythmias has been demonstrated in previous studies. However, there are limited data related to a relationship between synthetic cannabinoids (SCs) and VRPs. The aim of this study was to analyze the acute effects of SCs on VRPs using electrocardiogram (ECG) measurements of the T-peak to T-end interval (Tp-e), Tp-e/QT ratio, and Tp-e/corrected QT (QTc) ratio. METHODS: The present study included 58 patients who were admitted to the emergency department who used SCs (SC +) between 2014 and 2016, and 50 healthy control subjects (SC -). The QT and QTc intervals, Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were measured from a 12-lead ECG. These parameters were compared between groups and correlation analysis was performed. RESULTS: The Tp-e and QTc intervals were significantly higher in SC + patients when compared with the SC- group (92.2±177;10.0, 77.4 ±177;9.3, p<0.001; 434.5±177;30.8, 410.9±177;27.3, p<0.001, respectively). Tp-e/QT and Tp-e/QTc ratios were greater in SC + patients in comparison with SC - participants (0.26±177;0.02, 0.22±177;0.02, p<0.001; 0.21±177;0.02, 0.18±177;0.02, p<0.001, respectively). Significant correlations were found between the use of SCs and the Tp-e interval (r=0.610; p<0.001), Tp-e/QT (r=0.655; p<0.001) and Tp-e/ QTc ratios (r=0.437; p<0.001). CONCLUSION: The Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were greater in subjects who used SCs. Therefore, SC users might have an increased risk of ventricular arrhythmia.

Osborn wave and new-onset atrial fibrillation related to hypothermia after synthetic cannabis (bonsai) abuse.

An Osborn wave may be observed on an electrocardiogram (ECG) as a late delta wave at the end of the QRS complex in cases of hypothermia. An 18-year-old male known to be a synthetic cannabinoid user was found unconscious and hypothermic. The patient's body temperature was 33ºC, and an Osborn wave and atrial fibrillation were detected in ECG readings. Following the application of heating and supportive therapy, consciousness returned and the ECG findings improved. Rewarming and supportive treatment can be life-saving in a hypothermic patient when initiated as soon as possible.

Transpulmonary Hypothermia with Cooled Oxygen Inhalation Shows Promising Results as a Novel Hypothermia Technique.

BACKGROUND: Therapeutic hypothermia was showed to improve neurologic outcome but current therapeutic hypothermia techniques have limitations. Novel techniques such as transpulmonary hypothermia with cooled oxygen inhalation may be beneficial. AIMS: To evaluate the performance of transthoracic hypothermia with cooled medical oxygen inhalation as a therapeutic hypothermia method. STUDY DESIGN: Animal experimentation. METHODS: A total of 36 adult male Wistar-Hannover rats were used in this research. Rats were randomised into four groups: group 1, Cooled oxygen group; group 2, IV cold fluid group; group 3, Surface cooling group; group 4, control group. No hypothermia method was applied in the control group. Hypothermia techniques were administered in the other three groups until the targeted core temperature was maintained. The target temperature was continued for one hour at 32-34 °C. After that, rats were heated up with hot blankets. Once the rectal temperature reached 38 °C, rats were euthanised. The main outcomes were the rate of temperature decrease (°C per minute) (S) and the time required to reach the target body temperature (T). RESULTS: All rats survived the study protocol. When compared to the control group, T and S values were better in the cooled medical oxygen inhalation group (p<0.001). The IV cold fluid group had lower S values and higher T values compared to the cooled oxygen group (p<0.001, and p=0.003, respectively). There was no meaningful pathology in the histological samples in any group. CONCLUSION: As an easy-to-use and inexpensive method, cooled oxygen inhalation may be a beneficial hypothermia technique.

Optimum Temperature of Oxygen for Transpulmonary Hypothermia with Cooled Oxygen Inhalation: A Preliminary Study in a Rat Model.

Cooled oxygen inhalation was hypothesized as a novel hypothermia technique in a previous study. In the current study, we aimed to determine the optimal temperature of oxygen for this method. This is a prospective, randomized, controlled, examiner-blinded experimental study conducted with 45 healthy, adult, Wistar Hannover male rats. Rats were randomly divided into five groups; group 1: +4°C intubated group (n = 7), group 2: +4°C nonintubated group (n = 9), group 3: +8°C intubated group (n = 9), group 4: +8°C nonintubated group (n = 9), and group 5: control group (n = 9). The control group received only a standardized anesthesia protocol, and no hypothermia technique was administered. Cooled oxygen was administered in the four study groups until the rectal temperature reached 34°C. The target temperature was maintained between 32°C and 34°C for 2 hours. Then, hypothermia protocols were terminated and rats were rewarmed externally with a blanket. Main outcomes were the speed (°C/minute) of temperature decrease (S) and the time required to reach the target body temperature (T). All study groups had better results than the control group in T and S values (p < 0.001) for both parameters. Group 1 had a better T value than group 4 (p = 0.01), but no difference in S value (p = 0.223). Comparison of group 2 and group 4 showed that group 4 had better results in T and S (p = 0.04 and 0.001, respectively). No pathologic changes in histologic examination were observed in any group. Our study showed that the optimal temperature of oxygen for the cooled oxygen technique was +4°C through an intubation tube.