Impact of airflow limitation in chronic heart failure.

BACKGROUND: Comorbidities are common in chronic heart failure (HF) patients, but diagnoses are often not based on objective testing. Chronic obstructive pulmonary disease (COPD) is an important comorbidity and often neglected because of shared symptoms and risk factors. Precise prevalence and consequences are not well known. Therefore, we investigated prevalence, pulmonary treatment, symptoms and quality of life (QOL) of COPD in patients with chronic HF. METHODS: 205 patients with stable HF for at least 1 month, aged above 50 years, were included from our outpatient cardiology clinic, irrespective of left ventricular ejection fraction. Patients performed post-bronchodilator spirometry, a six-minute walk test (6-MWT) and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). COPD was diagnosed according to GOLD criteria. Restrictive lung function was defined as FEV1/FVC ≥0.70 and FVC <80% of predicted value. The BODE and ADO index, risk scores in COPD patients, were calculated. RESULTS: Almost 40% fulfilled the criteria of COPD and 7% had restrictive lung disease, the latter being excluded from further analysis. Noteworthy, 63% of the COPD patients were undiagnosed and 8% of those without COPD used inhalation therapy. Patients with COPD had more shortness of breath despite little difference in HF severity and similar other comorbidities. KCCQ was significantly worse in COPD patients. The ADO and BODE indices were significantly different. CONCLUSION: COPD is very common in unselected HF patients. It was often not diagnosed and many patients received treatment without being diagnosed with COPD. Presence of COPD worsens symptoms and negatively effects cardiac specific QOL.

Biomarkers in outpatient heart failure management; Are they correlated to and do they influence clinical judgment?

AIMS: Heart failure (HF) management is complicated by difficulties in clinical assessment. Biomarkers may help guide HF management, but the correspondence between clinical evaluation and biomarker serum levels has hardly been studied. We investigated the correlation between biomarkers and clinical signs and symptoms, the influence of patient characteristics and comorbidities on New York Heart Association (NYHA) classification and the effect of using biomarkers on clinical evaluation. METHODS AND RESULTS: This post-hoc analysis comprised 622 patients (77 ± 8 years, 76 % NYHA class ≥3, 80 % LVEF ≤45 %) participating in TIME-CHF, randomising patients to either NT-proBNP-guided or symptom-guided therapy. Biomarker measurements and clinical evaluation were performed at baseline and after 1, 3, 6, 12 and 18 months. NT-proBNP, GDF-15, hs-TnT and to a lesser extent hs-CRP and cystatin-C were weakly correlated to NYHA, oedema, jugular vein distension and orthopnoea (ρ-range: 0.12-0.33; p < 0.01). NT-proBNP correlated more strongly to NYHA class in the NT-proBNP-guided group compared with the symptom-guided group. NYHA class was significantly influenced by age, body mass index, anaemia, and the presence of two or more comorbidities. CONCLUSION: In HF, biomarkers correlate only weakly with clinical signs and symptoms. NYHA classification is influenced by several comorbidities and patient characteristics. Clinical judgement seems to be influenced by a clinician's awareness of NT-proBNP concentrations.

COVID-19: booster(s) vs. hospitalization and Intensive Care Unit admission.

OBJECTIVE: As the pandemic continues, different vaccine protocols have been implemented to maintain the protection of vaccines and to provide protection against new variants. The aim of this study was to assess hospitalized patients' vaccination status and document the efficacy of boosters. PATIENTS AND METHODS: The patients that were hospitalized due to COVID-19 were enrolled from 28 hospitals in Turkey for five months from September 2021. 5,331 confirmed COVID-19 patients from collaborating centers were randomly enrolled to understand/estimate the distribution of vaccination status in hospitalized patients and to compare the efficacy of vaccination/booster protocols. RESULTS: 2,779 men and 2,552 women of which 2,408 (45.2%) were admitted to Intensive Care Units participated in this study. It was found that the highest risk reduction for all age groups was found in groups that received 4 doses. Four doses of vaccination for every 3.7 people under 50 years of age, for every 5.7 people in the 50-64 age group, and for every 4.3 people over 65 years of age will prevent 1 patient from being admitted to intensive care. Regardless of the type of vaccine, it was found that the risk of ICU hospitalization decreased in those who were vaccinated compared to those who were not vaccinated. Regardless of the type of vaccine, the ICU risk was found to decrease 1.25-fold in those who received 1 or 2 doses of vaccine, 1.18-fold in those who received 3 doses, and 3.26-fold in those who received 4 doses. CONCLUSIONS: The results suggested that the addition of a fourth dose is more effective in preventing intensive unit care even in disadvantaged groups.

Effects of dexmedetomidine or methylprednisolone on inflammatory responses in spinal cord injury.

BACKGROUND: The aim of this study was to compare the anti-inflammatory response of methylprednisolone and the alpha2-agonist dexmedetomidine in spinal cord injury (SCI). METHODS: Twenty-four male adult Wistar albino rats, weight 200-250 g, were included in the study. The rats were divided into four groups as follows: the control group (n: 6) received only laminectomy; the SCI group (n: 6) with trauma alone; the SCI+methylprednisolone group (n: 6) with trauma and 30 mg/kg methylprednisolone, followed by a maintenance dose of 5.4 mg/kg/h; and the SCI+dexmedetomidine group (n: 6) with trauma and 10 microg/kg dexmedetomidine treatment intraperitoneally. Twenty-four hours after the trauma, spinal cord samples were taken for histopathological examination and serum samples were collected for interleukin-6 (IL-6) and tumor necrosis factor (TNF)-alpha measurement. RESULTS: TNF-alpha (P=0.009) and IL-6 (P=0.009) levels were significantly increased in the SCI group. TNF-alpha and IL-6 levels were significantly decreased with methylprednisolone (P=0.002, 0.002) and dexmedetomidine (P=0.002, 0.009) treatment, respectively. Methylprednisolone and dexmedetomidine treatment reduced neutrophils' infiltration in SCI. CONCLUSIONS: The current study does not clarify the definitive mechanism by which dexmedetomidine decreases inflammatory cytokines but it is the first study to report the anti-inflammatory effect of dexmedetomidine in SCI. Further studies are required to elucidate the effects of dexmedetomidine on the inflammatory response.

Plasma levels of tumor necrosis factor-alpha and interleukin-6 in obsessive compulsive disorder.

AIM: Recent research implicated place of an immune mechanism in the pathophysiology of obsessive-compulsive disorder (OCD). Despite increasing evidence involvement of cytokine release in OCD, results of the studies are inconsistent. The aim of this study was to evaluate the plasma levels of the cytokines; tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in OCD patients. METHODS: Plasma concentrations of TNF-alpha and IL-6 were measured in 31 drug-free outpatients with OCD, and 31-year age and sex-matched healthy controls. TNF-alpha and IL-6 concentrations in blood were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: Both TNF-alpha and IL-6 levels showed statistically significant increases in OCD patients compared to controls (P < .000, P < .001, resp.). In addition, the age of onset was negatively correlated with TNF-alpha level (r = -.402, P = .025) and duration of illness was weakly correlated with IL-6 levels (r: .357; P: .048) in patients group. CONCLUSION: OCD patients showed increases in TNF-alpha and IL-6 levels compared to the healthy controls. This study provides evidence for alterations in the proinflammatory cytokines which suggest the involvement of the immune system in the pathophysiology of OCD.

Low levels of selenium in mothers and their newborns in pregnancies with a neural tube defect.

OBJECTIVE: Very few data are presented in the literature about selenium (Se) in human fetal development. The aim of this paper was to study the relationship between maternal and neonatal Se status and neural tube defects (NTDs). PATIENTS AND METHODS: Serum and hair samples were obtained from 20 nonpregnant women, 32 healthy mothers with normal newborns, and 28 mothers who had a newborn with NTD, and their newborns at delivery. Serum Se levels, as ng/mL, and hair Se levels, as microgram/g, were determined on a Perkin-Elmer 1000 spectrophotometer (United Kingdom) by fluorometry. RESULTS: The mean maternal serum and hair Se concentrations in the NTD group (42.9 +/- 1.75 ng/mL, 277 +/- 7.73 ng/g, respectively) were significantly lower than those of the control healthy mothers (50.2 +/- 2.35 ng/mL, 300 +/- 6.10 ng/g, respectively) and the nonpregnant women (58.1 +/- 3.12 ng/mL, 315 +/- 7.64 ng/g, respectively). A significant decrease in concentrations of Se in serum and hair was observed in newborns with a NTD (26.0 +/- 1.55 ng/mL, 181 +/- 3.71 ng/g, respectively) compared with healthy newborns (32.6 +/- 1.70 ng/mL, 204 +/- 4.43 ng/g, respectively). CONCLUSIONS: Maternal Se deficiency during pregnancy was thought to be one of the factors responsible for NTDs. However, the lowered serum and hair Se concentrations may be secondary manifestations of an abnormal pregnancy and did not contribute to its production. More studies on maternal Se status during the antenatal period, especially early gestation and neonatal Se status including normal newborns and NTD infants, are needed.

Changing trend of neural tube defects in eastern Turkey.

STUDY OBJECTIVE: The aim was to study the relationship between birth prevalence of neural tube defect (including anencephaly) in Eastern Turkey before and after the Chernobyl disaster. DESIGN: This was a prospective study of time trends in live births and stillbirths over the years 1985-1990. Medical and sociodemographic data were recorded for the mothers. SETTING: Elazig, Eastern Turkey. SUBJECTS: There were 5240 live births and stillbirths during the study period, 24 of whom had neural tube defect and of these 20 had anencephaly. MAIN RESULTS: Of the 5240 newborns, 24 had a neural tube defect, giving a birth prevalence of 4.5 per 1000 total births. Of these, 20 were anencephalic (3.8 per 1000). In all, of the 2355 conceptions estimated to have occurred prior to the Chernobyl disaster in May 1986, the birth prevalences of total neural tube defect and anencephaly were the same (1.7 per 1000). This contrasts with the years following after Chernobyl, when the birth prevalence of total neural tube defect was 6.9 per 1000 (5.5 per 1000 for anencephaly). The differences were statistically significant (p < 0.001). These two increased rates reached a peak of 12.4 (for total neural tube defects) and 8.9 (for anencephaly) in 1988. In 1989 the rate of total neural tube defects decreased to 10.0 and that of anencephaly to 8.6 per 1000. In 1990 the rate of total neural tube defects fell to 5.6 and that of anencephaly fell to 4.2. CONCLUSIONS: The changes in birth prevalence of neural tube defects might be due to the Chernobyl disaster. However, the increases observed occurred mainly in infants conceived well over a year after the Chernobyl disaster, suggesting that other factors may be responsible.

Comparative biosorption of mercuric ions from aquatic systems by immobilized live and heat-inactivated Trametes versicolor and Pleurotus sajur-caju.

Trametes versicolor and Pleurotus sajur-caju mycelia immobilized in Ca-alginate beads were used for the removal of mercuric ions from aqueous solutions. The sorption of Hg(II) ions by alginate beads and both immobilized live and heat-killed fungal mycelia of T. versicolor and P. sajur-caju was studied in the concentration range of 0.150-3.00 mmol dm(-3). The biosorption of Hg(II) increased as the initial concentration of Hg(II) ions increased in the medium. Maximum biosorption capacities for plain alginate beads were 0.144+/-0.005 mmol Hg(II)/g; for immobilized live and heat-killed fungal mycelia of T. versicolor were 0.171+/-0.007 mmol Hg(II)/g and 0.383+/-0.012 mmol Hg(II)/g respectively; whereas for live and heat-killed P. sajur-caju, the values were 0.450+/-0.014 mmol Hg(II)/g and 0.660+/-0.019 mmol Hg(II)/g respectively. Biosorption equilibrium was established in about 1 h and the equilibrium adsorption was well described by Langmuir and Freundlich adsorption isotherms. Between 15 and 45 degrees C the biosorption capacity was not affected and maximum adsorption was observed between pH 4.0 and 6.0. The alginate-fungus beads could be regenerated using 10 mmol dm(-3) HCl solution, with up to 97% recovery. The biosorbents were reused in five biosorption-desorption cycles without a significant loss in biosorption capacity. Heat-killed T. versicolor and P. sajur-caju removed 73% and 81% of the Hg(II) ions, respectively, from synthetic wastewater samples.

Procion Green H-4G immobilized poly(hydroxyethylmethacrylate/chitosan) composite membranes for heavy metal removal.

The effective removal of toxic heavy metals from environmental samples still remains a major topic of present research. Metal-chelating membranes are very promising materials as adsorbents when compared with conventional beads because they are not compressible, and they eliminate internal diffusion limitations. The purpose of this study was to evaluate the performance of a novel adsorbent, Procion Green H-4G immobilized poly(hydroxyethylmethacrylate (HEMA)/chitosan) composite membranes, for the removal of three toxic heavy metal ions, namely, Cd(II), Pb(II) and Hg(II) from aquatic systems. The Procion Green H-4G immobilized poly(hydroxyethylmethacrylate/chitosan) composite membranes were characterized by elemental analysis, scanning electron microscopy and Fourier transform infrared (FTIR) spectroscopy. The immobilized amount of the Procion Green H-4G was calculated as 0.018+/-0.003 micromol/cm(2) from the nitrogen and sulphur stoichiometry. The adsorption capacity of Procion Green H-4G immobilized poly(hydroxyethylmethacrylate/chitosan) composite membranes for selected heavy metal ions from aqueous media containing different amounts of these ions (30-400mg/l) and at different pH values (2.0-6.0) was investigated. The amount of Cd(II), Pb(II) and Hg(II) adsorbed onto the membranes measured at equilibrium, increased with time during the first 45 min and then remained unchanged toward the equilibrium adsorption. The maximum amounts of heavy metal ions adsorbed were 43.60+/-1.74, 68.81+/-2.75 and 48.22+/-1.92 mg/g for Cd(II), Pb(II) and Hg(II), respectively. The heavy metal ion adsorption on the pHEMA/chitosan membranes (carrying no dye) were relatively low, 6.31+/-0.13 mg/g for Cd(II), 18.73+/-0.37 mg/g for Pb(II) and 18.82+/-0.38 mg/g for Hg(II). Competitive adsorption of the metal ions was also studied. When the metal ions competed with each other, the adsorbed amounts were 12.74+/-0.38 mg Cd(II)/g, 28.80+/-0.86 mg Pb(II)/g and 18.41+/-0.54 mg Hg(II)/g. Procion Green H-4G immobilized poly(hydroxyethylmethacrylate/chitosan) membranes can be regenerated by washing with a solution of nitric acid (0.01 M). The percent desorption achieved was as high as 95%. These novel membranes are suitable for repeated use for more than five adsorption/desorption cycles without any considerable loss in adsorption capacity. Adsorption equilibria were well described by Langmuir equation. It can be concluded that Procion Green H-4G immobilized poly(hydroxyethylmethacrylate/chitosan) membranes may effectively be used for the removal of Cd(II), Pb(II) and Hg(II) ions from aqueous solutions.

Effect of ozone oxidative preconditioning in preventing early radiation-induced lung injury in rats.

Ionizing radiation causes its biological effects mainly through oxidative damage induced by reactive oxygen species. Previous studies showed that ozone oxidative preconditioning attenuated pathophysiological events mediated by reactive oxygen species. As inhalation of ozone induces lung injury, the aim of this study was to examine whether ozone oxidative preconditioning potentiates or attenuates the effects of irradiation on the lung. Rats were subjected to total body irradiation, with or without treatment with ozone oxidative preconditioning (0.72 mg/kg). Serum proinflammatory cytokine levels, oxidative damage markers, and histopathological analysis were compared at 6 and 72 h after total body irradiation. Irradiation significantly increased lung malondialdehyde levels as an end-product of lipoperoxidation. Irradiation also significantly decreased lung superoxide dismutase activity, which is an indicator of the generation of oxidative stress and an early protective response to oxidative damage. Ozone oxidative preconditioning plus irradiation significantly decreased malondialdehyde levels and increased the activity of superoxide dismutase, which might indicate protection of the lung from radiation-induced lung injury. Serum tumor necrosis factor alpha and interleukin-1 beta levels, which increased significantly following total body irradiation, were decreased with ozone oxidative preconditioning. Moreover, ozone oxidative preconditioning was able to ameliorate radiation-induced lung injury assessed by histopathological evaluation. In conclusion, ozone oxidative preconditioning, repeated low-dose intraperitoneal administration of ozone, did not exacerbate radiation-induced lung injury, and, on the contrary, it provided protection against radiation-induced lung damage.

Effect of ozone oxidative preconditioning in preventing early radiation-induced lung injury in rats

Ionizing radiation causes its biological effects mainly through oxidative damage induced by reactive oxygen species. Previous studies showed that ozone oxidative preconditioning attenuated pathophysiological events mediated by reactive oxygen species. As inhalation of ozone induces lung injury, the aim of this study was to examine whether ozone oxidative preconditioning potentiates or attenuates the effects of irradiation on the lung. Rats were subjected to total body irradiation, with or without treatment with ozone oxidative preconditioning (0.72 mg/kg). Serum proinflammatory cytokine levels, oxidative damage markers, and histopathological analysis were compared at 6 and 72 h after total body irradiation. Irradiation significantly increased lung malondialdehyde levels as an end-product of lipoperoxidation. Irradiation also significantly decreased lung superoxide dismutase activity, which is an indicator of the generation of oxidative stress and an early protective response to oxidative damage. Ozone oxidative preconditioning plus irradiation significantly decreased malondialdehyde levels and increased the activity of superoxide dismutase, which might indicate protection of the lung from radiation-induced lung injury. Serum tumor necrosis factor alpha and interleukin-1 beta levels, which increased significantly following total body irradiation, were decreased with ozone oxidative preconditioning. Moreover, ozone oxidative preconditioning was able to ameliorate radiation-induced lung injury assessed by histopathological evaluation. In conclusion, ozone oxidative preconditioning, repeated low-dose intraperitoneal administration of ozone, did not exacerbate radiation-induced lung injury, and, on the contrary, it provided protection against radiation-induced lung damage.

[Rheumatologic findings in patients with major and intermediate beta-thalassemia]. / Rheumatologische Befunde bei Patienten mit Beta-Thalassaemia major und intermedia.

Musculoskeletal systems of 19 patients with major and intermediate beta thalassemia were evaluated clinically and radiologically. Rheumatic findings were determined in 17 patients. Symptoms were localized mainly at shoulders, knees, and ankles. The most frequent signs were pain, inflammation, crepitance, radiologically determined periarticular cystic formations, and osteoporosis. Joint involvement was in the nature of non-erosive, destructive osteoarthropathy. It was also found that the symptoms in males were more severe and numerous than in females. No difference was observed between major and intermediate thalassemic cases. There was no correlation between the therapy and the findings. Upper limb involvement was almost equal to the lower limb involvement in contrast to a previous study.

Decreased adherence, chemotaxis and phagocytic activities of neutrophils from preterm neonates.

Using microanalytic assays various phagocytic functions of separated neutrophils from preterm neonates (mean birthweight 1,506 g, n = 13) were simultaneously studied. Adherence of neutrophils to nylon fibre was decreased in cells from preterm infants (77.1 +/- 3.1%) when compared with adult controls (86.9 +/- 2.1%, mean +/- 1 SD, p less than 0.05). In addition neutrophil chemotaxis in response to zymosan activated serum was reduced in preterm neonates (131.9 +/- 19.7, adults 166.6 +/- 11.1, p less than 0.001); directed migration towards Formyl-Methionyl-Leucyl-Phenylalanine was also decreased (preterm neonates 93.4 +/- 15, adults 111.1 +/- 16.8, p less than 0.05). Preterm infants had a higher percentage of slow moving neutrophils when compared with adults (p less than 0.001). Phagocytosis of Candida albicans was reduced in neutrophils from preterm neonates (phagocytic index: preterm neonates 41.4 +/- 12.7, adults 83 +/- 7.2). Adult neutrophils ingested more Candida per cell (p less than 0.001). Chemiluminescence, exocytosis of elastase and lactoferrin during uptake of opsonized zymosan was also reduced in neutrophils from preterm neonates. However, random migration, phagocytosis of Staphylococcus aureus and production of O2- in response to Phorbol myristate acetate or opsonized zymosan were identical in cells from either source. We conclude, that these abnormalities of neutrophils could predispose the preterm infant to serious and often overwhelming bacterial and fungal infections.

Brucellosis in a child complicated with multiple brain abscesses.

A 4-year-old boy developed symptoms consistent with brucellosis and was treated with combined streptomycin and tetracycline. He had a high brucella agglutinin titer. However, he continued to have headache and papilledema. A brain CT revealed 6 large abscesses. Brucella melitensis was isolated from abscess material. The boy recovered completely after drainage therapy.

Maternal carriage and neonatal colonisation of group B streptococci in labour are uncommon in Turkey.

Group B streptococcus infection is an important cause of neonatal morbidity and mortality. We studied 114 women and their newborns to determine the relationship between maternal carriage and neonatal group B streptococcal colonisation. Rectal, cervical and vaginal swabs were taken at delivery. Within a few minutes of birth, swab specimens were also taken from throat, ear, umbilicus, conjunctiva and skin of the newborns. Group B streptococcus was isolated in 10 (8.7%) of the 114 pregnant women studied and in five (4.3%) of the 114 newborns. Vertical transmission rate was found to be 50%. Neonatal group B streptococcus colonisation has not reached a high level in Turkey, and consequently does not warrant intrapartum screening at the moment.

Neonatal omphalitis is still common in eastern Turkey.

88 newborns with omphalitis diagnosed at a University Hospital in Eastern Turkey from January 1988 to December 1990 were reviewed. The yearly incidence was 7.7% in inpatient newborns. Risk factors including septic delivery (especially home delivery), prematurity, and being small for gestational age appeared to be important. Clinical manifestations, white blood cell and absolute neutrophil counts were non-specific and non-pathognomonic. Bacteriologic analysis revealed that Gram-positive bacteria (68%) predominated over Gram-negative isolates (60%). Staphylococcus aureus and Escherichia coli were the most frequent microorganisms. Mortality rate was 15%; all deaths occurred in patients presenting with systemic symptoms. The following poor prognostic factors were identified: septic delivery (particularly at home), prematurity, being small for gestational age and the development of systemic symptoms.

Cadmium removal from human plasma by Cibacron Blue F3GA and thionein incorporated into polymeric microspheres.

Poly(2-hydroxyethylmethacrylate-ethyleneglycoldimethacrylate) [poly(HEMA-EGDMA)] microspheres carrying Cibacron Blue F3GA and/or thionein were prepared and used for the removal of cadmium ions Cd(II) from human plasma. The poly(HEMA-EGDMA) microspheres, in the size range of 150-200 microm in diameter, were produced by a modified suspension copolymerization of HEMA and EGDMA. The reactive triazinyl dye-ligand Cibacron Blue F3GA was then covalently incorporated into the microspheres. The maximum dye incorporation was 16.5 micromol/g. Then, thionein was bound onto the Cibacron Blue F3GA-incorporated microspheres under different conditions. The maximum amount of thionein bound was 14.3 mg/g. The maximum amounts of Cd(II) ions removed from human plasma by poly(HEMA-EGDMA)-Cibacron Blue F3GA and poly(HEMA-EGDMA)-Cibacron Blue F3GA-thionein were of 17.5 mg/g and 38.0 mg/g, respectively. Cd(II) ions could be repeatedly adsorbed and desorbed with both types of microspheres without significant loss in their adsorption capacity.