Medeniyet medical journal最新文献

Objective: Despite significant advances in understanding hypertrophic cardiomyopathy (HCM) in recent years, there is a need to improve risk stratification for patients at high risk of adverse outcomes. The relationship between inflammation and disease severity in HCM patients is known. Recently, a new inflammation parameter called the pan-immune inflammation value (PIV) has been introduced. However, the relationship between PIV and HCM has not yet been examined. Hence, we aim to investigate the effect of PIV on prognosis in a large series of HCM patients.

Methods: The study included 389 consecutive patients with HCM admitted to a tertiary care hospital between 2004 to 2021. The PIV for patients was calculated as: Neutrophil count x platelet count x monocyte count / lymphocyte count. The cohort was categorized into three groups according to PIV, and the association between these groups and long-term mortality was evaluated.

Results: Over an average follow-up period of 55.5±12.7 months, long-term mortality occurred in 47 out of 389 patients. Long-term mortality was recorded in 7 patients in tertile 1, 12 patients in tertile 2, and 28 patients in tertile 3. Multivariate regression analysis revealed that long-term all-cause mortality was 3.5 times higher in tertile 3 compared to tertile 1. The receiver-operating characteristic curve based on the PIV had 62% sensitivity and 65% specificity for long-term mortality.

Conclusions: High PIV levels may serve as a predictor of long-term mortality in patients with HCM. PIV could be a useful screening tool for identifying HCM patients at increased risk of adverse outcomes.

Objective: To investigate head and neck paraganglioma cases treated at a tertiary center from 2007 to 2023. The research includes a thorough examination of published studies that have focused on long-term outcomes. The additional goal is to contribute to the existing knowledge on head and neck paraganglioma, with a particular emphasis on refining diagnostic algorithms, treatment selection, and follow-up procedures.

Methods: A total of 44 patients were retrospectively analyzed, and 39 were included. Demographic information, symptoms, radiological examination results, types, stages, and postoperative complications were recorded. A review was conducted to select articles that reported single-center experiences with large cohorts, long follow-ups, and different treatment modalities since 2010.

Results: The mean age of the patients was 54 years, and the female/male ratio was 3.55:1. Among the 39 cases examined, 18 and 19 were identified as cervical paraganglioma and 19 as temporal bone paraganglioma. All patients initially underwent surgical resection. The mean follow-up duration was 5.42 years. Four residual cases and two recurrences were identified postoperatively, and a Gamma Knife was used as additional treatment. Subsequently, 17 articles were selected and summarized, and then a flowchart was prepared showing the possible options for diagnosis, treatment, and follow-up.

Conclusions: Preoperative staging is essential for surgical planning and predicting potential intraoperative complications. Based on our findings and review of the articles, we have prepared a flowchart that includes all possibilities depending on the tumor stage to help in the diagnosis, treatment, and follow-up of head and neck paragangliomas.

Objective: Acute post-streptococcal glomerulonephritis (APSGN) is a common cause of acute glomerulonephritis in children. The condition may present as acute nephritic and/or nephrotic syndrome and rarely as rapidly progressive glomerulonephritis. ChatGPT (OpenAI, San Francisco, California, United States of America) has been developed as a chat robot supported by artificial intelligence (AI). In this study, we evaluated whether AI can be used in the follow-up of patients with APSGN.

Methods: The clinical characteristics of patients with APSGN were noted from patient records. Twelve questions about APSGN were directed to ChatGPT 3.5. The accuracy of the answers was evaluated by the researchers. Then, the clinical features of the patients were transferred to ChatGPT 3.5 and the follow-up management of the patients was examined.

Results: The study included 11 patients with an average age of 9.08±3.96 years. Eight (72.7%) patients had elevated creatinine and 10 (90.9%) had hematuria and/or proteinuria. Anti-streptolysin O was high in all patients (955±353 IU/mL) and C3 was low in 9 (81.8%) patients (0.56±0.34 g/L). Hypertensive encephalopathy, nephrotic syndrome, and rapidly progressive glomerulonephritis were observed in three patients. Normal creatinine levels were achieved in all patients. Questions assessing the definition, epidemiologic characteristics, pathophysiologic mechanisms, diagnosis, and treatment of APSGN were answered correctly by ChatGPT 3.5. All patients were diagnosed with APSGN, and the treatment steps applied by clinicians were similarly recommended by ChatGPT 3.5.

Conclusions: The insights and recommendations offered by ChatGPT for patients with APSGN can be an asset in the care and management of patients. With AI applications, clinicians can review treatment decisions and create more effective treatment plans.

During routine dissection of the anterior compartment of the arm region, we encountered several variations in the muscular and neural structures in the right upper extremity of a female cadaver. We observed one superiorly positioned extramuscular head with fibers originating from both the biceps brachii (BB) and coracobrachialis (CB) muscles and one inferiorly positioned extramuscular head with fibers solely from the BB muscle. The musculocutaneous nerve did not penetrate the CB muscle, but instead provided a muscular branch that communicated with the median nerve (MN). Both the MN and brachial artery (BA) flow beneath the extra head. This case suggests that the described variations may contribute to the entrapment of the MN and compression of the BA. Understanding these variations is crucial before surgical intervention. The failure to recognize such anatomical nuances could lead to inadvertent nerve injury or compromised vascular perfusion, emphasizing the need for preoperative planning and intraoperative vigilance.

Objective: This study investigated the modified Glasgow prognostic score (mGPS) to determine its predictive value and how it could be compared with various inflammatory markers, including C-reactive protein (CRP) to albumin ratio and neutrophil-to-lymphocyte ratio, for determining the extent and severity of coronary artery disease (CAD) in patients with non-ST-elevated myocardial infarction (NSTEMI).

Methods: This study analyzed the cases of 295 patients with NSTEMI who had undergone coronary angiography. In an effort to determine the seriousness and scope of CAD in each patient, the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score was calculated and then assessed. The study sample was divided into two separate groups based on the SYNTAX score: moderate to high SYNTAX (>22) and low SYNTAX (≤22).

Results: There were 295 patients (23.1% female, 76.9% male) included in the research, with an average age being 61.2±10.9 years, and the mean SYNTAX score being 7.3±10.4 (range: 0-40). Those with a SYNTAX score >22 were observed to possess significantly higher levels of CRP, CRP/albumin ratio, and mean mGPS 1-2 ratios compared with those with a SYNTAX score ≤22 (all p<0.001). Smoking [odds ratio (OR): 3.341, 95% confidence interval (CI): 1.531-7.294; p=0.002], CRP/albumin ratio (OR: 4.958, 95% CI: 1.335-18.418; p=0.017), and mGPS score of 1-2 (OR: 3.121, 95% CI: 1.430-6.814; p=0.004) were independent factors used to help predict a high SYNTAX score.

Conclusions: It seems possible to make use of the mGPS when estimating the degree and intricacies of CAD in patients with NSTEMI, as there appears to be a connection with higher SYNTAX scores.

Objective: Apelin and visfatin are adipokines secreted from adipose tissue that play important roles in regulating blood pressure. Therefore, the current study aimed to investigate the effects of candesartan versus enalapril on apelin, visfatin, and lipid profiles in hypertensive patients.

Methods: In this case-control study, 120 participants were enrolled in four groups; Healthy people, newly diagnosed hypertensive patients, and enalapril- and candesartan-treated patients.

Results: Serum apelin levels were significantly lower and visfatin levels were significantly higher in newly diagnosed hypertensive patients compared with the control group (p=0.0015, p=0.0175 respectively). Moreover, apelin levels were higher and visfatin levels were lower in the candesartan-treated patients compared with the newly diagnosed group (p=0.0487, p<0.0001 respectively). Interestingly, apelin levels were non-significantly higher and visfatin levels were significantly lower in enalapril-treated patients compared with the newly diagnosed group (p<0.0001).

Conclusions: Lower apelin and higher visfatin levels are associated with newly diagnosed patients with hypertension. Interestingly, the findings suggest that ACE inhibition and angiotensin receptor blockade by enalapril and candesartan, respectively, positively regulate apelin and visfatin levels in hypertension. Specifically, candesartan regulates these adipokine to a greater extent than enalapril.

Objective: To evaluate the systemic immune-inflammation (SII) index in patients with rheumatoid arthritis (RA) stratified by systemic inflammatory status.

Methods: Seropositive patients with RA (n=58) were divided into two groups based on serum hs-C-reactive protein (hs-CRP) levels: RA patients with hs-CRP levels of at or 3 mg/L or above (high systemic inflammatory status; n=38) and RA patients with hs-CRP levels of less than 3 mg/L (low systemic inflammatory status; n=20). The control group comprised 31 healthy individuals. Blood samples were tested for the next parameters: leukocytes, neutrophilic granulocytes, lymphocytes, thrombocytes [platelet (PLT)], high-sensitivity hs-CRP, sed rate [erythrocyte sedimentation rate (ESR)], neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR). The SII index was derived as Neu x PLT/Lym.

Results: In patients with RA, the SII index was elevated compared with that of healthy individuals and positively correlated with hs-CRP, erythrocyte sedimentation rate, NLR, MLR, PLR, tender joint count, and swollen-to-tender joint count ratio. Patients with RA who had hs-CRP levels of 3 mg/L above exhibited a statistically significant increase in the SII compared with those with hs-CRP levels below 3 mg/L. Additionally, within the cohort of RA patients with hs-CRP levels at or above 3 mg/L, a positive correlation was found between the SII index and both NLR and PLR. The SII index was positively correlated with NLR, MLR, and PLR in RA patients with hs-CRP levels below 3 mg/L. The cut-off point of the SII index for distinguishing between RA cases with hs-CRP levels 3 mg/L and those with hs-CRP levels 3 mg/L or higher was ≥323.4, with a sensitivity of 77.6% and a specificity of 54.8%.

Conclusions: The serum SII index can be a potentially useful marker for evaluating the inflammatory process and clinical progression of RA.

Objective: Ischemia-reperfusion (IR) of the aorta is a significant contributor to the development of postoperative acute lung damage after abdominal aortic surgery. The aim of the present study was to examine the effect of alpha B-crystallin, a small heat shock protein (known as HspB5), on lung injury induced by abdominal aortic IR in rats.

Methods: Male Sprague-Dawley rats were divided into three groups: control, ischemia-reperfusion (IR, 90 min ischemia and 180 min reperfusion), and alpha B-crystallin +IR. Alpha B-crystallin (50 μg/100 g) was intraperitoneally administered 1 h before IR. Lung tissue samples were obtained for histological and biochemical analyses of oxidative stress and cytokine and apoptosis parameters in plasma, lung tissues, and bronchoalveolar lavage (BAL) fluid.

Results: The levels of malondialdehyde, reactive oxygen species, total oxidant status, tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), nuclear factor kappa B (NFKβ), caspase-9 (CASP-9), 8-hydroxy-2'-deoxyguanosine, total antioxidant status, superoxide dismutase, and interleukin-10 levels in lung tissues, plasma, and BAL fluid (p<0.05 versus control) increased in Aortic IR. However, alpha B-crystallin significantly reduced the lung tissue levels of oxidative, inflamatuvar, and apoptotic parameters in the plasma, lung tissues, and BAL fluid (p<0.05 versus aortic IR). Histopathological results showed that alpha B-crystallin ameliorated the morphological changes related to lung injury (p<0.001).

Conclusion: Alpha B-crystallin substantially restored disrupted the redox balance, inflammation, and apoptotic parameters in rats exposed to IR. The cytoprotective effect of alpha B-crystallin on redox balance might be attributed to improved lung injury.