Mehmet Mustafa Can

Novel hematologic inflammatory parameters to predict acute mesenteric ischemia.

Acute mesenteric ischaemia (AMI) is an emergency condition that requires urgent diagnosis. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been studied as inflammatory biomarkers in atherosclerosis, but data regarding AMI are lacking. The study population included patients with AMI (nu200a=u200a46) versus age and sex-matched healthy controls (nu200a=u200a46). Computed multidetector tomographic angiography was performed to diagnose AMI. NLR and PLR were calculated using complete blood count. C-reactive protein (CRP) levels were also analyzed. Neutrophil levels and lymphocytes were significantly higher in patients with AMI than in the control individuals (Pu200a<u200a0.001 and Pu200a=u200a0.43, respectively). NLR levels were significantly higher in patients with AMI compared with that in the control individuals (Pu200a<u200a0.001). Platelet levels did not reach statistical significance between the groups (Pu200a=u200a0.709). However, patients with AMI had significantly higher PLR levels than the control group (Pu200a=u200a0.039). CRP levels on admission were higher in patients with AMI in comparison with control individuals. There was also a positive correlation between NLR and CRP (ru200a=u200a0.548, Pu200a<u200a0.001), and between PLR and CRP (ru200a=u200a0.528, Pu200a<u200a0.001). NLR level greater than 4.5, measured on admission, yielded an area under the curve value of 0.790 (95% confidence interval 0.681–0.799, sensitivity 77%, specificity 72%), and PLR level of greater than 157 yielded an area under the curve value of 0.604 (95% confidence interval 0.486–0.722, sensitivity 59%, specificity 65%). Patients with AMI had increased NLR, PLR, and CRP levels compared with controls. Increased NLR and PLR was an independent predictor of AMI.

The Relation between Sarcopenia and Mortality in Patients at Intensive Care Unit

Background and Aim Psoas muscle area (PMA) can reflect the status of skeletal muscle in the whole body. It has been also reported that decreased PMA was associated with postoperative mortality or morbidity after several surgical procedures. In this study, we aimed to investigate the relation between PMA and mortality in all age groups in intensive care unit (UNIT). Materials and Method The study consists of 362 consecutive patients. The demographic characteristics of patients, indications for ICU hospitalization, laboratory parameters, and clinical parameters consist of mortality and length of stay, and surgery history was obtained from intensive care archive records. Results The mean age was 61.2 ± 18.2 years, and the percentage of female was 33.3%. The mean duration of stay was 10.3 ± 24.4 days. Exitus ratio, partial healing, and healing were 25%, 70%, and 5%, respectively. The mean right, left, and total PMA were 8.7 ± 3.6, 8.9 ± 3.4, and 17.6 ± 6.9, respectively. The left and total PMA averages of the nonoperation patients were statistically significantly lower (p = 0.021u2009u2009p = 0.043). The mean PMA between the ex and recovered patients were statistically significantly lower (p = 0.001, p = 0.001, p < 0.001). Dyspnoea, renal insufficiency, COPD, transfusion rate, operation rate, ventilator needy, and mean duration of hospitalization were statistically significant higher in patients with exitus. There is a significant difference in operation types, anesthesia type, and clinic rates. Conclusion Our data suggest that sarcopenia can be used to risk stratification in ICU patients. Future studies may use this technique to individualize postoperative interventions that may reduce the risk for an adverse discharge disposition related to critical illness, such as early mobilization, optimized nutritional support, and reduction of sedation and opioid dose.

Factors Affecting the Length of Stay in the Intensive Care Unit: Our Clinical Experience

Background and Aim Long hospital days in intensive care unit (ICU) due to life-threatening diseases are increasing in the world. The primary goal in ICU is to decrease length of stay in order to improve the quality of medical care and reduce cost. The aim of our study is to identify and categorize the factors associated with prolonged stays in ICU. Materials and Method We retrospectively analyzed 3925 patients. We obtained the patients demographic, clinical, diagnostic, and physiologic variables; mortality; lengths of stay by examining the intensive care unit database records. Results The mean age of the study was 61.6 ± 18.9 years. The average length of stay in intensive care unit was 10.2 ± 25.2 days. The most common cause of hospitalization was because of multiple diseases (19.5%). The length of stay was positively correlated with urea, creatinine, and sodium. It was negatively correlated with uric acid and hematocrit levels. Length of stay was significantly higher in patients not operated on than in patients operated on (p < 0.001). Conclusion Our study showed a significantly increased length of stay in patients with cardiovascular system diseases, multiple diseases, nervous system diseases, and cerebrovascular diseases. Moreover we showed that when urea, creatinine, and sodium values increase, in parallel the length of stay increases.

Assessment of electrocardiographic parameters in adult patients undergoing extracorporeal shockwave lithotripsy

OBJECTIVEnExtracorporeal shock wave lithotripsy (ESWL) is a safe and effective treatment for urinary tract calculi. While serious side effects are rare, transient cardiac arrhythmias may occur. New electrocardiographic (ECG) parameters, such as P wave dispersion (PWD), QT dispersion (QTd), T peak to T end (Tp-e) interval, Tp-e interval/QT ratio, and Tp-e interval/corrected QT ratio have been defined to help predict atrial and ventricular arrhythmias. However, effect of ESWL on these ECG parameters has not been previously investigated. The present study was an examination of the effect of ESWL on ECG parameters.nnnMETHODSnTotal of 40 consecutive patients who underwent ESWL were prospectively enrolled in the study. Pre-procedure ECG parameters were compared with post-procedure ECG parameters.nnnRESULTSnPWD values were significantly longer on post-procedure ECG compared with pre-procedure ECG (p=0.017). Corrected QT duration and QTd were significantly longer on postprocedure ECG compared with pre-procedure ECG (p=0.046 and p=0.008, respectively). In addition, Tp-e interval, Tp-e interval/QT ratio, and Tp-e interval/QTc ratio were significantly longer post procedure (p=0.035, p=0.045, and p=0.022, respectively). In univariate correlation analysis, duration of procedure was significantly correlated with post-procedure PWD, QTc, and QTD values.nnnCONCLUSIONnClinical use of ECG parameters may be helpful in monitoring of patients receiving ungated ESWL in order to detect cardiac dysrhythmia.

Coronary artery bypass surgery in Syrian refugees. Outcomes in a Turkish tertiary center

Objectives: To assess outcomes of Syrian refugees undergoing coronary artery bypass surgery in a tertiary hospital in Turkey. Methods: We sought for in-hospital mortality and one year all-cause mortality as the main outcomes. We reviewed records of 67 Syrian and 427 Turkish patients undergoing isolated coronary bypass surgery between 2015 January and 2017 January retrospectively. Results: History of coronary, peripheral and carotid artery diseases and obesity were more frequent in Syrian patients. C-reactive protein levels were higher in Syrian patients whereas lipid profiles and systolic functions of the 2 groups were similar. Syrian patients more frequently presented with the acute coronary syndrome (26.9% versus 15.5%, p<0.001). SYNTAX I (Synergy between PCI with Taxus and Cardiac Surgery) and SYNTAX II-PCI were higher in Syrian patients whereas SYNTAX II-CABG was similar with Turkish patients. Extubation time was longer and amount of the hemorrhage was greater in Syrian patients; however, bleeding revision was not increased. Although wound infection was more frequent in Syrian patients, postoperative complications were similar between groups. In-hospital mortality and one year all-cause mortality did not differ between Syrian (n=1; 1.5% versus n=13; 13.1%) (p=0.476) and Turkish patients (n=3; 4.5% versus n=25; 5.9%) (p=0.63). Conclusion: Syrian patients had higher SYNTAX I and SYNTAX II PCI scores, but not SYNTAX II CABG score compared with Turkish patients. Intraoperative and postoperative complications were similar. In-hospital mortality and one year all-cause mortality of Syrian patients were similar with Turkish patients. Surgical outcomes of Syrian patients were acceptable. Primary prevention of obesity must be provided. Aggressive secondary preventive measures must be taken due to increased severity of coronary artery disease.

Unroofed Coronary Sinus Atrial Septal Defect Misdiagnosed as Ostium Primum Defect

https://e-kcj.org A 42-year-old woman presented with a 2-year history of shortness of breath. She was evaluated via transthoracic echocardiography at another institution and diagnosed with ostium primum atrial septal defect and advised to undergo surgery. Transthoracic echocardiography revealed a mildly enlarged right ventricle and mild tricuspid regurgitation with an estimated systolic pulmonary artery pressure of 40 mmHg. However, unroofed coronary sinus (UCS) was suspected when detailed reexamination was performed. Twoand three-dimensional (3D) transesophageal echocardiography (TEE) confirmed the diagnosis. The defect was repaired surgically. Enhanced temporal and spatial resolution 3D imaging enabled us to delineate the complex anatomy of an UCS without additional imaging modalities.

The Relationship between Inter-Arm Blood Pressure Difference and Coronary Artery Disease Severity Calculated by the SYNTAX Score

Objectives The inter-arm systolic blood pressure difference (IASBPD) is closely related to cardiovascular mortality and morbidity. The SYNTAX score indicates the extent and complexity of coronary artery disease, which are determined by coronary angiography. The aim of our study is to examine the relationship between the IASBPD (which is easily calculated in routine practice) and the SYNTAX score. Methods 104 patients were included in this cross-sectional study. The IASBPD was calculated by blood pressure measurements obtained simultaneously from both arms. The SYNTAX score was calculated by coronary angiography. Results Patients were divided into two groups: those with a high SYNTAX score (≥20) and those with a low SYNTAX score (<20). The mean IASBPD values were significantly higher in the group with a high SYNTAX score (≥20) (p<0.001). The patients with IASBPD≥10 were more likely to have a high SYNTAX score compared to the patients with IASBPD<10 (p<0.001). Multiple logistic regression analysis revealed that only the IASBPD values were found to be independently associated with high SYNTAX score (OR: 1.717 (CI: 1.307-2.257), p<0.001). Conclusion The IASBPD values obtained by only blood pressure measurements are closely related to the extent of coronary artery disease.

Increased neutrophil to lymphocyte ratio predicts myocardial injury in patients undergoing non-cardiac surgery

Background: The neutrophil to lymphocyte ratio (NLR), has been proposed as potential indicator of cardiovascular events. Our aim was to determine the relationship between NLR and development of myocardial injury after non‐cardiac surgery (MINS). Methods: This observational cohort study included 255 consecutive noncardiac surgery patients aged ≥45 years. Electrocardiography recordings and high sensitivity cardiac troponin T (hscTnT) levels of the patients were obtained for a period of 3 days postoperatively. Results: MINS was detected in 30 (11.8%) patients using the cut‐off level of ≥14 ng/L for hscTnT. In the MINS group NLR (3.79 ± 0.7 vs. 2.69 ± 0.6, p < 0.000) values were higher than non‐NLR group. The NLR to be independently associated with the development of MINS (OR: 11.690; CI: 4.619–29.585, p < 0.000). Conclusions: NLR seems to be a simple, easy and cheap tool to predict the development of MINS in patient undergoing non‐cardiac surgery.

Accessory tricuspid leaflet associated with persistent left superior vena cava

Right atrioventricular valve is historically named as tricuspid valve. However, cases depicting multi‐leaflet morphology of the right atrioventricular valve were reported. Accessory leaflet of the tricuspid valve is a rare entity and associated with congenital cardiac anomalies. We present an accessory tricuspid valve in a patient with isolated persistent left superior vena cava.

Comparison of Complication and Success Rates of ProGlide Closure Device in Patients Undergoing TAVI and Endovascular Aneurysm Repair

Introduction Usage of the Perclose ProGlide® (PP: Abbott Laboratories, Chicago, IL, USA) closure device is becoming increasingly prevalent during percutaneous endovascular aortic repair (EVAR) and transcatheter aortic valve implantation (TAVI). The respective conditions treated via these procedures, abdominal aortic aneurysm and aortic valve stenosis, share risk factors but are two different physiopathological problems. Aim Our aim was to compare the complication and success rates of PP closure device use in patients undergoing EVAR and TAVI. Materials and Methods A total of 74 patients, including 58 undergoing TAVI and 16 undergoing EVAR, were analysed in our study. Results Of the TAVI patients treated using the PP closure device, two (3.4%) had access to site-related bleeding complications and two (3.4%) experienced device failure. Of the EVAR patients who received the PP closure device, three (18.8%) had bleeding complications and three (18.8%) experienced device failure. Conclusion Due to the underlying diffuse aortic wall pathology, the success rate of PP closure device use was lower and the complication rate of PP closure device was higher in the EVAR group versus the TAVI group.