BACKGROUND:To our knowledge, a possible predictive relationship of the multi-inflammatory index (MII) with new-onset atrial fibrillation (AF) after off-pump coronary artery bypass grafting (CABG) has not yet been studied in the literature. AIMS:We aimed to investigate whether the MII is a novel group of hematological markers for predicting postoperative new-onset AF in patients undergoing off-pump CABG. METHODS:A total of 427 patients undergoing isolated off-pump CABG between October 2021 and December 2023 were enrolled in this retrospective observational cohort study and allocated to two groups: the AF group (n = 108) and the non-AF group (n = 319). The groups were compared in terms of baseline clinical patient characteristics, laboratory parameters, and operative and postoperative data. RESULTS:The median values of age, length of hospital stay, platelet and neutrophil count, C-reactive protein level, systemic immune-inflammation index, MII-1, MII-2, and MII-3 were significantly greater in the AF group compared to the non-AF group in univariate analyses. In multiple explanatory variable logistic regression analysis, MII-1, MII-2, and MII-3 were determined to be significant hematological variables, and thereby these indices were considered the independent predictors of postoperative new-onset AF. Receiver operating characteristic curve analyses showed that to predict postoperative new-onset AF, MII-1 of 22.47 constituted the cut-off value with 62.0% sensitivity and 57.0% specificity, MII-2 of 141.77 constituted the cut-off value with 43.5% sensitivity and 76.8% specificity, and MII-3 of 5669 constituted the cut-off value with 63.8% sensitivity and 58.3% specificity. CONCLUSION:This study demonstrated for the first time that all MIIs predicted new-onset AF after off-pump CABG.

Objective: There is no study in the literature evaluating the dynamic thiol/disulfide homeostasis in patients with chronic venous insufficiency. Thus, we designed this study to evaluate the dynamic thiol/disulfide homeostasis as a novel indicator of oxidative stress in patients with chronic venous insufficiency.Methods: This was a prospective case-control study performed at the department of cardiovascular surgery of a tertiary referral hospital in Turkey. A total of 80 (CEAP C3-C6) patients with lower extremity chronic venous insufficiency (as the study group) and 80 healthy subjects (as the control group) were enrolled to the study. The participants' basic demographic and clinical characteristics as well as serum levels of some laboratory parameters including albumin, ferroxidase, myeloperoxidase, native thiol, total thiol, disulphide, native thiol/total thiol, disulphide/native thiol, and disulphide/total thiol were determined, and then compared between the groups. Results: In terms of basic demographic and clinical characteristics, both groups were statistically similar, and there were no significant differences between the groups. When the laboratory parameters were considered, serum ferroxidase and myeloperoxidase levels were detected to be significantly higher, whereas albumin, native thiol, total thiol, and disulphide levels were detected to be significantly lower in the study group than in the control group. Conclusions: Dynamic thiol/disulphide homeostasis could be considered as an indicator reflecting the oxidative stress status in patients with chronic venous insufficiency. (J Vasc Surg Venous Lymphat Disord 2024;12:101689.)

Vascular inflammation has a pivotal role in the progression of atherosclerosis and major cardiovascular events (MACE). However, there is limited data concerning to role of changes in inflammatory markers in predicting MACE. In the current study, it was investigated whether the difference between high sensitive C-Reactive Protein (hs-CRP) and systemic immune-inflammatory index values (Δhs CRP and ΔSII) measured before and after the procedure and residual SYNTAX score (rSS) in stable coronary artery patients underwent percutaneous coronary intervention (PCI) could predict MACE. 203 patients (mean age: 62.11±9.20, 75% male) were included in the study. Before the first procedure and at the 1st month after the procedure(s), their blood was drawn. rSS was calculated. MACE was determined as cardiovascular mortality, target vessel revascularization non-fatal myocardial infarction, and ischemic stroke. MACE was observed in 20 patients (9.9%). Of these patients, 3 (1.5%) had cardiovascular mortality, 3 (1.5%) had a non-fatal myocardial infarction, 12 (5.9%) had target vessel revascularization due to unstable angina, and the remaining 2 (1.0%) had an ischemic stroke. The area under the curve (AUC) to predict MACE diagnosis was 0.548 for ΔSII and 0.647 for Δhs-CRP and 0.766 for rSS. In multiple regression analysis, only rSS > 4 was an independent predictor for MACE (HR=3.41, 95% CI: 1.39-8.35, p=0.007). The change in SII and hs-CRP after PCI was found to be insufficient to predict MACE, while rSS was the only independent predictor for MACE. [Med-Science 2023; 12(2.000): 536-41]

Depression, and anxiety are considered to be linked with hypertension. In our study, we planned to investigate association between depression /anxiety and hypertension (HT) in young patients . A cross sectional study was conducted .The study group consisted of 175 patients under 45 years of age with a mean arterial blood pressure above 130/80 in 24-hour ambulatory blood pressure monitoring. The control group consisted of 125 volunteer health workers under 45 years of age with a mean arterial blood pressure below 130/80 in 24-hour ambulatory blood pressure monitoring. All the participants were requested to answer the questions of 'Hospital Anxiety Depression Scale' (HADS). A score of above 10 was defined as depression or anxiety based on the chosen scale. In the study group ,the mean age was 38.15±4.62 years and the ratio of male was 45 % where as in the control group ,the mean age was 38.44±4.63 years and the ratio of male was %46. (P:0.537 for mean age, P:0.866 for the ratio of male ). The active smoking rate and the body mass index (BMI) value were significantly higher in the study group (p:0.005 and p: 0.029 respectively). The study group had the higher median anxiety score and depression score (p<0.001). Body mass index (BMI) (HR: 1.102, CI:1.014-1.199, p:0.023) HADS anxiety and depression scores above 10 (HR: 21.989, CI: 8.280-58.397, p:<0.001 and HR: 29.087, CI: 8.579–98.624, p<0.001 respectively) were associated with HT. In our study, the presence of depression/anxiety determined by HADS score and high BMI values were found to be associated with hypertension in patients under 45 years of age.

Aim: The mortality of chronic systolic heart failure has been decreased thanks to state-of-the-art therapy.However, the mortality rate is still high in acute heart failure (AHF).Our study was planned to investigate the mortality rates and predictors of mortality in AHF. Material and Method:A single-center retrospective study was conducted on 805 patients hospitalized due to AHF between March 2009 and June 2013.The patients were separated into two main groups: the decompensated heart failure group (DHF), which comprised the patients with signs of right heart failure with or without pulmonary edema (722 patients -89.7%), and the acute pulmonary edema group (PE) presenting only with pulmonary edema (83 patients -10.3%).The two groups were compared for the patient-related variables.The survival analysis of the groups based on the etiology was performed.Finally, the independent predictors for 2-year mortality in AHF were investigated. Results:The 2-year mortality rate was higher in DHF than in PE (51.4% vs. 31.6%p<0.001).The mortality rates of ischemic cardiomyopathy, nonischemic cardiomyopathy, and heart failure with preserved ejection fraction (HFpEF) were 52.8%, 39.6%, and 47.3%, respectively (p=0.389).Advanced age, previous cerebrovascular diseases, anemia, hyponatremia, hypoalbuminemia, lower left ventricular ejection fraction (LVEF), and lower systolic blood pressure predicted increased 2-year mortality independently.In contrast, usage of beta-blockers during hospitalization predicted reduced 2year mortality independently. Conclusion:Mortality rate was similar between different heart failure types.Various laboratory and clinical parameters predict mortality, whereas beta-blockers and ACE inhibitors reduce mortality.

Objective Platelet distribution width (PDW) has been reported in a wide range of pathological settings. In this study, we aimed to investigate the relationship between PDW and lower extremity chronic venous insufficiency (CVI) by comparing the levels of PDW and other parameters derived from complete blood count (CBC) tests in young individuals with or without lower extremity CVI. Methods This prospective clinical study was conducted between January 2020 and December 2020. A total of 108 patients, 72 patients with lower extremity CVI (study group) and 36 healthy volunteers (control group) were enrolled from the Bursa Yuksek Ihtısas Educatıon Research Hospıtal and the Bolu Abant Izzet Baysal University Training and Research Hospital. The age range of the participants was between 18 and 50 years old. Participants’ baseline clinical features and CBC parameters including PDW, white blood cell, hemoglobin, hematocrit, mean corpuscular volume, red cell distribution width, neutrophil, lymphocyte, platelet count, mean platelet volume, plateletcrit, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were compared between the two groups. Results The groups were statistically similar in terms of baseline clinical features. The median PDW value was significantly higher for the CVI patients relative to the control group (17.6 vs 16.8; p < 0.001). In terms of other CBC parameters, there were no significant differences between the groups. According to ROC analysis, area under the curve of PDW was 0.749 (95% confidence interval: 0.653–0.846 and p < 0.001). If the value of PDW was accepted as 17, it could predict CVI with 76% sensitivity and 59% specificity, whereas a PDW value of 17.5 could predict CVI with 51% sensitivity and 81% specificity. Conclusion Platelet distribution width might be a useful marker to determine an increased inflammatory response and thrombotic status in young patients with CVI.

BACKGROUND:The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age 65-74 years, female gender) score is used to estimate thromboembolic risk in atrial fibrillation (AF). Current studies have shown that CHA2DS2-VASc score can predict adverse clinical outcomes in coronary artery disease, stroke, and many diseases irrespective of the presence of AF. The usefulness of CHA2DS2-VASc score in predicting mortality of peripheral arterial disease (PAD) patients is unknown. In this study, we aimed to evaluate the predictive value of the CHA2DS2-VASc score for mortality of PAD patients. METHODS:A total of 396 patients diagnosed with PAD for the first time in our clinic between January 2010-July 2016 were included in this study. Patients were divided into two groups as deceased (group 1, N.=153) and living (group 2, N.=243). A ROC analysis was performed to determine if CHA2DS2VASc score could predict the death events among PAD patients. Kaplan-Meier analysis was used to evaluate the timing of death events in the two groups. RESULTS:The mean ages of group 1 and group 2 were 76.6±0.81 and 66.5±0.83 (P=0.007), respectively. The CHA2DS2VASc scores of group-1 (4.37±0.1) and group 2 (2.96±0.9) were significantly different (P<0.001). A significant correlation between CHA2DS2VASc score and death was determined in Spearman correlation (R:0.454, P<0.001). According to multivariate cox regression analysis, CHA2DS2-VASc score [odds ratio (OR): 1.81 (95% CI: 1.42-2.30); P<0.001], Stroke [OR: 0.43 (95% CI: 0.21-0.85); P=0.016] and CRP [OR: 1.04 (95% CI: 1.01-1.06); P=0.002] were independent predictors of death. CONCLUSIONS:The CHA2DS2VASc score is directly related with mortality in PAD patients. The CHA2DS2VASc score may be a useful and practical scoring method to identify high-risk patients, and further future studies are needed to assess the role of CHA2DS2VASc score in PAD.

Aim: Venous leg ulcers are the most common lower extremity ulcers.The pathophysiology of venous leg ulcers has not been fully elucidated.Venous leg ulcers may cause exudate, pain, and bad smell.Compression bandaging has been known as the most effective treatment modality for venous leg ulcers.This study aimed to evaluate the effects of four-layer compression bandages and hyperbaric oxygen treatment on the outcomes of patients with venous leg ulcers. Material and Method:In our outpatient clinic of the Underwater and Hyperbaric Medicine Department between September 2016 and September 2019, 25 patients treated with four-layer compression bandages and hyperbaric oxygen adjuvant HBO -when needed for venous leg ulcers were evaluated retrospectively for the effects on outcomes. Results:The mean age of the patients was 57.4 years.The most common concomitant systemic disease was essential hypertension.On admission, the mean ulcer size was 74.4 cm² and the mean ulcer duration was 20.3 months.Complete healing was achieved in all patients with a mean follow-up of 3.36 months. Conclusion:In this study, healing rates were 64% and 92% after 12 and 24 weeks, respectively.In particular, the high healing rate achieved after 6 months proved that the treatment methods applied were reliable and effective.Using hyperbaric oxygen therapy as an adjunctive treatment method may have an impact on achieving these results.It is warranted to design further studies investigating the effect of adjunctive hyperbaric oxygen therapy on venous leg ulcers in a higher number of patients.

IntroductionChronic inflammation plays a considerable role in atherosclerosis and may occur simultaneously in different arteries. This condition is referred to as multisite arterial disease (MSAD). We aimed to investigate the association between inflammatory markers and MSAD.MethodsIn this cross-sectional study we included 526 patients with peripheral artery disease (PAD). Patients with PAD were evaluated by conventional or computed tomography angiography for the presence of coronary artery disease (CAD) and those with at least 30% stenosis were included in the study. Patients were divided into two groups: either MSAD+(PAD and CAD), Group 1) or MSAD- (only PAD without CAD, Group 2). Inflammatory markers were compared between the two groups.ResultsAmong all patients, 293 had MSAD while 233 had only PAD. The MSAD+group had higher neutrophil-to-lymphocyte ratio (NLR) and platelet-to-neutrophil ratio (PLR) (5.08±0.19, 4.67±0.51, and 207.1±6.23, 169.3±10.8, respectively, p<0.001). In multivariate analysis, HT [odds ratio (OR): 2.40 (1.61-3.59)); p<0.002], male gender [OR: 2.03 (1.29-3.17); p=0.002], DM [OR:1.56 (1.03-2.36); P=0.035], NLR [OR: 1,08 (1.02-1.16); p=0.021, and PLR [OR:1.05 (1.03-1.08); p<0.001] were found to be associated with MSAD.ConclusionNLR and PLR are correlated with MSAD and may indicate the extent of atherosclerosis.

OBJECTIVE:Peripheral artery disease (PAD) is a condition caused by the narrowing of limb arteries due to atherosclerosis. In recent years, polymorphisms in a number of genes have been shown to contribute to the risk of PAD development. However, whether the contribution of these inheritable factors is independent of traditional cardiovascular risk factors remains unclear. This study was an investigation of the effects of diabetes mellitus (DM) and genetic background, examined singly and together, on the pathogenesis of PAD.METHODS:The effects of the factor V Leiden (G1691A), factor V H1299R, prothrombin G20210A, factor XIII V34L, B-fibrinogen -455 G>A, PAI-1 4G/5G, HPA1, MTHFR C677T, MTHFR A1298C, ACE I/D, APO B R3500Q, and APOE polymorphisms were evaluated using a cardiovascular disease strip assay (CVD StripAssay). Two groups were created: 100 patients with PAD (50 with DM, 50 without DM) and 60 controls without PAD (30 with DM, 30 without DM).RESULTS:There was a significantly greater presence of the MTHFR A1298C and PAI 4G/5G homozygous polymorphisms in the PAD patients compared with the control group (p=0.035, p=0.004, respectively). There were no significant associations between the other genotypes and polymorphism frequencies. In the presence of DM, the PAI-1 4G/5G homozygous polymorphism was linked to the formation of PAD (p=0.021). Regression analysis indicated that the PAI-1 4G/5G gene homozygous polymorphism demonstrated a 17.1 times greater risk for DM with PAD [95% confidence interval (CI): 2.113-138.660; p=0.008] and the MTHFR A1298C homozygous polymorphism demonstrated a 316.6 times greater risk (95% CI: 10.763-9315.342; p<0.001) for the possibility of DM with PAD.CONCLUSION:The MTHFR A1298C and PAI 4G/5G homozygous polymorphisms may be associated with the development of PAD. The presence of the PAI 4G/5G homozygous polymorphism with DM was a powerful predictor for the development of PAD.

Aim: To investigate the vascular damage of internal mammary artery graft with electron microscope secondary to chronic renal failure transmission in patients who underwent coronary artery bypass grafting surgery. Method: A total of 30 patients (10 patients with chronic renal failure and 20 patients without chronic renal failure) who underwent coronary artery bypass graft surgery were included in this prospective study. Left internal mammary artery graft was harvested as conventional fashion with no touch technique. Samples were prepared and then examined with the transmission electron microscope. Every arterial sample was individually examined ultrastructurally, and the changes were recorded. Then the samples of the control group and chronic renal failure group were compared. Results: There were no significant differences between chronic renal failure group and the control group in terms of demographics, comorbidities, intraoperative data and postoperative outcomes, and the groups were statistically similar (p<0.05). Moreover, no statistically significance was detected in terms of structure and ultrastructure between the groups. Conclusion: The results of our study revealed that no ultrastructural changes were observed in the structure of IMA, suggesting that this graft would provide a good graft patency.

Purpose: We analyzed the role of oxidative stress in detrusor overactivity (DO) by measuring serum total antioxidant capacity (TAC), total oxidant status (TOS), binding capacity of exogenous cobalt to human albumin (IMA), serum advanced oxidation protein products (AOPP), paraoxonase (PON), and arylesterase. Materials and Methods: The study included 38 female patients diagnosed with DO and 29 healthy female subjects forming the control group. Serum total antioxidant capacity (TAC), total oxidant status (TOS), binding capacity of exogenous cobalt to human albumin (IMA), serum advanced oxidation protein products (AOPP), paraoxonase (PON), and arylesterase were analyzed. The results of serum TAC, TOS, IMA, AOPP, PON, and arylesterase of the subjects in both groups were compared. Results: There was no difference between the groups in terms of age. When compared to the control group, serum TAC and IMA levels were statisticaly lower (P < 0.001) and higher (P = 0.003), respectively. However, TOS, AOPP, PON, arylesterase levels were similar in both groups ( P > 0.05). Conclusion: There seems to be an association between DO and oxidative damage according our results, this can be measured by analyzing TAC and IMA in this patient group.

Introduction:In this study, we aimed to compare the efficacy of infraclavicular and supraclavicular brachial plexus block in patients undergoing upper extremity surgery.Methods:After obtaining ethics committee approval, 50 patients who were between the ages of 18-80 years with an “American Society of Anesthesiologists (ASA)” score of I or II and who would undergo elective upper extremity surgery in the orthopedics and traumatology clinic were included in the study. Patients were randomly divided into two groups; 25 patients in infraclavicular block group (group I) and 25 patients in supraclavicular block group (group S). In both groups, nerves were searched using peripheral nerve stimulator and a total of 20 mL of 0.5% levobupivacaine and 20 mL 2% lidocaine were injected into the brachial plexus sheath. Demographic data, ASA scores, operative indications, time to block point, needle depth, onset of block time, operative time, duration of motor and sensory block, and onset of postoperative initial pain were recorded.Results:There was no statistically significant difference regarding the demographic data and operative time between the patients. The time to block point, needle depth and onset of block time were significantly longer in group I than group S (p<0.001, for all). No significant difference was found between the groups in terms of duration of motor block and sensory block, and onset of postoperative initial pain.Conclusion:In our study, we found that the supraclavicular block is more advantageous in terms of time to block point, needle depth and onset of block time.

Preeclampsia/eclampsia is a contributing factor for high rates of maternal mortality worldwide. Data suggests that cerebral haemorrhage is a major cause of death among individuals suffering from preeclampsia. In this research, data was collected for over three years from pregnant women who were undergoing treatment at perinatology intensive care unit. They were admitted due to severe and uncontrolled eclampsia and preeclampsia. This research seeks to determine the frequency of patients who displayed cerebrovascular events, their clinical presentations and neuroimaging abnormalities. A retrospective evaluation of all obstetric patients who were diagnosed as pregnancy induced hypertension and followed-up between January 2011 and 2014 was performed. Retrospective computer records of age, neurologic symptom and neuroimaging findings were recorded and examined. Of the 222 participants in the study, 26 were diagnosed with severe preeclampsia while 10 patients have eclampsia. The study was performed on 36 patients whose age are ranking between 17 and 42 with a mean age of 30.06 ± 5.77. Mean systolic blood pressure was 156.89 ± 26.48 mmHg; and the average diastolic blood pressure was 98.29 ± 23.13 mm Hg. Of the 36-severe preeclampsia and eclampsia participants, 18 had begun to exhibit neurological attributes arising from eclampsia and pregnancy induced hypertension. Most common presenting symptom was generalized tonic-clonic seizures (eight, 44%). Five women had cerebral infarction and only one case had intraventricular haemorrhage. Two patients died after eclampsia crisis related intraparenchymal haemorrhage. Women ailing from advanced systolic hypertension (160 mm Hg) and severe eclampsia or preeclampsia have a higher risk of developing haemorrhagic stroke. Cerebral haemorrhage and stroke occurring in pregnancy and puerperium is a severe complication that can lead to maternal death. There should be recognition of using CT in those cases that are refractory to antihypertensive therapy can be lifesaving.

there are not a sufficient number investigating the factors in splenic injuries influencing mortality. In this study, we aimed to investigate the factors affecting mortality in splenic injuries.MATERIALS AND METHODS:All 237 patients with splenic injury between 2005 to 2014 were retrospectively analyzed. The patients were divided into two groups, survivors and non-survivors. Age, gender, mechanism of injury, grade of splenic injury, pulse, respiratory rate, systolic blood pressure, hemoglobin levels, number of transfusions, surgical procedure, ISS, RTS and hospitalization period were recorded. Univariate and multivariate analysis were used to compare survivors and non-survivors.RESULTS:The average age of the patients was 32 and most (82.7%) were male. Mortality was observed in 18 patients (7.6%). Mortality was found significantly lower in patients who had isolated splenic injury (p=0.048). In univariate analyses, decreased RTS (p<0.001), increased number of blood transfusion (p<0.001), decreased hemoglobin level (p=0, 025) and increased ISS (p<0.001) were found significant in non-survivors. In multivariate analysis; number of transfusions, ISS and RTS were found as independent risk factors for mortality.CONCLUSIONS:We found high number of transfusions, high ISS and low RTS as independent risk factors for mortality in patients with splenic injury.KEY WORDS:Mortality, ISS, RTS, Splenic trauma.