NT-proBNP predicts impaired myocardial function in newly diagnosed hypertensive patients with preserved ejection fraction

N-terminal pro-brain natriuretic peptide (NT-proBNP) is an excellent biomarker to diagnose left ventricular (LV) dysfunction. LV myocardial performance index (MPI-Tei index) is commonly used as a measure of combined systolic and diastolic function. We aimed to investigate the relationship between NT-proBNP and tissue Doppler derived MPI in newly diagnosed hypertensive patients with preserved LV ejection fraction (LVEF). We studied 236 patients with newly diagnosed HT (mean age; 52.9?±?5.2 years). Echocardiographic examination was performed in all patients. LV mass index (LVMI) was calculated. Conventional Doppler indices (E and A waves) were recorded. The MPI value was obtained from the tissue Doppler derived ejection time, isovolumic contraction and relaxation times. The patients were divided into two groups according to the median NT-proBNP value (NT-proBNP_low group <114?pg/ml and NT-proBNP_high group ≥114?pg/ml). Patients with NT-proBNP_high were older and had higher levels of glucose and creatinine, lower E/A ratio and higher LVMI and MPI values than patients with NT-proBNP_low. However, LVEF were similar among the groups. Multiple linear regression analysis showed that NT-proBNP was independently associated with age, LVMI, MPI and E/A ratio. Increased NT-proBNP level was independently associated with impaired myocardial performance index in newly diagnosed hypertensive patients with preserved LVEF.     

Minor hemoglobins HbA2 and HbF associate with disease severity in bipolar disorder with a likely protective role of HbA2 against post-partum episodes

Background

There exist studies indicating that bipolar disorder (BD) associates with changes in brain blood flow. Human brain with its high demand to oxygen constitutes 2% of the total body weight, while it receives 20% of cardiac output. α and β globin chains of hemoglobin were recently found in neural tissues, yet no study has questioned blood hemoglobins in BD.

Methods

A total of 120 euthymic BD patients (40 males and 80 females) were analyzed via high performance liquid chromatography (HPLC) to measure minor hemoglobin levels, which were statistically compared with disease characteristics.

Results

Minor hemoglobins HbA2 and HbF associated positively with episode density as a measure of disease severity in BD. An increased level of HbA2 meant significantly less postpartum episodes in child bearing women. HbF levels were higher in patients with a positive family history of any psychotic disorder. Sum of HbA2 and HbF correlated with episode density with a stronger significance (p<0.001) supporting intermittent hypoxia hypothesis in BD.

Limitations

The study was conducted only on euthymic patients to avoid likely bigger exogenous effects such as electro-convulsive therapy and diverse drug regimes, yet larger comparative studies are needed to support our current findings.

Conclusions

Higher HbA2 and HbF in more severe bipolar disorder may be compensations against intermittent hypoxias in BD. HbA2 increases following myocardial angina and in mountain dwellers, which may indicate protective roles in extreme conditions. HbF increase may act more as a maladaptation or emerge via haplotypal associations of BD genes and gamma-globin locus at 11p15.5.     

Usefulness of Neutrophil-to-Lymphocyte Ratio to Predict In-hospital Outcomes in Infective Endocarditis

Background

The neutrophil-to-lymphocyte ratio is an independent predictor of worse prognosis in both infectious and cardiovascular disease. We hypothesized that an increased neutrophil-to-lymphocyte ratio at admission would predict in-hospital unfavourable outcomes in patients with infective endocarditis (IE).

Methods

We retrospectively analyzed clinical, laboratory, and echocardiographic data in a total of 121 consecutive adult patients (64 men; mean age, 54.7 ± 14.2 years) with definite IE.

Results

Among all patients, the prespecified clinical outcomes were experienced in 46 patients (38%). In-hospital mortality and central nervous system (CNS) events occurred in 29 (24%) and 21 patients (17%), respectively. The neutrophil-to-lymphocyte ratio at admission was found to be significantly higher for either composite end point. On using multiple Cox regression analysis, vegetation size ≥ 10 mm, end-stage renal disease, Staphylococcus aureus infection, low hemoglobin level, increased C-reactive protein (CRP) level, and high neutrophil-to-lymphocyte ratio at admission emerged as independent predictors of in-hospital unfavourable outcomes. In the receiver operating characteristics (ROC) curve analysis, a neutrophil-to-lymphocyte ratio > 7.1 had 80% sensitivity and 83% specificity in predicting adverse outcomes.

Conclusion

High neutrophil-to-lymphocyte ratio at admission is an independent predictor of in-hospital mortality and CNS events in patients with IE. However, prospective validation of these findings is required.     

An international polypectomy practice survey

Abstract

Background and study aims: In recent years, cold snare polypectomy (CSP) has been recommended as the preferred approach for removal of small and diminutive colorectal polyps. We conducted an international survey among endoscopists to understand the uptake of CSP and changes in polypectomy practice during recent years.

Patients and methods: Endoscopists were invited through gastroenterology, colorectal surgery and endoscopy societies to participate in an online survey. The primary outcome was to identify the predominant polypectomy approach used to remove 4?10?mm colorectal polyps. Secondary outcomes included the uptake of CSP in the past 5 years, current polypectomy practice patterns for 1?20?mm polyps, practice changes in recent years, and perceived benefits/concerns related to different polypectomy techniques.

Results: The survey was distributed internationally by nine societies and completed by 808 endoscopists (response rate 3.7%). CSP was the predominant polypectomy technique for 4?5?mm polyps (67.0%, 95% CI, 63.7–70.2%) and 6?10?mm polyps (55.2%, 95% CI, 51.8–58.6%). For 1?3?mm polyps, cold forceps remained the predominant technique (78.4%, 95% CI, 75.6–81.3%), whereas hot snare polypectomy (HSP) remained the predominant technique for 10?20?mm polyps (92.5%, 95% CI, 90.7–94.3%). 87.5% (95% CI, 85.2–89.8%) of endoscopists reported an increase in CSP use during the past 5 years.

Conclusions: This survey found a substantial increase in CSP use during recent years. CSP has become the predominant polypectomy approach for 4?10?mm colorectal polyps, while HSP remained the predominant approach for larger (10?20?mm) polyps. Clinical practice patterns are well aligned with recently issued guideline recommendations.     

Diversity of human rotavirus G9 among children in Turkey

Between September 2004 and December 2005 a prospective study was conducted to understand the epidemiology of rotavirus infection among children with diarrhea attending two hospitals in Ankara, Turkey. Rotavirus was detected in 39.7% of the 322 stool samples and affected mainly children in the age group of 6-23 months. More than 70% and 39% of these cases occurred in children <2 and <1 year of age, respectively. In the temperate climate of Ankara rotavirus infection was prevalent throughout the year. Serotype G1P[8] was dominant followed by G9P[8]. In 38 samples a total of 5 electropherotypes were detected. All G9P[8] were of long electropherotype except one of short electropherotype. A proportion of G1 and G9 strains were in combination with P[6], P[4] or P nontypable. Mixed serotypes were responsible for 2.4% of the infections. A phylogenetic tree constructed with the deduced amino acid sequences of the VP7 gene showed that 16 Turkish G9 strains clustered with rotaviruses of lineage III. One G9 strain formed a new lineage, lineage IV with the Sri Lankan G9 rotaviruses. In the phylogenetic tree of the VP8* gene, the Turkish G9P[6] rotaviruses clustered with human strains of lineage Ia. Increased diversity of the G/P type combination and the presence of infection throughout the year in Turkey was a situation similar to developing countries. The occurrence of rotavirus infection at later age and low level of mixed infections in Turkey represented the situation of developed countries. This study suggests that diverse G9 rotaviruses are emerging in Turkey.     

Assessment of the central corneal thickness and intraocular pressure in premature and full-term newborns

Purpose:

To assess the central corneal thickness (CCT) and intraocular pressure (IOP) in premature and full-term newborns.

Materials and Methods:

In this study, we evaluated measurements of CCT and IOP in 45 premature and 45 full-term newborns. IOP was determined with topical anesthesia using a Tono-Pen AVIA, applanation tonometer and a wire lid retractor in premature newborns undergoing screening for retinopathy. Full-term newborns were used as a control group. CCT was determined with a portable pachymeter after IOP measurements had been made in both groups. Because there was high correlation of CCT and IOP between right and left eyes, only the right eye data were used for further analyses.

Results:

The mean gestational age was 31.5 ± 2.7 weeks (ranging 25-35 weeks) and the mean age at measurement after birth was respectively 36.3 ± 0.9 weeks (ranging 33-37 weeks) in premature newborns and 38.2 ± 0.7 weeks (ranging 38-41 weeks) and 42 ± 2.2 weeks (ranging 39-46 weeks) in full-term newborns. The mean IOP was 16.2 ± 2.7 mmHg (ranging 10-22 mmHg) in premature and 16.6 ± 2.3 mmHg (ranging 10-22 mmHg) in full-term newborns. The mean CCT was found 600 ± 50 μm (ranging 515-790 μm) in the premature group and 586 ± 48 μm (ranging 475-730 μm) in the full-term group. Mean CCT was greater in premature newborns than in full-term newborns, but the difference between groups was not statistically significant (P = 0.7). Mean IOP measurement in two groups was found very similar and the difference also was not statistically significant (P = 0.27). There was no correlation between IOP and CCT, gestational age, gestational weight, age at measurement, weight at measurement neither right nor left eye in both groups in multiple regression analysis.

Conclusion:

We found that premature infants have slightly thicker corneas but no high IOP measurements than full-term newborns. It could be concluded that in premature at the mean gestational age of 36 weeks CCT is not different from that of full-term newborns.