Haldun Muderrisoglu

Mortality and hospitalization rates of heart failure (HF) increase with advancing age. However, the elderly are underrepresented in clinical trials; therefore, data on in-hospital outcomes and influencing factors of patients with HF in advanced age groups are limited. We aimed to investigate in-hospital outcomes and related factors in patients aged ≥80 years with decompensated HF. Records of patients hospitalized in the coronary care unit of a tertiary hospital between January 1, 2015, and December 31, 2020, were retrospectively reviewed. Eligible patients were ≥80 years of age and were followed for exacerbation of chronic HF. The primary outcome was in-hospital mortality rate. Patients were enrolled into 2 groups according to their survival status during index admission. The relationship between clinical, laboratory, and imaging features and in-hospital mortality rates was investigated. This study included 250 patients. The mean age of the subjects was 84.7 ± 4.8 years, and 57.6% of the population were women. The in-hospital mortality rate was 20.1%. The median length of hospitalization was 9 (4–12) days for non-survivors and 4 (3–6) days for survivors ( P < .001). The median hospitalization count was 0 (0–1) for survivors and 1 (0–2) for non-survivors ( P = .002). Systolic HF was more prevalent in non-survivors (73.8% vs 61.1%, P = .038), and ischemic HF was also more prevalent in deceased patients than in survivors (61.9% vs 45.2%, P = .048). Receiver operating characteristic analysis showed that risk factors increasing in-hospital mortality were white blood cell count ≥ 9.75 × 10 ⁹ /L, serum creatinine ≥ 1.75 mg/dL, serum sodium ≤ 137.5 mmol/L, serum potassium ≥ 4.65 mmol/L, C-reactive protein ≥ 28.45 mg/L, and serum albumin ≤ 33.5 g/L. This study provides preliminary data on the characteristics of older patients with HF who are at a higher risk of in-hospital mortality. Large prospective trials should be conducted to describe the causative relationship between these predictive factors and in-hospital outcomes in elderly HF patients.

Objective: Right ventricular (RV) dilatation and dysfunction are usually present in heart transplant (HTx) patients and worsened with residual pulmonary hypertension (PH). We aimed to determine the ability of different echocardiographic modalities to evaluate RV function in comparison with cardiac magnetic resonance (CMR) and their relations with pulmonary hemodynamics in HTx patients.Methods: A total of 62 data sets [echocardiographic, hemodynamic, and CMR] were acquired from 35 HTx patients. Comprehensive echocardiography, including two‐dimensional (2D) transthoracic echocardiography, speckle tracking echocardiography, and three‐dimensional (3D) echocardiography, was performed. Mean pulmonary artery pressure (mPAP) was obtained invasively from right heart catheterization. The correlations between all echocardiographic parameters and CMR imaging data and the differences between patients with and without residual PH were evaluated.Results: Diastolic and systolic RV volumes and RV ejection fraction (RVEF) by 3D echocardiography correlated strongly with CMR‐derived volumes and RVEF (r = .91, r = .79, r = .64; p < .0001 for each, respectively). Among other parameters, RV fractional area change (r = .439; p < .001) and RV free wall longitudinal strain (RVFW‐LS) (r = −.34; p < .05) correlated moderately with CMR‐RVEF, whereas tricuspid annulus S’ velocity (r = .29; p < .05) and tricuspid annular systolic plane excursion (r = .27; p < .05) correlated weakly with CMR‐RVEF. Additionally, 3D‐RVEF and RVFW‐LS were significantly decreased in studies with mPAP ≥ 20 mm Hg in comparison to those with mPAP < 20 mm Hg (47.7 ± 3.7 vs. 50.9 ± 5.3, p = .04 and −15.5 ± 3.1 vs. −17.5 ± 3, p = .03, respectively).Conclusion: The best method for the evaluation of RV function in HTx recipients is 3D echocardiography. Besides, the subclinical impact of residual PH on RV function can be best determined by RVFW‐LS and 3D‐RVEF in these patients.

Pertuzumab-mediated Cardiotoxicity: A Single Center Study. Objective: Recent clinical trials have shown that adding pertuzumab to trastuzumab improved the cellular response to therapy and provides a survival benefit compared with trastuzumab alone. However, it has raised concerns about additive risk of cardiotoxicity. Real life data on pertuzumab-induced cardiotoxicity are limited. Materials and Methods: Patients a diagnosis of breast cancer who had been treated trastuzumab plus pertuzumab between January 2017 and June 2022 and had undergone regularly transthoracic echocardiography, as a part of control visits, in our medical center were included. We performed descriptive statistical analysis to evaluate the patients’ characteristics and therapies, which could increase the risk of cardiac adverse events. Cardiotoxicity was evaluated by serial left ventricular ejection fraction (LVEF) measuring by 2D echocardiography at baseline and every three months during pertuzumab therapy and was defined as a decrease in LVEF > 10% to below 55%. Results: There were 118 patients fulfilling the inclusion criteria. The median age of the population was 51 (41-60) years. The median duration of pertuzumab therapy was 15 (9–57) weeks. Pertuzumab therapy was discontinued in two patients because of an allergic reaction and in other two patients due to cardiotoxicity. The reduced LVEF did not recover to baseline values in either patient. Conclusion: The incidence of cardiotoxicity (1.69%) in the current study was no higher than expected for trastuzumab alone. Data from previous studies and the results of this study support that pertuzumab causes no increase in cardiotoxicity. Still, large clinical trials are needed to verify the cardiac safety of pertuzumab in a real-world setting.

Objective: Systemic inflammatory parameters are predictors of poor prognosis in COVID-19 patients. This study evaluated whether the prognostic nutritional index, which was also related to nutrition risk and other inflammation-based prognostic scores, was predictive of in-hospital mortality in COVID-19 patients. Materials and Methods: This was a retrospective cross-sectional single-center study. Based on the exclusion criteria, 151 patients over 18 years old diagnosed with COVID-19 and hospitalized in the intensive care unit between March 2020 and December 2020 were eligible for this study. Multivariable logistic regression analysis was performed to evaluate the predictive value of the Glasgow Prognostic Score (GPS), Prognostic Index (PI), Prognostic Nutritional Index (PNI), and Systemic Inflammatory Index (SII). Results: In the univariate analyses, age, diabetes mellitus (DM), chronic kidney disease, acute kidney injury, hypothyroidism, hospitalization stay, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), D-dimer, ferritin, C-reactive protein (CRP), albumin, hemoglobin level, platelet count, urea, creatinine level, PNI, GPS were significantly associated with mortality. However, in the multivariable logistic regression analysis of the inflammation-based prognostic scores, only PNI was statistically significant in predicting in-hospital mortality (OR=0.83; [95% CI=0.71-0.97]; p=0.019). Conclusion: PNI is a more useful and powerful tool among these inflammation-based prognostic risk scores in predicting in-hospital mortality in COVID-19 patients. Keywords: COVID-19, inflammation-based prognostic scores, mortality, prognostic nutritional index

Para-aortic adipose tissue (PAT) is the local adipose tissue that externally surrounds the aorta. It contributes significantly to aortic atherosclerosis and enlargement. Studies conducted with comp...

Purpose: In this study, we compared the roles of inflammatory parameters such as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), C-reactive protein/lymphocyte ratio (CLR), monocyte/lymphocyte ratio (MLR), neutrophil/platelet ratio (NPR), neutrophil/monocyte ratio (NMR), CRP/albumin ratio (CAR), BUN/albumin ratio (BAR), MELD-XI score and 4C mortality score in predicting in-hospital mortality risk in COVID-19. Materials and Methods: A total of 117 patients over 18 years old with a PCR-confirmed diagnosis of COVID-19 between June 2020 and February 2021 were retrospectively included. The roles of parameters for independently predicting in-hospital mortality were determined and compared with each other using appropriate statistical methods. Results: Age, chronic kidney disease, diabetes mellitus, acute kidney injury, and length of hospital stay, urea, creatinine, LDH, AST, ferritin, D-dimer, CRP, albumin, Hb, CLR, BAR, CAR, MELD-XI score, and 4C mortality score were significantly correlated to in-hospital mortality. However, only the 4C mortality score and AST independently predicted in-hospital mortality in COVID-19 [OR 2.08 (%95 CI 1.06-2.36), for 4C mortality score, and OR 1.05 (%95 CI 1.00-1.10), for AST]. Conclusion: Unlike other mortality-related inflammatory parameters, the 4C mortality score and AST were independent and strong predictors of mortality in hospitalized COVID-19 patients.

Aim: Hydroxychloroquine (HCQ) is widely administered to patients with confirmed or suspected COVID-19. It may increase the risk of cardiac arrhythmias associated with QT and QTc prolongation. This study aimed to assess the change in iCEB, a new marker of drug-induced arrhythmia, and other repolarization parameters in suspected COVID-19 patients treated with short-course HCQ. Material and Method: This was a retrospective cross-sectional study including 40 patients hospitalized with suspected COVID-19 according to the CT findings and treated with HCQ. Serial assessments of the QT and QTc intervals and the calculation of the index of cardio-electrophysiological balance (iCEB) were performed using standard 12 lead electrocardiogram before hydroxychloroquine treatment, on the second day of HCQ treatment, and after the day of the last administered dose. Results: QT, QTcB, QTcF, iCEB, iCEBcB significantly increased on the second day of HCQ treatment compared to baseline (p=0.009, p=0.001, p=0.002, p=0.047, p=0.05, respectively). Similarly, QT, QTcB, QTcF, iCEBcB and iCEBcF were significantly higher on the fifth day compared to baseline (p=0.011, p=0.005, p=0.005, p=0.013, p=0.028, p=0.024 respectively). However, there were no differences between the second and the fifth days of treatment for any of the studied parameters. Conclusions: QT, QTc, and iCEB significantly increased compared to baseline on the second day, and remained increased on the fifth day of treatment. The differences were attributed to the amount of loading dose and the duration of HCQ treatment. Our study suggests that, along with other ECG markers, iCEB can be used in COVID-19 patients treated with HCQ.

Objective: The role of dipping blood pressure pattern in normotensives is unclear. The study aims to search the circadian blood pressure rhythm and the clinical determinants related to reverse dipping pattern in a strictly selected, normotensive population. Methods: The study population was divided into three groups depending on the nocturnal dipping pattern as dipping, non-dipping, and reverse dipping. Basal clinical characteristics, anthropometric measurements, and spot urine samples from the first-morning void were collected. Clinical determinants related to the presence of reverse dipping pattern were tested by the Multiple Binary Logistic Regression analysis. Results: A total of 233 participants were involved in the study population (median age 45 years [40–50]). Dipping pattern was detected in 55.4%, non-dipping pattern in 33.0%, and reverse dipping pattern in 11.6% of the study population. There was no difference between the groups in terms of basal clinical features. Albumin-to-creatinine ratio (ACR) (p < .001) and hs-CRP levels (p = .006) were also statistically significant across the groups. ACR (HR: 1.195, 95% CI: 1.067–1.338, p = .002) and hs-CRP (HR: 2.438, 95% CI: 1.023–5.808, p = .044) were found to be related to the presence of reverse dipping blood pressure pattern. Conclusions: The absence of nocturnal physiological dipping is seen at a remarkable rate in the normotensive Turkish population. ACR and hs-CRP are the clinical determinants related to the presence of reverse dipping blood pressure pattern.

Қазақстанда 1991 жылдан бастап денсаулық сақтау жүйесін жаңғырту бойынша бірқатар жобалар жүзегеасырылып келеді. Әлеуметтік медициналық сақтандыру жүйесін қалыптастыру және медициналық білім беруді дамытутұрғындарға көрсетілетін медициналық қызметтер сапасын, оның қолжетімділігін және тиімділігін арттыруға, сондайақ, тұрғындар үшін қаржылық тәуекелдерді төмендетуге бағытталған әлеуметтік медициналық сақтандыру жобасыменжалғасын тапты.Семей медициналық университеті мен Башкент университеті тек медициналық білім беру саласында ғана емес,сонымен қатар, университет клиникасын басқаруды дамытуда стратегиялық серіктестерге айналды. Жоба 21 ай мерзім ішінде жүзеге асырылды. Жобаны орындау барысында COVID-19 пандемиясы тудырған шектеулер мен кедергілергеқарамастан, барлық міндеттер мен жоспарланған іс-шаралар екі тарап сарапшыларының табысты ынтымақтастығыныңарқасында сәтті аяқталды.Жобаның негізгі міндеттері оқу бағдарламаларын әзірлеу, Башкент университетінің медициналық білім берумоделін енгізу, университет клиникаларын жаңғырту, сондай-ақ, қаржылық және стратегиялық шешімдер қабылдау жүйесіндамыту болды. Сәтті ынтымақтастықтың нәтижесінде құрылған модельдердің жүзеге асырылуының тұрақтылығынқамтамасыз етуге бағытталған жаңа жобалар пайда болды. Since 1991 Kazakhstan has formed up a series of development projects regarding the modernization of the healthcareservices. The formation of social health insurance and developments in medical education was followed by a Social Health InsuranceProject to increase the accessibility, quality, and efficiency of health service delivery and reduce financial risks to the population causedby severe health problems. As a part of the Project, Semey Medical University and Başkent University became strategic partners todevelop not only the education of the future medical doctors but also the management of the University Hospital. The project last for21 months. Although pandemic restrictions caused some obstacles during the implementation of the project, all the tasks and activitieswere executed with a successful cooperation of the experts of both parties. The development of the curriculum, implementation of theBaşkent University Medical Education Model, the modernization of the defined clinics as well as the development of the financial andstrategic decision making of the governance were the main tasks of the project. The success of this partnership leads to new projectsto enable the sustainability of the implemented models. В Казахстане начиная с 1991 года реализован ряд проектов по модернизации системы здравоохранения. Заформированием системы социального медицинского страхования и развитием медицинского образования последовалпроект социального медицинского страхования, направленный на повышение качества, доступности и эффективностимедицинских услуг, а также на снижение финансовых рисков для населения.Медицинский университет Семей и Университет Башкент стали стратегическими партнерами по развитиюне только медицинского образования, но и управления университетской клиникой. Реализация данного проекта занялав общей сложности 21 месяцев. Несмотря на ограничения и препятствия, вызванные пандемией COVID-19 во времяреализации проекта, все задачи и запланированные мероприятия были выполнены за счет успешного сотрудничестваэкспертов с обеих сторон.Основными задачами проекта были разработка учебных программ, внедрение модели медицинского образованияУниверситета Башкент, модернизация клиник, а также развитие системы принятия финансовых и стратегическихрешений. В результате успешного сотрудничества появились новые проекты, обеспечивающие устойчивостьвнедренных моделей.