Neutrophil to Lymphocyte Ratio and Outcomes in Patients with New-Onset or Worsening Heart Failure with Reduced and Preserved Ejection Fraction

Inflammation is thought to play a role in heart failure (HF) pathophysiology. Neutrophil-to-lymphocyte ratio (NLR) is a simple, routinely available measure of inflammation. Its relationship with other inflammatory biomarkers and its association with clinical outcomes in addition to other risk markers have not been comprehensively evaluated in HF patients. Methods We evaluated patients with worsening or new-onset HF from the BIOlogy Study to Tailored Treatment in Chronic Heart Failure (BIOSTAT-CHF) study who had available NLR at baseline. The primary outcome was time to all-cause mortality or HF hospitalization. Outcomes were validated in a separate HF population. Results 1622 patients were evaluated (including 523 ventricular ejection fraction [LVEF] < 40% and 662 LVEF ≥ 40%). NLR was significantly correlated with biomarkers related to inflammation as well as NT-proBNP. NLR was significantly associated with the primary outcome in patients irrespective of LVEF (hazard ratio [HR] 1.18 per standard deviation increase; 95% confidence interval [CI] 1.11–1.26, P < 0.001). Patients with NLR in the highest tertile had significantly worse outcome than those in the lowest independent of LVEF (<40%: HR 2.75; 95% CI 1.84–4.09, P < 0.001; LVEF ≥ 40%: HR 1.51; 95% CI 1.05–2.16, P = 0.026). When NLR was added to the BIOSTAT-CHF risk score, there were improvements in integrated discrimination index (IDI) and net reclassification index (NRI) for occurrence of the primary outcome (IDI + 0.009; 95% CI 0.00–0.019, P = 0.030; continuous NRI + 0.112, 95% CI 0.012–0.176, P = 0.040). Elevated NLR was similarly associated with adverse outcome in the validation cohort. Decrease in NLR at 6 months was associated with reduced incidence of the primary outcome (HR 0.75; 95% CI 0.57–0.98, P = 0.036). Conclusions Elevated NLR is significantly associated with elevated markers of inflammation in HF patients and is associated with worse outcome. Elevated NLR might potentially be useful in identifying high-risk HF patients and may represent a treatment target

E-page Original Images. Thrombotic lesion of saphenous vein graft resolved by antiaggregant therapy.

PubMedID: 18400618[No abstract available

Estrous, ovulation and pregnancy rates following PGF2 alpha injections in mares

Prostaglandin F2 alpha was commonly used for synchronisation in mares. The purpose of this study was to see the effect of single and double doses of PGF2 alpha on estrous, ovulation and pregnancy rates. Therefore 43 Thoroughbred mares, between 4-17 years old, were used. Thirty mares 10 mg PGF2 alpha (Dinoprost Tromethamine, Dinolytic) was injected intramuscularly, regardless of the stage of the estrous cycle, for synchronization. Estrous behaviors and follicular development were examined with daily teasing and rectal palpation every other day, after PGF2 alpha injection and ovulation times determined daily rectal palpation during estrous. The mares which in estrous (n: 11) natural service or artificial insemination with fresh semen were done every other day until estrous behavior lasted. The mares (n: 19), were not estrous after first PGF2 alpha injection, were injected second PCF2 alpha 14 days later and repeated all applications after first PGF2 alpha injections. Control group (n: 13) were chosen from the mares which were not injected PGF2 alpha in estrous and natural service or artificial insemination with fresh semen were done every other day until estrous behavior lasted. For pregnancy diagnosis, rectal palpation were done all mares between 30-35th and 60th days after ovulation. Estrous, ovulation and pregnancy rates obtained from first or second PCF2a injected mares and control group were 36.66%, 33.33% and 45.45%; 68.42%, 78.94% and 46.66; 100%, 92.30% and 53.84%, respectively

Myocarditis: Medical education [Miyokardit]

Myocarditis is an inflammatory disorder of the myocardium with necrosis of myocytes and associated inflammatory infiltrate. Although the etiological agent is usually a virus, some bacteria, fungi, autoimmune disorders and medical drugs may also be implicated. Myocarditis has a variable clinical manifestation from latent to very severe clinical forms, such as acute congestive heart failure and sudden death. Scintigraphy, echocardiography and cine magnetic resonance angiography are useful methods to identify myocarditis. Endomyocardial biopsy, using the Dallas criteria for histopathological classification, has remained the gold standard for the diagnosis of acute myocarditis. In this review, pathological mechanisms, modalities of diagnosis and treatment strategies of myocarditis are discussed. Copyright © 2006 by Türkiye Klinikleri

The effect of follicle diameter on estrous and ovulation time during PGF2 alpha injection in mares

Variations in estrous and ovulation times occur because of follicle diameter during PGF2 alpha injection, in mares. The purpose of this study was to see the effect of follicle diameter on estrous and ovulation. Therefore 43 estrous cycles were evaluated in 32 Thoroughbred mares. Ten mg PGF2 alpha (Dinoprost Tromethamine, Dinolytic) was injected intramuscularly in diestrous period for synchronization. Follicle diameters were measured and divided into groups in centimeters as follows less than or equal to 1 cm, 1-2 cm, 2-3 cm, 3-4 cm ve > 4 cm, during PGF2 alpha injection. Result of daily teasing and rectal palpation every other day and daily rectal palpation during estrous period revealed that post injection-estrous. estrous period, post injection-ovulation. and estrous-ovulation times were in group less than or equal to 1 cm 5.91+/-2.71, 7.25+/-1.43. 11.75+/-2.23 and 6.16+/-1.95 days, in group 1-2 cm 4.81+/-2.84, 6.56+/-1.94, 10.68+/-2.95 and 5.87+/-2.85 days, in group 2-3 cm 3.90+/-1.44, 5.10+/-1.57, 8.00+/-1.78 ad 4.20+/-1.53 days and in group 3-4 cm 3.00+/-1.41, 4.60+/-1.35. 6.20+/-2.31 and 3.60+/-1.01 days, respectively. There was no follicle > 4 cm during PGF2 alpha injection. As a result, reduced estrous and ovulation times occured because of enlarged follicle diameters during PGE2 alpha injection. Therefore it was concluded that evaluation of ovaries for follicle structurs before PGF2 alpha injection would be beneficial

Is there any link between joint hypermobility and mitral valve prolapse in patients with fibromyalgia syndrome?

PubMedID: 26216348The objective of the present study is to determine whether benign joint hypermobility syndrome (BJHS) modifies the risk of mitral valve prolapse (MVP) in patients with fibromyalgia (FM). Female patients fulfilling the 1990 American College of Rheumatology (ACR) diagnostic criteria for FM were included into the study. Joint hypermobility and BJHS were assessed using Beighton’s scoring system and Brighton criteria, respectively. Echocardiograpic evaluation was performed in order to test the presence of MVP. Of the 75 female FM patients, 68.0% (n=51) and 20.0% (n=15) were diagnosed with BJHS and MVP, respectively. The frequencies of both MVP and BJHS seemed higher than the general population prevalence (p=0.000 for both). The frequency of MVP was significantly higher in patients with BJHS than that in patients without BJHS (p=0.028). In addition, BJHS was found to increase the risk of MVP approximately ninefold [odds ratio (OR) 8.7, 95% confidence interval (CI) 1.1–70.7]. As a result, BJHS and MVP are both common in female patients with FM. Moreover, among the female patients with FM, those with BJHS are about nine times more prone to MVP than those without BJHS. Cardiologic assessment might be added to the routine follow-up strategies in FM patients with BJHS in order to exclude the cardiac pathologies, especially MVP. © International League of Associations for Rheumatology (ILAR) 2015