Background/aim: Asymmetric dimethyl arginine (ADMA) is a strong predictor of cardiovascular disease and mortality in patients under hemodialysis treatment. We aimed to investigate the relationship among volume status, endothelial dysfunction, and ADMA in hemodialysis patients. Materials and methods: A total of 120 patients with a history of hemodialysis treatment were included. ADMA and CRP were measured. Echocardiographic evaluation and carotid artery intima-media thickness (CIMT) measurements were performed. Patients were divided into two groups according to clinical evaluation, ultrafiltration rate, vena cava inferior diameter (VCI), and cardiothoracic index (CTI); the two groups were hypervolemic and normovolemic. Results: The hypervolemic group included 61 patients while the normovolemic group included 59 patients. CIMT was higher in the hypervolemic group, but this result was not statistically significant (0.95 mm versus 0.85 mm, P = 0.232). There was a statistically significant difference between the hypervolemic and normovolemic groups in terms of ADMA (P < 0.001) (0.69 ± 0.57 μmol/L and 0.41 ± 0.04 μmol/L, respectively). Positive correlations were observed between serum ADMA, VCI, CTI, CRP, CIMT, and cardiac mass (P < 0.001, P = 0.016, P < 0.001, P = 0.006, P = 0.022, respectively), and negative correlations were observed between ADMA and ejection fraction and albumin (P = 0.024, P = 0.024, respectively). In multiple linear regression analysis, ADMA was independently associated with age, systolic blood pressure, CTI, and volume status. Conclusion: ADMA may be a potential determinant of hypervolemia as well as atherosclerosis in patients under hemodialysis treatment.

Aim The aim of this study was to investigate the short-term effect of the COVID-19 pandemic on the management of warfarin therapy used for atrial fibrillation (AF) and prosthetic valve disease. Material and methods   The study included 139 Atrial fibrillation (AF) patients and 173 prosthetic valve patients (PVP) who were using warfarin. The time in therapeutic range (TTR), International Normalized Ratio (INR) averages, the numbers of INR tests, and the non-adherence to INR monitoring (NIM) were compared for the pre-covid period (PCP) and the COVID-19 period (CP). Also, adherence to warfarin therapy was evaluated with a questionnaire. Results For all patients, the INR values were higher in the CP (2.47 vs 2.60, p<0.001), and the NIM percentage was higher (19.2 % vs 71.5 %, p<0.001) in the CP. The number of INR tests was lower during the CP (p<0.001).The percentage of patients with TTR≥70 % was lower during the CP (41.7 % vs 33 % p=0.017). Subgroup analysis showed that for PVP, TTR values and the percentage of patients with TTR ≥70 % were similar in both the PCP and CP periods. The questionnaire showed that for 94.1 % of respondents, the major cause of NIM in the CP was the COVID-19 pandemic. However, during the CP, adherence to warfarin medication was high (95.5 %). Conclusion Lower TTR during the COVID-19 pandemic can increase bleeding and thromboembolic cases.Therefore, patients taking warfarin should be followed more closely, and more practical ways should be considered for INR testing.

Aspirin,hypertension,primary prevention,secondary prevention,Turkey

Background: Non-small cell lung cancer (NSCLC) is the most prevalent form of malignancy and the leading cause of cancer-related fatalities. In clinical practice, metastatic sites are identified on a case-by-case basis. ALK rearrangements are detected in 3–5% of NSCLC cases and are known to have a tendency (tropism) to metastasize to the brain. Methods: Data from 81 ALK-positive and 91 ALK-negative metastatic NSCLC patients were retrospectively analyzed. Systemic markers, including HALP score, NLR, PLR, LMR, and LDH, were calculated from blood tests at the time of metastasis. Optimal cut-off values were determined using ROC analysis. Survival outcomes and prognostic factors were assessed using Kaplan–Meier and Cox regression analyses. Results: ALK-positive patients were significantly associated with female gender (p = 0.002), non-smoking status (p = 0.001), adenocarcinoma histology (p = 0.001), and a higher incidence of brain metastases (p = 0.001). In univariate analysis, age, time to metastasis, liver metastasis, and NLR were prognostic for survival. Crucially, multivariate analysis identified liver metastasis as an independent predictor of poor prognosis (HR = 1.618; 95% CI: 1.050–2.494; p = 0.029), indicating a 61.8% increased risk of death or progression. While inflammation markers (NLR, HALP, PLR, LMR) did not predict metastasis to specific sites, elevated LDH levels were significantly associated with liver metastasis (p = 0.007). Conclusion: ALK-positive NSCLC demonstrates a marked CNS tropism; however, liver metastasis remains a more critical adverse prognostic factor than brain metastasis in real-world settings. While routine inflammation markers showed limited utility in predicting site-specific metastasis, LDH levels correlated significantly with liver involvement. Aggressive management strategies are warranted for ALK-positive patients presenting with liver metastases.

Background/Objectives: Malignant melanoma remains a highly aggressive malignancy with substantial mortality despite advances in systemic therapy. Identifying simple and reproducible prognostic biomarkers is essential for improving risk stratification. Inflammation- and nutrition-based indices—including the Systemic Immune–Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), dynamic SIRI, and the Controlling Nutritional Status (CONUT) score—have shown prognostic value in various cancers. This study assessed the prognostic significance of these indices in patients with locally advanced or metastatic melanoma using real-world data. Methods: A retrospective cohort of 138 patients treated between 2010 and 2023 was analyzed. Baseline demographic, clinical, nutritional, and inflammatory parameters were collected. Optimal cut-off values for SII, SIRI, 6-month SIRI, and dynamic SIRI were determined using receiver operating characteristic analysis. Overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan–Meier method, and independent predictors were identified with multivariate Cox regression. Results: Elevated baseline SII and SIRI were significantly associated with shorter overall survival. Both 6-month SIRI and dynamic SIRI demonstrated strong prognostic value, emphasizing the importance of longitudinal inflammatory changes. In multivariate analysis, response to first-line therapy emerged as the only independent predictor of disease progression. Patients with a CONUT score ≥ 3 showed significantly shorter OS and PFS in univariate analyses, underscoring the prognostic relevance of nutritional status. Conclusions: SII, SIRI, 6-month SIRI, dynamic SIRI, and CONUT are practical, accessible, and reproducible biomarkers with meaningful prognostic value in advanced melanoma. Incorporating these indices into routine clinical assessment may enhance risk stratification and support more personalized treatment decision-making.