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Objectives: This study aimed to evaluate the validity and reliability of an oral anticoagulation knowledge (OAK) test in Turkish patients on warfarin therapy at an anticoagulant outpatient clinic. Materials and Methods: This study was conducted at an ambulatory anticoagulation clinic and included patients older than 18 years who had been using warfarin for at least six months. Patients' demographic and clinical data were collected. Internal consistency was calculated using the Kuder-Richardson 20 (KR-20) coefficient, and the test-retest reliability of the Turkish version of the OAK test was assessed. Results: Patients' mean age was 59.83 +/- 11.93 (26-90) years (n=240; 133 women). The mean score of the OAK test was 14.19 +/- 3.01. The test-retest reliability of the scale (n=30) was moderate for the total score (p

Objectives The aim of the present study is to evaluate the diagnostic powers of fractional magnesium, sodium and potassium as markers of renal tubular damage in normotensive type 2 diabetes mellitus (T2DM) patients with respect to microalbuminuria and estimated glomerular filtration rate (eGFR). Materials and methods Forty healthy volunteers and 91 normotensive T2DM patients were included in the study. Patient group was divided into two according to albuminuria level; 49 were normoalbuminuric and 42 were microalbuminuric. In addition to albumin in urine, urine and serum Na, K, Mg and creatinine values were measured to calculate fractional electrolyte excretion rates. Results In normoalbuminuric and microalbuminuric groups, fractional excretion of magnesium (FEMg) values were found to be significantly higher than the control group (p Conclusion For renal tubular damage predicted by microalbuminuria, FEMg could be accepted as a candidate biochemical marker with diagnostic and prognostic value.

Clinical pharmacist-led medication dose adjustment is required to provide safe and effective pharmacotherapy in patients with impaired renal function. This study aimed to assess clinical pharmacist-led medication dose adjustments in hospitalised patients with impaired renal function by comparing three online drug information databases.This retrospective observational study was conducted in an internal medicine ward between November 2016 and February 2017 among hospitalised patients with at least one estimated glomerular filtration rate (eGFR) valuelt;60 mL/min/1.73 msup2/sup. Clinical pharmacist-led medication dose adjustments according to eGFR were performed by comparing three online drug information databases: Micromedex, Medscape and Lexicomp. The number of items related to dose adjustments detected during the study period and the concordance between databases were evaluated.This study was conducted among 100 hospitalised patients (mean age 74.6±13.2 years) with impaired renal function. Clinical pharmacists detected at least one medication dose adjustment in 71.0% of patients. Among these patients, it was found that physician-led medication dose adjustments were made in only 15.5% of them. Of 1053 medications, the number of medications that required dose adjustments were 149 (14.2%), 151 (14.3%) and 163 (15.5%) according to Micromedex, Medscape and Lexicomp, respectively. The Fleiss kappa coefficient was 0.875 and the agreement of the three clinical decision support systems were almost perfect.In renal dose adjustments, Micromedex, Lexicomp and Medscape are concordant as online drug information databases. Clinical pharmacists could detect medication dose adjustment requirements in hospital patients with impaired renal function. The potential positive impact of clinical pharmacist-led medication dose adjustment should be investigated in further studies.

Background The aim of the study was to evaluate potentially inappropriate medication use in elderly patients with cancer. Method This study was conducted at outpatient oncology clinic from December 2014 to March 2015 among elderly cancer patients. Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria were used to identify potentially inappropriate medication in elderly patients. Results Among 114 cancer patients 55.26% of them were male and the mean age of them was 71.78 ± 5.50 (years). The most common concurrent diseases were hypertension in 45 (39.47%) and diabetes in 26 (22.81%) patients. Polypharmacy (≥5 medications) was seen in 94.73% of them. Eighteen patients (15.79%) utilized medications inappropriately according to Screening Tool of Older Person's Prescriptions criteria. Medication omissions were identified in 112 patients (98.25%) with Screening Tool to Alert doctors to Right Treatment criteria. Conclusions Clinical pharmacists could improve the current prescribing practices in elderly patients with cancer by assessing potentially inappropriate medications.

Summary Background The metabolic syndrome (MS) is a clustering of factors that are associated with increased cardiovascular risk. A low-grade inflammatory process acts as the underlying pathophysiology, which suggests that the MS may have a detrimental effect on coronary interventions, including coronary artery bypass grafting (CABG) surgery performed with cardiopulmonary bypass (CPB). We aimed to evaluate the effect of the MS on morbidity and mortality rates in the early postoperative period in patients undergoing CABG. Methods We prospectively included 152 patients (109 males and 43 females; mean age 60.1 ± 8.6 years) who underwent elective CABG on CPB between January and September 2011. Early postoperative morbidity and mortality rates were compared between subjects with and without the MS. Diagnosis of the MS was based on the American National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Results Of the study group, 64 patients (42%) had the MS. The two groups were similar in age and gender. In the postoperative period, rates of atrial fibrillation, wound infection, pulmonary complications, and lengths of intubation, hospitalisation and intensive care unit stay were significantly higher in MS patients (p < 0.01). The MS was significantly associated with wound infection (OR 6.64, 95% CI: 1.72–25.75), pulmonary complications (OR 6.44, 95% CI: 1.58–26.33), arrhythmia (OR 5.47, 95% CI: 1.50–19.97) and prolonged intubation (OR 1.17, 95% CI: 1.05–1.32). The mortality rate was 3.1% in the MS group and 1.1% in the non-MS group, with no significant difference (p > 0.05). Conclusion The MS was associated with a higher rate of early postoperative morbidity following CABG, without having a significant effect on the mortality rate.

ObjectiveApelin is a novel adipocytokine with a significant role in ischemia/reperfusion injury that is synthesized and secreted in myocardial cells and coronary endothelium. There is debate on its value for the diagnosis and prognosis of myocardial infarction. We aimed to investigate plasma apelin level in patients with acute ST segment elevation (STEMI) and non-ST segment elevation (NSTEMI) myocardial infarction and its relationship with left ventricular function and prognostic parameters.MethodsForty-one patients with STEMI, 21 patients with NSTEMI and 10 patients as control group with normal coronary angiograms were included. Plasma apelin level at presentation was investigated regarding its relationship with other diagnostic and prognostic parameters.ResultsApelin level was significantly higher in acute myocardial infarction (0.31 ± 0.56 ng/mL) compared to control group (0.08 ± 0.05 ng/mL) (p 0.05). No correlation was found between apelin and NT-proBNP, hsCRP, troponin, ejection fraction (EF) and Killip score (p > 0.05). A positive correlation was found between apelin and TIMI, GRACE and Gensini scores (p ConclusionApelin level was found to be high in acute myocardial infarction. With its inotropic and vasodilator effects, apelin was thought to have a protective role against severe ischemia.

Giriş ve Amaç: Dispepsili genç hastalarda alarm semptomlarının olmaması malignite yokluğuna dair güvenilir bir gösterge olarak kabul edilmektedir. Ancak alarm semptomlarının pozitif prediktif değeri nispeten zayıf kalmaktadır. Bu çalışmadaki amacımız alarm semptomlarının üst gastrointestinal sistem maligniteleri için tanısal değerini ve alarm semptomlarının yanısıra üst gastrointestinal sistem malignitelerini predikte eden farklı kriterlerler olup olmadığını araştırmaktır. Gereç ve Yöntem: 01.07.2011 ile 15.12.2012 tarihleri arasında Haydarpaşa Numune EAH Endoskopi Ünitesi’ne çeşitli nedenlerle üst gastrointestinal sistem endoskopisi yapılması amacıyla yönlendirilen 18-70 yaş arasında 200 hastaya hazırlamış olduğumuz anket yapılarak alarm semptomlarının olup olmadığı sorgulandı. Herhangi bir alarm semptomu varlığının ve tek tek alarm semptomlarının üst gastrointestinal sistem malignite prediksiyonu açısından duyarlılıkları, seçicilikleri, pozitif prediktif değerleri ve negatif prediktif değerleri hesaplandı. Bulgular: Çalışmada üst gastrointestinal sistem malignite prevalansı %3.5 olarak bulundu. Malignite görülen olguların tamamında herhangi bir alarm semptomu tespit edilirken, malignitesi olmayan olgularda alarm semptomu görülme oranı %91.2 idi. Herhangi bir alarm semptomu varlığının ve her bir alarm semptomunun pozitif prediktif değeri düşük, negatif prediktif değeri yüksek saptandı. Maligniteli olguların %28’i iyi differansiye, %28’i orta differansiye, %44’ü az differansiye idi. Üst gastrointestinal sistem malignitesi ile kilo kaybı olan ve sarılık, abdominal kitle ya da lenfadenopati olan olgular arasında istatistiksel açıdan anlamlı ilişki saptandı. Malignite tanısına 45 yaş ve üstünde olmak, disfaji, kilo kaybı, anoreksi, sarılık ve gastrik cerrahi öykü parametrelerinin etkilerini lojistik regresyon analizi ile değerlendirdiğimizde malignite ile ilişkileri istatistiksel olarak anlamlı (p: 0.002; p

We investigated the effect of ciprofloxacin, rifampicine and doxycycline on myeloperoxidase (MPO) activity, glutathione (GSH) and malondialdehyde (MDA) levels in allergic asthma patients and healthy volunteers. Polymorphonuclear leukocytes (PMNs) were isolated with ficoll-hypaque gradient centrifugation method. MPO activity was assayed with modified o-dianisidine, GSH by Ellman's and MDA levels by Beuge's method. PMN functions and MDA levels of patients significantly decreased when compared with healthy volunteers. Ciprofloxacin significantly increased PMN functions, MPO activity and MDA levels of both groups. We have demonstrated that ciprofloxacin has beneficial effects on MPO activity and PMN functions in allergic asthma patients and healthy volunteers.

We present a case of tuberculous peritonitis in a 46-year-old woman with rheumatoid arthritis treated with adalimumab, and we review the association between anti-tumour necrosis factor therapy and tuberculosis. This case illustrates that tuberculosis can develop with atypical clinic and uncertain laboratory findings and may mimic malignancies during adalimumab therapy.

Background/aim: This study aimed to compare washed red blood cell (WRBC) transfusion versus nonwashed RBC (NWRBC) transfusion in terms of posttransfusion potassium levels in dialysis patients on a day when the patient did not receive dialysis. Materials and methods: The patients were randomly assigned into two groups, i.e. those receiving WRBCs (n = 21) and those receiving NWRBCs (n = 17). Both groups received one unit of RBCs. Serum potassium and sodium levels were measured before and at the 1st, 2nd, 3rd, 4th, and 6th hours after transfusion. Results: In the WRBC group, the changes in the serum potassium levels at the 3rd, 4th, and 6th hours after transfusion were significant compared with pretransfusion levels. In the serum potassium levels mean decreases by 0.38 ± 0.57 mEq/L at the 3rd hour (P = 0.006), by 0.32 ± 0.47 mEq/L at the 4th hour (P = 0.005), and by 0.32 ± 0.51 mEq/L at the 6th hour (P = 0.009) after transfusion were significant compared with the pretransfusion levels. Conclusion: Although nonwashed RBC transfusion does not change serum potassium levels, washed RBC transfusion significantly reduces serum potassium levels. Washed RBC transfusion is considered to be safer in hemodialysis patients with hyperkalemia and anemia.

Objectives The present study aimed to investigate the effect of smoking on thyroid nodule formation and goiter development in healthy subjects living in Istanbul, an iodine-sufficient region. This study was designed as a prospective, randomized, and observational study. Methods Included in the study were voluntary hospital staff and relatives of patients between the ages of 28 and 71 who had no known disease or drug use, who have been living in Istanbul and had been smoking more than 10 cigarettes per day for at least 10 years. Nonsmoker volunteers (45) shared similar demographic characteristics and were matched for age to the (46) smokers. By means of thyroid ultrasounds performed in all participants, volumes of the right and left lobes of the thyroid gland, and number, diameter and characteristics of nodules were evaluated. Results Comparing the smokers and nonsmokers, no statistically significant difference was determined in terms of presence of nodules and volumes of the left and right thyroid lobes (P = 0.68, P = 0.09, and P = 0.63, respectively). Making enhanced diffuse enlargement of the thyroid gland, but not to a statistically significant degree. Smoking was observed to have no effect on non-toxic nodules, or the levels of thyroid-stimulating hormone, free thyroxin, free triiodothyronine, anti-thyroid peroxidase, or anti-thyroglobulin antibodies. Conclusions Smoking does not effect, to a statistically significant degree goiter development thyroid nodule formation in iodine-sufficient regions like Istanbul.

Background Many studies have shown that subclinical inflammation persisted during remission period of Familial Mediterranean Fever (FMF) patients but long term effects of subclinical inflammation in these patients aren't clearly known. Besides, a few of the recent studies revealed that risk of atherosclerosis had increased in FMF patients. β-Thromboglobulin (β-TG) is considered as a sensitive marker of platelet activation. In this study Mean Platelet Volume (MPV) and β-TG levels were evaluated in FMF patients. Methods Following the Local Ethics Committee's consent, 25 FMF patients were included in the study. Twenty eight age and sex matched healthy volunteers were recruited as a control group. Lipid profile, inflammatory parameters, hemogram, β-TG, MPV were assessed. Statistical analysis was performed with SPSS for Windows 16.00. Results Group I consisted of 25 FMF cases (16 females, 9 males; mean age: 35.72 ± 12.34 years), Group II consisted of 28 cases (22 females, 6 males; mean age 31.78 ± 10.31 years). There was no statistically significant difference between the groups in terms of age and gender distribution, smoking status, total cholesterol, triglyceride, LDL and MPV (p > 0.05). HDL levels were found to be statistically lower in Group I (p:0.04). Median β-TG levels was significantly higher in Group II than Group I (129.50 (range:372.00) ng/mL versus 104.00 (range:212.80) ng/mL respectively; p:0.03). Conclusion In this study MPV and β-TG were evaluated for FMF cases and healthy controls, β-TG levels were found significantly lower among patients; we hypothesized that this difference may have resulted from the effect of colchicine use on platelet functions.

The pathogenesis of dialysis-induced hypotension (DIH) is multifactorial and may include increased aortic stiffness. This study was undertaken to determine aortic elastic properties in patients undergoing hemodialysis with and without DIH, and to assess the effects of DIH on mortality.Aortic stiffness and left ventricular functions were evaluated in 70 patients undergoing hemodialysis with (n=34) and without DIH (n=36). We also evaluated total mortality at 36 months.Patients with DIH in comparison with patients without DIH, had lower aortic strain (5.0+/-3.8 vs. 7.8+/-3.0%, P0.005) and distensibility (2.3+/-1.9 vs. 3.2+/-1.7 cm2/dyn/10(3), P0.01). In univariate analysis, age, aortic stiffness and left ventricular systolic dysfunction, and coronary artery disease were also found to be the main factors associated with DIH. On multivariate logistic regression analysis, aortic distensibility [odds ratio (OR): 0.61; 95% confidence interval (95% CI): 0.40-0.93; P=0.01] and the coronary artery disease (OR: 6.46; 95% CI: 1.62-25.73; P=0.009) remained as significant variables associated with DIH. During follow-up period, 12 out of 34 patients with DIH died compared with 4 out of 36 patients without DIH (log rank, P=0.02).Our data suggest that DIH is strongly associated with increased aortic stiffness and poor outcome. Larger long-term follow-up studies, however, investigating whether the DIH plays a surrogate or causative role on mortality in patients undergoing hemodialysis should be designed.

Background and objective: In addition to reducing blood pressure, antihypertensive drugs should modify other atherosclerotic risk factors. One such risk factor is the prothrombotic state, which is characterised mainly by increased fibrinogen and plasminogen activator inhibitor-1 levels and abnormalities in platelet function. Platelet activity and aggregation potential can be estimated by measuring mean platelet volume (MPV). Serotonin plays a role in vasospasm and increased platelet aggregation capacity, and has been shown to increase MPV in vitro. However, serotonin levels and MPV have not been studied in the metabolic syndrome. We evaluated mean platelet volume (MPV) in patients with the metabolic syndrome, and compared the effects of doxazosin and amlodipine on MPV and serum serotonin level in patients with this condition. Methods: Thirty-eight patients who met the Adult Treatment Panel III criteria for the metabolic syndrome and 20 healthy controls were included in the study. Patients were randomised into two groups to receive doxazosin 4 mg/day (n = 20) or amlodipine 10 mg/day (n = 18). Patients’ MPV, serum serotonin, insulin, insulin sensitivity, fasting blood glucose and lipid profiles were measured at baseline and after 8 weeks. Results: Patients with the metabolic syndrome had a significantly higher MPV compared with the control group. MPV was significantly decreased in the doxazosin-treated group (from 6.9 ± 1.0fL at baseline to 6.1 ± 1.1fL after treatment; p = 0.02) but not in the amlodipine-treated group (6.8 ± 0.9fL at baseline vs 6.9 ± 1.0fL after treatment; p = 0.9). Fasting blood glucose and total cholesterol were also significantly decreased compared with baseline in the doxazosin group. In the amlodipine group, there was a significant increase in serum serotonin levels and a decrease in serum insulin and improved insulin sensitivity. Conclusion: In patients with the metabolic syndrome, doxazosin treatment not only decreases platelet activity, as measured by a change in MPV, but also improves metabolic abnormalities. Amlodipine also has beneficial effects in patients with the metabolic syndrome but has no effect on MPV.

Herediter hemorajik telenjiektazi, otozomal dominant geçişli, birçok klinik bulguyla karakterize, anormal vasküler formasyonla ilişkili nadir gözlenen bir hastalıktır. Biz bu vakada, gastrointestinal sistemin multiple bölgesinde (özofagus, mide korpus ve antrumu, duodenum) anjiodisplazik lezyonlarla seyreden, öyküsünde dört kez geçirilmiş miyokard infarktüsü bulunan, acil servise melena ile başvuran 65 yaşındaki olguya tanı anında yapılan argon plazma koagülasyon ve supportif yaklaşım kombinasyonun tedavi başarısını gözlemledik. Tanı anında uygulanan argon plazma koagülasyon ve bipolar koagülasyon yöntemleri bir çok çalışmada tercih edilen yöntemler olmuştur. Bu nedenle biz bu olgumuzda argon plazma koagülasyon yöntemini ve çalış-malarda etkisi kanıtlanmış konservatif tedavi kombinasyonunu tercih ettik. Bizim vakamızın argon plazma koagülasyon yöntemiyle beraber destek tedavisine verdiği hızlı cevap argon plazma koagülasyonun herediter hemorajik telenjiektaziye bağlı anjiodisplazik lezyonlarda seçkin tedavi yöntemi olduğu görüşünü desteklemektedir., Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome), a vascular disorder with autosomal dominant transmission, has a variety of clinical manifestations. In this case, we monitored a 65-year-old female who admitted to our hospital with gastrointestinal bleeding. Her history revealed repeated myocardial infarction (4 times). We diagnosed multiple angiodysplastic lesions with endoscopic examination. We evaluated the success of combination treatment with argon plasma coagulation and supportive approach at the time of diagnosis. argon plasma coagulation and bipolar coagulation methods have been reported as the preferred treatments in several studies. Therefore, we preferred the combination of argon plasma coagulation and conservative treatment methods in our case. The rapid healing observed with this treatment supports that combination treatment is effective in angiodysplastic lesions associated with hereditary hemorrhagic telangiectasia

Objective: In this study we evaluated the elastic properties of the aorta in patients with subclinical hypothyroidism and their relation with left ventricular diastolic function by transthoracic echocardiography. Patients and Methods: Aortic transthoracic echocardiography was performed and the aortic elasticity was evaluated using the following parameters; strain, the beta index and distensibility. results: There was significant difference in terms of aortic strain (5.79% vs. 9.45% p

We aimed to evaluate acute kidney injury (AKI), occurrence of recovery and risk factors associated with permanent kidney injury and mortality in the elderly individuals.Evidence for this study was obtained from retrospective cohort study from our center.A total of 193 patients (65 years, mean age: 79.99 ± 6.93) with acute kidney injury were enrolled in this study between 2011 and 2012. PATIENTS with kidney failure or renal replacement therapy (RRT) history at admission were excluded.Main outcome measurements: serum creatinine (SCr), estimated GFR (with CKD-Epi) and complete blood counts were evaluated at baseline and daily basis thereafter. The AKI was defined based on Kidney Disease Improving Global Outcomes (KDIGO) classification.Among 193 patients, 43 (22%) patients required RRT. Mortality rate was 18% (n = 36) SCr levels were restored within 9.9 ± 6.7days on average (8-39 days). Sixteen patients (12.7%) required RRT after discharge. The mean hospital stay was 10.1 ± 8.6 days (7-41 days). Mortality rate of patients who have no renal recovery was higher (44.8% vs. 4.8%) than renal recovery group (p 0.01).The AKI represents a frequent complication in the elderly patients with longer hospital stay and increased mortality and morbidity. Our results show that dialytic support requirement is an independent predictor of permeant kidney injury in the elderly AKI patients. Older age, low diastolic blood pressure, high CRP and low hemoglobin levels were independent risk factors for mortality.

This study aims to investigate long-term effects of iodinated radiographic contrast media used for coronary angiography (CAG) on the thyroid function in euthyroid patients.In a prospective observational cohort study, nonionic iodinated contrast material was electively used in 101 patients for coronary angiography. The patients were recruited without age restrictions and, at baseline, all had normal levels of free triiodothyronine (FT3), free thyroxine (FT4) and thyrotropin (TSH). The morphology of the thyroid was evaluated by thyroid ultrasonography (USG). Four and eight weeks after CAG, serum TSH, FT3 and FT4 levels were assessed.Compared to a mean baseline level of 1.49 (25%-75%, range 13-2.21), follow-up TSH levels decreased significantly to 1.45 (25%-75%, range 1.98-0.92, p=0.017) and 1.40 (25%-75%, range 1.89-0.87, p=0.003) at 4 weeks and 8 weeks, respectively (p=0.008). No significant diffe-rence was observed in TSH levels between the 4th and 8th weeks (p=0.833).Iodinated radiographic contrast agents may cause subclinical hyperthyroidism in euthyroid patients undergoing CAG.AMAÇ: Bu çalışma ötiroid hastalarda koroner anjiyografi için kullanılan radyolojik iyotlu kontrast maddelerin uzun dönemde tiroid fonksiyonlarına etkisini araştırmak amacıyla yapıldı. YÖNTEMLER: Elektif şartlarda koroner anjiyografi amacıyla noniyonik iyotlu kontrast madde kullanılan 101 hastada prospektif gözlemsel kohort çalışması yapıldı. Çalışmaya alınan tüm hastaların serbest triiodotironin (sT3), serbest tiroxin (sT4), bazal tirotropin (TSH) değerleri normaldi ve yaş sınırlaması yapılmadı. Tiroid ultrasonografi (USG) yapılarak tiroid morfolojisi değerlendirildi. KAG işleminden 4 hafta ve 8 hafta sonra hastaların serum TSH, sT3, sT4 değerleri kontrol edildi. BULGULAR: TSH bazalda 1.49 (%25-%75;13-2.21); 4.haftada 1.45 (%25-%75; 0.92-1.98) ve 8.haftada 1.40 (%25-%75; 0.87-1.89) olarak saptanmış olup; takipler arası değişim istatistiksel olarak anlamlı bulunmuştur (p=0.008). Bazal TSH düzeylerine göre 4. haftada (p=0.017) ve 8. haftada (p=0.003) istatistiksel olarak anlamlı düşüşler gözlenirken; 4. hafta ile 8. hafta TSH düzeyleri arasında anlamlı değişim gözlenmedi (p=0.833). SONUÇ: Ötiroid hastalarda koroner anjiyografi amacıyla iyotlu radyolojik kontrast maddelerin kullanılması subklinik hipertiroidizme neden olabilir.

Chronic skin ulcers require extensive, systemic differential diagnosis; thus, they are difficult to diagnose and treat. Transient or persistent hypercoagulable states are among the rare causes of skin ulcers. Here, we present the case of a 27-year-old woman patient with recurrent, nonhealing skin ulcers of 8 years’ duration, who had been treated unsuccessfully with various medications under different diagnoses at different clinics. On admission, a skin biopsy demonstrated occlusive vasculopathy, and the search for an inherited hypercoagulable state revealed a heterozygous factor V Leiden mutation. The patient was treated with anticoagulants and hyperbaric oxygen. On treatment, the skin lesions healed and did not recur.

The group G streptococcal endocarditis is a rare form of infective endocarditis. In this form of infective endocarditis, serious neurological complications most commonly develop. We reported this case because of its being an unusual form of infective endocarditis that was caused by Group G Streptococcus. We also reviewed the literature. The patient was admitted to infectious disease service with a presumptive diagnosis of central nervous system infection. Blood cultures were positive for group G streptococcus. There was a mass on the posterior surface of the mitral valve which was 2x 2.5 cm in length on the echocardiography. In the cranial computerized tomography of our patient, slightly increased contrast media uptake was observed in the both parietal lobes, in the both frontal lobes, and in the anterior areas of right occipital lobe. Therefore, this case was assumed as infective endocarditis caused by group G streptococcus with multiple cerebral emboli. Ceftriaxone was given for 4 weeks and gentamicin was given for 2 weeks, and progressive improvement of the patient’s condition was seen.

Osteoporosis that is by far the most common metabolic bone disease, has been defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Anabolic therapy with teriparatide, recombinant human parathyroid hormone (PTH 1-34), stimulates bone formation and resorption and improves trabecular and cortical microarchitecture. Teriparatide is indicated for the treatment of men and postmenopausal women with osteoporosis who are at high risk for fracture, including those who have failed or are intolerant of previous osteoporosis therapy. In conclusion, although teriparatide seems quite effective in the treatment of osteoporosis, it may cause life-threatening hypercalcemia. Therefore, patients should be closely monitored if symptoms of hypercalcemia are present during teriparatide treatment. Sustained hypercalcemia due to teriparatide treatment can not be seen in literature so we wanted to emphasize that severe hypercalcemia may develop due to teriperatide.

The activation of the platelets plays a key role in the formation of thrombosis. The variables such as mean platelet volume, platelet factor 4 and β-thromboglobulin have been used in the demonstration of the platelet activation. However, when the literature was reviewed, there was not found any study investigating the level of β-thromboglobulin in patients with rheumatoid arthritis. Our goal is to evaluate the β-thromboglobulin levels together with mean platelet volume in patients with arthritis. This study is a clinical study which has a control group that has been designed prospectively, and in this study, Rheumatology Outpatient Clinic follow-up patients with rheumatoid arthritis and healthy control group were studied. All patients and healthy volunteers were examined β-thromboglobulin and mean platelet volume. Twenty-two patients with rheumatoid arthritis and 21 healthy volunteers participated in the study. β-Thromboglobulin mean was found as 98.00 ± 60.49 ng/mL in rheumatoid arthritis group and it was 62.38 ± 30.41 ng/mL in healthy control group. The differences between these groups were significant in terms of the levels of β-thromboglobulin (p = 0.02). We found significant differences between the groups in terms of mean platelet volume (p = 0.049). In this study, the level of β-thromboglobulin was found significantly higher in patients with rheumatoid arthritis, which is a chronic inflammatory disease. This result could be an indicator, such as platelet activation in patients with rheumatoid arthritis, or it may be a helper marker in the follow-up and treatment of developing cardiovascular risk.

Systemic amyloidosis with AA-type amyloid deposition is the major complication of FMF, leading to end stage renal disease. There is no clear data on the prevalence of adrenal involvement in patients with FMF amyloidosis. The aim of this study is to determine the adrenal axis function in patients FMF with amyloidosis. Twenty patients with FMF with amyloidosis (F/M: 10/10, mean age; 38 ± 11 SD years), twenty without amyloidosis (F/M: 14/6, mean age 32 ± 10 years), and healthy controls (F/M: 12/8, mean age: 30 ± 7.6 SD years) were recruited. A dose of 250 mg tetracosactide (Synacthen) was then administered intravenously and further blood samples collected 30 and 60 min later. Blood samples were separated and collected at 4°C, and serum cortisol levels were measured. A normal cortisol response to Synacthen was defined as a post-stimulation peak cortisol value of >18 mg/d either at 30 or 60 min. sample. The mean disease duration was 8.8 ± 6 SD years, (range, 2-21) in FMF patients without amyloidosis compared to 16 ± 9.5 years (range, 0-30) in FMF with amyloidosis (P = 0.001). The cortisol concentrations increased significantly at 30 and 60 min compared to baseline after injection of synacthen in all groups. There were no statistically significant differences found among three groups, for basal, 30 and 60 min for cortisol levels (P = 0.154). FMF patients with amyloidosis do not exhibit overt adrenal insufficiency even though their basal cortisol levels were mildly lower.

Pulmonary hypertension and right ventricular (RV) dysfunction are severe complications of systemic lupus erythematosus (SLE). The role of increased pulmonary artery stiffness (PAS) has not been studied in RV dysfunction. We investigated the relationship between PAS and RV function in SLE patients without cardiovascular symptoms.The study included 32 patients with SLE (30 males, 2 females; mean age 34+/-9 years) and 30 age- and sex-matched healthy controls (28 males, 2 females; mean age 36+/-5 years). All the subjects underwent echocardiographic examination. Using Doppler echocardiography, PAS was calculated by dividing maximal frequency shift of the pulmonary flow by the acceleration time. To assess RV function, RV myocardial performance index (MPI) was determined by the sum of isovolumetric contraction and relaxation times divided by the ejection time. In addition, tricuspid annular plane systolic excursion (TAPSE) was measured on two-dimensional M-mode recordings.Compared to the control group, patients with SLE exhibited significantly higher PAS (p=0.004) and RV MPI (p=0.001), and lower TAPSE (p=0.001). In univariate correlation analysis, SV MPI was significantly correlated with PAS (r=0.60, p=0.001), age (r=0.48, p=0.003), SLE duration (r=0.51, p=0.002), and pulmonary artery systolic pressure (r=0.36, p=0.03). Multivariate linear regression analysis showed that PAS (95% CI 0.002-0.005; p=0.001) and SLE duration (95% CI 0.001-0.004; p=0.004) were independently associated with RV MPI. In addition, a significant inverse relationship was found between TAPSE and RV MPI (r= -0.48, p=0.005). Twenty-four SLE patients had normal RV function (TAPSEor = 17 mm). Eight patients with RV dysfunction (TAPSE17 mm) had significantly different RV MPI (p=0.001), PAS (p=0.002), age (p=0.04), and SLE duration (p=0.004).Our data suggest that increased PAS is strongly associated with the development of RV dysfunction in patients with SLE.

Albuminuria is a predictor of cardiovascular morbidity and mortality in patients with diabetes (DM). In this study, we tested the hypothesis suggesting that the presence of albuminuria reflects impaired aortic elastic properties in type 2 DM.Overall 140 patients with type 2 DM without obvious renal impairment (serum creatinine1.5 mg/dl) were included in this cross-sectional study. Patients were divided into 3 groups based on amount of albuminuria: Group 1 - patients with no signs of albuminuria (16 men, 34 women, mean age 51+/-11 years); Group 2--patients with microalbuminuria (15 men, 35 women, mean age 52+/-9 years); Group 3--patients with macroalbuminuria (14 men, 26 women, mean age 56+/-8 years). Each patient underwent transthoracic two-dimensional and Doppler echocardiography with assessment of diastolic function, aortic strain and aortic root distensibility. Statistical analysis was performed using ANOVA analysis for comparison of variables between 3 groups. The relationship of albuminuria with clinical variables, parameters of left ventricular mass, diastolic function, aortic strain and distensibility was assessed using multivariate regression analysis.A significant stepwise decrease in the aortic strain and distensibility was seen across Group 1 to Group 3. Similar findings were noted in left ventricular diastolic functions with longer deceleration time (DT) and lower peak early to late transmitral filling velocity ratios (E/A) in groups with albuminuria. Aortic distensibility significantly correlated with DT (r=-0.35, p0.001), isovolumic relaxation time (r=-0.31, p0.005) and left ventricular mass/height2.7 (r =-0.26, p0.005). In multivariate analysis, the amount of albumin was significantly associated with aortic distensibility (standardized beta coefficient -0.23, p0.01) and DT (standardized beta coefficient 0.26, p0.005).Our results suggest increased urinary albumin excretion is significantly correlated with impaired aortic elastic properties and left ventricular diastolic dysfunction in type 2 diabetes, which may contribute to the relation of albuminuria and increased rate of cardiovascular events among diabetics.

Patients with subclinical hypothyroidism (sHT) have an increased risk of developing atherosclerosis, probably related to dyslipidemia. We compared the effects of levothyroxine (L-T4) versus simvastatin treatment on carotid intima-media thickness (IMT) and lipid profiles in patients with sHT.Forty female patients with newly-diagnosed sHT and 20 age- and-sex matched euthyroid female controls were enrolled. Patients were randomized to receive L-T4 (n = 20) or simvastatin (n = 20) for 8 months. Carotid IMT and the serum concentration of cholesterol were measured at baseline and at the end of the treatment.Compared with controls, sHT patients had higher IMT values (0.66 +/- 0.16 mm versus 0.54 +/- 0.10 mm, P0.001). A significant reduction in serum levels of total and low-density lipoprotein (LDL)-cholesterol, triglycerides and mean IMT was observed in patients randomized to the simvastatin group compared to their baseline values. No correlation was demonstrated between the changes in total or LDL-cholesterol concentration and IMT in the simvastatin group. L-T4 replacement resulted in a significant reduction in IMT but serum lipid levels did not change significantly.Our results demonstrate that simvastatin significantly reduces IMT in addition to the significant improvement in serum lipids in female patients with sHT. This reduction of IMT was independent of the decrease in serum cholesterol during simvastatin treatment. Although L-T4 substitution therapy also decreases IMT, it does not appear to significantly improve lipid levels.

Aims Platelet activity and aggregation potential, which are essential components of thrombogenesis and atherosclerosis, can be conveniently estimated by measuring mean platelet volume (MPV) as part of whole blood count. It has been shown that MPV was significantly higher in diabetes mellitus (DM); however, the effect of glycemic control on MPV has not been studied. The aim of this study was to investigate the relationship among MPV, glycemic control, and micro- and macrovascular complications in type 2 DM. Methods Seventy patients with type 2 DM and 40 age- and sex-matched healthy individuals were enrolled. Diabetic patients were grouped into those with glycated hemoglobin (HbA1c) levels ≤7% (Group A, n =35 patients) and those with HbA1c >7% (Group B, n =35 patients). Initially, both groups were compared with regard to MPV, HbA1c, serum lipid levels, coronary artery disease, retinopathy, neuropathy, and nephropathy. Thereafter, Group B was called to monthly visits to obtain improved control glycemic control, which was defined as achievement of HbA1c ≤7%. At the end of 3 months of follow-up, Group B was reevaluated. Results MPV was significantly higher in patients with DM than in controls (8.7±0.8 fl vs. 8.2±0.7 fl, P =.002). In diabetic patients, there was a significant positive correlation between MPV and HbA1c levels ( r =.39, P =.001) but not diabetic vascular complications. When we compared the two diabetic groups, Group B patients had significantly higher MPV than Group A (9.0±0.7 fl vs. 8.4±0.8 fl, P =.01). Thirty patients (86%) of Group B achieved improved glycemic control at the end of the 3 months. MPV of the patients with improved glycemic control were significantly decreased compared to baseline MPV (8.4±0.8 fl vs. 9.0±0.7 fl, P =.003). Conclusions Our results suggested a close relationship between poor glycemic control and increased platelet activity in patients with type 2 DM. Furthermore, platelet activity recovered through improved glycemic control, which may prevent the possible role of platelets in cardiovascular events in these patients.

Objective Adenotonsillar hypertrophy (ATH) causing upper airway obstruction and obstructive sleep apnea (OSA) syndrome and may lead to the pulmonary hypertension and cor pulmonale. This study was designed to determine the clinical value of right ventricular (RV) myocardial performance index (MPI) in ATH. The effects of adenotonsillectomy on MPI were also assessed. Methods Twenty-one children with grade 3 and grade 4 ATH and 21 age-and-sex matched healthy children were enrolled. MPI, defined as the sum of isovolumetric contraction and relaxation time divided by ejection time, was measured by using Doppler echocardiography preoperatively and postoperatively in all subjects. The quality of life in children was also assessed with obstructive sleep disorder questionnaire (OSA-18). Results The RV MPI in patients with ATH was significantly higher than the control group (0.41 ± 0.06 vs. 0.29 ± 0.07; P

Patients with subclinical hypothyroidism (SCH) have impaired endothelial function probably related to dyslipidemia. The present study compares the effects of simvastatin versus levothyroxine (LT-4) treatment on lipid profile and endothelial function in patients with SCH. Fifty-nine patients with newly diagnosed SCH were enrolled. Patients were randomized into 3 groups to receive no treatment (n = 19), LT-4 (n = 20), or simvastatin (n = 20). We measured endothelium-dependent vasodilation (EDV) and endothelium-independent vasodilation (EIV) at baseline and after 8 months. Serum total cholesterol, triglycerides and LDL-cholesterol were significantly lower following simvastatin. EDV increased significantly in simvastatin treatment group (7.5% +/- 3.3% vs 14.0% +/- 4.5% (P < 0.01). The improvement of EDV correlated with the percent decrease of LDL-cholesterol (rho = 0.68, P < 0.01). Although LT-4 therapy caused a trend towards an increase in EDV compared to baseline, statistical significance was not achieved. EIV remained unchanged in all three groups. Simvastatin but not LT-4 treatment significantly improves EDV of the brachial artery and dyslipidemia in patients with SCH. Improvement in brachial artery endothelial function may be related in part to a hypolipidemic effect of simvastatin treatment.

Platelets play an important role in developing intravascular thrombus, the major cause of acute coronary syndromes. We investigated the clinical value of mean platelet volume (MPV) in coronary atherosclerosis and its possibility of being an independent risk factor for acute myocardial infarction (MI).Two hundred patients who underwent coronary angiography were included in the study. Thirty-five patients were randomly selected for each of the four study groups of stable (SAP) and unstable (USAP) angina pectoris and MI with and without ST-segment elevation. Sixty patients with chest pain having normal coronary angiograms were controls. The groups were compared regarding age, sex, smoking, diabetes, hypertension, positive family history, number of diseased vessels, lipid profile, complete blood count, creatine kinase (CK)-MB, Troponin-I, and MPV.MPV was found to be elevated in MI patients compared with controls (p0.001) and SAP (p0.05) and patients with two- (p0.001) and three-vessel (p0.001) disease. We observed a significant association between MI and higher MPV (or = 12 fl). High MPV (p0.001) and WBC (p0.001) were independent risk factors, among others. CK-MB, Troponin-I, and higher MPV demonstrate MI risk with 87%, 70%, and 87% specificity, respectively, while higher MPV only demonstrates coronary artery disease with 98% specificity.Our study shows high MPV is an independent risk factor for coronary atherosclerosis and MI. Because this is a simple, economic, and practical method, we suggest MPV be considered with other conventional risk factors.

… Turkish Soc Cardiol

Amac: Calismamizda diabetes mellitus (DM)’lu hastalarin polimorf nuveli lokosit (PNL) fonksiyonlari ile saglikli gonullulerin miyeloperoksidaz (MPO) aktivitesi, glutatyon (GSH) ve malondialdehit (MDA) duzeylerini karsilastirip arasindaki iliskiyi saptamayi amacladik. Bunun yaninda siprofloksasin, rifampisin ve doksisiklinin PNL fonksiyonlari, MPO aktivitesi ve GSH ile MDA duzeyleri uzerine immunomodulator etkilerini arastirdik. Yontemler: Calismamizda Tip 2 diyabeti olan 13 hasta ve 13 saglikli gonullu yer almaktadir. Antibiyotiklerin PNL fonksiyonlari uzerine olan etkileri in vitro kosullarda arastirildi. PNL’ler (1x107 hucre/ml) venoz kandan Ficoll-hypaque gradient santrifugasyon metodu kullanilarak izole edildi. PNL’lerin MPO aktivitesi modifiye O-dianisidin yontemi, GSH miktari Ellman yontemi ve MDA duzeyleri ise Beuge yontemi kullanilarak belirlendi. Bulgular: DM’lu hasta PNL’lerinin fagositik (p