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Background. NR5A1 [Steroidogenic factor 1 (SF1)] is a nuclear receptor that is essential for the development of gonads and adrenal glands as well as the establishment of steroidogenesis in these organs. The clinical findings of the mutations of NR5A1 gene in 46, XY individuals are variable. Virilization at puberty can be seen in some of the 46, XY children who have a female phenotype and are raised as female. A girl aged 13 years and 10 months old was brought by the family for deepening of her voice. On physical examination, her breast development was Tanner stage 2, axillary hair (+) and pubic hair was Tanner stage 4. She had labioscrotal fusion and 4.4 cm phallus (External Masculinisation Score was 6). Hypergonadotropic hypogonadism, low AMH and high testosterone levels were detected in laboratory tests. Uterus was not visualized in pelvic ultrasonography. Karyotype analysis was reported as 46, XY. Sequence analysis of the NR5A1 gene revealed a novel heterozygote c.1075_1089del (p.Leu359_Leu363del) variant. The patient was raised as a female and oestrogen replacement was started following gonadectomy. Conclusion. It should be kept in mind that virilization may develop at puberty in individuals with 46, XY disorder of sexual development due to NR5A1 mutation. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the association between behavioral emotion regulation strategies and symptoms of depression, anxiety, and stress among Turkish university students. Participants consisted of 633 students continuing their university education in two different universities in Türkiye. Participants completed a data collection tool comprising a Sociodemographic Information Form, the Behavioral Emotion Regulation Questionnaire, and the Depression Anxiety Stress Scales-21. Data were analyzed using descriptive statistics, Pearson's product-moment correlation coefficient analysis, and multivariate multiple regression analysis. The results of this study revealed that seeking distraction was negatively associated with symptoms of depression, anxiety, and stress, whereas withdrawal, seeking social support, and ignoring were positively associated with symptoms of depression, anxiety, and stress among university students. Additionally, actively approaching was negatively associated with depressive symptoms. Overall, the findings demonstrate that university students who use maladaptive behavioral emotion regulation strategies (e.g., withdrawal, ignoring) tend to have higher levels of psychological distress, whereas university students who use adaptive emotion regulation strategies (e.g., distraction) tend to have lower levels of psychological distress. However, contrary to expectations, seeking social support was positively associated with symptoms of psychological distress. Given the paucity of research on the relationship between behavioral emotion regulation strategies and psychological distress in the Turkish cultural context, this study may contribute to identifying both universal and culturally specific strategies associated with depressive, anxiety, and stress symptoms among Turkish university students.

Sacubitril/valsartan (S/V), an angiotensin receptor-neprilysin inhibitor, has been shown to reduce the risk of cardiovascular death or heart failure hospitalization and relieve symptoms in patients with chronic heart failure with reduced ejection fraction. The objective of this study was to assess the effects of S/V on erectile dysfunction in patients with heart failure with reduced ejection fraction (HFrEF). A prospective, open-label study was conducted with 59 male patients diagnosed with HFrEF and concomitant erectile dysfunction. Patients were treated with S/V for a duration of 1 month. The International Index of Erectile Function (IIEF) questionnaire was used to assess the severity of erectile dysfunction and sexual activities at baseline and follow-up visits. Other clinical parameters, including heart rate, were also monitored. After S/V treatment, a significant improvement was observed in sexual activities at the 1-month follow-up visit. The IIEF score showed a statistically significant increase, indicating a decrease in the severity of erectile dysfunction. However, it should be noted that the numerical increase in the IIEF score did not reach clinical significance. This study suggests that S/V treatment in patients with HFrEF may lead to improvements in sexual activities and a reduction in the severity of erectile dysfunction as measured by the IIEF score., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: The aim of this study is to reveal the perception levels of heart failure (HF) patients about the disease, their adaptation to the disease process, their compliance with the treatment, and their knowledge and thoughts about the disease from the patient's perspective., Method: Patients with a diagnosis of HF for at least 6 months who applied to the cardiology clinics of 10 different centers were included in this cross-sectional, multicenter and questionnaire-based study. A questionnaire consisting of sections that included demographic information, evaluation of the patient's symptoms, knowledge and experience of clinical follow-up, knowledge of HF, compliance and awareness of treatment was applied to the patients., Results: 504 patients with a mean age of 59.8 ± 14.9 years (M/F: 360/144, 71.4%/28.6%) were included in the study. 61.2% of the patients stated that they knew about HF disease before. Most of the patients knew that the complaints of shortness of breath, fatigue and palpitation could develop due to HF (95.4%; 92.7%; 89.7%, respectively). The patients reported that they were mostly worried about not being able to provide their own self-care without the support of another person (67.5%). While the majority of patients (37.6%) thought that the worst disease was to have a cerebrovascular disease; only 10.9% stated that HF was the worst disease. While 98.8% of the patients stated that they used HF drugs regularly, a relatively large part of the patients did not know that the drugs were effective on kidney functions (68.5%) and blood pressure (76.9%). In the daily practice of the patients, the rate of weight follow-up was 35.5%, the rate of blood pressure monitoring was 26.9%, and the rate of patients who exercised was 27%. Among the patients, 73.3% said that they pay attention to the amount of salt they take with diet, and 33.5% have a completely salt.free diet. There was no difference between the groups with low and high knowledge scores in terms of Pittsburgh Sleep Quality Index (P > 0.005). The knowledge level score was significantly higher in patients with previous myocardial infarction (P = 0.002)., Conclusion: Most of the HF patients participating in the study are aware of the signs and symptoms of HF, follow the recommendations of their physicians, and use drugs regularly. These patients should have more information about blood pressure monitoring, weight monitoring, diet and sodium restriction, exercise, which are included in the non-pharmacological part of treatment management.

Background and Objective: Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, has been shown to significantly reduce cardiovascular mortality, heart failure hospitalizations, and all-cause mortality in patients with heart failure with reduced ejection fraction. This study aims to investigate the long-term impact of the sacubitril/valsartan combination on lipid parameters in patients with heart failure with reduced ejection fraction., Methods: For this single-center retrospective cross-sectional study, data of patients using sacubitril/valsartan because of heart failure with reduced ejection fraction were collected. In addition to routine controls, the patients' lipid levels were measured at 3-month intervals. The parameters that were obtained over 3 years included total cholesterol, high-density lipoprotein cholesterol, triglyceride, and N-terminal pro-B-type natriuretic peptide levels., Results: A total of 192 patients with a functional capacity New York Heart Association II-V, and who were using sacubitril/valsartan because of heart failure with reduced ejection fraction, were included in this study. Independent of statin use, there was a decrease in total cholesterol levels (196.1 ± 44.8 mg/dL vs 161.5 ± 41.7 mg/dL, p < 0.001) and triglyceride levels (159.1 ± 10.4 mg/dL vs 121.4 ± 6.9 mg/dL, p < 0.001), and there was an improvement in high-density lipoprotein cholesterol levels (44.9 ± 1.9 mg/dL vs 48.2 ± 2.4 mg/dL, p < 0.001) when comparing baseline levels with third-year levels., Conclusions: Sacubitril/valsartan in patients with heart failure with reduced ejection fraction, independent of statin use, may cause a decrease in total cholesterol and triglyceride levels and an improvement in high-density lipoprotein cholesterol levels., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

The angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan and sodium-glucose cotransporter-2 (SGLT-2) inhibitor dapagliflozin have been shown to reduce rehospitalization and cardiac mortality in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We aimed to compare the long-term cardiac and all-cause mortality of ARNI and dapagliflozin combination therapy against ARNI monotherapy in patients with HFrEF. This retrospective study involved 244 patients with HF with New York Heart Association (NYHA) class II-IV symptoms and ejection fraction ≤40%. The patients were divided into 2 groups: ARNI monotherapy and ARNI+dapagliflozin. Median follow-up was 2.5 (.16-3.72) years. One hundred and seventy-five (71.7%) patients were male, and the mean age was 65.9 (SD, 10.2) years. Long-term cardiac mortality rates were significantly lower in the ARNI+dapagliflozin group (7.4%) than in the ARNI monotherapy group (19.5%) ( P = .01). Dapagliflozin [Hazard Ratio (HR) [95% Confidence Interval (CI)] = .29 [.10-.77]; P = .014] and left ventricular ejection fraction (LVEF) [HR (95% CI) = .89 (.85-.93); P < .001] were found to be independent predictors of cardiac mortality. Our study showed a significant reduction in cardiac mortality with ARNI and dapagliflozin combination therapy compared with ARNI monotherapy.

Objective: Heart failure (HF) is a growing public health problem with high morbidity and mortality. Recently, angiotensin receptor neprilysin inhibitor (ARNi) has emerged as a promising treatment for HF with reduced ejection fraction (HFrEF). Here, we shared our experience with the use of ARNi in HFrEF from multiple centers in Turkey., Methods: The ARNi-TR is a multicenter, noninterventional, retrospective, observational study. Overall, 779 patients with HF from 22 centers in Turkey who were prescribed sacubitril/valsartan were examined. Initial clinical status, biochemical and echocardiographic parameters, and New York Heart Association functional class (NYHA-FC) values were compared with follow-up values after 1 year of ARNi use. In addition, the effect of ARNi on number of annual hospitalizations was investigated, and the patients were divided into 2 groups, depending on whether ARNi was initiated at hospitalization or under outpatient clinic control., Results: N-terminal pro-brain natriuretic peptide (NT-proBNP), left-ventricle ejection fraction (LV-EF), and NYHA-FC values improved significantly in both groups (all parameters, p<0.001) within 1-year follow-up. In both groups, a decrease in hemoglobin A1c (HbA1c) values was observed in ARNi use (p<0.001), and a decrease in daily diuretic doses and hospitalizations owing to HF were observed after ARNi use (all comparisons, p<0.001). Hypotension (16.9%) was the most common side effect in patients using ARN., Conclusion: The ARNi-TR study offers comprehensive real-life data for patients using ARNi in Turkey. The use of ARNi has shown significant improvements in FC, NT-proBNP, HbA1c levels, and LV-EF. Likewise, reductions in the number of annual hospitalizations and daily furosemide doses for HF were seen in this study.

Objective: Guidelines recommend measuring and addressing health-related quality of life in the management of atrial fibrillation (AF); however, a disease-specific questionnaire is lacking for the Turkish language. Our aim was to translate and adapt the Atrial Fibrillation Impact Questionnaire (AFImpact) into Turkish and to explore its psychometric properties., Methods: This cross-sectional study was conducted in two phases, including the translation and cultural adaptation of AFImpact into Turkish language and the analysis of psychometric properties of the translated questionnaire. 98 patients diagnosed with AF were evaluated using the Turkish version of AFImpact, Short Form-36 (SF-36) and Pittsburg Sleep Quality Index (PSQI). Reliability, validity, and factor structure of the Turkish version of AFImpact was explored., Results: Cronbach's alpha coefficients for vitality, emotional distress, and sleep domains of AFImpact was 0.956, 0.955, and 0.819, respectively, indicating good-to-excellent internal consistency. No significant difference was detected between the initial and retest scores, and intraclass correlation coefficients of each domain varied between 0.991 and 0.996, indicating excellent test-retest reliability. Each domain of AFImpact highly correlated with similar domains of SF-36 and PSQI, having correlation coefficients between -0.484 and -0.699. AFImpact was able to discriminate between the patients in different functional classes, confirming know-groups validity. Factor analysis revealed AFImpact had the same factorial structure as the original questionnaire., Conclusion: The Turkish version of AFImpact is a valid and reliable questionnaire for evaluating health-related quality of life in patients with AF.

Background: Coronary artery ectasia (CAE) is described as the enlargement of a coronary artery segment by 1.5 times or more, which is generally associated with the atherosclerotic process. Atherosclerotic changes lead to arterial remodeling result in CAE. In our study, we measured serum transforming growth factor (TGF)-β1 levels, which have a protective role against atherosclerosis. Further, we aimed to assess the TGF-β1 gene variants rs1800469 (-509C>T, c.-1347C>T) and rs1800470 (c.+29T>C, p.Pro10Leu, rs1982073), which might have an effect on TGF production. Overall, 2877 patients were screened including 56 patients with CAE and 44 patients with normal coronary arteries who were included in the study. Serum TGF-β1 levels were measured using ELISA and compared between two groups. Additionally, TGF-β1 rs1800469 and rs1800470 gene variations were determined using TaqMan® SNP Genotyping Assays., Results: Serum TGF-β1 levels were significantly lower in patients with CAE than in controls (p=0.012). However, there was no difference in terms of the genotype and allele distributions of TGF-β1 rs1800469 and rs1800470 polymorphisms. Serum TGF-β1 levels were higher in individuals carrying the TGF-β1 rs1800470 G allele (GG+AG) than in individuals with normal homozygous AA genotype in the CAE group (p=0.012)., Conclusion: Our findings suggest that lower serum TGF-β1 levels are associated with an increased risk for CAE development and that TGF-β1 polymorphisms exert a protective effect. Furthermore, TGF-β1 rs1800470 G allele carriers were shown to have higher TGF-β1 levels in the CAE group. This suggests that having the G allele in the TGF-β1 rs1800470 polymorphism could prevent CAE development.

Objective: The performance of coronary bypass grafting (CBG) induces a type of subclinical systemic inflammatory response syndrome. The present study was performed to examine the changes in pentraxin 3 (PTX3) and oxidative parameters during cross-clamping in patients undergoing CBG. We also examined factors affecting the development of postoperative atrial fibrillation (POAF)., Method: This study involved 40 patients who underwent elective on-pump CBG (33 men, 7 women; mean age, 60.8 ± 8.0 years). Blood specimens were drawn before anaesthesia and after aortic cross-clamping. POAF was detected by analysing the rhythm records of telemetry units for 96 hours postoperatively., Results: The mean PTX3 concentration prior to surgery was 176.3 ± 148.4 pg/mL. After cross-clamping, it increased to 947.7 ± 377.2 pg/mL. The increase was statistically significant. Twelve patients had POAF. The leucocyte count and change in the oxidative stress index were significantly higher in patients without than with POAF. Although the increase in PTX3 was higher in patients without POAF, the difference was not statistically significant., Conclusion: The PTX3 concentration significantly increases during CBG. A significant change in the oxidative stress index and a more intense increase in the PTX3 concentration were seen in patients without POAF.

Background: Nutritional deficiency is a critical factor in the development and prognosis of heart failure. An optimal diet should be ensured and maintained to manage the symptoms of heart failure., Purpose: This study assessed the dietary habits of patients with chronic heart failure using diet quality indices with the goal of determining their nutritional status., Methods: Forty-four female patients and 56 male patients (mean age: 66 ± 11.38 years) who had been admitted to the cardiology clinics of a university hospital in Istanbul between March 2012 and August 2014 were included in this study., Results: In terms of body mass index, 34% of the participants were normal weight, 37% were overweight, and 21% were obese. Furthermore, this study found the mean daily total energy intake to be inadequate and the total mean score of the Healthy Eating Index to be 74.6 ± 9.32. The diet quality of most participants fell into the "needs improvement" category., Conclusions: This study used the Healthy Eating Index, a measure developed to assess diet quality, to assess the food consumption patterns of patients with chronic heart failure. The findings support using this index before providing diet recommendations to patients.

The aim of the present study was to evaluate the efficacy and safety of S-amlodipine 2.5 and 5 mg/d in patients with hypertension who were treatment-naive or previously received antihypertensive monotherapy. During the 8-week treatment period, all patients received S-amlodipine 2.5 mg/d for the first 4 weeks, followed by S-amlodipine 5 mg/d for the second 4 weeks. For efficacy assessments, ambulatory and office blood pressure (BP) measurements were performed during the baseline, fourth-week, and eighth-week visits. For safety assessments, all adverse events and abnormal laboratory findings were recorded. This study is registered with ClinicalTrials.gov (NCT03038451). Of 43 patients evaluated at the screening visit, 33 were enrolled. In the treatment-naive arm, significant reductions in both office and ambulatory systolic BP (SBP) and diastolic BP (DBP) were observed with S-amlodipine 2.5 mg/d and additional significant reductions were achieved with dose titration (S-amlodipine 5 mg/d). At the end of the study, the rate of the treatment-naive patients with BP under control (SBP/DBP <140/90 mm Hg) was 53% with S-amlodipine 2.5 mg and increased to 78% with S-amlodipine 5 mg. For the noninferiority evaluation, S-amlodipine 2.5 and 5 mg/d treatments were generally noninferior to both office and ambulatory BP levels achieved with the medications that the patients received before participating in the study. Five nonserious adverse events likely to be associated with the study drug were observed. No serious adverse event was encountered. Consequently, S-amlodipine can be suggested as an effective and safe treatment option for patients with hypertension.

Objective: The goal of this study was to define clinical practice patterns for assessing stroke and bleeding risks and thromboprophylaxis in nonvalvular atrial fibrillation (NVAF) and to evaluate treatment outcomes and patient quality of life., Methods: A clinical surveillance study was conducted in 10 tertiary healthcare centers across Turkey. Therapeutic approaches and persistence with initial treatment were recorded at baseline, the 6th month, and the 12th month in NVAF patients., Results: Of 210 patients (57.1% male; mean age: 64.86±12.87 years), follow-up data were collected for 146 patients through phone interviews at the 6th month and 140 patients at the 12th month. At baseline, most patients had high CHADS2 score (≥2: 48.3%) and CHA2DS2-VASc (≥2: 78.7%) risk scores but a low HAS-BLED (0-2: 83.1%) score. Approximately two-thirds of the patients surveyed were using oral anticoagulants as an antithrombotic and one-third were using antiplatelet agents. The rate of persistence with initial treatment was approximately 86%. Bleeding was reported by 22.6% and 25.0% of patients at the 6th and 12th month, respectively. The proportion of patients with an INR of 2.0-3.0 was 41.8% at baseline, 65.7% at the 6th month, and 65.9% at the 12th month. The time in therapeutic range was 61.0% during 1 year of follow-up. The median EuroQol 5-dimensional health questionnaire (EQ-5D) score of the patients at baseline and the 12th month was 0.827 and 0.778, respectively (p<0.001). The results indicated that patient quality of life declined over time., Conclusion: In atrial fibrillation, despite a high rate of persistence with initial treatment, the outcomes of stroke prevention and patient quality of life are not at the desired level. National health policies should be developed and implemented to better integrate international guidelines for the management of NVAF into clinical practice.

Objectives: We aimed to investigate the role of oxidative stress related with ischemia- reperfusion damage on the pathogenesis of atrial fibrillation (AF) developing after coronary artery bypass graft (CABG) surgery., Study Design: In our prospective, single-center study, 118 patients who underwent elective isolated on-pump CABG surgery were included. Patients were divided into two groups according to the development of postoperative atrial fibrillation (POAF) as Group 1: Patients who developed POAF, and Group 2: Patients who remained in sinus rhythm. In addition to preoperative demographic, laboratory, echocardiographic, intraoperative, and postoperative clinical characteristics, levels of plasma total oxidative status (TOS) after placement and removal of aortic cross clamp (ACC) were compared between the two groups. Predictors of POAF were also investigated by multivariate logistic regression analysis., Results: A comparison of preoperative demographic, laboratory, echocardiographic, and postoperative clinical characteristics between the two groups showed that patients in Group 1 were significantly older (65.6±7.20 vs. 59.6±9.07, p<0.001), had a lower hematocrit level (37.5±5.16 vs. 39.7±5.28; p=0.034), and an enlarged left atrium diameter (39±0.45 vs. 3.6±0.48; p=0.006). Changes in plasma TOS levels after placement and removal of ACC were statistically significant in Group 1 [13 (8.6-23), 30 (18.1-47.3); p=0.001 vs. 14 (8.8-22.2), 24 (21.4-42.7); p=0.060]. Length of stay in the intensive care unit [3 (2-14) vs. 2 (1-58); p=0.001] and length of stay in hospital [7 (6-85) vs. 7 (5-58); p=0.001] were prolonged in Group 1. In multivariate logistic regression analysis, aging (odds ratio (OR): 1.088, 95% confidence interval (CI): 1.005-1.177; p=0.036), hematocrit level (OR: 0.718, 95% CI: 0.538-0.958; p=0.025), pump temperature (OR: 1.445, 95% CI: 1.059-1.972; p=0.020), and plasma TOS level (OR: 1.040, 95% CI: 1.020-1.050; p=0.040) were found to be independent predictors of POAF., Conclusion: Ischemia-reperfusion damage related with ACC placement may be an important factor on the pathogenesis of POAF. Minimizing the oxidative stress occurring intraoperatively should be targeted for preventing mortality and morbidity due to POAF.

Introduction: To determine whether elevated N-terminal pro-BNP (NT pro-BNP) predicts pulmonary artery systolic pressure increase on exercise stress echocardiography in asymptomatic or mildly symptomatic patients with moderate to severe mitral stenosis., Methods and Results: Forty-one asymptomatic or mildly symptomatic patients with moderate to severe mitral stenosis and 21 age- and sex-matched healthy subjects. Transthoracic echocardiography was performed in all patients to assess the severity of the valve disease and to measure pulmonary artery pressure before and immediately after treadmill exercise. Blood samples for NT pro-BNP were also collected before and immediately after treadmill exercise at the time of echocardiographic examination. The plasma concentrations of NT pro-BNP levels were significantly higher in patients with mitral stenosis than in control subjects before and after exercise (P < 0.001). Patients with atrial fibrillation had significantly higher NT pro-BNP levels compared to those with sinus rhythm (P < 0.001). Pre- and postexercise NT pro-BNP levels correlated statistically significantly with the left atrial (LA) dimension, right ventricle enddiastolic diameter, exercise duration, heart rate, rest, and exercise pulmonary artery systolic pressure, after exercise mitral valve mean gradient. Area under the receiver-operating characteristic curve for NT pro-BNP as an exercise induced augmentation of pulmonary artery pressure was 0.78. Using an optimized cutoff value of 251 pg/mL for NT pro-BNP, sensitivity was 89.47%. The independent determinants of higher pulmonary artery pressure were LA diameter and pretest NT pro-BNP levels in multivariante analysis., Conclusion: NT pro-BNP levels correlate with functional class and echocardiographic findings in patients with mitral stenosis and indicate exercise induced augmentation of peak PAP > 60 mmHg. (Echocardiography 2011;28:8-14)., (© 2010, Wiley Periodicals, Inc.)

Objectives: We evaluated the validity and reliability of the Turkish versions of the Beliefs about Medication Compliance Scale (BMCS), Beliefs about Dietary Compliance Scale (BDCS), and Beliefs about Self-Monitoring Scale (BSMS) for patients with chronic heart failure (CHF)., Study Design: After language and content validity studies, the Turkish versions of the three scales were administered to 80 patients (47 men, 33 women; mean age 59.3±12.5 years; range 24 to 79 years) with CHF. Internal consistency of the scales was assessed using the Cronbach's alpha coefficient. Test-retest reliability was assessed using the interclass correlation coefficient measured from two consecutive interviews interspersed by 15 days., Results: There were no significant differences between the two interviews with respect to the total scores of the benefit and barrier subscales of each scale (p>0.05). Cronbach alpha coefficients of the benefit and barrier subscales at the first interview were 0.74 and 0.59 for the BMCS, 0.71 and 0.58 for the BDCS, and 0.77 and 0.68 for the BSMS, respectively. Interclass correlation coefficients for test-retest reliability for the benefit and barrier subscales were as follows: 0.90 and 0.91 for the BMCS, 0.86 and 0.86 for the BDCS, and 0.90 and 0.93 for the BSMS, respectively., Conclusion: Our findings suggest that all three scales have high validity and reliability and can be used as valid and reliable instruments in Turkish patients with CHF.

The purpose of our study was to determine the normal cardiovascular responses of healthy Turkish children to exercise and to determine the reference values. Two hundred and eighty-four healthy children (115 girls, 169 boys) aged 5-14 were enrolled in the study. Exercise time (ET), workload that can be tolerated with exercise (MET value), change in heart rate (A HR), peak systolic and peak diastolic blood pressures (SBPmax and DBPmax), change in systolic blood pressure (delta SBP), and peak rate-pressure product (RPPmax) were positively correlated with age. There was no correlation between peak heart rate (HRmax) and age and there was also no significant increase in change in diastolic blood pressure (delta DBP) with increasing age. The means +/- SD values for ET, workload, HRmax, delta HR, SBPmax, DBPmax, delta SBP, deltaDBP, and RPPmax were 13.18 +/- 1.4 min, 8.56 +/- 0.93 MET, 171.46 +/- 1.91/min, 67.22 +/- 6.65/min, 125.16 +/- 13.36 mmHg, 73.32 +/- 4.06 mmHg, 24.3 +/- 5.96 mmHg, 7.2 +/- 6.9 mmHg, and 21504.7 +/- 2176.4, respectively. The values found in our study may be accepted as reference values of healthy Turkish children for exercise testing. The formula modified as (200-age) x 0.85 is thought to be more suitable to predict the target heart rate in children.

Background: Pressure ulcers (PrUs) remain a common problem in all healthcare settings. The aim of this study was to assess the presence of risk factors in patients with PrUs., Methods: The study included 32 immobilized inpatients with PrUs and 30 immobilized inpatients without PrUs as a control group, who were being followed up at the Ankara Physical Therapy and Rehabilitation Hospital, Ankara, Turkey. Patients were given physical examinations and assessed for medical history, as well as for associated diseases, the duration of PrUs, the presence of stool and urinary incontinence, the use of pressure-reducing bed surface, and change of position. Routine biochemical and hematologic blood examinations were performed in all of the patients involved in the study., Results: When risk factors for PrUs were assessed, 81.2% of the patients with PrUs had stool and urine incontinence, 46.8% had been smoking, 46.8% had hypoalbuminemia, 15.6% had been drinking alcohol, and 9.3% had diabetes; 18.7% had been using a pressure-reducing bed surface before the ulcer appeared, and 40.6% started to use a pressure-reducing bed surface after the ulceration occurred; and 59.3% were repositioned periodically. PrUs were found to develop earlier in patients who were smoking and who had anemia. A significant relation also was found between the grade of the ulcer and the frequency of change of position in bed. Smoking and urinary/stool incontinence were found to be significantly present more frequently in the patient group than the control group. Stool incontinence and the absence of the use of a pressure-reducing bed were also found to be risk factors in the patient group when compared with the control group., Conclusions: The authors believe that stool and urinary incontinence, smoking, anemia, not using a pressure-reducing bed surface, and infrequent change of position in bed are considerable risk factors for the development of PrUs. Immobilized patients should be assessed for these risk factors, and measures should be taken to prevent PrU development.

Background: The relationship between prolonged intubation period and postoperative complication incidence following cardiac surgery was investigated., Material/method: Evaluated were 237 adult patients who underwent coronary artery bypass graft operation, of whom 115 (group I) had intubation periods of more than 24 hrs (mean: 56.1+/-39.1 hrs) and 122 (group II) less than 24 hrs (mean: 16.25+/-14.6 hrs). Preoperative and postoperative pulmonary function test values as well as postoperative changes in the two groups were compared., Results: Mean hospital stay for group I and II patients were determined as 24.6+/-2.04 and 10.61+/-3.04 days, respectively (p<0.0001). The preoperative pulmonary function test results compared with the predicted values for both groups were similar. A significant decrease was determined in the postoperative pulmonary function test values in both groups, but the decrease in group I was significantly higher than in group II. Pulmonary complications developing in groups I and II were 26.09% (30 patients) and 7.38% (9 patients), respectively (p<0.0001). Also, total general complications were 39.14% (45 patients) and 13.12% (16 patients), respectively., Conclusion: Under similar conditions, the patients whose partial bypass time and aortic clamp period were significantly longer needed to be ventilated for more than 24 hours, being related to late complications following bypass operation, and the complication risk of this group was 3.5 times higher than for those who remained intubated less than 24 hours.

Hyperlipidemic patients with coronary heart disease were treated with atorvastatin, and its effects on hemostatic and inflammatory parameters were assessed. After 3 months of therapy, the plasma levels of plasminogen activator inhibitor, prothrombin fragment 1+2, highly sensitive C-reactive protein, von Willebrand factor, and fibrinogen were significantly reduced; no significant reductions were observed in lipoprotein(a) and tissue plasminogen activator antigen levels.

Aim: Prolongation of P wave time and increase of its dispersion as an independent predictor of atrial fibrillation. In patients with paroxysmal atrial fibrillation (PAF) as in healthy people, exercise augments sympathetic activity and therefore can cause the development of atrial fibrillation. The aim of this study is to evaluate the effect of exercise on P wave dispersion and to predict the development of atrial fibrillation., Methods: One hundred and ninety-eight patients (93 women, 105 men, mean age: 59.05 +/- 11.01 years) having the diagnosis of PAF were included in the study. The left atrial diameter of all these patients was more than 4.0 cm. One hundred and fifty-five patients (72 females, 83 males, mean age: 58.41 +/- 10.79 years), with left atrial diameter more than 4.0 cm and without PAF were taken as control group. Symptom limited exercise test with modified Bruce protocol was performed on all patients. Rest, maximum exercise and recovery, and first, third, and fifth-minute 12-derivation ECG was taken in all patients. The velocity of ECG was adjusted to 50 mm/s; shortest and largest P wave durations were measured and P wave dispersion was calculated., Results: The mean left atrial diameter was 4.41 +/- 0.58 cm in PAF patients and 4.38 +/- 0.48 cm in control group. No differences were found between PAF patients with the controls in exercise time (10.38 +/- 2.93 vs 10.81 +/- 2.75 minutes); METs (6.98 +/- 1.72 vs 7.28 +/- 1.75 minutes); resting heart rate (79.13 +/- 14.86 vs 79.69 +/- 10.43 bpm); peak heart rate (146.83 +/- 23.21 vs 146.94 +/- 16.13 bpm). Maximum exercise P wave duration and P wave dispersion were greater than the rest measurements in PAF group (respectively P < 0.0001 and P = 0.0004)., Conclusion: In PAF patients, P wave dispersion is significantly longer at rest, maximum exercise and recovery time than in a control group without PAF.

The effects of smoking on postoperative lung volumes, arterial blood gas tensions, and pulmonary complications were studied prospectively in 213 consecutive Turkish patients undergoing elective coronary artery bypass graft surgery. One hundred and seventeen patients were current smokers (19 females, 98 males, mean age. 59.0 +/- 6.1 years. group 1) and 96 were nonsmokers (40 females, 56 males mean age. 59.6 +/- 5.8 years, group 2). Demographic data and the anesthesia and surgical methods were similar in both groups. Pulmonary function tests, arterial blood gas analyses, and chest radiographs were done preoperatively and postoperatively. Pulmonary complications were recorded. Postoperative partial arterial oxygen tension values in both groups revealed moderate hypoxemia which was more intense in smokers (decreased from preop. 82.0 +/- 7.8 mmHg to postop. 66.1 +/- 8.0 mmHg). Mean partial carbon dioxide tension increased significantly, remaining within acceptable limits (from 32.5 +/- 2.2 mmHg to 38.6 +/- 3.6 mmHg) in smokers following surgery. The postoperative pulmonary function test values decreased significantly in both groups but the deterioration in the smoking group was highly significant, except for FMFT. In the smokers, the preoperative mVC/pFVC (%) value was at the lower normal limit which indicates slight restrictive respiratory problems. Patients in both groups developed a severe restrictive ventilatory defect after coronary artery surgery (P < 0.0001 for both), but this restriction was also statistically significant in the smoking group compared to nonsmokers after surgery (mVC/pFVC from 74.7 +/- 12.6% to 52.3 +/- 10.0% and 80.8 +/- 13.5% to 63.2 +/- 10.7%. in the smokers and nonsmokers, respectively). Also, the significantly greater decrease in the FEV1/FVC ratio in the smokers (from 75.4 +/- 12.2% to 72.2 +/- 11.5%) (P = 0.037) was indicative of greater airway obstruction. Pulmonary complications developed in 20.5% (24 people) of the smokers and 10.4% (10 people) of the nonsmokers. The mean time to extubation, intensive care unit stay, and hospital stay for groups 1/2 were 19.9 +/- 11.5/14.1 +/- 4.3 hours (P < 0.0001) 3.2 +/- 1.3/2.4 +/- 0.6 days (P < 0.0001), and 14.1 +/- 4.4/12.5 +/- 2.4 days (P = 0.0013), respectively. For the male group, we obtained results similar to those for the whole (males + females) study population and concluded that the observed differences in various parameters between smokers and nonsmokers were not due to gender. As a result. we revealed that cigarette smoking affects pulmonary functions by causing obstructive type respiratory problems and by worsening existing restrictive type respiratory problems postoperatively. The postoperative deterioration in blood gas measurements of smokers was also statistically significant compared with nonsmokers. In addition, the incidence of pulmonary complications in smokers was 2-fold greater than in nonsmokers and was related to the number of cigarettes consumed daily, leading to prolongation of the postoperative intubation period, and ICU and hospital stays.

The objective of the present study was to compare pre- and postoperative pulmonary function tests in adult patients who had intubation periods greater and less than 24 hours following elective open heart surgery. Group 1 consisted of 91 patients (18 females and 73 males) gr, whose intubation periods were more than 24 hours (mean: 8.1+/-18.6 hours); and group 2 75 patients (13 females and 62 males) who had intubation periods less than 24 hours (mean: 13.25+/-3.60 hours). The pulmonary function test measurements were obtained from a vitalograph before and after the operation (just before being discharged from the hospital), All patients underwent cardiopulmonary physiotherapy and a rehabilitation programme during their hospital stay. The patients were similar in height and weight. The duration of hospitalization of the patients who had a prolonged intubation period was 17.26+/-9.7 days, while that of the control group was 10.64+/-2.04 days (P<0.0001). When the preoperative pulmonary function test values of each patient were compared with the expected values, the percent values of forced expiratory volume for one second, flow velocity of the mid-forced expiration and forced expiratory flow which were achieved by group 2 were significantly high compared to those of group 1 (P=0.014, P= 0.03 and P<0.0001, respectively). However, the percent values of forced vital capacity were similar. When the percent variations of the differences between the pre- and postoperative pulmonary function test values of the groups were compared, all values except the flow velocity of the mid-forced expiration, and forced vital capacity, were found to be significantly lower statistically in the group having a prolonged intubation period. As a result, it was determined that the patients whose preoperative pulmonary function test values were poor, had longer intubation periods and similarly, they continued to be worse after the operation. We believe that it is advantageous to apply more intensive pulmonary rehabilitation for prolonged periods to these patients in the postoperative period.