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Objective: To evaluate clinical efficacy, safety and tolerability of long-term inhaled iloprost treatment in the daily practice for the management of pulmonary arterial hypertension (PAH). Methods: A total of 115 patients with PAH on inhaled iloprost treatment were included. New York Heart Association (NYHA) functional class, brain natriuretic peptide (BNP) and N-terminal pro--B-type natriuretic peptide (NT-proBNP) levels, and 6-minute walk distance (6MWD) were recorded at baseline and at 3rd to 24th month visits. Safety and tolerability of iloprost treatment were also evaluated during follow-up, as were the survival, clinical worsening, and the related risk factors. Results: The treatment was associated with an increase in the percentage NYHA functional class II (from 0.0% at enrolment to 36.2% at 24th month visit) patients but no significant difference was noted in 6MWD values. Clinical worsening was observed in 63.5% patients, while survival rate was 69.6%. NT-proBNP levels were significantly higher in non-survivors than in survivors (p=0.042). Cox regression analysis revealed the association of female sex [odds ratio (OR)=0.318; 95% confidence interval (CI), 0.128-0.792; p=0.014] and scleroderma-related PAH (OR=0.347; 95% CI, 0.140-0.860; p=0.022) with significantly lower risk (3.14 fold and 2.88 fold, respectively) of mortality. Conclusion: Our findings indicate favorable efficacy, safety, and tolerability of long-term iloprost treatment in the management of PAH, whereas improved NYHA functional class was not accompanied with a significant change in 6MWD values. Patient age was a risk factor for clinical worsening, while female sex, scleroderma subtype, and lower NT-proBNP levels were associated with significantly lower mortality risk. [ABSTRACT FROM AUTHOR]

Copyright of Gulhane Medical Journal is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Platelet activation is thought to play a key pathogenetic mechanism in acute coronary syndromes. We investigated the mean platelet volume and platelet count in patients with both ST elevation myocardial infarction and non-ST elevation myocardial infarction. Fifty two patients with non-ST elevation myocardial infarction and 56 patients with ST elevation myocardial infarction were enrolled in the study. Age- and gender-matched 50 healthy subjects constituted the control group. Venous blood samples for whole blood analysis were drawn on admission and analyzed by an autoanalyser. The difference in mean platelet volume was statistically significant in ST elevation myocardial infarction and non-ST elevation myocardial infarction patients, which was 8.7±1 and 7.9±0.7 fl (p<0.01), respectively. However, the difference in mean platelet volume between non-ST elevation myocardial infarction and control group was not significant (7.9±0.7 and 8.1±0.7 fl; p=0.52, respectively). Moreover, platelet counts of both ST elevation myocardial infarction and non-ST elevation myocardial infarction groups were significantly lower than the controls. Platelet counts in the ST elevation myocardial infarction and non-ST elevation myocardial infarction patients did not show any statistically significant difference. The underlying mechanism should be investigated in further studies, which may shed light on developing new therapeutic strategies for this particular acute coronary syndrome. [ABSTRACT FROM AUTHOR]

Some reports have revealed that warfarin inhibits the matrix carboxyglutamic acid protein (MGP), which inhibits calcification. Treatment of rats with warfarin at doses that inhibit the carboxylation of MGP causes rapid calcification of elastic lamellae of arteries and of aortic heart valves and increased expression of MGP-mRNA in the calcifying artery. Therefore warfarin use might result in increased calcification of vessel wall. Our aim was to investigate whether warfarin causes excess calcification in coronary arteries. A total of 39 patients (with a mean age of 54±15 years) who underwent prosthetic heart valve surgery 66±46 months ago were enrolled into the study. The control subjects (n=28) were selected from those people without any medical problem with a mean age of 52±11 years. Multidetector computed tomography was used to identify the calcium score of the coronary arteries. We found that coronary calcium score was similar between the study and control groups. In addition, the length of warfarin use was not correlated with the calcium score in the patient group. Male gender, hypertension, and LDL-C, but not warfarin usage were independent predictors for coronary calcification. The results of our study imply that warfarin has no effect on coronary calcification at least in middle aged adult humans. [ABSTRACT FROM AUTHOR]

Copyright of Gulhane Medical Journal is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Gulhane Medical Journal is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Anatolian Journal of Cardiology / Anadolu Kardiyoloji Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Anatolian Journal of Cardiology / Anadolu Kardiyoloji Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: It was suggested that knowledge might influence the adherence to treatment in hypertension. Accordingly, in this study, we investigated the effects of content of knowledge on medication adherence and knowledge-based predictors of adherence to treatment in hypertensive patients Methods: This cross-sectional study included 227 hypertensive patients (70% female; mean age: 57±12 years), who were followed by cardiology and internal medicine clinics. The patients were asked to fulfill a questionnaire including 40 items. Besides the demographic and disease-related questions, the patients were also asked (1) the name of the drug, (2) the duration of the drug use; (3) the reason of using the drug; (4) the cause of hypertension; (5) the target level of hypertension; (6) the result of hypertension; (7) the side effects of antihypertensive medicines. Statistical analyses were performed using Chi-square, Fischer exact, Mann Whitney U tests and logistic regression analysis. Results: It was found that 163 (72%) were adherent and 64 (28%) were nonadherent to the treatment. Angiotensin-II receptor antagonist use (OR=4.405; 95%CI: 1.561-12.365, p=0.022) and hypertension duration ≥5 years (OR= 0.446; 95%CI: 0.246-0.811, p=0.006) was found to be independently related to adherence. Among the knowledge-based variables, knowing the duration of use of the medicine (OR= 6.822; 95% CI: 1.478-31.241, p=0.075), the reason of use of medicine (OR= 2.828; 95% CI: 1.445-5.543, p=0.018), the cause of the hypertension (OR= 3.447; 95% CI: 1.889-6.290, p=0.037) and the target level of blood pressure (OR= 12.859; 95% CI: 5.045-32.640, p<0.001) significantly increased the adherence rates. On the other hand, knowing the name of the medicine (p=0.112) or the results of hypertension (p=0.719) had no effect on adherence, while knowing the side effects of the medicine (OR= 0.607; 95% CI: 0.340-1.084, p=0.005) had negative effect. The total number of correct answers was also higher in patients with adherence to treatment (p=0.002). Conclusion: Patient knowledge about hypertension and medications is associated with higher adherence rates. However, it should be taken into consideration that the possible effects of knowledge may differ according to its content. [ABSTRACT FROM AUTHOR]

Objective: In this cross-sectional, case-controlled study, we aimed to evaluate classical and novel risk factors in young patients with coronary artery disease (CAD), and the relation between coronary risk factors and coronary lesion distribution. Methods: Fifty-three patients under age of 45 years with severe coronary artery stenosis on angiography (group A) and age matched sixty patients having normal or non-critical stenosis on coronary angiography (group B) comprised the study groups. Conventional (smoking, family history, diabetes, hypertension) and novel risk factors (lipoprotein (a), homocysteine) were compared between the groups. Moreover, the relation between risk factors, and coronary lesions distribution, including left main artery (LMA) or proximal or mid left anterior descending (LAD) artery and remaining coronary lesions was investigated. Logistic regression analysis was used to define confounding factors predicting severe CAD and coronary lesion distribution and ROC curve analysis was performed to determine the cut-off value of independent factors, which were assessed by logistic regression analysis. Results: Smoking was more prevalent in group A compared to group B. Lipoprotein (a) and homocysteine levels were also higher in group A than group B. For group A and B median (max-min) values of lipoprotein (a) were 34 (2-174) mg/dl and 38 (2-203) mg/dl (p=0.038), respectively and homocysteine levels were 12.3 (5-56.6) micromol/L and 9 (1.4-19) micromol/L (p=0.012), respectively. Smoking and homocysteine were independent predictors of severe CAD in young patients according to logistic regression analysis with an Odds ratio of 3.7 (95% CI=1.572-8.763; p=0.002) and 1.2 (95% CI=1.045-1.341; p=0.008), respectively. For predicting significant CAD the cut-off value of homocysteine was 11.6 micromol/L with a sensitivity and specificity of 53% and 77%, respectively (AUC=0.637; 95% CI=0.542-0.725; p=0.008). Within group analysis in group A patients revealed that only homocysteine was an independent predictor of LMA or proximal or mid-LAD lesion presence with an odds ratio of 1.2 (95% CI=1.011-1.465; p=0.016). ROC curve analysis revealed a cut-off value of 12 micromol/L in predicting LMA or proximal or mid-LAD lesions with a sensitivity and specificity of 65% and 91%, respectively (AUC=0.735; 95% CI=0.594-0.850; p=0.002). Conclusion: In our study, we found that young patients with severe CAD had different risk profile with higher frequency of smoking and increased levels of lipoprotein (a) and homocysteine. While smoking status and homocysteine may be used for prediction of severe CAD in young individuals, only homocysteine predicted coronary lesion distribution in LMA and proximal or mid-LAD. [ABSTRACT FROM AUTHOR]

Copyright of Anatolian Journal of Cardiology / Anadolu Kardiyoloji Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In all medical and surgical interventions, the main principle is to inform the patient of possible complications, side and adverse effects of the intervention and patient's acceptance with his/her own will. However, it is impossible to obey this ethical norm in attempting cardiopulmonary resuscitation. May a legal problem arise when the goals of health care providers and the patient and family members could not be overlapped? Have expected survey and quality of life influence on resuscitative efforts? In order to discuss legal and cultural norms in our country, which is still under discussion all over the world, we tried to summarize our own opinions about the patient's autonomy, principle of futility, termination of resuscitation, who should attempt resuscitation and relations with family members during resuscitation under current guidelines and literature. [ABSTRACT FROM AUTHOR]

Copyright of Gulhane Medical Journal is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents a case study 20-year-old asymptomatic male who was brought to the clinic for delineation of the cause of the enlarged cardiac silhouette. The patient's medical and family history and physical examination were unremarkable except 1/6-grade systolic murmur. Moreover, his echocardiographic test indicated enlarged coronary sinus, right atrium and right ventricle.

A right atrial appendage thrombus is almost always associated with atrial fibrillation. We tried to emphasize in this case report that such a thrombus may develop in heart failure patients even in the presence of sinus rhythm. [ABSTRACT FROM AUTHOR]

The article presents a study that examines the impact of antihypertensive drugs on the platelet serotonin levels in hypertensive patients. It defines serotonin as bioamine, which is synthesized from L-tryptophan mainly in enterochromaffin cells of gastrointestinal tract. It states that the study was participated by 90 patients with hypertension. According to the article, the platelet serotonin levels were accordingly determined in venous blood samples.

A letter to the editor is presented on the role of silent infective endocarditis in mitral valve perforation.

A letter to the editor is presented on the resistance of warfarin induced by oxcarbamazepine.