Left Atrial Mechanical Function And Stiffness In Patients With Premature Ventricular Contraction: A Speckle Tracking Study.

AIM: Ventricular extrasystole (PVC) is characterized by premature ventricular depolarization and is associated with increased risk of arrhythmias and structural heart disease. This study aimed to investigate the association between the PVC burden and left atrial (LA) function in individuals without known cardiac disease. MATERIAL AND METHODS: A cross-sectional study was conducted on 102 patients with PVCs who were admitted to a cardiology clinic. Transthoracic echocardiography was used to assess left ventricle (LV) parameters, including LV mass, LV ejection fraction (LVEF), LV global longitudinal strain (LVGLS), and LA function was evaluated using strain imaging. The PVC burden was categorized into three groups: <10 %, 10-20 %, and >20 %. RESULTS: Changes in LV dimensions and LV mass index were associated with the groups with the PVC burden with 10-20 %, and >20 %. but differences in LVEF and LVGSL were not significant. Mean E / e' increased as the PVC burden increased (p<0.001). The mean global LA peak strain decreased as the PVC burden increased (p<0.001), while other mean LA measurements increased as the PVC burden increased (p<0.001) A higher PVC burden was associated with impaired LA function, as indicated by decreased global LA peak strain (PVC burden <10 %=38.1±3.2 vs. PVC burden 10-20 %=32.4±3.2 vs. PVC burden >20 %=27.7±2.6, in all groups p<0.001) and with increased LA stiffness (PVC burden <10 %=18.6±3.2 vs. PVC burden 10-20 %=27.5±5.5 vs. PVC burden >20 %=39.0±7.9, in all groups p<0.001). A strong negative correlation was found between global LA peak strain and LA stiffness (r=-0.779, p<0.001). CONCLUSION: In individuals without known cardiac disease, a higher PVC burden was associated with impaired LA function, indicated by increased E / e', decreased LA strain, and increased LA stiffness. These findings suggest that PVC burden may contribute to LA dysfunction, potentially increasing the risk of cardiovascular events.

A new indicator of contrast-induced nephropathy in patients undergoing elective coronary angiography: tissue doppler-derived E/(EA × SA) index.

OBJECTIVE: Hemodynamic instability plays an important role in the development of contrast-induced nephropathy (CIN), which is an important complication of coronary angiography. Left ventricular (LV) end-diastolic pressure (LVEDP) accurately reflects hemodynamic changes. In clinical practice, measuring LVEDP invasively presents some challenges and is not always accessible. This study aimed to investigate the relationship between tissue Doppler-derived early diastolic conduction velocity (E)/[early mitral annular diastolic velocity (Ea), × peak systolic annular velocity (Sa)] index, an important surrogate for LVEDP, and CIN in patients undergoing elective coronary angiography (ECA). PATIENTS AND METHODS: This retrospective study included 388 consecutive patients undergoing ECA. CIN was defined as a 25% or 0.5 mg/dL increase in serum creatinine compared to baseline values within 72 hours after ECA. Mehran score was calculated in all patients and systolic and diastolic functions were evaluated with Doppler echocardiography. RESULTS: The incidence of CIN was 9.7%. There was a positive correlation between LV EDP levels and LV E/(Ea × Sa) index (r = 0.691, p < 0.001). Higher LV E/(Ea × Sa) index (OR = 1.03, p < 0.001) and Mehran score (OR = 1.41, p < 0.001) were independent predictors of CIN. The threshold value of LV E/(Ea × Sa) index in predicting CIN was > 1.71 with 75.7% sensitivity and 84.3% specificity (AUC = 0.825). CONCLUSIONS: In patients undergoing ECA, the non-invasively measured E/(Ea × Sa) index can be used as a risk indicator for CIN.

Clinical characteristics, maternal and neonatal outcomes of pregnant women with SARS-CoV-2 infection in Turkey.

OBJECTIVES: To evaluate clinical features, laboratory test results, maternal and neonatal outcomes of pregnant patients with the Coronavirus disease (COVID-19). BACKGROUND: COVID-19 is a highly contagious disease caused by a severe acute respiratory coronavirus 2 (SARS-CoV-2). Healthy pregnant women are more susceptible to developing COVID-19. METHODS: We reviewed clinical data from pregnant patients with a laboratory-confirmed SARS-CoV-2, who were admitted to two tertiary care hospitals in Turkey. Demographic, clinical characteristics, laboratory test results, imaging findings, treatment received, maternal and neonatal outcomes were collected. RESULTS: A total of 24 pregnant women were enrolled in this study. The mean maternal and gestational age was 26.9±5.37 years and 24.15±10.61 weeks, respectively. Cough was observed as the most common symptom (n=15; 62.5 %). The lowest lymphocyte percentage was 20.83±13.05 (%). Nine women have delivered by Caesarean section, while one had a vaginal birth. One woman with critical COVID-19 died 2 days later postpartum. The neonate had been transferred to neonatal intensive care unit and died within 24 hours of birth. CONCLUSION: Our findings showed that except for one patient, the clinical course of COVID-19 during pregnancy was mild. Early hospitalization of pregnant women with confirmed and suspected COVID-19, liberal testing for SARS-CoV-2, active management with a multidisciplinary team seemed to be critical to recovery (Tab. 3, Ref. 31).

Could hematologic parameters be useful biomarkers for the diagnosis of endometriosis?

OBJECTIVES: The objective of this study was to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR), lymphocyte­to­monocyte ratio (LMR), and mean platelet volume (MPV) in patients with endometriosis as compared with healthy controls. BACKGROUND: Currently, no non-invasive diagnostic test of endometriosis has been implemented in clinical practice. METHODS: A total of 121 women with endometriosis and 136 controls participated in this retrospective study. The extent of the disease in the patients with endometriosis was determined using the American Society of Reproductive Medicine revised classification. Sensitivities and specificities of NLR, LMR and MPV were evaluated by receiver-operating characteristic (ROC) analysis. RESULTS: Patients with endometriosis had higher neutrophil counts, white blood cell (WBC) levels, NLR, MPV, and lower lymphocyte count and LMR than the control group. The cut-off values were found to be 1.6 for NLR at 87.6 % sensitivity and 44.8 % specificity and 8 for MPV at 75.2 % sensitivity and 68.4 % specficity. For LMR, the cut-off value was 5.6 with 66.1 % sensitivity, 50 % specificity. Patients with stages III or IV had significantly lower MPV (p = 0.039) and LMR levels (p = 0.016) than patients with stages I or II. CONCLUSION: NLR, LMR, and MPV may be used to distinguish patients with endometriosis from controls (Tab. 4, Fig. 4, Ref. 37).

Second-stage vs first-stage caesarean delivery: comparison of maternal and perinatal outcomes.

Abstract In this observational study, we investigated the maternal and perinatal complications of caesarean delivery performed in the second stage compared with the first stage of labour at a tertiary hospital in Istanbul. This study was performed from June 2008 to July 2011. Primary maternal outcomes measured included intraoperative surgical complications, surgery duration, need for blood transfusion, endometritis, requirement for hysterectomy, unintended extension and length of hospital stay. Neonatal outcomes included a 5 min Apgar score ≤ 3, admission to a neonatal intensive care unit, fetal injury, septicaemia and neonatal death. In total, 3,817 caesarean deliveries were available for analysis; 3,519 were performed in the first stage, and 298 in the second stage. Caesarean deliveries performed in the second stage were associated with increased intraoperative complications, unintended extensions, need for blood transfusion, higher rates of endometritis and requirement for hysterectomy and were, therefore, associated with longer operation time and hospital stay. Neonatal complications included a significantly low Apgar score at 5 min, increased neonatal death, admission to the neonatal intensive care unit, septicaemia and fetal injury (all p < 0.05). Caesarean deliveries performed in the second stage of labour were associated with higher rates of maternal and neonatal complications, particularly in women who had undergone previous caesarean delivery.

Maternal and perinatal outcomes of eclampsia with and without HELLP syndrome in a teaching hospital in western Turkey.

In this study, we compared the perinatal and maternal outcomes of women with eclampsia with and without HELLP syndrome. A total of 219 pregnancies complicated by eclampsia with and without HELLP syndrome managed between January 2002 and December 2011, were reviewed. The incidence of eclampsia was 1.7/1,000 deliveries. Among 219 patients with eclampsia, 141 (64.4%) did not develop HELLP syndrome and 78 (35.6%) did develop HELLP syndrome. Maternal age and the rates of nulliparity were similar in both groups. Interval time from eclamptic seizure to delivery was significantly longer in the without-HELLP syndrome group (0.92 ± 0.29 weeks vs 0.16 ± 0.12 weeks, p = 0.028). Furthermore, overall perinatal mortality (particularly after gestational week 32) was significantly higher in the with-HELLP syndrome group (20.5% vs 9.9%, p = 0.029). In conclusion, patients with HELLP syndrome had significantly higher perinatal mortality than those with eclampsia without HELLP syndrome and no regular prenatal care.

Interactions of thyroid hormones; insulin-like growth factor-1 (IGF-1), IGF binding proteins, and nutritional anthropometric parameters in school children with goiter detected by palpation.

AIM: In the present study we evaluated anthropometric indices, serum thyroid hormones, insulin-like growth factor-1 (IGF-1) and IGF- binding proteins (IGFBPs) levels, in children who has palpable goiter at endemic population. We aimed to 1) compare children with palpable goiter with healthy peers, 2) detect interaction of anthropometric indices, serum thyroid hormones, IGF-1 and IGFBPs parameters in both groups 3) evaluate the effects of their nutritional status to these parameters. SUBJECTS AND METHODS: We performed goiter palpation to 1 018 child and found goiter at 81 child. Seventy-three pubertal children were included in this study. Seventy-five healthy children were defined as the control group. Weight and height of all children were measured. Thyroid hormone levels, IGF-1, IGFBP-3, and IGFBP-1 were assessed in both groups. RESULTS: Height and weight SDS were significantly lower in children who had goiter by palpation than healthy peers (p<0.05). Free T4 (FT4) levels were significantly higher in control group than children with palpable goiter (p<0.05). IGF-1 level and IGF-1 SDS were significantly lower in children with palpable goiter (p<0.001), IGFBP3 and IGFBP1 levels were not significantly different between the two groups (p>0.05). Serum IGF-1 and IGFBP-3 levels were significantly lower (p<0.05) in underweight children with goiter than normal weight group. In the presence of goiter, IGF-1 levels were lower (B: 0.97, 95% CI: 0.96-0.98, p<0.001). CONCLUSION: In endemic areas, children with palpable goiter were shorter and thinner than the healthy peers. Thyroid hormones were between the reference ranges. In children with palpable goiter, IGF-1 levels were lower and IGFBP-3 and IGFBP-1 levels were not different from the healthy control group. However, at the presence of goiter IGF-1 levels decrease. This decrease can be the result of insufficient nutrition and result in short stature and weakness than their healthy peers.

Visual evoked potentials in neurobrucellosis.

OBJECTIVE: To investigate whether visual evoked potentials (VEPs) are valuable for distinguishing between brucellosis with or without neurological involvement. METHODS: A total of 23 patients who were admitted to the Department of Infectious Diseases and Microbiology, and Neurology, Ministry of Health Ankara Education and Research Hospital, Ankara, Turkey between December 2004 and August 2005 with a diagnosis of brucellosis were included in this study. After a detailed neurological and ophthalmological examination, VEPs were recorded. The P100 latencies and amplitudes were compared between the group of brucellosis (n=17) and neurobrucellosis (n=6) patients. RESULTS: Although there was no difference in the mean P100 latencies between the groups (n=17 for brucellosis, and n=6 for neurobrucellosis) (p=0.38), the mean P100 amplitude in patients with neurobrucellosis was significantly lower (p=0.012). CONCLUSION: It could be emphasized that VEPs might reflect an underlying axonal pathology as a distinctive feature in neurobrucellosis.

Factors affecting adult knowledge of diabetes in Narlidere Health District, Turkey.

The objective was to determine the level of knowledge on diabetes in an adult population in Turkey. In this cross-sectional study, 524 people aged over 30 were selected from the population of Narlidere Health District, Izmir, Turkey. A questionnaire was performed to determine sociodemographic characteristics and knowledge of diabetes. Each item on the questionnaire was given a score with a possible final total of 100 points. Knowledge level was evaluated in the whole group, DM-positive and -negative groups. "DM-positive" group refers to respondents who either have diabetes themselves or whose relatives have it. "DM-negative" group refers to respondents who do not have diabetes themselves and whose relatives do not. In total, 479 people were included in the study (response rate=87.6%). The mean age of the study group was 50.2+/-12.8 and 61% of them were women. Mean diabetes knowledge scores were 62.9+/-17.9 for the study group, 68.3+/-16.1 for the "DM-positive" group and 60.6+/-18.2 for the "DM-negative" group. The "DM-negative" group had a significantly lower mean score than the other two groups. Overall, diabetes knowledge was higher in participants with diabetes or who had a relative with diabetes, who were educated for more than 5 years and who had health insurance. The diabetes knowledge of the study group was not satisfactory. Diabetics and people who have relatives with diabetes had a higher knowledge level than the population without diabetes. Detailed information regarding diabetes should be provided to not only diabetics, but also the population as a whole.

The factors affecting the relation between the menarcheal age of mother and daughter.

BACKGROUND: Menarche is one of the most important biologic signals in the life of a woman. Menarche is a biological variable which has a significant genotypic component in girls. In recent years, many studies reporting the earlier onset of menarche owing to the improvement of socio-economic conditions have been published. DESIGN: We asked some questions about menarche to 1017 female students studying in the high schools of Manisa region in order to determine the menarcheal age and the correlation of menarcheal age between the mothers and daughters in our region. RESULTS: The mean age at menarche for the girls was 12.82+/-1.07 years and for the mothers was 13.6+/-1.39 years. The mean menarcheal age of the mothers was higher than the mean menarcheal age of the girls (P<0.001). This difference persisted independent of the socio-economic status, nutritional state and physical activity of the girls. There was a significant correlation between the menarcheal age of the girls and their mothers (r=0.262, P<0.001). This correlation existed in all the girls with different socio-economic status, nutritional state and physical activity. However, this correlation disappeared in girls with body mass index (BMI)>25 (r=0.04, P=0.813). In girls with BMI<25, there was a correlation between the menarcheal age of the girls and mothers (r=0.282, P<0.001). CONCLUSION: These results suggest that the menarche occurs earlier in the daughters than their mothers. The correlation between the menarcheal age of the girls and their mothers persists under all circumstances except in obesity. The mother's menarcheal age is a good predictor of the daughter's menarcheal age in non-obese girls and the BMI is an important factor.

Salmonellosis and ulcerative colitis. A causal relationship or just a coincidence.

Coincidence of salmonellosis and ulcerative colitis is a rare clinical problem. Salmonella infection was reported to complicate the ulcerative colitis, as either facilitating its occurrence or activation. In this article, we present a case with salmonellosis whose clinicopathological findings also suggested ulcerative colitis. The patient improved rapidly after taking additional mesalazine to norfloxacin treatment. We conclude that salmonella infection might have either been coincidentally present or might have triggered an early ulcerative colitis in this patient who did not have history of inflammatory bowel diseases. In case of persistent severe diarrhea despite appropriate treatment, the possibility of a coincident inflammatory bowel disease such as ulcerative colitis should always be considered, especially in endemic regions for salmonellosis.

Effects of different socioeconomic conditions on menarche in Turkish female students.

PURPOSE: The aim of this study was to determine the age at menarche, the menarcheal features, and the association between menarcheal age and socioeconomic status in an urban area in Turkey. In addition, we tried to assess whether there is a relationship between age at menarche and body composition. METHODS: We asked some questions about menarche of 1017 female adolescent students in the high schools of Manisa region. Height and weight were measured. The body mass index (BMI; kg/m2) was used as an index of relative weight. Adolescent girls were grouped into three socioeconomic status according to the educational and occupational levels of their parents. The age at menarche and the menarcheal pattern were evaluated according to the socioeconomic status. RESULTS: The ages of girls involved in the study ranged between 14 and 18 years, with a mean of 15.7+/-1.1 years. Although the menarcheal age was found to be lower in girls with higher socioeconomic status, there was no significant difference between the three different socioeconomic status. In all of the three groups, menarche was more common in summer and fall than in spring and winter. Although the mother was an important source of knowledge in all groups, it was significantly more important in the group with high socioeconomic status. Adolescent girls with low socioeconomic status had fewer premenstrual complaints. However, there was no significant difference between the groups. We found an inverse correlation between menarcheal age and postmenarcheal weight and the BMI (r=-0.14, p=0.000). However, there was no correlation between menarcheal age and postmenarcheal height. CONCLUSION: These results indicate that as the social status differences decrease, the difference observed in menarcheal age and pattern disappears in urban areas of developing countries. Menarcheal age may be an indicator of socioeconomic development. It does not influence postmenarcheal height; however, as menarcheal age decreases, BMI increases.