The Effect of Computerized Wobble Board and Core Stabilization Exercises on Balance Performance and Exercise Capacity in Patients With Heart Failure: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effects of computerized wobble board exercise training (CWBET) and core stabilization exercise training (CSET) on balance performance, and exercise capacity in patients with heart failure (HF). DESING: Single-blind randomized controlled prospective study. SETTING: Cardiology department of a local university hospital. PARTICIPANTS: Fifty-one patients with HF with reduced ejection fraction, whose clinical status and medication had been stable for the previous 3 months, were included (N=51). Nine patients could not complete the follow-up period due to personal reasons. No patient experienced any adverse events during exercise training. INTERVENTIONS: Patients were randomized to CWBET, CSET, and control group. CWBET and CSET groups participated in their own exercise programs, 3 days a week for 8 weeks. The control group received no exercise program. MAIN OUTCOME MEASURES: All patients were evaluated at baseline and after 8 weeks. Postural stability, static and functional balance, and exercise capacity were evaluated with the Sensamove Balance Test Pro with Miniboard, the one-leg stance test (OLS), the Berg Balance Scale (BBS), and the six-minute walk distance (6MWD), respectively. Core stabilization and health-related quality of life (HRQOL) were assessed with OCTOcore app, and Minnesota Living with Heart Failure Questionnaire, respectively. RESULTS: A mixed model repeated-measures ANOVA revealed significant group × time interaction effect for static postural stability performance (P<.001, ηp2=0.472), vertical (P<.001, ηp2=0.513), horizontal performance (P<.001, ηp2=0.467), OLS (P<.001, ηp2=0.474), BBS (P<.001, ηp2=0.440) scores, 6MWD (P<.001, ηp2=0.706), and HRQOL. Post hoc analysis revealed CWBET and CSET groups had similar improvements balance performance, exercise capacity, and HRQOL and both groups significantly improved compared with control group (P<.001). Core stabilization was significantly improved only in CSET group after 8 weeks. CONCLUSION: CWBET and CSET programs were equally effective and safe for improving balance performance and exercise capacity in patients with HF.

Patient Perception, Knowledge and Adaptation in The Management of Heart Failure: A Multicenter, Cross-Sectional, Observational, Questionnaire-Based Study: ADAPTATION HF.

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.

Impact of Treatment With Sacubitril/Valsartan on Erectile Dysfunction in Patients With Heart Failure With Reduced Ejection Fraction.

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.

Six-minute stepper test for evaluating functional exercise capacity in patients with sarcoidosis.

BACKGROUND: Researchers and clinicians may benefit from alternative tests that do not require large physical spaces or corridors for simply evaluating functional exercise capacity in the clinical practice. OBJECTIVE: Aim of this study was to investigate whether six-minute stepper test (6MST) is a valid tool for measuring functional exercise capacity in patients with sarcoidosis. METHODS: Thirty-six patients with sarcoidosis and 18 healthy controls were evaluated with 6MST and six-minute walk test (6MWT). Patients performed 6MST twice. Cardiovascular and symptom responses to tests including heart rate, blood pressure, SpO2, levels of dyspnea and fatigue were recorded. RESULTS: Receiver operating characteristic (ROC) curve analysis revealed an area under the ROC curve of 0.74 for 6MST in identifying the patients and controls, indicating acceptable discriminative ability. Patients performed significantly worse in 6MST compared to controls (277±54 vs 349±87 steps; p<0.001). 6MST was able to explain 66% of variance in 6MWT (p<0.001), and there was a strong relationship between 6MWT and 6MST (r = 0.812). SpO2 responses to tests were similar, however, 6MST generated more severe heart rate, dyspnea and fatigue responses. Intraclass correlation coefficient calculated for initial and retest scores of 6MST was 0.990, indicating excellent test-retest reliability. However, there was a systematical improvement (∼4%) in retest 6MST scores. CONCLUSIONS: 6MST is a valid and reliable alternative test for measuring functional exercise capacity in sarcoidosis. 6MST may also help better testing the upper limits of cardiac system and physical endurance as it is more physically demanding than 6MWT.

Impact of Sacubitril/Valsartan on Lipid Parameters in Patients with Heart Failure with Reduced Ejection Fraction.

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.

Cut-off values of 6-min walk test and sit-to-stand test for determining symptom burden in atrial fibrillation.

BACKGROUND: Since symptomatology is a major predictor of quality of life and an endpoint for the management of atrial fibrillation (AF), practical approaches for objectively interpreting symptom burden and functional impairment are needed. AIMS: We aimed to provide cut-off values for two frequently used field tests to be able to objectively interpret symptom burden in atrial fibrillation. METHODS: One hundred twenty-five patients with AF were evaluated with European Heart Rhythm Association (EHRA) score, 6-min walk test (6MWT), 30 s sit-to-stand test (30 s-STST), Short-Form 36 (SF-36), International Physical Activity Questionnaire-Short Form (IPAQ-SF), and spirometry. Patients with EHRA 1 were classified as "asymptomatic", and those with EHRA 2-4 as "symptomatic". Cut-off values of 6MWT and 30 s-STST for discriminating between these patients were calculated. RESULTS: The optimal cut-off value was "450 m" for 6MWT (sensitivity: 0.71; specificity of 0.79) and "11 repetitions" for 30 s-STST (sensitivity 0.77; specificity of 0.70). Area under ROC curve was 0.75 for both tests (p < 0.001). Discriminative properties of the two tests were similar, and they were significantly correlated (r = 0.58; p < 0.001). Subgroup analysis revealed patients below cut-off values also had worse outcomes in SF-36, IPAQ-SF, and spirometry. CONCLUSIONS: In patients with AF, walking < 450 m in 6MWT or performing < 11 repetitions in 30 s-STST indicates increased symptom burden, as well as impaired exercise capacity, quality of life, physical activity participation, and pulmonary function. These cut-off values may help identifying patients who may require adjustments in their routine treatment or who may benefit from additional rehabilitative approaches.

Effect of Sacubitril/Valsartan Combined with Dapagliflozin on Long-Term Cardiac Mortality in Heart Failure with Reduced Ejection Fraction.

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.

Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR).

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.

Atrial Fibrillation Impact Questionnaire (AFImpact): Validity and reliability of the Turkish version.

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.

The comparison of serum TGF-beta levels and associated polymorphisms in patients with coronary artery ectasia and normal coronary artery.

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)-ß1 levels, which have a protective role against atherosclerosis. Further, we aimed to assess the TGF-ß1 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-ß1 levels were measured using ELISA and compared between two groups. Additionally, TGF-ß1 rs1800469 and rs1800470 gene variations were determined using TaqMan® SNP Genotyping Assays. RESULTS: Serum TGF-ß1 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-ß1 rs1800469 and rs1800470 polymorphisms. Serum TGF-ß1 levels were higher in individuals carrying the TGF-ß1 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-ß1 levels are associated with an increased risk for CAE development and that TGF-ß1 polymorphisms exert a protective effect. Furthermore, TGF-ß1 rs1800470 G allele carriers were shown to have higher TGF-ß1 levels in the CAE group. This suggests that having the G allele in the TGF-ß1 rs1800470 polymorphism could prevent CAE development.

Differences Between Morbid Obesity With Metabolic Syndrome and Overweight Turkish Adult Participants in Multiple Atherosclerotic Cardiovascular Disease Risk Factors.

Obesity and metabolic syndrome (MetS) are public health problems and are increasing globally. We assessed the differences in lipid profiles through lipid testing, thrombotic and inflammatory parameters, and oxidative stress indexes between overweight and obese patients with MetS in a Turkish adult population. We included 100 obese (body mass index [BMI] >30 kg/m2) patients with MetS (66 women, 34 men, mean age 54.0 ± 10.1 years) and 15 overweight (BMI 25-30 kg/m2) individuals (11 women, 4 men, mean age 50.2 ± 14.5 years) as controls. The group with MetS had significantly higher levels of glycaemia, uric acid, high-sensitivity C-reactive protein, homocysteine, fibrinogen, total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, small dense LDL, oxidized LDL, apolipoprotein B (Apo B), lipoprotein (a), small and intermediate high-density lipoprotein (HDL) particles, oxidative stress index, and significantly lower levels of HDL-cholesterol (HDL-C), Apo A, and large HDL particles. In conclusion, obesity with MetS increase atherogenic dyslipidemia and thrombotic, inflammatory and oxidative stress biomarkers. Furthermore, obesity with MetS decreases protective mechanisms of atherosclerosis. We should at least try to prevent overweight individuals from becoming obese with MetS.

Changes in pentraxin 3 and oxidative parameters during coronary bypass grafting and factors affecting postoperative atrial fibrillation.

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.

Effects of Kinesio Taping and compression stockings on pain, edema, functional capacity and quality of life in patients with chronic venous disease: a randomized controlled trial.

OBJECTIVE: The aim of this study was to compare the effects of Kinesio Taping and compression stockings on pain, edema, functional capacity and quality of life in patients with chronic venous disease (CVD). DESIGN: This is a prospective, randomized, controlled, single-blind clinical trial. SETTING: The study was conducted in a physiotherapy and rehabilitation unit of a university hospital. SUBJECTS: A total of 62 patients with early-stage CVD were allocated to either an experimental group or a control group. INTERVENTIONS: Experimental group (n = 29) received Kinesio Taping intervention once a week for four weeks, while control group (n = 29) received compression stockings for four weeks. All patients additionally undertook an exercise training programme including calf muscle pump exercises, flexibility exercises and diaphragmatic breathing. MAIN MEASURES: Visual analogue scale, lower limb circumference measurements, 6-minute walk test and Short Form 36 questionnaire were applied before and after four weeks of treatment. RESULTS: Control group showed statistically significant improvements in pain (P < 0.001), ankle circumferences (right, P = 0.002; left, P = 0.037), calf circumferences (right, P = 0.020; left, P = 0.022), knee circumference (left, P = 0.039) and thigh circumferences (right, P = 0.029; left, P = 0.002) compared with experimental group. There were no significant differences between groups with respect to functional capacity and quality of life (P > 0.05). Both groups significantly improved 6-minute walk distance (P < 0.001) and Short Form 36 physical component summary (experimental group, P = 0.002; control group, P = 0.006). CONCLUSION: This study demonstrated that Kinesio Taping and compression stockings revealed similar improvements of functional capacity and quality of life in patients with CVD. The symptoms of pain and edema caused by CVD can be decreased more efficiently with compression stockings than Kinesio Taping intervention.

Assessment of Dietary Habits in Patients With Chronic Heart Failure.

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.

Do Restoring and Maintaining Sinus Rhythm Have a Beneficial Effect on Secondary Prevention of Stroke in Patients With Atrial Fibrillation? A Pilot Study.

We aimed to determine whether attempts to restore and maintain sinus rhythm will reduce recurrent stroke in patients with atrial fibrillation (AF). Patients (n = 245) between March 1998 and May 2002 with AF who had an ischemic stroke including transient ischemic attack 1 to 12 months before transesophageal echocardiographic examination and had been followed for 3 years were retrospectively reviewed. Cardioversion was attempted in 130 patients; 117 (90%) patients were successfully cardioverted (rhythm control group). The 13 patients who could not be cardioverted and 115 patients who did not undergo cardioversion were assigned to the rate control group. Age, gender, ischemic heart disease, hypertension, diabetes mellitus, congestive heart failure, mitral valve disease, and left atrial diameter were similar in both groups. The rhythm control group included 56 patients (48.7%) who were still in sinus rhythm after 3 years. During follow-up, there were 2 embolic events (3.4%) and 2 deaths (3.4%) in the rhythm control group, whereas 18 embolic events (14.6%) and 18 deaths (14.6%) occurred in the rate control group (P = .049 and P = .049, respectively). Restoration and maintenance of sinus rhythm seems to have a beneficial effect on secondary prevention of stroke in patients with AF.

Does weight loss affect the parameters that are metabolically related to cardiovascular diseases?

OBJECTIVES: To assess the differences in the parameters that are metabolically related to cardiovascular diseases after weight loss in obese people with coronary artery diseases (CADs). METHODS: This study was conducted on 184 patients who were diagnosed with CADs in Istanbul University Cardiology Institute Hospital, Istanbul, Turkey. The levels of leptin, fibrinogen, homocysteine, high-sensitivity C-reactive protein (hs-CRP), triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), fasting blood glucose and insulin, glycated hemoglobin, and uric acid of the obese patients who were put on calorie restricted diet were evaluated retrospectively and compared before and after weight loss. For comparison, non-obese control patients were also studied. Student's t-test and Chi-square test were used for the statistical analysis. Results: Levels of homocysteine, glycated hemoglobin, and leptin were significantly higher in the obese patients than in the non-obese patients. Diabetic obese patients with CADs lost (11.1%) and non-diabetic obese patients with CADs lost (10.5%) of their body weight in 6 months. The levels of cholesterol, LDL-C, and fibrinogen were significantly improved in both groups. Conclusion: The obese patients lost weight after being on calorie-restricted diets and showed significant improvement in the levels of cholesterol, LDL-C, fibrinogen. There was no significant difference in the levels of homocysteine, hs-CRP, and leptin before and after weight loss in both diabetic and non-diabetic obese patients.

Effects of core stabilization exercises on pulmonary function, respiratory muscle strength, and functional capacity in adolescents with substance use disorder: Randomized controlled trial.

BACKGROUND: Adolescent substance abuse is a serious and growing problem worldwide. The aim of this study was to investigate the effects of core stabilization exercises on pulmonary function, respiratory muscle strength, and functional capacity in adolescents with substance use disorder (SUD). METHODS: This was a prospective randomized controlled trial. A total of 49 adolescent male patients with SUD were randomly assigned to either the exercise group (n = 25; mean age 16.6 years) or the control group (n = 24; mean age 16.7 years), for 6 weeks. All participants underwent a medical and behavioral therapy program 5 days a week for 6 weeks. The exercise group received five core stabilization exercises combined with deep breathing as a group training for 45 to 60 minutes, twice a week for 6 weeks, and the control group received recreational activities in addition to the usual care for 45 to 60 minutes, twice a week for 6 weeks. Spirometry, maximal inspiratory and expiratory pressures, and the 6-minute walk test were performed and measured at baseline and after training. RESULTS: There were significant improvements in maximal inspiratory pressure (24.16 cm H2 O; P < 0.0001), maximal expiratory pressure (30.28 cm H2 O; P < 0.0001), forced vital capacity (5.80% predicted, P < 0.0001), forced expiratory volume in 1 second (7.34% predicted; P = 0.002), peak expiratory flow (13.32% predicted; P = 0.0003), forced expiratory flow 25%-75% (11.84% predicted; P = 0.027), and the 6-minute walking distance (65.84 m; P < 0.0001) in the exercise group compared with the control group. CONCLUSIONS: Core stabilization exercise can improve pulmonary function, respiratory muscle strength, and functional capacity in adolescents with SUD.

What have we learned from Turkish familial hypercholesterolemia registries (A-HIT1 and A-HIT2)?

BACKGROUND AND AIMS: Familial hypercholesterolemia (FH) is a common genetic disease of high-level cholesterol leading to premature atherosclerosis. One of the key aspects to overcome FH burden is the generation of large-scale reliable data in terms of registries. This manuscript underlines the important results of nation-wide Turkish FH registries (A-HIT1 and A-HIT2). METHODS: A-HIT1 is a survey of homozygous FH patients undergoing low density lipoprotein (LDL) apheresis (LA). A-HIT2 is a registry of adult FH patients (homozygous and heterozygous) admitted to outpatient clinics. Both registries used clinical diagnosis of FH. RESULTS: A-HIT1 evaluated 88 patients (27 ±â€¯11 years, 41 women) in 19 centers. All patients were receiving regular LA. There was a 7.37 ±â€¯7.1-year delay between diagnosis and initiation of LA. LDL-cholesterol levels reached the target only in 5 cases. Mean frequency of apheresis sessions was 19 ±â€¯13 days. None of the centers had a standardized approach for LA. Mean frequency of apheresis sessions was every 19 ±â€¯13 (7-90) days. Only 2 centers were aware of the target LDL levels. A-HIT2 enrolled 1071 FH patients (53 ±â€¯8 years, 606 women) from 31 outpatients clinics specialized in cardiology (27), internal medicine (1), and endocrinology (3); 96.4% were heterozygous. 459 patients were on statin treatment. LDL targets were attained in 23 patients (2.1% of the whole population, 5% receiving statin) on treatment. However, 66% of statin-receiving patients were on intense doses of statins. Awareness of FH was 9.5% in the whole patient population. CONCLUSIONS: The first nationwide FH registries revealed that FH is still undertreated even in specialized centers in Turkey. Additional effective treatment regiments are urgently needed.