A Qualitative Research Survey on Cardiologist's Ethical Stance in Cases of Moral Dilemmas in Cardiology Clinics.

This study sought to determine cardiologists' degrees of ethical awareness and preferred courses of action for ethical dilemmas frequently encountered in clinical settings. For this evaluation, an online survey was created and sent to cardiologists affiliated with various academic posts in Ankara, Turkey. The survey included ten cases with various ethical considerations selected from our book, "Clinic Ethics with Cases from Cardiology." Four possible action choices were defined for each case. Participants were asked to choose one or more of these preferences. In addition, a fictional change was made in each case's context without changing the original ethical issue, and participants were asked whether an attitude different from the first chosen one was preferred. The participation ratio was 49/185 (26%), consent ratio 47/185 (25,4%), and completion ratio 44/185 (23,7%). Nine of the ten scenario changes did not change participants' preferred action. For most questions, action preferences were concentrated between the two options. Although legal regulations did not reduce ethical dilemmas, they clarified physicians' action preferences. Similarly, as an obscure moral issue gained prominence, physicians were forced to draw clearer lines in their actions. External factors such as healthcare emergencies can change physicians' ethical dilemma-solving attitudes.

Comparison of Glidesheath Slender and Subcutaneous Nitrate Administration in Terms of Radial Artery Complications: A Retrospective Single-Center Experience.

Objectives: The transradial route is used in most coronary procedures today. Although this method seems to be advantageous in terms of bleeding complications and patient comfort, the small radial artery diameter brings with it complications such as radial artery spasm and occlusion. It has been demonstrated in previous studies that subcutaneous nitrate administration dilates the radial artery. The Glidesheath Slender, which has a thinner outer wall than conventional sheaths, is another method that has been shown to reduce complications by reducing friction on the radial artery wall. Our aim was to compare these two methods in terms of complications. Methods: We retrospectively reviewed patients with complete clinical and radial Doppler ultrasound records who had undergone transradial interventions. We compared procedures using subcutaneous nitrate application plus conventional sheaths with procedures using the Glidesheath Slender sheath in terms of procedural and post-procedural complications. Results: Eighty-seven patients in the subcutaneous nitrate group and 35 patients in the Glidesheath Slender group were included in the study. There were no significant differences between the two groups in terms of procedural and postprocedural complications (p = 0.511 and p = 0.333, respectively). Conclusions: In cases where a thin-walled sheath such as a Glidesheath Slender is not available, subcutaneous nitrate administration seems to be similar, especially in terms of preventing radial artery spasm.

Comparison of COVID-19 studies registered in the clinical trial platforms: A research ethics analysis perspective.

BACKGROUND: The coronavirus disease (COVID-19) treatment must be based on scientific methods such as clinical trials. Trials involving human subjects and those requiring a risk-benefit analysis may occasionally face challenges owing to the time limitations in the pandemic. METHODOLOGY: This study analyses the WHO's International Clinical Trials Registry Platform and clinicaltrials.gov, where most COVID-19 clinical trials are registered, according to ethical criteria including study design, conflicts of interest, enrollment of healthcare workers, study locations, site-, design-, and participant-related issues. The discussion is based on three aspects: the quality of the information to be produced, the relevance to significant health problems, and the creation or evaluation of interventions, policies, or practices that promote individual or public health. RESULTS: There were significant differences between the two platforms regarding the investigational medicinal product (IMP), the comparator, ethics committee/institutional review board approval, plan to share individual participant data, study phase, site, IMP, and design-related issues. Conflict of interest, sponsor information, and management of vulnerable groups were the main areas wherein both platforms lacked sufficient information. CONCLUSION: With this analysis, we aimed to define a minimum set of ethical criteria for clinical trial platforms to obtain standardization between these two platforms.

[A rare cause of heart failure: aortocaval fistula associated with herniated lumbar disc surgery]. / Kalp yetersizliginin nadir bir nedeni: Lomber disk hernisi ameliyatina bagli aortokaval fistül.

Although aortocaval fistula is mostly encountered as a complication of abdominal aortic aneurysms, it may also arise as a complication of lumbar disc surgery. Great arteriovenous shunts especially may lead to high-output heart failure in due time. In this paper, we aim to present a case of high-output heart failure secondary to aortocaval fistule caused by lumbar disc surgery.

Ethical evaluation of informed consent forms used in cardiology clinics and the importance of institutional standardized approach.

OBJECTIVE: This study aimed to evaluate the content of informed consent forms (ICFs) used during cardiology interventions by the university, research and training (R-T), and private hospitals with regard to ethical standards and compare them with the Turkish Society of Cardiology (TSC) templates and among various institutions. METHODS: A total of 185 forms from the university, R-T, and private hospitals and 19 TSC templates were selected and analyzed for 26 criteria. Compliance with TSC templates was also evaluated. Data were presented as the percentage of ICFs satisfying the criteria and compared using the Fisher exact test, and 95% confidence intervals were calculated. RESULTS: TSC templates were more compatible and included more information to comply with ethical standards than ICFs of all 3 types of healthcare institutions. The areas of improvement for these templates were prospects of treatment and alternative treatments, quality of life, explanation for third-party consent, duration of hospitalization, and time to return to normal life. Among the 3 types of hospitals, R-T-ICFs were more compatible with templates. Private hospital ICFs had the poorest compliance with TSC templates. Separate anesthesia ICFs and detailed information about exposure to radioactivity were lacking. CONCLUSION: The current ICFs for cardiology interventions have major ethical deficiencies and need urgent improvement. Professional societies such as TSC are essential institutions to develop and provide guidance and templates for ICFs to meet the ethical standards during the informed consent process and standardization of the process among various institutions.

Tissue Doppler imaging must be performed to detect early left ventricular dysfunction in patients with type 1 diabetes mellitus.

AIMS: We sought to compare diastolic parameters in patients having type 1 diabetes mellitus (DM) and healthy controls using both pulse-wave (PW) Doppler and relatively novel tissue-Doppler imaging (TDI) to evaluate the possible effect of diabetes on left ventricular dysfunction. METHODS AND RESULTS: One hundred and thirty-two patients were evaluated (81 type 1 diabetic patients and 51 healthy volunteers). The detailed M-mode, two-dimensional, colour Doppler; PW Doppler; and TDI analyses were performed on resting subjects in a regular setting. Posterior wall thickness, left atrial indexed diameter, and A velocity were significantly higher in the diabetics when compared with control group (P = 0.019, <0.001, 0.033, respectively). Rest of the M-mode and PW Doppler parameters of diabetics were comparable with those of control subjects (P > 0.05 for all). However, both septal E' and lateral E' velocities were significantly lower in diabetics than in the control subjects on TDI echocardiographic examination (P < 0.001 and 0.011, respectively). In addition, E'/septal E' and E/lateral E' ratios were significantly higher in the diabetic group (P < 0.001 and 0.008, respectively). CONCLUSION: TDI is a more accurate and powerful method than PW or M-mode in determination of early cardiac involvement related to type 1 DM even in the subclinical phase as well as hereditary cardiomyopathies.

[Reversible first-degree atrioventricular block due to hyperthyroidism]. / Hipertiroidiye bagli geri dönüsümlü birinci derece atriyoventriküler blok.

Hyperthyroidism often causes tachyarrhythmia. Reversible atrioventricular block caused by hyperthyroidism is rare occurrence. Presently described is a case of atrioventricular block due to hyperthyroidism and recovery after antithyroid treatment.

Hepatitis C infection is associated with increased coronary artery atherosclerosis defined by modified Reardon severity score system.

BACKGROUND: The link between arteriosclerotic disease in the carotid or coronary artery and chronic hepatitis C virus (HCV) infection has been shown in some studies although other studies have produced contrary results. However, the effect of chronic HCV infection on the extension or severity of coronary artery disease (CAD) has not been determined so the aim of the present study was to determine the effect of HCV infection on the severity of CAD. METHODS AND RESULTS: The study group comprised 139 HCV seropositive and 225 HCV seronegative patients with angiographically documented CAD. A modified scoring system of Reardon et al was used. There were no significant differences between groups in terms of sex, age, hypertension, diabetes mellitus, smoking or family history. Levels of C-reactive protein and fibrinogen were significantly higher in the HCV seropositive group (p<0.001) and the Reardon severity score was higher (8.75+/-1.69 vs 6.01+/-1.80, p<0.001). After adjustment, HCV seropositivity still represented an independent predictor for severity of coronary atherosclerosis demonstrated by higher Reardon severity score with an odds ratio of 2.018 (95% confidence interval 1.575-2.579, p<0.001). CONCLUSION: HCV infection is an independent predictor for increased coronary atherosclerosis, as demonstrated by higher Reardon severity score.

Isolated noncompaction of the left ventricular myocardium complicated by thromboembolic cerebrovascular accident in a patient with essential thrombocythemia.

There are up to 3 prominent trabeculations in the normal left ventricle. Sometimes, left ventricle has excessive trabeculations and intertrabecular recesses. This appearance is called as noncompaction or hypertrabeculation. It may be together with other structural cardiac abnormalities (non-isolated) or without them (isolated). Here we present a rare case with isolated noncompaction of the left ventricular myocardium. Rarity comes from its coexistence with essential thrombocythemia. In addition, it was complicated by thromboembolic cerebrovascular accident.