Reliability and validity of the Turkish translation of the beliefs about medicines questionnaire (BMQ-T) in patients with Behçet's disease.

OBJECTIVES: The aim of this study was to evaluate the reliability and validity of the Turkish translation of the Beliefs about Medicines Questionnaire (BMQ-T, ©Prof. Rob Horne) for patients with Behçet's disease. METHODS: This methodological study enrolled a sample of 125 patients. The scale was adapted to Turkish through a process including translation, comparison with versions in other languages, back translation, and pretesting. Construct validity was evaluated by factor analysis. Medication adherence evaluated as poor, moderate and good according to the Morisky Medication Adherence Scale (MMAS). BMQ-T scores compared along medication adherence status groups. RESULTS: In our study, as in the original scale, the factor analysis confirmed that the BMQ-T had a four-factor structure explaining 54.73% of the total variance. The BMQ-T had acceptable internal consistency (Cronbach's alpha coefficient: Specific Necessity=.812; Specific Concerns=.672; General Harm=.677; General Overuse=.656), adequate test-retest reliability (intraclass correlation coefficients: Specific Necessity=.715; Specific Concerns=.680; General Harm=.678; General Overuse=.327). Specific Necessity and Specific Concerns scores were significantly different between medication adherence status groups. CONCLUSIONS: The psychometric properties of the BMQ-T were consistent with those reported in the original study. The BMQ-T was found to be a valid and reliable tool for evaluating beliefs about medicines in patients with Behçet's disease.

Serum endocan levels as a marker of disease activity in patients with Behçet disease.

BACKGROUND: Endocan is a novel human endothelial cell-specific molecule. The central role of leukocytes and endothelial dysfunction in the development of Behçet disease (BD) led us to hypothesize that endocan might be a marker of this disease. OBJECTIVE: We investigated the relationship between serum levels of endocan and disease activity in patients with BD. METHODS: In all, 33 patients (16 active, 17 inactive) with BD and 35 healthy persons were included in the study. Endocan and C-reactive protein were measured in all subjects. RESULTS: Patients with BD had significantly higher serum endocan levels. Mean serum levels of endocan were 1.29 ± 0.60 ng/mL (range: 0.58-2.99) in patients with BD and 0.75 ± 0.16 ng/mL (range: 0.48-1.21) in control subjects (P < .001). In patients with BD, serum endocan levels correlated moderately but significantly with C-reactive protein, erythrocyte sedimentation rate, and disease activity. Receiver operating characteristic curve analysis suggested that the optimum endocan level cut-off point for patients with BD was 0.87 ng/mL, with a sensitivity and specificity of 75.8% and 80%, respectively (area under curve 0.835, 95% confidence interval 0.738-0.932). LIMITATIONS: The main limitation of our study is the relatively small sample size. CONCLUSIONS: Circulating endocan may be a marker of BD activity.

Blood total carbon dioxide content and bicarbonate can be used together to predict blood pH correctly in venous blood samples.

Blood gas analyses are needed to reveal any kind of acid-base imbalance in some patients. Traditionally, arterial punctures are performed to obtain the blood samples for blood gas analyses. Arterial puncture is not a completely safe procedure. It may cause serious problems including arterial thrombosis, arteriovenous fistula, pseudoaneurysms and hematoma. In this retrospective reviewing, it was aimed to yield novel formulations to predict the blood pH only from CtCO2 and HCO3 values which can easily be measured in venous blood samples obtained for other diagnostic and follow-up purposes.

The relationship between some of the cardiovascular risk factors and arterial stiffness parameters in essentially hypertensive patients.

Hypertensive patients have strong evidence of endothelial dysfunction. We aimed to explore the relationships between cardiovascular risk factors and arterial stiffness parameters in hypertensive patients. The study population included 109 hypertensive patients (63 females, 46 males). Arterial stiffness measures including pulse wave velocity, augmentation index, and central aortic pressure were applied. Augmentation index and central aortic pressure were found to be significantly higher (P < .001 and P = .03, respectively) in women. The higher augmentation index and central aortic pressure values were observed in women than in men. These data offer new evidences for the role of sex hormones in the pathogenesis of atherosclerosis in women.

Skinfold thickness as a predictor of arterial stiffness: obesity and fatness linked to higher stiffness measurements in hypertensive patients.

Hypertensive patients have strong evidence of endothelial dysfunction. Some novel endothelial dysfunction parameters such as pulse wave velocity (PWV), augmentation index (AIx), and central aortic pressure (CAP) have been investigated as predictive markers of atherosclerosis. It is well known that obesity has relationships with endothelial dysfunction and atherosclerosis. We aimed to investigate relationships between anthropometric measurements and arterial stiffness parameters in essentially hypertensive patients. The study population included 100 patients (56 females, 44 males) newly or formerly diagnosed as essentially hypertensive in an outpatient clinic. Arterial stiffness measurements, including PWV, AIx, CAP, and body mass index (BMI); waist circumference, hip circumference; waist/hip ratio; and triceps, biceps, subscapular, and suprailiac skinfold thicknesses were also applied to all the study patients. Then, the relationships between BMI, anthropometric measurements, and arterial stiffness parameters were investigated. The mean systolic arterial blood pressure of the study population was 135.85 ± 15.27 mm Hg and the mean diastolic arterial blood pressure of the study population was 84.17 ± 9.58 mm Hg. The parameters such as PWV, AIx, and CAP measured for arterial stiffness had correlations between BMI and different anthropometric measurements. The statistically significant correlations were present between PWV and triceps skinfold thickness (TST) (r = 0.377, P < .001) and it was also seen when regression analysis was performed (PWV = 6.41 + [0.072 × TST]; R(2) = 0.142, F[1-98] = 16.23, P < .001). Triceps skinfold thickness among these correlations may be used to estimate the carotid-femoral PWV, which is an indicator of subclinical organ damage due to hypertension.

Investigation of the aortic pulse wave velocity in patients with Gilbert's syndrome.

Arterial stiffness is currently the "gold standard" measure of aortic (carotid-femoral) pulse wave velocity (PWV), which is an important independent predictor of risk of developing a cardiovascular event. Gilbert's syndrome is a congenital disorder characterized by intermittent and non-hemolytic elevation of indirect bilirubin levels due to the deficiency of the enzyme UDP-glucuronyl transferase in the liver and many prospective studies found an inverse relationship between bilirubin levels and cardiovascular events in these patients. We aimed to investigate serum bilirubin levels and arterial stiffness parameters in patients with Gilbert's syndrome in this study. A total of 53 cases, consisting of 26 patients with a diagnosis of Gilbert's syndrome and 27 healthy control subjects, were included in the study. Serum bilirubin levels, other routine blood chemistry, and arterial stiffness measurements were recorded. The mean ages of Gilbert's syndrome and the control group were 31.5 ± 9.7 and 36.8 ± 11.1 years, respectively. PWV measurements were significantly lower in Gilbert syndrome patients (6.68 and 7.3 m/s in patients and controls; respectively) (P < .05). In correlation analysis in Gilbert's syndrome patients, PWV had a significant correlation with total and indirect bilirubin levels (r = -0.370, P = .009/r = -0.495, P = .003, respectively). Gilbert's syndrome patients have lower PWV measurements compared to healthy subjects, and the total and indirect bilirubin levels are also associated with PWV measurements. These findings may indicate the decreased atherosclerotic disease incidence in Gilbert's syndrome patients.

The comparative effects of valsartan and amlodipine on vWf levels and N/L ratio in patients with newly diagnosed hypertension.

High levels of circulating Von Willebrand factor (vWf) and increased neutrophil to lymphocyte (N/L) ratio may reflect vascular inflammation in hypertensive patients. In present study, we aimed to investigate the effects of valsartan as an angiotensin II receptor antagonist and amlodipine as a calcium channel blocker on the vWf levels and N/L ratio in patients with essential hypertension. Patients were randomized to one of the following intervention protocols: calcium channel blocker (amlodipine, 5-10 mg/day) as group A (n = 20 mean age = 51.85 ± 11.32 y) and angiotensine II receptor blocker (valsartan, 80-320 mg/day) as group B (n = 26 mean age = 49.12 ± 14.12 y). Endothelial dysfunction and vascular inflammation were evaluated with vWf levels and N/L ratio in hypertensive patients before treatment and after treatment in the 12th week. No statistically significant differences were found among the groups in terms of age, sex, and body mass index (BMI). There was a significant decrease in vWf levels (P < .001) and N/L ratio after treatment (P = .04, P < .001, respectively) in both the groups. Von Willebrand factor levels and N/L ratio are very important markers having a role in vascular inflammation and antihypertensive treatment with amlodipine and valsartan may improve cardiovascular outcomes by decreasing these biomarkers.

The comparative effects of valsartan and amlodipine on vascular microinflammation in newly diagnosed hypertensive patients.

Pentraxin 3 (PTX3) is a new candidate immunoinflammatory marker that has been reported to be associated with cardiometabolic risk factors. We aimed to investigate the effects of valsartan and amlodipine on the PTX3 and C-reactive protein (CRP) levels in patients with essential hypertension. Patients with a newly diagnosed essential hypertension were admitted to our internal medicine outpatient clinic. Patients were randomized to one of the following intervention protocols: calcium channel blocker (amlodipine, 5-10 mg/day) as group A (n = 22; mean age ± standard deviation [SD]: 52 ± 11 year) and angiotensine II receptor blocker (valsartan, 80-320 mg/day) as group B (n = 28; mean age ± SD: 50 ± 14 year). Endothelial dysfunction and systemic inflammation were evaluated with PTX3 and CRP. There was a significant decrease in the level of PTX3 after treatment in two groups (P < .05). Although there was a significant decrease in the level of CRP after treatment in amlodipine group, there was no significant decrease in the levels of PTX3 and CRP after treatment in two groups. There were no significant differences in the systolic and diastolic blood pressure reduction between the two treatment groups. In the treatment of hypertension, prior knowledge of the level of plasma PTX3 could be important in antihypertensive drug choice. C-reactive protein and PTX3 are the markers that have role in vascular inflammation and are found associated with the prognosis of cardiovascular outcomes in many trials. In our study, PTX and CRP levels were decreased when compared to baseline levels.

An additional LDL-lowering effect of amlodipine; not only an antihypertensive?

Hypertension is a modifiable risk factor for cardiovascular diseases and is associated with several metabolic disorders like dyslipidemia. Higher levels of triglyceride and low-density lipoprotein (LDL) are quite strong factors for the development of cardiovascular diseases. In this study, we investigated the effects of valsartan and amlodipine on the lipid profile in patients with newly diagnosed essential hypertension. We observed a beneficial effect of amlodipine on the lipid profile with a significant reduction of LDL compared to valsartan. In the treatment of hypertension, prior knowledge of the plasma cholesterol levels can be important in antihypertensive drug choice.

Amlodipine seems to be superior to valsartan in decreasing microalbuminuria in newly diagnosed hypertensive patients: a novel effect to be explained with hyperfiltration?

BACKGROUND: Microalbuminuria (MA) is common in hypertensive population and is a marker for endothelial dysfunction and a predictor of increased cardiovascular risk. A great body of data shows the importance of MA as a strong predictor of renal and cardiovascular disease (CVD) risk in hypertensive population. AIM: In this study, we aimed to compare the anti-albuminuric effects of an angiotensin II receptor antagonist, valsartan, with a calcium channel blocker, amlodipine, in newly diagnosed hypertensive patients. MATERIAL AND METHODS: Totally, 20 patients were recruited into the study. Patients were randomized to one of the following intervention protocols: An (a) angiotensin II receptor blocker (valsartan, 80-320 mg/day) or (b) calcium channel blocker (amlodipine, 5-10 mg/day), for 12 weeks immediately after baseline measurements. Ten patients were randomized into valsartan group and 10 patients into the amlodipine group. Twenty-four-hour urinary albumin excretion (UAE) levels of the patient groups were measured before treatment and on the 12th week. RESULTS: Patients of the two groups were matched for age and body mass index. In the amlodipine group, baseline urine microalbumin levels were higher compared to valsartan group, although the difference was not statistically significant (p = 0.082). At the 12th week, there was a significant decrease in urine microalbumin levels in the amlodipine group, but no significant change was observed in the valsartan group. CONCLUSION: Amlodipine seems to be superior to valsartan in decreasing UAE. To reduce cardiovascular risks, endothelial dysfunction, and microinflammation, these factors are taken into consideration while prescribing antihypertensive drugs in hypertensive patients.

Amlodipine increases vitamin D levels more than valsartan in newly diagnosed hypertensive patients: pointing to an additional effect on bone metabolism or a novel marker of inflammation?

Hypertension is a major challenge for public health. Appropriate antihypertensive treatment seem to provide a better life with lower morbidity and mortality rates. Another pathologic condition, osteoporosis, mainly affects postmenouposal women, and constitutes a growing body of risks after a particular age. As bone is a dynamic organ system that is directly related to calcium and phosphor metabolism, imbalance in these two parameters upon aging or menopause finally may lead to osteoporosis. Today, both osteoporosis and high blood pressure are major morbidities, especially in the elderly population. There are some intriguing results on the effects of antihypertensive agents on bone metabolism in the literature. In this study, we aimed to investigate the effects of widely used antihypertensive agents, valsartan and amlodipine on vitamin D levels in newly diagnosed hypertensive population. We found that amlodipine increased vitamin D levels significantly in patients with a newly diagnosed hypertension on a 12-week treatment duration compared to valsartan.

Nutritional anemia in reproductive age women with postadolescent acne.

CONTEXT: Postadolescent acne has been defined as the presence of acne beyond the age of 25 years. Postadolescent acne affects approximately 14% of women between the ages of 25 and 50 years. Namely, postadolescent acne usually occurs in women of reproductive age. Nutritional anemia occurs from an insufficient intake of nutrients such as iron, folate and vitamin B12. It is very common in women of reproductive age. Nutritional anemia causes irritability, apathy, fatigue, depressive symptoms and difficulty in concentration. The major etiological factor in adult acne can be increased levels of emotional stress, leading to increase in adrenal androgens. Thus, nutritional anemia may aggravate the lesions of acne by affecting the emotional status in women of reproductive age. OBJECTIVE: We aimed to investigate the relationship between postadolescent acne and nutritional anemia in this study. MATERIALS AND METHODS: The study population comprised of 52 patients with postadolescent acne and 52 healthy control subjects. Hemogram, vitamin B12, folate, serum iron, ferritin and total iron-binding capacity (TIBC) were measured. RESULTS: No significant differences were observed between both groups in hemoglobin, vitamin B12, serum iron, ferritin and TIBC levels. Serum folate levels were significantly decreased in postadolescent acne patients (p < 0.001). There were no significant correlations between hemoglobin, vitamin B12, folate, serum iron, ferritin and TIBC levels and acne severity. DISCUSSION AND CONCLUSION: We could not find any relationship between postadolescent acne and nutritional anemia in our study. However, serum folate levels were decreased in postadolescent acne patients. Prospective research studies are needed to clarify the role of nutrition in the pathophysiology of postadolescent acne. We think that nutritional interventions can be inexpensive, safe, easy to administer and generally acceptable to patients with postadolescent acne.

Lower plasma soluble TWEAK concentration in patients with newly diagnosed hypertension.

PURPOSE: To determine circulating levels of the soluble TNF-like weak inducer of apoptosis (sTWEAK)and its association with demographic and biochemical parameters in a young group of patients with newly diagnosed and never treated hypertension. METHODS: A total of 51 patients (mean age 21.7 ±1.4 years, body mass index (BMI) 24.5 ±1.6 kg/m2) with primary untreated hypertension, and 37 age- and BMI-matched healthy controls (mean age 22.5 ± 1.9 years, BMI 24.7 ± 1.5 kg/m2) were studied. Serums TWEAK and plasma asymmetrical dimethyl arginine (ADMA) levels were measured by EIA. RESULTS: In patients and controls, mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 149.8±5.65/93.4±3.4 mmHg and 124.2±6.4/78.24±5.5 mmHg, respectively. Serum sTWEAK levels were lower in the patient group (882.6±228.9 µmol/L vs. 1060.2±231.7µmol/L, p=0.001), whereas plasma ADMA levels were higher(0.837±0.34µmol/L vs.0.3176±0.25µmol/L, p < 0.001). sTWEAK serum levels correlated with SBP(r=-0.301; p=0.005) and DBP (r=-0.279; p=0.009). Circulating plasma ADMA levels also correlated with SBP (r=0.734; p < 0.001) and DBP (r=0.733; p < 0.001). CONCLUSION: Young patients with yet untreated primary hypertension have lower circulating serum sTWEAK level compared with healthy controls. Further research for possible associations among serum sTWEAK, endothelial dysfunction and other measures of atherosclerosis may be of benefit in order to better understand the pathophysiology of hypertension and to establish more effective treatment options.

Findings of biopsy-proven chronicity and end-stage renal failure associated with oral sodium phosphate solution.

Bowel purgatives containing oral sodium phosphate (OSP) solution are used frequently in general practice and they have the potential of causing acute kidney injury especially in patients with some identified risk factors. Kidney injury may lead to chronicity and end-stage renal disease. Here we present, with renal biopsy findings, an elderly patient suffering from end-stage renal failure due to OSP solution.

Vascular health, systemic inflammation and progressive reduction in kidney function; clinical determinants and impact on cardiovascular outcomes.

INTRODUCTION: Systemic inflammation, endothelial dysfunction and arterial thickening contribute to the elevated cardiovascular risk of dialysis patients. However, the course of these derangements and their relative contribution to the cardiovascular risk of nondialysed chronic kidney disease (CKD) are scarcely investigated. METHODS: Flow-mediated dilatation (FMD) and intima-media thickness (IMT) were assessed in 304 nondialysed CKD patients Stages 1-5 (mean age 46 ± 12 years, 158 men), together with routine biochemical measurements, C-reactive protein (CRP) and insulin resistance. Patients were then followed for time-to-event analysis of cardiovascular outcomes (fatal and nonfatal). RESULTS: CRP and IMT increased, while FMD decreased in parallel with estimated glomerular filtration rate (eGFR) decline (P < 0.001 for all). CRP and intact parathormone, as well as eGFR, appeared as strong determinants of FMD and IMT in multivariate analyses. After a median follow-up of 41 (range 6-46) months, 30 fatal and 59 nonfatal cardiovascular events occurred. In univariate analysis, FMD, IMT and CRP were significant predictors of outcome. In a multivariate Cox model excluding IMT, both FMD [hazard ratios 0.52 (95% confidence intervals 0.37-0.73) per %] and CRP [1.07 (1.03-1.11) per mg/L] predicted cardiovascular outcomes independently of confounders. In a model excluding FMD, only CRP (and not IMT) was a significant predictor. CONCLUSIONS: Endothelial dysfunction, arterial thickening and inflammation occur in parallel with the decline in eGFR, contributing to the increased cardiovascular risk of nondialysed CKD. Our results support the use of FMD over IMT measurements to monitor nondialysed CKD patients at risk.

QT Wave Dispersion in Patients With Major Depressive Disorder.

OBJECTIVE: A limited number of studies have investigated QT wave dispersion (QTd) in depressive disorder. The objective of this study was to investigate whether QTd differed in patients diagnosed with depression compared to a control group and whether the difference correlated with the depression and anxiety scores. METHODS: Forty patients diagnosed with major depressive disorder (DSM-5 criteria) who did not receive their first treatment after the first episode were included in the study. Forty healthy individuals with similar sociodemographic characteristics were included in the control group. A sociodemographic and clinical data form, the Beck Depression Inventory, and the Beck Anxiety Inventory were given to all patients. Electrocardiograms were evaluated in a single-blind setting by the same cardiologist. The longest QT interval (QTmax) and the shortest QT interval (QTmin) were calculated. Heart rate-corrected QTmax (QTcmax) and QTmin (QTcmin) were calculated using the Bazett formula (QT[ms]/√R-R). The difference between QTcmax and QTcmin was accepted as the corrected QT dispersion (QTcd). The study was conducted from December 2018-March 2019. RESULTS: No statistically significant difference was found between patient and control groups on the basis of age, sex, body mass index, or smoking. Beck Anxiety Inventory and Beck Depression Inventory scores of the patient group (28.48 ± 12.39 and 32.2 ± 11.58, respectively) were significantly higher compared to the control group (2.7 ± 3.41 and 2.75 ± 3.2, respectively). The patient group QTcmax (419.8 ± 24.46) and QTcd (42.55 ± 17.47) values were significantly higher compared to the QTcmax (405.2 ± 24.54) and QTcd (30.48 ± 9.25) values of the control group. There was a positive correlation between QTcd, QTcmax, and anxiety and depression scores. CONCLUSIONS: QTcd values of depressed patients were higher than those of the healthy controls, and there was a positive correlation between QTcd and depression and anxiety scores.

Carotid Intima Media Thickness and Its Association With Total Bilirubin Levels in Patients With Coronary Artery Ectasia.

Atherosclerosis plays an important role in the etiopathogenesis of coronary artery ectasia (CAE). The relationship between total bilirubin (TBil) and carotid intima media thickness (cIMT) in patients with CAE has not been fully investigated. Hence, we evaluated the relationship between TBil levels and cIMT in 142 consecutive eligible patients with CAE, newly diagnosed coronary artery disease (CAD), and normal coronary arteries. There were no significant differences in TBil (P = .772) and cIMT (P = .791) between the CAE and CAD groups. Bilirubin levels were significantly lower in both CAE and CAD groups compared to the controls (P < .01). The cIMT was significantly higher in both CAE and CAD groups compared to control participants (P < .01). A negative correlation between cIMT and TBil was found in all the groups (P < .01, r = .354). We show for the first time that patients with CAE and CAD have lower TBil and greater cIMT compared to controls with normal coronary angiograms.