THE PREVALENCE OF POLYNEUROPATHY IN THE PRE-DIABETES PERIOD.

Objective: This study aims to determine the prevalence of neuropathy in the prediabetic period. Design Subjects and Method: Informed consent was attained from the patients who volunteered to participate in the study after ethics committee approval was obtained. Patients under the age of 18, having vitamin B12 or folic acid deficiency, history of collagen tissue-rheumatological disease, chronic kidney failure, cirrhosis, ethylism, thyroid disease, autoimmune disease, malignancy, tuberculosis, type 1 or 2 diabetes mellitus and pregnant women were excluded from the study. Patients diagnosed with prediabetes were evaluated by the DN4 neuropathy complaint questionnaire. Neuropathy was diagnosed in patients having a score of four or more. For the statistical analyses Student t-test, Pearson chi-square test, and Fisher's exact test were performed using the NCSS program. Results: A total of 224 volunteers, 167 women and 57 men, were included in the study. The mean age of the participants was 51 and the mean level of hemoglobin A1C was 5.9. Neuropathy was detected in 45% of the cases. Especially in women, there was a significant increase in the frequency of neuropathy compared to men. The most common complaints found in our study were burning sensation and numbness in the extremities. Conclusions: Similar to diabetic patients, prediabetic patients also have a high rate of neuropathy. For the early diagnosis of neuropathy and to be treated promptly, screening tests such as DN4 should be performed for all prediabetic patients. According to the test results, advanced examinations such as EMG or biopsy should be performed earlier.

Endocan is markedly overexpressed in severe erectile dysfunction.

This study aimed to measure the serum endocan level of patients with erectile dysfunction (ED) and to investigate the possible association between this and vasculogenic severe ED. We performed a prospective analysis of 86 consecutive patients affected by ED. Patients were divided into severe ED (IIEF-5 score < 7) and mild or moderate ED (IIEF-5 score > 7). A strong negative correlation was found between serum endocan levels and peak systolic velocity (p < .001 and r = -.665) in men with severe ED. Univariate logistic regression analysis demonstrated that tobacco consumption (p < .05), serum total 25-hydroxyvitamin D (p < .01), serum endocan levels (p < .01), peak systolic velocity (p < .01), hypertension (p < .001), dyslipidaemia (p < .001), metabolic syndrome (p = .026) and a history of a cardiovascular event (p < .001) significantly increase the risk of severe ED. In the multivariate logistic regression model, we also found that age, hypertension, metabolic syndrome, cardiovascular events and higher serum endocan levels were independently associated with severe ED. Circulating endocan may be used in daily practice as a new marker that correlates with cardiovascular risks and the severity of ED disease.

Independent risk factors for COVID-19-associated coagulopathy.

OBJECTIVE: Past three years since the beginning of the outbreak, we have obtained satisfactory data on COVID-19. However, data on risk factors of COVID-19-associated coagulopathy (CAC) are extremely limited. Prediction of CAC might be a game changer since it is related to poor prognosis. Seeking independent risk factors for CAC was the main aim of the study. PATIENTS AND METHODS: 510 hospitalized COVID-19 patients were retrospectively screened. Forty-eight of them were excluded due to irrelevant D-dimer or ferritin elevation. The remaining patients were stratified into three groups as overt coagulopathy, significant pulmonary microthrombosis, and patients without coagulopathy. The overt coagulopathy group included cases with macrothrombosis or disseminated intravascular coagulation (DIC). The significant pulmonary microthrombosis group covered the cases that had clinical deterioration with simultaneous marked D-dimer elevation. The group of patients without coagulopathy included the asymptomatic patients with normal or elevated D-dimer levels. RESULTS: Overt coagulopathy developed in 3.2% and significant pulmonary microthrombosis in 10.1% of the patients. In the multivariate analysis, not receiving low molecular weight heparin (LMWH) (p=0.002), a level of D-dimer >15,000 U/ml (p=0.013) were associated with overt coagulopathy. In addition, levels of initial LDH >480 IU/L (p=0.022) and initial ferritin >1,000 ng/ml (p=0.036) were associated with significant pulmonary microthrombosis. Not receiving LMWH (p=0.001) was also associated with significant pulmonary microthrombosis, when multivariate analysis was performed by the parameters with a p-value <0.1 in the univariate analysis. Furthermore, all cases with DIC had Gram-negative bacterial sepsis. CONCLUSIONS: Not receiving LMWH, high levels of D-dimer, initial LDH, and initial ferritin are independent risk factors for CAC. DIC does not appear to develop based on COVID-19.

Severe vitamin D deficiency is associated with endothelial inflammation in healthy individuals even in the absence of subclinical atherosclerosis.

OBJECTIVE: Vitamin D has beneficial effects, some of which involve the cardiovascular system. No study to date has investigated the association between serum endocan levels, as a biomarker of endothelial inflammation, and vitamin D levels in the absence of subclinical atherosclerosis detected by carotid intima-media thickness (CIMT) in healthy individuals. PATIENTS AND METHODS: Subjects were categorized into three groups based on vitamin D levels according to Endocrine Society guidelines. Mean CIMT was calculated from six measurements on two scans. Statistical significance was set at p < 0.05, and all testing was two-sided. RESULTS: The concentration of serum endocan was 802.8 ± 411.4 ng/L in the group with the lowest serum vitamin D level, 454.8 ± 334.3 ng/L in the mild/moderately low serum vitamin D level group, and 269.4 ± 180.2 ng/L in the group with normal serum vitamin D levels (p < 0.01). Receiver operating characteristics curve analysis revealed that a serum vitamin D concentration of 7.5 ng/mL had a 97% sensitivity and 81% specificity for the prediction of serum endocan level greater than 270 ng/L, which could be an indicator for endothelial inflammation. CONCLUSIONS: Demonstrating that vitamin D deficiency can cause endothelial damage in the early period of atherosclerosis without the development of clinical cardiovascular disease will have a pivotal role in the prevention of cardiovascular mortality and morbidity.

The effects of high intensity-interval training on vaspin, adiponectin and leptin levels in women with polycystic ovary syndrome.

AIM: We aimed to investigate the metabolic effects of HIIT exercise on PCOS patients and how it affects adiponectin, vaspin and leptin. MATERIAL AND METHODS: Twenty women with PCOS were included in the study and were divided into two groups. HIIT program was applied for 10 PCOS and Medium Intensity Continuous Training (MICT) program was applied for other 10 PCOS. At the beginning and at the end of the study, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride(TG), insulin, Adiponectin, Leptin, Vaspin levels of both PCOS groups were evaluated. RESULTS: When PCOS patients by performed HIIT exercise for 12 weeks, we found that the levels of leptin and vaspin did not change while adiponectin levels increased. Moreover serum levels of insulin, TG, total cholesterol, LDL-C decreased but levels of HDL-C increased. CONCLUSION: HIIT increased in the adiponectin levels in women with PCOS and provided more weight loss.

Older Adults Hospitalized with Covid-19: Clinical Characteristics and Early Outcomes from a Single Center in Istanbul, Turkey.

OBJECTIVE: Older adults have been continuously reported to be at higher risk for adverse outcomes of Covid-19. We aimed to describe clinical characteristics and early outcomes of the older Covid-19 patients hospitalized in our center comparatively with the younger patients, and also to analyze the triage factors that were related to the in-hospital mortality of older adults. DESIGN: Retrospective; observational study. SETTING: Istanbul Faculty of Medicine hospital, Turkey. PARTICIPANTS: 362 hospitalized patients with laboratory-confirmed Covid-19 from March 11 to May 11, 2020. MEASUREMENTS: The demographic information; associated comorbidities; presenting clinical, laboratory, radiological characteristics on admission and outcomes from the electronic medical records were analyzed comparatively between the younger (<65 years) and older (≥65 years) adults. Factors associated with in-hospital mortality of the older adults were analyzed by multivariate regression analyses. RESULTS: The median age was 56 years (interquartile range [IQR], 46-67), and 224 (61.9%) were male. There were 104 (28.7%) patients ≥65 years of age. More than half of the patients (58%) had one or more chronic comorbidity. The three most common presenting symptoms in the older patients were fatigue/myalgia (89.4%), dry cough (72.1%), and fever (63.5%). Cough and fever were significantly less prevalent in older adults compared to younger patients (p=0.001 and 0.008, respectively). Clinically severe pneumonia was present in 31.5% of the study population being more common in older adults (49% vs. 24.4%) (p<0.001). The laboratory parameters that were significantly different between the older and younger adults were as follows: the older patients had significantly higher CRP, D-dimer, TnT, pro-BNP, procalcitonin levels, higher prevalence of lymphopenia, neutrophilia, increased creatinine, and lower hemoglobin, ALT, albumin level (p<0.05). In the radiological evaluation, more than half of the patients (54.6%) had moderate-severe pneumonia, which was more prevalent in older patients (66% vs. 50%) (p=0.006). The adverse outcomes were significantly more prevalent in older adults compared to the younger patients (ICU admission, 28.8% vs. 8.9%; mortality, 23.1% vs. 4.3%, p<0.001). Among the triage evaluation parameters, the only factor associated with higher mortality was the presence of clinically severe pneumonia on admission (Odds Ratio=12.3, 95% confidence interval=2.7-55.5, p=0.001). CONCLUSION: Older patients presented with more prevalent chronic comorbidities, less prevalent symptomatology but more severe respiratory signs and laboratory abnormalities than the younger patients. Among the triage assessment factors, the clinical evaluation of pulmonary involvement came in front to help clinicians to stratify the patients for mortality risk.

Acute effect of low-flux hemodialysis process on the results of the interferon-gamma-based QuantiFERON-TB Gold In-Tube test in end-stage renal disease patients.

BACKGROUND: Screening for latent tuberculosis infection before solid organ transplantation is mandatory, but this is not so easy in uremic patients on hemodialysis (HD) treatment. The newly developed interferon-gamma (IFN-gamma)-based QuantiFERON((R))-TB Gold In-Tube test (QFT-G) seems to be superior to the other available tests. Objective. To investigate the acute effect of the low-flux HD process on the results of the QFT-G assay. METHODS: A total of 56 HD patients participated in this prospective study. They were dialyzed under low-flux HD for at least 1 month before blood sampling for QFT-G assay. This assay was performed before and after the 4-h low-flux HD session. RESULTS: Compared with the pre-dialysis level, there was an obvious reduction in the IFN-gamma production level (in response to the TB-antigen cocktails) after the HD process (P=0.00). The pre-dialysis test result was negative in 21 (37.5%), positive in 33 (58.9%), and indeterminate in 2 (3.6%) patients. One pre-dialysis negative result changed to positive after the HD process. On the other hand, 7 pre-dialysis positive and 2 indeterminate results become negative after HD (P=0.012). CONCLUSION: In order to maintain the sensitivity of QFT-G assay in chronic renal failure patients on low-flux HD treatment, it is better to perform the test immediately before (not after) the HD process.

Type I cardiorenal syndrome in patients with acutely decompensated heart failure: the importance of new renal biomarkers.

OBJECTIVE: Type 1 cardiorenal syndrome (CRS) is an acute renal failure in patients with acute decompensated heart failure with an incidence of 24% to 45%. The aim of our study was to investigate the significance of new renal biomarkers to predict type 1 CRS. PATIENTS AND METHODS: The study included 111 patients with acute decompensated heart failure diagnosed at the Istanbul Medical Faculty Emergency Department between 2014 and 2016, and 24 healthy volunteers. All urine samples were stored at -80°C after centrifugation. Samples were run according to the instructions of TIMP-2, ILGF-7, KIM-1, and IGFBP-7 ELISA kits. Diuretic treatments were then administered with intravenous administration of at least 80 mg furosemide per day. Follow-up biochemical and spot urine specimens were taken after 72 hours. For statistical analysis, SPSS version 21.0 statistical software was used. Significance was evaluated at p<0.05. RESULTS: The baseline creatinine level was measured as 1.33 ± 0.39 mg/dL in the heart failure group. It was seen that 67% (75) of the patients had increased creatinine levels and developed type 1 CRS. ILGF-7, TIMP-2, and (ILGF-7 * TIMP-2) values were significantly higher in patients with cardiorenal syndrome when we separated the two groups as patients with and without cardiorenal syndrome (0.40 (0.25-0.71), p1: 0.049/2.40 (1.42-3.70), p2: 0.003/1.15 (0.29-2.43), p3: 0.001). CONCLUSIONS: Renal tubular markers reveal promising developments in the pathophysiology of cardiorenal syndrome in light of recently obtained data. Renal tubular biomarkers may have the potential to be a predictor of heart failure and cardiorenal syndrome.

Increased QT dispersion in hemodialysis patients improve after renal transplantation: a prospective-controlled study.

Increased QT dispersion (QTd), predicting patients with risk of malignant arrhythmia, have recently been reported in hemodialysis patients (HDp). In this prospective study, we aimed to investigate changes in QTd and signal averaged-ECG (SAECG) in HDp after transplantation. Twenty-seven HDp (M/F:18/9, mean age 30+/-8 years) and 24 controls (M/F:14/10, mean age 33+/-6 years) were included. All QT parameters (QTmax, Qtmin, and QTd) were increased in HDp. QTmax and QTd started to decrease at the first month after transplantation. Percentage change in QTd at the third month was significantly correlated with percentage change in LV mass index (r=0.45, P=0.04), serum calcium (r=-0.47, P=0.02) and intact parathyroid hormone (r=0.68, P=0.01). In multivariate regression analysis, only percent chance in LV mass index was retained as significant. As for analysis of SAECG, 4 of the 23 (17%) HDp has abnormal late potentials which disappeared after transplantation. HDp with LV hypertrophy had higher filtered-QRS duration compared to patients without hypertrophy (110+/-12 vs. 97+/-11 msec, P=0.01). It was concluded that increased QTd and presence of late potentials improved early after renal transplantation. These changes were mainly associated with the regression of the LV mass.

Effect of Valsalva maneuver on surface electrocardiographic P-wave dispersion in paroxysmal atrial fibrillation.

The purpose of this study was to investigate the effect of the Valsalva maneuver on P-wave durations and dispersion. After the Valsalva maneuver, we found that maximum P-wave duration increased, minimum P-wave duration decreased, and P-wave dispersion increased in controls, whereas the opposite was true for unselected patients with paroxysmal AF. It was concluded that patients with paroxysmal AF performing the Valsalva maneuver normalized their P-wave dispersion, thereby correcting the inhomogeneous intra-atrial conduction.

Assessment of left atrial appendage function and its relationship to pulmonary venous flow pattern by transesophageal echocardiography.

We evaluated left atrial appendage function and its relationship to pulmonary venous flow in 53 patients divided into four groups. Group 1 consisted of 10 normal subjects. Group 2 included 15 patients with significant pure mitral stenosis in sinus rhythm. In group 3, there were 13 patients with pure significant mitral stenosis and atrial fibrillation. Group 4 consisted of 15 patients with normal mitral valve and atrial fibrilltion. We found significant decrease in left atrial appendage ejection fraction and maximum emptying flow velocity, velocity time integral of systolic pulmonary venous flow in Groups 2, 3 and 4 in comparison with normal subjects. Systolic pulmonary venous flow velocity was significantly decreased in Groups 3 and 4. There was significant correlation between left atrial appendage ejection fraction and peak emptying flow velocity (r = 0.62, P < 0,001). Systolic peak pulmonary venous flow velocity was significantly correlated with left atrial appendage ejection fraction and maximum emptying flow velocity (r = 0.67, P = 0,01; r = 0.58, P < 0,001, respectively). There was also significant correlation between systolic pulmonary venous flow velocity time integral and left atrial appendage ejection fraction (r = 0.66, P = 0.001). When normals were excluded from analysis, all the correlations were still significant. We concluded that left atrial appendage is a contractile structure, and that systolic pulmonary venous flow velocity is influenced by left atrial appendage dysfunction. Therefore left atrial appendage function needs to be considered when interpreting Doppler transmitral and systolic pulmonary venous flow patterns.

Effect of left atrial size and function on P-wave dispersion: a study in patients with paroxysmal atrial fibrillation.

BACKGROUND: Paroxysmal atrial fibrillation (PAF), a common arrhythmia, is caused by the fractionated and nonhomogeneous propagation of sinus impulse. HYPOTHESIS: This study was undertaken to examine the effect of left atrial (LA) dimension and function on P-wave dispersion (deltaP) in unselected patients with PAF and health controls. METHOD: In this study, 62 consecutive patients with PAF (32 men, 30 women, mean age 55+/-11 years) and 62 age- and gender-matched healthy controls (33 men, 29 women, mean age 52+/-13 years) were studied to compare the effect of LA size, volume, and function on deltaP (difference between maximum and minimum P-wave duration on 12-lead electrocardiogram). RESULTS: P-wave dispersion in patients with PAF and normal LA diastolic diameter (LAD) was longer than that in controls with normal LA size (53+/-8 vs. 34+/-8 ms, p < 0.001). P-wave dispersion increased in patients with PAF (62+/-12 vs. 53+/-8 ms, p = 0.003) and controls (40+/-7 vs. 34+/-8 ms, p = 0.005) with increased LAD. Presence or absence of PAF did not interact with LAD for their effect on deltaP (2 x 2 analysis of variance test p = 0.20). In the PAF group, deltaP correlated with LAD (r = 0.43, p = 0.002), LA diastolic volume (r = 0.6, p < 0.001), and LA ejection fraction (AEF) (r = - 0.33, p = 0.05). The AEF was preserved when LAD increased in the patients without PAF (0.52+/-0.07 vs. 0.57+/-0.10, p = NS), however was significantly decreased in the PAF group (0.37+/-0.12 vs. 0.49+/-0.10, p = 0.01). On multivariate logistic regression analysis, only deltaP retained significance on development of PAF. CONCLUSION: It was concluded that deltaP increased in patients with PAF and normal LA size. In controls with increased LA size, deltaP increased but did not reach the levels attained in patients with PAF. The AEF was decreased in patients with PAF but was preserved in those without PAF. These findings can be explained by the changes in LA microarchitecture which concurrently decreased atrial myocardial contraction, increased deltaP, and predisposed to PAF.

QT dispersion and signal-averaged electrocardiogram in hemodialysis and CAPD patients.

OBJECTIVE: The aim of this study was to compare QT dispersion (QTd) and signal-averaged electrocardiogram (SA-ECG) parameters that may predict risk of malignant arrhythmias in patients on hemodialysis (HD), on continuous ambulatory peritoneal dialysis (CAPD), and in controls. SETTING: Controlled cross-sectional study in a tertiary-care setting. PATIENTS: 28 HD (M/F 18/10; mean age 32 +/- 9 years), 29 CAPD (M/F 17/12; mean age 34 +/- 10 years), and 29 healthy controls (M/F 17/12; mean age 32 +/- 8 years) were included. INTERVENTIONS: On ECG, minimum (QTmin) and maximum (QTmax) QT duration and their difference (QTd) were measured. In SA-ECG, duration of filtered QRS, HFLA signals less than 40 microV, and RMS voltage (40 ms) were also measured. RESULTS: Higher serum Ca2+ and lower K+ levels were found in CAPD compared to HD. All QT parameters were increased in HD and CAPD compared to controls. QT dispersion was significantly prolonged in HD compared to CAPD. In HD, QTd was correlated with left ventricular (LV) mass index (r = 0.53, p = 0.004), but not in CAPD (r = -0.09, p = 0.63). QT dispersion was significantly prolonged in patients with LV hypertrophy compared to patients without hypertrophy on HD (68 +/- 18 ms vs 49 +/- 18 ms, p = 0.008). In the analysis of SA-ECG, 3 of the 28 (11%) HD and 2 of the 29 (7%) CAPD patients had abnormal late potentials. Patients on HD and CAPD had significantly higher filtered-QRS duration compared to controls (105 +/- 15 ms and 104 +/- 12 ms vs 95 +/- 5 ms, respectively, p = 0.04). Patients with LV hypertrophy had higher filtered-QRS duration compared to patients without hypertrophy (109 +/- 12 ms vs 95 +/- 8 ms, p < 0.001). CONCLUSION: Dialysis patients had prolonged QTd and increased filtered-QRS duration in SA-ECG compared to controls. Patients on HD had longer QTd than patients on CAPD. QTd has been correlated to LV mass index in HD, but not in CAPD. This difference might be due to the effect of different dialysis modalities on electrolytes, especially the higher serum Ca2+ levels.

Echocardiographic findings in professional league soccer players. Effect of the position of the players on the echocardiographic parameters.

BACKGROUND: The purpose of the study was to compare the echocardiographic parameters of soccer players to healthy controls and to assess the effect of the position of the soccer players on the echocardiographic findings. METHODS: M Mode 2D and Doppler echocardiographic examination were carried out on 83 professional league soccer players and 52 healthy controls. RESULTS: Soccer players had increased interventricular septum (1.14+/-0.13 cm vs 0.99+/-0.17 cm, p<0.001) left ventricular posterior wall (1.08+/-0.16 cm vs 0.91+/-0.13 cm, p<0.001) thickness, increased left ventricular diastolic diameter (5.24+/-0.40 cm vs 4.88+/-0.43 cm, p<0.001), volume (133+/-23 ml vs 113+/-22 ml, p<0.001) and increased left ventricular mass index (142+/-28 g/m2 vs 103+/-23 g/m2, p<0.001) compared to controls. Soccer players had greater mitral E wave to A wave ratio (2.08+/-0.53 vs 1.65+/-0.43, p<0.001) compared to controls. Soccer players were subgrouped according to their position in the play as goal keepers, defensive, midfielder, and offensive players. Comparison among defensive, midfield and offensive players revealed subtle differences between defensive and midfield players. Right ventricular dimensions were higher in goal keepers compared to midfielders due to the greater body surface area of the goal keepers (2.8+/-0.4 cm vs 2.4+/-0.5 cm, p<0.05). Left ventricle end diastolic dimension were similar between groups but when these dimensions were corrected for the greater height of the defensive players the difference between midfields and defensive players became significant (3.05+/-0.18 vs 2.89+/-0.22, p=0.05). On Doppler flow parameters the ratio of peak E wave to A wave velocity (2.27+/-0.55 vs 1.84+/-0.36, p<0.05) was increased in midfield players compared to defensive players. CONCLUSIONS: It was concluded that soccer players had greater left ventricular wall thickness, volume and mass compared to controls. But the effect of the position of the players on the measured cardiac dimensions were minimal. These subtle findings were explained by the leveling effect of the playing system and training, and lack of physical training during the previous month.

The effect of fluvastatin of hyperlipidemia in renal transplant recipients: a prospective, placebo-controlled study.

Posttransplant hyperlipidemia is a common complication which may affect long term cardiovascular mortality. In this prospective, placebo-controlled study, 19 renal transplant recipients (11 male 8 female, mean age 31.2 +/- 8.4 years) with good allograft function (serum creatinine <2 mg/dl) more than 6 months after transplantation were included. All the patients had hyperlipidemia (serum cholesterol >230 mg/dl and/or LDL-cholesterol >130 mg/dl) despite dietary interventions. The patients were treated with a triple immunosuppressive regimen. After a 8-week period of placebo plus diet regimen, the patients were put on fluvastatin plus diet for another 8 weeks. The patients were followed for its effect on lipid parameters and side effects. After convertion to fluvastatin, serum cholesterol (263.0 +/- 31.6 vs 223.2 +/- 31.6 mg/dl, p = 0.001), LDL-cholesterol (174.4 +/- 28.3 vs 136.4 +/- 28.5 mg/dl, p = 0.002), Apolipoprotein (Apo) A1 (131.1 +/- 16.9 vs 114.7 +/- 18.4 mg/dl, p = 0.001) and Apo B (109.0 +/- 29.8 vs 97.3 +/- 31.5 mg/dl, p = 0.02) levels decreased significantly. Serum levels of triglycerides, VLDL-cholesterol and HDL-cholesterol levels did not vary under fluvastatin. Serum lipoprotein (a) levels were also unchanged during the whole study period (24.9 +/- 19.4 vs 23.1 +/- 19.8 mg/dl, p > 0.05). We concluded that fluvastatin effectively decreased atherogenic lipoproteins such as serum cholesterol, LDL-cholesterol, Apo B in posttransplant hyperlipidemia, however fluvastatin had no effect on another independent risk factor of atherogenesis, serum lipoprotein (a) levels.

Idiopathic portal hypertension during a catastrophic attack in a patient with primary antiphospholipid syndrome.

A 43-year old male patient with hyponatremic hypertensive syndrome was diagnosed as catastrophic primary antiphospholipid syndrome (PAPS). He subsequently developed hepatosplenomegaly. The patient also carried thrombophilia- and haemochromatosis-associated gene mutations. Further investigations upon persistence of splenomegaly indicated development of idiopathic portal hypertension.

Effects of amlodipine and fosinopril on heart rate variability and left ventricular mass in mild-to-moderate essential hypertension.

The differences between long-acting dihydropyridines and angiotensin-converting enzyme inhibitors with regard to their long-term effects on 24-h heart rate variability (HRV) and left ventricular (LV) mass are less clear in mild-to-moderate essential hypertension. We studied the long-term effects of amlodipine and fosinopril on 24-h HRV and LV mass in mild-to-moderate essential hypertension. In this study, 27 patients with never treated mild-to-moderate essential hypertension were randomised to receive either amlodipine or fosinopril once daily as monotherapy. At baseline and at the end of the third and sixth months, each of the patients underwent 24-h HRV and ambulatory systolic (SBP) and diastolic (DBP) blood pressure analysis. LV mass index was calculated from echocardiographic examination at baseline and at the end of the sixth month. In amlodipine group (n = 14), 24-h SBP/DBP (mmHg) decreased from 144 +/- 8/94 +/- 4 to 128 +/- 6/83 +/- 3 at the end of the third month and to 125 +/- 5/81 +/- 2 at the end of the sixth month (p < 0.0001). In fosinopril group (n = 13), the respective changes were 143 +/- 9/97 +/- 7, 132 +/- 6/87 +/- 5 and 127 +/- 6/82 +/- 3 (p < 0.0001). At the end of the sixth month, LV mass index (g/m(2)) decreased from 122 +/- 26 to 105 +/- 21 in amlodipine group (p < 0.0001) and from 118 +/- 23 to 101 +/- 14 in fosinopril group (p < 0.0001). There were no significant changes in HRV parameters in both the groups. It was concluded that both drugs caused significant decrease in SBP and DBP, and LV mass in patients with mild-to-moderate essential hypertension did not have significant long-term effects of either amlodipine or fosinopril on 24-h HRV parameters reflecting sympathetic or parasympathetic activity in these patients.

Risk factors for coronary heart disease in patients with spinal cord injury in Turkey.

OBJECTIVE: To compare the standard risk factors for coronary heart disease (CHD), defined in National Cholesterol Education Program II (NCEP II) of Turkish spinal cord injury (SCI) patients with healthy controls, discuss the results according to the findings in Turkish population, and SCI patients in the literature. DESIGN: We assessed 52 age and sex matched healthy control subjects, and 69 SCI patients (16 females, 53 males with the mean age of 33.9+/-11.37 years) with time since injury of 12.8+/-13.45 months. The study consisted of 45 paraplegics, and 24 tetraplegics with 54% incomplete, and 46% complete injury. RESULTS: Risk factors for CHD according to NCEP II were; age and sex in 16%, positive family history in 0%, cigarette smoking in 54%, hypertension (HT) in 0%, high total cholesterol (TC) in 32%, high low-density lipoprotein cholesterol (LDL) in 41%, low high-density lipoprotein cholesterol (HDL) in 52%, and diabetes mellitus (DM) in 7% of our SCI patients, respectively. Compared to controls DM, high TC, LDL, and low HDL were statistically more frequent in SCI patients. We found a negative correlation between serum HDL and time since injury. TC (186+/-32 vs 205+/-36; P=0.025), TC/HDL (5.34+/-1.17 vs 6.26+/-1.5; P=0.005), and LDL/HDL (3.57+/-0.9 vs 4.16+/-1.3; P=0.027) were significantly increased in patients with time since injury of more than 1 year, while HDL levels (35.8+/-6.36 vs 33.86+/-6.47; P=0.213) decreased without reaching statistical significance. The lipid profiles did not show any correlation with the neurological level, and completeness of lesions. CONCLUSIONS: SCI confers additional CHD risk over that present inherently in the parent population due to enforced sedentary lifestyle and this increases with time since injury. The preliminary study consisting of 26 patients was accepted for poster presentation in Copenhagen, Denmark (18-20 June 1999) at the 38th Annual Scientific Meeting of IMSOP in association with the Nordic Medical Society of Paraplegia.