Which aerobic exercise is more effective in Parkinson's patients? Cycle ergometer versus body weight-supported treadmill.

Objectives: The study aimed to evaluate the effects of aerobic exercise applied with bodyweight-supported treadmill (BWSTT) or cycle ergometer (CE) in Parkinson's patients. Patients and methods: In the prospective single-blind study, 38 Parkinson's patients with Hoehn-Yahr Stage 1-3 were randomized into the CE and BWSTT groups between May 2019 and March 2020. Evaluations before and after six weeks of treatment included a six-min walking test with a software device as the primary outcome and functional balance tests (Tinetti balance and gait test, one-leg stance balance test) as secondary outcomes. Both groups received 40 min of aerobic exercise three days per week with conventional rehabilitation and various methods. CE and BWSTT groups were created. The aerobic exercise program was designed based on treatment recommendations for Parkinson's patients of the American College of Sports Medicine (CE test, with the Karvonen formula, 40-60% reserve). Posttreatment and pretreatment evaluations were compared within and between groups. Results: The six-week aerobic exercise program was completed by 16 participants (9 males, 7 females; mean age: 65.9±8.1; range, 47 to 78 years) in the CE group and 15 participants (9 males, 6 females; mean age: 62.5±7.5; range, 49 to 79 years) in the BWSTT group. The demographic characteristics of the patients were similar. Primary and secondary outcomes were significantly different after treatment than before treatment in both groups. There were no significant differences between the groups in outcomes. Conclusion: The results showed that both methods are effective and not superior to each other. Aerobic exercise programs led by experienced clinicians can benefit patients.

The importance of speckle tracking echocardiography in the evaluation of cardiac functions in patients with rheumatoid arthritis.

Objectives: In this study, we aimed to analyze the layer-specific strain values obtained by speckle tracking echocardiography (STE) method in the determination of subclinical cardiac dysfunction in rheumatoid arthritis (RA) patients. Patients and methods: Between February 2019 and October 2019, a total of 63 female RA patients (mean age: 51.82±6.07 years; range, 40 and 65 years) who had a confirmed diagnosis were included. Thirty-one age-matched female healthy individuals (mean age: 50.71±5.37 years; range, 40 and 65 years) were selected as the control group. The patients were divided into three groups according to the duration of disease as <5 years, 5-10 years and >10 years. The Disease Activity Score in 28 joint - C-reactive protein (CRP) was used to determine disease activation. The standard assessment included complete serum CRP, anti-cyclic citrullinated peptide, rheumatoid factor, N-terminal pro B-type natriuretic peptide (NT-proBNP), and homocysteine. Global longitudinal strain (GLS) analysis was performed with STE. Results: The NT-proBNP values were found to be higher in RA patients compared to the control group (p=0.044). In terms of conventional echocardiographic parameters, a significant difference between E/A and E/E' ratios was observed (p<0.001 and p=0.015). Endocardium, transmural, and epicardium GLS values obtained by STE were found to be lower in RA patients (p<0.05). The left ventricular (LV) GLS values worsened, as the duration of disease increased (p<0.05). There was a significant correlation between RA disease activity and LV GLS values, showing that increasing levels of disease activity was associated with worse LV GLS (r=0.583, p<0.01 and r=0.681, p<0.01 and r=0.689, p<0.01 for endocardium, transmural and epicardium, respectively). Conclusion: Our study results suggest that the layer-specific GLS values obtained by STE decrease in RA patients.

Differential Anxiety Responses in Acute Myocardial Infarction vs. COVID-19 Pneumonia Patients.

Background and Objectives: Amidst the COVID-19 pandemic, concerns about the psychological impact of disease-related anxiety on public health have risen. This study aims to compare general and death anxiety levels between acute coronary artery syndrome and COVID-19 pneumonia patients. Materials and Methods: A cross-sectional study of 132 individuals, including acute myocardial infarction (MI), COVID-19 pneumonia patients, and healthy volunteers from Trakya University Hospital (Turkey), was analyzed. Validated scales like the Beck Anxiety Inventory (BAI), Coronavirus Anxiety Scale Short Form, and Thorson-Powell Death Anxiety Scale (TPDAS) were employed. Demographic data such as age, gender, income levels, employment status, presence of a close relative with COVID-19, and whether participants followed COVID-19-related news were collected and compared across groups with significance level of 0.05 set for all analyses. Results: Among 41 COVID-19, 41 MI, and 50 healthy subjects, the pneumonia group showed highest COVID-19 anxiety (p = 0.01) and BAI scores (p = 0.008). Both COVID-19 and MI patients had significantly higher BAI and TPDAS scores compared to healthy controls (p < 0.001). Factors like female gender (p = 0.004), low education (p = 0.003), current employment (p = 0.008), and low income (p = 0.002) correlated with higher BAI scores. Low income (p = 0.001) and COVID-19 news exposure (p = 0.002) correlated with higher TPDAS scores. Males and married patients had lower anxiety scores (p = 0.008). High income, education, and employment reduced anxiety levels (p = 0.008). TPDAS scores decreased with higher income (p = 0.001), but increased in the MI group (p = 0.002) with COVID-19 news exposure. The multivariate linear regression analysis found that MI and COVID-19 pneumonia were associated with TPDAS; female gender, university education, and COVID-19 pneumonia with the Beck scale; and COVID-19 pneumonia with anxiety scores on the COVID-19 Anxiety scale. Conclusions: This research showcases differing anxiety patterns between illnesses such as MI and COVID-19 pneumonia amidst the pandemic, emphasizing the amplifying influence of media coverage on death-related anxieties. It underscores the imperative of targeted interventions and socioeconomic considerations in managing psychological consequences and formulating responsive public health strategies.

Hypertension and Occupational Health: A General Overview and Expert Consensus Suggestions.

Hypertension is a common public health issue, and its incidene increases parallel to age. It is inevitable that certain occupational conditions may pose risks for high blood pressure or cause difficulties in managing blood pressure. Working under specific circumstances may compromise the safety of individuals with hypertension and potentially others. Therefore, it is crucial to implement activities that enhance awareness of hypertension, to ensure regular periodic examinations, and to establish necessary precautions in the workplace for the health of employees and the public. Given the limited resources offering guidance on hypertension in the context of occupational health, the authors of this paper, who hail from different disciplines, have prepared a set of consensus-based suggestions.

A Novel Potential Biomarker for Predicting the Development of Septic Embolism in Patients with Infective Endocarditis: Systemic Coagulation Inflammation Index.

OBJECTIVE: Early diagnosis of septic emboli is crucial to prevent the associated morbidity and mortality. This study aimed to examine the relationship between the systemic coagulation inflammation index (SCII) and septic embolism in patients with infective endocarditis (IE). METHODS: We retrospectively analyzed the data of 167 IE patients treated at our tertiary care hospital between January 2007 and January 2023. We collected information on symptoms, comorbidities, predisposing valve diseases, prosthetic valves, devices, history of injectable drug use, blood culture results, echocardiographic findings, and complications. The SCII index was calculated using the formula: [platelet count (PLT) × fibrinogen level (g/L) / white blood cell count (WBC)]. RESULTS: The mean age of the patients was 61 years, with rheumatic valve disease being the most common predisposing factor. The most common etiologic microorganism was Staphylococcus species. Septic embolism developed in 25.7% of the patients, with the cerebral system being the most commonly affected (46.5%). The SCII was identified as an independent marker for the development of septic embolism. Receiver operating characteristic (ROC) curve analysis confirmed that an optimal SCII value of 59.8 predicted septic emboli with a sensitivity of 65.1% and a specificity of 59.6% (area under the ROC curve: 0.649 [95% confidence interval (CI): 0.556 - 0.743], P = 0.004). CONCLUSION: This study demonstrates that high SCII levels are an independent predictor for the development of septic embolism in patients with IE.

Hyponatremia and takotsubo syndrome: a review of pathogenetic and clinical implications.

Hyponatremia is a common electrolyte abnormality with important prognostic and therapeutic implications. It might exert detrimental effects on various organ systems including the central nervous system (CNS), bone, and heart along with its potential association with poor quality of life. These adverse effects might be largely mediated through a variety of mechanisms including osmotic stress, dysfunctional transmembrane exchangers, and enhanced oxidative stress.Interestingly, hyponatremia might also have an important association with takotsubo syndrome (TTS) that has been universally considered as a reversible form of cardiomyopathy usually emerging in response to various stressors. In this context, severe hyponatremia was previously reported to serve as a direct trigger of TTS evolution largely through its potential impact on CNS and heart. However, pathogenetic and clinical implications of hyponatremia still need to be thoroughly evaluated in patients with TTS. This paper aims to analyze the clinical features of published cases with TTS primarily triggered by hyponatremia and also aims to discuss the association between hyponatremia and TTS from a broader perspective.

Novel Predictor of the AF Development in Patients with OSAS: Importance of Visceral Adipose Index.

Objective: Obstructive sleep apnea syndrome (OSAS) is a sleep disorder whose frequency is increasing daily due to modern lifestyle. Patients with atrial fibrillation (AF), which has the same predisposing factors, frequently visit the outpatient clinic with complaints of palpitation. Existing symptoms are often associated with the course of OSAS, and the development of AF, a disease with high morbidity and mortality, cannot be detected. In our study, we investigated the relationship between the visceral adiposity index (VAI) and AF development in these patients. Methods: We retrospectively analyzed 207 patients with OSAS who visited the cardiology outpatient clinic. The data of 44 patients with AF and 163 patients without AF were compared. Results: Demographic characteristics and clinical risk factors were similar between the groups (p>0.05). VAI, apnea-hypopnea index, and inflammatory markers were higher in the AF group, and these risk factors were significant in the multivariate analysis (p<0.05). Conclusions: Our study is important in terms of showing VAI as one of the most important predictors of AF, which has an impact on mortality and morbidity in patients with OSAS, whose frequency is increasing daily. Further prospective studies are required to confirm our observations and determine their clinical applicability.

A Stent Misplaced in the Septal Perforating Artery: Right Ventricular Fistula, Interventricular Septal Hematoma, and Right Ventricular Outflow Tract Obstruction. / Um Stent Mal Colocado na Artéria Septal Perfurante: Fístula Ventricular Direita, Hematoma do Septo Interventricular e Obstrução da Via de Saída do Ventrículo Direito.

Coronary-cameral fistulas, though mostly regarded as congenital entities, have also been encountered as complications of major traumas and percutaneous coronary interventions (PCIs).1 On the other hand, interventricular septal (IVS) hematoma might potentially arise mostly during retrograde chronic total occlusion (CTO) interventions and has a benign course in this context.2 Herein, we describe a challenging PCI complication (and its management strategy) presenting with IVS hematoma, right ventricular fistula, and right ventricular outflow tract (RVOT) obstruction due to a misimplanted coronary stent in the septal perforating artery (SPA).

As fístulas coronário-camerais, embora consideradas em sua maioria como entidades congênitas, também têm sido encontradas como complicações de grandes traumas e intervenções coronárias percutâneas (ICPs).1 Por outro lado, o hematoma do septo interventricular (SIV) pode potencialmente surgir principalmente durante intervenções de oclusão total crônica retrógrada (OTC) e tem um curso benigno nesse contexto.2 Aqui, descrevemos uma complicação desafiadora da ICP (e sua estratégia de manejo) apresentando hematoma do SIV, fístula ventricular direita e obstrução da via de saída do ventrículo direito (VSVD) devido a um stent coronário mal implantado na artéria septal perfurante (ASP).

Coexistence of Anti-PD1-Induced Immune Myocarditis and Complete Atrioventricular Block: A Case Report.

The present report describes the late recovery of an emerging complete atrioventricular (AV block) in a patient with immune check point inhibitor-related myocarditis following a period of immunosuppresive therapy. Therefore, decision-making for permanent pacemaker implantation should be implemented after a substantial period of time owing to the potential recovery of bradyarrhythmic complications in similar cases.

TyG index as a predictor of spontaneous coronary artery dissection in young women.

OBJECTIVE: Spontaneous coronary artery dissection (SCAD) is a rare but potentially life-threatening pathology and cases are especially seen in women under 50 years of age and with relatively fewer cardiovascular risk factors. Although risk factors facilitating the development of SCAD have been defined in the literature, modifiable risk factors remain unclear. In this study, it was aimed to investigate the relationship between the triglyceride glucose index (TyG) and the development of SCAD in the population of young women. METHODS: The results of 281 patients were analyzed and compared with each other in terms of clinical, demographic, laboratory parameters, and coronary angiography results. RESULTS: The mean age was 45 years and all of them were female. When the groups were compared, the TyG and inflammatory parameters were higher in the SCAD group (p < 0.001). When these two groups with low cardiovascular risk factors were compared in logistic regression analysis, high TyG was found to be an independent predictor of SCAD development in young women (p < 0.001). CONCLUSION: As a result, our study shows that the development of these non-atherosclerotic conditions can be predicted by simple biochemical tests in young women with low atherosclerotic cardiovascular risk factors.

Comparison of Myocardial Perfusion Scintigraphy and Coronary Angiography Results in Breast Cancer Patients Treated with Radiotherapy.

Breast cancer is the most common type of malignancy in women and radiotherapy (RT) is an important part of treatment. Although it reduces cancer recurrence, it has been shown to cause accerelerated athnerosclerosis. This study aimed to compare the results of myocardial perfusion scintigraphy (MPS) for ischemia investigation with coronary angiography (CAG) findings and to investigate the effect of RT on the development of coronary artery disease in breast cancer patients who underwent RT. The results of 660 patients were analyzed and compared with each other in terms of clinical, demographic, laboratory parameters and MPS results. The mean age was 57.5 years and all of them were female. When the groups were compared, the Gensini score and marking of the left anterior descending artery (LAD) area as ischemic area localization were found more, but angiographically, the rate of severe stenosis in the area indicated by MPS was found to be lower in the RT group (p < 0.001). While the sensitivity of MPS in the RT group was 67.5% and non-RT group was 88.5% (p < 0.001), the result of our study shows that the sensitivity of the MPS test is significantly lower in the patient group receiving RT.

Cancer Therapy-Related Pulmonary Hypertension: A Review of Mechanisms and Implications for Clinical Practice.

Cancer therapy-related pulmonary hypertension is a rare yet potentially fatal cardiotoxicity. However, it is a reversible cause of pulmonary hypertension if detected in its early stages. Cancer therapy-related pulmonary hypertension has been encountered in patients using tyrosine kinase inhibitors, particularly dasatinib. However, it is also well known that many agents used in cancer treatment such as alkylating agents, proteasome inhibitors, thoracic radiation exposure, and immune checkpoint inhibitors are particularly associated with pulmonary hypertension evolution. In case that history, symptoms, and clinical findings suggest a potential cancer therapy-related pulmonary hypertension, echocardiography is considered as the initial tool to detect pulmonary hypertension. If the possibility of pulmonary hypertension is high based on echocardiographic data, cancer treatment, as the initial step, should be discontinued due to its potential risks and other causes for pulmonary hypertension should be investigated thoroughly. Right heart catheterization should be the next step to establish the final diagnosis, and medical management, where appropriate, should be started without delay in these patients according to their pulmonary hypertension subgroup. There exists limited information regarding the diagnostic and management strategies of cancer therapy-related pulmonary hypertension in the current guidelines. In this review article, we aim to present current literature data on the mechanisms and management of cancer therapy-related pulmonary hypertension along with its follow-up algorithm in the setting of cardio-oncology practice.

The Effect of SGLT2 Inhibitors on the Development of Contrast-Induced Nephropathy in Diabetic Patients with Non-ST Segment Elevation Myocardial Infarction.

Background and Objectives: Percutaneous procedures using contrast agents are modern diagnosis and treatment methods for cardiovascular diseases. Contrast use may cause nephropathy, especially in diabetic patients. SGLT2 inhibitors have strong cardioprotective and renal protective effects. In our study, we investigated the effectiveness of this drug group in preventing the development of Contrast-Induced Nephropathy (CIN). Materials and Methods: The results of 312 diabetic patients who underwent CAG were analyzed. The study group included 104 DM patients using SGLT2 and the control group did not use SGLT2. These groups were compared with each other in terms of clinical, demographic, and laboratory parameters. Results: The groups were similar characteristics. However, post-CAG creatinine values compared with before the procedure, the development of CIN was observed to be significantly less in the group using SGLT2 inhibitor (p = 0.03). When the results of the multivariate analysis were examined, it was seen that the use of SGLT2 inhibitors significantly reduced the risk of CIN (odds ratio (OR): 0.41, 95% confidence interval (CI): 0,142-0.966, p = 0.004). Conclusions: Our study showed that SGLT2 inhibitors may be protective against the development of CIN, especially in patients with comorbid conditions such as diabetes.

Systemic Immune-Inflammation Index: A Novel Predictor of Coronary Thrombus Burden in Patients with Non-ST Acute Coronary Syndrome.

Background and Objectives: Excessive coronary thrombus burden is known to cause an increase in mortality and major adverse cardiac events (MACEs) in NSTE-ACS (non-ST acute coronary syndrome) patients. We investigated the association between the systemic immune-inflammation index (SII) and coronary thrombus burden in patients with non-ST segment elevation myocardial infarction (NSTEMI) who underwent coronary angiography and percutaneous coronary intervention (PCI). Materials and Methods: A total of 389 patients with the diagnosis of NSTEMI participated in our study. Coronary thrombus burden was classified in the TIMI (thrombolysis in myocardial infarction) thrombus grade scale and patients were divided into two groups: a TIMI thrombus grade 0-1 group (n = 209, 157 males) and a TIMI thrombus grade 2-6 group (n = 180, 118 males). Demographics, angiographic lesion images, coronary thrombus burden, clinical risk factors, laboratory parameters, and SII score were compared between the two groups. Results: The high thrombus burden patient group had a higher neutrophil count, WBC count, platelet count, and systemic immune-inflammation index (SII) (p < 0.001). The receiver operating characteristic (ROC) curve analysis showed that at a cutoff of 1103, the value of SII manifested 74.4% sensitivity and 74.6% specificity for detecting a high coronary thrombus burden. Conclusions: Our study showed that the SII levels at hospital admission were independently associated with high coronary thrombus with NSTEMI.