Relation of asymmetric dimethylarginine and cardiac involvement in systemic sclerosis.

OBJECTIVES: The heart is a commonly involved organ in systemic sclerosis (SSc) and pulmonary hypertension is a commonly observed complication that is associated with poor prognosis in this disease. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthases. In this study, we aimed to contribute to an early diagnosis of cardiac involvement by evaluating ADMA and tissue Doppler electrocardiographic findings in patients with SSc. METHODS: 30 SSc patients without clinical cardiac symptoms and 30 controls were included. Plasma ADMA levels were measured and tissue Doppler electrocardiography examination was carried out for all participants. Systolic and diastolic functions were assessed; pulmonary arterial systolic pressure and mean pulmonary arterial pressure were measured. RESULTS: The patient and control groups demonstrated a significant difference with regard to right ventricular free wall tissue Doppler late diastolic wave, pulmonary arterial systolic pressure, right ventricular ejection fraction, and right ventricular diastolic dysfunction values. ADMA levels were significantly higher in SSc patients and also in active patients compared to inactive patients. No significant relationship between ADMA and echocardiographic parameters was found. CONCLUSION: Tissue Doppler echocardiography is capable of revealing impaired right ventricular functions and increased pulmonary arterial systolic pressure before the occurrence of any cardiac clinical symptoms in patients with SSc. Serum ADMA levels were increased in SSc and in patients with active disease.

Increased epicardial fat thickness is related with body mass index in women with polycystic ovary syndrome.

AIM: We aimed to investigate the relationship between PCOS and epicardial fat thickness with transthoracic echocardiography. PATIENTS AND METHODS: PCOS patients were divided into two groups according to the lean or obesity status: PCOS patients with lean 34 subjects (BMI: 23.3±2.8; mean age: 25.5±4), PCOS patients with obese16 subjects (BMI: 32.3±7.6; mean age: 27.2±3.7) were compared with control healthy lean subjects (BMI: 23.5±1.7; mean age: 25.9±2.2). RESULTS: There was increased epicardial thickness in obese PCOS subjects compared to lean PCOS subjects (6.3±0.9 mm, 4.7±0.5, respectively, p < 0.001). However, epicardial fat thickness between lean PCOS subjects and lean healthy control groups were not significantly varied (4.7±0.5 mm, 4.5±0.5, respectively, p = 0.6). There was increased epicardial thickness in obese PCOS subjects compared to lean healthy control subjects (6.3±0.9 mm, 4.5±0.5, respectively, p < 0.001). This sudy showed for the first time that increased epicardial fat thickness measured using transthoracic echocardiography is associated with increased BMI in PCOS subjects. CONCLUSIONS: Epicardial fat thickness between lean PCOS subjects and lean healty control group were similar which indicate the importance of obesity in PCOS subjects.

Effect of hypoglycemic drugs on aspirin resistance in patients with diabetes mellitus.

BACKGROUND: Aspirin reduces the odds of an arterial thrombotic event in high-risk patients. However, 10%-20% of patients with an arterial thrombotic event who are treated with aspirin have a recurrent arterial thrombotic event during long-term followup. Aspirin resistance has been described in some patient populations such as those with an acute coronary syndrome, ischemic stroke, percutaneous coronary intervention with drug-eluting stent, stent re-stenosis, and diabetes mellitus (DM). The aim of this study was to assess aspirin resistance and to compare it to the use of oral anti-diabetic drugs and insulin in patients with diabetes. METHODS AND RESULTS: Platelet aggregation was measured after aspirin treatment in 101 diabetic patients undergoing percutaneous coronary intervention. Two patient populations were included in the investigation: use of insulin (group 1) and use of oral anti-diabetic agents (OAD) (group 2) in diabetic patients. Platelet aggregation was determined using a multichannel Multiplate analyzer. Among group 1 patients, 4.7% were aspirin non-responders and among group 2 patients, 8.6% were aspirin non-responders. Statistical differences were not found between the groups (p = 0.359). CONCLUSIONS: This study demonstrated that there was no significant difference in aspirin resistance between type 2 diabetes mellitus patients on insulin treatment and type 2 diabetes mellitus patients on OAD treatment.

A rare cause of syncope: cough.

BACKGROUND: Syncope is a transient loss of consciousness, associated with loss of postural tone, with spontaneous return to baseline neurologic function. Syncope is a common complaint in the emergency department. OBJECTIVES: Cough syncope occurs immediately after coughing. Cough syncope rapidly recovers in 1-2 second. Although cough syncope has been classified in vasovagal syncope, it may differ from pathogenetic mechanism. Physicians should be aware of this easily recognizable cough induced syncope. CASE REPORT: We present a 59-year-old obese man was referred for clinical evaluation because of recurrent syncope without seizures following coughing who developed cough syncope. CONCLUSIONS: Physicians should be aware of this easily recognizable cough induced syncope in all subjects admitted with syncope and should screen possible underlying sources of cough.