Objective: This study aims to assess the sensitivity and specificity of ankle-brachial index (ABI) measurements in diagnosing peripheral artery disease (PAD) among a cohort of Turkish subjects, with angiography serving as the reference standard. Material and Methods: In this single-center, cross-sectional and observational study, subjects who had an aorta and lower extremity arterial imaging by angiography subsequently underwent an ABI measurement. Anthropometric measurements, cardiovascular risk factors, and blood biochemistry data were recorded. Sensitivity and specificity analyses were performed for a low ankle-brachial index (ABI ≤ 0.9), with angiography as the reference standard. Results: A total of 57 patients (age: 59.1±15.9, male/female: 47/10) were included. Diabetes mellitus, coronary artery disease and cerebrovascular disease were present in 40.4%, 42.1% and 15.8% of the participants, respectively. Three or more cardiovascular risk factors were present in 54.4%. The angiographic diagnostic method was computed tomography angiography in 57.9%, digital subtraction angiography in 38.6%, and magnetic resonance angiography in 3.5% of the subjects. The presence of PAD on angiography was documented in 55 of 57 participants. The calculated mean ABI value was 0.6±0.2 in the overall group, and a low ABI (≤0.9) was found by 82.5% (n = 47). Compared to angiography, the low ankle-brachial index (ABI) test demonstrated a sensitivity of 83.6% and a specificity of 50%. The positive predictive value of 97.9% was calculated. When an ABI≤0.95 was used as the diagnostic threshold, the sensitivity of the ABI test increased to 90.9%. Conclusion: Our study confirms the reliability of ABI measurements as a diagnostic method for lower extremity peripheral artery disease (PAD) when compared to angiographic techniques, the gold standard. Establishing a higher cut-off value (≤0.95) may enhance the diagnostic performance of the test in Turkish patients.

Objective: The primary aim of this study was to compare the retinal vessel caliber (RVC) with both arterial stiffness (AS) parameters and nocturnal blood pressure dipping status (DS) in essential hypertension (EH). Materials and Methods: The retinal vessel diameter of 101 patients with EH and 31 sex- and age-matched healthy controls was measured using retinal fundus photography. Venous blood samples were obtained for biochemical tests and anthropometric measurements were also recorded. The AS parameters of carotid-femoral pulse wave velocity (cfPWV), augmentation index (AIx), and central aortic pressure (CAP) were assessed using a non-invasive TensioClinic arteriographic system (TensioMed Kft., Budapest, Hungary). DS was evaluated using 24-hour ambulatory blood pressure measurements. The baseline characteristics, AS parameters, and the nocturnal DS of hypertensive patients were statistically compared with those of healthy individuals according to RVC values. Results: The hypertensive group had significantly higher heart rates (p=0.023); AS parameters (PWV [p<0.001], CAP [p<0.001]); and fasting glucose (p=0.028), creatinine (p=0.046), triglyceride (p=0.045), uric acid (p=0.014) and microalbuminuria (p=0.004) values than the healthy controls. Although there was a significant positive linear correlation between the duration of hypertension and PWV (p=0.024), AIx (aortic) (p=0.005) and AIx (brachial) (p=0.013), no significant difference between the EH patients and the control subjects was observed in the AS parameters and nocturnal DS values according to the RVC value. Conclusion: The results of this study did not demonstrate a significant correlation between the RVC and the AS parameters and nocturnal DS in EH. Additional prospective studies are warranted to reach a consensus on the clinical significance of RVC measurements in EH.

Results: The study included 90 patients with IHT (mean±SD age: 57.25±14.5 years, 63.3% female). No statistically significant difference was detected in ABPI (1.1±0.1 vs. 1.1±0.2, p=0.342) and PWV (10.9±2 vs. 10.5±1.9, p=0.341) measurements between male and female patients. In both sexes, SBP and DBP values correlated with CAP (Female: r=0.935, p<0.001; r=0.637, p<0.001, respectively. Male: r=0.944, p<0.001; r=0.749, p<0.001, respectively). SBP values correlated with ABPI among female patients (r=-0.277, p=0.037) but not among male patients. DBP did not correlate with ABPI in both sexes. No correlation was found between CAP and PWV in both sexes.

YÖNTEM ve GEREÇLER: Çalışma grubumuza nabız dalga hızı belirlenmiş toplam 713 birey dahil edilmiştir. Çalışmaya alınan bireylerin yaş, cinsiyet, sigara kullanımı, koroner arter hastalığı ve eşdeğeri hastalık mevcudiyeti, hipertansiyon varlığı, kullandığı ilaçlar, ek hastalıklar incelendi. Avrupa Kardiyoloji Derneği Heart-SCORE hesaplayıcısına girilerek hastaların total kardiyovasküler hastalık risk değeri belirlendi. Bu belirteçler ile nabız dalga hızı arasındaki ilişkiler araştırıldı.

Diabetes mellitus is a metabolic disorder with an increasing incidence all over the world leading to high sequelae and high mortality rates behind other microvascular and macrovascular complications. The deterioration in angiogenesis in particular is known to cause deterioration of vascular complications of diabetes. After the discovery of a natural angiogenesis inhibitor, angiostatin in the ethiopathogenesis of retinopathy and nephropathy, which are frequent complications of diabetes, several successful clinical trials have been made. However, the most lethal complication of diabetes, diabetic heart failure, lacks any trial about effectiveness of angiostatin. In this study, the levels and the clinical significance of angiostatin were investigated in oral antidiabetic or Insulin treated diabetic patients with heart failure. The patient group consisted of 31 patients with a diagnosis of diabetes mellitus and heart failure and the control group included 30 patients with heart failure without diabetes mellitus. Serum levels of angiostatin were studied. A total of 61 subjects were enrolled in the study. The patient group consisted of 31 patients; between the age of 56-88 (73.06 ± 8.7) years, of which 16 (51.6%) were female and 15 (48.4%) were male. The control group included 30 patients; 15 (% 50) women and 15 (50%) of were male, between the ages of 57 to 85 (74.23 ± 8.27). In the case group, the average angiostatin levels were 133.25 ± 78.46 and in the control group it was found to be 121.7 ± 71.81. The average angiostatin levels were similar in diabetic and non-diabetic heart failure groups (p=0.55). The average serum angiostatin levels showed a significant negative correlation with the level of fasting blood glucose. In our study, diabetic patients with heart failure, when compared with non-diabetic patients with heart failure, showed no significant difference in the levels of angiostatin. Levels of angiostatin are not affected by the level of HbA1c. Fasting blood glucose level has a negative correlation with the level of angiostatin. In order to be used in determining the prognosis in diabetic patients with heart failure, further studies are needed on angiostatin levels.

Diabetic ketoacidosis (DKA) typically presents with abdominal pain, vomiting, fatigue, and excessive thirst.Although it is a state of acidosis, symptoms related to the central nervous system are not frequent in DKA.We here report our experience of a patient with DKA receiving immunosuppressive drugs due to renal transplantation who initially presented with the meningeal syndrome.The condition resolved quickly after correction of acidosis and hyperglycemia.In this particular case, we had clues for drug-related side effects of immunosuppressants that possibly facilitated the occurrence of meningeal irritation.Our observations may contribute to the care of patients with DKA who are on such treatment regimens.

Abstract Background Diabetes mellitus (DM) is a multifactorial chronic disease, in which patients need to be treated with insulin in some conditions. Capillary growth is regulated by growth factors like vascular endothelial growth factor (VEGF) and endogenous inhibitors such as the splice variant of VEGF receptor-1 (sVEGFR-1). We aimed to show the levels and the clinical significance of VEGF, sVEGFR-1 in patients with DM on insulin treatment. Materials and methods A total of 83 subjects consisting of patients with the diagnosis of DM (n=47) and healthy control (n=36) were included the study. Plasma levels of VEGF and sVEGFR-1, were measured using the enzyme-linked immunosorbent assay method. Results The average sVEGFR-1 levels of DM group was significantly higher than the control group (0.106±0.052 and 0.073±0.049, respectively; p=0.005). Significantly lower sVEGFR-1 levels were determined in patients receiving metformin vs. without metformin using (0.065±0.016 and 0.118±0.053, respectively; p=0.001). Conclusion This is the first study evaluating and demonstrating the importance of plasma VEGF and sVEGFR-1 levels together in DM patients receiving insulin. Using metformin may have positive effect on angiogenesis in DM. Further studies are required to understand these effects.

BACKGROUND:The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines on hypertension management recommend new stage 1 hypertension thresholds (130-139/80-89 mmHg) for starting antihypertensive treatment. OBJECTIVE:To analyze the impact of the 2017 ACC/AHA guidelines on patients' diagnoses within daily practice, in comparison with management using the 2018 European hypertension guidelines, regarding the new thresholds. DESIGN AND SETTING:Cross-sectional study conducted in a hypertension outpatient clinic at a tertiary-level public hospital. METHODS:The diagnosis of hypertension was defined separately using each guideline. The participants were patients who were attending the hypertension clinic, who were evaluated using the thresholds of two guidelines, based on cardiovascular risk factors, including age, gender, smoking status, diabetes mellitus, dyslipidemia, obesity, osteoporosis, chronic renal failure and family history of hypertension. RESULTS:After adapting the guidelines to the blood pressure values of our sample, 74.5% (n = 277) of the patients were diagnosed as hypertensive according to the blood pressure classification of the European Society of Cardiology (ESC) guidelines published in 2018, while 91.1% (n = 339) of the patients were hypertensive according to the new 2017 ACC/AHA guidelines. Multivariate regression analysis revealed that the significant demographic and cardiovascular risk factors associated with hypertension, based on the 2018 European Society of Hypertension (ESH)/ESC guidelines, were age (odds ratio, OR: 1.027; 95% confidence interval, CI: 1.001-1.054; P = 0.042), obesity (OR: 4.534; 95% CI: 1.830-11.237; P = 0.001) and family history of hypertension (OR: 2.199; 95% CI: 1.252-3.862; P = 0.006). CONCLUSIONS:The factors associated with the definition of hypertension may vary through changing the threshold values.

Background/aim:The clinical effect of angiostatin in diabetes mellitus (DM) patients receiving insulin is a meaningful gap in the literature. In this study, we aimed to show the levels and the clinical significance of angiostatin in DM patients receiving insulin.Materials and methods:This is a case-control study. Serum angiostatin levels were determined by ELISA. A total of 83 people consisting of healthy subjects (n = 36) and patients with a diagnosis of DM receiving insulin therapy (n = 47) were included in this study.Results:The mean angiostatin levels of the DM group were significantly higher than those of the control group (86.0 ± 68.1 ng/mL and 58.0 ± 22.4 ng/mL, respectively; P = 0.011). Significantly lower angiostatin levels were determined in the DM patients receiving metformin with respect to those not receiving metformin (97.2 ± 74.4 ng/mL and 49.3 ± 7.0 ng/mL, respectively; P = 0.021). Significantly higher levels of angiostatin were observed among the DM patients using a beta-blocker (BB) than the DM patients not using a BB (115.5 ± 78.71 ng/mL and 73.44 ± 60.08 ng/mL, respectively; p = 0.029).Conclusion:This is the first study evaluating and demonstrating the serum angiostatin levels in DM patients receiving insulin. Further studies are required to understand the effect of angiostatin in diabetics and the effect of medications on angiogenesis in these patients.

Introduction: It is called as heart failure with reduced ejection (HFrEF) while ejection fraction (EF) is lower than 40%.Patients with EF=40-50% is called as heart failure with mid-range ejection fraction (HFmrEF) which is considered as a subgroup of heart failure with preserved ejection fraction (HFpEF) rather than HFrEF.Angiostatin inhibits the proliferation of smooth muscles, endothelial cells, and mesenchymal stem cells.In this study, we aimed to investigate the clinical significance of angiostatin in HFrEF and HFmrEF patients without chronic kidney disease (CKD).Body text: A total of 62 people consisting of patients with a diagnosis of HFrEF and HFmrEF without CKD (n = 25) and healthy (n = 37) subjects were included in this study.Blood samples were obtained and serum angiostatin, plasma Nterminal Pro-BNP analysis, and transthoracic echocardiography were performed.Results and Discussion: The angiostatin level of HFrEF and HFmrEF group was significantly higher than the control group (94,32 (58,7-282,1); 47,14 (18,8-100,2); p<0.001; respectively).Average angiostatin level of HFrEF and HFmrEF patients using calcium chanel blocker (CCB) was significantly higher than the HF patients without CCB (200,4 (79,1 -282,1); 83,5 (58,7 -228,7; p = 0.021; respectively).Average angiostatin level of HFrEF and HFmrEF patients using spironolactone was significantly lower than the HF patients without spironolactone use (61,8 (58,7 -64,1); 133,8 (62,3 -282,1); p = 0.027; respectively).Conclusion: Our study is the first study in this area.Angiostatin may be an important marker in HFrEF and HFmrEF patients.Use of spironolactone may induce angiogenesis and apoptosis and CCB may inhibit angiogenesis in HFrEF and HFmrEF patients.Further studies are required on this subject.

OBJECTIVES:To show the levels of vascular endothelial growth factor (VEGF), soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) in patients with end-stage renal disease (ESRD) and to show the associations with clinical findings such as demographic features, laboratory findings, comorbidities, and medications. METHODS:A total of 73 people, consisting of patients with ESRD (n=38) and healthy subjects (n=35) in Gulhane Education and Research Hospital, Ankara, Turkey, were included in this cross-sectional study between the years 2011 and 2013. Blood samples were obtained and plasma VEGF, sVEGFR-1 analyzes were performed. Results: The VEGF level of ESRD group was not significantly higher (0.280±0.264) than the control group (0.321±0.210) (p=0.475). The sVEGFR-1 level of ESRD group was significantly higher (0.217±0.135) than the control group (0.068±0.047) (p less than 0.001). The correlation between VEGF and sVEGFR-1 was significant and negative (r=-0.246, p=0.036). Average VEGF level of ESRD patients using recombinant human erythropoietin (rhEPO) was significantly higher (0.567±0.28) than the ESRD patients not using rhEPO (0.246±0.24) (p=0.025). CONCLUSION:Our study is the first showing the significance of sVEGFR-1 in ESRD patients, and associations with comorbidities, medications. Especially our finding of rhEPO and VEGF may illuminate a reasonable positive effect of rhEPO on angiogenesis. Soluble vascular endothelial growth factor receptor-1 and VEGF may be important markers in the pathophysiology of ESRD.

Abstract Objective In this study, our aim was to investigate the clinical significance of VEGF, sVEGFR-1 in HFpEF patients. Materials and methods Seventy-two participants enrolled in this cross-sectional case-control study including HFpEF patients (n=41) and healthy (n=31) subjects. Blood samples were collected and serum VEGF, sVEGFR-1 analysis, and transthoracic echocardiography were performed. Results and discussion The average sVEGFR-1 level of HFpEF patient group was significantly higher than the control group (respectively 0.136 ng/L (0.04–0.34), 0.06 ng/L (0.01–0.25); p<0.001). The average VEGF level of HFpEF patients using beta blocker was significantly higher than the HFpEF patients not using it (respectively 0.585±0.194 ng/L; 0.349±0.269 ng/L; p=0.025). The average VEGF level of HFpEF patients using statins was significantly higher than the HFpEF patients without a medication (respectively 0.607±0.099 ng/L; 0.359±0.273 ng/L; p=0.038). Conclusion Our study is the first study demonstrating the relations among HFpEF, accompanying morbidities, VEGF and sVEGFR-1 levels. Statins and beta blockers may have positive effects on angiogenesis in HFrEF patients via increasing VEGF levels.

BACKGROUND The aim of this study was to determine the impacts of different administration modes on sensitivity and specificity of Edinburgh Claudication Questionnaire (ECQ) in estimation of Ankle Brachial Index (ABI) detecting lower extremity arterial disease (LEAD). METHODS Eligible respondents aged fifty years or older underwent first a self-administered (SA-) ECQ, and then an interviewer-administered (IA-) ECQ. Interviewing included additional guidance on symptoms relevant to claudication. ABI was measured by hand-held Doppler. RESULTS A total of 177 respondents (age: 64.67±9.19, male/female: 80/97) were enrolled. Questions 1, 2, 3, and 5 (collectively defines claudication) were responded significantly different on SA-ECQ and IA-ECQ modes. Markings of pain on the figure of ECQ also changed significantly when the procedure was guided. Of the respondents, none on SA-ECQ and 13.6% on IA-ECQ with positive claudication had a low ABI. Subjects with higher formal education level did similar to the whole group in both modes. Sensitivity and specificity of IA-ECQ was calculated as 25% and 88.5%, respectively, for ABI detected LEAD. CONCLUSIONS Respondents' perceptions of pain, discomfort, exertion or body regions described on ECQ may subject to errors without guidance. ECQ seems reliable in evaluating claudication only when specifically interviewed by an observer.

DOI: 10.21276/sjmcr.2017.5.9.14 Abstract: Aortic coarctation is a disease of the aorta, which is characteristically detected at the insertion of the ductus arteriosus just distal to the left subclavian artery and narrows the remainder part of the aorta. The majority of aortic coarctation cases are congenital. In formerly unrecognized patients, the most known presenting sign is hypertension. The detecting of reduced systolic blood pressure in the lower extremities compared with upper extremities make think a diagnosis of coarctation of the aorta, which can be often verified by echocardiography or alternate imaging modalities. Medical care depends upon the severity of the coarctation, clinical presentation. and patient age. Options for correction of coarctation of the aorta comprise percutaneous interventions like balloon angioplasty and stent placement or surgical intervention.

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) accounts for an important part of hyponatremia cases. The causes of SIADH can be detected almost always. As a rare disorder, Morvan Syndrome can be defined by the sum of peripheral nerve hyperexcitability, autonomic instability and neuropsychiatric features. Antibodies to voltage-gated potassium channels (Anti – VGKC-Ab) including contactin associated protein-like 2 antibodies (CASPR2-Ab) and leucine-rich glioma inactivated protein 1 antibodies (LGI1-Ab) were previously known for the potential association with this condition. We present a Morvan Syndrome in a patient who presented with various neuropsychiatric symptoms and SIADH.