Sarcoidosis is a systemic granulomatous disease of unknown origin, which principally affects lungs and lymphatic system. Even though cardiac involvement is rarely seen in sarcoidosis patients, it is important as it causes fatal outcomes. In this study, we aimed to determine the frequency of cardiac involvement in sarcoidosis cases with late gadolinium enhancement cardiac MR studies, Echocardiography and Holter ECG. Forty-nine cases with the diagnosis of sarcoidosis that presented to Necmettin Erbakan University Meram Medical Faculty between January 2004 and August 2013 were planned to enroll this study. Male / female ratio of the enrolled patients was 6.1 and their mean age was 46.3 ± 10.6. A 24-hour holter recording and echocardiography were performed to the patients. After these procedures delayed gadolinium involvement was observed in cardiac MR, by administering intravenous gadolinium. In conclusion, gadolinium involvement in MR was detected in 16 (33%) of 49 cases. There was no significant difference between the 24 hours holter records of these patients with involvement and the patients without involvement. In ECHO evaluation while the systolic function was maintained, it was seen that diastolic functions were deteriorated in patients with MR involvement. In the light of our study and the other studies done before, we can say that delayed gadolinium involvement in MR is a usable imaging with high specifity and sensitivity in cardiac involvement of Sarcoidosis. This imaging method should take place especially among diagnostic methods of patients having abnormal findings in ECG, Holter ECG and ECHO.

Background/Aim: Oxidative stress status in obstructive sleep apnea syndrome (OSAS) is well discussed in the literature. Oxidative stress levels increase, and antioxidant system activi-ty decreases in OSAS patients. However, the change in oxidative stress status in positional (pOSAS) and non-positional (npOSAS) OSAS has not been adequately examined. The aim of this study was to compare OSAS patients’ polysomnographic (PSG) parameters and oxidative stress capacities with the structural and functional properties of the upper respiratory tract. Methods: This study was designed as prospective case-control study and patients were divided into three groups as control, pOSAS and npOSAS according to their PSG findings. Ear nose throat examinations including rhinomanometry test and oxidative stress blood parameter tests were conducted to all patients. Variables among the groups were compared. Results: All PSG parameters were significantly worse in the OSAS groups than the control group (P<0.05). The mean AHIs of the pOSAS and npOSAS groups were 21.7 (16.5), and 31.2 (21.9), respectively. AHI, desaturation number and minimal SpO2 values of the pOSAS group were significantly lower compared to the npOSAS group (P=0.043, P=0.017 and P=0.006, respectively). TNF α was significantly lower and adiponectin was significantly higher in the pOSAS group compared to the npOSAS group (P=0.001, P<0.001 respectively). The two groups were similar in terms of rhinomanometry results (P=0.888). Conclusion: The lack of difference between pOSAS and npOSAS patients in terms of rhinomanometry results may indicate that the nose may not play a decisive role in the differentiation of these groups. Only OSAS severity may not be a determinant factor in oxidative stress balance in patients with pOSAS and np OSAS.

Aim: Nonhomogeneous distribution of antegrade cardioplegia especially in cases with severe myocardial hypertrophy or proximal stenosis of coronary arteries may be a serious problem. This prospective randomized study was designed to determine whether combined antegrade–retrograde cardioplegia provides improved myocardial protection in the early period and is associated with better laboratory results compared with antegrade technique alone.Material and Methods: A total of 60 patients who underwent coronary artery bypass grafting surgery, 45 (75%) males and 15 (25%) females, were included in the study as 2 groups: In Group 1, 30 patients were given the combined cardioplegia solution antegrade via the aortic root and retrograde via the coronary sinus, in Group 2, 30 patients were given only antegrade cardioplegia solution via the aortic root. The CK-MB, TpI, TNF- α, IL-1, IMA, ICAM-1, and BNP parameters were studied in the blood samples which were taken preoperatively, intraoperatively and postoperative sixth day. The patients were evaluated preoperatively and on the sixth postoperative day using transthoracic echocardiography.Results: The postoperative mean EF decrease was significantly lower in Group 1 compared to Group 2 (4.13 ± 9.09 vs 8.90 ± 10.76 in Group 1 vs. Group 2, respectively, p=0.046). When the change in TNF-α levels were compared between groups 1 and 2, the magnitude of increase in TNF-α was significantly higher in Group 2 (p=0.047). Conclusion: We concluded that co-administration of antegrade and retrograde cardioplegia may provide improved myocardial protection compared to antegrade cardioplegia method alone in the early postoperative period.

In ankylosing spondylitis (AS) patients, cardiac and vascular involvement may manifest as atherosclerosis and coronary artery disease. Systemic inflammation, oxidative stress, increased low-density lipoprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterol constitute a significant risk for atherosclerosis. This study investigated the relationship between carotid intima–media thickness (CIMT), LDL/HDL ratio, total oxidant status (TOS; an indicator of oxidative stress) and ischemic modified albumin (IMA; an ischemic marker in AS patients).

It is of clinical importance to determine creatinine clearance and adjust doses of prescribed drugs accordingly in patients with heart failure to prevent untoward effects. There is a scarcity of studies in the literature investigating this issue particularly in patients with heart failure, in whom many have impaired kidney function. The purpose of this study was to determine the degree of awareness of medication prescription as to creatinine clearance in patients hospitalized with heart failure. Patients hospitalized with a diagnosis of heart failure were retrospectively evaluated. Among screened charts, patients with left ventricular ejection fraction <40% and an estimated glomerular filtration rate (eGFR) of ≤50 mL/min were included in the analysis. The medications and respective doses prescribed at discharge were recorded. Medications requiring renal dose adjustment were determined and evaluated for appropriate dosing according to eGFR. A total of 388 patients with concomitant heart failure and renal dysfunction were included in the study. The total number of prescribed medications was 2808 and 48.3% (1357 medications) required renal dose adjustment. Of the 1357 medications, 12.6% (171 medications) were found to be inappropriately prescribed according to eGFR. The most common inappropriately prescribed medications were famotidine, metformin, perindopril, and ramipril. A significant portion of medications used in heart failure requires dose adjustment. Our results showed that in a typical cohort of patients with heart failure, many drugs are prescribed at inappropriately high doses according to creatinine clearance. Awareness should be increased among physicians caring for patients with heart failure to prevent adverse events related to medications.

There is controversial data regarding the relationship between uric acid (UA) and coronary artery disease and cardiovascular events. Despite the deleterious effects of hyperuricemia on endothelial function, the effect of UA on myocardial ischemia has not been previously studied. We aimed to investigate the relationship between UA and myocardial ischemia that was identified using dobutamine stress echocardiography (DSE). In this retrospective study, the laboratory and DSE reports of 548 patients were reviewed. The patients were divided into two groups based on the presence of ischemia and further subdivided into three groups according to the extent of ischemia (none, ischemia in 1–3 segments, ischemia in >3 segments). Serum UA levels were compared. Determinants of ischemia were assessed using a regression model. UA was increased in patients with ischemia and was correlated with the number of ischemic segments (p < 0.001). A cutoff value of UA > 5 mg/dl had 63.9 % sensitivity, 62.0 % specificity, 42.5 % positive predictive value (PPV), and 79.6 % negative predictive value for ischemia. When the positive DSE exams were further sorted according to the UA cutoff, the PPV of DSE increased from 80.2 to 94.0 %. Uric acid (odds ratio 1.51; 95 % CI 1.14–1.99), diabetes mellitus, HDL and glomerular filtration rate were found to be independent determinants of myocardial ischemia in DSE. Increased UA is associated with both the presence and extent of DSE-identified myocardial ischemia. A UA cutoff may be a good method to improve the PPV of DSE.

The constriction of vessels due to atherosclerotic lesions causes hypoxia/ischemia and oxidative changes resulting in transformation of free albumin to ischemia-modified albumin (IMA) in the circulation and increased carotid intima-media thickness (cIMT). We investigated the reliability of IMA increase in evaluating atherosclerosis in patients with familial Mediterranean fever (FMF) compared with cIMT. Patients with FMF (n = 58) diagnosed by the Tel-Hashomer criteria in attack-free period and 38 healthy people were included in the study. Patient demographics as well as the clinical and laboratory characteristics of the healthy controls and patients with FMF were noted. The IMA levels and cIMT in patients with FMF were 0.30 ± 0.09 absorbance units (ABSUs) and 1.12 ± 0.27 mm, respectively, and in the control group, IMA levels and cIMT were 0.25 ± 0.07 ABSU and 0.74 ± 0.26 mm, respectively. The IMA levels and cIMT were significantly higher in patients with FMF than in controls (P= .020 andP< .0001, respectively). The IMA values showed positive correlation with cIMT in patients with FMF(r= .302,P= .041). Our results reveal that IMA--an oxidative stress marker--may be an indicator of atherosclerosis in patients with FMF. This finding deserves further investigation.

BACKGROUND:Cardiovascular diseases, among which atherosclerotic heart disease, are known to be one of the most important mortality and morbidity causes in patients with rheumatoid arthritis (RA). Ischemia modified albumin (IMA) is a potential marker that can be used to assess atherosclerosis-related myocardial ischemia. Another frequently used marker for the assessment of atherosclerotic lesions is the carotid intima media thickness (CIMT).AIM:To evaluate the role that IMA has on atherosclerosis development and its clinical usability in patients with RA, by assessing the values of IMA and CIMT.METHODS AND MATERIALS:Our prospective study was conducted between June 2012 and March 2013 at the Rheumatology Department of Necmettin Erbakan Meram Medical School, Turkey. Fifty-two RA patients, diagnosed according to the 1987 criteria of the American College of Rheumatology, and an age- and sex-matched control group of 46 healthy subjects were included in this study.RESULTS:No significant difference was detected between the groups with respect to age, sex and body mass index. In the patient group the IMA and CIMT values were found to be 0.37 ± 0.12 absorbance units (ABSU) and 0.80 ± 0.22 mm, respectively, while in the control group they were 0.31 ± 0.11 ABSU and 0.51 ± 0.18 mm, respectively. The IMA and CIMT values were significantly higher in the patient group (P = 0.022 and P < 0.0001, respectively). A positive correlation was found between IMA, CIMT and Disease Activity Score of 28 joints (P = 0.016 and P = 0.002, respectively).CONCLUSION:Since the values of IMA were higher in the patient group compared to controls and because of its correlation with CIMT, we suggest the use of IMA as an early marker of atherosclerosis in RA patients.

Many drugs that are administered during hospitalization are metabolized or excreted through kidneys, consequently require dosage adjustment. We aimed to investigate inappropriate prescription of drugs requiring renal dose adjustment (RDA) in various surgical and medical inpatient clinics. We retrospectively determined dialysis patients hospitalized between January 2007 and December 2010. Inpatient clinics, including cardiology, pulmonary medicine, neurology, infectious diseases (medical clinics) and cardiovascular surgery, orthopedics, general surgery, obstetrics and gynecology, and neurosurgery (surgical clinics), were screened via electronic database. Total and RDA medications were determined. RDA drugs correctly adjusted to creatinine clearance were labeled as RDA-A (appropriate), otherwise as RDA-I (inappropriate). Renal doses of RDA medications were based on the “American College of Physicians Drug Prescribing in Renal Failure, fifth Edition.” Two hundred seventeen hospitalization records of 172 dialysis patients (92 men and 80 women) were included in the analysis. Mean age of patients was 59.4 ± 14.6 years, and the mean hospitalization duration was 8.5 ± 7.8 days. In total, 247 (84.3%, percentage in drugs requiring dose adjustment) and 175 (46.2%) drugs have been inadequately dosed in surgical and medical clinics, respectively. The percentage of patients to whom at least 1 RDA-I drug was ordered was 92% and 91.4% for surgical and medical clinics, respectively (P > 0.05). Nephrology consultation numbers were 8 (7.1%) in surgical and 32 (30.4%) in medical clinics. The most common RDA-I drugs were aspirin and famotidine. A significant portion of RDA drugs was ordered inappropriately both in surgical and medical clinics. Nephrology consultation rate was very low. Measures to increase physician awareness are required to improve results.

Today, smart mobile devices (telephones and tablets) are very commonly used due to their powerful hardware and useful features. According to an eMarketer report, in 2014 there were 1.76 billion smartphone users (excluding users of tablets) in the world; it is predicted that this number will rise by 15.9% to 2.04 billion in 2015. It is thought that these devices can be used successfully in biomedical applications. A wireless blood pressure measuring device used together with a smart mobile device was developed in this study. By means of an interface developed for smart mobile devices with Android and iOS operating systems, a smart mobile device was used both as an indicator and as a control device. The cuff communicating with this device through Bluetooth was designed to measure blood pressure via the arm. A digital filter was used on the cuff instead of the traditional analog signal processing and filtering circuit. The newly developed blood pressure measuring device was tested on 18 patients and 20 healthy individuals of different ages under a physician's supervision. When the test results were compared with the measurements made using a sphygmomanometer, it was shown that an average 93.52% accuracy in sick individuals and 94.53% accuracy in healthy individuals could be achieved with the new device.

Electrocardiogram (ECG) is widely used in the diagnosis of myocardial infarction (MI). It mostly gives important hints to detect the infarct-related artery (IRA). The changes in the morphology and in the position of the heart cause changes in ECG as well. Though ECG is used for the diagnosis of MI, it is not sufficient on its own in detecting the location of the underlying lesion. The pathologies changing the morphology of the heart, such as the atrial septal defect (ASD), increase the margin of error of ECG. We report a rare case; falsely positive ECG for anteroseptal MI in patient with ASD admitted with acute coronary syndrome. Coronary angiography revealed right coronary artery (RCA) lesion in the patient with acute MI who was found to have ST elevation in both precordial and inferior derivations. As a potential cause of mismatch between IRA and infarct location at ECG, echocardiography showed right ventricle dilatation related with cribriform ASD. It was percutaneously closed at 30days after MI. Therefore, when observed a mismatch between IRA and infarct location at ECG, a detailed examination should be performed to determine potential causes of the mismatch.

Takotsubo cardiomyopathy (TCMP) is characterised by a temporary aneurysm of the left ventricular apex in individuals without significant stenosis of the coronary arteries. It is extremely rare to see it combined with a thrombus. In this case report, we present a 57-year-old female patient with TCMP in whom apical thrombus was treated with short-term warfarin use.

A 72-year-old female patient with respiratory distress and chest pain was referred for echocardiography after which a severe aortic stenosis was diagnosed. From clinical perspective an AVR would have carried too much risk in this case, therefore TAVI with transapical approach via left anterior thoracotomy was the treatment of choice. In this case report, we describe our experience with this new procedure in our country.

The aim of our study was to evaluate serum paraoxonase (PON1), total antioxidant status (TAS), total oxidant status (TOS), and ischemia-modified albumin (IMA) levels in patients with prediabetes, diabetes, and in healthy control subjects. The subjects were aged between 20 and 60 years. Forty diabetic subjects (mean age 46.6 ± 9.7 years), 39 prediabetic subjects (mean age 44.0 ± 9.3 years) and 24 healthy control subjects (mean age 43.7 ± 9.7 years). Lipid profile, PON1, TAS, TOS and IMA levels were measured. The serum TOS and IMA levels in diabetes were significantly higher than those of the control subjects (P = 0.024 and P = 0.012, respectively), while the serum PON1 levels of the diabetes patients were significantly lower than those of the control subjects (P = 0.039). The serum TOS levels of the diabetes patients were significantly higher than those of the subjects with prediabetes (P = 0.013). There were no significant differences between the serum IMA and PON1 levels of the prediabetes and diabetes groups (P = 0.075 and P = 0.110, respectively). The serum TAS levels of the three groups were similar. The present study demonstrated that in diabetes there is greater oxidative stress. Patients with type 2 diabetes had higher TOS and IMA levels, but lower PON1 values, than controls. There were no differences in oxidative stress markers between prediabetic patients and healthy subjects.

The neutrophil to lymphocyte ratio (NLR) predicts cardiovascular events. The aim of this study was to determine whether NLR improved the positive predictive value (PPV) of dobutamine stress echocardiography (DSE) in patients with stable coronary artery disease (CAD). We conducted a retrospective review of laboratory and DSE data from the medical records of 1,012 patients who were divided into two groups according to the presence of ischemia and further subdivided into three groups according to the extent of ischemia (nonischemic segments, 1-3 ischemic segments, or > 3 ischemic segments). NLRs were compared among these groups. NLRs increased in patients with ischemia and correlated with the number of ischemic segments (P < 0.001). The optimal cutoff value of NLR determined using receiver operating characteristic analysis was > 2.04, and the diagnostic value of NLR for discriminating patients with ≥ 50% coronary stenosis in at least one of the coronary arteries from those without significant CAD was high [area under the curve (AUC) = 0.671, standard error = 0.052, P < 0.001, 95% confidence interval (CI) = 0.569-0.773)]. An NLR cutoff value of > 2.04 predicted CAD presence with significant stenosis (62.10% sensitivity and 64.10% specificity). PPV of DSE for a significant coronary artery lesion identified using coronary angiography was 73.8% (95% CI = 75.1-88.5, P < 0.001, AUC = 0.818). On including a cut-off value of > 2.04 for NLR in this multivariable predictive model, the AUC value slightly increased to 0.905 (95% CI = 85.4-95.6) and PPV of DSE increased from 73.8% to 92.6%. NLR improved PPV of DSE for patients with stable CAD.

Background Ankylosing Spondylitis (AS) is a chronic inflammatory disease that mainly affects the spine and sacroiliac joints, and is often causing deformity and loss of function (1). AS, can also affect non-vertebral tissues and organs such as cardiac, ocular and gastrointestinal tract. Cardiovascular (CVS) mortality is increased in other rheumatic diseases (2). Objectives To evaluate the relation between carotid intima-media thickness and low-density lipoprotein (LDL) cholesterol - high-density lipoprotein (HDL) cholesterol ratio as indicators of atherosclerosis and ischemic modified albumin (IMA) and total antioxidant status (TOS) as markers of inflammation and oxidative stress in patients with AS. Methods Sixty AS patients and 54 healthy controls were included in our study. BASDAI and BASFI disease activity scores were recorded. The participants serum lipid panel, IMA and TOS levels were measured. Carotid intima-media thickness (CIMT) of patients and healthy subjects were measured. Results There were no differences between groups in terms of age, gender and Body mass index (BMI). LDL -HDL ratio was higher in AS patients compared to healthy subjects (2.85±1.00, 2.47±0.90, respectively, p<0.047) AS patients had higher IMA values compared to healthy subjects as well (0.44±0.17, 0.32±0.13, respectively, p<0.0001). AS patients had higher TOS values compared to healthy subjects as well (212.57±149.44, 116.70±122.98, respectively, p<0.005). Also CIMT was significantly higher in AS patients compared to healthy subjects (0.99±0.27, 0.76±0.25, respectively, p<0.0001). There was no correlation between CIMT, IMA and TOS. We also did not find correlation between IMA, TOS values and BASDAI and BASFI. However, there was a positive correlation between LDL-HDL ratio and CIMT (r=0.395, p=0.002) (figure 1). Conclusions LDL-HDL ratio and CIMT as markers of atherosclerosis are found to be higher in patients with AS. These findings might be the main reasons of increased CV morbidity and mortality in this population. References Daikh DI, Chen PP. Advances in managing ankylosing spondylitis. F1000prime reports. 2014;6:78. Mason JC, Libby P. Cardiovascular disease in patients with chronic inflammation: mechanisms underlying premature cardiovascular events in rheumatologic conditions. European heart journal. 2014 Nov 27. Disclosure of Interest None declared