Achtergrond: Het schriftelijk screenen van depressie in de huisartspraktijk kan de herkenning sterk verbeteren. Een goede respons is hierbij zeer van belang. Het is de vraag of een goede respons haalbaar is bij Turkse en Marokkaanse patie¨nten op een Nederlandstalige depressievragenlijst Doel :Wat is het responspercentage van oudere Turkse, Marokkaanse en Nederlandse huisartspatie¨nten op een schriftelijk Nederlandstalige depressievragenlijst, en wat zijn de redenen voor non-respons? Methode:Oudere huisartspatie¨nten kregen na een praktijkbezoek de GDS-15 (Geriatric Depression Scale) vragenlijst thuisgestuurd. Door telefonisch contact en huisbezoek werden redenen voor non-respons getraceerd. Resultaten: De respons op de depressievragenlijst voor de Nederlandse populatie (n=6060) was 62%. Voor de Turkse en Marokkaanse populatie was dit respectievelijk, (n=39) 31% en (n=117) 34%. De belangrijkste reden voor de Turkse groep voor non-respons was tijdelijk een andere verblijfplaats (Turkije). Voor de Marokkaanse groep bleek analfabetisme de belangrijkste reden voor non-respons. Conclusie: De respons onder Turkse en Marokkaanse ouderen was aanzienlijk lager dan bij Nederlandse ouderen. Mogelijk dat een depressievragenlijst in eigen taal voor toename van respons zorgt. Bij analfabetisme zal alleen een interview effectief zijn.

BACKGROUND:Dipper and non-dipper hypertension are different clinical forms of essential hypertension. In this study, the effect of circadian blood pressure changes on serum SCUBE-1 and soluble CD40 ligand (sCD40L) levels was investigated in patients with hypertension.METHODS:A total of 100 participants aged 23-89 years were included in the study. Patients with essential hypertension were followed up by ambulatory blood pressure measurement.RESULTS:Serum SCUBE1 levels were significantly higher in the non-dipper group than in the normal group (P < 0.001). Dipper and non-dipper patients had significantly higher serum sCD40L levels when compared to the normal group (P = 0.048 and P = 0.035, respectively). We also found a positive correlation between SCUBE1, sCD40L levels and 24-hour mean systolic blood pressure levels (r: 0.232, p: 0.034 and r: 0.241, p: 0.027, respectively).CONCLUSION:Serum SCUBE1 and sCD40L levels were higher in hypertensive patients than normal participants. Serum SCUBE1 levels were higher in patients with non-dipper compared to other participants.

Purpose: Hypertension (HT) is known to be of the main risk factors for erectile dysfunction (ED). But non-dipping (<%10 drop in the night) of HT is not investigated truly. The aim of this study was to test the hypothesis that the non-dipper hypertensive patients are more prone to develop erectile dysfunction. Materials and Methods: This was a cross-sectional clinical study. 70 HT patients diagnosed by Ambulatory blood pressure monitoring (ABPM) were classified into 3 groups (No ED, mild to moderate and severe) according to their International Index of Erectile Function (IIEF) scores. All three groups were compared for their dipping status by ABPM, heart rate variability (HRV) by holter monitoring. Results: In our study non-dipper hypertensives had statistically more erectile dysfunction (P = 0.004). Also severe ED patients with non-dipping pattern had decreased dipping blood pressure levels then those of ED(-) patients with non-dipping HT (P = .003) Conclusion: Autonomic dysfunction especially sympathetic overactivity is associated with both non dipping pattern of HT and erectile dysfunction as a common pathologic pathway, besides there might be an association between ED and non dipping HT.

BACKGROUND:Hyperhomocysteinemia is a known risk factor for acute coronary syndrome (ACS) and is related with the severity of coronary artery disease (CAD). Previous studies have used less quantifiable scoring systems for assessing the severity of CAD. Therefore, we aimed to assess the relationship between homocysteine levels and SYNTAX score (SXscore), which is currently more widely used to grade the severity of CAD.METHODS:A total of 503 patients with adiagnosis of ACS were examined angiographically with SXscore. The patients were divided into three groups according to SXscore; Group 1 a low SXscore (≤ 22), Group 2 a moderate SXscore (23-32), and Group 3 a high SXscore (≥ 33).RESULTS:Plasma homocysteine levels were 16.3 ± 6.2 nmol/mL in Group 1, 18.1 ± 9.6 nmol/mL in Group 2, and 19.9 ± 9.5 nmol/mL in Group 3. Homocysteine levels were significantly higher in Group 2, and Group 3 compared to Group 1 (p = 0.023 and 0.007, respectively). In the correlation analysis, homocysteine levels were correlated with SXscore (r: 0.166, p < 0.01).CONCLUSIONS:Serum homocysteine levels on admission were associated with an increased severity of CAD in the patients with ACS.

Erectile dysfunction (ED) is one of the common health problem and occurs at a higher incidence in men with hypertension. Hypertension (HT) is one of the most important risk factor for ED and could also show complex characteristics, especially subtypes which are introduced by nocturnal blood pressure alterations.

Bu derlemede, ESC (European Society of Cardiology) 2017 ST segment yukselmeli miyokart enfarktusu (STYME) kilavuzunda degisen ve yeni eklenen oneriler ele alinacaktir. Bu kilavuzda ST segment yukselmeli miyokart enfarktusu tanimi genisletilerek hasta kapsami arttirilmistir. Acil tedavide oksijen tedavisinin ve opioidlerin onemi azalirken reperfuzyon suresinin kisaltilmasina yonelik ‘tanidan tel gecisine’ kavrami gelistirilmistir. Koroner anjyografi suresi 2-24 saate indirilirken, 48 saatten sonra perkutan koroner girisim (PKG) iskemi yoklugunda onerilmemistir. Radial girisim ve ilac kapli stent kullanimi on plana cikarken rutin trombus aspirasyonu artik onerilmemektedir. Komplet revaskularizasyon artik hastaneden cikmadan onerilmektedir. Stent trombozunu artirdigindan bivalirudin endikasyonu azalirken, enoxaparin heparine alternatif olarak PKG de daha guclu onerilmektedir. Potent P2Y12 inhibitorlerinin kullanimi klopidogrele ustun gozukmektedir. Kangrelor oral alamayanlarda iv olarak ilk kez kullanima girmistir. Maksimum doz statine ragmen, >70 mg/dl LDL olanlarda ek ilaclarin kullanimi onerilmektedir. Ikili antiplatelet tedavi bir yil onerilirken, 36 aya uzatilabileceginden bahsedilmistir. Kalite kontrolu degerlerinin standardizasyonu icin kriterler belirlenmistir.

Aim: Patency of infarct-related artery (IRA) in patients with ST-segment elevation myocardial infarction (STEMI) before primary percutaneous coronary intervention (pPCI) is associated with better clinical outcomes. However, there were limited data regarding the predictors of IRA patency before pPCI in the setting of STEMI. We intended to evaluate the association of monocyte count to high-density lipoprotein ratio (MHR) with IRA patency in STEMI. Material and Methods: A total of 726 patients were recruited. IRA patency was determined by the thrombolysis in myocardial infarction (TIMI) flow grade. According TIMI flow grade in the IRA before PCI, the study population was divided into two groups as TIMI 0,1 or 2 group (occluded IRA, n=624) and TIMI 3 group (patent IRA, n=102). Blood samples were collected on admission to calculate MHR. Of all patients, 92 (20.4%) patients revealed pre-pPCI TIMI 3 flow in IRA. Results: The MHR was significantly higher in occluded IRA group (22.4 ± 5.4 vs 17.8 ± 6.9, P < 0.001). Glucose, troponin I, and platelet to lymphocyte ratio (PLR) levels were also higher in occluded IRA group (P < 0.05). Multivariate regression analysis demonstrated the MHR on admission (odds ratio [OR]: 1.191; 95% confidence interval [CI]: 1.116-1.272, P < 0.001) and prehospital use of prasugrel or ticagrelor (OR: 7.045; CI: 1.687-29.414, P = 0.007) as independent predictors of IRA patency. Conclusion: IRA patency is more frequently found in patients having received fast acting antiplatelet therapy before pPCI and a higher MHR value independently predicts it.

Amaç: ST segment yükselmeli miyokard enfarktüsü (STEMI) olan hastalarda, primer perkütan koroner girişim (pPKI) öncesi enfarktüs ilişkili arter acıklığı daha iyi klinik sonuçlar ile ilişkilidir. Bununla birlikte, STEMI ortamında pPKI öncesinde IRA açıklığının öngördürücüleri ile ilgili sınırlı veri vardır. STEMI'de monosit sayısı /yüksek yoğunluklu lipoprotein oranı (MHR) ile enfarktla ilişkili arterin acıklığı arasındaki ilişkiyi değerlendirmek istedik. Gereç ve Yöntemler: Toplam 726 hasta çalışmaya alındı. IRA açıklığı, miyokard enfarktüsünde tromboliz (TIMI) akım sınıflaması ile belirlendi. PKI öncesi IRA'da TIMI akım derecesine göre çalışma popülasyonu, TIMI 0,1 veya 2 grup (tıkalı IRA, n=624) ve TIMI 3 grubu (patent IRA, n=102) olmak üzere iki gruba ayrıldı. MHR hesaplamak için basvuruda kan örnekleri toplandı. Tüm hastaların 92'sinde (%20,4) IRA'da pre-pPKI TIMI 3 akımı vardı. Bulgular: MHR, tıkanan IRA grubunda anlamlı derecede yüksekti (22,4 ± 5,4'e karşılık 17,8 ± 6,9, P < ,001). Tıkalı IRA grubunda, glikoz, troponin İ ve trombosit/lenfosit oranı (PLR) düzeyleri de yüksekti (P < 0.05). Çok değişkenli regresyon analizinde, başvuru sırasındaki MHR değeri (odds oranı [1,391]; %95 güven aralığı [CI]: 1,116-1,272, P < 0,001) ve prasugrel veya tikagrelorun hastane öncesi kullanımı (OR: 7,045; CI:1,687-29,414, P = 0,007) IRA açıklığının bağımsız öngördürücüleri olarak bulundu. Sonuçlar: IRA açıklığı, pPKI öncesi hızlı etkili antitrombosit tedavi alan hastalarda daha sık görülmektedir ve daha düşük bir MHR değeri IRA açıklığını bağımsız bir şekilde tahmin eder.

Objective: Coronary artery disease (CAD) is a common, complex, and progressive disorder characterized by the accumulation of lipids and fibrous elements in the arteries. It is one of the leading causes of death in industrialized nations. Oxidative modification of low-density lipoprotein (LDL) in the arterial wall plays an important role in the initiation and progression of atherosclerosis. Paraoxonase1 (PON1) is involved in lipid metabolism and is believed to protect LDL oxidation. In our study, we aimed to clarify the relationship between PON1 gene L55M polymorphism and the extent and severity of CAD. Methods: In total, 114 patients (54 males, mean age: 56.7±12.0 years; 60 females, mean age: 55.7±13.2 years) with stable angina or angina equivalent symptoms were enrolled in this prospective study. Cardiological evaluation was performed with electrocardiogram and transthoracic echocardiogram. The presence of hypertension, dyslipidemia, diabetes, and smoking status were ascertained. The patients were grouped according to their Gensini scores and gender. Genetic analysis of the PON1 gene L55M polymorphism was performed by polymerase chain reaction-restriction fragment length polymorphism. Results: We determined that the LL genotype was more prevalent in patients with Gensini score higher than or equal to 20 (p=0.026) and that this correlated with severe atherosclerotic coronary artery lesions in both gender groups, reaching a statistical significance in the female subjects (p=0.038). Conclusion: It was thought that the PON1 gene L55M polymorphism plays a significant role in CAD progression, especially in females.

The Chernobyl Nuclear Power Plant (CNPP) accident occurred on April 26 of 1986, it is still an episode of interest, due to the large amount of radionuclides dispersed in the atmosphere. Caesium-137 (137Cs) is one of the main radionuclides emitted during the Chernobyl accident, with a half-life of 30 years, which can be accumulated in humans and animals, and for this reason the impacts on population are still monitored today. One of the main parameters in order to estimate the exposure of population to 137Cs is the concentration in the air, during the days after the accident, and the deposition at surface. The transport and deposition of 137Cs over Europe occurred after the CNPP accident has been simulated using the WRF-HYSPLIT modeling system. Four different vertical and temporal emission rate profiles have been simulated, as well as two different dry deposition velocities. The model simulations could reproduce fairly well the observations of 137Cs concentrations and deposition, which were used to generate the ‘Atlas of Caesium deposition on Europe after the Chernobyl accident’ and published in 1998. An additional focus was given on 137Cs deposition and air concentrations over Turkey, which was one of the main affected countries, but not included in the results of the Atlas. We estimated a total deposition of 2–3.5 PBq over Turkey, with 2 main regions affected, East Turkey and Central Black Sea coast until Central Anatolia, with values between 10 kBq m− 2 and 100 kBq m− 2. Mean radiological effective doses from simulated air concentrations and deposition has been estimated for Turkey reaching 0.15 mSv/year in the North Eastern part of Turkey, even if the contribution from ingestion of contaminated food and water is not considered, the estimated levels are largely below the 1 mSv limit indicated by the International Commission on Radiological Protection.

Giderek artan bilgiler depresyonun bagimsiz bir kardiyovaskuler hastalik (KVH) risk faktoru oldugunu ortaya koymaktadir. Bu calismamizda seratonin geri alim inhibitorleri (SSRI) ile tedavinin kalbin sistolik ve diyastolik fonksiyonlari ve kardiyovaskuler hastalik gelisimi icin bagimsiz ongorduruculer olan aortik sertlik ve endotel fonksiyon parametreleri uzerine etkisini arastirdik. Calismaya 16-65 yas arasi bilinen KVH oykusu olmayan ve major depresyon nedeni ile ilk defa SSRI tedavisi baslanan 41 hasta dâhil edildi. Tedavi baslangicinda ve 8 haftalik tedavi sonunda hastalarin ekokardiyografik olarak sistolik ve diyastolik fonksiyon parametreleri, miyokard performans indeksi (MPI) ve aortikgerilim (Ao strain) degerlendirildi. Otomatik analizor ile parmaktan pletismografik yontemle yapilan nabiz dalga analizi ile belirlenen nabiz ilerleme zamani (PPT), sertlik indeksi (SI) ve Refleksiyon indeksi (RI) hesaplandi. Endotel fonksiyonlari akima bagli dilatasyon yontemi ile degerlendirildi. Sekiz haftalik tedavi sonunda 19 hasta kontrole geldi (%46,3) ve nihai degerlendirmeye bu hastalarin sonuclari dâhil edildi. Analiz yapilan hastalarin tedavi oncesine gore tedavi sonunda sol ventrikul ejeksiyon fraksiyonunun (%64,83±4,54 vs %66,80±3,3, p=0,020) ve fraksiyonel kisalmasinin arttigi (%35,39±3,53 vs %37,11±2,49, p=0,013), MPI degerinin dustugu gozlendi (0,60±0,21 vs 0,45±0,15, p=0,004). Bunun disinda diyastolik fonksiyon parametreleri,aortik strain, endotel fonksiyon ve aortik sertlik parametreleri acisindan tedavi sonrasinda anlamli farklilik izlenmedi. Calismamiz yeni tani konmus depresyonlu hastalarin SSRI inhibitoru ile kisa donem tedavilerinin sol ventrikul sistolik fonksiyonlarini olumlu yonde etkileyebilecegini, diyastolik fonksiyonlarda, endotel fonksiyonlarinda ve buyuk arter sertliginde ise degisiklik yapmadigini gosterdi.

We investigated whether serum bilirubin level (a marker of heme oxygenase activity) is a predictor of high levels of SYNTAX score (SXscore) in patients with acute myocardial infarction. Patients (n = 281; male 77%; mean age 60 ± 12) who were admitted with ST-elevation myocardial infarctions (STEMIs) were enrolled. Patients were divided into 2 groups. Group 1 was defined as SXscore <22 and group 2 was defined as SXscore ≥22. Total bilirubin levels were significantly higher in the high-SXscore group than in the low-SXscore group (0.86 ± 0.42 vs 1.02 ± 0.51, P = .005). A significant correlation was detected between total bilirubin and SXscore ( r = .42; P = .001). At multivariate analysis, total bilirubin (odds ratio: 1.86, 95% confidence interval 1.04-3.35; P = .038) was an independent risk factor for high SXscore in patients with STEMI. In conclusion, serum bilirubin level is independently associated with SXscore in patients with STEMI.

Bu calismanin amaci hemodiyaliz hastalarinda sessiz miyokard iskemisini belirlemede BNP’nin on gordurucu rolunu arastirmaktir. Calismaya anjinal yakinmasi olmayan toplam 53 hemodiyaliz hastasi dâhil edildi. Sessiz miyokard iskemisini belirlemek amaci ile tum olgulara saatlik ambulatuar elektrokardiyografik monitorizasyon yapilarak sessiz iskemisi olanlar ve olmayanlar olarak gruplandi. BNP duzeyleri icin kanlar tum hastalardan haftanin 2.hemodiyaliz seansi oncesi alindi. Calismaya katilan hastalarin ortanca yasi 50 (%60 erkek) idi. Erkek cinsiyet ve hiperlipidemi sikligi sessiz iskemi olan grupta daha fazla idi bunun disindaki demografik ve ekokardiyografik parametreler acisindan gruplar arasinda fark yoktu. Ortanca BNP konsantrasyonu sessiz iskemi olan grupta anlamli derecede artmis bulundu [sirasi ile 682,7 (234,7) pg/ml vs 503,2 (103,7) pg/ml, p=0.006]. Sol ventrikul kitle indeksi (r=0.502,p < 0.001) ilemitral E/Em ortalama (r=0.604,p

Bu calismanin amaci hemodiyaliz hastalarinda sessiz miyokard iskemisini belirlemede BNP’nin on gordurucu rolunu arastirmaktir. Calismaya anjinal yakinmasi olmayan toplam 53 hemodiyaliz hastasi dâhil edildi. Sessiz miyokard iskemisini belirlemek amaci ile tum olgulara saatlik ambulatuar elektrokardiyografik monitorizasyon yapilarak sessiz iskemisi olanlar ve olmayanlar olarak gruplandi. BNP duzeyleri icin kanlar tum hastalardan haftanin 2.hemodiyaliz seansi oncesi alindi. Calismaya katilan hastalarin ortanca yasi 50 (%60 erkek) idi. Erkek cinsiyet ve hiperlipidemi sikligi sessiz iskemi olan grupta daha fazla idi bunun disindaki demografik ve ekokardiyografik parametreler acisindan gruplar arasinda fark yoktu. Ortanca BNP konsantrasyonu sessiz iskemi olan grupta anlamli derecede artmis bulundu [sirasi ile 682,7 (234,7) pg/ml vs 503,2 (103,7) pg/ml, p=0.006]. Sol ventrikul kitle indeksi (r=0.502,p < 0.001) ilemitral E/Em ortalama (r=0.604,p

OBJECTIVE:In this prospective study, we aimed to investigate acute effect of nasal continuous positive airway pressure (CPAP) therapy on the endothelial function of patients with obstructive sleep apnea syndrome (OSA) by using brachial artery flow mediated dilatation (FMD) method.METHODS:Newly diagnosed thirty OSA patients with ages between 29 and 72 years were included in this study. FMD and high sensitivity C-reactive protein (hsCRP) values of patients obtained before and after CPAP dose titration test were compared with paired samples t test or Wilcoxon signed ranks test.RESULTS:With CPAP therapy apnea hypopnea indices were reduced (60.6±24.9/h vs. 9.6±7.9/h; p<0.001) and oxygen desaturation indices recovered (50±27/h vs. 6±7/h; p<0.001). Heart rates of patients decreased after CPAP therapy (80±10/min vs. 73±8/min; p=0.003). FMD values significantly increased after CPAP (8.55±5.82 percent vs. 12.08±7.17 percent; p=0.003). HsCRP values after CPAP were not different from baseline values.CONCLUSION:Acute improvement of the endothelial function with one night CPAP therapy suggests endothelial dysfunction in OSA patients to be result of acute pathophysiologic factors. In intermediate and severe OSA patients, CPAP therapy may be considered in acute treatment of diseases associated with endothelial dysfunction.