The Effects of Methylphenidate on Ventricular Repolarization Parameters in Children with Attention-Deficit Hyperactivity Disorder.

Background: Long-acting methylphenidate (MPH), a psychostimulant agent, is widely used in the treatment of attention-deficit hyperactivity disorder (ADHD). Methylphenidate might cause an increment in the risk of lethal arrhythmias by deteriorating ventricular repolarization. QT intervals, the corrected QT (QTc), QT dispersion, T-peak to T-end (TpTe), and the TpTe/QTc ratio are the most utilized indicators of ventricular repolarization in electrocardiogram (ECG). The present study was conducted to examine the effects of long-term MPH use on the ECG in pediatric patients. Methods: A total of 52 children with ADHD and 51 age- and gender-matched controls were enrolled in the study. The children had been using MPH regularly for at least 6 months. Comparisons were made regarding ECG parameters, including the mean intervals of QT, QTc, QTc dispersion interval duration, TpTe intervals, TpTe/QT, and TpTe/QTc ratio. Results: The median duration of treatment with MPH was 30 months (minimum-maximum: 6-120), and the median MPH dose was 30 mg/day (minimum-maximum: 18-54). The main findings showed significantly prolonged P-wave dispersion, TpTe interval, TpTe dispersion, and TpTe/QT and TpTe/QTc ratios in the ADHD group compared to the healthy controls (P < .001). These parameters were not associated with MPH dose or treatment duration. Additionally, nearly half of the patients had QTc values of 460 ms or higher, but there were no significant differences in treatment duration and dose compared to the remaining group (P = .792 and P = .126). Conclusion: Methylphenidate may have proarrhythmogenic effects in children with ADHD, which may not be adversely affected by long-term use and treatment dose. Considering the extensive use of MPH, cardiac monitoring of these children is important.

Maximizing Pharmacological Treatment Adherence of Children and Adolescents: A Randomized Controlled Study.

The aim of the current randomized controlled study was to evaluate treatment adherence of children and adolescents who visited an outpatient psychiatry clinic and started medication for the first time, with telehealth application. This study was performed with parents of patients who visited the clinic from October 1, 2020, to March 31, 2021. Data were collected using a personal information form, Medication Control Form, and Morisky Medication Adherence Scale via telephone after verbal and written consent were obtained. It was found that 96.7% of participants in the experimental group had high medication adherence, whereas 93.3% of participants in the control group had low medication adherence. Results show that telehealth application is effective in maximizing adherence to treatment among children and adolescents. [Journal of Psychosocial Nursing and Mental Health Services, 61(1), 16-24.].

The relationship between mean platelet volume and resistant hypertension.

OBJECTIVE: Resistant hypertension (RH) is associated with an increased risk of cardiovascular events.Mean platelet volume (MPV) has been shown to indicate platelet activation and is associated with increased cardiovascular disease risk. In our study, we aimed to evaluate the relationship between mean platelet volume and resistant hypertension. METHOD: A total of 279 patientswere included in our study and divided into three groups (GroupI: seventy-eight patients with resistant hypertension, group II: seventy-nine patients with controlled hypertension and group III: one-hundred-five patients without hypertension). Routine laboratory tests and ambulatory blood pressure measurement (ABPM) were followed up in all patients. RESULTS: Of the patients in the study, 25% were female while 75% were male, and the mean age was 56.5 ± 11.8 years. The mean MPV values were found to be 9.34 ± 1.49 fL in the RHT group, 8.82 ± 0.83 fLin the controlled HT group, and 8.5 ± 0.85 fL in the normotensive individuals, and there was a significant correlation between the RHT group and the other groups (RHT versus controlled HT p1 = 0.008, RHT versus normotensive individuals p2 < 0,001). When we compared controlled HT and normotensive individuals, no significant relationship was found between MPV values (p3 = 0,157). CONCLUSION: The MPV value was found to be higher in resistant hypertensive patients compared to controlled hypertensive and normotensive patients. MPV values can be used to predict adverse cardiovascular events in RHT patients.

Diagnostic Accuracy of Early Systolic Notching in Pulmonary Embolism.

OBJECTIVE: Recently, a cardiac sonography finding, early systolic notching (ESN), was reported with high sensitivity and specificity for the diagnosis of pulmonary embolism (PE) in a limited population. The aim of this study was to determine the diagnostic accuracy of ESN finding for PE in emergency department (ED) patients. METHOD: This prospective multicenter study was conducted in 4 academic EDs. All patients who underwent computed tomography angiography for suspected PE were included in the study. After inclusion, cardiac ultrasound including the right ventricular outflow tract Doppler signal was performed. The diagnostic tests of ESN finding were used for PE and its subgroups. RESULTS: In the study, 183 of 201 patients met the study criteria. Of all patients, 52.5% had PE (n = 96), and 19.7% (n = 36) had ESN finding. In all ED patients, the sensitivity of ESN for PE was 34% (95% CI 25-45), and the specificity was 97% (95% CI 90-99). In the subgroup analysis, the sensitivity of ESN for PE with high or intermediate-high risk was 69% (95% CI 49-85), and the specificity was 90% (95% CI 84-94). Inter-rater reliability for ESN finding between the cardiologist and emergency physician was strong with a kappa statistic of 0.87. CONCLUSION: The pulmonary Doppler flow of ESN was moderate to high specific but low sensitive for PE in all ED patients. In the subgroup analysis, this finding was moderate specific and low sensitive.

Is Masked Hypertension an underlying Cause of Unexplained Left Ventricle Hypertrophy?

OBJECTIVES: Unexplained left ventricular hypertrophy (ULVH) is defined as increased wall thickness in the absence of conditions that predispose to hypertrophy. The aim of this study was to evaluate the rate of masked hypertension in patient with unexplained left ventricle hypertrophy. METHOD: A total of 120 consecutive unexplained left ventricle hypertrophy patients without overt hypertension and diabetes and 121 healthy control subjects were included in the study. After a complete medical history and laboratory examination, patients' height, weight, waist circumference heart rate, and office blood pressure were recorded. All subjects underwent ambulatory blood pressure monitoring, and transthoracic echocardiography. RESULTS: Mean age were similar between patients with ULVH and controls. There was no significant difference in total cholesterol, HDL, LDL cholesterol and triglyceride levels, left ventricle ejection fraction, between the groups. Prevalence of Masked hypertension was significantly higher in patients with ULVH than controls (28.3% vs 6.6%, p < .001). Left ventricular mass index (141.9 ± 16.8 g/cm2 vs. 67.3 ± 10.3 g/cm2, p < .001) was significantly higher in masked hypertensive patients with ULVH compared to normotensive ULVH and control subjects. CONCLUSION: In this study, we found high prevalence of masked hypertension in ULVH patients. Patients with ULVH should be screened by ABPM to detect possible masked hypertension.

Masked hypertension is related to alteration of myocardial arrhythmia Parameters.

BACKGROUND: Imbalance in autonomic nervous system and impaired myocardial repolarization have been shown to increase the risk for arrhythmias in patients with arterial hypertension. This study evaluated the effects of masked hypertension on QT interval dynamicity. METHODS: The study group consisted of 108 consecutive patients with masked hypertension and 102 control subjects. Twenty-four-hour Holter monitoring was performed before anti-hypertensive treatment. CONTEC holter software was used to calculate HRV and QT dynamicity parameters. All subjects had a complete history, laboratory examination, and transthoracic echocardiography. RESULTS: There was no significant difference in age-gender distribution between patients and controls. Non-sustained VT was present in four patients (2.9%). SDNN, RMSSD, PNN50, LFnu, HFnu were significantly decreased in masked hypertension, whereas LF/HF ratio was significantly increased. QT/RR slopes over 24 hours were significantly increased in masked hypertension for QT end and QT apex (QTapex/RR: 0,15 ± 0,12 vs 0,27 ± 0,18 p < .001; QTend/RR: 0.19 ± 0.12 vs 0.35 ± 0.22, p < .001). CONCLUSIONS: This study showed for the first time that masked hypertension was associated with a significant worsening of HRV and QT dynamicity parameters.

Increased masked hypertension prevalence in patients with polycystic ovary syndrome (PCOS).

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common disorder with important clinical consequences. Many studies have proven that hypertension is one of the most important comorbid disorders in PCOS. Masked hypertension is defined as a presence of normal office blood pressure together with abnormal results in 24-h ambulatory blood pressure monitoring (ABPM). The prevalence of this condition in patients with PCOS is not well defined. The aim of this study was to evaluate the prevalence of masked hypertension in PCOS compared to control subjects. METHODS: Sixty patients with PCOS and 60 control subjects were enrolled in the study. All patients with PCOS and controls without a history of hypertension underwent physical examination including office blood pressure measurement, ABPM, and measurement of laboratory and anthropometric parameters. RESULTS: Mean age was 30.5 ± 6.6 in control group and 26.4 ± 7.1 year in patients with PCOS (p = .001). Twenty-four patients (40%) had masked hypertension in PCOS group whereas 11 patients (18.3%) in the control group (p = .009). Twenty-four-hour diastolic blood pressure (p = .03), daytime systolic (p < .001), and daytime diastolic blood pressure (p = .01) and nighttime systolic blood pressure (p = .01) were significantly higher in patients with PCOS compared with control group. CONCLUSIONS: This study demonstrates increased masked hypertension prevalence in patients with PCOS. We suggest that all patients with PCOS should undergo ambulatory blood pressure monitoring for detecting masked hypertension.

Evaluation of atrial electromechanical properties in patients with masked hypertension.

PURPOSE: In this study, we evaluated the electromechanical properties of atriums in patients with masked hypertension by using tissue Doppler echocardiographic technique to predict the predisposition to atrial arrhythmias. METHODS: A total of 118 subjects were included in the study. Twenty-four-hour blood pressure monitorization (ABPM) was used to determinate the masked hypertension in the study group. Tissue Doppler imaging was used to find intra-left and -right atrial electromechanical delay (AEMD) and inter-atrial electromechanical delay. The results compared between patients with masked hypertension and without. RESULTS: There were 55 (%46.6) patients with masked hypertension and 63 (%53.4) patients without masked hypertension without any difference regarding age sex heart rate. No statistically significant difference was found in intra-right AEMD between the groups. Left ventricular end-diastolic and systolic diameters (p <0.01 vs p=0.034), left ventricular posterior and septal wall thickness (p < .01 vs p < .01), left ventricular mass index (p <0.01), left atrium volume (p = 0.02), and indexed left atrial volume (p <0 .01) were high in patients with masked hypertension Inter-AEMD (48.07 ± 11.49 ms vs 43.73 ± 8.61 p=0.02) and intra-left AEMD (24.8 ± 6.35 ms vs 21.42 ± 7.99 ms p=0.013) were significantly higher in masked hypertensive patients. CONCLUSIONS: Masked hypertension shares the same clinical outcomes like overt hypertension. Any effort must be given to prevent unwanted events in masked hypertensive patients. According to our findings we suggesting that masked hypertensive patients must be evaluated for atrial arrhythmia.

Increased rate of any retinopathy risk in patients with masked hypertension.

PURPOSE: Hypertension is a common chronic disorder with end organ damage. Hypertensive retinopathy is a response to elevated blood pressure characterized retinal arteriolar intimal thickening, hyperplasia of the intima-media end with sclerosis. There is a relationship between high blood pressure and retinopathy grade. Masked hypertension is a phenomenon of normal blood pressure in the office but high in out of office that associated with an increases risk of cardiovascular disease. In this study, we aimed to investigate retinopathy in masked hypertensive patients. METHODS: We enrolled 92 patients with masked hypertension and 87 healthy controls in to the study. We use ambulatory blood pressure monitoring (ABPM) to detect the masked hypertension. Bilateral fundus examination was performed. Hypertensive retinopathy (HTRP) grading was determined according to the Keith-Wagener-Barker classification. We examined retinopathy grade in patients with masked hypertension and without. RESULTS: 55 (11.6%) participants had signs of retinopathy. Fifty (54.3%) subjects had any retinopathy in patients with masked hypertension and five (5.7%) subjects had any retinopathy in controls (p < .001). Median of KWB grade was 1 (0-4) in patients with masked hypertension and 0 (0-2) in controls (p < .001). There were a positive significant correlation between KWB grade and day-time systolic blood pressure (r = 0.460, p < .001), day-time diastolic blood pressure (r = 0.448, p < .001), presence of masked hypertension (r = 0.527, p < .001). CONCLUSIONS: There was a considerable rate of any retinopathy in masked hypertension. Consequently, ophthalmoscopic examination should be as part of the care in patients who have a risk for masked hypertension.

Is tinnitus an early voice of masked hypertension? High masked hypertension rate in patients with tinnitus.

OBJECTIVES: Tinnitus is hearing a sound without any external acoustic stimulus. There are some clues of hypertension can cause tinnitus in different ways. The aim of the study was to evaluate the relationship between tinnitus and masked hypertension including echocardiographic parameters and severity of tinnitus. METHODS: This study included 88 patients with tinnitus of at least 3 months duration and 85 age and gender-matched control subjects. Tinnitus severity index was used to classify the patients with tinnitus. After a complete medical history, all subjects underwent routine laboratory examination, office blood pressure measurement, hearing tests and ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level. RESULTS: Baseline characteristics in patients and controls were similar. Prevalence of masked hypertension was significantly higher in patients with tinnitus than controls (18.2% vs 3.5%, p = 0.002). Office diastolic BP (76 ± 8.1 vs. 72.74 ± 8.68, p = 0.01), ambulatory 24-H diastolic BP (70.2 ± 9.6 vs. 66.9 ± 6.1, p = 0.07) and ambulatory daytime diastolic BP (73.7 ± 9.5 vs. 71.1 ± 6.2, p = 0.03) was significantly higher in patients with tinnitus than control group. Tinnitus severity index in patients without masked hypertension was 0 and tinnitus severity index in patients with masked hypertension were 2 (1-5). CONCLUSION: This study demonstrated that masked hypertension must be kept in mind if there is a complaint of tinnitus without any other obvious reason.

Increased masked hypertension prevalence in patients with obesity.

OBJECTIVES: Masked hypertension is associated with an increased risk for cardiovascular conditions. The aim of the study was to evaluate the relationship obesity parameters, including body weight, waist circumference, and body mass index. METHODS: The study group consisted of 251 consecutive outpatient subjects without overt hypertension. Subjects were classified according to BMI. After a complete medical history and laboratory examination, patients' height, weight, waist circumference heart rate, and office blood pressure were recorded. All subjects underwent ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level. RESULTS: Baseline characteristics in patients and controls were similar. Prevalence of Masked hypertension was significantly higher in patients with obesity than controls (30.9% vs 5.7%, p < 0.001). Body mass index (33.2 ± 4.3 vs 25.1 ± 2.7 p < 0.001), waist circumference (98.5 ± 11.7 vs 86.8 ± 8.8, p < 0.001), and weight (86.5 ± 11.8 vs. 69 ± 9.1, p < 0.001) in patients with obesity were significantly higher than in patients with normal weight. Office Systolic BP (121.8 ± 4.4 vs 120.5 ± 4.78, p = 0.035), ambulatory daytime systolic BP (128.8 ± 8.9 vs 124.5 ± 7.4, p < 0.001), ambulatory daytime diastolic BP (73.9 ± 9.5 vs 71.5 ± 7.0, p = 0.019), ambulatory night-time systolic BP in patients with obesity was significantly higher than in patients with normal weight. CONCLUSION: This study demonstrated that masked hypertension prevalence is higher in patients with obesity than control patients. It can be suggested that predefining obesity might be helpful in early detection of masked hypertension.

Investigation of distinctive characteristics of children with specific learning disorder and borderline intellectual functioning

Abstract Background Borderline intelligence function (BIF) and specific learning disorder (SLD) are common diagnoses in children who are brought up for learning problems and school failure. Objective The aim of our study was to determine whether there were distinctive aspects of cognitive testing routinely used in evaluating SLD and BIF and investigate emotion regulation skills and minor neurologic symptoms. Method Sixty children (30 SLD and 30 BIF) who are currently attending primary school are selected for study. Visual Aural Digit Span Test - Form B, Gessel Figure Drawing Test, Bender Gestalt Visual Motor Perception Test, WISC-R, Emotion Regulation Scale (ERS) and Neurological Evaluation Scale (NES) was administered. Results There was no statistically significant difference between groups in cognitive tests. The emotional regulation ability measured by the emotional regulation subscale was better in the SLD group than the BIF group (p = 0.014). In the NES, sensory integration (p = 0.008), motor coordination (p = 0.047) and other (p < 0.001) subscales showed higher scores in the BIF group. Discussion It has been shown that cognitive tests don't have distinguishing features in the evaluation of SLD and BIF. Emotion regulation subscale score of ERS and sensory integration, motor coordination, and total scores of NES can be used in both discrimination of groups.

Surgeon performed continuous intraoperative ultrasound guidance decreases re-excisions and mastectomy rates in breast cancer.

BACKGROUND: Intraoperative ultrasound guided (IUG) breast conserving surgery (BCS) is being increasingly embraced by breast surgeons worldwide. We aimed to compare the efficacy of IUG-BCS for palpable and nonpalpable breast cancer with respect to margin status, re-excision rate, tissue sacrifice and cost-time analysis. METHODS: Intraoperative localization protocol includes intraoperative ultrasound prior to excision to localize the lesion and guide the initial resection. The excised specimen was then examined visually and by palpation and the specimen and cavity was examined with ultrasound. Frozen sections were obtained routinely from a portion of all six faces of the resected specimen, and shaved cavity margins were sent for permanent histology. RESULTS: Of the 208 patients, 57.2% had nonpalpable tumors. The sensitivity of ultrasound localization was 100%. Negative margins were achieved in 92.43% of nonpalpable and 91.01% of palpable lesions at initial procedure. The involved margins were correctly identified by the surgeon via specimen sonography in 95.4% of cases. Final positive margin rate was 2.4%. Calculated resection ratio and time analysis revealed nothing significant. CONCLUSION: IUG-BCS is an invaluable and effective modality for obtaining clear surgical margins with optimum resection volumes and reducing re-operations. Furthermore, by means of this algorithm, in case of shaving cavity margins of the tumor bed for permanent analysis, frozen section evaluation might be omitted.

A possible cause of epistaxis: increased masked hypertension prevalence in patients with epistaxis / Uma possível causa de epistaxe: maior prevalência de hipertensão mascarada em pacientes com epistaxe

Abstract Introduction Epistaxis and hypertension are frequent conditions in the adult population. Masked hypertension is defined as a clinical condition in which a patient's office blood pressure level is <140/90 mmHg, but the ambulatory or home blood pressure readings are in the hypertensive range. Many studies have proved that hypertension is one of the most important causes of epistaxis. The prevalence of this condition in patients with epistaxis is not well defined. Objective This study aimed to evaluate the prevalence of masked hypertension using the results of office blood pressure measurement compared with the results of ambulatory blood pressure monitoring. Methods Sixty patients with epistaxis and 60 control subjects were enrolled in the study. All patients with epistaxis and controls without history of hypertension underwent physical examination, including office blood pressure measurement, ambulatory or home blood pressure, and measurement of anthropometric parameters. Results Mean age was similar between the epistaxis group and the controls – 21–68 years (mean 42.9) for the epistaxis group and 18–71 years (mean 42.2) for the control group. A total of 20 patients (33.3%) in the epistaxis group and 7 patients (11.7%) in the control group (p = 0.004) had masked hypertension. Night-time systolic blood pressure was significantly higher in patients with epistaxis than in the control group (p < 0.005). However, no significant difference was found in daytime systolic blood pressure between the control group and the patients with epistaxis (p = 0.517). Conclusion This study demonstrates increased masked hypertension prevalence in patients with epistaxis. We suggest that all patients with epistaxis should undergo ambulatory or home blood pressure to detect masked hypertension, which could be a possible cause of epistaxis.

Resumo Introdução Epistaxe e hipertensão são condições frequentes na população adulta. Hipertensão mascarada é definida como uma condição clínica em que o nível da pressão arterial do paciente no consultório é < 140/90 mm Hg, mas as leituras da pressão arterial ambulatorial ou em casa se encontram na faixa hipertensiva. Muitos estudos demonstraram que a hipertensão é uma das causas mais importantes de epistaxe. Ainda não está devidamente definida a prevalência dessa condição em pacientes com epistaxe. Objetivo Avaliar a prevalência de HM com o uso dos resultados de mensurações da pressão arterial no consultório, em comparação com os resultados da MAPA. Método Foram recrutados 60 pacientes com epistaxe e 60 indivíduos para controle. Todos os pacientes com epistaxe e os controles sem histórico de hipertensão passaram por exame físico, inclusive determinação da pressão arterial no consultório, MAPA e mensuração dos parâmetros antropométricos. Resultados A média de idade foi similar entre o grupo com epistaxe e os controles: de 21 a 68 (média 42,9) anos para o grupo com epistaxe e de 18 a 71 (média 42,2) anos para o grupo controle. No total, 20 pacientes (33,3%) no grupo com epistaxe e sete (11,7%) no grupo controle (p = 0,004) apresentaram hipertensão mascarada. A pressão arterial sistólica noturna foi significantemente mais alta em pacientes com epistaxe, em comparação com o grupo controle (p < 0,005). No entanto, não foi observada diferença significante na pressão arterial sistólica obtida durante o dia entre o grupo controle e os pacientes com epistaxe (p = 0,517). Conclusão O presente estudo demonstra maior prevalência de hipertensão mascarada em pacientes com epistaxe. Sugerimos que todos os pacientes com epistaxe devam ser submetidos à monitoração da pressão arterial caseira ou em consultório com o objetivo de detectar hipertensão mascarada, que pode ser uma causa possível de epistaxe.

A possible cause of epistaxis: increased masked hypertension prevalence in patients with epistaxis.

INTRODUCTION: Epistaxis and hypertension are frequent conditions in the adult population. Masked hypertension is defined as a clinical condition in which a patient's office blood pressure level is <140/90mmHg, but the ambulatory or home blood pressure readings are in the hypertensive range. Many studies have proved that hypertension is one of the most important causes of epistaxis. The prevalence of this condition in patients with epistaxis is not well defined. OBJECTIVE: This study aimed to evaluate the prevalence of masked hypertension using the results of office blood pressure measurement compared with the results of ambulatory blood pressure monitoring. METHODS: Sixty patients with epistaxis and 60 control subjects were enrolled in the study. All patients with epistaxis and controls without history of hypertension underwent physical examination, including office blood pressure measurement, ambulatory or home blood pressure, and measurement of anthropometric parameters. RESULTS: Mean age was similar between the epistaxis group and the controls - 21-68 years (mean 42.9) for the epistaxis group and 18-71 years (mean 42.2) for the control group. A total of 20 patients (33.3%) in the epistaxis group and 7 patients (11.7%) in the control group (p=0.004) had masked hypertension. Night-time systolic blood pressure was significantly higher in patients with epistaxis than in the control group (p<0.005). However, no significant difference was found in daytime systolic blood pressure between the control group and the patients with epistaxis (p=0.517). CONCLUSION: This study demonstrates increased masked hypertension prevalence in patients with epistaxis. We suggest that all patients with epistaxis should undergo ambulatory or home blood pressure to detect masked hypertension, which could be a possible cause of epistaxis.

Predictive Value of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Patients with Coronary Slow Flow.

BACKGROUND: Increased microvascular resistance due to chronic inflammation is assumed to be one of the mechanisms associated with coronary slow flow (CSF). Previous studies have shown that the platelet-to-lymphocyte ratio (PLR) and the neutrophil-lymphocyte ratio (NLR) are markers of inflammation for various diseases. In this study we aimed to evaluate the relationship between CSF and PLR-NLR. METHODS: Seventy-eight patients with CSF and 50 patients with normal coronary flow were enrolled into this study. The study subjects underwent medical examination and testing, after which their platelet-to-lymphocyte ratios and NLR values were calculated. An independent observer measured the coronary flow rate by Thrombolysis in Myocardial Infarction Frame Count (TFC) method. The platelet-to-lymphocyte ratio and NLR values were compared between the groups and correlation analysis was performed to explore the relationship between mean TFC with PLR and NLR. RESULTS: Platelet-to-lymphocyte ratio and NLR values were significantly higher in patients with CSF (p < 0.001). There was a positive significant correlation between TFC with NLR and PLR (Spearman's Rho: 0.59, p < 0.001 and Spearman's Rho: 0.30, p = 0.001, respectively). Multivariate logistic regression analysis revealed that NLR is the one independent predictor for CSF. CONCLUSIONS: This study demonstrated an association between CSF and PLR-NLR. Although the exact mechanism could not be explained, our findings support the possible role of inflammation in CSF physiopathology.

Association between parathyroid hormone levels and the extensiveness of coronary artery disease.

OBJECTIVE: Previous studies have suggested that there is a relationship between coronary artery disease (CAD) and parathyroid hormone (PTH) levels. Here, we aimed to evaluate the association between PTH levels and severity of CAD. METHODS: Patients were divided into two groups based on their serum PTH values. Patients with PTH levels ≤72 pg/mL were accepted as Group 1 (n=568) and >72 pg/mL as Group 2 (n=87). Gensini score system and >50% stenosis in any coronary artery with conventional coronary angiography were used to determine the extensiveness of CAD. This study was designed as a prospective and cross-sectional study. RESULTS: Baseline characteristics except for age, gender, and blood pressure were similar between groups. Mean serum PTH levels of the entire cohort was 43.4±29.5 pg/mL. Median Gensini score was 19.5 in Group 1 and 14.5 in Group 2 (p=0.75). On the other hand, PTH levels were weakly correlated with Gensini score (Spearman's Rho=0.11, p=0.003). Additionally, we did not observe a statistically significant difference between PTH levels and the number of stenotic vessels (p=0.14). This study was designed as a prospective and cross-sectional study. CONCLUSION: There is no association between serum PTH levels and extensiveness of CAD.

Steatosis Grade is the Most Important Risk Factor for Development of Endothelial Dysfunction in NAFLD.

It is shown that there are strong associations between nonalcoholic fatty liver disease (NAFLD) and endothelial dysfunction. The aim of our study was to reveal whether steatosis or fibrosis score is more important in the development of endothelial dysfunction in patients with NAFLD in a prospective manner.This cross-sectional study included 266 subjects. These subjects were divided into 2 groups depending on presence of hepatosteatosis sonographically. Patients with hepatosteatosis were also divided into 3 subgroups depending on degree of steatosis: grade 1, 2, and 3. In all patients, Aspartate aminotransferase-to-Platelet Ratio Index and Fibrosis-4 (FIB4) scores were calculated. In addition, flow-mediated dilatation (FMD) measurements were recorded.There was NAFLD in 176 (66.2%) of 266 patients included. There were no significant differences in sex and age distributions between patients with NAFLD (group 1) and controls without NAFLD (group 2) (P = 0.05). Mean Aspartate aminotransferase-to-Platelet Ratio Index score was significantly higher in group 1 compared with the control group (P = 0.001), whereas no significant difference was detected regarding FIB4 scores between groups (P = 0.4). Mean FMD value was found to be significantly lower in group 1 (P = 0.008). Patients with grade 3 hepatosteatosis had significantly lower FMD values than those with grade 1 steatosis and controls (P = 0.001). In univariate and multivariate analyses in group 1, no significant difference was detected regarding mean FMD measurements (P = 0.03). Again, no significant difference was detected in mean FMD measurement between FIB4 subgroups among patients with NAFLD and the whole study group (P = 0.09).The endothelial dysfunction is associated with steatosis in patients with NAFLD.

A real world data of dabigatran etexilate: multicenter registry of oral anticoagulants in nonvalvular atrial fibrillation.

Atrial fibrillation (AF) is a common cardiac arrhythmia. Dabigatran etixalate (DE) is one of the new oral anticoagulant drugs being used in nonvalvular AF (NVAF). There is no adequate real world data in different populations about DE. The aim of this registry was to evaluate the efficacy and safety of DE Consecutive NVAF patients treated with warfarin or both DE doses were enrolled during 18 months study period. The patients were re-evaluated at regular 6-month intervals during the follow-up period. During the follow-up period outcomes were documented according to RELY methodology A total of 555 patients were analyzed. There was no significant difference in ischemic stroke rates (p = 0.73), death rates (p = 0.15) and MI rates (p = 0.56) between groups. The rate of major bleeding was significantly higher in warfarin and dabigatran 150 mg group than dabigatran 110 mg (p < 0.001). Intracranial bleeding rate and relative risk were significantly lower in dabigatran 110 mg group than warfarin group (p = 0.004). Dyspepsia was significantly higher in both DE doses than warfarin (p = 0.004) Both DE doses are as effective as warfarin in reducing stroke rates in NVAF patients, without increasing MI rates. Intracranial bleeding rates are significantly lower in warfarin than both doses of DE and gastrointestinal bleeding risk increases with increased DE doses.

Relationship between serum vitamin D levels and angiographic severity and extent of coronary artery disease.

BACKGROUND: Vitamin D is known for its effect in calcium and bone homeostasis. There is an increasing evidence for health benefits accomplished by activated vitamin D that go beyond these classical functions. Previous studies have suggested that lower vitamin D levels are associated with increased cardiovascular disease risk. Therefore, we aimed to evaluate relationship between vitamin D levels and extent and severity of coronary artery disease. MATERIALS AND METHODS: A total of 746 patients in whom coronary angiography was performed between August 2012 and July 2013 were enrolled in this study. Serum vitamin D levels were measured, and patients were grouped according to their serum vitamin D levels (vitamin D <20 ng/mL (n = 602) Group 1 versus >20 ng/dL (n = 144) Group 2). Gensini score system was used to evaluate the association between serum vitamin D levels and severity and extent of coronary artery disease. RESULTS: There was no significant difference between the groups in terms of baseline characteristics and demographic characteristics. Mean serum vitamin D levels of all patient cohort was 15.54 ± 7.46 ng/mL. Group 1 and Group 2 had an average serum vitamin D levels of 12.6 ± 3.3 ng/mL and 27.5 ± 7.8 ng/mL, respectively. Gensini score for all cohort was 26.25 ± 34.32. Group 1 had an average Gensini score of 26.4 ± 35.7; on the other hand, Gensini score was 25.5 ± 27.5 in Group 2 (P = 0.097). CONCLUSIONS: This study failed to demonstrate significant relationship between serum vitamin D levels and the severity and extent of coronary artery disease. Further studies with more participation and homogenous groups with comparable individual and environmental features are needed to evaluate the association of serum vitamin D levels and cardiovascular diseases.