Evaluation of serum Vitamin B12 level and related nutritional status among apparently healthy obese female individuals.

OBJECTIVE: Obesity is a major public health problem and great risk for not only cardiovascular diseases but also cancer, musculoskeletal, and gynecological diseases. This study was aimed to investigate the association between serum Vitamin B12 (vitB12), body mass index (BMI), and nutritional status among obese women. METHODS: This cross-sectional study enrolled consecutive female subjects. The consumptions of red meat, fish, bovine liver, egg, and mushroom were recorded. According to the Dietary Reference Intakes, the patients were categorized as insufficiency and sufficiency. Three cutoff points were defined for vitB12 status: (1) Deficiency if vitB12 is <200 pg/mL; (2) insufficiency if vitB12 is 250-350 pg/mL, and (3) sufficient if vitB12 is ≥350 pg/mL. According to BMI, the patients were assigned to nonobese and obese groups. BMI, serum vitB12 level, consumptions of red meat, fish, bovine liver, egg, and mushroom were evaluated and compared between two groups. RESULTS: Mean level of vitB12 was 247.8 ± 10.4 pg/mL and significantly associated with consumption of egg (P = 0.031), bovine liver (P = 0.004), mushroom (P = 0.040), and red meat (P = 0.003). VitB12 was significantly higher in nonobese than obese group (282.5 ± 106.8 vs. 242.5 ± 107.5 pg/mL, P = 0.001). The ratio of vitB12 deficiency was significantly higher in obese than nonobese group (37.6% vs. 24.7%; P = 0.019). VitB12 level was negatively correlated with BMI (r = -0.155; P< 0.001), but not insulin resistance (r = -0.172; P = 0.062). CONCLUSION: Obesity was associated with low level of vitB12 in obese women, and more likely to be vitB12 deficient. Consumption of certain types of food contributes to increase vitB12 level.

Carotid and cerebral CT angiography using low volume of iodinated contrast material and low tube voltage.

PURPOSE: To evaluate image quality of carotid computed tomography angiography (CTA) using a low voltage (80kV) and low amount of iodinated contrast material. MATERIALS-METHODS: A total of 101 patients referred for carotid CTA were randomly assigned to receive a specific protocol. In group A patients received intravenous administration of contrast material at a dose of 1mL/kg and CTA examinations were performed at 100kV. In group B, patients received intravenous administration of contrast material at a dose of 0.5mL/kg and CTA examinations were performed at 80kV. The same nonionic iodinated contrast material containing 370mg of iodine per mL was used in both groups. Attenuation values were measured from the center of specific arterial segments using regions of interest. Attenuation values above 300HU were accepted as significant. Institutional review board approval was obtained. RESULTS: A total of 50 patients were included in group A (38 men, 12 women; mean age, 63.56 years±13.18 [SD]) and 51 patients in group B (33 men, 18 women; mean age, 59.60 years±16.63 [SD]). A total of 1615 arterial segments (1515 common carotid artery-middle cerebral artery and 101 aortic arches) were analyzed. Venous contamination was not observed in either group. The mean attenuation values of all arterial segments in both groups were greater than 300HU. Mean arterial attenuation value in group B (499.22HU±97.25 [SD]) was significantly greater than in group A (374.36HU±73.79 [SD]) (P<0.01). Hemodynamically significant stenosis (grade III stenosis or >70%) was detected in 2 segments in group A and in 3 segments in group B, while grade IV stenosis (occlusion) was detected in 2 segments in group B. Distal common carotid artery dissection was detected in 1 patient and aortic dissection was detected in 1 patient in group B. Total dose-length product (DLP) value was significantly greater in group A (225.74mGy·cm±21.80 [SD]) than in group B (116.60mGy·cm±21.22 [SD]) (P<0.01). The mean tube current was similar in group A (2013.11mAs±195.92 [SD]) and in group B (2096.64 mAs±309.03 [SD]) (P<0.05). CONCLUSION: Carotid and cerebral CTA examinations using 128-section CT can be successfully obtained using an imaging protocol that combines low voltage and 50% reduction in the volume of iodinated contrast material. This provides good image quality with low radiation dose.

THE RELATIONSHIP BETWEEN CONGENITAL HEART DEFECTS AND e-NOS GENE IN DOWN SYNDROME.

The aim of the study was to compare the effects of three eNOS gene polymorphisms associated with congenital heart defects, between Down syndrome patients with and without cardiac anomalies. Transthoracic echocardiographic examinations and eNOS single-nucleotide polymorphisms were investigated on seventy-five patients, prospectively. The frequencies of mutant alleles in the eNOS promoter (the -786T/C polymorphism) and exon 7 mutant alleles (the 894G--->T polymorphism) were significantly higher in Down syndrome patients with and without cardiac anomalies. The frequency of the intron GIOT polymorphism did not significantly differ between patients with and without cardiac anomalies. We found a significant relationship between eNOS gene polymorphisms and the congenital heart defects in patients with Down syndrome. Screening for the presence or absence of eNOS polymorphisms may be useful to obtain preliminary data on the risk of congenital heart defects in patients with Down syndrome.

The prevalence and clinical characteristics of mitral valve prolapse in a large population-based epidemiologic study: the MELEN study.

OBJECTIVE: Mitral valve prolapse (MVP) is the most common cardiac valvular abnormality in industrialized countries. Its prevalence has been estimated to be between 2% to 4%. However, some studies found the prevalence of MVP less than 1% which is significantly lower than the prevalence reported in the Framingham Heart Study. The purpose of this study was to determine the prevalence, demographic, clinical and echocardiographic characteristics of MVP in a large population-based epidemiologic study. PATIENTS AND METHODS: The final cohort included 2,228 participants. Data were obtained by a validated questionnaire, physical examination of the cardiovascular system, recording of a resting electrocardiogram, transthoracic echocardiographic examination. RESULTS: The echocardiographic prevalence of MVP was 0.36%. Baseline demographic and clinical characteristics of patients were as follows; 12.5% had hypertension, 37.5% had depression, 12.5% had migraine, 12.5% had diabetes mellitus, 12.5% had diastolic dysfunction, 25% had multi-nodular goiter, 12.5% had diffuse goiter and 25% had hyperthyroidism. During the follow-up of 36 months no major adverse events occurred in patients with MVP during the follow-up. CONCLUSIONS: This finding suggests that MVP is a benign disorder and the prevalence of MVP is lower than previously studies. There might be a relationship between MVP and goiter, and depression.

Does the inhibition of renin-angiotensin system decrease inter-dialytic weight gain in anuric hemodialysis patients?

OBJECTIVE: Knowledge about the inhibition of centrally located angiotensin-I (AT-I) receptors by highly lipophilic AT-I receptor blockers and its' effect are limited with experimental studies. Thus, we aimed to investigate the effect of Telmisartan on Inter-dialytic weight gain (IDWG) % and echocardiographic measurements in anuric hemodialysis (HD) patients. PATIENTS AND METHODS: A total of forty-one anuric HD patients with ≥ 6 months maintenance on HD were included in this prospective, randomized and self-controlled study. Four weeks prior the study, angiotensin converting enzyme blockers and AT-I receptor blocker drugs were stopped. Patients were assessed three times during the study protocol. These are baseline, three months later (without Telmisartan period) and three months after Telmisartan therapy. RESULTS: IDWG % was significantly decreased in the period of with Telmisartan compared to period without Telmisartan (5.6 ± 1.0% vs 5.3 ± 1.0%, p = 0.03). After the administration of Telmisartan left ventricule end-diastolic diameter (LVEDD) (p = 0.001) and inferior vena cava diameter (IVCD) (19.1 ± 3.8 mm vs 17.3 ± 4.2 mm, p = 0.001) were significantly decreased compared to the period of without Telmisartan. Despite of significantly changes observed in IVCD and LVEDD measurements in a period without Telmisartan, there was no significantly difference in left ventricular mass index (LVMI) measurements in this period. However, LVMI was significantly regressed after the administration of Telmisartan (269.3 ± 82.7 g vs 256.3 ± 70.3 g, p = 0.003 respectively). CONCLUSIONS: Treatment of anuric HD patients with Telmisartan at a dose of 40 mg a day reduces IDWG%, LVEDD and IVCD measurements. Further studies investigating the long-term effect of these beneficial effects on clinical outcomes are necessary.

Analysis of Turkish groundwater legislation and policy regarding international principles and conventions.

Water resources have shaped the destinies of societies and affected settlement choice of civilizations for centuries. Demand for them is constantly increasing and this surge has become an important threat for water resources due to those excessive demands and variety of usage types; at the same time, balancing the protection and use of ground and surface waters has become more difficult. The progress in legal and corporate structures for water management has been too slow for a long time. In this study, principles of international conventions on groundwater are compared with the relevant Turkish groundwater legislation, which is in the process of harmonization with European Union (EU) acquis under the scope of Turkey's nomination for EU membership. The purpose of this study is to measure the compliance of Turkish legislation on groundwater with the relevant international principles and conventions, and also to analyze legal loopholes in Turkish legislation in accordance with the international principles and conventions to be determined.

The impact of metabolic syndrome on carotid intima media thickness.

OBJECTIVES: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities involving several cardiovascular risk factors. Carotid intima media thickness (CIMT) is an important early screening tool to assess subclinical manifestation of cardiovascular and metabolic diseases. We aimed to investigate the impact of MetS on CIMT in a large scaled community based study. METHODS: The study was conducted on 2102 participants. Carotid intima media thickness was measured in all of the participants. The study sample was divided into 4 groups; Group 1 subjects with a body mass index (BMI) < 25.0 kg/m2 [n = 499 (MetS- = 488, MetS+ = 11)], Group 2 BMI between 25.0 and 29.9 kg/m2 [n = 693 (MetS- = 559, MetS+ = 134)], Group 3 BMI between ≥ 30 kg/m2 and 39.9 kg/m2 [n = 822 (MetS- = 375, MetS+ = 477)], and Group 4 BMI ≥ 40 kg/m2 [n = 88 (MetS- = 27, MetS+ = 61)]. RESULTS: Carotid intima media thickness was higher in the individuals with MetS compared to their normal counterparts. Furthermore, the subgroup analysis showed that CIMT values in Group 1 (0.55±0.18 vs 0.82±0.70; p < 0.001), Group 2 (0.59±0.20 vs 0.68±0.18; p < 0.001) and Group 3 (0.61±0.15 vs 0.65±0.18; p < 0.001) were significantly higher in subjects with MetS compared to their normal counterparts, whereas the values were similar in Group 4 (0.62±0.13 vs 0.65±0.17; p = 0.363). CONCLUSIONS: Carotid intima media thickness of overweight, obese and normal weight individuals without MetS were lower than their counterparts with MetS. MetS had no impact on CIMT in morbid obese individuals possibly due to established insulin resistance earlier than MetS.

Predictors of hypertension control in Turkey: the MELEN study.

BACKGROUND: Hypertension is one of the most common causes of atherosclerosis, morbidity and mortality in adults. A total of 11 million hypertensive patients were estimated in Turkey. AIM: The aim of this study was to investigate the prevalence, awareness and control of hypertension in Duzce and compare the current data with the literature. MATERIALS AND METHODS: The visits were carried out in May and June, 2010 in Yigilca town health centre on 2298 participants (1471 female, 827 male with a mean age of 50). Data were obtained by a simple form, physical examination and sampling of blood. Hypertension was defined as a blood pressure 140 mmHg and/or 90 mmHg, and/or use of antihypertensive medication. The data of patients under control were compared with the patients who were not under control. RESULTS: Hypertension was detected in 964 participants. General prevalence was 42%. Hypertension awareness ratio was 70%, use of antihypertensive medication was 39% and the ratio of patients under control was 28%. Antihypertensive drug use, age and awareness were lower in the uncontrolled group. Logistic regression analysis revealed that only antihypertensive drug use and BMI < 30 were the independent predictors of hypertension under control [Odd's ratio (OR) = 3.43; 95% confidence interval (CI) = 2.54-4.64, p < 0.001 and OR = 1.69; 95% CI = 1.23- 2.32, p = 0.01; respectively]. CONCLUSIONS: Hypertension is one of the most important public health problems in Turkey. According to the literature data the awareness of hypertension was increased significantly in the last five years. On the other hand, control ratio was increased very little compared with the previous studies.

Effect of combined oral contraceptive use on platelet volume in women at reproductive age.

INVESTIGATION: Combined oral contraceptives use is associated with an increased risk of developing venous and arterial thromboembolic events. Platelet size, measured as mean platelet volume (MPV), is associated with platelet reactivity. METHODS: Ninety-five women using oral contraceptives for contraception were investigated retrospectively. The patients' blood pressure, pulse and hematological values at application and at the sixth month were evaluated retrospectively. RESULTS: There was no difference between the values of blood pressure (systolic and diastolic), pulse, hematological values (which contain leukocytes, platelets and mean platelet volume) at application and at the sixth month. CONCLUSION: We determined that using oral contraceptives for contraception did not change MPV values in young women.

Correlation between the body fat composition and high sensitive C-reactive protein in Turkish adults.

OBJECTIVES: The adipose tissue is an active immune organ. High sensitive C-reactive protein CRP (hs-CRP) is a strong independent predictor of a possible future myocardial infarction and stroke, and it has also been shown to be related to the subclinical atherosclerosis. The aim of this study was to investigate the relation between the body fat composition, metabolic syndrome, and the hs-CRP plasma levels. METHODS: Total 246 consecutive Turkish subjects, admitted to the internal medicine clinic with the diagnosis of diabetes mellitus, insulin resistance or metabolic syndrome, were included into the study. The total body fat composition was measured in every participant with a commercially available bio-impedance meter. The hs-CRP levels, body composition parameters, and biochemical variables were compared. RESULTS: The hs-CRP levels increased in parallel with the body weight in Turkish subjects. This increase was significant especially in the women. The waist circumference, body mass index (BMI), and body composition variables (visceral fat level, total body fat, and total body muscle mass) were significant correlates of the hs-CRP. The waist circumference and BMI were independent predictors of the hs-CRP. CONCLUSION: The waist circumference, BMI, and body composition variables (visceral fat level, total body fat and total body muscle mass) were significant correlates of the hs-CRP in Turkish adults. Body weight control may account for an important target especially in patients with the metabolic syndrome.

The effect of pretreatment with renin-angiotensin-aldosterone system blockers on cardioversion success and acute recurrence of atrial fibrillation.

BACKGROUND: Renin-angiotensin-aldosterone system (RAS) may be activated during atrial fibrillation (AF). It is unclear whether RAS inhibition may facilitate cardioversion from AF and may prevent acute recurrence of AF (ARAF). We thus investigated the effect of pretreatment with RAS blockers on cardioversion success and ARAF in patients with AF scheduled for elective cardioversion. METHODS: This observational study included 356 patients with AF undergoing elective pharmacological or electrical cardioversion. Of these patients, 135 were not included based on exclusion criteria and the remaining 221 patients were divided into RAS group (n = 116, 69 male) or non-RAS group (n = 105, 58 male) based on precardioversion use of any RAS blocker. RESULTS: Hypertension, coronary heart disease and heart failure were more frequent in the RAS group. Cardioversion from AF was more successful in the RAS group than in the non-RAS group (%92 vs. %82, p = 0.026). The rate of ARAF was lower in RAS group compared with that in non-RAS group (17% vs. 31%, p = 0.026). In multivariate analysis, pretreatment with RAS blockers in addition to shock number and enlarged left atrium, independently predicted ARAF (OR: 0.33, 95% CI: 0.15-0.75, p = 0.008). Independent predictors of cardioversion success were shock number and left atrial dilatation, but not use of RAS blocker. CONCLUSION: Precardioversion use of RAS blockers may reduce ARAF following successful cardioversion of AF, but did not improve electrical cardioversion.

A clinical comparison of psoas compartment and inguinal paravascular blocks combined with sciatic nerve block.

The extent of inguinal paravascular blockade and psoas compartment blockade with sciatic nerve block was evaluated in 60 patients. Volumes of 30 ml and 20 ml 0.35% bupivacaine with 1/200,000 epinephrine were injected for lumbar plexus and sciatic nerve block, respectively. Complete lumbar plexus blockade was achieved in 73% of the group who were treated with the psoas compartment technique and 43% of the group who were treated with the inguinal paravascular technique. Sensory blockade of the femoral, lateral femoral cutaneous and obturator nerves was obtained in 100%, 97% and 77% of the patients in the psoas compartment group, and 93%, 63% and 47% of the patients in the inguinal paravascular group, respectively. Sensory blockade of the lateral femoral cutaneous and obturator nerves was more rapid with psoas compartment block. The study suggests that the psoas compartment block is effective in blocking the femoral, lateral femoral cutaneous and obturator nerves, but the inguinal paravascular block is only effective in blocking the femoral nerve.