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Öğe Acute myocardial infarction triggered by bee sting(Wiley-Blackwell, 2013) Aribas, Alpay; Akilli, Hakan; Aribas, Fusun Zeynep; Kayrak, Mehmet; Turan, Yasar[Abstract Not Availabe]Öğe Assessment of the left atrial volume index and plasma NT-proANP level in patients with acute ST-elevation myocardial infarction(Hospital Clinicas, Univ Sao Paulo, 2013) Bacaksiz, Ahmet; Vatankulu, Mehmet Akif; Kayrak, Mehmet; Telli, Hasan Huseyin; Ayhan, Selim S.; Sonmez, Osman; Alp, AyseOBJECTIVES: Acute ST-elevation myocardial infarction is associated with ventricular dysfunction due to ischemia-induced progressive myocardial damage. The decrease in ventricular compliance causes left atrial dilatation and stretching of the atrial myocardium, which are the main stimuli for the secretion of atrial natriuretic peptide. The aim of this study was to evaluate left atrial dimensions and atrial natriuretic peptide levels in patients early after their first acute ST-elevation myocardial infarction and assess the probable interaction between coronary lesions and these measurements. METHODS: A total of 110 patients with acute myocardial infarction and 50 controls were studied. Plasma atrial natriuretic peptide was measured at admission. Left ventricular function, diameter, and volume index were evaluated using transthoracic echocardiography. Gensini and vessel scores of the patients who underwent coronary angiography were calculated. RESULTS: Plasma atrial natriuretic peptide in the patients with myocardial infarction was increased compared with that in controls (3.90 +/- 3.75 vs. 1.35 +/- 0.72 nmol/L, p<0.001). Although the left atrial diameter was comparable in patients and controls, the left atrial volume index was increased in patients with acute myocardial infarction (26.5 +/- 7.1 vs. 21.3 +/- 4.9 mL/m(2), p<0.01). Multivariate regression analysis showed a strong independent correlation between the left atrial volume index and the plasma atrial natriuretic peptide level (beta = 0.23, p = 0.03). CONCLUSIONS: The left atrial volume index and plasma atrial natriuretic peptide level were correlated in patients with acute myocardial infarction.Öğe The association between thoracic periaortic fat and major adverse cardiovascular events(Springer Wien, 2015) Kaya, Zeynettin; Ulucan, Seref; Kayrak, Mehmet; Akyurek, Omer; Katlandur, Huseyin; Keser, Ahmet; Efe, DuranThe study aimed to examine the association between thoracic periaortic fat tissue volume and the long-term incidence of major adverse cardiovascular events. This retrospective cohort study included 433 consecutive patients (372 male and 61 female). Periaortic fat tissue volume was measured via electrocardiogram-gated 64-multidetector computed tomography. The patients were evaluated on an average 3 years of follow-up for major adverse cardiovascular events. The patients were divided into groups according to the presence of major adverse cardiovascular events. Major adverse cardiovascular events were noted in 44 (10.2 %) patients during follow-up. Periaortic fat tissue volume was significantly higher in the major adverse cardiovascular events (+) group (35.4 +/- A 26.1 cm(3) vs. 24.1 +/- A 14.9 cm(3), P = 0.001). The logistic regression model showed that periaortic fat tissue volume (hazard ratio: 1.03; 95 % CI: 1.01-1.05; P = 0.001), the glomerular filtration rate (hazard ratio: 0.98; 95 % CI: 0.96-0.99; P = 0.03), and male gender (hazard ratio: 4.76; 95 % CI: 1.08-20.90; P = 0.04) were independent predictors of major adverse cardiovascular events. Thoracic periaortic fat tissue volume may be considered a useful new parameter for predicting major adverse cardiovascular events.Öğe Association of pulmonary artery obstruction index with elevated heart-type fatty acid binding protein and short-term mortality in patients with pulmonary embolism at intermediate risk(Turkish Soc Radiology, 2012) Gul, Enes Elvin; Can, Ilknur; Guler, Ibrahim; Yesildag, Ahmet; Abdulhalikov, Turyan; Kayrak, Mehmet; Ozdemir, KurtulusPURPOSE Heart-type fatty acid binding protein (H-FABP) is a sensitive marker of myocardial injury and predictor of worse prognosis in patients with pulmonary embolism (PE). Assessment of right ventricular dysfunction and pulmonary artery obstruction index (PAOI) with computed tomography (CT) has been reported as a predictor of mortality in PE. Therefore, we aimed to assess the correlation between H-FABP and CT angiographic PAOI in PE patients at intermediate risk. MATERIALS AND METHODS Sixty-one patients (28 males; mean age, 62 +/- 17 years) with diagnosis of PE were included in this study. CT was performed in all patients, and the following parameters were evaluated: right ventricle/left ventricle ratio (RV/LV), pulmonary artery axial diameter, superior vena cava axial diameter, and PAOI determined with Qanadli score. Blood samples were assessed for H-FABP and troponin levels. Patients were followed for 30 days after discharge. RESULTS Mean PAOI was 57 +/- 18%. Eleven patients died during the follow-up period due to PE (18% mortality rate). H-FABP was positive in 21 patients (35%). There was no difference in CT parameters between patients with positive H-FABP and negative H-FABP. In addition, CT parameters were similar between patients who survived and those who did not. RV/LV ratio correlated with PAOI score. Among the biomarkers, troponin levels correlated with both RV/LV ratio and PAOI. H-FABP was an independent predictor of mortality. PAOI and RV/LV ratio did not predict 30-day mortality. CONCLUSION Although H-FABP positivity confers a bad prognosis on PE patients at intermediate risk, PAOI did not predict mortality in this group.Öğe Atrial Functions in Prediabetic Patients(Elsevier Science Inc, 2013) Abdulhalikov, Turyan; Gul, Enes Elvin; Akilli, Hakan; Kayrak, Mehmet; Alibasic, Hajrudin; Yazici, Mehmet; Gok, Hasan[Abstract Not Availabe]Öğe Can neutrophil/lymphocyte ratio predict recurrence of non-valvular atrial fibrillation after cardioversion?(2013) Arıbaş, Alpay; Akıllı, Hakan; Gül, Enes Elvin; Kayrak, Mehmet; Demir, Kenan; Duman, Çetin; Gök, Hasan; Alibasiç, Hajrudin; Yazıcı, Mehmet; Özdemir, KurtuluşAmaç: Yüksek nötrofil/lenfosit oranının (NLO) koroner arter baypas cerrahisi sonrası atriyal fibrilasyon (AF) gelişmesiyle ilişkili olduğu gösterilmiştir. Bu çalışmada NLO’nın kapak hastalığının eşlik etmediği AF’de elektriki kardiyoversiyon (KV) sonrası nüksü öngördürmede etkinliği araştırıldı. Yöntemler: Bu prospektif kohort çalışmasına, elektriki KV sonrası başarılı olunan toplam 149 hasta alındı. Tüm hastaların KV öncesi; kişisel bilgileri kaydedildi, tam kan sayımı, alışılagelen biyokimyasal tetkikleri ve yüksek duyarlılıklı C-reaktif protein (hs-CRP) çalışıldı. İşlem öncesi ekokardiyografik ölçümleri kaydedildi. KV sonrası hastalar rekürrens açısından altı ay takip edildi. Nüks gelişen grubun bazal karakteristikleri sinüs grubu ile Student t- testi kullanılarak karşılaştırıldı. Rekürrensin bağımsız öngördürücüleri lojistik regresyon analizi ile araştırıldı. Bulgular: Kırk altı hastada nüks izlendi. Nüks grubunda AF süresi [ortanca: 16 (çeyrekler arası aralık (ÇAA): 14.25]’e karşın, ortanca: 12 (ÇAA: 11) ay ve sol atriyum (SA) çapı (4.5±0.4 cm’e karşın, 4.3±0.5 cm belirgin uzun bulundu. Nüks gurubunda, sinus ritmine oranla başlangıç hs-CRP değerleri belirgin yüksek (ortanca: 9.80’e (ÇAA: 8.50) karşın ortanca: 4.28 (ÇAA: 5.65) mg/dL iken, NLO her iki grupta benzerdi. [rekürrens grubunda ortanca: 2.38 (ÇAA: 2.09), sinüs grubunda ortanca:2.23 (ÇAA: 1.23). NLO ile hs-CRP seviyeleri ve yaş arasında zayıf bir pozitif ilişki mevcuttu. Çoklu lojistik regresyon analizinde hs-CRP [OO: 1.34 (1.09-1.65 %95 GA) SA çapı [OO: 11.92 (1.84-77.07 %95 GA) spontan eko kontrast varlığı [OO: 5.40 (1.04-12.02 %95 GA) ve sistolik kan basıncı [OO: 1.05 (1.01-1.10 %95 GA) nüksün bağımsız öngördürücüleri olarak izlendi. Sonuç: NLO başarılı kardiyoversiyon sonrası AF nüksünü öngördürmede etkisiz bulunmuştur. Hs-CRP başarılı kardiyoversiyon sonrası nüksü öngördürmede etkin olarak kullanılabilir. (Anadolu Kardiyol Derg 2013; 13: 123-30).Öğe Öğe Development of a wireless blood pressure measuring device with smart mobile device(Elsevier Ireland Ltd, 2016) Ilhan, Ilhan; Yildiz, Ibrahim; Kayrak, MehmetToday, 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. (C) 2015 Elsevier Ireland Ltd. All rights reserved.Öğe Dobutamin Stres Ekokardiyografiye Genel Bir Bakış: Tek Merkez Deneyimi(2014) Akıllı, Hakan; Kayrak, Mehmet; Alibasiç, Hajrudin; Arıbaş, Alpay; Doğan, Umuttan; Yazıcı, MehmetAmaç: Bu çalışmada, kliniğimizde yapılan dobutamin stres ekokardiyografi (DSE) tetkikleri endikasyon, güvenlik, yan etki, komplikasyonlar ve sonuçları açısından değerlendirildi. Ayrıca, DSE sayısı ve maliyeti miyokard perfüzyon sintigrafisi (MPS)’ninki ile karşılaştırıldı. Gereç ve Yöntem: Ocak 2007 ile Mayıs 2013 tarihleri arasında yapılan DSE tetkikleri geriye dönük olarak tarandı. Verilerine ulaşılan 1880 hastanın demografik özellikleri, DSE endikasyonu, işlem sırasında gelişen yan etkiler, komplikasyonlar ve DSE sonuçları değer- lendirildi. Aynı yıllarda yapılan MPS sayıları hastane bilgi sisteminden elde edildi. Bulgular: Çalışmaya DSE yapılan 1880 hasta ile MPS yapılan 1862 hasta dahil edildi. Yıllara göre DSE sayısı gittikçe artarken MPS sayısının azaldığı görüldü. MPS'nin toplam maliyeti DSE'nin toplam maliyetinden 5,4 kat fazla bulundu. DSE'nin 1307 hastada (%69,5) miyokard iskemisi, 527 hastada (%28,1) canlı doku, 46 hastada (%2,4) kapak patolojisi değerlendirmek için yapıldığı görüldü. DSE'ye bağlı ölüm, ventrikül fibrilasyonu, devamlı ventriküler taşikardi gibi komplikasyonlar hiç bir hastada görülmez iken 1 hastada (%0,05) akut miyokard enfarktüsü, 28 hastada ventriküler taşikardi (%1,5), 52 hastada (%2,8) atriyal fibrilasyon görülmüştü. Kalp dışı semptomlar %19,7 oranı ile en fazla görülen yan etki idi. Sonuç: DSE, düşük yan etki ve komplikasyon oranı ile güvenle uygulanabilecek maliyet etkin bir tetkiktir.Öğe Drug Dose Adjustment in Dialysis Patients Admitted in Clinics Other Than Internal Medicine(Lippincott Williams & Wilkins, 2016) Solak, Yalcin; Biyik, Zeynep; Gaipov, Abduzhappar; Kayrak, Mehmet; Ciray, Hilal; Cizmecioglu, Ahmet; Tonbul, Halil ZekiMany 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.Öğe Dysphagia due compression of right pulmonary artery aneurysm to the esophagus(Turkish Soc Cardiology, 2013) Kayrak, Mehmet; Erdogan, Halil Ibrahim; Yildirim, Oguzhan[Abstract Not Availabe]Öğe Effect of serum uric acid on the positive predictive value of dobutamine stress echocardiography(Springer, 2016) Aribas, Alpay; Akilli, Hakan; Kayrak, Mehmet; Alibasic, Hayrudin; Yildirim, Oguzhan; Sertdemir, Ahmet Lutfi; Karanfil, MustafaThere 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.Öğe Effect of termination of the left anterior descending coronary artery (wrapped or non-wrapped property) on tissue Doppler echocardiography findings in patients with anterior myocardial infarction: An observational study(2012) Sönmez, Osman; Vatankulu, Mehmet Akif; Kayrak, Mehmet; Karaarslan, Şükrü; Altunbaş, Gökhan; Özdemir, Kurtuluş; Gök, HasanAmaç: Primer perkütan koroner girişim ile başarılı tedavi edilen anteriyor miyokart enfarktüs (AME) hastalarında sol ön inen koroner arter (LAD) sonlanımının doku Doppler ekokardiyografi(DDE) bulgularına etkisinin değerlendirilmesi amaçlandı. Yöntemler: Çalışma enine kesitli gözlemsel prospektif olarak planlandı. Seksen dört hasta çalışmaya dahil edildi. Hastalara ilk üç gün içinde ekokardiyografik değerlendirme yapıldı. Klasik DDE parametreleri sağ ventrikül (RV) lateral duvar ve sol ventriküle (LV) ait dört duvardan alındı. DDE parametreleri olarak; sistolik fonsiyonların değerlendirilmesinde - DDE mitral annüler sistolik hız değeri - Sm, diyastolik fonksiyonların - DDE mitral annüler erken ve E/A değerleri, kombine sistolik ve diyastolik fonksiyonların değerlendirilmesinde - miyokart performans indeksi (MPI) değeri kullanıldı. LAD sonlanım özelliğine göre iki gruba (sarılı olan ve olmayan LAD) ayrıldı. İstatistiksel analizde Student-t, Mann-Whitney U ve Ki-kare testleri, Pearson ve Spearman bivaryasyon korelasyon analizleri kullanıldı. Bulgular: Hastaların demografik verileri ve bazal ekokardiyografik ölçümleri benzerdi. RV ve LV için 4 duvardan alınan anüler DDE parametrelerinden sadece anteriyor Sm değerinde (Ant Sm) istatistikî anlamlılık ortaya çıkarken, Em, Am ve MPI değerlerinde anlamlı değişiklik tespit edilmemiştir. LAD koroner arterin LV apikalde sonlanan, diyafragmatik yüze (sarılı olmayan) geçiş göstermeyen olgularda anteriyor duvarın Sm değeri LAD koroner arterin LV apikalde sonlanmayan, diyafragmatik yüze geçiş gösterdiği (sarılı olan) olgulara göre daha fazla etkilendiği ortaya çıkmıştır. Anteriyor Sm değeri ile LAD uzunluğu arasında korelasyon tespit edildi. Sonuç: LAD sonlanımı primer perkütan koroner girişim ile başarılı tedavi edilen AME hastalarında, erken dönemde anteriyor duvarın sistolik fonksiyonları için önemli bir parametredir.Öğe The evaluation of doxorubicin-induced cardiotoxicity: Comparison of Doppler and tissue Doppler-derived myocardial performance index(Via Medica, 2012) Ayhan, S. Selim; Ozdemir, Kurtulus; Kayrak, Mehmet; Bacaksiz, Ahmet; Vatankulu, M. Akif; Eren, Onder; Koc, FatihBackground: Doxorubicin is a chemotherapeutic agent used in a wide spectrum of cancers. However, cardiotoxic effects have limited its clinical use. The early detection of doxorubicin-induced cardiotoxicity is crucial. The purpose of our study was to assess values of Doppler and tissue Doppler imaging (TDI) -derived myocardial performance index (MPI) in adult cancer patients receiving doxorubicin treatment. Methods: A total of 45 patients underwent echocardiographic examinations before any doxorubicin had been administered and then after doxorubicin. Doppler and TDI-derived MPI of left ventricular (LV) were determined in the evaluation of cardiotoxicity. Additionally, TDI-derived MPI of right ventricular (RV) was determined. Results: All patients underwent control echocardiographic examination after mean 5 +/- 1.7 months. The LV MPI obtained by both Doppler and TDI were increased after doxorubicin treatment (0.56 +/- 0.11, 0.61 +/- 0.10, p = 0,005 vs 0.51 +/- 0.09, 0.59 +/- 0.09, p = 0.001, respectively). There was no correlation between Doppler-derived MPI and cumulative doxorubicin dose (coefficient of correlation 0.11, p = 0.6). TDI-derived MPI was correlated with cumulative doxorubicin dose (coefficient of correlation 0.35, p = 0.015), but this correlation is weak (r = 0.38). The study population was divided into two groups according to doxorubicin dose (below and above 300 mg level). There was a moderate correlation between TDI-derived MPI and less than 300 mg of doxorubicin dose (coefficient of correlation 0.51, p = 0.028). However, Doppler-derived MPI was not correlated with less than 300 mg of doxorubicin dose (coefficient of correlation 0.38, p = 0.123). Also, there was no significant change in the TDI-derived RV-MPI (0.49 +/- 0.14, 0.50 +/- 0.12, p = 0.56). Conclusions: TDI-derived MPI is a useful parameter and an early indicator compared with Doppler-derived MPI in the detection of cardiotoxicity during the early stages. Also, doxorubicin administration does not affect RV function. (Cardiol J 2012; 19,4: 363-368)Öğe Gender-Related Changes of the Epicardial Fat Thickness and Leptin in Obstructive Sleep Apnea(Wiley, 2014) Akilli, Hakan; Kayrak, Mehmet; Bekci, Taha Tahir; Erdogan, Halil Ibrahim; Aribas, Alpay; Yildirim, Oguzhan; Taner, AlpaslanBackgroundEpicardial fat thickness (EFT), an indicator of visceral obesity, and leptin are 2 novel markers for studying the obstructive sleep apnea (OSA) population. This study aimed to investigate the effects of gender on leptin levels and EFT, and the relation with OSA severity. MethodsA total of 149 patients with OSA (female/male 55/94 and mean age 50.89.2 years) and 50 control patients (female/male 24/26 and mean age 48.98.8 years) were included in the study. The study population was divided into 4 groups according to apnea/hypopnea index (AHI) as control (AHI <5), the mild OSA (AHI 5-14), the moderate OSA (AHI 15-29), and the severe OSA (AHI 30). EFT was obtained from parasternal long-axis and parasternal short-axis echocardiographic images. ResultsLeptin levels among females were significantly higher than among males (10.5 [7.8] vs. 5.4 [4.5] ng/mL, P=0.001, respectively). Among women, leptin levels were significantly higher in the severe OSA group compared to the control group (9.8 [9.0] vs. 15.5 [10.1] ng/mL, P=0.05, respectively). Conversely, no relation was observed between OSA severity and the leptin levels among men. EFT was not significantly different between the 2 genders (P>0.05). EFT was thicker in the severe OSA group than in the control and mild OSA groups among women, whereas EFT was not changed according to OSA severity among males (P>0.05). ConclusionLeptin and EFT may be a valuable parameter in the evaluation of OSA severity in women than in men.Öğe Hafif-orta şiddette kalp yetmezliği olgularında spironolaktonun sol ventrikül fonksiyonlarına etkisi(Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, 2005) Kayrak, Mehmet; Özdemir, KurtuluşŞiddetli kalp yetmezliğinde (KY) etkinliğini kanıtlanmış olan spironolaktonun; hafıf-orta şiddette KY olgularında sol ventrikül (SV) fonksiyonları üzerine etkisini değerlendirmek amacıyla bu çalışmayı planladık. MATERYAL-METOD: Ejeksiyon fraksiyonu (EF) % 35-50 ve fonksiyonel kapasitesi NYIIA sınıf I-II olan 60 hasta çalışmaya alındı. Hastalar 2 gruba randomize edildi. Birinci grup standart KY tedavisi alırken ikinci gruba standart tedaviye ilave olarak spironolakton 25mg/gün verildi. Hastaların tedavi öncesi ve tedavinin 4. ayında ekokardiyografi kayıtları alındı. EF, doku Dopler yöntemi ile sistolik miyokardiyal hızlar (Sm), erken diyastolik hızlar (Em), ve miyokard performans indeksi hesaplandı. Renkli M- mod yöntemi ile akım ilerleme hızları (Vp) ve konvansiyonel pulse wave dopler ile mitral annulus diyastolik erken akım hızı (E) kaydedildi. E/Em ve E/Vp oranlan hesaplandı. Tedavi öncesi ve tedavinin 4. ayındaki ekokardiyografık değerler karşılaştırldı. İstatiksel değerlendirmede grup içi değişimler için student-t testi, gruplar arası değişim içinse uni variyet covaryans analiz ile kullanıldı. BULGULAR: iler iki gruptada bazal demografik değerler, ekokardiyografık parametreler arteriyel kan basıncı ile aldıkları p-bloker ve ACE inhibitörü dozları benzerdi. EF spironolakton almayanlarda %40'dan %43'e yükselirken alanlarda %39'dan %44'e yükseldi. Spironolakton alanlardaki EF'deki artış almayanlarla kıyaslandığında anlamlıydı (P=0.02). Doku Doppler Sm değerleri incelendiği zaman spironolakton alanlarda interventriküler septum ortalama Sm 6.2cm/sn'den 6.9cm/sn'ye, lateral duvar ortalama Sm 7.4cm/sn'den 9.0cm/sn'ye, anteriyor duvar Sm 6.0cm/sn'den 7.1cm/sn'ye ve SV ortalama Sm değeri ise 6.6cm/sn'den 7.6cm/sn'ye yükseldi. Bu artışlar her bir duvar için anlamlıydı (pO.001). Spironolakton almayanlarda ise hiç bir duvarın Sm değişimi anlamlılığa ulaşmadı. Doku Doppler yöntemi ile elde edilen MPİ'de spironolakton almayanlarda anlamlı fark izlenmezken spironolakton alanlarda 0.75 'den 0.69'a geriledi (P=0.03). Spironolakton almayanlarda E/Em anlamlı değişiklik göstermezken (8.9-9.5 p=0.4) spironolakton alanlarda anlamlı olarak (1 1.3'den 10.0'a) azaldı (p=0.05). Gruplar ise arası değişim istatistiksel anlamlılığa ulaşmadı. E/Vp spironolakton almayanlarda önemli bir değişim göstermezken spironolakton alanlarda 1.9'dan 1.3 'e geriledi (P=0.000). Gruplar arası değişim ise istatistiksel anlamlılığa yakındı (P=0.09). 58SONUÇ; Standart tadaviye eklenen spirotıolakton EF, doku Doppler Sın, MP! ve mitral E/Em ve Vp parametrelerinde sağladığı düzelmeler halîf-orta şiddette K.Y olgularında etkin bir tedavi yöntemi olabileceğini düşündünncktedir.Öğe Homocysteine levels in patients with masked hypertension(2014) Yücel, Kamile; Bekçi, Taha Tahir; Alparslan, Taner; Kayrak, Mehmet; Nedime, Emine Korucu; Ünlü, AliObjective: Masked hypertension is a clinical condition, the importance of which is agreed in recent years and which is characterized by increased cardiovascular mortality and morbidity and is thought to be important endothelial dysfunction in the pathophysiology. Plasma total homocysteine levels are accepted as a major independent biomarker for endothelial dysfunction and/or a contributor to hypertension and coronary artery disease. In this study, we aimed to measure the level of serum homocysteine and to evaluate the relationship between the parameters of ambulatory blood pressure monitoring in patients with masked hypertension. Methods: This cross-sectional observational study included 37 subjects with normal blood pressure, 30 with masked-hypertension and 27 patients with obvious hypertension. Masked hypertension (MHT) was defined as office blood pressure >140/90 mm Hg and mean daytime ambulatory systolic blood pressure in 24 hours monitoring ≥135/85 mm Hg. Homocysteine levels of the subjects were measured by using HPLC system with fluorescent detector. Lipid parameters were measured by routine methods. Mann-Whitney U test was used for statistical analysis. Results: In the analysis of homocysteine, it was observed that there was no difference between the control group and patients with masked hyper- tension. Patients with high blood pressure showed higher homocysteine levels when compared to masked hypertension (p0.02). Homocysteine levels showed a weak positive correlation with average systolic blood pressure (r0.335, p0.043). Homocysteine levels were higher in smokers than non-smokers. compared with non-smokers group in all participants (p0.036). Conclusion: We have reached the opinion that in the individuals with no obvious health problems but with masked hypertension, homocysteine levels may not have any significant effect upon high blood pressure levels.Öğe The Impact of Central Blood Pressure Levels on the Relationship Between Oscillometric and Central Blood Pressure Measurements: A Multicenter Invasive Study(Wiley, 2013) Alihanoglu, Yusuf I.; Kayrak, Mehmet; Ulgen, Mehmet S.; Yazici, Mehmet; Yazici, Mehmet; Yilmaz, Remzi; Demir, KenanThe aim of this study was to investigate impact of central blood pressure (BP) levels and sex on the difference between central and upper arm oscillometric BP values. Oscillometric arterial BP measurements of 675 patients were simultaneously compared with values measured from the ascending aorta. The patients were divided into 3 groups according to systolic BP levels. The upper arm oscillometric device overestimated systolic BP (SBP) at low and medium BP levels but it underestimated SBP at high BP level. As for the effect of sex on differences in central and oscillometric BP, SBP was overestimated to a lesser degree in women than in men at low BP levels, but it was more highly underestimated in women than in men at high BP levels. The difference between oscillometric upper arm BP and aortic BP was directly affected by the patient's central BP level. In addition, the difference between central and oscillometric BP was also affected by sex factor.Öğe IMPACT OF ON-PUMP CIRCULATION ON HEMOTOLOGIC PARAMETERS OF PATIENTS WITH ACUTE KIDNEY INJURY AFTER OPEN HEART SURGERY(Oxford Univ Press, 2015) Gaipov, Abduzhappar; Solak, Yalcin; Kilicaslan, Alper; Pektas, Fatih; Ucar, Ramazan; Dossov, Mukhit; Kayrak, Mehmet[Abstract Not Availabe]Öğe Is Neutrophil/Lymphocyte Ratio Predict to Short-term Mortality in Acute Cerebral Infarct Independently from Infarct Volume?(Elsevier, 2014) Tokgoz, Serhat; Keskin, Suat; Kayrak, Mehmet; Seyithanoglu, Abdullah; Ogmegul, AysegulBackground: Neutrophil/lymphocyte ratio (NLR) is related with increased mortality in both myocardial infarction and acute ischemic stroke. It remains unclear whether NLR is a simple marker of ischemic infarct volume or an independent marker of stroke mortality. The aim of this study is to investigate the relationship of NLR with infarct volume and short-term mortality in acute ischemic stroke (AIS). Methods: This retrospective study included 151 patients with first AIS that occurred within 24 hours of symptom onset. Patients were screened from the hospital's electronic record system by using International Classification of Diseases code (G 46.8). NLR was calculated as the ratio of neutrophils to lymphocytes. Short-term mortality was defined as 30-day mortality. Results: A total 20 of 151 patients died during follow-up. Both NLR and infarct volume of nonsurvived group were significantly higher than survived group (P < . 05). Infarct volume, NLR, and National Institutes of Health Stroke Scale (NIHSS) were independent predictors of the mortality in Cox regression analysis. The optimal cutoff value for NLR as a predictor for short-term mortality was determined as 4.81. NLR displayed a moderate correlation with both NIHSS and Glasgow Coma Scale (P < . 01). NLR values were significantly higher in the highest infarct volume tertile than both in the lowest volume tertile and midtertile of infarct volume (P = .001). Conclusions: NLR at the time of hospital admission maybe a predictor of short-term mortality independent from infarct volume in AIS patients. NLR should be investigated in future prospective trials investigating AIS.
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