Ekrem Güler

Assessment of Atrial Electromechanical Delay, Diastolic Functions, and Left Atrial Mechanical Functions in Patients with Type 1 Diabetes Mellitus

OBJECTIVE The aim of this study was to evaluate atrial electromechanical coupling obtained by tissue Doppler imaging (TDI), left and right ventricular diastolic functions, and left atrial (LA) mechanical functions in patients with type 1 diabetes mellitus (DM-1). METHODS A total of 43 patients with DM-1 (age 19.6 +/- 6.8 years) and 42 age- and gender-matched controls (age 19.5 +/- 6.4 years) were included. Atrial electromechanical coupling was measured with TDI and corrected for heart rate. P-wave dispersion (Pd) was calculated from the 12-lead electrocardiograms. Systolic and diastolic functions in both ventricles were assessed using conventional echocardiography and TDI. Myocardial performance index was calculated with TDI. LA maximal, minimal, and pre-systolic volumes were measured according to the biplane area-length method. LA mechanical function parameters were calculated. RESULTS Intra- and interatrial electromechanical delays and Pd were significantly higher in patients with DM-1 compared with controls (P = .02, P < .0001, and P = 0.005, respectively). A-wave velocity and isovolumic relaxation time were higher and E/A ratio was lower in patients with DM-1 (P = .03, P = .03, and P = .003, respectively). According to TDI, systolic velocities and myocardial performance index values of both ventricles were comparable. Diastolic filling velocities of the left ventricle, including E(m) global, A(m) global, E(m)/A(m) ratio, and right ventricular A(m), were different between groups (P = .03, P = .02, P < .001, and P = .02, respectively). LA passive emptying fraction was decreased, and LA active emptying volume and LA active emptying fraction were increased in patients with DM-1 (P = .02, P = .001, and P < .0001, respectively). Interatrial electromechanical delay was positively correlated with the presence of DM-1, age, LA active emptying fraction, and Pd (P < .001, P = .007, P < .001, and P = .002, respectively), and was negatively correlated with E(m)/A(m) ratio and LA passive emptying fraction (P < .001 and P = .001, respectively). In multivariate analyses, age and DM-1 were independent predictors of interatrial electromechanical delay (P = .001 and P < .001, respectively). CONCLUSION This study shows that intra- and interatrial electromechanical delays are prolonged diastolic functions of both ventricles and that LA mechanical functions are impaired in patients with DM-1. Age and the presence of DM-1 were independent factors of the interatrial electromechanical delay.

A sandfly fever virus outbreak in the East Mediterranean region of Turkey

OBJECTIVES To report a sandfly fever virus (SFV) outbreak that occurred in Kahramanmaras Province, Turkey. METHODS We investigated the cases of 40 patients with a history of sandfly bites and with clinical findings, who were referred to our emergency service between July and August 2010. Serum samples of 19 patients were selected and analyzed using a commercial mosaic immunofluorescence test (IFT) to detect IgM and IgG antibodies against SFV. RESULTS Sandfly fever was diagnosed in nine patients. All cases had a history of fly bite, and the clinical findings included fever, headache, myalgia, conjunctival hyperemia, and gastrointestinal symptoms such as diarrhea, nausea, and vomiting. In two patients, the diagnosis was confirmed by real-time PCR as sandfly Sicilian virus (SFSV). Laboratory findings in the patients included leukopenia, thrombocytopenia, and elevated levels of aspartate aminotransferase, alanine aminotransferase, creatine kinase, and C-reactive protein. All patients made a complete recovery with symptomatic treatment. CONCLUSIONS SFV is endemic in the Mediterranean Basin and data regarding SFV activity in Turkey are limited. This is the first report of an SFV outbreak from Kahramanmaras Province, Turkey, and provides information on epidemiological, clinical, and laboratory aspects of SFV infections.

PREMARITAL SCREENING TEST RESULTS FOR β-THALASSEMIA AND SICKLE CELL ANEMIA TRAIT IN EAST MEDITERRANEAN REGION OF TURKEY

Hemoglobinopathies are common diseases in Mediterranean region of Turkey. In this study, the results of a 3-year premarital screening program are reported in Kahramanmaras province, which is located in East Mediterranean region. A total of 48,126 persons were screened in this program. Hematological analyses and electrophoresis were done to identify carriers. The prevalence of β-thalassemia trait and of sickle cell anemia trait, which were 2.1% and 0.5% in Turkey, were found to be 2.8% and 0.4%, respectively, in our study. Of the carriers of the β-thalassemia trait, 82% had high hemoglobin A2, 34% had high hemoglobin F, and 18% had both high hemoglobin F and hemoglobin A2. β-Thalassemia trait in Kahramanmaras is slightly higher than the average rate in Turkey. However, sickle cell anemia trait is similar to Turkeys averages.

Encephalitis in a child during atypical course of rubella.

Rubella is usually encountered as a mild viral illness in children and complications are not common. We reported rubella encephalitis in the atypical course of rubella without rash in a 9-year-old boy. He was admitted with a headache, fever, loss of consciousness and bilateral retroauricular lymphadenopathy. The cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis, increased protein levels and a normal glucose value. Immunoglobulin (Ig) M antibodies against rubella virus were positive in CSF and serum. IgG antibody also became positive in his serum 3 weeks after his admittance. We emphasized that rubella may appear without any rash and cause encephalitis. In unvaccinated children, rubella should be considered in the differential diagnosis of encephalitis.

Myocardial injury biomarkers after radiofrequency catheter and cryoballoon ablation for atrial fibrillation and their impact on recurrence

BACKGROUND Myocardial injury induced by catheter ablation (CA) for atrial fibrillation (AF) leads to elevated biomarker levels. AIM This prospective study examined levels of myocardial injury biomarkers (creatinine kinase [CK], myocardial bound for CK [CK-MB], and troponin I [TnI]) and their impact on AF recurrence following two different ablation strategies, namely: cryoballoon ablation (CBA) and radiofrequency ablation (RFA). We also aimed to evaluate the relationship between AF recurrence after CA and other clinical, echocardiographic and procedural parameters. METHODS We enrolled 98 patients with AF, 21% of whom had persistent AF and 79% had paroxysmal AF. 58% of patients underwent CBA, and 42% underwent RFA. CK, CK-MB, and TnI levels were measured before and 6 h after the procedure. Patients had follow-up visits three, six, and nine months after the index procedure. Biomarker levels were compared between the patients with and without AF recurrence. RESULTS Post-ablation CK (postCK), post-ablation CK-MB (postCKMB), and post-ablation TnI (postTnI) levels were significantly high in the CBA and RFA groups (p < 0.001 for all). TnI elevation (DTnI) was correlated with age (p = 0.033) and median temperature reached during ablation (p < 0.005) in the CBA group, while it was correlated with application time in the RFA group (p < 0.001). Multivariate analysis in the CBA group revealed age and left atrium diameter as positive independent predictors (p = 0.029 and p = 0.046), and DTnI as a negative independent predictor for AF recurrence (p = 0.001). Elevated cardiac biomarkers were not associated with AF recurrence in the RFA group (p > 0.05). CONCLUSIONS The levels of all cardiac biomarkers were elevated after CBA and RFA. Elevated TnI levels after CBA were independent negative predictors of AF recurrence. Measurement of TnI levels after CBA may be useful for the prediction of better clinical outcome.

Hand grip and pinch strength in patients with nocturnal enuresis: is there a role of muscle strength in pathogenesis of enuresis?

To examine the association of muscle strength with nocturnal enuresis.

Diffuse Cystic Bronchiectasis Associated with Left Microtia and External Auditory Canal Atresia: A Very Rare Coincidence

Objective: To present a case in which diffuse cystic bronchiectasis was associated with left microtia/external auditory canal atresia. Clinical Presentation: A 10-year-old girl suffering from cough, fever, dyspnea and sputum for 6 months was transferred to our clinic due to the diagnosis of bronchopneumonia. She had recurrent episodes of bronchopneumonia. On examination, left microtia and left external auditory canal atresia were detected. Thorax CT revealed diffuse cystic bronchiectasis on the left lung. Radiological examination showed atresia of the left external auditory canal. We could not find any etiopathological reason causing bronchiectasis. Intervention: The patient underwent left pneumonectomy and postoperative histopathology was reported as bronchiectasis. Conclusion: This report shows a unique case in which an association of diffuse cystic bronchiectasis and left microtia/external auditory canal atresia was observed. Hence in newborns with microtia and/or external auditory canal atresia, the probability of development of bronchiectasis should be borne in mind and such patients should be followed up more carefully regarding this rare association.

An Unexpected Cause of Hepatotoxicity and Myopathy in A Patient with Coronary Artery Disease: It Is Not Statin

Sertraline is a selective serotonin reuptake inhibitor; it is safe and effective for treating depression in patients with coronary artery disease. Although nausea, diarrhea, and dyspepsia are common adverse effects, less frequent reactions such as maculopathy, hepatotoxicity, and rhabdomyolysis have also been reported. In patients receiving multiple drugs for co-morbid conditions (heart failure, coronary artery disease, etc.), these side effects can be underdiagnosed. Here, we present a patient with coronary artery disease and elevated liver function tests and skeletal muscle enzymes who had multiple admissions and prolonged follow-ups in the emergency room because of elevated creatine kinase and creatine kinase-MB levels, which delayed his appropriate management including discontinuation of sertraline instead of statin.

Assessment of repolarization abnormalities in baseline electrocardiograms of patients with myocarditis

Background/aim: Myocarditis in the acute phase usually presents with sinus tachycardia but many other arrhythmias might be seen as well. In this study we aimed to investigate repolarization abnormalities in baseline ECG of patients with myocarditis for the first time.Materials and methods: Thirty patients diagnosed with myocarditis and 25 healthy age-matched controls were included. Two different cardiologists measured corrected QT (QTc), QT dispersion (QTd), QT peak (QTp), T wave peak to T wave end (TpTe), TpTe/QT ratio, and TpTe/QTc ratio in 12-lead ECG.Results: When compared with the control group, QTp (P: 0.021), QT (P: 0.003), TpTe (P < 0.001), TpTe/QTc ratio (P < 0.001), and TpTe/QT ratio (P: 0.005) were significantly higher in patients with myocarditis. A comparison of receiver operating characteristic (ROC) curves was conducted using the Hanley and McNeil method. The area under the curve (AUC) of the electrocardiographic characteristics QT (AUC: 0.736; 95% CI [0.600-0.846]), QTP (AUC: 0.680; 95% CI [0.540-0.799]), and TpTe (AUC: 0.771; 95% CI [0.638-873]) and TpTe/QTc (AUC: 0.774; 95% CI [0.641-0.876]) and TpTe/QT (AUC: 0.726; 95% CI [0.589-0.838]) in myocarditis were not significantly different from each other but all of them were different from 0.5.Conclusion: Baseline ECGs of patients with myocarditis were associated with repolarization abnormalities. These novel findings may be one of the reasons underlying arrhythmic events in patients with myocarditis.

The relationship between the S-wave in lead 1 and recurrence of RVOT PVC ablation

BACKGROUND Radiofrequency catheter ablation (CA) is a common non-pharmacological treatment option for ventricular premature contractions (PVCs) originating from right ventricular outflow tract (RVOT). In this study, we aimed to investigate the relationship between recurrence after CA for RVOT-PVC and S-wave in lead 1 that was shown to be associated with RVOT depolarization. METHODOLOGY A total of 104 patients who were referred to our clinic for CA for idiopathic RVOT-PVC between 2012 and 2015years were enrolled. All ECG parameters were measured before and after the ablation procedure. RESULTS Ablation was successful in 100 patients (96,1%). These patients with successful ablation were followed for a mean duration of 1078days. 13 patients (13%) had recurrence. Univariate logistic regression analysis revealed age (odds ratio: 1.916, p:0,012), presence of post-procedural S1 (odds ratio:1.040 p:0,028), post-procedural S1 area (oddsratio:1.023 p:0,041), ΔS1 area (odds ratio:1.242 p:0,004) as predictors for recurrence. Multivariate logistic regression analysis detected age (odds ratio:1.053 p:0,032) and ΔS1 area (odds ratio:0.701 p:0,009) as predictors for recurrence. CONCLUSION Radiofrequency CA for RVOT-PVC can be performed with high procedural success and low complication rates. Age and ΔS1 area might be helpful for prediction of recurrence after CA.