Hayrettin Saglam

Electrocardiographic Findings of Acute Organophosphate Poisoning

In this study, we evaluated 85 patients who presented to our Emergency Department with organophosphate (OP) poisoning and discuss their associated electrocardiographic (ECG) abnormalities. Over a period of 3 years, 85 patients with OP poisoning were included in this retrospective study. ECG analysis included the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals. The mean age was 32.2 +/- 14.9 years. Sixty percent of the patients were female. The mean corrected QT interval (QTc interval) was 0.435 +/- 0.052 s. Prolongation of the QTc interval (55.5%) was the most common ECG abnormality, followed by sinus tachycardia (31.8%). Elevation of the ST segment and low amplitude T waves were seen in 15 cases (17.6%). Patients with OP poisoning might reveal ECG abnormalities such as QTc interval prolongation or non-specific ST-T changes. QTc interval prolongation cannot be used as a unique predictive factor in determining short-term prognosis in OP poisoning. We found no clear relation between OP poisoning-related malignant ventricular dysrhythmia and QTc interval.

Association of left ventricular diastolic function abnormalities with aortic elastic properties in asymptomatic patients with type 2 diabetes mellitus. A tissue doppler echocardiographic study

Background:  The aim of this study was to investigate the association between the aortic elastic properties and the left ventricular diastolic function measured by tissue Doppler echocardiography (TDE) in asymptomatic type 2 diabetes mellitus.

Effect of diphenhydramine on myocardial injury caused by organophosphate poisoning

Background. The aim of this experimental study was to investigate whether diphenhydramine could prevent or diminish myocardial injury caused by organophosphate poisoning as defined by histologic findings and cardiac troponin I (cTnI) levels. Methods. Twenty-four Sprague-Dawley rats were divided into equal three groups. Group 1 did not receive any agent during the experiment. Group 2 received 0.8 g/kg fenthion subcutaneously followed by normal saline (3 ml/kg) intramuscularly 30 minutes later. Group 3 received 0.8 g/kg fenthion subcutaneously, followed by diphenhydramine 30 mg/kg (in 3 ml/kg) intramuscularly 30 minutes later. All rats underwent laparotomy and thoracotomy while under anesthesia at 24 hours. Results. Treatment with diphenhydramine significantly decreased the blood cTnI levels. Additionally, diphenhydramine significantly reduced myocardial injury, including edema, inflammation, vacuolization and necrosis, as determined by pathologic scoring. Conclusion. Organophosphate poisoning can cause myocardial injury as determined by measurement of I cTnI levels. Our study demonstrates that this injury can be attenutated by the administration of diphenydramine.

Evaluation of myocardial perfusion and function by gated SPECT in patients with Behçet's disease.

BackgroundBehçet’s disease (BD) is a systemic multi-system vasculitis that can have a wide range of effects on the cardiovascular system.ObjectiveTo determine the existence of myocardial perfusion defects caused by coronary microvascular dysfunction in BD and to evaluate coronary arterial distribution and left ventricular systolic function by gated single-photon emission computed tomography (SPECT).MethodsThe study population consisted of 23 (15 men and 8 women) patients with BD and 20 healthy controls (12 men and 8 women). Technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) gated SPECT studies were performed at stress and rest in a 2-day protocol. Stress and rest left ventricular ejection fraction (LVEF) were calculated. Using non-gated SPECT images myocardial perfusion scores [summed stress score (SSS), summed rest score (SRS), summed difference score (SDS), and fix defect score (FDS)] and perfusion defect extent as percentage (stress, rest ischemic, and fix %LV) were determined. Using gated SPECT images, wall motion score indices (stress wall motion score indices and rest wall motion score indices) were calculated. Coronary angiography (CAG) was applied to patients with abnormal myocardial perfusion scintigraphy (MPS).ResultsThe mean ages of the BD and control groups were 39.3 ± 10.6 years and 36.2 ± 8.3 years, respectively. No statistically significant differences were observed between the two groups regarding clinical features and cardiologic findings. Abnormal MPS was found in 13 (56.5%) of the BD patients; 3 patients had non-transmural infarcts and 10 patients reversible perfusion defects. Reversible perfusion defects were also found in two controls (10.0%). When the two groups were compared regarding the gated SPECT findings, differences were determined in the following parameters; SSS, SRS, SDS, FDS, stress and rest LVEF, stress and rest %LV, and stress and rest WMSI. In the BD group, when gated SPECT results were compared between those with and without abnormal MPS, differences were determined in SSS, SRS, SDS, FDS, stress and rest %LV, and stress and rest WMSI. Epicardial coronary arteries were normal in CAG.ConclusionsMyocardial perfusion and function are disturbed owing to influenced coronary microvascularity in BD, and CAG is frequently observed to be normal. Gated SPECT is a non-invasive reliable method that simultaneously evaluates the existence, extent and severity of myocardial ischemia or infarction and the wall movements in cardio-Behçet.

Arterial stiffness and dipper/nondipper blood pressure status in women with preeclampsia

IntroductionThe aim of this study was to investigate the clinical relevance of dipper status in women with preeclampsia by comparing arterial stiffness index (SI) values, and dipper and nondipper status.MethodsA total of 60 pregnant women in their third trimester were enrolled in the study. SI values were measured using a digital photoplethysmographic method (Pulse Trace System, Micro Medical Ltd., Gillingham, Kent, UK). Twenty-four-hour ambulatory blood pressure was measured by a SpaceLabs 90217 oscillometric device (SpaceLabs Inc., Redmond, WA, USA). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) were recorded. Those preeclamptic women whose mean nighttime blood pressure measurements were at least 10% lower compared with mean daytime measurements were classified as dipper status, and those with a decrease of less than 10% were classified as nondipper status.ResultsSeventeen women were preeclamptic with a dipper status, 13 women had nondipper status preeclampsia, and 30 women were normotensive. SI values were significantly higher in preeclamptic women compared with normotensive women (8.8±1.2 m/s vs. 5.9±0.8 m/s, P<0.001), but SI values of preeclamptic women with dipper status and preeclamptic women with nondipper status did not differ significantly from each other (P=0.485).ConclusionThere was no significant difference in SI values between the dipper and nondipper preeclamptic groups. These results indicate that dipper and nondipper measurements may not be suitable for clinical follow-up of preeclamptic women.

SHORT-TERM PROGNOSTIC VALUE OF REST Tc99m-MIBI GATED SPECT AFTER ACUTE NON-Q WAVE MYOCARDIAL INFARCTION

Aim: The purpose of this study is to determine the short–term prognostic value of technetium 99m methoxyisobutylisonitrile gated single photon emission computed tomography (Tc99m–MIBI Gated SPECT) in patients with acute Non–Q wave myocardial infarction (NQMI) in 30 days. Methods: We identified 36 patients who underwent rest Tc99m–MIBI Gated SPECT and who were followed-up 30.65±0.49 days after first a NQMI. 21 patients were males, 15 females, with a mean age of 60.30±10.17 years. Rest Tc99m–MIBI Gated SPECT were performed within 48 (30.7±2.3) hours of admission to the coronary care unit after acute myocardial infarction (MI). The left ventricular ejection fraction (LVEF), end diastolic (EDV) and end systolic volumes (ESV), and summed rest score (SRS) and extent score (ES) were assessed using rest Tc99m–MIBI Gated SPECT. Results: Rest Tc99m–MIBI Gated SPECT parameters and clinical datas were analyzed and divided two group according to prognosis, as new cardiac event (poor prognosis) and stable stuation (good prognosis). During follow-up, 12 patients (33%) had a new clinical event, [4 congestive heart failure (11%), 7 revascularization (19%) and 1 reinfarct (2%)], whereas 24 patients (66%) showed a good outcome. There were significant differences LVEF, EDV, ESV, SRS and ES values between poor and good prognosis group (p=0.011, p=0.016, p=0.017, p 70 ml (RR=5.31, CI 1.17 to 24.14, p=0.027), SRS≥7 (RR=7.00, CI 1.25 to 39.14, p=0.032) and ES≥3 (RR=6.59 CI 0.72 to 60.02, p=0.037). Conclusion: Left ventricular parameters (LVEF, ESV) and perfusion scores (SRS, ES) which obtained by rest Tc99m–MIBI Gated SPECT, provide useful information in the prediction of future cardiac events after NQMI in 30 days.