Osman Zikrullah Şahin

The independent association of plateletcrit with long-term outcomes in patients undergoing primary percutaneous coronary intervention

PURPOSE Platelets play a key role in the genesis of thrombosis. Plateletcrit (PCT) provides complete information on total platelet mass. The relationship between PCT values and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary angioplasty is not known. We sought to determine the effect of PCT values on the outcomes of primary angioplasty for STEMI. METHODS Overall, 2572 consecutive STEMI patients (mean age, 56.6±11.8 years) undergoing primary percutaneous coronary intervention were enrolled retrospectively into the present study. Plateletcrit at admission was measured as part of the automated complete blood count. Patients were classified into 2 groups: high PCT (>0.237, n=852) and nonhigh PCT (<0.237, n=1720). Clinical characteristics and in-hospital and long-term (median, 21 months) outcomes of primary angioplasty were analyzed. RESULTS A higher in-hospital shock rate was observed among patients with high PCT values compared with those with nonhigh PCT values (6.5 vs 3.8%, respectively; P=.003). The long-term cardiovascular prognosis was worse for patients with high PCT values (Kaplan-Meier, log-rank test; P=.007). We used Cox proportional hazard models to examine the association between PCT and adverse clinical outcomes. High PCT values were also an independent predictor of cardiovascular mortality (hazard ratio, 1.85; 95% confidence interval, 1.061-3.22; P=.03). CONCLUSION High PCT values on admission are independently associated with long-term adverse outcomes in patients with STEMI who undergo primary angioplasty.

The effect of exposure of rats during prenatal period to radiation spreading from mobile phones on renal development

Abstract Background: The aim of this study was to investigate the effects of exposure to a 900-MHz electromagnetic field (EMF) produced by mobile phones on the renal development of prenatal rats. Histopathological changes and apoptosis in the kidneys, together with levels of urea, creatinine and electrolyte in serum were determined. Methods: A total of 14 Sprague–Dawley rats were studied. Pregnant rats were divided into two equal groups: a control group and an EMF-exposed group. The study group was exposed to 900-MHz of EMF during the first 20 days of pregnancy, while the control group was unexposed to EMF. Sections obtained from paraffin blocks were stained for caspase-3 by immunohistochemistry, hematoxylin–eosin and Masson’s trichrome. Results: Mild congestion and tubular defects, and dilatation of Bowman’s capsule were observed in the kidney tissues of rats in the exposed group. Apoptosis was evaluated using anti-caspase-3; stronger positive staining was observed in the renal tubular cells in the study group than those of the control group. Although there was a significant difference between the study and control groups in terms of K+ level (p < 0.05), no significant difference was observed in the other parameters studied (p > 0.05). Conclusion: Our study shows that the electromagnetic waves propagated from mobile phones have harmful effects on the renal development of prenatal rats.

The relationship of plasma catestatin concentrations with metabolic and vascular parameters in untreated hypertensive patients: Influence on high-density lipoprotein cholesterol

Objective: Catestatin has several cardiovascular actions, in addition to diminished sympatho-adrenal flow. Decreased plasma catestatin levels may reflect a predisposition for the development of hypertension and metabolic disorders. We planned to investigate the possible roles of catestatin in untreated hypertensive patients. As a secondary objective, we compared catestatin concentrations of healthy subjects with those of hypertensive patients in order to understand whether catestatin is increased reactively or diminished at onset. Methods: Our study was cross-sectional and observational. The patient group, comprising 109 consecutive untreated hypertensive patients without additional systemic or coronary heart disease, underwent evaluations of plasma catestatin, waist circumference, lipid parameters, left ventricular mass, carotid intima-media thickness, and flow-mediated dilation of the brachial artery. Additionally, we measured catestatin concentrations of 38 apparently healthy subjects without any disease using a commercial enzyme-linked immunosorbent assay kit. Results: We documented increased catestatin concentrations in previously untreated hypertensive patients compared to healthy controls (2.27±0.83 vs. 1.92±0.49 ng/mL, p=0.004). However, this association became insignificant after adjustments for age, gender, height, and weight. Within the patient group, catestatin levels were significantly higher in females. Among all study parameters, age, high-density lipoprotein cholesterol (HDL-C) correlated positively to plasma catestatin, whereas triglycerides, hemoglobin, and left ventricular mass correlated negatively to plasma catestatin. We could not detect an association between vascular parameters and catestatin. Catestatin levels were significantly elevated with increasing HDL-C (1.91±0.37, 2.26±0.79, and 3.1±1.23 ng/mL in patients with HDL-C <40, 40-60, and >60 mg/dL, respectively). Multiple linear regression analysis revealed age (beta: 0.201, p=0.041) and HDL-C (beta: 0.390, p<0.001) as independent correlates of plasma catestatin concentration. Additionally, male gender (beta:-0.330, p=0.001) and plasma catestatin (beta: 0.299, p=0.002) were significantly associated with HDL-C concentrations. Conclusion: We documented that plasma catestatin is an independent predictor of high-density lipoprotein cholesterol. In addition to antihypertensive effects, catestatin appears to be related to improved lipid and metabolic profiles. Coexistence of low catestatin levels with low HDL-C may provide a probable mechanism for the predictive value of low HDL-C for increased hypertension and cardiovascular events.

Bilirubin Level is Associated with Left Ventricular Hypertrophy Independent of Blood Pressure in Previously Untreated Hypertensive Patients.

Background and Objectives Left ventricular hypertrophy (LVH), a sign of subclinical cardiovascular disease, is an important predictor of cardiovascular morbidity and mortality. The aim of our study was to determine the association of left ventricular mass (LVM) with possible causative anthropometric and biochemical parameters as well as carotid intima-media thickness (CIMT) and brachial flow-mediated dilation (FMD) as surrogates of atherosclerosis and endothelial dysfunction, respectively, in previously untreated hypertensive patients. Subjects and Methods Our study included 114 consecutive previously untreated hypertensive patients who underwent echocardiography and ultrasonography to evaluate their vascular status and function via brachial artery CIMT and FMD. Results Among all study parameters, age, systolic blood pressure (BP), diastolic BP, pulse pressure, plasma glucose, uric acid, total bilirubin, direct bilirubin, hemoglobin, and CIMT were positively correlated with the LVM index. Multiple logistic regression analysis revealed that office systolic BP, age, male gender, and total bilirubin were independent predictors of LVH. Conclusion Bilirubin seems to be related to LVM and LVH. The positive association of bilirubin with these parameters is novel and requires further research.

Relation between Increased P Wave Duration Variability and Coronary Artery Disease with High Risk Parameters: Scintigraphic Evaluation

Obesity is a complex, multifaceted condition. Increasing evidence suggests that obesity is not simply a problem of will power or self-control but a complex disorder involving appetite regulation and energy metabolism that is associated with a variety of comorbid conditions. Overweight and obesity are major preventable and modifiable risk factors for disease, but research affirms that weight loss and maintenance can be accomplished only through a reduction in the number of calories a person consumes and an increase in exercise. To achieve long-term weight loss and maintenance requires a life-long commitment to behavioral change. Many different approaches to obesity treatment interventions have been evaluated to achieve weight loss and weight maintenance. According to the findings, in order to achieve best treatment outcomes, it is recommended that the combination of dietary therapy with low-calorie diet, increased physical activity, and the inclusion of behavioral interventions should be incorporated. Weight loss could be achieved by different weight loss programmes such as a oneyear weight loss programme in health care centres and a one-year dietary based weight loss programme. Moreover, the attendance at weight loss sessions has been found to be more important in successful weight loss than the component of the diet. Behavioral approachs are not used alone but in conjunction with other approaches like diet and exercise strategies, and they have been shown to be effective. The main strategies employed in behavioural therapy for weight control are self-monitoring, stress management, stimulus control, problem solving, cognitive strategies, and social support.*Self-monitoring. Keeping an extended food and exercise diary helps to give insight into personal behavior and to bring unrecognized behavior to light. *Stress management. Stress can trigger dysfunctional eating patterns. Coping strategies, meditation, and relaxation techniques can be learned to reduce stress. *Stimulus control techniques focus the patients attention on changing the antecedents of overeating and underexercising. *Problem solving. Patients engage in self-correction of problem areas related to their eating and physical activity. *Cognitive strategies. Cognitive restructuring requires modifying negative thoughts, unrealistic goals, and inaccurate beliefs about weight loss and preparing in advance for relapses. *Social support. A strong system of social support can facilitate weight reduction. Family members, friends, or colleagues can assist in maintaining motivation and providing positive reinforcement. Finally, patients should be encouraged to take themselves, their health, and, thus, their weight seriously rather than attempting to lose weight so they can like themselves. Reaffirming the patients self-worth, independent of body weight, is perhaps one of the most powerful interventions a health care provider can provide an obese patient.