Zekeriya Kucukdurmaz

Cardiac findings in children with Crimean-Congo hemorrhagic fever

Summary Background Crimean-Congo hemorrhagic fever (CCHF) involves the multi-organ systems. The involvement of the heart in adult patients has been described previously. We investigated the electrocardiographic and echocardiographic findings of pediatric patients with CCHF. Material/Methods Patients younger than 16 years of age diagnosed with CCHF were enrolled in the study. The diagnosis of CCHF infection was based upon typical clinical and epidemiological findings and serological tests. All patients underwent a thorough cardiologic evaluation. A standard 12-lead electrocardiography and echocardiography were performed. Results Twenty-three consecutive patients who were hospitalized with diagnosis of CCHF were enrolled in the study (mean age: 12±2 years, 6 female). All electrocardiographic parameters were within normal ranges according to age. Seven patients (30%) had minimal (<1 cm) pericardial effusion. Fifteen (65%) patients had segmental wall motion abnormalities (hypokinesia). A second echocardiography revealed that all wall motion abnormalities had disappeared; the pericardial effusion persisted in only 2 of 7 patients (28%). Conclusions Cardiac involvement appears to be more frequent in children with CCHF disease than in adults, but it is slighter and almost totally reversible; however, the course of the disease in children is milder than it is in adults.

Blood pressure response to exercise is exaggerated in normotensive diabetic patients

Abstract Introduction. The aim of this study was to investigate the blood pressure (BP) response to exercise in normotensive patients with type II diabetes mellitus (DM). Materials and methods. A cross-sectional study was carried out on 75 normotensive subjects with type 2 DM (group 1), and 70 age-gender matched normotensive healthy volunteers (group 2). Treadmill exercise test, 24-h ambulatory BP monitoring (ABPM) were performed for each patients and healthy volunteers. Results. There were 67 patients (mean age 52 ± 9 years and 42% male) in group 1 and 68 healthy volunteers (mean age 51 ± 7 years and 43% male) in group 2. Eight patients from group 1 and 2 subjects from group 2 were excluded because of high BP on ABPM. Groups were similar for systolic BP (SBP) and diastolic BP (DBP) on office measurements and on ABPM. Groups were similar for rest SBP, DBP, heart rate, exercise duration on exercise test. Peak SBP was significantly higher in group 1 than in group 2, but peak DBP was not (196.9 ± 18 vs 165.9 ± 18.6 mmHg, p 0.001; 88.1 ± 11.6 vs 86.2 ± 8.7 mmHg, p = 0.283, respectively). Hypertensive response to exercise (HRE) was more frequent in group 1 than in group 2 [39 (58%) vs 6 (9%), p 0.001]. Independent predictors of peak SBP were DM, office SBP and male gender, while independent predictors of HRE were DM, office SBP and age in multivariate analysis. Conclusions. SBP response to exercise is exaggerated in normotensive diabetic patients compared with non-diabetic subjects. DM, office SBP and male gender are independent predictors of peak SBP. DM, office SBP and age are independent predictors of HRE.

The evaluation of hypoxia-inducible factor 1 in N-nitro-L-arginine methyl ester preeclampsia model of pregnant rats.

Objective The objective of the study was to evaluate hypoxia-inducible factor 1 (HIF-1), which plays a major role in the stimulation of angiogenesis in placental tissues, by using immunohistochemical staining in preeclampsia model of rats, developed by N-nitro-L-arginine methyl ester (L-NAME) Methods Thirty pregnant rats were randomized into 2 groups (n = 15 in each group) on day 10 of gestation. L-NAME was given to rats in the study group by gavage. On days 0, 10, and 20 of gestation, rats were weighted, and urine protein values and blood pressures were measured. Hypoxia-inducible factor 1 expressions were assessed with immunohistochemical staining by using avidin-biotin peroxidase via selecting preparation. Results Systolic and diastolic blood pressures and urine protein value of L-NAME group on day 20 of gestation were found to be significantly higher than those obtained on days 0 and 10 of gestation in the same group and those obtained on day 20 of gestation in the sham group (P < 0.05). Maternal weight, number of fetuses, and mean fetal weight of rats in L-NAME group on day 20 of gestation were found to be significantly lower than those obtained from rats in the sham group (P < 0.05). Regarding HIF-1 expression of placental tissues, mild immunohistochemical staining was found in 2 rats (13.4%) and moderate in 13 rats (86.6%) in the L-NAME group. A significant difference was found in terms of HIF-1 positivity in the maternal placentas of both groups (P < 0.05). Conclusions L-NAME preeclampsia model of pregnant rats is consistent with human preeclampsia in terms of hypertension, proteinuria, and intrauterine growth retardation; in addition, it also shows evidence of placental hypoxia findings.

Abnormal Heart Rate Recovery in Stable Heart Failure Patients

Heart rate decrease after exercise, that is associated with reactivation of parasympathetic system, is important, as it is also associated with mortality. Previous studies have shown that this is an independent mortality predictor in patients having no coronary artery disease and having normal left ventricular function. In our study, we aimed to study heart rate recovery (HRR) after exercise in patients having impaired left ventricular function.

Giant Left Atrium

A 58-year-old woman with a history of mitral valve replacement (MVR) 17 years ago was admitted to our outpatient clinic with shortness of breath and a nonproductive cough. On physical examination, her blood pressure was 90/ 60 mmHg, and heart rate was 122 beats/min. Distended neck veins were noted, basal crepitations were heard in lungs, and there was grade I peripheral edema. A prosthetic valve sound and a grade III pansystolic murmur were present along the left mid-clavicular line. ECG (Cardioline Delta 60 Plus CP/1 version, Remco Italy Cardioline, Milan, Italy) showed atrial fibrillation with a ventricular rate of 110 beats/min. Laboratory evaluation revealed a creatinine level of 1.36 mg/dL (0.4–1.0), an albumin level of 3.8 mg/dL (3.2– 4.8), and pro-brain natriuteric peptide level of 3050 ng/L (12–133). Chest x-ray revealed marked cardiomegaly (Fig. 1). Echocardiographic examination (Vivid 7 pro, GE, Horten, Norway) showed normal functioning MVR with massive biatrial enlargement (left larger than right), moderate mitral regurgitation, severe tricuspid regurgitation, and mildly depressed left ventricular systolic function. The left atrium, measuring 209 9 96 mm, was so large that it was not possible to fit it to the screen in its entirety (Fig. 2). Giant left atrium is a condition in which the left atrial diameter exceeds 65 mm or one that touches the right lateral thoracic wall. This condition is commonly caused by rheumatic mitral disease and malfunctioning replaced mitral valve. Dilatation is the left atrial compensation mechanism due to the chronic pressure overload in mitral stenosis, to balance pulmonary capillary wedge pressure. It may be misdiagnosed as pleural effusion or a mass, so the clinician must be alert to avoid from further invasive examinations like pleurocentesis or biopsy, which may be associated with dangerous complications. References 1. Hurst JW: Memories of patients with giant left atrium. Circulation 2001;104:2630–2631. 2. Akdemir I, Davutoglu V, Aksoy M: Giant left atrium, giant thrombus, and left atrial prolapse in a patient with mitral valve replacement. Echocardiography 2002;19(8):691– 692. Figure 1. Increased cardiothoracic index and left atrial size in x-ray.

Red cell distribution width and hypertensive response to exercise in patients with type 2 diabetes mellitus

Abstract Objective: There is no study about hypertensive response to exercise (HRE), which is a marker of unborn hypertension (HT), and red cell distribution width (RDW) association, in diabetic normotensive patients. So, we aimed to investigate any correlation among RDW and HRE in normotensive type 2 diabetic patients. Methods: Consecutive type 2 diabetic patients without history of HT and with normal blood pressure (BP) on ambulatory BP monitoring were included to the study. We divided the patients into two groups depending on their peak systolic BP on exercise; HRE (Group 1) or normal response to exercise (Group 2). Results: Data of 75 diabetic patients (51.9 ± 9.7) were analyzed (31 male (48%)). Their mean RDW was 13.11 ± 0.46. Patients with HRE were significantly older than patients without HRE. Smoking was more frequent in Group 2. Gender distribution and body mass index were similar between the groups. Else hemoglobin, hematocrit, red blood cell count and RDW values were not significantly different. Office systolic BP and diastolic BP, daytime and 24-h systolic BP were significantly higher in Group 1 but heart rate was similar between the groups. Conclusions: This study revealed that RDW do not differ between diabetic normotensive patients with HRE or not.

Hypertensive response to exercise in dipper and non-dipper normotensive diabetics.

Abstract Non-dipper blood pressure (NDP) as an indicator of autonomic dysfunction could be associated with hypertensive response to exercise (HRE) in diabetic patients. HRE was determined as a predictor of development of unborn hypertension. We aimed to investigate if any correlation among NDP and HRE in normotensive type 2 diabetic patients. A total of 59 consecutive type 2 diabetic patients without history of hypertension and with normal blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) were enrolled to the study. We divided the study population in to two groups depending on their BP on ABPM as dipper (group 1) or non-dipper (group 2). There were 22 patients (mean age 49.5 ± 7 and 10 male) in group 1 and 37 patients (mean age 53.1 ± 10 and 14 male) in group 2. Daytime diastolic and mean BP of dippers and night time systolic and mean BP of non-dippers were significantly higher. HRE was not significantly different between groups (59% vs. 62%, p = 0.820). Hemodynamic parameters during the exercise test were similar. At multivariate linear regression analysis, resting office systolic blood pressure (SBP) (r = 0.611, p < 0.001), male sex (r = 0.266, p = 0.002) and age (r = 0.321, p = 0.010) were independently correlated with peak exercises SBP. Logistic regression analyses identified the resting office SBP (OR 1.191, 95% CI 1.080–1.313; p < 0.001) and age (OR 1.161, 95% CI 1.038–1.298; p = 0.012) were independent predictors of HRE. This study revealed that HRE is not related with non-dipper BP in diabetic patients. This study could inspire to further studies to explore the main reasons of HRE in diabetes mellitus.