Decreased heart rate recovery may predict a high SYNTAX score in patients with stable coronary artery disease

An impaired heart rate recovery (HRR) has been associated with increased risk of cardiovascular events, cardiovascular, and all‐cause mortality. However, the diagnostic ability of HRR for the presence and severity of coronary artery disease (CAD) has not been clearly elucidated. Our aim was to investigate the relationship between HRR and the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score in patients with stable CAD (SCAD). A total of 406 patients with an abnormal treadmill exercise test and ≥50% coronary stenosis on coronary angiography were included. The HRR was calculated by subtracting the HR in the first minute of the recovery period from the maximum HR during exercise. The SYNTAX score ≥23 was accepted as high. Correlation of HRR with SYNTAX score and independent predictors of high SYNTAX score were determined. A high SYNTAX score was present in 172 (42%) patients. Mean HRR was lower in patients with a high SYNTAX score (9.8 ± 4.5 vs. 21.3 ± 9, p < 0.001). The SYNTAX score was negatively correlated with HRR (r: -0.580, p < 0.001). In multivariate logistic regression analysis, peripheral arterial disease (OR: 13.3; 95% CI: 3.120–34.520; p < 0.001), decreased HRR (OR: 0.780; 95% CI: 0.674–0.902; p = 0.001), peak systolic blood pressure (OR: 1.054; 95% CI: 1.023–1.087; p = 0.001), and peak HR (OR: 0.950; 95% CI: 0.923–0.977; p < 0.001) were found to be independent predictors of a high SYNTAX score. Our results showed that HRR is significantly correlated with the SYNTAX score, and a decreased HRR is an independent predictor of a high SYNTAX score in patients with SCAD

Evaluation of social media posts for touristic places with artificial ıntelligence methods: the case of Artvin province

Sosyal medya günümüzde birçok alanda olduğu gibi turizm alanında da kullanılmakta ve bu kullanım neticesinde büyük miktarda veri açığa çıkmaktadır. Bu veriler hem turizm tüketicileri için hem de turizm yöneticileri için yararlı bilgiler içermektedirler. Ancak sosyal medya paylaşımlarının farklı türlerde veriler içermesi bu verileri analiz etmeyi ve verilerden anlamlı bilgiler elde etmeyi zorlaştırmaktadır. Bu bilgi keşfi süreci için geleneksel analiz yöntemlerinin ötesinde yöntemlere ihtiyaç duyulmaktadır. Bu çalışmada turistlerin ziyaret ettikleri yerlere ilişkin sosyal medya ortamında paylaştıkları yorumlar ve fotoğraflar üzerinde duygu durumu tespiti yapmak amaçlanmıştır. Duygu durumu tespiti için metin verileri üzerinde destek vektör makineleri algoritması, fotoğraf verilerinde ise evrişimli sinir ağları kullanılmıştır. Çalışmada ele alınan verilerin analizi için duygu analizi, konu modelleme analizi, trend analizi ve korelasyon analizi kullanılmıştır. Gerçekleştirilen analizler neticesinde çalışmanın uygulama alanını ziyaret eden ziyaretçilerin duygu durumları, duygu durumlarının zamana göre değişimi, memnun oldukları ve memnun olmadıkları konular tespit edilmiş, elde edilen bulgular yol ve hava durumu gibi dışsal verilerle ilişkilendirerek doğrulanmıştır. Bu çalışma ile turizm işletmesi yöneticileri ve politika geliştiricilere örnek bir çalışma yanında bir değerlendirme yaklaşımı da sunulmuştur.Today, as in many fields, social media is also used in tourism. This produce a large amount of data which is also called big data. These data contain useful information for both tourism consumers and tourism managers. However, the fact that social media posts contain different types of data makes it difficult to analyze these data and to obtain meaningful information from the data. Methods beyond traditional data analysis approaches are needed for this knowledge discovery process. This study, it is aimed to determine the mood on the comments and photos shared by the tourists on social media about the places they visited. For mood detection, a support vector machines algorithm was used on text data and convolutional neural networks were used on photographic data. As a result of the analyzes carried out, the emotional states of the visitors who visited the application area of the study, the change of their moods according to time, the subjects they were satisfied and dissatisfied were determined, and the findings were verified by associating them with external data such as road and weather conditions. Sentiment analysis, subject modeling analysis, trend analysis and correlation analysis were used for analysis. With the study, an evaluation approach was presented to tourism business managers and policy developers as well as an exemplary stud

Prevalence of Fibromyalgia Syndrome and Its Correlations with Arrhythmia in Patients with Palpitations

Objective: It is aimed to determine the prevalence of fibromyalgia syndrome (FMS) and its correlations with arrhythmia in patients with palpitations. Material and Methods: Sixty-two patients who underwent electrophysiological study (EPS) due to palpitation complaints in Cardiology department and 40 healthy controls were included in the study. The precise diagnosis of arrhythmia was established using EPS. All participants were screened for FMS using American College of Rheumatology 2010 Fibromyalgia diagnostic criteria. Clinical assessments included measurement of severity of pain, fatigue and morning fatigue with visual analog scale (VAS), functional status with Fibromyalgia Impact Questionnaire (FIQ), and anxiety/depression with Hospital Anxiety and Depression Scale (HAD). Results: FMS was diagnosed in 22 of the 62 patients (36%), and 4 of the 40 healthy controls (10%) (p 0.05). EPS+ patients with FMS had higher fatigue levels, HAD and FIQ scores than EPS− patients, although statistically insignificant. HV durations were statistically longer in the EPS− subgroup (p < 0.05) but other EPS data were similar. Conclusion: FMS frequency and HAD anxiety scores were found to be higher in patients with palpitation complaints. However, we found no association between arrhythmia, EPS parameters and FMS. In our clinical practice we should keep in mind to carry out assessments in terms of FMS in patients with palpitation

Association between ocular trauma and attention‑deficit/hyperactivity disorder in adult patients

Purpose: To investigate the potential relationship between ocular trauma and attention-deficit/hyperactivity disorder (ADHD)-related clinical outcomes in adults. Methods: This prospective case-control study included 108 ocular trauma patients and 90 age-sex-matched healthy control. The ocular trauma group was separated into the subgroups home accident, outdoor activity, and work related in terms of the reasons for ocular trauma, and as ocular surface problems, blunt trauma-related, and open globe injury in terms of the clinical findings. The ADHD-related clinical outcomes were evaluated using the Wender-Utah Rating Scale (WURS). The outcomes were compared between ocular trauma and control groups, and ocular trauma subgroups. Results: The demographic characteristics of ocular trauma groups and controls were similar (P > 0.05, for all). In comparison to the control group, the ocular trauma group had higher total WURS score and WURS subscale scores, but not significantly (P > 0.05, for all). According to comparisons of the subgroups separated by the reasons, there was significant difference in the mean behavioral problems/impulsivity scores in favor of outdoor activities (P = 0.015). On the other hand, the mean scores for WURS subscales of the subgroups separated by the clinical findings were similar (P > 0.05, for all). Conclusion: WURS scores in ocular trauma patients are similar to control; however, the score in behavioral problems/impulsivity subscales is higher for ocular trauma caused by outdoor activities

Türkiye’deki kardiyologların mevcut “malpraktis” sistemi ve alternatif “malpraktis” sistem önerisi hakkındaki görüşleri

WOS: 000418480800009PubMed ID: 28990944Objective: Cardiologists participate in the diagnosis and interventional treatment of numerous high-risk patients. The goal of this study was to investigate how the current malpractice system in Turkey influences cardiologists' diagnostic and interventional behavior and to obtain their opinions about an alternative patient compensation system. Methods: The present cross-sectional study assessed the practice of defensive medicine among cardiologists who are actively working in various types of workplace within the Turkish healthcare system. A 24-item questionnaire was distributed to cardiology residents, specialists, and academics in Turkey in print format, by electronic mail, or via cell phone message. Results: A total of 253 cardiologists responded to the survey. Among them, 29 (11.6%) had been sued for malpractice claims in the past. Of the cardiologists who had been sued, 2 (6.9%) had been ordered to pay financial compensation, and 1 (3.4%) was given a sentence of imprisonment due to negligence. In all, 132 (52.8%) of the surveyed cardiologists reported that they had changed their practices due to fear of litigation, and 232 (92.8%) reported that they would prefer the new proposed patient compensation system to the current malpractice system. Among the cardiologists surveyed, 78.8% indicated that malpractice fear had affected their decision-making with regard to requesting computed tomography angiography or thallium scintigraphy, 71.6% for coronary angiography, 20% for stent implantation, and 83.2% for avoiding treating high-risk patients. Conclusion: The results of this survey demonstrated that cardiologists may request unnecessary tests and perform unneeded interventions due to the fear of malpractice litigation fear. Many also avoid high-risk patients and interventions. The majority indicated that they would prefer the proposed alternative patient compensation system to the current malpractice system.Amaç: Kardiyologlar birçok riskli hastanın teşhis, tedavi ve girişimsel tedavisiyle uğraşmaktadırlar. Bu çalışmada Türkiye’deki mevcut “malpraktis” sisteminin kardiyologların tanı ve tedavi yaklaşımlarını nasıl etkilediğini ve önerdiğimiz yeni hasta tazminat sistemine yaklaşımlarını inceledik. Yöntemler: Bu kesitsel çalışmada Türk sağlık sisteminin farklı seviyelerinde çalışan kardiyologların mesleki risk algılarının uygulamalarına etkisini araştırma amacıyla 24 soruluk bir anketi asistan, uzman ve öğretim üyelerine elektronik posta, basılı evrak ve cep telefonu mesajı ile gönderildi. Bulgular: Ankete toplam 253 kardiyolog cevap verdi. Bunların 29’una (%11.6) geçmişte malpraktis talepleri için dava açılmıştı. Dava edilen kardiyologların 2’sine (%6.9) maddi tazminat talebinde bulunuldu, 1’ine (%3.4) ihmal nedeniyle hapis cezası verildi. Bunun yanında 132 (%52.8) kardiyolog “malpraktis” korkusu nedeni ile pratiklerinde değişiklik yaptıklarını bildirmekteydi. Ayrıca 232 (%92.8) kardiyolog önerdiğimiz hasta tazminat sistemini tercihe değer buluyordu. Kardiyologların %78.8’i bilgisayarlı tomografik anjiyografi (BTA) veya perfüzyon sintigrafisi, %71.6’sı koroner anjiyografi, %20 ’si stent implantasyonu, %83.2’si ise yüksek riskli hastalardan kaçınma kararlarında malpraktisten kaçınmanın etkili olduğu kanaatindeydi. Sonuç: “Malpraktis” korkusu kardiyologlarda yüksek oranlarda gereksiz test isteme, girişim yapma veya yüksek riskli hastalardan kaçınma eğilimi yaratmaktadır. Önerdiğimiz yeni “malpraktis” sistemi çalışmaya katılan kardiyologların büyük çoğunluğu tarafından mevcut sisteme tercih edilir bulunmuştur.Cardiovascular Academy Society of TurkeyThis work was supported by the Cardiovascular Academy Society of Turkey

Evaluating the Results of Retrograde Intramedullary Nailing for Distal Femur Fractures: A Level 3 Trauma Center Retrospective Study

Aim: Distal femur fractures can be treated with modern anatomic plates and nails. This study aimed to examine the clinical and radiological results of displaced distal femur fractures in adult people who had been treated with a retrograde intramedullary nail (RIN).Material and Methods: The study included all patients who underwent RIN surgery for distal femur fracture between January 2013 and April 2018 in a level 3 trauma center. Patients were divided into two groups based on fracture pattern: open fracture and closed fracture. The preoperative and postoperative clinical, radiological and functional characteristics of patients who had RIN for a distal femur fracture were analyzed.Results: Thirty patients were included in the study. 21 (70%) patients were male. The median age of the patients was 39 (range, 18-58) years. 17 (56.7%) of the affected femur were left-sided. The etiology of the fractures was traffic accident and fall in 19 (63.3%) patients and gunshot injury in 11 (36.7%) patients. Of the patients, 17 (56.7%) were closed fractures and 13 (43.3%) were open fractures. There were no significant differences between two groups related to the surgery time (p=0.086), fluoroscopy time (p=0.805), blood loss (p=0.967), and hospitalization time (p=0.967), clinical pain and function scores (p=0.341, p=0.902), and union time (p=0.385) at the postoperative period.Conclusion: RIN is a minimally invasive method that may prevent excessive blood loss and decrease the duration of surgery time. It is an effective and reliable surgical intervention that should be considered for the treatment of distal femur fractures

Znaczenie wskaźnika HATCH w prognozowaniu skutecznego powrotu do rytmu zatokowego po kardiowersji elektrycznej z powodu migotania przedsionków

Background: The HATCH score predicts the development of persistent and permanent atrial fibrillation (AF) one year after spontaneous or pharmacological conversion to sinus rhythm in patients with AF. However, it remains unknown whether HATCH score predicts short-term success of the procedure at early stages for patients who have undergone electrical cardioversion (EC) for AF. Aim: The present study evaluated whether HATCH score predicts short-term success of EC in patients with AF. Methods: The study included patients aged 18 years and over, who had undergone EC due to AF lasting less than 12 months, between December 2011 and October 2013. HATCH score was calculated for all patients. The acronym HATCH stands for Hypertension, Age (above 75 years), Transient ischaemic attack or stroke, Chronic obstructive pulmonary disease, and Heart failure. This scoring system awards two points for heart failure and transient ischaemic attack or stroke and one point for the remaining items. Results: The study included 227 patients and short-term EC was successful in 163 of the cases. The mean HATCH scores of the patients who had undergone successful or unsuccessful EC were 1.3 ± 1.4 and 2.9 ± 1.4, respectively (p &lt; 0.001). The area of the HATCH score under the curve in receiver operating characteristics analysis was (AUC) 0.792 (95% CI 0.727–0.857, p &lt; 0.001). A HATCH score of two and above yielded 77% sensitivity, 62% specificity, 56% positive predictive value, and 87% negative predictive value in predicting unsuccessful cardioversion. Conclusions: HATCH score is useful in predicting short-term success of EC at early stages for patients with AF, for whom the use of a rhythm-control strategy is planned.  Wstęp: Skala HATCH umożliwia prognozowanie rozwoju przetrwałego i utrwalonego migotania przedsionków (AF) w ciągu roku po samoistnym lub spowodowanym leczeniem powrocie do rytmu zatokowego u chorych z AF. Nie wiadomo jednak, czy wskaźnik HATCH jest przydatny w określaniu prawdopodobieństwa powodzenia zabiegu w perspektywie krótkoterminowej we wczesnym stadium u pacjentów, których poddano kardiowersji elektrycznej (EC) z powodu AF. Cel: Celem pracy była ocena, czy wskaźnik HATCH umożliwia prognozowanie wczesnego powodzenia EC u chorych z AF. Metody: Do badania włączono chorych w wieku 18 i starszych, których w okresie od grudnia 2011 r. do października 2013 r. poddano EC z powodu AF występującego krócej niż 12 miesięcy. U wszystkich chorych obliczono wskaźnik HATCH. Akronim HATCH oznacza Hypertension (nadciśnienie tętnicze), Age (wiek, powyżej 75 lat), Transient ischaemic attack or stroke (przemijające niedokrwienie mózgu lub udar mózgu), Chronic obstructive pulmonary disease (przewlekła obturacyjna choroba płuc) i Heart failure (niewydolność serca). W tej skali niewydolność serca i przemijające niedokrwienie mózgu lub udar oznaczają 2 punkty, natomiast obecność każdego z pozostałych elementów — 1 punkt. Wyniki: W badaniu uczestniczyło 227 chorych. W przypadku 163 z nich odnotowano powodzenie EC we wczesnym okresie po zabiegu. Średnie wartości w skali HATCH u chorych, u których przeprowadzono skuteczną i nieskuteczną EC, wynosiły odpowiednio 1,3 ± 1,4 i 2,9 ± 1,4 (p &lt; 0,001). Pole pod krzywą (AUC) wskaźnika HATCH w analizie krzywych ROC wynosiło 0,792 (95% CI 0,727–0,857; p &lt; 0,001). Wskaźnik HATCH ≥ 2 pozwalał na prognozowanie niepowodzenia kardiowersji, przy czym czułość tego parametru wynosiła 77%, swoistość — 62%, wartość predykcyjna dodatnia — 56%, a wartość predykcyjna ujemna — 87%. Wnioski: Skala HATCH jest przydatna w prognozowaniu szans powodzenia EC we wczesnym okresie po zabiegu u chorych z AF, u których planuje się zastosowanie strategii kontroli rytmu serca.