The effects of baseline heart rate recovery normality and exercise training protocol on heart rate recovery in patients with heart failure

Objective: It is unclear which exercise training protocol yields superior heart rate recovery (HRR) improvement in heart failure (HF) patients. Whether baseline HRR normality plays a role in the improvement is unknown. We hypothesized that an exercise training protocol and baseline HRR normality would be factors in altering HRR in HF patients. Methods: In this prospective, randomized, controlled and 3 group parallel study, 41 stable HF patients were randomly assigned to 3-timesweekly training sessions for 12 weeks, consisting of i) 30 minutes of interval training (IT) (n=17, 63.7±8.8 years old) versus ii) 30 minutes of continuous training (CT) (n=13, 59.6±6.8 years old) versus iii) no training (CON) (n=11, 60.6±9.9 years old). Each patient had cardiopulmonary exercise testing before and after the training program. Maximum heart rates attained during the test and heart rates at 1 and 2 min (HRR1 and HRR2) during the recovery phase were recorded. Paired samples t-test or Wilcoxon signed-rank test was used for comparisons before and after training. One-way ANOVA or Kruskal-Wallis variance analysis was used for comparisons among groups. Results: HRR1 was unchanged after training. HRR2 improved in the IT group after training, and post-training HRR2 values were significantly faster in the IT group than in controls. Both HRR1 and HRR2 was significantly faster, irrespective of exercise protocol in patients with abnormal baseline values after training. Conclusion: HRR1 did not improve after training. HRR2 improved only in the IT group. Both HRRs in patients with abnormal baseline values improved after both exercise protocols. IT might be superior to CT in improving HRR2. Baseline HRR might play a role in its response to exercise. © 2015 by Turkish Society of Cardiology

Predictive power of different obesity measures for the presence of diastolic dysfunction

Objective: Body mass index (BMI) and waist circumference (WC) as measures of obesity have some limitations. The aim of this study was to evaluate whether one measure could predict the presence of diastolic dysfunction (DD) more accurately than the other measures. Methods: A total of 91 obese patients without any other risk factors for DD were prospectively enrolled. Echocardiographic examination was performed. DD was defined and categorized according to recent guidelines. The study participants were divided into 2 groups according to the presence of DD. Weight, height, and WC were measured; BMI and waist-to-hip ratio (WHR) were calculated; and a body shape index (ABSI) was calculated as WC/(BMI2/3height1/2). The associations between ABSI, BMI, WHR, and WC and the presence of DD were examined using logistic regression analyses. Analysis of covariance was used to examine the differences. Results: WC and BMI were significantly greater in subjects with DD (p=0.049 and 0.051, respectively). A greater BMI, WC, and WHR increased the risk of the presence of DD (BMI-DD: odds ratio [OR]=1.096, p=0.024; WC-DD: OR=1.059, p=0.007; WHR-DD: OR=2.363, p=0.007). After adjustment for age and sex, only BMI continued to be significantly associated with DD (p=0.031). ABSI was not associated with DD. Conclusion: After adjustment for age and sex, BMI was the only predictor of DD in obesity. Despite its limitations, BMI may still be a potentially more accurate measure of DD compared with other obesity measures. © 2018 Turkish Society of Cardiology

The Relationship of Hemogram Parameters and Night Desaturation in Patients Diagnosed with Obstructive Sleep Apnea Syndrome

Objective: Obstructive Sleep Apnea syndrome (OSAS) is a disease characterized by recurrent complete (apnea) or partial (hypopnea) upper respiratory tract obstructions episodes during sleep and often a decrease in blood oxygen saturation. Night hypoxias and sympathetic activity increase of arousals in OSAS are thought to stimulate that endothelial dysfunction and hypercoagulability. Materials and Methods: In this study, it was aimed to evaluate the relationship between the severity of the disease and the night hypoxia severity with hemogram parameters in patients diagnosed with OSAS who examined in our clinics. A total of 94 cases were included in the study, including 24 controls, 24 mild, 23 moderate, and 23 severe OSAS. Results: The mean and minimum oxygen saturation values in polisomnography with the number of neutrophils and neutrophil/lymphocyte (N/L) ratio were negatively correlated in the mild and severe OSAS groups. A negative correlation was observed between erythrocyte distribution width (EDW) and, mean oxygen saturation and minimum oxygen saturation in moderate and severe OSAS. When the mean and minimum oxygen saturation with regression analysis of EDW and N/L ratio were examined in each three groups; the 1 unit decrease in the minimum oxygen saturation increases the N/L ratio by 0.5-fold (p=0.02) in the mild OSAS, 0.5-fold (p=0.01) in the severe OSAS and it increases the EDW by ratio 0.5-fold (p=0.02) in the moderate OSAS. The 1 unit decrease in the mean oxygen saturation increases the N/L ratio by 0.4-fold (p=0.04) and the EDW by 0.8-fold (p=0.001) in the severe OSAS. Conclusion: As long as the OSAS severity increases, it is determined that the hematocrit values of patients increasing. However, as patients’ sleep desaturation increase, we can see that EDW, the number of neutrophils, and N/L ratio also increasing. This situation suggests that the local inflammation caused by both mechanical stress and ischemia-reperfusion cycles in the respiratory tract in OSAS is a consequence of spillage into the systemic circulation

How Do Patients Understand Safety for Cardiac Implantable Devices? Importance of Postintervention Education

This study was designed to assess the effect of patient education on the knowledge of safety and awareness about living with cardiac implantable electronic devices (CIEDs) within the context of phase I cardiac rehabilitation. Methods. The study was conducted with 28 newly implanted CIED patients who were included in "education group (EG)". Patients were questioned with a survey about living with CIEDs and electromagnetic interference (EMI) before and 1month after an extensive constructed interview. Ninety-three patients who had been living with CIEDs were included in the "without education group (woEG)". Results. Patients in EG had improved awareness on topics related to physical and daily life activities including work, driving, sports and sexual activities, EMI of household items, harmful equipment, and some of the medical devices in the hospital setting (p<0.05). Patients in EG gave significantly different percent of correct answers for doing exercise or sports, using the arm on the side of CIEDs, EMI of some of the household appliances, medical devices, and all of the harmful equipment compared to woEG (p<0.05). Conclusion. It was demonstrated that a constructed education interview on safety of CIEDs and living with these devices within the context of phase I cardiac rehabilitation is important for improving the awareness of patients significantly. Thus, patients might achieve a faster adaptation to daily life and decrease disinformation and misperceptions and thus promote the quality of life after the device implantation

Contribution of heme oxygenase 2 to blood pressure regulation in response to swimming exercise and detraining in spontaneously hypertensive rats

Background: We aimed to determine the effects of exercise followed by detraining on systolic blood pressure (SBP), heme oxygenase 2 (HO-2) expression, and carboxyhemoglobin (COHb) concentration in spontaneously hypertensive rats (SHR) to explain the role of carbon monoxide (CO) in this process. Material/Methods: Animals were randomized into exercised and detrained groups. Corresponding sedentary rats were grouped as Time 1–2. Swimming of 60 min/5 days/week for 10 weeks was applied. Detraining rats discontinued training for an additional 5 weeks. Gene and protein expressions were determined by real-time PCR and immunohistochemistry. Results: Aorta HO-2 histological scores (HSCORE) of hypertensive rats were lower, while SBP was higher. Swimming caused enhancement of HO-2 immunostaining in aorta endothelium and adventitia of SHR. Exercise induced elevation of blood COHb index in SHR. Synchronous BP lowering effect of exercise was observed. HO-2 mRNA expression, HSCORE, and blood COHb index were unaltered during detraining, while SBP was still low in SHR. Conclusions: CO synthesized by HO-2 at least partly plays a role in SBP regulation in the SHR-and BP-lowering effect of exercise. Regular exercise with short-term pauses may be advised to both hypertensives and individuals who are at risk. © Med Sci Monit

Çok Kategorili Hastalık Durumlarında Tanısal Modele Yeni Bir Belirteç Eklenmesinin Tanı Performansındaki Değişime Etkisinin İncelenmesi

Accurate assessment of the risks in the field of health, which are derived from diagnostic prediction models is important in identifying patients and healthy people. In some cases, classifications may consist of more than two categories. By using the ROC analysis method, which is the most commonly method in two-category classifications, some methods have been developed for multicategory classification problems. These are HUM (Hypervolume Under the ROC Manifold) and CCP (Correct Classification Probability). However, these methods are considered to be unsuccessful in measuring improvement in the performance of the model that occurs when a new biomarker is added to an existing model. Therefore, when a new biomarker is added to the model, two performance measures have been developed to show the performance of the new classification result. These are NRI (Net Reclassification Improvement) and IDI (Integrated Discrimination Improvement) methods. In this study, we aim to investigate the relationship between HUM, CCP measures, which are the performance measures used in multi-category classification models, and NRI, IDI which measure the effect of markers affecting model performance. Considering the type of dependent variable (ordinal and nominal), the effect of the order of adding the markers to the model performance was investigated. Investigations were made with real data sets and a simulation study. In the simulation study, we simulated data based on the correlation structure with low, medium and strong magnitude in both positive and negative directions for relationships between ordinal dependent variable and the markers and within the markers. According to the simulation results of negative correlation structures, it was seen that there was a positive relationship between HUM, CCP and NRI, IDI. As the NRI and IDI methods are affected by the order of the marker added to the model as opposed to the HUM and CCP methods, it is concluded that the correct classification performance can be improved with fewer markers added in the correct order.Sağlık alanında, hasta ve sağlıklı bireylerin belirlenmesinde, tanı kestirim modellerinden elde edilen risklerin doğru değerlendirilmesi önemlidir. Bazı durumlarda sınıflamalar ikiden fazla kategoriden oluşabilir. İki kategorili sınıflandırmalarda en sık kullanılan yöntem olan ROC analizi yönteminden yola çıkarak çok kategorili sınıflandırma problemleri için HUM (Hypervolume Under The ROC Manifold) ve CCP - Doğru Sınıflandırma Olasılığı (Correct Classification Probability) yöntemleri geliştirilmiştir. Ancak, bu yöntemlerin var olan bir modele yeni bir belirteç eklendiğinde meydana gelen performans artışını ölçümlemede başarılı olmadığı düşünülmektedir. Bu nedenle, yeni bir belirteçin modele eklendiğinde oluşturulan yeni sınıflama sonucunun performansını gösteren iki performans ölçüsü geliştirilmiştir. Bunlar; NRI (Net Reclassification Improvement) ve IDI (Integrated Discrimination Improvement)’dır. Bu çalışmada, çok kategorili sınıflandırma modellerinde kullanılan performans ölçüleri HUM ve CCP’nin, model performansına etki eden belirteçlerin etkisini ölçen NRI ve IDI ile ilişkilerinin incelenmesi amaçlanmıştır. Bağımlı değişkenin farklı türde olduğu durumlar göz önüne alınarak (sıralı ve sırasız), belirteçlerin modele eklenme sırasının model performansına etkisi araştırılmıştır. İncelemeler, gerçek veri setleri ve bir benzetim çalışması ile yapılmıştır. Benzetim çalışmasında, hem belirteçlerin kendi arasında hem de belirteçler ve bağımlı değişken arasında olmak üzere; pozitif, negatif, düşük, orta ve kuvvetli seviyelerde ilişki yapıları ve sıralı yapıda bir bağımlı değişken tasarlanmıştır. Sonuçlarda, negatif ilişki yapısında benzetim yapılarak elde edilen verilerle oluşturulan modellerin performans sonuçlarında, HUM ve CCP yöntemleri ile NRI ve IDI arasında pozitif yönde ilişkiler olduğu görülmüştür. NRI ve IDI yöntemlerinin, HUM ve CCP yöntemlerinin aksine modele eklenen belirtecin sırasından etkilenmesinden dolayı, doğru sırada eklenen daha az sayıda belirteç ile doğru sınıflandırma performansının arttırılabileceği sonucu elde edilmiştir

An alternative approach to the examination of coronary artery disease risk factors: Genetic algorithms

Bilgisayar uygulamalarının her alanda yaygın olarak kullanıldığı günümüzde, potansiyel olarak depolanan veri hacmi hızla artmaktadır. Özellikle sağlık sektöründe depolanan ancak kullanılmayan bilgilerin hayata geçirilmesi işlemi, büyük önem taşımaktadır. Veri tabanlarında toplanan çok büyük hacimli verilerden, anlamlı bilgilerin elde edilmesi için geliştirilen ve özellikle son yıllarda yaygın kullanım alanları bulan yöntemler veri madenciliği yöntemleri olarak adlandırılırlar. Bu alanda birçok algoritmadan faydalanılmaktadır. Genetik Algoritmalar (GA) yönteminde problemler sanal olarak evrimsel süreçten geçirilir ve bu süreç sonunda en iyi sonucu veren çözüme ulaşılmaya çalışılır. Bu çalışmada, GA ile optimize edilerek sınıflama yapılmış olan 20, 50, 100, 500 ve 1000 ağaçlı Random Forest (RF) sonuçları; tek bir Karar Ağacından elde edilen sonuçlarla, GA ile optimizasyon yapılmamış olan 20, 50, 100, 500 ve 1000 ağaçlı RF sonuçlarıyla aynı zamanda da sınıflamalara etki eden en önemli 9 değişken temel alınarak sınıflama yapılmış olan 20, 50, 100, 500 ve 1000 ağaçlı RF sonuçlarıyla kıyaslanmıştır. Yapılan bu çalışmadan elde edilen sonuçlardan yola çıkılarak, GA yöntemiyle optimize edilerek kurulan RF modellerinin, optimize edilmemiş olan RF modellerine oranla çok daha yüksek başarıya sahip olduğu söylenebilir. Aynı şekilde RF modellerinin sınıflama başarısını yükseltmesi açısından, ağaç sayısı kaç olursa olsun, kurulacak olan modellerin GA yöntemiyle optimize edilmesi yapılan bu çalışma sonucunda ulaşılabilen en önemli sonuç olmaktadır.In the present day that computer applications are widely being used in all areas, potentially the data volume being stored is rapidly increasing. Particularly, putting into practice the stored but not used data in the health sector has a great importance. Methods which are developed for obtaining significant informations from huge datas accumulated in data bases, and which are finding wide are of usage particularly in late years, are called data mining. In this area many algorithms are followed up. In Genetic Algorithms (GA) method, problems are virtually undergone an evolutionary process, and at the end of this process it is tried to achieve the solution giving the best result. In this study, 20, 50, 100, 500 and 1000 trees Random Forest (RF) results classified by optimizing with GA were compared with; the results obtained from only one Decision Tree, nonoptimized 20, 50, 100, 500 ve 1000 ağaçlı RF results, at the same time 20, 50, 100, 500 ve 1000 trees RF results classified based on the most important 9 variables affecting the classifications. Setting out from the results of this study, it can be speculated that the RF models optimized by GA method have greater succes than nonoptimized RF models. In the same way, the most important result achieved in this study is that, in terms of increasing the succes in classification of RF models, optimizing the established models by GA method irrelevant from the number of trees

COVID-19 Pandemi Döneminin Özel Gereksinimli Çocuk Annelerinde Anksiyete ve Yaşam Kalitesi Üzerine Etkisinin İncelenmesi

Amaç: COVID-19, ilk olarak Çin’de solunum yolu belirtileri gelişen bir grup hastada yapılan araştırmalar sonucundatanımlanan bir virüstür. Bu çalışma, COVID-19 pandemi döneminin özel gereksinimli çocuk annelerinde anksiyete veyaşam kalitesi üzerindeki etkisini incelemek amacıyla planlanmıştır.Gereç ve Yöntemler: Özel gereksinimli çocuğu olan, yaş ortalaması 39,3 ± 8,94 yıl olan 87 anne çalışmaya dahiledildi. Çalışmada demografik veri formu, COVID-19 ve pandemi dönemine ait hazırlanan soru formu, NottinghamSağlık Profili (NSP) ve Beck Anksiyete Ölçeği (BAÖ) kullanılmıştır.Bulgular: Annelerin %83,9’u (n=73) COVID-19 hakkında bilgisinin olduğunu, %57,5’i (n=50) çocuklarının ruhsağlığının bu süreçten etkilenmediğini ve %63,2’si (n=55) kendi ruh sağlıklarının bu süreçte etkilendiğini ancak%60,9’u (n=53) bu süreçte anne olarak kendini tükenmiş hissetmediğini bildirmiştir. Çocuğun ruh sağlığı ile anneninNSP alt parametresi olan sosyal izolasyon puanı arasında anlamlı fark bulunmuştur. Annenin ruh sağlığı ile NSP altparametresi olan emosyonel reaksiyon ve sosyal izolasyon puanları arasında anlamlı fark bulunmuştur. Annenintükenmişlik durumu ile NSP alt parametresi olan emosyonel reaksiyon, uyku, sosyal izolasyon, NSP toplam ve BAÖpuanları arasında anlamlı fark bulunmuştur.Sonuç: COVID-19 özel gereksinimli çocuğa sahip annelerin anksiyete ve yaşam kalitelerini etkilemektedir. Bu nedenleliteratürde bu alanda daha geniş popülasyonların dahil edildiği çalışmalara ihtiyaç vardır

Clinical significance of chitotriosidase in outpatients with advanced heart failure

The previous studies have shown that plasma chitotriosidase (CHIT) levels increase in many diseases with inflammation. However, there are no reported studies investigating the relationship between CHIT and chronic heart failure (CHF) which is an inflammatory process. Therefore, we aimed to investigate the role of CHIT in diagnosis and severity of CHF in this study. 36 patients (50% male, mean age 63.1710.18 years) with left ventricular ejection fraction <40% and 27 controls (44% male, mean age 61.338.73 years) were included in this study. Patients with CHF were divided into two groups as ischemic heart failure (IHF) and non-ischemic heart failure (NIHF) according to the underlying etiology. Plasma CHIT and N-terminal pro brain natriuretic peptide (NT-proBNP) levels were measured by ELISA method. Plasma CHIT and NT-proBNP levels were higher in patients with CHF than in controls (CHIT 931.25461.39 ng/mL, 232.7961.28 ng/mL, p<0.001; NT-proBNP, 595.31428.11 pg/mL vs 78.1330.47 pg/L; p<0.001). Also, the levels of these parameters increased in IHF compared with NIHF (CHIT, 1139.28495.22 ng/mL, 671.22237.21 ng/mL, p=0.002; NT-proBNP, 792.87461.26 pg/mL vs 348.36202.61 pg/mL, p=0.001) and there was a strong correlation between NT-proBNP and CHIT (r=0.969, p<0.001). According to this study findings, plasma CHIT level increases in CHF and its increased levels are correlated with NT-proBNP which is used diagnosis and prognosis of HF. © American Federation for Medical Research 2020. No commercial re-use. See rights and permissions. Published by BMJ