Silent myocardial ischemia and related risk factors in patients with type 2 diabetes mellitus

Objectives: The aim of this study was to investigate the frequency of silent myocardial ischemia (SMI) in patients with Type 2 diabetes mellitus (DM) who do not have ischemiccardiac disease.Materials and Methods: To examine the relationship between ischemic cardiac disease and related factors such as blood pressure, lipid profile, smoking, gender, family history, body mass index (BMI), microalbuminuria, hsCRP, 150 diabetic patients who have never had any known coroner artery disease, exertional or rest dyspnea and labored breathing, aged between 35 and 70 years were included. Effort testing (treadmill) were performed to examine the existence of SMI.Results: Effort testing gave positive result for SMI in 20 patients and negative in 130 patients. Coronary angiographywas performed in 20 patients with positive effort testing results. The frequency of SMI was found as %13.3 by effort testing. The frequency of SMI (including non-criticalpatients) was %10.6 (16 patients) by using coronary angiography, which 13(8.6%) had critical and 3(2%) had non-critical coronary stenosis. No significant differences were found in age, gender, diabetic duration, trigliserid, HDL- cholesterol, blood pressure, BMI and hsCRP levels between positive and negative SMI patients with Type 2 DM.Conclusion: We determined that high LDL-Cholesterol and HbA1c and existence of microalbuminuria indicated significant SMI risk for patients with Type 2 DM

Comparison of QT dispersion between subclinical hypothyroid and euthyroid patients

Objectives: The aim of this study was to investigate the relationship between subclinical hypothyroid and QTc dispersionindicating local heterogeneity in repolarization of myocardium, which is well known as independent cardiac risk factor for sudden death and ventricular arrhythmia.Materials and Methods: We compared QTc dispersion of subclinical hypothyroid patients, after treatment and healthy control group. We included a total of 50 patients with 41 women and 9 men in the study group. Electrocardiographywith 12 derivations, thyroid hormones, serum electrolytes and basic biochemical parameters were measured.The control group consisted of 25 healthy individuals.QT distances were calculated by using Bazet formula. The difference between the longest QTc and the shortest QTc distance was accepted as QTc dispersion (QTcd).Results: Comparison of subclinical hypothyroid patients, their euthyroidic period after treatment and healthy controlgroup, gave no significant differences in age, body weight, body mass index and free thyroxin values. However,significant difference was found in durations of QTd and QTcd between the subclinical hypothyroid, the control and the euthyroidic groups (p<0.001). No significant differenceswere found in QTc and QTcd durations between euthyroidic period and healthy subjects (p>0.05).Conclusion: Our results suggested that subclinical hypothyroidpatients had longer QTc dispersion compared to euthyroidic period and healthy subjects. However there was no QTcd difference between the euthyroidic period and healthy control group

Correlation between Left Ventricular Mass Index and Calcium Metabolism in Patients with Essential Hypertension

Objective: To determine the correlation between left ventricular mass index and calcium metabolism in patients with essential hypertension. Study Design: Cross sectional case-control study. Material and Methods: Twenty-seven patients with essential hypertension and 20 healthy individuals were compared with respect to calciotropic hormones, left ventricular mass index (LVMI), and urinary and serum biochemical parameters. The correlations between parathormone, vitamin D, and calcitonin levels and LVMI and blood pressure elevation were determined. Results: The parathormone level was significantly higher (p=0.006) and vitamin D level was significantly lower (p=0.01) in the patient group compared with the control group. However, the two groups were similar in terms of albumin-corrected calcium levels, which were within the normal range (p=0.988). The serum sodium (p=0.014) and urinary calcium (p=0.003) levels and LVMI (p<0.01) were also significantly higher in the patient group. No significant correlations were determined between ambulatory blood pressure and parathormone and vitamin D levels, but a significant correlation was found between LVMI and parathormone level (p=0.06) in hypertensive patients. Conclusion: Essential hypertension alters calcium metabolism, causing calciuresis by hypernatremia. Parathormone release increases to compensate for this, and leads to protein synthesis, which in turn provokes the development of myocardial hypertrophy

Multipl skleroz'da izlenen okkult ve nadir semptom: Patolojik ağlama ve gülme

Pathological laughing and crying (PLC) has an approximately prevelance of 7%-10% among patients with multiple sclerosis (MS). Various damages of prefrontal, temporal cortex, internal capsule, hypothalamus, thalamus, brainstem and the cerebellar pathways may cause pathological laughing or crying. We interviewed 160 MS patients for PLC. Only 5 of our 160 cases complained about pathological laughing or crying. All 5 patients had PLC defined as sudden, involuntary displays of laughing or crying or both, without associated subjective feelings of depression or euphoria. Patient group, consisting 2 women and 3 men had a mean age of 41, mean Expanded Disability Status Scale (EDSS) score of 4.8, disease duration of 12.8 years. In our patients PLC was not associated with disease exacerbations. All PLC patients had numerous brainstem and cerebellar relapses, which caused obvious disabilities including gait ataxia, intention tremor, dysmetria, dysarthria, nystagmus and other cerebellar dysfunctions. All of our patients had so many lesions especially in brainstem because of this we think that the brainstem lesions have crucial role in PLC. This hypothesis needs further investigation especially in functional imaging which may add further information to pathogenesis of PLC. Before the investigation of PLC none of our patients informed us about their complaints of PLC so the physician must be aware of this symptom.Patolojik ağlama ve gülme (PLC), multipl skleroz (MS) hastalarında yaklaşık %7-10 oranında görülür. Prefrontal, temporal korteks, internal kapsül, hipotalamus, talamus, beyinsapı ve serebellar yolaklarda gelişebilecek çeşitli nedenli hasarlar patolojik ağlama ve gülmeye neden olabilir. 160 MS hastasını PLC açısından sorguladık. 160 hastanın sadece 5’i PLC’den yakındı. 5 hastada da PLC; depresyon ya da öfori olmadan, koşullarla uyumsuz, ani, istemsiz ağlama, gülme ya da ikisinin birden varlığı olarak tanımlandı. Hasta grubunda 2 kadın, 5 erkek olmak üzere toplam var olan 5 hastanın ortalama yaşı 41, ortalama EDSS skoru 4.8, ortalama hastalık süresi 12.8 yıldı. Hastalar atak döneminde değildi. Çalışmamızdaki tüm PLC hastalarında ataksi, intansiyonel tremor, dismetri, dizartri, nistagmus ve diğer serebellar system disfonksiyon bulgularına neden olan çeşitli sayıda beyin sapı ve serebellar system atak öyküsü mevcuttu. PLC tanımlanan tüm hastalarda özellikle CMJ Cumhuriyet Medical Journal beyin sapında çok sayıda lezyon mevcuttu, bu nedenle beyin sapının anatomic olarak PLC’de önemli olduğu düşünüldü. Ancak bu hipotez daha fazla sayıda hastada yapılacak olan fonksiyonel görüntüleme çalışmaları ile desteklenmesi gerektiği düşünüldü. Hastaların hiçbiri sorgulama öncesi PLC’den yakınmadığı için klinisyenbu semptomun farkında olmalıdır. Anahtar sözcükler: Multipl skleroz, patolojik gülme ve ağlama, MR