Takotsubo Syndrome: Still Graveyard of Case Reports?

Takotsubo syndrome, or previously named as Takotsubo cardiomyopathy, is an increa-singly recognized acute reversible form of heart failure, which is typically seen in post-menopausal women following emotional or physical stress. Although several mechanisms regarding pathophysiology had been proposed, the most common ones include catecholamine toxicity, diffuse epicardial coronary artery spasm and microvascular dysfunction. A vast majority of patients with TTS (>90%) have good prognosis as they regain normal left ventricular systolic function in 3–6 months after the acute phase. Increased awareness among physicians led to the recognition of a great number and variety of conditions associated with TTS and played a key role for the development of new diagnostic criteria. However, there are still big gaps in the management and treatment of this syndrome to be supported with further well-designed randomized controlled trials

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To the Editor, We would like to thank the authors for their interest in our paper and their comments regarding our study entitled “A review of the fixed dose use of new oral anticoagulants in obese patients: Is it really enough?” published in Anatol J Cardiol 2015; 15: 1020-9 (1). Under-representation of obese patients in the subgroups of relevant studies raises concerns about the efficacy and safety of new oral anticoagulants (NOACs). The number of patients with high body weights is quite low in studies investigating the pharmacodynamics and pharmacokinetics of NOACs. In the context of data obtained from these studies, a fixed dose use of NOACs is recommended for obese or morbidly obese patients with no distinction from other patients

Changes in electrocardiographic p wave parameters after cryoballoon ablation and their association with atrial fibrillation recurrence

Background: Changes in P wave parameters after circumferential pulmonary vein isolation (CPVI) have been previously identified. In this study, we aimed to determine the changes in P wave parameters surface electrocardiogram (ECG) after cryoballoon ablation (CBA) for atrial fibrillation (AF) and evaluate their relationship with AF recurrence. Methods: Sixty-one patients (mean age 53 ± 11 years, 50.8% male) with paroxysmal AF who underwent CBA were enrolled. A surface ECG was obtained from all patients immediately before the procedure, and repeated 12 hours after the procedure. P wave amplitude (Pamp), P wave duration (Pwd), and P wave dispersion (Pdis) values in preprocedural and postprocedural ECGs were measured and compared. Recurrence rates of AF in 3, 6, and 9 months following ablation were recorded for all patients. Changes in P wave parameters were compared between patients with and without AF recurrence. Results: Compared to preprocedural measurements, Pamp (from 0.58 ± 0.18 mV at baseline to 0.48 ± 0.17 mV, P 0.05). Conclusion: Pamp, Pwd, and Pdis parameters exhibited significant decrease after CBA compared to preprocedural measurements. Decreased Pamp was shown to be a predictor for good clinical outcomes following CBA

Should we use a staged or ad hoc approach in percutaneous coronary interventions through the radial artery to avoid radial artery spasm?

Objective: Transradial approach has recently been adopted as the default strategy for percutaneous coronary interventions due to benefits which include reduced all-cause mortality, major access-site complications, and hospital stay, as well as increased patient comfort and early ambulation. However, radial artery spasm (RAS) is still a major drawback. The impact on RAS of an ad hoc compared with a staged intervention strategy has not previously been investigated. In this study, we sought to investigate the effect of ad hoc and staged percutaneous coronary intervention (PCI) on RAS in patients undergoing elective transradial coronary interventions. Materials and Methods: In this retrospective study, patients with symptoms suggestive of ischemia who were scheduled for coronary angiography and candidates for elective PCI were enrolled and divided into two equal groups: ad hoc group and staged group. RAS was clinically identified and established based on the existence of two or more of predefined clinical features. Results: A total of 60 patients was enrolled in the study: 30 in the ad hoc group and 30 in the staged group. The mean time between coronary angiography and intervention in the staged group was 2.5 [1–30] days. RAS rates were similar between the ad hoc and staged PCI groups (16.7% [n=5] vs. 31% [n=9], p=0.233), but post-procedural pain was more frequent in patients in the ad hoc group (64.5% [n=20] vs. 33.3% [n=10], p=0.021). Radial artery occlusion did not differ between the ad hoc and staged PCI groups (10.7 % [n=3] vs. 11.1 [n=3], p=1

Serbest dalış öncesi ve sonrası elektrokardiyografik değişikliklerin incelenmesi

Aim: To evaluate the electrocardiographic (ECG) parameters and hemodynamic parameters in predicting the development of arrhythmias after free diving static apnea performance and maximum breath hold. Material and Methods: Twenty-four volunteer athletes participating in the free diving competition in 2015 (19 males (79.2%) and 5 females (20.8%)) were included in the study. Peripheral O2 saturation (SpO2), heart rate (HR), ECG parameters (PR interval, QRS time, T wave amplitude, corrected QT time, presence of bandle branch block and new bandle branch block development, atrial premature beats, ventricular premature beats) were analyzed. Results: There was no statistically significant difference between before static apnea measurements (systolic blood pressure (SBP) 124.7 ± 10.8 mmHg, diastolic blood pressure (DBP) 76.5 ± 6.7 mmHg, heart rate (HR) 80.2 ± 13.4 beats / min, SpO2 97.1 ± 0.9%) and after performance (SBP 128.8 ± 13.6 mmHg DBP 78.0 ± 5.9 mmHg, HR 85.8, ± 16.5 beats / min and SpO2 96.7 ± 2.3%)(p = 0.175; p = 0.334; p = 0.104; p = 0.336, respectively). Conclusion: No significant changes were observed in ECG parameters, heart rate, saturation and blood pressure values evaluated after static apnea performance. These findings can be used to support that the risk of arrhythmia during static apnea does not persist after apnea has ended.Amaç: Serbest dalış statik apne performansı ile maksimum nefes tutma sonrası aritmi gelişimini öngörmede elektrokardiyografik (EKG) parametreleri ve hemodinamik göstergeleri değerlendirmek. Gereç ve Yöntemler: Çalışmaya 2015 yılında düzenlenen serbest dalış yarışmasına katılan 24 gönüllü sporcu dahil edilmiştir (19 erkek (%79,2) and 5 kadın (%20,8)). Performans öncesi ve sonrası ( 5. dakikada) periferik O2 satürasyonu ( pO2), kalp hızı (KH), EKG parametreleri ( PR aralığı, QRS süresi, T dalga amplitüdü, düzeltilmiş QT süresi, dal bloğu varlığı ve yeni dal bloğu gelişimi, atriyal erken atım, ventriküler erken atım varlığı) analiz edildi. Bulgular: Sporcuların statik apne öncesi sistolik kan basınçları (SKB) 124,7±10,8 mmHg, diyastolik kan basınçları (DKB) 76,5±6,7 mmHg, kalp hızı 80,2 ±13,4 atım/dk, pO2 %97,1±0,9 ve performans sonrası SKB 128,8±13,6 mmHg, DKB 78,0 ±5,9 mmHg, KH 85,8±16,5 atım/dk, pO2 %96,7±2,3 arasında istatistiksel olarak anlamlı fark saptanmadı ( sırasıyla p=0,175; p=0,334; p=0,104; p=0,336). Sonuç: Statik apne performansı sonrası değerlendirilen EKG parametrelerinde, kalp hızında, satürasyon ve tansiyon değerlerinde herhangi bir anlamlı değişiklik izlenmedi. Bu bulgular statik apne esnasında gelişebilecek aritmi riskinin apne sonlandıktan sonra devam etmediğini desteklemede kullanılabilir

Motorsiklet kazası sonrası triküspit kapağında korda rüptürü

WOS: 000380166800008PubMed ID: 27372618Cardiac valve injury, a condition that can follow blunt thoracic trauma, has a wide range of clinical presentations, depending on the structures involved. Post-traumatic tricuspid regurgitation is relatively rare, caused by increase in intrathoracic pressure when the tricuspid valve leaflets close, leading to rupture of the chordae tendineae. A case of severe tricuspid regurgitation due to chordal rupture presenting with atrial flutter following a motorbike accident is described in the present report.Özet– Künt toraks travmaları sonrası gelişen kalp travması olguları, etkilenen yapılara bağlı olarak çeşitli klinik sunumlar göstermektedir. Travma sonrası triküspit yetersizliği literatürde nadirdir, triküspit kapak yapraklarının kapalı olduğu sırada travmaya sekonder toraks içi basıncı artışı sonucu triküspit kapak kordalarının rüptürüne bağlı olarak geliştiği düşünülmektedir. Bu yazıda, motorsiklet kazası sonrası atriyum flutteri ve ileri triküspit yetersizliği ile karşımıza çıkan hastanın triküspit kapaktaki korda rüptürü olgusu tartışıldı

Bir Matematik Öğretmeninin Öğrencilerin Orantısal Akıl Yürütme Becerilerini Destekleme Eylemlerinin İncelenmesi

Bu çalışmada bir matematik öğretmeninin öğrencilerin orantısal akıl yürütme becerilerini destekleme eylemlerinin incelenmesi amaçlanmıştır. Verilerin toplanması, analiz edilmesi ve yorumlanmasında nitel araştırma yöntemlerine bağlı kalınarak gözlem tekniği kullanılmıştır. Bu çalışma kapsamında, İzmir ili Buca ilçesinde yer alan bir ortaokulda deneyimli bir matematik öğretmeniyle çalışılmıştır. Doğrusal denklemler ve eşitsizlikler konularının kapsadığı 9 kazanımı içeren 14 ders gözlemlenmiştir. Ders gözlemleri çevrim içi ve yüz yüze eğitim yapıldığı ortamlarda kamera kaydı ile gerçekleştirilmiştir. Çevrim içi ders kayıtları EBA platformunda yapılan derslerin öğretmen tarafından kaydedilmesi yoluyla toplanmıştır. Yüz yüze ders kayıtları ise araştırmacı tarafından kurulan kamera kaydı ile toplanmıştır. Veriler, çalışmada iş birliği yapılan öğretmenin işlediği dersler gözlemlenirken Ellis, Özgür ve Reiten’ın (2019) matematiğe özgü geliştirdikleri Öğrenci Muhakemesini Destekleyen Öğretmen Eylemleri çerçevesinden faydalanılarak analiz edilmiştir. Çalışmanın sonucunda araştırmaya katılım gösteren matematik öğretmeninin cevap isteme, doğru yanıtı onaylama, açıklığa kavuşturma, değerlendirme isteme, kavramsal bilgi verme ve açıklama yapma eylemlerinin ön planda olduğu gözlemlenmiştir.This study aimed to examine the actions of a mathematics teacher to support students' proportional reasoning skills. Qualitative research methods were employed for data collection, analysis, and interpretation, utilizing the observation technique. The study involved working with an experienced mathematics teacher at a middle school in Buca, Izmir. Fourteen lessons were observed, covering nine learning objectives within the topics of linear equations and inequalities. Lesson observations were conducted using camera recordings in both online and face-to-face learning environments. Online lesson recordings were collected by the teacher recording the lessons conducted on the EBA platform. Face-to-face lesson recordings were collected by the researcher using a set-up camera. The data were analyzed using Ellis, Özgür, and Reiten's (2019) Teacher Actions Supporting Student Thinking framework, developed specifically for mathematics, while observing the lessons taught by the collaborating teacher. The findings revealed that the participating mathematics teacher primarily employed the actions of eliciting responses, confirming correct answers, providing clarification, requesting evaluation, providing conceptual knowledge, and explaining

Practical considerations on non-vitamin K oral anticoagulants in patients with high body weight

We have read with great interest the manuscript by Housseinsabet (1) entitled “Assessment of atrial conduction times in patients with mild diastolic dysfunction and normal atrial size,” published in the Anatolian Journal of Cardiology 2015; 15: 925-31. In this study, Hosseinsabet (1) clearly demonstrated that there were no differences in atrial conduction times (ACTs) and atrial electromechanical delays (EMDs) in patients with mild diastolic dysfunction and normal left atrial volume compared with normal subjects

Seraya giren faydalı ışınım enerjisini hesaplamak için bir yöntem - II

The quantity of radiation in the greenhouses is the most important limiting factor for growing of plants. The quantity of this radiation mainly depends on the solar geometry and the structural components of the greenhouse. In this study, a model for estimating the transmitted direct and diffuse sun radiation inside a greenhouse which includes all factors mentioned above has been developed and also a computer code for simplifying the calculations has been written. This model has two modules. In first module, Ihe quantity of transmitted radiation into the greenhouse has been calculated. In second -module, the distribution of the transmitted radiation in the greenhouse has been analysed.Seraya giren ışığın miktarı, serada yetiştirilen bitkilerin gelişmelerini belirleyen en önemli etkenlerden biridir. Seraya giren güneş ışınımının miktarı, güneşin gökyüzündeki geometrik konumuna, seranın bulunduğu yerin enlem derecesine, seranın yönlendirilmesine, çatı tipi ve eğimine, seranın boyutlarına, örtü malzemesinin ışık geçirgenliğine ve sera yapı unsurlarının gölgeleme etkisine bağlıdır. Bu çalışmada, sıralanan tüm etkenler dikkate alınarak, seraya giren güneş ışınımını hesaplamak için uygulanabilecek bir yöntem ve bilgisayar programı geliştirilmiştir. Geliştirilen hesaplama yöntemi iki bölümde açıklanmıştır. Birinci bölümde sera yüzeyine gelen ve yüzeyden içeri giren ışınımın hesaplanmasında uygulanan mantık belirtilmektedir. Bu makaleyi oluşturan ikinci bölümde ise sera içine giren ışın demetinin içerde kalan miktarının belirlenmesinde uygulanan yol açıklanmaktadır