Obstructive sleep apnea as a risk factor for cardiovascular diseases

Obstructive sleep apnea (OSA) is a common medical condition that occurs in approximately 5% to 15% of the population. It is usually associated with an increased risk of cardiovascular disease. Diagnosis of OSA is based on polysomnography, and its severity is measured with an apnea-hypopnea index. Most of the adverse effects of OSA on the cardiovascular system are reversible with treatment. In addition to continous positive airway pressure therapy, precautions such as weight loss, avoidance of central nervous system depressants, treatment of nasal congestion and sleeping in the lateral position may help to treat OSA. (Cardiol J 2007; 14: 534-537)

Henoch-Schönlein purpura in children: A cross sectional study

Background: Henoch-Schönlein purpura (HSP) is a leukocytoclastic vasculitis with small vessel involvement and mainly affects the skin as well as joints, the gastrointestinal system (GIS), kidneys, and, more rarely, other organs. Objective: The objective of this study was to evaluate the sociodemographic characteristics, and clinical and laboratory findings of patients diagnosed with HSP. Materials and Methods: This was a retrospective study done to find out the sociodemographic data, clinical, laboratory findings, and treatment information of patients diagnosed with HSP and was admitted to the Pediatric Clinic of a tertiary care hospital between January 1, 2008, and August 31, 2013. The data were obtained from the hospital’s data processing system. HSP cases were validated according to EULAR/PRINTO/PRES criteria. Mean standard deviation, median, lowest and highest, frequency, and ratio values were used in the descriptive statistics of the data. Results: The study included 85 patients between the ages of 2 and 16 years, wherein 49 patients (57.6%) were male and 36 (42.4%) were female. The mean age was 9.9±3.3 years and 53 patients (62.4%) were under 10 years of age. The most common precipitating factor was upper respiratory tract infections. Purpura was the only symptom observed in all the patients and joint involvement was the second most common symptom (60%). GIS involvement was observed in 46 patients (58.8%) and intussusception was observed in one patient. Nine patients (10.6%) had renal involvement with mild nephropathy. The most frequently observed laboratory findings were increased C-reactive protein (47%) and leukocytosis (31%). Conclusion: HSP is commonly seen in children and leads to life-threatening complications in a minority of patients. Whole patients with GIS and renal involvement should be examined and monitored to assess the severity of the disease and any complications

Obturacyjny bezdech senny jako czynnik ryzyka rozwoju chorób układu sercowo-naczyniowego

Obturacyjny bezdech senny jest stosunkowo często występującym schorzeniem, które dotyka około 5-15% populacji. Zaburzenie to zazwyczaj ściśle wiąże się ze zwiększonym ryzykiem rozwoju chorób układu sercowo-naczyniowego. Diagnostyka obturacyjnego bezdechu sennego opiera się na badaniu polisomnograficznym, a jego nasilenie mierzy się za pomocą wskaźnika bezdechów i spłyceń oddychania. Większość działań niepożądanych wywoływanych przez obturacyjny bezdech senny w odniesieniu do układu sercowo-naczyniowego ma, w toku włączonego leczenia, charakter odwracalny. Oprócz terapii za pomocą wentylacji w trybie ciągle dodatniego ciśnienia w drogach oddechowych w celu kompleksowego leczenia obturacyjnego bezdechu sennego zaleca się również zmniejszenie masy ciała, unikanie leków o depresyjnym wpływie na centralny układ nerwowy, leczenie niedrożności jamy nosowej, a także spanie w pozycji bocznej. (Folia Cardiologica Excerpta 2008; 3: 74-78

Determining Risk Factors of Bleeding in Patients on Warfarin Treatment

Background. Warfarin is a commonly used oral anticoagulant agent. The most common adverse effects of warfarin are bleeding complications. Methods. We performed a 1-year retrospective chart review of emergency department patients using warfarin. A total of 65 patients with bleeding disorder (study group) and 63 patients without bleeding (control group) were included, making up a total of 128 subjects. Demographic data, frequency of international normalized ratio (INR) checks, and routine blood results were extracted. Logistic regression analysis was used to determine which factors were most closely associated with bleeding complications. Results. Median age was 62.0±14.4 and 61.9±14.5 for study group and control group, respectively. Educational status and frequency of INR checks were similar in both groups (P=0.101 and P=0.483, resp.). INR levels were higher in the study group (5.45±3.98 versus 2.63±1.71, P<0.001). Creatinine levels were also higher in the study group (1.14±0.57 mg/dL versus 0.94±0.38 mg/dL, P=0.042). Acetylsalicylic acid use was more frequent in the study group and was associated with a 9-fold increase in bleeding complications (P<0.001). Conclusions. High INR levels, high creatinine levels, and acetylsalicylic acid use were associated with bleeding complications in ED patients using warfarin

The utility of pregnancy associated plasma protein-A MoM values in prediction of term respiratory distress syndrome

This study aimed to investigate if the pregnancy associated plasma Protein-A (PAPP-A) multiples of median (MoM) levels could be used as a marker for the early prediction of RDS. The present study was designed with data gathered from 1773 patients who were referred to our institution for first trimester fetal chromosomal anomaly screening. First trimester PAPP-A MoM values and postnatal RDS occurrences in these pregnancies were retrospectively analysed. Of the 1773 neonates that were included in the study, 28 were delivered at or beyond 37 weeks, and 42 were delivered less than 37 weeks of gestation. In the group of neonates at or beyond 37 weeks, the cut-off value for RDS prediction was determined as 1.02. For this cut-off value, sensitivity was 72.41% and specificity was 91.84%. The area under curve (AUC) was determined to be statistically significant (p < .01). In conclusion, it was determined that in neonates that were delivered at or beyond 37 weeks of gestation, RDS occurrence could be predicted at a significant rate by utilising PAPP-A MoM values.IMPACT STATEMENT What is already known on this subject? Respiratory distress syndrome (RDS) is one of the major global healthcare problems, and continues to effect newborns despite the improvements in diagnosis and treatments of the disease. Studies have shown that pregnancy associated plasma protein-A (PAPP-A) has a critical role in cellular proliferation and differentiation, and it is closely associated with many physiological and pathological processes via regulation of local insulin like growth factor (IGF) concentrations. In majority of the past studies in the literature regarding PAPP-A values in pregnancies, the association between low values of PAPP-A MoM and maternal-fetal complications were investigated. What do the results of this study add? This study retrospectively examines the PAPP-A MoM levels and the occurence of RDS. In neonates that were delivered at or beyond 37 weeks of gestation, RDS occurrence could be predicted at a significant rate by utilising PAPP-A MoM values which was measured at the first trimester fetal anomaly screening test. What are the implications of these findings for clinical practice and/or further research? In the light of these findings, in order to reduce RDS related neonatal morbidity and mortality, pregnancies with PAPP-A MoM values greater than 1.02 at the first trimester fetal anomaly screening should be more closely followed up and a higher rate of suspicion should be kept for RDS occurrence

Clinical significance of aortic stiffness, carotid intima-media thickness and serum osteoprotegerin level in rheumatoid arthritis patients

Aim of the work: Cardiovascular diseases represent a major source of morbidity and mortality for patients with rheumatoid arthritis (RA). The increase in aortic stiffness, carotid intima-media thickness (CIMT) and serum osteoprotegerin (OPG) have been shown to be independent risk factors for cardiovascular events. This work aimed to investigate the clinical significance of these parameters in RA patients. Patients and methods: 60 RA patients and 30 control with no primary cardiovascular risk factors were included. Disease activity score (DAS28) was assessed in patients. Aortic stiffness was evaluated by transthoracic echocardiography and CIMT evaluated by Doppler ultrasonography. OPG was determined by ELISA. Results: The 60 RA patients had a mean age of 40.8 ± 8.3 years, disease duration of 6.9 ± 4.9 years and were 46 females and 14 males. In RA patients, serum OPG and CIMT (thickest and mean) were significantly higher than the control (60.5 ± 32.4 pg/ml vs 29.4 ± 16.7 pg/ml, p < 0.001; 0.73 ± 0.18 mm vs 0.63 ± 0.13 mm, p < 0.001; 0.61 ± 0.1 mm vs 0, 56 ± 0.1 mm, p = 0.007, respectively). The aortic stiffness tended to be higher in patients (6.9 ± 4.8 vs 5.2 ± 2.5, p = 0.114) and in males (9.7 ± 7.4) vs females (5.7 ± 3.4, p = 0.013). OPG levels were significantly higher in those with erosions (n = 41) (68.6 ± 34.5 pg/ml vs 49.1 ± 22 pg/ml p = 0.038) and in those seropositive (n = 54) (65.4 ± 32.2 pg/ml vs 36 ± 18.3 pg/ml p = 0.012). In patients, CIMT (thickest and mean) correlated significantly with the aortic stiffness (p = 0.02 and p = 0.04 respectively). Conclusion: RA is an independent risk factor associated with cardiovascular events. For determining this risk, measuring the serum OPG, CIMT and aortic stiffness may be a useful guide. Keywords: Aortic stiffness, Atherosclerosis, Carotid intima-media thickness, Osteoprotegerin, Rheumatoid arthritis, DAS2

Direct venous spinal reabsorption of cerebrospinal fluid: a new concept with serial magnetic resonance cistemography in rabbits Laboratory investigation

Object. For nearly 100 years it has been believed that the main reabsorption of CSF occurs in arachnoid projections into the superior sagittal sinus, but a significant number of experiments and cases conflict with this hypothesis. According to recently published studies, CSF is permanently produced and absorbed in the whole CSF system. Clusters of arachnoidal villi, which are speculated to have a role in the reabsorption of CSF, have recently been revealed in the dorsal root of the spinal nerves. Huge absorptive surface areas of microvessels have been suggested to serve a putative role in reabsorption. The authors' aim was to observe direct venous connections between the subarachnoid space and the perispinal veins

Data on prevalence of dyslipidemia and lipid values in Turkey: Systematic review and meta-analysis of epidemiological studies on cardiovascular risk factors

WOS: 000453084600006PubMed ID: 30391985Objective: Dyslipidemias, primarily hypercholesterolemia, are independent and strong predictors of cardiovascular (CV) events. The frequency of dyslipidemia is very important in terms of determining CV prevention policies. In order to determine the up-to-date frequency of CV risk factors in Turkey, a meta-analysis of the epidemiologic studies carried out in the last 15 years was performed. This article presents the results on the dyslipidemia data including hypercholesterolemia principally. Methods: Epidemiological studies conducted during the last 15 years and having the potential to represent the general population in Turkey were searched in databases (Ovid Medline, Web of Science Core Collection, and Turkish Academic Network and Information Center [ULAKBIM]) and web pages (Ministry of Health, Turkey Statistical Institute, Turkish Society of Cardiology, Nephrology and Endocrinology Associations). A total of 7 studies including lipid data were found. Systematic review and meta-analysis of the studies with low bias score were performed. Crude values of the prevalence of hypercholeterolemia, hypertriglyceridemia and low HDL and mean lipid levels were calculated. Random effects model was used in meta-analysis. Results: The prevalence of hypercholesterolemia defined as a LDL-cholesterol > 130 and/or >= 130 mg/dL, was 29.1% (95% CI 23.6-35.0) in the general population, 30.2% in females (%95 CI 24.7-36.1), and 27.8% in males (95% CI 22.3-33.6). The prevalence of low HDL-cholesterol ( 150 mg/dL) was 36.5% (95% CI 30.6-42.5) in general, 32.0% (95% GA 26.6-37.8) in females and 41.3% (95% CI 34.9-47.8) in males. Conclusion: Dyslipidemia constitutes a major public health problem in Turkey. In the adult population, almost 3 of 10 have hypercholesterolemia, one of 2 has a low HDL-cholesterol, and 1 of 3 has high triglycerides levels