The relation between echocardiographic epicardial fat thickness and mitral annular calcification

Background: Mitral annular calcification (MAC) is associated with several cardiovascular disorders including coronary artery disease (CAD), atrial fibrillation, heart failure, ischemic stroke and increased mortality. Epicardial fat thickness (EFT) has strong correlation with obesity, CAD, insulin resistance, metabolic syndrome, hypertension, diabetes mellitus, and atherosclerosis. There are strong similarities between EFT and MAC from the aspect of risk factors and pathogenesis.Objective: In this study we aimed to investigate the EFT in patients with MAC.Methods: The study group consisted of 78 patients with MAC. An age, gender and body mass index matched control group consisted of 47 subjects who admitted to echocardiography laboratory due to suspicion of organic heart disease and eventually found to be free of MAC. We measured EFT in patients with MAC and control subjects.Results: EFT was significantly higher in patients with MAC than in control subjects (5.7±0.9 vs. 4.4±0.6 mm respectively; P< 0.001). Correlation analysis indicated that EFT was positively correlated with presence of MAC (p<0.001, r=0.597).Conclusion: We showed that EFT was significantly elevated in patients with MAC and it was positively correlated with MAC.Keywords: mitral annular calcification, epicardial fat thickness, cardiovascular risk

The relation between echocardiographic epicardial fat thickness and mitral annular calcification

Background: Mitral annular calcification (MAC) is associated with several cardiovascular disorders including coronary artery disease (CAD), atrial fibrillation, heart failure, ischemic stroke and increased mortality. Epicardial fat thickness (EFT) has strong correlation with obesity, CAD, insulin resistance, metabolic syndrome, hypertension, diabetes mellitus, and atherosclerosis. There are strong similarities between EFT and MAC from the aspect of risk factors and pathogenesis. Objective: In this study we aimed to investigate the EFT in patients with MAC. Methods: The study group consisted of 78 patients with MAC. An age, gender and body mass index matched control group consisted of 47 subjects who admitted to echocardiography laboratory due to suspicion of organic heart disease and eventually found to be free of MAC. We measured EFT in patients with MAC and control subjects. Results: EFT was significantly higher in patients with MAC than in control subjects (5.7\ub10.9 vs. 4.4\ub10.6 mm respectively; P< 0.001). Correlation analysis indicated that EFT was positively correlated with presence of MAC (p<0.001, r=0.597). Conclusion: We showed that EFT was significantly elevated in patients with MAC and it was positively correlated with MAC. DOI: https://dx.doi.org/10.4314/ahs.v19i1.41 Cite as: Guler S, Varol E. The relation between echocardiographic epicardial fat thickness and mitral annular calcification. Afri Health Sci. 2019;19(1). 1657-1664. https://dx.doi.org/10.4314/ahs. v19i1.4

Obogaćivanje kefira vlaknima jabuke i limuna

The effects of apple and lemon fiber addition on some properties of kefir were investigated. Five different kefirs were produced (A is control, B, C, D, E, F and G: contain 0.25 % apple fiber, 0.5 % apple fiber, 1 % apple fiber, 0.25 % lemon fiber, 0.5 % lemon fiber and 1 % lemon fiber, respectively) and stored for 20 days at 4±1 °C. pH, titratable acidity, dry matter, water activity, water holding capacity, viscosity, L, a and b values, sensorial analysis, total lactic bacteria, Lactococcus spp., Leuconostoc spp. and yeast counts of kefirs were determined at 1st, 10th and 20th days of storage. The addition of apple and lemon fiber enhanced rheological, microbiological and sensorial properties of kefirs (p<0.01). Apple and lemon fiber could be used for kefir production at a rate of 0.25 or 0.5 %.Istražen je utjecaj dodatka vlakana jabuke i limuna na neka svojstva kefira. U tu svrhu proizvedeno je pet različitih kefira (A je kontrolni, B, C, D, E, F i G: sadrže 0,25 % jabučnih vlakana, 0,5 % jabučnih vlakana, 1 % jabučnih vlakana, 0,25 % limunskih vlakana, 0,5% limunskih vlakana i 1 % limunskih vlakana), koji su bili pohranjeni 20 dana na 4±1 °C. pH, titriracijska kiselost, suha tvar, aktivnost vode, kapacitet zadržavanja vode, viskoznost, L, a i b vrijednosti, senzorska analiza, ukupni broj bakterija mliječne kiseline, Lactococcus spp., Leuconostoc spp. i broj kvasaca u kefiru određeni su 1., 10. i 20. dana skladištenja. Dobiveni rezultati upućuju na to da dodatak vlakana jabuke i limuna poboljšava reološka, mikrobiološka i senzorska svojstva kefira (p<0,01), te da se vlakna jabuke i limuna mogu koristiti za proizvodnju kefira do udjela od 0,25 % ili 0,5 %

Effect of spacing on some mechanical properties of narrow leaved ash (Fraxinus angustifolia) wood

In this study, conducted to test the effect of spacing on wood quality; the effect of four different spacing types, applied in Adapazarı Süleymaniye plantation (Region 1; 3x2 m; Region 2; 3x2,5 m; Region 3; 3,75x3,75m; Region 4; 4x4 m), on some mechanical properties of narrow leaved ash (Fraxinus angustifolia) have been studied. In the present study, some mechanical properties such as the compression strength parallel to grain,tensile stress perpendicular to grain, bending strength, impact bending strength and modulus of elasticity were determined. As a result, the ash wood, grown in region 4 with a wide range of planting, has high mechanicalproperties. However, when analyzed in terms of wood quality characteristics, it has been found that spacing in region 1 (2x3 m) is more suitable for applications of ash plantations

Comparison of the prevalence and sonographic features of thyroid nodules accompanying autoimmune thyroid diseases

Introduction: The coexistence of thyroid nodules and autoimmune thyroid disease (ATD) has been widely reported. The aim of our study was to retrospectively evaluate the prevalence and sonographic features of malignancy of thyroid nodules in ATD patients. Material and methods: We retrospectively analysed data from 500 patients with ATD in our hospital. We recorded ultrasonographic, histopathological and laboratory features of these patients. Thyroid ultrasonography was performed on all the patients, as well as fine needle aspiration biopsy (FNAB) of the thyroid nodule, when required. Patients underwent operations depending on the result of the FNAB. Results: Of the 500 with ATD (400 female and 100 male; mean age = 42.4 years), 300 (60%) had Hashimoto&#8217;s thyroiditis (HT) and 200 (40%) presented with Graves&#8217; disease (GD). The frequency of thyroid nodules was statistically significantly higher in those with GD (37.8%) than in those with HT (24.3%) (p < 0.001). One hundred and forty-nine nodules underwent FNAB (37.8%, 76 out of 200 had GD and 24.3%; 73 out of 300 had HT). The results of the cytological examination were: non-diagnostic cytology, benign, malignant and indeterminate in 19.4%, 73.8%, 2% and 4.5% of the nodules, respectively. When 55 GD and 32 HT patients, on whom total thyroidectomy had been carried out, were evaluated, the incidence of thyroid carcinoma was similar between patients with GD (n = 3, 5.5%) and HT (n = 2, 6.3%) (p > 0.05). Conclusions: We observed that the prevalence of thyroid nodules in patients with GD was higher than patients with HT. However, in general, the characteristics of the nodules and FNAB results were similar in both ATDs. (Pol J Endocrinol 2010; 61 (6): 658-664)Wstęp: W licznych doniesieniach stwierdza się współwystępowanie guzków tarczycy i autoimmunologicznych chorób tarczycy. Celem pracy była retrospektywna ocena występowania i sonograficznych cech złośliwości guzków tarczycy u pajcentów z autoimmunologicznymi chorobami tarczycy (ATD, autoimmune thyroid disease). Materiał i metody: Analizie retrospektywnej poddano dane 500 pacjentów z ATD, u których przeprowadzono badania ultrasonograficzne, histopatologiczne i laboratoryjne. U wszystkich pacjentów wykonano badanie ultrasonograficzne oraz, w zależności od wymagań, biopsję aspiracyjną cienkoigłową (BAC). Pacjentów poddano operacji w zależności od wyniku BAC. Wyniki: Spośród 500 pacjentów z ATD (400 kobiet i 100 mężczyzn, średnia wieku: 42,4 lat), u 300 (60%) stwierdzono zapalenie tarczycy Hashimoto (HT, Hashimoto thyroids), a u 200 (40%) chorobę Gravesa (GD, Graves disease). U pacjentów z GD stwierdzono statystycznie wyższą częstość występowania guzków tarczycy (37%) w porównaniu z pacjentami z HT (24,3%) (p < 0,001). Wykonano BAC 149 guzków, w 37,8% (76 z 200) przypadków z GD i w 24,3% ( 73 z 300) z HT. Wyniki badania cytologicznego: cytologia niediagnostyczna (19,4%), guzki łagodne (73,8%), guzki złośliwe (2%) i guzki o pośredniej złośliwości (4,5%). Spośród 55 pacjentów z GD i 32 z HT, u których wykonano tyroidektomię totalną, stwierdzono podobną częstość występowania raka tarczycy - u pacjentów z GD (n = 3, 5,5%), a u pacjentów z HT (n = 2, 6,3%) (p > 0,05). Wnioski: Zaobserwowano wyższą częstość występowania guzków tarczycy u pacjentów z GD w porównaniu z pacjentami z HT. Natomiast charakterystyka guzków i wyniki BAC nie różniły sie w obu typach ATD. (Endokrynol Pol 2010; 61 (6): 658-664

Fractionated Mapping-Guided Ablation Strategy in Patients with Long-Standing Persistent Atrial Fibrillation: a Case Series

Although pulmonary vein isolation (PVI) remains the cornerstone of ablation for paroxysmal atrial fibrillation (AF), optimal ablation strategy for long-standing persistent AF (LSPAF) remains unclear. This article presents two patients with LSPAF in whom acute AF termination was achieved during ablation by using fractionated-guided extended PVI, posterior wall isolation, and mitral isthmus

Nieinwazyjny pomiar ilości tkanki tłuszczowej trzewnej metodą ultrasonograficzną — potencjalne zastosowanie w ocenie zaawansowania subklinicznej miażdżycy u mężczyzn z niedoczynnością przysadki i niedoborem hormonu wzrostu

Introduction: Growth hormone (GH) deficiency, either isolated or combined with other pituitary hormone deficiencies, is associated with increased mortality and abnormal body composition, particularly visceral adiposity. We aimed to investigate the effects of GH deficiency with or without sex steroid deficiencies on ultrasonographic visceral fat (VF) and cardiovascular risk markers in patients with hypopituitarism on conventional hormone replacement therapy.Material and methods: Forty hypopituitarism patients (24 women, 16 men; mean age 48 ± 16.1 years) with GH deficiency and 15 age- and sex-matched healthy controls were included in this cross-sectional study. The patients were stable on conventional hormone replacement but they were not on GH therapy. Patients who had sex steroid replacement were classified as Group 1 (n = 19), and patients who did not use sex steroids were classified as Group 2 (n = 21). Anthropometric measurements were performed. VF in three regions, subcutaneous fat, and carotid intima-media thickness (CIMT) were measured. VF volume was calculated by using a formula.Results: Visceral fat volume and mean CIMT were significantly higher in patients than healthy controls (p = 0.001 and 0.019 respectively). Homocysteine and hs-CRP were higher in patients (p &lt; 0.05). In males, VF volume and VF thickness measured between abdominal muscle and splenic vein were significantly correlated with CIMT (r = 0.54, p = 0.047 and r = 0.66, p = 0.010 respectively). Furthermore, there was a strong positive correlation between VF thickness in pararenal region and homocysteine (r = 0.74, p = 0.001) in males.Conclusions: VF volume evaluated by ultrasound can be accepted as a cause of subclinical atherosclerosis in GH deficient hypopituitary patients, particularly males.Wstęp: Niedobór hormonu wzrostu (GH, growth hormone) może występować jako zaburzenie izolowane lub współistnieć z niedoborami innych hormonów przysadki. Wszyscy pacjenci z niedoborem GH są jednak obarczeni większym ryzykiem zgonu i mają nieprawidłowy skład tkanek ciała, z tendencją do otyłości brzusznej. Celem pracy była ocena zależności pomiędzy niedoborem GH, niezależnie od ewentualnego współistnienia niedoborów hormonów płciowych a grubością tkanki tłuszczowej trzewnej (VF, visceral fat) mierzoną metodą ultrasonograficzną oraz czynnikami ryzyka sercowo-naczyniowego u pacjentów z niedoczynnością przysadki, leczonych konwencjonalnymi preparatami hormonalnymi.Materiał i metody: Badanie miało charakter przekrojowy i zakwalifikowano do niego 40 pacjentów z niedoczynnością przysadki i niedoborem GH, w tym 24 kobiety, 16 mężczyzn; średni wiek badanych wynosił 48 ± 16,1 lat. Do badania włączono też 15 osób w grupie kontrolnej, dobranych pod względem płci i wieku do osób z grupy badanej. Pacjenci w grupie badanej leczeni byli konwencjonalnie preparatami hormonalnymi, ale nie otrzymywali hormonu wzrostu. Pacjenci leczeni hormonami płciowymi zostali włączeni do grupy 1 (n = 19), a pacjenci nie otrzymujący takich preparatów do grupy 2 (n = 21). U wszystkich wykonano badania antropometryczne. Wykonywano pomiar grubości VF w trzech miejscach, badano grubość podskórnej tkanki tłuszczowej oraz grubość warstwy wewnętrznej i środkowej ściany tętnicy szyjnej (CIMT, carotid intima-media thickness). Objętość VF wyliczano według wzoru.Wyniki: U pacjentów w grupie badanej stwierdzono znamiennie większą objętość trzewnej tkanki tłuszczowej i średnią wartość CIMT w porównaniu z osobami zdrowymi (odpowiednio p = 0,001 i p = 0,019). Stężenie homocysteiny i hs-CRP były również większe w grupie badanej (p &lt; 0,05). U mężczyzn stwierdzono istotną korelację pomiędzy objętością VF i grubością VF mierzoną pomiędzy mięśniami brzucha a żyłą śledzionową a wartością CIMT (odpowiednio r = 0,54 i p = 0,047 oraz r = 0,66 i p = 0,010). Ponadto, u mężczyzn stwierdzono wyraźną zależność pomiędzy grubością VF w okolicy nerek a stężeniem homocysteiny (r = 0,74 i p = 0,001).Wnioski: Objętość VF mierzona ultrasonograficznie może być wykładnikiem subklinicznie toczącej się miażdżycy u pacjentów z niedoborem hormonu wzrostu na skutek niedoczynności przysadki, w szczególności u mężczyzn

Clinical Study Comparison of Efficiencies of Michigan Neuropathy Screening Instrument, Neurothesiometer, and Electromyography for Diagnosis of Diabetic Neuropathy

Aim. This study compares the effectiveness of Michigan Neuropathy Screening Instrument (MNSI), neurothesiometer, and electromyography (EMG) in detecting diabetic peripheral neuropathy in patients with diabetes type 2. Materials and Methods. 106 patients with diabetes type 2 treated at the outpatient clinic of Ankara Numune Education and Research Hospital Department of Endocrinology between September 2008 and May 2009 were included in this study. Patients were evaluated by glycemic regulation tests, MNSI (questionnaire and physical examination), EMG (for detecting sensorial and motor defects in right median, ulnar, posterior tibial, and bilateral sural nerves), and neurothesiometer (for detecting alterations in cold and warm sensations as well as vibratory sensations). Results. According to the MNSI score, there was diabetic peripheral neuropathy in 34 (32.1%) patients (score ≥2.5). However, when the patients were evaluated by EMG and neurothesiometer, neurological impairments were detected in 49 (46.2%) and 79 (74.5%) patients, respectively. Conclusion. According to our findings, questionnaires and physical examination often present lower diabetic peripheral neuropathy prevalence. Hence, we recommend that in the evaluation of diabetic patients neurological tests should be used for more accurate results and thus early treatment options to prevent neuropathic complications

3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial

Background: Liraglutide 3·0 mg was shown to reduce bodyweight and improve glucose metabolism after the 56-week period of this trial, one of four trials in the SCALE programme. In the 3-year assessment of the SCALE Obesity and Prediabetes trial we aimed to evaluate the proportion of individuals with prediabetes who were diagnosed with type 2 diabetes. Methods: In this randomised, double-blind, placebo-controlled trial, adults with prediabetes and a body-mass index of at least 30 kg/m2, or at least 27 kg/m2 with comorbidities, were randomised 2:1, using a telephone or web-based system, to once-daily subcutaneous liraglutide 3·0 mg or matched placebo, as an adjunct to a reduced-calorie diet and increased physical activity. Time to diabetes onset by 160 weeks was the primary outcome, evaluated in all randomised treated individuals with at least one post-baseline assessment. The trial was conducted at 191 clinical research sites in 27 countries and is registered with ClinicalTrials.gov, number NCT01272219. Findings: The study ran between June 1, 2011, and March 2, 2015. We randomly assigned 2254 patients to receive liraglutide (n=1505) or placebo (n=749). 1128 (50%) participants completed the study up to week 160, after withdrawal of 714 (47%) participants in the liraglutide group and 412 (55%) participants in the placebo group. By week 160, 26 (2%) of 1472 individuals in the liraglutide group versus 46 (6%) of 738 in the placebo group were diagnosed with diabetes while on treatment. The mean time from randomisation to diagnosis was 99 (SD 47) weeks for the 26 individuals in the liraglutide group versus 87 (47) weeks for the 46 individuals in the placebo group. Taking the different diagnosis frequencies between the treatment groups into account, the time to onset of diabetes over 160 weeks among all randomised individuals was 2·7 times longer with liraglutide than with placebo (95% CI 1·9 to 3·9, p&lt;0·0001), corresponding with a hazard ratio of 0·21 (95% CI 0·13–0·34). Liraglutide induced greater weight loss than placebo at week 160 (–6·1 [SD 7·3] vs −1·9% [6·3]; estimated treatment difference −4·3%, 95% CI −4·9 to −3·7, p&lt;0·0001). Serious adverse events were reported by 227 (15%) of 1501 randomised treated individuals in the liraglutide group versus 96 (13%) of 747 individuals in the placebo group. Interpretation: In this trial, we provide results for 3 years of treatment, with the limitation that withdrawn individuals were not followed up after discontinuation. Liraglutide 3·0 mg might provide health benefits in terms of reduced risk of diabetes in individuals with obesity and prediabetes. Funding: Novo Nordisk, Denmark