Comparison of coronary risk scoring systems to predict the severity of coronary artery disease using the SYNTAX score

Background: Reliable risk scoring systems that can predict the severity of coronary artery disease (CAD) are necessary to implement effective management strategies in high-risk patients. Atherosclerotic vascular disease and with cardiovascular morbidity and mortality risk are patients who would benefit most from a change in patients at high risk factors. Framingham Risk Score, the Prospective Cardiovascular Münster (PROCAM) score and Systematic Coronary Risk Evaluation (SCORE) risk scores are used for this purpose. The severity of the CAD as detected by coronary angiography can be estimated using the SYNTAX score. In this study, it is aimed to assess the relation between SYNTAX score and the Framingham, PROCAM and SCORE scores in the context of their utility for the determination of the severity of the CAD. Methods: A total of 205 patients with documented CAD who underwent coronary angiography due to a diagnosis of stable angina pectoris were included in this study. Coronary risk scores were determined for each patient. The relation between the SYNTAX score and the results of coronary risk scoring systems were analyzed. Results: A positive relationship between the SYNTAX score, which reflects the severity of the CAD and coronary risk scores was found. However, Framingham and SCORE were superior, i.e., had more predictive value, regarding their ability to predict the SYNTAX score (p = 0.029, 0.033 and 0.002, respectively). Conclusions: Examination of the distribution of SYNTAX score across low, intermediate and high-risk groups showed a significantly higher predictive value of SCORE for high-risk patients (p = 0.005).

Ameliyat Öncesi Değerlendirilen Hastaların Antikoagülan ve Antiplatelet İlaç Kullanım Farkındalığı

Objective: To determine anticoagulant and anti-platelet medication awareness of peri-operative patients Method: A questionnaire was applied to the 208 preoperative patients taking anticoagulants (AC) or anti-platelets (AP). The questionnaire included the questions about whether they were using any drug that thinners blood or prevents clots, indication and duration of drug use, whether they underwent an operation while using the drug, whether they knew that the drug should be discontinued in case of undergoing an operation and presence of a planned surgical procedure when commencing the drug. Results: Mean age of the study population was 63.3±12.7 years and 50.5% of the patients were male, 27.9 % of the patients were illiterate, 39.4% of patients were not aware of using AC or AP and 12.5% of patients didn’t know duration of AC or AP use. An operation had been planned before commencement of the drug in 9.1% of the patients. The incidence of undergoing a surgical procedure while using AC or AP was 18.8%. While 23.1 % were urgent, 76.9% were elective procedures. General anesthesia was applied in 41% of these patients. When the patients who were aware or unaware of AC or AP use were compared, mean age was younger and level of education was higher among the patients who were aware of using AC or AP (p=0,018 and p<0,001 respectively). No difference was detected between the patients who were using old or new generation drugs with regard to awareness of drug use (p=0.113). Conclusion: Patients who are taking AC or AP may have to undergo surgical procedures more than once while using these drugs. However, an important proportion (39.4 %) of these patients was found to be unaware of using AC or AP

Are the birth month and season predictors of coronary artery disease?

The month and season of birth have been found to be associated with cardiovascular mortality, but the mechanisms are not fully explained. We planned a study to examine the relationship between SYNTAX score, which shows the severity of coronary artery disease (CAD), and the month and season of birth. 346 patients who underwent coronary angiography between October 2019 and January 2020 were evaluated. Birth month, birth seasons and demographic data of patients were recorded. SYNTAX scores were calculated from patients' coronary angiographies. Patients with birth months September, October, November and December had the lowest SYNTAX score (6.42±8.78, 5.61±8.42, 8.93±12.07, 6.35±8.02, respectively). SYNTAX score of patients who were born in October was statistically significantly lower compared to other months (p= 0.005). Coronary artery disease was highest in those born in June (%81.2) and July (%82.6). The presence of CAD in patients born in fall was 46.5% (p [Med-Science 2021; 10(2.000): 474-8

Triglyceride Glucose Index and The Triglyceride/HDL Ratio as Predictors of Coronary Artery Disease

Aim: Triglyceride to high density lipoprotein cholesterol (TG/HDL-C) ratio and triglyceride-glucose (TyG) index are simple, reliable screening methods. It has been shown that the TyG index predicts mortality in cardiovascular diseases and the TG/HDL-C ratio predicts the severity of coronary artery disease (CAD). We planned a study to define the relationship between the SYNTAX score, which indicates the severity of CAD, and the TyG index and TG / HDL-C ratio.Material and Methods: A total of 408 patients who underwent coronary angiography were evaluated in this study. TyG index, TG/HDL-C ratio and SYNTAX scores were calculated. Patients were grouped according to their diagnosis and SYNTAX scores. Relationships between TyG index, TG / HDL-C ratio and SYNTAX score were examined.Results: There is a significant relationship between the TyG index and the presence of CAD (p&lt;0.001). When the TyG index was evaluated in terms of the severity of CAD, there was a positive significant relationship between mild and severe CAD (p&lt;0.040). While there was a significant positive correlation between TG/HDL-C ratio and the presence of CAD (p&lt;0.001), there was no significant relationship between severity of CAD (p:0.814). There was a low level significant positive correlation in terms of TyG index between patients with unstable angina pectoris and ST-elevation myocardial infarction (p:0.046).Conclusion: The TyG index and TG/HDL-C ratio are predictors of the presence of CAD and the TyG index also provides guidance on the severity of CAD. Standard use may be considered in addition to risk scoring in the diagnosis of CAD and planning coronary angiography

The partition of the estate

Gerçek kişinin ölümü üzerine bu kişiye ait değerler, bu kimsenin küllî halefi olan mirasçılarına intikal eder ve bu şekilde bu mirasçılar arasında miras ortaklığı teşekkül eder. Bu şekilde kurulan miras ortaklığının ilelebet devam etmesi, söz konusu ortaklığın nihaî amacının tasfiye olmasına ve ayrıca mirasçıların menfaatlerine aykırıdır. Bu ortaklığın, tek sona erme sebebi olmamakla birlikte, olağan sona erme biçimi, mirasın paylaşılmasıdır. Mirasın paylaşılması, mirasçılar, mirasbırakan veya kanunkoyucu tarafından belirlenen paylaşma kuralları dikkate alınarak, miras paylarının oluşturulması ve bu paylarının mirasçılara özgülenmesi ve bu şekilde her bir mirasçının kendisine özgülenen tereke değeri veya değerleri üzerinde bireysel hak sahipliğinin tesis edilmesiyle gerçekleşmektedir. Dikkat edilirse, mirasın paylaşılması işlemi, bu işlemle borçların paylaşılması da mümkünse de, aktiflerin paylaşılmasına ilişkindir. Bu çerçevede, mirasın paylaşılması işlemi, ilgili tereke değerinin kendisine özgülendiği mirasçı lehine, diğer tüm mirasçıların, söz konusu tereke değeri üzerindeki elbirliğiyle hak sahipliğinden vazgeçmeleriyle sağlanacaktır. Mirasın paylaşılması mirasçılar tarafından oybirliği ile yapılacak paylaşma sözleşmesiyle gerçekleştirilebilir. Bu sözleşme, elden paylaşma veya yazılı paylaşma sözleşmesi şeklinde yapılır. Paylaşma, elden paylaşma işleminde sözleşmenin yapıldığı; yazılı paylaşma sözleşmesinde ise sözleşmenin ifa edildiği anda gerçekleşir. Mirasçılar paylaşmaya ilişkin anlaşmaya varamadıkları takdirde, paylaşma, mirasçılardan birinin talep etmesi üzerine hâkim tarafından gerçekleştirilecektir. Mirasçının talebini paylaşma dâva açarak ileri sürmesi ve hâkimin dâvayı kabul etmesiyle, ilgili mirasçı miras payını alarak miras ortaklığından ayrılır. Mirasın paylaşılmasının sonuçlandırılmasından sonra mirasçıların birbirlerine ve üçüncü kişilere karşı sorumlulukları söz konusudur. Mirasçılar birbirlerine karşı özgüleme konusu tereke mallarının üçüncü kişi tarafından zapt edilmesi veya ayıplı çıkmasından, özgüleme konusu alacağın borçlusunun ödeme gücünden yoksun olmasından, paylaşmadan başlayarak bir yıllık süre boyunca miras payları oranında sorumludurlar. Mirasçıların tereke borçlarının alacaklılarına karşı, bu borçların ödenmesinden müteselsil olarak sorumlu olmaları, paylaşmadan sonra da belli bir süre devam eder. Müteselsil sorumluluk, mirasçılar arasında yapılan ve borcun iç yüklenilmesi niteliğinde olan anlaşmaya alacaklının rıza göstermesi veya paylaşmadan başlayarak beş yıllık sürenin dolmasıyla sona erer.The values belonging to the deceased real person, descents to the legal heirs who are the universal succession of the deceased and in this way there is a community of heirs among the inheritors. It is against the interests of the inheritors and the definite objective that is the liquidation, of such community if the community of heirs occurred in this way, continues ever more. Although, it is not the only way of termination, the usual way of termination is the partition of the estate. The partition of the estate is executed in accordance with the rules of legislator on partition or the inheritors or deceased, thus the constitution of the pour parties and distribution of the pour parties to inheritors whose individual right ownership are constituted on distributed succession value or values for inheritors. It is noted that the estate partition proceedings is on the partition of the assets, although the debts can be subject of the partition, as well. In this frame, the partition of estate proceeding will be able to be realized when all other inheritors leave their ownership rights in cooperation on related estate value in favour of the inheritor who is distributed the related estate. The partition of the estate can be executed with the partition contract which is concluded by all inheritors unanimously. The contract can be formed for the heirs upon formation and acceptance of the lots or with the execution of written partition contract. The partition of the estate is achieved for the first one as soon as the contract is formed; for the latter one, as soon as the written contract is fulfilled. In case the inheritors cannot reach an agreement for the partition, the partition will be executed by the judge upon any of the inheritors' demand. As the inheritor brings a lawsuit and the judge accepts the judicial partition case, related inheritor leaves the community of heirs where he/she takes his/her own share. There are responsibilities of the inheritors against each other and third parties after the completion of partition of estate. The inheritors are responsible proportional to their share against each other for one year starting on the date of achievement of partition for the cases of eviction of the distributed assets by any third party or defection of the assets; existence of a debtor who cannot afford a claim for any distributed share. The joint liability of the inheritors for the debt of estate against the third parties continues after completion of the partition for a length of time. The joint liability discontinues if the claimant consents for the agreement on assumption of indebtedness among all the inheritors or expiration of five years from the date of completion of the partition

Effect of left bundle branch block on TIMI frame count

Aim: Left bundle branch block is an independent risk factorfor cardiac mortality. In this study we aimed to evaluatecoronary blood flow with TIMI frame count in patients with left bundle branch block and angiographically proven normal coronary arteries.Materials and methods: We retrospectively studied 17 patients with left bundle branch block and as a control group 16 patients without left bundle branch block. All patientshad angiographically proven normal coronary arteries.Left bundle branch block was determined according to standart electrocardiographic criteria. The TIMI frame count was measured for each major coronary artery in each patient.Results: TIMI frame count for left anterior descending coronary artery was found to be significantly higher in patientswith left bundle branch block compared with patients without left bundle branch block (35.4±16.7 ve 23.8±4.5, p=0.012). TIMI frame counts for circumflex and right coronaryarteries were similar in patients with and without left bundle branch block (TIMI frame count for circumflex artery:32.4±15.4 ve 27.7±7.6, p=0.275; TIMI frame count for right coronary artery: 31.9±9.6 ve 27.0±8.6, p=0.141).Conclusion: We have found that TIMI frame count for left anterior descending coronary artery was higher in patients with left bundle branch block compared with patients without left bundle branch block whereas there were no difference for TIMI frame counts for circumflex and right coronary arteries. Impaired coronary blood flow in left anterior descending artery may help to explain the sintigraphic perfusion defects in septum of patients with left bundle branch block

The relationship between nutritional status and heart rate variability in elderly patients

Aim: Malnutrition is a common health problem in elderly patients. Prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) are two easily calculable indexes developed as indicators of nutritional status, showing prognosis relationships with some diseases. We planned a study to define the relation- ship between PNI, GNRI, which indicates nutritional status and is also a criterion of frailty, and heart rate variability (HRV), which is a cardiovascular risk marker. Material and Methods: A total of 96 patients over 65 years of age who had no known chronic disease other than controlled hypertension and regulated diabetes and who underwent rhythm holter monitoring were evaluated. Framingham risk scores (FRS), PNI, GNRI of the patients were calculated. HRV parameters were recorded. Results: The root mean square of successive differences (rMSSD) (p:0.02) and percentage of adjacent RR intervals with a difference of duration >50ms (pNN50) (p:0.035) were significantly lower in the patient group with low PNI. HRV frequency domain parameters, low-frequency/high-frequency (LF/HF) (p:0.048) and total power (TP) (p:0.044) were significantly higher in the patient group with low PNI. There was no significant relationship between GNRI and HRV parameters. Discussion: PNI is a simple indicator of decreased HRV and increased cardiac risk in elderly patients. PNI is more valuable than GNRI in predicting increased cardiac risk related to HRV in elderly patients. The results of our study support the effect of adequate nutrition on cardiac autonomic modulation in the elderly and confirm that nutrition in this age group is a correctable cardiac risk factor

Urodynamic disorders and renal scarring in pediatric patients with nonmonosymptomatic nocturnal enuresis

Background/aim: In nonmonosymptomatic nocturnal enuresis (NMNE), the incidence of organic abnormality and urodynamic disorder is more frequent than the general population. The aim of this study is to identify urodynamic disorders and renal scarring in children with NMNE. Materials and methods: This study evaluated the urodynamic disorders and renal scarring of a total of 30 patients who were diagnosed with NMNE. A video-urodynamic test and Tc-99m dimercaptosuccinic acid renal scintigraphy were applied. Results: Records of 605 patients who had been diagnosed with enuresis were analyzed, and 215 (33.5\%) of them had been diagnosed with NMNE. Thirty patients older than 6 years old with NMNE were included in the study. Detrusor overactivity was identified in 10 patients. Bladder capacity was low in 5 patients and bladder compliance was low in 2 patients. Renal scarring was identified in 1 patient. Unilateral vesicoureteral reflux was found in 4 patients. Conclusion: Bladder function disorder is also a significant risk factor for the development of renal scarring, besides other risk factors. Organic abnormalities are seen more often in patients with NMNE than patients with monosymptomatic nocturnal enuresis, so urodynamic studies should be remembered for patients with NMNE

Poor Nutritional Status Is Associated with Arrhythmic Events on 24-Hour Holter Recording

Background: Malnutrition is associated with cardiovascular disease morbidity and mortality. Arrhythmias may be the cardiac consequences of malnutrition. Objectives: The objective of the study was to evaluate the association between prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) score, and arrhythmic events on 24-h electrocardiography (ECG) Holter recording in patients without manifested arrhythmia. Methods: In this retrospective analysis of 477 patients who underwent 24-h ECG Holter monitoring, PNI and CONUT score were calculated and patients were divided into tertiles according to PNI and into three groups according to CONUT score; 0: normal, 1-2: mild risk of malnutrition, >= 3: moderate-severe risk of malnutrition. Arrhythmic events were compared between PNI tertiles and CONUT score groups. Results: Total number of premature atrial contractions, premature ventricular contractions (PVCs), PVC burden, and incidence of paroxysmal atrial fibrillation (PAF) were significantly higher in patients within the lowest PNI tertile. Total number of PVCs, PVC burden, and incidence of PAF were significantly higher in patients with CONUT score >= 3. The cut-off value for PNI to predict the presence of PVC was defined as 39.41 using ROC curve analysis. The area under the curve was 0.650 (p < 0.001). Multivariate analysis showed that PNI was independent predictor of the presence of PVC and PAF. Also, CONUT score was independent predictor of the presence of PVC and PAF. Incidence of nonsustained ventricular tachycardia did not differ between PNI tertiles or CONUT score groups. Conclusion: Poor nutritional status, assessed by PNI and CONUT score, is associated with arrhythmic events on 24-h ECG Holter recording in patients without manifested arrhythmia