Magnetic resonance imaging based kidney volume assessment for risk stratification in pediatric autosomal dominant polycystic kidney disease

IntroductionIn the pediatric context, most children with autosomal dominant polycystic kidney disease (ADPKD) maintain a normal glomerular filtration rate (GFR) despite underlying structural kidney damage, highlighting the critical need for early intervention and predictive markers. Due to the inverse relationship between kidney volume and kidney function, risk assessments have been presented on the basis of kidney volume. The aim of this study was to use magnetic resonance imaging (MRI)-based kidney volume assessment for risk stratification in pediatric ADPKD and to investigate clinical and genetic differences among risk groups.MethodsThis multicenter, cross-sectional, and case-control study included 75 genetically confirmed pediatric ADPKD patients (5–18 years) and 27 controls. Kidney function was assessed by eGFR calculated from serum creatinine and cystatin C using the CKiD-U25 equation. Blood pressure was assessed by both office and 24-hour ambulatory measurements. Kidney volume was calculated from MRI using the stereological method. Total kidney volume was adjusted for the height (htTKV). Patients were stratified from A to E classes according to the Leuven Imaging Classification (LIC) using MRI-derived htTKV.ResultsMedian (Q1-Q3) age of the patients was 6.0 (2.0–10.0) years, 56% were male. There were no differences in sex, age, height-SDS, or GFR between the patient and control groups. Of the patients, 89% had PKD1 and 11% had PKD2 mutations. Non-missense mutations were 73% in PKD1 and 75% in PKD2. Twenty patients (27%) had hypertension based on ABPM. Median htTKV of the patients was significantly higher than controls (141 vs. 117 ml/m, p = 0.0003). LIC stratification revealed Classes A (38.7%), B (28%), C (24%), and D + E (9.3%). All children in class D + E and 94% in class C had PKD1 variants. Class D + E patients had significantly higher blood pressure values and hypertension compared to other classes (p > 0.05 for all).DiscussionThis study distinguishes itself by using MRI-based measurements of kidney volume to stratify pediatric ADPKD patients into specific risk groups. It is important to note that PKD1 mutation and elevated blood pressure were higher in the high-risk groups stratified by age and kidney volume. Our results need to be confirmed in further studies

The impact of festivals on city promotion: A comparative study of Turkish and Swedish festivals

Tourism literature suggests that cities as corporate brands which can be promoted in the market and communicated to stakeholders. City tourism managers use tourism products such as festivals or other special events to promote their city as a corporate brand. This paper examines how festivals, in particular, affect the promotion and communication of a city in different market levels. A survey instrument was used to gather data from festival managers in Izmir, Turkey, in April 2009; and Göteborg, Sweden, in April 2009. The main findings indicate that managers perceive their festivals as creating community cohesiveness and strong communication among the current residents. However, they view the impact of the festivals on the promotion of the city within its country or in the international tourism market as limited. This study ultimately suggests that the festivals of Izmir are less efficient in promoting the city and that Göteborg festivals work to promote the city in Sweden and in the larger regions of Scandinavia

Type 2 myocardial infarction after ingestion of mad honey in a patient with normal coronary arteries

[No abstract available

The effect of circadian blood pressure pattern on presence of fragmented QRS complexes in hypertensive subjects

The association of deteriorated circadian blood pressure (BP) variability with presence of fragmented QRS (fQRS) on electrocardiography (ECG) is not clear. The present study aims to evaluate the relationship of BP patterns with presence of fQRS on ECG. A total of 338 consecutive newly diagnosed and never treated hypertensive patients who are without left ventricular hypertrophy and underwent 24-hour ambulatory BP monitoring were enrolled. Patients were classified as dippers, nondippers, and reverse dippers according to ambulatory BP monitoring results. The groups were compared regarding frequency of fQRS on ECG. The frequency of fQRS was significantly higher in reverse dippers compared with dippers (37.7% vs. 20.6%, P=.013). In multivariate logistic regression analysis, nighttime systolic BP was found to be an independent predictor of fQRS on ECG (P<.001, 95% confidence interval = 0.901-0.955). Other predictors of fQRS were daytime diastolic BP and age. Furthermore, fQRS was found to be an independent predictor of reverse dipping BP pattern in hypertensive patients (P=.004, odds ratio: 2.416, 95% confidence interval = 1.327-4.396). In conclusion, as a marker of fibrosis and higher fibrotic burden within myocardium, fQRS may be useful to determine the high-risk hypertensive patients in the absence of left ventricular hypertrophy. (C) 2017 American Society of Hypertension. All rights reserved

Pre-treatment vitamin B12, folate, ferritin, and vitamin D serum levels in patients with warts: a retrospective study

Aim To compare the serum levels of 25-hydroxyvitamin D, ferritin, folate, vitamin B12, zinc, and thyroid stimulating hormone between patients with warts and healthy individuals. Methods This retrospective study enrolled 40 patients with warts and 40 healthy individuals treated at the Ufuk University Hospital, Ankara, between July and December 2017. Serum levels of 25-hydroxyvitamin D, ferritin, folate, vitamin B12, zinc, and thyroid stimulating hormone status were evaluated retrospectively. Results Participants with and without warts had similar mean serum 25-hydroxyvitamin D, ferritin, folate, zinc, and thyroid stimulating hormone levels. However, patients with warts had significantly lower mean serum vitamin B12 level (P=0.010). Patients with warts non-significantly more frequently had decreased serum levels of 25-hydroxyvitamin D, ferritin, and folate (P=0330, P=0.200, P=0.070, respectively). Conclusion Patients with warts may require evaluation of serum levels of vitamin B12, folate, ferritin, and vitamin D

Usefulness of fragmented QRS in hypertensive patients in the absence of left ventricular hypertrophy

In the absence of left ventricular hypertrophy, importance of fragmented QRS complex (fQRS) in individuals with hypertension is unknown. The authors aimed to evaluate the relationship between blood pressure levels and fQRS in the absence of left ventricular hypertrophy. A total of 548 never-treated patients who underwent 24-hour ambulatory blood pressure monitoring were enrolled. The frequency of fQRS was significantly higher in patients with hypertension than normotension (36.4% vs 17.6%, P<.05). Multivariate logistic regression analysis revealed that systolic blood pressure is significantly associated with presence of fQRS on electrocardiography (odds ratio, 0.931; 95% CI, 0.910-0.9521 [P<.001]) even after adjusting for other confounding factors. Receiver operating characteristic analysis revealed a cutoff value of 147.65mmHg for systolic blood pressure to predict presence of fQRS (sensitivity: 51%, specificity: 99%, area under the curve=0.764; 95% CI, 0.717-0.811 [P<.001]). fQRS may be a sign of increased blood pressure and may predict higher fibrotic burden in patients with hypertension

Body mass index is a predictor of presence of fragmented QRS complexes on electrocardiography independent of underlying cardiovascular status

Background: Fragmented QRS (fQRS) as a sign of myocardial fibrosis indicates adverse outcomes in various cardiovascular diseases. However, there are no clear data regarding relationship between obesity and fQRS. We aimed to investigate whether high body mass index (BMI) predicts fQRS on electrocardiography (ECG) independent of underlying cardiovascular status

The relationship between the systemic immune‐inflammation index and reverse‐dipper circadian pattern in newly diagnosed hypertensive patients

Abstract Although hypertension is considered high intravascular pressure, impairing circadian blood pressure (BP) has been shown to potentially contribute to poor clinical outcomes. Systemic immune‐inflammation index (SII), based on platelet, neutrophil, and lymphocyte counts, has been established as a strong prognostic marker in cardiovascular disease. The role of inflammation in the pathogenesis of hypertension is a well‐known issue and inflammatory markers are associated with BP variability. We aimed to investigate whether there is a relationship between circadian BP changes and SII in newly diagnosed hypertensive patients. The study population consisted of 196 newly diagnosed hypertensive patients without LVH. In total, 76 (38%) patients had a dipper BP pattern, 60 (31%) patients had a non‐dipper BP pattern, and 60 (31%) patients had a reverse‐dipper BP pattern. SII was calculated according to Multivariate logistic regression analysis revealed SII and HDL‐C as an independent predictors of reverse‐dipper circadian pattern in newly diagnosed hypertensive patients. The cut‐off value of the SII for reverse‐dipper hypertension in a ROC curve analysis was >639.73 with 63.3% sensitivity and 84.2% specificity. Our study showed that the SII level was higher in the reverse‐dipper hypertension patient group than in the dipper and non‐dipper hypertension groups. Furthermore, SII was an independent predictor of newly diagnosed reverse‐dipper hypertensive patients. The high SII value in newly diagnosed hypertensive patients can be used as an early warning parameter to identify reverse‐dipper hypertension patients

Evaluation of Left Atrial Functions and the Electromechanical Delay Time by Echocardiography in Patients with prediabetes

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEYWOS: 000329858400341Turkish Soc Cardio