Left ventricular microfistulization: A rare cause of ischemia in a patient with normal coronary arteries

A 71-year-old woman with chest pain occurring on physicalexercise was admitted to cardiology department.Myocardial perfusion scintigraphy revealed inferior andanteroapical segment hypoperfusion. Selective coronaryangiography revealed multiple coronary-cameral fistulasoriginating from the left anterior descending artery andthe right coronary artery and emptying into the left ventriclewithout any significant coronary artery stenosis. Coronaryartery fistulas are defined as abnormal communicationsbetween a coronary artery and a cardiac chamber ormajor vessel. Coronary-cameral fistulas terminating in theleft ventricle are uncommon. Small fistulas usually do notcause any hemodynamic compromise. However, the largerand multiple fistulas may cause myocardial ischemiaascribed to a coronary steal phenomenon. The best wayto manage cameral fistulae is uncertain largely due to therarity of the condition. In the present case, anti-ischemicmedications with metoprolol 50 mg/day provided an uneventfulfollow-up of six months without any intervention

The association of epicardial fat thickness with blunted heart rate recovery in patients with metabolic syndrome

WOS: 000294273000003PubMed ID: 21737994Epicardial fat tissue has unique endocrine and paracrine functions that affect the cardiac autonomic system. Epicardial fat thickness (EFT) and blunted heart rate recovery (HRR) are newly identified cardiovascular risk factors in patients with metabolic syndrome (MS). The objective of this study is to evaluate the association between EFT and HRR in patients with MS. Forty patients with MS and 36 healthy controls were included in the study. Echocardiographic EFT and HRR at 1min after exercise termination (HRR-1) are measured and compared between the two groups. HRR-1 equal to or lower than 18 beats is considered as blunted HRR. EFT was increased (7.2 +/- 2 vs. 5.6 +/- 1.8 mm; p = 0.001) and HRR-1 was significantly reduced in patients with MS compared to control group (21 +/- 8 vs. 26 +/- 9; p = 0.006). Among the MS patients, subjects with blunted HRR had increased EFT compared to patients without blunted HRR (8.5 +/- 2.0 vs. 5.9 +/- 1.1 mm, p < 0.001). In multivariate analysis, EFT was the only independent predictor of blunted HRR in patients with MS (95% confidence interval = 1.42-3.87, OR = 2.34, p = 0.001). Furthermore, EFT of equal to or thicker than 5.5 mm was associated with the blunted HRR with 84% sensitivity and 52% specificity (ROC area under curve: 0.84, 95% confidence interval = 0.70-0.96, p < 0.001). In conclusion, EFT is an independent predictor of blunted HRR, a novel cardiovascular risk factor, in patients with MS

Patients’ satisfaction levels with hospital services at a university hospital

Amaç: Bu çalışma, Afyon Kocatepe Üniversite Hastanesinin çeşitli birimlerinde hizmet alan hastaların hastanenin fiziki durumu ve ulaşımı, sekreterlik ve resmi işlemler ve poliklinik hizmetleri hakkında memnuniyet düzeylerini belirlemek amacıyla gerçekleştirilmiştir. Gereç ve Yöntem: Araştırmaya katılmayı kabul eden 345 kişiye yüz yüze görüşülerek anket uygulanmıştır. Anket formunda, hastane hizmetleri hakkındaki memnuniyet düzeyleri 5’li Likert ölçeğine göre değerlendirilmiştir. Ortalama memnuniyet düzeyleri 1-5 arasında derecelendirilmiş- tir. Bulgular: Hastaların hastane ulaşımı ve fiziki durumundan memnun olma düzeyleri 4.04±0.83, sekreterlik ve resmi işlemlerden 3.99±0.98 ve poliklinik hizmetlerinden 4.14±0.83 olarak bulunmuştur. 50 ve üzeri yaşta olan hastalar hastane hizmetlerinden daha çok memnun olduklarını belirtmişlerdir (p<0,05). Bekar olan hastalar ve lisans eğitim düzeyine sahip olan hastaların genel olarak memnuniyet düzeyleri ise diğer gruplara göre düşük çıkmıştır (p<0,05). Hastaların meslek grupları, gelir durumları ve sosyal güvenceleri ile memnuniyet düzeyleri arasında anlamlı bir farklılık bulunmamıştır. Gelecekteki bir hastalık durumunda tekrar hastaneyi veya poliklinikleri tercih edeceklerini bildiren hastaların memnuniyet düzeyleri yüksek bulunmuştur (p<0,001). Sonuç: Genel olarak hastaların, hastane ulaşımı ve fiziki durumundan, sekreterlik hizmetleri ve resmi işlemlerden ve poliklinik hizmetlerinden yüksek düzeyde memnun oldukları görülmüştür. Memnuniyet düzeylerini olumsuz yönde etkileyen faktörler belirlenmiş ve bunlara karşı alınması gereken önlemler üzerinde durulmuştur.Objective: This work was carried out to determine the patients’ satisfaction levels with physical condition and transportation, secretarial and legal processes and outpatient services in Afyon Kocatepe University Hospital. Material and Methods: A questionnaire was applied through face-to-face interviews with 345 individuals who accepted to participate in this study. The satisfaction levels about hospital services were evaluated using 5-point likert scale in the questionnaire. Mean satisfaction levels were graded between 1 and 5. Results: Patients’ satisfaction levels were determined as 4.04±0.83 for physical condition and transportation, 3.99±0.98 for secretarial and legal processes, and 4.14±0.83 for outpatient services. Patients above 50 years old expressed that they were more pleasant with hospital services than younger group (p<0.05). Satisfaction levels of single patients and patients with higher education level were found to be lower compared to other groups (p<0.05). There were no significant relations between satisfaction levels and patients’ occupation, income status, and social security. The satisfaction levels of patients who will prefer the same hospital or outpatient service in the case of their illness were found to be higher (p<0.001). Conclusion: Generally, patients were found to be highly satisfied in terms of physical condition and transportation, secretarial and legal processes and outpatient services in the hospital. The factors that adversely affect the satisfaction levels were determined and the measures to be taken were emphasized

New potential monotherapeutic candidates for helicobacter pylori: Some pyridinazo compounds having both urease enzyme inhibition and anti-helicobacter pylori effectiveness

To contribute to the monotherapeutic approach to Helicobacter pylori, some new pyridinazo compounds containing natural phenols such as eugenol and guaiacol were synthesized and their antioxidant capacities, urease enzyme inhibition and anti-Helicobacter pylori effect were investigated. This monotherapeutic approach suggests that a single synthetic drug with both a strong urease enzyme inhibitor and effective antibiotic properties can be used to treat Helicobacter pylori infection As expected, all newly obtained pyridinazo compounds have been found to have both urease enzyme inhibitor properties and anti-Helicobacter pylori activity

Türkiye’de telsizciliğin gelişimi (1970-1990)

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2017.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by Yiğit, Tarık Tansu

The effect of body mass index on location of recurrence and survival in early-stage colorectal cancer

Introduction: Obesity has become one of the major public health problems in many countries. Controversial results were reported in publications on the relationship between obesity and mortality in patients diagnosed with colorectal cancer (CRC) and that receive curative treatment. In this study, we evaluated the effects of body mass index (BMI) on the location of recurrence and disease-free survival (DFS) in patients with early-stage CRC. Materials and Methods: Patients that were followed up and treated in the Department of Medical Oncology between 1999 and 2016 were retrospectively included in the study. Patients with operated Stage I, II, and III CRC were included in the study. Patients were divided into three groups based on their BMI (kg/m2) of below 25, between 25 and 30, and above 30. Results: A total of 950 patients, of which 527 (55.5%) were male and 423 (44.5%) were female, were included in the study. The median age of the patients was 56 years. Of the patients, 408 (42.4%) had BMI of 30. Local recurrence rate was significantly higher in the group with BMI >= 30 compared to the other groups (P = 30 (P = 0.02) and that difference was more evidently observed in Stage III (P = 0.02). There was no statistically significant difference of overall survival in the BMI groups (P = 0.87). In multivariate analysis, the BMI >= 30 (hazard ratio [HR], 1.49, 95% confidence interval [CI], 1.02-2.17), rectal tumor (HR, 1.70, 95% CI, 1.15-2.51), Stage III (HR, 3.91, 95% CI, 1.86-8.25), number of positive lymph nodes (HR, 1.05, 95% CI, 1.03-1.07), and R1 resection (HR, 3.47, 95% CI, 1.71-7.05) were identified as independent risk factors negatively affecting DFS. Conclusion: In this study, we observed that the high BMI increased the risk of recurrence, especially in Stage III CRC patients, and that the recurrence frequently occurred locally

Echocardiographic epicardial fat thickness is related to altered blood pressure responses to exercise stress testing

Objective. Hypertensive response at peak exercise and blunted blood pressure (BP) recovery, altered BP responses obtained from exercise stress testing, have been suggested as risk factors for future onset of hypertension in previous studies. Epicardial fat, a new cardiometabolic risk factor, has been linked to hypertension in some recent studies. In this study, we tested the primary hypothesis suggesting that the epicardial fat thickness (EFT) is related to altered BP responses to treadmill exercise testing. We also evaluated the sensitivity and specificity of the EFT as a predictor of hypertensive response to peak exercise. Methods. Normotensive subjects underwent to treadmill stress testing and transthoracic echocardiography. Hypertensive response to peak treadmill exercise testing was defined as ? 210/105 mmHg and ?190/105 mmHg at peak exercise in males and females, respectively. BP recovery index (BPRI) was defined as the ratio of the BP at the 3rd minute of the recovery phase to BP at peak exercise. EFT was measured by echocardiography. Thirty-two subjects with hypertensive response to peak exercise constituted Group 1 and 48 subjects with normal response constituted Group 2. Results. The mean EFT of subjects in Group 1 was significantly higher (8.2 ± 1.1 mm vs 5.1 ± 1.5 mm; p = 0.0001) than subjects in Group 2. In correlation analysis performed in Group 1, EFT was found to be significantly correlated with BPRI (r = 0.51, p < 0.003). An EFT of ?6.5 mm predicted the hypertensive response to peak exercise test with 68.8% sensitivity and 87.5% specificity (receiving operator characteristic area under curve: 0.879, 95% CI 0.7930.965, p < 0.001). Patients with EFT ?6.5 mm showed a significantly increased BPRI (0.89 ± 0.07 vs 0.74 ± 0.09, p < 0.0001) and peak systolic BP (198.4 ± 15.3 mmHg vs 169.4 ± 19.8 mmHg, p < 0.0001). There were significant differences in metabolic equivalents, maximum heart rate, homeostatic model assessment of insulin resistance, high-density lipoprotein-cholesterol, waist circumference and age values between two patients groups dichotomized according to the cut-off value of EFT. BPRI was the only independent variable related to EFT in the multivariate analysis (odds ratio = 1.4, 95% CI 2.757.16, p = 0.001). Conclusions. EFT was found to be related to altered BP responses to exercise stress testing. The echocardiographic measurement of EFT may serve as a useful non-invasive indicator of heightened risk of future hypertension