The effects of baseline heart rate recovery normality and exercise training protocol on heart rate recovery in patients with heart failure

Objective: It is unclear which exercise training protocol yields superior heart rate recovery (HRR) improvement in heart failure (HF) patients. Whether baseline HRR normality plays a role in the improvement is unknown. We hypothesized that an exercise training protocol and baseline HRR normality would be factors in altering HRR in HF patients. Methods: In this prospective, randomized, controlled and 3 group parallel study, 41 stable HF patients were randomly assigned to 3-timesweekly training sessions for 12 weeks, consisting of i) 30 minutes of interval training (IT) (n=17, 63.7±8.8 years old) versus ii) 30 minutes of continuous training (CT) (n=13, 59.6±6.8 years old) versus iii) no training (CON) (n=11, 60.6±9.9 years old). Each patient had cardiopulmonary exercise testing before and after the training program. Maximum heart rates attained during the test and heart rates at 1 and 2 min (HRR1 and HRR2) during the recovery phase were recorded. Paired samples t-test or Wilcoxon signed-rank test was used for comparisons before and after training. One-way ANOVA or Kruskal-Wallis variance analysis was used for comparisons among groups. Results: HRR1 was unchanged after training. HRR2 improved in the IT group after training, and post-training HRR2 values were significantly faster in the IT group than in controls. Both HRR1 and HRR2 was significantly faster, irrespective of exercise protocol in patients with abnormal baseline values after training. Conclusion: HRR1 did not improve after training. HRR2 improved only in the IT group. Both HRRs in patients with abnormal baseline values improved after both exercise protocols. IT might be superior to CT in improving HRR2. Baseline HRR might play a role in its response to exercise. © 2015 by Turkish Society of Cardiology

Predictive power of different obesity measures for the presence of diastolic dysfunction

Objective: Body mass index (BMI) and waist circumference (WC) as measures of obesity have some limitations. The aim of this study was to evaluate whether one measure could predict the presence of diastolic dysfunction (DD) more accurately than the other measures. Methods: A total of 91 obese patients without any other risk factors for DD were prospectively enrolled. Echocardiographic examination was performed. DD was defined and categorized according to recent guidelines. The study participants were divided into 2 groups according to the presence of DD. Weight, height, and WC were measured; BMI and waist-to-hip ratio (WHR) were calculated; and a body shape index (ABSI) was calculated as WC/(BMI2/3height1/2). The associations between ABSI, BMI, WHR, and WC and the presence of DD were examined using logistic regression analyses. Analysis of covariance was used to examine the differences. Results: WC and BMI were significantly greater in subjects with DD (p=0.049 and 0.051, respectively). A greater BMI, WC, and WHR increased the risk of the presence of DD (BMI-DD: odds ratio [OR]=1.096, p=0.024; WC-DD: OR=1.059, p=0.007; WHR-DD: OR=2.363, p=0.007). After adjustment for age and sex, only BMI continued to be significantly associated with DD (p=0.031). ABSI was not associated with DD. Conclusion: After adjustment for age and sex, BMI was the only predictor of DD in obesity. Despite its limitations, BMI may still be a potentially more accurate measure of DD compared with other obesity measures. © 2018 Turkish Society of Cardiology

Periodontitis Şiddetine Göre Hastaların Aktif Ve Destekleyici Periodontal Tedaviye Uyumlarının Değerlendirilmesi

Amaç: Periodontal prognoz açısından, aktif tedaviyi takiben destekleyici periodontal tedavinin önemi bilinmekle birlikte, bu süreçte hasta uyumuna etki eden faktörler tam olarak aydınlatılamamıştır. Bu çalışmanın amacı, aktif periodontal tedavi ve idame döneminde klinik indeksler, periodontitis şiddeti ve bireysel faktörler ile hasta uyumu arasındaki ilişkiyi belirlemektir. Gereç ve Yöntemler: Çalışmaya periodontitis tanısı almış 112 birey dahil edildi. Hastaların demografik özelliklerinin yanısıra başlangıç periodontal kayıtları alınarak periodontitis şiddeti ve derecesi belirlendi. Aktif periodontal tedavi süreci ve 1 yıllık idame periyodunda hasta uyumuna etki eden faktörler tek değişkenli ve çok değişkenli regresyon analizi ile değerlendirildi. Bulgular: Hastaların başlangıç klinik periodontal ölçümleri, periodontitis şiddeti ve derecesi yönünden aktif periodontal tedaviye uyumları benzerdi (p>0.05). Katılımcıların % 38’i destekleyici periodontal tedavi sürecine tamamen uyumsuzluk gösterdi. Periodontitis şiddeti arttıkça destekleyici periodontal tedaviye uyumun azaldığı tespit edildi. Aktif periodontal tedavi fazında uyumsuz olan hastalar, destekleyici periodontal tedavi döneminde de anlamlı derecede uyumsuzdu. Çok değişkenli regresyon analizi, sigara kullanımının ve aktif periodontal tedaviye uyumsuzluğun periodontal idame dönemindeki hasta uyumunu etkilediğini gösterdi. Sonuç: Hem başlangıç periodontal belirteçler hem de periodontitis şiddeti destekleyici periodontal tedavi fazında hasta uyumu ile anlamlı derecede ilişkilidir. Bununla birlikte, aktif tedaviye devamlılığı zayıf bireylerin idame döneminde de uyumsuz olduğu gözlenmiştir. Anahtar Kelimeler: Periodontitis, İdame, Hasta Uyumu, Periodontal Tedav

The Relationship of Hemogram Parameters and Night Desaturation in Patients Diagnosed with Obstructive Sleep Apnea Syndrome

Objective: Obstructive Sleep Apnea syndrome (OSAS) is a disease characterized by recurrent complete (apnea) or partial (hypopnea) upper respiratory tract obstructions episodes during sleep and often a decrease in blood oxygen saturation. Night hypoxias and sympathetic activity increase of arousals in OSAS are thought to stimulate that endothelial dysfunction and hypercoagulability. Materials and Methods: In this study, it was aimed to evaluate the relationship between the severity of the disease and the night hypoxia severity with hemogram parameters in patients diagnosed with OSAS who examined in our clinics. A total of 94 cases were included in the study, including 24 controls, 24 mild, 23 moderate, and 23 severe OSAS. Results: The mean and minimum oxygen saturation values in polisomnography with the number of neutrophils and neutrophil/lymphocyte (N/L) ratio were negatively correlated in the mild and severe OSAS groups. A negative correlation was observed between erythrocyte distribution width (EDW) and, mean oxygen saturation and minimum oxygen saturation in moderate and severe OSAS. When the mean and minimum oxygen saturation with regression analysis of EDW and N/L ratio were examined in each three groups; the 1 unit decrease in the minimum oxygen saturation increases the N/L ratio by 0.5-fold (p=0.02) in the mild OSAS, 0.5-fold (p=0.01) in the severe OSAS and it increases the EDW by ratio 0.5-fold (p=0.02) in the moderate OSAS. The 1 unit decrease in the mean oxygen saturation increases the N/L ratio by 0.4-fold (p=0.04) and the EDW by 0.8-fold (p=0.001) in the severe OSAS. Conclusion: As long as the OSAS severity increases, it is determined that the hematocrit values of patients increasing. However, as patients’ sleep desaturation increase, we can see that EDW, the number of neutrophils, and N/L ratio also increasing. This situation suggests that the local inflammation caused by both mechanical stress and ischemia-reperfusion cycles in the respiratory tract in OSAS is a consequence of spillage into the systemic circulation

How Do Patients Understand Safety for Cardiac Implantable Devices? Importance of Postintervention Education

This study was designed to assess the effect of patient education on the knowledge of safety and awareness about living with cardiac implantable electronic devices (CIEDs) within the context of phase I cardiac rehabilitation. Methods. The study was conducted with 28 newly implanted CIED patients who were included in "education group (EG)". Patients were questioned with a survey about living with CIEDs and electromagnetic interference (EMI) before and 1month after an extensive constructed interview. Ninety-three patients who had been living with CIEDs were included in the "without education group (woEG)". Results. Patients in EG had improved awareness on topics related to physical and daily life activities including work, driving, sports and sexual activities, EMI of household items, harmful equipment, and some of the medical devices in the hospital setting (p<0.05). Patients in EG gave significantly different percent of correct answers for doing exercise or sports, using the arm on the side of CIEDs, EMI of some of the household appliances, medical devices, and all of the harmful equipment compared to woEG (p<0.05). Conclusion. It was demonstrated that a constructed education interview on safety of CIEDs and living with these devices within the context of phase I cardiac rehabilitation is important for improving the awareness of patients significantly. Thus, patients might achieve a faster adaptation to daily life and decrease disinformation and misperceptions and thus promote the quality of life after the device implantation

The association between central adiposity and autonomic dysfunction in obesity

Objective: To determine the relationship between central adiposity parameters and autonomic nervous system (ANS) dysfunction. Subjects and Methods: The study included 114 obese individuals without any cardiovascular risk factors. Weight (in kg), height (in m), and waist circumference (WC; in cm) were measured and body mass index was calculated. Echocardiographic examination was performed to measure left ventricular mass and epicardial fat thickness (EFT). All the participants underwent an exercise test and electrophysiological evaluation using electromyography. Heart rate recovery (HRR) at 1-5 min, R-R interval variation at rest and during hyperventilation, and sympathetic skin response were measured. Pearson's correlation analysis was used. Multiple linear regression analysis was used to identify the factors associated with autonomic dysfunction. Results: The HRR at 1-5 min was negatively correlated with WC and age (WC-HRR1: r = -0.32; WC-HRR2: r = -0.31; WC-HRR3: r = -0.26; WC-HRR4: r = -0.23; WC-HRR5: r = -0.21; age-HRR2: r = -0.32; age-HRR3: r = -0.28; age-HRR4: r = -0.41; age-HRR5: r = -0.42). Age was the only independent predictor of reduced HRR at 1-5 min. In addition, WC predicted a reduced HRR at 3 min. There were no significant associations between central obesity and electrophysiological parameters. EFT was not associated with ANS dysfunction. Conclusion: In this study, central adiposity and aging were associated with ANS dysfunction in obese individuals. The WC could be a marker of ANS dysfunction in obese individuals without any cardiovascular risk factors. The HRR assessment at a later decay phase could be more valuable for evaluating ANS function than during early recovery. © 2016 S. Karger AG, Basel

Radiation exposure in acute myeloid leukaemia, diffuse large B-cell lymphoma, and multiple myeloma patients in the first year following diagnosis

Purpose: Radiological examinations are critical in the evaluation of patients with haematological malignancies for diagnosis and treatment. Any dose of radiation has been shown in studies to be harmful. In this regard, we assessed the radiation exposure of 3 types of haematological malignancies (diffuse large B-cell lymphoma [DLBCL], acute myeloid leukaemia [AML], and multiple myeloma [MM]) in our centre during the first year after diagnosis. Material and methods: In the first year after diagnosis we retrospectively reviewed the radiation exposure data of 3 types of haematological malignancies (DLBCL, AML, and MM). The total and median CED value (cumulative effective radiation dose in millisieverts [mSv]) of each patient was used. Each patient's total and median estimated CED value was calculated using a web-based calculator and recorded in millisieverts (mSv). Results: The total radiation doses in one year after diagnosis (CED value) were 46.54 ± 37.12 (median dose: 36.2) in the AML group; 63.00 ± 42.05 (median dose: 66.4) in the DLBCL group; and 28.04 ± 19.81 (median dose: 26.0) in the MM group (p = 0.0001). There was a significant difference between DLBCL and MM groups. Conclusions: In all 3 haematological malignancies, the radiation exposure was significant, especially in the DBLCL group, within the first year of diagnosis. It is critical to seek methods to reduce these dosage levels. In diagnostic radiology, reference values must be established to increase awareness and self-control and reduce patient radiation exposure. This paper is also the first to offer thorough details on the subject at hand, and we think it can serve as a guide for further investigation

Is CONUT score a prognostic index in patients with diffuse large cell lymphoma?

Background/aim: The aim of the study was to evaluate the effect of Controlling Nutritional Status (CONUT) score on the prognosis in patients with diffuse large B-cell lymphoma (DLBCL). Materials and methods: The present study was a retrospective study. The CONUT score was calculated based on serum albumin, total cholesterol and lymphocyte levels. This study included a total of 266 patients, 131 (49.2%) were female and 135 (50.8%) were male. The median follow-up period was 51 months (range: 1-190). Results: The median age was 64 years. The cut off CONUT was 1.5. There was a significant difference between patients with high (>_ 2) or low (_ 65 years (HR = 1.80, p = 0.028), Eastern Cooperative Oncology Group (ECOG) > 1 (HR = 2.04, p = 0.006), stage IIIA-IVB disease (HR = 2.75, p = 0.001) and the CONUT score (HR = 1.15, p = 0.003) were found statistically significant. In the multivariate analysis for PFS, age >_ 65 years (HR = 2.02, p = 0.007), stage IIIA-IVB disease (HR = 2.42, p = 0.002) and the CONUT score (HR = 1.19, p = 0.001) were found to be significant parameters. Conclusion: High CONUT score reduces OS and PFS in DLBCL. CONUT score is an independent, strong prognostic index in patients with DLBCL

Koroner arter hastalığının risk faktörlerinin irdelenmesinde alternatif bir yaklaşım: Genetik algoritmalar

Bilgisayar uygulamalarının her alanda yaygın olarak kullanıldığı günümüzde, potansiyel olarak depolanan veri hacmi hızla artmaktadır. Özellikle sağlık sektöründe depolanan ancak kullanılmayan bilgilerin hayata geçirilmesi işlemi, büyük önem taşımaktadır. Veri tabanlarında toplanan çok büyük hacimli verilerden, anlamlı bilgilerin elde edilmesi için geliştirilen ve özellikle son yıllarda yaygın kullanım alanları bulan yöntemler veri madenciliği yöntemleri olarak adlandırılırlar. Bu alanda birçok algoritmadan faydalanılmaktadır. Genetik Algoritmalar (GA) yönteminde problemler sanal olarak evrimsel süreçten geçirilir ve bu süreç sonunda en iyi sonucu veren çözüme ulaşılmaya çalışılır. Bu çalışmada, GA ile optimize edilerek sınıflama yapılmış olan 20, 50, 100, 500 ve 1000 ağaçlı Random Forest (RF) sonuçları; tek bir Karar Ağacından elde edilen sonuçlarla, GA ile optimizasyon yapılmamış olan 20, 50, 100, 500 ve 1000 ağaçlı RF sonuçlarıyla aynı zamanda da sınıflamalara etki eden en önemli 9 değişken temel alınarak sınıflama yapılmış olan 20, 50, 100, 500 ve 1000 ağaçlı RF sonuçlarıyla kıyaslanmıştır. Yapılan bu çalışmadan elde edilen sonuçlardan yola çıkılarak, GA yöntemiyle optimize edilerek kurulan RF modellerinin, optimize edilmemiş olan RF modellerine oranla çok daha yüksek başarıya sahip olduğu söylenebilir. Aynı şekilde RF modellerinin sınıflama başarısını yükseltmesi açısından, ağaç sayısı kaç olursa olsun, kurulacak olan modellerin GA yöntemiyle optimize edilmesi yapılan bu çalışma sonucunda ulaşılabilen en önemli sonuç olmaktadır.In the present day that computer applications are widely being used in all areas, potentially the data volume being stored is rapidly increasing. Particularly, putting into practice the stored but not used data in the health sector has a great importance. Methods which are developed for obtaining significant informations from huge datas accumulated in data bases, and which are finding wide are of usage particularly in late years, are called data mining. In this area many algorithms are followed up. In Genetic Algorithms (GA) method, problems are virtually undergone an evolutionary process, and at the end of this process it is tried to achieve the solution giving the best result. In this study, 20, 50, 100, 500 and 1000 trees Random Forest (RF) results classified by optimizing with GA were compared with; the results obtained from only one Decision Tree, nonoptimized 20, 50, 100, 500 ve 1000 ağaçlı RF results, at the same time 20, 50, 100, 500 ve 1000 trees RF results classified based on the most important 9 variables affecting the classifications. Setting out from the results of this study, it can be speculated that the RF models optimized by GA method have greater succes than nonoptimized RF models. In the same way, the most important result achieved in this study is that, in terms of increasing the succes in classification of RF models, optimizing the established models by GA method irrelevant from the number of trees