Browsing by Author "Tavli, T"
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Item The acute effect of orlistat on endothelial function in young obese womenSekuri, C; Tavli, T; Avsar, A; Sozcuer, H; Uyanik, BS; Ari, ZRecent studies indicate that abdominal fat accumulation is related to impaired endothelial function in young healthy volunteers. The aim of this study was to determine the acute effect of gastrointestinal lipase inhibitor on brachial flow-mediated vasodilatation and hemodynamic parameters in young obese women. The study population was composed of 42 female obese patients (mean age 29 +/- 4 years, age range between 18 and 34 years). Flow-mediated endothelial-dependent vasodilatation was assessed in the brachial artery in response to reactive hyperemia using high-resolution ultrasound. Brachial artery diameter (3.46 +/- 0.72 mm to 3.82 +/- 0.84 mm) and flow-mediated vasodilation (7.6 +/- 0.8% to 9.8 +/- 1.6%) changed significantly after 12 weeks of therapy (p < 0.001). Brachial artery flow was not changed (124 +/- 92 ml/min to 148 +/- 14 ml/min, p > 0.05). The results of this study demonstrate that orlistat improved endothelial function, weight, body mass index and systolic and diastolic blood pressure in young women.Item Diffuse left anterior descending coronary artery dissection with aortic coarctationMergen, H; Nazli, Y; Acar, M; Tavli, V; Tavli, TItem A rare cause of reversible dilated cardiomyopathy: HypocalcemiaAvsar, A; Dogan, A; Tavli, THypocalcemia is a rare cause of reversible heart failure. We reported a 40-year-old woman who had severe heart failure resistant to the usual antifailure therapy. She had severe hypocalcemia due to hypoparathyroidism after strumectomy. Echocardiography showed a large left ventricle with very low ejection fraction of 25% and moderate mitral regurgitation. After supplementation of calcium and vitamin D, her clinical situation and hemodynamics improved rapidly. At 15 months, myocardial impairment resolved fully. In conclusion, hypocalcemia should be considered in the differential diagnosis of resistant severe heart failure.Item Validity and Reliability of the QIDS-SR16-Turkish in Comparison with BDI-II-Turkish Among Young Outpatient Sample of Turkish University StudentsMergen, H; Tavli, T; Öngel, KObjective: To evaluate the validity and reliability of 16-item self-report version of the Quick Inventory of Depressive Symptomatology (QIDS-SR16) scale in comparison with BDI-II-Turkish (BDI-II-T) in a young sample of Turkish university students. Methods: A slightly modified version of the QIDS-SR16-Turkish (QIDS-SR16-T) available at www.ids-qids.org, along with the BDI-II-T, was administered to 628 young Turkish university students who attended the Family Health Center in Uludag University Campus between February and April 2010. Descriptive analyses, Student's t-test, receiver operating characteristic (ROC) analysis, and confirmatory factor analyses were used in the study. Results: The mean age of the participants was 21.1 +/- 2.16 (SD) years; 67.8% were female and 32.2% were male. Cronbach's a coefficient for internal consistency of the QIDS-SR16-T was found to be 0.769. The mean item-total correlation was 0.45, ranging from 0.29 to 0.71. The correlation between the BDI-II-T and QIDS-SR16-T was 0.72. ROC curve analysis suggested 9 as the optimal cut-off for a clinical depression level for the QIDS-SR16-T. Conclusion: We observed that the QIDS-SR16-T demonstrated good psychometric properties in a sample of young Turkish students and has convergent validity with the BDI-II-T, a widely used scale for depression. It is essential to diagnose reliably the major depressive disorder and to follow up the patients by valid screening instruments in primary care setting. The internal consistencies of the QIDS determined in studies from the United States were greater than our Cronbach's alpha coefficient, but there was no statistically significant difference between them (z=0.55, p>0.05). The QIDS-SR16-T can be reliably used in primary care settings. (Archives of Neuropsychiatry 2012;49: 1-5)Item Cardiovascular risk factors and noninvasive assessment of arterial structure and function in obese Turkish childrenYilmazer, MM; Tavli, V; Carti, OU; Mese, T; Güven, B; Aydin, B; Devrim, I; Tavli, TObesity is associated with a number of risk factors, such as hyperlipidemia, hyperinsulinemia, hypertension, and early atherosclerosis. Evidence indicates that atherosclerosis begins in childhood and progresses over decades. In this work, we examined the relationship between cardiovascular risk factors and ultrasonographic signs of subclinical atherosclerosis in 77 obese children and adolescents compared to 40 non-obese healthy peers. Carotis intima media thickness (cIMT), carotid artery compliance (CAC), brachial artery flow-mediated dilatation (FMD), and established cardiovascular risk factors were studied. In the obese patients, cIMT was significantly increased (0.57 mm vs 0.45 mm, p < 0.001) whereas CAC (1.84% vs 3.29%, p < 0.001) and FMD (9.67 % vs 14.81%, p < 0.001) were significantly decreased. In multiple linear regression analysis, a relation was observed between cIMT, CAC, brachial FMD on one hand, and body mass index (BMI) on the other. Among the lipid anomalies, only hypertriglyceridemia was found to be positively correlated with cIMT. Additionally, we found a significant association between waist circumference (WC) and FMD. These findings indicate that obesity in children is associated with arterial wall alterations and endothelial dysfunction. In hyperlipidemic situations, only hypertriglyceridemia was found to be positively correlated with cIMT. This finding has consistently indicated TG to be a risk factor for the development of atherosclerosis. To our knowledge this is the first study to determine the relation between FMD and WC, which is used as a parameter of obesity in childhood.Item Spectral and time-domain analyses of heart-rate variability during head-upright tilt-table testing in children with neurally mediated syncopeEvrengul, H; Tavli, V; Evrengul, H; Tavli, T; Dursunoglu, DNeurocardiac syncope (NS) is a common cause of syncope in children. The mechanism, though related to abnormalities in autonomic function, has not been fully elucidated, particularly in pediatric patients. This study assessed the heart-rate variability (HRV) response to head-upright tilt-table test (HUT) in children with NS and normal volunteers. Spectral and time-domain analysis of HRV was used to assess changes in autonomic function in 27 children (9 male, mean age 12.3 +/- 1.6 years) with a history of at least one episode of syncope and positive passive HUT and 27 age-matched normal volunteers with negative passive HUT before and during postural tilt and to attempt to relate such changes to specific types of hemodynamic response to tilt. Frequency-domain measurements of the high-(HF) and low-(LF) frequency bands and the ratio LF/HF were derived from Holter recordings and computed by fast Fourier analysis for 5-min intervals. Time-domain measurements of the SDNN, SDNNI, SDANN, RMSSD, and triangular index were derived from 24-h Holter recordings. There were no significant differences between clinical characteristics, time-domain, and basal frequency domain parameters of the groups. Mean values of LF and LF/HF ratio was increased and HF was decreased significantly in response to tilt in both patient and control groups. Mean values of LF and LF/HF ratio were higher and HF was lower compared to controls immediately after tilt. LF and LF/HF ratio showed a statistically significant decrease and a significant increase in HF during syncope in patients. The three subgroups of patients had similar patterns of changes in autonomic activity. The results of this study show that although the basal autonomic function was similar to that of the control group, patients with NS have a different pattern of response to the HUT. In our study, patients with NS demonstrated an exaggerated response to the HUT. This exaggerated response may be the factor that activates the pathological reflexes of NS. The pathological mechanism leading to NS appears to be independent of the specific type of hemodynamic response to HUT.Item Acute phase reactants in patients with coronary slow flow phenomenonMadak, N; Nazli, Y; Mergen, H; Aysel, S; Kandaz, M; Yanik, E; Çekdemir, D; Tavli, TObjective: In this study, we sought to investigate the serum levels of high sensitivity C-reactive protein (Hs-CRP), N-terminal pro-brain natriuretic peptide (NT proBNP), erythrocyte sedimentation rate, leukocyte, thyroid hormone and fibrinogen levels in patients with coronary slow flow phenomenon (CSFP). Methods: A total of 82 patients with angiographically proven normal coronary arteries and slow coronary flow in all three coronary vessels (45 males and 37 females, mean age 59 11 years) and 34 patients with normal coronary arteries and normal coronary flow (19 males and 15 females, mean age 56 10 years) with similar risk profiles were included in this cross-sectional observational study. Coronary flow rates of all patients and control subjects were documented by Thrombolysis In Myocardial Infarction (TIMI) frame count, serum level of Hs-CRP, NT proBNP, sedimentation, leukocyte, free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH) and fibrinogen levels were measured. Statistical analysis was performed using t test for independent samples, Chi-square test and Pearson correlation analysis. Results: Hs-CRP (0.88 +/- 0.86 vs 0.36 +/- 0.35 mg/L, p<0.001) and NT proBNP (117.83 +/- 163.2 vs 47.33 +/- 30.6 ng/ml, p<0.01) were found to be significantly higher in patients with coronary slow flow compared with normal control group. There were no significant differences regarding thyroid hormones, fibrinogen, sedimentation rate and leukocyte count between two groups. The mean TIMI frame counts were positively correlated (r=0.454, p=0.001 and r=0.554, p=0.001, respectively) with plasma Hs-CRP levels and NT-proBNP levels. Conclusion: Hs-CRP and NT proBNP are significantly higher in patients with coronary slow flow compared with normal control group. Their increased levels are positively correlated with TIMI frame count. (Anadolu Kardiyol Derg 2010; 10:416-20)Item Effect of losartan on exercise tolerance and echocardiographic parameters in patients with mitral regurgitationSekuri, C; Utuk, O; Bayturan, O; Bilge, A; Kurhan, Z; Tavli, TObjectives. The aim of this study was to assess the effects of losartan treatment on exercise tolerance and echocardiographic parameters in patients with mitral regurgitation (MR) secondary to mitral valve prolapse or rheumatic heart disease. Methods. Twenty-seven patients (14 males, 13 females, mean age 51 +/- 11, range 21-76) with moderate MR due to mitral valve prolapse or rheumatic heart disease were examined by means of Doppler echocardiography. The subjects were submitted to treadmill exercise tests using the modified Bruce protocol at baseline, after six hours and after the six-week treatment period to be evaluated based on their exercise tolerance. Mitral Regurgitant Volume (MRV), effective regurgitant orifice diameter, left atrial volume, left ventricle (LV) end-diastolic volume index, IV end-systolic volume index, IV ejection fraction (LVEF), left ventricle mass index were calculated at baseline and after six weeks of treatment with single dose of losartan (50 mg/day). Results. Total treadmill exercise time increased from 477.7 +/- 147.9 to 535.7 +/- 149.0 seconds after six hours (p < 0.01) and to 559.6 +/- 142.8 seconds after six weeks of treatment. Also, metabolic equivalent values increased following six hours of first dose and six weeks of losartan treatment (from 10.9 +/- 2.9 to 11.8 +/- 3.1, p=0.006 and 12.4 +/- 3.1, p=0.002; respectively). However, peak exercise systolic blood pressure (BP) was reduced after six hours and six weeks of treatment, and resting diastolic BP did not change after six hours but reduced at the end of the treatment period. MR volume decreased significantly from 29.3 +/- 14.1 ml to 25.1 +/- 14.8 ml, (p=0.025) without significant change in regurgitant orifice diameter (0.72 +/- 0.37 cm vs. 0.66 +/- 0.37 cm, p=NS), left atrium diameter and area while LVEF increased from 51.70 +/- 13.37 to 54.11-11-75 (p=0.015) with losartan. Conclusion. We conclude that the angiotensin II receptor antagonist losartan improves exercise tolerance and echocardiographic parameters in patients with moderate MR.Item THE EFFECT OF SMOKING AND DISEASE SEVERITY ON QT DISPERSION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASEHepcivici, U; Acar, M; Tikiz, H; Tezcan, UK; Tavli, T; Bilge, AR; Bayturan, O; Utuk, OItem Serum testosterone, growth hormone, and insulin-like growth factor-1 levels, mental reaction time, and maximal aerobic exercise in sedentary and long-term physically trained elderly malesAri, Z; Kutlu, N; Uyanik, BS; Taneli, F; Buyukyazi, G; Tavli, TThe aim of the study was to investigate the effect of regular exercise on maximum oxygen uptake capacity (VO2max), reaction time (RT), testosterone (T), growth hormone (GH), insulin-like growth Jactor-I (IGF-I) in athletes compared to sedentary controls. VO2max RT, T, GH, and IGF-I levels were 31.2 +/- 6.2 ml/min/kg, 106.7 +/- 23.2 s, 8.3 +/- 1.3 ng/mL, 1.6 +/- 0.7 ng/mL, 106.5 +/- 27.0 ng/mL in master athlete group and 18.8 +/- 5.1 ml/min/kg, 148.3 +/- 39.3 s, 5.4 +/- 1.7 ng/mL, 0.8 +/- 0.3 ng/mL, 90.2 +/- 23.8 ng/mL in sedentary control group, respectively. The differences between regularly exercising males and the control group of sedentary males were found to be statistically significant. The results showed that long-term exercise decreased RT and increased VO2max T, and GH in elderly males; elevated serum T and GH levels may be advantageous for brain functions.Item A RARE CAUSE OF ISCHEMIC CHEST PAIN: CONGENITAL OSTIAL ATRESIA OF THE RIGHT CORONARY ARTERYTavli, T; Alkan, A; Bayturan, O; Dalgic, O; Utuk, O; Kamali, B; Madak, NItem Thrombosis of a Coronary Artery Related to the Myocardial BridgingUtuk, O; Bilge, A; Bayturan, O; Tikiz, H; Tavli, T; Tezcan, UItem Effects of cilazapril on endothelial function and pulmonary hypertension in patients with congestive heart failureTavli, T; Gocer, HFlow-mediated vasodilation (FMV), brachial artery flow (BAF), and brachial artery diameter were evaluated in 30 patients with congestive heart failure before and after cilazapril treatment. While mean pulmonary artery pressure and Pulmonary capillary wedge pressure decreased significantly, flow-mediated vasodilation and left ventricular ejection fraction increased significantly following cilazapril administration (P<0.001). Brachial artery diameter and brachial artery flow did not change following the treatment period (P>0.05). In conclusion, short term cilazapril administration improved endothelial function and pulmonary pressure in patients with congestive heart failure.Item Effects of low-dose combination therapy with an angiotensin-converting enzyme inhibitor and a diuretic on flow-mediated vasodilation in hypertensive patients: A 6-month, single-center studySekuri, C; Bayturan, O; Gocer, H; Tavli, T; Tezcan, UKBackground: Combination therapy with an angiotensin-converting enzyme (ACE) inhibitor and a diuretic has been shown to be highly effective in hypertension. Clinical trials have demonstrated that ACE inhibitors may improve endothelial cell dysfunction in hypertension. However, the effectiveness of the combination treatment in endothelial cell dysfunction is unknown. Objective: This study investigated the effects of a new low-dose combination, perindopril 2 mg plus indapamide 0.625 mg, on brachial artery flow-mediated vasodilation (FMD) and left ventricular diastolic function in hypertension. Methods: Patients aged 18 to 75 with newly diagnosed stage I or II hypertension were eligible. Endothelium-dependent brachial artery FMD and endothelium-independent vasodilation were assessed at baseline. Patients were treated with oral perindopril 2 mg plus indapamide 0.625-mg tablets once daily for 6 months. FMD measurements were then repeated. Percentage changes in FMD from baseline to 6 months, as well as left ventricular diastolic function parameters (isovolumic relaxation time [IVRT] and mitral diastolic E-wave deceleration time [EDT]), indicated the effectiveness of the intervention. Results: Twenty-nine Turkish patients were enrolled (17 women, 12 men; mean [SD] age, 54.5 [9.5] years [range, 38-75 years]). The mean (SD) baseline FMD was 7.00% (2.39%) (endothelial cell dysfunction) and increased significantly to 8.68% (2.78%) at 6 months (P = 0.02); FMD improved in 15 patients (51.7%). At baseline and 6 months of therapy, mean (SD) IVRT was 101.7 (12.4) ms and 95.5 (7.7) ms, respectively (P < 0.001), and EDT was 234.7 (33.9) ms and 217.9 (25.6) ms, respectively (P < 0.001). Conclusions: In this small sample of hypertensive patients, a low-dose combination ACE inhibitor and diuretic significantly improved brachial artery FMD and left ventricular diastolic function. The improvement in FMD values was independent of the stage of hypertension. These findings suggest a relationship between improvement in endothelial cell function and diastolic function. Copyright (C) 2003 Excerpta Medica, Inc.Item The acute effects of cilazapril on pulmonary function tests and arterial blood gas changes in patients with pulmonary hypertensionTavli, T; Sekuri, C; Goktalay, T; Uyanik, BS; Ari, ZThe aim of the present study was to evaluate pulmonary function tests and arterial oxygen transport in patients with pulmonary hypertension due to congestive heart failure before and after cilazapril treatment. Thirty patients (16 men and 14 women, mean age, 65 18 years) with congestive heart failure and 30 healthy volunteers (20 men and 10 women, mean age 59 +/- 12 years, p > 0.05) were included in the study. All patients underwent evaluation of pulmonary function by spirometry and arterial blood gas analysis. Arterial oxygen saturation and arterial oxygen transport changed significantly after treatment (81 +/- 7 to 87 +/- 8 and 317 +/- 74 to 392 +/- 8, respectively). Forced expiration volume in 1 second, vital capacity and total lung capacity were increased after cilazapril treatment (2.55 +/- 0.7 to 2.61 +/- 0.8, 3.2 +/- 0.9 to 3.3 +/- 1.0 and 3.6 +/- 0.9 to 4.1 +/- 1.1, respectively p < 0.05). In conclusion, short-term cilazapril administration improved pulmonary function and arterial oxygen transport because it increased cardiac output, produced pulmonary vasodilatation, improved the pulmonary hemodynamics and removed interstitial fluid.Item Comparative Validity and Reliability Study of The QIDS-SR16 in Turkish and American College Student SamplesMergen, H; Bernstein, IH; Tavli, V; Ongel, K; Tavli, T; Tan, SComparative validity and reliability study of the QIDS-SR16 in Turkish and American college student samples Objective: To evaluate the validity and reliability of the Quick Inventory of Depressive Symptomatology, self-reported version, in a Turkish student sample (QIDS-SR16-T) by comparing it to (a) the American version (QIDS-SR16-US) and (b) the Turkish version of the Beck Depression Inventory (BDI-II-T). Materials and Methods: Slightly modified versions of the QIDS-SR16-T, and the BDI-II-T were administered to 626 outpatients at the Uludag University campus-based family health center. The QIDS-SR16-US was administered to 584 respondents at an American university. SAS and MPlus were used to provide descriptive statistics, classical exploratory factor analysis, and item response theory analyses (in the form of a multiple group confirmatory factor analysis). Results: The internal consistency (Cronbach a) of the QIDS-SR16-T was 0.77. Both QIDS-SR16 versions were unidimensional, but the BDI-II-T was not. The mean QIDS-SR16-T and QIDS-SR16-US item-total correlations were similar. The correlation between the QIDS-SR16-T and BDI-II-T was 0.72 (.90 when disattenuated). Multiple-group confirmatory factor analysis suggested that the QIDS-SR16-T and QIDS-SR16-US had the same factor loadings but different intercepts. This reflects group differences in level of depression, perhaps because the Turkish respondents, unlike their US counterparts, were seen in a medical context where illness-related depression is more prevalent. Scores on the QIDS-SR16-T and the BDI-II-T were also equated. Discussion: The QIDS-SR16-T has good psychometric properties and convergent validity with the BDI-II-T. Its use is recommended when a self-reported instrument is appropriate.Item Myocardial performance after successful intervention for native aortic coarctationTavli, V; Saritas, T; Guven, B; Okur, F; Saylan, BC; Tavli, T; Uyanik, BS; Ari, Z; Isbilen, BCoarctation of the aorta is associated with increased risk for hypertension in adulthood, despite successful repair. The intrinsic mechanisms underscoring hypertension and left ventricular performance in these patients, however, remains to be determined. Our objective was to evaluate left ventricular performance by means of echocardiographic and biochemical parameters at midterm follow-up in normotensive children who have had undergone successful surgical or catheter interventional treatment of coarctation with a residual gradient of less than 20 mmHg at rest. We studied prospectively 14 patients with native aortic coarctation who underwent surgery or balloon angioplasty, the cohort made up of equal numbers of boys and girls, and having a mean age of 8.5 plus or minus 4 years. We also studied 30 age-matched healthy subjects, measuring mitral inflow pulsed wave signals, isovolumic relaxation and contraction times, myocardial performance index parameters, and levels of B-type natriuretic peptide and endothelin-1 in both groups. We found no differences in systolic blood pressure at rest between the patients and their controls. The ventricular septal diastolic dimensions, left ventricular posterior wall dimensions, mitral valve E wave, deceleration time, isovolumic relaxation time, isovolumic contraction time and myocardial performance index were all significantly increased in the patients. Levels of plasma B-type natriuretic peptide and endothelin-1 were also significantly higher in the patients when compared to the control group. We conclude that aortic coarctation is a chronic disease characterized by persistency of myocardial and vascular alterations. The elevated levels of plasma b-type natriuretic peptide and endothelin-1 may be indicative of late onset hypertension after successful treatment of native coarctation in early childhood.Item Diastolic spectrum of left-ventricular hypertrophy: The impact of etiology and coronary artery disease on Doppler transmitral velocityTavli, T; Ammar, A; Wong, MDiastolic Filling of hypertrophied left ventricles has frequently been observed by Doppler methods. We hypothesized that filling characteristics in hypertrophy vary with etiology and concurrent ischemia. For patients with hypertrophy, the left-ventricular ejection fraction was >0.47 +/- 0.16, end-diastolic pressure was > 15 +/- 2 mm Hg, end-diastolic volume index was <96 +/- 12 ml/m(2) and left-ventricular mass index was 127 +/- 7 g/m(2). Peak E (early) and peak A (late) diastolic velocities and E-wave deceleration time, respectively, were as follows (significant unless otherwise indicated): normal subjects (NS), 79 +/- 9 and 82 +/- 19 cm/s, and 151 +/- 7 ms; cardiomyopathic hypertrophy, 63 +/- 16, 83 +/- 15 (NS) and 193 +/- 63, aortic stenosis without coronary disease, 110 +/- 10, 128 +/- 12 and 158 +/- 22 (NS); aortic stenosis with coronary disease, 57 +/- 12, 86 +/- 26 (NS) and 187 +/- 39; hypertension without coronary disease, 107 +/- 9, 128 +/- 9 and 143 +/- 22 (NS); hypertension with coronary disease, 58 +/- 12, 84 +/- 26 (NS) and 189 +/- 29. Conclusions: Hypertrophied left ventricles filled with two diastolic Doppler patterns: a relaxation abnormality with low peak E and delayed deceleration in hypertrophic cardiomyopathy, and a compliance abnormality with tall peak E and normal deceleration in pressure overload hypertrophy. When coronary artery disease occurred with pressure overload hypertrophy, impaired relaxation was the dominant pattern. Therefore, in addition to the known physiologic influences on diastolic filling, the etiology and presence of coronary artery disease modulate the configuration of transmitral velocities into hypertrophied ventricles.Item TAKOTSUBO SYNDROME DUE TO ENERGY DRINK: A CASE REPORTTavli, T; Mergen, H; Madak, N; Acar, M; Sozcuer, H; Tavli, V