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Item Standard dose of inhaled albuterol significantly increases QT dispersion compared to low dose of albuterol plus ipratropium bromide therapy in moderate to severe acute asthma attacks in children(2001) Coskun S.; Yuksel H.; Tikiz H.; Danahaliloglu S.Background: Beta-2 agonist therapy has previously shown to increase the QT dispersion (QTd) in asthmatic patients and increased QTd has been well documented in association with cardiac arrhythmias and sudden death. However, the data concerning the effect of low doses of beta-2 agonist therapy in combination with the anticholinergic agents to potentiate bronchodilatation on QTd in asthmatic children are limited. The objectives of this study was to investigate the changes on QTd during both the standard dose of nebulized albuterol therapy and low dose nebulized albuterol plus inhaled ipratropium therapyn to assess the potential arrhytmogenic risk of these two treatment strategies in children with acute asthmatic attacks. Methods: Forty-three children with the diagnosis of moderate to severe acute asthma were enrolled in the study. Standard dose of nebulized albuterol therapy (0.15 mg/kg) were administered to 20 patients (group 1) and low dose of nebulized albuterol (0.075 mg/kg) plus nebulized ipratropium bromide therapy (250 μg/dose) were given to the remaining 23 patients (group 2). Respiratory distress score, peak expiratory flow rate, arterial blood pressure, O2 saturation, serum potassium and urea nitrogen levels were studied and QT interval parameters were measured from the standard 12-lead electrocardiograms at baseline and after treatment. Results: Significant improvement was achieved in respiratory distress score and peak expiratory flow rate after three dose inhalation. No significant difference was observed between the pre and post-treatment values of serum potassium, blood urea nitrogen, O2 saturation and arterial blood pressure values. The evaluation of the corrected QTd (QTcd) showed that while there was no statistical difference in the pre and post-treatment values in group 2 (30.4 ± 3.1 msn vs 32.1 ± 3.9 msn), QTcd was found to be significantly increased in group 1 after treatment (29.0 ± 3 msn vs 40.6 ± 5.1 msn, P < 0.0001). Conclusion: The data of the present study suggest that the increase of the QTd is more prominent with the use of a standard dose of albuterol compared to low dose albuterol plus ipratropium therapy. Therefore, it may be concluded that a low dose of albuterol plus ipratropium bromide therapy may be preferred to avoid rhythm disturbances in asthmatic children.Item The effect of tirofiban on ST segment resolution in patients with non-ST elevated myocardial infarction(2004) Bayturan Ö.; Bilge A.R.; Seküri C.; Ütük O.; Tikiz H.; Eser E.; Tezcan U.K.ST segment resolution in ST elevated myocardial infarction has independent predictive value for congestive heart failure and death at 30 days. ST segment depression in unstable angina pectoris (UAP) and non-ST elevated myocardial infarction (NSTEMI) predicts high risk of MI and death and may discriminate patients likely to have greater benefit from aggressive antithrombotic and interventional therapy. This study assessed the effect of tirofiban added to conventional treatment on ST segment resolution in NSTEMI patients. Sixty-four patients were randomized to one of the two groups: 32 patients received conventional treatment while tirofiban was added in the second group of 32 patients. In the first group, 6 patients refused to participate further after giving initial informed consent while 1 patient in the tirofiban group dropped out. We had 26 patients (mean age, 59 years) in the conventional treatment group and 31 patients (mean age, 59 years) received also tirofiban. Tirofiban was administered by intravenous infusion over a 72 hour period. More than 50% regression of depression was considered to be ST segment resolution. The characteristics of the two groups were comparable (Table I). The ST segment resolution evolution did not differ at the 4th and 24th hours between the two groups. Significant differences occurred in the 72nd hour ECG (Table III). ST resolution was present in 67.9% of the tirofiban patients and in 32.1% of the conventional treatment group (P < 0.05). Tirofiban treatment was not associated with an increase in major bleeding even though there was a trend toward an increase in minor bleeding cases and did not influence the occurrence of refractory angina pectoris.Item The effect of diazepam premedication and penthothal induction on upper airway changes by ultrasonography; [Ḋiyazepam premeḋ ikasyonu ve ṫ iyopental ̇ indü kṡiyonunun ÿst hava yolu deǧ̇ iş̇ ikl̇ ikleṙ ine etk̇iṡiṅin ultrasonograḟ ik deǧ erlenḋ iṙ ilmeṡi](2004) Ok G.; Tekin Mirzai I.; Tarhan S.; Lüleci N.We aimed to determine diazepam premedication effect on airway changes during anesthesia induction with thiopental. 40 patients (ASA I-II, aged 20-50 years) who were planned to undergo elective operations were divided into 2 groups. 10 mg diazepam orally one hour before operation, was given to Group I premedication was not given to Group II. We monitored pulse, TA, ECG, SPO2, PETCO2 and kept head in neutral position. We recorded ultrasonographic views of tongue movements by ultrasound probe located below the chin while the patients were ventilating by mask. For anesthesia induction Na pentothal was given iv until lash reflex diminished. Tongue movements were monitored before induction until one minute after lash reflex and consciousness were lost. Difficulty in mask ventilation was recorded. The distance between ultrasound probe and back-front points of tongue arc was measured and differences were recorded. The demografic data and ASA classification of groups were similar (p>0.05). A particular movement of tongue in any direction was not observed in either group (p>0.05). Difficult ventilation with mask was observed in 30% of all patients. In patients with premedication apnea rate was found to be high. We concluded that difficult ventilation with face mask was not result of tongue movement. Difficult ventilation with mask is not related with premedication or anesthetics given for induction alone; diazepam premedication is thought to potantialize central apnea effect of thiopenthal used for induction.Item Cardiovascular disease risk factors in post-menopausal women in West Anatolia: A rural region prevalence study(2004) Sekuri C.; Eser E.; Akpinar G.; Cakir H.; Sitti I.; Gulomur O.; Ozcan C.Cardiovascular risk factors are important causes of morbidity and mortality in post-menopausal women. The aim of this cross-sectional study was to evaluate the cardiovascular risk factors in 207 postmenopausal Turkish women over 45 years old in a rural district of West Anatolia, Manisa Muradiye district. A questionnaire on socioeconomic and sociodemographic characteristics was conducted in the women followed by the measurement of blood pressure, fasting blood glucose, cholesterol levels, and waist-hip ratio along with an electrocardiogram (ECG). The European Cardiology Society risk index was used for cardiovascular risk evaluation. The results showed that 86% percent of the women will be carrying more than a 5% probability of developing a cardiovascular risk in the next 10 years. Moreover, the results proved 7% of the women are at high risk for a cardiovascular condition. Hypertension, hypercholesterolemia, and impaired glucose tolerance, were observed in 62%, 35.3%, and 13.5% of the women, respectively. Seven percent had smoked for at least six months. Fourteen cases had complained of exercise angina and pathologic ECG signs were diagnosed in one-third of these 14 cases. The waist-hip ratio measured 0.8 or more in 66.2% of the cases, with a range of 68-147 cm (mean; 95.6 ± 11.55). The results indicate that the risk of a cardiovascular condition developing is extremely high in postmenopausal West Anatolian women and increases with age. Morever, the prevalance of hypertension increased with age and was very closely related with low socioeconomic levels. These hazardous cardiovascular disease risk factors should be considered as high priority health problems in rural and low socioeconomic areas of developing communities. Intervention to modify the cardiovascular risk factors should be included in routine primary health care programs. Copyright © 2004 by the Japanese Heart Journal.Item The relationship between paraoxanase gene Leu-Met (55) and Gln-Arg (192) polymorphisms and coronary artery disease; [Paraoksonaz geninde Leu-Met (55) ve Gln-Arg (192) polimorfizmleri ile koroner arter hastaliǧi arasindaki ilişki](2009) Taşkiran P.; Çam S.F.; Şekuri C.; Tüzün N.; Alioǧlu E.; Altintaş N.; Berdeli A.Objectives: Paraoxonase (PON1) is a high-density lipoprotein (HDL)-associated esterase that hydrolyses lipoperoxides. PON1 serves as a protective factor against oxidative modification of LDL, suggesting that it may play an important role in the prevention of atherosclerotic process. Research has focused on two polymorphisms: leucine (L allele) to methionine (M allele) substitution at codon 55, and glutamine (A allele) to arginine (B allele) substitution at codon 192. Study design: We examined amino acid changes at codon 55 and 192 in the PON1 gene by polymerase chain reaction and using restriction enzymes in 120 patients (92 men, 28 women; mean age 48.2±4.3 years) with premature coronary artery disease (CAD) and in 102 healthy subjects (80 men, 22 women; mean age 46.8±5.2 years) with no history of CAD and a normal electrocardiogram. Results: Distribution of genotypes in the patient and control groups at codon 55 were 6.7% and 4.9% for MM, 46.7% and 29.4% for LM, 46.7% and 65.7% for LL, respectively. The frequency of genotypes at codon 192 were as follows: 4.2% and 2% for RR, 40% and 35.3% for QR, and 55.8% and 62.8% for QQ, respectively. While the frequency of PON1 55M allele was higher in the CAD group (0.3 vs. 0.2), PON1 192R allele frequency did not differ (0.2). There was a significant relationship between the PON1 M/L55 polymorphism and CAD (p=0.017), whereas the R/Q192 polymorphism was not associated with CAD (p=0.445). Conclusion: These data suggest that the PON1 M/L55 polymorphism shows a significant relationship with CAD and the Q/R192 polymorphism is not a major risk factor causing susceptibility to CAD in our population.Item Strenuous exercise induced syncope due to coronary artery anomaly(Iranian Cardiovascular Research Journal, 2014) Yavuz V.; Cetin N.; Tuncer E.; Dalgic O.; Taskin U.; Bilge A.R.; Tikiz H.Coronary artery anomalies are among the neglected topics in cardiology. Anomalous origin of the left main coronary artery from the right sinus of valsalva is a rare coronary anomaly observed in 0.15% of patients. During exercise, the distended aorta and pulmonary artery with increased blood flow may squeeze the Left Main Coronary Artery (LMCA) between them. Even though arrhythmias are common causes of syncope, one should also think about aberrant coronary artery in the patients with syncope of unexplained origin. Patients experiencing exercise induced syncope accompanied by symptoms of coronary ischemia (typically: chest pain, ischemic findings on ECG, and raised cardiac markers) should be referred to diagnostic coronary angiography.Item Perimyocarditis mimicking acute coronary syndrome and intravenous immunoglobulin use: Case report; [Akut Koroner Sendromu Taklit Eden Perimiyokardit ve İntravenöz İmmünglobulin Kullanimi](Ortadog u Reklam Tanitim Yayincilik Turizm Egitim Insaat Sanayi ve Ticaret A.S., 2016) Alkan F.; Paytoncu Ş.; Çetin M.; Coşkun Ş.Perimyocarditis is an inflammatory syndrome characterized by myocardial and partly pericardial involvement. In developed countries, viral infections are the most common cause. The other reasons are idiopathic, bacterial or rheumatic diseases and immune drugs. The findings are subclinical, varies from chest pain, heart failure to death. Treatment is performed according to reasons. Anti-inflammatory drugs are used for signs and symptoms. Intravenous immunoglobulin is preferred in selected cases. In this article, we present a case with chest pain, electrocardiogram changes and elevated cardiac enzymes, exclusion of acute coronary syndrome with computed tomography coronary angiography, determination of diffuse myocardial involvement with cardiac magnetic resonance imaging and showing dramatic improvement with intravenous immunoglobulin for persistent clinical signs. Copyright © 2016 by Tür ki ye Kli nik le ri.Item Evaluation of cardiac autonomic functions in children with thalassemia trait, iron deficiency anemia and iron deficiency(Yuzuncu Yil Universitesi Tip Fakultesi, 2018) Cetin M.; Moumin N.; Karaboga B.; Coskun S.; Gulen H.Distruption of cardiac autonomic functions during diseases associated with anemia were reported in multiple studies previously. Objective in this study is to investigate heart rate variability (HRV) for evaluation of cardiac autonomic functions in children patients with Thalassemia trait (TT), iron deficiency anemia (IDA) and iron deficiency (ID) without anemia. Twenty-five patients with TT, 25 patients with IDA, 25 patients with ID, and 25 healthy controls were assessed with 24-hour ambulatory electrocardiography recordings. The following time-domain indices were calculated; standard deviation values of all normal sinus R-R intervals for 24 hours (SDNN), standard deviation levels of all mean normal sinus R-R interspaces over each 5-minute strip in the 24-hour enrollments (SDANN), the square root of the mean of the sum of squares of differences between adjacent RR intervals (RMSSD), percentage of difference between adjacent normal R -R intervals that are greater than 50 ms computed for the overall 24-hour ECG recording (pNN50). Re-evaluation regarding HRV were done in children with IDA after 4 months of treatment. Although reduction in HRV parameters was detected in IDA group compared to ID, TT, and control groups, it wa s statistically not significant. The pNN50 was significantly low only in the IDA group (p=0.042). When ID group and TT group were compared with control group, it was found that HRV parameters were not affected. In IDA group, SDNN, SDANN, RMSSD and pNN50 index were significantly higher after trea tment (p=0.002, p=0.005, p=0.005, p=0.010, respectively). Our results indicate that cardiac autonomic activity are affected in IDA and improvement occurs after treatment. HRV parameters were found to be especially associated with hemoglobin and hematocrit values. © 2018, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.Item Prognostic value of plasma ST2 in patients with non-ST segment elevation acute coronary syndrome(Emergency Medicine Association of Turkey, 2018) Kokkoz Ç.; Bilge A.; Irik M.; Dayangaç H.I.; Hayran M.; Akarca F.K.; Erdem N.B.; Çavuş M.Objective: The aim of this study is to detect plasma ST2 levels in patients who were admitted to emergency department with chest pain and diagnosed with non st segment elevation myocardial infarction (NSTEMI) and to research the relationship between 28-day mortality and ST2 levels. Methods: The present study was conducted at Emergency Department of Celal Bayar University Hafsa Sultan Hospital between September 2015 and January 2016 as a prospective, single-center, cross-sectional study. Plasma ST2 levels were detected in patients who were diagnosed with NSTEMI based on physical examination, ECG and troponin. The eligible patients were followed up with regard to mortality during 28 days. Results: A total of 88 patients diagnosed with NSTEMI were included in the study and followed up for 28 days. While 18 (20.5%) patients died at the end of 28 days, 70 (79.5%) patients survived. Mean ST2 level of surviving 70 patients was 651.37 ± 985.66 pg/mL and mean ST2 level of dying 18 patients was 2253.66 ± 1721.15 pg/mL (p < 0.001). ST2 value was higher among the dying (non-survivors) compared to the survivors at the end of 28 days and this was found related to mortality. ST2 cut-off value was found as 1000 pg/mL with 72.2% sensitivity and 20.0% specificity. Conclusion: Among the patients who were diagnosed with NSTEMI at the emergency department, ST2 levels on admission were found significantly higher among the non-survivors compared to the survivors. ST2 level was accepted as a reliable biomarker for prediction of 28 mortality in patients diagnosed with NSTEMI. © 2018 The Emergency Medicine Association of TurkeyItem Type 1 Kounis Syndrome Induced by Inactivated SARS-COV-2 Vaccine(Elsevier Inc., 2021) Özdemir İ.H.; Özlek B.; Özen M.B.; Gündüz R.; Bayturan Ö.Background Vaccination is the most important way out of the novel coronavirus disease 2019 (COVID-19) pandemic. Vaccination practices have started in different countries for community immunity. In this process, health authorities in different countries have preferred different type of COVID-19 vaccines. Inactivated COVID-19 vaccine is one of these options and has been administered to more than 7 million people in Turkey. Inactivated vaccines are generally considered safe. Kounis syndrome (KS) is a rare clinical condition defined as the co-existence of acute coronary syndromes and allergic reactions. Case Report We present the case of a 41-year-old woman with no cardiovascular risk factors who was admitted at our emergency department with flushing, palpitation, dyspnea, and chest pain 15 min after the first dose of inactivated CoronaVac (Sinovac Life Sciences, Beijing, China). Electrocardiogram (ECG) showed V4-6 T wave inversion, and echocardiography revealed left ventricular wall motion abnormalities. Troponin-I level on arrival was elevated. Coronary angiography showed no sign of coronary atherosclerosis. She was diagnosed with type 1 KS. The patient's symptoms resolved and she was discharged from hospital in a good condition. Why Should an Emergency Physician Be Aware of This? To the best of our knowledge, this is the first case of allergic myocardial infarction secondary to inactivated coronavirus vaccine. This case demonstrates that KS can occur after inactivated virus vaccine against COVID-19. Although the risk of severe allergic reaction after administration of CoronaVac seems to be very low, people who developed chest pain after vaccine administration should be followed by ECG and troponin measurements. © 2021 Elsevier Inc.Item Comparison of hydroxychloroquine plus moxifloxacin versus hydroxychloroquine alone on corrected QT interval prolongation in COVID-19 patients(Czech Society of Cardiology Z.S, 2021) Yavuz V.; Ozyurtlu F.; Cetin N.Background: Hydroxychloroquine (HCQ) alone or with some antibiotic and antiviral agents is used off label in the treatment of Coronavirus Disease 2019 (COVID-19). It seems that the most important safety problem about these medications are their cardiac side effects. Although there are data on arrhythmogenic events associated with the use of HCQ alone, such as corrected QT (QTc) prolongation, Torsade de pointes (TdP) or bradycardia, there are insufficient data on its combination with moxifloxacin (MOX). Objective: The aim of our study is to analyze the effect of HCQ alone or in combination with the use of MOX on QTc interval, heart rate, and arrhythmic events in patients with a diagnosis of COVID-19. Methods: This is a single center cohort study of non-intensive care unit (ICU) patients hospitalized with clinical signs consistent with pneumonia and at least one positive COVID-19 nasopharyngeal polymerase chain reaction test result. QTc intervals and heart rates in patients whose treatment consisted of HCQ alone or its separate combination with MOX at baseline and post-treatment were calculated and compared. Results: 312 patients were included (median age of 42 [IQR: 31.25–57.75] years, 54.16% male). Patients were divided into two groups based on their in-hospital treatment strategy as follows: HCQ alone (n: 166, 53.20%) or HCQ + MOX (n: 146, 46.79%). As compared to baseline, QTc intervals were significantly increased in all patients after treatment (406.00 [388.00–422.00] ms vs 418.00 [401.00–435.00] ms, p< 0.001). When the baseline QTc intervals were evaluated, there was no statistically significant difference between HCQ alone and HCQ + MOX groups (403.00 [384.50–419.00] ms vs. 409.50 [390.00–425.00] ms, p: 0.086). After treatment period, QTc intervals were significantly higher in HCQ + MOX group compared to the group in which patients only used HCQ (413.00 [398.00–430.00] ms vs. 426.50 [405.00–441.00] ms, p< 0.001). We found a significant decrease in heart rate in both groups after treatment period. From 79.00 (70.00–88.00) bpm to 70.00 (63.00–79.00) bpm in HCQ alone group (p< 0.001) and from 80.00 (70.00–88.00) bpm to 70.50 (63.00–78.75) bpm in HCQ + MOX group (p< 0.001). On the other hand, no statistically significant difference was observed between the groups in terms of heart rates either before or after the treatment. Conclusion: In this cohort study, patients who received HCQ for the treatment of COVID-19 were at high risk of QTc prolongation, and concurrent treatment with MOX was associated with greater changes in QTc. However, none of patients experienced malignant ventricular arrhythmia or death during treatment. Clinicians should carefully weigh risks and benefits with close monitoring of QTc if considering treatment with HCQ especially concomitant use with MOX. Further prospective studies are needed to determine the exact implications of these drugs on arrhythmias in patients with COVID-19. © 2021, ČKS.Item Multi-Center Experience of Coronary Artery Perforation during Percutaneous Coronary Intervention: Clinical and Angiographic Characteristics, Management, and Outcomes between 2010 and 2020(Turkish Society of Cardiology, 2022) Gündüz R.; Yıldız B.S.; Çetin N.; Özgür S.; Çizgici A.Y.; Tülüce K.; Tülüce S.Y.; Özen M.B.; Duman S.; Bayturan Ö.Background: Coronary artery perforations are one of the most feared, rare, and catastrophic complication of percutaneous coronary intervention. Despite the remarkable increase in coronary angiography and percutaneous coronary intervention, there is no large database that collects coronary artery perforation for the Turkish population. Our study aimed to report our experience over a 10-year period for clinical and angiographic characteristics, management strategies, and outcomes of coronary artery perforation during the percutaneous coronary intervention at different cardiology departments in Turkey. Methods: The study data came from a retrospective analysis of 48 360 percutaneous coronary intervention procedures between January 2010 and June 2020. A total of 110 cases who had coronary artery perforation during the percutaneous coronary intervention were found by angiographic review. Analysis has been performed for the basic clinical, angiographic, procedural characteristics, the management of coronary artery perforation, and outcome of all patients. Results: The coronary artery perforation rate was 0.22%. Out of 110 patients with coronary artery perforation, 66 patients showed indications for percutaneous coronary intervention with acute coronary syndrome and 44 patients with stable angina pectoris. The most common lesion type and perforated artery were type C (34.5%) and left anterior descending (41.8%), respectively. The most observed coronary artery perforation according to Ellis classification was type III (37.2%). Almost 52.7% of patients have a covered stent implanted in the perforated artery. The all-cause mortality rate of coronary artery perforation patients in the hospital was 18.1%. Conclusion: The observed rate of coronary artery perforation in our study is consistent with the studies in this literature. However, the mortality rates related to coronary artery perforation are higher than in other studies in this literature. Especially, the in-hospital mortality rate was higher in type II and type III groups due to perforation and its complications. Nevertheless, percutaneous coronary intervention should be done in selected patients despite catastrophic complications. Copyright@Author(s) - Available online at anatoljcardiol.com.Item Frontal QRS/T angle can predict mortality in COVID-19 patients(W.B. Saunders, 2022) Gunduz R.; Yildiz B.S.; Ozgur S.; Ozen M.B.; Bakir E.O.; Ozdemir I.H.; Cetin N.; Usalp S.; Duman S.Aims: The frontal QRS-T (fQRS) angle has been investigated in the general population, including healthy people and patients with heart failure. The fQRS angle can predict mortality due to myocarditis, ischaemic and non-ischaemic cardiomyopathies, idiopathic dilated cardiomyopathy, and chronic heart failure in the general population. Moreover, no studies to date have investigated fQRS angle in coronavirus disease 2019 (COVID-19) patients. Thus, the purpose of this retrospective multicentre study was to evaluate the fQRS angle of COVID-19 patients to predict in-hospital mortality and the need for mechanical ventilation. Methods and results: An electrocardiogram was performed for 327 COVID-19 patients during admission, and the fQRS angle was calculated. Mechanical ventilation was needed in 119 patients; of them, 110 died in the hospital. The patients were divided into two groups according to an fQRs angle >90° versus an fQRS angle ≤90°. The percentages of mortality and the need for mechanical ventilation according to fQRS angle were 67.8% and 66.1%, respectively, in the fQRs >90° group and 26.1% and 29.9% in the fQRS ≤90°group. Heart rate, oxygen saturation, fQRS angle, estimated glomerular filtration rate, and C-reactive protein level were predictors of mortality on the multivariable analysis. The mortality risk increased 2.9-fold on the univariate analysis and 1.6-fold on the multivariate analysis for the fQRS >90° patient group versus the fQRS ≤90° group. Conclusion: In conclusion, a wide fQRS angle >90° was a predictor of in-hospital mortality and associated with the need for mechanical ventilation among COVID-19 patients. © 2022 Elsevier Inc.Item Tremor, Gait, and Balance Disorders in Essential Tremor and the Efficacy of Atenolol(Wolters Kluwer Medknow Publications, 2023) Kisabay A.K.A.; Durmaz G.S.; Ataç C.; Duksal T.; Gökçay F.; Çelebisoy N.Background: To assess gait and balance in patients with essential tremor (ET), which is the most common tremor disorder characterized by bilateral action tremor of the hands with possible involvement of further tremor locations and to test the efficacy of atenolol on tremor and gait and balance. Methods: In this prospective study, gait and balance were evaluated by static posturography in addition to International Cooperative Ataxia Rating Scale (ICARS) in 22 ET patients without any additional neurologic signs on examination. Tremor severity was assessed by The Essential Tremor Rating Assessment Scale (TETRAS). The efficacy of atenolol 100 mg/day both on tremor and gait and balance was investigated. Posturographic recordings were performed in gender, age-, and height-matched healthy volunteers who constituted the control group. Results: The mean center of gravity sway velocity of the ET patients recorded on firm and foam surfaces with eyes open and closed was not significantly different from the healthy controls but sway velocity on tandem stance was significantly increased (P = 0.032). Gait speed (P = 0.015) was decreased and step width was increased (P = 0.001). An improvement in TETRAS scores was recorded with atenolol treatment (P = 0.046). An improvement not reaching statistical significance was present in ICARS scores (P = 0.059). However, posturographic parameters did not change significantly (P > 0.05). Conclusion: Increased sway velocity on tandem stance, decreased gait speed and increased step width are consistent with midline cerebellar dysfunction in ET patients with no obvious gait and balance deficits on clinical examination. Atenolol seems to be effective on tremor but does not cause a significant improvement in gait and balance deficits. © 2023 Neurological Sciences and Neurophysiology.Item Evaluation of cardiac structure, exercise capacity and electrocardiography parameters in children with partial and complete growth hormone deficiency and their changes with short term growth hormone replacement therapy(Springer, 2023) Alkan F.; Ersoy B.; Kızılay D.O.; Ozyurt B.C.; Coskun S.Purpose: To evaluate cardiac structure, exercise capacity and electrocardiography (ECG) parameters of children with complete and partial growth hormone (GH) deficiency (GHD) and the effect of 12 months GH treatment on these. Methods: M-mode echocardiography, ECG and exercise test expressed as metabolic equivalent (MET) were performed in children with GHD, aged 9–14 years, divided into those with a peak GH response < 7 µg/L (complete GHD; n = 30) and 7–10 µg/L (partial GHD; n = 17) after two GH stimulation tests, at baseline and 12 months after GH initiation. Forty-eight healthy peers underwent the same tests once. Results: Left ventricular mass (LVM) was significantly lower before treatment in both groups with GHD compared to healthy peers (p = 0.015 and p = 0.032) but LVM in the GHD groups was similar to controls after 12 months of treatment. The increase in LVM in the complete GHD group was significant (p = 0.044). LVM index was significantly reduced with treatment in children with partial GHD (p = 0.035). Max METs, VO2max and exercise duration were significantly increased in children with complete GHD after treatment (p = 0.022, p = 0.015 and p = 0.002, respectively). Significant changes in P wave and QTc dispersion on ECG between groups were within physiological limits. Conclusion: This study showed that children with both partial and complete GHD had smaller cardiac structures and less exercise capacity compared to their healthy peers prior to GH treatment but this improved with 12 months of treatment. The cardiac trophic effect of GH, as well as the effect of increasing exercise capacity, is greater in those with complete GHD than in those with partial GHD. © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.Item The effects of mechanical ventilation on heart rate variability and complexity in mice(Hellenic Veterinary Medical Society, 2023) Kazdağli H.; Özel H.F.; Özbek M.In a variety of diseases, altered respiratory modulation is often as an early sign of autonomic dysfunction. Therefore, understanding and evaluating the effects of mechanical ventilation on the autonomic nervous system is vital. The effects of mechanical ventilation on autonomic balance have been assessed by heart rate variability (HRV) using frequency domain and non-linear analysis including fractal complexity and entropy analysis in anesthetized mice. BALB/c mice (n=48) were divided into two groups: Spontaneous breathing and mechanical ventilation. The electrocardiograms were recorded. Four different types of analysis were employed: i. frequency domain analysis, ii. Poincaré plots, iii. Detrended Fluctuation Analysis (DFA) and iv. Entropy analysis. An unpaired t-test was used for statistical analysis. In a ventilated group, very low frequency (VLF) and low frequency (LF) parameters were not changed, whereas the high frequency parameter was decreased compared to spontaneous breathing mice. DFAa1 was significantly increased due to mechanical ventilation but DFAa2 was unchanged. In Poincaré plots analysis, standard deviation 2 (SD2) / standard deviation 1 (SD1) ratio was increased, however, SD1 and SD2 were not significantly affected. Also, Approximate Entropy and Sample Entropy remained unchanged. HF parameter, DFAa1, and SD2/SD1 were affected by mechanical ventilation. Decreased HF and increased DFAa1, further support the notion that HRV is dominated by respiratory sinus arrhythmia at high frequencies, this may be due to decreased vagal tone caused by mechanical ventilation. This novel results of HRV analysis are important considering increased usage of HRV techniques day by day in animal models and other medical practices. © 2023 H Kazdağli, HF Ozel, MA Özbek. All Rights Reserved.Item The effect of background audio and audiovisual stimuli on students' autonomic responses during and after an experimental academic examination(John Wiley and Sons Ltd, 2023) Balıkçı İ.; Tok S.; Binboğa E.Background: Due to the Covid-19 pandemic lockdown during the online-distant education period, certain students tended to combine their courses and homework with TV or social media news or other media content, such as classical music, including a wealth of audio and audiovisual stimuli. As the audio and audiovisual stimuli existing in a learning environment may affect students' autonomic nervous system (ANS) responses negatively, the present study aimed to monitor the impact of background TV, classical music, and silence on students' ANS activity represented by heart rate (HR), heart rate variability (HRV), blood volume amplitude (BVA), and skin conductance level (SCL) during and after an experimental academic examination. Method: Seventy-six students were randomly allocated to background TV, classical music, or silence groups. The experiment with repeated measures design consisted of four consecutive periods: baseline, anticipation, challenge, and recovery, lasting 4 min each. Results: Within-subject analyses indicated significant HRV decrement only in the background TV group. Regardless of the experimental groups, HR and SCL increased while BVA decreased during the task. In addition, the between-subject analysis showed that the background TV group experienced significantly larger changes in HR and HRV parameters compared to the other experimental groups relative to their respective baseline measurements. Conclusions: Based on these results, we concluded that relative to classical music and silence, background TV, including audiovisual and verbal stimuli, extant in a learning environment might raise students' sympathetic activity. Further, classical music, without lyrics, may suppress the withdrawal of vagal activity and elevate the autonomic regulation capacity during the academic reading comprehension task. HRV is a more valid and reliable indicator of students' autonomic responses during a challenging academic task. © 2023 The Authors. Brain and Behavior published by Wiley Periodicals LLC.Item A simple approach to determine loss of physiological complexity in heart rate series(Institute of Physics, 2023) Ozel H.F.; Kazdagli H.There are several ways to assess complexity, but no method has yet been developed for quantitatively calculating the ‘loss of fractal complexity’ under pathological or physiological states. In this paper, we aimed to quantitatively evaluate fractal complexity loss using a novel approach and new variables developed from Detrended Fluctuation Analysis (DFA) log-log graphics. Three study groups were established to evaluate the new approach: one for normal sinus rhythm (NSR), one for congestive heart failure (CHF), and white noise signal (WNS). ECG recordings of the NSR and CHF groups were obtained from PhysioNET Database and were used for analysis. For all groups Detrended Fluctuation Analysis scaling exponents (DFAα 1, DFAα 2) were determined. Scaling exponents were used to recreate the DFA log-log graph and lines. Then, the relative total logarithmic fluctuations for each sample were identified and new parameters were computed. To do this, we used a standard log-log plane to standardize the DFA log-log curves and calculated the differences between the standardized and expected areas. We quantified the total difference in standardized areas using parameters called dS1, dS2, and TdS. Our results showed that; compared to the NSR group, DFAα 1 was lower in both CHF and WNS groups. However, DFAα 2 was only reduced in the WNSgroup and not in the CHFgroup. Newly derived parameters: dS1, dS2, and TdS were significantly lowerin the NSR group compared to the CHF and WNS groups. The new parameters derived from the DFA log-log graphs are highly distinguishing for congestive heart failure and white noise signal. In addition, it may be concluded that a potential feature of our approach can be beneficial in classifying the severity of cardiac abnormalities. © 2023 IOP Publishing Ltd.Item Evaluation of differential effects of CDP-choline and choline on parasympathetic activity and changes in choline levels with heart rate variability(Marmara University, 2024) Kazdagli H.; Alpay S.; Ozel H.F.; Baris E.Objective: Heart rate variability (HRV) is used to evaluate the autonomic activity of heartbeat. This study aimed to investigate the effects of cholinomimetic drugs cytidine diphosphate-choline (CDP-choline) and choline, on short-term HRV parameters. Materials and Methods: Animals were randomized into three groups; control (0.9% NaCl), choline (100 mg/kg), CDP-choline (400 mg/kg). Electrocardiography recordings were obtained for 45-minutes after treatments with 15-minutes intervals. HRV analyses and total choline level measurements in serum and heart tissues were performed. Results: High frequency power and total power increased in treatment groups, while heart rates were decreased. Low frequency was decreased with choline while very low frequency power decreased with CDP-choline. Choline affected most of the HRV parameters in the first 15 minutes, while the effect of CDP-choline started within 30 minutes. Total choline levels were higher in both treatment groups than in the control while the levels were also higher in the choline group compared to CDP-choline group. Conclusion: This study showed that CDP-choline and choline treatments produced a rapid response to short-term HRV parameters, while increasing tissue choline levels. Moreover, the differences in effects and onset time between the drugs on HRV might be related to tissue choline concentration. © 2024 Marmara University Press, All Rights Reserved.Item Salt-and-pepper appearance of the skin in systemic sclerosis; [Aspecto sal y pimienta de la piel en la esclerosis sistémica](Ediciones Doyma, S.L., 2024) Tasgöz F.C.; Ali Acar E.; Kaçar M.; Soysal Gündüz Ö.; Uslu S.[No abstract available]