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One of the most influential figures in the history of Islamic thought is Fakhr al-Dīn al-Rāzī (d. 606/1210). The identities of mushakkik, which creates problems on many subjects, especially metaphysical and theological ones, the muhaqqiq who tries to solve the problems above the sects, and the jâmî who brings many different views together in the highest concepts, have seriously affected all the thinkers after him. Therefore, in the tradition, all schools had to inherit the philosophical and scientific dynamism that he created and displayed an attitude about the problems he created and the solutions he offered. The real important motive that makes Râzî so indispensable and effective is his problematic identity (mushakkik), which carries the kalām to philosophy and philosophy to kalām, and criticizes philosophy on the basis of the kalām, and the kalām on the basis of philosophy. For this reason, when we look at the works of Râzî, who has been evaluated politically and sociologically within Ash'arism throughout his life, it is clearly seen that he is a thinker who is suitable to be embraced by different schools and to be interpreted in different ways. The fact that many Ahl as-sunnah theologians emphasized the works written by Râzî with a theological-Ash'ari theme, caused his supra-sectarian identity to be overshadowed. On the other hand, it is seen that some thinkers are making an effort to know and recognize Râzî as a philosopher-theologian and muhaqqiq. This effort is clearly seen especially in scientific figures who benefited from Kamaladdin Ibn Yûnus (d. 639/1242) in some way. Af?al al-Dīn Khūnajī (d. 646/1248), Athir al-Din al-Abharî (d. 663/1265), Najm al-Din al-Qazwinî al-Kâtibî (d. 675/1277) can be given as examples. These personalities, on the one hand, played an active role in the spread of Râzî's scientific heritage and they were effective in bringing Râzî to the fore with his supra-sectarian identity on the other. Sirāj Al-Dīn Al-Urmawî (d. 682/1283), who inherited his scientific legacy, is among the important names who established his identity as a muhaqqiq who mostly solved supra-sectarian problems. Human actions are at the forefront of the issues in which this facility has clearly emerged. Urmawî tries to revise al-Arba'în's expressions, which seem to ignore the power and influence of human beings in terms of human actions as well as criticizing Razi's arguments very seriously. In his work Lübâb, on the one hand, he summarizes al-Erba'în of Razî he seriously criticizes Razi's Ash'ari attitude towards human actions on the other. He does this largely on the axis of the arguments that Râzî himself expressed from his encyclopedic works such as al-Matâlibu'l-'âliyya mina'l-'ilmi'l-ilâhi. It is clear that this is not an ordinary situation. Because human actions are at the forefront of the issues that determine the thinkers' conception of divinity and the relationship between God and man. In this study, Râzî's attitude on this issue and Urmavi's philosophical and theological criticisms will be tried to be determined. Thus, it is clearly seen that he is trying to establish Râzî as a muhaqqiq in the axis of human actions. [ABSTRACT FROM AUTHOR]

Lactate is a product of anaerobic metabolism and increases in states of tissue hypoxia. Furthermore, it is demonstrated that lactate level is correlated with the extent of infarct area and short term (30-day) mortality rates in patients with acute coronary syndrome with ST segment elevation (STE-ACS). Therefore, we aimed to test the prognostic value of this easily obtainable parameter on outcomes in patients presenting with STE-ACS. All adult patients who admitted with STE-ACS between 2019 and 2020 were screened. The cases with admission lactate levels were included. Patients were separated into two groups as low (<2mmol/l) and high (>2mmol/l) lactate groups. A total of 70 patients were enrolled. The mean age of the study population was 62.3 ± 15.0 years and 53 (75.7%) of them were male. The most common infarct related artery was the left anterior descending (LAD) artery. The median lactate level was 2.5 (0.80-15.3) mmol/L. Malignant arrhythmia, contrast induced nephropathy (CIN), and in-hospital mortality rates were not different between the high and low lactate groups. However, all-cause mortality was significantly higher in the high lactate group during the follow-up (p=0.005). Among all included parameters; lactate level [OR:1.76, (CI: 1.28-2.42); p<0.001] and age [OR:1.10, (CI: 1.03-1.17); p=0.004] were predictors for all-cause mortality. Admission lactate level can predict all-cause mortality in patients with STE-ACS. In addition, high admission lactate levels could help to raise more attention even if the patients have been discharged from the hospital. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea is common in adults with cardiovascular disease. Accumulating evidence suggests an association between obstructive sleep apnea and cardiovascular disease independent of the traditionally recognized cardiovascular disease risk factors. Observational studies indicate that obstructive sleep apnea is a risk factor for development of cardiovascular disease and that alleviation of obstructive events with positive airway pressure may improve cardiovascular disease outcomes. However, recent randomized controlled trials have not supported the beneficial effect of positive airway pressure in cardiac populations with concomitant obstructive sleep apnea. Some evidence suggests that the relationship between obstructive sleep apnea and traditionally recognized cardiovascular disease risk factors is bidirectional, suggesting that patients with cardiovascular disease may also develop obstructive sleep apnea and that efficient treatment of cardiovascular disease may improve obstructive sleep apnea. Recent data also indicate that the apnea-hypopnea index, which is commonly used as a diagnostic measure of obstructive sleep apnea severity, has limited value as a prognostic measure for cardiovascular disease outcomes. Novel markers of obstructive sleep apnea-associated hypoxic burden and cardiac autonomic response seem to be strong predictors of adverse cardiovascular disease outcomes and response to treatment of obstructive sleep apnea. This narrative review and position paper from the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to update the current evidence about the relationship between obstructive sleep apnea and cardiovascular disease and, consequently, raise awareness for health professionals who deal with cardiovascular and respiratory diseases to improve the ability to direct resources at patients most likely to benefit from treatment of obstructive sleep apnea and optimize treatment of the coexisting cardiovascular diseases. Moreover, the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to contribute to strengthening the efforts of the International Collaboration of Sleep Apnea Cardiovascular Trialists in this context. [ABSTRACT FROM AUTHOR]

Background: Facioscapulohumeral muscular dystrophy is one of the most common congenital muscle disorders. Whether facioscapulohumeral muscular dystrophy causes cardiac involvement is still controversial. Although electrocardiography and conventional echocardiography studies have been performed, there is no data on strain echocardiography in facioscapulohumeral muscular dystrophy. Our study aims to compare the myocardial strain parameters by 2-dimensional speckle tracking echocardiography in patients with facioscapulohumeral muscular dystrophy and the normal group. Methods: This prospective single-center study included 35 patients with facioscapulohumeral muscular dystrophy and 54 control patients. Demographic, clinical, and laboratory parameters of both groups were compared. In addition to conventional echocardiography images, myocardial strain parameters were performed using 2-dimensional speckle tracking echocardiography. Results: The median age of the study population was 25 (19-35 IQR) and 51 (57.3%) of them were male. Left ventricle-global circumferential strain was significantly lower in the facioscapulohumeral muscular dystrophy group than in the normal group [-20.3 (-22.0; -19.0) vs. -21.6 (-22.5; -20.0), P = .020]. Two-dimensional speckle tracking echocardiography findings except left ventricle-global circumferential strain [for left ventricle-global longitudinal strain P = .259, for left ventricle-global radial strain P = .338, for right ventricle-global circumferential strain P = .250, and for right ventricle-free wall longitudinal strain P = .288] were similar in both groups. Conclusions: As a result of our study, there was no significant difference between 2-dimensional speckle tracking echocardiography parameters other than the left ventricle-global circumferential strain between facioscapulohumeral muscular dystrophy and normal groups. [ABSTRACT FROM AUTHOR]

Introduction: Single‐center observational studies have shown promising results with fragmented electrogram (FE)‐guided ganglionated plexus (GP) ablation in patients with vagally mediated bradyarrhythmia (VMB). We aimed to compare the acute procedural characteristics during FE‐guided GP ablation in patients with VMB performed by first‐time operators and those of a single high‐volume operator. Methods and Results: This international multicenter cohort study included data collected over 2 years from 16 cardiac hospitals. The primary operators were classified according to their prior GP ablation experience: a single high‐volume operator who had performed > 50 GP ablation procedures (Group 1), and operators performing their first GP ablation cases (Group 2). Acute procedural characteristics and syncope recurrence were compared between groups. Forty‐seven consecutive patients with VMB who underwent FE‐guided GP ablation were enrolled, n = 31 in Group 1 and n = 16 in Group 2. The mean number of ablation points in each GP was comparable between groups. The ratio of positive vagal response during ablation on the left superior GP was higher in Group 1 (90.3% vs. 62.5%, p =.022). Ablation of the right superior GP increased heart rate acutely without any vagal response in 45 (95.7%) cases. The procedure time was longer in group 2 (83.4 ± 21 vs. 118.0 ± 21 min, respectively, p <.001). Over a mean follow‐up duration of 8.0 ± 3 months (range 2–24 months), none of the patients suffered from syncope. Conclusion: This multi‐center pilot study shows for the first time the feasibility of FE‐guided GP ablation across a large group of procedure‐naïve operators. [ABSTRACT FROM AUTHOR]

Improved renal recovery in patients with atypical hemolytic uremic syndrome following rapid initiation of eculizumab treatment. The presence of complement gene abnormalities is a risk for aHUS relapse after anti-C5 treatment discontinuation, including in P-aHUS patients. Dear Editor, A typical hemolytic uremic syndrome (aHUS), which occurs with the uncontrolled activity of the complement system, can occur at any age. When there is no haematological and renal improvement in the first four or five PEX treatments, the treatment should be based on the patient's ADAMTS-13 level. [Extracted from the article]