Search

The species composition and seasonal abundance of sand flies (Diptera: Phlebotominae) were studied in the years 2000–2002 in the Sanlıurfa region, which is the largest focus of cutaneous leishmaniasis in south-eastern Turkey. Sixteen species were identified among 29 771 specimens collected at 17 different sites by light traps, sticky papers and aspirators. The most common species werePhlebotomus papatasi(Scopoli) (45.4%),P. perfiliewiParrot (21.9%), andP. sergentiParrot (19.4%). The other species found wereP. majorAdler&Theodor (3%),P. neglectusLeger&Pesson (2.2%),P. brevisTheodor&Mesghali (2%),P. alexandriSinton (1.9%),P. galilaeusTheodor (1.6%),P. halepensisTheodor (0.84%),Sergentomyia adleriTheodor (0.78%),S. dentataSinton (0.49%),S. minutaRondani (0.42%),S. theodoriParrot (0.16%),P. kazeruniTheodor&Mesghali (0.001%) andP. mascittiGrassi (0.001%) and one unidentifiedPhlebotomusspecies. Among these speciesP. galilaeus,S. minutaandS. dentataare the first records for this area. All species showed seasonal fluctuations, with the period of highest abundance between May and October. [ABSTRACT FROM AUTHOR]

Study design:Retrospective case survey.Objective:To examine incidence and clinical characteristics of hepatitis B infection in individuals with spinal cord injury (SCI).Setting:Inpatient clinic within a physical medicine and rehabilitation hospital specialized in rehabilitation.Participants:A total of 161 patients with SCI.Interventions:Patients' records were investigated and the status of hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV), anti-hepatitis B surface antigen positivity, alanine aminotransferase levels, duration of hospitalization and cost were recorded.Main outcome measures:Incidence of acute hepatitis B.Results:Six patients were diagnosed with acute hepatitis B on the first hospitalization for rehabilitation. A total of 11 patients (4.2%) were HBsAg positive with a previously established diagnosis of hepatitis B virus infection, 1 patient (0.4%) was anti-HCV positive. After a follow-up of 6 months, three of the acute hepatitis B patients progressed into chronic hepatitis B stage. In acute hepatitis B patients' initiation of the rehabilitation was delayed, duration of hospitalization was increased.Conclusions:After SCI, patients are at high risk of acute hepatitis B infection. A high rate of chronicity may be associated with impaired immune response, secondary to neurological deficit. Screening and vaccination protocols may prevent the spread of the hepatitis B infection, healthcare losses and financial loss. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common cardiac dysrhythmia and a common cause of ischemic stroke. Stroke prevention with oral anticoagulation (OAC) is the cornerstone of AF management. Patients and their treating physicians may have different views on different attributes of OACs. The objective of this study was to quantify the relative importance that patients and physicians in Turkey place on different OAC attributes when making treatment decisions in AF. A cross-sectional survey was administered to AF patients (≥ 50 years) receiving OAC and practising cardiologists, including residents with ≥ 2 years of experience in Turkey. For both patients (N = 230; 50% male) and physicians (N = 194; 74% male), the most important attributes for OAC treatment decision making in AF were "success in preventing stroke" (57% and 73.9% or overall importance, respectively) and "risk of major bleeding" (20% and 23.4%, respectively). For patients, other attributes were much less important, but not altogether unimportant: reversal agent availability (7%), monitoring (5%), food or drug interactions (3%), minor bleeding (3%), and ease of swallowing (2%). For physicians, among the other attributes, only the need for monitoring (1.3%) had a relative importance of > 1%. For all Turkish participants, efficacy and safety were found to be the most important attributes influencing OAC choice in AF with these two attributes accounting for 77% and 97.3% of overall importance for patients and physicians, respectively. Certain considerations, especially reversal agent availability and monitoring appear to be more important to patients than to physicians This is the first study to use BWS to quantify patient and physician preferences for OAC treatments in AF in Turkey., (© 2024 The Author(s). Clinical Cardiology published by Wiley Periodicals, LLC.)

Understanding the local tick species composition is crucial for overcoming the diseases they transmit. A comprehensive survey integrating molecular identification was conducted in the eastern and southeastern parts of Turkey, where tick surveys have previously been neglected. A total of 596 specimens belonging to four tick genera were collected from 27 localities in Turkey during the summers of 2019 and 2020. Seventy-seven representative individuals were chosen for molecular analysis. Nine distinct species, Rhipicephalus bursa, Rhipicephalus turanicus, Rhipicephalus rossicus, Hyalomma asiaticum, Hyalomma excavatum, Hyalomma marginatum, Hyalomma aegyptium, Haemaphysalis sulcata, and Dermacentor marginatus were identified. The presence of R. rossicus was demonstrated for the first time in Turkey. Two lineages of R. turanicus were identified, and representatives of both lineages were recorded. Our Hyalomma phylogenetic tree was consistent with previous findings from Turkey; however, new sympatric areas for Hy. marginatum and Hy. excavatum and Hy. marginatum and Hy. asiaticum were recorded. Two haplotypes (Haemaphysalis sp. and Dermacentor sp.) could not be identified using morphological and molecular methods. In addition to making a valuable contribution to the molecular database of ticks in the Middle East, this study will also stimulate comparative studies on the genetic structure, ecology, and vector competence of different populations of these species in Turkey as well as in other parts of the world., (Copyright © 2021. Published by Elsevier GmbH.)

Background: The coronavirus disease 2019 (COVID-19) pandemic has interfered with the treatment algorithm for patients with gastrointestinal (GIS) cancer, resulting in deferral of surgery. We presented the outcomes of our patients to evaluate whether surgery could be safely performed and followed-up without delaying any stage of GIS cancer during the pandemic., Methods: This was an observational study of 177 consecutive patients who underwent elective GIS cancer surgery between March 11 and November 1, 2020. They were assessed regarding their perioperative and 60 days follow-up results for either surgical or COVID-19 status. Morbidity was determined according to the Clavien-Dindo classification (CDC). Continuous and categorical data were presented as median ± SD and number with percentage (%), respectively., Results: The study included 44 gastric, 33 pancreatic, 40 colon, and 59 rectal cancer patients. All patients underwent surgery and received neo/adjuvant treatments without delay. The overall morbidity (CDC grade II-IV) and mortality rates were 10.1% and 3.9%, respectively. None of the patients or medical staff were infected with COVID-19 during the study period., Conclusion: GIS cancer surgery can be safely performed even within a pandemic hospital if proper isolation measures can be achieved for both patients and health workers. Regardless of the tumor stage, surgery should not be deferred, depending on unstandardized algorithms., (© 2021 Wiley Periodicals LLC.)

Objective: To investigate whether breast and axilla maximum standard uptake (SUVmax) values contribute to the treatment approach in breast cancer subgroups., Study Design: A descriptive study., Place and Duration of Study: University of Health Sciences/Adana City Training and Research Hospital, Turkey, from April 2017 to September 2019., Methodology: Ninety patients, operated for early breast cancer, were examined histopathologically and demographically. Those patients were divided into subgroups, according to the St. Gallen consensus. Breast and axillary SUVmax uptakes of these subgroups were determined using (Fluorine18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). These values were compared with postoperative pathology results Results: The triple negative group had the highest values and the Luminal B pos (+) group had the lowest values, when the mean values of breast and axilla SUVmax were compared. Axilla SUVmax value in those with metastatic lymph node was 1.939 times higher than those without it. The cut-off value of SUVmax value of the axillary lymph nodes was found to be 1.1 in distinguishing metastatic from non-metastatic., Conclusion: As the biological aggressiveness of tumor increased, SUVmax values increased in parallel. As a result, SUVmax values guided in determining the presence of axillary metastasis and treatment strategy. Key Words: Breast cancer, 18F-FDG PET/ CT, SUVmax values, Tumor subgroups, Axilla.

Objective:  To evaluate the mechanical properties of the tissues and muscles in the anal region with the shearwave elastography for anal fissure etiology., Study Design: Descriptive study., Place and Duration of Study: Adana City Training and Research Hospital, Turkey, from March2019 to March 2020., Methodology: In this study, 30 patients (fissure group), who were diagnosed with anal fissure in the outpatient clinic; and 20 patients (control group), who did not have any problem in anal examination were included. The anorectal tissues and muscles mechanical properties(elasticity,compliance and stiffness) were compared with the shear wave elastography values.Fissure area,internal anal sphincter,external anal sphincter and levator ani muscles elastographic measurements was performed with 5-18 MHzin lithotomy position, at rest and with Valsalva maneuver., Results: In elastographic measurement of fissure area (fissure) and normal anorectal tissue (control, AFE); control group values were significantly higher than the fissure group values (p<0.001, and padj <0.001, respectively). Control group valuesof internal anal sphincter in rest and Valsalva maneuver (IAS-R, and IAS-V, respectively) were significantly higher than the fissure group values (p<0.001, padj< 0.001, and p<0.001,  padj <0.001, respectively). There was no significant difference between the elastographic measurement values in rest and valsalva maneuver of the external anal sphincter (EAS-R and EAS-V) (p>0.05). Elastographic measurement values of levator ani muscle (LAM) resting state; were significantly higher in thefissure group than the control group (p<0.001, and padj <0.001, respectively). Elastographic cut-off values that differentiate the fissure group from control group were found to be ≤1kPa forAFE group, ≤44 kPa forIAS-R, ≤0.4kPa forIAS-V,and >11kPa for LAM,respectively. Conclusıon: In anal fissure disease, tissues mechanical properties measured by shear wave elastography showed increased tissue stiffness, which may be added to etiology of this disease. Key Words: Anal fissure, Ultrasonography, Shear wave elastography, Anal sphincter, Tissue elasticity, Tissue stiffness.

Background: Pathophysiologic mechanisms underlying lone atrial fibrillation (AF) have not been clearly demonstrated yet. Emerging evidence has indicated that autoimmunity may play a role in the development of AF. Relationship between serum anti-M2-muscarinic receptor autoantibody (anti-M2-R) and anti-β1-adrenergic receptor autoantibody (anti-β1-R) levels and lone paroxysmal atrial fibrillation (PAF) has not been investigated. We aimed to compare anti-M2-R and anti-β1-R levels between lone PAF patients and healthy control subjects., Methods and Results: 75 patients with lone PAF (age: 52.80 ± 6.80 years, 53 % male) and 75 healthy control subjects (age: 53.30 ± 6.80 years, 54 % male) were enrolled in the study. Serum anti-M2-R and anti-β1-R levels were measured by ELISA and compared between two groups. Anti-M2-R [142.30 (77.65-400.00) vs. 69.00 (39.48-299.04) ng/mL; p < 0.001) and anti-β1-R [102.56 (65.18-348.41) vs. 44.17 (30.89-158.54) ng/mL; p < 0.001] levels were significantly higher in patients with lone PAF compared to healthy controls. Multivariate regression analysis showed that left atrial diameter (OR: 1.471, p < 0.001), hs-CRP(OR: 1.940, p < 0.001), anti-M2-R (OR: 1.158, p < 0.001) and anti-β1-R (OR: 1.296, p < 0.001) levels were independent predictors for the presence of lone PAF. Using a cut-off level of 101.83 ng/mL, anti-M2-R levels predicted presence of lone PAF with a sensitivity of 94.68 % and specificity of 81.33 %. Anti-β1-R levels predicted presence of lone PAF with a sensitivity of 92.00 % and specificity of 73.30 %, using a cut-off level of 72.16 ng/mL., Conclusion: Our results demonstrated that higher serum anti-M2-R and anti-β1-R levels are associated with lone PAF. Autoantibodies related to autonomic system may play an important role in the development of lone AF.

Purpose: Elevated red blood cell distribution width (RDW) has been associated with atrial fibrillation (AF) in cross-sectional and prospective studies. In this study, we aim to evaluate the relation of preablation RDW levels to late AF recurrence following cryoablation., Methods: A total of 299 patients with symptomatic paroxysmal or persistent AF despite ≥ 1 antiarrhythmic drug(s) who were scheduled for cryoballoon-based AF ablation were enrolled in this prospective study., Results: A total of 299 patients (55.40 ± 10.60 years, 49.20 % male) were involved and followed up at a median time of 24 (6-44) months. Patients with late AF recurrence had higher RDW levels (14.30 ± 0.93 vs. 13.52 ± 0.93 %, p < 0.001). Multivariate Cox proportional hazard regression analysis showed that RDW level was an independent predictor for late AF recurrence (HR 1.88, 95 % CI 1.41-2.50, p < 0.001) along with left atrial (LA) diameter (HR 3.09, 95 % CI 1.81-5.27, p < 0.001), duration of AF (HR 1.04, 95 % CI 1.01-1.07, p = 0.02), and early AF recurrence (HR 6.39, 95 % CI 3.41-11.97, p < 0.001). A cut-off level of 13.75 % for RDW predicted late AF recurrence following cryoballoon-based pulmonary vein isolation (PVI) with a sensitivity and specificity of 78.00 and 70.00 %, respectively., Conclusion: These findings suggest that elevated RDW may be a predictor of late recurrence following cryoballoon-based AF ablation. Further studies are needed to establish its exact pathophysiologic and prognostic roles.

Ticks may act as vectors for a number of infectious diseases including Crimean Congo Hemorrhagic Fever (CCHF). The causative agent is Crimean Congo Hemorrhagic Fever Virus (CCHFV), a member of Bunyaviridae, causing extensive ecchymosis, visceral bleeding and hepatic dysfunction with a high fatality rate in the affected individuals. CCHF was initially recognized in Turkey in 2002 and the current number of reported cases exceeds 4,400. This study was conducted to confirm the presence of tick species established as potential CCHFV vectors and investigate CCHFV activity in ticks at Ankara province, Turkey's second most-densely populated province, where CCHF cases were demonstrated. A total of 1,196 adult ticks, collected from various animals and vegetation in 12 sites located in 5 counties of Ankara during April-July 2010 were identified to species level. Twenty-two tick pools from county K2 were also evaluated for the presence of CCHFV RNA via a one-step real-time RT-PCR assay and reactive results were further confirmed by an in house nested RT-PCR assay. Nine tick species were identified: Rhipicephalus bursa (44.9%), R. sanguineus (18.9%), R. turanicus (18.1%), Haemaphysalis parva (8.3%), Hyalomma marginatum marginatum (5.4%), H. aegyptium (1.4%), H. anatolicum excavatum (1.3%), Hae. punctata (0.3%) and Dermacentor marginatus (0.2%). A total of five tick pools (22.7%) were reactive in real-time and nested RT-PCR assays. The pools included R. bursa, H. m. marginatum and Hae. parva ticks, collected from mammal hosts from two villages in one county. This is the first documentation of CCHFV activity in ticks from Ankara province, which indicates requirement for detailed surveillance to predict high risk zones in the region.

The aim of this study was to adapt the Zarit Burden Interview (ZBI) to family caregivers of inpatients in medical and surgical clinics to assess the validity and reliability of the Turkish version. The study design was descriptive and methodological. A total of 223 family caregivers providing care to patients for at least 1 week in clinics were selected through convenience sampling. Data were collected using the Turkish translation of the ZBI. The psychometric testing of the adapted instrument was carried out to establish internal consistency, interitem correlation, and construct validity. The content validity procedure resulted in a final scale comprising 18 items. Cronbach's alpha was .82. Factor analysis yielded one factor. The Turkish version of the ZBI adapted to the clinics can be used as a one-factor tool.

Purpose: In this study, the aim was to examine the quality of life of family caregivers of cancer patients in the east of Turkey., Method: The study design was descriptive. Data were collected by the researcher in Oncology-Hematology policlinic and Chemotherapy unit of Yakutiye Research Hospital of Atatürk University. Participants were 18 years old and older. The sample included 106 family caregivers who were living in the same flat with the patients during caregiving. Data were collected using a questionnaire that included sociodemographic questions for family caregivers and the World Health Organization Quality of Life-Short Form, Turkish Version (WHOQOL-BREF TR)., Results: The mean domain scores of WHOQOL-BREF(TR) were 70.12 (SD=19.24) for social, 68.26 (SD=20.10) for physical, 59.70 (SD=18.07) for psychological, 56.32 (SD=15.12) for national environment, and 53.87 (SD=16.99) for environment domains. About 71.7% of caregivers shared the caregiving process with someone else. Environmental domain scores of those who shared the caregiving process with someone else were higher. The environment domain scores of men (49.6, SD=17.1) were lower than those of women. As the income lowers, lowered, so did the quality of life score in every domain. The quality of life scores of those feeling unhealthy during the last two weeks were low in every domain., Conclusion: Physical and psychological health of family caregivers in assisted living facilities should be comprehensively supported by professionals.

Aim: This study is a report of a study to characterize the prevalence and severity of symptoms in patients with cancer and describing the clustering of symptoms., Background: Patients with cancer experience multiple symptoms caused by multiple factors, including progression of the cancer, acute physiological changes associated with treatment, delayed side effects of treatment and long-term consequences of the disease., Methods: A convenience sample of 287 patients with cancer at a Turkish university hospital completed a structured questionnaire on demographical characteristics and a symptom inventory for patients with cancer. Cluster analysis, principal components and internal consistency reliability analyses were used to analyse the data. The study was conducted in 2007., Findings: The most common symptoms experienced were fatigue, difficulty remembering, sadness, loss of appetite, lack of enjoyment of life, pain, distress, difficulty walking and dry mouth. The least experienced symptoms were shortness of breath and vomiting. Overall, 37.5% of the patients experienced moderate symptoms and 12.5% experienced severe symptoms. Among the severe symptoms were loss of appetite, fatigue, sadness, dry mouth and distress; however, 48% rated these as moderate or severe., Conclusions: Symptom cluster research is still in its early years. Further work is needed to reach a standard definition of a symptom cluster and a consensus of its criteria. Additional studies are needed to examine symptom clusters in cancer survivors. As individuals are living longer with the disease, comprehensive understanding of the symptom clusters that may be unique to cancer survivors is critical.

Background: In Diyarbakir, the rate of falls from height increases during summer months since people sleep on the unprotected balconies and roofs of their houses. We aimed to determine the frequency of falls from height and the related risk factors., Methods: We used questionnaire method and clinical data in this study. The questionnaire was administered in 1445 residences. Clinical data were obtained from files of patients hospitalized due to trauma in the Neurosurgery Clinic of Dicle University over the last six years., Results: In this questionnaire study, it was determined that 246 people had fallen, their average age was 15.4 years, 98% of them had fallen accidentally (mostly from 3.6 m height in summer months), mortality was 6.9%, and the prevalence of falls from height over the previous six years was 472/100,000. Of 464 patients who were hospitalized during the last six years, 326 were cases of fall from height and 59% of these patients were falls from a roof. The average age of these patients was 8.9 years, and average height of the fall was 4.2 m., Conclusion: Falls from height, particularly from roofs in Diyarbakir, remain a serious problem in terms of public health.

The aim of this research is twofold: 1) to determine attitudes of high school students toward addictive substances; and 2) to determine students' attitudes toward addictive substances in terms of some variables including gender, grade, and perceived parental attitudes. To this end, Addictive Substances Attitudes Scale and Parental Attitudes Scale were given to a sample of 745 high school students (F = 330, M = 415) chosen by purposive sampling method. Results showed that compared to the males, females had more negative attitudes toward addictive substances. And compared to students from the upper grades, students from lower grades had more negative attitudes toward addictive substances. It is also found that students' attitudes toward addictive substances correlate with perceived parental attitudes. The correlation is low and positive for perceived democratic parental attitudes (r = .29), negative and low for perceived authoritarian parental attitudes (r = -.27).

We attempted to isolate West Nile virus from mosquitoes collected in the field for the first time in Turkey. A total of 6,457 mosquito specimens from Culex pipiens Linnaeus, Ochlerotatus caspius (Pallas) and Aedes spp. species were included in this study. Culex pipiens samples made up 56% of the total species, O. caspius 24% and Aedes spp 20%. There were no positive results after studying mosquito samples using Real-time PCR, VecTest, and Vero cell culture. In serological tests of 181 human serum samples, 29 (16%) were found to be West Nile positive. On the basis of these results, we intend to collect more mosquito samples especially from those areas from which positive serum samples were obtained.

West Nile virus (WNV) and tick-borne encephalitis virus (TBEV) are among the medically important Flaviviruses that cause significant morbidity and mortality in humans. In this study, seroprevalence of WNV and TBEV in sera from two state medical hospitals from the southeastern part of Turkey was investigated. One hundred eighty-one serum samples were evaluated for WNV immunoglobulin G (IgG) by an indirect immunofluorescence test (IIFT) and for IgG antibodies against TBEV by a commercial enzyme-linked immunosorbent assay (ELISA) kit with enhanced sensitivity and specificity. Sera positive for WNV IgG were further analyzed by plaque reduction neutralization assay (PRNA). TBEV IgM was also investigated by ELISA in all seroreactive samples. Of 181 sera, 29 (16%) were positive for WNV IgG by IIFT and 17 of 179 (9.5%) were confirmed by PRNA. Nineteen of 181 (10.5%) sera were detected to have TBEV IgG. Mean titer of TBEV IgG was 43.0 RU/mL (median, 33.9 RU/mL; cutoff: 20 RU/mL). Four samples with WNV IgG antibodies were also positive for TBEV IgG antibodies. TBEV IgM was detected in 9 of 39 (23%) of all seroreactive sera, where IgM positivity were accompanied by IgG for 6 samples. These results suggest the presence of possible human WNV and TBEV infections in southeastern Turkey where vector activity have previously been detected.

The population dynamics of sand flies (Diptera: Psychodidae) were studied in Sanliurfa province in southeastern Turkey, in the country's largest focus of typical anthroponotic cutaneous leishmaniasis, during 2000-2002. Sand flies were collected at nine different sampling stations, located throughout the city, representing a cross section of urban and rural habitats. In total, 29,771 sand flies were collected, 45.35% of which were Phlebotomus papatasi Scopoli. In this study, the overall sand fly species diversity, relative abundance of each species, biodiversity, and similarity indices among sampling stations and efficiency of trapping methods were evaluated. Among the sampling stations, Sanliurfa city center and Suruç were shown to have the highest number of sand fly species; Harran-Akcakale and Hilvan habitats produced the largest number of individuals. The greatest similarity rates (80%) in terms of sand fly species were observed between Hilvan and city center, Harran-Akcakale and city center, Harran-Akcakale and Yenice, and Siverek and Viransehir. The lowest similarity rate (16%) was observed between Bozova-Birecik and city center. Comparison of biodiversity and similarity indices between the various sampling stations reveals the distribution of the suspected vector species and provides basic knowledge required to develop logical and effective control strategies. Among the trapping methods used, light traps showed the highest capture efficiency, above aspirators and sticky papers. It was concluded that light traps alone were sufficient to determine the sand fly fauna of the study area. It is recommended that the spatial and temporal dynamics of sand fly populations be monitored throughout the southeastern Anatolia Project (GAP) construction period, considering the potential impact the project may have on mean temperature, humidity, and human population movements.

Previous studies revealed that there were various mutations on endothelial nitric oxide synthase (eNOS) gene and these mutations might be a risk factor for coronary artery disease (CAD), myocardial infarction (MI), and hypertension (HT). In this study, we aimed to investigate the relationship between eNOS gene polymorphism (T-786 C) and coronary artery disease in the Turkish population. Two hundred and eleven unrelated individuals (152 male, 59 female, mean age 59 years, range 27-85) whose angiographic examinations were performed in our hospital were enrolled into the study; 159 of these had angiographically determined coronary artery lesions (>or=50% stenosis at least in one vessel). Fifty-two individuals were free of coronary artery disease on their coronary angiography. The Gensini scoring system was used to determine the severity of the CAD. The polymerase chain reaction (PCR) method was used for genotyping the individuals. To determine the independent risk factors for coronary artery disease, multivariate logistic regression analysis was used. The variant distribution of the T-786 C polymorphism was as follows. For all individuals: TT 94 (44.5%), TC 88 (41.7%), CC 29 (13.8%); in CAD patients: TT 63 (39.6%), TC 73 (45.9%), CC 23 (14.5%); and in normal individuals: TT 31 (59.6%), TC 15 (28.8%), CC 6 (11.5%). There was a statistically significant difference in the variant distribution between CAD and normal individuals (P<0.05). On the other hand, when we compared the frequency of the at-least-one-C-allele carriers (CC+TC, dominant model) and TT homozygous, those with at least one C allele were more prevalent in CAD patients. The results were as follows. In coronary artery disease patients: CC+TC 96 (60.4%), TT 63 (39.6%); in normals: TC+CC 21 (40.4%), TT 31 (59.6%) (P<0.01). When we compared the allele distribution (T vs C, additive model) between CAD patients and normal controls, the results were as follows: T 0.625 vs 0.740, C 0.375 vs 0.260; there was also a statistically significant association between CAD and C allele (P<0.05). When we compared the means of the Gensini scores between each genotype of the T-786 C mutation, there was a statistically significant difference. The results were TT (48.6+/-37.3, median 43.0), TC (55.4+/-41.2, median 41.0), CC (77+/-43.6, median 80.0) (P<0.05). Multivariate logistic regression analysis revealed that C-dominant (CC+TC) individuals had 2.9-fold more likelihood to suffer from CAD (odds ratio: 2.902; confidence interval: 1.272-6.622) (P<0.05). We conclude that the T-786 C polymorphism of eNOS gene might be a risk factor for coronary artery disease in the Turkish population.

Objective: To determine the effects of the thermolabile methylene tetrahydrofolate reductase (MTHFR) mutation on the presence and extent of coronary atherosclerosis in a population with low plasma folate., Methods: 242 consecutive patients undergoing coronary angiography were prospectively evaluated for conventional risk factors, plasma homocysteine, vitamin B-12, and folate, and MTHFR genotype. The severity of coronary atherosclerosis was determined by the Leaman score., Results: Mean (SD) plasma homocysteine was 15.6 (10) micromol/l in controls and 18.5 (11) micromol/l in patients with coronary artery disease (p > 0.05). Plasma homocysteine concentrations above 15 micromol/l were a risk factor for coronary artery disease (p = 0.03, risk ratio 2.1, 95% confidence interval (CI) 1.07 to 4.4). Homocysteine remained an independent risk factor on multivariate analysis when conventional risk factors were taken into account (p = 0.04). Homocysteine concentrations above 15 micromol/l were correlated with the extent of atherosclerosis (p = 0. 04, risk ratio 3.2, 95% CI 1.3 to 8.2). Homocysteine had no effect on other lipid variables (p > 0.05). Plasma folate was 15.8 (7.2) nmol/l in controls and 11.5 (2.9) nmol/l in patients with coronary artery disease. Plasma folate concentrations below 12.9 nmol/l (5.7 ng/ml) conferred a risk for coronary artery disease (p = 0.03, risk ratio 2.42, 95% CI 1.05 to 5.59). When the MTHFR genotype was determined, the TT genotype was present in 7.4% of patients and 5.2% of controls (p > 0.05). The prevalence of alleles was within the Hardy-Weinberg equilibrium (TT 7, CT 40, CC 53, chi2 = 2.3, p = 0.3). The highest homocysteine concentrations were found in patients with the TT genotype and folate below the median of the population (p = 0. 01). The extent of coronary atherosclerosis judged by the Leaman score was significantly higher in patients with the TT genotype (p = 0.03)., Conclusions: Plasma homocysteine over 15 micromol/l was a significant risk factor for the presence and extent of coronary artery disease. The mean plasma folate of the population was low and correlated negatively with homocysteine. Although TT genotype was not an independent predictor of coronary artery disease, it was an important predictor of the extent of coronary atherosclerosis and plasma homocysteine, especially in the presence of plasma folate values below the median of the population. These findings may have important implications for folate replacement in patients with the TT genotype.