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Serkan Akdag,1 Aytac Akyol,1 Huseyin Altug Cakmak,2 Aydin Rodi Tosu,3 Muntecep Asker,1 Mehmet Yaman,4 Naci Babat,1 Yasemin Soyoral,5 Muhammed Bilal Cegin,6 Ali Kemal Gur,7 Hasan Ali Gumrukcuoglu11Department of Cardiology, Yuzuncu Yil University Medical Faculty, Van, 2Department of Cardiology, Rize Kackar Government Hospital, Rize, 3Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital, Istanbul, 4Department of Cardiology, Samsun Education and Training Hospital, Samsun, 5Department of Nephrology, 6Department of Anesthesiology and Reanimation, 7Department of Cardiovascular Surgery, Yuzuncu Yil University Medical Faculty, Van, TurkeyBackground: End stage renal disease is related to increased cardiovascular mortality and morbidity. Hypertension is an important risk factor for cardiovascular disorder among hemodialysis (HD) patients. The aim of this study was to investigate the effect of low-sodium dialysate on the systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels detected by ambulatory BP monitoring (ABPM) and interdialytic weight gain (IDWG) in patients undergoing sustained HD treatment.Patients and methods: The study included 46 patients who had creatinine clearance levels less than 10 mL/min/1.73 m2 and had been on chronic HD treatment for at least 1 year. After the enrollment stage, the patients were allocated low-sodium dialysate or standard sodium dialysate for 6 months via computer-generated randomization.Results: Twenty-four hour SBP, daytime SBP, nighttime SBP, and nighttime DBP were significantly decreased in the low-sodium dialysate group (P

Serkan Akdag, Hakki Simsek, Musa Sahin, Aytac Akyol, Ramazan Duz, Naci Babat Department of Cardiology, Yuzuncu Yil University Medical Faculty, Van, Turkey Background: Epicardial adipose tissue (EAT), mean platelet volume (MPV), platelet-to- lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) have been shown to be helpful in predicting adverse cardiovascular events. However, to date, in the literature, there have been no studies demonstrating the relationship between EAT, MPV, PLR, NLR, and thromboembolism risk in atrial fibrillation (AF). Therefore, we examined the relationship between EAT, MPV, PLR, NLR, and CHA2DS2-VASc score used for the evaluation of thromboembolism risk in patients with AF.Methods: The study included 96 consecutive patients with AF and 52 age- and sex-matched control subjects. We calculated CHA2DS2-VASc risk score for each patient and measured baseline EAT thickness, MPV, PLR, NLR, left atrial volume index, and left ventricular ejection fraction.Results: The group with high CHA2DS2-VASc score had higher EAT (7.2±1.5 vs 5.9±1.2 mm, P

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a prevalent disease with many potential long-term cardiovascular risks. P-wave dispersion (Pdis) and QT dispersion (QTdis) have been shown to be noninvasive electrocardiographic predictors for development of cardiac arrhythmias. In this study we aimed to search Pdis and QTdis parameters in patients with PCOS. PATIENTS AND METHODS: The study included 82 patients with PCOS and 74 age- and sex-matched healthy controls. Baseline 12-lead electrocardiographic and transthoracic echocardiographic measurements were evaluated. P-wave maximum duration (Pmax), Pwave minimum duration (Pmin), Pdis, QT interval, heart rate-corrected QT dispersion and QTdis were calculated by two cardiologists. RESULTS: Patients wirh PCOS had significantly higher QT dispersion (49.5 ± 14.1 vs. 37.9 ± 12.6 ms, p < 0.001), and P wave dispersion (54.2 ± 11.4 vs. 45.9 ± 10.1 ms, p < 0.001) than the controls. Serum testosterone and estradiol levels was correlated with the Pdis (r = 0.677, p < 0.001 and r = 0.415, p < 0.001 respectively) and QTdis (r = 0.326, p < 0.001 and r = 0.321, p < 0.001 respectively). CONCLUSIONS: Pdis and QTdis are simple and useful electrocardiographic markers which may be used in the prediction of the risk of adverse cardiovascular events in PCOS patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Endothelial dysfunction is considered the first stage in the development of atherosclerosis. Brachial artery flow-mediated dilatation (FMD) has been impaired in patients with coronary slow flow (CSF). Recently, color M-mode derived propagation velocity of descending thoracic aorta (aortic propagation velocity-AVP) was shown to be an ultrasonographic marker for atherosclerosis. AIM: To assess endothelial function in patients with CSF and the correlation of AVP with FMD. MATERIALS AND METHODS: FMD and AVP were measured in 90 patients with CSF and 39 patients having normal coronary arteries (NCA) detected by coronary angiography. RESULTS: Compared to patients with normal coronary arteries patients having CSF had significantly lower AVP (39.1±8.4 vs. 53.7±12.7 cm/s, p < 0.001) and FMD (5.6±3.2 vs. 17.6±4.4 %, p < 0.001) measurements. There were significant correlations between AVP and FMD (r = 0.524, p < 0.001). CONCLUSIONS: Transthoracic echocardiographic determination of color M-mode propagation velocity of descending aorta is a simple practical method and correlates well with coronary slow flow and brachial endothelial function. [ABSTRACT FROM AUTHOR]

Objective: To assess blood transfusion decisions in blood losses using a continuous total haemoglobin (SpHb) and non-invasive haemoglobin (Hb) device., Study Design: Double-blinded randomised controlled trial., Place and Duration of Study: Marmara University Hospital, Istanbul, Turkey, from March 2018 to December 2019., Methodology: One hundred and twenty adult patients scheduled for elective major surgery and expected to experience a blood loss greater than 20% of their total blood volume were divided into two groups. These groups were compared for bleeding management with conventional blood gas sampling (Group Hb, the control group) according to Hb monitoring versus SpHb measurement (Group SpHb, the study group)., Results: In the postoperative measurement, there were fewer red blood cells (RBC) in the SpHb group than in the Hb group (p=0.020). There was a greater change in the amount of RBC from the perioperative to the postoperative period in the SpHb group compared to the Hb group (p<0.001). Postoperative Hb levels of patients in the intensive care unit (ICU) were higher in the SpHb group than in the Hb group (p<0.05)., Conclusion: SpHb can provide effective patient blood management in cases of major surgery. It does not cause a delay in the decision of blood transfusion during surgery., Key Words: Haemorrhage, Anaemia, Blood transfusion, General surgery.

With the increasing challenge of attaining sustainable balance in socioeconomic-ecosystem activities, the aspects of the global goals are continously being harnesed in order to ensure a sustainable interaction. As an alliance of the United Nations, the G-20 member countries have not only committed to attaining the Sustainable Development Goals 2030, the alliance body has further fostered frameworks that are targeted at advancing global economic and environmental sustainability. Within this context, the current study examined the environmental sustainability effects arising from the economic freedom prowess in the panel of the G-20 economies over the period 2000-2016. Among the sparse studies, the study employed the indices of economic freedom: freedom to trade internationally, regulation, sound money, legal framework, and property right and alongside the real income and renewable energy consumption as explanatory indicators. With the result of the difference- and two-step system GMM (generalized method of moments), the legal system and property right, sound money, freedom to international trade, and regulatory efficiency are detrimental to the panel countries' environmental quality. Although this is likely to be untrue for countries that have advanced their climate actions and especially the Sustainable Development Goals (SDGs) 2030, it suggests a dearth in the SDGs achievement among the developing and emerging economies. Moreover, it probably shows the depth of traditional or business-as-usual practices (such as the lack of sustainable economic and environmental practices) and the socioeconomic system that are obtainable in most of the developing and emerging economies. Thus, the study put forward tangible policies that are essential for governance and toward attaining desirable country-specific SDGs., (© 2022. The Author(s).)

This study aimed to evaluate the impact of digital stories in the learning-based themes of safe schools and to examine the perceptions of special educational needs in safe school environments. Training were carried out with informative videos created through the Distance Education and Information Technology Center (UZEBIM) for principals and teachers-in-charge, and the effectiveness of this process was evaluated through reflective opinion forms. In addition to this, an evaluation form was presented to the prospective special education teachers to obtain their opinions and evaluate the effectiveness of digital stories at safe schools. A total of 100 prospective teachers participated in the evaluation of the impact of digital stories on their learning about safe school environments. Digital stories regarding safe schools become an important source of information in creating a safe school environment more rapidly and efficiently. In line with the interviews, it was observed that the awareness of safe school environments was increased and the digital dimensions of safe school environments were internalized through digital stories. Due to the raising awareness in the COVID-19 process, it was revealed that the schools did not have sufficient safe school characteristics and all stakeholders should take preventive measures in coordination to establish a safe school environment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Akdag and Altinay.)

Background and Objective: Visceral adipose tissue-derived serine proteinase inhibitor (vaspin) is an adipokine that correlates with insulin resistance and obesity in human beings. Previous studies have evaluated the serum vaspin levels in several diseases such as chronic haemodialysis patients and coronary artery disease. To our knowledge, serum vaspin levels have not yet been reported in predialysis patients. Carotid intima-media thickness (CIMT) is a noninvasive procedure to detect early atherosclerotic changes. The aim of this study was to evaluate serum vaspin levels in predialysis patients and their relationships with glomerular filtration rate and CIMT levels., Methods: A total of twenty-five predialysis patients (14 females and 11 males) and 22 healthy subjects (8 females and 14 males) were enrolled in the study. Serum samples were subjected to the human vaspin RIA system. CIMT was measured by B-mode ultrasonography., Results: Serum vaspin levels were significantly lower in predialysis patients than control subjects (P < .05), while CIMT levels were significantly higher (P < .001). Serum vaspin levels were found to be significantly correlated with glomerular filtration rate (r = 0.42, P < .001) and CIMT (r = -0.47, P < .05) in predialysis patients., Conclusions: This is the first report to describe the association between serum vaspin levels and CIMT in predialysis patients. We concluded that serum vaspin levels were decreased in predialysis patients than control subjects. In addition, serum vaspin levels were found to be significantly correlated with glomerular filtration rate and CIMT., (© 2021 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.)

Background: The pathogenesis chronic urticaria (CU) hasn't been fully understood. In recent years, it has been shown that thiol-disulphide homoeostasis, as an antioxidant system, plays important roles in both healthy individuals and various diseases. In different ischaemia-reperfusion states, high oxidative stress causes ischaemia-modified albumin (IMA) generation., Aim: To investigate thiol/disulphide balance and IMA level in children with CU and their association with disease severity., Methods: Thirty children with CU and 20 healthy children as controls, aged 1-18 years, were included in this cross-sectional study. In all subjects, total thiol, native thiol, disulphide levels and IMA levels were measured in plasma by spectrophotometry. Disulphide/native thiol, disulphide/total thiol and native thiol/total thiol ratios were calculated. The disease severity was rated by Urticaria Activity Score (UAS)., Results: In the children with CU, the levels of native thiol (375.56 ± 56.22 μmol/L) and total thiol (415.69 ± 54.75 μmol/L) were significantly lower than the control group (475.20 ± 71.87 and 511.20 ± 73.73 μmol/L, respectively) ( p  = 0.000, p  = 0.000). The ratio of native/total thiol * 100 was lower in patients than the control group ( p  = 0.002). IMA was significantly higher in the patient group than control group ( p  = 0.000). No significant correlation was found between UAS and thiol/disulphide homoeostasis ( p  > 0.05). The disulphide levels, disulphide/native thiol and disulphide/total thiol levels were found to be higher in patients with positive family history for autoimmune disorders than those without ( p  < 0.05)., Conclusion: In children with CU, impaired thiol/disulphide homoeostasis and increased IMA suggest that oxidative stress may play role in the disease pathogenesis.

The efficient use of energy contributes to less energy consumption and the reduction of greenhouse gases released to nature, thus improving environmental sustainability. For this reason, many countries pioneered by the developed nations are trying to develop policies for energy efficiency. In this context, the relationship between energy efficiency and greenhouse gas emissions was tested by panel co-integration, panel causality, and FMOLS and DOLS analysis. Given that the study used the datasets of 29 European countries over the period 1995-2016, there result suggests that there is a long-term relationship between energy efficiency and greenhouse gas emissions and that the quantity of greenhouse gas emission decreases as energy efficiency increases. Finally, the robustness and novelty by employing the Emirmahmutoglu & Kose (2011) Testing for Granger causality in heterogeneous mixed panels. Economic Modelling, 28(3), 870-876 approach, the findings illustrated that there is a causal relationship between energy efficiency and greenhouse gas emissions for many European countries. Overall, the current study presents a relevant policy direction for the European bloc countries., (© 2020 The Authors.)

Background and Objective: Vaspin is a molecule belonging to adipokine family which is associated with insulin resistance and obesity in humans. Several studies have evaluated the serum levels of vaspin in various conditions including coronary artery disease and chronic hemodialysis patients. To our best knowledge, serum vaspin levels have not yet been studied in pre dialysis patients. Carotid intima-media thickness (CIMT) is a noninvasive procedure used to diagnose the extent of carotid atherosclerotic vascular disease. The objective of this study is to evaluate serum vaspin levels in pre dialysis patients and their relationships with glomerular filtration rate and CIMT levels., Methods: A total of twenty-five pre dialysis patients (14 female and 11 male) and 22 healthy controls (8 female and 14 male) were included in the study. CIMT was measured through B-mode ultrasonography., Results: Serum vaspin levels were significantly lower (p<0.05) and CIMT levels were significantly higher (p<0.001) in pre dialysis patients than in control subjects. Serum vaspin levels were found to be significantly correlated with glomerular filtration rate (r=0.42, p<0.001) and CIMT (r=-0.47, p<0.05) in pre dialysis patients., Conclusions: This is the first report to describe the correlation between serum vaspin levels and CIMT in pre dialysis patients. We concluded that serum vaspin levels were decreased in pre dialysis patients compared to the control subjects. In addition, serum vaspin levels were found to be significantly correlated with glomerular filtration rate and CIMT. This article is protected by copyright. All rights reserved., (This article is protected by copyright. All rights reserved.)

Purpose: The purpose of the current prospective study was to evaluate the effects of low sodium dialysate on oxidative stress parameters, blood pressure (BP) and endothelial dysfunction in maintenance hemodialysis (HD) patients., Methods: After baseline measurements were taken, the dialysate sodium concentration was reduced from 140 to 137 mEq/L. Oxidative stress parameters and flow-mediated dilatation (FMD %) were measured before and after 6 months of HD with low sodium dialysate. Interdialytic weight gain (IDWG) and pre- and post-dialysis BP were monitored during the study., Results: A total of 52 patients were enrolled and 41 patients completed the study. There was a significant reduction in systolic blood pressure at the end of the study [130.00 (90.00-190.00) vs. 120.00 (90.00-150.00), p < 0.001]. Similarly, there were significant improvements in IDWG [2670.00 (1670.00-4300.00) vs. 1986.00 (1099.00-3998.00), p < 0.001] and FMD % [7.26 (4.55-8.56) vs. 9.56 (6.55-12.05), p < 0.001]. Serum MDA levels (p < 0.001) were significantly decreased; serum SOD (p < 0.001) and GPx (p < 0.001) activities were significantly increased after low sodium HD compared to standard sodium HD., Conclusion: Our data seem to suggest a potential role of 137 mEq/L sodium dialysate for improving hemodynamic status, endothelial function and reducing oxidative stress than 140 mEq/L sodium dialysate in maintenance HD patients.

Background: Coronary slow-flow (CSF) is an angiographic phenomenon characterised by delayed opacification of vessels in the absence of any evidence of obstructive epicardial coronary disease. QT interval dispersion (QTD) reflects regional variations in ventricular repolarisation and cardiac electrical instability and has been reported to be longer in patients with CSF., Aim: To examine QT duration and dispersion in patients with CSF and the effects of nebivolol on these parameters., Methods: The study population included 67 patients with angiographically proven normal coronary arteries and CSF, and 38 patients with angiographically proven normal coronary arteries without associated CSF. The patients were evaluated with 12-lead electrocardiography, and echocardiography before and three months after treatment with nebivolol., Results: Compared to the control group QTcmax and QTcD were significantly longer in patients with CSF (p = 0.036, p = 0.019, respectively). QTcD significantly correlated with the presence of CSF (r = 0.496, p < 0.001). QTcmax (p = 0.027), QTcD (p = 0.002), blood pressure (p = 0.001), and heart rate (p < 0.001) values significantly decreased after treatment with nebivolol., Conclusions: Coronary slow flow is associated with increased QTD. Nebivolol reduced increased QTD in patients with CSF after three months.

Introduction: Recently, platelet-to-lymphocyte ratio (PLR) has emerged as a significant inflammatory marker and a novel predictor of major adverse consequences in cardiovascular disease., Aim: In this study, we aimed to explore the relationship between PLR and coronary collateral circulation (CCC) in patients with non-ST elevation myocardial infarction (NSTEMI)., Material and Methods: Clinical and laboratory data of 386 patients who underwent coronary angiography were evaluated retrospectively. The patients were classified into 2 groups as follows: poor CCC (group 1: Rentrop grades 0-1) and good CCC (group 2: Rentrop grades 2-3). The PLR was calculated from the complete blood count., Results: The PLR values of the patients with poor CCC were significantly higher than those of patients with good CCC (153.9 ±26.6 vs. 129.8 ±23.5, p < 0.001). In the multiple logistic regression tests, PLR (odds ratio: 1.51, 95% confidence interval: 1.27-1.74; p < 0.001) and hs-CRP (odds ratio: 1.56, 95% CI: 1.03-2.11; p < 0.001) were found to be independent predictors of poor CCC. The receiver operating characteristic (ROC) curve analysis yielded a cutoff value of 140.5 for PLR to predict poor CCC with 79% sensitivity and 71% specificity, with the area under the ROC curve being 0.792 (95% CI: 0.721-0.864)., Conclusions: Our study revealed that high PLR is independently associated with poor coronary collateral circulation in patients with NSTEMI.

Background: Platelet-to-lymphocyte ratio (PLR) is an emerging inflammatory indicator which is closely associated with adverse cardiovascular events. Therefore, we aimed to investigate the relationship between PLR and the severity of calcific aortic stenosis (AS)., Material and Methods: The study was designed as a retrospective study. A total of 86 consecutive patients with calcific AS were divided into two groups as mild-to-moderate AS and severe AS according to the transaortic mean pressure gradient. PLR levels were calculated from the complete blood count (CBC)., Results: Platelet to lymphocyte ratio was significantly higher in severe and mild-to-moderate AS groups when compared to the control subjects (151±31.2, p<0.001, 138±28.8 vs. 126±26.5, p=0.008, respectively). In the subgroup analysis of AS patients, PLR was found to be higher in the severe AS group compared to mild-to-moderate group (p<0.001). A significant correlation was found between PLR and transaortic mean pressure gradient in patients with AS (r=0.421, p<0.001)., Conclusions: Our study results demonstrated that increased PLR correlates with the severity of calcific AS.

Background and Objectives: Obstructive sleep apnea syndrome (OSAS) is associated with increased arterial stiffness and cardiovascular complications. The objective of this study was to assess whether the color M-mode-derived propagation velocity of the descending thoracic aorta (aortic velocity propagation, AVP) was an echocardiographic marker for arterial stiffness in OSAS., Subjects and Methods: The study population included 116 patients with OSAS and 90 age and gender-matched control subjects. The patients with OSAS were categorized according to their apnea hypopnea index (AHI) as follows: mild to moderate degree (AHI 5-30) and severe degree (AHI≥30). Aortofemoral pulse wave velocity (PWV), carotid intima-media thickness (CIMT), brachial artery flow-mediated dilatation (FMD), and AVP were measured to assess arterial stiffness., Results: AVP and FMD were significantly decreased in patients with OSAS compared to controls (p<0.001). PWV and CIMT were increased in the OSAS group compared to controls (p<0.001). Moreover, AVP and FMD were significantly decreased in the severe OSAS group compared to the mild to moderate OSAS group (p<0.001). PWV and CIMT were significantly increased in the severe group compared to the mild to moderate group (p<0.001). AVP was significantly positively correlated with FMD (r=0.564, p<0.001). However, it was found to be significantly inversely related to PWV (r=-0.580, p<0.001) and CIMT (r=-0.251, p<0.001)., Conclusion: The measurement of AVP is a novel and practical echocardiographic method, which may be used to identify arterial stiffness in OSAS.

Background: Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive collapse of the upper airway during sleep. Red blood cell distribution width (RDW) increases platelet activation and has been reported as an independent predictor of adverse outcomes in the general population and is believed to be associated with cardiovascular morbidity and mortality. We evaluated RDW, mean platelet volume (MPV), and platelet distribution width (PDW) as a severity index in OSAS and the relationship between carotid intima media thickness and pulmonary hypertension., Material/methods: The study population consisted of 99 patients who were admitted to the sleep laboratory. Based on the apnea-hypopnea index, patients were grouped into 3 OSAS severity categories. Morning blood samples were withdrawn from patients after a 12-hour fasting period. MPV, PDW, and RDW were measured in a blood sample. Bilateral common carotid arteries of the patients were scanned., Results: Ninety-nine patients--73 with OSAS and 26 simple snoring control cases--were included. Mean values of MPV, PDW, and RDW were similar in patients compared to simple snoring subjects in the control group (p=0.162, p=0.656, p=0.091). RDW showed an inverse correlation with mean desaturation and lowest desaturation (p<0.01). Body mass index, apnea-hypopnea index, pulmonary artery pressure, and desaturation time under 90% were positively correlated with RDW (p<0.05). MPV, PDW, and carotid intima media thickness had no correlation with any other parameters., Conclusions: The study showed a positive relationship between RDW and the apnea-hypopnea index and systolic pulmonary hypertension in patients with OSAS.

Background: Several reports have demonstrated an association between psoriasis and cardiovascular diseases. P wave dispersion (PWD) is the most important electrocardiographic (ECG) markers used to evaluate the risk of atrial arrhythmias. QT dispersion (QTD) can be used to assess homogeneity of cardiac repolarization and may be a risk for ventricular arrhythmias., Aim: To search PWD and QTD in patients with psoriasis., Methods: Ninety-four outpatient psoriasis patients and 51 healthy people were evaluated by physical examination, 12-lead ECG, and transthoracic echocardiography. Severity of the psoriasis was evaluated by psoriasis area and severity index (PASI)., Results: Mean disease duration was 129.4 ± 83.9 (range, 3-360) months and PASI ranged from 0 to 34.0 (mean ± SD; 7.6 ± 6.7). Compared to control group, psoriatic patients had significantly shorter Pmax and Pmin durations, longer QTcmax, and greater PWD and QTcD. Transmitral deceleration time (DT) and isovolumetric relaxation time (IVRT) were significantly longer among psoriasis patients. QTcD and PWD were significantly correlated with disease duration (r = 0.693, P < 0.001, and r = 0.368, P = 0.003, resp.)., Conclusions: In this study, we found that both PWD and QTcD are increased in psoriasis patients compared to healthy subjects. In addition, they had longer DT and IVRT.