Publications by authors named "Mustafa Alkan"

19 Publications

  • Page 1 of 1

Colistin resistance increases 28-day mortality in bloodstream infections due to carbapenem-resistant Klebsiella pneumoniae.

Eur J Clin Microbiol Infect Dis 2021 May 8. Epub 2021 May 8.

Istanbul Universitesi-Cerrahpasa, Cerrahpasa Faculty of Medicine, Cerrahpasa Tip Fakultesi, İstanbul, Turkey.

Mortality due to K. pneumoniae bacteremia is on rise, particularly in regions with high rates of carbapenem and colistin resistance. We aimed to define risk factors for colistin resistance and its impact on mortality. Patients diagnosed with "carbapenem-resistant K. pneumoniae (CRKp)" bacteremia between 2014 and 2018 were divided into two groups as "colistin susceptible (ColS)" and "colistin resistant (ColR)" based on broth microdilution method. Retrospective case-control study was conducted to compare characteristics and outcomes. Multiple logistic regression model was used to define independent risk factors for acquired colistin resistance and Cox proportional hazard model for 28-day mortality. A total of 82 patients (39 ColS and 43 ColR) were included. Mean age was 61.5 years, and 50 (61%) were male. Colistin resistance was significantly increased with duration of hospital stay (p = 0.007) and prior colistin use (p = 0.007). Overall, the 28-day mortality rate was 66%. Age (p = 0.014) and colistin resistance significantly increased 28-day (p = 0.009) mortality. Microbiological response to treatment within 7 days favors survival. PFGE analysis revealed an outbreak with K. pneumoniae ST78 and ST45 clones. Patients treated with combined antimicrobials had significantly lower 28-day mortality (p = 0.045) in comparison to monotherapy. However, types of combinations did not show significant superiority on each other. Colistin resistance increases 28-day mortality in CRKp bacteremia. Although combined regimens are more effective than monotherapy, existing antibacterial combinations have no apparent superiority to each other. New treatment options are pivotal.
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http://dx.doi.org/10.1007/s10096-020-04124-yDOI Listing
May 2021

Cytokine storm in severe COVID-19 pneumonia.

J Med Virol 2021 May 8. Epub 2021 May 8.

Department of Dermatology, Gaziosmanpasa Research and Training Hospital, University of Health Sciences, Istanbul, Turkey.

In this study, laboratorial parameters of hospitalized novel coronavirus (COVID-19) patients, who were complicated with severe pneumonia, were compared with the findings of cytokine storm developing in macrophage activation syndrome (MAS)/secondary hemophagocytic lymphohistiocytosis (sHLH). Severe pneumonia occurred as a result of cytokine storm in some patients who needed intensive care unit (ICU), and it is aimed to determine the precursive parameters in this situation. Also in this study, the aim is to identify laboratory criteria that predict worsening disease and ICU intensification, as well as the development of cytokine storm. This article comprises a retrospective cohort study of patients admitted to a single institution with COVID-19 pneumonia. This study includes 150 confirmed COVID-19 patients with severe pneumonia. When they were considered as severe pneumonia patients, the clinic and laboratory parameters of this group are compared with H-score criteria. Patients are divided into two subgroups; patients with worsened symptoms who were transferred into tertiary ICU, and patients with stable symptoms followed in the clinic. For the patients with confirmed COVID-19 infection, after they become complicated with severe pneumonia, lymphocytopenia (55.3%), anemia (12.0%), thrombocytopenia (19.3%), hyperferritinemia (72.5%), hyperfibrinogenemia (63.7%) and elevated lactate dehydrogenase (LDH) (90.8%), aspartate aminotransaminase (AST) (31.3%), alanine aminotransaminase (ALT) (20.7%) are detected. There were no significant changes in other parameters. Blood parameters between the pre-ICU period and the ICU period (in which their situation had been worsened and acute respiratory distress syndrome [ARDS] was developed) were also compared. In the latter group lymphocyte levels were found significantly reduced (p = 0.01), and LDH, highly sensitive troponin (hs-troponin), procalcitonin, and triglyceride levels were significantly increased (p < 0.05). In addition, there was no change in hemoglobin, leukocyte, platelet, ferritin, and liver function test levels, including patients who developed ARDS, similar to the cytokine storm developed in MAS/sHLH. COVID-19 pneumonia has similar findings as hyperinflammatory syndromes but does not seem to have typical features as in cytokine storm developed in MAS/sHLH. In the severe patient group who has started to develop ARDS signs, a decrease in lymphocyte level in addition to the elevated LDH, hs-troponin, procalcitonin, and triglyceride levels can be a predictor in progression to ICU admission and could help in the planning of anti-cytokine therapy.
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http://dx.doi.org/10.1002/jmv.27068DOI Listing
May 2021

Clinical characteristics of adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia.

J Infect Chemother 2021 Feb 23;27(2):306-311. Epub 2020 Oct 23.

Anesthesia and Reanimation, Istanbul Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey.

Background: The clinical spectrum of COVID-19 has a great variation from asymptomatic infection to acute respiratory distress syndrome and eventually death. The mortality rates vary across the countries probably due to the heterogeneity in study characteristics and patient cohorts as well as treatment strategies. Therefore, we aimed to summarize the clinical characteristics and outcomes of adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia in Istanbul, Turkey.

Methods: A total of 722 adult patients with laboratory-confirmed COVID-19 pneumonia were analyzed in this single-center retrospective study between March 15 and May 1, 2020.

Results: A total of 722 laboratory-confirmed patients with COVID-19 pneumonia were included in the study. There were 235 (32.5%) elderly patients and 487 (67.5%) non-elderly patients. The most common comorbidities were hypertension (251 [34.8%]), diabetes mellitus (198 [27.4%]), and ischemic heart disease (66 [9.1%]). The most common symptoms were cough (512 [70.9%]), followed by fever (226 [31.3%]), and shortness of breath (201 [27.8%]). Lymphocytopenia was present in 29.7% of the patients, leukopenia in 12.2%, and elevated CRP in 48.8%. By the end of May 20, 648 (89.7%) patients had been discharged and 60 (8.5%) patients had died. According to our study, while our overall mortality rate was 8.5%, this rate was 14.5% in elderly patients, and the difference was significant.

Conclusions: This case series provides characteristics and outcomes of sequentially adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia in Turkey.
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http://dx.doi.org/10.1016/j.jiac.2020.10.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584418PMC
February 2021

Falsely low values of oxygen saturation measured by pulse oximetry in patients with coronavirus disease 2019.

Lung India 2020 Nov-Dec;37(6):553-554

Department of Rheumatology, University of Health Sciences, Istanbul Gaziosmanpasa Research and Training Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.4103/lungindia.lungindia_392_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879873PMC
November 2020

Performance of pneumonia severity index and CURB-65 in predicting 30-day mortality in patients with COVID-19.

Int J Infect Dis 2020 Sep 14;98:84-89. Epub 2020 Jun 14.

Department of Rheumatology, Gaziosmanpasa Research and Training Hospital, University of Health Sciences, Istanbul, Turkey. Electronic address:

Objective: The aim of the study was to analyze the usefulness of CURB-65 and the pneumonia severity index (PSI) in predicting 30-day mortality in patients with COVID-19, and to identify other factors associated with higher mortality.

Methods: A retrospective study was performed in a pandemic hospital in Istanbul, Turkey, which included 681 laboratory-confirmed patients with COVID-19. Data on characteristics, vital signs, and laboratory parameters were recorded from electronic medical records. Receiver operating characteristic analysis was used to quantify the discriminatory abilities of the prognostic scales. Univariate and multivariate logistic regression analyses were performed to identify other predictors of mortality.

Results: Higher CRP levels were associated with an increased risk for mortality (OR: 1.015, 95% CI: 1.008-1.021; p < 0.001). The PSI performed significantly better than CURB-65 (AUC: 0.91, 95% CI: 0.88-0.93 vs AUC: 0.88, 95% CI: 0.85-0.90; p = 0.01), and the addition of CRP levels to PSI did not improve the performance of PSI in predicting mortality (AUC: 0.91, 95% CI: 0.88-0.93 vs AUC: 0.92, 95% CI: 0.89-0.94; p = 0.29).

Conclusion: In a large group of hospitalized patients with COVID-19, we found that PSI performed better than CURB-65 in predicting mortality. Adding CRP levels to PSI did not improve the 30-day mortality prediction.
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http://dx.doi.org/10.1016/j.ijid.2020.06.038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293841PMC
September 2020

The Importance of Intra-aortic Pulse Pressure After Anterior ST-segment Elevation Myocardial Infarction.

Braz J Cardiovasc Surg 2018 Nov-Dec;33(6):579-587

Department of Cardiology, Near East University Faculty of Medicine, Nicosia, Cyprus.

Objective: To evaluate the association of pulse pressure (PP) with mortality and major adverse cardiac events (MACE) in one-year period after anterior ST-elevation myocardial infarction (A-STEMI).

Methods: A total of 261 consecutive patients whose blood pressure was measured with the aid of a catheter before primary percutaneous coronary intervention (PPCI) between August 2016 and February 2017 were included in the study. The patients were divided into three groups according to pulse pressure (PP) (Group 1, PP<35 mmHg; Group 2, 35≤PP≤50 mmHg; Group 3, PP>50 mmHg).

Results: The mean age of the patients was 63.4±14.1 years, and 206 of them were male. The groups were similar in terms of age and diastolic blood pressure (DBP). The ratio of female patients in Group 1 was higher, and their systolic blood pressure (SBP) was lower than those from the other groups (P=0.005 vs. P=0.042). The rates of MACE and mortality were higher in Group 1. The predictive PP values were calculated to be 42.5 mmHg for development of MACE and 41.5 mmHg for mortality. One-year survival ratio was worse in Group 1 than in the others according to Kaplan-Meier analysis (P<0.001).

Conclusion: The values of PP which was measured intra-aortically in patients with A-STEMI were associated with mortality and MACE in the one-year follow-up period.
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http://dx.doi.org/10.21470/1678-9741-2018-0106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326447PMC
March 2019

The Negative Effect of Mean Perfusion Pressure on the Development of Acute Kidney Injury after Transcatheter Aortic Valve Implantation.

Braz J Cardiovasc Surg 2018 Nov-Dec;33(6):559-566

Near East University, Faculty of Medicine, Department of Cardiology, Nicosia, Cyprus.

Objective: To evaluate the predictive value of mean perfusion pressure (mPP) in the development of acute kidney injury (AKIN) after transcatheter aortic valve implantation (TAVI).

Methods: One hundred and forty seven consecutive patients with aortic stenosis (AS) were evaluated for this study and 133 of them were included. Mean arterial pressure (mAP) and central venous pressure (CVP) were used to calculate mPP before TAVI procedure (mPP = mAP-CVP). The occurrence of AKIN was evaluated with AKIN classification according to the Valve Academic Research Consortium-2 recommendations. The patients were divided into two groups according to the receiver operating characteristic (ROC) analysis of their mPP levels (high-risk group and low-risk group).

Results: The AKIN prevalence was 22.6% in this study population. Baseline serum creatinine level, glomerular filtration rate, amount of contrast medium, and the level of mPP were determined as predictive factors for the development of AKIN.

Conclusion: The occurrence of AKIN is associated with increased morbidity and mortality rates in patients with TAVI. In addition to the amount of contrast medium and basal kidney functions, our study showed that lower mPP was strongly associated with development of AKIN after TAVI.
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http://dx.doi.org/10.21470/1678-9741-2018-0137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326433PMC
March 2019

Evaluating functional capacity, and mortality effects in the presence of atrial electromechanical conduction delay in patients with systolic heart failure.

Anatol J Cardiol 2016 Aug 21;16(8):579-586. Epub 2015 Oct 21.

Department of Cardiology, Faculty of Medicine, Ege University, İzmir-Turkey.

Objective: Atrial functions are relatively suppressed in heart failure (HF). We aimed to investigate the associations of intra- and inter-atrial electromechanical conduction delay (EMCD) with functional class and mortality over a 12-month follow-up period.

Methods: The prospective study included 65 patients with systolic HF and 65 healthy subjects with normal sinus rhythm. Left ventricular (LV) systolic functions and left atrial (LA) dimensions and volumes were evaluated by transthoracic echocardiography. Tissue Doppler imaging (TDI) signals at the lateral border of the mitral annulus (lateral PA'), septal mitral annulus (septal PA'), and tricuspid annulus (tricuspid PA') were measured. Intra- and inter-atrial EMCD were calculated.

Results: Mitral inflow velocities were studied using pulsed-wave Doppler after placing the sample volume at the leaflets' tips. The peak early (E wave) and late (A wave) velocities were measured. The septal annular E/E' ratio was relatively higher and lateral, septal, and right ventricular S, E', and A' waves were significantly lower in the HF group than in the control group (12.49±6.03 - 7.16±1.75, pE/E' <0.0001). Intra-atrial EMCD was detected as 117.5 ms and inter-atrial EMCD as 127.5 ms in patients with prolonged atrial EMCD. A significant increase was found in prolonged intraand inter-atrial EMCD according to functional capacity increase (p=0.012 and p=0.031, respectively). The incidence of mortality was significantly higher in patients with prolonged atrial EMCD (p=0.025), and 5 patients in the HF group died during the study over the 12-month follow-up period.

Conclusions: In this study, we found a relationship between prolonged atrial conduction time and increased functional class and mortality in patients with systolic HF.
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http://dx.doi.org/10.5152/AnatolJCardiol.2015.6445DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368513PMC
August 2016

Successful treatment of post-transplant hepatitis C virus cirrhosis with daclatasvir and asunaprevir.

J Gastrointestin Liver Dis 2015 Sep;24(3):393-4

Infectious Diseases Dept., Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.

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September 2015

Unusual association of multiple congenital left ventricular diverticulum and cerebrovascular events in an adult.

Turk Kardiyol Dern Ars 2015 Apr;43(3):269-71

Department of Cardiology, Ege University Faculty of Medicine, İzmir, Turkey.

Congenital ventricular diverticulum is a rare and usually asymptomatic cardiac malformation which can cause major complications such as systemic thromboembolism, infective endocarditis, cardiac rupture, heart failure, arrhythmia and sudden death. We present a case with multiple congenital left ventricular diverticulum admitted to hospital with sudden onset right-sided hemiplegia and dysarthria.
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http://dx.doi.org/10.5543/tkda.2015.68249DOI Listing
April 2015

The change in right ventricular systolic function according to the revascularisation method used, following acute ST -segment elevation myocardial infarction.

Cardiovasc J Afr 2016 Jan-Feb;27(1):37-44

Department of Cardiology, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey.

Objective: The level of right ventricular (RV) systolic function has prognostic importance in right ventricular ST-segment elevation myocardial infarction (RV-STEMI). This study aimed to evaluate the changes in RV systolic function in patients with RV-STEMI according to the revascularisation method used for their management.

Methods: The first group consisted of 132 patients who received primary percutaneous coronary intervention (PPCI). The 78 patients who had received thrombolytic therapy (TT) in external centres before referral to our centre for PCI within three to 12 hours of RV-STEMI were included in the second group. All patients were evaluated by conventional and two-dimensional speckle-tracking echocardiography.

Results: There were 172 male patients and their mean age was 63.7 ± 11.8 years. There were no significant differences between the two groups with regard to right ventricular systolic parameters at admission and at the one-month follow-up visit. The echocardiographic changes between admission and the one-month follow up were investigated for the patients included in the study groups. Mean values of each parameter observed at the one-month follow up were significantly increased compared to those at admission within each group.

Conclusion: Our study demonstrated that PCI within three to 12 hours following TT provided similar benefits on right ventricular systolic function compared to PPCI in patients with RV-STEMI.
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http://dx.doi.org/10.5830/CVJA-2015-077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817064PMC
December 2016

Subintimal angioplasty and stenting in chronic total femoropopliteal artery occlusions: Early- and mid-term outcomes.

Cardiol J 2015 20;22(1):115-20. Epub 2014 May 20.

Department of Cardiology, Duzce University School of Medicine, Duzce, Turkey.

Background: This study was conducted to evaluate the initial and mid-term patency rates of chronic total femoropopliteal artery (FPA) occlusions treated by subintimal angioplasty (SIA) and stenting.

Methods: From March 2010 to February 2013, 74 patients were included in the study. Seventy two patients with total occlusion of the FPA and good distal runoff (2 or 3 patent vessels) were treated with percutaneous SIA and stenting. All patients had severe claudication or critical limb ischemia. In all cases, the procedure was performed with a contralateral approach. Follow-up was done at 6 months with clinical evaluation and color-Doppler. If it was necessary, peripheric angiography was performed.

Results: Immediate technical success was achieved in 72 (97%) patients. Two (3%) distal embolizations, 2 (3%) groin hematomas, 1 (1%) femoral pseudoaneurysm and 1 (1%) rupture of the junction-external iliac-superficial femoral artery occurred. All of the complications were treated successfully. Total occlusion in 1 patient and critical occlusion in 3 patients were showed at the 6th month. Patency rate at the sixth month was 94% with a stent length of 13.4 ± 8.2 cm.

Conclusions: Percutaneous SIA and stenting for chronic total of the FPA occlusion showed good initial and mid-term patency rates, with few periprocedural complications.
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http://dx.doi.org/10.5603/CJ.a2014.0043DOI Listing
August 2016

Comparison of anti-embolic protection with proximal balloon occlusion and filter devices during carotid artery stenting: clinical and procedural outcomes.

Postepy Kardiol Interwencyjnej 2013 16;9(3):221-7. Epub 2013 Sep 16.

Department of Neurosurgery, Ada TIp Hospital, Sakarya, Turkey.

Aim: The objective of this study was to compare the periprocedural and clinical outcomes after carotid artery stenting (CAS) with proximal protection devices versus with distal protection devices.

Material And Methods: Patients with internal carotid artery (ICA) stenosis undergoing CAS with cerebral embolic protection were randomly assigned to proximal balloon occlusion or distal filter protection. Adverse events were defined as death, major stroke, minor stroke, transient ischemic attack (TIA) and myocardial infarction (MI). Periprocedural and 30-day adverse events and ICA vasospasm rates were compared between the two embolic protection groups.

Results: Eighty-eight consecutive patients were randomized: 48 patients with proximal protection (mean age 68.8 ±13.6, 66% male) and 40 patients with a distal protection device (mean age 65.4 ±12.3; 70% male). There was no significant difference in periprocedural or 30-day adverse event rates between the two groups (p > 0.05). However, there was a higher periprocedural ICA vasospasm rate in the distal filter protection group (9 patients, 23%) compared with the proximal balloon occlusion group (1 patient, 2%) (p = 0.019).

Conclusions: There was no difference between the clinical periprocedural and 30-day adverse event rates of distal filter and proximal balloon protection systems. However, distal filter protection systems showed higher rates of periprocedural ICA vasospasm.
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http://dx.doi.org/10.5114/pwki.2013.37499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3915994PMC
February 2014

Does sildenafil contribute to acute coronary thrombosis?

Turk Kardiyol Dern Ars 2012 Sep;40(6):536-9

Department of Cardiology, Ada Medical Hospital, Sakarya, Turkey.

Sildenafil was the first oral compound to be approved for the treatment of erectile dysfunction. It is a selective inhibitor of isoform 5 of phosphodiesterase, which is the enzyme responsible for the breakdown of 3', 5'-cyclic guanosine mono-phosphate. Sildenafil-associated myocardial infarction (MI) is rarely seen in patients without previous history of coronary artery disease. A 43-year-old man presented with sudden onset of chest pain. It was determined that his chest pain started after sildenafil intake. Findings consistent with acute anterior MI were observed on electrocardiography. Coronary angiography showed total occlusion of left anterior descending artery with thrombosis. Coronary angioplasty and stenting was successfully performed.
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http://dx.doi.org/10.5543/tkda.2012.47716DOI Listing
September 2012

Serum chitotriosidase activity in acute coronary syndrome.

J Atheroscler Thromb 2013 18;20(2):134-41. Epub 2012 Sep 18.

Department of Cardiology, Denizli State Hospital, Denizli, Turkey.

Aim: Inflammation is a critical participant in mediating all stages of cardiovascular disease. Studies related with chitotriosidase that was recently found to be relevant to arterial inflammation. In this study we evaluated activity of serum chitotriosidase in acute coronary syndrome patients and its relationship with cardiovascular events, cardiac enzymes and inflammatory indicators.

Methods: We prospectively analyzed consecutive 30 patients with ST-segment elevation myocardial infarction, 30 patients with non ST-segment elevation myocardial infarction, 30 patients with unstable angina pectroris who were admitted to our intensive care unit and 30 healthy people (average age 56.86±10.44 years, 81 male) between Jaunary and June 2010. Details of baseline clinical characteristics, biochemical values, receiving treatment and basal ECG findings were recorded. Data of patients with coronary angiography were evaluated.

Results: Cut off value of chitotriosidase was calculated 82.00 mmol·ml-1·h-1, with 83 percent sensitivity and 72 percent spesificity. The activity of chitotriosidase in acute coronary syndrome group was 88.85±23.08 mmol·ml-1 ·h-1, where as the control group was 68.47±28.44 mmol·ml-1·h-1, respectively p=0.001).The highest activity of chitotriosidase (96.11±19.77 mmol·ml-1·h-1) was found in ST-segment elevation myocardial infarction group and the minimal activity of chitotriosidase was in the control group (68.47±28.44 mmol·ml-1·h-1) (p= 0.001). The activity of chitotriosidase in ST-segment elevation myocardial infarction and non ST-segment elevation myocardial infarction groups were significantly higher than control group (p=0.001 and p=0.045). When acute coronary syndrome groups compared to control; a positive correlation was found between chitotriosidase activity and hs-CRP (r=0.21, p= 0.046), troponin T (r=0.25, p=0.016), creatine kinase-MB (r=0.20, p=0.059).

Conclusion: The activity of chitotriosidase is increased in acute coronary syndrome patients. Chitotriosidase is higher in ST-segment elevation myocardial infaction group than non ST-segment elevation myocardial infarction and unstable angina pectoris group.
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http://dx.doi.org/10.5551/jat.13920DOI Listing
September 2013

Survival of patients with well-developed collaterals undergoing CABG or medical treatment: an observational case-controlled study.

Anadolu Kardiyol Derg 2012 Mar 26;12(2):97-101. Epub 2012 Jan 26.

Clinic of Cardiology, Ada Tıp Hospital, Sakarya-Turkey.

Objective: The effects of coronary artery bypass grafting (CABG) on mortality have not been evaluated in patients with well-developed coronary collaterals. We investigated functional capacity, presence of angina, the occurrence of acute myocardial infarction, survival and mortality in patients with well-developed coronary collaterals both undergoing and refusing CABG.

Methods: The study was designed as a retrospective observational case-controlled study. Seventy-eight patients undergoing coronary angiography were included in this study. They had critical occlusion in the proximal left anterior descending artery (LAD) with Rentrop-3 collateral circulation towards LAD, and to proceed with CABG has been suggested. The patients were divided in two groups; first group proceeding with CABG (n=40) and the second, rejecting the surgery (medical treatment group; n=38). The rates of survival, the incidence of angina pectoris and acute myocardial infarction as well as the functional capacities were evaluated in all patients. Survival rates were evaluated using Kaplan-Meier survival analysis.

Results: No statistically significant difference was observed between the two groups regarding the baseline characteristics of patients, the presence of angina pectoris, the severity of angina pectoris according to CCS, the occurrence of acute myocardial infarction or stroke, and the functional capacity according to NYHA (p>0.05). Death due to cardiovascular reasons was observed in eight patients of CABG group and in five patients of medical treatment group (p=0.710). The 5-year survival rate was observed to be 80% in CABG group while it was observed to be 84% in the medical treatment group (p=0.730).

Conclusion: There was no significant difference regarding the survival rates in patients with well-developed coronary collaterals proceeding with CABG or medical treatment.
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http://dx.doi.org/10.5152/akd.2012.033DOI Listing
March 2012

A survey for the evaluation of the training period of cardiology specialists in Turkey.

Anadolu Kardiyol Derg 2011 Dec 28;11(8):661-5. Epub 2011 Oct 28.

Department of Cardiology, Faculty of Medicine, Ege University, İzmir, Turkey.

Objective: To evaluate postgraduate training period, social life and problems of cardiology residents in Turkey by using a questionnaire form and to compare with the core curriculum of European Society of Cardiology for general cardiology.

Methods: Overall, 529 residents of cardiology ages in range of 24-35 years (mean age: 26.5±2.0 years, 81.4% male) participated as volunteers in this cross-sectional survey study. An 86-item questionnaire form was used to evaluate the education process, capacity of knowledge and skill and social effectiveness level of participants. The questionnaire were composed both closed- and open-ended questions. The questionnaire form was filled in with the face-to-face communication method. The data of survey were compared with the core curriculum of European Society of Cardiology for general cardiology training period. Chi-square or Fischer exact test was used for statistical analysis.

Results: The participants were working in various university hospitals (70.3%) and training-research (state) hospitals in 31 different provinces in Turkey (40.8% in Marmara region). They visited 40±10 outpatients and 10±5 hospitalized pts daily in the clinics. The 3-5 residents worked at the clinic on night shifts and mostly (89%) 8 or more night shifts per month were held in their first training years. During first three-years of training 76% of residents have performed echocardiography, 40.8%-transesophageal echocardiography and 10% - intraoperative echocardiography. The 84.3% of them evaluated exercise tests, 76.4%-Holter electrocardiography and 53.3%-tilt-table tests. The rate of residents working in coronary angiography laboratories was 54.3%. The 53.7% of residents performed coronary angiography and 64%-only in the 4th year of their training. The number of coronary angiography performance was under expected when compared with European Society of Cardiology curriculum. The 18.5% of residents were participated as assistant researcher in an international multi-center study and only 10% had an article published in national journals (4.3% published in Science Citation Index). The 30.6% considered the cardiology training period in their centers to be insufficient, whereas 37.4% found it partially sufficient and 31.9% sufficient. Only 32.9% of participants could dedicate time for social activities.

Conclusion: According to the referred core curriculum of ESC for general cardiology the training of cardiology residents in non-invasive applications is adequate however coronary angiography applications are slightly insufficient in Turkey. In addition, the number of publications per capita is quiet low.
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http://dx.doi.org/10.5152/akd.2011.185DOI Listing
December 2011

Termination of idiopathic sustained monomorphic ventricular tachycardia by intravenous adenosine in a pregnant woman.

Europace 2009 Nov 29;11(11):1560-1. Epub 2009 Sep 29.

Department of Cardiology, Ege University School of Medicine, Bornova, Izmir 35100, Turkey.

A 34-year-old pregnant woman presented to the emergency department with the complaints of palpitations at 32 weeks gestation. The diagnosis of right ventricular outflow tract ventricular tachycardia (VT) was made. Intravenous 5 mg of metoprolol and 25 mg of diltiazem did not terminate the VT. Ten milligrams of adenosine were administered. Within 10 s of adenosine administration, sustained VT converted to repetitive monomorphic VT and within 30 s to normal sinus rhythm. The mother and the foetus tolerated the medications well. Non-stress test for the assessment of the foetal well-being was normal.
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http://dx.doi.org/10.1093/europace/eup260DOI Listing
November 2009

Anti-inflammatory activity of bis(3-aryl-3-oxo-propyl)methylamine hydrochloride in rat.

Biol Pharm Bull 2007 Jan;30(1):63-7

Department of Pharmacology, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

In this study the effects of compound B1, bis(3-aryl-3-oxo-propyl)methylamine hydrochloride, and an anti-inflammatory drug, indomethacin, were tested by carrageenan-induced paw edema and cotton pellet granuloma tests, for effects on acute and chronic phases of inflammation, respectively. Their effects on vascular permeability were also determined by hyaluronidase-induced capillary permeability test. Anti-inflammatory activity of B1 was compared with indomethacin. B1 decreased the carrageenan-induced paw edema by 49%, 35%, and 47% at 50, 100, and 200 mg kg(-1) doses, respectively, while this decrease was 82% by indomethacin at 20 mg kg(-1) dose. Antiproliferative effects in cotton pellet test of B1 at 50 mg kg(-1) and indomethacin at 20 mg kg(-1) doses were 44% and 43%, respectively. Indomethacin but not B1 inhibited the hyaluronidase-induced increase in capillary permeability. Our results suggest that B1 inhibits both acute and chronic phases of inflammation probably by an effect not mediated by prevention of increased capillary permeability. Especially, its anti-inflammatory activity against chronic phase of inflammation was comparable with that of indomethacin. Further detailed studies are needed to clarify the mechanism(s) of action responsible for the anti-inflammatory activity of B1.
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http://dx.doi.org/10.1248/bpb.30.63DOI Listing
January 2007