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Öğe Constrictive Calcific Pericarditis Masked by Haemodialysis(2009) Solak, Yalçın; Selçuk, Nedim; Tekinalp, Mehmet; Özbek, Orhan; Atalay, HüseyinWe admitted a maintenance haemodialysis patient with hypotension and weakness. He had undergone cadaveric renal transplantation 19 years earlier. He had lost his kidney due to chronic allograft nephropathy 1 year after transplantation and returned to haemodialysis. He had hypotension, especially remarkable during haemodialysis. He also had hepatitis C but no cirrhosis. The patient denied a previous pulmonary tuberculosis. On physical examination, he was hypotensive (80/60 mmHg) but without peripheral oedema, neck vein distention or hepatomegaly. Heart sounds were weakly heard and there was no audible murmur or friction rub. Pericardial calcification was noticed on chest x-ray (Figure 1). Echocardiography could not visualize the pericardium or heart. Only coarse calcification of the pericardium from the subphrenic angle, but no further detail, was visible. Subsequently, we performed computerized tomography of the pericardium (Figure 2), which revealed a crescent-like calcification of the pericardium. There were calcific plaques on the right lower lobe of the pulmonary pleura as well.Öğe P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke(IVYSPRING INT PUBL, 2012) Doğan, Umuttan; Doğan, Ebru Apaydın; Tekinalp, Mehmet; Tokgöz, Osman Serhat; Arıbaş, Alpay; Akıllı, Hakan; Özdemir, KurtuluşBackground: Detection of paroxysmal atrial fibrillation (PAF) in acute ischemic stroke patients poses diagnostic challenge. The aim of this study was to predict the presence of PAF by means of 12-lead ECG in patients with acute ischemic stroke. Our hypothesis was that P-wave dispersion (P-d) might be a useful marker in predicting PAF in patients with acute ischemic stroke. Methods: 12-lead resting ECGs, 24-hour Holter recordings and echocardiograms of 400 patients were analyzed retrospectively. PAF was detected in 40 patients on 24-hour Holter monitoring. Forty out of 360 age and gender matched patients without PAF were randomly chosen and assigned as the control group. Demographics, P-wave characteristics and echocardiographic findings of the patients with and without PAF were compared. Results: Maximum P-wave duration (p=0.002), P-d (p<0.001) and left atrium diameter (p=0.04) were significantly higher in patients with PAF when compared to patients without PAF. However, in binary logistic regression analysis P-d was the only independent predictor of PAF. The cut-off value of P-d for the detection of PAF was 57.5 milliseconds (msc). Area under the curve was 0.80 (p<0.001). On a single 12-lead ECG, a value higher than 57.5 msc predicted the presence of PAF with a sensitivity of 80% and a specificity of 73%. Conclusion: P-d on a single 12-lead ECG obtained within 24 hours of an acute ischemic stroke might help to predict PAF and reduce the risk of recurrent strokes.Öğe A Rare but Ominous Association: Intracardiac Thrombus and Vegetation Simultaneously in a Hemodialysis Patient(Wiley-Blackwell, 2010) Solak, Yalçın; Tekinalp, Mehmet; Atalay, Hüseyin; Kayrak, Mehmet; Yeksan, MehdiA 74-year-old woman with metastatic endometrium cancer presented with complaints of nausea and vomiting. She was commenced on hemodialysis due to acute renal failure via a right jugular central venous catheter (CVC). We also administered enoxaparine as deep qvein thrombosis prophylaxis. She developed fever during the course of hospitalization. Two sets of blood cultures yielded methicillin-resistant Staphylococcus aureus. qEnoxaparine was stopped due to thrombocytopenia. We administered appropriate broad-spectrum antibiotics; however, she remained febrile after 72 hours. We found that the patient developed swelling and redness in the right calf, in which Doppler ultrasound revealed acute deep vein thrombosis. Transthoracic echocardiography depicted a mobile thrombus in the right atrium, which was moving in and out of the right ventricle.Öğe The relationship between serum asymmetric dimethylarginine levels and subjective sleep quality in normotensive patients with type 2 diabetes mellitus(KOREAN ASSOC INTERNAL MEDICINE, 2015) Arıbaş, Alpay; Kayrak, Mehmet; Tekinalp, Mehmet; Akıllı, Hakan; Alibaşiç, Hayruddin; Yıldırım, Serkan; Gündüz, MehmetBackground/Aims: Poor sleep quality (SQ) is associated with increased cardiovascular mortality and morbidity. Additionally, asymmetric dimethylarginine (ADMA) is an independent predictor of cardiovascular mortality and morbidity. However, no sufficient data regarding the relationship between ADMA levels and SQ have been reported. The goal of the current study was to evaluate the association between SQ and ADMA levels in normotensive patients with type 2 diabetes mellitus. Methods: The study participants consisted of 78 normotensive type 2 diabetics. The SQ of all participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). Patients with a global PSQI score > 5 were defined as "poor sleepers." Factors associated with poor SQ were analyzed using a multiple regression model. Serum ADMA levels were measured using high performance liquid chromatography. Results: The median ADMA levels of the poor sleepers were increased compared with patients defined as good sleepers (5.5 [4.2 to 6.6] vs. 4.4 [2.9 to 5.4], p < 0.01, respectively). However, the L-arginine/ADMA ratio was decreased in poor sleepers (p < 0.01). Global PSQI scores were positively correlated with ADMA levels (p < 0.01) and negatively correlated with the L-arginine/ADMA ratio (p = 0.02). ADMA levels were correlated with sleep latency (p < 0.01) and sleep efficiency (p = 0.01). Logistic regression analysis showed that ADMA levels (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.16 to 2.44; p = 0.01) and body mass index (OR, 1.15; 95% CI, 1.01 to 1.31; p = 0.04) were associated with poor SQ independently of glomerular filtration rate, sex, age, duration of diabetes, hemoglobin A1c, total cholesterol, and systolic blood pressure. Conclusions: Self-reported SQ was independently associated with ADMA levels in normotensive patients with diabetes mellitus.Öğe Tip 2 diyabetes mellituslu hastalarda kardiyovasküler otonom nöropati sıklığı ve bununla ilişkili risk faktörlerinin belirlenmesi(Selçuk Üniversitesi Tıp Fakültesi, 2011) Tekinalp, Mehmet; Soylu, AhmetTip 2 DM'li hastalarda KVONP sıklığını, KVONP risk faktörlerini ve bu risk faktörlerinin KVONP?un progresyonu ile ilişkisini araştırmayı amaçladık. Materyal ve Metod: Çalışmamız normotansif tip 2 DM tanısı olan, yaşları 32 ile 64 arasında değişen (ort. 49.20 ± 7.44 yıl), 38?i (%63.3) kadın, 22?si (%36.7) erkek olmak üzere toplam 60 hastanın dahil edildiği gözlemsel bir çalışmadır. Tüm hastalara başvuruda ve birinci yıl sonunda standart Ewing Battery testleri (derin solunum, Valsalva manevrası, 30:15 oranı, ayağa kalkmaya ve handgribe kan basıncı yanıtı) uygulandı. Test sonuçları bir skorlama sistemi kullanılarak ifade edildi. Test sonuçlarına göre KVONP yok (0-0.5 skor) ve KVONP var (1-5 skor) olarak sınıflandırıldı. Bulgular: Çalışmamızda başlangıçta KVONP prevalansı % 78.3 iken, birinci yılın sonunda % 70?e gerilerken (P=0.245), Ewing skoru toplamı 1.50 (1.00-2.50)?dan 1.00 (0.50-2.00)?e geriledi (P=0.035). KVONP grubunda başvuruda hastaların yaşı daha ileriydi ve 12.ayın sonunda sistolik kan basıncı (SKB) daha yüksekti (sırasıyla P=0.037, P=0.039). KVONP, yaş ve SKB?dan, anlamlılığa yakın olarak da statin kullanımının azlığından etkilenmekteydi (sırasıyla B=0.12, P=0.015; B=0.09, P=0.007; B= -1.83, P=0.052). Ewing skoru SKB ile anlamlı (r=0.38, P=0.034), yaş, diyabet süresi ve HbA1c ile anlamlılığa yakın koreleydi (sırasıyla r=0.25, P=0.062; r=0.24, P=0.063; r=0.24, P=0.071). Ewing skorundaki değişimle sadece total kolesteroldeki azalmanın anlamlı olduğu görüldü (B=0.26, P=0.047). Sonuç: Yaş, SKB ve total kolesterol seviyeleri tip 2 DM hastalarında KVONP ile ilişkili olabilir. Statinler KVONP tedavisinde umut vaat edebilir. Bu konuda farklı şekilde dizayn edilmiş ileri çalışmalara ihtiyaç vardır.Öğe The value of serum asymmetric dimethylarginine levels for the determination of masked hypertension in patients with diabetes mellitus(ELSEVIER IRELAND LTD, 2013) Taner, Alpaslan; Unlu, Ali; Kayrak, Mehmet; Tekinalp, Mehmet; Ayhan, Selim S.; Aribas, Alpay; Erdem, Said SamiBackground: An increased prevalence of masked hypertension (MHT) has been demonstrated among patients with diabetes mellitus (DM). MHT appears to cause cardiovascular (CV) complications similar to clinically overt hypertension. Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide inhibitor and higher plasma levels of ADMA are related to increased CV risk in both the general population and among patients with DM. The aim of this study was to evaluate the relationship between MHT and ADMA in diabetic patients. Methods: This study included DM patients (n = 131) with normal office blood pressure (<140/90 mmHg). None of the participants were using antihypertensive medications. All participants utilized an ambulatory blood pressure monitor (ABPM) for 24 h. Serum ADMA and arginine levels were measured using the fluorescence detector high performance liquid chromatography method. Results: The prevalence of MHT was 24.4% among the study subjects. ADMA levels were increased in the MHT group when compared with normotensive diabetics (6.2 +/- 2.2 vs 4.2 +/- 1.7 mu mol/L p = 0.001, respectively). Furthermore, arginine/ADMA ratio was lower in the MHT group than among the normotensive group (29.9 +/- 12.1 vs 46.0 +/- 19.0 p = 0.001). In the multivariate logistic regression model, ADMA, BMI and HDL levels were found to be independent predictors of MHT Odds ratio: 1.63 (1.28-2.06), 1.19 (1.05-1.35), and 0.95 (0.90-0.99), respectively. The cut-off value of the ADMA was 4.34 mu mol/L with a sensitivity, specificity, positive predictive value, and negative predictive value of 84.4%, 59.6%, of 40.3%, and 92.2%, respectively (AUC - 0.78). Conclusions: Serum ADMA may play a role in both the pathophysiology and screening of MHT in DM subjects. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
