Diclofenac is a member of nonsteroidal anti-inflammatory drugs. In Turkey, ıt is often used as a ... more Diclofenac is a member of nonsteroidal anti-inflammatory drugs. In Turkey, ıt is often used as a analgesic. Diclofenac may very occasionally lead to spontaneous extensive ecchymosis and hematoma despite a normal coagulation parameters. In this paper, we report one patient who presented with spontaneous extensive ecchymosis and was diagnosed with a hematoma in the anterior chest wall associated with diclofenac use despite normal coagulation parameters. In countries like Turkey where NSAID are used extensively, drug history should be questioned in patients presenting with spontaneous bleeding and have normal coagulation parameters by physicians.
Vitamin D is known for its effect in calcium and bone homeostasis. There is an increasing evidenc... more Vitamin D is known for its effect in calcium and bone homeostasis. There is an increasing evidence for health benefits accomplished by activated vitamin D that go beyond these classical functions. Previous studies have suggested that lower vitamin D levels are associated with increased cardiovascular disease risk. Therefore, we aimed to evaluate relationship between vitamin D levels and extent and severity of coronary artery disease. A total of 746 patients in whom coronary angiography was performed between August 2012 and July 2013 were enrolled in this study. Serum vitamin D levels were measured, and patients were grouped according to their serum vitamin D levels (vitamin D <20 ng/mL (n = 602) Group 1 versus >20 ng/dL (n = 144) Group 2). Gensini score system was used to evaluate the association between serum vitamin D levels and severity and extent of coronary artery disease. There was no significant difference between the groups in terms of baseline characteristics and demographic characteristics. Mean serum vitamin D levels of all patient cohort was 15·54 ± 7·46 ng/mL. Group 1 and Group 2 had an average serum vitamin D levels of 12·6 ± 3·3 ng/mL and 27·5 ± 7·8 ng/mL, respectively. Gensini score for all cohort was 26·25 ± 34·32. Group 1 had an average Gensini score of 26·4 ± 35·7; on the other hand, Gensini score was 25·5 ± 27·5 in Group 2 (P = 0·097). This study failed to demonstrate significant relationship between serum vitamin D levels and the severity and extent of coronary artery disease. Further studies with more participation and homogenous groups with comparable individual and environmental features are needed to evaluate the association of serum vitamin D levels and cardiovascular diseases.
Catheterization and Cardiovascular Interventions, 2013
Device closure of atrial septal defect (ASD) and patent foramen ovale (PFO) are both associated w... more Device closure of atrial septal defect (ASD) and patent foramen ovale (PFO) are both associated with short- and long-term complications. Our knowledge of the complication rates of ASD and PFO closure is limited. Our objective was to review the peri-procedural and long-term complications of ASD and PFO closure. Medline, EMBASE, and Scopus databases were searched between 1973 and 2012. A total of 28,142 patients from 203 case series were included. Of these 203 articles, 111 were reporting ASD closure, 61 were reporting PFO closure, and 31 were reporting both. Pooled incidence rates of cardiac complications were calculated separately for peri-procedural and at follow-up. Peri-procedural major complications were reported from 0% to 9.4%, with a pooled estimate rate of 1.4% (95% CI: 1.3-1.6%). It was 1.6% (95% CI: 1.4-1.8%) in ASD group, 1.1% (95% CI: 0.9-1.3%) in PFO group, and 1.3% (95% CI: 0.9-1.9%) in ASD/PFO group. The most common major complication was the device embolization requiring surgery. Peri-procedural minor complications were reported with a pooled estimate rate of 1.4% (95% CI: 1.2-1.7%). It was 1.6% (95% CI: 1.2-2.1%) in ASD group, 1.3% (95% CI: 1.0-1.7%) in PFO group, and 1.5% (95% CI: 1.1-1.2.1%) in ASD/PFO group. The most frequent major complications at follow-up were cerebrovascular events [1.3% (95% CI: 1.1-1.6%)] and device thrombosis [1.2% (95% CI: 1.0-1.4%)]. Both were more frequent in PFO group. Device closure of ASD and PFO are associated with non-negligible serious complications, both in early and long-term.
Journal of the American Society of Echocardiography, 2015
This study was planned by the EACVI/ASE/Industry Task Force to Standardize Deformation Imaging to... more This study was planned by the EACVI/ASE/Industry Task Force to Standardize Deformation Imaging to (1) test the variability of speckle-tracking global longitudinal strain (GLS) measurements among different vendors and (2) compare GLS measurement variability with conventional echocardiographic parameters. Sixty-two volunteers were studied using ultrasound systems from seven manufacturers. Each volunteer was examined by the same sonographer on all machines. Inter- and intraobserver variability was determined in a true test-retest setting. Conventional echocardiographic parameters were acquired for comparison. Using the software packages of the respective manufacturer and of two software-only vendors, endocardial GLS was measured because it was the only GLS parameter that could be provided by all manufactures. We compared GLSAV (the average from the three apical views) and GLS4CH (measured in the four-chamber view) measurements among vendors and with the conventional echocardiographic parameters. Absolute values of GLSAV ranged from 18.0% to 21.5%, while GLS4CH ranged from 17.9% to 21.4%. The absolute difference between vendors for GLSAV was up to 3.7% strain units (P < .001). The interobserver relative mean errors were 5.4% to 8.6% for GLSAV and 6.2% to 11.0% for GLS4CH, while the intraobserver relative mean errors were 4.9% to 7.3% and 7.2% to 11.3%, respectively. These errors were lower than for left ventricular ejection fraction and most other conventional echocardiographic parameters. Reproducibility of GLS measurements was good and in many cases superior to conventional echocardiographic measurements. The small but statistically significant variation among vendors should be considered in performing serial studies and reflects a reference point for ongoing standardization efforts.
Diclofenac is a member of nonsteroidal anti-inflammatory drugs. In Turkey, ıt is often used as a ... more Diclofenac is a member of nonsteroidal anti-inflammatory drugs. In Turkey, ıt is often used as a analgesic. Diclofenac may very occasionally lead to spontaneous extensive ecchymosis and hematoma despite a normal coagulation parameters. In this paper, we report one patient who presented with spontaneous extensive ecchymosis and was diagnosed with a hematoma in the anterior chest wall associated with diclofenac use despite normal coagulation parameters. In countries like Turkey where NSAID are used extensively, drug history should be questioned in patients presenting with spontaneous bleeding and have normal coagulation parameters by physicians.
Vitamin D is known for its effect in calcium and bone homeostasis. There is an increasing evidenc... more Vitamin D is known for its effect in calcium and bone homeostasis. There is an increasing evidence for health benefits accomplished by activated vitamin D that go beyond these classical functions. Previous studies have suggested that lower vitamin D levels are associated with increased cardiovascular disease risk. Therefore, we aimed to evaluate relationship between vitamin D levels and extent and severity of coronary artery disease. A total of 746 patients in whom coronary angiography was performed between August 2012 and July 2013 were enrolled in this study. Serum vitamin D levels were measured, and patients were grouped according to their serum vitamin D levels (vitamin D <20 ng/mL (n = 602) Group 1 versus >20 ng/dL (n = 144) Group 2). Gensini score system was used to evaluate the association between serum vitamin D levels and severity and extent of coronary artery disease. There was no significant difference between the groups in terms of baseline characteristics and demographic characteristics. Mean serum vitamin D levels of all patient cohort was 15·54 ± 7·46 ng/mL. Group 1 and Group 2 had an average serum vitamin D levels of 12·6 ± 3·3 ng/mL and 27·5 ± 7·8 ng/mL, respectively. Gensini score for all cohort was 26·25 ± 34·32. Group 1 had an average Gensini score of 26·4 ± 35·7; on the other hand, Gensini score was 25·5 ± 27·5 in Group 2 (P = 0·097). This study failed to demonstrate significant relationship between serum vitamin D levels and the severity and extent of coronary artery disease. Further studies with more participation and homogenous groups with comparable individual and environmental features are needed to evaluate the association of serum vitamin D levels and cardiovascular diseases.
Catheterization and Cardiovascular Interventions, 2013
Device closure of atrial septal defect (ASD) and patent foramen ovale (PFO) are both associated w... more Device closure of atrial septal defect (ASD) and patent foramen ovale (PFO) are both associated with short- and long-term complications. Our knowledge of the complication rates of ASD and PFO closure is limited. Our objective was to review the peri-procedural and long-term complications of ASD and PFO closure. Medline, EMBASE, and Scopus databases were searched between 1973 and 2012. A total of 28,142 patients from 203 case series were included. Of these 203 articles, 111 were reporting ASD closure, 61 were reporting PFO closure, and 31 were reporting both. Pooled incidence rates of cardiac complications were calculated separately for peri-procedural and at follow-up. Peri-procedural major complications were reported from 0% to 9.4%, with a pooled estimate rate of 1.4% (95% CI: 1.3-1.6%). It was 1.6% (95% CI: 1.4-1.8%) in ASD group, 1.1% (95% CI: 0.9-1.3%) in PFO group, and 1.3% (95% CI: 0.9-1.9%) in ASD/PFO group. The most common major complication was the device embolization requiring surgery. Peri-procedural minor complications were reported with a pooled estimate rate of 1.4% (95% CI: 1.2-1.7%). It was 1.6% (95% CI: 1.2-2.1%) in ASD group, 1.3% (95% CI: 1.0-1.7%) in PFO group, and 1.5% (95% CI: 1.1-1.2.1%) in ASD/PFO group. The most frequent major complications at follow-up were cerebrovascular events [1.3% (95% CI: 1.1-1.6%)] and device thrombosis [1.2% (95% CI: 1.0-1.4%)]. Both were more frequent in PFO group. Device closure of ASD and PFO are associated with non-negligible serious complications, both in early and long-term.
Journal of the American Society of Echocardiography, 2015
This study was planned by the EACVI/ASE/Industry Task Force to Standardize Deformation Imaging to... more This study was planned by the EACVI/ASE/Industry Task Force to Standardize Deformation Imaging to (1) test the variability of speckle-tracking global longitudinal strain (GLS) measurements among different vendors and (2) compare GLS measurement variability with conventional echocardiographic parameters. Sixty-two volunteers were studied using ultrasound systems from seven manufacturers. Each volunteer was examined by the same sonographer on all machines. Inter- and intraobserver variability was determined in a true test-retest setting. Conventional echocardiographic parameters were acquired for comparison. Using the software packages of the respective manufacturer and of two software-only vendors, endocardial GLS was measured because it was the only GLS parameter that could be provided by all manufactures. We compared GLSAV (the average from the three apical views) and GLS4CH (measured in the four-chamber view) measurements among vendors and with the conventional echocardiographic parameters. Absolute values of GLSAV ranged from 18.0% to 21.5%, while GLS4CH ranged from 17.9% to 21.4%. The absolute difference between vendors for GLSAV was up to 3.7% strain units (P < .001). The interobserver relative mean errors were 5.4% to 8.6% for GLSAV and 6.2% to 11.0% for GLS4CH, while the intraobserver relative mean errors were 4.9% to 7.3% and 7.2% to 11.3%, respectively. These errors were lower than for left ventricular ejection fraction and most other conventional echocardiographic parameters. Reproducibility of GLS measurements was good and in many cases superior to conventional echocardiographic measurements. The small but statistically significant variation among vendors should be considered in performing serial studies and reflects a reference point for ongoing standardization efforts.
Uploads
Papers by Serkan Unlu