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Accelerated atherosclerosis and digital clubbing in sickle cell diseases
(Medi+World Int, 2016) Helvaci, Mehmet Rami; Sahan, Mustafa; Sulhan, Agit; Acik, Abdullah Fatih; Ocak, Adil; Salaz, Semih; Pocock, Lesley
Background: Sickle cell diseases (SCDs) are chronic destructive processes mainly on the capillary endothelium. We tried to understand the significance of digital clubbing in severity of SCDs. Methods: All patients with SCDs were taken into the study. Results: The study included 397 patients (193 females). There were 36 cases (9.0%) with digital clubbing. Male ratio was significantly higher in the digital clubbing group (66.6% versus 49.8%, p<0.05). The mean age was significantly higher in the digital clubbing group, too (36.5 versus 29.0 years, p=0.000). Additionally, smoking was also higher in the digital clubbing group, significantly (30.5% versus 11.0%, p<0.001). The mean white blood cell counts of peripheric blood were similar in both groups (p<0.05). On the other hand, the mean hematocrit value and platelet count of peripheric blood were lower in the digital clubbing group, significantly (p=0.001 and p=0.012, respectively). Beside that, prevalence of leg ulcers, pulmonary hypertension, chronic obstructive pulmonary disease, coronary heart disease, cirrhosis, and stroke were significantly higher in the digital clubbing group (p<0.01 for all). There were 25 mortalities during the period, and 13 of them were males. The mean ages of mortality were 33.0 +/- 9.6 (range 1947) in females and 30.0 +/- 8.6 years (range 19-50) in males. Conclusion: SCDs are chronic destructive processes on endothelium particularly at the capillary level, and terminate with accelerated atherosclerosis induced end-organ failures in early years of life. Probably digital clubbing is one of the terminal consequences of the SCDs indicating significantly shortened survival in such patients.
Acute chest syndrome in severity of sickle cell diseases
(E-Century Publishing Corp, 2014) Helvaci, Mehmet Rami; Acipayam, Can; Aydogan, Akin; Akkucuk, Seckin; Oruc, Cem; Gokce, Cumali
Background: Sickle cell diseases (SCDs) are chronic inflammatory processes on capillary level. We tried to understand whether or not there are some positive correlations between acute chest syndrome (ACS) and severity of SCDs. Methods: All patients with the SCDs were taken into the study. Results: The study included 337 cases (167 females). There were 15 patients (4.4%) with the ACS. The mean ages were similar in both groups (29.4 versus 29.7 years in the ACS group and other, respectively, P > 0.05). The female ratios were similar in both groups, too (60.0% versus 49.0%, respectively, P > 0.05). Additionally, prevalences of associated thalassemia minors were similar in them (66.6% versus 65.5%, respectively, P > 0.05). Smoking was higher in the ACS group (20.0% versus 13.9%), but the difference was nonsignificant (P > 0.05). Although the mean white blood cell count and hematocrit value of peripheric blood were higher in the ACS group, the mean platelet count was lower in them, but the differences were nonsignificant again (P > 0.05 for all). On the other hand, although the painful crises per year, tonsilectomy, priapism, ileus, digital clubbing, pulmonary hypertension, rheumatic heart disease, cirrhosis, stroke, and mortality were higher in the ACS group, the difference was only significant for the stroke (P < 0.05), probably due to the small sample size of the ACS group. Conclusion: SCDs are chronic destructive processes on capillaries iniatiating at birth, and terminate with early organ failures in life. Probably ACS is one of the terminal consequences of the inflammatory processes that may indicate shortened survival in such patients.
ASSOCIATION OF INCREASED TRIGLYCERIDE LEVELS IN METABOLIC SYNDROME WITH CORONARY ARTERY DISEASE
(Professional Medical Publications, 2010) Helvaci, Mehmet Rami; Kaya, Hasan; Gundogdu, Mehmet
Objective: We tried to understand significance of increased triglyceride (TG) values in metabolic syndrome and coronary artery disease (CAD). Methodology: Check up cases with a TG value lower than 60 mg/dL were collected into the first, between 60 and 99 mg/dL into the second, between 100 and 149 mg/dL into the third, between 150 and 199 into the fourth, and 200 mg/dL and greater into the fifth groups. Results: Study included 478 cases. Values of the mean age, weight, body mass index, TG, and low density lipoprotein cholesterol (LDL-C) and prevalences of smoking, white coat hypertension (WCH), hypertension (HT), type 2 diabetes mellitus (DM), and CAD increased gradually and significantly nearly in all steps from the first towards the fifth groups. Conclusion: Metabolic syndrome may be a progression step between complete physical health and irreversible end points, such as obesity, type 2 DM, HT, CAD, and stroke. Hypertriglyceridemia and White Coat Hypertension (WCH) may be the most significant reversible parameters of the syndrome, and it is better to have the lowest TG value as much as possible. The most significant increase was seen after the value of 100 mg/dL. The overweight, smoking, hypertriglyceridemia, hyperbetalipoproteinemia, and WCH may only be one of hundreds of parameters of the syndrome. Therefore, it is advisable that underlying etiologies rather than revesible parameters of the syndrome should be targeted for treatment. For example, increased TG and LDL-C values, and prevalence of WCH by aging may be secondary to decreased physical and mental stresses in elderly.
Association of increased triglyceride levels in metabolic syndrome with coronary artery disease
(2010) Helvaci, Mehmet Rami; Kaya, Hasan; Gundogdu, Mehmet
Objective: We tried to understand significance of increased triglyceride (TG) values in metabolic syndrome and coronary artery disease (CAD). Methodology: Check up cases with a TG value lower than 60 mg/dL were collected into the first, between 60 and 99 mg/dL into the second, between 100 and 149 mg/dL into the third, between 150 and 199 into the fourth, and 200 mg/dL and greater into the fifth groups. Results: Study included 478 cases. Values of the mean age, weight, body mass index, TG, and low density lipoprotein cholesterol (LDL-C) and prevalences of smoking, white coat hypertension (WCH), hypertension (HT), type 2 diabetes mellitus (DM), and CAD increased gradually and significantly nearly in all steps from the first towards the fifth groups. Conclusion: Metabolic syndrome may be a progression step between complete physical health and irreversible end points, such as obesity, type 2 DM, HT, CAD, and stroke. Hypertriglyceridemia and White Coat Hypertension (WCH) may be the most significant reversible parameters of the syndrome, and it is better to have the lowest TG value as much as possible. The most significant increase was seen after the value of 100 mg/dL. The overweight, smoking, hypertriglyceridemia, hyperbetalipoproteinemia, and WCH may only be one of hundreds of parameters of the syndrome. Therefore, it is advisable that underlying etiologies rather than revesible parameters of the syndrome should be targeted for treatment. For example, increased TG and LDL-C values, and prevalence of WCH by aging may be secondary to decreased physical and mental stresses in elderly.
Autosplenectomy in severity of sickle cell diseases
(E-Century Publishing Corp, 2014) Helvaci, Mehmet Rami; Acipayam, Can; Davran, Ramazan
Background: We tried to understand whether or not there is an association between prevalence of autosplenectomy and severity of sickle cell diseases (SCDs). Methods: All SCDs patients with red blood cell (RBC) transfusions of less than 50 units in their lives were put into the first group and 50 units or higher were put into the second group. Results: The study included 316 patients (155 females). There were 224 cases (70.8%) in the first group and 92 cases (29.1%) in the second group (p<0.001). The male ratio was significantly higher in the second group (64.1% versus 45.5%, p<0.001). Although both the white blood cell and platelet counts were higher in the second group, there was a significant difference in platelet counts (p=0.005), and this was probably due to the small sample sizes. Although the prevalence of autosplenectomy was significantly higher in the first group (56.2% versus 45.6%, p<0.05), the mean number of painful crises per year, digital clubbing, chronic obstructive pulmonary disease (COPD), leg ulcers, stroke, chronic renal disease (CRD) and coronary heart disease (CHD) were significantly higher in the second groups (p<0.05 for all). Conclusion: In contrast to the lower prevalence of autosplenectomy, the mean number of painful crises per year, digital clubbing, COPD, leg ulcers, stroke, CRD, and CHD were significantly higher in the second group. So there may be an inverse relationship between prevalence of autosplenectomy and severity of SCDs, and spleen may act as a chronic inflammatory focus as a filter of blood for these abnormally hard RBCs.
A Behcet's case presenting with central retinal vein occlusion: Case report
(Ortadogu Ad Pres & Publ Co, 2008) Helvaci, Mehmet Rami; Oezcura, Fatih; Hacioglu, Alper; Civi, Kismet
Behcet's disease is a systemic vasculitis, dominated clinically by recurrent oral and genital ulcerations, uveitis, and erythema nodosum-like cutaneous lesions. However, widespread organ involvement is now well recognized, and geo-graphic and ethnic variations of the clinical manifestations are common. The majority of the affected individuals do not have a life-threatening disease, but mortality can be increased with vascular and/or thrombotic complications. Although ocular involvement occurs approximately in 70% of patients, clinically presented retinal vascular events are rare in the disease. We report a Behcet's case, initially diagnosed with a right-sided central retinal vein occlusion in the absence of uveitis as a rare presentation and a short review of the literature.
A Behçet's case presenting with central retinal vein occlusion: Case report
(Turkiye Klinikleri, 2008) Helvaci, Mehmet Rami; Özcura, Fatih; Hacio?lu, Alper; Çivi, Kismet
Behçet's disease is a systemic vasculitis, dominated clinically by recurrent oral and genital ulcerations, uveitis, and erythema nodosum-like cutaneous lesions. However, widespread organ involvement is now well recognized, and geo-graphic and ethnic variations of the clinical manifestations are common. The majority of the affected individuals do not have a life-threatening disease, but mortality can be increased with vascular and/or thrombotic complications. Although ocular involvement occurs approximately in 70% of patients, clinically presented retinal vascular events are rare in the disease. We report a Behçet's case, initially diagnosed with a right-sided central retinal vein occlusion in the absence of uveitis as a rare presentation and a short review of the literature. Copyright © 2008 by Türkiye Klinikleri.
Body mass index or body weight alone
(Medi+World Int, 2013) Helvaci, Mehmet Rami; Aydin, Yusuf; Gundogdu, Mehmet
Background: Excess weight and smoking may be the major underlying causes of metabolic syndrome. Methods: Consecutive patients with coronary heart disease (CHD) were studied. Results: Study included 1,620 females and 1,240 males. Prevalences of CHD were similar in both sexes (3.8% versus 4.4%, respectively, p>0.05). Smoking and chronic obstructive pulmonary disease (COPD) were higher in males with CHD (p<0.001 and p<0.05, respectively). Low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) were higher in females (p= 0.008 and p= 0.002, respectively). Hypertension (HT) and diabetes mellitus (DM) were higher in females, too (p<0.001 and p<0.05, respectively). WCH was also higher in females, but the difference was nonsignificant probably due to the small sample sizes (p>0.05). Although body weight of males with CHD was significantly higher (79.1 versus 74.4 kg, p= 0.027), females had a higher BMI value (29.7 versus 28.3kg/m2, p>0.05), but the difference was nonsignificant probably due to the above reason again. Conclusion: Metabolic syndrome is a systemic atherosclerotic process mainly caused by aging, excess weight, and smoking. Smoking and excess weight come with a similar degree of clinical severity. CHD, as a major consequence of the syndrome, is seen with similar prevalences in both sexes with the higher prevalence of smoking in males against the higher prevalences of BMI and its consequences including LDL-C, TG, WCH, HT, and DM in females. Although body weight is higher in males, BMI and its consequences are higher in females, thus BMI should be preferred to determine excess weight rather than weight alone.
Body weight and white coat hypertension
(2009) Helvaci, Mehmet Rami; Kaya, Hasan; Sevinc, Alper; Camci, Celaletdin
Objective: To understand prognostic significance of white coat hypertension (WCH), and any its association with excess weight. Methodology: We studied consecutive check up patients between the ages of 35 and 70 years to be able to see possible consequences of excess weight on health and to avoid debility induced weight loss in elderly people. Results: The study included 721 cases (426 females). Prevalences of normal weight, overweight, and obesity were detected as 19.0%, 43.3%, and 37.5%, respectively. There were gradual and significant increases in the prevalences of WCH and hypertension (HT) towards the overweight and obesity groups (p<0.001 for all). So 73.7% of the obesity cases had either WCH or HT, and overall prevalence of WCH was 37.9%, which was nearly equal to the prevalence of obesity. When we compared the groups according to the prevalences of hyperbetalipoproteinemia, dyslipidemia, diabetes mellitus (DM), and coronary heart disease (CHD), gradual and significant increases towards the overweight and obesity groups were seen nearly in all steps. Conclusion: There is gradual increased prevalence of WCH in the overweight and obesity groups, parallel to gradually increased prevalences of hyperbetalipoproteinemia, dyslipidemia, HT, DM, and CHD. In addition nearly equal prevalence of WCH with obesity, and additional very low prevalence of sustained normotension in obesity group, WCH should be accepted as an alarming sign of excess weight and many associated disorders in future rather than just being a predisposing factor of HT and atherosclerosis alone. Its management should be focused on prevention of excess weight.
BODY WEIGHT AND WHITE COAT HYPERTENSION
(Professional Medical Publications, 2009) Helvaci, Mehmet Rami; Kaya, Hasan; Sevinc, Alper; Camci, Celaletdin
Objective: To understand prognostic significance of white coat hypertension (WCH), and any its association with excess weight. Methodology: We studied consecutive check up patients between the ages of 35 and 70 years to be able to see possible consequences of excess weight on health and to avoid debility induced weight loss in elderly people. Results: The study included 721 cases ( 426 females). Prevalences of normal weight, overweight, and obesity were detected as 19.0%, 43.3%, and 37.5%, respectively. There were gradual and significant increases in the prevalences of WCH and hypertension ( HT) towards the overweight and obesity groups (p<0.001 for all). So 73.7% of the obesity cases had either WCH or HT, and overall prevalence of WCH was 37.9%, which was nearly equal to the prevalence of obesity. When we compared the groups according to the prevalences of hyperbetalipoproteinemia, dyslipidemia, diabetes mellitus (DM), and coronary heart disease (CHD), gradual and significant increases towards the overweight and obesity groups were seen nearly in all steps. Conclusion: There is gradual increased prevalence of WCH in the overweight and obesity groups, parallel to gradually increased prevalences of hyperbetalipoproteinemia, dyslipidemia, HT, DM, and CHD. In addition nearly equal prevalence of WCH with obesity, and additional very low prevalence of sustained normotension in obesity group, WCH should be accepted as an alarming sign of excess weight and many associated disorders in future rather than just being a predisposing factor of HT and atherosclerosis alone. Its management should be focused on prevention of excess weight.
Chronic obstructive pulmonary disease may be one of the terminal end points of metabolic syndrome
(Professional Medical Publications, 2012) Helvaci, Mehmet Rami; Aydin, Leyla Yilmaz; Aydin, Yusuf
Objective: We tried to understand presence of any effect of excess weight on respiratory system by means of excessive adipose tissue functioning as an endocrine organ and causing a pulmonary inflammation. Methodology: Mild (stage 1), moderate (stage 2), and severe (stage 3 and 4) chronic obstructive pulmonary disease (COPD) patients were detected, and compared according to the metabolic parameters in between. Results: There were 145, 56, and 34 patients in the mild, moderate, and severe COPD groups, respectively. The mean age increased gradually (52.4, 56.4, and 60.0 years) from the mild towards the severe COPD groups, respectively (p<0.05 nearly in all steps). Similarly, the mean pack-years increased gradually and significantly (26.7, 34.8, and 36.8 pack-years) in the same direction (p<0.05 nearly in all steps). Parallel to them, the mean body mass index increased up to the moderate COPD cases (28.2 versus 29.6 kg/m2, p=0.039), and then decreased significantly (29.6 versus 26.8 kg/m2, p=0.006). Conclusion: The metabolic syndrome includes some reversible indicators such as overweight, hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, impaired fasting glucose, impaired glucose tolerance, and white coat hypertension for the development of terminal diseases including obesity, hypertension, diabetes mellitus, peripheral artery disease, coronary heart disease, and stroke. In our opinion, COPD may be one of the terminal end points of the syndrome.
Chronic obstructive pulmonary disease may be one of the terminal endpoints of the sickle cell diseases
(Medi+World Int, 2015) Helvaci, Mehmet Rami; Dogru, Sibel
Background: Sickle cell diseases (SCDs) are chronic destructive processes on vascular endothelium initiating at birth all over the body. We tried to understand whether or not there is an association between chronic obstructive pulmonary disease (COPD) and severity of the SCDs. Methods: All patients with the SCDs were taken into the study. Results: The study included 411 patients with the SCDs (199 females and 212 males). There were 60 patients (14.5%) with the COPD. Mean age of the patients was significantly higher in the COPD group (33.0 versus 29.5 years, P=0.005). The male ratio was significantly higher in the COPD group, too (80.0% versus 46.7%, P<0.001). Smoking was also higher in the COPD group, significantly (36.6% versus 9.9%, P<0.001). Parallel to the smoking, alcoholism was also higher among the COPD cases, significantly (3.3% versus 0.8%, P<0.05). Beside these, transfused red blood cell units in their lives (69.1 versus 32.9, P=0.001), priapism (10.0% versus 1.9%, P<0.001), leg ulcers (26.6% versus 11.6%, P<0.001), digital clubbing (25.0% versus 7.1%, P<0.001), coronary heart disease (26.6% versus 13.1%, P<0.01), chronic renal disease (16.6% versus 7.1%, P<0.01), and stroke (20.0% versus 7.9%, P<0.001) were all higher among the COPD cases, significantly. Conclusion: SCDs are chronic catastrophic processes on vascular endothelium particularly at the capillary level, and terminate with accelerated atherosclerosis induced end-organ failures in early years of life. COPD may be one of the terminal endpoints of the diseases.
Clinical presentation and laboratory findings of organic phosphorus poisoning
(Springer, 2007) Ozer, Cahit; Kuvandik, Guven; Gokel, Yuksel; Duru, Mehmet; Helvaci, Mehmet Rami
This study was conducted to evaluate the demographic, causative, and biologic characteristics of patients with organophosphate (OP) poisoning who were admitted to tertiary teaching and research hospitals at 2 different universities. All patients admitted to the emergency departments of Cukurova University Hospital in Adana, Turkey, between 2001 and 2003 and the Hospital of Mustafa Kemal University in Hatay, Turkey, between 2004 and 2006 were included. The study group consisted of subjects with a mean age of 28.5 +/- 14.1 y (range, 14-80 y), and the maximum number of cases in the second decade of life; the female-to-male ratio was 2.2:1. In all, 27 of 43 females and 16 of 20 males were married. Most subjects (n=55) had graduated from primary school; 3 were illiterate and 5 were highly educated. A total of 36 (57.1%) subjects belonged to lower socioeconomic groups. Fifty-three patients intended to commit suicide, and 10 cases were accidental. Mean arrival time of subjects to the hospital after poisoning was 9.9 +/- 16.1 h (range, 1-96 h); mean Glasgow Coma Scale score was 10.2 +/- 2.9 (range, 3-15). A total of 19 subjects were intubated, and 4 died. A total of 59 patients recovered completely. The mortality rate (6.3%) depended on various factors such as OP compound consumed, amount ingested, time interval before hospitalization, and patients' general health. Chances for recovery were greater when the patient was hospitalized at the earliest indication. In conclusion, ON especially affected young single females, and most cases were due to attempted suicide. Because OP poisoning is an important cause of morbidity and mortality, therapy should be started immediately to avoid undesirable consequences.
Digital clubbing and metabolic syndrome
(Medi+World Int, 2011) Helvaci, Mehmet Rami; Aydin, Leyla Yilmaz; Maden, Emin; Aydin, Yusuf
Background: Any relationship between clubbing and metabolic syndrome was studied. Methods: The study was performed in the Internal Medicine Polyclinic. Results: The study included 224 cases (104 with clubbing), in total. The mean age of clubbing cases was 49.2 years, and there was a male predominance (81.7%). There were significantly higher prevalences of smoking and chronic obstructive pulmonary disease (COPD) in the clubbing group (69.2 vs 41.6% and 27.8 vs 10.8%, respectively, p<0.001 for both). Although the body mass index (BMI), weight, and fasting plasma glucose (FPG) were lower in the clubbing group, the differences were nonsignificant probably due to the small sample size, although the negative effect of small sample size, and prevalence of type 2 diabetes mellitus (DM) was significantly lower in the clubbing group (12.5 vs 21.6%, p<0.05). Mean low density lipoprotein cholesterol and triglyceride values were higher in the clubbing group, non-significantly. Although both the systolic and diastolic blood pressures (BP) were lower in the clubbing group, the difference was only significant for systolic BP (127.6 vs 136.9 mmHg, p=0.011). On the other hand, prevalence of coronary heart disease (CHD) and/or peripheric artery disease (PAD) were significantly higher in the clubbing group (7.6 vs 0.0%, p<0.01). Conclusion: There are direct relationships between clubbing and prevalence of smoking, COPD, CHD and PAD, probably due to the atherosclerotic effects of smoking, whereas BMI, weight, FPG, systolic and diastolic BPs and prevalence of DM are inversely related with clubbing, probably due to suppressor effects of smoking on appetite.
Digital clubbing may be an indicator of systemic atherosclerosis even at microvascular level
(Drunpp-Sarajevo, 2012) Helvaci, Mehmet Rami; Aydin, Leyla Yilmaz; Aydin, Yusuf
Background: Presence of any relationship between digital clubbing and microvascular atherosclerosis was tried to be understood. Methods: Cases with digital clubbing and controls were studied. Results: The study included 104 cases with clubbing and 120 controls. Mean age of clubbing cases was 49.2 years, and there was a male predominance (81.7%) among them. There were significantly higher prevalences of smoking and chronic obstructive pulmonary disease (COPD) in the clubbing group (69.2 versus 41.6% and 27.8 versus 10.8%, respectively, p<0.001 for both). Although body mass index (BMI), weight, and fasting plasma glucose (FPG) were lower in the clubbing group, the differences were nonsignificant probably due to the small sample sizes. Although the negative effect of small sample sizes, prevalence of type 2 diabetes mellitus (DM) and mean value of systolic blood pressure (BP) were significanlty lower in the clubbing group (12.5 versus 21.6% and 127.6 versus 136.9 mmHg, respectively, p<0.05 for both). On the other hand, prevalence of coronary heart disease (CHD) and/or peripheric artery disease (PAD) were significantly higher in the clubbing group (7.6 versus 0.0%, p<0.01). Conclusions: There are significant relationships between digital clubbing and smoking, COPD, and CHD and/or PAD probably due to strong atherosclerotic effects of smoking with highly suspected atherosclerotic background of COPD. Whereas the BMI, weight, FPG, systolic BP, and prevalence of DM are inversely related with digital clubbing probably due to suppressor effects of smoking on appetite. So clubbing may be a significant indicator of systemic atherosclerosis even at microvascular level.
Dyslipidemia May Be An Indicator for Trend of Body Weight
(Medi+World Int, 2008) Helvaci, Mehmet Rami; Akdemir, Cihangir; Kaya, Hasan; Ozer, Cahit
Background: Prevalence of excess weight is increasing with a high cost on health worldwide. Methods: The study was performed in the Internal Medicine Polyclinic on routine check up patients, and consecutive patients at and above the age of 20 years were studied to permit growth of height in youngers. Results: The study included 1068 cases (628 females) totally. There were only 19 (1.7%) cases with underweight and 307 (28.7%) with normal weight, so 69.4% (742) of cases at and above the age of 20 years had excess weight. The prevalence of excess weight increased from 28.7% (52) in the third to 63.6% (100) in the fourth decades (p<0.001), and decreased from 87.0% (94) in the seventh to 78.5% (84) in the eighth decades (p<0.05). Similarly, prevalences of hyperbetalipoproteinemia, hypertriglyceridemia, and dyslipidemia showed similar patterns of tendency with the excess weight, by increasing in the fourth and decreasing in the eighth decades of life (p<0.05 in all). Conclusion: Prevalence of excess weight and dyslipidemia are increasing by decades, particularly in the fourth decade, and this increase turns to a decrease in the eighth decade of life. So 30th and 70th years of age may be the breaking points of life, both for dyslipidemia and body weight, and dyslipidemia may be a pioneer sign for tendency of body weight. Probably decreased physical and mental stresses after the age of 30th years and debility and comorbid disorders induced restrictions after the age of 70th years may be the major causes for the changes.
Effect of sickle cell diseases on height and weight
(Professional Medical Publications, 2011) Helvaci, Mehmet Rami; Kaya, Hasan
Objectives: We tried to understand what are the effects of the sickle cell diseases (SCD) on metabolic parameters, especially the body weight and height in the study. Methodology: The study was performed in the Hematology and Internal Medicine Polyclinics on SCDs and routine check up patients. Results: The study included 122 patients with SCDs (58 females) and 176 control cases. Mean age of the SCDs cases was 28.6 years. When we compared the patients and control groups, mean body weight and body mass index (BMI) were significantly reduced in the SCDs cases (71.6 vs. 57.8 kg and 24.9 vs. 20.7 kg/m2, p= 0.000 for both), whereas the mean heights were similar in both groups (166.1 vs. 168.5 cm, respectively, p>0.05). Similar to the decresed mean body weight and BMI, mean values of the low density lipoprotein cholesterol and high density lipoprotein cholesterol were significantly lower in the patients group (p= 0.000 for both), whereas the fasting plasma glucose and triglyceride values were unchanged between the groups (p>0.05). Additionally, probably parallel to the reduced mean body weight and BMI, mean values of the alanine aminotransferase (34.9 vs. 56.7 U/L, p= 0.000) and systolic and diastolic blood pressures were also significanly lower in the patients group (113.3 vs. 118.8 and 72.3 vs. 83.6 mmHg, respectively, p<0.01 for both), all of which can be explained by definition of the metabolic syndrome. Conclusion: Although the body weight can significantly be reduced by SCDs, the body height may strongly be determined by heredity.
Effects of season-induced hormonal changes on mortality
(Medi+World Int, 2012) Helvaci, Mehmet Rami; Ari, Mustafa; Maden, Emin; Aydin, Leyla Yilmaz; Aydin, Yusuf; Ozer, Cahit
Background: We tried to understand whether or not there are some seasonal differences in human mortality rates in the present study. Methods: The study was performed in the General Internal Medicine and Hematology Clinics between March 2007 and December 2010. All hospitalized cases in these units during the 45-month period were included into the study. The total number of deaths in each season were detected and compared. Results: There were 68 deaths during the period, with various causes. Although there were only three deaths in July, there were nine in October. In other words, the total number of deaths was the highest in autumn with 22 deaths (32.3% of all) in the 45-month period, totally. It was 13 (25.4%) in winter, 16 (23.5%) in spring, and 17 (25.0%) in the summer. Although there is obvious difference in the number of deaths between autumn and the other seasons, the difference was statistically nonsignificant probably due to the small number of death cases (p= 0.481). Conclusion: Although seasonal differences of human mortality rates were statistically nonsignificant, this was probably due to the small number of death cases of the present study; there may actually be a significant increase in autumn with unexplained reasons yet. Relative hormonal insufficiencies during the passage from a summer-like relaxed, to an autumn-like stressful season may be one of the causes. If so, it can be prevented by some hormonal replacement therapies, thus this theory should be searched with a higher number of cases in a more detailed approach.
Funduscopic changes in white coat hypertension
(Medi+World Int, 2012) Helvaci, Mehmet Rami; Ozcura, Fatih; Akin, Mehmet Mustafa
Background: Diagnosis and management of hypertension is complicated by the fact that blood pressure (BP) varies greatly depending on various stresses. In the doctor's office in particular, measurements are often too high, which is defined as white coat hypertension (WCH). Although already known to have a high prevalence in society, prognostic significance of WCH remains controversial. Methods: We studied consecutive patients with WCH and sustained normotension (NT) at and over the age of 50 years just to catch, if found, the long term effects of WCH on eyes. Funduscopic examination was performed by the same ophthalmologist who was unaware of the patients' subclassification. Keith, Wagener, and Barker's classification of hypertensive retinopathy (HR) was used to define the funduscopic findings. Results: Fifty-six WCH and 51 sustained NT cases were studied. No case of grade III or IV HR was observed in either group. Eight cases of grade I HR (14.2%) were detected in the WCH group, whereas this ratio was 9.8% (five cases) in the sustained NT group (p>0.05). Similarly, although three cases of grade II HR (5.3%) were detected in the WCH group, this ratio was 3.9% (two cases) in the sustained NT group (p>0.05). Conclusion: As a result of nonsignificant differences between WCH and sustained NT groups according to funduscopic findings, and the already known high prevalences of WCH in society even in early decades, WCH should be considered as a response of the body against some metabolic stresses, and its follow up about progression to HT should be performed with regular home BP measurements.
Funduscopic examination has limited benefit for management of hypertension
(Int Heart Journal Assoc, 2007) Helvaci, Mehmet Rami; Ozcura, Fatib; Kaya, Hasan; Yalcin, Atilla
Hypertension (HT) increases the risks of major cardiovascular events and affects a majority of elderly populations. Thus, blood pressure control is the mainstay for prevention of cardiovascular diseases. However, there is only a limited number of parameters for management of HT. This study was performed on consecutive patients between the ages of 35 and 70 years with normotension (NT) and HT in order to determine the possible consequences of HT on retinal vasculature and to avoid debility-induced weight loss. We studied 120 patients (64 females, 54 +/- 9.3 years) with NT and 147 (81 females, 57.3 +/- 11.0 years) with HT. No case of grade III or IV hypertensive retinopathy (HR) was detected in the groups. Although the prevalences of grades I and 11 HR were higher and grade 0 HR was lower in the hypertensive group, respectively (P < 0.001 for all), differences according to obesity, diabetes mellitus, hypertriglyceridemia (P < 0.001 for all), and dyslipidemia (P < 0.01) were also significant between the 2 groups. Therefore, only 18.3% (27 cases) of the hypertensives, even in whom the effect of aging could not be excluded, had HT only in the absence of any other risk factor of atherosclerosis. Despite the relatively higher specificities of grades III and IV HR for HT, particularly for hypertensive crisis, funduscopic examination has limited benefit in the management of HT due to the very low prevalences of grades III and IV HR, the multifactorial backgrounds of grades I and 11 HR, and the association of the multiple risk factors of atherosclerosis in a majority of the hypertensive cases.

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