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    Determination of subclinical atherosclerosis in obstructive sleep apnea syndrome patients without traditional risk factors for atherosclerosis [Ateroskleroti·k ri·sk faktörleri· olmayan obstrükti·f uyku apne sendromlu hastalarda subkli·ni·k aterosklerozun saptanmasi]
    (2013) Karakaş M.S.; Altekin R.E.; Özbek S.C.; Yanikoglu A.; Akdemir B.; Er A.; Yalçinkaya A.S.
    Objective: Obstructive sleep apnea-hypopnea syndrome (OSAS) is associated with high cardiovascular morbidity and mortality. Recent studies have suggested a pathophysiological link between OSAS and atherosclerosis; for which carotid intima-media thickness (CIMT) and pulse wave velocity (PWV) has been considered as an early marker. The aim of this study was to assess the presence of early signs of atherosclerosis and cardiovascular effects of OSAS depending on its severity, in patients without clinically diagnosed cardiovascular disease and any coincident risk factors for atherosclerosis. Material and Method: Thirty one healthy subjects without any systemic disease and OSAS, and patients with OSAS without known atherosclerosis and also without any risk factors for atherosclerosis were examined in the study. According to the severity, 30 patients were in mild OSAS, 32 were in moderate OSAS and 31 patients were in severe OSAS group. Bilateral CIMT assesment and PWV analysis were performed in patients and controls. Results: Significant differences existed between control subjects and patients with mild, moderate and severe OSAS in PWV (5.70±0.48, 6.76±0.61, 7.72±0.82, 8.94±1.72 m/sec respecitively; p<0.0001) and CIMT (0.712±0.040, 0.812±0.037, 0.900±0.056, 0.971±0.74 mm respectively; p<0.0001). AHI and TST% were positively correlated with the following; the PWV (p<0.001- r=0.67 / p<0.001- r=0,70 respectively), the maximal CIMT (p<0.001- r=0.79 / p<0.001- r=0.74 respectively), The minimal SaO2 values were negatively correlated with the following; the PWV (p<0.001, r=-0.66), the maximal CIMT (p<0.001, r=-0.68). Conclusion: OSAS patients have tendency to atherosclerosis development, and this process increases proportionally with the severity of the disease.
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    Evaluation of renal function in non-hypertensive patients with obstructive sleep apnea [Obstrüktif uyku apne sendromu olan normotansif hastalarda böbrek fonksiyonlari{dotless}ni{dotless}n degerlendirilmesi]
    (2012) Karakaş M.S.; Özbek S.C.; Akdemir B.; Er A.; Yanikoglu A.; Altekin R.E.; Çilli A.
    Objective: Obstructive sleep apnea syndrome (OSAS) is one of the most common sleep disorders in society. The presence of hypertension is shown in 30-60% of OSAS patients. Creatinine clearance (CC) in hypertensive OSAS patients was found to be lower than non-hypertensive OSAS patients. In our study, we aimed to determine CC in non- hypertensive OSAS patients comparing with the control group and determine that CC is affected by the severity of OSAS. Material and Methods: Ninety-three patients with complaints of snoring who were diagnosed as obstructive sleep apnea syndrome with polysomnography were examined in the study between March 2009-November 2010. Renal function tests were performed in these patients and creatinine clearance was calculated. Results: According to the OSAS severity, 30 patients were in the mild, 32 in moderate and 31 in severe OSAS group.There were no statistically significant differences in the demograpic data, systolic and diastolic blood pressure and CC between OSAS and control groups There was no corelation between severity of disease and CC. Conclusion: Due to the pathophysiologic features of OSAS, chronic kidney disease can develop in these patients, although hypertension has not yet developed. Therefore it must be considered that, hypertension may develop in patients with OSAS; blood pressure monitoring, evaluation and monitoring of renal function should not be neglected. © 2012 by Erciyes University School of Medicine.
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    Relation between mean platelet volume and subclinical atherosclerosis in patients with metabolic syndrome [Metabolik sendromlu hastalarda ortalama trombosit hacminin subklinik ateroskleroz ile ilişkisi]
    (Turkish Anaesthesiology and Intensive Care Society, 2014) Gülcan A.R.; Karakaş M.S.; Akdemir B.; Uçar M.; Altekin R.E.; Yilmaz H.
    Objectives: Metabolic syndrome (MetS) is associated with increased cardiovascular morbidity and mortality. There is evidence of platelet activation in MetS. Mean platelet volume (MPV), a determinant of platelet activation, is a newly emerging risk factor for atherothrombosis. Therefore, we investigated the possible association between subclinical atherosclerosis, as evaluated by carotid intima-media thickness (CIMT) measurement and MPV, in MetS patients. Study design: Seventy-four patients with MetS were enrolled in the study. Patients were divided into two groups according to CIMT measurement: 35 patients with CIMT ?1.0 mm were in Group 1 and 39 patients with CIMT <1.0 mm were in Group 2. MPV was measured using an automated blood cell counter. Results: The MPV level was significantly higher in patients with CIMT ?1.0 mm than in patients with CIMT <1.0 mm (8.2±0.7 vs. 7.8±0.6 fl; p=0.01). In our study, we observed that platelet count was lower in KIMK ?1.0 mm group and this finding was also found to be statistically significant. Conclusion: The risk of atherosclerosis could be shown by following the MPV values in MetS patients. Therefore, our results suggest that MPV is an important marker for early detection of atherosclerotic risk in patients with MetS. © 2014 Türk Kardiyoloji Dernegi.
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    Relation of neutrophil-to-lymphocyte ratio with GRACE risk score to in-hospital cardiac events in patients with ST-segment elevated myocardial infarction
    (SAGE Publications Inc., 2015) Oncel R.C.; Ucar M.; Karakas M.S.; Akdemir B.; Yanikoglu A.; Gulcan A.R.; Demir I.
    In this study, we aimed to investigate the association of the neutrophil-to-lymphocyte ratio (NLR) with Global Registry of Acute Coronary Events (GRACE) risk score in patients with ST-segment elevated myocardial infarction (STEMI). We analyzed 101 consecutive patients with STEMI. Patients were divided into 3 groups by use of GRACE risk score. The association between NLR and GRACE risk score was assessed. The NLR showed a proportional increase correlated with GRACE risk score (P <.001). The occurrence of in-hospital cardiac death, reinfarction, or new-onset heart failure was significantly related to NLR at admission (P <.001). Likewise, NLR and GRACE risk score showed a significant positive correlation (r =.803, P <.001). In multivariate analysis, NLR resulted as a predictor of worse in-hospital outcomes independent of GRACE risk score. Our study suggests that the NLR is significantly associated with adverse in-hospital outcomes, independent of GRACE risk score in patients with STEMI. © 2014 The Author(s).
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    The significance of the left atrial volume index in cardioversion success and its relationship with recurrence in patients with non-valvular atrial fibrillation subjected to electrical cardioversion: A study on diagnostic accuracy [Elektriksel kardiyoversiyon planlanan valvüler olmayan atriyal fibrilasyonlu hastalarda sol atriyum volüm indeksinin kardiyoversiyon başari{dotless}si{dotless} ve erken dönem atriyal fibrilasyon tekrari{dotless} ile ilişkisi; bir tani{dotless}sal dogruluk çali{dotless}şmasi{dotless}]
    (AVES Ibrahim Kara, 2013) Akdemir B.; Emre Altekin R.; Küçük M.; Yanikoglu A.; Serkan Karakaş M.; Aktaş A.; Ermiş C.
    Objective: The aim of this study was to assess the predictive value of the left atrial volume index (LAVI) in electrical cardioversion (ECV) and observe the recurrence rate of atrial fibrillation (AF) after a successful ECV in patients with non-valvular atrial fibrillation. Method: This study was designed as a diagnostic accuracy and prospective cohort study. Eighty patients (mean age 62±12 years; 52.5% female) were enrolled in study. LAVI was measured using the area-length method and the indexed body surface area. Patients in whom the sinus rhythm (SR) was established following the ECV were assessed according to the clinical and electrocardiography (ECG) findings at the first month and grouped as those with continued SR or recurrent AF. The Student's t, Mann-Whitney U, Fisher's exact, Chi-square tests, ROC and logistic regression analyses were used for statistical analysis. Results: Subsequent to the ECV, SR was achieved in 62.5% (n=50) of the patients. In those where SR was established, the AP-Lad (4.32±0.62 vs. 4.77±0.4 cm/p=0.002) and LAVI (35.3±11.5 vs. 53.1±10.1 mL/m2/p<0.001) values were observed to be lower. ECV success was found to be associated only with the LAVI (OR:1.122, 95%CI: 1.058-1.191, p<0.001). The AUC was found as 0.892±0.041 for the LAVI (95% CI:0.075-0.285, p<0.001). During the controls at the end of the 1st month, SR was maintained in 72% (n=36) of the successful ECV group. Among the patients with maintained SR, the antero-posterior left atrial dimension (4.17±0.62 vs. 4.72±0.5 cm/p=0.004) and LAVI (30.8±6.2 vs. 46.8±13.9 mL/m2/p<0.001) values were also observed to be lower. Only the LAVI was found to be associated with the recurrence of the AF (OR:1.355, 95% CI: 1.154-1.591, p<0.001). The AUC was found as 0.950±0.029 for the LAVI (95% CI:0.063-0.313, p=0.003) Conclusion: Lower LAVI values before the ECV are strong and independent predictors of the success of the ECV and the maintenance of SR after a successful ECV. © 2013 by AVES Yayi{dotless}nc{dotless}l{dotless}k Ltd.