Background and objective: Elevation of plasma homocysteine (Hcy) level has been implicated in th... more Background and objective: Elevation of plasma homocysteine (Hcy) level has been implicated in the pathogenesis of slow coronary flow (SCF) as it can severely disturb vascular endothelial function. Helicobacter pylori chronically infect the human stomach and causes malabsorption of vitamin B12 and folate in food, leading ultimately to an increase in circulating Hcy levels.Methods: Forty‐three patients with angiographically proven SCF (group I) were enrolled in this study; 43 cases with normal coronary flow pattern (group II) served as controls. Fasting plasma levels of Hcy, vitamin B12, and folate were measured in all subjects. Presence of H. pylori infection was defined as positive 14 C urea breath test. Coronary flow patterns for each major epicardial coronary artery were determined with the Thrombolysis in Myocardial Infarction (TIMI) frame count method.Results: Mean TIMI frame count was 46.3 ± 8.7 in group I and 24.3 ± 2.9 in Group II (p = .0001). Vitamin B12 levels were similar, whereas folate levels were dramatically reduced in group I compared to group II (13.2 ± 4.3 vs. 17.1 ± 5.2, p = .0001). Plasma Hcy levels were significantly higher in group I compared to group II (13.4 ± 5.6 vs. 7.9 ± 2.5, p = .0001) as was the prevalence of H. pylori infection (90.7% in group I vs. 58.1% in group II, p = .001). Hcy levels were elevated (11.7 ± 5.3 vs. 7.5 ± 2.7, p = .0001) and folate levels were reduced (13.9 ± 4.7 vs. 18.6 ± 4.9, p = .0001) in patients with H. pylori infection, while vitamin B12 levels were similar in patients with and without H. pylori infection. Correlation analysis revealed a significant negative correlation between plasma folate and Hcy levels and also between folate levels and mean TIMI frame counts (r = –.33, p = .002 vs. r = –.33, p = .003). Moreover, there was a significant positive correlation between plasma Hcy levels and mean TIMI frame counts (r = .66, p = .0001). In addition, the folate level was the only significant determinant of the variance of Hcy in multiple regression analysis (r = –.21, p = .03).Conclusion: Our data showed that plasma folate levels were decreased and plasma Hcy levels were increased in patients with SCF compared to controls. Also, the prevalence of H. pylori infection was increased in patients with SCF. These findings suggest that elevated levels of plasma Hcy, possibly caused by H. pylori infection, and/or a possible disturbance in its metabolism may play a role in the pathogenesis of SCF.
European journal of physical and rehabilitation medicine, 2013
In the literature, it is not yet clear whether sex may affect the outcomes of exercise training i... more In the literature, it is not yet clear whether sex may affect the outcomes of exercise training in obese adults. The aim of this study was to investigate gender difference in the effects of combined aerobic resistance exercise (ARE) versus aerobic exercise (AE) alone on body composition in overweight and obese adults. Randomized clinical trial. University-based outpatient clinic. Sixty-five healthy, untrained overweight and obese men and women They were randomized into one of two intervention groups; AE group (N.=33) performed leg cycle exercises with increasing duration and frequency; ARE group (N.=32) performed additionally progressive weight-resistance exercises for the upper and lower parts of body. Both groups were asked not to change their diet. Body composition including percentage of fat (PF), fat mass (FM) and fat free mass (FFM) in regional and whole body was determined by dual-energy X-ray absorptiometry (DXA) at baseline and week 12. ARE leads to more gains on regional a...
completed her post graduation in three steps. First, she got a title of internal medicine special... more completed her post graduation in three steps. First, she got a title of internal medicine specialist and then she educated in nuclear medicine. Later, she studied in nuclear Cardiology Lab in Yale University Medical School, USA and got nuclear cardiology certificate. Prof. Kiraç is a fellow of ASNC. She is generally interested in nuclear cardiology and cardiac imaging. Currently she is the editor in chief consultant of Anatolian J Cardiology and is responsible for ethical issues, in addition to being a part of the editorial boards of medical journals. Prof. Kiraç contributed as an attendant, presenter and speaker to national and international congress, symposium and courses on nuclear medicine, cardiology, nuclear cardiology and other related subjects. Her publications in the national and international journals are on general nuclear medicine and cardiac imaging subjects. She has five printed books and book chapters one of which got mansion award from The Turkish Academy of Sciences in 2011.
European Archives of Psychiatry and Clinical Neuroscience, 2007
Single photon emission computed tomography (SPECT) with 99mTc-HMPAO was used to compare regional ... more Single photon emission computed tomography (SPECT) with 99mTc-HMPAO was used to compare regional cerebral blood flow (rCBF) in patients with bipolar disorder and in healthy controls. The sample of this study consisted of 16 euthymic bipolar patients who met the DSM-IV criteria and 10 healthy control subjects. The mean regional cerebral blood flow values of the bipolar euthymic patients were significantly lower than those of the controls in the bilateral medial-basal temporal, occipital; medial frontal; parietal regions and in the cingulate gyrus; the hypoperfusion in the cingulate had the highest significant P value (.001, Bonferroni correction). No significant differences in rCBF emerged between right and left-brain regions. The most important findings of the current study are the presence of regional cerebral perfusion alterations, particularly in the cingulate gyrus in the euthymic bipolar patients. Our results imply that underlying brain dysfunction may be independent from manic or depressive episodes in bipolar disorder. Because of the small number of subjects, however, this finding should be viewed as preliminary.
A l0-year-old girl with facial anomalies, mental retardation, peripheral lymphoedema, convulsions... more A l0-year-old girl with facial anomalies, mental retardation, peripheral lymphoedema, convulsions, cerebral cortical dysgenetic changes, bronchiectasis and chronic sinusitis is presented. She had features of both yellow nail syndrome and Hennekam syndrome. We think that our case might be a new congenital lymphoedema syndrome or an intermediate form between these syndromes.
Journal of Indian College of Cardiology, Sep 1, 2013
Introduction: Dipyridamole is increasingly used for vasodilatation stress test. Caffeine diminish... more Introduction: Dipyridamole is increasingly used for vasodilatation stress test. Caffeine diminishes its effect. At present, there is still no consensus as to whether and how long caffeine should be interrupted. We hypothesized that caffeine impacts the dypyridamole gated MPS findings in patients with coronary artery disease. Methods: Thirty-six patients who had >50% stenosis in at least one vessel on coronary angiography (CAG) were included in our study. Gated MPS with standard dipyridamole stress test was used to assess myocardial perfusion defects and LVEF values before and after caffeine ingestion. Myocardial perfusion images and gated analyses were assessed visually and quantitatively. The results were analyzed by the t test for paired observations. Results: The mean serum caffeine levels were significantly higher 1 h after caffeine ingestion (1.10 AE 0.05 mg/L vs. 5.82 AE 1.80 mg/L) (p < 0.05). Heart rates and blood pressures changed significantly at both baseline and caffeine dipyridamole stress tests (p 0.05). The percentage of total perfusion defects (62%) at baseline gated MPS images was significantly higher than gated MPS with caffeine (34%) (p < 0.05). The LVEF was not significantly different between baseline dipyridamole (67.25 AE 2.61) and caffeine dipyridamole (63.81 AE 2.41) gated MPS studies. The mean transient ischemic dilatation (TID) was significantly lower at dipyridamole stress MPS (0.98 AE 0.01) than caffeine dipyridamole stress MPS (1.05 AE 0.02) (p 0.05). Conclusions: We demonstrated that caffeine may cause attenuation of extent and severity of myocardial perfusion abnormalities during dipyridamole stress gated MPS study. Thus, patients should refrain from caffeine at least 1 day before the test.
Introduction: We aimed to assess whether the vasodilator effect of oral dipyridamole on the left ... more Introduction: We aimed to assess whether the vasodilator effect of oral dipyridamole on the left ventricular systolic function in patients with suspected CAD is different from that of intravenous (IV) dipyridamole using Tc-99m MIBI myocardial perfusion gated SPECT. Methods: Eighty-nine patients (17 male, 72 female; 61±10 years) were enrolled in this study. The patients underwent a dipyridamole stress test for the gating study. Forty-one patients were given oral dipyridamole (OD), and 48 patients were given intravenous dipyridamole (ID). Each group was divided into two subgroups according to whether they had normal or abnormal myocardial perfusion scintigraphy (MPS) findings (reversible perfusion defect). A two-day dipyridamole pharmacologic stress-rest Tc-99m MIBI myocardial perfusion gated SPECT protocol was performed in all patients. The LV ejection fraction (EF), end diastolic volume (EDV) and end systolic volume (ESV) were calculated from the gated data. Results: In the ID group, LV myocardial perfusion was normal in 28 cases and abnormal in 20 cases. In abnormal ID cases, a significant difference between rest and stress EDV was detected (P = 0.017). In the OD group, the LV myocardial perfusion was normal in 20 and abnormal in 21 cases. In the OD normal cases, the rest EF (P = 0.012) and EDV (P = 0.029) were significantly different from the stress cases. Conclusion: The effect of ID test continues during gated SPECT and results in LV diastolic dysfunction in patients with abnormal myocardial perfusion. Oral administration is also highly effective for detecting real myocardial ischemia that causes LV systolic and diastolic dysfunction.
A 44-year-old woman was diagnosed with type II diabetes in 1998 and 1 year later she developed ne... more A 44-year-old woman was diagnosed with type II diabetes in 1998 and 1 year later she developed necrolytic migratory erythema, which is a specific skin lesion of glucagonoma. During the clinical investigation, a nodular 6 cm mass in the distal pancreatic region and multiple cystic liver metastases were found. She was operated on, and glucagonoma was detected and the long-acting, repeatable, octreotide treatment was started. 3 years after resection of a pancreatic glucagonoma she presented to a hospital emergency department with diabetic ketoacidosis. Hepatic multiple cystic metastases were visualized by computed tomography. During hospitalization she developed severe pulmonary embolism and deep-venous thrombosis of the lower extremities. Indium-labeled octeotide scintigraphy showed multiple cystic lesions in the liver with additional lesions in the iliocecal region, which had not been visualized by computed tomography. Despite somatostatin therapy the tumor had expanded in the liver. Arterial chemoembolization was performed but 6 months later she died.
, for the investigation of coughing and abnormal chest roentgenogram. She suffered flu 3 weeks pr... more , for the investigation of coughing and abnormal chest roentgenogram. She suffered flu 3 weeks prior to this and her coughing was persisting since then. She denied fever, phlegm, dyspnoea, wheeze, night sweats and haemoptysis. Before a splenectomy at aged 18 yrs, blood transfusions had been applied monthly. Physical examination revealed a blood pressure of 120/ 80 mmHg, pulse rate of 96 beats per min, respiratory rate of 21 breaths per min and marked hepatomegaly. Chest examination results were normal. Haematological examination showed a haemoglobin level of 1.38 mmol?L-1 (89.3 g?L-1), haematocrit value of 0.19, mean corpuscular volume of 91.4 fL, mean corpuscular haemoglobin concentration of 466 g?L-1 , red blood cell count of 2.1610 12 cells?L-1 , reticulocyte count of 0.14, white blood cell count of 23610 9 cells?L-1 , and platelet count of 1072610 9 platelets?L-1. Serum biochemical findings were as follows: aspartate aminotransferase 85 U?L-1 , alanine aminotransferase 84 U?L-1 , blood urea nitrogen 1.33 mmol urea?L-1 , total protein 73 g?L-1 , total bilirubin 30.8 mmol?L-1 , iron 36.7 mmol?L-1 , ferritin 2.3 g?L-1 , and total iron binding capacity 40.3 mmol?L-1. The chest radiographs (fig. 1a and 1b), computed tomography (CT) of the chest (fig. 2), thoracic single photon emission computed tomography (SPECT) study with TC-99M (fig. 3) and peripheral blood smear (fig. 4) were as shown.
Background and objective: Elevation of plasma homocysteine (Hcy) level has been implicated in th... more Background and objective: Elevation of plasma homocysteine (Hcy) level has been implicated in the pathogenesis of slow coronary flow (SCF) as it can severely disturb vascular endothelial function. Helicobacter pylori chronically infect the human stomach and causes malabsorption of vitamin B12 and folate in food, leading ultimately to an increase in circulating Hcy levels.Methods: Forty‐three patients with angiographically proven SCF (group I) were enrolled in this study; 43 cases with normal coronary flow pattern (group II) served as controls. Fasting plasma levels of Hcy, vitamin B12, and folate were measured in all subjects. Presence of H. pylori infection was defined as positive 14 C urea breath test. Coronary flow patterns for each major epicardial coronary artery were determined with the Thrombolysis in Myocardial Infarction (TIMI) frame count method.Results: Mean TIMI frame count was 46.3 ± 8.7 in group I and 24.3 ± 2.9 in Group II (p = .0001). Vitamin B12 levels were similar, whereas folate levels were dramatically reduced in group I compared to group II (13.2 ± 4.3 vs. 17.1 ± 5.2, p = .0001). Plasma Hcy levels were significantly higher in group I compared to group II (13.4 ± 5.6 vs. 7.9 ± 2.5, p = .0001) as was the prevalence of H. pylori infection (90.7% in group I vs. 58.1% in group II, p = .001). Hcy levels were elevated (11.7 ± 5.3 vs. 7.5 ± 2.7, p = .0001) and folate levels were reduced (13.9 ± 4.7 vs. 18.6 ± 4.9, p = .0001) in patients with H. pylori infection, while vitamin B12 levels were similar in patients with and without H. pylori infection. Correlation analysis revealed a significant negative correlation between plasma folate and Hcy levels and also between folate levels and mean TIMI frame counts (r = –.33, p = .002 vs. r = –.33, p = .003). Moreover, there was a significant positive correlation between plasma Hcy levels and mean TIMI frame counts (r = .66, p = .0001). In addition, the folate level was the only significant determinant of the variance of Hcy in multiple regression analysis (r = –.21, p = .03).Conclusion: Our data showed that plasma folate levels were decreased and plasma Hcy levels were increased in patients with SCF compared to controls. Also, the prevalence of H. pylori infection was increased in patients with SCF. These findings suggest that elevated levels of plasma Hcy, possibly caused by H. pylori infection, and/or a possible disturbance in its metabolism may play a role in the pathogenesis of SCF.
European journal of physical and rehabilitation medicine, 2013
In the literature, it is not yet clear whether sex may affect the outcomes of exercise training i... more In the literature, it is not yet clear whether sex may affect the outcomes of exercise training in obese adults. The aim of this study was to investigate gender difference in the effects of combined aerobic resistance exercise (ARE) versus aerobic exercise (AE) alone on body composition in overweight and obese adults. Randomized clinical trial. University-based outpatient clinic. Sixty-five healthy, untrained overweight and obese men and women They were randomized into one of two intervention groups; AE group (N.=33) performed leg cycle exercises with increasing duration and frequency; ARE group (N.=32) performed additionally progressive weight-resistance exercises for the upper and lower parts of body. Both groups were asked not to change their diet. Body composition including percentage of fat (PF), fat mass (FM) and fat free mass (FFM) in regional and whole body was determined by dual-energy X-ray absorptiometry (DXA) at baseline and week 12. ARE leads to more gains on regional a...
completed her post graduation in three steps. First, she got a title of internal medicine special... more completed her post graduation in three steps. First, she got a title of internal medicine specialist and then she educated in nuclear medicine. Later, she studied in nuclear Cardiology Lab in Yale University Medical School, USA and got nuclear cardiology certificate. Prof. Kiraç is a fellow of ASNC. She is generally interested in nuclear cardiology and cardiac imaging. Currently she is the editor in chief consultant of Anatolian J Cardiology and is responsible for ethical issues, in addition to being a part of the editorial boards of medical journals. Prof. Kiraç contributed as an attendant, presenter and speaker to national and international congress, symposium and courses on nuclear medicine, cardiology, nuclear cardiology and other related subjects. Her publications in the national and international journals are on general nuclear medicine and cardiac imaging subjects. She has five printed books and book chapters one of which got mansion award from The Turkish Academy of Sciences in 2011.
European Archives of Psychiatry and Clinical Neuroscience, 2007
Single photon emission computed tomography (SPECT) with 99mTc-HMPAO was used to compare regional ... more Single photon emission computed tomography (SPECT) with 99mTc-HMPAO was used to compare regional cerebral blood flow (rCBF) in patients with bipolar disorder and in healthy controls. The sample of this study consisted of 16 euthymic bipolar patients who met the DSM-IV criteria and 10 healthy control subjects. The mean regional cerebral blood flow values of the bipolar euthymic patients were significantly lower than those of the controls in the bilateral medial-basal temporal, occipital; medial frontal; parietal regions and in the cingulate gyrus; the hypoperfusion in the cingulate had the highest significant P value (.001, Bonferroni correction). No significant differences in rCBF emerged between right and left-brain regions. The most important findings of the current study are the presence of regional cerebral perfusion alterations, particularly in the cingulate gyrus in the euthymic bipolar patients. Our results imply that underlying brain dysfunction may be independent from manic or depressive episodes in bipolar disorder. Because of the small number of subjects, however, this finding should be viewed as preliminary.
A l0-year-old girl with facial anomalies, mental retardation, peripheral lymphoedema, convulsions... more A l0-year-old girl with facial anomalies, mental retardation, peripheral lymphoedema, convulsions, cerebral cortical dysgenetic changes, bronchiectasis and chronic sinusitis is presented. She had features of both yellow nail syndrome and Hennekam syndrome. We think that our case might be a new congenital lymphoedema syndrome or an intermediate form between these syndromes.
Journal of Indian College of Cardiology, Sep 1, 2013
Introduction: Dipyridamole is increasingly used for vasodilatation stress test. Caffeine diminish... more Introduction: Dipyridamole is increasingly used for vasodilatation stress test. Caffeine diminishes its effect. At present, there is still no consensus as to whether and how long caffeine should be interrupted. We hypothesized that caffeine impacts the dypyridamole gated MPS findings in patients with coronary artery disease. Methods: Thirty-six patients who had >50% stenosis in at least one vessel on coronary angiography (CAG) were included in our study. Gated MPS with standard dipyridamole stress test was used to assess myocardial perfusion defects and LVEF values before and after caffeine ingestion. Myocardial perfusion images and gated analyses were assessed visually and quantitatively. The results were analyzed by the t test for paired observations. Results: The mean serum caffeine levels were significantly higher 1 h after caffeine ingestion (1.10 AE 0.05 mg/L vs. 5.82 AE 1.80 mg/L) (p < 0.05). Heart rates and blood pressures changed significantly at both baseline and caffeine dipyridamole stress tests (p 0.05). The percentage of total perfusion defects (62%) at baseline gated MPS images was significantly higher than gated MPS with caffeine (34%) (p < 0.05). The LVEF was not significantly different between baseline dipyridamole (67.25 AE 2.61) and caffeine dipyridamole (63.81 AE 2.41) gated MPS studies. The mean transient ischemic dilatation (TID) was significantly lower at dipyridamole stress MPS (0.98 AE 0.01) than caffeine dipyridamole stress MPS (1.05 AE 0.02) (p 0.05). Conclusions: We demonstrated that caffeine may cause attenuation of extent and severity of myocardial perfusion abnormalities during dipyridamole stress gated MPS study. Thus, patients should refrain from caffeine at least 1 day before the test.
Introduction: We aimed to assess whether the vasodilator effect of oral dipyridamole on the left ... more Introduction: We aimed to assess whether the vasodilator effect of oral dipyridamole on the left ventricular systolic function in patients with suspected CAD is different from that of intravenous (IV) dipyridamole using Tc-99m MIBI myocardial perfusion gated SPECT. Methods: Eighty-nine patients (17 male, 72 female; 61±10 years) were enrolled in this study. The patients underwent a dipyridamole stress test for the gating study. Forty-one patients were given oral dipyridamole (OD), and 48 patients were given intravenous dipyridamole (ID). Each group was divided into two subgroups according to whether they had normal or abnormal myocardial perfusion scintigraphy (MPS) findings (reversible perfusion defect). A two-day dipyridamole pharmacologic stress-rest Tc-99m MIBI myocardial perfusion gated SPECT protocol was performed in all patients. The LV ejection fraction (EF), end diastolic volume (EDV) and end systolic volume (ESV) were calculated from the gated data. Results: In the ID group, LV myocardial perfusion was normal in 28 cases and abnormal in 20 cases. In abnormal ID cases, a significant difference between rest and stress EDV was detected (P = 0.017). In the OD group, the LV myocardial perfusion was normal in 20 and abnormal in 21 cases. In the OD normal cases, the rest EF (P = 0.012) and EDV (P = 0.029) were significantly different from the stress cases. Conclusion: The effect of ID test continues during gated SPECT and results in LV diastolic dysfunction in patients with abnormal myocardial perfusion. Oral administration is also highly effective for detecting real myocardial ischemia that causes LV systolic and diastolic dysfunction.
A 44-year-old woman was diagnosed with type II diabetes in 1998 and 1 year later she developed ne... more A 44-year-old woman was diagnosed with type II diabetes in 1998 and 1 year later she developed necrolytic migratory erythema, which is a specific skin lesion of glucagonoma. During the clinical investigation, a nodular 6 cm mass in the distal pancreatic region and multiple cystic liver metastases were found. She was operated on, and glucagonoma was detected and the long-acting, repeatable, octreotide treatment was started. 3 years after resection of a pancreatic glucagonoma she presented to a hospital emergency department with diabetic ketoacidosis. Hepatic multiple cystic metastases were visualized by computed tomography. During hospitalization she developed severe pulmonary embolism and deep-venous thrombosis of the lower extremities. Indium-labeled octeotide scintigraphy showed multiple cystic lesions in the liver with additional lesions in the iliocecal region, which had not been visualized by computed tomography. Despite somatostatin therapy the tumor had expanded in the liver. Arterial chemoembolization was performed but 6 months later she died.
, for the investigation of coughing and abnormal chest roentgenogram. She suffered flu 3 weeks pr... more , for the investigation of coughing and abnormal chest roentgenogram. She suffered flu 3 weeks prior to this and her coughing was persisting since then. She denied fever, phlegm, dyspnoea, wheeze, night sweats and haemoptysis. Before a splenectomy at aged 18 yrs, blood transfusions had been applied monthly. Physical examination revealed a blood pressure of 120/ 80 mmHg, pulse rate of 96 beats per min, respiratory rate of 21 breaths per min and marked hepatomegaly. Chest examination results were normal. Haematological examination showed a haemoglobin level of 1.38 mmol?L-1 (89.3 g?L-1), haematocrit value of 0.19, mean corpuscular volume of 91.4 fL, mean corpuscular haemoglobin concentration of 466 g?L-1 , red blood cell count of 2.1610 12 cells?L-1 , reticulocyte count of 0.14, white blood cell count of 23610 9 cells?L-1 , and platelet count of 1072610 9 platelets?L-1. Serum biochemical findings were as follows: aspartate aminotransferase 85 U?L-1 , alanine aminotransferase 84 U?L-1 , blood urea nitrogen 1.33 mmol urea?L-1 , total protein 73 g?L-1 , total bilirubin 30.8 mmol?L-1 , iron 36.7 mmol?L-1 , ferritin 2.3 g?L-1 , and total iron binding capacity 40.3 mmol?L-1. The chest radiographs (fig. 1a and 1b), computed tomography (CT) of the chest (fig. 2), thoracic single photon emission computed tomography (SPECT) study with TC-99M (fig. 3) and peripheral blood smear (fig. 4) were as shown.
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