Cosgun, Muharrem Said; Cosgun, Cansu

Background. Shoulder dysfunction after cardiac implantable electronic device (CIED) implantation may impair upper-extremity function and quality of life (QoL). Although a prior randomized trial demonstrated short-term benefits of early postoperative exercises, long-term outcomes remain unclear. Aim. To evaluate the 3-year efficacy and safety of an early postoperative shoulder exercise protocol after CIED implantation. Methods. Of 92 patients randomized in the original trial, 82 completed the 3-year follow-up. Participants had completed a 6-week intervention consisting of pendulum exercises (PE), stretching & strengthening exercises (SSE) or standard care, without further structured exercise. Outcomes included Visual Analog Scale (VAS) pain scores, grip strength, shoulder flexion and abduction range of motion (ROM), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and the Physical and Mental Component Summary scores (PCS and MCS) of the 36-Item Short-Form Survey (SF-36). Lead-related complications were also assessed. Results. VAS and SF-36 MCS scores were comparable across groups. However, compared with standard care, both exercise groups maintained superior outcomes at 3 years for grip strength (PE: +9.0 kgf; SSE: +9.0 kgf), shoulder flexion ROM (PE: +10.0 degrees; SSE: +11.0 degrees), shoulder abduction ROM (PE: +7.0 degrees; SSE: +7.0 degrees), QuickDASH (PE: -5.0 points; SSE: -6.0 points), and SF-36 PCS (PE: +9.0 points; SSE: +10.0 points) (all P < 0.05). No lead-related complications occurred during follow-up. Conclusion. Early postoperative shoulder exercise after CIED implantation provides sustained improvements in shoulder function and physical QoL without compromising lead safety.

Hamur, Hikmet; Onk, Oruc Alper; Coskun, Resit; Cosgun, Muharrem Said; Salcan, Ismail; Emır, Izzet

Background and Aims. Tympanosclerosis (TS) is a scarring process that may occur during otitis media. Aortic stiffness (AS) is a significant predictor for the development of heart diseases due to its close relationship with atherosclerosis. Similar pathophysiological processes based on inflammation may explain both TS and AS formation. This study aimed to determine echocardiographically whether aortic elasticity is impaired in TS-detected patients and to correlate blood inflammatory parameters with TS and aortic elasticity. Methods. Ninety-eight participants diagnosed with chronic otitis media were enrolled in the study. TS-detected 42 participants were assigned to the study group, while 56 without TS constituted the control group. The two groups' demographic, clinical, echocardiographic, and laboratory characteristics were comparable. Results. Demographic, clinical, and laboratory parameter differences were insignificant. Hs-CRP, neutrophil-to-lympho-cyte ratio, and systemic immune-inflammation index were significantly higher in the study group than in the control group (P=0.018, P=0.003, P=0.019, respectively). The study group had significantly lower aortic strain (11.80 ± 4.84 vs. 16.30 ± 3.91; P<0.001) and distensibility (5.23 ± 2.68 vs. 7.24 ± 2.89; P=0.001) values than the control group. The AS index was significantly higher in the study group than in the control group (4.81 ± 2.41 vs. 3.12 ± 1.02; P<0.001). Conclusion. In TS-detected patients, AS parameters were found to be impaired. Aortic elasticity parameters measured by echocardiography, a non-invasive and easily accessible method, may signify early cardiovascular involvement in TS-developed patients.

Cosgun, Muharrem Said; Hamur, Hikmet; Degirmenci, Husnu; Coskun, Resit; Karayumak, Mustafa Rauf; Karabiyik, Ugur; Salcan, Ismail

Aims. Drug-related atrioventricular block (DR-AVB) may develop in patients with underlying latent degenerative con-duction disorders, especially with antiarrhythmics and antihypertensives. Although, according to the current guide-lines, reversal is achieved with cessation of the inducing agent, this is not the case for nearly half of the patients. The pathophysiological processes of DR-AVB and myringosclerosis include systemic inflammation and degeneration. This study investigated the role of myringosclerosis in predicting irreversible high-grade DR-AVB despite drug cessation. Methods. This observational, non-randomized, prospective study involved 152 patients with high-grade DR-AVB, 72 of whom had reversible DR-AVB and 80 had irreversible DR-AVB and required permanent pacemakers. The patients’ de-mographic, clinical, echocardiographic, and laboratory characteristics were recorded. Otoscopic tympanic membrane examinations for myringosclerosis were performed. Results. There were no major differences in demographic, echocardiographic or laboratory characteristics between the two groups or previous medications. The median monitoring time with a temporary pacemaker was significantly longer in the irreversible than in the reversible group (5 [4−7] days vs. 2 [1−5] days; P<0.001). The incidence of myringo-sclerosis was significantly higher in the irreversible than in the reversible group (61.3% vs. 22.2%; P=0.001). Multivariate logistic regression analysis showed that myringosclerosis was an independent predictor of irreversible DR-AVB (odds ratio: 1.703, 95% confidence interval: 1.194–3.058; P=0.01). Conclusion. Myringosclerosis is a readily available, inexpensive, and non-invasive assessment and is a marker of inflammation and degeneration that can predict irreversible DR-AVB.

Bakirci, Eftal Murat; Degirmenci, Husnu; Duman, Hakan; Demirelli, Selami; Hamur, Hikmet; Buyuklu, Mutlu; Ceyhun, Gokhan; Kutlusoy, Ergun

Aims. To investigate the association of the aortic propagation velocity (APV) with coronary artery disease (CAD) in patients with stable angina pectoris (SAP) through SYNTAX scores (SS). Methods. The study population comprised 214 SAP subjects who received a coronary angiography. The APV and carotid intima–media thickness (CIMT) were examined and SS was calculated. Subjects were grouped following specific SS criteria: SS less than 22 (low) and SS greater than or equal to 22 (high). Results. High SS subjects had lower APV compared to low SS [39.0 (32.0-51.7) vs. 55.0 (45.0-62.0) cm/s, respectively; P<0.001] and higher CIMT (0.86 ± 0.24 vs. 0.74 ± 0.21 mm, respectively; P<0.001). APV demonstrated a negative correlation with the CIMT (r=-0.239, P<0.001), age (r=-0.188, P=0.006), and SS (r=-0.561, P<0.001) and showed a positive association with LV ejection fraction (r=0.163, P=0.017). APV, CIMT, diabetes, low-density lipoprotein cholesterol (LDL-C), and age were determined to be markers independently of a high SS. Conclusion. APV, CIMT, diabetes, LDL-C and age are independently linked to the CAD severity of SAP subjects. Decreased APV, an indicator of subclinical atherosclerosis, may independently help determine the severity of atherosclerotic CAD in SAP patients.

Akbas, Emin Murat; Akbas, Nergis

The current Coronavirus disease outbreak requires that physicians work in collaboration with other physicians especially in intensive care and emergency units. To fight against this new disease, whose pathogenesis, effects, and results have not been clearly demonstrated, especially in patients with the pre-existing chronic disease, requires special expertise and perspectives. Due to the need for dynamic glucocorticoid treatment at different stages of the disease in patients with adrenal insufficiency, the existence of reports indicating that “coronavirus disease 2019” also affects the adrenal reserve, and the use of glucocorticoids also in advanced stages in patients with Coronavirus disease require this issue to be emphasized with precision. Herein, treatment of the pre-existing adrenal insufficiency in patients with actual Coronavirus disease and the effects of the this critical disease on the adrenal gland have been reviewed.