Objective: After coronary artery bypass graft (CABG) surgery, there is a disease management process that patients should follow, and healthy behaviors play a key role in this process. The aim of this study was to evaluate the health-promoting behaviors of patients after CABG surgery and to determine the influential factors.
Methods: This was a cross-sectional study of 152 patients who were admitted to the polyclinic between March and June 2016 and underwent a CABG procedure. The data were collected using a patient information form and the Health-Promoting Lifestyle Profile (HPLP). Number, percentage, SD, mean, independent t and analysis of variance tests were used to evaluate and describe the data.
Results: The mean age of the patients in the study was 58±13.71 years. Of the total, 6% of the patients were male, 55.4% stated that they had the CABG surgery between 1 and 4 months prior, and 88.4% went to check-ups regularly after discharge. The mean HPLP score of the enrolled patients was 110.28±17.32. The patients who were under 55 years of age, married, had a comfortable income, no comorbid disease, those who underwent the CABG surgery between 1 and 4 months earlier, went to follow-up regularly after discharge, and those who were educated about their disease had a higher HPLP score (p<0.05).
Conclusion: This study found that patients who underwent CABG surgery had a moderate HPLP score and that training on health-promoting behaviors at discharge had a positive effect on their implementation.

Objective: The aim of this study was to evaluate the long-term, post-discharge follow-up of antithrombotic management patterns (AMPs), clinical outcomes, and real-life health status of patients hospitalized acute coronary syndrome (ACS).
Methods: A total of 1034 patients hospitalized for ACS within 24 hours of symptom onset who survived to discharge were included. Of those, 514 had ST-segment elevation myocardial infarction (STEMI) and 520 had unstable angina (UA)/non-STEMI (NSTEMI). Data on follow-up AMPs, clinical outcomes, and health status were collected during 24 months of follow-up.
Results: The overall all-cause mortality was 6.4% (6.7% in UA/NSTEMI and 6.0% in STEMI patients), cardiovascular (CV) events had occurred in 9.4% (9.8% in UA/NSTEMI and 8.9% in STEMI patients), and bleeding events in 2.0% (2.3% in STEMI and 1.7% in UA/NSTEMI patients) of patients at 2 years after discharge. EuroQol-visual analogue scales scores increased from 78.9 to 81.6 in STEMI patients, and from 76.0 to 76.2 in UA/NSTEMI patients. Discharge and 2-year post-discharge scores for the EuroQol-5D index were 0.7 and 0.9, respectively in STEMI patients, while it was 0.8 for each period in UA/STEMI patients. Overall, 57.5% of the patients on dual antiplatelet (AP) therapy at discharge remained on this treatment at 2 years after discharge. The use of 1AP/0 anticoagulant (AC) and ≥2AP/0AC were associated with a CV event risk of 10.5% and 8.9%, a mortality risk of 10.5% and 5.8%, and a bleeding event risk of 0.9% and. 2.2%, respectively.
Conclusion: These findings in a real-life population of ACS patients emphasize the importance of longer-term follow-up of ACS patients surviving hospitalization and support the likelihood of more favorable long-term outcomes in ACS management with the current treatment practices.

Objective: The aim of this study was to investigate lipid profiles and atherogenic indices and their association with platelet indices in Familial Mediterranean Fever (FMF) patients.
Methods: A total of 63 FMF patients and 51 healthy individuals were included in this retrospective study. Inflammatory marker values (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] and fibrinogen), platelet indices (mean platelet volume, plateletcrit value, platelet large cell ratio, and platelet distribution width), lipid profiles (levels of total cholesterol, triglycerides, high-density lipoprotein [HDL] cholesterol, and low-density lipoprotein cholesterol) were recorded. Atherogenic indices (atherogenic index of plasma [AIP], atherogenic coefficient [AC], Castelli’s risk indices I and II [CRI I and II]) were calculated using lipid parameters.
Results: In FMF patients, while AIP, AC, and CRI I and II values were significantly higher than in the healthy control group, the HDL cholesterol level was significantly lower (all p<0.05). However, no significant difference was determined in terms of the other studied parameters (all p>0.05). In male FMF patients, whereas AIP, AC, and CRI I and II values were significantly higher than in female FMF patients, the platelet count, ESR, and HDL cholesterol levels were significantly lower (all p<0.05). The level of CRP was negatively correlated with HDL cholesterol (r=−0.275; p=0.032) and total cholesterol level (r=−0.313; p=0.014) in FMF patients. HDL cholesterol level was negatively correlated with disease duration (r=−0.269; p=0.049).
Conclusion: The use of atherogenic indices may be recommended to identify patients with an increased risk of atherosclerotic cardiovascular disease in FMF, especially in male patients.

Objective: The aim of the present study was to investigate cardiac autonomic effects in restless leg syndrome (RLS) using heart rate variability (HRV).
Methods: A total of 35 patients with RLS and 35 healthy individuals were enrolled in the study. The severity of RLS symptoms was assessed using the International Restless Legs Syndrome Study Group rating scale (IRLS). The correlation between the severity of RLS symptoms and HRV parameters measured on an electrocardiogram was analyzed.
Results: There were no statistically significant differences between the 2 groups with respect to age, gender, or body mass index. The mean heart rate was 85±7.1 bpm in the RLS group compared with 79.6±5.5 bpm in the control group (p=0.001). The standard deviation (SD) of all normal to normal (NN) intervals (SDNN), the mean of the deviation of 5-minute NN intervals over the entire recording (SDNN index), and the SD of the average NN intervals calculated over a 5-minute period of the entire recording (SDANN) were significantly lower in the RLS group compared with the control group (p<0.05 for all). There were no statistically significant differences between the 2 groups in the square root of the mean squared differences of successive NN intervals (RMSSD) and the proportion of adjacent RR intervals differing by >50 milliseconds in the 24-hour recording (pNN50) values (p=0.119 and p=0.07, respectively). In patients with RLS, the low frequency (LF) power and LF/high frequency (HF) ratio were significantly higher than those in the control group (2248.6±245.6 vs 712.1±346.3, 10.7±3.7 vs 2.9±1.8; p<0.0001 and p<0.0001, respectively). Compared with the control group, the RLS group had lower values for HF power, but the difference was not statistically significant (p=0.07). The severity of RLS symptoms was negatively correlated with the SDNN, SDANN index, and pNN50 (r=-0.453 and p=0.009, r=-0.340 and p=0.046, r=-0.446 and p=0.007, respectively), and positively correlated with LF power (r=0.681 and p<0.0001).
Conclusion: The study data demonstrated that cardiac autonomic impairment is associated with RLS.

Objective: Service quality (SQ) generally refers to the non-clinical aspects of health services and primarily focuses on the relationship between the care provider and the customers, and the environment in which care services are delivered. The aim of this study was to assess the SQ provided for myocardial infarction (MI) from the patients’ perspective.
Methods: A cross-sectional study was conducted with 164 patients with MI at the Tabriz Shahid Madani cardiology clinic. Study participants were selected using convenience sampling. SQ was measured using a validated Comprehensive Quality Measurement in Healthcare SQ questionnaire. The reliability was confirmed based on Cronbach’s alpha coefficient (α=0.81). SQ was calculated using the formula SQ=10–(importance × performance), based on the importance and performance of non-health-related aspects from the customers’ perspective. Importance scores ranged from 1 to 10 and performance was scored between 0 and 1.
Results: Of 164 participants, about 75% were men and almost 44% were between 51 and 65 years of age. From the customers’ perspective, the total SQ score was 6.80 (0-10 scale), and the individual scores for all SQ aspects were below an acceptable level. Confidentiality, dignity and continuity were given the highest scores, while availability of support groups had the lowest score.
Conclusion: The study findings revealed an opportunity to improve SQ. Patient and provider participation in quality improvement activities could be an effective strategy to improve the aspects of health care quality that were most important to the customers and those with low scores, such as availability of support groups.

Objective: The present study was an investigation of the effect of statins on the expression of circulating sirtuin 1 (SIRT1) and endothelial nitric oxide synthase (eNOS) proteins, and on the distribution of single nucleotide polymorphisms (SNPs) of the SIRT1 gene in patients with a history of premature myocardial infarction (PMI).
Methods: A total of 108 patients who had suffered from a premature ST-elevation myocardial infarction (STEMI) under the age of 45 years were enrolled in this study. While 79 patients had been taking statins since the index event, 29 patients had not been treated with statins post myocardial infarction (MI) or the therapy had been withdrawn at the 4-week follow-up control. The control group consisted of 91 healthy patients without a previous cardiovascular event. The levels of SIRT1 and eNOS protein; oxidative stress markers, like total antioxidant status (TAS), total oxidant status (TOS), and the oxidative stress index (OSI); as well as the distribution of the SNPs rs7069102 and rs2273773 were measured and analyzed.
Results: A significant increase in the SIRT1 level (p<0.001) and a significant decrease in the eNOS level (p=0.001) was observed in all genotypes and alleles for both SNPs in patients who received statin therapy compared with the control group. Both SNPs were distributed in a similar frequency in the 2 MI groups, irrespective of statin treatment.
Conclusion: Statins induce SIRT1 protein, which might have a cardioprotective role after PMI. In addition, the eNOS protein level was low in all of the MI patients, suggesting that impairment of eNOS expression is disease-specific without a causal link to SIRT1.

Pulmonary atresia (PA) and ventricular septal defect (VSD) can occur in a variety of ways, from simple valve atresia to a condition in which circulation to the pulmonary bed occurs through collateral arteries separated from the aorta and there are no real pulmonary arteries, or they are present but hypoplastic. The size of the pulmonary arteries and concomitant complex cardiac lesions are important in making decisions about treatment and correctional alternatives. While complete correction surgeries in the style of a correction of tetralogy of Fallot are performed in simpler cases, many very invasive procedures are also performed and the resulting quality of life is very variable. The size of the pulmonary artery and its branches and the presence of accompanying collateral vessels are determining factors in the management of the disease. In this report, 2 cases of VSD and PA, in which the circulation of the pulmonary arteries was through the coronary arteries, diagnosed as a result of echocardiography performed following murmurs heard during examination, are described. The first patient was 40 days old and the second was 2 days old. In the second case, diagnosis was confirmed by catheter angiography, and in the first case, the final diagnosis was made during surgery. The aim of this report is to emphasize the importance of pulmonary artery size, the presence of pulmonary confluence, the origin of circulation, and concomitant collateral arteries when considering treatment methods.

Pulmonary vein isolation is an effective treatment for patients with symptomatic paroxysmal atrial fibrillation. Cryoablation balloon therapy has been developed as an alternative. Cryoablation complications have primarily been related to phrenic nerve palsy, vascular complications, stroke, and others of lesser incidence. Esophageal lesions are rare and they are not yet completely understood.

Kounis syndrome is defined as the clinical development of acute coronary syndrome caused by the activation of inflammatory cells due to an allergy, hypersensitivity, anaphylaxis, or anaphylactic reaction. Corticosteroids that are used in the treatment of many inflammatory conditions may paradoxically cause allergic reactions and even anaphylaxis. This article is a description of the case of a 52-year-old female patient who had a non-ST elevation myocardial infarction after the administration of triamcinolone that was relieved with antihistaminic treatment. The patient had been diagnosed with dermatitis at another medical center and injected with 40 mg/mL (intravenous [IV]) of triamcinolone acetonide and developed chest pain 15 minutes after the first dose. Despite a normal physical examination and echocardiogram, laboratory tests revealed troponin positivity and an inferolateral ST depression was present on an electrocardiogram (ECG). The ECG findings and clinical symptoms resolved completely after conservative anti-ischemic treatment and antihistaminic therapy (pheniramine maleate 45.5 mg/2 mL, Avil ampoule, IV; Sanofi-Aventis, Paris, France) and coronary angiography evaluation of the arteries was normal. The heart, and in particular the coronary arteries, are among the organs that are most damaged during hypersensitivity reactions and anaphylaxis. Although Kounis syndrome is not a rare condition, few cases have been reported in clinical practice. The failure to recognize Kounis syndrome due to inadequately defined cases may lead to unwanted medical results. Kounis syndrome should be kept in mind in order to make a rapid and accurate diagnosis.

Coronary angiography and percutaneous coronary artery intervention are important tools for the diagnosis and treatment of coronary artery disease. Nevertheless, despite both technical and pharmacological advances, bleeding and vascular complications remain problematic. With recent trials supporting the safety and decreased bleeding risk associated with the radial approach, radial access has become more popular, and conferences providing instruction on this technique are often standing room only. Herein, a case in which coronary angiography was performed by punching through the radial artery snuff box (fovea radialis) is described. Radial angiography from the snuff box allows for easier palpation and punching, less risk of neuropathy and bleeding, and less compression after the procedure.

Presently described is a case of disseminated adenovirus infection in a heart-kidney transplant recipient that was successfully treated with cidofovir. There are several reports of adenovirus infections in adult solid organ transplant recipients and the prognosis is usually poor, with mortality rates of 40% to 60%. Severe disseminated adenovirus infections have been associated with increased risk of adverse transplant events, such as rejection, ventricular dysfunction, allograft vasculopathy, graft loss, and the need for re-transplantation. The patient’s lack of clinical improvement, the onset of hemorrhagic cystitis and acute kidney injury were factors in our decision to temporarily discontinue administration of immunosuppressive agents and start an antiviral agent. It is important to suspect adenovirus in transplant patients when they do not respond to antibiotics and cultures are negative. Early diagnosis and treatment are critical to improving outcomes in immunocompromised patients.