The aims of this study were to determine the psychiatric symptoms which may develop because of infertility in Turkish women and to find out the precipitating factors. Fifty women with primary infertility and 50 health controls were evaluated using the Beck Depression Inventory, Spielberger Stait-Trait Anxiety Inventory, Rosenberg self-esteem scale and Symptom Checklist scale. They were also asked to describe the reactions received from their husband, husbands' families and social group because of infertility. Psychiatric symptoms were not significantly different between the two groups. However, within the infertile group, depression and anxiety were more frequent in the women who received negative reactions from their husband, their husbands' families and social group. Depression, anxiety and self-esteem were improved in the infertile women as age and the duration of infertility increased. In conclusion, our findings indicate that the reactions the infertile women are faced with play an important role in the development of certain psychiatric symptoms.

Chronic renal failure patients on maintenance hemodialysis (HD) have a number of ECG abnormalities and cardiac arrhythmias. Clinical and experimental data have shown that increased QT dispersion is associated with severe ventricular arrhythmias and sudden cardiac death. Therefore, the aim of this study was to investigate whether the uremic patients receiving long-term HD have increased QTc interval and/or QTc dispersion compared to normal subjects and to evaluate the effect of electrolyte changes between the predialysis and postdialysis phases on these parameters. Forty patients with end-stage renal failure on long-term HD (22 men, 18 women, mean age 44 years) were included in this study. Serum concentrations of K+, Na+, Ca++, Mg++, Cl-, phosphate, urea, creatinine, HCO3-, and arterial blood gases (PO2, PCO2), together with blood pH, were monitored and QTc intervals and QTc dispersion were measured from 12-lead ECG in predialysis and postdialysis phases. The hemodialyzed patients had an increased predialysis QTc maximum interval and QTc dispersion compared to normal subjects (480 +/- 51 vs 310 +/- 38 msec, p < 0.001 and 61 +/- 17 vs 42 +/- 14 msec, p < 0.001, respectively). Both QTc maximum interval and QTc dispersion increased significantly at the end of the HD (480 +/- 51 vs 505 +/- 49 msec p < 0.001 and 61 +/- 17 vs 86 +/- 18 msec, p < 0.001, respectively). The serum K+ (5.3 +/- 0.56 vs 3.36 +/- 0.41 mEq/L, p < 0.001), phosphate (7.19 +/- 1.62 vs 3.81 +/- 1.02 mg/dL, p < 0.001), magnesium (0.87 +/- 18 vs 0.75 +/- 0.14 mg/dL) and urea concentrations (174 +/- 22 vs 74 +/- 14 mg/dL, p < 0.001) significantly decreased, whereas the Ca++ (2.21 +/- 0.18 vs 2.47 +/- 0.24 mg/dL, p < 0.001), HCO3- (15.5 +/- 3.2 vs 20.1 +/- 3.4 mmol/L, p<0.001) concentrations and pH (7.27 +/- 1.1 vs 7.43 +/- 1.2, p < 0.001) significantly increased after HD compared to predialysis values. There was significant correlation between the QT dispersion increase and serum electrolyte changes (K+, Ca++, and pH levels) (p < 0.05). The association between serum electrolyte changes, acid-base status and QT measurements might provide new insights into the evaluation of the ionic bases involved in inhomogeneous ventricular repolarization.

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In this study, we show that patients with SCF have elevated levels of NGAL. We further show a strong correlation between the NGAL levels and coronary blood flow. We conclude that elevated NGAL levels might be a useful tool in predicting SCF in patients who undergo coronary angiography.

QT dispersion defined as interlead QT variability in a 12-lead electrocardiogram was proposed by Day and associates as a simple method to evaluate the repolarization heterogenicity of the ventricular myocardium. The frequency of onset of myocardial infarction and sudden death has been reported to have a circadian variation, with a peak incidence in the early morning hours. The authors investigated whether there is diurnal variation of QT interval and QT interval dispersion in healthy subjects and in patients with coronary artery disease. The study population consisted of two groups. Group I consisted of 62 subjects without coronary artery disease and group II consisted of 82 patients with coronary artery disease. Twelve-lead ECG was recorded for each patient in the morning (between 7 AM and 8 AM), afternoon (between 3 PM and 5 PM) and at night (between 11 PM and 1 AM), on the day after performance of coronary angiography. QTc dispersion was significantly higher in patients with coronary artery disease than in healthy subjects in the morning hours and afternoon (p<0.001). Although the differences were much prominent in group I than group II, both QTc dispersion of morning and afternoon were significantly greater than those at night. There were no statistically significant differences between group I and group II at nighttime with respect to maximum QTc, minimum QTc intervals, and QTc dispersion (p>0.05). In conclusion, QT dispersion shows diurnal variation with an increase in the morning hours in both patients with coronary artery disease and subjects without coronary artery disease. The mechanism of diurnal variation of QT dispersion in patients with coronary artery disease is quite different from that of healthy subjects.

Objective Delayed revascularisation in patients with ST‐segment elevation myocardial infarction (STEMI) is associated with poor prognosis. The aim of this study is to investigate how the timeline in STEMI treatment was affected during the Covid‐19 outbreak. Method Consecutive 165 STEMI patients were enrolled in the study during the Covid‐19 pandemic period (Pandemic period) and the prepandemic period (Control period). The time period until patients' leaving their current position after the onset of pain (home delay), the time from the onset of pain to the first medical contact (FMC delay), door‐to‐balloon time, procedure time and hospitalisation time were recorded. Results A total of 165 patients, 82 in the Pandemic period and 83 in the Control period, were included in the study. When compared with the control period, home delay [30 (5‐6912) minutes vs 165 (10‐360) minutes, P < .001] and FMC delay [61 (20‐6932) minutes vs 190 (15‐3660) minutes, P < .001] were significantly prolonged during the pandemic period. In addition, non‐IRA PCI rate (8.8% vs 19.3% P = .043) and hospitalisation time [71 (15‐170) vs 74.2 (37‐329) hours, P = .045] were decreased. Conclusion During the Covid‐19 pandemic period, prolonged prehospital time parameters were observed in STEMI patients. Therefore, additional measures may be required to prevent unfavourable delays in STEMI patients during the outbreak.

BackgroundAlthough myocardial bridging (MB) is defined as an angiographic phenomenon with a benign course, it has also been associated with adverse cardiovascular events. The effects of exercise on myocardial repolarization in patients with MB were tested in this study, with Tp-e and Tp-e/QT repolarization indexes.Material/MethodsA total of 50 patients in whom isolated MB was diagnosed at coronary angiography (CAG) (Group I) and 48 patients with normal CAG results (Group II) were included in this study. The participants underwent treadmill exercise stress testing according to the Bruce protocol. QT dispersion (QTd) was defined as the minimum QT interval subtracted from the maximum. The Tp-e interval was defined as the difference between the QT and the QT peak time period. QTd and Tp-e intervals were calculated for all patients before and after exercise testing and differences between groups were compared.ResultsAt peak exercise, QTd and cQTd showed a significant increase in comparison to baseline values in the group of patients with myocardial bridges. Significant increases were also found with exercise in the Tp-e, cTp-e durations and Tp-e/QT ratio of the MB patient group in comparison to the baseline values. On the other hand, significant differences in QTd, cQTd, Tp-e, cTp-e intervals, and Tp-e/QT ratio during peak exercise in comparison with baseline values were not detected in the control group (p>0.05).ConclusionsSignificant increases in QTd, cQTd, Tp-e and cTp-e intervals and Tp-e/QT ratio were detected in the MB patients during exercise testing.

Left bundle branch block (LBBB) is a strong predictor of mortality in the presence of coronary artery disease (CAD). Noninvasive evaluation of CAD in these patients has some difficulties. Exercise-induced electrocardiographic ST segment changes are nondiagnostic, and several scintigraphic studies have reported false-positive anteroseptal and septal perfusion defects up to 80%. The authors aimed to assess the diagnostic accuracy of thallium-201 (Tl-201) exercise myocardial single photon emission computerized tomography (SPECT) in comparison with coronary angiography (CAG) for detection of CAD in patients with LBBB. Seventy-seven consecutive patients suffering from chest pain with complete and permanent LBBB were included in the study. All patients (40 women, 37 men, mean age = 54 +/- 7 years) were studied with Tl-201 exercise SPECT and coronary angiography. Tl-201 exercise SPECT for diagnosis of left anterior descending (LAD) artery lesions was interpreted by using three different approaches: method A (conventional approach), method B (involvement of anterior and septal wall regardless of apical wall), and method C (apical approach: involvement of anterior septal and apical wall). Methods A and B gave a sensitivity of 100% each but a specificity of 47% and 56%, respectively. Although method C gave a higher value of specificity than that of methods A and B (98% vs 47% and 56%, respectively p < 0.05), the sensitivity of method C significantly decreased in respect to methods A and B (33% vs 100% p < 0.01). Isolated septal defects were evaluated separately. Isolated septal defects on exercise Tl-201 SPECT were detected in 11 patients, and none of them had CAD according to CAG results. Isolated septal wall involvement had a sensitivity of 0% and a specificity of 74%. The sensitivity and specificity of Tl-201 SPECT for diagnosis of CAD in the right coronary and left circumflex artery territories were 91% and 89%, respectively. In conclusion, the apical approach increased the specificity and decreased the sensitivity of the test. Isolated septal defects seem to have no value for diagnosis of CAD in patients with left bundle branch block.