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Introduction: Previous studies have demonstrated the predictive value of the neutrophil-to-lymphocyte ratio (NLR) in many cardiovascular disorders. The aim of this study was to assess whether NLR is associated with echocardiographic or electrocardiographic parameters, or with predicted five-year risk of sudden cardiac death (SCD), in patients with hypertrophic cardiomyopathy (HCM). Methods: This prospective observational study included 74 controls and 97 HCM patients. Three years of follow-up results for HCM patients were evaluated. Results: NLR was significantly higher in patients with fragmented QRS, ventricular tachycardia, and presyncope than in those without (p=0.031, 0.030, and 0.020, respectively). NLR was significantly higher in patients whose predicted five-year risk of SCD was more than 6% and whose corrected QT interval was greater than 440 ms (p=0.022 and 0.001, respectively). It was also significantly higher in patients whose left ventricular ejection fraction (LVEF) was 60% (p=0.017). Conclusion: NLR was significantly higher in patients with HCM compared to the control group. A high NLR is associated with a higher five-year risk of SCD in patients with HCM. Resumo: Introdução: Estudos prévios demonstraram o valor preditivo da relação neutrófilos/linfócitos (RNL) em muitas alterações cardiovasculares. O objetivo deste estudo foi avaliar se a RNL está associada a parâmetros ecocardiográficos ou eletrocardiográficos, ou com o score de risco de morte súbita cardíaca (MSC) a cinco anos em doentes com miocardiopatia hipertrófica (MCH). Métodos: Este estudo prospetivo observacional incluiu 74 controlos e 97 doentes com MCH. Foram avaliados os resultados dos doentes com MCH ao longo de três anos de seguimento. Resultados: O valor da RNL foi significativamente superior nos doentes com QRS fragmentado, com taquicardia ventricular e com pré-síncope do que nos que não revelaram esses sinais (valores p: 0,031, 0,030, 0,020, respetivamente). O valor RNL foi estatística e significativamente superior nos doentes com risco de MSC previsível a cinco anos superior a 6%, e com um intervalo QT corrigido superior a 440 ms (valores p: 0,022, 0,001, respetivamente). O valor da RNL foi significativamente superior nos doentes com fração de ejeção (FE) 60% (valor p = 0,017). Conclusão: A RNL foi significativamente superior nos doentes com MCH quando comparada com o grupo controlo. Uma RNL alta está associada a um score de risco de MSC elevado aos cinco anos em doentes com MCH. Keywords: Hypertrophic cardiomyopathy, Neutrophil-to-lymphocyte ratio, Five-year risk of sudden cardiac death, Palavras-chave: Miocardiopatia hipertrófica, Relação neutrófilos/linfócitos, Score de risco a cinco anos de morte súbita cardíaca

OBJECTIVE: This study aimed to evaluate the efficacy of flecainide therapy in neonates and infants with drug resistant incessant supraventricular tachycardia. METHODS: The study included 11 neonates and infants who received medical and/or ablation therapy between January 2010 and December 2013. Mean patient age and weight were 101.6+-96 days and 5.3+-1.9 kg respectively. Of the 12 patients, 5 underwent ablation between January 2010 and December 2011, and 6 were treated medically between January 2012 and December 2013. Mean follow-up time was 18 months (6 months–4 years). RESULTS: The antiarrhythmic agent flecainide only became available in Turkey in 2012, and the most noteworthy point was its addition to the therapy administered prior to ablation (adenosine, esmolol-propranolol, propafenone, amiodarone and cardioversion). In all 6 patients admitted between January 2012 and December 2013, refractory SVT was successfully treated with the administration of a triple therapy regimen of esmolol-propranolol, amiodarone and flecainide. One patient with myocarditis developed an atrial flutter complicated by a concealed accessory pathway and was put on extracorporeal membrane oxygenation (ECMO) support due to cardiopulmonary failure. The SVT was terminated, but the patient died on the fifteenth day of ECMO support. One patient with recurrent tachycardia, who had previously undergone ablation for a complex cardiac anomaly and Wolf-Parkinson-White syndrome, was treated with ablation again. No recurrence of tachycardia was observed in any of the other 9 patients. CONCLUCION: It appears that the use of propranolol-esmolol and amiodarone combined with flecainide in the medical treatment of drug-resistant SVT may reduce the need for ablation in critical neonates and infants.

Objectives: The radiation dose from interventional cardiac catheterization is particularly relevant when treating children because of their greater radiosensitivity compared to adults. The transcatheter closure of patent ductus arteriosus (PDA), as well as other more complex pediatric interventions, have raised concerns regarding radiation exposure, particularly relevant when treating children. The purpose of this study is to show how to perform the transcatheter closure of PDA in children while giving less ionized radiation and to prove that the amount of radiation and contrast material can be reduced. Study design: Following appropriate device selection based on PDA morphology and diameter, transthorasic echocardiography images and control aortography findings were analyzed. The following devices were used during the procedure: Gianturco coils (10/63), an Amplatzer Duct Occluder (ADO, 31/63), Flipper coils (19/63), and an Amplatzer vascular plug (3/63). Results: The scopy time, radiation dose, and contrast were 12+-6.4 mins, 28.1+-14.7 cmGy/cm2/kg, and 4.2 +- 2.3 cc/ kg, respectively. In the control aortography shortly after the procedure, residual shunt was detected at various levels in 39.7% of patients, and 9.5% demonstrated residual shunt in real-time echocardiography. In the control aortography, the exposure to radiation was 13.3% of the total, and the amount of infused contrast was 27.2% of the total. Conclusion: Patients may be exposed to less radiation and contrast material if an echocardiographic evaluation, instead of a final control aortography injection, is performed after the transcatheter closure of PDA.

Objective: Experience with administration of inhaled nitric oxide (iNO) in pediatric cardiac intensive care unit was retrospectively reviewed. Methods: Data from 32 pediatric patients treated with iNO between 2011 and 2012 were collected. Patients were divided into 3 groups: Group I comprised postoperative patients, Group II comprised newborns with persistent pulmonary hypertension (PPH), and Group III comprised patients with primary pulmonary hypertension (PH) or Eisenmenger's syndrome. Age, sex, weight, primary diagnosis, arterial blood sample, pulmonary artery pressure (PAP), systemic arterial pressure (SAP), and oxygen saturation levels were analyzed. Results: Groups I, II, and III included 25, 3, and 4 patients, respectively. Median weight was 8 kg (range: 3–40 kg), and median age was 7 months (range: 2 days–10 years). On average, iNO treatment was initiated at the 12th hour after admission to the unit (range: 1–48 hours) and continued for a median duration of 24 hours (range: 12–168 hours). Systolic PAP was 40+-15 mmHg, mean SAP was 57+-18 mmHg, PAP/SAP ratio was 0.69, and oxygen saturation levels were 88% prior to iNO treatment. Following iNO treatment, PAP decreased to 24+-9 mmHg (p

Background: Congenital complete atrioventricular block without any structural heart disease and anti-Ro/La negativity is very rare. Discordant complete atrioventricular block, which is more frequently defined in the literature as an autoimmune mechanism, is much more rare in monozygotic twins. Case Report: The 26-year-old healthy mother had given birth in her first spontaneous, uneventful pregnancy to monozygotic twins at week 35. While the first twin’s physical examination proved her to be normal with a pulse rate consistent with her age, the second twin had a pulse rate of approximately 40 beats/minute.The patient was confirmed to have congenital complete atrioventricular block. Conclusion: Despite this case appears to be an isolated one, a discordant complete atrioventricular block regression without any autoimmune evidence should be included in the differential diagnosis of bradycardia in infants

Aim: Acute exacerbation in chronic obstructive pulmonary disease (COPD) may result in a lot of systemic consequences due to hypoxemia and systemic inflammation. We investigated uric acid levels and uric acid to creatinine ratio in COPD patients developing acute exacerbation. Methods: We included 25 patients who had been admitted with acute exacerbation of COPD according to the GOLD diagnosis and treatment guidelines between May and December 2011. Uric acid and creatinine levels were recorded from blood samples of the patients. Results: Average uric acid and uric acid to creatinine ratio values were 5.7±2.09 mg/dl and 7.32±3.0 in patients with mild hypoxemia, 6.4±2.1 mg/dl and 7.01±2.9 in those with moderate hypoxemia, and 6.7±2.0 mg/dl and 9.1±1.8 in those with severe hypoxemia, respectively. While no statistically significant correlation was found between uric acid levels and uric acid to creatinine ratio in the three groups (p=0.97, p=0.76, respectively), these values were found to increase along with increasing severity of hypoxemia. Conclusion: Uric acid levels and the ratio of uric acid to creatinine remained unchanged while severity of hypoxemia increased during acute exacerbations of COPD, however, these values were found to increase with increasing severity of hypoxemia. (The Medical Bulletin of Haseki 2013; 51: 147-50)

In this article, we present a 10-year-old boy who was admitted to the hospital with recurrent syncope. There was no remarkable finding in patient’s physical examination, family history, and the diagnostic 12-lead electrocardiogram (ECG), chest x-ray, ECG Holter monitoring, event recording, echocardiography, coronary computed tomography (CT) angiography, Ajmaline test for the diagnosis of Brugada syndrome, brain magnetic resonance imaging, and sleep/wake electroencephalogram. We started beta-blocker therapy because the patient had exercise-induced syncope. An Implantable loop recorder (ILR) was inserted to the patient. Three years later, polymorphic ventricular tachycardia called torsades de pointes was detected by the ILR during syncope occurred with exercise. The patient had been taking high-dose betablocker treatment, an implantable cardioverter defibrillator was implanted into the patient. ILR can play an important role in the diagnosis of life-threatening arrhythmia in children with unexplained syncope. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 123-5)

Aim: Arterial stiffness is an independent risk factor for cardiovascular disease. In previous studies, emotional stress has been reported to be a risk factor for cardiovascular disease. In this study, we aimed to investigate the effects of anxiety, stress and fatigue associated with working at night in hospital environment on arterial stiffness in physicians. Methods: The study was carried out with 30 physicians employed in Medical Faculty of Uludağ University between October 2011 and March 2012. Measurements were made using Pulse Wave Sensor HDI system (Hypertension Diagnostics Inc, Eagan, MN)(Set No: CR000344) by radial artery pulse wave at the onset and end of night shift. Results: The mean age of night doctors included in the study was 26 years (range: 22-38) and the female/male ratio was 2/1. It was determined that mean values of arterial stiffness were significantly higher after night shift (1330±360 dyne/sn/cm-5) compared to mean values before night shift (1093±250 dyn/s/cm-5) (p=0.01). In the evaluation of other parameters before and after night shift, no statistically significant difference was detected (p>0.05). Conclusion: The increasing arterial stiffness in hospital employees after night shift could be attributed to the effects of stress and fatigue experienced during night shift. (The Me di cal Bul le tin of Ha se ki 2012; 50: 93-5)