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Neutrophil gelatinase-associated lipocalin (NGAL) is a member of the lipocalin family best known as a novel and early marker of acute kidney injury (AKI). Recent data suggest that NGQueryAL is not only a marker of AKI, but also an important player in the vascular remodeling, atherosclerotic plaque stability and thrombus formation. We conducted this study to investigate the association of serum NGAL levels with fatal and composite (fatal and non-fatal) cardiovascular events (CVE) in a cohort of patients with stage 1–5 CKD. This was an observational cohort study in which serum NGAL was obtained from 298 CKD (stages 1–5) patients. Fatal and composite CVE were recorded for a median 41 months. We examined alteration of serum NGAL through CKD groups as well as association with inflammatory markers. We also performed a Cox regression analysis to determine the association of NGAL with predefined clinical outcomes. The median value of NGAL was 50.5 ng/mL (IR 47.6–54.9 ng/mL), and higher NGAL values were recorded in diabetic patients. In a multiple linear regression model, including all univariate associates of NGAL, only log eGFR, log hs-CRP and log HDL cholesterol maintained an independent association with log NGAL. During the observational period, 30 patients died due to cardiovascular causes and 69 non-fatal CVE were registered. In the fully adjusted model, we observed a 2.08-fold increase in the risk of fatal CVE and a 1.50-fold increase in the risk of fatal and non-fatal CVE for each increment of 1 SD in log NGAL values. This is the first study that shows that serum NGAL is associated with cardiovascular events (fatal and non-fatal) in patients with CKD, independently of traditional risk factors, renal function and inflammation.

Introduction: The number of geriatric patients presenting to the emergency department increases every year. In addition, it is known that the mental status of geriatric patients may deteriorate as ...

Article history: Received 3 November 2015 Accepted 4 November 2015 Available online 5 November 2015 (ACS) [1]. Ticagrelor has more rapid onset of action on platelet inhibition and was superior to clopidogrel. It decreases major adverse cardiac events compared to the clopidogrel. According to the PLATO trial, ticagrelor may lead to increased incidence of asymptomatic ventricular pauses [1–4]. In addition, there are some reports about the side effects of ticagrelor like bradycardia and dyspnea [5–8]. It is considered that the inhibition of the re-uptake of adenosin from the red cells

Takotsubo cardiomyopathy(TCM) is a reversible cardiomyopathy characterized by left ventricular dysfunction due to transient left ventricular apical hypokinesia or akinesia and basal hyperkinesis following some trigger factors like physical or emotional stressful events and may mimic myocardial infarction especially in middle age females. Pathophysiology of TCM is not clear but it is associated with excessive adrenergic stimulation[1-3]. TCM is usually precipitated by acute physical and emotional stresssors, use of exogenous catecholamines or exacerbation of chronic illnesses like asthma attack. We report a case of TCM after an asthma attack as a potential stressor. This is an interesting association between asthma attack and TCM.

The transapical transcatheter approach for percutaneous interventions is performed in high-risk patients with peripheral vascular disease and when transseptal attempt failed. The apical access is traditionally performed through a left minithoracotomy at the fifth intercostal space under general anesthesia. But, there are some complications and risks like ventricular arrhythmias, ventricular tear and life-threatening surgical bleeding in the apical access even though it is a minimally invasive procedure [1]. Although new apical closure devices have been developed and tested in animals and humans, the apical closure remains a challenge in recent studies [2]. The cardiologists started to use the occluders to close the percutaneous apical accesses [3–11]. We report a case of a successful percutaneous closure of the apical access with a 4 mm ADO-II device after a standard transapical mitral paravalvular leak closure procedure without minithoracotomy with the computed tomography guidance. This case is the second from Turkey, so the first one was published recently in this journal [12]. In this second case, we used the CT guidance for optimal puncture of cardiac apex. A 44 year old female was admitted to our department with severe dyspnea (NHYA classes II–III). She had hemolytic anemia (hemoglobin level 8.0 g/dL, lactate dehydrogenase level was high). She had a history ofmitralmetallic prosthesis valve replacement in 1994. Transesophageal echocardiography (TEE) showed two severe mitral paravalvular leaks (6 and 9mm) of themitral valve prosthesis. Transesophageal echocardiography (TEE) showed two severe mitral paravalvular leaks (6 and

Atherosclerotic plaque rupture and subsequent thrombosis are major pathophysiological mechanisms as cause of acute coronary syndromes. Patients with stable obstructive coronary artery disease may live for many years without any cardiovascular events through only risk factor modification and prompt medical treatment. However patients with minimal coronary artery disease may experience premature cardiovascular events moreover death. Thus, plaque stabilization may be much important rather than struggle with stenosis. We report a case of NSETMI with ruptured atherosclerotic plaque and subsequent thrombosis as a culprit lesion in right coronary artery.

Objective: Carbon monoxide (CO) poisoning leads to cardiac dysrhythmia. Increased heterogeneity in ventricular repolarisation on electrocardiogram (ECG) shows an increased risk of arrhythmia. A number of parameters are used to evaluate ventricular repolarisation heterogeneity on ECG. The aim of our study is to investigate the effect of acute CO poisoning on indirect parameters of ventricular repolarisation on ECG. Methods: Sixty-seven patients were included in this case-control study. Thirty patients with acute CO poisoning were assigned to group 1 (19 females, mean age: 30.8 ± 11.3 years). A control group was formed with patients without known cardiac disease (group 2, n = 37; 25 females, mean age: 26.0 ± 5.2 years). Twelve-lead ECG and serum electrolyte levels were recorded in all patients. Also, carboxyhaemoglobin (COHb) levels were recorded in group 1. Tpeak-Tend (TpTe) interval, TpTe dispersion, TpTe/QT ratio, QT interval and QTd durations were measured as parameters of ventricular repolarisation. Corrected QT (QTc) and QTc dispersion (QTcd) intervals were determined with the Bazett's formula. Results: The mean COHb level in group 1 was 27.6 ± 7.4% and mean duration of CO exposure was 163.5 ± 110.9 min. No statistically significant difference was found in age, gender, serum electrolytes or blood pressure levels between the groups. QRS, QT, QTc, TpTe interval and TpTe/QT ratio were similar between the groups (p > 0.05). QTcd (65.7 ± 64.4 vs 42.1 ± 14.2 ms, p = 0.003) and TpTe dispersion (40.5 ± 14.8 vs 33.2 ± 4.9 ms, p = 0.006) were significantly longer in group 1 than group 2. COHb level was moderately correlated with TpTe dispersion (r = 0.29; p = 0.01). Conclusion: To our knowledge, this is the first study to investigate TpTe interval and dispersion in CO poisoning. Our results showed that TpTe dispersion and QTc dispersion increased after CO poisoning.

Objectives. Secondary amyloidosis is the most important complication of FMF and endothelial function is more severely impaired. Elevated asymmetric dimethyl arginine (ADMA) may mediate the excess cardiovascular disease (CVD) risk of this group. We aimed to compare endothelial function characteristics, including ADMA, in patients with FMF-related amyloidosis and primary glomerulopathies and to define risk factors for a CVD event. Methods. We undertook a cross-sectional study with prospective follow-up including consecutive patients with FMF-related amyloidosis (n = 98) or other non-diabetic glomerulopathies (n = 102). All patients had nephrotic-range proteinuria and normal glomerular filtration rate. Flow-mediated dilatation (FMD) was assessed and ADMA levels, CRP and pentraxin 3 (PTX3) were determined. Patients were followed for cardiovascular events. Results. Amyloidosis patients secondary to FMF showed higher levels of ADMA, CRP and PTX3 and lower FMD as compared with patients with other glomerulopathies. Cardiovascular events (n = 54) were registered during 3 years of follow-up. Increased ADMA levels and lower FMD were observed in patients with cardiovascular risk in both groups, but especially in individuals with amyloidosis. Conclusion. Patients with FMF-related amyloidosis have increased CVD event risk, probably related to the high ADMA levels, elevated inflammatory markers and decreased FMD measures observed in these patients.

Soft tissue trauma is a type of acute traumatic ischemia. We investigated in this study whether the edema, inflammation and ischemia caused by the trauma could be affected positively by hyperbaric oxygen (HBO) and ozone therapy.Soft tissue trauma was generated in a total of 63 adult male Sprague-Dawley rats. Subsequently, rats were divided into three groups. The first group was treated with ozone, the second group with HBO, and the third group served as controls. Tissue and blood samples were taken at the end of the procedures. Tissue lipid peroxidation (LPO), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), inducible nitric oxide synthase (iNOS), heme oxygenase (HO)-1, and hypoxia-inducible factor (HIF)-1 levels were detected. Hematoxylin-eosin staining was used to determine the inflammation and edema histopathologically.We also detected HIF-1 activity, which decreases when the oxygen concentration increases, HO-1 activity, which has anti-inflammatory effects, and iNOS activity, which releases in any type of acute case. We determined a statistically significant reduction in iNOS and LPO levels in both the HBO and Ozone groups. A significant decrease in inflammation was detected in both the Ozone and HBO groups compared with the Control group, and a significant decrease in edema was detected in all three groups.We think that HBO and Ozone therapy have beneficial effects on biochemical and histopathological findings. Related clinical trials will be helpful in clarifying the effects.

Background Soluble TWEAK (sTWEAK) and asymmetric dimethyl arginine (ADMA) concentrations have been associated with endothelial function in patients with chronic kidney disease (CKD). We tested the hypothesis that the improvement in endothelial function observed after renal transplantation is directly linked to the normalization of both sTWEAK and ADMA. Materials and methods One hundred and seventy-five kidney transplant recipients (71% men; 31·6 ± 9·4 years) were studied immediately before and on the 180th day post-transplantation. At each visit, blood samples were taken to assess circulating levels of sTWEAK and ADMA. Brachial artery endothelium-dependent vasodilatation (FMD) assessments were also performed. Results Renal transplantation was followed by an improvement in FMD. This improvement was paralleled by an increase in sTWEAK and a reduction in ADMA after transplantation (P

INTRODUCTION Fetuin‑A is a glycoprotein secreted from hepatocytes, which affects diabetes and peripheral arterial disease. However, there has been no studies regarding the relation between diabetic foot and fetuin‑A levels. OBJECTIVES We aimed to analyze the association between diabetic foot development and serum fetuin‑A levels. PATIENTS AND METHODS Following the approval of the local ethical board, 137 patients were included in the study. Patients were divided into 3 groups: diabetes group (n = 49), diabetic foot group (n = 57), and control group (n = 31). In all patients, serum fetuin‑A, C‑reactive protein, magnesium, and hemoglobin A1c (HbA1c) levels were measured. Diabetic foot wounds were classified according to the Wagner classification and lower extremity arteries were evaluated by ultrasonography. RESULTS Median fetuin‑A levels in patients with diabetic foot were significantly higher than in those with diabetes. However, the differences in HbA1c levels between both groups were not statistically significant. A positive correlation was found between the Wagner classification and ultrasound evaluation of the peripheral arteries (degree of atherosclerosis) in patients with diabetic foot. In the diabetic foot group, fetuin‑A levels were also found to be positively correlated with ultrasound evaluation. CONCLUSIONS We observed a positive correlation between serum fetuin‑A levels and the development of diabetic foot.

Purpose: To determine the relationship between the dental root indentation and maxillary sinusitis. Methods: We assessed the records of the patients who underwent paranasal sinus computed tomography imaging for suspected sinusitis. Results: We identified a total of 52 patients with a pre-diagnosis of maxillary sinusitis. Dental indentation was detected in 58 of 104 (55.7%) sinuses. Forty six of 58 sinuses (79.3%) with dental indentation had mucosal thickening higher than 2 mm. The difference between the groups was statistically significant (p = 0.007). Conclusion: Dental indentation should be kept in mind as a reason for chronic maxillary sinus inflammation, if an underlying cause cannot be identified.

Severe aortic stenosis is associated with significant morbidity and mortality if untreated. The transcatheter aortic valve implantation(TAVI) is now feasable and effective gold standart treatment option in patients with severe aortic valve stenosis(AS) and associated with similar rate of major adverse events compared to the surgery. The relation between aortic stenosis and gastrointestinal angiodysplasia was known as Heyde’s Syndrome since 1958. High fluid shear stress through the narrowed valve is thought to be the underlying mechanism leads to the mechanical disruption of the large von Willebrand factor multimers. Aortic valve replacement either surgical or with TAVI seems to reduce gastrointestinal bleeding in approximately 80% in patients with Heyde syndrome in whom gastrointestinal bleeding is associated with intestinal angiodysplasia due to acquired von Willebrand’s disease (type 2A) and aortic valve stenosis. The patients especially with atrial fibrillation who need anticoagulant therapy may have bleeding risk despite aortic valve replacement. We report a case of patient presenting with a massive intestinal bleeding originating from intestinal angiodysplasia after percutaneous aortic valve replacement.

The endovascular aortic repair (EVAR) is the treatment of choice for the majority of patients with abdominal aortic aneurysms(AAA) by supporting endovascular technology. But there are some potential complications during or post procedure. We present a case who underwent endovascular aortic repair (EVAR) for an AAA occured splenic artery infarction after procedure.

The no-reflow (NR) phenomenon represents an acute reduction in coronary blood flow without coronary vessel obstruction, coronary vessel dissection, spasm, or thrombosis. No reflow is an important complication among patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The complete blood count (CBC) is one of the most frequently ordered laboratory tests in clinical practice. Various studies have evaluated the performance of CBC parameters to predict disease severity and mortality risk. Automated cell counters are routinely available in many clinical laboratories and can be used to determine red blood cell distrubiton width (RDW), platetecrit, platelet count, and and some ratios like the neutrophil–lymphocyte ratio and RDW-platelet ratio. These hematological markers have been reported to be independent predictors of impaired angiographic reperfusion and long-term mortality among patients with STEMI undergoing pPCI. In this context, we reviewed the role of admission CBC parameters for the prediction of NR in patients with STEMI undergoing pPCI.

BACKGROUND: Low vitamin D status has been associated with increased risk of cardiovascular disease. Atrial fibrillation (AF) is the most common cardiac arrhythmia. We evaluated the association between low vitamin D and AF. METHODS: We analyzed data from 162 Chinese patients with nonvalvular persistent AF and no other cardiovascular disease whose serum 25‐hydroxyvitamin D [25(OH)D] levels were measured in our hospital (AF group). Healthy subjects without AF who underwent health screening at our hospital served as controls (non‐AF group, n = 160). 25(OH)D was measured by chemiluminescence assay. RESULTS: The serum 25(OH)D level was significantly lower in the AF group than in the non‐AF group (18.5 ± 10.3 vs 21.4 ± 10.7 ng/mL, P < 0.05). The high‐sensitivity C‐reactive protein (hsCRP) level was significantly higher in the AF group than in the non‐AF group (0.35 ± 0.19 vs 0.2 ± 0.17 mg/dL, P < 0.01). The average left atrial diameter was significantly larger in the AF group than in the non‐AF group (P < 0.01). The serum 25(OH)D level showed a negative correlation with left atrial diameter, hsCRP level, and pulmonary artery systolic pressure. Logistic regression analysis identified that 25(OH)D was related to AF. Patients whose vitamin D levels were in the lowest 25(OH)D category (30 ng/mL). CONCLUSIONS: Low vitamin D levels are associated with AF. It may be involved in its development.

a b s t r a c t Objectives: Acetaminophen (APAP) overdose may cause acute liver injury. Ozone therapy (OT) is shown to reduce inflammation and necrosis in several entities. Thus, we have designed this study to evaluate the efficacy of OT in a rat model of APAP-induced liver injury. Methods: Twenty-seven Sprague-Dawley rats were divided into three groups: sham, APAP and APAP+OT groups. In the APAP and the APAP+OT groups, liver injury was induced by oral administration of 1 g/kg APAP. The APAP+OT group received a single dose ozone/oxygen mixture (0.7 mg/kg) intraperitoneally 1 h after APAP administration. All animals were killed at 24 hour after APAP administration. Blood samples and liver tissues were harvested to determine liver injury and oxidative stress parameters. Liver tissues and blood samples were obtained for biochemical and histopathological analyses. Results: APAP administration caused necrosis in the liver after 24 h. The degrees of liver necrosis of the APAP group were higher than the other groups (in both p < 0.05, respectively). In the APAP+OT group, liver antioxidant enzymes activities were significantly higher than the APAP group (p < 0.05), but were lower than the sham group (p < 0.05). In the sham group, serum neopterin, a marker of cell-mediated immunity, concentrations (4.8 ± 1.2 nmol/L) were lower than the APAP (14.7 ± 1.4 nmol/L) and APAP+OT groups (7.5 ± 2.4 nmol/L) (in both p < 0.05, respectively). Conclusion: Our results showed that OT prevented liver necrosis in rats and reduced neopterin levels. These findings suggest that the use of OT as an adjuvant therapy which might improve the outcome in APAP induced liver injury.

Snakebites are common in people living or working in rural area. Military personnel are among the risk groups for viper envenomation. In this study, we presented seven cases of vipera snakebites in military personnel and discussed how to minimize functional loss and maximize the outcome. All of the bites were located in extremities and 5 were at hands. All patients were admitted at the day of snake bite which is an indicator of good triage. Hematological complications were the most common systemic complications. Antivenom therapy was performed according to the severity of the envenomation. Local wound care, grafts and flaps were used for wound coverage. Pit viper envenomation can cause serious morbidity in military personnel especially at hot climates. A suspicion of snake bite must be managed properly. Triage is the most important step to reduce the morbidity. Almost all snake bites occur in extremities, thus protective measurement must be taken especially for hands. [TAF Prev Med Bull 2012; 11(2.000): 127-130]

Dear Editor, We have read the article “Epicardial fat thickness(EFT) in patients with rheumatoid arthritis” written by Erdem et al. with a great interest.1 The authors aimed to explain the relationship between epicardial fat thickness and clinical and echocardiographic parameters in patients with rheumatoid arthritis. They concluded that EFT as an indicator of cardiovascular involvement was higher in rheumatoid arthritis patients. Thanks to the authors for their contribution of the present study which is successfully designed and documented. Epicardial tissue makes active endocrine organ function which produces several markers involved in oxidative stress, endothelial dysfunction, atherosclerosis and inflammation,2,3. Increased epicardial adiposity can lead to cardiovascular diseases due to endocrine actions that include increased production of reactive oxygen species, atherogenic and inflammatory cytokines. Various studies have highlighted EFT is also clinically related to hypertension, type 2 diabetes, metabolic syndrome, dyslipidemia, nonalcoholic fatty liver disease, and chronic kidney disease. EFT is also a cardiometabolic risk factor in various inflammatory diseases and is also independently associated with psoriasis.4 EFT may be included among the clinical parameters associated with OSA severity. The association of EFT with OSA, both cardiovascular risk factors, is independent of obesity as defined by classical measures5. Echocardiographic epicardial fat measurement in both clinical and research scenarios has several advantages, including its low cost, easy accessibility, rapid applicability, and good reproducibility. However, more evidence is necessary to evaluate whether echocardiographic epicardial fat thickness may become a routine way of assessing cardiovascular risk in a clinical setting6. In present study, EFT was calculated on the free wall of the right ventricle in the still images obtained at end diastole the parasternal long-axis view, using the aortic annulus as an anatomic reference. However, second image as short axis view may be add useful information about EFT values. Then, the mean value of two images obtained in the parasternal long-axis and short-axis views should be measured. Secondly, the echocardiography method might not be the optimal technique for quantification of epicardial tissue. The gold standard in evaluating EFT is magnetic resonance imaging (MRI); the lack of MRI use is one of the limitations of the present study. After that, because echocardiography measures EFT linearly, echocardiographic EFT may not reflect the total epicardial fat volume exactly. EFT has a 3-dimensional distribution and two-dimensional echocardiography cannot give adequate window of all cardiac segments especially in obese subjects and is highly dependent on acoustic windows2. In this point of view, it would be better to give interobserver and intraobserver variability for EAT measurement in the current study7. As a conclusion, EFT may provide information to clinicians about the systemic inflammation. So, we believe that these findings will evaluate further studies about EFT on cardiovascular risk in systemic inflammatory disease patients.

The association between vascular stiffening and blood pressure is likely bidirectional. The present study was designed to examine temporal relationships among vascular stiffness, blood pressure progression, and hypertension. The Asymptomatic Polyvascular Abnormalities Community study is a community‐based, prospective, long‐term follow‐up observational study. The present investigation is based on the baseline examinations (2010–2011) and the first follow‐up measurements (2012–2013) included in the study. A total of 4025 participants were followed for an average of 27 months. Of 2153 participants free of hypertension at the baseline examination, 432 (20.07%) had incident hypertension. The authors observed that brachial‐ankle pulse wave velocity (baPWV) was an independent predictor of incident hypertension. baPWV during baseline examination was positively associated with higher systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure during the first follow‐up examination. baPWV but not blood pressure during baseline examination was associated with baPWV during the first follow‐up examination. This study not only provides evidence that baPWV is an independent predictor of blood pressure progression and incident hypertension, but also provides evidence that blood pressure is not associated with baPWV after adjusting for baseline baPWV.

Narghile known in different names as shisha, hookah, hubble-bubble, waterpipe has been smoked widely in Middle East countries traditionally and recently began to spread to European countries and USA. Narghile is consumed particularly by university youth in cafes as a social activity in Turkey. We report a case series of five patients presented with narghile induced carbon monoxide (CO) poisoning. We believe that this problem might be overlooked and underreported. We want to emphasize that, in the differential diagnosis of nonspecific neurological complaints (especially headache, nausea, vomiting and vertigo) CO poisoning must be considered and patient must be questioned about the usage of narghile smoking especially in areas popular of it.

To the Editor: We have read the article entitled, "Association between Red Blood Cell Distribution Width (RDW) and Coronary Artery Calcification in Patients Undergoing 64-Multidetector Computed Tomography" by Gurel et al.1) They aimed to determine whether the RDW measures are associated with the coronary artery calcification score (CACS) in patients who did not present with obvious coronary artery disease (CAD). They concluded that the RDW is an independent predictor of the CACS, suggesting that it might be a useful marker for predicting CAD. This study provides important information on this clinically relevant condition. Inflammation is a significant feature of the arteriosclerotic process, and some novel inflammatory indicators have been shown in any stage of the arteriosclerotic process.2) Complete blood count has several routinely available markers that can indicate inflammatory status. At present, many studies concluded that parameters like neutrophil-lymphocyte ratio, RDW, mean platelet volume levels were higher in patients with inflammatory diseases compared with controls.2),3),4) RDW indicates the variability in the size of circulating erythrocytes and is expressed as the coefficient of variation of the erythrocyte volume. Recently, a number of studies have reported that RDW levels, which may be related to subclinical inflammation, are increased in many inflammatory diseases.5) Furthermore, some studies reported that RDW levels were independently associated with mortality in both the general population and in patients with certain diseases. However, some conditions should be considered when RDW levels are evaluated. RDW can reflect ethnicity, neurohumoral activation, renal dysfunction, thyroid disease, nutritional deficiencies (i.e. iron, vitamin B12, and folic acid), bone marrow dysfunction, inflammatory diseases, chronic or acute systemic inflammation6) and use of some drugs.7) The correlation with bilirubin could also be due to hepatic dysfunction and excessive alcohol intake, resulting in macrocytosis and increased RDW. Also, it would be better if the authors might define how much time they specified on measuring RDW levels, because delaying blood sampling can lead to abnormal results in RDW assessments.8) In conclusion, we strongly believe that the findings obtained from the current study will lead to further studies assessing the relationship between RDW and CAD. Finally, not only RDW but also mean platelet volume, neutrophil lymphocyte ratio, platelet distribution width, RDW- lymphocyte ratio are easy methods for predicting cardiovascular disease in patients.9) These markers might be useful in clinical practice.10)

They concluded that there was a significant association between increased embolism load in the pulmonary artery and increased serum GGT levels.Several noninvasive tests have been used for accurately diagnosing pulmonary embolism. Some inflammatory markers like red cell distribution width may show pulmonary embo-lism through further diagnostic tests.

la valvula y la direccion de la calcificacion anular son muy importantes para predecir estas complicaciones. Ademas de la formacion del trombo, la calcificacion residual asociada a la valvula natural tambien es un posible factor etiologico en la embolia. Dada la posibilidad de estas catastroficas complicaciones del TAVI, los pacientes deben ser objeto de seguimiento estricto mediante ecocardiografia durante y despues de la intervencion. En la ecocardiografia, detectar la formacion de un trombo en la valvula aortica implantada es esencial despues del TAVI, y el cardiologo intervencionista debe iniciar de inmediato un tratamiento antiagregante plaquetario y antitrombotico despues del TAVI en estos pacientes. En conclusion, es muy importante tener presente la posibilidad de este evento catastrofico, y todos los cardiologos intervencionistas deben tomar todas las medidas preventivas posibles, como colocar un cateter guia en el ostium de la coronaria izquierda.

Dear Editor, We read the article Coronary artery ectasia—A sample from Saudi Arabia written by Almansori et al. [1] with great interest. The authors showed that the prevalence of coronary artery ectasia in Saudi Arabia was higher than what has been published in previous studies and a significant number of patients had severe disease. Why is the prevalence of coronary artery ectasia in Saudi Arabia high compared to the previous studies? There are some comments that need to be discussed. In the study [1], it was reported that an interventional cardiologist had reviewed all angiograms and classified ectatic segments of the coronary arteries according to the Markis classification. We thought that the ectatic segments of the coronary arteries would be analyzed at least by two interventional cardiologists, as there may be some differences between observers; analysis of intraobserver and interobserver differences is important. We often encounter ectasia of the coronary arteries during invasive coronary angiogram in our daily practice. What is the importance of this situation? Some reports show that the coronary artery ectasia is thought of as a variant of atherosclerosis and coronary artery ectasia had the same clinical parameters and pathophysiologic processes. In addition, the ectatic segments may tend to have more thrombus formation and slow flow compared to the normal segments [2], [3], [4], [5], [6]. Depression is a strong predictor of cardiovascular events [7]. There is a recent report about the relation between coronary artery ectasia and anxiety and depression [8]. It was shown that the patients with coronary artery ectasia were less anxious and less depressive than the coronary obstructive disease patients. They concluded that autonomic nervous system imbalance had a possible role for explaining pathophysiological mechanism of the ectatic segments. Do the Saudi patients have less anxiety and depression? In addition, the possibility comes to mind that the hot climate may affect psychological condition of the patients in Saudi Arabia. Do the authors have any comments about this idea? We think that further studies will need to explain the effects of psychological–environmental factors on patients with coronary artery ectasia.

We read the article ‘‘The Relationship Between Serum Endocan Levels With the Presence of Slow Coronary Flow: A CrossSectional Study’’ by Kundi et al. They aimed to investigate the relation between endocan levels and slow coronary flow (SCF). They concluded that higher endocan levels were significantly and independently related to the presence of SCF. Slow coronary flow phenomenon is recently well known as an atherosclerotic process, which is triggered by increased inflammatory conditions. Indeed, various studies demonstrated the relation between SCF and inflammation. Furthermore, elevated levels of systemic inflammatory markers are related to SCF based on endothelial dysfunction. Endocan, a novel endothelial marker, was increased by many inflammatory diseases. In line with inflammation, we have reported that the elevated levels of endocan were described in some atherosclerotic processes. Hypertension is one of the most important fatal and nonfatal disease worldwide, and it is also associated with endothelial inflammation, endothelial injury, activation, and dysfunction caused by oxidative stress. Furthermore, diminished endocan levels by endocan antibody enhanced survival rate. Another cardiovascluar risk factor such as chronic kidney disease (CKD) can lead to endothelial dysfunction. Hence, Yilmaz et al have investigated the relation between endocan levels and CKD. They have showed that endocan levels were associated with all-cause mortality and cardiovascular events (CVEs) in patients with CKD, but plasma endocan concentrations also correlated positively with both markers of inflammation. Vasculitis related to endothelial dysfunction is considered to play a key role in pathogenesis of Behcet disease (BD). So we investigated endocan levels in patients with BD. Increased endocan levels were observed in these patients. Also, we have showed that serum endocan levels correlated positively with C-reactive protein, erythrocyte sedimentation rate, and activity of the disease. Serum levels of endocan were also higher in patients with systemic involvement. In other study, we investigated endocan levels in patients with psoriasis, which is associated with an increased risk of CVD. We showed higher serum levels of endocan in these patients. Additionally, serum endocan levels were correlated positively with cardiovascular risk and activity of the disease. In addition, some medications may change the endocan levels. We also reported antihypertensive therapy such as valsartan and amlodipine significantly diminished the endocan levels. There was a possibly significantly increased rate in these patients due to statin use. The potential effect of control of hyperlipidemia and pleiotropic effects of statin use on endocan levels would better be briefly discussed. Also, some of the oral antidiabetics may change endothelial dysfunction. In this context, medication should be considered. In conclusion, endocan is a novel indicator to evaluate the endothelial dysfunction in clinical practice, and without the above-mentioned conditions, endocan alone may not provide information to clinicians about inflammation in patients with SCF. It would have been better, if these factors were included in the recent text.

In the present study, the association between red cell distribution width (RDW) with functional significance of intermediate coronary artery lesions was investigated.Two hundred and forty-six consecutive patients, 168 males and 78 females, who underwent fractional flow reserve (FFR) measurement for angiographically intermediate coronary stenosis (40-70% in quantitative coronary analysis) in the left anterior descending coronary artery were enrolled into the study. The functional significance of intermediate coronary artery lesions was determined by FFR measurement. An FFR value0.75 was defined as functionally significant. Venous blood samples were taken within 48 h before the FFR measurement, and RDW levels were determined by a Coulter LH Series hematology analyzer. Logistic regression analysis was used to examine the association between functional significance in FFR measurement and other variables.Of the 246 patients, 62 (25.2%) exhibited significant functional stenosis (FFR0.75) in the FFR measurement. The mean RDW level was significantly higher in patients with significant stenosis (14.19 ± 0.73 vs. 13.69 ± 0.77, p0.001). In stepwise multivariate logistic regression analysis, RDW (OR = 2.489, 95% CI = 1.631-3.799, p0.001) and male gender (OR = 2.826, 95% CI = 1.347-5.928, p = 0.006) were independent predictors of significant functional stenosis.Increased RDW levels were associated with functional significance of angiographically intermediate coronary artery stenoses.

Background Premature ventricular contractions (PVCs) presenting as isolated complexes are insignificant, but if they present as salvos they are considered indicators of high risk for potentially fatal arrhythmias. Case report We present the case of a 39-yr-old male military parachuter with PVCs and ventricular tachycardia that were incidentally detected on ECG and treated with radiofrequency catheter ablation (RFCA). He had no significant past medical history. Physical examination and biochemical tests were normal. Transthoracic echocardiography showed no structural heart disease. Due to frequent ventricular extrasystoles (VES) detected on his ECG, 24-h Holter monitoring was conducted and revealed VES, including 13,351 isolated PVCs, 1427 episodes of bigeminy, 397 of trigeminy, 30 couplets, and 4 salvo periods. After beta-blocker and calcium channel blocker treatment for 1 mo, his repeat 24-h Holter monitoring showed 18,414 isolated PVCs, 819 episodes of bigeminy, 181 of trigeminy, and 6 couplet VES, but no episodes of salvos. Electrophysiological studies (EPS) were performed and the baseline measurements were: basic cycle length: 890 ms; atrium His interval: 78 ms; and ventricular His interval: 54 ms. VES were found to orginate from the right ventricular outflow tract and were terminated by RFCA. Medical treatment was stopped. Repeat Holter showed no VES. The parachuter was qualified for full duties. Discussion As the patient is an aircrew member and further usage of antiarrhythmic agents will interfere with his flying status, instead of initiating a drug therapy again, we performed EPS and RFCA as an effective and dependable method in order to treat and to determine his fitness.

We read the article ‘Pretreatment lymphocyte-monocyte ratio (LMR) as a potential prognostic factor in a cohort of patients with upper tract urothelial carcinoma’ by Hutterer et al .1 They aimed to investigate the potential prognostic impact of the LMR in a large European cohort of patients with localised upper urinary tract urothelial carcinoma. They concluded that LMR might be considered an additional prognostic factor in upper urinary tract urothelial carcinoma in the future. A complete blood count is an easy examination technique that gives us information about the patients’ formed …

We readwith interest the letter by Han et al. [1] regarding our paper entitled ‘Carotid intima media thickness can predict coronary artery disease’ [2]. Coronary artery disease (CAD) has led to higher mortality rate worldwide. Thus, early diagnosis of CAD is important issue indaily routine practice. Some inflammatory indicators may be observed subclinic atherosclerosis. In clinical practice, one of these indicators, carotid intima media thickness(CIMT) is widely used as an inflammatory marker [3]. CIMT measurement is easy, accessible, routine, and cheap method for evaluating the inflammatory condition or endothelial dysfunction [4]. In recent letter, Han et al. [1] have mentioned the relation between CIMT and the risk of CAD. We agree with these comments. Indeed, in many studies, the authors investigated the relation between CIMT and various conditions including CAD risk factors, inflammatory diseases, any of vascular atherosclerotic diseases [4–8]. These studies reported that CIMT would be used as inflammatory markers in routine examination in many disorders [4–8]. Moreover, CIMT values are positively correlated inflammatory disease activity levels or inflammatory status [9]. However, some confounding factors should be mentioned. One of these factors, CIMT ismeasured by using ultrasoundwith linear probe. Clinicians' experiences are important to give interobserver and intraobserver variabilities in accepted limits, when CIMT is measured. Secondly, when CIMT is used as an inflammatory marker, the authors should measure some accepted inflammatory markers like C-reactive protein and examine the relationship between them [10]. As a conclusion, although CIMT may give useful information to clinicians about the systemic inflammation [11], one should be kept in mind that these above conditions are considered, when CIMT is assessed.

Hyperbaric oxygen (HBO) therapy has been shown to attenuate renal ischemia/reperfusion (I/R) injury in rats, when applied in the early reperfusion period. The aim of this study was to elucidate possible beneficial effects of HBO therapy on renal I/R injury, when applied 24 h after ischemia. Rats were randomized into three groups: (1) control group (n = 20), (2) I/R group (n = 20), and (3) I/R + HBO group (n = 20). Renal I/R injury was created by interrupting renal blood flow for 30 min with a non-traumatic vascular clamp. HBO therapy was administered 24 h after I/R injury and continued for 5 days. At the end of the study, rats were sacrificed under anesthesia, blood was drawn, and right kidneys were harvested for analysis. Renal I/R injury increased serum and tissue malondialdehyde (MDA) levels and reduced superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels. HBO therapy attenuated MDA levels by increasing SOD and GPx activities. HBO therapy also prevented neutrophil infiltration and tissue injury in kidneys. Taken together, HBO therapy has been found to be effective in the delayed period of I/R injury.

Purpose To evaluate the contribution of transoral ultrasonography (TUS) in the diagnosis and treatment of peritonsillar abscess. Methods We assessed the records of the patients who underwent TUS for suspected peritonsillar abscess. Results We identified a total of 26 patients with a prediagnosis of peritonsillar abscess. Following TUS examination, while the diagnosis was confirmed for 23 of the 26 patients (88.46%), the remaining 3 (11.53%) were diagnosed as having peritonsillar cellulitis. Conclusion TUS allows the differentiation of peritonsillar abscess from cellulitis, hence to avoid an unnecessary invasive procedure in the case of a peritonsillar cellulitis.

We read the article ‘‘The Ankle-Brachial Index is Associated With Cardiovascular Complications After Noncardiac Surgery’’ by Carmo et al with interest. They evaluated the role of ankle–brachial index (ABI) as a predictor of cardiovascular (CV) complications in patients with and without an abnormal ABI submitted to noncardiac surgery. An ABI 0.9 indicated a >7-fold chance for the occurrence of the primary outcome. Patients with symptomatic and asymptomatic atherosclerosis or several risk factors have relatively high rates of CV events. Additionally, several studies demonstrated an independent positive association between asymptomatic peripheral artery disease (PAD) and CV events, including stroke, transient ischemic attack, myocardial infarction, and death among patients with previous stroke. Serena et al analyzed the adjusted predictive capacity of the ABI together with additional markers of atherothrombotic disease as predictors of CV events. In the ARTICO stroke population, symptomatic PAD and particularly the association of both symptomatic PAD and ABI 0.9 with internal carotid artery stenosis >50% were independently associated with a 3.72 and 4.39 times increased risk of new vascular events. The ABI is a relatively simple, easy, noninvasive, and inexpensive test, and it is >90% sensitive and specific compared with angiography, the gold standard. Although the ABI provides several benefits, it also has limitations. For example, 10% of the general population have a congenital absence of the dorsalis pedis or posterior tibial artery meaning that ABI would not be accurate. In conclusion, Carmo et al describe the ABI as a predictor of CV complications in patients with noncardiac surgery. This relationship needs to be evaluated in large-scale prospective randomized clinical trials.

Comparison of WBC, Eosinophil%, and Basophil% among the -OP-038 patients suffered death from ACS and the patients survived from ACS Reduction of Eosinophil Percentage may Predict the Mortality from Acute Coronary Syndromes. Cengiz Ozturk, Mustafa Aparci, Sevket Balta, Turgay Celik, Ali Osman Yildirim, Mustafa Demir, Atilla Iyisoy. Dept. of Cardiology, Gulhane Military Medical Academy, Ankara, Turkey; Dept.of Cardiology Kasimpasa Military Hospital, Istanbul, Turkey; Eskisehir Military Hospital, Dept. of Cardiology and Aviation Medicine. Aim: Although medical and interventional therapeutic options had provided particular improvement in the management of patients with acute coronary syndrome (ACS). Various parameters which were related with the myocardial damage or systemic inflammatory response had been defined as the criteria for the poor prognosis. Recently eosinophil, basophil had been reported as having a potential role within the interaction of thrombotic process, systemic inflammatory response and tissue damage. We evaluated the whether those parameters could have been utilized as a predictor for the worst prognosis of ACS, mortality. Material-Method: We evaluated the CBC parameters among the patients who suffered death (n1⁄450) or survived (n1⁄429) from ACS. Results: We observed that WBC, MPV, and PDW were significantly elevated and basophil tended to be slightly elevated (p1⁄40.064) while eosinophil% was significantly reduced in mortality group (Table 1, Figure 1). Also we found that eosinophil percentage 1.45 could predict the mortality with sensitivity and specificity of 68% and 76%, (AUC1⁄40.776,CI 0.672-0.879, p

increased volume and increased heterogeneity of volume. Higher thrombotic activity represents a higher volume of myocardium jeopardized by continuing ischemia or infarction. Those parameters could be utilized in the context of a panel whichwas derived from several complete blood count parameters and myocardial injury biomarkers. In fact those parameters should be assessed in large populated studies designed to determine the prognostic factors related with acute coronary syndromes.

[1] Everon SH,WeisenbergM,Haroe E, et al. Proper insertion depth of endotracheal tubes in adults bytopographic landmarks measurements. J Clin Anesth 2007;19:15–9. [2] Rigini N, BoazM, Ezri T, et al. Prompt correction of endotracheal tube positioning after intubation prevents further inappropriate positions. J Clin Anesth 2011;23:367–71. [3] Hossein-nejadH, PayandemehrP, Bashiri SA, et al.Chest radiographyafter endotracheal tube placement: is it necessary or not? Am J Emerg Med 2013;31(8):1181–2.

Amiloidosis is most fatal complication of FMF. Former studies recognize that endothelial functions were severely impaired in patients who have amyloidosis than the patients who have other glomerulopathies. Asymmetric dimethyl arginine (ADMA), the endogenous inhibitor of nitric oxide synthase is possibly a causative or predictive factor in endothelial dysfunction in humans.