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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.

The aim of this study was to investigate the protective effects of taurine (Tau) on experimental acute pancreatitis (AP) in a rat model by measuring cytokines and oxidant stress markers. Forty rats were randomly divided into four groups: sham, AP, Tau and AP + Tau. AP was induced with sodium taurocholate. No treatment was given to the AP. All rats were killed 5 days later. Pancreatic tissues of rats and blood samples were obtained. Tau treatment significantly decreased serum amylase activity ( p < 0.001), total injury score ( p < 0.001), malondialdehyde levels ( p < 0.001) and myeloperoxidase (MPO) activity ( p < 0.001). There was no significant difference between the Tau and AP + Tau groups in serum and pancreatic tumor necrosis factor-α, interleukin (IL)-1β and IL-6 levels ( p = 1.000). Histopathologic scores in the AP + Tau and Tau groups were significantly lower compared with the AP group (both p < 0.001). These results showed that Tau reduces lipid peroxidation, amylase and MPO activities and the concentrations of proinflammatory cytokines secondary to AP and also increases superoxide dismutase and glutathione peroxidase activities in rats with sodium taurocholate-induced AP. It also has a marked ameliorative effect at histopathologic lesions. With these effects, Tau protects the cells from oxidative damage, reduces inflammation and promotes regression of pancreatic damage.

Summary Background: Studies with single-session hyperbaric oxygen exposures have shown that HBO-induced oxidative stress is proportional to exposure pressure and duration. Since the efficacy of hyperbaric oxygen mainly depends on repetitive exposures, this study aimed to investigate the oxidative effect of hyperbaric oxygen administered for 5 to 40 sessions. Methods: Sixty rats were divided into one control and 6 study groups. Study groups were exposed to 5, 10, 15, 20, 30, and 40 daily consecutive 2.8 atm/90 min hyperbaric oxygen sessions. Animals were sacrificed 24 h after the last hyperbaric oxygen administration. Malondialdehyde and carbonylated protein levels as well as superoxide dismutase activities were determined in isolated rat erythrocytes. Results: Carbonylated protein levels increased significantly after just 5 hyperbaric oxygen exposures; reached a peak level with 10 exposures; were still significantly higher than controls after 15 sessions; and decreased to normal limits after 20 exposures. Malondialdehyde levels were found to be significantly increased in the 10 to 30, but not in the 5 and 40-session groups. Superoxide dismutase activity showed elevated levels only in the 5 and 10 times hyperbarical oxygen-exposed groups. Conclusions: The suppressed oxidative stress level after 40 exposures suggests an effective endogenous antioxidant defense in repetitive HBO administrations.

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 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.

Here, we report a case of late device embolization to the abdominal aorta at the level of the superior mesenteric artery, approximately one month after percutaneous closure of an ASD.

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.

Afari et al. [1] in their review conclude that the neutrophil to lymphocyte ratio (NLR) may be enjoying a renaissance as an inflammatory biomarker. Indeed the NLR is a simple and cheap test when co...

Objectives: To determine whether the mean platelet volume (MPV) and MPV/platelet (PLT) values can be used in the study of sepsis and systemic inflammatory response syndrome (SIRS). Methods: In this retrospective case-controlled study, 69 sepsis, 69 SIRS patients, and 72 control group who were treated in the years 2012-2013 were reviewed, and both the MPV and MPV/PLT rates were evaluated in all groups at Kahramanmaras Sutcu Imam University Intensive Care Unit, Kahramanmaras, Turkey. Results: Statistically significant difference was found between sepsis, SIRS, and control groups when comparing the MPV and MPV/PLT ratio (p0.05). Mean platelet volume values for sepsis and control groups was 10.07/8.731 femtoliter (fL) (p=0.000), and 9.45/8.731 fL (p=0.000) for SIRS and control groups. In the group of sepsis patients, the MPV was found to be at cut-off 8.915, sensitivity 71%, and specificity 63.9%. In the group of patients with SIRS, MPV was found to be at cut-off 8.85, sensitivity 69.6%, and specificity 62.5%. For the MPV/PLT values, the specificity and sensitivity were found to be insignificant. Conclusion: This study shows that although there was no significant reduction in the PLT values between the sepsis and SIRS patients, the MPV and MPV/PLT ratio values were found to have significant differences. However, the specificity and sensitivity of the values were not reliable standard to be used as a test.

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)

Article history: Received 22 September 2015 Accepted 24 September 2015 Available online 6 November 2015 taneous coronary intervention. There are some reports about the spontaneous coronary artery dissections and their treatment with stenting. Some studies and case reports had reported that the conservative therapy for spontaneous coronary artery dissection might be favorable. But the proximal life threatening and progressed dissections during the acute stage of the disease must be treated with PCI or CABG.

Serum neuron-specific enolase (NSE) and S-100β levels are considered novel biochemical markers of neuronal cell injury. In this study, the initial and post-treatment levels of NSE and S-100β were compared in carbon monoxide (CO) poisoning patients, who received normorbaric oxygen (NBO) or hyperbaric oxygen (HBO) therapy. Forty consecutive patients with acute CO poisoning were enrolled in this prospective, observational study. According to their clinical symptoms and observations, twenty patients were treated with NBO, and the other twenty with HBO. Serum S-100β and NSE levels were measured both at time of admission and 6 h later (post-treatment). Serum NSE and S-100β values decreased significantly in both of the therapeutic modalities. The initial and post-treatment values of NSE and S-100β in NBO or HBO patients were comparable. A clear negative correlation was observed between the decrease of NSE and S-100β levels and initial blood carboxyhemoglobin levels. In conclusion, the present results suggested the use of serum S-100β and NSE levels as indicators for brain injury. Due to the significant increase of their values with oxygen therapy, they may also be useful as prognostic follow-up markers. However, the current findings reflected no difference between the efficacy of NBO or HBO therapy.

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.