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One of the most influential figures in the history of Islamic thought is Fakhr al-Dīn al-Rāzī (d. 606/1210). The identities of mushakkik, which creates problems on many subjects, especially metaphysical and theological ones, the muhaqqiq who tries to solve the problems above the sects, and the jâmî who brings many different views together in the highest concepts, have seriously affected all the thinkers after him. Therefore, in the tradition, all schools had to inherit the philosophical and scientific dynamism that he created and displayed an attitude about the problems he created and the solutions he offered. The real important motive that makes Râzî so indispensable and effective is his problematic identity (mushakkik), which carries the kalām to philosophy and philosophy to kalām, and criticizes philosophy on the basis of the kalām, and the kalām on the basis of philosophy. For this reason, when we look at the works of Râzî, who has been evaluated politically and sociologically within Ash'arism throughout his life, it is clearly seen that he is a thinker who is suitable to be embraced by different schools and to be interpreted in different ways. The fact that many Ahl as-sunnah theologians emphasized the works written by Râzî with a theological-Ash'ari theme, caused his supra-sectarian identity to be overshadowed. On the other hand, it is seen that some thinkers are making an effort to know and recognize Râzî as a philosopher-theologian and muhaqqiq. This effort is clearly seen especially in scientific figures who benefited from Kamaladdin Ibn Yûnus (d. 639/1242) in some way. Af?al al-Dīn Khūnajī (d. 646/1248), Athir al-Din al-Abharî (d. 663/1265), Najm al-Din al-Qazwinî al-Kâtibî (d. 675/1277) can be given as examples. These personalities, on the one hand, played an active role in the spread of Râzî's scientific heritage and they were effective in bringing Râzî to the fore with his supra-sectarian identity on the other. Sirāj Al-Dīn Al-Urmawî (d. 682/1283), who inherited his scientific legacy, is among the important names who established his identity as a muhaqqiq who mostly solved supra-sectarian problems. Human actions are at the forefront of the issues in which this facility has clearly emerged. Urmawî tries to revise al-Arba'în's expressions, which seem to ignore the power and influence of human beings in terms of human actions as well as criticizing Razi's arguments very seriously. In his work Lübâb, on the one hand, he summarizes al-Erba'în of Razî he seriously criticizes Razi's Ash'ari attitude towards human actions on the other. He does this largely on the axis of the arguments that Râzî himself expressed from his encyclopedic works such as al-Matâlibu'l-'âliyya mina'l-'ilmi'l-ilâhi. It is clear that this is not an ordinary situation. Because human actions are at the forefront of the issues that determine the thinkers' conception of divinity and the relationship between God and man. In this study, Râzî's attitude on this issue and Urmavi's philosophical and theological criticisms will be tried to be determined. Thus, it is clearly seen that he is trying to establish Râzî as a muhaqqiq in the axis of human actions. [ABSTRACT FROM AUTHOR]

Ganglionated plexus (GP) ablation is an emerging technique in patients with cardioinhibitory vasovagal syncope and vagally mediated atrial fibrillation. Localization of GPs can be impacted by the technique used. A reproduciblemethodology for GP detectionis needed to account for individual variations during electrophysiologic study.In this article, we aim to compare and contrast high-frequency stimulation vs. a fragmented electrogram guided strategy for GP localization. [ABSTRACT FROM AUTHOR]

Background/aim: The number of patients with heart transplantation has dramatically increased in the last decade. Considerable studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. We analyzed the dispersion of myocardial repolarization using electrocardiographic Tp-e interval and Tp-e/QTc ratio in patients with heart transplantation. Materials and methods: This observational study included 38 patients (12 female and 26 male) with heart transplantation and 38 wellmatched controls. From electrocardiograms, Tp-e interval and Tp-e/QTc ratio were calculated and compared between the 2 groups. Results: Noninvasive arrhythmia indicators including Tp-e interval (84.63 ± 14.17 ms vs 71.82 ± 7.47 ms, P < 0.001), Tp-e/QTc ratio (0.19 ± 0.04 vs 0.16 ± 0.02, P < 0.001) and QTc interval except QT interval were significantly higher in transplanted hearts compared to normal hearts. Conclusion: Patients with heart transplantation have increased myocardial dispersion of repolarization. [ABSTRACT FROM AUTHOR]

Background: Delirium is common after cardiac surgery and is independently associated with increased morbidity, mortality, prolonged hospital stays, and higher costs. Cobalamin (vitamin B12) deficiency is a common cause of neuropsychiatric symptoms and affects up to 40% of elderly people. The relationship between cobalamin deficiency and the occurrence of delirium after cardiac surgery has not been examined in previous studies. We examined the relationship between cobalamin deficiency and delirium in elderly patients undergoing coronary artery bypass grafting (CABG) surgery. Material and methods: A total of 100 patients with cobalamin deficiency undergoing CABG were enrolled in this retrospective study. Control group comprised 100 patients without cobalamin deficiency undergoing CABG. Patients aged 65 years or over were included. Diagnosis of delirium was made using Intensive Care Delirium Screening Checklist. Delirium severity was measured using the Delirium Rating Scale-revised-98. Results: Patients with cobalamin deficiency had a significantly higher incidence of delirium (42% vs 26%; P=0.017) and higher delirium severity scores (16.5±2.9 vs 15.03±2.48; P=0.034) than patients without cobalamin deficiency. Cobalamin levels were significantly lower in patients with delirium than patients without delirium (P=0.004). Delirium severity score showed a moderate correlation with cobalamin levels (ρ=-0.27; P=0.024). Logistic regression analysis demonstrated that cobalamin deficiency was independently associated with postoperative delirium (OR 1.93, 95% CI 1.03-3.6, P=0.038). Conclusion: The results of our study suggest that cobalamin deficiency may be associated with increased risk of delirium in patients undergoing CABG. In addition, we found that preoperative cobalamin levels were associated with the severity of delirium. This report highlights the importance of investigation for cobalamin deficiency in patients undergoing cardiac surgery, especially in the elderly. [ABSTRACT FROM AUTHOR]

Objective: Cryoballoon ablation (CA) is a safe and efficient method for pulmonary vein isolation in the treatment of paroxysmal atrial fibrillation (AF). There are conflicting results about the predictors of AF recurrence. The aim of this study is to evaluate the role of hematological indices to predict AF recurrence after CA. Methods: A total of 49 patients (mean age 58.3±12.2 years, 51.02% female) with symptomatic paroxysmal AF underwent CA procedure. One hundred and sixty-eight pulmonary veins were used for pulmonary vein isolation with the second-generation cryoballoon. The hematological samples were obtained before and 24 hours after ablation. Results: At a mean follow-up of 10.2±2.4 months, the probability of being arrhythmia-free after a single procedure was 86%. Patients with AF recurrence had higher red cell distribution width levels (16.10%±1.44% vs 14.87%±0.48%, P=0.035). The neutrophil/lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein levels were detected in the patients with or without recurrence. Left atrial diameter (46.28±4.30 mm vs 41.02±4.10 mm, P=0.002), duration of AF (6.71±4.57 years vs 3.59±1.72 years, P=0.003), and age (65.01±15.39 years vs 54.29±11.32 years, P=0.033) were the other independent predictors of clinical recurrence after CA. Multiple regression analysis revealed that left atrial diameter was the only independent predictor for AF recurrence (P=0.012). Conclusion: In this study of patients with paroxysmal AF undergoing cryoablation, increased preablation red cell distribution width levels, and not C-reactive protein or erythrocyte sedimentation rate, was associated with a higher rate of AF recurrence. Our results support the role of a preablation, proinflammatory, and pro-oxidant environment in the development of AF recurrence after ablation therapy but suggest that other factors are also important. [ABSTRACT FROM AUTHOR]

Background: Rheumatic heart disease (RHD) is a serious health concern in developing countries. Rheumatic mitral stenosis (RMS) is the most long-term sequel in RHD. The neutrophil to lymphocyte ratio (NLR) is a novel marker, and a higher NLR has been associated with poor clinical outcomes in various cardiovascular disorders. We evaluated the availability of NLR to predict severity of mitral stenosis (MS) in patients with RHD. Methods: We analyzed 300 consecutive patients with RMS. The patients were divided into tertiles according to NLR: 0.85< NLR ⩽1.85 (n=100, tertile 1), 1.86⩽ NLR ⩽2.46 (n=100, tertile 2), and 2.47⩽ NLR ⩽7.08 (n=100, tertile 3). Patients with RMS were divided into three groups based on the degree of MS as mild, moderate, and severe MS. After the initial evaluation, 187 patients with moderate-to-severe RMS (Group 1) and 113 patients with mild RMS (Group 2) were reassessed. Results: The patients with severe RMS had significantly elevated NLR, mean platelet volume, and pulmonary artery systolic pressure values compared to patients with moderate and mild MS (P<0.001, P<0.001, P<0.001 respectively). Multivariate binary logistic regression analysis revealed that high levels of NLR was an independent predictor of severe RMS (odds ratio =0.68, P=0.008). Moderate-to-severe RMS incidence was significantly higher among patients in the tertile 3 (odds ratio =2.8, P=0.001). Conclusion: NLR is a new inflammatory marker and a simple, rapid, and easily accessible prognostic parameter that can be associated with severity of RMS in patients with RHD. [ABSTRACT FROM AUTHOR]

Lactate is a product of anaerobic metabolism and increases in states of tissue hypoxia. Furthermore, it is demonstrated that lactate level is correlated with the extent of infarct area and short term (30-day) mortality rates in patients with acute coronary syndrome with ST segment elevation (STE-ACS). Therefore, we aimed to test the prognostic value of this easily obtainable parameter on outcomes in patients presenting with STE-ACS. All adult patients who admitted with STE-ACS between 2019 and 2020 were screened. The cases with admission lactate levels were included. Patients were separated into two groups as low (<2mmol/l) and high (>2mmol/l) lactate groups. A total of 70 patients were enrolled. The mean age of the study population was 62.3 ± 15.0 years and 53 (75.7%) of them were male. The most common infarct related artery was the left anterior descending (LAD) artery. The median lactate level was 2.5 (0.80-15.3) mmol/L. Malignant arrhythmia, contrast induced nephropathy (CIN), and in-hospital mortality rates were not different between the high and low lactate groups. However, all-cause mortality was significantly higher in the high lactate group during the follow-up (p=0.005). Among all included parameters; lactate level [OR:1.76, (CI: 1.28-2.42); p<0.001] and age [OR:1.10, (CI: 1.03-1.17); p=0.004] were predictors for all-cause mortality. Admission lactate level can predict all-cause mortality in patients with STE-ACS. In addition, high admission lactate levels could help to raise more attention even if the patients have been discharged from the hospital. [ABSTRACT FROM AUTHOR]

The article discusses the case of a 20-year old woman presented for type 3 Gaucher's disease histopathologically after a liver biopsy which detected an oculomotor apraxia.

Obstructive sleep apnea is common in adults with cardiovascular disease. Accumulating evidence suggests an association between obstructive sleep apnea and cardiovascular disease independent of the traditionally recognized cardiovascular disease risk factors. Observational studies indicate that obstructive sleep apnea is a risk factor for development of cardiovascular disease and that alleviation of obstructive events with positive airway pressure may improve cardiovascular disease outcomes. However, recent randomized controlled trials have not supported the beneficial effect of positive airway pressure in cardiac populations with concomitant obstructive sleep apnea. Some evidence suggests that the relationship between obstructive sleep apnea and traditionally recognized cardiovascular disease risk factors is bidirectional, suggesting that patients with cardiovascular disease may also develop obstructive sleep apnea and that efficient treatment of cardiovascular disease may improve obstructive sleep apnea. Recent data also indicate that the apnea-hypopnea index, which is commonly used as a diagnostic measure of obstructive sleep apnea severity, has limited value as a prognostic measure for cardiovascular disease outcomes. Novel markers of obstructive sleep apnea-associated hypoxic burden and cardiac autonomic response seem to be strong predictors of adverse cardiovascular disease outcomes and response to treatment of obstructive sleep apnea. This narrative review and position paper from the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to update the current evidence about the relationship between obstructive sleep apnea and cardiovascular disease and, consequently, raise awareness for health professionals who deal with cardiovascular and respiratory diseases to improve the ability to direct resources at patients most likely to benefit from treatment of obstructive sleep apnea and optimize treatment of the coexisting cardiovascular diseases. Moreover, the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to contribute to strengthening the efforts of the International Collaboration of Sleep Apnea Cardiovascular Trialists in this context. [ABSTRACT FROM AUTHOR]

Excessive haemodilution and the resulting anaemia during CPB is accompanied by a decrease in the total arterial oxygen content, which may impair tissue oxygen delivery. Hyperoxic ventilation has been proven to improve tissue oxygenation in different pathophysiological states of anaemic tissue hypoxia. The aim of this study was to examine the influence of arterial hyperoxaemia on tissue oxygenation during CPB. Records of patients undergoing isolated CABG with CPB were retrospectively reviewed. Patients with nadir haematocrit levels below 20% during CPB were included in the study. Tissue hypoxia was defined as hyperlactataemia (lactate >2.2 mmol/L) coupled with low ScVO2 (ScVO2 <70%) during CPB. One hundred patients with normoxaemia and 100 patients with hyperoxaemia were included in the study. Patients with hyperoxaemia had lower tissue hypoxia incidence than patients with normoxaemia (p<0.001). Compared with patients without tissue hypoxia, patients with tissue hypoxia had significantly lower PaO2 values (p<0.001) and nadir haematocrit levels (p<0.001). Nadir haematocrit levels <18% (OR: 5.3; 95% CI: 2.67–10.6; p<0.001) and hyperoxaemia (OR: 0.28; 95% CI: 0.14–0.56; p<0.001) were independently associated with tissue hypoxia. Conclusions: Hyperoxaemia during CPB may be protective against tissue hypoxia in patients with nadir haematocrit levels <20%. [ABSTRACT FROM AUTHOR]

Background: Facioscapulohumeral muscular dystrophy is one of the most common congenital muscle disorders. Whether facioscapulohumeral muscular dystrophy causes cardiac involvement is still controversial. Although electrocardiography and conventional echocardiography studies have been performed, there is no data on strain echocardiography in facioscapulohumeral muscular dystrophy. Our study aims to compare the myocardial strain parameters by 2-dimensional speckle tracking echocardiography in patients with facioscapulohumeral muscular dystrophy and the normal group. Methods: This prospective single-center study included 35 patients with facioscapulohumeral muscular dystrophy and 54 control patients. Demographic, clinical, and laboratory parameters of both groups were compared. In addition to conventional echocardiography images, myocardial strain parameters were performed using 2-dimensional speckle tracking echocardiography. Results: The median age of the study population was 25 (19-35 IQR) and 51 (57.3%) of them were male. Left ventricle-global circumferential strain was significantly lower in the facioscapulohumeral muscular dystrophy group than in the normal group [-20.3 (-22.0; -19.0) vs. -21.6 (-22.5; -20.0), P = .020]. Two-dimensional speckle tracking echocardiography findings except left ventricle-global circumferential strain [for left ventricle-global longitudinal strain P = .259, for left ventricle-global radial strain P = .338, for right ventricle-global circumferential strain P = .250, and for right ventricle-free wall longitudinal strain P = .288] were similar in both groups. Conclusions: As a result of our study, there was no significant difference between 2-dimensional speckle tracking echocardiography parameters other than the left ventricle-global circumferential strain between facioscapulohumeral muscular dystrophy and normal groups. [ABSTRACT FROM AUTHOR]

We investigated 2 hypotheses: (1) a relationship between platelet indices and stable coronary artery disease (CAD) and acute ST-segment elevation myocardial infarction (STEMI) and (2) a relationship between platelet indices on admission and thrombolysis outcomes in patients with STEMI. A total of 260 patients were enrolled. The white blood cell (WBC) and platelet distribution width (PDW) were found to be increased in patients with STEMI (P for both < .001). White blood cell and PDW were independent predictors of acute STEMI. Mean platelet volume (MPV) and PDW were significantly higher in the thrombolysis failure group than in the thrombolysis success group (9.9 ± 1.8 vs 9.2 ± 1.5 fL, P = .021 and 17.7 ± 1.0 vs 16.4 ± 2.1 fL, P < .001, respectively). Mean platelet volume and PDW were independent predictors of thrombolysis failure. Patients with acute STEMI had higher PDW than did patients with stable CAD. In addition, higher PDW and MPV seem to correlate with thrombolysis failure in patients with STEMI. [ABSTRACT FROM AUTHOR]

The article presents a case study of 43-year-old woman with dyspnea and palpitation.. Examination revealed presence of right ventricular enlargement along with severe pulmonary hypertension, atrial fibrillation, and absence of interatrial septum (IAS). Patient was treated with bosentan and furosemid and calcium channel blocker and attend attained New York Heart Association functional class I–II.

Introduction: Single‐center observational studies have shown promising results with fragmented electrogram (FE)‐guided ganglionated plexus (GP) ablation in patients with vagally mediated bradyarrhythmia (VMB). We aimed to compare the acute procedural characteristics during FE‐guided GP ablation in patients with VMB performed by first‐time operators and those of a single high‐volume operator. Methods and Results: This international multicenter cohort study included data collected over 2 years from 16 cardiac hospitals. The primary operators were classified according to their prior GP ablation experience: a single high‐volume operator who had performed > 50 GP ablation procedures (Group 1), and operators performing their first GP ablation cases (Group 2). Acute procedural characteristics and syncope recurrence were compared between groups. Forty‐seven consecutive patients with VMB who underwent FE‐guided GP ablation were enrolled, n = 31 in Group 1 and n = 16 in Group 2. The mean number of ablation points in each GP was comparable between groups. The ratio of positive vagal response during ablation on the left superior GP was higher in Group 1 (90.3% vs. 62.5%, p =.022). Ablation of the right superior GP increased heart rate acutely without any vagal response in 45 (95.7%) cases. The procedure time was longer in group 2 (83.4 ± 21 vs. 118.0 ± 21 min, respectively, p <.001). Over a mean follow‐up duration of 8.0 ± 3 months (range 2–24 months), none of the patients suffered from syncope. Conclusion: This multi‐center pilot study shows for the first time the feasibility of FE‐guided GP ablation across a large group of procedure‐naïve operators. [ABSTRACT FROM AUTHOR]

Objective: Acute kidney injury (AKI), which is prevalent in ST-segment elevated myocardial infarction (STEMI) patients who have undergone primary percutaneous coronary intervention (PCI), is associated with poor cardiovascular outcomes. As high pulse pressure (PP) is associated with adverse cardiovascular events, the present study's aim was to evaluate the relationship between fractional PP (PPf) and AKI in patients with STEMI who underwent primary PCI.Subjects and Methods: All laboratory findings as well as echocardiographic and angiographic data of 1,170 consecutive STEMI patients were retrospectively screened. PPf was calculated from the pressures invasively measured after sheath insertion and before performing coronary angiography.Results: From 1,170 eligible STEMI patients (mean age 56 years, 18.2% female), AKI developed in 143 (12.2%) patients. The PPf and pulsatility index were significantly higher in patients with AKI than those without (0.53 ± 0.10 vs. 0.61 ± 0.10, p < 0.001, and 0.80 ± 0.03 vs. 0.82 ± 0.03, p < 0.001, respectively). PPf was also found to be associated with AKI in univariable (OR 2.183, 95% CI 1.823-2.614, p< 0.001) and multivariable (OR 1.874, 95% CI 1.513-2.322, p < 0.001) analysis. In-hospital mortality was higher in patients with AKI than those without.Conclusion: Invasively measured PPf, which can be easily measured and has no additional cost in STEMI patients undergoing coronary intervention, is an independent predictor of AKI. In addition, PPf is superior to other blood pressure values and derivatives in AKI prediction. [ABSTRACT FROM AUTHOR]

Improved renal recovery in patients with atypical hemolytic uremic syndrome following rapid initiation of eculizumab treatment. The presence of complement gene abnormalities is a risk for aHUS relapse after anti-C5 treatment discontinuation, including in P-aHUS patients. Dear Editor, A typical hemolytic uremic syndrome (aHUS), which occurs with the uncontrolled activity of the complement system, can occur at any age. When there is no haematological and renal improvement in the first four or five PEX treatments, the treatment should be based on the patient's ADAMTS-13 level. [Extracted from the article]

The aim of this study is to investigate the impact of ticagrelor as compared to clopidogrel based dual antiplatelet therapy (DAPT) during post-discharge management on the incidence of left ventricular (LV) thrombus in patients with first acute anterior ST elevation myocardial infarction (STEMI). 641 patients who met the inclusion criteria were divided into two groups based on the receipt of either ticagrelor or clopidogrel based DAPT. Left ventricular thrombus was detected in 73 (11.4%) patients at the first month echocardiographic examination. Ticagrelor based DAPT was associated with significantly less incidence of LV thrombus when compared to clopidogrel [20 (7.4%) vs 53 (14.0%) OR: 0.50 (0.29–0.86)]. Penalized maximum likelihood estimation (PMLE) logistic regression analyses were performed to fourteen candidate variables for identifying the independent predictors of LV thrombus, ticagrelor (compared with clopidogrel) [OR: 0.53 (0.28–0.96), p = 0.039], body mass index (BMI) [OR: 0.58 (0.44–0.77), p < 0.001], KILLIP class (I vs II–IV) [OR: 0.35 (0.14–0.83), p = 0.017], age [OR: 1.22 (1.08–1.40), p < 0.001], poor postprocedural myocardial blush grade (MBG) [OR: 3.35 (1.32–8.15), p = 0.012] and LVEF predischarge [OR: 0.79 (0.72–0.86), p < 0.001] were found to be associated with LV thrombus. Our study demonstrated that the incidence of LV trombus was significantly lower with ticagrelor than clopidogrel-based DAPT during postdischarge treatment for anterior STEMI patients. • Left ventricular thrombus is a potential source of systemic embolization after STEMI. • Prophylactic treatment in addition to DAPT is not recommended after discharge. • Ticagrelor has faster and achieves more consistent P2Y12 inhibition than clopidogrel. • The incidence of left ventricular thrombus is lower with ticagrelor than clopidogrel. [ABSTRACT FROM AUTHOR]

Objectives. Coronary collateral circulation (CCC) may limit the size of right ventricular (RV) infarcts but does not fully explain the relationship between CCC and clinical adverse events in patients with inferior STEMI. In this study, it was aimed to assess the relationship between preintervention angiographic evidence of CCC and clinical outcomes in patients with inferior STEMI who have undergone percutaneous coronary intervention. Methods. A total of 235 inferior STEMI patients who presented within the first 12 hours from the symptom onset were included. CCC to the right coronary artery (RCA) before angioplasty were angiographically assessed, establishing two groups: 147 (63%) patients without CCC and 88 (37%) with CCC according to presence of CCC. Results. RV infarction, complete atrioventricular block, VT/VF, cardiogenic shock, and in-hospital death were noted less frequently in patients with CCC than in those without CCC. Absence of CCC to RCA was found to be the independent predictor for in-hospital death among them (odds ratio 4.0, 95% CI 1.8–12.6; p=0.03). Conclusion. Presence of angiographically detectable CCC was associated with better in-hospital outcomes including RV infarction, complete AV block, cardiogenic shock, and VT/VF in patients with inferior STEMI. [ABSTRACT FROM AUTHOR]

Objective: Emergency departments are the first places to which patients present with unexpected or unforeseen health problems. The purpose of this study was to assess the urgency of cases brought by ambulance to the Hospital on the basis of a three-level triage system. Methods: This study was performed between 01.06.2013 and 31.09.2013 at the Diyarbakır Education and Research Hospital. Our emergency service unit is a third degree service for all adult patient groups and all child trauma types. Triage of patients brought to the emergency department by ambulance was performed by emergency medicine specialists. Patients' vital findings, identity data and triage categories were assessed. Results: 712 patients were included, 382 (53.7%) male and 330 (46.3%) female, with a mean age of 45. In this study, 619 (86.9%) patients were transferred from the scene and 93 (13.1) between hospitals, 483 (67.8%) patients were brought by emergency medicine technician (EMT) teams, 107 (15%) by physician-led teams, 107 (15) by paramedic teams and 15 (2.1%) by other teams, 442 (62.1%) patients were assessed as yellow, 141 (19.8%) as green and 129 (19.1%) as red zone. Five hundred eighty (81.5%) patients were discharged and 115 (15.9%) were hospitalized. Conclusion: Emergency health services are clearly developing rapidly in Turkey. In order for pre-hospital emergency health services not to be abused, we think that these services should be up to the standards of those in developed countries and that public awareness needs to be increased, particularly with regard to triage. [ABSTRACT FROM AUTHOR]

As the CHADS2 and CHA2DS2-VASc scores include similar risk factors for the development of coronary artery disease (CAD), they may provide crucial information regarding the severity of coronary artery lesions and the risk of thromboembolism. To increase the likelihood of determining CAD severity, we formulated the CHA2DS2-VASc-HS score comprising hyperlipidemia and smoking in addition to the components of the CHA2DS2-VASc score and male instead of female gender. We aimed to investigate whether these 3 risk scores can be used to predict CAD severity. A total of 407 consecutive patients who underwent coronary angiography were enrolled in the study. Presence of >50% stenosis in a coronary artery was assessed as significant CAD. Of the patients, 87 had normal coronary angiograms and served as group 1. The remaining 320 patients with coronary stenosis were further classified into 2 groups according to CAD with stenosis of <50% or ‡50%: 123 patients with mild CAD as group 2 and 197 patients with severe CAD as group 3. The CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores were significantly different among the 3 groups. The CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores correlated significantly with the number of diseased vessels (r [ 0.406, p <0.001; r [ 0.308, p <0.001; and r [ 0.533, p <0.001, respectively) and the Gensini score (r[0.383, p <0.001; r[0.300, p <0.001; and r[0.500, p <0.001, respectively). The CHA2DS2-VASc-HS score was found to be the best scoring scheme to predict CAD severity in the area under the curve comparison of these scoring systems. For prediction of severe CAD, the cut-off value of CHA2DS2-VASc-HS score was >2 with a sensitivity of 85.2% and a specificity of 57.5% (area under the curve 0.802, 95% confidence interval 0.760 to 0.839, p <0.001). In conclusion, our findings suggest that the CHADS2, CHA2DS2-VASc, and especially CHA2DS2-VASc-HS scores could be considered predictive of the risk of severe CAD. [ABSTRACT FROM AUTHOR]

The article discusses the evaluation of extractable metals lead, copper, manganese, strontium, nickel, vanadium, iron, zinc and chromium in street dust samples from Sakarya, Turkey, using the three-step sequential extraction procedure described by the Standards, Measurements, and Testing Programme of the European Union (EU). The determination of multielements in the samples is described. The author also discuss the validation of the proposed method using BCR 701 certified reference material.

A letter to the editor is presented in response to the article "Value of serial platelet indices measurements for the prediction of pulmonary embolism in patients with deep venous thrombosis" by U. Sevuk and colleagues in the August 2015 issue along with the author's reply.

This study was sought to examine the effects of repetitive monomorphic premature ventricular contractions (PVCs) on left ventricular (LV) diastolic function. Thirty-three symptomatic patients (Study group, 10 males, mean age 40 ± 8 years) with normal LV systolic function and repetitive PVCs originating from the right ventricular outflow tract (RVOT-PVCs) on 24-h Holter monitoring, and 30 healthy controls (Control group, 9 males, mean age 37 ± 9 years) were enrolled in the study. None of the patients had structural heart disease. Diastolic function was assessed by echocardiographic mitral inflow pattern and tissue Doppler imaging. The study group displayed a lower E/A ratio, longer isovolumetric relaxation time (IVRT), and longer E-wave deceleration time (EDT). In the study group 13 patients showed impaired relaxation. While mean values of the systolic velocity (Sa), early diastolic velocity (Ea), and early/late diastolic velocity (Ea/Aa) ratio were significantly lower in the study group, the Aa velocity and E/Ea ratio were significantly higher. Ea velocity was <10 cm/s in 7 study patients. Mitral inflow pattern and Ea velocity was normal in all controls. Significant correlations were found between ventricular premature beats percentage and early to late transmitral flow velocity ratio, EDT, IVRT, Ea velocity, the Ea/Aa ratio, and the E/Ea ratio. In multivariate analysis, total PVC count and age were found to be independent predictors of impaired relaxation. These results suggest that repetitive monomorphic RVOT-PVCs lead to abnormalities of LV diastolic function that may contribute to clinical symptoms in patients with structurally normal hearts. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 72-year-old man who was treated for pericardial calcification of atrioventricular (AV) groove and constrictive physiology of tricuspid and mitral valve. Topics include the diagnosis of acute coronary syndrome, the interpretation of the patient's coronary angiography result, and the treatment through coronary artery by-pass graft surgery and pericardial resection.