Objective: Contrast-induced nephropathy (CIN) is associated with significantly increased morbidity and mortality after percutaneous coronary intervention (PCI). Patients with acute coronary syndrome (ACS) are at higher risk of CIN. The platelet-to-lymphocyte ratio (PLR) is closely linked to inflammatory conditions. We hypothesized that PLR levels on admission can predict the development of CIN after PCI for ACS. Subjects and Methods: A total of 426 patients (mean age 63.17 ± 13.01 years, 61.2% males) with ACS undergoing PCI were enrolled in this study. Admission PLR levels were measured before PCI. Serum creatinine values were measured before and within 72 h after the administration of contrast agents. Patients were divided into 2 groups: the CIN group and the no-CIN group. CIN was defined as an increase in serum creatinine level of ≥0.5 mg/dl or 25% above baseline within 72 h after contrast administration. Results: CIN developed in 53 patients (15.9%). Baseline PLR was significantly higher in patients who developed CIN compared to those who did not (160.8 ± 29.7 and 135.1 ± 26.1, respectively; p < 0.001). Multivariate analyses found that PLR [odds ratio (OR) 3.453, 95% confidence interval (CI) 1.453-8.543; p = 0.004] and admission creatinine (OR 6.511, 95% CI 1.759-11.095; p = 0.002) were independent predictors of CIN. Conclusions: The admission PLR level is an independent predictor of the development of CIN after PCI in ACS.

Atrial fibrillation is the most common sustained arrhythmia in clinical practice. It is important to specify patients with a high risk of thromboembolus due to elevated procoagulant and prothrombotic state. The aim of this study is to assess the relation of stroke/transient ischaemic attack (TIA) with mean platelet volume (MPV), which is an indicator of platelet activation in patients with paroxysmal atrial fibrillation (PAF). Patients with PAF were enrolled in this study during years of 2012-2014. Patients were divided into two groups according to the presence or absence of stroke/TIA. Demographic data were registered and CHA2DS2VASc scores of patients were calculated. It was investigated whether there was a difference among groups regarding MPV levels. Ninety patients, 31 of whom had history of stroke/TIA (symptomatic group), were enrolled to study. CHA2DS2VASc score of symptomatic group was 4.77 ± 1.26, while CHA2DS2VASc score of asymptomatic group was 2.63 ± 1.41. Nevertheless, there was not any difference regarding CHA2DS2VASc score among two groups when 2 points due to stroke/TIA were subtracted in symptomatic patients. MPV was detected higher in symptomatic patients than asymptomatic patients (11.1 ± 1.3 vs. 9.1 ± 1.0 fL, P < 0.001, respectively). A value of 9.85 for the MPV ascertained with receiver operating characteristic (ROC) curve analysis to predict stroke/TIA was found to have a sensitivity of 87% and specificity of 78%. Elevated MPV levels were ascertained to be related with stroke/TIA in patients with PAF. Assessment of MPV apart from CHA2DS2VASc score in patients with PAF might be subsidiary to specify patients with an enhanced risk of stroke/TIA.

No abstract

Celiac disease (CD) is an immune-mediated enteropathy involving the small intestines. Genetic and environmental risk factors as well as autoimmunity have been linked to its etiology. Studies have shown that coronary artery disease, autoimmune myocarditis, arrhythmias and premature atherosclerosis are more prevalent in individuals with CD compared to individuals without the disease. In this case report a young male patient with CD presented with acute myocardial infarction with spontaneous coronary artery dissections of two vessels. To the best of our knowledge, this is the first case report of spontaneous multi-vessel coronary artery dissection in a patient with CD.

No abstract

Patients with a higher risk of pseudoaneurysm development following intervention via the femoral artery should be specified and extra attention given during the intervention. These patients should be informed of the increased risk of this complication and its results, and should be under close follow-up concerning development of iatrogenic femoral pseudoaneurysm.

We disclosed that left ventricular structural changes and diastolic dysfunction occur in obese patients, and by weight loss, these abnormalities may be reversible which we demonstrated both by conventional and TDE. In addition, obesity might impair RV function as well, and we observed an enhancement in right ventricular functions by weight loss.

We discuss the case of a 46-year-old male patient presenting to the emergency department with acute inferior myocardial infarction. Coronary angiography demonstrated a vasospasm of the left main coronary artery and proximal segment of the left anterior descending artery. Furthermore, a thrombotic total occlusion was ascertained in the right coronary artery. The vasospasm in the left main and left anterior descending artery disappeared after nitrate administration. We successfully implanted a stent to the thrombotic occlusion in the right coronary artery after predilatation. On detailed questioning, the patient stated that ozonated autohemotherapy had been applied that morning in a private clinic for the revitalization and regeneration of tissues. The patient did not have any traditional atherosclerotic risk factors. He denied any history of cardiac complaint. Factor V Leiden, prothrombin 20210 and MTHFR a1298c and c677t mutations were investigated and found to be negative except for MTHFR a1298c, which was a heterozygote. The levels of antithrombin III, homocysteine and protein C and S were all within normal ranges. Ozone as a medical therapy has been used in many medical conditions; unfortunately, however, like every other therapy, ozone therapy has side effects. The literature concerning ozone therapy supports possible strong vasoconstrictor and prothrombotic effects of ozone therapy, further supporting our suggestion that ozone can lead to acute coronary syndromes in human beings. In conclusion, to our knowledge, our case report reveals a possible complication of ozone therapy that has never been reported before. We think that this article will raise the awareness of the possibility of thrombotic complications after ozonated autohemotherapy.