Effect of new oral anticoagulants on platelet indices in non-valvular atrial fibrillation patients.

New-generation oral anticoagulants (NOACs) are now preferred as a first-line treatment in the management of atrial fibrillation for prevention of thromboembolic complications. Mean platelet volume (MPV), one of the indicators of increased platelet activity, is also associated with an increased stroke risk in atrial fibrillation patients. The aim of this study was to evaluate changes in MPV, platelet distribution width (PDW) and plateletcrit following use of NOACs. The study included 116 patients with non-valvular atrial fibrillation without previous NOAC use. Complete blood counts, biochemical analyses and echocardiography were performed for all patients. No significant differences were observed in MPV or other platelet indices at 6 months compared to baseline. Our results indicate that MPV and other platelet indices are not affected by NOAC use in non-valvular atrial fibrillation patients.

The role of baseline and post-treatment frontal QRS-T angle for detecting arterial blood pressure control.

Objectives: In this study, we aimed to investigate the value of the frontal QRS-T angle (f(QRS-T)) in determining blood pressure control among newly diagnosed hypertensive patients with no left ventricular hypertrophy.Methods: Fifty patients with newly diagnosed hypertension were included in this single-center study. The patients were examined with 12-lead ECGs and 24-hour ambulatory blood pressure monitoring (24 h-ABPM) before and 1 month after antihypertensive treatment.Results: Baseline and post-treatment f(QRS-T) angle values were observed to be similar (38.0 [0.0-174.0] and 37.0 [1.0-139.0], respectively; p = .827). The values of QT minimum (p = .006), QTc mean (p = .030), Tp-e (p = .027), and JTc (p = .010) significantly decreased after control of blood pressure.Conclusions: The f(QRS-T) angle, which can be easily calculated on the ECG, is not a useful tool to determine hypertension control at early stage in newly diagnosed hypertensive patients.

Differential value of eosinophil count in acute coronary syndrome among elderly patients.

We aimed to search eosinophil (EOS) counts in elderly acute coronary syndrome (ACS) subjects and to investigate its value for discrimation between unstable angina pectoris (UAP) and myocardial infarction (MI) [non-ST elevation MI (NSTEMI) or ST elevation MI (STEMI)]. The patients were divided into three groups regarding the diagnosis: patients with UAP (63), with NSTEMI (154), and with STEMI (73). General characteristics such as gender, age, systolic and diastolic blood pressure were obtained from patients' files. Complete blood count and biochemical parameters were measured before coronary angiography. EOS was found significantly higher in UAP (0.134 (0.002-0.746) u/mm3) compared to NSTEMI (0.085(0.001-0.601) u/mm3) and STEMI (0.020(0.001-0.479) u/mm3) groups. Kruskal-Wallis test with Bonferroni-corrected Mann-Whitney U-test revealed that EOS count was significantly different between UAP and NSTEMI (p < .001), UAP and STEMI (p < .001) and NSTEMI and STEMI (p < .001) groups. A receiver operating curve (ROC) analysis revealed that a cut-off >0.083 u/mm3 EOS value had a sensitivity of 79% and specificity of 57% for determination of ACS as UAP (AUC = 0.686, 95% CI, 0.617-0.755). In the present study, we detected an inverse relationship between the number of blood eosinophil count and the severity of ACS subgroups in elderly patients with higher counts in UAP than MI groups.

Significant correlation between uric acid levels and flow-mediated dilatation in patients with masked hypertension.

BACKGROUND: Serum uric acid (UA) level is associated with prognosis in cardiovascular disorders such as sustained hypertension, diabetes mellitus and chronic kidney diseases. Increased UA levels in sustained hypertension may reflect early renal vascular alterations. However, it remains unclear if serum UA is associated with endothelial dysfunction in masked hypertensive patients. METHODS: A total of 100 individuals (57% men and 43% women; mean 45 ± 8 years) with masked hypertension were included in the present study. The clinical and laboratory data were collected. Endothelial function was estimated by flow-mediated dilatation (FMD) of the brachial artery and expressed as percentage change relative to baseline diameter. RESULTS: Univariate regression analysis showed that the FMD was significantly negative correlated with uric acid (r = -0.300, p = 0.002), ambulatory 24-h systolic blood pressure (SBP) (r = -0.275, p = 0.008), hs-CRP (r = -0.222, p = 0.033) and diastolic aortic diameter (r = -0.243, p = 0.019). In multivariate linear regression analysis, only uric acid levels and ambulatory 24-h SBP were significantly associated with FMD. CONCLUSION: There was an independent correlation between UA and FMD, and a higher UA level was related to worse endothelial function which may contribute to hypertension and cardiovascular morbidity.

Mean platelet volume: an important predictor of coronary collateral development.

Collaterals, which develop in response to ischemic stimuli derived from coronary artery disease (CAD), contribute to reduction of infarct size, left ventricular dysfunction, and mortality. However, there is considerable variation among patients with coronary heart disease regarding the extent of coronary collateral development (CCD). In this study, we aimed to investigate the association of the degree of platelet activation via mean platelet volume (MPV) with coronary collateral circulation. Therefore, 210 patients who underwent coronary angiography and had coronary stenosis ≥50 % in at least one coronary artery were included in the study. Clinical information and analyses of blood samples were obtained from a review of the patients' chart. Blood samples for MPV were analyzed by K3 EDTA and collateral vessels were graded according to the Rentrop classification. In the study group, 150 of the 210 patients were found to have inadequate CCD. Although there was no difference between the two groups with regard to platelet count, MPV levels were significantly higher in the patients who had inadequate CCD (11.3 ± 1.0 fl vs. 9.5 ± 1.5 fl, p < 0.001). Furthermore, the Gensini score was significantly lower in patients who had inadequate CCD (45 ± 46 vs. 91 ± 35, p < 0.001). MPV, Gensini score, age, female gender, total cholesterol, red cell distribution width, triglyceride, and fasting glucose levels were found to have univariate association with poor CCD. In multivariate logistic regression model, MPV (OR = 2.45, p < 0.001) and Gensini score (OR = 0.98, p < 0.001) were found to be the independent predictors of impaired CCD. In receiver operator characteristic curve analysis, optimal cut-off value of MPV to predict inadequate CCD was found as >9.6 fl, with 96% sensitivity and 84.7% positive predictive value. In conclusion, we can say that MPV is an important, simple, effortless, and cost effective tool and can be useful in predicting the CCD in patients with significant CAD.

Effect of masked hypertension on aortic elastic properties.

Aortic stiffness is increased in patients with sustained hypertension (SH). The aim of this study was to investigate the relationship between aortic elastic properties and masked hypertension (MH). We evaluated aortic elastic properties in 35 individuals with MH, 35 patients with SH, and 35 normotensive healthy volunteers using transthoracic Doppler echocardiography. All aortic distensibility values were carried out at the same time or immediately after the blood pressure (BP) measurement. Baseline clinical and demographic characteristics of the patients were similar in all three groups. Aortic stiffness index and elastic modulus values were higher in MH group compared to SH group and control group (8.9 ± 6.3 vs. 5.4 ± 2.2 vs. 4.2 ± 2.5, P < .001 and 9.0 ± 6.3 vs. 6.4 ± 2.5 vs. 4.1 ± 2.4, P < .001, respectively). Aortic strain values were lower in MH group compared to SH group and control group (7.4 ± 5.3 vs. 9.5 ± 4.1 vs. 14.6 ± 7.1, P < .001, respectively). Aortic distensibility values were lower in MH and SH groups compared to controls (3.1 ± 1.9 vs. 3.7 ± 1.6 vs. 6.4 ± 3.4, P < .001, respectively). Furthermore, diastolic aortic diameter, left ventricular mass index, interventricular septum, and posterior wall thickness were higher in MH and SH groups when compared to controls. This study shows that masked hypertensive patients are at higher risk of "aortic" stiffness, a risk factor for cardiovascular morbidity and mortality, than normotensive and sustained hypertensive patients.

Myocardial infarction due to lightning strike.

Cardiac events due to lightning strike and their severity vary according to the strength of the electric current and the duration of exposure. The electrophysiological effects of lightning on the heart can result in ventricular fibrillation, asystole, QT prolongation, supraventricular tachycardia, and non-specific ST-T wave changes. In this report, a case of a patient who suffered myocardial infarction due to lightning strike is presented, which is a rare complication.

Elevated red blood cell distribution width in healthy smokers.

OBJECTIVES: Red blood cell distribution width (RDW) has been reported to be a marker of morbidity and mortality for some cardiovascular and pulmonary diseases. We aimed to evaluate RDW values in otherwise healthy smokers. STUDY DESIGN: Two hundred and twenty consecutive subjects with current smoking and 230 age- and gender-matched healthy subjects without smoking history were enrolled. Number of cigarettes smoked per day and duration of smoking, evaluated as pack years, were recorded. Complete blood count, high-sensitivity C-reactive protein (hs-CRP) levels and lipid profile were analyzed in all study participants. RESULTS: The mean RDW values were higher in smokers than in nonsmokers (13.9±1.2 vs. 13.1±0.8, p<0.0001). The mean leukocyte count, mean platelet volume and hs-CRP levels were also significantly greater in smokers when compared to nonsmokers (8440±1.750 vs. 7090±1550, p<0.0001; 8.7±0.8 fL vs. 8.3±0.6 fL, p<0.0001; 2.42±0.53 mg/L vs. 1.46±0.52 mg/L, p<0.0001, respectively). Significant positive correlations between RDW and number of cigarettes smoked per day and between RDW and duration of smoking were identified (r=0.565 and r=0.305, respectively). CONCLUSION: Elevated RDW is associated with cigarette smoking and may be a useful indicator of inflammatory activity in smokers.

The relationship between D-dimer level and the development of atrial fibrillation in patients with systolic heart failure.

Heart failure (HF) is one of the most common and leading cause of death worldwide. Clinical trials provide evidence that the development of atrial fibrillation (AF) is a marker of poor prognosis in patients with HF. Furthermore, elevated D-dimer level is associated with increased cardiovascular mortality independent of AF in HF patients. We investigated whether plasma D-dimer levels in patients with hospitalized systolic HF could predict development of AF. A total of 150 consecutive patients with sinus rhythm who admitted to the emergency department with hospitalized systolic HF were evaluated. All hospitalized patients were obtained D-dimer levels within the first 24 h following admission. Atrial fibrillation developed in 31 (20.7%) patients during follow-up period of 6.3 ± 5 months. Patients who developed atrial fibrillation had significantly increased levels of D-dimer [608 (339-1,022) ng/ml versus 1,100 (608-2,599) ng/ml, P = 0.001]. Optimal cut-off level of D-dimer to predict development of AF was found to be >792 ng/ml. D-dimer >792 ng/ml, right ventricular dilatation, age, systolic pulmonary pressure, left atrium size, moderate to severe tricuspid regurgitation, and beta blocker usage were found to have prognostic significance in univariate analysis. In multivariate Cox proportional-hazards model, D-dimer levels >792 ng/ml (HR = 3.019, P = 0.006), and right ventricular dilatation (HR = 8.676, P = 0.003) were associated with an increased risk of new-onset AF. In conclusion, D-dimer could predict development of AF in patients with hospitalized systolic HF.

Evaluation of Endothelial Dysfunction in COVID-19 With Flow-Mediated Dilatation. / Avaliação da Disfunção Endotelial em Casos de COVID-19 com Dilatação Fluxo-Mediada.

BACKGROUND: Inflammation is known to play a crucial role in many diseases, including COVID-19. OBJECTIVE: Using flow-mediated dilatation (FMD), we aimed to assess the effects of inflammation on endothelial function in COVID-19 patients. METHODS: This study was conducted with a total of 161 subjects, of whom 80 were diagnosed with COVID-19 within the last six months (comprising 48 women and 32 men with a mean age of 32.10 ± 5.87 years) and 81 were healthy controls (comprising 45 women and 36 men with a mean age of 30.51 ± 7.33 years). We analyzed the findings of transthoracic echocardiography and FMD in all subjects. All results were considered statistically significant at the level of p < 0.05. RESULTS: The echocardiography and FMD of the COVID-19 group were performed 35 days (range: 25-178) after diagnosis. There was no statistically significant difference in echocardiographic parameters. Differently, FMD (%) was significantly higher in the control group (9.52 ± 5.98 vs. 12.01 ± 6.18, p=0.01). In multivariate analysis with the forward stepwise model, FMD was significantly different in the control group compared to the COVID-19 group (1.086 (1.026 - 1.149), p=0.04). A Spearman's correlation test indicated that FMD (r=0.27, p=0.006) had a weak positive correlation with the presence of COVID-19. CONCLUSION: Our findings point to COVID-19-induced endothelial dysfunction, as assessed by FMD, in the early recovery phase.

FUNDAMENTO: Sabe-se que a inflamação desempenha um papel crucial em muitas doenças, incluindo a COVID-19. OBJETIVO: Utilizando a dilatação fluxo-mediada (DFM), objetivou-se avaliar os efeitos da inflamação na função endotelial de pacientes com COVID-19. MÉTODOS: Este estudo foi realizado com um total de 161 indivíduos, dos quais 80 foram diagnosticados com COVID-19 nos últimos seis meses (48 mulheres e 32 homens com idade média de 32,10±5,87 anos) e 81 eram controles saudáveis (45 mulheres e 36 homens com idade média de 30,51±7,33 anos). Os achados do ecocardiograma transtorácico e da DFM foram analisados em todos os indivíduos. Resultados com p<0,05 foram considerados estatisticamente significantes. RESULTADOS: O ecocardiograma e a DFM do grupo COVID-19 foram realizados 35 dias (intervalo: 25­178) após o diagnóstico. Não houve diferença estatisticamente significativa nos parâmetros ecocardiográficos. Em contraste, a DFM (%) foi significativamente maior no grupo controle (9,52±5,98 versus 12,01±6,18; p=0,01). Na análise multivariada com o modelo stepwise progressivo, a DFM foi significativamente diferente no grupo controle em relação ao grupo COVID-19 (1,086 (1,026­1,149), p=0,04). O teste de correlação de Spearman indicou que a DFM (r=0,27; p=0,006) apresentou correlação positiva fraca com a presença de COVID-19. CONCLUSÃO: Os achados deste estudo apontam para disfunção endotelial induzida por COVID-19, avaliada por DFM, na fase inicial de recuperação.

Assessment of Aortic Stiffness by Transthoracic Echocardiographic in Young COVID-19 Patients.

Background: Deteriorated aortic elasticity is part of the atherosclerotic process. Inflammation is an underlying factor in both COVID-19 and atherosclerosis. Aims and Objectives: Using aortic elastic properties, we aimed to assess the subclinical indicators of susceptibility to inflammatory atherosclerosis in patients with COVID-19. Materials and Methods: Out of 194 participants included in this study, 100 were diagnosed with COVID-19 in the last 6 months (60 women and 40 men with a mean age of 34.13 ± 6.45 years) and 94 were healthy controls (55 women and 39 men with a mean age of 30.39 ± 7.21 years). We analyzed transthoracic echocardiographic and aortic stiffness parameters in all participants. Results: Values of systolic blood pressure (110 [85-140] vs. 110 [80-140], P = 0.037) and pulse pressure (PP) (37 [25-55] vs. 40 [25-55], P < 0.01) were significantly different between the groups. As for laboratory parameters, levels of glucose (97.89 ± 20.23 vs. 92.00 ± 9.95, P = 0.003) and creatinine (0.80 ± 0.13 vs. 0.75 ± 0.09, P = 0.003) were significantly higher in the COVID-19 group. Echocardiographic parameters showed that both groups differed significantly in diastolic aortic diameter (2.42 ± 0.28 vs. 2.31 ± 0.35, P = 0.017), aortic strain (9.66 [1.20-31.82] vs. 12.82 [2.41-40.11], P = 0.025), aortic distensibility (0.502 [0.049-2.545] vs. 0.780 [0.120-2.674], P < 0.01), and aortic stiffness (16.67 [4.19-139.43] vs. 11.71 [3.43-65.21], P = 0.006). Conclusion: Measurement of aortic stiffness is a simple, practical yet inexpensive method in COVID-19 patients, and therefore, may be used as an early marker for COVID-19-induced subclinical atherosclerosis.

Poorly controlled hypertension is associated with elevated serum uric acid to HDL-cholesterol ratio: a cross-sectional cohort study.

OBJECTIVES: The diagnosis and follow-up of hypertension (HT) depend on the blood pressure measurements, which can be affected by several factors. In the present work, we aimed to explore the role of uric acid/HDL-cholesterol ratio (UHR) in HT and whether/or not it was associated with poor blood pressure control. METHODS: In this retrospective cross-sectional cohort study, all the participants treated for hypertension and then followed up in the internal medicine clinics of our institution were enrolled. Hypertensive patients were grouped as either poorly or well-controlled hypertension groups, according to the suggestions of Joint National Committee VIII criteria and healthy volunteers were enrolled as control group. UHR of the study groups was compared. RESULTS: Our study cohort consisted of 535 subjects; 258 in the well-controlled HT group, 186 in the poorly controlled HT group, and 91 in the control group. Median UHR levels of the poorly controlled HT group (13 (4-43) %) were significantly higher than well-controlled HT group 11 (4-22) %) and control group (8 (4-19) %) (p < 0.001). UHR was correlated with systolic (r = 0.33, p < 0.001) and diastolic (r = 0.28, p < 0.001) BP. UHR level greater than 11% has 70% sensitivity and 60% specificity in predicting poor BP control (AUC: 0.73, p < 0.001, 95%CI: 0.68-0.77). UHR was an independent risk factor for poor BP control in HT subjects and a unit elevation in UHR increased the risk of poorer BP control by 7.3 times (p < 0.001, 95%CI: 3.9-13.63). CONCLUSION: Assessment of UHR may be useful in HT patients since elevated UHR levels could be associated with poor blood pressure control in this population.

Dating thrombus organization with eosinophil counts in deep venous thrombosis.

OBJECTIVE: It is known that eosinophils (EOS) are essential for thrombus formation. Studies have demonstrated the association of EOS with coronary artery disease, stent thrombosis, coronary collateral development, and vasospastic angina. However, there is little data about the association of hemogram parameters, especially EOS counts, with deep venous thrombosis (DVT) subgroups. METHODS: The present study comprised 243 patients diagnosed with DVT (of whom 86 were acute, 72 were indeterminate, and 85 were chronic) and 75 control patients. Medical records of all the patients were reviewed, and relevant data were collected retrospectively. The baseline characteristics, as well as hemogram and biochemistry parameters, were recorded. RESULTS: The patients with DVT had significantly lower median EOS count yet higher median neutrophil to lymphocyte ratio (NLR) than those of control patients (P < .001). Similarly, acute DVT patients had lower EOS count yet higher NLR values compared with those of indeterminate and chronic DVT patients. However, EOS count was not significantly different between chronic DVT and control groups. While NLR ratio was significantly correlated with acute DVT (r = 0.34; P < .001), Spearman's correlation test revealed that EOS count was inversely correlated with the presence of acute DVT (r = -0.52; P < .001). CONCLUSIONS: Low EOS count may lead the physician to a higher probability of acute DVT rather than indeterminate and chronic DVT.

P-wave Duration and Dispersion in Lone Obesity.

OBJECTIVE: To assess P-wave duration and dispersion (PD) in morbidly obese young subjects who do not have co-associated atrial fibrillation (AF) risk factors, such as hypertension, diabetes, atrial enlargement and diastolic dysfunction. STUDY DESIGN: An observational cross-sectional study. PLACE AND DURATION OF STUDY: Bolu Abant Izzet Baysal University Medical Faculty, Turkey; and the study was conducted between October 2017 and June 2018. METHODOLOGY: P-wave duration and dispersions were determined on 12-lead surface ECG in 47 morbidly obese and 44 healthy weight subjects, aged between 21-40 years. Above mentioned risk factors were studied. The correlation between BMI, PD and Pmax were investigated by Pearson correlation analysis.  Results: Average body mass index (BMI) of obese and control groups were 42.3 (8.5) vs. 19.5 (1.5) (P <0.001). Maximum P-wave duration [(Pmax), 105.3±9.8 vs. 95.6±8.5, p<0.001] and PD [27.6 (7.6) vs. 12.2(8.3), p<0.001] were statistically significantly prolonged in obese patients when compared to the normal weight group. BMI correlation with Pmax and PD (r=0.485; p<0.001 and r=0.620; p<0.001, respectively) were significant. CONCLUSION:   Pmax and PD, which are potential electrocardiographic AF predictors, may increase in lone obese patients having no comorbidities. Key Words:  Electrocardiography, Arrhythmia, P-wave duration, P-wave dispersion, Severe obesity.

Echocardiographic assessment of epicardial fat tissue thickness in patients with severe periodontitis.

OBJECTIVES: This study aims to assess the thickness of epicardial fat tissue (EFT), a sign of cardiovascular risk, using echocardiography in patients with severe periodontitis. METHODS: Thirty-three patients with stage III or IV periodontitis and 33 healthy participants were enrolled into the study. Epicardial fat tissue thickness was measured perpendicularly via echocardiography of the free wall of the right ventricular at end-diastole in three cardiac cycles. Body mass index (BMI) was calculated by dividing weight in kilograms by the height in meters squared. EFT to BMI ratio (EFT/BMI) was measured by dividing EFT by the BMI. RESULTS: There was no significant difference between study patients and the control group as regards to the frequency of diabetes, hypertension, smoking, and hyperlipidemia. The EFT and EFT/ BMI ratio were significantly different in the control and periodontitis groups (0.51±0.17 vs. 0.77±0.16, respectively; p ≤0.001) (0.021±0.008 vs. 0.030±0.006, respectively; p≤0.001). Pearson's correlation coefficient demonstrated a significant relationship between EFT and the clinical parameters of periodontitis (p<0.001) CONCLUSIONS: EFT thickness measured by echocardiography appears to be associated with severe periodontitis and may thus be an indirect sign of cardiovascular disease in periodontitis patients.

Evaluation of Electrocardiographic Ventricular Depolarization and Repolarization Variables in Type 1 Diabetes Mellitus.

BACKGROUND: The risk of cardiovascular events and sudden death increases with type 1 diabetes mellitus (T1DM). OBJECTIVE: To evaluate electrocardiographic markers of arrhythmias in T1DM patients. METHODS: Electrocardiographic parameters reflecting ventricular depolarization and repolarization, namely, QT, QTc, QTd, QTdc, Tp-e, JT, and JTc intervals and Tp-e/QT and Tp-e/QTc ratios, of 46 patients diagnosed with T1DM were retrospectively analyzed and compared with 46 healthy age-, sex-, and body mass-matched controls. Correlations between T1DM duration, hemoglobin A1c (HbA1c), and ventricular repolarization variables were analyzed. P values lower than 0.05 were considered statistically significant. RESULTS: Diabetes duration was 16.6 ± 7.1 years, and HbA1c was 10.81% ± 3.27% in the T1DM group. In comparison with the control group, heart rate, QTc, QTd, QTdc, Tp-e and JTc intervals, Tp-e/QT ratio (p < 0.001), and Tp-e/QTc ratio (p = 0.007) were significantly higher in T1DM patients. T1DM duration and HbA1c levels were significantly correlated with QTc, QTd, QTdc, Tp-e, and JTc intervals and Tp-e/QT and Tp-e/QTc ratios. CONCLUSIONS: In T1DM patients, potential electrocardiographic repolarization predictors were significantly increased in correlation with disease duration and HbA1c levels. These findings may contribute to the understanding of sudden cardiac death in patients with T1DM.

Assessment of neutrophil and neutrophil/lymphocyte ratio in coronary collateral developed patients with acute coronary syndrome.

OBJECTIVE Inflammation-related markers provide diagnostic and prognostic information for coronary artery disease and acute coronary syndrome. We aimed to compare neutrophil count and neutrophil/lymphocyte ratio (NLR) in acute coronary syndrome patients with coronary collateral development in our study. METHODS A total of 426 patients (102 unstable angina pectoris (USAP), 223 non-ST-elevation myocardial infarction (non-STEMI), 103 ST-elevation myocardial infarction (STEMI) were compared regarding hemoglobin, platelet, lymphocyte, neutrophil count, and NLR. RESULTS Neutrophil count and NLR were significantly lower in USAP patients and higher in STEMI patients; 5.14± 1.79 vs. 7.21± 3.05 vs. 9.93±4.67 and 2.92±2.39 vs. 5.19±4.80 vs. 7.93±6.38, p <0.001. Other parameters, i.e., hemoglobin, platelet, and lymphocyte count, were not significantly different between the groups. CONCLUSIONS In our study, it was concluded that there may be a statistically significant difference in the number of neutrophil counts and NLR among the types of acute coronary syndromes with coronary collateral development.

The relationship between epicardial fat thickness and high-grade varicocele.

BACKGROUND: Varicocele is abnormal dilation of testis veins. The precise mechanism of varicocele is not fully understood despite some hypothesis were suggested in the literature. Disequilibrium between constrictor and dilatator mechanism of the veins have been shown to cause varicocele. High-grade varicoceles have been also linked to endothelial dysfunction and increased vasoconstriction. OBJECTIVES: We hypothesized that epicardial fat thickness (EFT), flow-mediated dilatation (FMD) and aortic stiffness (AS) could be associated with varicocele. In the present study, we aimed to compare vascular parameters such as FMD, EFT and AS in healthy subjects and high-grade varicocele patients. METHODS: The study population consisted of 35 men with high-grade varicocele and 32 age- and sex-matched control subjects younger than 45 years old. This is a cross-sectional study conducted at Bolu Abant Izzet Baysal University Hospital between May to October 2018. RESULTS: EFT, aortic diastolic diameters (AoDD) and EFT/BMI ratio were significantly higher in control group than in patients with high-grade (p=0.012, p=0.044, p=0.026, respectively). EFT and EFT /BMI ratio were significantly and inversely correlated with presence of varicocele (r=-0.422, p=0.009; r=-0.38, p=0.026, respectively). CONCLUSION: The present study suggests that high-grade varicocele may be associated with decreased echocardiographic EFT but not with aortic stiffness and FMD.

Assessment of the hemogram parameters in patients with paroxysmal supraventricular tachycardia: a retrospective study.

OBJECTIVE: Inflammation has been suggested as a potential mechanism in the pathogenesis of arrhythmia. Hemogram parameters such as monocyte count to high-density lipoprotein cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), and monocyte/lymphocyte ratio (MLR) have been considered to be markers of inflammation and new cardiovascular risk predictors. This retrospective study aimed to investigate the relationship between MHR, NLR, and MLR in patients with paroxysmal supraventricular tachycardia (PSVT). METHODS: A retrospective study conducted at a university hospital in Bolu, Turkey, between 2017 and 2019. Our study included 196 patients who underwent electrophysiological study (EPS) due to palpitation or documented PSVT on electrocardiography (ECG). Patients having documented atrioventricular nodal re-entrant tachycardia (AVNRT) on ECG or inducible AVNRT on EPS were included in the PSVT group (n=130), and patients with palpitation but without inducible arrhythmia on EPS (n=66) were included in the control group. Routine biochemical and hemogram tests were performed before the EPS procedure. RESULTS: When hemogram parameters were compared, there was no statistically significant difference in MHR values [0.010 (0.001-0.030) vs 0.010 (0.001-0.020) p =0.67]. Additionally, both NLR [2.21(0.74-11.36) vs 1.98(0.72-24.87) p=0.13] and MLR [0.25 (0.03-1.05) vs 0.24(0.07-1.39) p=0.41] were not statistically significant between the two groups. CONCLUSION: There is no significant difference in PSVT patients regarding hemogram parameters including white blood cell subtypes, MLR, NLR, and MHR. Therefore the evaluation of hemogram parameters may not be clinically relevant for PSVT patients.

Is ionizing radiation a risk factor for anxiety in employees?

OBJECTIVE: Workers describe many physical and mental symptoms when working in radiation areas. This study aimed to assess these symptoms in radiation workers using the Beck Anxiety Inventory (BAI). METHODS: A total of 42 radiation workers (22 males and 20 females, mean age 34±7 years) and 47 control subjects (22 males and 27 females, mean age 31± 8 years) who work in non-radiation areas in the hospital were included in the study. All participants anonymously filled out the Beck Anxiety Inventory (BAI) questionnaire. RESULTS: The demographic data of workers were not significantly different between groups. In the BAI, the dizzy or lightheaded (p =0.01), terrified (p= 0.01), unsteady (p=0.02), heart-pounding and racing (p=0.02) items were significantly higher in the radiation-exposed group compared to the control group. |The BAI score was also significantly higher in the radiation-exposed group (11.1±6.8 vs. 8.7±3.8, p =0.04). CONCLUSION: These results suggest the possibility that radiation may play a role in the psychometric properties of workers. The effects of radiation on the health of employees need to be further investigated and understood.