The value of STAF (Score for the Targeting of Atrial Fibrillation) in Patients with Cryptogenic Embolic Stroke.

INTRODUCTION: The aim of the present study was to predict paroxysmal atrial fibrillation (PAF) in acute ischemic stroke patients with presumed cryptogenic embolic etiology. METHODS: In this retrospective cohort study, demographics, blood tests, data of neuroimaging studies such as non-contrast computed tomography (NCCT), magnetic resonance imaging (MRI), standard 12-lead electrocardigraphy (ECG), 24-hour Holter ECG, echocardiography was collected. The diagnostic work-up to detect atrial fibrillation (AF) was either medical history of the patient or 12-lead ECG or 24-hour Holter ECG or continuous ECG monitoring. Score for the targeting of atrial fibrillation (STAF) was calculated for all patients. Cryptogenic ischemic stroke (CS) patients with and without documented AF were recorded. RESULTS: Between July 2014 and December 2015, a total of 133 of the 258 patients with CS were included in this study. Overall, 133 patients were enrolled and AF was detected in 30 (22.6%) patients. In univariate analysis gender (p<0.001), age (p=0.001), smoking habit (p=0.004), aortic and mitral valve insufficiency (p=0.014 and p=0.021), left ventricular systolic dysfunction (p=0.04), and left atrial dilatation (p=0.03) were predictors of AF but multivariate analysis showed that only gender and age were independent predictors of AF in patients with presumed cryptogenic ischemic stroke. According to ROC analysis, area under the curve was 70% and the sensitivity and specificity of STAF score of ≥5 was 86% and 71% respectively. CONCLUSION: STAF score predicted with fair accuracy, and has a limited use for the risk of PAF in stroke patients.

[Do Turkish reimbursement recommendations cover current European Lipid Guidelines? A retrospective analysis of patients presenting with first acute coronary syndrom]. / Türkiye'de geri ödeme önerileri mevcut Avrupa Lipid Kilavuzlari'ni kapsiyor mu? Ilk akut koroner sendrom ile basvuran hastalarin geriye dönük incelenmesi.

OBJECTIVE: This study was a comparison of the statin therapy protocol issued by the European Society of Cardiology (ESC) and the Ministry of Health's Health Implementation Directive (SUT) in Turkey, performed in order to assess the adequacy of hyperlipidemia treatment indications for primary prevention. METHODS: A total of 582 patients with first acute coronary syndrome were included in the study. Patients with noncritical stenosis observed on coronary angiography or a history of atherosclerotic disease were excluded. The risk calculation was determined using age, sex, smoking status, presence of diabetes mellitus, total cholesterol, and lipoprotein levels. Statin treatment indications were evaluated according to the ESC guidelines (2016) and the SUT (2016). RESULTS: Statin treatment was indicated for 96% of diabetic patients, and according to the ESC, it was appropriate for 13.5% of nondiabetic patients, while the SUT recommendation included 13.3% of nondiabetic patients (p<0.05). For patients younger than 60 years of age, the SUT had more guidelines than the ESC; however, for patients aged 70 to 90, the ESC had more guidelines than the SUT. For patients over 90, the indications were the same. For patients with low-density lipoprotein-cholesterol (LDL-C) >190 mg/dL there was greater discrepancy between the SUT and ESC guidelines. According to the SUT, all patients >190 mg/dL are to receive treatment. The ESC had more guidelines than the SUT for cases of LDLC <160b mg/dL. CONCLUSION: The scope of the SUT guidelines is generally not narrower than the ESC indications. However, the indications for patients >60 years of age and those with LDL-C >160 mg/ dL should be reassessed, as they are more limited than those of the ESC. A new treatment algorithm should be defined.

A Case of Brucellosis with a Rare Complication: Pericarditis.

OBJECTIVES: To describe brucellosis and its possible complications according to clinical, laboratory and radiological findings. METHODS: We describe a case of Brucella pericarditis visualized at transthoracic echocardiography with clinical manifestations. RESULTS: Clinical manifestations, imaging and laboratory findings provided the correct diagnosis of Brucella pericarditis. The patient recovered fully following doxycycline and rifampin therapy. CONCLUSION: Brucellosis should be considered in the differential diagnosis of disorders that affect the pericardium in endemic areas. LEARNING POINTS: Brucella pericarditis should be considered in case of disorders that affect the pericardium in endemic areas such as the Mediterranean region.When a patient has been diagnosed with brucellosis, oral doxycycline 100 mg twice daily plus oral rifampin 600 mg once daily must be given immediately.

Predictors of Symptom Development in Intermediate Carotid Artery Stenosis: Mean Platelet Volume and Platelet Distribution Width.

Platelets play an important role in the pathogenesis of atherothrombosis. Platelet activation is associated with increased mean platelet volume (MPV) and platelet distribution width (PDW). In this study, we investigated the relation of MPV and PDW with the risk of stroke in patients with intermediate (50%-70%) carotid artery stenosis. A total of 254 patients (115 symptomatic and 139 asymptomatic) with intermediate carotid artery stenosis were enrolled in this study. Symptomatic and asymptomatic patients were compared in regard to MPV and PDW. Mean platelet volume was significantly greater in the symptomatic group compared with the asymptomatic group (11.1 and 9.4 fL, respectively; P < .001). Platelet distribution width was significantly greater in the symptomatic group compared with the asymptomatic group (15.0% and 11.9%, respectively; P < .001). Multivariate regression analysis showed that an MPV ≥10.2 fL and a PDW ≥14.3% were independent predictors of developing symptomatic carotid artery stenosis. Mean platelet volume and PDW are increased in the presence of symptomatic intermediate carotid artery stenosis. Increased MPV and PDW may be independent predictors of developing symptomatic carotid artery plaque.

Successful percutaneous coronary intervention for acute coronary syndrome in a patient with haemophilia B.

Haemophilia is a congenital coagulation defect brought about by the deficiency or lack of coagulation factor IX. The prevalence of coronary artery disease and acute coronary syndrome (ACS) is lower among haemophiliacs than in the normal population. However, with the administration of factor concentrate, average life expectancy can now extend to as long as 70 years in patients with haemophilia, and this in turn is leading to an increase in the prevalence of cardiac diseases among this population. Data regarding a treatment protocol for ACS and percutaneous coronary intervention (PCI) in patients with congenital coagulation defects is limited. We report a 41-year-old male patient with haemophilia B who presented with a non-ST elevation myocardial infarction, and on whom PCI was performed following monitoring of factor IX levels. The patient had no cardiovascular risk factor except smoking.