Assessment of the neutrophil/lymphocyte ratio in patients with supraventricular tachycardia

OBJECTIVE

The neutrophil/lymphocyte ratio (NLR) has been evaluated as a new predictor of cardiovascular risk. Inflammation has been shown to be associated with various arrhythmias including supraventricular tachycardias (SVTs). In this study, we aimed to investigate the relation between NLR and SVT in patients with a documented atrial tachyarrhythmia.

METHODS

The study used a retrospective cross-sectional design. Patients who had SVT but were otherwise healthy were included. The exclusion criteria included drug use (except antiarrhythmic agents), morbid obesity, acute or chronic infection, inflammatory diseases, systemic diseases, and cancer. Total and differential leukocyte counts and routine biochemical tests were performed before the ablation procedure.

RESULTS

The study included 150 patients with SVT and 98 healthy controls. The biochemical and hematological parameters were comparable between the groups, except neutrophil and lymphocyte counts. The neutrophil count was significantly higher (4.7±1.5x103/µL versus 4.1±1.0x103/µL; p<0.001) and lymphocyte count was significantly lower (2.2±0.6x103/µL versus 2.5±0.6x103/µL; p=0.001) in the SVT group than in the control group. As a result, the SVT group had significantly higher NLR values than the control group (2.2±0.9 versus 1.7±0.5; p<0.001). In addition, NLR values were higher in patients in whom tachycardia was induced during an electrophysiological study (EPS) (2.3±0.9 versus 2.0±0.8; p=0.02). The association between NLR and SVT remained significant after multivariate analysis (odds ratio: 1.5, 95% confidence interval: 1.001-2.263, p=0.049).

CONCLUSION

Our study indicated that NLR values were significantly higher in patients with documented SVT than in control subjects. Inducibility of SVT during EPS was associated with higher NLR values.

Association between the neutrophil to lymphocyte ratio and prehypertension

OBJECTIVES

To explore the neutrophil-lymphocyte ratio (NLR) in patients with prehypertension (PHT).

BACKGROUND

Inflammation plays an important role in the development of cardiovascular diseases. A pathophysiological link also exists between inflammation and PHT. NLR is a simple marker for the assessment of inflammatory status. There is a lack of data regarding the association between NLR and pre-hypertensive state.

METHODS

The present cross-sectional study included 33 newly diagnosed PHT patients and 35 normotensive control subjects. Prehypertension was defined as a systolic blood pressure (BP) of 120-139 mm Hg and/or a diastolic BP of 80-89 mm Hg.

RESULTS

Patients were divided into tertiles based on NLR values: 1.17 (0.9-1.42) in tertile 1; 1.57 (1.43-1.78) in tertile 2; and 2.40 (1.82-4.5) in tertile 3. The frequency of PHT was significantly higher for patients in the upper NLR tertile compared to the middle and lower NLR tertiles (21 (91.3%), 7 (30.4%), and 5 (22.7%), respectively; p<0.001). Systolic BP and diastolic BP were significantly higher among patients in the upper NLR tertile than among those in the other NLR tertiles.

CONCLUSION

An association exists between PHT and NLR. NLR measurement, as well as monocyte count, may be used to indicate increased risk of prehypertension (Tab. 2, Ref. 48).

The Effect of Chronic Alcoholism on the Conjunctival Flora

AIM

We aimed to investigate the effect of alcohol abuse on the conjunctival flora.

MATERIALS AND METHODS

The cases were evaluated as two groups. The study group consisted of 55 heavy-drinking males diagnosed with alcohol abuse, while the control group consisted of 55 males without a history of alcohol abuse. Samples were taken from the inferior fornix conjunctiva with sterile cotton-tipped swabs (Amies transport medium) for culture. The samples were inoculated into blood agar, chocolate agar, eosine methylene blue agar and Saboraud-Dextrose agar (Oxoid/UK) with the dilution method.

RESULTS

The microorganisms that grew in study group subjects were Coagulase Negative Staphylococcus (CNS) in 30 (54.5%), Staphylococcus aureus in 14 (25.5%), Moraxella spp. in 3 (5.5%), Streptococcus spp. in 3 (5.5), Bacillus spp. in 3 (5.5%), Corynebacterium spp. in 3 (5.5%), Candida spp. in 3 (5.5%), Haemophilus spp. in 2 (3.6%), Acinetobacter spp. in 2 (3.6%), Neisseria spp. in 1 (1.8%) and Micrococcus spp. in 1 (1.8%). The results for control group were CNS in 31 (56.4%), Bacillus spp. in 7 (12.7%), S. aureus in 5 (9.1%), and Corynebacterium spp. in 2 (3.6%). Moraxella spp., Streptococcus spp., Candida spp., Haemophilus spp., Acinetobacter spp., Neisseria spp. and Micrococcus spp. microorganisms grew in the conjunctival flora samples of the study group but not in the control group. S. aureus colonization was significantly higher in the study group than the control group (p < 0.05).

CONCLUSION

The S. aureus colonization rate was statistically significantly higher in the study group. Some microorganisms only grew in the conjunctival flora samples of the study group. These findings indicate that the conjunctival flora in persons with chronic alcoholism is different than the normal population.

The importance of hematologic indices in the risk stratification of patients with acute decompensated systolic heart failure

OBJECTIVES

In patients with heart failure, a variety of hemogram parameters are known to be of prognostic significance. This study aimed to investigate which of these parameters is/are useful in predicting one-year all-cause mortality in patients with acute decompensated heart failure (ADHF).

STUDY DESIGN

Patients who were hospitalized between September 2012-March 2013 in our hospital with systolic-ADHF with ejection fraction ≤40%, symptoms, and findings of congestion were enrolled retrospectively in the study. The study population was divided into two groups based on one-year-mortality.

RESULTS

119 patients with ADHF (mean-age 67±14 years; 55% male) were enrolled in the study. One-year-mortality occurred in 29% of patients. Hemoglobin levels, platelet, basophil and lymphocyte counts were significantly lower, while red-cell distribution width (RDW) was found to be significantly higher in the one-year-mortality group. Neutrophil, monocyte, and eosinophil counts were similar in the two groups. Furthermore, lower estimated glomerular-filtration-rate (eGFR) and unused angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) were associated with mortality. Age, presence of hypertension, right-ventricular diameter, eGFR, ACE/ARB treatment, hemoglobin levels, RDW and platelet, leukocyte, lymphocyte, basophil, neutrophil, monocyte, and eosinophil-counts were found to have prognostic significance in univariate analysis. In multivariate analysis, decreased platelet, lymphocyte-counts and hemoglobin level on admission and unused ACE/ARB treatment at discharge (p<0.05) were found to be independent factors predicting one-year-mortality.

CONCLUSION

Among hematological indices; hemoglobin level, platelet and lymphocyte counts are readily available, useful and inexpensive markers for the prediction of one-year all-cause mortality in ADHF patients.

Novel predictors of infarct-related artery patency for ST-segment elevation myocardial infarction: Platelet-to-lymphocyte ratio, uric acid, and neutrophil-to-lymphocyte ratio

OBJECTIVE

The neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), and uric acid (UA) are inflammatory markers in cardiovascular disease. However, there are not enough data on infarct-related artery (IRA) patency in ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the association of NLR, PLR, and UA with IRA patency before percutaneous coronary intervention (PCI) in STEMI.

METHODS

The study was designed as a retrospective study. Three hundred and twenty-four consecutive patients with STEMI were divided into two groups according to pre-PCI Thrombolysis in Myocardial Infarction flow grade (TIMI). Patients with a TIMI flow grade of into the spontaneous reperfusion (SR) group, while patients with TIMI flow grade of 0, 1 and 2 were placed into the non-SR group. The χ2 and independent-samples t-test, Mann-Whitney U test, multivariate logistic regression analysis, and receiver-operator characteristic (ROC) curve analysis were used for the statistical analysis.

RESULTS

PLR, NLR, and UA values in the SR group were lower than in the non-SR group (p<0.004, p<0.001, p<0.001, respectively). In the multivariate analysis, serum UA level and PLR were found to be independent predictors of pre-PCI IRA patency. In the ROC curve analysis, PLR >190, UA>5.75 mg/dL, and NLR>4.2 predicted non-SR. The sensitivity and specificity of the association between low IRA TIMI flow grade and PLR were 88% and 84%, 72% and 66% for UA, and 74% and 44% for NLR, respectively.

CONCLUSION

We determined that PLR and UA are novel predictors of IRA patency before PCI. We suggest that PLR and UA may be used in risk-stratifying STEMI.

Association of pentraxin-3 with the severity of rheumatic mitral valve stenosis

OBJECTIVE

Inflammation is involved in the pathogenesis of rheumatic mitral valve stenosis (RMVS). Pentraxin-3 (PTX3) indicates the inflammatory state of humans. However, circulating PTX3 levels in patients with RMVS, remain largely unknown. In this study, we investigated whether there is an association between the severity of RMVS and PTX3.

METHODS

All patients diagnosed as rheumatic mitral valvular stenosis between December 2013 and April 2014 were included in the study. We investigated circulating PTX3 and high-sensitivity C-reactive protein (hsCRP) levels in patients with RMVS and healthy controls.

RESUITS

The study population included 72 subjects (41 patients with RMVS and 31 healthy subjects, 56 female) with a mean age of 40 +/- 13 years. Patients with RMVS had higher left atrial diameters than healthy subjects. PTX3 and hsCRP were significantly higher in patients with RMVS when compared to control subjects and this difference was more significant in PTX3 compared to hsCRP (3.37 +/- 1.11 vs 2.86 +/- 0.59, P = 0.014 and 2.36 +/- 1.48 vs. 1.72 +/- 0.73, P = 0.019, respectively). PTX3 was positively correlated with Wilkins score, mitral valvular area, mitral pressure gradient and left atrium diameter.

CONCLUSIONS

We demonstrated that plasma PTX3 and hsCRP levels were increased in patients with RMVS. Compared to hsCRP, PTX3 was more closely related with the severity of mitral valve stenosis. These findings suggest that PTX3 may participate in the pathophysiology of RMVS.

Association between neutrophil to lymphocyte ratio and pulmonary arterial hypertension

OBJECTIVES

Pulmonary hypertension (PH) is composed of a heterogeneous group of disorders marked by increased pulmonary artery resistance leading to right heart failure, with high mortality. Evidence is increasing to propose that inflammation plays a significant role in the pathophysiological mechanism. Increased prevalence of PH in patients with systemic inflammatory diseases is already known. Herein, we sought to evaluate the association between neutrophil to lymphocyte ratio (N/L ratio) and pulmonary arterial hypertension (PAH).

STUDY DESIGN

Twenty-five patients with PAH and 25 controls were evaluated. Baseline clinical and echocardiographic variables were obtained. Complete blood counts in all patients and controls were reviewed retrospectively.

RESULTS

The N/L ratio was higher in patients with PAH compared to healthy volunteers (p=0.05). A cut-off value of 1.65 for N/L ratio predicted the presence of PAH with 72% sensitivity and 69% specificity. After multivariate analysis, only N/L ratio remained a significant predictor of PAH.

CONCLUSION

We showed for the first time that N/L ratio was significantly increased in patients with PAH compared to controls.

Apelin Levels In Isolated Coronary Artery Ectasia

Background and Objectives

The etiopathogenesis of coronary artery ectasia (CAE) is not known completely. In most of the cases, CAE is associated with atherosclerosis; however, isolated CAE has a nonatherosclerotic mechanism. The association between atherosclerotic coronary artery disease and apelin has been examined in previous studies. However, the role of plasma apelin in isolated coronary artery ectasia has not been studied. In this study, we investigated the relationship between plasma apelin levels and isolated coronary artery ectasia.

Subjects and Methods

The study population included a total of 54 patients. Twenty-six patients had isolated CAE (53.6±8.1 years); 28 patients with normal coronary arteries (51.6±8.8 years) and with similar risk factors and demographic characteristics served as the control group. Apelin levels were measured using an enzyme-linked immunoassay kit.

Results

Apelin level in the CAE group was significantly lower (apelin=0.181±0.159 ng/mL) than that in the control group (apelin=0.646±0.578 ng/mL) (p=0.033). Glucose, creatinine, total cholesterol, triglyceride, low density lipoprotein cholesterol, and high density lipoprotein cholesterol levels were not significantly different between the two groups.

Conclusion

In this study, we showed that patients with isolated CAE have decreased plasma apelin levels compared with the control group. Based on the data, a relationship between plasma apelin and isolated CAE was determined.

Nontraumatic Descemet Membrane Detachment with Tear in Osteogenesis Imperfecta

We report the first case of unilateral spontaneous Descemet membrane detachment (DMD) with tear occurring in a patient with osteogenesis imperfecta (OI). A 20-year-old male patient with OI presented with a history of recent primary repair (2 weeks prior) of left globe rupture following local finger trauma to the left eye. The patient had no history of other ocular surgery or trauma. The examination revealed a best corrected visual acuity of 20/40 in the right and no light perception in the left eye. Slit-lamp examination showed an oval giant Descemet tear extending from the 12 o’clock to the 5 o’clock area and a large DMD involving the upper and nasal quadrants in the right cornea. It was thought that monitoring the patient without intervention and only considering a surgical procedure if the disorder progressed was the best option, taking into account the patient’s reasonable visual acuity and the risks of keratoplasty. The dimensions of the DMD and tear had remained the same at 1-year follow-up period. We believe that follow-up without intervention should be considered for non-progressive DMD with a giant tear if the patient has a single functional eye.

The relationship of TIMI risk index with SYNTAX and Gensini risk scores in predicting the extent and severity of coronary artery disease in patients with STEMI undergoing primary percutaneous coronary intervention

OBJECTIVE

The prognostic value of the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) and the Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) have been reported in patients with coronary artery disease (CAD). In this study, we sought to evaluate the association between TRI and the extent and severity of CAD evaluated by SYNTAX score (SS) and Gensini score in patients with ST elevation myocardial infarction (STEMI).

METHODS

A total of 290 patients with STEMI were included in the study. GRS and TRI were calculated on admission using specified variables. The extent and severity of CAD were evaluated using the SS and Gensini scores. The patients were divided into low (TRI ⩽19), intermediate (TRI 19-30), and high (TRI ⩾30) risk groups. A Pearson correlation analysis was used for the relationship between TRI, GRS, Gensini score and SS.

RESULTS

There were significant differences in the mean age (p < 0.001), admission heart rate (p < 0.001), admission systolic blood pressure (p = 0.009), SS (p < 0.001), GRS (p < 0.001) and in-hospital major adverse cardiac events (MACE) in all patients between the low, intermediate and high TRI risk groups. There was a positive significant correlation between TRI and SS (r = 0.24, p < 0.001), Gensini score (r = 0.18, p = 0.002), GRS (r = 0.74, p = 0.001) and in-hospital MACE (r = 0.29, p < 0.001).

CONCLUSION

TRI is significantly related to SS and Gensini score in predicting the extent and severity of CAD in patients with STEMI.

Toxic effects of systemic cisplatin on rat eyes and the protective effect of hesperidin against this toxicity

CONTEXT

In the present study, cisplatin (CP) induced eye toxicity and the beneficial effect of hesperidin (HP) was investigated.

METHODS

Twenty-eight rats were equally divided into four groups; the first group was kept as control. In the second and third group, CP and HP were given at the doses of 7 mg/kg and 50 mg/kg/d, respectively. In the fourth group, CP and HP were given together at the same doses. Tissue samples were collected on day 14 of CP treatment.

RESULTS

The results demonstrated that CP caused a significant increase in thiobarbituric acid reactive substances (TBARS) levels and decrease of glutathione levels and antioxidant enzyme activity (catalase, superoxide dismutase and glutathione peroxidase) in eye tissues compared to other groups, HP prevented these effects of CP. Besides, CP led to histopathological damage in the retina and cornea. On the other hand, HP treatment prevented histopathological effects of CP.

CONCLUSION

CP had severe dose-limiting toxic effects and HP treatment can be beneficial against the toxic ocular effects of CP. Thus, it appears that co-administration of HP with CP may be a useful approach to attenuate the negative effects of CP on the eye.

Evaluation of scleral-fixated intraocular lens position anomalies by anterior segment optical coherence tomography

BACKGROUND/AIM

To measure the positions of scleral-fixated intraocular lenses (IOLs) using anterior segment optical coherence tomography (OCT) and to evaluate the influence of the position of scleral-fixated IOL on the quality of vision.

MATERIALS AND METHODS

Twenty-six eyes of 26 patients were included in the study. The average age was 57.5 (11 to 78) years. Anterior segment images were taken using slit lamp optical coherence tomography (SL-OCT) and were used to evaluate the position of the IOL.

RESULTS

The average amounts of tilt and decentration were 2.25° ± 1.93° and 359.28 ± 194.70 µm, respectively. There was a positive and moderate relationship between tilt and astigmatism caused by the position of the IOL (P = 0.030). No relationship was detected between decentration and the astigmatism caused by the position of the IOL (P = 0.285).

CONCLUSION

Scleral-fixated IOL position can be evaluated with SL-OCT, which is a noncontact, noninvasive, reproducible, and reliable method of evaluation. Anterior segment OCT has been shown to provide sensitive measurements but not in all cases. The present study showed that a tilted scleral-fixated IOL behaved like a toric IOL, and the astigmatism caused by the position of the scleral-fixated IOL therefore could increase or decrease total astigmatism.

The prognostic significance of serum albumin in patients with acute decompensated systolic heart failure

BACKGROUND

Despite improvements in the diagnosis and treatment of heart failure, mortality is still high. It is important to identify high-risk patients. In this study, we investigated whether the serum albumin level is a useful predictor of annual mortality in patients with acute decompensated systolic heart failure (ADSHF).

METHODS

One-hundred and thirty-five consecutive patients with a left ventricular ejection fraction ≤ 40% who were hospitalized with the diagnosis of ADSHF were included in this retrospective study. Patients were divided into two groups based on whether or not hypoalbuminaemia was present, and the relationship between hypoalbuminaemia and mortality was evaluated.

RESULTS

The mean age of the study population was 67 ± 14 years and 54% of the patients were male. Hypoalbuminaemia was detected in 69.6% of the patients. The systolic blood pressure, haemoglobin levels, lymphocyte count, cholesterol and sodium values were low and the direct bilirubin and CRP levels were elevated in the hypoalbuminaemia group. The one-year mortality was 37% in the hypoalbuminaemia group and 12% in the group with normal albuminaemia (P = 0.003). Multivariate analysis showed that hypoalbuminaemia, decreased haemoglobin levels and increased creatinine values were independent predictors of mortality (P < 0.05). A serum albumin cut-off value of 3.10 g/dl predicted 1-year mortality with a sensitivity of 70% and specificity of 70% in patients with ADSHF disease.

CONCLUSION

All-cause annual mortality rates are significantly increased in ADSHF patients with hypoalbuminaemia. The serum albumin level, as well as the creatinine and haemoglobin values, may be helpful biomarkers in this group.

Choroidal tuberculoma showing paradoxical worsening in a patient with miliary TB

Tuberculosis (TB) remains an important public health problem worldwide. Ocular involvement in patients with systemic TB has traditionally been considered uncommon. Diagnosing ocular TB is challenging and often delayed, especially in the absence of pulmonary signs or symptoms typical of TB. Here we describe a case of paradoxical reaction after antituberculosis therapy in an immunocompetent patient with ocular TB.