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 12lead 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.

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.

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.

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. KEYWORDS Brucellosis, pericarditis; infectious disease. INTRODUCTIONBrucellosis is a zoonotic disease which is a systemic infection with a broad clinical presentation ranging from asymptomatic to severe disease. Brucella infection can affect any organ and system in the human body. The spleen, liver, bone marrow and reticuloendothelial cells are the most frequently affected, with cardiovascular involvement, such as endocarditis, pericarditis and myocarditis, being extremely rare. Here we describe a patient with Brucella infection complicated with Brucella pericarditis in the absence of concomitant endocarditis, diagnosed as a result of clinical manifestations, imaging, laboratory findings including culture and serology, and the patient's occupation.

BACKGROUNDData on the effect on re-hospitalization are limited when levosimendan is added to conventional treatment. We aimed to investigate the role of fragmented QRS (f QRS) on the surface electrocardiogram in predicting the response to levosimendan therapy in patients with acute systolic heart failure. MATERIAL and METHODSPatients with a left ventricular ejection fraction of <35% were enrolled in this retrospective observational study. They were administered a levosimendan therapy for 24 h, and the number of re-admissions due to decompensated heart failure annually were recorded. Patients were divided two groups: group 1, 0-7 admissions per year and group 2, >7 admissions per year. RESULTSThere were 42 patients in group 1 and 24 in group 2. The presence of fragmented QRS was seen in 41% of the patients in group 1 and in 92% of the patients in group 2 (p<0.001). The presence of fragmented QRS during the hospitalization of patients treated with levosimendan was found to be an independent predictor of the admission of more than 7 patients in the multivariate analysis. CONCLUSIONThe presence of fragmented QRS during hospitalization may predict a lower response to levosimendan therapy in patients with decompensated heart failure.