Introduction: We aimed to investigate the effect of stress (acute) hyperglycemia in patients with acute coronary syndrome who had not been previously diagnosed with diabetes mellitus (DM) on the prognosis of the disease in terms of mortality. Material and methods: Patients who were admitted to the Adana Numune Training and Research Hospital Emergency Service Clinic between August 2010 and August 2013 and whose plasma blood glucose level was over 140 mg/dl at the time of admission but were not previously diagnosed with DM, who were over the age of 18 and considered to have acute myocardial infarction were included. Results: A total of 259 patients whose data were fully attainable were included in the study. 80.3% (n = 208) of the patients were male and 19.7% (n = 41) were female. Non-ST elevation myocardial infarction was found in 71.6%, ST elevation myocardial infarction was found in 28.4% of the patients with stress hyperglycemia. It was determined that 10.1% of patients with stress-related hyperglycemia and 1.3% of patients without stress-related hyperglycemia had died. Conclusions: The plasma blood glucose level at presentation of patients diagnosed with acute myocardial infarction at the emergency room is associated with early in-hospital mortality.
Background: Considering the critical role of early diagnosis and management of acute ischemic stroke, biomarkers that can reliable assist in the diagnosis are still needed. These biomarkers should rapidly analyze, have high specificity for brain damage, and be available in the emergency settings for early diagnosis and exclusion of other conditions that mimic acute ischemic stroke. Soluble tumor necrosis factor-like weak inducer of apoptosis, a protein involved in the regulation of several biological functions, could be a potential acute ischemic stroke biomarker. Aims: To investigate the diagnostic value of soluble tumor necrosis factor-like weak inducer of apoptosis in patients with acute ischemic stroke and examine the relationship between ischemic area volume determined at diffusion-weighted magnetic resonance imaging and soluble tumor necrosis factor-like weak inducer of apoptosis. Study Design: A prospective, case-control study. Methods: This case-control prospective study included 36 patients with acute ischemic stroke and 36 healthy volunteers. Information on age, sex, presence of chronic disease, neurological examination findings, times of presentation to the emergency department after acute ischemic stroke, soluble tumor necrosis factor-like weak inducer of apoptosis levels, ischemic area volumes at diffusion-weighted magnetic resonance imaging, and 6-month mortality rates after stroke were recorded. The results were analyzed on SPSS 22.0 software (SPSS Inc., Chicago, IL, USA), and p<0.05 was considered statistically significant. Results: A soluble tumor necrosis factor-like weak inducer of apoptosis cut-off value of 995.5 pg/mL exhibited a sensitivity of 80.5% and a positive predictive value of 82.5% with an area under the curve of 0.84 (95% confidence interval: 0.74-0.94; p<0.001). The mean soluble tumor necrosis factor-like weak inducer of apoptosis levels in the acute ischemic stroke group (1968.08±1441.99 μg/L) were significantly higher than those in the control group (704.81±291.72 μg/L) (p<0.001). No correlation was observed between soluble tumor necrosis factor-like weak inducer of apoptosis levels and ischemic area volume measured at diffusion-weighted magnetic resonance imaging (r=-0.008; p=0.07). The mean ischemic area volume was 505.68±381.10 and 60.96±80.89 mm 3 in the nonsurviving and surviving patients, respectively (p=0.002). Conclusion: Soluble tumor necrosis factor-like weak inducer of apoptosis can be used in the diagnosis of acute ischemic stroke. However, it is inconclusive in estimating ischemic area volume and early mortality following acute ischemic stroke. Ischemic area volume measured at diffusion-weighted magnetic resonance imaging is a marker of poor prognosis and can be used in predicting early mortality.
Objectives: The severity of inflammation occurring during chronic obstructive pulmonary disease (COPD) is closely associated with oxidative stress. The aim of this study was to investigate the diagnostic value of Thiol/disulphide homeostasis (TDH) and ischemia modified albumin (IMA) levels in evaluating oxidative stress in COPD patients. Methods: This prospective study was performed with COPD patients presenting to the Kırıkkale University Hospital and with healthy volunteers. Subjects' demographic data (age, sex, body mass index, and smoking status), native thiol (NT), total thiol (TT), disulphide (Ds), IMA levels and Ds/NT, Ds/TT and NT/TT ratios were recorded. Statistical analysis was performed with SPSS 21.0 software. Results: One hundred ninety subjects were enrolled in the study, 141 COPD patients and 49 healthy volunteers. No difference was determined between the patient and control groups in terms of age, sex or body mass index. The antioxidant markers; NT and TT levels and NT/TT ratio were significantly lower in the patient group compared to the control group (p < 0.001, p < 0.001, and p < 0.003, respectively). The oxidant markers; IMA levels and Ds/NT and Ds/TT ratios were significantly higher in the patient group (p = 0.006, p = 0.003, and p = 0.003, respectively). Significant negative correlation was determined between antioxidant and oxidant parameters. Sensitivity values were NT: 87.2%, TT: 83.3%, Ds/NT ratio: 68.1%, Ds/TT ratio: 68.1%, and IMA: 77.8%. Conclusions: TDH was impaired in favor oxidants in COPD patients. TDH parameters and IMA can be used to monitor oxidative stress emerging in COPD.
We present a case of suicide attempt with levetiracetam (LEV) in an epilepsy patient. Multifocal ventricular contractions were observed together with bradycardia in this patient due to LEV overdose. Reported patient of LEV overdose in the literature rarely show electrocardiography findings. Although LEV is less toxic than other antiseizure medications, clinicians should be aware of its potential cardiac side effects.
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