Objective: Our aim is to evaluate S100β in serum in addition to clinical syncope decision rules and to determine the utility of this parameter along with OESIL and SFSR for any short term (10 days) adverse events. Material and Methods: This observational prospective cohort study included all consecutive patients older than 18 years who presented to the ED of Marmara University Hospital between June 2005 and January 2007 with the complaint of syncope within the previous 48 hours unless they had exclusion criteria. Two hundred and fifty-four patients were admitted, 80 were enrolled and 62 completed the follow-up. Multivariable logistic regression analysis was used to develop a risk score to predict the probability any adverse event in the short term using parameters of OESIL risk score, SFSR and serum S-100β level. Results: Patients with any short term adverse events had a higher pulse rate, lower hematocrit and hemoglobin levels, and higher serum S100B levels on admission. There were no significant differences between the accuracies of OESIL, SFS Rule and S100B level. Absence of prodromal symptoms, abnormal ECG and high serum S100B level were significant contributors of the model of adverse events. OESIL and S100B level were relatively effective compared to SFSR. The predictive value of each risk score was increased when combined with S100B level. Conclusion: The OESIL and SFSR were ineffective in recognizing patients with adverse events because of relatively low sensitivity. Serum S100B level seems to be a promising biochemical test which may increase the utility of prognostic syncope risk scales. (JAEM 2013; 12: 1-7) Key words: S100B protein, syncope, sensitivity and specificity
ÖzetAmaç: Serum S100β değerini OESIL ve San Fransisko Senkop Kuralı (SFSK) gibi senkop klinik karar verme kurallarıyla birleştirerek erken dönem (10 gün) advers olay riskini belirlemede sağladığı faydayı belirlemeyi hedefledik. Gereç ve Yöntemler: Bu gözlemsel prospektif kohort çalışmasına, 2005 Haziran ve 2007 Ocak ayları arasında Marmara Üniversitesi Acil Servisine son 48 saat içerisinde bayılma şikayetiyle başvuran, 18 yaşından büyük ve dışlanma kriterlerini içermeyen tüm hastalar dahil edilmiştir. Taranan 254 hastadan 80'i çalışmaya dahil edilmiş, 62'si çalışmayı tamamlamıştır. OESIL ve SFSK'nın parametreleri ve serum S100β değeri çoklu regresyon analizi ile incelenerek erken dönemde herhangi bir advers olay olasılığını öngördürecek bir risk skoru geliştirilmeye çalışılmıştır. Bulgular: Erken dönemde advers olay görülen hastaların başvuru esnasında daha yüksek nabız hızı, daha düşük hematokrit ve hemoglobin düzeyleri ve daha yüksek serum S100β düzeyine sahip oldukları belirlenmiştir. OESIL skoru, SFSK ve S100β düzeylerinin kesinlikleri (accuracy) arasında istaitstiksel olarak anlamlı fark tespit edilmemiştir. Prodromal semptom olmaması, anormal EKG varlığı ve yüksek serum S100β düzeyi advers olayı belirleyebilecek regresyon modeline anlamlı katkıda bulunan değişkenler olarak belirlenmişlerdir. OESIL risk skoru ve S100B düz...
Insulin glargine is a long acting novel recombinant human insulin analogue indicated to improve glycemic control, in adults and children with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. The time course of action of insulins including insulin glargine may vary between individuals and/or within the same individual. Insulin glargine is given as a 24-h dosing regimen and has no documented half-life or peak effect. Hypoglycemia is the most common adverse effect of insulin, including insulin glargine. As with all insulins, the timing of hypoglycemia may differ among various insulin formulations. We present a case of a 76-year-old male insulin-dependent diabetic patient with refractory hypoglycemia secondary to an intentional overdose of insulin glargine. We would like to highlight the necessity of prolonging IV glucose infusion, for a much longer period than expected from pharmacokinetic properties of these insulin analogues after intentional massive overdose.
Acute hepatitis is characterized by liver inflammation and liver cell necrosis. The most frequently observed underlying cause thereof is viruses, but various other causes, such as alcohol, medication, or toxins may also lead thereto.In this paper, a case of acute hepatitis presenting with bradycardia, hypotension, and a prominent increase in liver enzymes following mad honey ingestion is discussed. Since there are only few cases of acute hepatitis following mad honey ingestion in the literature, we want to present this subject matter.
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