Birsen Ertekin

Lipoprotein-associated phospholipase-A2 activity and its diagnostic potential in patients with acute coronary syndrome and acute ischemic stroke

Background The study examined the Lp-PLA2 activity at the patients presented to the emergency department with acute coronary syndrome (ACS) or acute ischemic stroke (AIS), as well as its diagnostic value. Methods The prospective study included consecutive male and female patients aged >18 years that presented to the our emergency department with ACS or AIS between November 2009 and January 2010. Blood samples were obtained immediately following diagnosis in the ACS and AIS groups. The diagnostic value of Lp-PLA2 was determined based on receiver operating characteristic curves, sensitivity, specificity, predictive values, likelihood ratios and accuracy rates. Results In all, 34 ACS and 32 AIS patients were included in the study, and the control group included 35 patients. Lp-PLA2 enzyme activity was significantly lower in the ACS and AIS groups than in the control group (26.7 ± 13.8, 31.4 ± 13.6, and 41.4 ± 8.1 nmol min−1·mL−1, respectively; p < 0.0001, p = 0.022). In the ACS group the area under the curve (AUC) was 0.825 (95%CI: 0.722–0.929), sensitivity was 71% for an optimal Lp-PLA2 cut-off value of 31.4 nmol min−1·mL−1, and specificity was 91%, whereas in the AIS group the AUC was 0.768 (95%CI: 0.652–0.884), sensitivity was 75% for an optimal Lp-PLA2 cut-off value of 38.1 nmol min−1·mL−1, and specificity was 74%. Conclusions Lp-PLA2 enzyme activity was significantly lower during the early stage of both ACS and AIS. The obtained statistic data suggest that low Lp-PLA2 enzyme activity can be used for diagnostic purposes.

Phenytoin induced dystonia

Acar T, Alkan G, Çaksen H, Ertekin B, Ergin M, Koçak S, Cander B. Phenytoin induced dystonia. Turk J Pediatr 2018; 60: 111-112. The abnormalities of dopaminergic activity in the basal ganglia have been emphasized to be effective in dystonia. We hereby report a case of a 2.5-year-old male patient who presented with tonic-clonic sezures and who developed dystonia after being given phenytoin. Biperidene hydrochloride was administered intramuscularly; primidone was added to the treatment regimen. After a 7-day-follow-up at the hospital, the patient had no dystonia and was discharged.

Affiliated Oral Uptake of Lidocaine Suicidal Initiative: A Case Report

Lidokain, lokal anestezik ve antiaritmik olarak, topikal ve parenteral yolla kullanılabilen, ülkemizde de yaygın kullanımı olan bir ajandır. Literatürde kaza ile ya da suicid amacıyla parenteral kullanımına ilişkin bildirimler yanında az sayıda fakat ölümle sonuçlanmış oral maruziyetler de bildirilmiştir. Kırk iki yaşında erkek hasta 20 adet jetokain ampulun (Lidokain HCL + Epinefrin) içeriğini oral olarak aldığı ifade edilerek yakınları tarafından acil servisimize getirildi. Geldiğinde genel durumu iyi, şuuru açık olan hasta ile kooperasyon yeterince kurulamıyordu. Fizik muayenesinde vital bulguları stabildi ve belirgin patolojik bulguya rastlanmadı. Yakınlarından daha önce psikiyatrik problemleri olduğu ve benzeri girişimlerde bulunduğu öğrenildi. Hasta ileri tetkik ve izlem için acil gözlem ünitesine yatırıldı. İzleminde hemodinamik açıdan problem gelişmeyen, laboratuar tetkiklerinde anlamlı bulguya rastlanmayan hasta, 24 saat gözlendikten sonra psikiyatri kliniği ile konsülte edilip önerilerle taburcu edildi. Lidokainin oral alımda biyoyararlanımı oldukça düşük olmasına rağmen, özellikle yüksek dozlarda maruziyet durumunda ölümcül olma potansiyeli olduğu akılda tutulmalıdır. Hastalara oral ilaç intoksikasyonlarında uygulanan rutin protokol uygulanmalı ve yeterli süre gözlem altında tutulmalıdırlar.