Mehmet Cagri Goktekin

Copeptin Levels in Cerebral Infarction, Intracranial Hemorrhage and Subarachnoid Hemorrhage.

BACKGROUND To determine copeptin levels in patients with suspected intracranial events and to determine whether copeptin levels could be used in the discrimination of cerebral infarction, intracranial hemorrhage, and subarachnoid hemorrhage in the emergency room. METHODS Blood samples were obtained from the patients prior to imaging to determine the levels of copeptin. Patients were divided into diagnostic groups after the imaging. One hundred and seventy-six participants, who were enrolled in the study, were as follows: 50 cerebral infarction (CI) patients (M/F: 24/26), 47 intracranial hemorrhage (ICH) patients (M/F: 27/20), 29 subarachnoid hemorrhage (SAH) patients (M/F: 17/12) and 50 healthy controls. Differences and correlations between groups were analyzed. RESULTS Plasma levels of copeptin in patients with CI, ICH, and SAH were 5.49 ng/dL (IQR 4.73 to 6.96), 4.50 ng/dL (IQR 3.04 to 9.77), and 5.90 ng/dL (IQR 3.11 to 13.26), respectively. It was found to be 2.0 ng/dL (IQR 1.57 to 2.5) in healthy volunteers. There was no significant correlation between copeptin levels and Intracerebral Hemorrhage Score (ICHS) (r = 0.231, p = 0.118). However, significant positive correlation was found between copeptin levels with the National Institutes of Health Stroke Scale (NIHSS) (r = 0.365, p = 0.009) and the BotterelHunt and Hess Scale (BHHS) (r = 0.590, p = 0.001). The copeptin levels of 41 (32.5%) patients who died were found to be significantly higher than those 85 (67.5%) patients who were discharged (p < 0.001). CONCLUSIONS Copeptin levels in patients with CI, ICH, and SAH are significantly higher than healthy volunteers, but the plasma level of copeptin is not decisive in the discrimination of CI, ICH, and SAH.

Utilization of glial fibrillary acidic protein and galectin-3 in the diagnosis of cerebral infarction patients with normal cranial tomography

Objective: It was aimed to determine whether levels of glial fibrillary acidic protein (GFAP) and Galectin-3 contribute to the diagnosis of cerebral infarction in clinically suspected ischemic stroke patients with normal computerized cranial tomography (CCT) in the emergency department. Materials and Methods: In this study, patients above the age of 18 years who presented to emergency department of Firat University between December 2011-November 2012 and were diagnosed with cerebral infarction were included. Exclusion criteria were as follows: symptom onset exceeding 24 hours, trauma, pregnancy, acute myocardial infarction, acute pulmonary embolism, chronic renal insufficiency and steroid therapy. Results: A total of 90 participants, forty patients with ischemic infarction who were diagnosed by CCT and clinical findings (Normal CCT in 17 patients and CCT with an area of infarction in 23 patients) and fifty healthy controls, were included in this study. Compared with the control group, levels of Galectin-3 and GFAP were found to be significantly increased in patients with ischemic infarction (P <0.001 and P = 0.01, respectively). It was found that levels of Galectin-3 and GFAP were significantly increased in ischemic stroke patients with normal CCT compared to the control group (P = 0.04 and P = 0.025, respectively). In ROC curve analysis, we detected %70.59 sensitivity and 70% specificity (AUC = 0.684, P = 0.0213, 95% CI: 0,558-0.792) with a cutoff value of 33.24 ng/ml for GFAP and 76.47% sensitivity and 68% specificity (AUC = 0.734, P = 0.0048, 95% CI: 0.611-0.834) with a cutoff value of 0.84 ng/ml for Galectin-3. No correlation was found between National Institutes of Health Stroke Scale (NIHSS) scores and Galectin-3 and GFAP (r = 0.251, P = 0.118 and r = 0.164, P = 0.311, respectively). Conclusion: The levels of Galectin-3 and GFAP were increased in acute ischemic stroke patients.

Leriche syndrome in the emergency department: Two case reports

DOI: 10.4328/JCAM.5010 Received: 05.04.2017 Accepted: 20.05.2017 Publihed Online: 22.05.2017 Corresponding Author: Mustafa Yilmaz, Department of Emergency Medicine, Firat University Faculty of Medicine, 23200, Elazig, Turkey. T.: +90 4242370000/1443 GSM: +905057700734 E-Mail: drmylmz@hotmail.com Özet Aortik bifürkasyonun oklüzyonu sonucu meydana gelen Leriche sendromu, cerrahi olarak tedavi edilen, ciddi morbidite ve mortaliteye neden olan nadir görülen periferik vasküler hastalıklardandır. Tek yada iki taraflı alt ekstremitede kladicasyo, femoral nabızların azalması yâda yokluğu ile karakterizedir. Alt ekstremitelerde ağrı ya da güçsüzlük şikâyeti olan hastalarda ayırıcı tanıda düşülmelidir.

The Relationship between Ghrelin and Copeptin Levels, and Anxiety and Depression Levels in Suicide Attempts

Objective It was aimed to detect acylated ghrelin (AG), unacylated ghrelin (UG) and copeptin levels in patients with suicide attempts and to determine if these biomarkers are risk factors for suicide attempts. Methods Serum copeptin, AG and GU levels were screened in 128 patients who were admitted to emergency department with suicide attempts and 59 healthy controls. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were applied simultaneously, and the data were compared statistically. Results AG, UG and copeptin levels were higher in the patient group compared with the healthy control group. BAI scores of patients were found to be positively correlated with BDI scores. While there was a significant difference (p=0.0064) between psychiatric and non-psychiatric patients with suicide attempts in terms of BAI scores, there were no differences in BDI scores and levels of biomarkers. We found significantly increased BDI and BAI scores and increased levels of AG, UG and copeptin in psychiatric and non-psychiatric patients compared with healthy individuals. The specificities yielded by receiver operating characteristic curve analysis in patients with suicide attempts were as follows: 91.53% for AG, 72.88% for UG and 94.92% for copeptin. Conclusion Serum levels of AG, UG and copeptin increase with increasing anxiety and depression in patients with suicide attempts. Increased levels of AG, UG and copeptin could be considered a risk factor for suicide attempts.

Investigation of UCH-L1 levels in ischemic stroke, intracranial hemorrhage and metabolic disorder induced impaired consciousness

Objective We aimed to determine the levels of ubiquitin C‐terminal hydrolase‐L1 (UCH‐L1) in patients admitted to the emergency department with impaired consciousness due to metabolic or neurological reasons. Materials – methods The study included 80 patients with ischemic stroke (IS), 40 patients with intracranial hemorrhage (ICH), 80 patients with metabolic disorder induced impaired consciousness (MDIC) and 40 healthy controls. Results The levels of UCH‐L1 [median (IQR)] were as follows: 5.59 ng/mL (3.90–9.37) in IS, 5.44 ng/ml (4.01–13.98) in ICH, 3.34 ng/ml (2.29–5.88) in MDIC and 3.94 ng/ml (3.31–7.95) in healthy volunteers. Significantly higher levels were detected in IS and ICH than in MDIC and healthy volunteers. In ROC curve analysis, we detected 63.75% sensitivity and 62.5% specificity (AUC = 0.626, p < 0.0199, 95% CI: 0.533–0.713) with a cutoff value of 4.336 ng/ml for IS and 75% sensitivity and 55% specificity (AUC = 0.664, p < 0.0071, 95% CI: 0.549–0.766) with a cut‐off value of 4.036 ng/ml for ICH. However, the sensitivity and specificity for MDIC was 36.25% and 77.5%, respectively, with a cut‐off value of 3.256 ng/ml (AUC = 0.525, p = 0.6521, 95% CI: 0.432–0.617). UCH‐L1 levels were found to increase significantly with increasing time between the onset of symptoms and blood sampling (r = 0.345, p < 0.001). However, no correlation was found between UCH‐L1 levels and age (r = 0.014, p = 0.833), GCS (r = −0.115, p = 0.074), mRS (r = 0.063, p = 0.475) and NIHSS (r = 0.056, p = 0.520). Conclusion In this study, we detected significantly higher levels of UCH‐L1 in patients with IS and ICH compared to patients with MDIC and healthy volunteers.

Serum Salusin Levels in ST-Segment Elevation Myocardial Infarction.

BACKGROUND In our study, we aimed to determine the change in levels of salusin-alpha and salusin-beta at admission and after the treatment in patients with STEMI, who have active atherosclerosis. METHODS Serum salusin-alpha and beta levels of 50 patients diagnosed with STEMI in the emergency department were measured at admission and on 7th day post-treatment and compared with serum salusin levels of 50 healthy volunteers. RESULTS In STEMI patients, salusin-alpha levels were found to be significantly decreased (p < 0.001) and salusinbeta levels were found to be significantly increased (p < 0.001) compared to healthy volunteers in the control group. 7th day post-treatment salusin-alpha levels were found to be lower and salusin-beta levels were found to be at a higher level compared to healthy individuals (p < 0.001). Negative correlation (r = -.322 p = 0.023) was found between salusin-alpha levels and pulse rate. But no significant correlation was found between salusin-beta levels and biochemical parameters. CONCLUSIONS The data of this study support the fact that salusin-alpha levels decrease and salusin-beta levels increase in acute cases such as STEMI.