Mehmet Gul

The role of optic nerve ultrasonography in the diagnosis of elevated intracranial pressure

Objective: To evaluate the convenience and utility of optic nerve ultrasonography (ONUS) in the evaluation of emergency patients with elevated intracranial pressure (EICP) due to traumatic or non-traumatic causes. Methods: This study was conducted between May 2005 and December 2005 in the emergency department of Meram Faculty of Medicine, Selcuk University. Patients with traumatic or non-traumatic EICP were included in the study. Among these, 28 patients with EICP determined on cranial computed tomography (CCT) and a control group of 26 patients with no disease had the vertical and horizontal diameters of the optic nerves (ONs) of both eyes measured by ultrasonography (US). The measurements were done by wetting the closed eyelids and using a 7.5-MHz linear probe. Results: Horizontal and vertical diameters of both ONs of the 54 patients were measured and the averages calculated. The mean (SD) ON diameter for the group suspected of having EICP was found to be 6.4 (0.7) mm, and that for the control group to be 4.6 (0.3) mm. In the statistical analysis carried out between these two groups (t test), the difference was found to be significant at p<0.001. Conclusions: In detection and follow-up of EICP cases, such as cerebrovascular accident and trauma, ONUS is a practical, risk-free, inexpensive, convenient and, if performed by experts, reliable method. As a result, although CCT may be more useful in diagnosis, ONUS may be more efficient in detecting EICP. In those cases where CCT and other conventional imaging methods are not available, ONUS can facilitate the diagnosis and help in treatment.

The relationship between red blood cell distribution width and the clinical outcomes in non-ST elevation myocardial infarction and unstable angina pectoris: a 3-year follow-up.

ObjectivesRed blood cell distribution width (RDW), a marker of variation in the size of the circulating red blood cells, was evaluated in patients with non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP). BackgroundHigher RDW is associated with mortality in the general population, particularly in those with symptomatic cardiovascular disease, and heart failure. We hypothesized that admission RDW might be predictive of adverse clinical outcomes for patients with NSTEMI and UAP. MethodsWe prospectively enrolled 310 patients with NSTEMI and UAP (mean age 59.3±11.9 years; 236 men, 74 women) in this study. Admission RDW was measured and the study population was classified on the basis of RDW tertiles. A high RDW (n=95) was defined as a value in the upper third tertile (>14%) and a low RDW (n=215) was defined as any value in the lower two tertiles (⩽14%). The patients were followed up for clinical outcomes for up to 3 years after discharge. ResultsIn the Kaplan–Meier survival analysis, the 3-year mortality rate was 19% in the high RDW group versus 5.6% in the low RDW group (P<0.001). In the receiver operating characteristic curve analysis, an RDW value of more than 14% yielded a sensitivity of 60% and a specificity of 72.5%. A significant association was found between a high admission RDW level and the adjusted risk of cardiovascular mortality (hazard ratio: 3.2, 95% confidence interval: 1.3–7.78, P=0.01). ConclusionRDW is a readily available clinical laboratory value associated with long-term cardiovascular mortality in NSTEMI and UAP.

Predictive value of neutrophil to lymphocyte ratio in clinical outcomes of non-ST elevation myocardial infarction and unstable angina pectoris: a 3-year follow-up.

We sought to determine the prognostic value of neutrophil to lymphocyte ratio (NLR) in non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP). A total of 308 (mean age 59.22 ± 11.93) patients with NSTEMI and UAP were prospectively evaluated. The study population was divided into tertiles based on admission NLR values. The patients were followed for clinical outcomes for up to 3 years after discharge. In the Kaplan-Meier survival analysis, 3-year mortality was 21.6% in patients with high NLR versus 3% in the low-NLR group (P < .001). In a receiver–operating characteristic curve analysis, an NLR value of 3.04 was identified as an effective cut point in NSTEMI and UAP of a 3-year cardiovascular mortality (area under curve [AUC] = 0.86, 95% confidence interval [CI] 0.8-0.92). An NLR value >3.04 yielded a sensitivity of 79% and specificity of 71%. Admission NLR is the strong and independent predictor of a 3-year cardiovascular mortality in patients with NSTEMI and UAP.

Serum Ischemia-modified Albumin Levels in an Experimental Acute Mesenteric Ischemia Model

OBJECTIVES This experimental study aimed to assess the changes in the levels of serum ischemia-modified albumin (IMA) and interleukin-6 (IL-6) by time in cases of acute mesenteric ischemia due to superior mesenteric artery occlusion. METHODS Twenty-one New Zealand rabbits were randomly divided into three groups. Blood samples were collected at hours 0, 1, 3, and 6 from animals in a control group; a sham group following a simple laparotomy; and in an ischemia group following superior mesenteric artery ligation. All blood samples were analyzed for serum IMA and IL-6 levels, and then the time-dependent changes of biomarkers were investigated. RESULTS The serum IMA levels of the ischemia group at hours 3 and 6 were significantly higher than those of the control and sham groups (hour 3, p = 0.017; hour 6, p = 0.001). The increase in serum IL-6 levels in the ischemia group at hours 1, 3, and 6 compared to the control and sham groups was also significant (hour 1, p = 0.002; hour 3, p = 0.003; hour 6, p = 0.003). CONCLUSIONS IMA may be helpful as a marker in the diagnosis of acute mesenteric ischemia; however, its diagnostic value and use as a routine biochemical test should be assessed in further studies.

The relationship between platelet to lymphocyte ratio and the clinical outcomes in ST elevation myocardial infarction underwent primary coronary intervention.

The platelet to lymphocyte ratio (PLR) has been investigated as a new predictor for cardiovascular risk. The aim of the present study was to investigate the prognostic role admission PLRat admission in predicting in-hospital and early mortality in patients presenting with ST segment elevation myocardial infarction (STEMI). A total of 639 consecutive patients with STEMI who underwent primary percutaneous coronary intervention (PCI) were included. The study population was divided into tertiles on the basis of PLR values at the admission. A high PLR (N = 213) was defined as a value in the upper third tertile (PLR >174.9) and a low PLR (N = 426) was defined as any value in the lower two tertiles (PLR ⩽174.9). The patients were followed for clinical outcomes for up to 6 months after discharge. In Kaplan–Meier survival analysis, the rate of 6-month all-cause deaths was 7% in the high PLR group versus 3% in the low PLR group (P = 0.03). In multivariate analyses, a significant association was noted between high PLR levels and the adjusted risk of 6-month all-cause deaths (odds ratio = 2.51, 95% confidence interval = 1.058–5.95; P = 0.03). PLR is a readily available clinical laboratory value associated with 6-month all-cause death in patients with STEMI who undergo primary PCI.

Impact of day versus night as intervention time on the outcomes of primary angioplasty for acute myocardial infarction

Background: Conflicting datas exist regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST‐segment elevation myocardial infarction (STEMI) when the intervention is performed during night hours. Methods and Results: 2,644 consecutive patients with STEMI (mean age 56.7 ± 11.9, years, 2,188 male) undergoing primary PCI between October 2003 and March 2008 were retrospectively enrolled into this study (single high‐volume center: >3,000 PCIs/year). Day time was defined according to intervention between 08:00 am and 06:00 pm and night as intervention time between 06:00 pm and 08:00 am. 1,141 patients (43.2%) were treated during the day and 1,503 (56.8%) at night. The baseline characteristics of both groups were similar except for more frequent hypertension (42.6 vs. 36.5%; P = 0.002), women (19.7 vs. 15.4%; P = 0.003), and old (≥75y) patients (9.6 vs. 7.4; P = 0.046) in the day time group. Compared with those treated during night time, day time patients had longer angina‐reperfusion times (mean, 205 vs. 188 minutes, P = 0.016). Door‐to‐balloon times were similar (P = 0.87), and less than 90 minutes in both groups. There were no differences concerning clinical events and PCI success between the two groups. Hospital mortality was 6.1% during the day and 5.2% during the night (OR 0.98, 95% CI 0.7–1.36; P = 0.89). The median follow‐up time was 21 months. The Kaplan‐Meier survival plot for long‐term cardiovascular death was not different for both groups (P = 0.78). In‐hospital and long‐term cardiovascular mortality was also similar in shock and nonshock subgroups. Conclusions: Primary PCI can be performed safely during the night at a high‐volume PCI center with suitable and effective organization of cardiology department and catheterisation laboratory with 24 hours per day, 7 days per week onsite staffing.

Which is worst in patients undergoing primary angioplasty for acute myocardial infarction? Hyperglycaemia? Diabetes mellitus? Or both?

Objective— The objective of this study was to evaluate the effect of admission hyperglycaemia and/or diabetes mellitus (DM) on the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).Methods— 2482 consecutive patients with STEMI (mean age 56.5 ± 11.9, years, 2064 men) undergoing primary PCI between October 2003 and March 2008 were retrospectively enrolled into the present study. Hyperglycaemia was defined as a venous plasma glucose level > 200 mg/dl on admission. Patients were classified into four groups: non-diabetic/non-hyperglycaemic (NDNH, n = 1806) patients; diabetic/non-hyperglycaemic (DNH, n = 271) patients; non-diabetic/hyperglycaemic (NDH, n = 64); and diabetic/hyperglycaemic (DH, n = 341).Results— In-hospital mortality was higher in NDH (12.5%) compared to DH (8.5%), DNH (6.3%), and NDNH (0.9%) patients (P < 0.001). The composite end points including death, reinfarction, and target-vessel revascularization (major adverse cardiac eve...

Diagnostic and prognostic value of procalcitonin and phosphorus in acute mesenteric ischemia

BACKGROUND In this study, using an animal model of acute mesenteric ischemia (AMI), we investigated the possible use of procalcitonin and phosphorus in the early diagnosis of AMI. METHODS In this study, 21 New Zealand rabbits were used. Subjects were allocated into three groups as Control, Sham and Ischemia. No intervention was performed in the subjects in the Control group. In the subjects in the Sham and Ischemia groups, laparotomy was performed with midline incision. In the Ischemia group, the superior mesenteric artery was found and tied after laparotomy. Blood was drawn from the animals in all groups at 0, 1, 3 and 6 hours, and procalcitonin and phosphorus levels were studied in these samples. RESULTS In the Ischemia group, the increase in the levels of serum phosphorus and procalcitonin was found to be statistically significant compared to the Control and Sham groups (p<0.05). The levels of phosphorus and procalcitonin were detected to increase from the 1st hour after ischemia onset, and the increase continued for the following 6 hours (p<0.05). CONCLUSION Phosphorus and procalcitonin may be important parameters for use in the early diagnosis and prognosis of AMI.

Association between serum galectin-3 levels and coronary atherosclerosis and plaque burden/structure in patients with type 2 diabetes mellitus.

BackgroundLevels of galectin-3, a member of a family of soluble &bgr;-galactoside-binding lectins, are reported to be higher in patients with type 2 diabetes mellitus (DM) and metabolic syndrome. Conflicting results exist on the effects of galectin-3 in diabetic patients. The aim of this study was to investigate the relationship between galectin-3 levels and coronary artery disease (CAD), coronary plaque burden, and plaque structures in patients with type 2 DM. Patients and methodsA total of 158 consecutive patients with type 2 DM undergoing planned coronary computed tomography angiography (CCTA) were included in this study. The study population was divided into CAD and non-CAD groups according to the presence of CCTA-determined coronary atherosclerosis. ResultsGalectin-3 concentrations were significantly higher in the CAD group than in the non-CAD group (1412.0±441.7 vs. 830.2±434.9 pg/ml, P<0.001). Galectin-3 levels were correlated positively with BMI, high-sensitivity C-reactive protein, the total number of diseased vessels, the number of plaques (all, P<0.001), and the calcified plaque type (P=0.001). In addition, galectin-3 levels were found to be a significant independent predictor of coronary atherosclerosis in type 2 diabetic patients (P=021; odds ratio, 1.002; 95% confidence interval, 1.000–1.003). ConclusionGalectin-3 is a novel, promising biomarker that may help identify type 2 diabetic patients who may require early CAD intervention because of the potential risk of coronary atherosclerosis.

Predictive value of elevated D-dimer in patients undergoing primary angioplasty for ST elevation myocardial infarction.

The aim of this study was to evaluate the prognostic value of D-dimer in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). The prognostic value of D-dimer has been documented in patients with acute coronary syndrome without ST-segment elevation. However, its value in acute ST-segment elevation myocardial infarction (STEMI) remains unclear. We prospectively enrolled 453 consecutive STEMI patients (mean age 55.6 ± 12.4 years, 364 male, 89 female) undergoing primary PCI. The study population was divided into tertiles based on admission D-dimer values. The high D-dimer group (n = 151) was defined as a value in the third tertile [>0.72 ug/ml fibrinogen equivalent units (FEU)], and the low D-dimer group (n = 302) included those patients with a value in the lower two tertiles (⩽0.72 ug/ml FEU). Clinical characteristics, in-hospital and 6-month outcomes of primary PCI were analyzed. The patients of the high D-dimer group were older (mean age 60.1 ± 13.5 versus 52.4 ± 10.6, P < 0.001). Higher in-hospital cardiovascular mortality and 6-month all-cause mortality rates were observed in the high D-dimer group (7.2 versus 0.6%, P < 0.001 and 13.9 versus 2%, P < 0.001, respectively). In Cox multivariate analysis; a high admission D-dimer value (>0.72 ug/ml FEU) was found to be a powerful independent predictor of 6-month all-cause mortality (odds ratio: 10.1, 95% confidence interval: 1.24–42.73, P = 0.03). These results suggest that a high admission D-dimer, level was associated with increased in-hospital cardiovascular mortality and 6-month all-cause mortality in patients with STEMI undergoing primary PCI.