Metin Atescelik

Meteorologic parameters and migraine headache: ED study

AIM Migraine is common in society and is one of the primary causes of chronic headache with episodes. In this study, we aimed to determine the role of meteorologic parameters and moon phase on triggering migraine attacks and effects on the number of patients presenting to the emergency department with migraine headaches. MATERIALS AND METHODS Patients admitted to the emergency department due to a migraine headache during a 1-year period were studied retrospectively. Correlation between moon phases, pressure, temperature, humidity, wind speed values of meteorologic observation, and recording station located in the same city and daily number of patients was analyzed. RESULTS A total of 3491 patients, of whom 72% (n = 2518) were women, were enrolled. The average daily number of patients was 9.6 ± 4 (3-24). A statistically significant correlation was found between the number of daily patients and daily maximum temperature (P = .005), mean temperature (P = .013), minimum temperature (P = .041), and daily temperature change (P = .003). In addition, a negative correlation was found between the daily number of patients presenting to the emergency department and daily relative humidity (in percentage; P = .031). No significant relationship was found between moon phases and the number of patients. CONCLUSION We have determined that the number of patients admitted to the emergency department with migraine headache has increased with high temperature and low humidity and that there is no relationship between the number of patients and moon phases.

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.

Paraoxonase-1 gene in patients with chronic obstructive pulmonary disease investigation Q192R and L55M polymorphisms.

BACKGROUND The effect of increased oxidative stress on the development of chronic obstructive pulmonary disease (COPD) is well known. One of the antioxidative systems against oxidative stress in human body is paraoxonase (PON) enzyme that protects low density lipoproteins (LDL) against oxidation. This study aimed to explore the polymorphisms on PON1, Q192R, L55M genes of patients with COPD. METHODS DNAs extraction was obtained from blood samples of 50 patients diagnosed with COPD and 50 patients as a control group who were presented to emergency clinic. Genotypes were obtained with polymerase chain reaction (PCR) and AIw I and Hsp92II restriction enzymes were used for Q192R and L55M polymorphisms, respectively. Analysis of data was done with the Chi-square test and Fishers exact test. RESULTS A statistically significant difference in Q192R polymorphism was found between the COPD patients and the control group (P=0.05). There was no statistically significant difference in L55M polymorphisms between the patient and control groups (P>0.05). Q192R polymorphism was significantly correlated with the PON1 gene and cigarette smoking; however other risk factors did not show any significant correlation with this polymorphism. Though L55M polymorphism was significantly correlated with family history and tuberculosis, there was no significant correlation with other risk factors. CONCLUSION We believe that more studies are needed to study the correlation of L55M polymorphism with other factors.

Neuron-Specific Enolase, S100 Calcium-Binding Protein B, and Heat Shock Protein 70 Levels in Patients With Intracranial Hemorrhage

AbstractThe authors evaluated neuron-specific enolase (NSE), S100 calcium-binding protein B (S100B), and heat shock protein 70 (HSP 70) levels and their relationships with in-hospital mortality, Glasgow Coma Scale (GCS) scores, and National Institute of Health Stroke Scale (NIHSS) scores.In total, 35 patients older than 18 years were presented to our emergency department and were diagnosed with non-traumatic intracranial hemorrhage (ICH) and 32 healthy controls were included. Blood samples were drawn on days 0 and 5.S100 calcium-binding protein B and HSP levels were significantly higher in patients than in controls on days 0 and 5. Neuron-specific enolase levels were higher in patients than in controls on day 0, but there was no significant difference on day 5.S100 calcium-binding protein B was negatively correlated with GCS, whereas it was positively correlated with NIHSS and bleeding volume. There was also a negative correlation between NSE and GCS, but it was not statistically significant. In addition, no significant correlation was found in terms of bleeding volume or NIHSS. Heat shock protein 70 was negatively correlated with GCS and positively correlated with bleeding volume and NIHSS, but these results were not statistically significant. S100 calcium-binding protein B and HSP 70 levels were significantly higher in those who died compared with survivors. The areas under the curve of S100 B, NSE, and HSP 70 for mortality were 0.635, 0.477, and 0.770, respectively.Neuron-specific enolase, S100B, and HSP 70 levels are simple, inexpensive, and objective measures in cases of ICH. These tests can be used to support an assessment for screening ICH patients with clinical scoring systems, such as GCS and NIHSS.

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.

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.

Copeptin levels and blood lipid profile in borderline patients with or without self-mutilation

Purpose Self-mutilation, known as self-harming behaviour of an individual without the intention of suicide, is commonly observed in individuals with borderline personality disorder. The objective of this study is to compare copeptin levels that are known to be related to aggressive behaviour and blood lipid profiles in borderline patients with and without self-mutilation. Methods Twenty patients with self-mutilation [SM(+)] and 20 patients without self-mutilation [SM(−)] between the ages of 18 and 49, diagnosed with borderline personality disorder based on DSM-IV-TR(8) diagnostic criteria and attended to by Fırat University Psychiatry Polyclinic, participated in the study. Socio-demographic and clinical data form, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale (HAMA) and Barrat Impulsivity Scale (BIS) were applied to all participants. Copeptin levels and plasma lipid levels were studied in the blood samples taken from the participants. Results Mean copeptin level found in SM(+) group (37.54 ± 18.8 ng/mL) was statistically significantly higher than SM(−) group (18.53 ± 16.6 ng/mL) (p = 0.002). A negative correlation was found between mean copeptin and mean total cholesterol levels (r = −0.436; p = 0.005), and between copeptin and low-density lipoprotein cholesterol (LDL) levels (r = −0.403; p = 0.01) in both SM(+) and SM(−) patient groups. HAMA mean score for SM(+) group was found as 36.45 ± 13.2, and for SM(−) group, it was found as 35.7 ± 12.9. There was a statistically significant difference between the depression points achieved by the two groups (p = 0.046). BIS total points average for SM(+) group was determined as 71 ± 9.71, whereas it was determined as 66.8 ± 7.92 in SM(−) group. There was no statistically significant difference between the groups based on anxiety points. Barrat planning, Barrat motor and Barrat attention points for SM(+) group were higher than the SM(−) group. However, the difference was not statistically significant (p > 0.05). Conclusion Findings of the study demonstrated that as cholesterol and LDL levels decreased, copeptin levels increased, and that could be related to the self-mutilation behaviour.

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.

Can we define migraine patients with blood high-sensitivity C-reactive protein and galectin-3 levels in the emergency department?

Introduction Migraine, the most widespread cause of headache in young adults, is a frequent reason for presentation to emergency departments. The aim of this study was to determine the diagnostic value of serum galectin-3 and high-sensitivity C-reactive protein (hsCRP) levels in migraine patients. Material and methods Serum galectin-3 and hsCRP levels were measured using enzyme-linked immunosorbent assay in 70 migraine patients and 70 healthy control subjects. Results The mean values of hsCRP and galectin-3 levels were significantly higher in the migraine group than those in the control group (1.67 ±0.49, 1.12 ±0.38 mg/l, p < 0.001; and 3.76 ±1.45, 2.05 ±0.29 ng/ml, p < 0.001, respectively). When the diagnostic values of the biomarkers were assessed in the migraine attack and control groups, the sensitivity and specificity of the test for hsCRP at the cut-off point of 1.32 mg/l were 70% and 73% (AUC = 0.805, 95% CI: 0.74–0.88, p < 0.001), and for galectin-3 at the cut-off point of 2.4 ng/ml, 89% and 90% (AUC = 0.97, 95% CI: 0.95–0.99, p < 0.001), respectively. Conclusions This study showed the presence of a relation between high serum levels of hsCRP and galectin-3 in migraine patients. However, well-controlled, carefully executed longitudinal studies are required to confirm these findings.