316 research outputs found

    Serum neuronal specific enolase as a biomarker in differentiating the side of brain lesion in acute hemorrhagic stroke: a hospital based study

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    Background: Neuronal specific Enolase (NSE) is the neuronal form of the glycolytic enzyme enolase. This study has been conducted to see the role of serum NSE in differentiating the side of brain lesion within 24 hours of acute hemorrhagic stroke onset.Methods: The study was conducted in collaboration with the Department of Physiology and Medicine after Ethical clearance from December 2013 to April 2015. Our study group consists of 35 acute hemorrhagic stroke patients (clinically and radio logically confirmed) irrespective of age and sex, admitted in Emergency Unit, Medicine Department within 24 hours of stroke symptom onset. The patients were undergone plain CT scan brain on admission to confirm the diagnosis and the side of the lesion in brain. Serum NSE for these patients was estimated by using NSE Human ELISA Kit, in the Department of Physiology.Results: In this study, serum NSE bears a positive significant correlation to the hematoma volume in brain (r=0.786, p<0.001) and to the National Institute of Health Stroke Scale (NIHSS) (r=0.44, p=0.008). However, there is no significance difference between the serum NSE in right hemispheric brain lesion compared to left hemispheric brain lesion (p=0.597).Conclusions: Serum NSE within 24 hours of stroke onset can reflect the volume of brain lesion and severity of neurological deficit but cannot differentiate the side of brain lesion in these patients.

    Diagnostic Value of Serum Neuron-Specific Enolase Level in Patients With Acute Ischemic Stroke; A Systematic Review and Meta-Analysis

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    Background: We aim to assess the predictive value of serum neuron-specific enolase (NSE) level in patients with acute ischemic stroke referring to the emergency department.Methods: This systematic review and meta-analysis performed, considering the PRISMA and MOOSE statement guidelines. A computerized literature search of the known medical database conducted by using the relevant keywords. We included studies published before November 2016 in which stroke patients compared with non-stroke controls and also studies evaluating the serum levels of NSE in the study groups. Statistical analysis was pooled in a random effect model analysis using the Comprehensive Meta-Analysis software.Results: We included 12 articles in the qualitative and quantitative analysis, that their quality acceptable based on the Newcastle Ottawa Scale (NOS scale). The pooled effect estimates showed that NSE is significantly higher in ischemic stroke patients in comparison with their controls with a high effect estimate [OR 9.68, 95% CI (3.06 to 30.6)]. The effect estimate remained statistically significant under the fixed and random effects model.Conclusion: Our results show higher levels of NSE in patients with stroke than in the control group, indicating that NSE plays a role in the diagnosis of stroke. In terms of prognosis, there is evidence regarding the direct and indirect relationship; and it founded that serum levels of NSE is higher in larger stroke volume, which needs further research

    Biomarkers of Acute Brain Injury in the Emergency Department

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    The diagnosis of acute brain injury in the acute care setting is based on neurological examination and neuroimaging tools such as computed tomography (CT) scanning and magnetic resonance imaging (MRI). However, there are limitations to both CT and MRI scanning. The lack of objective, noninvasive and readily accessible clinical tools to detect injury has left clinicians with uncertainty about how to best identify and treat these conditions. It is also very difficult for patients and their families who struggle to better understand the deficits they deal with on a daily basis. There have been many studies exploring many promising biomarkers during the last decade. Despite the large number of published studies there is still a lack of any Food and Drug Administration (FDA)-approved biomarkers for brain injury in adults and children. Given all of these researches, there is now an important need to validate and introduce them into the clinical setting. This chapter reviews commonly studied biomarkers for acute brain injury in humans, with an emphasis on traumatic brain injury and stroke

    Clincal Aspects of Biological Brain Damage Markers

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    Biomarkers for organ damage and/or dysfuntion are used in almost all areas of medicine. The brain has eluded this technological development for some time. Recently, the S100B protein has been shown to be a promising marker of brain damage. However, before S100S can reach clinical reality, several problems must be solved. The specificity of S100B requires special investigative attention. Although the sensitivity has seldom been criticised in the literature and assumed to be very high for S100B, this also craves further analysis. Furthermore, other clinical applications of biomarkers such as S100B need to be examined. Aim/brief methods This thesis therefore looks at these aspects in 6 clinical studies comprising 294 separate patients. The main aims were to; examine the specificity of serum S100B in clinically relevant situations; to examine the sensitivity of serum S100B in head injury; to investigate serum S100B levels in infectious disease; to investigate the source of serum S100B in patients with multitrauma and brain injuries; to examine the clinical utility potential for serum S100B as a daily measurement parameter in neurointensive care; and finally, to examine the ability of a biomarker panel (including the three most promising brain biomarkers; S100B, GFAP and NSE, with a biomarker of coagulation system activation; PCI-APC) to differentiate ischemic from haemorrhagic acute stroke. Biomarker analysis for S100B and NSE was performed with commercial assays. Analysis of GFAP and APC-PCI was performed by non-commercial assays. Results The results show that elevated levels of S100B were seen, in absence of brain injury, in isolated orthopaedic fractures, extracerebral infectious disease and in extracranial surgery after total brain herniation. These levels were generally consistent with levels seen after minor head injury. Epidural haematomas showed near-normal levels of S100B, even soon after the head trauma has occurred. Serum S100B is generally elevated in CNS infections, for instance in bacterial meningitis. S100B was especially raised in encephalitis. Daily S100B levels did not predict secondary neurological complications or outcome in the neurointensive care unit. Serum GFAP and APC-PCI measurements, prior to neuroimaging, had a 97% negative predictive power for haemorrhagic stroke and a 100% value if only samples within 12 hours were considered. Conclusions The clinical specificity of S100B is low. Elevated levels of S100B, in patients with clinical evidence of extracerebral tissue damage, should not be interpreted as brain damage. The sensitivity of serum S100B in head injury is high. However, epidural haematomas showed near-normal levels of S100B. Therefore, the magnitude of S100B levels in head trauma patients should not be directly related to the risk and/or magnitude of intracranial pathology. S100B is elevated in cerebral infections, especially in encephalitis where levels were found to be high. Most of the circulating S100B in serum after multitrauma injuries originates from the brain. Daily serum S100B levels are not clinically useful in the neurointensive care setting. Serum GFAP and APC-PCI measurements, prior to neuroimaging, can accurately rule out haemorrhagic stroke in a mixed population of stroke patients

    Biomarcadores séricos e prognóstico no acidente vascular cerebral

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    Fundamentação: O acidente vascular cerebral (AVC) é uma das principais causas de morte em todo o mundo e a maioria dos sobreviventes permanece com alguma sequela neurológica após o evento agudo. O presente estudo objetiva investigar a associação de alguns biomarcadores sanguíneos com as escalas de AVC, bem como avaliar a capacidade dos biomarcadores selecionados na predição de desfechos neurológicos durante o tempo de acompanhamento. Material e Métodos: Incluímos nesse estudo 60 pacientes com AVC agudo admitidos na unidade neurovascular da emergência ou na unidade de medicina intensiva do Hospital de Clínicas de Porto Alegre, nas primeiras 24 horas do início dos sintomas. Foram coletas amostras sanguíneas nas primeiras 24 horas, no terceiro e no quinto dias após o AVC para dosagem de enolase neurônio específica (ENS), proteína S100ß (S100ß), interleucina 6 (IL-6), proteína C reativa (PCR) e fator neurotrófico derivado do cérebro (BDNF). A gravidade do AVC e o grau de dependência funcional dos pacientes após o AVC foram mensurados através das escalas do National Institutes of Health Stroke Scale (NIHSS) e modified Rankin Scale (mRS) nos três momentos das coletas sanguíneas e na alta hospitalar. Resultados: Os níveis séricos de S100ß, IL-6 e PCR mostraram-se o melhor painel de biomarcadores após o AVC nesse estudo. Quando os pacientes foram subdivididos em dois grupos para a avaliação de desfechos neurológicos, usando as escalas do NIHSS (NIHSS ≤ 6 e NHISS > 6) e mRS (mRS ≤ 3 e mRS > 3), ambas as escalas apresentaram boa associação entre as concentrações de S100ß e de IL-6 em todas as medidas e as escalas de AVC para bom prognóstico (NIHSS ≤ 6 e mRS ≤ 3) na alta hospitalar. Dentre os biomarcadores selecionados para o estudo, foram os três citados acima que apresentaram as melhores correlações com as escalas de AVC e com o prognóstico pós AVC durante o tempo de acompanhamento. Conclusão: Os biomarcadores séricos podem ser úteis na avaliação da gravidade e do prognóstico após o AVC. A associação de S100ß, IL-6 e PCR parece acrescentar pouco às escalas validadas de AVC na capacidade de predizer desfechos após o evento agudo.Background and Purpose: Stroke is an important cause of death worldwide, and the majority of stroke survivors suffer from some form of residual disability. This study aimed to investigate the association of blood biomarkers with stroke scales and their predictive value after acute stroke at the time of admission until hospital discharge. Design and Methods: We investigated 60 patients with acute stroke who were admitted within 24 h of event onset at the intensive care unit or neurovascular emergency unit of Clínicas Hospital. All patients provided venous blood samples for the measurement of neuron-specific enolase (NSE), S100ß protein (S100ß), interleukin-6 (IL-6), C-reactive protein (CRP) and brain-derived neurotrophic factor (BDNF) within 24 h of the acute event, on the third day and on the fifth day after the stroke. Neurological stroke severity and global disability were determined with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at the same three times of blood collection and at the time of hospital discharge. Results: The serum levels of the S100ß protein, IL-6 and CRP seem to constitute the best panel of biomarkers after acute stroke in this study. When patients were subdivided into two groups according to the NIHSS (NIHSS ≤ 6 and NIHSS > 6) and mRS (mRS ≤ 3 and mRS > 3) scores, which were used as neurological outcome measures, both neurologic scores for good outcome (NIHSS ≤ 6 and mRS ≤ 3) at hospital discharge were significantly related to the S100ß protein and IL-6 levels at all of the measured time points. Among the analyzed blood markers, S100ß, IL-6 and PCR levels significanttly correlated with the stroke scales and prognostic value. Conclusion: Blood biomarkers may be useful in acute stroke either by suggesting stroke severity or providing a prognostic value. The addition of the S100ß protein, IL-6 and CRP to previously validated stroke scales slightly improves the ability of these scales to predict outcome

    Assessment of S100\u3b2 Biomarker in Acute Ischemic Cerebrovascular Stroke Patients with Hypertension

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    Background: Cerebrovascular stroke (CVS) is the third leading most common cause of death in the world. Role of antihypertensive drugs and nitric oxide donors such as glyceryl trinitrate (GTN) in acute ischemic cerebrovascular stroke varies in their effects on cerebral autoregulation (CA). Assessment of biochemical marker as S100\u3b2 protein is an important diagnostic tool. Objective: The aim of this study is to assess the role of transdermal glyceryl trinitrate (GTN) patch in the management of acute ischemic CVS and to evaluate the role of S100\u3b2 protein as a prognostic marker in acute ischemic CVS. Methods: Forty acute ischemic CVS patients with hypertension were included. They were divided in to two groups, Group (A); 20 patients maintained on their anti-hypertensive treatment, and Group (B); 20 patients received GTN nitro dermal patch 5mg. All cases were subjected to, clinical evaluations by European stroke scale, assessment of S100\u3b2 on third day and after 14 days of stroke onset and brain CT. Results: There was no significant statistical difference between patient groups as regard clinical stroke evaluation on third day on stroke onset but there was significant statistical difference between group (A) and (B) after 14 days of stroke. There was highly significant statistical difference in the serum level of S100\u3b2 in group (A) and (B) on third day of stroke onset. Conclusion: Using GTN nitro dermal patch is a promising solution in management of hypertension in acute ischemic CVS and S100\u3b2 may help in the prediction of its prognosis

    A review of the clinical utility of serum S100B protein levels in the assessment of traumatic brain injury.

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    BACKGROUND: In order to improve injury assessment of brain injuries, protein markers of pathophysiological processes and tissue fate have been introduced in the clinic. The most studied protein "biomarker" of cerebral damage in traumatic brain injury (TBI) is the protein S100B. The aim of this narrative review is to thoroughly analyze the properties and capabilities of this biomarker with focus on clinical utility in the assessment of patients suffering from TBI. RESULTS: S100B has successfully been implemented in the clinic regionally (1) to screen mild TBI patients evaluating the need to perform a head computerized tomography, (2) to predict outcome in moderate-to-severe TBI patients, (3) to detect secondary injury development in brain-injured patients and (4) to evaluate treatment efficacy. The potential opportunities and pitfalls of S100B in the different areas usually refer to its specificity and sensitivity to detect and assess intracranial injury. CONCLUSION: Given some shortcomings that should be realized, S100B can be used as a versatile screening, monitoring and prediction tool in the management of TBI patients
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