The diagnostic value of myoglobin in the early diagnosis of acute myocardial infarction

Akut Myokard İnfarktüsü (AMI) düşündüren göğüs ağrılı hastalarda erken dönemde AMI'nü teşhis ya da ekarte edebilmek için myoglobinin (Mgb) tanısal değerini Troponin T (TnT) ve kreatin kinaz/myokarda özgü kreatin kinaz oranı (CK/CK-MB) ile karşılaştırdık. 01.06.2000-01.08.2001 tarihleri arasında, göğüs ağrısının başlangıcından sonraki ilk 12 saat içinde acil servisimize başvuran 101 hasta çalışmaya alındı. Bu çalışmada Mgb eşik değeri 100 mg/L olarak alınan hızlı kaset yöntemiyle kalitatif olarak ölçülmüştür. Aynı şekilde TnT eşik değeri 0.1 mg/L olarak alınan yatak başı hızlı kaset yöntemiyle kalitatif olarak ölçülürken, CK/CK-MB eş zamanlı alınan kan örneklerinden kantitatif olarak ölçülmüştür. Çalışmaya alınan 101 hastanın 50'si göğüs ağrısının başlangıcından sonraki ilk 3 saat içinde, 39'u 3-5 saat arasında ve 12 hasta da 5 saatten sonra acil servise başvurmuştur. Hastaların acil servise gelir gelmez alınan kan örneklerinden bakılan Mgb, TnT ve CK/CK-MB'nin AMI tanısını koydurma açısından sensitivite, spesifite, pozitif prediktif değer (PPD) ve negatif prediktif değerleri (NPD) hesaplanmıştır. Mgb hızlı kaset yönteminin sensitivitesi ve NPD'i TnT ve CK/CK-MB'den belirgin derecede yüksek bulunurken, spesifıtesi ve PPD'i TnT ve CK/CK-MB ile benzer bulunmuştur. Bu çalışma sonucunda Mgb hızlı kaset yönteminin acil serviste AMI tanısının konması veya ekarte edilmesi için bir tarama testi olarak kullanılabileceği kanısına varılmıştır.In this study, we investigated the diagnostic value of myoglobin (Mgb) in diagnosing or ruling out acute myocardial infarction (AMI) in patients admitted to the emergency department (ED) with chest pain. The results were compared with those of Troponin-T (TnT) and creatine kinase and creatine kinase myocardial band fraction (CK/CK-MB). Hundred and one patients who presented to our emergency department with chest pain within 12 hours after the onset of chest pain, were included in the study which was started on 01.06.2000 and ended on 01.08.2001. Rapid qualitative analysis kits for myoglobin (minimal detectable level of 100 mg/L) and TnT (minimum detectable level of 0,1 mg/L) were used. CK/CK-MB was measured quantitatively from a simultaneously drawn blood sample. Of the 101 patients included in the study 50 presented within 3 hours, 39 between 3 to 5 hours and 12 patients presented 5 hours after the onset of the chest pain. When patients were grouped according to their emergency department presentation time from the onset of pain, the sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of each marker were calculated. The sensitivity and NPV of Mgb rapid cassette test were found to be significantly higher then that of TnT and CK/CK-MB, specificity and PPV were found to be similar to those of TnT and CK/CK-MB. In conclusion, Mgb rapid cassette test can be used safely as a screening test to rule out AMI in the ED

Violence against emergency department employees and the attitude of employees towards violence

Conclusion: Violence against employees in the emergency department is a widespread problem. This situation has a strong negative effect on employee satisfaction and work performance. In order to reduce the incidence of violence in the emergency department, both patients and their families should be better informed so they have realistic expectations as an emergency patient, deterrent legal regulations should be put in place, and increased efforts should be made to provide enhanced security for emergency department personnel. These measures will reduce workplace violence and the stress experienced by emergency workers. We expect this to have a positive impact on emergency health care service delivery

Effectiveness of GFAP in Determining Neuronal Damage in Rats with Induced Head Trauma

CONCLUSION: Serum GFAP concentration can be used as a marker of the severity of head trauma and traumatic brain injury. However, more animal studies are required to reflect this result in clinical practice

Giant bladder (10,500 mL in volume) in the ED

A 66-year-old diabetic man presented to the emergency department with 3 days of abdominal distension and constipation. There was no history of neurologic and urologic disorders. A giant bladder was detected with abdominal ultrasound and computed tomography (CT). A total of 10,500 mL of urine was drained with urinary catheter. The diagnosis was neurogenic bladder due to diabetes mellitus with autonomic neuropathy. This is the largest volume of bladder in the literature

Serum levels of endocan, claudin-5 and cytokines in migraine

CONCLUSIONS: High serum levels of IL-1 beta, IL-6 and TNF-alpha in the migraine attack group indicate that inflammation plays a major role in migraine pathogenesis. In particular, the high ESM-1 and CLDN5 levels in patients with migraine suggest that inflammation should be investigated further, it may be a useful tool in the differential diagnosis of migraine

Effect of etanercept and lithium chloride on preventing secondary tissue damage in rats with experimental diffuse severe brain injury

OBJECTIVE: Studies in animals have provided key evidence that antagonizing TNF-alpha is a viable therapeutic strategy for diffuse severe brain injury. This study is planned to prevent post-traumatic secondary tissue damages in rat diffuse severe brain injury model, which is induced by alone or combined administration of Etanercept and lithium chloride (LiCl). MATERIALS AND METHODS: Male SpragueDawley rats were used in the current study. Rats were divided into 5 groups. Trauma was not induced and treatment was not applied to rats of Sham group. For rats of Trauma+Saline group, saline 0.9% was administered via intraperitoneal (i.p.) route at dose of 1 mg/100 g body weight 1 hour after trauma. For rats of Trauma+Etanercept group, Etanercept was administered via i.p. route at dose of 5 mg/kg body weight 1 hour after trauma. For rats of Trauma+LiCl group, LiCl was administered via i.p. route at dose of 50 mg/kg body weight 1 hour after trauma. For rats of Etanercept+LiCl group, Etanercept and LiCl were administered via i.p. route at dose of 5 mg/kg body weight and 50 mg/kg body weight, respectively, 1 hour after trauma. Serum glial fibrillary acidic protein (GFAP) and Tau levels were analyzed with ELISA. For analyses H&E, TUNEL, GFAP and TNF-alpha staining methods were used. RESULTS: We demonstrate that Etanercept treatment reduced the TBI-induced brain tissues alteration, reduced the expression of TNF-alpha and improve edema and axonal swelling. We observed a significant decrease in TNF-alpha and GFAP positivity after LiCl was administered. CONCLUSIONS: The findings obtained in this study suggest that the combination therapy with Etanercept and LiCl decreased neuronal degeneration and alleviated secondary tissue damage in post-traumatic period