Diagnostic and Prognostic Significance of Neutrophil Gelatinase- Associated Lipocalin and Pentraxin-3 in Acute Coronary Syndrome

Aim: The aim was to evaluate the levels of serum pentraxin-3 (PTX-3) and neutrophil gelatinase-associated lipocalin (NGAL) and the efficiency of making a diagnosis and to estimate the prognosis in patients with chest pain.Materials and Methods: The study was conducted in the Necmettin Erbakan University Meram Medicine School Emergency Department. Patients who had chest pain and met the inclusion criteria were accepted. They were divided into the following groups: acute coronary syndrome (ACS), a diagnosis other than ACS (non-ACS), and control. The patients in theACS and non-ACS groups were divided into five sub-group -groups: ST Elevated Myocardial Infarction (STEMI) Non- ST Elevated Myocardial Infarction (NSTEMI), Unstable Angina Pectoris (USAP), stable angina, and pulmonary embolus. For all patients, serum PTX-3, serum NGAL, troponin I, and creatine kinase-MB fraction (CK-MB) levels were measured.Results: There were 199 patients in the ACS and non-ACS groups and 30 patientsin the control group. There was no significant difference among the study groups in terms of age and PTX-3 and NGAL levels. When comparing survival and non-survival in terms of in-hospital death, CK-MB and troponin I levels were significantly higher in the ACS and non-ACS groups than in the control groups, whereas there was no significant difference in terms of PTX-3 and NGAL levels.Conclusion: The results of our study demonstrated that PTX-3 and NGAL are not effective biomarkers in the differential diagnosis and the determination of in-hospital mortality in ACS. However, the limitations of the study should be considered. The results confirmed that CK-MB and Troponin I can be safely used in the differential diagnosis and the prediction of mortality

Determination of lower extremity peripheral artery disease in patients undergoing carotid endarterectomy

Amaç: Aterosklerotik damar hastalığı sistemik bir hastalıktır. Bizim çalışmamızdaki amacımız karotis endarterektomi (KEA) operasyonu geçiren hastalardaki alt ekstremite periferik arter hastalığı (PAH) sıklığını belirlemek ve risk faktörlerini ortaya koymaktır.Gereç ve Yöntem: İstanbul Tıp Fakültesi’nde Kalp Damar Cerrahisi Anabilim Dalı tarafından Ocak 2011- Ocak 2015 yılları arasında karotis endarterektomi operasyonu geçiren 65 hasta buçalışmaya alınmıştır. Karotis endarterektomi operasyonu geçirenhastalar öykü, fizik muayene, ayak bileği kol indeksi ve alt ekstremite dupleks ultrasonografi sonuçları bir bütün halinde değerlendirilerek hastalarda periferik arter hastalığı olup olmadığı araştırıldı.Bulgular: Hastaların %72,3’ü (n=47) erkek, %27,7’si (n=18) kadın olmak üzere toplam 65 hasta bu çalışmaya alınmıştır. Hastaların yaşları 48 ile 88 arasında değişmekte olup ortalama 66,26±8,84 yıldır. Çalışmamız sonucunda karotis endarterektomi operasyonu geçiren hastalarda 65 yaş üstü olmanın (ODDS oranı (OR) 4,65 ,%95 CI:1,61-13,4), erkek cinsiyetin (OR 6,75 , %95 CI:1,71-26,50)sigara içmenin (OR 10,50 , %95 CI: 2,15-51,13), aile öyküsünün(OR 0,23 , %95 CI: 0,06-0,80), kronik böbrek yetmezliği varlığının (OR 0,41, %95 CI: 0,30-0,56) periferik arter hastalığını istatistiksel olarak anlamlı derecede arttırdığı tespit edildi. HDL düzeyleridüşük olgularda da periferik arter hastalığı sıklığında artış gözlendi. Çalışmamızda karotis endarterektomi operasyonu geçiren 65 hastadan 30’unda (%46,2) periferik arter hastalığı tespit edilmiştir.Sonuç: Karotis endarterektomi operasyonu geçiren hastalarda aterosklerozun sistemik tutulumu nedeniyle alt ekstremite periferik arter hastalığı olasılığı göz önünde bulundurulmalı ve hastalar bu şekilde değerlendirilmelidir.Objective: Atherosclerotic vascular disease is a systemic pathology. The aim of our study was to determine the frequency oflower extremity peripheral artery disease (PAD) in patients whounderwent carotid endarterectomy (CEA) and to identify riskfactors.Material and Method: The study included 65 patients who underwent carotid endarterectomy in Istanbul Medical Faculty, Department of Cardiovascular Surgery between January 2011 andJanuary 2015. The medical history, physical examination, anklebrachial index and lower extremity duplex ultrasonography results were evaluated and the patients were examined for peripheral artery disease.Results: Among 65 patients, 47 of them were male and 18 ofthem were female. The patients’ ages ranged from 48 to 88years, with an average of 66.26±8.84 years. In our study, beingabove the age of 65 (ODDS ratio (OR) 4.65, 95% CI: 1.61-13.4),male gender (OR 6.75, 95% CI: 1.71-26.50), smoking (OR 10.50,95% CI: 2.15-51.13), the family history (OR 0.23, 95% CI: 0.06-0,80), the presence of chronic renal failure (OR 0.41, 95% CI: 0.30-0.56) were found to increase peripheral artery disease in patients who underwent carotid endarterectomy statistically significant.In cases with low HDL levels, the frequency of peripheral arterydisease was found increased. In our study, peripheral artery disease was detected in 30 (46.2%) of 65 patients who underwentcarotid endarterectomy operation.Conclusion: Due to systemic involvement of atherosclerosis,lower extremity peripheral artery disease should be consideredin patients who underwent carotid endarterectomy operation,and patients should be evaluated accordingly

La revascularización de la arteria subclavia izquierda con un bypass axiloaxilar cruzado para la reparación híbrida de aneurismas de la aorta torácica

Aim: We present our subclavian artery revascularization experiences in the patients with thoracic aortic aneurysm who underwent hybrid repair. Materail and Methods: Between May 2015-December 2018,4 patients underwent TEVAR procedure following axilloaxillary bypass grafting.The mean age of the patients was 72.5 +/- 3.01 years.One patient was female and 3 patients were male.Patients had thoracic aortic aneurysms including the left subclavian artery or aberrant right subclavian artery. Results: All patients underwent endovascular stent graft repair following axilloaxillary bypass grafting in the same day.Mortality did not occur in the perioperative period.One patient had graft infection at 8th month of the operation and the graft was removed.He was lost due to pneumonia following the operation.The control computed tomographies of the other 3 patients revealed patent grafts together with successful endovascular interventions and they have been following uneventfully a mean of 27 +/- 6.2 months (range:24-32,median:29). Conclusion: The risk of stroke,spinal cord ischemia, and upper extremity ischemia are found higher in the patients who underwent coverage of the left subclavian artery without revascularization.The axilloaxillary bypass grafting may be performed in the patients with high risk to prevent carotid artery manipulation and clamping during carotid-subclavian bypass with long term promising patency rates.Objetivo: Presentamos nuestras experiencias de revascularización de la arteria subclavia en los pacientes con aneurisma de aorta torácica sometidos a reparación híbrida. Material y métodos: entre mayo de 2015 y diciembre de 2018, 4 pacientes fueron sometidos a TEVAR después de un injerto de derivación axiloaxilar. La edad media de los pacientes fue 72,5 ± 3,01 años. Un paciente era mujer y 3 pacientes eran varones. Los pacientes tenían aneurismas de la aorta torácica incluyendo el arteria subclavia izquierda o arteria subclavia derecha aberrante. Resultados: Todos los pacientes fueron sometidos a reparación endovascular con endoprótesis vascular en el mismo día después de un bypass axiloaxilar, no hubo mortalidad en el perioperatorio, un paciente presentó infección del injerto a los 8 meses de la operación y se retiró el injerto, se perdió por neumonía Las tomografías computarizadas de control de los otros 3 pacientes revelaron injertos permeables junto con intervenciones endovasculares exitosas y han estado siguiendo sin incidentes una media de 27 ± 6,2 meses (rango: 24-32, mediana: 29). Conclusión: El riesgo de ictus, isquemia medular e isquemia de la extremidad superior es mayor en los pacientes sometidos a cobertura de la arteria subclavia izquierda sin revascularización; en los pacientes con alto riesgo se puede realizar un bypass axiloaxilar para prevenir la manipulación de la arteria carótida. y pinzamiento durante la derivación carótido-subclavia con tasas de permeabilidad prometedoras a largo plazo

A comparison of clinical characteristics and course predictors in early- and childhood-onset schizophrenia

Aim: The aim of this study was to compare the clinical characteristics of childhood-onset schizophrenia (COS) and early-onset schizophrenia (EOS) during the first- episode psychosis and the stable period, to examine psychopharmacological treatment approaches, and to investigate potential predictive factors for prognosis. Methods: Demographic, clinical, and psychopharmacological therapy data for 31 patients diagnosed with COS and 66 with EOS were retrieved from the file records in this multicenter study. Symptom distribution and disease severity and course were evaluated twice, in the acute psychotic stage and in the latest stable phase, during follow-up using the positive and negative syndrome scale (PANSS) and clinical global impression (CGI) scales. Results: A statistically significant difference was observed between the groups' CGI improvement rates and median last stable stage PANSS positive, negative, and general psychopathology symptom scores (p =.005, p =.031, p =.005, and p =.012, respectively). Premorbid neurodevelopmental disorder and obsessive-compulsive disorder and comorbidities were more common in the COS group (p =.025 and p =.030, respectively), and treatment required greater multiple antipsychotic use in that group (p =.013). When the independent variables affecting the difference between pre- and post-treatment PANSS scores were examined using linear regression analysis, the model established was found to be statistically significant (F = 5.393; p =.001), and the group variable (p =.024), initial disease severity (p =.001), and socioeconomic level (p =.022; p =.007) emerged as predictive factors for the disease course. Conclusion: Although early diagnosis and treatment is an important factor in improving prognosis in schizophrenia, more specific predictors for schizophrenia need to be identified. Additionally, preventive programs and pharmacological methods need to be developed in children with neurodevelopmental problems, particularly those from low socioeconomic status families. © 2024 John Wiley ; Sons Australia, Ltd