Can HIF-1 Alpha (Hypoxia- inducible factor-1 alpha) be a New Cardiac Hypoxia Marker in Acute Coronary Ischemia?

Objective:Hypoxia- inducible factor-1 alpha (HIF-1 alpha) is a gene protein whose activation is a primary defensive mechanism against tissue hypoxia. It is the main regulator of cellular oxygen delivery and consumption. HIF-1 alpha activity is increased in tissue ischemia and this induces the angiogenic growth factor release that is needed for vascular remodeling and collateral formation, and contributes to improvement in cardiac functions. In this study, it was aimed to measure HIF-1 alpha levels in acute cardiac ischemia, to evaluate its relationship with inflammatory and biochemical parameters, and to investigate HIF-1 alpha as a possible cardiac hypoxia marker.Method:First 31 patients who were admitted to coronary ICU with Acute Coronary syndrome (ACS) diagnosis in March 2018 were included in the study and 22 (14 female, 8 male) age-gender-matched healthy control group were included in the study. In both case (coronary ICU patient) and control groups), after 12-hour hunger, venous blood samples were taken to measure HIF-1 alpha, biochemical parameters [glucose, urea, creatinine, uric acid, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT)], hemoglobin, platelets, platelet parameters [mean platelet volume (MPV), procalcitonin (PCT), platelet distribution width (PDW)], inflammatory parameters [C-reactive protein (CRP), neutrophil/lymphocyte ratio] and homocysteine levels. Results were evaluated using SPSS 22.0 program.Results:Thirty one patients in the case group and 22 patients in the control group, totally 53 patients, were included in the study. The mean age was 68.2±14.3 years in the case group and 63.6±9.6 years in the control group. Age and gender distribution, glucose, AST, ALT, PLT, MPV, PCT, PDW and homocysteine levels did not show any significant difference in the case and control groups (p>0.05). Urea, creatinine, uric acid, GGT, CRP, hemoglobin, and N/L levels were significantly higher in the case group when compared to the control group (p˂0.05). Although HIF-1 alpha level was higher in the case group when compared to the control group, it was not statistically significant.Conclusion:There are studies showing the role of HIF-1 alpha in myocardial remodeling, angiogenesis and cardiac function improvement. In hypoxic conditions, increase in HIF-1 alpha improves tissue oxygenation. Same adaptive mechanism was not observed in our study. We think the reasons underlying this situation could be that in our patients, ischemia was localized but not generalized like in hypoxia, medical therapy was started immediately after admission (e.g.oxygen, nitrates, acetyl salicylic acid, heparin), the patients were normotensive under treatment, they did not have anemia, and they were given specific medications (e.g. ACE inhibitors, ARB) that could decrease oxidative distress. New treatment modalities to protect the heart from ischemic damage will be available when our knowledge about cardiac functions at different oxygen levels and factors affecting them increases. Then, HIF-1 alpha might be re-evaluated as a potential cardiac hypoxia marker

Porphyria cutanea tarda: a case report

Abstract Background The porphyrias are a rare group of metabolic disorders that can either be inherited or acquired. Along the heme biosynthetic pathway, porphyrias can manifest with neurovisceral and/or cutaneous symptoms, depending on the defective enzyme. Porphyria cutanea tarda, the most common type of porphyria worldwide, is caused by a deficiency of uroporphyrinogen decarboxylase, a crucial enzyme in heme biosynthesis, which results in an accumulation of photosensitive byproducts, such as uroporphyrinogen, which leads to the fragility and blistering of sun-exposed skin. Porphyria cutanea tarda is a condition that affects the liver and skin by reduction and inhibition of uroporphyrinogen decarboxylase enzyme in erythrocytes. Areas of skin that are exposed to the sun can generate blisters, hyperpigmentation, and, sometimes, lesions that heal leaving a scar or keratosis. Liver damage might present in a wide range of ways from liver function test abnormalities to hepatocellular carcinoma. The toxic effect of iron plays a role in liver damage pathogenesis. Case presentation A 59-year-old Turkish man presented with hyperpigmented skin lesions, fatigue, and elevated ferritin level and liver function tests. He was diagnosed as having porphyria cutanea tarda after a clinical investigation and treated with phlebotomy. Conclusion Porphyria cutanea tarda is a rare condition of the liver but it must be remembered in a differential diagnosis of liver disease with typical skin involvement to decrease morbidity and health costs with early treatment

Evaluation of Oral Glucose Tolerance Test in Hyperlipidemic Normoglycemic Patients

Background: Atherosclerotic coronary artery disease is an important health issue and a leading mortality reason in developed countries. In this study; we aimed to diagnose diabetes and other glucose disturbances early by evaluating the glycemic profi le in hyperlipidemic patients and to decrease the cardiovascular morbidity and mortality by an early intervention. Methods: 46 female and 19 male, totally 65 hyperlipidemic normoglycemic patients were included in the study. Patients had no history of diabetes and normal fasting blood glucose levels and were diagnosed with hyperlipidemia during routine blood tests. There were no limitations for age, gender or body mass index. Coronary heart disease risk factors were questioned and fi ndings were used to determine the pathological low density lipoprotein (LDL) levels. 2-hour oral glucose tolerance test (OGTT) was performed for all patients. Results were evaluated according to American Diabetes Association (ADA) 1997 criteria. Results: Mean total cholesterol level of patients was 236±41 mg/dl, mean trigliserid level was 223±141 mg/dl and mean LDL level was 153±38 mg/dl. According to OGTT results ; mean fasting blood glucose level was 95±13 mg/dl and mean 2nd hour glucose level was 128±34 mg/dl. According to ADA 97 criteria; OGTT of 33 (51%) patients were normal. 2 (3%) patients had impaired fasting glucose (IFG), 11 (17%) patients had impaired glucose tolerance (IGT) and 19 patients (29%) had diabetes. Conclusions: Hyperlipidemia and diabetes are important risk factors for cardiovascular disease and they usually coexist. Identifi cation and early intervention of these risk factors are prognostically important. Thus; patients who are diagnosed with hyperlipidemia should be screened for glucose disturbances as a secondary risk factor and by early intervention of both risk factors, cardiovascular morbidity and mortality should be decreased

İNME HEMŞİRELİĞİ: STANDARTLAR VE PRATİK UYGULAMALAR KILAVUZU TÜRK BEYİN DAMAR HASTALIKLARI DERNEĞİ VE NÖROLOJİ HEMŞİRELİĞİ DERNEĞİ ORTAK STRATEJİ PROJESİ

Akut inme klinik pratiğinde intravenöz tromboliz ya da trombektomi / aspirasyon gibi nörogirişimsel tedavilerin başarıyı yakalayabilmesi için iki uygulama ile desteklenmesi gerekir. Bunların ilki akut hastaların merkezlere zamanında ve güvenli triyajını sağlayacak olan “akut inme sevk ve idare sistemi”, diğeri ise bu hastaların akut dönem hastane kalışındaki uygulamalarıdır. Hastane uygulamaları nöroloji yoğun bakım veya inme ünitelerinde başlayan bir süreç olup sonuçları hemşirelik uygulamalarının kalitesinden doğrudan etkilenir. Akut inme hemşireliği inme spesifik tedavilerin etkin ve güvenli uygulaması, kan basıncı, kan şekeri, yutma, nütrisyon ve hidrasyonun yönetimi; hastanın postür, mobilizasyon, erken dönem fizik tedavi ve rehabilitasyon planı; bilinç ve nörolojik muayenenin takibi; ayrıca venöz tromboembolizm, gastrik ve enfeksiyon proflaksisi; KIBAS, enfeksiyon, solunumsal yetmezlik ve kanama gibi komplikasyonların önlenmesi ile yoğun bakımda hasta takibi ve çok etkili hasta, hasta yakını ve takım etkileşimi ve iletişimini içerir. Bu derleme akut inme hemşireliğinin birçok güncel rehberinin ülkemiz için adapte edilmiş temel uygulama ve metriklerini sunar. Anahtar Sözcükler: İnme hemşireliği, tromboliz, trombektomi, inme ünitesi, komplikasyon, kalite, metrik

The effect of anemia on serum hepcidin levels in patients with heart failure

Background: Anemia is an accelerating problem among patients with heart failure (HF) and its presence is associated with more symptoms. In this study, we investigated whether anemia in heart failure was related to hepcidin concentration. Methods: 50 patients with heart failure and 20 healthy subjects with no history of a chronic illness including heart failure as control group, were included in the study. Heart failure was verified by echocardiography in each subject and patients were defined as ones with reduced ejection fraction (HFrEF) if EF ≤ 40% and with preserved ejection fraction (HFpEF) if EF 40% - 50%. Blood samples were taken from all patients after 10-12 hours fasting. Anemia assessment was performed according to World Health Organization (WHO) criterias. Results: There was a positive correlation between hepcidin concentration and urea, ferritin, hemoglobin, hematocrite, C-reactive protein (p < 0,05). Hepcidin concentrations of anemic heart failure patients were significantly lower than the non-anemic heart failure patients (p < 0,05). Conclusion: We found that serum hepcidin concentration in anemic patients with heart failure was lower than in heart failure patients without anemia. We believe that iron defiency occurs as a result of inflammatory process in heart failure and therefore hepcidin concentrations decrease as a response. However, long-term follow up studies are needed