The relationship between neutrophil/lymphocyte, monocyte/ /lymphocyte, platelet/lymphocyte ratios and clinical outcomes after ninety days in patients who were diagnosed as having acute ischemic stroke in the emergency room and underwent a mechanical thro.

AIM: To determine whether there was a relationship between the neutrophil/lymphocyte (NLR), monocyte//lymphocyte (MLR), and the platelet/lymphocyte ratios (PLR) measured in blood samples taken at admission and clinical outcomes (CO) on the 90th day in patients, who were diagnosed as acute ischemic stroke (AIS) in the emergency department (ED) and underwent a mechanical thrombectomy (MT). METHOD: Patients aged ≥ 18 years, who were diagnosed as AIS in the ED and underwent MT were included in the study. Patients, who received diagnostic codes of "Cerebrovascular Diseases" (CVD) according to the ICD-10 diagnostic codes were identified. One hundred fifty patients were enrolled in the study. Modified Rankin Scale (mRS) score was used to determine neurologic status on the 90th day. The patients were divided into the two groups: good and poor CO (mRS 0-2 and mRS 3-6, respectively). The groups were compared in terms of age, sex, and NIHSS, ASPECT, and mRS scores. RESULTS: The rates of successful recanalization and good CO were 81.3 % and 38.7 %, respectively. The mortality rate was 22 %. The recanalization rates in the good and poor CO groups were 100 % and 69.6 %,respectively. Recanalization was achieved in 73.6 % of those with hyperlipidaemia and 88.5 % of those without hyperlipidaemia, which was statistically significant (p = 0.034). We observed a statistically significant relationship between the clinical outcome and NLR, MLR, PLR (p < 0.05). As the result of multivariate analysis, we found only NLR as an independent risk factor for poor CO (p = 0.043). There was also a statistically significant difference between mortality and NLR, PLR (p = 0.001). CONCLUSION: We found that NLR, MLR, PLR values were associated with CO after 90 days; high rates were associated with poor CO and low rates were associated with good CO (Tab. 7, Ref. 38). Text in PDF www.elis.sk Keywords: acute ischemic stroke; neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio; platelet/ /lymphocyte ratio; thrombectomy.

Role of Gal-3 and H-FABP in the early diagnosis of acute coronary syndrome.

OBJECTIVES: We aimed to compare the plasma levels of biomarkers such as: serum Gal-3, H-FABP, cTnI, and CK-MB in patients, who were admitted to the emergency room with chest pain, and to determine whether these biomarkers have early diagnostic value of acute coronary syndrome (ACS). METHODS: The study was performed in 60 patients aged ≥ 18 years, who were admitted to emergency room. These patients were divided into 3 groups: patients with STEMI (group I, n = 20), patients with NSTEMI (group II, n = 20), and patients with USAP (group III, n = 20). Serum Gal-3, H-FABP, cTnI, and CK-MB levels were measured at admission, and at the 2nd and 4th hours. RESULTS: There were statistically significant differences between the groups in terms of Gal-3 levels at admission, and the 2nd and 4th hours (p = 0.007, p = 0.002, and p = 0.001, respectively). There were statistically significant differences between the groups in terms of H-FABP levels at admission, and the 2nd and 4th hours (p = 0.001, p = 0.003, and p = 0.003, respectively).There were statistically significant differences between the groups in terms of cTnI levels at admission, and the 2nd and 4th hours (p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSIONS: According to the results of the study, cTnI, H-FABP, and Gal-3 are useful parameters that can be used in the early diagnosis of ACS (Tab. 4, Ref. 36).

Comparison of pentraxin-3 and ischemia-modified albumin with troponin in early diagnosis of acute coronary syndrome.

INTRODUCTION: In this study, our aim was to evaluate clinical utilities of Pentraxin 3 (PTX3) and Ischemia-modified Albumin (IMA) in diagnosis of acute coronary syndrome (ACS) and compare these two biomarkers with a conventional diagnostic marker, cardiac troponin I (cTnI). MATERIALS AND METHODS: Sixty adult patients with ACS diagnosis were involved into this prospective study. Additionally, 20 healthy subjects were determined as control group (Group IV). Patients were divided into 3 groups as follows: Patients with Acute Myocardial Infarction (STEMI Group, n=20, Group I), patients without ST elevation but with elevated cTnI levels (NSTEMI Group, n=20, Group II), and patients with unstable angina pectoris (USAP Group, n=20, Group III). Blood measurements were obtained for each marker at admission and in the 4th hour. RESULTS: Troponin level was significantly different between groups I and II at both admission and in the 4th hour. Additionally, PTX 3 level was significantly different at admission and 4th hour between groups II and III. CONCLUSION: This study revealed that cTnI is the most sensitive test in ACS diagnosis at the admission to Emergency Department. Our results also revealed that PTX 3 may be a useful diagnostic tool for ACS at admission, however, IMA alone cannot be used for diagnosis of ACS. Similarly, in the 4th hour, cTnI was found to be the most useful marker in ACS diagnosis, however, PTX 3 and IMA were found to be inadequate for diagnosis of ACS (Tab. 3, Ref. 19).

Comparison of hyperpronation and supination-flexion techniques in children presented to emergency department with painful pronation.

CONTEXT: Radial head subluxation, also known as 'pulled elbow', 'dislocated elbow' or 'nursemaid's elbow', is one of the most common upper extremity injuries in young children and a common reason to visit Emergency Department (ED). AIM: To compare supination of the wrist followed by flexion of the elbow (the traditional reduction technique) to hyperpronation of the wrist in the reduction of radial head subluxations (nursemaid's elbow) maneuvers in children presented to ED with painful pronation and to determine which method is less painful by children. SETTINGS AND DESIGN: This prospective randomize study involved a consecutive sampling of children between 1-5 year old who were presented to the ED with painful pronation. MATERIALS AND METHODS: The initial procedure was repeated if baseline functioning did not return 20 minutes after the initial reduction attempt. Failure of that technique 30 minutes after the initial reduction attempt resulted in a cross-over to the alternate method of reduction. STATISTICAL ANALYSIS USED: Datas were analyzed using SPSS for Windows 16.0. Mean, standard deviation, independent samples t test, Chi-square test, and paired t test were used in the assessment of pain scores before and after reduction. RESULTS: When pain scores before and after reduction were compared between groups to determine which technique is less painful by children, no significant difference was found between groups. CONCLUSIONS: It was found that in the reduction of radial head subluxations, the hyperpronation technique is more effective in children who were presented to ED with painful pronation compared with supination-flexion. However, there was no significant difference between these techniques in terms of pain.

Medial circumflex femoral artery with different origin and course: a case report and review of the literature.

The femoral artery (FA) and its branches play important roles in the arterial supply of the lower extremity. If the femoral artery is occluded, the circulation of the extremity is maintained by certain anastomoses. Therefore, identification of variations of these arteries is critical from a clinical and surgical point of view. During routine anatomical dissections for student education at the Department of Anatomy of the School of Medicine at Ondokuz Mayls University, a variation of the medial circumflex femoral artery (MCFA) was observed and photographed in a male, formalin-fixed cadaver aged 55 years. In this case, MCFA branched off from the posterolateral aspect of the FA, 32 mm distal to the inguinal ligament. A frequency rate of 17-26% has been reported regarding this variation. However, MCFA emerging from the postero-lateral aspect of the FA and its course, as in this case, is not that frequent. Knowledge of anomalies in the emergence and course of the arteries that join the cruciate anastomosis and are important in the arterial supply of the head and neck of the femur appear to be a critical component that requires caution during surgical interventions towards this region.

The double outlet right ventricle with additional cardiac malformations: an anatomic and echocardiographic study.

Double outlet right ventricle (DORV) is a complex group of abnormal ventriculoarterial connections where both the aorta and pulmonary artery rise from the right ventricle morphologically. It is a rare condition affecting 1-1.5% of patients with congenital heart disease. The patient's cardiac measurements were taken by two-dimensional echocardiography. The pathological findings of the defined case are illustrated in the figures. A 20-year-old male patient with palpitations, tachypnea, and tiredness with weak exercise capacity and back pain was diagnosed with heart murmur in different degrees; slight cyanosis, cachexia, and developmental retardation were found clinically. Echocardiography showed: DORV, perimembranous ventricular septal defect, pulmonary stenosis, dilatated right ventricle, and dilatated left atrium. However, the left ventricle was normal. In addition, the septum interatriale filled the left atrium like an aneurysm. DORV is an important and rare congenital cardiac malformation. This complex condition may result in different clinical findings and require different therapeutic approaches.

Absence of the musculocutaneous nerve together with unusual innervation of the median nerve.

During routine anatomical dissections, absence of the musculocutaneous nerve was determined in a 58-year-old male cadaver. Moreover, the biceps brachii and brachialis muscles were innervated by two separate branches which divided from the median nerve instead of the musculocutaneous nerve. From a branch that divides from the main trunk of the median nerve at nearly the middle of the arm a motor branch again divided that innervated the brachialis muscle and a sensory branch that conveyed the sense of the lateral part of the forearm. Furthermore, it was found that the brachial artery divided into its terminal branches, the radial and ulnar arteries. We believe that this rare variation of the median nerve will shed light upon surgical procedures involving the median nerve.