Spexin level in acute myocardial infarction in the emergency department.

Background: We aimed to determine the serum spexin level in patients with acute myocardial infarction (AMI) admitted to the emergency department. Methods: A total of 100 patients with AMI (50 with ST-segment elevation myocardial infarction (STEMI) and 50 with non-ST-segment elevation myocardial infarction (NSTEMI)) and 50 control group patients with non-cardiac chest pain were included in the study. A detailed anamnesis was taken, a physical examination was performed, and 12-lead electrocardiograms and venous blood samples were taken at the time of admission. Spexin levels were measured via enzyme-linked immunosorbent assay. Results: Serum spexin levels were significantly lower in the AMI group than in the non-cardiac chest pain group (p<0.001). There was no significant difference in serum spexin levels between STEMI and NSTEMI patients (p=0.83). In receiver operating curve analysis, we detected 58% sensitivity, 76% specificity, 82.9% positive predictive value, and 47.5% negative predictive value with an optimal cutoff value of 532 pg/mL for the diagnosis of AMI. Conclusions: In this study, serum spexin levels were significantly lower in AMI patients compared to patients with non-cardiac chest pain. The decrease in spexin levels suggests that it has the potential to be used as a diagnostic marker in AMI patients.

The Relationship of Liver and Pancreas Density With Chest Computed Tomography Score Progression and Laboratory Findings in Patients With COVID-19.

OBJECTIVE: Abdominal involvement of COVID-19 is a current issue. We aimed to evaluate hepatic and pancreatic density alterations on computed tomography (CT) and to analyze whether these alterations had a relationship with chest CT score and laboratory findings. METHODS: Patients with reverse transcription-polymerase chain reaction-confirmed COVID-19 from March 11, 2020, to February 6, 2021, were retrospectively analyzed. Patients were divided into nonprogressive and progressive groups according to their chest CT scores. Liver and pancreas density, and liver-to-spleen (L/S) ratio were calculated. Laboratory findings, medication, intensive care unit stay, and survival were noted. RESULTS: There were 51 patients in the nonprogressive group and 123 patients in the progressive group. The median (minimum to maximum) L/S value of the nonprogressive group was 1 (0.28-1.53) at admission and 1.06 (0.33-1.83) at follow-up ( P < 0.001). In the progressive group, the median L/S value was 1.08 (0.35-1.51) at admission and 0.92 (0.33-1.75) at follow-up ( P < 0.001). A significant difference was found between the 2 groups at admission and follow-up ( P = 0.010 and P < 0.001, respectively). Pancreatic density measured at follow-up was significantly lower in the progressive group ( P = 0.045). In the progressive group, aspartate aminotransferase, total bilirubin, creatinine, urea, C-reactive protein, D-dimer, and white blood cell values were higher; albumin and lymphocyte values were lower ( P < 0.05). CONCLUSIONS: Patients with COVID-19 with progressive CT scores may have a decrease in L/S values, and their pancreatic density is lower than nonprogressives. Aspartate aminotransferase, total bilirubin, creatinine, urea, C-reactive protein, D-dimer, and white blood cell values tend to be higher in patients with a high chest CT score.

Eotaxin-1 Levels in Patients with Myocardial Infarction.

BACKGROUND: Acute myocardial infarction is one of the leading causes of morbidity and mortality worldwide. Eotaxin-1, an eosinophil-specific chemoattractant, has been shown to be overexpressed in human atherosclerotic lesions. Eotaxin-1 levels are higher in coronary artery disease patients than in healthy individuals. In this study, we aimed to determine the eotaxin-1 concentrations of patients with myocardial infarction and to investigate the role of eotaxin-1 in myocardial infarction. METHODS: The study included 42 patients diagnosed with AMI (patients with suspected AMI based on history, physical examination, ECG, and biochemical markers and confirmed by angiography) and 40 healthy controls. Plasma eotaxin-1 levels were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: Eotaxin-1, troponin-I, CK, and CKMB levels were statistically higher in the patient group than in the control group. ROC analysis demonstrated that eotaxin-1 gave a sensitivity of 93% and a specificity of 48% once the cutoff value was 341.6 pg/mL. Additionally, the ROC analysis showed that troponin I yielded a specificity of 100% and a sensitivity of 91% when the cutoff value was 0.025 µg/L. CONCLUSIONS: Eotaxin-1/eosinophils appear to have a role in coronary artery disease independent of known risk factors. Accordingly, this study and recent studies suggest that eotaxin-1 may be useful in the diagnosis of AMI in addition to other cardiac markers.

Suicidal Ideation, Self-esteem, and Hopelessness in Patients With Pulmonary Arterial Hypertension.

Objective: To investigate the frequency of suicidal ideation and its correlation with other clinical variables in patients with pulmonary arterial hypertension.Methods: Fifty patients with pulmonary arterial hypertension who presented to the cardiology department between 2018 and 2019 and 50 healthy controls were included in the study. A sociodemographic and clinical data form was completed by both the patients and controls, and the Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Rosenberg Self-Esteem Scale (RSE), and Suicide Probability Scale (SPS) were administered. SPSS version 22 software was used in the statistical analysis.Results: The mean ± SD systolic pulmonary pressure of the patients was 47.48 ± 18.86 and the pulmonary artery pressure was 33.32 ± 19.69. BHS, BDI, and SPS total scores were statistically significantly higher in the patient group compared to the control group (P < .001, P = .001, P = .026, respectively). RSE scores were also higher in the patient group compared to the control group (P = .017).Conclusions: It is important to identify pulmonary arterial hypertension patients with intense feelings of hopelessness and depressive symptoms and to provide psychiatric treatment and psychotherapeutic interventions to improve their self-esteem.

The Effectiveness of Ischemia Modified Albumin in Determining Acute Cholecystitis and its Severity.

BACKGROUND: Acute cholecystitis (AC) is caused by chemical and bacterial inflammation of the gallbladder. The use of Tokyo guidelines is recommended in determining the diagnosis of AC and its clinical severity. In the early stages of AC, many cytokines are secreted due to the local inflammatory cell activation, leading to exacerbation of inflammation and organ failure. Ischemia modified albumin (IMA) is a type of albumin that occurs in ischemia and oxidation and is used as a marker of hypoperfusion and oxidative stress. This study aims to investigate the effectiveness of ischemia modified albumin, C-reactive protein (CRP), and some other inflammation parameters in predicting the severity of the AC on admittance. METHODS: Forty-two patients diagnosed with AC and 30 healthy individuals in the control group were included in the study. The severity assessment of the patients was performed based on the revised Tokyo guidelines (TG 13). The patients were divided into 3 groups according to severity of the disease. Blood samples were taken from the subjects on admittance. Serum IMA levels were studied using an ELISA kit. SPSS 22.00 package program was used for statistical analysis. RESULTS: Thirty (71.4%) of the participants were in the mild group, while 12 (28.6%) were in the moderate group. There were no patients in the severe group. Leukocyte, CRP, and IMA values in the patient group were higher than those of the control group (p > 0.05). According to the Tokyo classification, a significant difference was found between the groups with mild and moderate grades in terms of CRP and IMA values (p < 0.001 and p < 0.05, respectively). When the cutoff value of IMA was 84 ng/mL, the sensitivity was found to be 76% and specificity was determined to be 40% (AUC: 0.665, p = 0.017, 95% Confidence Interval). CONCLUSIONS: It is considered that IMA could be useful in predicting the clinical severity of TG13-based acute cholecystitis and, therefore, could be used in the management of treatment by the clinician such as medical treatment, early surgery, and interval surgery.

Diagnostic and Prognostic Relevance of Serum Irisin Level in Patients with Pulmonary Embolism.

BACKGROUND: We aimed to determine the diagnostic and prognostic value of serum irisin level in patients with acute pulmonary embolism (PE) admitted to the emergency department. METHODS: Ninety patients who underwent computed tomography pulmonary angiography (CTPA) due to suspected PE were included in the study. Demographic data, PE risk factors, and associated diseases, vital signs, Wells score, Revised Geneva score, pulmonary embolism severity index (PESI), and simplified PESI (sPESI) were recorded. Irisin levels were measured by enzyme linked-immunosorbent assay. RESULTS: Serum irisin level in patients with confirmed PE (n = 45) was significantly lower than that in patients (n = 45) without PE (p = 0.001). On receiver operating characteristic curve analysis, use of optimal irisin cutoff level of 8.6 µg/mL for diagnosis of PE was associated with 82.2% sensitivity, 60% specificity, 67.3% positive predictive value (PPV), and 77.1% negative predictive value (NPV) [area under the curve (AUC): 0.744, 95% confidence in-terval (CI): 0.641 - 0.830, p < 0.001)]. Use of optimal D-dimer cutoff level of 1,720 µg/L was associated with 86.7% sensitivity, 62.2% specificity, 69.6% PPV, and 82.4% NPV (AUC: 0.801, 95% CI: 0.704 - 0.878, p < 0.001). Irisin level showed no significant correlation with Wells score or revised Geneva score; however, irisin level showed a significant negative correlation with PESI and sPESI. CONCLUSIONS: Patients with acute PE showed significantly lower serum levels of irisin. The sensitivity, specificity, NPV, and PPV of irisin level for diagnosis of PE were lower than those of D-dimer.

Eotaxin levels in patients with primary dysmenorrhea.

PURPOSE: Primary dysmenorrhea (PD) is a common cause of pelvic pain that can cause limitations in daily activities. Treatment options sometimes result in failure, suggesting that different mechanisms may be effective in etiopathogenesis. Eosinophils are cells that are present in endometrium only in the perimenstrual period. The aim of this study was to evaluate the levels of eotaxin, a potent eosinophilic chemoattractant, in patients with PD. PATIENTS AND METHODS: Thirty patients with PD and thirty healthy women were included in the study. Venous blood sample of 10 mL was collected from each participant. Blood samples were taken in the first 2 days of the menstrual cycle at any period of the day. Serum eotaxin levels were determined by enzyme-linked immunofluorescence assay. RESULTS: There were no statistically significant differences between the demographic properties of groups in terms of age and body mass index. Eotaxin levels were significantly different in patients with PD than the control subjects (p=0.012). CONCLUSION: Detection of different levels of eotaxin in patients with PD may be a new and important step in determining the factors contributing to the pathogenesis of dysmenorrhea.

A condition that should be kept in mind in incarcerated hernia: Amyand's hernia.

As a complication of inguinal hernia, incarcerations are often seen in emergency services. Incarceration is an acute complication of inguinal hernia presenting as surgical emergency. The sac of inguinal hernia most frequently contains omentum and intestine but sometimes organs such as appendix and Meckel's diverticulum can also be seen in the hernial sac. We present a case of Amyand's hernia containing appendix in the incarcerated herniated sac.

Is Surgery Safe in Gallstone-Related Acute Diseases in Elderly Patients?

OBJECTIVE: To determinate the safety of the surgical treatment of acute biliary pancreatitis and acute cholecystitis in elderly patients. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of General Surgery, Elazig Training and Research Hospital, Elazig, Turkey, from January 2010 to July 2012. METHODOLOGY: Records of 172 patients with acute complications of biliary calculi, aged over 65 years, were included. Patients were assessed for demographic information, hospitalisation diagnosis, leucocyte count, ASA classification, treatment type, conversion rates, length of hospital stay, morbidity and mortality. Statiscal analyses were performed using the SPSS version 20.0. RESULTS: The sample included 128 females (74.4%) and 44 males (25.6%). Patients' diagnoses included 135 (78.4%) acute cholecystitis and 37 (21.6%) acute pancreatitis. Medical treatment was offered to 113 patients (65.7%). Open cholecystectomy was directly performed in 17 patients (9.9%). Two patients (4.8%) were converted to an open cholecystectomy during surgery, while a laparoscopic cholecystectomy was performed sucessfully on 42 patients (24.4%). Those who underwent surgery were discharged as cured, except for minimal surgical complications. CONCLUSION: Treatment choice in acute gallstone complications in the elderly depends on the patient's general condition, severity of the disease, and ASAscore. Early laparoscopic cholecystectomy is a good option in selected elderly patients with acute cholecystitis and non-severe acute biliary pancreatitis.

The Diagnostic Role of Adiponectin in Pulmonary Embolism.

BACKGROUND AND AIMS: Pulmonary thromboembolism (PTE) is a frequent disease with difficult diagnosis and high mortality. Misdiagnosis occurs in 2/3 patients and mortality rates reach up to 30%. The aim of our study was to investigate the role of adiponectin used in emergency service in diagnosis of PTE. MATERIALS AND METHODS: 95 patients with suspected PTE included in the study. Plasma adiponectin and D-dimer levels were measured and chest X-ray and multidetector row computed tomography scan obtained. Diagnosis was supported by vascular filling defect on tomography. Control group consisted of patients with suspected PTE and normal chest computed tomography findings. RESULTS: Mean D-dimer level was 4241.66 ± 1082.98 ng/mL in patients and 2211.21 ± 1765.53 ng/mL in the control group (p ≤ 0.05). Mean adiponectin level was 5.46 ± 4.39 µg/mL in patients and 7.68 ± 4.67 µg/mL in the control group (p ≤ 0.05). Wells and Geneva scores were higher in patients compared to the control group. CONCLUSIONS: As a result, we conclude that lower adiponectin levels have an important role in the diagnosis of PTE.

An obstruction not to forget: Pseudo-obstruction (Ogilvie syndrome): Single center experience.

PURPOSE: Colonic pseudo obstruction disease commonly seen in the elderly, immobile patient group can cause serious mortality and morbidity. Our objective in this retrospective study is to share our clinical experience by evaluating patients with Ogilvie syndrome who were followed and treated in our clinic. METHODS: Eleven cases with the diagnosis of Ogilvie syndrome followed up and treated between September 2010 and April 2013 were evaluated retrospectively. All the patients that had no symptoms of acute abdominal pain were initiated conservative treatment. Colonoscopic decompression was attempted for patients whose clinical pictures were not recovered. Patients underwent operation if they developed peritoneal irritation symptoms during these procedures and of their number of white blood cells seriously increased during the follow-up period. RESULTS: A total of 11 patients were treated for Ogilvie syndrome. 6 of the patients underwent surgical treatment, and 5 were treated medically. Mortality developed in two patients. The main cause of mortality was a delay in diagnosis and additional severe underlying diseases. Seven patients were given Neostigmine. Of these, 2 patients required surgery and 3 patients responded to Neostigmine. CONCLUSION: Ogilvie syndrome is a rare cause of ileus of the colon. It is more common particularly in old patients with additional problems. If the disease is suspected and diagnosed early, unnecessary surgical interventions can be prevented with medical treatment choices.

The association between apelin-12 levels and paroxysmal supraventricular tachycardia.

AIMS: Our aim was to investigate the apelin-12 levels in patients with atrioventricular tachyarrhythmias and compare with those in patients with lone atrial fibrillation. METHODS: Forty four patients with supraventricular tachycardia as atrial fibrillation, 44 patients with paroxysmal supraventricular tachycardia (P-SVT) as atrioventricular tachyarrhythmias, including atrioventricular nodal reentrant tachycardia or atrioventricular reentrant tachycardia, and 30 age- and sex-matched healthy individuals were included in the study. RESULTS: The apelin-12 levels were significantly lower in both atrial fibrillation and P-SVT groups than control group. In post-hoc analysis, there was no significant difference in apelin-12 levels between atrial fibrillation and P-SVT groups (P = 0.9). Patients in atrial fibrillation group and patients in P-SVT group had significantly lower apelin-12 levels than control group, separately (P < 0.001 and P < 0.001, respectively). The sensitivity and specificity values of the apelin-12 levels for predicting SVT, including both atrial fibrillation and atrioventricular reentrant tachycardia or atrioventricular nodal reentrant tachycardia were 64.77 and 90%, respectively (cut-off value was 0.87). The area under the receiver operator characteristic curve was 0.834 for the apelin-12 levels (P = 0.0001). CONCLUSION: Apelin-12 levels are lower in patients with atrial fibrillation and P-SVT than control groups. Lower apelin levels in patients with atrial fibrillation and P-SVT would be expected to result in a decrease in the conduction velocity.

Spontaneous rupture of tubal leiomyoma causing haemoperitoneum.

Leiomyomas are benign tumours that usually originate from the genital tract organs, particularly from the uterus. Spontaneous rupture of leiomyomas is a relatively rare condition. Herein, we report a 70 years old lady who was admitted through the emergency room with sudden abdominal pain. A ruptured mass originating from the fallopian tube, causing haemoperitoneum was revealed at laparotomy. Pathological examination revealed cellular leiomyoma.

Decreased saliva/serum irisin concentrations in the acute myocardial infarction promising for being a new candidate biomarker for diagnosis of this pathology.

Irisin is a muscle-secreted protein. Cardiac muscle produces more irisin than skeletal muscle in response to acute exercise, and is associated with myocardial infarction (MI) in an experimental model induced by isoproterenol in rats. The timing and significance of its release in patients with acute myocardial infarction (AMI) needs further investigation. We have studied the relationship between serum/saliva irisin concentration and AMI in humans. Serum and saliva samples were taken within 3 days of admission in 11 patients with AMI and in 14 matched controls. Salivary gland irisin was detected immunohistochemically, and serum and saliva levels were measured by ELISA. The three major paired salivary glands (submandibular, sublingual and parotid) produce and release irisin into saliva. Troponin-I, CK, CK-MB concentrations in the AMI group gradually increased from up to 12h, while saliva and serum irisin gradually decreased from up to 48 h, compared with the control group (P<0.05). After 12h, troponin-I, CK, CK-MB started to decrease, while saliva and serum irisin started to increase at 72 h. Serum irisin levels correlated with age, while troponin I, CK-MB, and CK were correlated and with saliva irisin in AMI patients. Besides cardiac troponin and CK-MB, irisin adds new diagnostic information in AMI patients, and the gradual decrease of saliva/serum irisin over 48 h could be a useful biomarker.

Irisin: a potentially candidate marker for myocardial infarction.

Myocardial infarction (MI) causes energy depletion through imbalance between coronary blood supply and myocardial demand. Irisin produced by the heart reduces ATP production by increasing heat generation. Energy depletion affects irisin concentration in circulation and cardiac tissues, suggesting an association with MI. We examined: (1) irisin expression immunohistochemically in rat heart, skeletal muscle, kidney and liver in isoproterenol (ISO)-induced MI, and (2) serum irisin concentration by ELISA. Rats were randomly allocated into 6 groups (n=6), (i) control, (ii) ISO (1h), (iii) ISO (2h), (iv) ISO (4h), (v) ISO (6h), and (vi) ISO (24h), 200mg ISO in each case. Rats were decapitated and the blood and tissues collected for irisin analysis. Blood was centrifuged at 1792 g for 5 min. Tissues were washed with saline and fixed in 10% formalin for histology. Serum irisin levels gradually decreased from 1h to 24h in MI rats compared with controls, the minimum being at 2h, increasing again after 6h. Cardiac muscle cells, glomerular, peritubular renal cortical interstitial cells, hepatocytes and liver sinusoidal cells and perimysium, endomysium and nucleoi of skeletal muscle were irisin positive, but its synthesis decreased 1-4h after MI. At all time-points, irisin increased near myocardial connective tissue, with production in skeletal muscle, liver and kidney recovering after 6h, although slower than controls. Unique insight into the pathogenesis of MI is shown, and the gradually decrease of serum irisin might be a diagnostic marker for MI.

The effect of nesfatin-1 levels on paroxysmal supraventricular tachycardia.

BACKGROUND: Nesfatin-1 was originally identified as a neuropeptide of the hypothalamus, which is a key integration area of the brain, where numerous neuropeptides and transmitters are released to participate in the control of essential body functions. In the literature, there are no studies showing the relationship between the nesfatin-1 level and paroxysmal supraventricular tachycardia. We hypothesize that the circulating levels of nesfatin-1 may increase during supraventricular tachycardia, to engage the vagal stimulation to terminate by the inhibition of neuropeptide-Y, and may activate oxytocin and the corticotropin-releasing hormone. MATERIALS AND METHODS: This study includes 120 cases (80 patients and 40 controls). Patients with paroxysmal supraventricular tachycardia were compared with the control group with regard to sex, nesfatin-1 level, comorbid diseases, serum renal function values, and patients' vital findings. RESULTS: The nesfatin-1 levels were significantly higher in the paroxysmal supraventricular tachycardia group than in the control group and positively correlated highly with heart rate (r = 0.634; P < 0.001). The area under the receiver operating characteristic curve was 0.644 for the nesfatin-1 levels (P = 0.0051). The sensitivity and specificity values of the nesfatin-1 levels were 41.2% and 95%, respectively (cutoff value >1743.7 pg/mL). CONCLUSION: At the end of this study, a statistically significant correlation was found between the serum nesfatin-1 level and supraventricular tachycardia. Although multifactorial causes may explain the relationship, we based our hypothesis on the relationship of the antagonistic effects of nesfatin-1 on the neuropeptide-Y and activated oxytocin.