Purpose Acute myocardial infarction (AMI) is the most common cause of death in the world. Comprehensive risk assessment of patients presenting with chest pain and eliminating undesirable results should decrease morbidity and mortality rates, increase the quality of life of patients, and decrease health expenditure in many countries. In this study, the advantages and disadvantages of the enzymatic and nonenzymatic biomarkers used in the diagnosis of patients with AMI are given in historical sequence, and some candidate biomarkers - hFABP, GPBB, S100, PAPP-A, RP, TNF, IL6, IL18, CD40 ligand, MPO, MMP9, cell-adhesion molecules, oxidized LDL, glutathione, homocysteine, fibrinogen, and D-dimer procalcitonin - with a possible role in the diagnosis of AMI are discussed. Methods The present study was carried out using meta-analyses, reviews of clinical trials, evidence-based medicine, and guidelines indexed in PubMed and Web of Science. Results These numerous AMI biomarkers guide clinical applications (diagnostic methods, risk stratification, and treatment). Today, however, TnI remains the gold standard for the diagnosis of AMI. Details in the text will be given of many biomarkers for the diagnosis of AMI. Conclusion We evaluated the advantages and disadvantages of routine enzymatic and nonenzymatic biomarkers and the literature evidence of other candidate biomarkers in the diagnosis of AMI, and discuss challenges and constraints that limit translational use from bench to bedside.

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Biomarkers in acute myocardial infarction: current perspectives

Because only 25% of cases of premature ovarian insufficiency (POI) have a known etiology, the aim of this review was to summarize the associations and mechanisms of the impact of the environment on this pathology. Eligible studies were selected from an electronic literature search from the PUBMED database from January 2000 to February 2016 and associated references in published studies. Search terms included ovary, follicle, oocyte, endocrine disruptor, environmental exposure, occupational exposure, environmental contaminant, pesticide, polyaromatic hydrocarbon, polychlorinated biphenyl PCB, phenol, bisphenol, flame retardant, phthalate, dioxin, phytoestrogen, tobacco, smoke, cigarette, cosmetic, xenobiotic. The literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We have included the human and animal studies corresponding to the terms and published in English. We have excluded articles that included results that did not concern ovarian pathology and those focused on ovarian cancer, polycystic ovary syndrome, endometriosis or precocious puberty. We have also excluded genetic, auto-immune or iatrogenic causes from our analysis. Finally, we have excluded animal data that does not concern mammals and studies based on results from in vitro culture. Data have been grouped according to the studied pollutants in order to synthetize their impact on follicular development and follicular atresia and the molecular pathways involved. Ninety-seven studies appeared to be eligible and were included in the present study, even though few directly address POI. Phthalates, bisphenol A, pesticides and tobacco were the most reported substances having a negative impact on ovarian function with an increased follicular depletion leading to an earlier age of menopause onset. These effects were found when exposure occured at different times throughout the lifetime from the prenatal to the adult period, possibly due to different mechanisms. The main mechanism seemed to be an increase in atresia of pre-antral follicles. Environmental pollutants are probably a cause of POI. Health officials and the general public must be aware of this environmental effect in order to implement individual and global preventive actions.

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Environmental pollutants, a possible etiology for premature ovarian insufficiency: a narrative review of animal and human data

Interleukin-10 (IL-10) is an important anti-inflammatory cytokine expressed in response to brain injury, where it facilitates the resolution of inflammatory cascades, which if prolonged causes secondary brain damage. Here, we comprehensively review the current knowledge regarding the role of IL-10 in modulating outcomes following acute brain injury, including traumatic brain injury and the various stroke subtypes. The vascular endothelium is closely tied to the pathophysiology of these neurological disorders and research has demonstrated clear vascular endothelial protective properties for IL-10. In vitro and in vivo models of ischemic stroke have convincingly directly and indirectly shown IL-10-mediated neuroprotection; although clinically, the role of IL-10 in predicting risk and outcomes is less clear. Comparatively, conclusive studies investigating the contribution of IL-10 in subarachnoid hemorrhage are lacking. Weak indirect evidence supporting the protective role of IL-10 in preclinical models of intracerebral hemorrhage exists; however, in the limited number of clinical studies, higher IL-10 levels seen post-ictus have been associated with worse outcomes. Similarly, preclinical traumatic brain injury models have suggested a neuroprotective role for IL-10; although, controversy exists among the several clinical studies. In summary, while IL-10 is consistently elevated following acute brain injury, the effect of IL-10 appears to be pathology-dependent and preclinical and clinical studies often paradoxically yield opposite results. The pronounced and potent effects of IL-10 in the resolution of inflammation and inconsistency in the literature regarding the contribution of IL-10 in the setting of acute brain injury warrant further rigorously controlled and targeted investigation.

/pdf/role-of-interleukin-10-in-acute-brain-injuries-54brammucq.pdf

Role of Interleukin-10 in Acute Brain Injuries.

Inflammation and insulin/IGF-1 resistance as the possible link between obesity and neurodegeneration

Neurotoxic effects of organophosphorus pesticides and possible association with neurodegenerative diseases in man: A review.

ISSN Sepsis is the leading cause of morbidity and mortality in patients with burn injury and emerges as a clinical challenge for both emergency specialists and critical care staff. Since early diagnosis and appropriate treatment are known to be the milestones of sepsis management, use of biomarkers in diagnosis is highly recommended in the initial stage of sepsis. Although currently used Procalcitonin, as a traditional marker, may accurately indicate the presence of a systemic inflammation in burn patients, there is a need for more accurate markers of sepsis in burn patients. For now, use of a combination of markers may be suggested for a more accurate diagnosis. In the near future, gene therapy may make not only early prediction, but also appropriate treatment of sepsis in burn patients possible. In this article, we aimed to clarify roles of current biomarkers in early diagnosis of sepsis in burn patients and make future reflections in this growing field. Copyright 2020 Wolters Kluwer Health, Inc. All rights reserved.

Early biochemical predictors of sepsis in patients with burn injury: current status and future perspectives

Objective: In our study, the purpose was to determine the relationship between thyroid hormones and mortality of patients over the age of 55 who were hospitalized in an intensive care unit from the emergency service. Material and Methods: This study was planned as a prospective, randomized study, and patients hospitalized in an intensive care unit from the emergency medicine department were enrolled in this study following ethics committee approval. A standard data collection form was used to collect the data. After confirmation from the patients and their relatives, we included 73 patients in our study: 48 (65.8%) males and 25 (34.2%) females. Blood samples were taken from each patient, and thyroid hormone levels were studied in our laboratory. The “SPSS for Windows version 18” program was used for statistical analysis of the data. Chi-square test was used to compare categorical measures between the groups. Mann-Whitney U-test and t-test were used to compare quantitative measurements between the groups. The log-rank test was performed under Kaplan-Meier survival analysis to determine the relationship between the estimated lifetime and free T3 (fT3), free T4 (fT4), and thyroid-stimulating hormone (TSH). Results: There was no statistically significant difference in mean ages and genders of patients who died and survived. The mean duration of hospitalization in the deceased patient group was lower than in the surviving patient group, but there was no statistically significant difference between the groups. According to the Kaplan-Meier survival analysis, the patients with low or high levels of fT3 were found to have a shorter median life expectancy. No significant relationship was found between mortality and fT4 TSH. Conclusion: According to our study, increased or decreased levels of fT3 in patients over the age of 55 without known thyroid disease, hospitalized in an intensive care unit from the emergency department, showed increased mortality. This study will be useful for emergency medicine physicians to be able to predict the mortality of patients and contribute to more clinical experience. FT3 levels can be used as a prognostic indicator after more detailed studies are completed. (JAEM 2014; 13: 71-4)

http://www.akademikaciltip.com/sayilar/235/buyuk/71-74.pdf

Investigation of the Relationship between Thyroid Hormone Levels and Mortality in Old Patients Hospitalized in an Internal Medicine Intensive Care Unit from the Emergency Service

Purpose: The aim of this study was to determine the admission complaints, demographic characteristics, etiology, diagnosis, and outcome of patients who admitted to emergency department with eye-related complaints. Material and Methods: All patients, over the age of 18, who admitted to emergency department with eye-related complaints between June 2011 and May 2012, were included prospectively in this study. Demographic characteristics, etiology, admission complaints, diagnosis, and outcome of the patients in the emergency department were evaluated with statistical analysis. Results: At the time of the study, a total of 201427 adult patients admitted to our emergency department and 3256 (1.6%) were included in the study. 77.5% of the patients (2524) were males. The most frequent diagnosis was trauma (30.3%) in female gender, whereas it was superficial foreign bodies (46.2%) in male gender. The most common cause of trauma was home accidents (57.4%) in females, whereas it was work accidents (73%) in males. Of patients admitted due to vision loss (0.46%), it was identified that these patients were older and visual loss is more dependent on non-traumatic ophthalmic emergencies.  Conclusions: The majority of cases of ophthalmic emergencies are work accidents in young active workingmen patients group. The most common complaints of patients are trauma and superficial foreign bodies. Vision loss depends mostly on non-traumatic ophthalmic emergencies seen in the elderly.

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Analysis of ophthalmic emergencies

Aim: Toxicity findings affecting many systems, particularly the cardiovascular system, are observed in calcium channel blocker (CCB) overdose. Here, we aimed to present the incidence of CCB overdose patients with intraperitoneal and intrapleural free fluids detected by abdominal ultrasonography (USG). Materials and Methods: CCB overdose patients admitted to the emergency room in a 2-year period were prospectively included. All patients with CCB overdose were evaluated by bedside abdominal USG in terms of the presence of pleural and peritoneal fluid. Results: A total of 14 patients with CCB poisoning were included in our study. Six (42.8%) patients had taken verapamil, 7 (50%) patients amlodipine, and 1 (7.2%) patient nifedipine. The mean age of the patients was 27.2±15.9 years (range: 18–65 years). The median time from drug intake to arrival at the hospital was 3.0 h (IQR: 1.75–5). Nine (64.28%) of these patients were detected to have intraperitoneal and intrapleural free fluid by bedside USG. The mean arterial pressure of patients with intraabdominal and intrapleural fluid was lower than that of patients without the detected fluid, i.e., 56.8 (IQR: 54.8–61.8) vs. 65.6 (IQR: 64.2–66.8), respectively (p<0.001). Conclusion: Besides the cardiovascular findings, intraperitoneal and intrapleural free fluid is also a common feature in CCB overdose. Bedside USG may help to identify these patients. (Eurasian J Emerg Med 2016; 15: 82-5)

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Intrapleural and Intraperitoneal Free Fluid in Calcium Channel Blocker Overdose

Hirudoterapi, sulukler kullanilarak yapilan alternatif bir tedavi yontemidir. Ozellikle agri, siyaledenit, osteoartrit ve venoz yetersizlik tedavisi icin kullanilmaktadir. Suluklerin salgisinda bulunan hirudin adli madde kan koagulasyonunu onleyerek kanamaya neden olmaktadir. Bu yazida, bilincsiz ve kontrolsuz yapilan hirudoterapinin asiri kanamaya neden olarak hayati tehlike olusturabilecegine dikkat cekilmesi amaclandi. Bacaklarindaki derin ven trombozu nedeniyle warfarin kullanan ve bilincsiz hirudoterapi uygulamasina bagli olarak cilt kanamalari ve hemorajik sok ile Acil Servise basvuran nadir bir olgu sunuldu.

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Mehmet Oğuzhan Ay

Papers

Early biochemical predictors of sepsis in patients with burn injury: current status and future perspectives

Investigation of the Relationship between Thyroid Hormone Levels and Mortality in Old Patients Hospitalized in an Internal Medicine Intensive Care Unit from the Emergency Service

Analysis of ophthalmic emergencies

Intrapleural and Intraperitoneal Free Fluid in Calcium Channel Blocker Overdose

Kontrolsüz çoklu sülük ısırması ile yapılan hirodoterapiye bağlı hemorajik şok