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Purpose Even if migraine is not fatal, it is a common and challenging disease with adverse effects on individuals' lives. The lack of objective diagnostic tools causes delays in diagnosis and treatment initiation. The primary aim of this study is to reveal the diagnostic value of Calcitonin Gene-Related Peptide (CGRP) and Pentraxin-3 (PTX-3) in acute migraine. To this aim, we compared the serum CGRP and PTX-3 levels of migraine patients with acute attacks to those in healthy individuals. Material and method A total of 135 individuals (85 patients with migraine attacks with or without aura and 50 healthy controls) participated in the study. Serum CGRP and PTX-3 levels were measured with ELISA analysis. A p value less than 0.05 was considered significant. Results Serum CGRP [146.70 (21.52-413.67) vs. 65.90 (3.80-256.60) pg/mL] and PTX-3 levels [12.71 (0.62-33.97) vs. 1.01 (0.06-9.48) ng/mL] were higher in patients with migraine attack than the control group (p < 0.01 and p < 0.01, respectively). ROC analysis showed that the cutoff value for serum CGRP was 121.39 pg/mL (AUC: 0.751, Sen:%61, Spe:%64) whereas the cutoff value for PTX-3 was 4,06 ng/mL (AUC:0.876, Sen:%73, Spe:%76). Serum CGRP levels were positively correlated with pain intensity. Serum CGRP and PTX-3 levels did not differ across gender groups and presence of aura in subgroup analysis. Conclusion Patients with acute migraine attacks have higher serum CGRP and PTX-3 levels than controls. Both biomarkers show high potential for the diagnosis of a migraine attack.

Objectives: Stroke is a frequently encountered life-threatening medical condition in emergency departments (EDs). Despite all worldwide efforts, a reliable circulating biomarker has not been identified yet. This study investigates the diagnostic and prognostic value of neurogranin (Ng) in acute ischemic stroke (AIS). Methods: This prospective case-control study was conducted on ED patients with AIS and healthy volunteers. We collected the basic demographics, measured serum Ng levels of the patients vs. controls, and followed up the patient group for 6-month by phone or clinical notes to assess the functional outcomes. Results: Data analysis was completed with 142 subjects (86 patients vs. 55 controls). The groups did not differ in terms of age and gender. The median serum Ng level of the patient group was significantly higher compared to the control group [160.00 (75.93) vs. 121.26 (90.35) ng/mL and p ˂ 0.001, respectively]. Serum Ng level of 25 patients admitted to the ED within the first 6 hours from the onset of AIS was 177.93 (24.03) ng/mL, while serum Ng level of 61 patients admitted to the ED within 6-24 hours was 131.84 (76.44) ng/mL. AUROC results were 0.717 vs. 0.868 vs. 0.874 for stroke patients admitted during the first 24 hours, 6 hours, and 4.5 hours after the onset, respectively. Lesion volume, NIHSS, and modified Rankin Scale scores (mRS) at admission showed no significant correlation with Ng levels as well as 6-month mortality and 6-month mRS. Conclusions: Timely AIS diagnosis is still a challenge for emergency departments due to the dependency on imaging. Serum Ng can be a promising diagnostic biomarker for AIS patients admitted in the first 24 hours. Even it outperformed in the first 4.5 and 6-hour time windows. However, it did not show a significant prognostic value.

Introduction: Insulin is a highly used parenteral medication in emergency departments. Although most severe insulin overdoses occur as suicide attempts, medication errors can be the reason. We aimed to highlight the potential medication errors in emergency departments due to the poor control of critical drugs like insulin and the similarities between the brand names of drugs, as we experienced during this case. Case Report: We present a 75-year-old diabetic woman with an extreme insulin overdose. A total of 3000 UI of insulin was administered by subcutaneous and intramuscular routes. She developed typical and atypical episodes of hypoglycemia requiring intravenous dextrose, a high-calorie diet, and glucagon administration. Almost all of the classic side effects of glucagon occurred during her intensive care unit follow-up. She recovered without any sequela or recurrence of hypoglycemia at the end of 5 days of admission.Conclusion: Insulin overdose can be a life-threatening condition by causing hypoglycemia. Albeit rare, insulin overdose can occur as a medication error in hospitals. To prevent such incidents for emergency departments, the medication errors should be objectively laid out, and proactive strategies should be integrated without adversely affecting acute care., Giriş: İnsülin acil servislerde sıklıkla kullanılan parenteral bir ilaçtır. Çoğu şiddetli insülin doz aşımı intihar girişimi olarak ortaya çıksa da, nedeni ilaç hataları da olabilir. Bu vakada tecrübe ettiğimiz gibi, acil servislerde insülin gibi kritik ilaçların yetersiz kontrolü ve ilaçların marka isimleri arasındaki benzerlikler nedeniyle ortaya çıkabilecek olası ilaç hatalarını vurgulamayı amaçladık.Olgu Sunumu: Aşırı insülin doz aşımı olan 75 yaşında diyabetik bir kadın sunmaktayız. Hastanın subkütan ve kas içi yollarla toplam 3000 UI insülin alımı oldu. Hastada intravenöz dekstroz, yüksek kalorili diyet ve glukagon uygulaması gerektiren, tipik ve atipik hipoglisemi atakları gelişti. Glukagonun klasik yan etkilerinin neredeyse tamamı yoğun bakım ünitesi takibi sırasında ortaya çıktı. Hasta hastaneye yatışından sonraki 5. günün sonunda herhangi bir sekel veya hipoglisemi nüksü olmadan taburcu oldu.Sonuç: İnsülin doz aşımı, hipoglisemiye neden olarak yaşamı tehdit eden bir durum olabilir. Nadir de olsa insülin doz aşımı hastanelerde ilaç hatası olarak ortaya çıkabilir. Acil servislerde bu tür olayları önlemek için, ilaçla ilgili hatalar objektif bir şekilde ortaya konulmalı ve akut bakımı olumsuz yönde etkilemeden proaktif stratejiler entegre edilmelidir.

Diffuse large B-cell lymphoma (DBCL) is the largest subgroup of non-Hodgkin's lymphomas. Primary dural lymphoma, primary skull vault lymphoma, and primary sternum lymphoma are the rare lymphomas. We present the case of a 69-year-old patient with scalp, skull, and dura involvement that accompanying sternum involvement. It should be kept in mind that in the differential diagnosis of high-grade diffuse large B-cell lymphoma in patients presenting with a mass in the skull or sternum.

Background: Traumatic brain injuries (TBIs) are serious morbidity and mortality risk for especially in the young population. Primary and secondary injury mechanisms may cause cerebral edema and intracranial hypertension. The target point of the TBI treatment is lowering the intracranial pressure medically or surgically if indicated. Methods: The files of the patients with severe brain injury admitted between January 2015 and December 2017 were reviewed retrospectively. Patients who underwent decompression surgery due to severe brain injury ([The Glasgow Coma Scale [GCS] score]

Imbalance between antioxidant and oxidant systems in the body play an important role in the pathogenesis of coronary atherosclerosis and its complications. The aim of this clinical study was to investigate total serum thiol (TS-H) levels in patients with non ST Elevation Acute Coronary Syndrome (NSTE-ACS) patients and relationships between these results and cardiac markers. This study included 55 patients and a control group consisted of 50 healthy people. Samples for serum total TS-H levels were obtained from the patients considered with NSTE-ACS at the time of admission to emergency department. The patient group was divided into two subgroups according to troponin levels; that is patients with positive troponin levels in the non-ST-elevation myocardial infarction (NSTEMI) group and, and patients with negative troponin levels in the unstable angina pectoris (USAP) group. SPSS for Windows Ver. 15.0 software packages were used for statistical analysis of data in patient and control groups. The patients group included a total of 55 patients with 40 men (72.7%) and 15 women (27.3%) and the control group included 50 healthy individuals people with 28 men (56%) and 22 women (44%). Total serum TS-H values were significantly lower in patients group when compared with the control group. Serum total TS-H values were significantly lower in USAP subgroup when compared with patients with NSTEMI. In addition, negative correlations between total serum TS-H values and troponin I and CK-MB were found. According to this study, total serum levels of thiol which is antioxidant marker TS-H may be useful as a confirming test in diagnosis of patients with NSTE-ACS and in differentiating patients with NSTEMI and USAP. J. Exp. Clin. Med., 2013; 30:295-299

A 39-year-old male patient was admitted to the emergency department with the complaints of difficulty swallowing, a sensation of something “stuck” in his throat and a swollen uvula that he had seen in the mirror while brushing his teeth. His complaints had started 1 day before with sore throat as well as difficulty and pain when eating and drinking. He denied any fever, cough or breathing difficulties. His vital signs were stabile with blood pressure 120/70 mmHg, heart rate 86/min, respiration rate 12/min and body temperature 36.6°C. On physical examination, his lung sounds were normal. No lymphadenopathy was noted, but his uvula was erythematous and edematous (Fig. 1). No tonsillar hypertrophy was seen. His laboratory tests showed no significant results; there was no leukocytosis or any alterations in the neutrophil, basophil or eosinophil counts. The postero-anterior chest x-ray was normal. A bedside nasopharyngeal scope revealed a normal epiglottis and vocal cords, with significant uvular edema. He had no medical history of trauma, known food or drug allergy, asthma or frequently repeating infections. The only remarkable point in his medical history was that 1 week before he had been prescribed oral pinaverium bromide 50 mg (Dicetel®) for irritable bowel syndrome. He was treated with intravenous pheniramine hydrogen maleate (Avil®) and dexamethasone (Dekort®) in the emergency department and prescribed oral antihistaminic tablets for the next 48 h. Fig. 1 Oropharyngeal examination of a 39-year-old patient: isolated uvular angioedema (the patient's consent was obtained for the photograph) Isolated uvular angioedema was first defined by Quincke in 1882 [1]. Isolated uvular angioedema, or Quincke's disease, is a relatively rare presentation of angioedema of the upper airway [2]. Several causes of uvular edema have been described, including hereditary angioedema, trauma, inhalation exposure, medication reactions and infectious causes [3, 4]. Isolated uvular angioedema is usually caused by a type I hypersensitivity reaction [2, 3]. This should be differentiated from uvulitis, which is infectious and frequently has concomitant epiglottitis. Direct visualization or a lateral neck plain radiograph should be considered to help rule out epiglottitis [3, 5]. In this situation, the primary strategy should invovle maintaining the airway. In spite of being a rare condition, uvular edema may cause obstructive respiratory distress and require immediate airway care. The general treatment strategies in the emergency department consist of intravenous H1 and H2 histamine blockers, corticosteroids and infrequently epinephrine [2]. Dexamethasone has been considered the medication of choice considering its potent anti-inflammatory properties and long half-life.