Fetuin‐A and interleukin‐18 levels in ankylosing spondylitis

Aim: Interleukin‐18 (IL‐18) and fetuin‐A have been implicated in atherosclerosis. Preliminary evidence suggests that ankylosing spondylitis (AS) is associated with an increased risk of atherosclerosis. The aim of the present study was to investigate possible abnormalities in IL‐18 and fetuin‐A levels in AS. Methods: Subjects without established cardiovascular (CV) risk factors were studied. Fasting glucose, serum lipids, high sensitive C‐reactive protein (hsCRP), erythrocyte sedimentation rate, IL‐18 and fetuin‐A were assessed. Patients were also evaluated with the Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index, and the Bath Ankylosing Spondylitis Disease Activity Index. Results: Fourty‐five patients with AS (37.4 ± 9.7 years; 35M/10F) and 29 controls (35.5 ± 11.1 years; 21M/8F) were studied. Fetuin‐A levels were significantly higher in AS patients compared to controls (1023.5 ± 171.6 vs. 856.9 ± 207.9 μg/mL, P < 0.001). IL‐18 levels were also higher in the AS group but the difference was not significant (184 ± 186 vs. 140 ± 115, P = 0.1). Significant but weak correlations were found between fetuin‐A, IL‐18, hsCRP, low density lipoprotein cholesterol, and triglyceride levels (P < 0.05; r = 0.4, 0.3, 0.2, and 0.3 respectively). Comparison of subjects with respect to the treatment type, disease activity and history of peripheral arthritis yielded no difference regarding fetuin‐A and IL‐18 between groups. Conclusion: Fetuin‐A and IL‐18 levels seem to be increased in AS patients regardless of disease activity and treatment type.     

Tau and S100B proteins as biochemical markers of bilirubin-induced neurotoxicity in term neonates

We investigated the relationship between total serum bilirubin and serum Tau and S100B protein levels, and predicted a cutoff level of bilirubin-induced neurotoxicity in term newborns. Total serum bilirubin, serum Tau, and S100B levels were measured in 92 jaundiced term newborns. A neurologic examination, electroencephalogram, brainstem auditory-evoked response, and otoacoustic emission were performed in the infants on admission and at age 3 months. Serum Tau (r = 0.921, P < 0.001) and S100B (r = 0.927, P < 0.001) levels were correlated with total serum bilirubin levels in all infants. Serum Tau and S100B protein levels remained at a steady level up to a total serum bilirubin level of 19.1 mg/dL, and then demonstrated a significant increase. Mean total serum bilirubin, serum Tau, and S100B levels of infants who manifested auditory neuropathy, neurologic abnormalities, or electroencephalogram abnormalities were significantly higher than in infants without these abnormalities (P < 0.05). Clinical and laboratory findings of bilirubin-induced neurotoxicity developed after a total serum bilirubin level of 22 mg/dL was reached. Serum levels of Tau and S100B proteins in jaundiced term newborns were strongly correlated with early-phase bilirubin encephalopathy.     

Intracranial foreign body

Intracranial foreign bodies due to nonmissile intracranial penetrations occur rarely. Most of these penetrating injuries result from industrial accidents or criminal assaults. The complications which cause mortality in early stage are intracerebral hemorrhage, contusion, major vascular injury and meningitis. In case of such injuries, foreign bodies near the major vascular structures should not be attempted to taken out. Total excision of the foreign body via craniotomy should be planned and possible dural and vascular injuries should be repaired during surgery. Urgent surgery should be performed as there is 53% morbidity in case of late surgery and 62% morbidity in nonoperated cases. We herein report a 20-year old man who attempted suicide by introducing a nail into his brain and review the related literature.     

The use of therapeutic plasmapheresis in the treatment of poisoned and snake bite victims: an academic emergency department's experiences

The objective of this study is to describe the clinical status, procedural interventions, and outcomes of critically ill patients with poisoning and snake bite injuries presenting to a tertiary-care emergency department for treatment with therapeutic plasmapheresis. Records of 20 patients who presented to our academic emergency department over a 2-year period and who underwent plasmapheresis for poisoning or snake bite were retrospectively reviewed. Plasmapheresis was performed using centrifugation technology via an intravenous antecubital venous or subclavian vein catheter access. Human albumin or fresh frozen plasma were used as replacement fluids. Data extracted from the patient record included demographic data, clinical status, and outcome measures. Sixteen patients underwent plasmapheresis because of toxicity from snake bite. Three patients were treated for drug poisoning (phenytoin, theophylline, bipyridene HCl) and one patient for mushroom poisoning. Haematologic parameters such as platelet count, PT, and INR resolved rapidly in victims of snake bite injuries after treatment with plasmapheresis. Loss of limbs did not occur in these cases. Seven patients required admission to the intensive care unit. One patient with mushroom poisoning died. Mean length of hospital stay was 14.3 days (range 3-28 days) for all cases. Plasmapheresis was a clinically effective and safe approach in the treatment of snake bite envenomation and other drug poisoning victims especially in the management of hematologic problems and in limb preservation/salvage strategies. In addition to established conventional therapies, emergency physicians should consider plasmapheresis among the therapeutic options in treatment strategies for selected toxicologic emergencies.     

Anti-tumor necrosis factor-alpha-induced psoriasis

We describe a patient with rheumatoid arthritis who developed psoriasis during treatment with etanercept; psoriatic lesions resolved completely after the drug was discontinued, but returned on rechallenge. No such adverse skin reaction occurred after switching therapy to infliximab. Through a Medline search we identified 11 reports involving 32 patients who developed psoriasis/psoriasiform eruptions during therapy with tumor necrosis factor-alpha (TNF-alpha) inhibitors. All TNF-alpha blocking agents have been reported to lead to or exacerbate psoriasis. In some cases skin changes were severe enough to discontinue the medication.     

Gout attack with unusual ocular complications

Uveitis is reported in vanishingly small numbers in gout. This case with bilateral uveitis, increased intraocular pressure and blurred disc margins may unravel strange ocular complications of the disease and arise awareness of gout while prescribing diuretics and cyclosporine in patients with uveitis and increased intraocular pressure.     

A case of carbon monoxide poisoning with thrombus in the heart: a case report

Carbon monoxide is a nonirritant, odorless, colorless gas, and is lighter than air. It is an end product of the incomplete combustion of hydrocarbons. Its effects are most prominent in organs sensitive to oxygen deprivation, such as the heart, brain, and kidney. Carbon monoxide poisoning becomes more abundant in winter and at cold places. In Turkey, every year we see several deaths due to poisonous gas leaks from coal or wood stoves. Deaths particularly due to hypoxia-related central nervous system damage and ventricular dysrhythmias are observed. On the other hand, an association between thromboembolic accidents and carbon monoxide poisoning has been shown in literature. Thromboembolic accidents in the mesenteric, central nervous system, and extremities are reported. However, no atrial thrombus has been mentioned. In this study, a case of an atrial thrombus associated with carbon monoxide poisoning following a diagnosis of carbon monoxide poisoning and treatment in the emergency room is reported and the literature is revisited.     

Cardiac tamponade in a newborn because of umbilical venous catheterization: is correct position safe?

Cardiac tamponade is a rare but life-threatening complication of umbilical venous catheterization in the newborn. Most complications from central venous catheters are related to incorrect position of the catheter and it is emphasized to confirm the position of the catheter tip after placement in order to avoid possible complications. We present an unusual complication of cardiac tamponade because of umbilical venous catheterization in a term newborn which is extremely rare with correct location of the catheter tip at the junction of inferior vena cava and right atrium. We suggest that correct position never guarantees uneventful catheterization in the newborn. In any infant with a central venous catheter in situ who deteriorates clinically, pericardial effusion/cardiac tamponade must be considered and appropriate action taken.