Investigation of the relationship between coagulation parameters and mortality in COVID-19 infection

This study, which included patients over the age of 18 who were diagnosed with coronavirus disease 2019 (COVID-19) in the emergency clinic, aims to determine the relationship between coagulation parameters and mortality. Epidemiologic data such as age, gender, medical history, vital parameters at emergency department admission, clinical findings, coagulation parameters such as d-dimer, prothrombin time (PT), active partial thromboplastin time (aPTT), international normalized ration (INR), fibrinogen, and platelet were evaluated. Patients with positive computerized tomography (CT) findings and positive polymerase chain reaction (PCR) together were included in the study. It was revealed that d-dimer, fibrinogen, INR, and PT values were higher in the elderly group. It was shown that there was a significant relationship between hospitalization days (ward or intensive care unit) and d-dimer levels. It was observed that d-dimer, fibrinogen elevation was significantly associated with prognosis by increasing mortality, and that platelet and aPTT values were also associated with prognosis and were lower in the mortality group. On the other hand, in receiver operating characteristic (ROC) analysis, the sensitivity and specificity data were 80.3%/80.0% for d-dimer, 70.5%/72.2% for fibrinogen, 58.2%/59.4% for aPTT, and 59.7%/59.2% for platelet, respectively. The overall classification success was 88.6% and mortality prediction success was 37.7% in the regression model of some coagulation parameters (d-dimer, fibrinogen, aPTT, and platelet) which were effective on prognosis. In conclusion, it was determined that d-dimer, fibrinogen, aPTT, and platelet parameters were directly associated with mortality and when these coagulation parameters were used together with the clinical, vital, and demographic data of the patients, the success of mortality prediction increased significantly.

Diagnostic Value of Galectin-3 for Identifying Acute Pulmonary Embolism in the Emergency Department

BACKGROUND

Pulmonary embolism (PE) is a common disease associated with high mortality and morbidity. Diagnosing PE is challenging due to diverse clinical presentations and the lack of specific biomarkers.

OBJECTIVE

We hypothesized that plasma galectin-3 (Gal-3) levels might reflect the severity of acute PE and be useful for diagnostic assessment.

METHODS

In this prospective study, 150 patients (100 patients with PE and 50 control patients) were included. Patients were stratified into high-risk, medium-risk, and low-risk groups according to the Wells and revised Geneva scoring systems, and Gal-3 levels were compared among the groups. PE was diagnosed by means of computed tomography pulmonary angiography.

RESULTS

In this study, of the 100 PE patients included in the study, 69 patients recovered and were discharged and 31 patients died. Median Gal-3 value in the PE group was 27.0 ng/mL (range 11.5-35.0 ng/mL), whereas the median Gal-3 value in the control group was significantly lower at 8.8 ng/mL (range 1.0-21.0 ng/mL) (p < 0.001). When the Gal-3 values of the PE group and the control group were evaluated with the receiver operator characteristic curve, the area under the curve was calculated as 0.99 (95% confidence interval 0.979-1). At a Gal-3 cutoff value of 13.55 ng/mL, which was determined to be the most appropriate value for PE diagnosis, the sensitivity was 98% and the specificity was 92%.

CONCLUSIONS

A biomarker that rapidly and accurately diagnoses acute PE in the emergency department can be an extremely useful tool. We concluded that plasma Gal-3 levels can be regarded as a promising marker of acute PE.

Sternal Fractures in Blunt Chest Trauma: Retrospective Analysis of 330 Cases

OBJECTIVE

To analyse the range of injuries associated with sternal fracture (SF) and their clinical features and outcomes.

STUDY DESIGN

Observational study.

PLACE AND DURATION OF STUDY

Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey, from July 2010 to July 2020.

METHODOLOGY

Sternal fractures were considered in 330 patients with blunt trauma during the study period. They were categorised according to the Johnson and Branfoot classification and the Arbeitsgemeinschaft fur Osteosynthesefragen / Orthopaedic Trauma Association classification. Demographic data were collected, including age, gender, mechanism of injury, associated injuries, and the length of hospital stay.

RESULTS

During the 10-year study period, a total of 4024 thoracic trauma patients were admitted to the emergency department. Of these, 330 (8.2%) had a sternal fracture. The median age of the patients was 41 (8-90) years, and 72.7% were male. Isolated sternal fractures occurred in 93 patients (28.2%). An additional thoracic injury was observed in 74 patients (22.4%) included in the study, and an accompanying extrathoracic injury was observed in 34 patients (10.3%). In 129 patients (39.1%), both thoracic and extrathoracic pathologies were detected, in addition to SF. The mortality rate among patients with isolated sternal fracture was 1.1%; the mortality rate among patients with sternal fracture accompanied by additional pathologies was 6.6%.

CONCLUSION

Sternal fractures are frequently associated with other injuries. Although isolated sternal fracture has a good prognosis, careful evaluation and clinical observation are essential for additional injuries.

KEY WORDS

Emergency medicine, Sternal fracture, Chest trauma.

Phytochemical profile, antimicrobial, and anti-quorum sensing properties of fruit stalks of Prunus avium L

The aim of this study is to investigate the phytochemical contents and antibacterial properties of 2-year Prunus avium L. standard cultivars [Cristalina (Cr), 0900 Ziraat (Zr)] and to elucidate the mechanism of action of the extracts on the quorum sensing (QS) system by using homology modelling and molecular docking. Phenolic contents of methanol extract of Cr and Zr stalks were detected by HPLC. As a result, catechin hydrate (6364·67-8127·93 µg g^-1 ) and chlorogenic acid (998·81-1273·4 µg g^-1 ) were found to be the highest in stalk extracts in the two varieties in 2017. All extracts had inhibitory effect on Gram-positive bacteria. Stalk extract of Zr showed higher inhibition rate (86%) on swarming motility. Stalk samples of Zr collected in 2017 and 2018 also reduced biofilm formation by 75 and 73%, respectively. The computational analysis revealed that one of the major component of the extracts, chlorogenic acid, was able to bind to the QS system receptors, LasR, RhlR, and PqsR. Therefore, the mechanism of decreasing the production of virulence factors by the extracts might be through inhibiting these receptors and thus interfering with the QS system.

Detecting the Effect of Umckaloabo/EPs®7630 Liquid Extract after its Therapeutic Purposed Usage in Calves Showing Symptoms of Respiratory Tract Infection

Background: Respiratory tract diseases are commonly seen in beef cattle. Young calves are affected with many respiratory pathogens. Viral pathogens are particularly seen. There are many causative factors, e.g. environmental conditions, immune system of calves. Therefore, alternative treatments are needed for viral respiratory infections. The purpose of the current study was to investigate effectiveness of Umckaloabo/EPs®7630 liquid extract in some bovine viral pathogens of young beef calves.Materials, Methods & Results: Antibody presence in terms of bovine herpesvirus type 1 (BHV-1), bovine viral diarrhea virus (BVDV), bovine parainfluenza virus type 3 (BPIV-3), bovine respiratory syncytial virus (BRSV) and bovine adenovirus type 3 (BAV-3) was searched in blood serum samples of 40 Holstein calves aged 6 months and over showing respiratory tract infection symptoms. All animals were found seronegative in terms of other factors except BRSV. Out of 20 BRSV seropositive calves, 10 of them were classified as control group and the other ten as testing group. BRSV antibody titers were also detected in blood samples of both groups on day 0. Umckaloabo/EPs®7630 liquid extract was given through oral route to animals in testing group according to their weights for 14 days morning, noon and night. No application was performed on animals in control group. BRSV antibody titers were detected in blood samples of animals in both groups taken on days 1st, 3rd, 5th, 7th, 10th and 14th. At the end of day 14th, BRSV antibody titer increased in 9 out of 10 animals (90%) in testing group that were given Umckaloabo/EPs® 7630 liquid extract while one of them (10%) showed no variability. BRSV antibody titer increased in 6 out of 10 animals (60%) in control group while it decreased in one of them (10%) and 3 of them (30%) showed no variability. In testing group, BRSV antibody titer started to increase on day 3rd in 6 out of 10 animals (60%), on day 5th in one (10%), on day 10th in one (10%) and on day 14th in another (10%). In control group, BRSV antibody titer started to increase on day 3rd in 3 out of 10 animals (30%) and on day 5th in 3 of them (30%). When haematologic values of blood samples taken from animals in testing and control groups on day 14th were studied comparatively, no statistical importance (P < 0.01 or P < 0.05) and difference was detected. As a result, in stock calves showing respiratory tract infection symptoms, applying Umckaloabo/EPs® 7630 liquid extract helped BRSV antibody titer to increase and symptoms decreased. The increase in antibody titers started from day 3rd especially after applying Umckaloabo/EPs® 7630 liquid extract.Discussion: Respiratory system infections are contagious and fatal in calves. Respiratory tract bacterial and viral vaccinations are applied in order to prevent losses of calves due to these problems. However, these vaccinations are not sufficient most of the time and antibiotics+supportive treatment applications follow afterwards. Therefore, we advise to use a herbal product, Umckaloabo/ EPs®7630 liquid extract, that has both an antiviral efficiency and a feature of supporting immune system in order to prevent mortalities in stock calves, to stop the infection from spreading on all the herd and to decrease the symptoms of respiratory system. We believe that the obtained data should be supported with more examples and more wide-ranging studies.

Transcatheter vs. surgical aortic valve replacement and medical treatment : Systematic review and meta-analysis of randomized and non-randomized trials

BACKGROUND

Transcatheter aortic valve replacement (TAVR) has emerged as the procedure of choice for patients with severe aortic stenosis (AS) and high perioperative risk. We performed a meta-analysis to compare the mortality related to TAVR with medical therapy (MT) and surgical aortic valve replacement (SAVR).

METHODS

A systematic literature search was conducted by two independent investigators from the database inception to 30 December 2014. Relative risk (RR) and odds ratio (OR) were calculated and graphically displayed in forest plots. We used I ² for heterogeneity (meta-regression) and Egger's regression test of asymmetry (funnel plots).

RESULTS

We included 24 studies (n = 19 observational studies; n = 5 randomized controlled trials), with a total of 7356 patients in this meta-analysis. Mean age had a substantial negative impact on the long-term survival of AS patients (OR = 1.544; 95% CI: 1.25-1.90). Compared with MT, TAVR showed a statistically significant benefit for all-cause mortality at 12 months (OR = 0.68; 95% CI: 0.49-0.95). Both TAVR and SAVR were associated with better outcomes compared with MT. TAVR showed lower all-cause mortality over SAVR at 12 months (OR = 0.81; 95% CI: 0.68-0.97). The comparison between SAVR and TAVR at 2 years revealed no significant difference (OR = 1.09; 95% CI: 1.01-1.17).

CONCLUSION

In AS, both TAVR and SAVR provide a superior prognosis to MT and, therefore, MT is not the preferred treatment option for AS. Furthermore, our data show that TAVR is associated with lower mortality at 12 months compared with SAVR. Further studies are warranted to compare the long-term outcome of TAVR versus SAVR beyond a 2-year follow-up period.

Cerebrovascular ischaemia after carbon monoxide intoxication

Carbon monoxide intoxication is the most prevalent cause of death from carbon monoxide poisoning. We herein report the case of a 56-year-old man who was found unconscious and smelled of smoke after exposure to carbon monoxide from a heater. He scored 5 on the Glasgow Coma Scale, and had respiratory insufficiency and elevated troponin I, creatine kinase-MB fraction and carboxyhaemoglobin levels. He was treated by mechanical ventilation. After regaining consciousness, brain magnetic resonance imaging showed diffusion restriction in the left occipital lobe; there was a loss of vision (right temporal hemianopsia), which improved by the follow-up session. Carbon monoxide intoxication may cause neurologic and cardiac sequelae, and the initial treatment includes oxygen therapy. Acute carbon monoxide poisoning can cause serious injury to the brain, heart and other organs; the most severe damages that could be inflicted to the brain include cerebral ischaemia and hypoxia, oedema, and neural cell degeneration and necrosis.

Dyspnoea and chest pain as the presenting symptoms of pneumomediastinum: two cases and a review of the literature

Pneumomediastinum is the presence of air in the mediastinum. It may occur as spontaneous, traumatic, or iatrogenic pneumomediastinum. Although spontaneous pneumomediastinum is usually observed in healthy young men, traumatic pneumomediastinum may be caused by blunt or penetrating trauma to the chest and neck. Pneumomediastinum is a clinical condition with potential complications that cause high morbidity and mortality rates. Pneumomediastinum also may develop without tracheal or oesophageal injury after spontaneous or blunt chest, neck and facial injuries, and it may be accompanied by pneumothorax. We treated two patients who had pneumomediastinum. Case 1 was a 20-year-old man who had pain and dyspnoea around the sternum for one hour, as a result of a blow from an elbow during a football match. Case 2 was a 23-year-old man who had a two-day history of dyspnoea and chest pain with no history of trauma. In both patients, diagnosis of pneumomediastinum was confirmed with thoracic computed tomography scans, and the condition resolved within five days of in-patient observation. In conclusion, the diagnosis of pneumomediastinum should be considered for all patients who present to the emergency department with chest pain and dyspnoea.

Pulmonary embolism severity index, age-based markers and evaluation in the emergency department

OBJECTIVES

The purpose of this study was to assess the severity of pulmonary embolism in the emergency department using vital signs and age-based vital parameters and compare these parameters with pulmonary embolism severity index (PESI) score.

METHODS

Between January 2011 and October 2014, there were 284 patients diagnosed with pulmonary embolism in the Emergency Unit of Selcuk University Hospital. Patient records were reviewed retrospectively. The PESI scores were calculated, and patients were divided into high- and low-risk groups. Shock index (SI), age-based shock index (SIA), maximum heart rate (MHR), minpulse (MP) and pulse maximum index (PMI) were calculated. The association of these parameters with PESI was evaluated. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the association of risk and mortality with age-based markers.

RESULTS

There were 75 men (43%) in the 173 patients included in the study. The PESI classification showed 54 patients in the low-risk group and 119 patients in the high-risk group. Mortality was higher in the PESI high-risk group, and no deaths occurred in the low-risk group. Comparison of the age-based markers and PESI for patients who died or survived showed that AUC for PESI was 0.807, AUC for SI was 0.824 and AUC for SIA was 0.825.

CONCLUSIONS

The SIA risk classification was more efficient than SI in pulmonary embolism patients who presented to the emergency unit. The SIA was more accurate than SI or PESI in predicting mortality.

Neuroprotective effects of sildenafil in experimental spinal cord injury in rabbits

Neuroprotective agents such as methylprednisolone and sildenafil may limit damage after spinal cord injury. We evaluated the effects of methylprednisolone and sildenafil on biochemical and histologic changes after spinal cord injury in a rabbit model. Female New Zealand rabbits (32 rabbits) were allocated to 4 equal groups: laminectomy only (sham control) or laminectomy and spinal trauma with no other treatment (trauma control) or treatment with either methylprednisolone or sildenafil. Gelsolin and caspase-3 levels in cerebrospinal fluid and plasma were determined, and spinal cord histology was evaluated at 24 hours after trauma. There were no differences in mean cerebrospinal fluid or plasma levels of caspase-3 between the groups or within the groups from 0 to 24 hours after injury. From 0 to 24 hours after trauma, mean cerebrospinal fluid gelsolin levels significantly increased in the sildenafil group and decreased in the sham control and the trauma control groups. Mean plasma gelsolin level was significantly higher at 8 and 24 hours after trauma in the sildenafil than other groups. Histologic examination indicated that general structural integrity was better in the methylprednisolone in comparison with the trauma control group. General structural integrity, leptomeninges, white and grey matter hematomas, and necrosis were significantly improved in the sildenafil compared with the trauma control group. Caspase-3 levels in the cerebrospinal fluid and blood were not increased but gelsolin levels were decreased after spinal cord injury in trauma control rabbits. Sildenafil caused an increase in gelsolin levels and may be more effective than methylprednisolone at decreasing secondary damage to the spinal cord. 

Red cell distribution width and neurological scoring systems in acute stroke patients

OBJECTIVES

The purpose of the present study was to evaluate the association between the red blood cell distribution width (RDW) and the Glasgow Coma Scale (GCS), Canadian Neurological Scale (CNS), and National Institutes of Health Stroke Scale (NIHSS) scores in patients who had acute ischemic stroke.

METHODS

This prospective observational cohort study included 88 patients who have had acute ischemic stroke and a control group of 40 patients who were evaluated in the Emergency Department for disorders other than acute ischemic stroke. All subjects had RDW determined, and stroke patients had scoring with the GCS, CNS, and NIHSS scores. The GCS, CNS, and NIHSS scores of the patients were rated as mild, moderate, or severe and compared with RDW.

RESULTS

Stroke patients had significantly higher median RDW than control subjects. The median RDW values were significantly elevated in patients who had more severe rather than milder strokes rated with all three scoring systems (GCS, CNS, and NIHSS). The median RDW values were significantly elevated for patients who had moderate rather than mild strokes rated by GCS and CNS and for patients who had severe rather than mild strokes rated by NIHSS. The area under the receiver operating characteristic curve was 0.760 (95% confidence interval, 0.676-0.844). Separation of stroke patients and control groups was optimal with RDW 14% (sensitivity, 71.6%; specificity, 67.5%; accuracy, 70.3%).

CONCLUSION

In stroke patients who have symptoms <24 hours, the RDW may be useful in predicting the severity and functional outcomes of the stroke.

Causes of poisoning in patients evaluated in a hospital emergency department in Konya, Turkey

OBJECTIVES

To evaluate demographic and clinical characteristics of patients with poisoning at a community hospital.

METHODS

The retrospective study comprised records of patients who were admitted to the emergency department of Konya Numune Hospital, Turkey, because of poisoning between January 1, 2009, and December 31, 2011. Data was evaluated for age, gender, educational status, occupation, arrival time, mechanism of intoxication , body temperature, pulse, respiratory rate, Glasgow Coma Scale score, treatment applied, duration of hospital stay, duration of follow-up, test results, final diagnosis, clinical disposition, and outcome. Agents causing the poisoning were also determined.

RESULTS

Records of 1036 patients were evaluated. Of them, 764(74%) were female and 272(26%) were male. The predominant age range was 15-24 years in 617(60%) patients. The median time from substance exposure to admission to the emergency department was 2 hours. The most common cause of poisoning was attempted suicide in 955 [92%] patients and drug intoxication was the agent involved in 932 (90%). In the 15-24 year age range, there were 469 (76%) female patients. Of the total female population in the study, 716 (94%) attempted suicide. The median hospital stay was 24 hours. There were 908 (88%) patients who were advised to seek further evaluation at the psychiatry clinic, and 9 (0.9%) patients were admitted to the psychiatry inpatient units after medical treatment. In patients who were hospitalized and followed up, 1 (0.1%) died because of multiple drug poisoning.

CONCLUSION

Most admissions to the emergency department for poisoning related to young women had used drugs during a suicide attempt.

Blunt chest trauma as a cause of acute myocardial infarction

Chest pain after thoracic trauma may be a symptom of cardiac injury or myocardial infarction. A 63-year-old healthy man had chest pain after blunt chest trauma in a motor vehicle accident. Chest computed tomography scan showed a displaced sternal fracture, lung contusion in the left upper lobe, atelectasis and consolidation in both lower lobes, and bilateral haemothorax. Electrocardiography showed ST elevation (2 mm) in leads II, III, and aVF and ST depression (2 mm) in leads I and aVL, consistent with acute inferior myocardial infarction. Urgent coronary angiography showed ostial occlusion of the right coronary artery. After the right coronary occlusion was passed with a guide wire, dissection of the right coronary artery was observed and treated with a balloon and stent to reestablish normal flow. This case emphasizes the importance of a high index of suspicion for coronary artery injury and myocardial infarction after blunt chest trauma.

D-dimer and D-dimer/fibrinogen ratio in predicting pulmonary embolism in patients evaluated in a hospital emergency department

OBJECTIVES

The D-dimer level, fibrinogen level, and D-dimer/fibrinogen ratio are used in the diagnosis of pulmonary embolism, but results vary. We evaluated these parameters in the diagnosis of pulmonary embolism in emergency clinic patients.

METHODS

In this prospective study, 200 patients (pulmonary embolism, 100 patients; no pulmonary embolism, 100 patients) had D-dimer and fibrinogen levels measured before intervention. Pulmonary embolism was diagnosed with computed tomography angiography or ventilation-perfusion scintigraphy.

RESULTS

Compared with patients who did not have pulmonary embolism, patients who had pulmonary embolism had significantly greater mean D-dimer level (pulmonary embolism, 6±7 μg/ml; no pulmonary embolism, 1±1 μg/ml; P⩽0·001) and D-dimer/fibrinogen ratio (pulmonary embolism, 3±3; no pulmonary embolism, 0·4±0·4; P⩽0·001), but similar mean fibrinogen levels (pulmonary embolism, 337±184 mg/dl; no pulmonary embolism, 384±200 mg/dl; not significant). In patients who had pulmonary embolism, mean D-dimer level and D-dimer/fibrinogen ratio were greater in high-risk than non-high-risk patients. With D-dimer cutoff 0·35 μg/ml, sensitivity was high (100%) and specificity was low (27%) for pulmonary embolism. With D-dimer/fibrinogen ratio cutoff 0·13, sensitivity was high (100%) and specificity was low (37%) for pulmonary embolism.

CONCLUSION

A D-dimer level <0·35 μg/ml may exclude the diagnosis of pulmonary embolism. At a D-dimer cutoff 0·5 μg/ml and D-dimer/fibrinogen ratio cutoff 1·0, the D-dimer/fibrinogen ratio may have better specificity than D-dimer level in the diagnosis of pulmonary embolism, but the D-dimer/fibrinogen ratio may lack sufficient specificity in screening.

Hemolysis associated with pneumatic tube system transport for blood samples

Objective: The frequency of hemolysis of blood samples may be increased by transport in a pneumatic tube system. The purpose of this study was to evaluate the effect of pneumatic tube system transport on hemolysis of blood samples.

Methods: Blood samples were transported from the emergency department to the hospital laboratory manually by hospital staff (49 patients) or with a pneumatic tube system (53 patients). The hemolysis index and serum chemistry studies were performed on the blood samples and compared between the different methods of transport.

Results: The blood samples that were transported by the pneumatic tube system had a greater frequency of hemolysis and greater mean serum potassium and median creatinine, aspartate aminotransferase, and lactate dehydrogenase levels than samples transported manually.

Conclusion: Blood samples transported from the emergency department to the hospital laboratory by a pneumatic tube system may have a greater frequency of hemolysis than samples transported manually. This may necessitate repeat phlebotomy and cause a delay in completing the laboratory analysis.

High-sensitivity C-reactive protein, lipoprotein-related phospholipase A2, and acute ischemic stroke

BACKGROUND

Serum biomarkers may be useful for early diagnosis of acute ischemic stroke, exclusion of other diseases that may mimic stroke, and prediction of infarct volume. We evaluated serum high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-related phospholipase A2 (Lp-PLA2) in patients who had acute ischemic stroke.

METHODS

In 200 patients who presented to an emergency service (acute ischemic stroke, 102 patients; control with no stroke, 98 patients), stroke patients were evaluated with the Canadian neurological scale and diffusion-weighted magnetic resonance imaging, and all patients were evaluated with the Glasgow coma scale and their serum hs-CRP level and Lp-PLA2 activity were assessed. The volume of stroke lesions was calculated from magnetic resonance images.

RESULTS

Patients who had stroke had higher mean serum hs-CRP level (stroke, 7±6 mg/dL; control, mean ± standard deviation 1±1 mg/dL; P≤0.001) and Lp-PLA2 activity (stroke, mean ± standard deviation 113±86 nmol/min/mL; control, mean ± standard deviation 103±50 nmol/min/mL; P≤0.001) than control patients who did not have stroke. The mean hs-CRP level and Lp-PLA2 activity were higher in patients who had greater stroke severity (lower Canadian neurological scale score) and were higher in patients who had larger volume strokes.

CONCLUSION

Higher hs-CRP level and Lp-PLA2 activity are significantly associated with more severe neurologic impairment and larger infarct size in patients who have acute ischemic stroke. These biomarkers may be useful for rapid diagnosis and prediction of ischemic tissue volume in the early stage of ischemic stroke. These findings may be important for health care facilities that have limited access to emergency computed tomography scanning for the diagnosis of stroke.

Quaternary ammonium salts of phenylglyoxylic acid as photobase generators for thiol-promoted epoxide photopolymerization

A novel series of photobase generators (PBGs), which are quaternary ammonium salts of phenylglyoxylic acid (PA) having the ability to generate strong bases such as 1,8-diazabicyclo[5.4.0]undec-7-ene (DBU), 1,5-diazabicyclo[4.3.0]non-5-ene (DBN) or 1,1,3,3-tetramethylguanidine (TMG), was synthesized.

Trauma in elderly patients evaluated in a hospital emergency department in Konya, Turkey: a retrospective study

PURPOSE

Trauma is a common cause of admission to the hospital emergency department. The purpose of this study was to evaluate the cause of admission, clinical characteristics, and outcomes of patients aged ≥65 years admitted to an emergency department in Turkey because of blunt trauma.

MATERIALS AND METHODS

Medical records were retrospectively reviewed for 568 patients (314 women and 254 men) aged ≥65 years who were admitted to an emergency department of a tertiary care hospital.

RESULTS

Trauma was caused by low-energy fall in 379 patients (67%), traffic accident in 79 patients (14%), high-energy fall in 69 patients (12%), and other causes in 41 patients (7%). The most frequent sites of injury were the lower extremity, thorax, upper extremity, and head. The femur was the most frequent fracture site. After evaluation in the emergency department, 377 patients (66%) were hospitalized. There were 31 patients (5%) who died. Risk of hospitalization after trauma was significantly associated with trauma to the lower extremity, thorax, and spine; fractures of the femur and rib; and intracranial injury.

CONCLUSION

Emergency department admission after trauma in patients aged ≥65 years is common after low-energy falls, and most injuries occur to the extremities. It is important to focus on prevention of falls to decrease the frequency of trauma in the elderly.

Seizures after overdoses of bupropion intake

BACKGROUND

Bupropion is a new-generation monocyclic antidepressant that has been accidentally found to have potential effects on reducing nicotine addiction. It is structurally similar to stimulants such as amphetamine and inhibits dopamine and noradrenalin reuptake selectively.

CASE REPORTS

We report two cases with no history of epilepsy who took oral bupropion for depression and had generalised tonic-clonic type of seizures in their follow-ups.

CONCLUSION

After an overdose of bupropion, clinical effects are seen primarily on the neurological, cardiovascular, and gastrointestinal systems. Neurological effects can include tremor, confusion, agitation, hallucinations, coma, and seizures.

Reversible myocarditis after spider bite

Black widow spiders (Latrodectus tredecimguttatus) are poisonous spiders endemic in Turkey. Latrodectus bites may cause myocarditis with increased cardiac enzymes. We treated two men (aged 20 and 33 years) who had myocarditis after black spider bites with leucocytosis and elevated levels of troponin I, creatine kinase and creatine kinase-MB fraction. Both patients had normal results on an ECG, and one patient had abnormal echocardiography with minimal left ventricular wall movement disorder. Both patients were hospitalised in the intensive care unit and treated with intravenous fluids, analgesics, spasmolytic drugs, tetanus prophylaxis and cardiac monitoring. The levels of troponin I, creatine kinase and creatine kinase-MB fraction improved, and the patients were discharged home on the third and fifth hospital day without complications. Myocarditis after a Latrodectus bite is rare, but may be associated with serious complications. Therefore, in regions endemic with Latrodectus spiders, prudent treatment of spider bites may include cardiac evaluation and monitoring.

The effects of ubiquinone (CoQ10) on heart tissue in cardiac toxicity related to organophosphate poisoning

The aim of this study was to examine the effects of ubiquinone (CoQ10) on heart tissue and erythrocytes in acute organophosphate poisoning (AOP). A total of 20 rabbits were divided into three groups: sham (n = 8), pralidoxime (PAM) + atropine (n = 6), and CoQ10 + PAM + atropine (n = 6). Blood samples were taken from each test subject to measure the values of acetylcholinesterase (AChE), nitric oxide (NO), and malondialdehyde (MDA) in the plasma and erythrocyte before administration of 50 mg/kg dichlorvos by orogastric tube. Blood samples were then taken at 1, 12, and 24 h post-dichlorvos to determine plasma and erythrocyte levels of AChE, NO, and MDA. Sham group received no treatment. PAM + atropine group received 0.05 mg/kg atropine with repeated doses and PAM: first a 30-mg/kg intravenous (IV) bolus, then a 15-mg/kg IV bolus every 4 h. CoQ10 + PAM + atropine group received same dose PAM and atropine and a 50-mg bolus of IV CoQ10. Thoracotomy was performed in all the animals 24 h after poisoning and then heart tissue samples were obtained. At 12 and 24 h, erythrocyte AChE levels in the CoQ10 animals were considerably higher than those in PAM + atropine animals (p = 0.023 and 0.017, respectively). At 12 and 24 h, erythrocyte MDA and NO levels in CoQ10 animals were significantly lower than those in PAM + atropine animals (p < 0.05). Heart tissue AChE levels in CoQ10 animals were considerably higher than those of the sham and PAM + atropine animals (p = 0.001). Heart tissue MDA and NO levels of CoQ10 animals were significantly lower than those of the sham and PAM + atropine animals (p < 0.01). Treatment of AOP with CoQ10 + PAM + atropine in this animal model had a beneficial effect on both erythrocyte and heart tissue lipid peroxidation and AChE activity.

Inferior vena cava diameter as a marker of early hemorrhagic shock: a comparative study

BACKGROUND

We determined the value of the inferior vena cava (IVC) diameter for predicting acute blood loss in control and blunt trauma patients and compared this with other parameters of hemorrhagic shock.

METHODS

Fifty volunteers and 28 consecutive hemorrhagic shock patients were recruited prospectively to participate in the study. Vital signs, blood lactate, and serum bicarbonate were measured, and shock index and base excess were calculated. Anteroposterior (AP) and mediolateral (ML) IVC diameters during inspiration and expiration were measured in the right subcostal region. IVC diameters in hemorrhagic shock patients were compared with those of controls and were also compared with other hemorrhagic shock parameters.

RESULTS

A significant relationship was determined between mean IVC AP and ML diameters during expiration and inspiration on admission in the study group and in the control group (p=0.000, p=0.000, p=0.000, p=0.000). Serum lactate levels correlated significantly with all IVC diameters (r=55), especially the IVC ML diameter during expiration.

CONCLUSION

IVC diameter, as measured by transabdominal ultrasound, was more accurate than the shock index and other commonly used non-invasive predictors of acute blood loss (blood pressure, heart rate per minute, serum lactate level, base deficit).

Lithium intoxication causing ST segment elevation and wandering atrial rhythms in an elderly patient

Lithium overdoses causing cardiotoxicity are uncommon and electrocardiographic changes suggesting myocardial ischemia are rare. However, some authors have specifically reported the occurrence of ischemic electrocardiography changes due to a lithium overdose. This paper describes a case where electrocardiography changes mimic inferior myocardial infarction during the course of chronic lithium treatment in an elderly patient. The patient's electrocardiography changes were partially resolved after hemodialysis.

Acute-phase vitamin B12 and folic acid levels in patients with ischemic and hemorrhagic stroke: is there a relationship with prognosis?

OBJECTIVE

The aim of this study was to investigate blood folic acid and vitamin B12 levels in patients with ischemic and hemorrhagic stroke patients and correlate these levels with prognosis.

METHODS

Patients presenting within 3 hours of onset of ischemic or hemorrhagic strokes were approached for participation in the study. Diagnosis was made by clinical examination and head computed tomography scan. Venous blood samples were taken for determination of blood folic acid and vitamin B12 levels. Parameters were evaluated with respect to stroke type and according to Glasgow coma scale (< or =8 or > or =9).

RESULTS

Eighty-seven patients with ischemic stroke (mean age: 65 +/- 10 years, 53% male) and 27 patients with hemorrhagic stroke (mean age: 60 +/- 10 years, 56% male) were included in the study. A significant direct correlation was found between Glasgow coma scale and mean plasma B12 levels in ischemic, but not hemorrhagic, stroke (r=112.75 and p=0.007, respectively). A significant direct correlation was found between Glasgow coma scale and mean plasma folic acid levels in hemorrhagic, but not ischemic, stroke (r=1.03 and p=0.017, respectively). In patients with Glasgow coma scale < or =8 (either hemorrhagic or ischemic stroke), a significant direct correlation was found between Glasgow coma scale and blood vitamin B12 levels. Vitamin B12 levels were significantly lower in patients with Glasgow coma scale < or =8 than in patients with Glasgow coma score > or =9 (p=0.04).

CONCLUSIONS

In patients with ischemic stroke, low vitamin B12 levels, and in patients with hemorrhagic stroke, low blood folic acid levels, are associated with lower Glasgow coma scale values and higher hospital mortality.

Autologous transplantation of arterial cells improves cardiac function in a rabbit model of infarcted myocardium

Cellular cardiomyoplasty is a promising approach for the treatment of severe heart failure. However, the question which cell line is the best to use is still a matter of debate. In this study, we aimed to evaluate the efficacy of arterial media-intima cell suspension (AMICS) transplantation in rabbit myocardial infarct model. The study was divided into 2 groups: group A (the cell-treated group, n = 9) and group B (the medium injection group, n = 8). Group A was further divided into 2 subgroups as branch-1 (treated with unlabeled cells) and branch-2 (treated with iron-labeled cells). The experimental myocardial infarction (MI) was induced by ligation of left anterior descending coronary artery with a combination of cryoinjury. Ten days after the MI, cells obtained from autologous femoral arteries were injected into the injured myocardium of group A, while group B received an injection of only DMEM medium. Clinical, echocardiographic, and histopathologic evaluations were done. As compared to the ninth day values, echocardiography showed a significant improvement in systolic functions and left ventricular (LV) dimensions of the cell-treated group on the 30th day. In the heart biopsy sections of branch-1, the immunostained injected cells were observed to exist closely, suggesting an organization. Cells existing separately and lumen-like structure organizations stained positive with both smooth muscle cell (SMC) alpha-actin and Prussian Blue were also showed in the histological observation of branch-2. Autologous AMICS transplantation seems to be a feasible and efficacious method for cellular cardiomyoplasty in our rabbit model.

Serum and cerebrospinal fluid magnesium levels, Glasgow Coma Scores, and in-hospital mortality in patients with acute stroke

The aim of this study was to determine the relationship between serum and cerebrospinal fluid (CSF) magnesium(Mg+2) levels, Glasgow Coma Scores (GCS), and 7-day mortality in acute stroke patients. Patients with acute ischemic or hemorrhagic stroke arriving within the first 3 h of symptoms were included in the study. The control group consisted of healthy volunteers. GCS was determined, and blood and CSF samples were taken in order to establish serum and CSF glucose, Mg+2, sodium, potassium, calcium, and chlorine levels.Mortality was recorded at 7 days after admission. CSF Mg+2 in the ischemic infarct group was significantly lower than in the control group (p=0.006). CSF Mg+2 in the ischemic infarct patients with a GCS < or = 8 were significantly lower (p=0.002) than controls and in ischemic infarct patients with a GCS > or = 9. In the ischemic stroke patients, CSF Mg+2 and GCS were significantly correlated (r=55, p=0.031). CSF Mg+2 levels in ischemic stroke patients who died within 7 days were significantly lower than controls, ischemic stroke patients who survived, and hemorrhagic stroke patients who died (p=0.002, p=0.042, and p=0.005,respectively). Low CSF Mg+2 levels in patients with acute ischemic stoke at admission predicted a higher 1-week mortality.

Magnesium sulfate in emergency department patients with hypertension

To compare the effect of IV magnesium with other antihypertensives in emergency department (ED) patients with hypertension. ED patients with a systolic BP > 135 mmHg or diastolic BP > 85 were approached for entry into the study. Those granting consent were randomly placed into one of three treatment groups: (1) 1.5 gm IV MgSO(4) (n = 42), (2) a parenteral or oral antihypertensive agent (n = 41), (3) both IV MgSO(4) and an antihypertensive agent (n = 44). Systolic and diastolic blood pressures were measured at entry into the study and at 15, 30, 45, and 60 min after magnesium or other antihypertensive medications were given. The main outcome measure was blood pressure at 60 min, and results were compared using one-way analysis of variance with the post hoc Tukey HSD test. Compared to systolic and diastolic blood pressures at time 0, both were lower at 15, 30, 45, and 60 min in all groups (p < 0.05). No significant difference in systolic or diastolic BP at any time point was observed when response to treatment was compared between the three groups. Intravenous MgSO(4) is as effective as antihypertensives at lowering BP in emergency department patients.

The effects of mannitol and melatonin on MRI findings in an animal model of traumatic brain edema

OBJECTIVES

The aim of this study was to compare the effects of mannitol and melatonin on brain edema secondary to trauma using magnetic resonance imaging (MRI).

METHODS

A mild traumatic brain injury with the Feeney method was performed upon twelve New Zealand rabbits. Three hours after the trauma was inflicted, MRI images were obtained, then the subjects were divided into two groups: a mannitol group and a melatonin group. The mannitol group (n = 6) was given 2 gr/kg of 20% mannitol IV over 10 minutes and the melatonin group (n = 6) received 100 mg/kg of melatonin IV over 30 minutes. Thirty-three hours after the first MRI, MRI was repeated. The 3-hour and 36-hour post-trauma MRI images in both groups were scored regarding signs of edema and extent of brain tissue protrusion in a blinded fashion by a staff radiologist. Intragroup and intergroup comparisons were made using the Fisher exact test and chi square test. Comparison of brain tissue protrusion measurements was done using the Mann Whitney U test.

RESULTS

Signs of raised intraventricular pressure, contusion and parenchymal edema were more prevelant, and parenchymal protrusion was more prominent on the 36-hour MRI in both mannitol and melatonin groups. No significant difference was found between the melatonin and mannitol groups in any parameter in the MRI images performed 3 and 36 hours after the head trauma.

CONCLUSIONS

In this animal model, melatonin and mannitol had similar effects on brain edema, as demonstrated on MRI 3 and 36 hours after head trauma.

Lactate Contents From Cerebrospinal Fluid in Experimental Subarachnoid Hemorrhage, Well Correlate With Vasospasm

The role of lactate composition of cerebrospinal fluid (CSF) with vasospasm severity and rabbit neurologic status in subarachnoid hemorrhage was determined. The neurologic status of 20 New Zealand rabbits were graded initially and then, anesthetized and basal angiograms were performed. Then 1.0 mL of CSF was withdrawn through cisterna magna and then 1 mL autologous arterial blood was injected in all rabbits over 1 minute. After 5 days, neurologic severity score (NSS) and vertebrobasilar angiograms of all rabbits were repeated. Rabbits without radiologic vasospasm or spasm under 50% (n=7) were termed as group 1. Rabbits whose cerebral vasospasm were 50% or over 50% (n=7) and NSS is lesser than 3 were termed as groups 2, and rabbits whose cerebral vasospasm were 50% or above 50% (n=7) and NSS is greater than 3 were termed groups 3. On day 7, the CSF lactate values of each group were significantly different (P<0.05) with each other. But when compared with only CSF baseline lactate values groups 2 and 3 were significantly different (P<0.05). However, the NSSs were similar in groups 1 and 2, but group 3 significantly differed from groups 1 and 2 (P<0.05). All groups significantly differed from baseline NSSs (P<0.05). The data showed clearly that the degree of vasospasm correlates not only with neurologic status but also with CSF lactate levels. We suggest that CSF lactate level may be useful as a surrogate marker of cerebral vasospasm degree after subarachnoid hemorrhage in clinics where invasive cerebral angiography could not be assessed for whatever reasons.

Fibrinolytic markers and neurologic outcome in traumatic brain injury

AIMS

To determine the usefulness of fibrinolytic markers as early prognostic indicators in patients with isolated head trauma.

MATERIALS AND METHODS

Sixty-two consecutive patients (26 women and 36 men; mean age 61 years, range 2-76 years) with isolated head trauma seen within the first three hours of the trauma were included in the study. The Glasgow Coma score (GCS), platelet counts (Plt), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, fibrin degradation products (FDP) and D-dimer levels were measured. Head computerized tomography (CT) findings were categorized as brain edema, linear fracture, depressed fracture, contusion and bleeding. Plt counts, PT, PTT, fibrinogen, FDP, D-dimer levels and CT findings were compared with both GCS and mortality in the first week. Statistical significance was accepted at P <or=0.05.

RESULTS

A marked negative relationship was found between GCS and PT, PTT, FDP and D-dimer levels (P < 0.001). Plt levels did not correlate with GCS. Mortality was most strongly related to GCS, PT, FDP and D-dimer levels (P < 0.001, P < 0.001, P < 0.001 and P < 0.001, respectively). We found no relationship between mortality and CT findings, nor was there any significant relationship between Plt, PTT and fibrinogen levels.

CONCLUSION

GCS and fibrinolytic markers measured within the first three hours were useful in determining the prognosis of patients with isolated head trauma.

Prediction of arterial blood gas values from venous blood gas values in patients with acute exacerbation of chronic obstructive pulmonary disease

Arterial blood gas (ABG) analysis has an important role in the clinical assessment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, arterial puncture or insertion of an arterial catheter has many drawbacks. The aim of this study was to evaluate whether venous blood gas (VBG) values of pH, partial pressure of carbon dioxide (PCO(2)) and oxygen (PO(2)), bicarbonate (HCO(3)), and oxygen saturation (SO(2)) can reliably predict ABG levels in patients with AECOPD. One hundred and thirty-two patients with a prior diagnosis of COPD presenting with acute exacerbation according to AECOPD criteria were included in this prospective study. AECOPD is defined as a recent increase in cough, wheezing, the volume and purulence of sputum or shortness of breath necessitating a change in regular medication, including corticosteroids or antibiotics. ABG samples were taken immediately after venous sampling, and both were analyzed. Linear regression analysis was performed and equations were established for the estimation of arterial values. The Pearson correlation coefficients for pH, PCO(2), HCO(3), PO(2), and SO(2) were 0.934, 0.908, 0.927, 0.252, and 0.296, respectively. There was a significant correlation between ABG and VBG values of pH, PCO(2), and HCO(3) (p < 0.001). Linear regression equations for the estimation of pH, PCO(2), and HCO(3) were as follows: arterial pH = 1.004 x venous pH; arterial PCO(2) = 0.873 x venous PCO(2); and arterial HCO(3) = 0.951 x venous HCO(3). VBG analysis can reliably predict the ABG values of pH, PCO(2) and HCO(3) in patients with AECOPD.

[An evaluation of the relationship between blood glucose level and prognosis in acute phase of head injuries]

BACKGROUND

We evaluated the relationship between blood glucose level and Glasgow Coma Scale (GCS) and prognosis in acute phase of head injuries.

METHODS

The study included 62 patients (26 females, 36 males; mean age 61 years; range 4 to 76 years) who were admitted within the first three hours following isolated head injuries. Initial GCS scores were determined and blood glucose levels were measured. Cranial computed tomography (CT) findings were classified as cerebral edema, fracture, contusion, hemorrhage, and multiple pathologies. Relationships were sought between GCS scores, outcome, CT findings, and blood glucose levels.

RESULTS

Cranial CT findings were cerebral edema in 15 patients (24.2%), hemorrhage in nine patients (14.5%), fractures in four patients (6.5%), contusion in two patients (3.2%), and multiple injuries in 32 patients (51.6%). The mean GCS score was 8 (range 3 to 13), which was 8 or lower in 37 patients (59.7%), and above 8 in 25 patients (40.3%). The mean blood glucose level was 219 mg/dl (range 136 to 397 mg/dl) in the study group. It was 293 mg/dl in those with a GCS score of 8 or lower, of which 18 patients died. Significant inverse relationships were found between (i) blood glucose level and GCS scores (p<0.01), and (ii) GCS scores and mortality (p<0.01). Blood glucose levels were significantly correlated with mortality (p<0.01). Computed tomography findings were not correlated with mortality and blood glucose levels.

CONCLUSION

High blood glucose levels in acute phase of head injuries may be a sign for poor prognosis.

Effect of Gamma-Hydroxybutyric Acid on Lipid Peroxidation and Tissue Lactate Level in Experimental Head Trauma

BACKGROUND

This study was designed to determine the effects of gamma-hydroxybutyric acid (GHB) on tissue lactate and malondialdehyde (MDA) levels in rabbit brain after experimental head trauma.

METHODS

Thirty New Zealand rabbits were divided equally into three groups: group S was the sham-operated group, group C, and group GHB received head trauma, where group C was the untreated and group GHB was the treated group. Head trauma was delivered by performing a craniectomy over the right hemisphere and dropping a weight of 10 g from a height of 80 cm. GHB was administered 400 mg/kg intravenously for 10 minutes after the head trauma to group GHB. The nontraumatized side was named "1" and the traumatized side was named "2." One hour after trauma, brain cortices were resected from both sides and the concentrations of lactate and MDA were determined.

RESULTS

There were significant differences between lactate and MDA levels of group S and all other groups (C1, C2, GHB1, and GHB2) except between lactate levels of group S and group GHB1, the nontraumatized and traumatized sides of groups C and group GHB, group C2 versus group GHB2, and group C1 versus group GHB1 (p < 0.05). Rectal temperature after the administration of GHB in group GHB was found lower than in groups S and C (p < 0.05).

CONCLUSION

These results demonstrate that head trauma leads to an increase in brain tissue lactate and MDA levels, and GHB effectively suppresses the increase of lactate and MDA.

Effects of hypertonic saline, HAES and dimethylsulphoxide on free oxygen radicals in haemorrhagic shock oxygen radicals in haemorrhagic shock

BACKGROUND

The aim of this study was to investigate the effects of antioxidant and resuscitation fluids which were used during haemorrhagic shock on tissue ischemia.

METHODS

Forty New Zealand type rabbits were divided into four groups as C (control), I (hypertonic saline), H (HAES) and D (Dimethylsulphoxide-DMSO). Haemorrhagic shock was induced by bleeding from carotid artery. Thirty minutes after shock, Group C was not resuscitated while Group I was resuscitated with Hypertonic saline 7.2, Group H with 10 % HAES and Group D with HAES 10 % and DMSO. Thiobarbituric acid reactive substances (TBARS) and lactate levels in blood, liver and small bowel samples were measured.

RESULTS

There were no significant differences among the groups tissue and plasma TBARS and lactate levels.

CONCLUSION

Resuscitation fluids and addition of antioxidants to the resuscitation fluids do not have any superiorities over each other to prevent tissue ischemic insult in haemorrhagic shock.

Effects of magnesium sulfate on tissue lactate and malondialdehyde levels after cerebral ischemia

In the present study, the effects of magnesium sulfate on tissue lactate and malondialdehyde (MDA) levels after cerebral ischemia in rabbits were studied. The rabbits were divided equally into three groups. Group 1 (n = 8) was the sham-operated control group, in group 2 (n = 8) only cerebral ischemia was induced by clamping bilaterally the common carotid arteries for 60 min, and in group 3 (n = 8) magnesium sulfate was administered at a dose of 100 mg/kg i.v. within 5 min after opening the clamps. In group 1 EEG recordings were obtained immediately and 60 and 120 min after craniectomy. In groups 2 and 3 EEG recordings were obtained immediately after craniectomy but before clamping and 60 min after clamping. One hour after opening the clamps and taking EEG recordings, brain cortices were resected, and the concentrations of lactate and MDA were determined using spectrophotometric/enzymatic and thiobarbituric acid methods, respectively. In all groups, there were significant differences between MDA and lactate levels (p < 0.05). There were no significant differences in lactate levels between groups 2 and 3 (p > 0.05), and also the preischemic EEG grades were the same in all groups. Preischemic and postischemic EEG values were significantly different (p < 0.05), and there were also significant differences between postischemic EEG grades in groups 2 and 3 (p < 0.05). There was a correlation between postischemic EEG grades and MDA and lactate levels. These results demonstrate that cerebral ischemia-reperfusion injury leads to an increase in brain tissue lactate and MDA levels, that magnesium sulfate suppresses the increase of MDA and lactate concentrations, and that magnesium sulfate treatment improves the EEG changes. The EEG grades correlated well with MDA and lactate levels.