Evaluation of emergency department admissions of mass casualty patients using the revised trauma score, injury severity score, and trauma and injury severity score.

BACKGROUND: There is a need for studies evaluating prognostic scoring systems in mass trauma patients in conflict regions to predict patient prognosis for emergency surgical prioritization. In this study, we aimed to evaluate scoring systems such as the Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS) in trauma patients admitted due to mass trauma in Northern Syria. METHODS: This study was a retrospective evaluation of patients admitted due to mass trauma to the emergency departments of hospitals in Northern Syria. The diagnostic efficiency of RTS, ISS, and TRISS scoring systems was evaluated in these admissions in the first half of 2021. RESULTS: The most common causes of mass trauma were bomb blast (67.3%), gunshot (28.8%), and 14 (3.9%) patients admitted with other causes. When the odds ratio (OR) was analyzed, a one-unit increase in the RTS score increased the odds of survival by a factor of 6.133, and a one-unit increase in the TRISS score increased the odds of survival by a factor of 1.057. Differently, it was found that each 1-unit increase in ISS decreased the patient's probability of survival by 0.856 units. When RTS, TRISS, and ISS scores were analyzed, the area under the ROC curve was statistically significant for all of them (p<0.001) and all of them had a diagnostic value for mortality with sensitivities of 99.0%, 94.8%, and 91.9%; specificities of 87.8%, 90.5%, and 88.6; AUC of 0.958, 0.975, and 0.958, respectively. CONCLUSION: The use of trauma scoring systems, especially TRISS, may be useful for prioritizing patients in mass casualty settings in the presence of overcapacity.

Investigation of the relationship between cultural sensitivity and effectiveness levels among nursing students.

AIM: The aim of this study is to investigate the relationship between cultural sensitivity and effectiveness levels among nursing students. BACKGROUND: The world is changing and globalizing, and societies are becoming increasingly multicultural. Therefore, nurses, who play an important role in health service delivery, are expected to be competent in interacting with patients from different cultures and to develop cultural sensitivity during their education. DESIGN: The design of this study is a prospective descriptive study. METHODS: The research was conducted with 284 nursing students in the faculty of nursing at a university in Ankara. The data collection process of this study was conducted at the end of the spring semester of the 2019-2020 academic year between 20 and 30 June 2020. The Sociodemographic Characteristics Form, Intercultural Sensitivity Scale, and Intercultural Effectiveness Scale were used to collect data. Descriptive statistics, parametric and nonparametric tests were used for data analysis. RESULTS: The mean age of the students was 20.80 ± 1.64, and 82% of the students were female. The mean scores on the Intercultural Sensitivity and Intercultural Effectiveness Scales were 92.56 ± 11.98 and 53.87 ± 6.28, respectively. A positive, moderate, and statistically significant correlation was found between the scores on the two scales. In the study, it was determined that females have higher cultural sensitivity and cultural effectiveness level than males, and students who could not understand and speak English have lower cultural sensitivity and cultural effectiveness level than students who could understand and speak English. CONCLUSION: In this study, it was evaluated that the nursing students had high cultural sensitivity and moderate cultural effectiveness levels, and cultural sensitivity levels were found to increase in line with cultural effectiveness levels. It is recommended to review the educational curricula to improve cultural communication competence and organize programs to improve English speaking and conduct more studies examining the cultural effectiveness of students.

The Effect of Anesthesia Type Applied in Transcatheter Aortic Valve Implantation.

OBJECTIVE: Different results have been obtained in studies on the effect of anesthesia type applied during transcatheter aortic valve implantation on in-hospital outcomes. In this study, we aimed to investigate the association of the type of anesthesia with the lenght of stay in the intensive care unit and the need for inotropes in patients undergoing transcatheter aortic valve implantation. METHODS: A total of 140 patients who underwent transcatheter aortic valve implantation between January 2016 and January 2022 were retrospectively analyzed. The patients were divided into 2 groups as deep sedation and general anesthesia according to the type of anesthesia. RESULTS: The mean age of all patients was 78.5 ± 8.6 years, and 69 of the patients (49.3%) were female. Length of stay in intensive care unit, midazolam dosage, use of inotropic agents, and procedural hypotension were significantly lower in the deep sedation group than in the general anesthesia group [(1[1-2] vs. 1[1-2.5] days, P = 0.03), (2.1 ± 0.4 mg/kg vs. 2.3 ± 05, P = 0.02), (39 (37.9%) vs. 22 (59.5%), P = 0.02), (41 (39.8%) vs. 25 (67.6%), P = 0.004)]. General anesthesia was associated with increased use of inotropic agents during transcatheter aortic valve implantation compared to deep sedation (odds ratio = 2.93 95% CI = 1.18-7.30, P = 0.02). CONCLUSION: The use of inotropes is less in transcatheter aortic valve implantation procedures performed under deep sedation and length of stay in intensive care unit is shorter.

Caring for Patients With Electrical Burns Using the Holistic Neuman Systems Model: A Case Study.

Patients with burns should be provided with holistic nursing care that considers all systems of the body. The Neuman Systems Model (NSM) is especially suited to holistic care as it proposes an open system approach and addresses five major interacting variables. This study aimed to investigate the applicability of the NSM when caring for a patient with electrical burns. In this case study, we planned and applied nursing care for a 20-year-old man with electrical burns based on the NSM. The study was conducted between November 25, 2018, and January 10, 2019. We used the six-item Neuman Diagnostic Tool (NDT) developed by Neuman in our interviews with the patient. We found that the electrical burns had caused multiple physiological, psychological, and sociocultural problems for our patient, most of which were physical problems, including the burn injury and subsequent limb amputation. The NDT guided our data collection and aided in our ability to determine stressors and formulate appropriate nursing diagnoses. The NSM strengthened the patient's flexible line of defense for coping individually and facilitated the identification of deficiencies in the normal and resistance lines of defense. The NSM provides a theoretical framework for nurses caring for patients with burns where entire systems are affected.

The Role of Prophylactic Ipsilateral Distal Femoral Artery Cannulation in Preventing Periprocedural Peripheral Complications During Transcatheter Aortic Valve Implantation.

OBJECTIVE: Access site-related vascular complications are common complications of trans- catheter aortic valve replacement. In this study, we aimed to investigate the efficacy and safety of prophylactic cannulation of the ipsilateral distal femoral artery in the management of access site-related vascular complications. METHODS: One hundred sixty-four patients, who were evaluated by the Heart Team of our institution and found eligible for transcatheter aortic valve replacement procedure between January 2016 and August 2019, were included in this retrospective study. Patients were divided into two groups according to the management of peripheral complications. The antegrade crossover was used as bailout treatment in the first 70 patients. Prophylactic cannulation of the ipsilateral distal femoral artery was performed in the last 94 patients. These 2 groups were compared. RESULTS: Peripheral complications developed in 15 of the first 70 patients included in the study. The percutaneous intervention was unsuccessful in 4 of the patients who underwent bailout antegrade crossover. Peripheral complications developed in 14 of the last 94 patients in whom prophylactic cannulation of the ipsilateral distal femoral artery was performed, and all these patients were managed successfully with percutaneous intervention. CONCLUSION: Prophylactic cannulation of the ipsilateral distal femoral artery is a simple, effec- tive, and safe method in the management of access site-related vascular complications.

Investigation of the relationship between social appearance anxiety and perceived social support in patients with burns.

INTRODUCTION: Since burns affect body image, they cause appearance anxiety. Interventions designed to reduce appearance anxiety that can cause psychological problems such as depression are important. This study aimed to determine the social appearance anxiety of individuals following burns and the factors affecting it and to examine the relationship between social appearance anxiety and perceived social support. METHODS: This descriptive study was conducted between November 2018 and November 2019 with 106 adult patients with burns. Data were collected using a Personal Information Form, the Social Appearance Anxiety Scale, and the Multidimensional Scale of Perceived Social Support. Shapiro-Wilk test, Independent Two Samples T-Test, One Way Analysis of Variance, Duncan's test, Pearson's correlation analysis, multiple linear regression analysis, the Q-Q plot, and the Durbin-Watson statistics were used in data analysis. RESULTS: The social appearance anxiety scores were moderate (39.38 ± 17.71). Being single; having a high level of education; burns on the face, head, or neck; burn-related amputation; and passing the one-week after injury period were found to significantly increase social appearance anxiety (p < 0.05). Although the perceived social support scores of the individuals with burns were high (68.34 ± 18.08), they were found to have no correlation with social appearance anxiety (p > 0.05). CONCLUSIONS: The results of this study show that social support does not affect social appearance anxiety. In this respect, we recommend that interventions such as reconstruction and professional psychological support initiatives be prioritized for individuals with burn trauma who are evaluated to have high social appearance anxiety by the appearance anxiety scales.

In vitro tooth-shaped scaffold construction by mimicking late bell stage.

Neogenesis of osseous and ligamentous interfacial structures is essential for the regeneration of large oral or craniofacial defects. However, current treatment strategies are inadequate in renewing supporting tissues of teeth after trauma, chronic infections or surgical resection. Combined use of 3D scaffolds with stem cells became a promising treatment option for these injuries. Matching different scaffolding materials with different tissues can induce the correct cytokines and the differentiation of cells corresponding to that particular tissue. In this study, a hydroxyapatite (HA) based scaffold was used together with human adipose stem cells (hASCs), human bone marrow stem cells (hBMSCs) and gingival epithelial cells to mimic human tooth dentin-pulp-enamel tissue complexes and model an immature tooth at the late bell stage in vitro. Characteristics of the scaffold were determined via SEM, FTIR, pore size and density measurements. Changes in gene expression, protein secretions and tissue histology resulting from cross-interactions of different dental tissues grown in the system were shown. Classical tooth tissues such as cementum, pulp and bone like tissues were formed within the scaffold. Our study suggests that a HA-based scaffold with different cell lineages can successfully mimic early stages of tooth development and can be a valuable tool for hard tissue engineering.

Genomic, transcriptomic and physiological analyses of silver-resistant Saccharomyces cerevisiae obtained by evolutionary engineering.

Silver is a non-essential metal used in medical applications as an antimicrobial agent, but it is also toxic for biological systems. To investigate the molecular basis of silver resistance in yeast, we employed evolutionary engineering using successive batch cultures at gradually increased silver stress levels up to 0.25-mM AgNO3 in 29 populations and obtained highly silver-resistant and genetically stable Saccharomyces cerevisiae strains. Cross-resistance analysis results indicated that the silver-resistant mutants also gained resistance against copper and oxidative stress. Growth physiological analysis results revealed that the highly silver-resistant evolved strain 2E was not significantly inhibited by silver stress, unlike the reference strain. Genomic and transcriptomic analysis results revealed that there were mutations and/or significant changes in the expression levels of the genes involved in cell wall integrity, cellular respiration, oxidative metabolism, copper homeostasis, endocytosis and vesicular transport activities. Particularly the missense mutation in the RLM1 gene encoding a transcription factor involved in the maintenance of cell wall integrity and with 707 potential gene targets might have a key role in the high silver resistance of 2E, along with its improved cell wall integrity, as confirmed by the lyticase sensitivity assay results. In conclusion, the comparative physiological, transcriptomic and genomic analysis results of the silver-resistant S. cerevisiae strain revealed potential key factors that will help understand the complex molecular mechanisms of silver resistance in yeast.

The level of two trace elements in carious, non-carious, primary, and permanent teeth.

PURPOSE: The boron and fluoride mainly accumulate in the bones and teeth of the human body. The purpose of this study is to determine boron or fluoride levels in the whole tooth, to evaluate the correlation between their levels and to compare these levels in primary/permanent, carious, and non-carious groups. MATERIALS AND METHODS: The boron and fluoride levels of thirty-six teeth, separated such as primary carious (n=9) and non-carious (n=9), permanent carious (n=9) and non-carious (n=9), were determined by ICP-MS and ion-selective electrode, respectively. RESULTS: While boron levels were between 0.001 and 5.88 ppm, the fluoride levels were between 21.24 and 449.22 ppm. The boron level of non-carious teeth was higher than those of carious teeth in primary and permanent tooth groups. However, this difference was not statistically significant (p>0.05). The fluoride level of non-carious teeth was higher than those of carious teeth in primary (p=0.062) and permanent teeth groups (p=0.046). Negative correlation, found between boron and fluoride in all groups, was significant only in non-carious teeth group (r=-0.488, p=0.040). CONCLUSION: The results of our study proved the importance of fluoride as a protective factor for dental caries once more. The boron levels in non-carious teeth were also higher than carious teeth. However, it was not significant. Moreover, there was negative correlation between teeth boron and fluoride levels. Therefore, it is necessary to conduct more detailed studies on the tooth boron level and its relation with caries formation and with fluoride levels.

Boron-rich diet may regulate blood lipid profile and prevent obesity: A non-drug and self-controlled clinical trial.

BACKGROUND: Boron is an element commonly found in nature. The main boron source for organisms is through food and drinking water. In recent years, it is suggested that the "boron-rich diet" can affect human health positively. However, more detailed studies are needed. OBJECTIVE: The aim of this study was to examine the effect of increased dietary boron intake on some biochemical parameters in humans. MATERIAL AND METHODS: Thirteen healthy women consumed diets containing 10 mg more boron than their routine diet for one month. This boron intake was provided with the increase of boron-rich foods such as dried fruits, avocado, and nuts in the diet. Some biochemical and hematologic parameters were determined in blood, urine and saliva samples taken before and after a boron-rich diet. RESULTS: Serum, salivary, and urine boron concentrations increased 1.3, 1.7, 6.0 fold, respectively. The most significant clinically change was found in the lipid profile. Serum total, LDL, VLDL cholesterol, and triglyceride levels decreased significantly. Body weight, body fat weight, and Body Mass Index also decreased. Significant changes in serum TSH and salivary buffering capacity were also found. CONCLUSION: Increasing the intake of boron through dietary means might contribute to beneficial effects on lipid metabolism, obesity, and thyroid metabolism; salivary boron may reflect serum boron; and boron may be used as a cariostatic agent in dentistry. An increased intake of other dietary factors such as fiber, potassium, iron, vitamin A, and vitamin E in the boron-rich foods might have been responsible of the effects described. To our knowledge, this study is the first clinical study in which dietary boron intake is increased via foods.

Boron Content of Some Foods Consumed in Istanbul, Turkey.

The boron content was determined in 42 different foods consumed in Istanbul, Turkey. Eleven species of fruit, ten species of vegetable, eight species of food of animal origin, four species of grain, two species of nuts, two species of legume, and five other kinds of foods were included to this study. They were analyzed by two methods: Inductively coupled plasma mass spectrometry (ICP-MS) technique and carminic acid assay, and the results of two methods were also compared. Boron concentration in foods ranged between 0.06-37.2 mg/kg. Nuts had the highest boron content while foods of animal origin had the lowest. A strong correlation was found between the results of the carminic acid assay and the ICP-MS technique (p = 0.0001, Pearson correlation coefficient: r = 0.956). Bland Altman analysis also supported this correlation. ICP-MS is one of the most common, reliable, and powerful method for boron determination. The results of our study show that spectrophotometric carminic acid assay can provide similar results to ICP-MS, and the boron content in food materials can be also determined by spectrophotometric method.

Is Preoperative Clopidogrel Resistance a Predictor of Bleeding and Risks in Patients Undergoing Emergency CABG Surgery?

OBJECTIVE: The aims of this study were to determine whether the detection of preoperative clopidogrel resistance in patients undergoing cardiac surgery while using clopidogrel could play a guiding role in the prediction of postoperative excessive bleeding, transfusion requirements, and risks and to provide clinically significant data. METHODS: Two hundred and twenty-two patients [median age: 59.4 (38-83) years; 38 females] undergoing emergency and elective coronary artery bypass graft (CABG) surgeries in our clinic were evaluated prospectively. Patients with multiple systemic diseases, other than diabetes mellitus (DM) and hypertension (HT), were excluded. Patients receiving clopidogrel were also evaluated for clopidogrel resistance and grouped according to the results of this test. Assessments of platelet functions were performed by multiplate impedance aggregometry method and adenosine diphosphate test. RESULTS: The use of postoperative fresh blood replacement and platelet transfusion was higher in patients receiving clopidogrel than in those not receiving it (P=0.001, P=0.018). DM, HT, myocardial infarction, and the number of presentation to the emergency room were significantly higher in patients receiving clopidogrel than in those not receiving it (P<0.05). No significant difference was determined between patients with and without clopidogrel resistance regarding the amount of bleeding during and after surgery, erythrocyte suspension and fresh-frozen plasma transfusion rates, preoperative troponin values, ejection fraction values, and length of hospital stays (P>0.05). CONCLUSION: We think that resistance studies in patients receiving clopidogrel before cardiac surgery are not efficient to predict bleeding and bleeding-related complications in patients undergoing emergency and elective CABG surgeries.

Is preoperative clopidogrel resistance a predictor of bleeding and risks in patients undergoing emergency cabg surgery?

Abstract Objective: The aims of this study were to determine whether the detection of preoperative clopidogrel resistance in patients undergoing cardiac surgery while using clopidogrel could play a guiding role in the prediction of postoperative excessive bleeding, transfusion requirements, and risks and to provide clinically significant data. Methods: Two hundred and twenty-two patients [median age: 59.4 (38-83) years; 38 females] undergoing emergency and elective coronary artery bypass graft (CABG) surgeries in our clinic were evaluated prospectively. Patients with multiple systemic diseases, other than diabetes mellitus (DM) and hypertension (HT), were excluded. Patients receiving clopidogrel were also evaluated for clopidogrel resistance and grouped according to the results of this test. Assessments of platelet functions were performed by multiplate impedance aggregometry method and adenosine diphosphate test. Results: The use of postoperative fresh blood replacement and platelet transfusion was higher in patients receiving clopidogrel than in those not receiving it (P=0.001, P=0.018). DM, HT, myocardial infarction, and the number of presentation to the emergency room were significantly higher in patients receiving clopidogrel than in those not receiving it (P<0.05). No significant difference was determined between patients with and without clopidogrel resistance regarding the amount of bleeding during and after surgery, erythrocyte suspension and fresh-frozen plasma transfusion rates, preoperative troponin values, ejection fraction values, and length of hospital stays (P>0.05). Conclusion: We think that resistance studies in patients receiving clopidogrel before cardiac surgery are not efficient to predict bleeding and bleeding-related complications in patients undergoing emergency and elective CABG surgeries.

Effect of acupressure application to the P6 acupoint before laparoscopic cholecystectomy on postoperative nausea-vomiting: A randomized controlled clinical study.

BACKGROUND: Nausea and vomiting are common postoperative complications that occur within the first 24 h in adults. Clinical practice guidelines and a Cochrane review recommend stimulating the P6 acupoint to prevent or reduce postoperative nausea and vomiting. However, there are currently no standards and optimal timing is not known. OBJECTIVES: The purpose of this study was to evaluate the effect of acupressure application on the P6 acupoint, using acupressure wristbands, in the prevention of postoperative nausea and vomiting and the antiemetic drug requirement in patients who had high postoperative nausea and vomiting risk related to laparoscopic cholecystectomy. DESIGN: This was a longitudinal, randomized controlled clinical study. SETTINGS: The study was conducted in the general surgery department of a training and research hospital (105 beds), from March 2015 to March 2016. PARTICIPANTS: A total of 111 female patients who underwent laparoscopic surgery were divided into three groups of 37, using a block randomization method. METHODS: Training on acupressure wristband use was provided to the intervention group and an acupressure wristband with a plastic cap was placed at the P6 acupoint. A wristband with the same appearance as the acupressure wristband, but without a cap, was used in the placebo group. No intervention was used in the control group. The wristband was placed approximately one hour before the surgery and removed six hours after the surgery in both the intervention and placebo groups. The data were collected at the 2nd, 6th, and 24th postoperative hours. RESULTS: The application of the acupressure wristband to the P6 acupoint in patients who underwent laparoscopic cholecystectomy was found to be more effective in decreasing the severity of nausea at the 2nd postoperative hour and the nausea incidence at 2-6 h, postoperatively, when compared to the placebo group (p < 0.05). However, there was no statistically significant difference between the intervention group and the control group. Therefore, acupressure application to the P6 acupoint was not found to be clinically effective in decreasing postoperative vomiting, antiemetic drug requirement, and in decreasing pain, anxiety, or the need for analgesic drugs (p > 0.05). CONCLUSIONS: We did not find the stimulation of the P6 acupoint with an acupressure wristband to be clinically effective in reducing postoperative nausea and vomiting or antiemetic drug requirement in patients who underwent laparoscopic cholecystectomy.

Open Heart Surgery at Patient's Own Temperature Without Active Cooling.

BACKGROUND: Hypothermia is a method of myocardial protection in cardiac surgery. This protection occurs by decreasing the metabolic demands, however, it creates susceptibility to various problems. In this study, we investigated patients operated on under normothermia (at the patient's own temperature) and hypothermia for postoperative differences. METHODS: The study was conducted between June 2015 and September 2016 with 167 patients. The patients were divided into two groups in accordance with our routine clinical practice: the normothermic group (native temperature goup; intraoperative body temperature ≥ 34°C), and the hypothermic group intraoperative body temperature  < 34°C - ≥ 28°C). Preoperative and postoperative data of patients were recorded and the two groups were compared. RESULTS: There was no significant difference between the two groups in terms of cross clamp time, cardiopulmonary bypass time, awakening and extubation times, intensive care unit and hospital stay, drainage, mean serum lactate levels, arrhytmia, all causes infection, renal insufficiency, neurologic complications, myocardial infarction, or mortality (P > .05). Inotrope and transfusion requirements were found to be statistically significantly lower in the normothermic group than the hypothermic group (P < .05). CONCLUSION: Although hypothermia is commonly used in cardiac surgery, it has harmful effects. We believe that cardiac surgery can safely be performed at a patient's own temperature without active cooling to avoid these dangers.

Study of the boron levels in serum after implantation of different ratios nano-hexagonal boron nitride-hydroxy apatite in rat femurs.

Boron and its derivatives are effective in bone recovery and osteointegration. However, increasing the boron levels in body liquids may cause toxicity. The aim of our study is to investigate serum boron levels using ICP-MS after implantation of different ratios of nano-hBN-HA composites in rat femurs. All rats were (n=126) divided into five experimental groups (n=24) and one healthy group (6 rats); healthy (Group1), femoral defect + %100 HA (Group2), femoral defect + %2.5 hBN + %97.5 HA (Group3), femoral defect + %5 hBN + %95 HA (Group4), femoral defect + %10 hBN + %90 HA (Group5), femoral defect + %100 hBN (Group6). The femoral defect was created in the distal femur (3mm drill-bit). Each implant group was divided into four different groups (n=24) also 6 rats sacrificed for each groups in one week intervals during four weeks. In our results; at 1, 2, 3, and 4 weeks after implantation near bone tissue, serum levels of boron were evaluated using ICP-MS. We demonstrated that neither short-term nor long-term implantation of hBN-HA composite resulted in statistically increased serum boron levels in experimental groups compared to healthy group. In conclusion, this study investigated the implant material produced form hBN-HA for the first time. Our data suggest that hBN is a new promising target for biomaterial and implant bioengineers.