Prognostic significance of the chemerin level in coronavirus disease 2019 patients.

Increased serum chemerin levels have been reported in several inflammatory diseases. Few studies have investigated the relationship between chemerin and clinical features of COVID-19. Thus, chemerin may modulate the development and progression of COVID-19. We compared the serum chemerin concentration between patients with and without SARS-CoV-2 infection and its association with the severity and prognosis of COVID-19 pneumonia. This is a prospective, single-center, cross-sectional study. We enrolled COVID-19 patients who presented to our tertiary hospital and healthy controls. The COVID-19 patients were conducted and the dates of symptom onset were recorded. After admission to the hospital and stabilization, blood samples were obtained for routine hemogram, biochemistry, and chemerin. The chemerin level was 37.93 ±â€…17.3 ng/mL in patients followed in the ICU, 29.41 ±â€…12.79 ng/mL in inpatients, 30.48 ±â€…10.86 ng/mL in outpatients, and 25.12 ±â€…9.82 ng/mL in healthy controls. The difference between patients treated in the ICU and healthy controls was significant (P < .001). The high-sensitivity C-reactive protein (hs-CRP), ferritin, procalcitonin (PCT), and D-dimer levels were significantly higher in the intensive care unit (ICU) group (P < .001). Moreover, the chemerin level of patients who died was significantly higher than that of those who survived (P < .001). The chemerin level was increased in COVID-19 patients and also increased with increasing disease severity. The chemerin level was higher in the COVID-19 patients than healthy controls and was significantly higher in patients who died compared to those who did not.

Pentraxin 3 level in acute migraine attack with aura: Patient management in the emergency department.

OBJECTIVES: We investigated the state of inflammation, PTX3 level and other routine inflammatory markers (high sensitivity C-reactive protein [hsCRP], and white blood cells [WBC]), in patients who presented to the emergency department (ED) with migraine. We also investigated the relationship between the clinical presentation, PTX3 level, and other routine inflammatory markers in the emergency management of these patients. METHODS: The study included 44 patients (group 1) who presented to the ED due to a migraine attack with aura and 44 controls (group 2) with similar demographic characteristics. RESULTS: The WBC count was 8.82 ±â€¯2.10 × 109/L in group 1 and 7.85 ±â€¯2.04 × 109/L in group 2. The mean PTX3 level was 11.57 ±â€¯3.99 ng/mL in patients who presented at the ED with a migraine attack, and 4.59 ±â€¯1.28 ng/mL in controls. The differences values of WBC and PTX3 between the two groups were significant (respectively; P = 0.031, P < 0.001). ROC analyses indicated significant results for PTX3 as a marker for acute migraine attack. It had a sensitivity of 93% and specificity of 84% at a cut-off value of 5.80 ng/mL. CONCLUSION: This is the first study to investigate plasma levels of PTX3 in patients with acute migraine. PTX3 as a biomarker may be used as an additional examination to the current subjective criteria to support the diagnosis of patients presenting to the ED with an acute migraine attack.

Plasma oxidative-stress parameters and prolidase activity in patients with various causes of abdominal pain.

PURPOSE: We aimed to investigate the predictive power of plasma prolidase activity and oxidative-stress parameters for distinguishing in patients with various causes of non-traumatic abdominal pain who presented to the emergency department. METHODS: This study enrolled 100 consecutive adult patients and 100 age- and sex-matched healthy controls. The patients were divided into surgically treated patients (STP); medically treated patients (MTP) and nonspecific abdominal pain (NSAP) patients. As predictors of early oxidative changes, the plasma prolidase activity, total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) were assessed using a novel automated method. RESULTS: No significant difference was observed between the patients and the controls with respect to age or sex (p = 0.837 and 0.188, respectively). The plasma TOS, OSI value, and prolidase activity were significantly higher in the patients with abdominal pain than in the controls (p < 0.001, p = 0.001, and p < 0.001, respectively); however, there was no significant difference in the TAS (p = 0.211). The mean plasma TOS, OSI value, and prolidase activity differed significantly among the three groups (p < 0.001, p = 0.001, and p < 0.001, respectively). The STP had the highest TOS and prolidase activity. However, there was no significant difference in the mean plasma TAS in either group of patients (p = 0.419). CONCLUSION: The plasma prolidase activity and TOS level, as biomarkers of oxidative stress, enable discrimination of patients with NSAP from those with surgical abdominal pain that requires emergent surgical treatment.

Acute inferior myocardial infarction associated with the ingestion of captagon pills: A case report.

Phenylethylamine HCL (PEA HCL), more commonly called Captagon on the market, is a synthetic stimulant consisting of a theophylline molecule covalently bonded to an amphetamine molecule. The pathophysiology of myocardial infarction (MI) causing amphetamine-like compounds such as amphetamine and phenylethyline is not clear, this effect may be attributed to the vessel wall narrowing and destabilization of the thrombus. In the literature, some cases of acute myocardial infarction (AMI) associated with amphetamine and ephedrine abuse already been reported. To our knowledge, there is only a cases reporting AMI associated with the use of PEA commonly called Captagon. In this case, we wanted to contribute to the literature by presenting the case of a 23-year-old who developed PEA due to captagon tablet use.

The association between mean platelet volume and inflammation in geriatric patients with emergency hypertension.

OBJECTIVES: We aimed to investigate the role of inflammation parameters and platelet activation in geriatric patients with hypertension. Therefore, we compared the levels of those parameters in patients with hypertensive urgency and emergency. We also investigated the potential relationship between those parameters. METHODS: Ninety-six hypertensive (HT) patients (aged > 60) were included in the study in two groups: HT emergency (N = 48, group 1) and HT urgency (N = 48, group 2). Mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR) and high-sensitive C reactive protein (hs-CRP) were compared between those groups. Optimum cut-off levels of each parameter were determined by the use of Receiver operating characteristic (ROC) curve analysis. Pearson correlation test was used to examine the relationship between variables. RESULTS: The mean MPV and hs-CRP levels were significantly higher in patients with HT emergencies (both P < 0.001). Mean NLR was also significantly different between the two groups (P = 0.011). Pearson correlation analysis revealed a positive but weak correlation between the MPV and NLR (r = 0.245, P = 0.016), the hs-CRP level (r = 0.394, P < 0.001), and the WBC count (r = 0.362, P < 0.001). CONCLUSION: Increased platelet activity and inflammation are associated with the end organ failure. Levels of MPV and other inflammatory parameters may be useful in the management of geriatric patients with HT.

Serum thiol levels and thiol/disulphide homeostasis in gunshot injuries.

BACKGROUND: Gunshot injuries result in serious traumatic tissue damage due to high velocity of the bullet, deep penetration, and ballistic effect. Trauma is known to be related with oxidative stress. Serum thiol levels and disulphide/thiol homeostasis are novel oxidative stress biomarkers. In this study, we aimed to investigate serum thiol levels and disulphide/thiol homeostasis in injury patterns of patients admitted to the emergency department with a gunshot injury. METHOD: A total of 128 participants were included in the study. The participants were divided into two groups: the patient group (Group 1; n = 73) and healthy controls (Group 2; n = 55). Native thiol, total thiol, disulphide levels, disulphide/native thiol, disulphide/total thiol, and neutrophil-to-lymphocyte ratio (NLR) were measured. The Revised Trauma Scale (RTS) and Glasgow Coma Scale (GCS) scores were calculated. RESULTS: Native thiol, total thiol, and disulphide levels were significantly lower in Group 1 (p < 0.001). Disulphide/native thiol ratio, disulphide/total thiol ratio, and NLR were significantly higher in Group 1, compared to Group 2 (p < 0.05). There was a positive correlation between thiol levels and RTS and GCS scores and NLR. Stepwise linear regression analysis showed that native thiol was an independent indicator of RTS and GCS scores. The receiver operating characteristic curve (ROC) analysis revealed that serum native thiol levels of ≤ 342.9 could predict gunshot injury with a sensitivity of 82% and a specificity of 77% (area under the curve = 0.853; 95% confidence interval 0.783-0.924). CONCLUSION: Our study results suggest that thiol-disulphide homeostasis is disrupted in patients sustaining gunshot injuries, and thiol levels decrease in correlation with the severity of trauma with a high sensitivity and specificity. As the level of native thiol is an independent predictor of the severity of trauma, reduced thiol levels may be of prognostic value in the early assessment of patients in the emergency room.

Prognostic importance of paraoxonase, arylesterase and mean platelet volume efficiency in acute ischaemic stroke.

OBJECTIVE: To study the prognostic importance activity of paraoxonase and arylesterase, and the value of mean platelet volume in patients with acute ischaemic stroke. METHODS: This case-control study was conducted at Harran University Hospital, Sanliurfa, Turkey, from January to June 2014, and comprised patients with symptoms of acute ischaemic stroke who presented to the emergency department. Paraoxonase activity, expressed in units per litre, or U/L, of serum, was evaluated in the absence of basal activity, and arylesterase activity was defined as micromoles, of phenol generated/min, and was expressed as U/L of serum. Mean platelet volume was measured as a routine parameter. SPSS 20 was used for data analysis. RESULTS: Of the 94 participants, 48(51%) were patients with acute ischaemic stroke and 46(49%) were control subjects. Moreover, 27(56.3%) patients were females and 21(43.7%) were males. In the control group, 26(56.5%) were females and 20(43.5%) were males. The mean age of patients was 68.39±11.83 years compared to controls' 65±9.95 years. Decreased activity of prognostic importance and arylesterase were significant in patients than in the controls (p= 0.016 and p= 0.001, respectively). The median platelets of patients was significantly lower than that of the controls (p=0.004). However, the median mean platelet volume values were similar in the both groups (p=0.568). Binary logistic regression analyses showed that the paraoxonase and arylesterase were risk markers for the patients. CONCLUSIONS: Decreased paraoxonase and arylesterase activity and decreased platelet counts were observed probably due to increased oxidative stress in acute ischaemic stroke patients.

Evaluation of oxidant, antioxidant, and S100B levels in patients with conversion disorder.

INTRODUCTION: Various psychodynamic, neurobiological, genetic, and sociocultural factors are believed to be involved in the etiology of conversion disorder (CD). Oxidative metabolism has been shown to deteriorate in association with many health problems and psychiatric disorders. We evaluated oxidative metabolism and S100B levels in the context of this multifactorial disease. METHODS: Thirty-seven patients with CD (25 females and 12 males) and 42 healthy volunteers (21 females and 21 males), all matched for age and sex, were included in this study. The total oxidant status, total antioxidant status, oxidative stress index, and S100B levels were compared between the two groups. RESULTS: The total oxidant status, oxidative stress index, and S100B levels were significantly higher in patients with CD than in the control group, whereas the total antioxidant status was significantly lower. CONCLUSION: CD is associated with deterioration of oxidative metabolism and increased neuronal damage.

Hemostatic efficacy of a traditional medicinal plant extract (Ankaferd Blood Stopper) in bleeding control.

The aim of this study is to assess the in vivo hemostatic effect of Ankaferd Blood Stopper (ABS) on rats using a tail bleeding model. Wistar rats were randomized into 4 groups of 9 each: group 1, control, no pretreatment, irrigated with saline; group 2, no pretreatment, irrigated with ABS; group 3, control, heparin pretreatment, irrigated with saline; and group 4, heparin pretreatment, irrigated with ABS. To control bleeding, compressive dressings were placed after instilling 1 mL of either ABS or saline to the bleeding area. Without heparin pretreatment, ABS shortened hemostasis time by 1.57 minutes and reduced the amount of bleeding by 0.85 g. With heparin pretreatment, ABS shortened hemostasis time by 3.29 minutes and reduced the amount of bleeding by 1.32 g. The ABS was more effective than saline irrigation for treating tail tip bleeding in rats, with or without heparin pretreatment, while also using a compressive dressing.

Factors affecting the clinical outcome of low-voltage electrical injuries in children.

PURPOSE: This study evaluated the clinical features of low-voltage (220-240 V) electrical injuries and their mortality in children. METHODS: This cross-sectional study evaluated 36 patients younger than 18 years who suffered a low-voltage electrical shock and presented to the emergency department between January 2009 and October 2011. For statistical analysis, Fisher exact test was used for categorical variables, and the Mann-Whitney U test for continuous variables. RESULTS: In the 34-month period, 36 patients (27 boys [75%] and 9 girls [25%]) were injured. The mean patient age was 9.19 ± 4.10 years (range, 2-17 years). Of the 36 patients, 5 (13.9%) died. Significant relationships were found between mortality and age (P =0.004), unconscious at the time of admission to the emergency department (P =0.013), the presence of clinical shock (P = 0.005), sinus tachycardia (P = 0.003), and high lactate dehydrogenase levels (P = 0.001). There were also significant relationships between mortality and hospital stay (P = 0.005), intensive care unit stay (P = 0.002), and detection of bacterial growth in blood culture (P = 0.024). By contrast, sex, the presence of an electrical exit wound, degree of the burn, surface area of the burn (%), accompanying flash burn, time elapsed transferring the patient from the accident scene to hospital, incomplete bundle-branch block or ST-wave changes on the electrocardiogram, increased troponin T, and creatine phosphokinase myocardial bundle did not affect mortality. CONCLUSIONS: Complications such as sepsis and electrolyte imbalance lead to mortality rather than low-voltage electrical injury itself.

Abdominal injuries related to bicycle accidents in children.

PURPOSE: Bicycling is a well-liked sporting activity in which many children participate, and bicycle accidents are one of the most common causes of abdominal injuries in children. We evaluated the characteristics and outcomes of abdominal injuries due to bicycle accidents in children. PATIENTS AND METHODS: This study was carried out retrospectively on children at the Department of Pediatric Surgery who were hospitalized for abdominal injury due to a bicycle accident, from 2008 to 2012. Abdominal injury-related bicycle accidents were evaluated with respect to patient characteristics, clinical presentation, management strategy, and outcome. RESULTS: Fifty-nine patients were hospitalized for abdominal injuries related to a bicycle accident. The mean age of the patients was 11.48 ± 3.6 years. Most patients had an imprint of the handlebar edge on their abdomen. The most common abdominal organ injury due to a bicycle accident was laceration of the liver. Most patients were treated conservatively. Surgery was performed in 14 (24.1 %) patients. Hospital stay was 1-68 (mean 4.34 ± 11.6) days. CONCLUSIONS: Abdominal injuries following a bicycle accident are frequent, serious, and preventable. Most patients were treated conservatively. Bicycle injuries can be prevented.

The characteristics and outcomes of foreign body ingestion and aspiration in children due to lodged foreign body in the aerodigestive tract.

OBJECTIVE: Injury due to foreign body (FB) aspiration and/or ingestion is a common and serious pediatric emergency. Foreign body injury (FBI) most commonly occurs in children younger than 6 years, and the incidence of FBI has increased in recent years. The aim of the present study was to evaluate and compare the characteristics of FBI due to ingestion and aspiration. METHODS: Data from patients who were hospitalized for FB ingestion and/or aspiration and underwent rigid bronchoscopy and esophagoscopy from 2008 to 2011 were retrospectively evaluated. Foreign body in the upper aerodigestive tract was evaluated with respect to the characteristics of patients, clinical presentation, management strategy, the outcome, and features of FB. RESULTS: A total of 192 patients admitted for FB ingestion or aspiration in the pediatric surgery department were evaluated. The mean age was 40.97 (SD, 35.73) months. The majority of patients were younger than 4 years. Foreign bodies were mainly located in the upper esophagus for ingested FBs (60.8%), whereas for aspiration 43% of FBs were in the main right bronchus. A total of 4 patients died. The hospitalization period of patients admitted for FB aspiration was longer than that of patients with FB ingestion. Surgery was performed in 4 patients. The most commonly ingested FBs were coins, whereas seeds were the most commonly aspirated. CONCLUSION: Prevention is the key to dealing with FBIs. Because the frequency of foreign bodies is higher in underdeveloped countries, education of parents regarding the dangers and prevention of aspiration and ingestion is important.

The role of oxidative stress and inflammation in the early evaluation of acute non-ST-elevation myocardial infarction: an observational study.

OBJECTIVE: We aimed to assess the role of oxidative stress (OS) and inflammation in the early evaluation of initial acute non -ST -elevation myocardial infarction (NSTEMI) compared with unstable angina pectoris (USAP). METHODS: Forty-seven (54%) patients with NSTEMI and 40 (46%) with (USAP) were included in this cross-section observational study. We assessed the oxidative stress and inflammation parameters. Statistical analysis was performed using Fisher's exact test, Chi-square test, Mann-Whitney U test, Student's t-test, and Pearson correlation analysis for assess the correlations between variables. RESULTS: Plasma total oxidative stress (TOS) and OS index levels were significantly higher (p<0.001 for both comparisons), in patients with NSTEMI. In addition, white blood cell count (WBC) and high-sensitive C-reactive protein (hs-CRP) levels were significantly higher in patients with NSTEMI (respectively; p<0.001, p=0.02). Age, WBC and low- density lipoprotein cholesterol showed positive correlations with TOS level (Pearson correlation coefficient: r=0.290, p=0.006; r=0.431, p<0.001; r=0.219, p=0.042 respectively), and also age showed positive correlation with OS index (Pearson correlation coefficient; r=0.246; p=0.021). However, the values of the troponin I and creatine kinase-MB fraction did not differ between the two groups (p>0.05 for all). CONCLUSION: TOS, OSI, WBC and CRP levels are significantly higher in NSTEMI subject. These data suggest that inflammatory processes and oxidative stress together play a role in the pathogenesis of acute NSTEMI.

Acute myocardial infarction and coronary vasospasm associated with the ingestion of cayenne pepper pills in a 25-year-old male.

Capsaicin, one of the major active components of cayenne pepper pills, is an over-the-counter substance with sympathomimetic activity used commonly by young individuals for weight loss. Here we report the case of a previously healthy young male who developed severe chest pain after using cayenne pepper pills for slimming and sustained an extensive inferior myocardial infarction. Electrocardiography combined with a bedside transthoracic echocardiogram confirmed the diagnosis of acute myocardial infarction. The patient denied using illicit substances, and he had no risk factors for coronary artery disease. His medication history revealed that he had recently started taking cayenne pepper pills for slimming. A subsequent coronary angiogram revealed patent coronary arteries, suggesting that the mechanism was vasospasm. We postulate that the patient developed acute coronary vasospasm and a myocardial infarction in the presence of this known sympathomimetic agent. This case highlights the potential danger of capsaicin, even when used by otherwise healthy individuals.

Isolated transverse sacrum fracture: a case report.

Sacral fracture commonly results from high-energy trauma. Most insufficiency fractures of the sacrum are seen in women after the age of 70. Fractures of the sacrum are rare and generally combined with a concomitant pelvic fracture. Transverse sacral fractures are even less frequent which constitute only 3-5% of all sacral fractures. This type of fractures provide a diagnostic challenge. We report a unique case of isolated transverse fracture of sacrum in a young man sustained low-energy trauma. The patient presented to our emergency department after several hours of injury, and diagnosed by clinical features and roentgenogram findings.

Clinical importance of ultrasonographic pelvic fluid in pediatric patients with blunt abdominal trauma.

BACKGROUND: The aim of this study was to evaluate the significance of the ultrasonographic finding of pelvic fluid as a predictor of organ injury in pediatric patients with blunt abdominal trauma. METHODS: We reviewed retrospectively the medical records of 85 consecutive pediatric patients who admitted to the Emergency Department of Dicle University from January 2008 to December 2008 with blunt abdominal trauma. Age, gender, mechanism of injury, isolated injuries, surgical interventions, hospitalization, and mortality were evaluated according to the location of fluid. RESULTS: A total of 85 pediatric patients (63 male, 22 female; mean age: 7.88+/-3.403 years) with blunt abdominal trauma were included in the present study. Forty percent of the patients had intraperitoneal fluid, while 60% had pelvic fluid. The majority (35.3%) of patients applied due to falling from height. The difference between the mechanism of the injuries and location and presence of the fluid was not statistically significant (p>0.05). Twenty-nine patients had solid organ injuries. Splenic injuries showed the highest association with intraperitoneal fluid (p<0.001). Of the patients, 15.3% underwent exploratory laparotomy and 44.7% required blood transfusion. The presence of intraperitoneal fluid statistically increased the probability of the exploratory laparotomy and necessity of blood transfusion (p<0.001). Mortality rate was 4.8%. CONCLUSION: In ultrasound examination, it was determined that the probability of solid organ injury was lower in the presence of pelvic fluid, while it was higher in the presence of intraperitoneal fluid outside the pelvis.