Prevalence and associated risk factors of post-traumatic stress disorder among survivors of the 2023 Turkey earthquake.

BACKGROUND: Earthquakes can cause psychological trauma among survivors as well as physical trauma. This study aims to determine the prevalence of post-traumatic stress disorder (PTSD) and identify associated risk factors among earthquake survivors after the 2023 Turkey earthquake. METHODS: This prospective cross-sectional study was conducted in the emergency department of a tertiary university hospital between May 6, 2023, and May 16, 2023. An online questionnaire was sent to the participants. The questionnaire form consisted of three parts. In the first part, the sociodemographic characteristics of the participants were included. In the second part, the participants were asked about their experiences with the earthquake. In the third part, the post-traumatic stress disorder checklist for the Diagnostic and Statistical Manual of Mental Disorders, which screens PTSD among the participants, was included. Participants who did not complete all the questions and had severe communication disorders were excluded. RESULTS: The prevalence of probable PTSD among the participants was 51.4% (n = 197). Age (OR: 0.96 95% CI: 0.93-99), female gender (OR: 4.54 95% CI: 2.39-8.61), being the head of the family (OR: 2.00 95% CI: 1.04-3.82), bereavement (OR: 1.71 95% CI: 1.03-2.82), lost loved ones (OR: 3.15 95% CI: 1.67-5.92), low social support (OR: 1.80 95% CI: 1.12-2.90) and receiving emergency care at the field (OR: 6.67 95% CI: 1.03-43.2) were the associated risk factors of PTSD among earthquake survivors. CONCLUSIONS: The prevalence of PTSD among survivors three months after the 2023 Turkey earthquake is over half of the survivors. Younger age, female gender, being the head of the family, bereavement, lost loved ones, low social support, and receiving emergency care in the field were the associated risk factors of PTSD among earthquake survivors. Considering survivors may visit EDs until other outpatient clinics are re-established and the high rate of PTSD, rapid psychological evaluations can be performed in emergency departments. Emergency physicians should be aware of possible risk factors and high rate of PTSD.

The diagnostic value of neurogranin in patients with carbon monoxide poisoning: Can it show early neurological damage?

BACKGROUND AND AIM: Carbon monoxide poisoning is a toxicological emergency that causes neurological complications. High serum neurogranin can be detected in acute or chronic conditions where brain tissue is damaged. This study aimed to investigate the diagnostic value of serum neurogranin level and its role in demonstrating neurological damage in patients admitted to the emergency department with carbon monoxide poisoning. MATERIALS AND METHODS: The study was conducted prospectively on patients with carbon monoxide poisoning (patient group) and healthy volunteers (control group). Demographic characteristics and serum neurogranin level of all participants and symptoms at admission, neurological examination findings, laboratory results, and Diffusion-Weighted Magnetic Resonance Imaging results of the patient group were recorded. We used an independent sample t-test to compare neurogranin levels and bivariate correlation analysis to compare the relationship between serum neurogranin levels and data belonging to the patient group. RESULTS: Sixty eight participants (patient group, n = 36; control group, n = 32) were included in the study. Serum neurogranin level was significantly higher in patients with carbon monoxide poisoning (0.31 ± 0.16 ng/ml) compared to control group (0.22 ± 0.10 ng/ml) (p = 0.015). The mean Glasgow Coma Scale of the patients with carbon monoxide poisoning was 14.59 ± 0.23, and of Diffusion Weighted Magnetic Resonance Imaging results were completely normal in 94.4% (n = 34). There was no correlation between serum neurogranin level and Diffusion Weighted Magnetic Resonance Imaging results (r = -0.011; p = 0.953). CONCLUSION: Serum neurogranin level may be a new diagnostic biomarker in patients admitted to the emergency department with carbon monoxide poisoning. The high serum neurogranin levels detected in patients with normal diffusion-weighted imaging after carbon monoxide poisoning suggest that there is neurological damage in these patients, even if imaging methods cannot detect it.

Endothelial and Autonomic Functions in Patients with Migraine.

OBJECTIVE: It has been shown that patients with migraine have endothelial dysfunction. Migraine patients with aura, especially, have more clinical manifestations of autonomic nervous system dysfunction. We aimed to evaluate the endothelial and autonomic functions in migraine patients during both migraine headache attack and headache-free periods. DESIGN: This was a cross-sectional, randomized study. SUBJECTS AND METHODS: A total of 130 participants (67 male and 63 female patients, minimum age = 19 years, maximum age = 71 years, mean age = 38.8 ± 12.2 years) were enrolled into the study. For the statistical evaluation of data, we classified the participants of the study as follows: group 1: headache (+) aura (+); group 2: headache (+) aura (-); group 3: headache (-) aura (+); group 4: headache (-) aura (-). Noninvasive evaluation of endothelial function was performed by flow-mediated dilation (FMD) and pulse wave analysis methods. Heart rate variability measurements were used for noninvasive evaluation of autonomic functions. RESULTS: Group 1 had a higher FMD ratio than the control group, group 3, or group 4 (P < 0.001, P < 0.001, and P = 0.003, respectively). Group 4 had lower FMD ratio levels than the other migraine groups and or the control group (P < 0.001). Group 3 had the highest high-frequency (HF) power levels among all migraine groups (P < 0.001). Group 2 had higher low-frequency/HF ratio values than other migraineurs (P < 0.001). CONCLUSIONS: We concluded that endothelial dysfunction and headache are closely related. Additionally, higher parasympathetic tonus might be associated with the presence of aura.

Osborn wave in hypothermia and relation to mortality.

BACKGROUND & AIM: The aim of this study was to compare hypothermia patients with and without an Osborn wave (OW) in terms of physical examination findings, laboratory results, and clinical survival. METHODS: The study was carried out retrospectively on hypothermic patients. The hypothermic patients were divided into two groups. Group 1 comprised patients with OW on electrocardiogram (ECG), and Group 2 comprised patients without OW on ECG. The Mann-Whitney U test was used to compare the two groups, and the relationships between the variables and the presence of OW and mortality were analyzed with ANOVA. A value of p < 0.05 was considered statistically significant. RESULTS: OW was detected on ECG of 41.9% of the patients (Group 1). The mean body temperature was 30.8 ±â€¯4.1 °C in Group 1 and 33.3 ±â€¯1.6 °C in Group 2 (p = 0.106). The mean creatinine level was 1.01 ±â€¯0.6 mg/dl in Group 1 and 0.73 ±â€¯0.5 mg/dl in Group 2 (p = 0.046). The mean bicarbonate level was 15.9 ±â€¯3.8 mmol/l in Group 1 and 18.6 ±â€¯3.5 mmol/l in Group 2 (p = 0.038). A relationship was determined between the presence of OW and pH, bicarbonate, and creatinine levels (p = 0.026; 0.013; 0.042, respectively). The mortality rate was 69.2% in Group 1 and 77.8% in Group 2 (p = 0.689). CONCLUSION: Although there is a relationship between the decrease in bicarbonate levels, changes in kidney functions that cause acidosis, and the presence of OW, it has no effect on mortality. The presence of OW in hypothermic patients is insufficient to make a decision regarding mortality.

The effect of different types of honey on healing infected wounds.

OBJECTIVE:: To investigate the effects of treatments of 'mad honey', blossom honey and nitrofurazone on infected wound healing. METHOD:: Male albino Wistar rats were randomly divided into four groups: 'mad honey' (MH), blossom honey (BH), nitrofurazone (N) and control (C). All rats were anaesthetised intraperitoneally. A circular skin incision was made to the back regions. Grafts containing slime-producing Staphylococcus epidermidis were placed on the incision area and then sutured to the skin. Infection in the wound area was confirmed after 48 hours. Wounds were dressed twice daily with the various treatment materials. Rats were randomly euthanised on days 7 or 14, and tissue samples taken. Tissue samples were assessed for hydroxyproline (HP), tensile strength (TS) and macroscopic measurement (area and intensity). RESULTS:: HP levels were higher in the treatment groups (MH, BH, N) at days 7 and 14 compared with the control group. 'Group x day' interaction was found in the HP levels (p=0.015). Increases in HP levels in the MH and N groups between days 7 and 14 were significantly higher than those in the other groups (p<0.05). Intensity was significantly lower in the control group and significantly higher in group MH compared with the other groups. Significant 'group x day' interaction was observed in intensity (p=0.006). TS was significantly lower on day 7 than on day 14 (p=0.022). No marked difference was observed between the groups, nor any 'group x day' interaction, in terms of TS. CONCLUSION:: Honey administration successfully healed infected wounds. However, there was no significant difference between the effect of MH and that of N in terms of wound healing.

The relation between scapula fracture and the severity of trauma in blunt thoracic trauma

Background/aim: The aim of this study was to determine the level of presence of scapula fractures (SFs) in cases of blunt thoracic trauma and to identify other injuries accompanying SF. Materials and methods: Blunt thoracic trauma cases with SF determined on direct radiography or computerized tomography (CT) were categorized as Group 1. Group 2 was constituted by selecting cases with high injury severity score (ISS) with no SF. The demographic characteristics and all injuries of the patients were evaluated. Results: SF was determined in 77 (11.3%) patients (Group 1), and Group 2 consisted of 607 patients. The ISS was significantly higher in Group 1 (27.7 ± 16.1) than Group 2 (15.9 ± 9.5) (P < 0.001). The rate of SF with direct radiography was only 9.1%, and more than 90% of patients were evaluated using CT. The most common accompanying injury to SF was rib fracture (44.2%), and the odds ratio was 2.4 (95% CI: 1.51­3.72). Conclusion: The incidence of SF in cases of blunt trauma was higher than in previous studies. The use of CT in blunt trauma can determine SF that cannot be identified through physical examination or radiography, and the most commonly observed accompanying damage in these patients is rib fracture.

Carbon monoxide poisoning cases presenting with non-specific symptoms.

Carbon monoxide (CO) is a colourless and odourless gas appearing as a result of incomplete combustion of carbon-containing fuels. Many domestic or occupational poisonings are caused by CO exposure. Malfunctioning heating systems, improperly ventilated motor vehicles, generators, grills, stoves and residential fires may be listed in the common sources of CO exposure. The aim of this study was to emphasize the significance of early diagnosis of CO poisoning with non-invasive measurement of CO levels of the patients with non-specific symptoms using a pulse oximeter device in the triage. Our study was a cross-sectional study. Patients who presented to the emergency department (ED) due to non-specific symptoms and had a Canadian Triage and Acuity scale level of 4 or 5 were included in the study; 106 (5.9%) of 1788 patients admitted during the study period were diagnosed with CO poisoning. Patients with CO poisoning and the other patients had statistically significant differences in terms of presenting symptoms, namely, headache, dizziness, nausea, and vomiting. More CO poisoning cases were admitted in the fall and winter compared to the spring and summer. The number of CO poisoning victims can be decreased if preventive measures like CO monitoring systems and well-designed ventilation systems are generalized at homes and workplaces. Measurement of carboxyhaemoglobin levels of patients presenting to ED due to non-specific symptoms like headache and dizziness during cold seasons and winter months using a pulse CO-oximeter should be a part of the routine of emergency medicine triage.

A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules.

INTRODUCTION: The aim of this study was to evaluate patients presenting to the emergency department (ED) with wrist trauma using physical examination findings and functional tests and to identify findings with high sensitivity and specificity among the parameters assessed in patients with fracture in the wrist. The ultimate objective was thus to establish a reliable and widely usable clinical decision rule for determining the necessity of radiography in wrist trauma. METHODS: This prospective, multicenter study was performed in 8 hospitals. The relation between radiologically determined fracture and clinical findings consisting of physical examination findings and functional tests was assessed in terms of whether or not these were markers of radiography requirement, with the aim of identifying predictive values for fracture. RESULTS: A total of 603 eligible trauma patients presented to the participating EDs during the study period. Fracture was identified in 24.5% of patients (n = 148). The 4-way combination with the highest sensitivity was identified as axial compression and the positive distal radioulnar drawer test, and pain with radial deviation and dorsal flexion. Sensitivity at distal ulna palpation was added as a fifth parameter, and sensitivity and negative predictive value thus increased to 100%. CONCLUSION: With their 100% sensitivity and 100% negative predictive values, the Karadeniz wrist rules may represent a clinical decision rule that can be used in practice in EDs. If all 5 findings are negative, there is no indication for wrist radiography.

Determination of radiography requirement in wrist trauma.

OBJECTIVES: The purpose of this study was to evaluate predetermined physical examination and function tests recommended to identify severe injury among patients presenting with wrist injury to the emergency department and to establish a reliable clinical decision rule capable of determining the need for radiography in wrist injuries. MATERIALS AND METHODS: This was a multicenter prospective derivation study of wrist injuries. All patients were assessed in terms of mechanism of trauma, inspection findings, heart rate, sensitivity at palpation, presence of pain with active movement, grasp strength, and functional tests using an examination form under main headings. Sensitivity, specificity, and positive and negative predictive values were expressed for each sign and each examination finding. RESULTS: One hundred nineteen adult patients were enrolled during the 6-month study period. Fracture was identified in 24.3% (n = 29). Presence of pain on the radial deviation, dorsal flexion, distal radioulnar drawer, and axial compression tests exhibited high sensitivity (82.8%, 89.7%, 82.8%, and 86.2%, respectively) and high negative predictive values (88.6%, 81.3%, 87.5%, and 93.6%, respectively) for wrist fracture. Sensitivity of 96.6% was observed when these 4 tests were evaluated together. CONCLUSIONS: The presence of one of these examination findings increases the likelihood of fracture and is adequate to recommend wrist radiography. In addition, there is a strong possibility of radiography being unnecessary if all 4 test results are negative in patients presenting with wrist injury, potentially preventing many nonessential radiographs being performed.

The Utilization of Emergency Department and Outpatient Clinics among Evacuated Victims after the 2023 Turkey Earthquake.

BACKGROUND: After the 2023 Turkey earthquake, thousands of people evacuated to different fields. Earthquake victims still need health care in the evacuation location. This study aims to determine the emergency department (ED) and outpatient clinic utilization characteristics of the evacuated earthquake victims outside the earthquake zone and to provide suggestions for planning the health care facilities in the regions where the evacuated earthquake victims will be placed. METHODS: This retrospective, observational study was conducted in a tertiary university hospital from February 7, 2023 through February 20, 2023. All evacuated earthquake victims who presented to the study hospital were included in the study. Non-victim patients were included as the control group. Missing medical records were excluded. Demographic characteristics of the patients, outpatient clinics, International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes, and outcomes were recorded. RESULTS: A total of 15,128 patients were included in the final analysis. Six-hundred-nine (4.0%) of the patients were evacuated victims. Three-hundred forty-six (56.8%) evacuated victims used the ED. One-hundred fifty-six (25.6%) earthquake victims were in the pediatric age group. Earthquake victims used the ED more than the control group in adult and pediatric age groups (22.5% versus 51.7% and 30.2% versus 71.8%; P <.001, respectively). Earthquake victims frequently presented to the hospital during night shifts in both age groups (P <.05). Pediatric victims were more hospitalized than the control group (4.8% versus 10.9%; P = .001). Diseases of the respiratory system were the most common emergency diagnosis of the victims in both age groups (26.5% and 57.1%, respectively). The most frequently used outpatient clinic was ophthalmology in both age groups (14.6% and 20.5%, respectively). CONCLUSIONS: Evacuated victims, especially pediatric victims, used the ED more than other outpatient clinics. Diseases of the respiratory system were the most common emergency diagnosis of the victims, and the most frequently preferred outpatient clinic was ophthalmology. The most common diseases and frequently preferred clinics should be considered in planning health care for the evacuated earthquake victims.

Effects of edaravone on testicular torsion-detorsion injury in rats.

BACKGROUND AND OBJECTIVE: This study aimed to assess the protective ability of edaravone on testicular torsion-detorsion injury in rats. METHODS: Eighteen adult male Sprague-Dawley rats were randomly divided into three groups: Sham group (control, n = 6); testicular torsion/detorsion (T/D group, n = 6) and T/D+edaravone (T/D+E group, n = 6). The spermatic cords of rats of the T/D group and the T/D+E group were rotated 720° in a clockwise direction and maintained for 120 min in this torsion position. Around 90 min after the torsion, edaravone at a dose of 10 mg/kg dissolved in saline was administered IP to the T/D+E group. The testicle was counter-rotated to its normal position to allow reperfusion for 4 h. Left testes of each animal were excised 240 min after beginning of reperfusion. Oxidative stress markers (TAS, TOS, SOD, and MDA) and apoptotic pathways (Caspase 3, Caspase 8, Caspase 9, Bcl-2, and Bax,) were assessed by ELISA methods. Also, testicles were subjected to the histopathologic and ultrasound examinations. RESULTS: Ultrasound imaging showed that edaravone reduced the surface area and increased vascularization in testicles with T/D (p < 0.0001, p < 0.05, respectively). Edaravone pretreatment markedly decreased the levels of MDA, TOS, Bcl-2, Bax, Caspase 3, Caspase 8, and Caspase 9 (p < 0.0001). Also, it increased significantly TAS levels (p < 0.0001) and reduced insignificantly SOD activity. Histopathologic examinations demonstrated that edaravone significantly attenuated the histological damage caused by T/D in testicles. CONCLUSION: Taken together, the findings indicate that pretreatment of edaravone has protective effect against testicular T/D injury.

The effect of 8-weeks of combined resistance training and chocolate milk consumption on maximal strength, muscle thickness, peak power and lean mass, untrained, university-aged males.

The overarching aim of this study was to investigate the combined effects of chocolate milk consumption (500 mL) with 8-week of resistance training on muscle hypertrophy, body composition, and maximal strength in untrained healthy men. A total of 22 Participants were randomly divided into two experimental groups: combined resistance training (3 sessions per week for 8 weeks) and chocolate milk consumptions (include 30 g protein) Resistance Training Chocolate Milk (RTCM) (Age: 20.9 ± 0.9 years old) and resistance training (RT) only (Age: 19.8 ± 0.7 years old). Muscle thickness (MT), using a portable ultrasound, body composition, body mass, maximal strength (one repetition maximum (1 RM), counter movement jump (CMJ) and peak power (PP) were determined at baseline and 8 weeks later. In the RTCM, finding showed a significant improvement in the outcomes compared to the RT group, besides the main effect of time (pre and post). The 1 RM total increased by 36.7% in RTCM group compared to 17.6% increased in the RT group (p < 0.001). Muscle thickness increased by 20.8% in the RTCM group and 9.1% in the RT group (p < 0.001). In the RTCM group, the PP increased by 37.8% compared to only 13.8% increase in the RT group (p = 0.001). The group*time interaction effect was significant for MT, 1RM, CMJ, and PP (p < 0.05), and it was observed that the RTCM and the 8-week resistance training protocol maximized performance. Body fat percentage (%) decreased more in the RTCM (18.9%) group than in the RT (6.7%) group (p = 0.002). In conclusion, chocolate milk (500 mL) with high protein content consumed in addition to resistance training provided superior gains in terms of MT, 1 RM, body composition, CMJ, and PP. The finding of the study demonstrated the positive effect of casein-based protein (chocolate milk) and resistance training on the muscle performance. Chocolate milk consumption has a more positive effect on muscle strength when combined with RT and should be considered as a suitable post-exercise nutritional supplement. Future research could be conducted with a larger number of participants of different ages and longer study durations.

The Diagnostic Value of sTWEAK in Acute Ischemic Stroke

Background: Considering the critical role of early diagnosis and management of acute ischemic stroke, biomarkers that can reliable assist in the diagnosis are still needed. These biomarkers should rapidly analyze, have high specificity for brain damage, and be available in the emergency settings for early diagnosis and exclusion of other conditions that mimic acute ischemic stroke. Soluble tumor necrosis factor-like weak inducer of apoptosis, a protein involved in the regulation of several biological functions, could be a potential acute ischemic stroke biomarker. Aims: To investigate the diagnostic value of soluble tumor necrosis factor-like weak inducer of apoptosis in patients with acute ischemic stroke and examine the relationship between ischemic area volume determined at diffusion-weighted magnetic resonance imaging and soluble tumor necrosis factor-like weak inducer of apoptosis. Study Design: A prospective, case-control study. Methods: This case-control prospective study included 36 patients with acute ischemic stroke and 36 healthy volunteers. Information on age, sex, presence of chronic disease, neurological examination findings, times of presentation to the emergency department after acute ischemic stroke, soluble tumor necrosis factor-like weak inducer of apoptosis levels, ischemic area volumes at diffusion-weighted magnetic resonance imaging, and 6-month mortality rates after stroke were recorded. The results were analyzed on SPSS 22.0 software (SPSS Inc., Chicago, IL, USA), and p<0.05 was considered statistically significant. Results: A soluble tumor necrosis factor-like weak inducer of apoptosis cut-off value of 995.5 pg/mL exhibited a sensitivity of 80.5% and a positive predictive value of 82.5% with an area under the curve of 0.84 (95% confidence interval: 0.74-0.94; p<0.001). The mean soluble tumor necrosis factor-like weak inducer of apoptosis levels in the acute ischemic stroke group (1968.08±1441.99 µg/L) were significantly higher than those in the control group (704.81±291.72 µg/L) (p<0.001). No correlation was observed between soluble tumor necrosis factor-like weak inducer of apoptosis levels and ischemic area volume measured at diffusion-weighted magnetic resonance imaging (r=-0.008; p=0.07). The mean ischemic area volume was 505.68±381.10 and 60.96±80.89 mm3 in the nonsurviving and surviving patients, respectively (p=0.002). Conclusion: Soluble tumor necrosis factor-like weak inducer of apoptosis can be used in the diagnosis of acute ischemic stroke. However, it is inconclusive in estimating ischemic area volume and early mortality following acute ischemic stroke. Ischemic area volume measured at diffusion-weighted magnetic resonance imaging is a marker of poor prognosis and can be used in predicting early mortality.

The value of ischemia-modified albumin compared with d-dimer in the diagnosis of pulmonary embolism.

STUDY OBJECTIVE: The primary aim of this study was to investigate whether IMA levels are helpful in the diagnosis of pulmonary embolism (PE). The secondary aim was to determine whether IMA was more effective alone or in combination with clinical probability scores in the diagnosis of PE. Thirdly, the sensitivity and specificity of IMA is compared with D-dimer both with and without clinical probability scores in patients with suspected PE. METHODS: Consecutive patients presenting to the emergency department with suspected PE were prospectively recruited, and healthy volunteers were also enrolled as controls. D-dimer and IMA levels were measured for the entire study group. Wells and Geneva scores were calculated and s-CTPA was performed on all suspected PE patients. RESULTS: The study population consisted of 130 patients with suspected PE and 59 healthy controls. Mean IMA levels were 0.362 +/- 0.11 ABSU for Group A, the PE group (n = 75); 0.265 +/- 0.07 ABSU for Group B, the non-PE group (n = 55); and 0.175 +/- 0.05 ABSU for Group C, the healthy control group (p < 0.0001). At a cut-off point of 0.25 ABSU, IMA was 93% sensitive and 75% specific in the diagnosis of PE. PPV was 79.4% and NPV was 78.6%. Mean D-dimer levels were 12.48 +/- 10.88 microg/ml for Group A; 5.36 +/- 7.80 microg/ml for Group B and 0.36 +/- 0.16 microg/ml for Group C (p < 0.0001). The D-dimer cut-off point was 0.81 microg/ml with a sensitivity of 98.9% and a specificity of 62.7%, PPV of 69.4% and NPV of 83.3%. The use of IMA in combination with Wells and Geneva clinical probability scores was determined to have a positive impact on these scores' sensitivity and negative predictive values. CONCLUSION: IMA is a good alternative to D-dimer in PE diagnosis in terms of both cost and efficiency. Used in combination with clinical probability scores, it has a similar positive effect on NPV and sensitivity to that of D-dimer. The PPV of IMA is better than D-dimer, but it is still unable to confirm a diagnosis of PE without additional investigation.

Medical students' knowledge of ultrasonography: effects of a simulation-based ultrasound training program.

INTRODUCTION: The use of simulation devices in medical education is becoming more prevalent with each passing day. The present study aimed to teach medical students to perform ultrasonography via a simulation-based ultrasound training program. METHODS: The study was prospectively conducted on final year medical students who had not received previous ultrasound training and who came to the Emergency Department of the Kirikkale University Faculty of Medicine between July 2015 and July 2016. Ultrasound training was provided by two emergency department specialists who are qualified in this field. The training time was determined to be 20h (4h for theoretical lessons, 16h for hands-on). The students were evaluated by a theory test and practical application exam both before and after training. RESULTS: Obtained were compared using the paired sample t-test, and p < 0.05 was considered to be significant. Results: Ninety-six final year medical students were included. Their mean age was 24.1 ± 2.1 years. The mean test score obtained in the theoretical exam before training was 7.9 ± 2.2, while that after training was 17.1 ± 1.6 (p < 0.0001). The mean score obtained in the practical application exam before training was 1.1 ± 0.9 points and that after training was 10.9 ± 0.2 points (p < 0.0001). CONCLUSION: Medical students can learn to use an ultrasound device within a short period of time via simulation-based training programs. New studies must be conducted for the inclusion of ultrasound training programs in the medical education curriculum.

Value of ischemia-modified albumin in the diagnosis of pulmonary embolism.

BACKGROUND: Pulmonary embolism (PE) is a common condition, but the diagnostic strategy for the evaluation of suspected PE is somewhat controversial. Despite the use of various biochemical markers (such as D-dimer and C-reactive protein) and various probability calculation algorithms based on clinical findings for that purpose, there is still a need for more specific and practical markers in PE diagnosis. The aim of this study was to investigate the diagnostic value of ischemia-modified albumin (IMA) levels in the diagnosis of PE. METHODS: This case-control study was performed in the emergency department between March and September 2006. The serum IMA levels of a total of 60 individuals, consisting of 30 PE patients who had been definitively diagnosed via spiral computed tomographic angiography and 30 healthy volunteers, were examined. RESULTS: The measurement of IMA levels in patient plasma yielded mean values of 0.724 +/- 0.122 absorbance unit (ABSU) in the PE group and 0.360 +/- 0.090 ABSU in the control group. When plasma IMA levels in the PE group were compared with those in the control group, statistically significant increases in IMA were observed in the former (t = 13.19, df = 56, P < .0005). The value of 0.540 ABSU was calculated as the upper limit of reference interval. In the PE group, 97.7% (n = 29) had values exceeding 0.540 ABSU; none of the control subjects had values exceeding this cutoff value. CONCLUSIONS: In conclusion, our data suggest that IMA levels may be useful as a discriminative marker to exclude pulmonary embolism.

Effect of hypothermia on apoptosis in traumatic brain injury and hemorrhagic shock model.

INTRODUCTION: The neuroprotective mechanisms of therapeutic hypothermia against trauma-related injury have not been fully understood yet. In this study, we aimed to investigate the effects of therapeutic hypothermia on biochemical and histopathological markers of apoptosis using Traumatic brain injury (TBI) and hemorrhagic shock (HS) model. METHODS: A total of 50 male albino-wistar rats were divided into five groups: Group isolated TBI, Group NT (HT+HS+normothermia), Group MH (HT+HS+mild hypothermia), Group MoH (HT+HS+moderate hypothermia) and Group C (control). Neurological deficit scores were assessed at baseline and at 24h. The rats were, then, sacrificed to collect serum and brain tissue samples. Levels of Caspase-3,6,8, proteoglycan-4 (PG-4), malondialdehyde (MDA), and nitric oxide (NO) were measured in serum and brain tissue samples. Histopathological examination was performed in brain tissue. RESULTS: There were significant differences in the serum levels of Caspase-3 between Group NT and Group C (p=0.018). The serum levels of Caspase-6 in Group NT (0.70±0.58) were lower than Group MH (1.39±0.28), although the difference was not statistically significant (p=0.068). There were significant differences in the brain tissue samples for Caspase-3 levels between Group NT and Group C (p=0.049). A significant difference in the Caspase-8 brain tissue levels was also observed between Group NT and Group C (p=0.022). Group NT had significantly higher scores of all the pathological variables (for edema p<0.017; for gliosis p<0.001; for congestion p<0.003, for hemorrhage p<0.011) than Group C. CONCLUSION: Our study results suggest that hypothermia may exert its neuroprotective effects by reducing markers of apoptotic pathway, particularly Caspase-3 on TBI and HS.

Effect of exposure to violence on the development of burnoutsyndrome in ambulance staff.

BACKGROUND/AIM: The aim of this study is to determine the condition of ambulance staff (AS) who have been exposed to any kind of violence and to predict risk of development of burnout syndrome. MATERIALS AND METHODS: Our study was performed with 120 AS working for the Kirikkale Ambulance Services. During the research, questionnaires collecting descriptive information and the extent of violence to which the AS were exposed were administered; participants were asked to fill out the questionnaire themselves. RESULTS: It was found that 81 (67.5%) participants had been subjected to at least one type of violence (verbal or physical). Sixty-two percent were exposed to verbal abuse and 55.8% to verbal threats. Rates of physical threats and attacks were higher among male staff (P = 0.036, P = 0.022), while the rate of personal accomplishment was determined to be significantly lower in males (P = 0.006). Emotional exhaustion and depersonalization scores were determined to be significantly higher in those who perceived less support from administrators (P = 0.014, P = 0.032). CONCLUSION: All kinds of negative situations exhaust an individual physically and mentally and lead to the development of burnout syndrome. AS are more prone to these kinds of situations.

A potentially fatal complication that may occur during dental treatment: "foreign body aspiration".

Numerous systemic emergency situations, such as hypotension or allergic reactions, may be encountered during dental treatment. In addition, rare but life-threatening complications such as foreign body aspiration in the air passages may also be seen. Aspirated foreign bodies include teeth, implants, mechanical supports or materials used during procedures. We report two separate cases of aspiration risk developing during the course of dental treatment.

Warning: This may be as dangerous as firearm injuries;"grease-gun injury": A case report.

High-pressure injection gun (Grease-gun) injuries mainly occur with industrial labourers. Injuries associated with high pressure grease guns are very rare and frequently involve the hand and chest. The non-dominant hand is generally injured since the grease gun is usually held in the dominant hand. Even if high-pressure injection injury causes only a small lesion in the skin, it is still characterized by severe damage to subcutaneous tissue. Since initial presentation may be deceptive, treatment is frequently delayed. The characteristics of the material injected need to be known as a priority, and systemic intoxication must be ruled out. The risk of amputation is 16-55%. With solvents it goes up to 50-80%. Surgical treatment must be performed immediately, under general anesthesia or plexus block. Foreign material and necrotic tissue must be early debrided with wide microsurgical exploration. Positive outcomes in reacquisition of hand functions can be obtained with long-term and early physiotherapy.