Patients with crush syndrome and kidney disease: lessons learned from the earthquake in Kahramanmaras, Türkiye.

This study investigated in-hospital outcomes and related factors in patients diagnosed with postearthquake crush syndrome after the earthquakes in Kahramanmaras, Türkiye. One thousand twenty-four adult patients diagnosed with crush syndrome were analyzed. Data on demographic characteristics, clinical presentation, laboratory values, treatments, and outcomes were collected. A total of 9.8% of patients died during their hospital stay. Nonsurvivors were generally older, more likely to have preexisting chronic kidney disease, and faced more severe injuries and complications, including hypotension-shock, arrhythmias, elevated markers of renal dysfunction, and higher rates of acute kidney injury (AKI) and compartment syndrome. In addition, intensive care unit needs were higher. Multivariate analysis confirmed that age, injury severity, shock, high potassium, uric acid, and lactate levels on admission, development of AKI, compartment syndrome, and intensive care unit admission were significant predictors of mortality. Better disaster preparedness and improved health care infrastructure could be potential explanations for improved in-hospital mortality in the current era, as compared to previous earthquakes.

Epidemiological analysis of the victims with crush syndrome in earthquakes of southeastern Turkey.

BACKGROUND: Each year, millions face natural disasters, encountering mass fatalities and severe medical issues such as crush injuries and crush syndrome. Crush syndrome, marked by acute kidney injury (AKI) and hyperkalemia, correlates with mortality. This study focuses on presenting epidemiological data on kidney disease resulting from the February 6, 2023 earthquakes centered in Kahramanmaras. METHODS: This retrospective analysis included patients diagnosed with crush syndrome after the 2023 Kahramanmaras earthquakes, treated in regional hospitals or referred elsewhere in Turkey. Patient data were documented using the web-based system developed by the Turkish Nephrology Association Renal Disaster Working Group. RESULTS: Of the 1024 analyzed patients from 46 centers, 515 (50.3%) were women. The mean age was 41 ± 16 years, with a median duration of 12 h under rubble, and the median presentation time to the first health facility was 4 h after extrication from the rubble. Upon admission, 79.8% received intravenous fluid therapy, all potassium-free. Initial serum creatinine, K+, and creatinine kinase levels averaged 2.59 ± 2 mg/dl, 5.1 ± 1 mmol/L 38,305 ± 54,303 U/L, respectively. Intensive care unit (ICU) admissions were 53.6%, with mean hospital and ICU stays of 20 and 11 days, respectively. Compartment syndrome occurred in 40.8% of patients, with 75.8% undergoing fasciotomy. Acute kidney injury developed in 67.9% of patients, with 70.3% undergoing hemodialysis, totaling 3016 sessions on 488 patients. The overall in-hospital mortality rate was 9.8%. CONCLUSION: Earthquakes have a significant impact on kidney health. Although our study indicates some progress compared to previous earthquake responses, there remains a crucial need for drills emphasizing post-earthquake initial response, fluid-electrolyte balance management, and emergency dialysis protocols.

The 677 C/T MTHFR polymorphism is associated with essential hypertension, coronary artery disease, and higher homocysteine levels.

BACKGROUND: Essential hypertension (EH) and cardiovascular disease are common, multifactorial disorders likely to be influenced by multiple genes of modest effect. The C677T methylenetetrahydrofolate reductase (MTHFR) gene polymorphism is related to MTHFR enzyme activity and to plasma homocysteine (Hcy) concentration. This study was designed to investigate an association of this polymorphism with coronary artery disease (CAD), EH, and healthy subjects. METHODS: In this study, we measured serum folate, serum vitamin B12, and plasma homocysteine and determined the MTHFR C677T genotype of 78 patients with essential hypertension, 100 patients with coronary artery disease, and 100 healthy subjects. MTHFR genotypes were assessed by real-time polymerase chain reaction. RESULTS: CC, CT, and TT genotype frequencies were 52, 44.0, and 4.0% in patients with CAD, respectively. In patients with essential hypertension, the CC, CT, and TT genotype frequencies were 46.2, 41.0, and 12.8%, respectively. In control subjects, the CC, CT, and TT genotype frequencies were 72.0, 26.0, and 2.0%, respectively. The C allele was significantly more frequent in controls compared with patients with EH (p<0.05), and CC genotypes were more frequent in controls compared to patients with EH and CAD. Homocysteine level was higher in TT genotypes in CAD patients compared with CC and CT genotypes (p<0.01). MTHFR gene polymorphism is an independent risk factor for EH but not for CAD. CONCLUSIONS: The TT genotype of the 677C/T MTHFR polymorphism is associated with EH and CAD. In addition, TT genotypes had higher plasma Hcy levels in CAD patients compared with CC and CT genotypes. MTHFR gene polymorphism is an independent risk factor for EH but not for CAD.

Effect of enalapril maleate on ghrelin levels in metabolic syndrome in rats.

We have explored how enalapril affects ghrelin levels in serum and renal tissues of rats with fructose-induced MetS, using 5-week-old Wistar albino male rats weighing 220 ± 20 g. They divided into 5 groups: (i) control (CT), no fructose supplement fed on standard rat pellet and tap water for 60 days, (ii) metabolic syndrome (MetS) fed with 10% fructose for 60 days, (iii) rats after metabolic syndrome developed treated with enalapril over 30 days (MetS+E30), (iv) rats in which only enalapril was administered for 60 days (E60), and (v) MetS-treated with enalapril for 60 days (MetS+E60). Enalapril maleate was given at 20mg/kg per day by gavage. Fasting serum insulin, uric acid, triglyceride, low-density lipoprotein cholesterol and total cholesterol levels were significantly higher, and the amount of high density lipoprotein cholesterol, and acylated and desacyl ghrelin levels was significantly lower in the MetS groups. Ghrelins were significantly lower in all 3 groups, which were administered enalapril than that of MetS and the control group. Immunohistochemical staining showed that the density of ghrelin was parallel to the serum levels of the peptide. Ghrelin immunoreactivity in the kidneys was of moderate density in the distal and collecting tubules, mild density in the proximal tubule and glomeruli, whereas the density decreased in the MetS group and other enalapril-treated groups. In conclusion, ghrelin levels in MetS groups were significantly lower than control group, and thus Enalapril treatment improves components of MetS and has direct effects on serum ghrelin levels that are independent of MetS.

C-reactive protein, procalcitonin, interleukin-6, vascular endothelial growth factor and oxidative metabolites in diagnosis of infection and staging in patients with gastric cancer.

AIM: The current study was to determine the serum/plasma levels of VEGF, IL-6, malondialdehyde (MDA), nitric oxide (NO), PCT and CRP in gastric carcinoma and correlation with the stages of the disease and accompanying infection. METHODS: We examined the levels of serum VEGF, IL-6, PCT, CRP and plasma MDA, NO in 42 preoperative gastric cancer patients and 23 healthy subjects. There were infection anamneses that had no definite origin in 19 cancer patients. RESULTS: The VEGF levels (mean+/-SD; pg/mL) were 478.05+/-178.29 and 473.85+/-131.24 in gastric cancer patients with and without infection, respectively, and these values were not significantly different (P>0.05). The levels of VEGF, CRP, PCT, IL-6, MDA and NO in cancer patients were significantly higher than those in healthy controls and the levels of CRP, PCT, IL-6, MDA and NO were statistically increased in infection group when compared with non-infection group (P<0.001). CONCLUSION: Although serum VEGF concentrations were increased in gastric cancer, this increase might not be related to infection. CRP, PCT, IL-6, MDA and NO have obvious drawbacks in the diagnosis of infections in cancer patients. These markers may not help to identify infections in the primary evaluation of cancer patients and hence to avoid unnecessary antibiotic treatments as well as hospitalization. According to the results of this study, IL-6, MDA, NO and especially VEGF can be used as useful parameters to diagnose and grade gastric cancer.