Factors affecting survival and neurological outcomes for patients who underwent cardiopulmonary resuscitation.

OBJECTIVE: To determine the impact of arrest location, arrest reason, the return of spontaneous circulation positivity, duration of cardiopulmonary resuscitation, chest compression method, and cardiac rhythm at the time of hospital admission on survival rates and neurological outcome in cardiac arrest cases. METHODS: The retrospective study was conducted at Bolu Abant Izzet Baysal Training and Research Hospital, Turkey, and comprised data related to the period from January 1, 2016, to June 31, 2018, of patients who received cardiopulmonary resuscitation at the Emergency Department. Demographic characteristics of the patients, the return of spontaneous circulation, and 6-month survival rates were evaluated with the use of a modified Rankin scale. Data was analysed using SPSS 25. FINDINGS: Of the 177 cases, 109(61.58%) were male. The return of spontaneous circulation was noted in 72(40.68%) patients. In-hospital, cardiac arrest developed in 80(45.20%) patients, and chest compression wasperformed on 105(59.32%) with the use of a mechanical chest compression device. A non-shockable rhythm state was observed in 150(84.75%) patients, and 18(10.17%) survived at the end of the sixth month. CONCLUSIONS: The return of spontaneous circulation rate was higher and the neurological prognosis was more positive in patients on whom cardiopulmonary resuscitation was performed for a shorter time period and who had a shockable cardiac rhythm at the time of admission.

The role of soluble urokinase plasminogen activator receptor (SuPAR) as an indicator of the severity of acute pancreatitis

Background/aim: Soluble urokinase plasminogen activator receptor (suPAR) has been reported to have a positive correlation with the activation degree of the immune system. This study's aim is to investigate the efficiency of SuPAR serum levels in acute pancreatitis (AP) patients in determining the severity of disease. Materials and methods: This prospective research involves patients who arrived at the emergency service, were over 18 years old, had nontraumatic abdominal pain and diagnosis of AP, and agreed to join the study. Demographic characteristics, contact information, laboratory and imaging test parameters, Ranson's criteria, the Balthazar Severity Index, the Rapid Acute Physiologic Score (RAPS), and the modified Glasgow (Imrie) score of all patients were recorded. Two study groups were created as score of <3 (mild, Group I) and ≥3 (severe, Group II) for pancreatitis according to Ranson's criteria. Results: During the study period, 59 sequential patients with AP were included in the study. It was seen that 79.7% of the study group (n = 47) were in Group I. Etiologically 67.8% (n = 40) cases were biliary and 32.3% (n = 19) were nonbiliary diseases. According to the results, suPAR level was effective in distinguishing the severity of AP (AUC = 0.902, P < 0.001 (95% CI: 0.821­0.984)). With regard to determining severe disease, suPAR had an optimum cutoff value of 6.815 ng/mL, sensitivity of 91.66%, specificity of 82.97%, and negative predictive value of 97.5%. Conclusion: Our study was performed the determine the efficiency of suPAR level in predicting severe disease in AP patients. We found it significant in indicating the severity of disease according to the study results.

Data analysis of patients admitted to the emergency medicine clinic of Mersin City Training and Research Hospital after the Kahramanmaras earthquake.

BACKGROUND: In earthquakes and other natural disasters, there is a significant number of injuries directly resulting from trauma. Additionally, due to the disaster's impact on overloaded health institutions, healthcare providers face significant challenges during earthquakes. In this context, nearby hospitals providing health services play a crucial role. Nonetheless, with proper planning, the health crisis can be managed in the best possible way. METHODS: A single-center retrospective study was conducted on patients admitted to Mersin City Training and Research Hospital due to injuries attributed to the earthquake that occurred in the southern and mid-eastern regions of Türkiye on February 6, 2023. A total of 2,155 patients meeting the study criteria were included in the analysis. RESULTS: Of the 2,155 patients enrolled in the study, 46.8% (n=1009) were male, with a mean age of 45.86±17.68 years. Falls (57.2%, n=1233) were the most common mechanism of injury, and 71.9% (n=1550) of cases presented to the hospital on their own. Among the head injuries, the most common types were soft tissue injury and lacerations, while soft tissue injury and rib fractures were most common in the thoracic region. Soft tissue injury and retroperitoneal bleeding were the most commonly recorded types among abdominal injuries, whereas soft tissue injury and fractures were most common in the upper and lower extremities. Fractures were identified in 11.1% (n=240) of cases in the upper extremities and 21.3% (n=458) in the lower extremities. Rhabdomyolysis was one of the most frequently observed injury types (n=443, 20.6%). Crush syndrome and acute kidney injury were recorded in 9.2% (n=198) of cases, leading to a total of 46 amputations in 40 (1.8%) patients and 164 fasciotomies in 132 (6.1%) patients. The orthopedics department performed the most frequent surgical interventions and hospitalizations. Mortality was noted in 2.87% (n=62) of cases. CONCLUSION: This study demonstrated a significant increase in workload and patient volume following the earthquake. There is a need for a large number of healthcare professionals for expedient intervention in conditions such as fractures, crush syndrome, amputation, and fasciotomy in disasters with a high risk of serious trauma, such as earthquakes. Disaster planning and preparedness for possible consequences will mitigate the healthcare crisis involving the hospitals and lead to significant reductions in mortality and morbidity.

The role of oxidative stress in α-amanitin-induced hepatotoxicityin an experimental mouse model.

BACKGROUND/AIM: This study aimed to evaluate oxidative stress markers of liver tissue in a mouse α-amanitin poisoning model with three different toxin levels. MATERIALS AND METHODS: The mice were randomly divided into Group 1 (control), Group 2 (0.2 mg/kg), Group 3 (0.6 mg/kg), and Group 4 (1.0 mg/kg). The toxin was injected intraperitoneally and 48 h of follow-up was performed before sacrifice. RESULTS: Median superoxide dismutase activities of liver tissue in Groups 3 and 4 were significantly higher than in Group 1 (for both, P = 0.001). The catalase activity in Group 2 was significantly higher, but in Groups 3 and 4 it was significantly lower than in Group 1 (for all, P = 0.001). The glutathione peroxidase activities in Groups 2, 3, and 4 were significantly higher than in Group 1 (P = 0.006, P = 0.001, and P = 0.001, respectively). The malondialdehyde levels of Groups 3 and 4 were significantly higher than Group 1 (P = 0.015 and P = 0.003, respectively). The catalase activity had significant correlations with total antioxidant status and total oxidant status levels (r = 0.935 and r = -0.789, respectively; for both, P < 0.001). CONCLUSION: Our findings support a significant role for increased oxidative stress in α-amanitin-induced hepatotoxicity.

Modified Early Warning Score and VitalPac Early Warning Score in geriatric patients admitted to emergency department.

OBJECTIVE: The aim of this study was to evaluate the value of the Modified Early Warning Score (MEWS) and the VitalPac Early Warning Score (VIEWS) in predicting hospitalization and in-hospital mortality in geriatric emergency department (ED) patients. PATIENTS AND METHODS: This prospective, single-centered observational study was carried out over 1 month at the ED of a university hospital in patients 65 years of age and older presenting to the ED. The vital parameters of the patients measured on admission to ED were recorded. The MEWS and VIEWS were calculated using the recorded physiological parameters of the patients. Hospitalization and in-hospital mortality were used as the primary outcomes. RESULTS: A total of 671 patients included in the study. The median age of the patients was 75 (11) years, and 375 (55.9%) were men. The MEWS is effective for discriminating patient groups that have been discharged from ED, admitted to a ward and admitted to ICU [1 (2) vs. 1 (1) vs. 3 (3), respectively, P<0.001]. The VIEWS is also effective for discriminating patient groups that have been discharged from ED, admitted to a ward, and admitted to ICU [2 (3) vs. 5 (5) vs. 8 (8), respectively, P<0.001]. The AUCs of the MEWS and VIEWS were 0.727 [95% confidence interval (CI) 0.689-0.765] and 0.756 (95% CI 0.720-0.792) in predicting hospitalization, respectively. The AUCs of the MEWS and VIEWS were 0.891 (95% CI 0.844-0.937) and 0.900 (95% CI 0.860-0.941) in predicting in-hospital mortality, respectively. CONCLUSION: The MEWS and VIEWS are powerful scoring systems that are easy-to-use for predicting the hospitalization and in-hospital mortality of geriatric ED patients.

Alpha-Amanitin Poisoning, Nephrotoxicity and Oxidative Stress: An Experimental Mouse Model.

BACKGROUND: Alpha-amanitin (α-AMA) plays a major role in Amanita phalloides poisoning, showing toxic effects on multi-organs, particularly on the liver and kidneys. Studies have shown a relationship between α-AMA-related injuries and reactive oxygen species. OBJECTIVES: We aimed to investigate whether there is renal injury and its relationship with oxidative stress after intraperitoneal injection of α-AMA in mice experimental poisoning models. MATERIALS AND METHODS: There were 37 male BALB/c laboratory mice treated with α-AMA, according to the study groups: control group (n = 7); low dose (0.2 mg/kg) (n = 10); moderate dose (0.6 mg/kg) (n = 10), and high dose (1 mg/kg) (n = 10). The sample size was detected according to the ethical committee's decision as well as similar studies in the literature. After a 48-hour follow-up period, all the subjects were sacrificed for pathological and biochemical assays. The study was held in Turkey. RESULTS: α-AMA poisoning in mice results in inflammatory changes and necrosis in renal structures. There were statistically significant differences between the study groups regarding measured levels of catalase, superoxide dismutase, glutathione peroxidase, total antioxidant status (TAS), total oxidant status (TOS) and malonyl dialdehyde in renal homogenates of mice (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P = 0.001, respectively). The TOS and TAS measurements helped to eliminate cumbersome analysis of diverse oxidant and antioxidant molecules. The TOS levels in renal homogenate of mice were significantly higher in all the intoxication groups compared to the control group (5.73, 7.02, 7.77, and 9.65 mmol trolox eq/g protein and P = 0.002, P = 0.001, and P = 0.001, respectively). The TAS levels in moderate and high-dose groups were significantly lower than all the other groups treated with α-AMA (0.130, 0.152, 0.065, and 0.087 mmol trolox eq/g protein and P = 0.031, P = 0.001, and P = 0.001, respectively). CONCLUSIONS: Our results indicated that α-AMA poisoning in mice led to inflammatory changes and necrosis in renal structures. Biochemical analysis showed a shift in the oxidative/anti-oxidative balance towards the oxidative status.