Does Preoperative Coffee Consumption Prevent Intraoperative Hypotension in Cesarean Section Surgeries?

OBJECTIVE: In this study, we evaluated the effects of a cup of coffee given to patients before surgery in a cesarean section by means of intraoperative hypotension, ephedrine requirement, and the incidence of post-dural puncture headache (PDPH). METHODS: A total of 140 patients undergoing elective cesarean section with spinal anesthesia were included in this study. Participants who drank a single cup of filtered coffee two hours before spinal anesthesia were included in the coffee group, and those who drank water were in the control group. In each group, 70 patients were included. Hemodynamic parameters were recorded every three to five minutes after spinal anesthesia. Intraoperative use of ephedrine was recorded. The PDPH was monitored for three days. RESULTS: The incidence of intraoperative hypotension was 48.6% in the coffee group and 71.4% in the control group (p = 0.006). The rate of ephedrine usage (25.7%) was significantly lower in the coffee group (p = 0.001). The incidence of PDPH in the first 24 hours (2.9%) was significantly lower in the coffee group (11.4%). The visual analog scale (VAS) score was similar between groups (p = 0.048, p > 0.05). CONCLUSIONS: Consumption of a single cup of coffee before spinal anesthesia reduced the incidence of intraoperative hypotension and the rate of ephedrine usage in cesarean sections.

PriPath: identifying dysregulated pathways from differential gene expression via grouping, scoring, and modeling with an embedded feature selection approach.

BACKGROUND: Cell homeostasis relies on the concerted actions of genes, and dysregulated genes can lead to diseases. In living organisms, genes or their products do not act alone but within networks. Subsets of these networks can be viewed as modules that provide specific functionality to an organism. The Kyoto encyclopedia of genes and genomes (KEGG) systematically analyzes gene functions, proteins, and molecules and combines them into pathways. Measurements of gene expression (e.g., RNA-seq data) can be mapped to KEGG pathways to determine which modules are affected or dysregulated in the disease. However, genes acting in multiple pathways and other inherent issues complicate such analyses. Many current approaches may only employ gene expression data and need to pay more attention to some of the existing knowledge stored in KEGG pathways for detecting dysregulated pathways. New methods that consider more precompiled information are required for a more holistic association between gene expression and diseases. RESULTS: PriPath is a novel approach that transfers the generic process of grouping and scoring, followed by modeling to analyze gene expression with KEGG pathways. In PriPath, KEGG pathways are utilized as the grouping function as part of a machine learning algorithm for selecting the most significant KEGG pathways. A machine learning model is trained to differentiate between diseases and controls using those groups. We have tested PriPath on 13 gene expression datasets of various cancers and other diseases. Our proposed approach successfully assigned biologically and clinically relevant KEGG terms to the samples based on the differentially expressed genes. We have comparatively evaluated the performance of PriPath against other tools, which are similar in their merit. For each dataset, we manually confirmed the top results of PriPath in the literature and found that most predictions can be supported by previous experimental research. CONCLUSIONS: PriPath can thus aid in determining dysregulated pathways, which applies to medical diagnostics. In the future, we aim to advance this approach so that it can perform patient stratification based on gene expression and identify druggable targets. Thereby, we cover two aspects of precision medicine.

EVALUATION OF ULTRASONOGRAPHIC ANATOMY OF TRANSVERSUS ABDOMINIS PLANE BEFORE AND AFTER CESAREAN SECTION.

Transversus abdominis plane (TAP) block is used to provide analgesia after lower abdominal surgery operations. TAP block has been shown to reduce postoperative pain scores and side effects of opioids after cesarean section. Generally, TAP block was introduced after cesarean section. It is assumed that delivery affects sonographic characteristics of the abdominal wall. For this reason, ultrasonographic measurement of the anatomy of the region defined for TAP block was performed before and after cesarean section. It was aimed to determine the estimated TAP block distance in the population undergoing cesarean section. Fifty patients who underwent cesarean section in the operating room were included in the study. The inclusion criteria were ASA score I-II, age 18-45 years, gestational age ≥32 weeks, and cesarean section performed by Pfannenstiel incision. Data on patient age, weight, height, body mass index, gravidity, parity, gestational age (weeks), concomitant disease and allergy were recorded. According to the results obtained in the study, ultrasound should be performed if TAP block is accessible. Before cesarean section, the external oblique muscle and internal oblique muscle are closer to surface than after cesarean section since the TAP distance after pregnancy will be deeper. Systematic data on ultrasonographic anatomy of the abdominal wall in pregnant women have not yet been published. The obstetric anesthesiologist should be aware of these changes when planning a TAP block in the context of cesarean section. There is a need for larger prospective studies.

Comparison of clinical characteristics of wild-type SARS-CoV-2 and Omicron

SUMMARY OBJECTIVE: This study aimed to investigate the effect of mutations by comparing wild-type SARS-CoV-2 and Omicron regarding clinical features in patients with COVID-19. It also aimed to assess whether SARS-CoV-2 cycle threshold value could predict COVID-19 severity. METHODS: A total of 960 wild-type and 411 Omicron variant patients with positive results in SARS-CoV-2 real-time reverse transcriptase polymerase chain reaction test from oropharyngeal and/or nasopharyngeal samples during their hospital admissions were included in this retrospective study. The reference symptoms of the patients were obtained from the hospital database. The correlation between chest computed tomography findings and the "cycle threshold" of patients with wild-type SARS-CoV-2 was assessed. RESULTS: Cough, fever, shortness of breath, loss of taste and smell, and diarrhea were found to be statistically significantly higher (p=0.001; 0.001; 0.001; 0.001; and 0.006; respectively) in the wild-type cohort, while in the Omicron cohort, sore throat and headache were found to be statistically significantly higher (p=0.001 and 0.003, respectively). An inverse relationship was found between chest computed tomography findings and viral load. CONCLUSION: This study revealed that the Omicron variant tended to infect predominantly the upper respiratory tract and showed decreased lung infectivity, and the disease progressed with a milder clinical course. Therefore, the study showed that the tropism of the virus was changed and the viral phenotype was affected. It was also found that SARS-CoV-2 viral load did not predict COVID-19 severity in patients with wild-type SARS-CoV-2.

Shear wave elastography for the evaluation of testicular salvage after testicular torsion.

The aim of this study was to assess the utility of shear wave elastography in the follow-up of testicular detorsion, evaluate long-term outcomes, and explore its relationship with parameters such as tissue stiffness values, pain duration, and torsion type. Elastography examinations were independently performed by two radiologists to evaluate patients who presented to our hospital for follow-up after being diagnosed with testicular torsion and age-matched controls. Inter-observer variability of the mean testicular tissue elasticity was excellent (Intraclass correlation coefficient: 0.939, p < 0.001). Median time between testicular detorsion and follow-up ultrasound examination was 18 months (range, 11-36 months). Torsion side, torsion degree, and pain duration were recorded, and testicular volumes were calculated. The study population comprised 24 patients (48 testes) with a mean age of 21.1 ± 7.8 years. The mean testicular volume was measured as 12.3 ± 5.4 ml for the testicular salvage group, 13.9 ± 3.8 ml for the contralateral testes, and 13.7 ± 2.7 ml for the control group (p = 0.553). The mean testicular speed mode values were higher in the testicular salvage group (1.34 ± 1.21 m/s) compared with the contralateral testes group (1.00 ± 0.08 m/s), and the control group (1.01 ± 0.06 m/s), however there was no statistically significant difference between the three groups (p = 0.861). While testicular atrophy was detected in three patients, an intraparenchymal wedge-shaped focal hypoechoic area developed after torsion in a further three patients. The elastography examination for focal hypoechoic areas revealed an increase or decrease in tissue stiffness compared to the normal parenchyma. The tissue stiffness values of the testicular salvage group were higher in complete torsion compared to incomplete torsion. The elastography method contributes to other imaging methods in distinguishing focal lesion areas that can be seen after testicular torsion from malignant conditions. Elastography presents as a feasible and practical complementary modality for the follow-up of testicular salvage after torsion.

Effect of preeclampsia and its severity on maternal serum NGAL and KIM-1 levels during pregnancy and the post-pregnancy period.

OBJECTIVE: The purpose of this trial was to appraise the effects of preeclampsia and its intensity on maternal serum neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) levels during pregnancy and the post-pregnancy period. STUDY DESIGN: Firstly pregnant participants (n = 156) were separated into three groups, as control, mild, and severe preeclampsia. Secondly women in post-pregnancy period (n = 368) were separated into three groups according to history of pregnancy, as healthy control, mild, and severe preeclampsia. These women were identified through the hospital data system and contacted by telephone to participate in the study. RESULTS: Our study comprised 147 patients, 77 of whom were pregnant and 70 of whom were in their post-pregnancy period after the exclusion criteria had been applied. In terms of maternal serum NGAL levels, there is a significant increase in the severe preeclampsia group compared with that in the mild preeclampsia and normal pregnancy groups (p < 0.001). During the post-pregnancy period, the maternal serum NGAL levels were found significantly higher in the severe preeclampsia group than in the mild preeclampsia group and non-hypertension control group (p < 0.001). Maternal serum KIM-1 levels were found as significantly higher in the severe and mild preeclampsia groups than in the non-hypertension pregnancy group (p = 0.004). During the post-pregnancy period, maternal serum KIM-1 levels were found as similar among all post pregnant groups (p = 0.792). CONCLUSIONS: Our results indicated that as the severity of preeclampsia increases, kidney damage as assessed using NGAL levels continues for a long period of time, even during the post-pregnancy period.

Predictive Value of Modified Early Warning Scoring System for Identifying Critical Patients with Malignancy in Emergency Department.

BACKGROUND: Identification of critically ill patient is particularly important in the emergency department (ED). The prolonged duration from hospital admission to delivering intensive care service is related to increased mortality. The aim of this study is to evaluate the effectiveness of Modified Early Warning Score (MEWS) for identifying critical patients with malignancy in ED settings. METHODS: We evaluated patients with malignancy who were admitted to our ED of a tertiary university hospital in Turkey over a three-month period. We evaluated MEWS on admission as MEWS 1. After the initial treatment depending on the patients' health status in ED, at 2 hours after admission, we evaluated MEWS again and recorded as MEWS 2. All patients were followed up for 30 days after the initial admission. RESULTS: Mean age (SD) was 59.2 (13.5) and male/female ratio was 295/206. MEWS1 was higher than MEWS2, (MEWS1: 3.05 ± 3.31, MEWS2: 2.35 ± 3.17, P < 0.001). A total of 362 patients (72.3%) survived and 139 (27.7%) died within 30 days of initial admission. MEWS1/MEWS2 values for alive and dead patients were 1.66/0.87, and 6.67/6.21, respectively, and the difference was significant (P < 0.001). ROC analysis was performed for MEWS 1; the area under curve (AUC) for hospitalization was 0.768 (95% CI 0.729 to 0.804) and for mortality was 0.900 (95% CI 0.870 to 0.924). ROC analysis revealed a cut-off value of 2 for predicting both hospitalization and mortality in these patients. The sensitivity of the presented cut-off was 77.32% (72.1%-82.0%) for hospitalization and 76.24% (95% CI 71.5-80.5) for mortality; the specificity was 69.52 (95% CI 62.8-75.7) for hospitalization and 90.65 (95% CI 84.65-94.9) for mortality. CONCLUSION: We found in our study that MEWS evaluation for patients with malignancy on admission to ED is predictive of mortality in the subsequent 30 days, and it is a valuable tool for identifying the critical group. Also, AVPU scores alone can predict mortality in patients admitted to ED.

Effect of preeclampsia and preeclampsia severity on insulin, HOMA-IR, and betatrophin levels in non-diabetic pregnant women.

BACKGROUND: The aim of the study was to evaluate the effect of preeclampsia and its severity on insulin, the homeostatic model assessment of insulin resistance (HOMA-IR), and betatrophin levels in non-diabetic pregnant women. METHODS: Our study comprised 102 pregnant women who were divided into the following three groups: (1) control, (2) severe preeclampsia, and (3) mild preeclampsia. The women were screened with the single-stage 75-g oral glucose tolerance test (OGTT), and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria were used for diagnosis. Those women with type 2 diabetes (T2D) mellitus or gestational diabetes mellitus (GDM) were excluded from the study. RESULTS: Maternal demographic characteristics were similar among the groups. Fasting plasma glucose and postprandial 2-h plasma glucose levels were significantly increased in the severe-preeclampsia group compared to that in the other groups. Fasting insulin levels were 14.3 ± 8.7uU/mL in the severe-preeclampsia group, 19.1 ± 6.0uU/mL in the mild-preeclampsia group, and 20.5 ± 12.5uU/mL in the control group and significantly lower in the severe-preeclampsia group than in the mild-preeclampsia and control groups. The serum betatrophin level was 7.8 ± 2.6 ng/mL in the severe-preeclampsia group, 6.1 ± 1.8 ng/mL in the mild-preeclampsia group, and 5.8 ± 1.3 ng/mL in the control group and significantly increased in the severe-preeclampsia group compared to other groups. HOMA-IR was similar among the groups. Maternal serum insulin levels were negatively (r = -0,255; P = 0.010) and serum betatrophin levels were positively (r = 0.368; P ≤ 0.001) correlated with preeclampsia severity. CONCLUSION: Our results indicated that severe preeclampsia effect maternal serum glucose, insulin and betatrophin levels. Histhopatholical and immunohistochemical demostrations on pancreatic cells in new preeclampsia rat models will expand the information on the current situation.

Thermochromic nail polish as a novel indicator to predict infraclavicular brachial plexus block success: A prospective cohort study.

BACKGROUND: Skin temperature measurements after peripheral nerve block can be used as an easy and objective method to help predict block success. Thermochromic nail polishes are popular cosmetic products especially among young women. The colour change of nail polish is based on a thermochromic reaction as the temperature changes. OBJECTIVE: The aim of this study was to test the hypothesis that the success of infraclavicular brachial plexus blocks (IBPBs) can be predicted by the colour change in thermochromic nail polish, which depends on skin temperature changes. DESIGN: A prospective cohort study. SETTING: Training and research hospital from December 2018 to March 2019. PATIENTS: A total of 50 patients who received IBPB for forearm, wrist or hand surgery were included. MAIN OUTCOME MEASURES: Thermochromic nail polish was applied to the nails of both hands of all patients before the block. Reaction of the nail polish in both hands was photographed immediately after application of nail polish and at 30 min after performing the block. The digital photographs of each patient were evaluated by observers. To evaluate the validity of the colour change in nail polish in predicting a successful IBPB, sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were estimated. RESULTS: The positive predictive value for colour change in thermochromic nail polish predicting a successful IBPB was 96% [95% confidence interval (CI) 90 to 98] and sensitivity was 94% (95% CI 87 to 97). Fleiss kappa value showed substantial agreement (0.76; 95% CI 0.59 to 0.93) in the assessment of interobserver agreement. CONCLUSION: The current study demonstrates that the colour change in thermochromic nail polish is a valid and reliable indicator for the prediction of block success. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03767868.

CONTRALATERAL VISION LOSS AFTER ENDONASAL DACRYOCYSTORHINOSTOMY: A CASE REPORT OF PURTSCHER-LIKE RETINOPATHY AND TREATMENT WITH INTRAVITREAL TISSUE PLASMINOGEN ACTIVATOR.

PURPOSE: To present a case of a patient with contralateral vision loss as a result of Purtscher-like retinopathy after an endonasal dacryocystorhinostomy and treatment with intravitreal tissue plasminogen activator injection. METHODS AND RESULTS: A 51-year-old woman who underwent a left endonasal dacryocystorhinostomy was referred with a complaint of decreased vision 1 day after surgery in her right eye. At the initial examination, the visual acuity of her right eye was hand motion. The fundoscopic examination revealed a premacular hemorrhage, diffuse intraretinal hemorrhages, multiple peripapillary cotton wool patches, and Purtscher flecken. The patient received 50 µg/0.1 mL of intravitreal tissue plasminogen activator injection. One day after the injection, visual acuity improved to 3/20. On 1-month follow-up without medication, the visual acuity improved to 6/20, and normal visual evoked potential latencies and amplitudes were detected. CONCLUSION: Purtscher- like retinopathy may occur as a complication of endonasal dacryocystorhinostomy. Intravitreal tissue plasminogen activator may help relieve the embolization that occurs in Purtscher-like retinopathy.

Comparison of seldinger and trocar techniques in the percutaneous treatment of hydatid cysts.

AIM: To comparatively evaluate Seldinger and Trocar techniques in the percutaneous treatment of hydatid disease. METHODS: Trocar and Seldinger techniques were used for 49 and 56 cysts, respectively, among 106 hydatid cysts in 88 patients. The number of males and females were 22 and 66, respectively with a mean age of 44.9 years (range, 15-87). Follow-up studies included cyst diameter, cyst contents, and morphological changes in the cyst wall, local recurrence, and secondary invasion, using ultrasound, computerized tomography and chest X-rays. RESULTS: The positive criteria of healing were a decrease in cyst diameter, progressive solidification of the cyst contents, and disappearance of the cyst. Local recurrence was defined as an increase in the cyst diameter and contents, and appearance of daughter cysts in the primary cavity, while secondary dissemination was defined as the appearance of new cysts outside the treated cyst. Mean duration of follow-up was 19.23 mo (range, 18-26 mo). Follow-up results demonstrated that no significant differences were present between the Trocar and Seldinger techniques in the percentage of decrease in the cyst volume, rate of early complications, local recurrence and secondary dissemination (P = 0.384, 0.069, 0.215 and 0.533, respectively). CONCLUSION: There are no differences between the Seldinger and Trocar techniques that gain entry to the cyst cavity in terms of the efficacy of the treatment and the rates of early and late complications.

Clinicopathologic study of kidney biopsies in patients before or after liver transplant.

OBJECTIVES: The purpose of this study was to evaluate the causes of kidney impairment associated with liver transplant in patients who had kidney biopsy before or after liver transplant. MATERIALS AND METHODS: In 408 patients who had liver transplant from January 1990 to December 2012, there were 10 patients who had kidney biopsy (total, 19 kidney biopsies) for evaluation of kidney dysfunction. A retrospective review of clinical records and kidney biopsies was performed. RESULTS: There were 7 male and 3 female patients (median age at liver transplant, 43 y; range, 10 to 62 y). The most frequent reason for liver transplant were hepatitis B virus cirrhosis (4 patients). There were 3 patients who had a kidney transplant before or concurrent with liver transplant. Increased serum creatinine level was the most common clinical finding at the time of kidney biopsy. The median interval from liver transplant to kidney biopsy was 495 days (mean, 1025 d; range, 10-4980 d). The most common pathology in the kidney biopsies was immune complex glomerulonephritis (total, 7 patients: IgA nephropathy, 4 patients; lupus nephritis, 2 patients; membranoproliferative glomerulonephritis, 1 patient). There were 4 patients who had allergic tubulointerstitial nephritis, 2 patients who had chronic calcineurin inhibitor nephrotoxicity, and 1 patient who had karyomegalic nephropathy. There were 7 patients who died at mean 34 months (range, 1-70 mo) after liver transplant. The other 3 patients were alive at mean 128 months (range, 67-193 mo) after liver transplant and had a functioning liver graft and chronic kidney disease. CONCLUSIONS: Chronic kidney disease after liver transplant has a major effect on mortality. The frequency of immune complex glomerulonephritis associated with liver transplant may be greater than previously recognized.

The role of neutrophil gelatinase-associated lipocalin in identifying contrast induced nephropathy development in the emergency department.

OBJECTIVE: To evaluate the diagnostic significance of neutrophil gelatinase-associated lipocalin in detecting the development of contrast-induced nephropathy in patients undergoing contrast imaging in an emergency department setting. METHODS: The case-control study was conducted at the emergency department of Uludag University, Turkey, between January 1 and July 1, 2012, and comprised patients who underwent a diagnostic thoracic or abdominal Computed Tomography examination with contrast agent. At 2 hours and 72 hours after the scan, control urea, creatinine, and neutrophil gelatinase-associated lipocalin values were recorded. Plasma lipocalin measurement was performed using fluorescence-detected immunoassay method. An increase in serum creatinine of more than 0.5 mg/dl or 25% elevation from the basal level was considered to be a marker for the occurrence of contrast-induced nephropathy. SPSS 13 was used for statistical analysis. RESULTS: Of the 80 subjects in the study, 60 (75%) were cases and 20 (25%) were controls. Contrast-induced nephropathy did not develop in any of the patients, and, accordingly, no significant increase of plasma urea, creatinine, or neutrophil gelatinase-associated lipocalin levels was observed. A significant positive relationship was found between urea and creatinine levels at 2 hours (p < 0.009) and at 72 hours (p < 0.001). CONCLUSIONS: Diagnostic contrast computed tomography examination in patients with normal renal function did not lead to Contrast-induced nephropathy or increased neutrophil gelatinase-associated lipocalin levels, an accepted early indicator of kidney injury.

Do the values of prostate specific antigen obtained from fresh and dried urine reflect the serum measurements?

AIM: To investigate if free PSA (fPSA) and total PSA (tPSA) values obtained from simultaneously collected urine, fresh and dried on filter paper, reflect the serum free and total PSA. MATERIALS AND METHODS: The sera and 20 cc first voided urine from 33 consecutive men aged between 40 and 84 (mean 61 ± 12), were collected in the morning and delivered to the laboratory. Three different aliquots of 100 microgram urine were taken with automatic pipette and dropped on 3 certain areas of a filter paper and allowed to dry for each patient. On each paper, borders of dried urine were marked. PSA values were obtained from the sera and fresh urine samples and recorded. Later on particular days dried urine samples were dissolved and eventually PSA values were derived and recorded again. The results were compared to each other. Correlations were evaluated by using an SPSS statistics program. RESULTS: Serum PSA values correlated weakly (r < 0.24) with fresh and dried urine PSA values. While PSA in fresh and dried urine samples showed strong correlation (0.5 < r < 0.74), a very strong correlation (r > 0.75) among PSA values of dried urine samples of 1-day, 7- and 28-days, were seen. CONCLUSIONS: We conclude that PSA values obtained from fresh and dried urine could not reflect serum PSA values. But, because dried urine on a filter paper can be stable for years, it could be used for forensic purposes.

Levator function in blepharoptosis surgery.

AIM: To investigate the predictive value of levator function in the outcomes of surgeries using the anterior levator resection technique in patients with aponeurotic blepharoptosis. METHODS: A retrospective analysis of 69 eyes of 65 patients who underwent anterior levator resection between 2005 and 2011 in the ophthalmology department of a tertiary care center was performed. Levator function was assessed as perfect (10 to 15 mm; group 1), good (9 to 10 mm; group 2), and moderate (5 to 8 mm; group 3). Postoperative success rates were analyzed with respect to preoperative levator function. RESULTS: The patient group consisted of 36 females (55.4%) and 29 males (44.6%) with a mean age of 57.2 (range: 16 to 71) years and average duration of follow-up of 13.7 (range: 6 to 36) months. The rates of success in the first, second, and third groups were 84.6%, 84%, and 71%, respectively. The success rate was found to be significantly lower in the third group (p < 0.05). The overall success rate, which was 78.3%, improved to 87% after revision surgery. CONCLUSION: In patients with aponeurotic blepharoptosis with relatively better preoperative levator function, the anterior levator resection technique seems to yield more successful surgical outcomes. Preoperative assessment of levator function may help in the selection of appropriate treatment modality in these patients.

General characteristics of patients with electrolyte imbalance admitted to emergency department.

BACKGROUND: Fluid and electrolyte balance is a key concept to understand for maintaining homeostasis, and for a successful treatment of many metabolic disorders. There are various regulating mechanisms for the equilibrium of electrolytes in organisms. Disorders of these mechanisms result in electrolyte imbalances that may be life-threatening clinical conditions. In this study we defined the electrolyte imbalance characteristics of patients admitted to our emergency department. METHODS: This study was conducted in the Emergency Department (ED) of Uludag University Faculty of Medicine, and included 996 patients over 18 years of age. All patients had electrolyte imbalance, with various etiologies other than traumatic origin. Demographic and clinical parameters were collected after obtaining informed consent from the patients. The ethical committee of the university approved this study. RESULTS: The mean age of the patients was 59.28±16.79, and 55% of the patients were male. The common symptoms of the patients were dyspnea (14.7%), fever (13.7%), and systemic deterioration (11.9%); but the most and least frequent electrolyte imbalances were hyponatremia and hypermagnesemia, respectively. Most frequent findings in physical examination were confusion (14%), edema (10%) and rales (9%); and most frequent pathological findings in ECG were tachycardia in 24%, and atrial fibrillation in 7% of the patients. Most frequent comorbidity was malignancy (39%). Most frequent diagnoses in the patients were sepsis (11%), pneumonia (9%), and acute renal failure (7%). CONCLUSIONS: Electrolyte imbalances are of particular importance in the treatment of ED patients. Therefore, ED physicians must be acknowledged of their fluid-electrolyte balance dynamics and general characteristics.

Effect of heamolysis on prostate-specific antigen.

Purpose. We have investigated the effect of haemolysis on free and total prostate-specific antigen (PSA) in daily clinical practice. Materials and Methods. Thirty-nine consecutive men were enrolled in this study. With an 18 gauge (G) needle 4 cc of blood samples were drawn from the right arm and 2 cc of it was expelled gently in a Vacutainer for regular PSA assay and the remaining was emptied into a second tube for complete haemolysis. Simultaneously 2 cc of more blood were taken with a 26 G insulin needle from the left arm of the same patient and expelled into another Vacutainer with forcing. All three samples were assayed for free PSA (fPSA), total PSA (tPSA), and potassium (K). Results. The results of the first tube were fPSA 0,535 ng/mL; tPSA 2,493 ng/mL; K(+) 4,178 mmol/L. The results from the haemolysis tube were 0,170 ng/mL; 0,929 ng/mL; 39,545 mmol/L for fPSA, tPSA, K(+), respectively, (P value was 0,001 for all the changes). In the same order the third tube results were 0,518 ng/mL, 2,322 ng/mL, and 7,11 mmol/L. Conclusions. Haemolysis may result in interference by decreasing free and total PSA falsely in daily blood draw practice, that could lead to misinterpreting the case in which especially small amount of increase may be of value.

Analysis of the necessity of routine tests in trauma patients in the emergency department.

BACKGROUND: The necessity of routine tests as regarded in the Advanced Trauma Life Support protocols has become controversial in recent years. The aim of this study was to analyze the necessity of routine tests in trauma patients. METHODS: This was a prospective study. A total of 103 blunt trauma patients aged between 15 and 65 years who presented to the emergency department with major trauma, Glasgow Coma Scale of 15 and Revised Trauma Score of 12 were admitted to the study. RESULTS: The average age of the patients (30.1% female, 69.9% male) was 35±12.97 years. A total of 72.8% of the patients presented for motor vehicle crashes, 12.6% for pedestrian injury and 14.6% for fall from a height. All of the routine tests were evaluated separately. With the exception of cervical examination-lateral cervical X-ray results and pelvic examination-complete blood count and urinalysis test results, significant relations were determined between the reason for requiring a test and the results of the other tests (complete blood count, lateral cervical X-ray and abdominal ultrasonography). CONCLUSION: According to our study, biochemical tests, anterior-posterior chest X-ray and anterior-posterior pelvic X-ray can be ordered as targeted tests. Conducting targeted tests will reduce costs and workload.

Hemostatic effect of a chitosan linear polymer (Celox®) in a severe femoral artery bleeding rat model under hypothermia or warfarin therapy.

BACKGROUND: In this study, the hemostatic efficacy of Celox® in rats under hypothermia or warfarin treatment was investigated. METHODS: A total of forty-eight Sprague-Dawley female rats weighing 200-350 g were used in the study. Six experimental study groups were designed, as follows: Group 1: Normothermia + compression; Group 2: normothermia + Celox®; Group 3: hypothermia + compression; Group 4: hypothermia + Celox®; Group 5: normothermia + warfarin + compression; and Group 6: normothermia + warfarin + Celox®. RESULTS: Celox® provided effective hemorrhage control in all three tested groups. There was a statistically significant difference between compression and Celox® implementation in all groups in terms of hemostasis (p-values for the normothermia, hypothermia and warfarin groups were p<0.05, p<0.01 and p<0.01, respectively). Furthermore, the compression numbers were significantly lower in all of the groups that received Celox ® than in those in which compression alone was applied (p-values for the normothermia, hypothermia and warfarin groups were p<0.01, p<0.01 and p<0.001, respectively). CONCLUSION: Celox® provides effective hemorrhage control under conditions of normothermia, hypothermia and use of the oral anticoagulant agent warfarin.

Factors affecting mortality in patients with thorax trauma.

BACKGROUND: The purpose of this study was to define the epidemiologic properties and correlation of physiological and anatomical risk factors with the mortality rate among patients with thorax trauma and to ensure early prediction of severe trauma. METHODS: Files of 371 cases were retrospectively examined. Their initial state in the emergency department was analyzed in terms of mortality development. Age, gender, trauma mechanism, systolic blood pressure and respiration type on admission, accompanying injuries, thorax pathology, trauma scores, and treatment approaches in exitus and surviving cases were compared. Survival probabilities and unexpected mortality rates were computed using the Trauma Revised Score-Injury Severity Score (TRISS). RESULTS: Age, hypotension, pathologic respiration, blunt injury, accompanying injury, abdominal trauma, high Injury Severity Score (ISS), and low Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and TRISS were the factors affecting mortality, and presence of blunt injuries, TRISS <85, ISS >22 and GCS <13 were found to be independent prognostic factors. The strongest factor indicating mortality was TRISS. Thirty-four of 307 cases with survival probability of over 50% died. CONCLUSION: In the presence of factors affecting mortality, patients with thorax trauma should be evaluated as being in a high-risk group and treatment strategies must be aggressive. Case analysis based on the TRISS model would further reveal the mistakes and may improve patient care.