Impact of COVID-19 Lockdown on Traumatic Bone Fracture Patterns and Hospital Outcomes in 1646 Elderly Patients: A Retrospective Study in Turkey.

BACKGROUND During the Coronavirus Disease-2019 (COVID-19) pandemic-related lockdowns, modifications in trauma-related behavior and other factors in the elderly population may have occurred. The present retrospective study aimed to compare outcomes from emergency admissions to a major trauma center in Turkey of 1646 elderly patients with traumatic bone fractures that occurred before, during, and after the COVID-19 pandemic lockdown period. MATERIAL AND METHODS A cohort of 1646 elderly trauma patients admitted between September 15, 2019 and September 15, 2020 were retrospectively scanned from the hospital registry system and were grouped as admitted during the COVID-19 pandemic before (Group 1), during (Group 2), or after (Group 3) the lockdown restrictions. Demographic and clinical data were examined by making comparisons between the 3 groups. RESULTS In all groups, female sex was more prevalent. Fractures were more common in the ulna and femur than in other bones (P=0.026, P=0.035). Among the groups, in Group 2, injuries due to the mechanism of falling from one's own height on the ground were more prominent (79.2%). Hospital costs were lower in Group 1 (P<0.001). The majority of hospitalized patients (n=874; 53.1%) were in Group 2 (P=0.009). CONCLUSIONS During pandemic lockdowns, the mechanism of falling from one's own height was more common in the elderly population. The ulna and femur were the predominant bones fractured. Therefore, during lockdown periods, precautions should be taken to prevent the elderly from falling from their own height.

Evaluation of Factors Related to Mortality Caused by Firearm Injury: A Retrospective Analysis from Malatya, Turkey.

BACKGROUND: Firearm related injuries continue to increase throughout the world and they become the first or second cause of mortality in worldwide. The present study aimed to determine the factors that affect mortality in firearm injuries. METHODS: The patients which were admitted to emergency service between January 2011 and December 2015 due to firearm injuries, were reviewed from hospital records. The patients were evaluated in terms of their age, sex, event time, admission time, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), the reason of event, type of weapon, the region of the body that injured, department in which they were hospitalized, hospitalization duration and the relation between these parameters and mortality. RESULTS: A total of 174 patients (86.8% male, 13.2% female) were identified. The mean age of patients was 35.2 years and 30 patients (17.2%) died. Among the cases, 137 were attempted homicide (78.7%), 23 were accidents and the remaining 14 were suicides. The suicidal cases had significantly higher mortality rate than other causes (P=0.003). The most frequently used weapon was pistols (73.6%) and the events took place between 18.00 and 24.00 (36.2%) hours mainly. The injuries were mostly on extremities, however many of deaths were seen after head- neck injuries and the mortality rate of head and neck injuries was significantly higher than other regions (P<0.001). The mean of hospitalization duration was 9.1 days and it was 10.2 ± 11.7 days for survivors, 4 ± 7.3 days for died subjects. The hospitalization duration of died patients was significantly shorter than survivors (P=0.042). The GCS of died patients (4.4 ± 1.7) was significantly lower than those of survivors (13.3 ± 2.8) (P<0.001). The ISS score of died patients (49.7 ± 24.1) was significantly higher than those of survivors (13.6 ± 10.6) (P<0.001). CONCLUSION: It was determined that GCS, ISS, length of hospitalization, injuries due to suicide attempt, the department of hospitalization, injuries to head-neck regions affected mortality significantly.

Potential Risk Factors for In-Hospital Mortality in Patients with Moderate-to-Severe Blunt Multiple Trauma Who Survive Initial Resuscitation.

INTRODUCTION: The aim was to identify risk factors that influence in-hospital mortality for patients with moderate-to-severe blunt multiple trauma (BMT) who survive initial resuscitation. METHODS: The prospective study involved 195 adult patients with BMT who were admitted to a referral hospital's emergency department (ED) between May 1, 2015, and May 31, 2016. RESULTS: Forty-three (22%) of the 195 patients died in hospital. Multivariate analysis identified low blood pH (odds ratio [OR] 6.580, 95% confidence interval [CI] 1.12-38.51), high serum lactate level (OR 1.041, 95% CI 1.01-1.07), high ISS (OR 1.109, 95% CI 1.06-1.16), high APACHE II score (OR 1.189, 95% CI 1.07-1.33), traumatic brain injury (TBI) (OR 4.358, 95% CI 0.76-24.86), severe hemorrhage (OR 5.314, 95% CI 1.07-26.49), and coagulopathy (OR 5.916, 95% CI 1.17-29.90) as useful predictors of acute in-hospital mortality. High ISS (OR 1.047, 95% CI 1.02-1.08), TBI (OR 8.922, 95% CI 2.57-31.00), sepsis (OR 4.956, 95% CI 1.99-12.36), acute respiratory distress syndrome (ARDS) (OR 8.036, 95% CI 1.85-34.84), respiratory failure (OR 9.630, 95% CI 2.64-35.14), renal failure (OR 74.803, 95% CI 11.34-493.43), and multiple organ failure [MOF] (OR 10.415, 95% CI 4.48-24.24) were risk factors for late in-hospital mortality. High Glasgow Coma Scale (GCS) was a good predictor for survival at 2, 7, and 28 or more days of hospitalization (OR 0.708 and 95% CI 0.56-0.09; OR 0.835 and 95% CI 0.73-0.95; OR 0.798 and 95% CI 0.71-0.90, resp.). CONCLUSION: Several factors signal poor short-term outcome for patients who present to the ED with moderate-to-severe BMT: low blood pH, high serum lactate level, presence of TBI, severe hemorrhage, coagulopathy, organ failure (respiratory, renal, and MOF), and ARDS. For this patient group, ISS and APACHE II scores might be helpful for stratifying by mortality risk, and GCS might be a good predictor for survival.

Prognostic Value of Procalcitonin, CRP, Serum Amyloid A, Lactate and IL-6 Markers in Liver Transplant Patients Admitted to ED with Suspected Infection.

BACKGROUND/AIM: Infections are one of the most important causes of mortality and morbidity after liver transplantation as in all transplantations. Infectious complications are known to be among the preventable causes with appropriate diagnosis and treatment. So early prediction of the risk of infections will provide an effective approach to determine the local antimicrobial resistance and prevention of specific risk factors. The aim of this study was to deterimne whether specific markers are useful or not to deterimne a suspected infection in patients that have undergone liver transplantation. PATIENTS AND METHODS: The study included 65 patients with liver transplantation admitted to emergency room with suspicion of infection. These patient's CRP, procalsitonin (PCT), lactate, SAA and IL-6 levels were initially measured in the emergency department. The patients were classified to three categories according to culture results; culture-negative, culture-positive and control group. Studying parameters were investigated according to whether the culture was positive or negative in these patients. RESULTS: CRP, PCT, lactate, SAA and IL-6 levels were significanlty high in patients with suspected infeciton when compared to the control group (p<0.05). CRP, PCT and IL-6 levels were higher in the culture-positive group than in the culture-negative group and there was a significant variation (p<0.05). When suspecting an infection evaluating the parameters CRP, PCT and IL-6 was very meaningfull (p<0.05). CONCLUSION: We can use CRP, PCT, lactate, SAA and IL-6 parameters to identify presence of infection at the liver transplantation patients admitted to the emergency department with suspected infection. If CRP, PCT and IL-6 levels are significantly high we can guess the patient's positive culture.

Protective effects of hesperidin in experimental testicular ischemia/reperfusion injury in rats.

INTRODUCTION: In this study, we aimed to determine the protective effects of hesperidin, a citrus flavonoid, in a model of testicular ischemia/reperfusion injury in rats. MATERIAL AND METHODS: Forty-two pubertal male Wistar-Albino rats were divided into six groups: group 1 - control; group 2 - 50 mg/kg hesperidin (low dose hesperidin) used without torsion (LH group); group 3 - 100 mg/kg hesperidin without torsion (HH group); group 4 - torsion/detorsion group (T/D); group 5 - T/D + 50 mg/kg hesperidin treatment group (T/D + LH); and group 6 - T/D + 100 mg/kg hesperidin treatment group (T/D + HH). Hesperidin was given to the treatment groups 30 min before detorsion. After the fourth hour of reperfusion, orchiectomy was performed on the rats under anesthesia. The tissue samples were examined histologically and biochemically. RESULTS: In the T/D group testicular malondialdehyde (MDA) levels were increased significantly (p < 0.001) whereas superoxide dismutase (SOD), catalase (CAT) and glutathione (GSH) levels were decreased compared to the control and other groups. However, hesperidin caused the effect of T/D to become closer to normal biochemical values. In addition, the histological examinations showed that T/D caused damage in the testis but hesperidin reduced this effect. The effects of hesperidin were found to be dose dependent. Thus, applying high doses would generate greater therapeutic effects. CONCLUSIONS: In a rat testicular T/D model we observed biochemical and histological damage due to ischemia. However, high and low dose applications of hesperidin were shown to have protective effects against this damage. Therefore, the aforementioned citrus flavonoid may provide positive results in cases of testicular torsion.

Unexpected lumbar abscess due to scarification wet cupping: a case report.

OBJECTIVE: This case presents a rare cause of lumbar abscess. METHODS: A 51-year-old male patient was admitted to the emergency department with a complaint of lumbar pain. Spinal magnetic resonance imaging revealed a lumbar abscess. RESULTS: The abscess was treated with drainage of the abscess and antibiotic. CONCLUSION: Scarification wet cupping therapy should be taken into consideration as a rare cause of lumbar abscesses in patients who present with skin findings indicative of scarification. Scarification wet cupping therapy practitioners must pay attention to hygienic measures.

Montelukast attenuates side effects of cisplatin including testicular, spermatological, and hormonal damage in male rats.

In the current study, the protective effect of montelukast (ML) on cisplatin induced reproductive toxicity in rats was investigated. Twenty-eight rats were equally divided into four groups; first group was kept as control. In the second group, ML was orally administered at the dose of 10 mg/kg/day for 10 days. In the third group, CP was intraperitoneally administered at the dose of 7 mg/kg a single injection, and in fourth group, CP and ML were given together at the same doses. Although CP induced oxidative stress via significant increase in the formation of TBARS, it caused a significant decline in the levels of GSH, CAT, GPx, and SOD in rats. In contrast, ML prevents these effects of CP through cause an increase in GSH, CAT, GPx, and SOD levels and a decrease in formation of TBARS. In addition, sperm motility and serum testosterone levels significantly decrease and histopathological damage increases with CP treatment. However, the effects of CP on sperm motility, serum testosterone level, oxidative and histopathological changes are eliminated by ML treatment. In conclusion, the current study demonstrated that the reproductive toxicity caused by CP may be prevented by ML treatment. Thus, it was judged that co-administration of ML with CP may be useful to attenuate the negative effects of CP on male reproductive system.

Histopathological effects of fibrin glue on penile fracture in a rat model.

PURPOSE: To evaluate both histopathological effects and potential clinical application of fibrin glue on the penile cavernosal tissue. METHODS: Experimental penile fracture was formed by incising from the proximal dorsal side of the penis in 32 Wistar Albino rats. The rats were randomly assigned to four main groups of eight animals each. In the control group, the incision was not repaired and it was left to secondary healing. In the primary repair group, the incision was primarily repaired. In the fibrin glue group, glue was applied only to the incision. In the final group, fibrin glue was applied to the incision following primary repair. Three weeks later, penectomy tissue was examined histopathologically. RESULTS: When the control group was compared with primary repair+fibrin glue group, the differences in cavernous tissue healing with fibrosis and inflammation were statistically significant (p = 0.04 and 0.01, respectively). The primary repair+fibrin glue group, showed the best cavernous healing with fibrosis observed in only one rat. . There was no significant difference between the control group and the other groups according to cavernous tissue healing with fibrosis and inflammation (p = 0.11 and 0.12). Hyperemia was observed in the all groups of rats. CONCLUSIONS: Fibrin glue can be used in cavernoseal surgeries due to its adhesive and potentially anti-inflammatory features.

Antioxidative effects of curcumin, ß-myrcene and 1,8-cineole against 2,3,7,8-tetrachlorodibenzo-p-dioxin-induced oxidative stress in rats liver.

The aim of this study was to investigate the effectiveness of curcumin, ß-myrcene (myrcene) and 1,8-cineole (cineole) on antioxidant defense system in rats given a persistent environmental pollutant (2,3,7,8-tetrachlorodibenzo-p-dioxin, TCDD). Rats (n = 112) were divided randomly into 8 equal groups. One group was kept as control and given corn oil as carrier. TCDD was orally administered at the dose of 2 µg/kg/week. Curcumin, myrcene and cineole were orally administered at the doses of 100 mg/kg/day, 200 mg/kg/day and 100 mg/kg/ day, respectively, by gavages dissolved in corn oil with and without TCDD. The liver samples were taken from half of all rats on day 30 and from the remaining half on day 60 for the determination of thiobarbituric acid reactive substances (TBARS), reduced glutathione (GSH), catalase (CAT), glutathione peroxidase (GSH-Px) and CuZn-SOD levels by spectrophotometric method. The results indicated that although TCDD significantly (p ≤ 0.01) increased formation of TBARS, it caused a significant decline in the levels of GSH, CAT, GSH-Px and CuZn-SOD in rats. In contrast, curcumin, myrcene and cineole significantly increased GSH, CAT, GSH-Px and CuZn-SOD levels but decreased formation of TBARS. Additionally, the antioxidative effects of curcumin, myrcene and cineole were increased at day 60 compared to day 30. In the TCDD groups given curcumin, myrcene and cineole, oxidative stress decreased by time. In conclusion, curcumin, myrcene and cineole showed antioxidant activity and eliminated TCDD-induced oxidative stress in rats in a time-dependent manner.

The evaluation of electrocardiogram findings in acute abdominal pain patients admitted to the emergency department.

The aim of this study was to determine the diagnostic value of electrocardiogram in differential diagnosis of patients with nonspecific abdominal pain. This prospective observational study was conducted in a university emergency department over 2 weeks. One hundred twenty patients with complaints of abdominal pain were admitted to the emergency department. During the study period, a total of 120 cases were evaluated. The final emergency department disposition status of the 120 patients was 1 (0.8%) died in the emergency department, 28 (23.3%) were admitted to the general ward, 27 (22.5%) were admitted to other services, and 10 (8.3%) were admitted to the cardiology service and coronary care unit. The examination indicated that 38 (31.7%) patients with abdominal pain showed cardiac pathologies on their electrocardiograms; 3 (2.5%) patients with abdominal pain admitted to cardiology service had ST elevation, and 2 (1.6%) had electrocardiogram depression on their electrocardiograms. According to the results, the authors claim that the electrocardiogram played an important role in the treatment and diagnosis of patients presenting with abdominal pain in emergency medicine. For this reason, it was thought that emergency medicine specialists should understand the basis of the perception of abdominal pain and develop a focused approach to the initial evaluation of these patients.

Effects of montelukast on burn wound healing in a rat model.

PURPOSE: Montelukast, a selective cysteinyl leukotriene D4-receptor antagonist, is used in the treatment of asthma. In a rat model, our aim was to investigate the effects of montelukast, alone or in combination with topical antibiotics, on local burn wound healing. METHODS: Rats were randomly allocated to four groups after local burn development: Group 1; rats were left to secondary healing without treatment, Group 2; a dose of 10 mg/kg montelukast was given by gastric gavage once a day for 10 days, Group 3; rats were treated with topical pomade (bacitracin neomycin sulphate), and Group 4; rats were treat with a combination of topical antibiotic and montelukast (10 mg/kg were given by gastric gavage once a day for 10 days). Skin biopsies were taken on days 3, 10, 14, and 20 relative to burn induction. RESULTS: Reepithelialization in the pomade and montelukast+pomade groups on the 10th day was significantly greater, in comparison with control and montelukast groups (p < 0.05). For the montelukast group, edema (on the 14th day) and angiogenesis, fibroblast proliferation, edema and macrophage infiltration (on the 20th day) were statistically improved in comparison with the control group (p < 0.05). For the montelukast+pomade group, angiogenesis, fibroblast proliferation and macrophage infiltration (on the 10th day), and angiogenesis, fibroblast proliferation, edema and macrophage infiltration (on the 14th and 20th days) were statistically improved in comparison with the control group (p < 0.05). CONCLUSION: In conclusion, montelukast was effective on burn wound healing. Moreover, the effect was amplified when combined with topical antibiotics applied in the early stage of burn wound healing.

Seroprevalence of Toxocara antibodies in patients with adult asthma.

Toxocariasis is a common worldwide infection. Asthma, considered to be one of the most common chronic diseases, is a serious global health problem. Toxocara may be a possible etiologic agent of asthma. The aim of this study was to investigate whether there is an association between adult asthma and Toxocara seroprevalence. Fifty three adult patients with asthma participated in the study. All patients had an age of disease onset of 20 years or older. Blood samples were tested for the presence of Toxocara antibodies using enzyme-linked immunosorbent assay (ELISA). We found a 13.2% Toxocara seropositivity for asthma. There was a significant difference in the Toxocara seropositivity between adult asthma patients and our healthy cohort populations. There was no significant difference between Toxocara seropositive asthma and Toxocara seronegative asthma in terms of the risk factors for Toxocara infection. We believe that further research with a large number of asthma patients is warranted and preventive strategies in this patient population are needed.