Serum pNF-H levels in the first six hours after experimental mild traumatic brain injury in rats.

OBJECTIVE: Mild traumatic brain injury (mTBI) cases with a normal CT scanning account for the vast majority of all TBI patients. The aim of this study was to investigate the course of serum Phosphorylated Neurofilament Heavy Chain (pNF-H) levels in the first six hours after trauma in rats in experimental mTBI. MATERIALS AND METHODS: In this experimental animal study, 32 female Sprague-Dawley rats were enrolled equally (n=8) into 3 experimental groups and 1 control group. In experimental groups, animals were exposed to a mTBI with a free fall of 50-gram metal disc from a height of 80 cm. We compared serum pNF-H levels at the 2nd, 4th, and 6th hours after traumatic brain injury in the experimental groups with the control group. RESULTS: Serum pNF-H levels at the 2nd and 4th hours after traumatic brain injury were statistically significantly higher than the control group. Serum pNF-H levels gradually decreased at the 4th and 6th hours compared to the 2nd hour and decreased to a similar level to the control group at the 6th hour after injury. CONCLUSIONS: A high serum pNF-H value, could be used in the diagnosis and management of mTBI patients.

Violence against emergency department employees and the attitude of employees towards violence.

INTRODUCTION: This study was conducted to evaluate the occurrence of violent incidents in the workplace among the various professional groups working in the emergency department. We characterised the types of violence encountered by different occupation groups and the attitude of individuals working in different capacities. METHODS: This cross-sectional study included 323 people representing various professional groups working in two distinct emergency departments in Turkey. The participants were asked to complete questionnaires prepared in advance by the researchers. The data were analysed using the Statistical Package for the Social Sciences (Windows version 15.0). RESULTS: A total of 323 subjects including 189 (58.5%) men and 134 (41.5%) women participated in the study. Their mean (± standard deviation) age was 31.5 ± 6.5 years and 32.0 ± 6.9 years, respectively. In all, 74.0% of participants had been subjected to verbal or physical violence at any point since starting employment in a medical profession. Moreover, 50.2% of participants stated that they had been subjected to violence for more than 5 times. Among those who reported being subjected to violence, 42.7% had formally reported the incident(s). Besides, 74.3% of participants did not enjoy their profession, did not want to work in the emergency department, or would prefer employment in a non-health care field after being subjected to violence. According to the study participants, the most common cause of violence was the attitude of patients or their family members (28.7%). In addition, 79.6% (n=257) of participants stated that they did not have adequate safety protection in their working area. According to the study participants, there is a need for legal regulations to effectively deter violence and increased safety measures designed to reduce the incidence of violence in the emergency department. CONCLUSION: Violence against employees in the emergency department is a widespread problem. This situation has a strong negative effect on employee satisfaction and work performance. In order to reduce the incidence of violence in the emergency department, both patients and their families should be better informed so they have realistic expectations as an emergency patient, deterrent legal regulations should be put in place, and increased efforts should be made to provide enhanced security for emergency department personnel. These measures will reduce workplace violence and the stress experienced by emergency workers. We expect this to have a positive impact on emergency health care service delivery.

Serum levels of endocan, claudin-5 and cytokines in migraine.

OBJECTIVE: Endothelial dysfunction is involved in inflammatory disorders, migration, angiogenesis, and tumor progression. There is a known relationship between migraine and inflammation; however, there are conflicting data as to whether there is a link between migraine and endothelial dysfunction. The current study aimed to determine the relationships between migraine and levels of serum Endocan (ESM-1), Claudin-5 (CLDN5), IL-1ß, IL-6 and TNF-α levels, which are proven indicators of endothelial dysfunction and inflammation in patients with migraine. PATIENTS AND METHODS: Thirty-one patients and 24 healthy subjects were included in this study. Participants underwent thorough physical and neurological evaluations, and levels of serum ESM-1, CLDN5, IL-1ß, IL-6 and TNF-α were measured for each patient. RESULTS: The levels of ESM-1, CLDN5, IL-1ß, IL-6, and TNF-α were significantly higher in the migraine attack group than in the control group (p: 0.006, p: 0.002, p: 0.002, p: 0.003, p: 0.036, respectively). Additionally, there were significant differences in the ESM-1 levels of the visual analog scale (VAS) subgroup (p = 0.041), and there were moderate differences in the CLDN5 levels of the VAS subgroup (p = 0.064). CONCLUSIONS: High serum levels of IL-1ß, IL-6 and TNF-α in the migraine attack group indicate that inflammation plays a major role in migraine pathogenesis. In particular, the high ESM-1 and CLDN5 levels in patients with migraine suggest that inflammation should be investigated further, it may be a useful tool in the differential diagnosis of migraine.

Effect of etanercept and lithium chloride on preventing secondary tissue damage in rats with experimental diffuse severe brain injury.

OBJECTIVE: Studies in animals have provided key evidence that antagonizing TNF-α is a viable therapeutic strategy for diffuse severe brain injury. This study is planned to prevent post-traumatic secondary tissue damages in rat diffuse severe brain injury model, which is induced by alone or combined administration of Etanercept and lithium chloride (LiCl). MATERIALS AND METHODS: Male Sprague-Dawley rats were used in the current study. Rats were divided into 5 groups. Trauma was not induced and treatment was not applied to rats of Sham group. For rats of Trauma+Saline group, saline 0.9% was administered via intraperitoneal (i.p.) route at dose of 1 mg/100 g body weight 1 hour after trauma. For rats of Trauma+Etanercept group, Etanercept was administered via i.p. route at dose of 5 mg/kg body weight 1 hour after trauma. For rats of Trauma+LiCl group, LiCl was administered via i.p. route at dose of 50 mg/kg body weight 1 hour after trauma. For rats of Etanercept+LiCl group, Etanercept and LiCl were administered via i.p. route at dose of 5 mg/kg body weight and 50 mg/kg body weight, respectively, 1 hour after trauma. Serum glial fibrillary acidic protein (GFAP) and Tau levels were analyzed with ELISA. For analyses H&E, TUNEL, GFAP and TNF-α staining methods were used. RESULTS: We demonstrate that Etanercept treatment reduced the TBI-induced brain tissues alteration, reduced the expression of TNF-α and improve edema and axonal swelling. We observed a significant decrease in TNF-α and GFAP positivity after LiCl was administered. CONCLUSIONS: The findings obtained in this study suggest that the combination therapy with Etanercept and LiCl decreased neuronal degeneration and alleviated secondary tissue damage in post-traumatic period.

Investigation of the course of GFAP in blood in the initial 24 hours in rats subjected to minor head trauma.

AIM: Aim of this study is to evaluate the diagnostic efficacy of Glial Fibrillar Acidic Protein (GFAP) particularly in minor head traumas. MATERIALS AND METHODS: 72 female and male, 3 month-old, Sprague Dawley rats were used in the study. The rats were divided into 9 groups. Following anesthesia, all rats were placed in prone position. A 10 mm long and 3 mm thick stainless steel metal disc was fixed onto the skull using dental paste in order to sustain a closed head trauma and evenly distribute the weight throughout the skull. After placing it under the metallic pipe arrangement over a height of 80 centimeters and fixing to make it constant, 50 g metallic discs were released by free fall, and the head trauma was sustained thanks to the gravity-generated force. Blood samples were collected from the rats under anesthesia for biochemical GFAP analysis 10 minutes after the trauma and in 1, 2, 3, 4, 5, 6 and 24 consecutive hours later. RESULTS: GFAP has a peak, and its peak level at hours 1 and 2 in rats subjected to a minor head trauma, with a slight decrease afterwards. CONCLUSIONS: GFAP is an important marker in determining the severity of traumatic brain injury.

Comparison of the effectiveness of intravenous diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillation.

OBJECTIVE: To compare the effectiveness of intravenous (IV) diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillation (AF). METHODS: This prospective, randomised study was conducted in the Emergency Department of the Uludag University Medical Faculty Hospital, Bursa, Turkey. Forty AF patients with a ventricular rate > or = 120/minute and systolic blood pressure > or = 95 mm Hg were included and randomised to receive IV diltiazem 0.25 mg/kg (maximum 25 mg) or metoprolol 0.15 mg/kg (maximum 10 mg) over 2 minutes. Blood pressures and heart rate were measured at 2, 5, 10, 15, and 20 minutes. Successful treatment was defined as fall in ventricular rate to below 100/minute or decrease in ventricular rate by 20% or return to sinus rhythm. RESULTS: Between January 2000 and July 2002, 40 patients (18 men, 22 women) met the inclusion criteria. Of these 20 (8 men, 12 women; mean age 60.2 years, range 31-82) received diltiazem and 20 (10 men, 10 women; mean age 64.0 years, range 31-82) received metoprolol. The success rate at 20 minutes for diltiazem and metoprolol was 90% (n = 18) and 80% (n = 16), respectively. The success rate at 2 minutes was higher in the diltiazem group. The percentage decrease in ventricular rate was higher in the diltiazem group at each time interval. None of the patients had hypotension. CONCLUSION: Both diltiazem and metoprolol were safe and effective for the management of rapid ventricular rate in AF. However, the rate control effect began earlier and the percentage decrease in ventricular rate was higher with diltiazem than with metoprolol.