From Tragedy to Resilience in a University Hospital: Characteristics of Patients in the Aftermath of the 2023 Turkey Earthquake.

OBJECTIVE: This study focuses on adults affected by the February 2023 Turkey earthquakes, aiming to uncover demographic and clinical traits. METHODS: A retrospective analysis of data from adult patients who sought emergency care between February 6 and February 21, 2023, following the earthquakes, was conducted. RESULTS: Among 3072 patients, 1544 (50.3%) of whom were women, trauma (31.1%) was the most prevalent cause of emergency department presentations. The median age of all patients was 44 y (interquartile range [IQR] 31-61 y). Hatay province accounted for 65.2% of trauma patients as origin. Most of the patients (66.8%) presented to the emergency department by their own means, while this was opposite for trauma patients, of whom 54.5% was transferred by means of Ambulance Service. Half of the total trauma patients were rescued from the debris, and 75.9% sustained limb injuries. Crush syndrome affected 24.7%, and emergency hemodialysis was performed on 9.1%, whereas emergency surgery was performed on 22.8% of all trauma cases. Overall, 10.2% of trauma patients lacked any identification. The rate of emergency department admittions due to respiratory and cardiovascular diseases was higher at the time of the earthquake compared with the previous year (P < 0.001). CONCLUSIONS: The insights gained from this study hold valuable implications for disaster response strategies, emphasizing the importance of preparedness, timely intervention, and comprehensive patient care.

Diagnostic role of thoracic ultrasound in patients with acute respiratory failure at emergency service.

BACKGROUND AND AIM: This study aimed to elucidate the effectiveness of bedside thoracic ultrasound according to BLUE protocol and to investigate its superiority over other imaging methods in the emergency service. METHODS: A total of 120 patients admitted to our institution's emergency care department due to respiratory distress have been enrolled in this prospective research. Thorax USG has been performed in the right and left hemithorax at the points specified in the BLUE protocol for each patient. Pleural sliding motion, A-lines, B-lines, consolidation, effusion, and the presence of barcode signs were evaluated individually. Age, sex, comorbid diseases, other radiological examination findings, laboratory findings, final clinical diagnosis, and hospitalization-discharge status of the patients were recorded. RESULTS: When a correct diagnosis of pneumonia has been analyzed for imaging techniques, the diagnostic rate of chest radiography was 83.3%, CT was 100.0%, and USG was 66.6%. The correct diagnostic rate of chest radiography was 94.5%; CT and USG were 100.0%. The correct diagnosis of pulmonary edema on chest radiography was 94.5%; CT and USG were 100.0%. While the correct diagnosis of pleural effusion on chest radiography and CT was 100.0%, it was 92.3% in USG imaging. Finally, CT and USG imaging performed better than chest radiography in patients with pneumothorax (chest radiography 80.0%, CT and USG 100%). CONCLUSION: USG imaging could be preferred in the diagnosis of pneumonia, pulmonary edema, pleural effusion, pneumothorax, pulmonary embolism, and differential diagnosis at the emergency service.

Amidst the clamor: Effects of emergency department noise on Physicians' health and attention.

OBJECTIVE: This study aims to assess effects of noise on physicians' stress levels and attention capacities within an emergency department. METHODS: In this prospective cross-sectional study, 15 physicians from a state hospital emergency department with 300,000 annual visits provided demographics, work factors, and physiologic data. Attention was evaluated through smartphone-based Stroop tests, while noise and heart rates were monitored via smartwatches. RESULTS: Median physician age was 26, with 16 months' emergency department experience. Average sound intensity was 68.80 dB. Despite noise, physicians in green/yellow areas showed increased Stroop scores (p = 0.002). Heart rate responses correlated with noise changes. End-of-shift surveys highlighted physicians' adaptability and resilience to high noise levels. CONCLUSION: Noisy emergency departments pose health risks to physicians, but noise-related stress did not significantly affect attention, beneficial for patient care.

Factors affecting the mortality of February earthquakes victims in Türkiye.

OBJECTIVE: >50,000 people died in the February 2023 earthquakes in Türkiye. The aim of this study was to identify the factors affecting mortality rates of the trauma patients who were presented to the emergency department (ED) after the earthquake and provide suggestions for better preparedness strategies for future natural disasters. METHODS: This retrospective, cross-sectional study encompassed data from 955 trauma patients out of 3072 patients aged 18 years and above who sought assistance in the ED. Patients were divided into two groups: the survivor group and the exitus group. Age, gender, the city where patients came from, type of presentation, injured organ systems and mechanisms of injury, laboratory findings, the diagnoses in the ED, time spent in the ED, surgical intervention, and hemodialysis sessions were analyzed. The characteristics of those who could not be identified at the presentation to the ED were subjected to additional analysis. RESULTS: Out of 955 patients, 75.9% had extremity injuries, with crushing injuries (23.6%) being predominant. There were no significant differences in age or gender between the survivor and exitus groups (p = 0.776, p = 0.522), nor in the province of admission (p = 0.249). Clinical factors indicated that the exitus group were more likely to lack identification documents (29.6%), have spent longer trapped under debris, and have a higher frequency of ambulance transportation. Injuries such as chest and abdominal trauma, specific injury types, and amputation or open wounds were notably more frequent in the exitus group. Diagnoses revealed that metabolic causes were more common in exitus group (p < 0.001). While no significant difference existed in the need for emergency surgical intervention (p = 0.939), a higher frequency of emergency hemodialysis was observed among exitus group (p = 0.001). Laboratory findings indicated higher levels of various markers and lower calcium, base excess, and pH levels among those in the exitus group. CONCLUSION: In the aftermath of a devastating earthquake, this study underscores the formidable challenges faced by healthcare systems during natural disasters. To prepare for future disasters, healthcare systems must enhance resilience, develop rapid identification techniques, and adopt a holistic patient care approach.

Assessing cytotoxic activities, theoretical and in silico molecular docking calculations of phthalocyanines bearing cinnamyloxy-groups.

Cancer has been recognized as one of the deadliest diseases in the world in recent years. By chemically tailoring specific properties, anticancer agents can be prepared very effectively for the treatment of various cancer types. In this manner, as anticancer agents, a series of soluble metal-free and metallophthalocyanines carrying cinnamyloxy-groups at peripheral ß-positions have been prepared. All synthesized phthalocyanines were characterized by various spectroscopic approaches such as ultraviolet - visible (UV - Vis), Fourier transform infrared (FT-IR), and matrix-assisted laser deionization/ionization time-of-flight mass spectroscopy (MALDI-TOF MS) techniques. These compounds are highly soluble in dimethyl sulfoxide (DMSO) and soluble in common organic solvents. The spectroscopic properties, cytotoxicity, and theoretical calculations of these complexes have been investigated. In cytotoxicity tests, compounds 1, 4, and 7 are the most active against HT-29 cell lines with IC50 values of 36.9 µM, 32.5 µM, and 51.1 µM, respectively. Also, the most and the least cytotoxic compounds against healthy CCD cell line is compounds 5 and 6 with the IC50 value of 13.4 µM and >250 µM, respectively. The PDB ID:4BQG target protein representing the HT-29 cancer cell line and the anti-cancer activities of phthalonitrile and its phthalocyanines were supported by molecular docking studies. Density Functional Theory (DFT) study supported the experimental results, including the spectral data, and implied that the compounds 5-7 are comparable by their characteristics, such as electronic properties, optical properties, electrostatic potentials, reactivity parameters, with the earlier studied compounds 2-4, which were successfully proved to be good candidates for cancer treatment.Communicated by Ramaswamy H. Sarma.

Prospective analysis of intoxicated patients developing shock and/or organ failure.

BACKGROUND: Data on intoxication patients with shock and acute organ failure is valuable for the prediction of the tailored scale prognosis of the patients in the emergency department. METHODS: : Our study was designed prospectively as a cross-sectional and observational over the course of four years. The patients over 18 years of age were included and the epidemiological data related to development of shock and acute organ failure, the treatments, and the outcome were recorded. The organic phosphate severity score was also calculated for all patients. RESULTS: A total of 89 patients with shock and/or acute organ failure 72 (80.9%) of the patients were males. Methanol (51 patients, 57.3%) was the most common cause of intoxications followed by cardiovascular agents. Thirty (33.7%) patients died despite all treatments and mortality was found to be higher in patients with hypotension (p = 0.031) at the time of admission to the emergency department and in those with a high organic phosphate poisoning severity index (p = 0.001). High levels of WBC, creatine, lactate, base excess and low bicarbonate and blood pH were associated with mortality. The discharge rates of patients who received extracorporeal treatment were statistically higher than those who did not receive this treatment (p = 0.001). DISCUSSION: The organic phosphate poisoning severity score can partially help us to predict the prognosis in all poisoning patients at the time of the first presentation. Emergency physicians may consider the development of hypotension, high creatine, lactate, base excess, low bicarbonate, and blood pH to be associated with a poor prognosis in the first hours of admission in acute poisoning patients. In these patients, it was predicted that the addition of selected extracorporeal methods without delay, in addition to the treatments that should be applied, may increase the survival rate.

Self-Healing Systems in Silicon Anodes for Li-Ion Batteries.

Self-healing is the capability of materials to repair themselves after the damage has occurred, usually through the interaction between molecules or chains. Physical and chemical processes are applied for the preparation of self-healing systems. There are different approaches for these systems, such as heterogeneous systems, shape memory effects, hydrogen bonding or covalent-bond interaction, diffusion, and flow dynamics. Self-healing mechanisms can occur in particular through heat and light exposure or through reconnection without a direct effect. The applications of these systems display an increasing trend in both the R&D and industry sectors. Moreover, self-healing systems and their energy storage applications are currently gaining great importance. This review aims to provide general information on recent developments in self-healing materials and their battery applications given the critical importance of self-healing systems for lithium-ion batteries (LIBs). In the first part of the review, an introduction about self-healing mechanisms and design strategies for self-healing materials is given. Then, selected important healing materials in the literature for the anodes of LIBs are mentioned in the second part. The results and future perspectives are stated in the conclusion section.

Effective removal of 137Cs ions from radioactive wastewater by Melamine-Styrene based Polymer (MSP).

Cesium (Cs) is a major product of uranium fission, which is one of the most existed radionuclides in radioactive wastes. Removal of Cs-137 has a critical role in the decontamination of liquid radioactive waste due to its half-life of 30.17 years. Concordantly, melamine styrene based conjugated polymer (MSP) was designed, synthesized, and characterized with FTIR, TGA, SEM and BET measurements. The novelty of the study is that the MSP adsorbent is designed as a highly conjugated structure to have better interaction with Cs over the Cs-π bond of the benzene groups of the adsorbent. In this work, the adsorption behavior and rate of MSP were investigated as parameters of adsorbent amount, pH, contact time, particle size, initial Cs+ concentration, and temperature. Besides, the adsorption efficiency of Cs-137 was examined by Gamma Spectroscopy. Adsorption results were fitted to three different isotherms which were Freundlich, Langmuir and Dubinin-Radushkevich (D-R). The maximum adsorption capacity of polymer for Cs+ ion was found from Langmuir isotherm as 78 mg g-1. As a part of kinetic parameters, pseudo first and second orders were investigated and in terms of the correlation coefficient pseudo second order was much more appropriate for adsorption of Cs-137 onto MSP.

Biologically active phthalocyanine metal complexes: Preparation, evaluation of α-glycosidase and anticholinesterase enzyme inhibition activities, and molecular docking studies.

In this study, preparation, as well as investigation of α-glycosidase and cholinesterase (ChE) enzyme inhibition activities of furan-2-ylmethoxy-substituted compounds 1-7, are reported. Peripherally, tetra-substituted copper and manganese phthalocyanines (5 and 6) were synthesized for the first time. The substitution of furan-2-ylmethoxy groups provides remarkable solubility to the complex and redshift of the phthalocyanines Q-band. Besides, the inhibitory effects of these compounds on acetylcholinesterase (AChE), butyrylcholinesterase (BChE), and α-glycosidase (α-Gly) enzymes have been investigated. The AChE was inhibited by these compounds (1-7) in low micromolar levels, and K i values were recorded between 11.17 ± 1.03 and 83.28 ± 11.08 µM. Against the BChE, the compounds demonstrated K i values from 7.55 ± 0.98 to 81.35 ± 12.80 µM. Also, these compounds (1-7) effectively inhibited α-glycosidase, with K i values in the range of 744.87 ± 67.33 to 1094.38 ± 88.91 µM. For α-glycosidase, the most effective K i values of phthalocyanines 3 and 6 were with K i values of 744.87 ± 67.33 and 880.36 ± 56.77 µM, respectively. Moreover, the studied metal complexes were docked with target proteins PDB ID: 4PQE, 1P0I, and 3WY1. Pharmacokinetic parameters and secondary chemical interactions that play an active role in interaction were predicted with docking simulation results. Overall, furan-2-ylmethoxy-substituted phthalocyanines can be considered as potential agents for the treatment of Alzheimer's diseases and diabetes mellitus.

Assessment of distribution of heavy metals and activity level of 210Pb in biota from the northern coast of the Marmara Sea and Western Black Sea.

In this study, heavy metals (Cd, Co, Cu, Ni, Pb, Zn, V) and 210Pb analyses have been performed in the marine biota (scaldfish, sea lettuce, crab). Samples were collected from 5 different parts of the Marmara Sea and Western Black Sea in January 2020. The results indicated that the highest Cu and Zn content was found in algae samples, but it was observed that heavy metal concentrations such as Co, Cu, Cd and V were generally low and under permissible limit. Also, 210Pb (radioactive isotope of Pb) activity levels were determined to vary from 23.20 Bq kg-1 to 52.67 Bq kg-1 dry weight. It was clearly seen that there was a linear correlation between the toxic and radioactive Pb when the obtained data were compared.

Add oleander to your list of corrosives.

INTRODUCTION: Nerium oleander is a toxic ornamental plant which usually grows in the Mediterranean area. In the past it was used to produce cardiotonic medicine and there are studies on using this plant as an anti-cancer medicine and on its use in alternative medicine for many causes. CASE PRESENTATION: Our case was of a 36 years old male who came to the emergency department with sore throat and burning feel in the throat following his curious bite of the oleander leaf. He had no trouble of breathing. The physical examination of the mouth showed burn-like lesions and edema of the uvula, oropharyngeal hyperemia, congestion and on the second day; necrosis. The edema and necrosis were later reduced with the treatment. We discharged the patient after observing for three following days without any complications or side effects. CONCLUSION: Besides the systemic effects of the oleander plant, this case demonstrates that it could cause serious tissue necrosis when applied locally and corrosive esophagitis when taken by oral way. Patients must be examined and followed also for local toxic effects.

A radioactively durable melamine-styrene based polymer: Highly efficient removal of 90Sr.

Removal of strontium has a vital importance for radioactive waste management due to its long half-life. In this context, melamine-styrene based polymer (MSBP) was synthesized and characterized by different spectrophotometric methods. Sr2+ ions were removed from the solution using MSBP sorbent. In this respect, adsorption of Sr2+ onto melamine-based polymer was studied as a part of pH, amount of adsorbent, initial Sr2+ concentration, contact time, temperature and particle size. Also, adsorption rate of radioactive strontium was investigated by using LSC (Liquid Scintillation Counter). The adsorption data were fitted to Langmuir, Freundlich and Dubinin-Radushkevich (D-R) isotherm models. MSBP sorbent reached maximum adsorption capacity for Sr2+ as 142.9 mg.g-1. Thermodynamic parameters such as free energy (ΔG0), entropy (ΔS0) and enthalpy (ΔH0) of Sr2+ adsorption on MSBP were examined at five different temperatures of 293 K, 303 K, 313 K, 323 K and 333 K. 0 < ΔH0 values indicated that sorption mechanism presented endothermic feature. 0 > ΔG0 and 0 < ΔS0 revealed that Sr2+ adsorption on MSBP occurred spontaneously and irreversible, respectively. Pseudo first and second orders were investigated as a part of kinetic parameters and seen that pseudo second order was much more convenient for adsorption of Sr2+ onto MSBP.

Monitoring the antioxidant activities by extracting the polyphenolic contents of algae collected from the Bosphorus.

The identification and quantification of ascorbic acid, phenolic acids and flavonoids were carried out simultaneously with a rapid method of reverse-phase high-performance liquid chromatography (RP-HPLC). Total flavonoid contents were being determined by UV-Vis spectrophotometry, and total phenolic contents were determined by UV-Vis spectrophotometry using the Folin-Ciocalteu Reagent (FCR) method. In all of the individual contents and total phenolic content analysis, the best results were obtained with the methanol-water solvent system. The methanol-hexane solvent system was selected as the best for the extraction of total flavonoid contents. The reason for this difference is the flavonoids in the analyzed samples which were the lipophilic character. Examining the algae species, the highest contents were achieved from Ulva lactuca and Ceramium rubrum species. Depending on industrial activity and the population density, regional characteristics have been shown to be effective in the changes of these contents which show antioxidant properties.

Orthogonal Synthesis of Block Copolymer via Photoinduced CuAAC and Ketene Chemistries.

A novel route for the synthesis of poly(ethylene glycol)-b-polystyrene copolymer, starting from commercially available poly(ethylene glycol) methyl ether and azido terminated polystyrene prepared by atom transfer radical polymerization and subsequent nucleophilic substitution, is applied with simplicity and high efficiency. The combination of photoinduced copper (I)-catalyzed alkyne-azide cycloaddition (CuAAC) and ketene chemistry reactions proceeds either simultaneously or sequentially in a one-pot procedure under near-visible light irradiation. In both cases, excellent block copolymer formations are achieved, with an average molecular weight of around 7000 g mo1(-1) and a polydispersity index of 1.20.

Polybenzoxazine: a powerful tool for removal of mercury salts from water.

A reusable macroporous polybenzoxazine resin with high specific surface area was prepared as sorbent material for the removal of mercury salts. For this purpose, allyl-functionalized bis-benzoxazine was cured in dimethyl sulfoxide by thermally activated ring-opening polymerization at 180 °C for 3 d followed by a freeze-drying process. The porous structure of the resin was confirmed by SEM analysis and N2 adsorption/desorption studies at 77.3 K. Among various metal ions, namely, Pb(II), Fe(II), Mn(II), Cu(II), Zn(II), and Cd(II), the porous polybenzoxazine resin exhibited a specific sorption behaviour towards Hg(II). Mainly chemisorption and to some extent adsorption mechanisms were proposed for the observed high loading capacity of the resin. As evidenced by FTIR spectral analysis, the chemisorption is attributed to the coordination system formed between free OH and tertiary amino groups in the polybenzoxazine structure and Hg(II) ions. It was also demonstrated that the porous polybenzoxazine can be regenerated simply by treatment with acids. The resin was recycled for up to seven cycles without any significant loss of activity, as proved by sorption and desorption experiments.

Toxic metal (Pb, Cd, As and Hg) and organochlorine residue levels in hake (Merluccius merluccius) from the Marmara Sea, Turkey.

Toxic metals (Pb, Cd, As and Hg) and organochlorine residue levels were measured in hake (Merluccius merluccius) from the Marmara Sea. Biota samples were collected by a trawling cruise of the R/V ARAR in August and December 2009. The concentrations of toxic metals varied between Pb, 3.23-14.4; Cd, <0.01-2.14; Hg, 0.01-0.18 and As, 0.01-0.21 [Formula: see text]g g(-1) dry wt. Pb levels in the Marmara Sea were found to be higher than the critical limits set by the both Turkish Ministry of Environment for Aquatic Products (1 µg g(-1) wet wt.) and European countries (2.0 µg g(-1), UNEP 1985). In contrast, As and Hg levels were found to be lower than the critical limits for two periods. Cd contents of fish from the Marmara Sea were also comparable to or slightly lower than contents of fish from the Southern Black Sea Shelf. The results of organochlorine residues ranged between total HCH, <0.05 and 99 ng g(-1); endrin, <0.001 and 381 ng g(-1); alpha-endosulphan, <0.05 and 90 ng g(-1); beta-endosulphan, <0.05 and 15.3 ng g(-1); o,p DDE, 3.5 and 52.4 ng g(-1); p,p DDE, 7.4 and 139 ng g(-1); o,p DDD, 1.5 and 90.2 ng g(-1) and p,p DDD, 2.7 and 86 ng g(-1) wet weight. The rivers for the distribution of organochlorine levels in the Marmara Sea ordered from highest to lowest as Dil R. > Susurluk R. > Biga R. > Gönen R. The high levels of o,p and p,p DDE, and o,p and p,p DDD compounds, which are metabolites of DDT, indicate its illegal use. Toxic metal and organochlorine residue levels of fish are significantly higher than levels from the Mediterranean Sea.