The diagnostic and prognostic value of serum neurogranin in acute ischemic stroke.

OBJECTIVES: Stroke is a frequently encountered life-threatening medical condition in emergency departments (EDs). Despite all worldwide efforts, a reliable circulating biomarker has not been identified yet. This study investigates the diagnostic and prognostic value of neurogranin (Ng) in acute ischemic stroke (AIS). METHODS: This prospective case-control study was conducted on ED patients with AIS and healthy volunteers. We collected the basic demographics, measured serum Ng levels of the patients vs. controls, and followed up the patient group for 6-month by phone or clinical notes to assess the functional outcomes. RESULTS: Data analysis was completed with 142 subjects (86 patients vs. 55 controls). The groups did not differ in terms of age and gender. The median serum Ng level of the patient group was significantly higher compared to the control group [160.00 (75.93) vs. 121.26 (90.35) ng/mL and p Ë‚ 0.001, respectively]. Serum Ng level of 25 patients admitted to the ED within the first 6 hours from the onset of AIS was 177.93 (24.03) ng/mL, while serum Ng level of 61 patients admitted to the ED within 6-24 hours was 131.84 (76.44) ng/mL. AUROC results were 0.717 vs. 0.868 vs. 0.874 for stroke patients admitted during the first 24 hours, 6 hours, and 4.5 hours after the onset, respectively. Lesion volume, NIHSS, and modified Rankin Scale scores (mRS) at admission showed no significant correlation with Ng levels as well as 6-month mortality and 6-month mRS. CONCLUSIONS: Timely AIS diagnosis is still a challenge for emergency departments due to the dependency on imaging. Serum Ng can be a promising diagnostic biomarker for AIS patients admitted in the first 24 hours. Even it outperformed in the first 4.5 and 6-hour time windows. However, it did not show a significant prognostic value.

Is working in the emergency department a risk factor for sleep disorders for healthcare workers?

OBJECTIVE: This study aims to investigate the relationship between work-related stress and sleep disorders in healthcare personnel working in emergency department and in other departments. MATERIAL AND METHODS: This cross-sectional study included 34 emergency department healthcare personnel (emergency group [EG]) and 35 healthcare personnel working in other departments (non-emergency group [NEG]) and was conducted between November 10, 2019 and March 1, 2020. All participants were administered the following questionnaires: work-related strain inventory (WRSI), Epworth sleepiness scale (ESS), Berlin questionnaire, insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), Beck depression inventory (BDI), and Beck anxiety inventory (BAI). RESULTS: While the mean WRSI score of EG was 39.53±7.77, the mean WRSI score of NEG was 30.06±7.26 (t=5.236, p<0.001). According to PSQI, 79.4% of EG and 57.1% of NEG were found to have poor sleep quality (X2=3.938, df=1, p=0.047). Median PSQI overall score was 12 (IQR 25th-75th percentiles: 10-14) in EG, and 7 (IQR 25th-75th percentiles: 4-9) in NEG (U=285.5, p<0.001). While the mean anxiety score of EG was 13.35±5.70, the mean anxiety score of NEG was 9.06±6.00 (t=3.046, p=0.003). Median depression score was 12 (IQR 25th-75th percentiles: 10-16) in EG, and was 8 (IQR 25th-75th percentiles: 4-12) in NEG (U=354, p=0.004). A significant positive correlation was found between work-related strain scores and sleep quality, sleepiness, and insomnia severity scores (r=0.541, p<0.001; r=0.310, p=0.010; r=0.357, p=0.004; respectively). CONCLUSION: It was determined that healthcare personnel working in the emergency department were at higher risk of developing sleep disorders compared to healthcare personnel working in other departments and that there was a significant relationship between sleep disorders and work-related stress.

The protective effect of JZL184 on ovarian ischemia reperfusion injury and ovarian reserve in rats.

AIM: Ovarian torsion is a gynecopathology that requires emergency surgery in women. However, ischemia reperfusion injury (IRI) occurs after treatment with detorsion. This study aimed to evaluate the effects of monoacylglycerol lipase inhibitor JZL184 on ovarian IRI and ovarian reserve. METHODS: Forty-eight female Wistar albino rats were divided into six groups. Group 1: Sham, Group 2: Ischemia, Group 3: ischemia/reperfusion (IR), Group 4: IR + JZL184 4 mg/kg, Group 5: IR + JZL184 16 mg/kg, Group 6: IR + vehicle (dimethyl sulfoxide). Three hours of ischemia followed by 3 h of reperfusion. Two different doses of JZL184 (4 and 16 mg/kg) were administered intraperitoneally in Group 4 and 5, 30 min before reperfusion. Ovarian IRI and ovarian reserve were evaluated in serum and tissue by using histopathological and biochemical parameters. RESULTS: Treatment with JZL184 was associated with a significant increase in ovarian 2-arachidonoylglycerol and improved serum anti-Mullerian hormone, Inhibin B, primordial follicle count, and ovarian histopathological damage score (p < 0.05). JZL184 treatment significantly decreased the level of malondialdehyde, and increased superoxide dismutase enzyme activity and glutathione (GSH) levels (p < 0.05). The increased phosphorile nuclear factor-κB (Phospho-NF-κB-p65), tumor necrosis factor alpha (TNF-α), interleukin-1beta (IL-1ß), transforming growth factor beta 1 (TGF-ß1), and TUNEL assay immunopositivity scores in ovarian I/R injury were decreased after treatment with JZL184 (p < 0.05). CONCLUSIONS: JZL184 showed significant ameliorative effects on ovarian IRI and ovarian reserve caused by IR through acting as an antioxidant, anti-inflammatory, and antiapoptotic agent. Thus, JZL184 may be a novel therapeutic agent for ovarian IRI.

Ability of Bedside Ultrasonography to Detect Pediatric Nasal Bone Fractures.

OBJECTIVES/HYPOTHESIS: The aims of this study were to evaluate the diagnostic test features of bedside ultrasonography in pediatric patients with nasal trauma and to investigate whether it is a preferable alternative method to conventional radiography (CR). STUDY DESIGN: Cross-sectional prospective study. METHODS: This prospective study was conducted from March 1, 2019, through November 1, 2019. Thirty-one patients under the age of 18 years who had nasal trauma were consecutively included. CR and ultrasonographic imaging tests were investigated in patients with clinical indications for nasal bone fracture. The sensitivity, specificity, and accuracy of ultrasonography and CR were calculated with respect to detecting nasal fractures according to the gold standard method. RESULTS: Participants were between 3 and 16 years old and the median age was 8 (5-13) years. Nasal bone fracture was clinically detected in 18 patients. While 13 of these fractures were detected with ultrasonography, only 11 were also detected with CR. The sensitivity and specificity of ultrasonography and CR in detecting nasal fractures were 72.2% (95% confidence interval [CI]: 46.5-90.3) and 76.9% (95% CI: 46.2-95.0) for ultrasonography and 61.1% (95% CI: 35.8-82.7) and 69.2% (95% CI: 38.6-90.9) for CR. CONCLUSIONS: According to the results of this study, ultrasonography may be used with confidence as a first imaging method in the investigation of nasal fractures, particularly with consideration for avoiding the effects of radiation as much as possible. Our findings point to the next step of conducting trials with a greater number of patients in order to define the diagnostic test features of ultrasonography in pediatric patients. LEVEL OF EVIDENCE: 2 Laryngoscope, 131:1398-1403, 2021.

Evaluation of Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in blunt chest trauma patients.

BACKGROUND: After blunt chest trauma, life-threatening arrhythmias may occur in the early post-injury period, as well as a few days after the injury. This study aimed to evaluate the risk of arrhythmias in blunt chest trauma patients using Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio. METHODS: In this study, patients who applied to the emergency department due to blunt chest trauma were examined prospectively. The 12-lead ECG was performed to both blunt chest trauma and control group. ECG measurements of QT and Tp-e intervals were performed from both groups. RESULTS: A total of 81 participants; 41 blunt chest trauma patients and 40 healthy volunteers were included in this study. Tpe, Tpe/QT, Tpe/QTc values were statistically significant in the trauma group compared to the control group (p<0.001). Although Tpe/QTc, max QT and min QT were statistically significant (p<0.05) in patients with a rib fracture, no difference was detected concerning Tpe, Tpe/QT compared to no-rib fracture group (p>0.05). CONCLUSION: Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in ECG predict the arrhythmias that may occur in blunt cardiac trauma, especially in blunt chest trauma patients.

Kounis syndrome due to hirudotherapy (leech therapy) in emergency department; a case report.

Kounis Syndrome is the development of acute coronary syndrome (ACS) because of allergic reactions; allergens, such as foods, insect venom, iodine contrast agent or drugs can cause this syndrome. Hirudotherapy (leech therapy) is increasingly used as a useful therapeutic option in a variety of medical and surgical procedures, and potential complications related to this therapy include Aeromonas species infections, bleeding, anemia and allergic reactions. Here, we present a patient diagnosed as Type 1 Kounis Syndrome after using hirudotherapy for her knee aches. 41-year-old woman admitted to emergency department with sudden onset of face edema, shortness of breath and chest pain complaints and diagnosed as an allergic reaction and anaphylaxis due to leech therapy. Kounis Syndrome should be considered in acute coronary syndrome patients who were admitted to emergency department with anaphylaxis clinic.

An incidental image of a patient with chest pain after fall from a tree: Swyer-James-MacLeod syndrome?

Unilateral hyperlucent lung was firstly described by Swyer and James 1950s. After that, some patients with same disease were detected by Macleod . Then this syndrome was named as Swyer- James-Macleod syndrome (SJMS), and this syndrome includes a smaller or normal sized unilateral hyperlucent lung. The diagnosis of SJMS includes a detailed evaluation and the exclusion of other reasons of unilateral hypertranslucency. In literature, small groups of patients with this syndrome have been described. This paper reports a 45-year-old male presented to our emergency department with chest pain after fall from height 24 h ago. In his computed tomography no rib fracture, pneumothorax and hemothorax. But an abnormal image (5.5 cm hyperlucent area) was seen in his left lung. This report aims to present one of incidentally diagnosed rare case of SJMS.

Alterations in optic nerve sheath diameter according to cerebrovascular disease sub-groups.

BACKGROUND: ONSD (optic nerve sheath diameter) is a method used for indirect measurement of the increased intracranial pressure. In previous studies, the relation between the increased intracranial pressure and ONSD was analyzed in the patients suffering from cerebrovascular diseases (CVD). In our study, the patients suffering from ischemic CVD were categorized into 4 subgroups according to Oxfordshire Community Stroke Project classification (OCSP); the relationship between each group and ONSD, and the influence on each eye were analyzed. METHODS: The study included the patients over the age of 18 applying to the emergency department of Malatya State Hospital with the symptoms of stroke between the dates of 1/1/2015 and 1/9/2016. The patients diagnosed with stroke by means of clinical and neuroradiological imaging were examined in 4 subgroups according to Oxfordshire Community Stroke Project. The aim of the study is to predict the intracranial pressure (ICP) levels of the patients through ONSD measurement and CT images. RESULTS: In the comparison of the right and left optic nerve sheath diameters of CVD group and control group, the obtained results were found to be statistically significant (p<0.001). When the CVD subgroups were compared with the control group in terms of right and left optic nerve sheath diameters, the highest right-left optic nerve sheath diameter was detected to be in TACI (Total Anterior Circulation Infarction) group (p<0.001). DISCUSSION/CONCLUSION: In the early cases of CVD, mortality and morbidity can be decreased through the early diagnosis of the possible existence of ICP increase according to ONSD level.

Comparison of the factors affecting neurological outcome in out-of vs in-hospital cardiac arrest cases.

Objective: To determine the differences between the factors such as return of spontaneous circulation positivity, duration of cardiopulmonary resuscitation, and cardiac rhythm at first arrival affecting neurological outcomes in cardiac-arrest cases. Methods: This study was conducted at the Malatya State Hospital, Malatya, Turkey, from January to December 2014, and comprised patients who had received cardiopulmonary resuscitation. Patients were divided into two groups; in-hospital cardiac arrest and out-of-hospital cardiac arrest. The groups were compared in terms of gender, age, initial rhythm, cardiopulmonary resuscitation durations, cardiopulmonary resuscitation results (exitus, return), return of spontaneous circulation rates observed after cardiopulmonary resuscitation, and neurological outcome responses of the cases in which return of spontaneous circulation was observed. SPSS 22 was used for data analysis. RESULTS: Of the 321 cases, 88(27.41%) were in-hospital and 233(72.59%) were out-of-hospital cardiac arrest cases. Besides, 189(58.9%) of the patients were men and 132(41.1%) were women with an overall mean age of 67.21±15.25 years (range: 18-98 years). Moreover, 16(18.2%) in-hospital cases and 47(20.2%) out-of-hospital cases had shockable rhythms at the time of arrival. Cardiopulmonary resuscitation was applied to 74(23%) patients for less than 20 minutes and to 247(76.9%) for more than 20 minutes. Return of spontaneous circulation positivity was recorded in 134(41.7%) patients, of whom 62(70.5%) were in-hospital and 72(30.9%) were out-of-hospital cases. Moreover, 19(5.9%) patients were discharged with good neurological outcome. In cases where cardiopulmonary resuscitation was applied for less than 20 minutes, return of spontaneous circulation positivity was present in 43(100%) in-hospital and 31(100%) out-of-hospital cases. Return of spontaneous circulation positivity and good neurological outcome rate of the patients having shockable rhythms was 48(76.2%) and 8(12.7%), respectively. CONCLUSIONS: Return of spontaneous circulation positivity, favourable neurological outcome response and survival rates were significantly higher among in-hospital cardiac arrest cases.