Transcutaneous Electrical Nerve Stimulation (TENS) for the Treatment of Renal Colic in the ED: A Randomized, Double-Blind, Placebo-Controlled Trial.

STUDY OBJECTIVE: To determine the analgesic efficacy of TENS treatment in patients with renal colic in the emergency department (ED). METHODS: This double-blind, randomized controlled trial was conducted in a tertiary care ED. Patients with a definitive diagnosis of renal colic were assigned (1:1) as randomized to receive the real TENS with frequency 100 Hz, pulse width 200 microseconds, voltage 2 mA, or placebo with sham TENS. Pain intensity was measured using visual analog scales (VAS) at baseline, after 15 and 30th minutes. RESULTS: A total of 100 patients were included in the final analysis: 50 patients treated with real TENS and 50 patients treated with sham TENS. VAS scores in both groups were similar at baseline. The mean reduction in VAS score at 15 min was 33.3 ± 17.6 (95% Confidence interval (CI): 28.3 to 38.3) for the real TENS group and 14.9 ± 11.6 (95% CI 11.6 to 18.2) for the sham TENS group (mean difference: 18.4 (95% CI: 12.5 to 24.4, P < 0.0001). The mean reduction in VAS score at 30 min was 63.7 ± 21.1 (95% CI: 57.7 to 69.7) for the real TENS group and 14.9 ± 16.2 (95% CI: 19.5 to 10.3) for the sham TENS group (mean difference: 48.8, 95% CI: 41.4 to 56.3, P < 0.0001). Four patients (8%) in the real TENS group and 24 patients (48%) in the sham TENS group required the rescue medication after 30th minutes. CONCLUSIONS: TENS is effective for acute pain treatment in renal colic patients in the ED. TENS therapy could be a treatment option for renal colic.

Evaluation Of Mean Platelet Volume, Red Cell Distributed Width And Neutrophil To Lymphocyte Ratio In Conversion Disorder.

BACKGROUND: The pathophysiology of conversion disorder (CD) is still not fully established. Many psychiatric disorders are known to be associated with inflammatory processes. We aimed to compare the routine hemogram values of CD patients with those of the participants in the healthy control group, to assess the inflammation levels of the two groups. METHODS: This study was conducted with CD patients (n=158) and healthy controls (n=145). Routine hematological parameters were examined in each participant. Group comparisons were made with Mann-Whitney U-test and Student's t-test. Regression analysis and receiver operating curve (ROC) analysis were also performed for the analysis of independent predictors. RESULTS: The comparisons revealed that while neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet, neutrophil, red cell distribution width (RDW), and mean platelet volume (MPV) were significantly higher in CD group (P<0.05), lymphocyte was decreased in that group (P>0.05). Multivariate and ROC analyses showed MPV, RDW, and NLR as independent predictors (P<0.05). ROC curve showed that MPV values of 7.8 or above could predict the CD with 84% sensitivity and 85% specificity (area under curve [AUC]=0.878; 95% confidence interval [CI]: 0.817-0.939), RDW values of 11.0 or above could predict the CD with 82% sensitivity and 73% specificity (AUC=0.871; 95% CI: 0.815-0.926), and NLR values of 1.8 or above could predict the CD with 85% sensitivity and 78% specificity (AUC=0.865; 95% CI: 0.802-0.929). CONCLUSION: CD is related to the acute inflammatory process. MPV, RDW, and NLR can reflect this inflammation. These parameters could be used in differential diagnosis; increased RDW and MPV levels can be used as a novel marker in CD.

Serum thiol levels and thiol/disulphide homeostasis in gunshot injuries.

BACKGROUND: Gunshot injuries result in serious traumatic tissue damage due to high velocity of the bullet, deep penetration, and ballistic effect. Trauma is known to be related with oxidative stress. Serum thiol levels and disulphide/thiol homeostasis are novel oxidative stress biomarkers. In this study, we aimed to investigate serum thiol levels and disulphide/thiol homeostasis in injury patterns of patients admitted to the emergency department with a gunshot injury. METHOD: A total of 128 participants were included in the study. The participants were divided into two groups: the patient group (Group 1; n = 73) and healthy controls (Group 2; n = 55). Native thiol, total thiol, disulphide levels, disulphide/native thiol, disulphide/total thiol, and neutrophil-to-lymphocyte ratio (NLR) were measured. The Revised Trauma Scale (RTS) and Glasgow Coma Scale (GCS) scores were calculated. RESULTS: Native thiol, total thiol, and disulphide levels were significantly lower in Group 1 (p < 0.001). Disulphide/native thiol ratio, disulphide/total thiol ratio, and NLR were significantly higher in Group 1, compared to Group 2 (p < 0.05). There was a positive correlation between thiol levels and RTS and GCS scores and NLR. Stepwise linear regression analysis showed that native thiol was an independent indicator of RTS and GCS scores. The receiver operating characteristic curve (ROC) analysis revealed that serum native thiol levels of ≤ 342.9 could predict gunshot injury with a sensitivity of 82% and a specificity of 77% (area under the curve = 0.853; 95% confidence interval 0.783-0.924). CONCLUSION: Our study results suggest that thiol-disulphide homeostasis is disrupted in patients sustaining gunshot injuries, and thiol levels decrease in correlation with the severity of trauma with a high sensitivity and specificity. As the level of native thiol is an independent predictor of the severity of trauma, reduced thiol levels may be of prognostic value in the early assessment of patients in the emergency room.

The Relationship Between Serum Thiol Levels and Thiol/Disulfide Homeostasis with Head Trauma in Children.

BACKGROUND: Oxidative stress may induce brain injury. Thiols are one of the most important antioxidant agents, and thiol/disulphide (SH/SS) homeo stasis is a novel oxidative stress marker. The goal of the study was to investigate the relationship of thiol levels and SH/SS homeostasis with head trauma in pediatric patients. METHODS: This prospective study was conducted in 85 consecutive pediatric patients aged < 18 years with isolated head trauma and 58 age- and gender-matched healthy controls in the Emergency Department (ED). RESULTS: The mean age was 4.40 ± 3.03 years for the patient group and 4.75 ± 1.81 years for the controls (p > 0.05). There were no significant differences in biochemical parameters including serum albumin, urea, alanine aminotransferase, total bilirubin, uric acid, high-sensitivity C-reactive protein (hs-CRP), and white blood cells (WBC) in the patient and control groups (for each, p > 0.05). The thiol (SH) level was significantly higher in the patient group than in the controls (388.83 ± 51.949 vs. 369.04 ± 37.62 µmol/L; p = 0.009). The total thiol (TT) level was somewhat higher in the patient group, but the difference was not significant (416.11 ± 47.29 vs. 405.08 ± 35.27 µmol/L; p = 0.113). The disulphide (SS) level was lower in the patient group (p < 0.001). The SS/SH and SS/TT ratios were significantly lower in the patient group, while the SH/ TT ratio was significantly higher (p < 0.001). CONCLUSIONS: Analysis of serum thiol levels and SH/SS homeostasis might be useful in order to determine the head trauma in pediatric patients.

Mean platelet volume and red cell distribution width levels in initial evaluation of panic disorder.

BACKGROUND: As the relationship between psychological stress and platelet activation has been widely studied in recent years, activated platelets lead to certain biochemical changes, which occur in the brain in patients with mental disorders. However, data relating to the mean platelet volume (MPV) in patients with panic disorder (PD) are both limited and controversial. Herein, we aimed to evaluate, for the first time, the red cell distribution width (RDW) levels combined with MPV levels in patients with PD. PATIENTS AND METHODS: Between January 2012 and June 2015, data of 30 treatment-naïve patients (16 females, 14 males; mean age: 37±10 years; range: 18-59 years) who were diagnosed with PD and 25 age- and sex-matched healthy volunteers (10 females, 15 males; mean age: 36±13 years; range: 18-59 years) (control group) were retrospectively analyzed. The white blood cell count (WBC), MPV, and RDW levels were measured in both groups. RESULTS: The mean WBC, MPV, and RDW levels were 9,173.03±2,400.31/mm3, 8.19±1.13 fl, and 12.47±1.14%, respectively, in the PD group. These values were found to be 7,090.24±1,032.61, 6.85±0.67, and 11.63±0.85, respectively, in the healthy controls. The WBC, MPV, and RDW levels were significantly higher in the patients with PD compared to the healthy controls (P=0.001, P=0.001, and P=0.003, respectively). However, there was no significant difference in the platelet number between the patients with PD and healthy controls (P>0.05). CONCLUSION: Our study results are the first to demonstrate that the RDW levels combined with MPV levels significantly increase among patients with PD. We believe that increased RDW and MPV levels can be used as a novel marker for PD.

Evaluation of oxidant, antioxidant, and S100B levels in patients with conversion disorder.

INTRODUCTION: Various psychodynamic, neurobiological, genetic, and sociocultural factors are believed to be involved in the etiology of conversion disorder (CD). Oxidative metabolism has been shown to deteriorate in association with many health problems and psychiatric disorders. We evaluated oxidative metabolism and S100B levels in the context of this multifactorial disease. METHODS: Thirty-seven patients with CD (25 females and 12 males) and 42 healthy volunteers (21 females and 21 males), all matched for age and sex, were included in this study. The total oxidant status, total antioxidant status, oxidative stress index, and S100B levels were compared between the two groups. RESULTS: The total oxidant status, oxidative stress index, and S100B levels were significantly higher in patients with CD than in the control group, whereas the total antioxidant status was significantly lower. CONCLUSION: CD is associated with deterioration of oxidative metabolism and increased neuronal damage.

The effects of lycopene on intestinal injury due to methotrexate in rats.

OBJECTIVE: The aim of this study was to investigate the effects of lycopene (Lyc) on methotrexate (Mtx)-induced intestinal damage in rats. METHOD: Twenty-eight male Sprague Dawley rats were divided into four equal groups: control, Mtx, Lyc, and Mtx-L. CONTROL GROUP: Rats were given only the vehicle. Lyc group: Rats were given Lyc (10 mg/kg) with corn oil by oral gavage for 10 days. Mtx group: Rats were injected intraperitoneally with a single dose of 20 mg/kg of Mtx and given corn oil by oral gavage. Mtx-L group: Rats were treated with Lyc (10 mg/kg) for 10 days after a single dose of Mtx (20 mg/kg). All of the rats were euthanized using terminal anesthesia, and the intestinal tissues were removed for histological examination and for pro-inflammatory cytokine measurement (tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1ß)), total oxidative status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI). RESULTS: Mtx administration increased histopathological damage and increased TNF-α, IL-1ß, TOS, TAC, and OSI levels in the small intestine tissues. Lyc therapy applied to the Mtx-L group provided significant improvement in all parameters of histopathological damage to the small intestine and significantly reduced the levels of IL-1ß, TOS, and OSI in the intestinal tissues. CONCLUSIONS: The results of this study indicate that Lyc might be useful for protecting intestinal damage induced by Mtx in rats by reducing the increased oxidative stress and pro-inflammatory cytokine (IL-1ß) levels.

Posterior reversible encephalopathy syndrome during the peripartum period: report of four cases and review of the literature.

Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiologic disorder affecting the brain's occipital and parietal lobes characterized by altered mental status, seizures, headache and blurred vision. Eclampsia is one of the main causes of posterior reversible encephalopathy. We aimed to discuss here literature guided clinical and radiologic findings of four women who had experienced status epilepticus at peripartum period and diagnosed as PRES.

Assessment of serum and urine ghrelin levels in patients with acute stroke.

INTRODUCTION: Ghrelin is a novel brain-gut peptide hormone consisted of 28 amino-acid. In the plasma, it exists in two major molecular forms, acylated and des-acyled ghrelin, filtered in glomeruli or secreted by nephrons. Primary biological effects of hormones are regulating appetite, foods intake and energy metabolism. We investigated the changing and relationships between serum and urine ghrelin levels in acute stroke patients to provide more information whether diagnostic parameter. METHODS: Thirty acute stroke patients and thirty consecutive volunteers included in study prospectively. To analyze serum and urine ghrelin levels, at the time of diagnose, all of participant blood and fresh urine (1 ml serum, 2 ml urine respectively) samples were obtained. Serum ghrelin levels analyzed ELISA technique, and urine ghrelin levels studied by validation technique. To compare quantitative data student's t test, and for qualitative data chi-square and Fisher's Exact Chi-square test was used. P<0.05 was considered statistically significant. RESULTS: Urine acyl ghrelin levels found statistically significant between patient and control groups (P=0.001), but there were no statistically significant differences between both groups (P>0.05) in serum acyl gherelin, des-acyl ghrelin and urine des-acyle ghrelin levels. CONCLUSIONS: The results indicate that urine acyl ghrelin levels may be considered as a diagnostic parameter in acute ischemic stroke patients. Further studies delineating the mechanism of these observed results are warranted.

Self mutilation of genitalia-using teeth.

Genital self-mutilation (GSM) is an uncommon self-inflicted injury, and rarely do self-mutilations have a serious nature. GSM is not a single clinical entity, and it can occur in any psychiatric state or condition. The instruments that are used for self-mutilation can vary, and treatment of these injuries requires a detailed clinical evaluation and multi disciplinary approach. We report here a case report about a 22-year-old mentally retarded man who referred to our emergency service for bloody vomitting by his family members. To our knowledge this is the first such case reported in literature as of injury technique.

Posttraumatic persistent shoulder pain: Superior labrum anterior-posterior (SLAP) lesions.

PATIENT: Male, 57 FINAL DIAGNOSIS: Typ 2 Superior labrum anterior-posterior lesion Symptoms: Shoulder pain after trauma Medication: - Clinical Procedure: - Specialty: Orthopedics and Traumatology • Emergency Medicine. OBJECTIVE: Rare disease. BACKGROUND: Due to the anatomical and biomechanical characteristics of the shoulder, traumatic soft-tissue lesions are more common than osseous lesions. Superior labrum anterior-posterior (SLAP) lesions are an uncommon a cause of shoulder pain. SLAP is injury or separation of the glenoid labrum superior where the long head of biceps adheres. SLAP lesions are usually not seen on plain direct radiographs. Shoulder MRI and magnetic resonance arthrography are useful for diagnosis. CASE REPORT: A 57-year-old man was admitted to the emergency department due to a low fall on his shoulder. In physical examination, active and passive shoulder motion was normal except for painful extension. Anterior-posterior shoulder x-ray imaging was normal. The patient required orthopedics consultation in the emergency observation unit due to persistent shoulder pain. In shoulder MRI, performed for diagnosis, type II lesion SLAP was detected. The patient was referred to a tertiary hospital due to lack of arthroscopy in our hospital. CONCLUSIONS: Shoulder traumas are usually soft-tissue injuries with no findings in x-rays. SLAP lesion is an uncommon cause of traumatic shoulder pain. For this reason, we recommend orthopedic consultation in post-traumatic persistent shoulder pain.

Circadian variation of blood pressure is impaired in normotensive pregnant women with gestational diabetes mellitus.

Data about circadian blood pressure (BP) in normotensive patients with gestational diabetes mellitus (GDM) are lacking. Thus, we sought to compare dipper and nondipper circadian variation of BP profile between normotensive women complicated with GDM and normal pregnant women. Forty-two women with GDM and 33 normal uncomplicated pregnant women who met the entry criteria for the study were enrolled in the study. Twenty-four-hour noninvasive ambulatory blood pressure monitoring and echocardiography to measure the left ventricle mass index and diastolic parameters were performed. Nocturnal blood pressure dipping was calculated as follows: (awake BP - sleep BP) × 100/awake BP. Patients with a nocturnal reduction in average daytime systolic BP and diastolic BP of less than 10% were classified as nondippers. Left ventricle mass index was higher in normotensive pregnant women with GDM group than in normal pregnant subjects (101.98 ± 24 g/m(2) vs. 90.67 ± 15 g/m(2), P < .018). Significant nocturnal systolic and diastolic nondippings were observed in GDM groups compared with normal subjects. From diastolic variables, the mitral E velocity and isovolumetric relaxation time were compatible with diastolic dysfunction relaxation abnormalities (P = .003 and P = .015, respectively) in nondipper group. From all confounding factors, only E velocity (P = .002) and diagnosis of GDM (P < .001) were predictive of nondipper circadian variation. This study shows that (i) circadian BP is impaired in normotensive pregnant subjects with GDM, (ii) the left ventricle mass index is higher in pregnant subjects with GDM than in normal pregnant subjects who despite a 24-hour BP are within normal limits, and (iii) in nocturnal nondipper group, the tendency to having diastolic relaxation abnormalities is noted.

Increased urotensin-II activity in patients with Raynaud's phenomenon and systemic lupus erythematosus.

AIM: Raynaud's phenomenon (RP) commonly co-exists with systemic lupus erythematosus (SLE). The obvious pathophysiological mechanism in RP is vasoconstriction. Although the roles of certain vasoconstrictor substances, like endothelin-1, have been identified in RP, underlying mechanisms remain unclear. METHODS: In this pilot study, we researched a relatively recently identified, very potent vasoconstrictor peptide, urotensin-II (U-II), in SLE patients versus those without RP. In addition to its vasoconstrictor effect, U-II has been implicated in cardiovascular events and atherosclerosis. Increased frequencies of atherosclerosis and cardiovascular events comprise another issue in SLE patients. To address these effects, we included 15 Raynaud's (+) and 15 Raynaud's (-) SLE patients and compared both cohorts against age and sex-matched controls. RESULTS: We found significantly elevated U-II activity in both RP (+) and RP (-) SLE patients, relative to controls (P < 0.0001); however, the difference among RP (+) SLE patients was more prominent. U-II was significantly elevated in RP (+) SLE patients when compared to RP (-) SLE patients (P < 0.001). CONCLUSIONS: The results of our study suggest that, either as a cause or by-product, U-II may have some role in Raynaud's-related vasoconstriction. It also might contribute to atherosclerosis and cardiovascular diseases in SLE patients. Further studies clearly are warranted.

Effectiveness of Ankaferd blood stopper in the topical control of active bleeding due to cutaneous-subcutaneous incisions.

OBJECTIVE: To assess the effectiveness of Ankaferd blood stopper (ABS) in the topical control of bleeding due to cutaneous/subcutaneous incisions. METHODS: We included in this study, 69 patients with cancer that were admitted for port insertion to the Emergency Department of Gaziantep University Hospital, Gaziantep, Turkey, between May and July 2008. We used the wet compress form of ABS in 37 patients (group I), and regular dry sterile sponges in 32 patients (group II), to stop the bleeding that occurs during the clinically indicated vascular port insertion in patients with cancer. The success rate in terms of bleeding control, time needed to stop the bleeding, recurrence of bleeding, and complications were recorded. RESULTS: A total of 69 patients were included in this study. The average time needed to stop the bleeding was 32.97 +/- 29.9 seconds for group I, and 123.75 +/- 47.5 seconds for group II. Bleeding restarted in 24% in group I, and in 50% in group II. Among the patients in group I, 13.5% developed localized redness, and 8.1% minor swelling, while 8.1% reported local pain at the wound site; in 5.4% of the patients, the sutures at the wound site opened. The same parameters were recorded for group II; 9.4% for localized redness, 0.0% for minor swelling, 6.2% reported local pain, and the sutures at the wound site opened in 3.2% (p=0.592). CONCLUSION: The Ankaferd blood stopper was proven to stop local bleeding in a shorter time, with a lower recurrence rate in comparison with the sterile sponge.

A case of carbon monoxide poisoning with thrombus in the heart: a case report.

Carbon monoxide is a nonirritant, odorless, colorless gas, and is lighter than air. It is an end product of the incomplete combustion of hydrocarbons. Its effects are most prominent in organs sensitive to oxygen deprivation, such as the heart, brain, and kidney. Carbon monoxide poisoning becomes more abundant in winter and at cold places. In Turkey, every year we see several deaths due to poisonous gas leaks from coal or wood stoves. Deaths particularly due to hypoxia-related central nervous system damage and ventricular dysrhythmias are observed. On the other hand, an association between thromboembolic accidents and carbon monoxide poisoning has been shown in literature. Thromboembolic accidents in the mesenteric, central nervous system, and extremities are reported. However, no atrial thrombus has been mentioned. In this study, a case of an atrial thrombus associated with carbon monoxide poisoning following a diagnosis of carbon monoxide poisoning and treatment in the emergency room is reported and the literature is revisited.