Determination of netrin-1 levels and its relationship with neurotoxicity in carbon monoxide poisoning.

OBJECTIVE: The aim of the study was to assess netrin-1 levels in carbon monoxide (CO) poisoning to determine its relationship with poisoning severity and neurotoxicity. METHODS: This is a cross-sectional prospective study. The patients older than 18 years with CO poisoning were included. The patients were categorized into two groups on the basis of neurological involvement. Both the patient and the control groups were sampled for netrin-1 at 0th hour, and the patient group only was sampled for netrin-1 at 4th hour. RESULTS: A total of 84 patients and 50 healthy controls were enrolled. The median 0th hour netrin-1 level of the patient group (765.1 pg/mL (619.8-983.1) was significantly higher than the control group (484 pg/mL (376-1031.6)) ( p < 0.001). There was also a significant difference between the 0th hour and 4th hour netrin-1 (888.9 pg/mL (700.3-1175.5)) levels in the patient group ( p < 0.001).There was no significant statistical difference between patients with and without neurological involvement ( p = 0.62) and between those who underwent hyperbaric oxygen therapy (HBOT) and those who did not ( p = 0.76) with respect to 4th hour netrin-1 levels. CONCLUSION: The significantly higher netrin-1 levels in patients with CO poisoning, suggests that netrin-1 is elevated as a stress marker. Although there is no significant difference in netrin-1 levels in patients with neurological impairment in CO poisonings, netrin-1 may show subclinically neurological effects. Hence, we believe that netrin-1 cannot be used as a marker of poisoning severity.

The effectiveness of greater occipital nerve blockade in treating acute migraine-related headaches in emergency departments.

OBJECTIVE: This study aimed to evaluate the effectiveness of a greater occipital nerve (GON) blockade against a placebo and classical treatments (non-steroidal anti-inflammatory drugs + metoclopramide) among patients who were admitted to the emergency department (ED) with acute migraine headaches. METHOD: This prospective-randomized controlled study was conducted on patients with acute migraine headaches. The patients were randomly assigned to 3 treatment groups: the GON blockade group (nerve blockade with bupivacaine), the placebo group (injection of normal saline into the GON area), and the intravenous (IV) treatment group (IV dexketoprofen and metoclopramide). Sixty acute migraine attack patients were assigned to 3 groups of 20 patients each. The pain severity was assessed at 5, 15, 30, and 45 minutes with a 10-point pain scale score (PSS). RESULTS: The mean decreases in the 5-, 15-, 30-, and 45-minutes PSS scores were greater in the GON blockade group than in the dexketoprofen and placebo groups. When comparing the 30- and 45-minutes PSS changes, a statistically significant difference was found among the 3 groups (P = .03 and P = .03, respectively). CONCLUSION: A GON blockade was as effective as an IV dexketoprofen + metoclopramide treatment and superior to a placebo in patients with acute migraine headaches. Despite being an invasive procedure, a GON blockade might be an effective option for acute migraine treatment in the ED due to its rapid, easy, and safe application.

What is the diagnostic value of computed tomography tractography in patients with abdominal stab wounds?

INTRODUCTION: Computed tomography (CT) tractography is a promising technique; it is a CT performed after an entire stab wound tract with a water-soluble contrast agent in patients with abdominal stab wounds. The aim of the current study was to investigate the diagnostic value of CT tractography and to compare with other radiodiagnostic tools in patients with abdominal stab wounds. MATERIALS AND METHODS: All of the patients with anterior abdominal stab wounds were retrospectively reviewed between January 2012 and December 2014. Included in this study for statistical analyses were patients who had contrast-enhanced (oral and intravenous, not rectal) abdominal CTs alone or had contrast-enhanced abdominal CTs combined the CT tractographies and laparotomies in the first 24 h. These patients were divided two groups: the CT scan group (patients who had abdominal CTs alone) and the CT tractography group (patients who had CT tractographies). Both groups underwent laparotomies. The endpoint of this study was to determine whether CT tractography predicted peritoneal violation, not requiring therapeutic laparotomy. The gold standard of diagnosis peritoneal violation was considered laparotomy (therapeutic or not therapeutic). RESULTS: A total of 102 patients with anterior abdomen stab wounds who had laparotomies were enrolled and 29 (27 %) of the patients were excluded for several causes in the study period. Finally, 73 of the patients were enrolled in this study for statistical analyses. The diagnostic performance of a CT tractography in detecting peritoneal violation resulted in 100 % sensitivity, 100 % specificity, 100 % positive predictive values (PPV), 100 % negative predictive values (NPV), and 100 % accuracy. CONCLUSION: A CT tractography combined with an abdominal CT scan seems successful in detecting peritoneal violation in hemodynamically stable patients with abdominal stab wounds. Certainly, randomized controlled trials are required on this topic to recommend this as a routine diagnostic procedure.

Can initial lactate levels predict the severity of unintentional carbon monoxide poisoning?

INTRODUCTION: Accidental carbon monoxide (CO) intoxication is a major cause of unintentional poisoning. This study aimed to determine the value of initial lactate levels in patients with CO poisoning and to evaluate its utilization in the emergency department (ED). METHODS: A retrospective cross-sectional study was carried out among patients with CO intoxication, who were admitted to the ED between April 1, 2011 and April 1, 2012. The study data were extracted from a hospital database system using International Classification of Diseases-10 diagnosis codes. The patients were analyzed according to lactate levels, carboxyhemoglobin (COHb) levels, electrocardiographic manifestations, and clinical features at admission to the ED. RESULTS: A total of 74 patients with CO poisoning were enrolled in this study. The average COHb value of the patients was 21.5 ± 13.9%. A total of 50 patients (67.6%) received normobaric oxygen treatment and 24 patients (32.4%) received hyperbaric oxygen (HBO) treatment. The patients who received HBO treatment had increased lactate levels compared with patients receiving normobaric oxygen treatment (2.3 mmol/L vs. 1.0 mmol/L, p < 0.001). The lactate levels were positively correlated with COHb values (r = 0.738, p < 0.001). We determined that a lactate level of 1.85 mmol/L has a sensitivity of 70.8% and a specificity of 78.0% to predict the HBO treatment needed in CO poisoning. CONCLUSION: In evaluating patients with CO poisoning, an initial lactate level could be taken into consideration as an adjunctive parameter of severity, together with the clinical criteria and levels of COHb.

Value of biomarker-based diagnostic test in differential diagnosis of hemorrhagic-ischemic stroke.

BACKGROUND AND AIM: Stroke is an emergency which threatens life and the third leading cause of death in developed countries and the leading cause of long-term disability. By means of this study, it was aimed to evaluate the position of triage stroke panel in differential diagnosis of acute hemorrhagic stroke and ischemic stroke and sub-types of ischemic stroke. MATERIAL AND METHODS: Patients with acute stroke admitted to Emergency Department were prospectively recruited between June 2008-January 2009. BNP, D-dimer, MMP-9, S-100b levels were asseyed. Statistical significance for intergroup differences was assessed by Pearson's chi2 for categorical variables and Mann-Whitney U test or Kruskal-Wallis test for continuous variables. RESULTS AND CONCLUSION: A total of 100 consecutive patients with a diagnosis of stroke were evaluated. Of these, 29 (29%) patients had brain hemorrhages on the computed tomography scan performed the Emergency Department, 71 (71%) patients had ischemic stroke. It was observed that the intercept obtained as a result of jointly evaluating BNP, D-dimer, MMP9 and S100b is more important in differential diagnosis (p < 0.005). We suggest that using a combination of plasma biomarkers may be usefull to ischemic or hemorrhagic stroke for differential diagnosis (Tab. 4, Ref. 22).

Complications of misuse of Bacillus Calmette-Guerin.

Intravesical BCG is a good treatment choice for vesical carcinomas. Nevertheless, it can also become a mortal toxin when applied in a wrong way. The application routes of the prescribed drug should be rigorously described to patients and detailed instructions regarding the ways of application such as intravesical application should be given to the persons taking this medicine (Ref. 9).

Poisoning from wild mushrooms in Eastern Anatolia region: analyses of 5 years.

The objective of this study was to describe the demographic and clinical features of patients who were admitted to the emergency department (ED) due to wild mushroom poisoning and to point the importance of mushroom poisonings in our area. This study was performed by examining the files of wild mushroom poisoning patients who were admitted to the ED of Firat University, Faculty of Medicine, between January 2000 and June 2004, retrospectively. Patients>or=16 years of age were included in the study. The frequency of wild mushroom poisoning, age and sex of the patients, season, place of the residence, laboratory findings, treatment and outcome of the patients were investigated. During the study period, 64 patients with wild mushroom poisoning were admitted to the ED. From 64 overall patients, 25 (39.1%) were males. The most common complaints during the admission were nausea, vomiting and abdominal discomfort. The duration of hospitalization was two (range 1-4 days) days. No death was observed. Severity of mushroom poisoning depends on the type of mushroom eaten, the time lag between the poisoning and admission to the hospital, and the rapid and correct treatment given to the patient either in the ambulance or at health centre.

A new echocardiographic formula to calculate ejection fraction by using systolic excursion of mitral annulus.

The correlation between echocardiographically and angiographically calculated ejection fraction and systolic excursion of the mitral annulus was studied in 81 patients. Knowing that the mitral annulus changes its size, shape, and position during the cardiac cycle, the authors measured systolic excursion of the annulus by 2D echocardiography. Displacement of the mitral annulus was measured from four different points (medial, lateral, anterior, posterior) by apical four-chamber and apical two-chamber approaches. Patients with and without regional wall motion abnormalities were included. Left ventricular volumes and ejection fraction (EF) were calculated in the standard manner introduced by Teichholz et al and also with biplane left ventriculography. As a result, EF calculated by cineangiography, was moderately correlated with the Teichholz method (r = 0.66) while it was highly correlated with measurements of mitral annular motion (MAM) (r = 0.87). The correlation can be expressed by the regression equation, EF (angiography) = 5.7 MAM (in mm) -6.5. They conclude that measurements of annular motion is an easy and reliable index of left ventricular function as an alternative to traditional methods.