Neuroprotective Effects of Coenzyme Q10 and Ozone Therapy on Experimental Traumatic Spinal Cord Injuries in Rats.

OBJECTIVE: This study investigates the neuroprotective effects and functional recovery potential of Coenzyme Q10 (CoQ10) and ozone therapy in spinal cord injury (SCI). MATERIAL AND METHODS: In this study, 40 female Sprague-Dawley rats were divided into 5 groups of 8. Surgical procedures induced spinal cord trauma in all groups, except the control group. The ozone group received 0.7 mg/kg rectal ozone daily for 7 days, starting 1 hour postspinal cord trauma. The CoQ10 group was administered 120 mg/kg CoQ10 orally once daily for 7 days, beginning 24 hours prior to trauma. The CoQ10 + ozone group received both treatments. Examinations included a modified Tarlov scale and inclined plane test on days 1, 3, 5, and 7. Malondialdehyde (MDA) analysis was conducted on serum samples, and assessments of caspase-3, Bcl-2, and Bax levels were performed on tissue samples. Additionally, a comprehensive examination analyzed histopathological and ultrastructural changes. RESULTS: After SCI, there was a statistically significant increase in serum MDA, tissue caspase-3, and Bax levels (MDA P < 0.001, caspase-3 P < 0.001, Bax P = 0.003). In the CoQ10 + ozone group, serum MDA (P = 0.002), tissue caspase-3 (P = 0.001), and Bax (P = 0.030) levels were significantly lower compared to the trauma group. Tissue Bcl-2 levels were also significantly higher (P = 0.019). The combined treatment group demonstrated improved histopathological, ultrastructural, and neurological outcomes. CONCLUSIONS: This study shows that CoQ10 + ozone therapy in traumatic SCI demonstrates neuroprotective effects via antioxidant and antiapoptotic mechanisms. The positive effects on functional recovery are supported by data from biochemical, histopathological, ultrastructural, and neurological examinations.

Agreement between axillary, tympanic, and mid-forehead body temperature measurements in adult emergency department patients.

OBJECTIVE: To assess the agreement between noncontact infrared thermometer (noncontact) with infrared tympanic thermometer (tympanic) and electronic axillary thermometer (axillary) in an adult emergency department population. MATERIALS AND METHODS: This is a single-center, cross-sectional, prospective trial carried out in a Joint Commission accredited private hospital in Turkiye. All consecutive patients above 16 years were included in the study. The agreements between three methods were analyzed by Bland-Altman analysis with MedCalc 11.0.4 statistical software. RESULTS: Body temperatures were measured on 400 patients (48% were men, mean 35.9±17.3°C). Mean noncontact, tympanic, and axillary measurements (±SD) were 37.22±1.03, 36.72±0.95, and 36.91±0.96°C, respectively, whereas Intraclass Correlation Coefficient of all measurements was 0.892 (95% confidence interval 0.821-0.929). Binary comparisons between body temperature measurements produced mean differences Δ axillary-tympanic, Δ axillary-noncontact, and Δ tympanic-noncontact as 0.5±0.63, 0.2±0.71, and 0.31±0.61°C, respectively. However, the agreement limits for axillary and noncontact was between -1.2 and 1.6°C; -1.74 and 0.74°C for tympanic and noncontact, and -1.52 and 0.9°C for tympanic and noncontact. CONCLUSION: There is a lack of agreement between body temperature measurements by noncontact, tympanic, and axillary in the adult emergency department population. The easy application may lead noncontact to be the preferable method for healthcare providers but large agreement limits should be considered.

Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial.

STUDY OBJECTIVE: We assess whether midazolam reduces recovery agitation after ketamine administration in adult emergency department (ED) patients and also compared the incidence of adverse events (recovery agitation, respiratory, and nausea/vomiting) by the intravenous (IV) versus intramuscular (IM) route. METHODS: This prospective, double-blind, placebo-controlled, 2×2 factorial trial randomized consecutive ED patients aged 18 to 50 years to 4 groups: receiving either 0.03 mg/kg IV midazolam or placebo, and with ketamine administered either 1.5 mg/kg IV or 4 mg/kg IM. Adverse events and sedation characteristics were recorded. RESULTS: Of the 182 subjects, recovery agitation was less common in the midazolam cohorts (8% versus 25%; difference 17%; 95% confidence interval [CI] 6% to 28%; number needed to treat 6). When IV versus IM routes were compared, the incidences of adverse events were similar (recovery agitation 13% versus 17%, difference 4%, 95% CI -8% to 16%; respiratory events 0% versus 0%, difference 0%, 95% CI -2% to 2%; nausea/vomiting 28% versus 34%, difference 6%, 95% CI -8% to 20%). CONCLUSION: Coadministered midazolam significantly reduces the incidence of recovery agitation after ketamine procedural sedation and analgesia in ED adults (number needed to treat 6). Adverse events occur at similar frequency by the IV or IM routes.

Glass foreign body in soft tissue: possibility of high morbidity due to delayed migration.

BACKGROUND: Soft tissue foreign bodies (FBs) are a common occurrence in emergency departments (EDs). Some FBs cause complications, whereas others are asymptomatic and remain undetected for months or years. CASE REPORT: A 32-year-old man presented to the ED with complaints of back pain in the area of a subcutaneous lump that had migrated toward the midline, nearly 25 cm from its former location, over the previous 2 weeks. Twelve years previously, after falling onto a glass door that shattered, he had gone to a local ED and had his wound sutured, but no X-ray studies were taken. Within a few months, he noticed a lump near his scapula, but he did not relate it to the fall and it did not bother him much. Physical examination revealed a normal neurological examination and a palpable mass in the right paraspinal area at the level of the tenth thoracic vertebra. An X-ray study showed a 34-mm-long sharp density in the vicinity of the spinal canal near T10. Efforts lasting almost 2 h to identify and remove the foreign body were unsuccessful. The following day, a 4 × 6 × 34 mm sharp glass fragment was removed in the operating room under fluoroscopy. CONCLUSIONS: Retained soft-tissue foreign bodies may migrate very late and can cause high morbidity or mortality. It is important to be diligent in the search for foreign bodies, using ultrasound, computed tomography scan, or magnetic resonance imaging in cases in which initial plain radiographs are negative.

Value of the timing of informing the emergency department patients on cardiac test results: a randomized controlled study.

OBJECTIVE: This study is designed to investigate the role of written information, and the value of its timing, provided to Emergency Department (ED) patients regarding cardiac enzyme tests (CET), on their personal concerns about their health status and their discussions with the emergency physicians as to their normal health status post-test. MATERIALS AND METHODS: This is a prospective randomized controlled study. All consecutive patients used for this study were admitted to the university-based ED within the 6-month study period with the presenting chief complaint of atypical chest pain, which was considered as the presumptive diagnosis. CET was ordered to rule out acute coronary syndromes, and these patients were enrolled into the study groups. RESULTS: The study sample included 523 patients whose CET were ordered and who were therefore eligible for the study. Three groups were similar in terms of persuasion and anxiety scores. Groups, which were informed about the test by leaflet had lower anxiety and persuasion scores. The lowest anxiety scores were found especially in the group in which the information was given before CET was drawn (P<0.001). The effects of monitoring on patients and providing information with a leaflet were found significant on reassurance scores (P=0.006, P<0.001). Reassurance scores of the patients on whom at least one of the procedures, for example, monitoring, more than one electrocardiogram and chest radiograph, had been carried out, showed significant difference compared with those on whom neither of these procedures had been done during the ED observation (P=0.001). CONCLUSION: Written information provided to patients undergoing cardiac tests in ED population was found effective on anxiety and persuasion scores.

Occupational hand injuries treated at a tertiary care facility in western Turkey.

The study was designed to investigate characteristics of work-related hand injuries (WRHI) referred to a University hospital emergency department (ED) in an industrialized region as well as to supply data for preventive strategies. All patients with WRHI referred to the University-based ED in the two-year period were investigated. Sociodemographic and injury-related clinical information were analyzed. Out of 746 patients who were admitted to the ED due to occupational injuries within the two-year study period, 244 (32.7%) with isolated wrist, hand and finger injuries were included in the study. Male patients constituted the majority 87.2% (n=213) and 57.0% (n=139) of the patients were between 25 and 34 yr of age. WRHI recorded in industries involving metal and machinery constituted 41.4% (n=101) of all injuries. The sites of injuries were not significantly affected by differences in age, social security status and sectors. The most common types of injury were lacerations, punctures, and abrasions (40.2%, n=98). There was a statistically insignificant rise in amputation injuries with increasing age. Incidences, etiologies and characteristics of WRHI should be highlighted and preventive strategies based on these facts be implemented due to higher level of suffering and more serious consequences attributed to this specific injury.

The impact of associated diseases on the etiology, course and mortality in geriatric trauma patients.

OBJECTIVES: To determine the impact of accompanying medical illnesses on the cause, course, mortality and morbidity of a geriatric trauma population. METHODS: This prospective and observational study was carried out in a university hospital that is a level 1 trauma center between January 2002 and January 2003 with a total of 55 patient aged over 65 years. All consecutive patients presented with trauma and having an Abbreviated Injury Severity Scale (AIS) score greater than 20 points were recruited. All patients and relatives were requested to give information on the accompanying diseases. The raw data were analyzed as to the effect of these factors on the findings relating to trauma severity, vital signs, course, short-term mortality and morbidity. RESULTS: The most common mechanism of trauma was pedestrians hit by cars (33%) in the young elderly group; 81.2% of the sample had an associated disease and 40% of these patients had a complaint related to the disease. The rates of admission to the intensive care units and mortality were higher in patients with higher total Abbreviated Injury Scale scores (P=0.007, P=0.003). Patients with pulmonary disease or myocardial infarction had a significantly higher mortality rate than those without. CONCLUSION: Although not an essential factor in the cause per se, the diseases often encountered in the geriatric trauma population have a significant role on the course and mortality.

Considerations in the aeromedical evacuation of a critically ill blast victim: lessons learned.

Rationale for the decision to transport and assessment of available resources are integral components of the decision for aeromedical evacuation of critically ill patients. We present the case of a 20-year-old man who sustained significant trauma after his vehicle struck a land mine. This case reviews and emphasizes the factors to consider in arriving at the decision to transport as well as the accurate assessment of available equipment and personnel resources.