Biomonitoring of Oxidative-Stress-Related Genotoxic Damage in Patients with End-Stage Renal Disease.

Chronic kidney disease (CKD), a common progressive renal failure characterized by the permanent loss of functional nephrons can rapidly progress to end-stage renal disease, which is known to be an irreversible renal failure. In the therapy of ESRD, there are controversial suggestions about the use of regular dialysis, since it is claimed to increase oxidative stress, which may increase mortality in patients. In ESRD, oxidative-stress-related DNA damage is expected to occur, along with increased inflammation. Many factors, including heavy metals, have been suggested to exacerbate the damage in kidneys; therefore, it is important to reveal the relationship between these factors in ESRD patients. There are very few studies showing the role of oxidative-stress-related genotoxic events in the progression of ESRD patients. Within the scope of this study, genotoxic damage was evaluated using the comet assay and 8-OHdG measurement in patients with ESRD who were undergoing hemodialysis. The biochemical changes, the levels of heavy metals (aluminum, arsenic, cadmium, lead, and mercury) in the blood, and the oxidative biomarkers, including superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and malondialdehyde (MDA) levels were evaluated, and their relationship with genotoxic damages was revealed. Genotoxicity, oxidative stress, and heavy-metal levels, except mercury, increased significantly in all renal patients. DNA damage, 8OHdG, and MDA significantly increased, and GSH significantly decreased in patients undergoing dialysis, compared with those not having dialysis. The duration and the severity of disease was positively correlated with increased aluminum levels and moderate positively correlated with increased DNA damage and cadmium levels. In conclusion, this study revealed that the oxidative-stress-related DNA damage, and also the levels of Al and Cd, increased in ESRD patients. It is assumed that these changes may play an important role in the progression of renal damage. Approaches for reducing oxidative-stress-related DNA damage and heavy-metal load in ESRD patients are recommended.

The Role of Brain CT in Patients with Out-of-Hospital Cardiac Arrest with Return of Spontaneous Circulation.

BACKGROUND AND AIM: The diagnosis and treatment process after resuscitation of patients with spontaneous return of circulation (ROSC) after cardiac arrest is important. There is no clear recommendation on utilization of computerized tomography (CT) of the brain in patients with ROSC. In this study, it was aimed to diagnosis the pathology detection rates in the brain tomography of out-of-hospital cardiac arrest (OHCA) patients with ROSC after resuscitation in the emergency department and the effect of these pathologies on treatment management. MATERIALS AND METHODS: 131 patients who were admitted to the Emergency Medicine Clinic with cardiac arrest between 08.05.2019 and 07.12.2020, had ROSC after resuscitation and underwent brain CT in the first 24 h were included in the study. The patients were divided into two groups; those with clinically significant pathology in brain CT who underwent treatment changes and those without clinically significant pathology. All data recorded in the study form were analyzed using IBM SPSS 20.0 (Chicago, IL, USA) statistics program. P < 0.005 value was considered statistically significant. RESULTS: 51.1% (67) of the patients were women. The age median value was 73 (IQR25-IQR75;63-83). The most common comorbidity in patients was hypertension with 42% (55). Patients with clinically significant pathology observed in brain tomography studied after ROSC were 12.2% (16) of all patients. The most common management changes were requesting a consultation from the neurology department (n = 9) and adding a new drug to the treatment (n= 5) The 30-day and 1-year mortality rates showed no significant difference between the two groups (p > 0.05). CONCLUSION: We have seen that the data obtained from the CT studied in the early period after the ROSC was achieved, did not change the management of our patients x in the early and late periods after resuscitation. We conclude that it is not necessary to have a brain CT scan in the emergency department in the early period.

Effects of treatment on anxiety levels among patients with benign paroxysmal positional vertigo.

PURPOSE: The association of vertigo with anxiety disorders is well known. Herein, we aimed to determine the relationship between pre-treatment and post-treatment anxiety levels, assessed with Beck anxiety inventory, with educational status among patients diagnosed with and treated for Benign paroxysmal positional vertigo (BPPV), and to evaluate the effect of treatment on the sub-parameters of the Beck anxiety inventory. METHODS: Our study included a total of 33 patients that presented to the otorhinolaryngology outpatient clinic with acute vertigo and were diagnosed to have posterior canal BPPV. Patients diagnosed with posterior BPPV were applied Beck anxiety inventory prior to the treatment as well as 1 week and 4 weeks after the treatment. RESULTS: Compared to the control group, statistically significant changes were observed in relation to pre-treatment and post-treatment inventory scores (p < 0.05). A comparison of the pre-treatment and post-treatment assessments revealed significant differences (p < 0.05). Improvements were observed in 48% (10/21) of the subparameters by the end of the first week at the earliest. Educational status had no significant effect on inventory scores (p > 0.05). CONCLUSION: Anxiety-related subjective symptoms mostly started to improve 1 week after the treatment at the earliest, and symptoms showed persistence at a certain level even at the end of the first month. Inequalities between the patients' educational levels affect anxiety levels. It should be remembered that educational status should be considered when approaching patients.

Retrospective analysis of forensic cases in refugees admitted to emergency department.

INTRODUCTION: The aim of this study was to compare the distribution and frequency of forensic medical events in a refugee group with that of the general population, and thus, extrapolate the problems encountered in the immigrant population. METHODS: Those cases admitted to the emergency department (ED) for any reason that required a forensic examination between January 2016 and June 2018 were investigated retrospectively. RESULTS: A total of 310 refugees were admitted to the ED for forensic medical events. The most common nations of origin of the refugees were Iraq (n = 167), Syria (n = 65), and Afghanistan (n = 28). The median age of the refugees was 24 years old (interquartile range = 17-33). With regard to forensics, the most common reasons for the refugees to present to the ED were motor vehicle accidents 27.4%, assaults 25.8%, employment and industrial accidents 16.1%, and suicide attempts 10.3%. Other than suicide attempts, all of the forensic presentations were more common in the males. The outcomes of the refugee group were as follows: 92.3% were discharged, 5.8% were admitted to the hospital, 1% were admitted to the intensive care unit (ICU), and 1% were transferred. Suicide attempts were the most common reasons for the ICU admissions, while the most common reasons for the hospital admissions were orthopedic injuries. CONCLUSION: In general, the forensic event frequency in the refugee group was lower (p = 0.001); however, this was a single center study, and there could have been unrecorded cases due to an inability to access healthcare assistance, so these results may not be reliable.

Bedside measurement of the optic nerve sheath diameter with ultrasound in cerebrovascular disorders

Background/aim: We aimed to show the role of determination of optic nerve sheath diameter (ONSD) by bedside ultrasonography in an emergency department in the diagnosis of cerebrovascular disorders and its correlation with the clinical picture. Materials and methods: This prospective cross-sectional study included 55 patients with cerebrovascular disorders and 53 controls. Age, sex, ONSD, comorbid disease status, and multidetector computed tomography results of all subjects and application periods and National Institutes of Health Stroke Scale (NIHSS) scores of the patient group were evaluated. Results: The ONSD of the patient and control groups was determined as a median of 5.7 mm and 3.6 mm, respectively. The ONSD of the patient group was determined to be significantly higher than that of the control group (P < 0.05). A positive relationship was determined between NIHSS scores and ONSD values (P < 0.05). The specificity and sensitivity values were determined as 98.1% and 81.8%, respectively, for a cutoff value of 5 mm and as 100% and 72.7%, respectively, for a cutoff value of 6 mm. Conclusion: This study showed that bedside measurement of ONSD is an easy, cheap, and noninvasive method that can be used to support the diagnosis and evaluation of patients with acute stroke.

The predictive value of Alvarado score, inflammatory parameters and ultrasound imaging in the diagnosis of acute appendicitis.

OBJECTIVE: Acute appendicitis (AA) is one of the most common surgical emergencies. Despite extraordinary advances in modern investigations, the accurate diagnosis of AA remains an enigmatic challenge. The aim of this study was to compare and evaluate the diagnostic accuracy of inflammatory parameters [C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR)], ultrasound (US) and Alvarado score (AS) in reducing the rate of negative appendectomies. MATERIAL AND METHODS: Two hundred seventy-eight patients were included in this study. Patients were separated into two main groups as the surgery group (n=184) and non-operative group (n=94). Complete blood count, ESR and PCT levels were assessed, abdominal US was performed and AS was calculated for all patients. RESULTS: In the surgery group, clinical predictive factors for histopathologic results such as AS ≥7, AA signs on US, neutrophilia and leukocytosis were significant. Neutrophilia and leukocytosis had the highest accuracy rate among these factors. Inflammatory parameters were not predictive for histopathologic results, although higher CRP and PCT levels were significant in perforated and necrotizing appendicitis. Multifactorial regression analyses showed that AS was not of significant predictive value in the non-operative group. CONCLUSION: There was no superiority of AS and/or US in the diagnosis of AA. Recent findings have shown the most reliable parameters in the diagnosis of AA to be primarily 'neutrophilia' and secondarily 'leukocytosis'. Other results of this study indicated that inflammatory parameters (CRP, PCT, ESR) were not superior to other parameters but CRP and PCT levels were significantly high in complicated cases.

Role of Procalcitonin in Evaluation of the Severity of Acute Cholecystitis.

OBJECTIVE: The aim of this study is to investigate the relationship between procalcitonin (PCT) level and the severity of acute cholecystitis. MATERIALS AND METHODS: This study included 200 patients diagnosed with acute cholecystitis. To diagnose and assess the severity of acute cholecystitis; physical examination and abdominal ultrasound findings were evaluated and blood samples were taken to determine white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and levels of coagulation factors, blood gas, C-reactive protein (CRP) and PCT. Patients were classified into three stages, namely, mild, moderate, and severe, according to the severity of acute cholecystitis using the Tokyo guidelines. The role of PCT level in the assessment of severity of acute cholecystitis and the correlation between the stages and PCT level were statistically analyzed. RESULTS: Among patients with acute cholecystitis, 110 (55%) were classified as mild, 61 (30.5%) as moderate, and 29 (14.5%) as severe. Leukocytosis or leukopenia was positive in 48.5%, ESR elevation was found in 72.5%, CRP positivity in 55.5%, PCT elevation in 27%, and positive findings of ultrasonographic imaging in 54.5% of the patients. Serum WBC count, ESR, and CRP and PCT levels increased as the severity of disease increased (p<0.05). PCT could discriminate grade I from grade II-III with 95.45% sensitivity and 46.67% specificity at the best cut-off value of ≤0.52 (p<0.001). PCT could also discriminate grade III from grade I-II with 72.4% sensitivity and 90.06% specificity at the best cut-off value of >0.8 (p<0.001). CONCLUSION: PCT level may be considered to be a parameter that could be added to the assessment of the severity of acute cholecystitis in the Tokyo guidelines, although further studies are needed to support our findings.

Comparison of end-tidal carbon dioxide levels with cardiopulmonary resuscitation success presented to emergency department with cardiopulmonary arrest.

OBJECTIVE: To measure end-tidal carbon dioxide pressure (PetCO2) in preset interval in order to evaluate the efficiency of cardiopulmonary resuscitation (CPR) performed on patients in cardiopulmonary arrest, evaluate the validity of PetCO2 in predicting the mortality and finally assess the PetCO2 levels of the patients in cardiopulmonary arrest based on the initial presenting rhythm. METHODS: This prospective study was conducted at the Ankara Training and Research Hospital on patients who presented with cardiopulmonary arrest. Standard ACLS (Advanced Cardiac Life Support) protocols were performed. Patients were categorized in two groups based on their rhythms as Ventricular Fibrillation and Asystole. Patients' PetCO2 values were recorded. RESULTS: PetCO2 levels of the Return of Spontaneous Circulation (ROSC) group in the 5th, 10th, 15th and 20th minutes were significantly higher compared to the exitus group (p<0.001). In distinguishing ROSC and exitus, PetCO2 measurements within 5-20 minute intervals showed highest performance on the 20th and lowest on the 5th minutes. CONCLUSION: PetCO2 values are higher in the ROSC group. During the CPR, the most reliable time for ROSC estimation according to PetCO2 values is 20th minute. None of the patients who had PetCO2 levels less than 14 mmHg survived.

Hemodialysis as an alternative treatment of mexiletine intoxication.

Mexiletine is a class IB antiarrhythmic agent. Although it is primarily used in treating ventricular arrhythmias, recent indications for use of mexiletine include chronic and neuropathic pains. At high doses, mexiletine causes drowsiness, confusion, nausea, hypotension, sinus bradycardia, paresthesia, seizures, bundle branch block, atrioventricular heart block, ventricular arrhythmias, asystole, cardiovascular collapse, and coma. A 23-year-old male patient presented to the emergency department with intentional ingestion of high-dose mexiletine. Despite decontamination and supportive treatment, his vitals deteriorated during the observation period; and he developed stupor and dysarthria. Patient then underwent hemodialysis. His vital signs and overall condition improved rapidly following hemodialysis treatment. In this case report, we aimed to emphasize hemodialysis as a useful alternative therapy for severe mexiletine intoxications.

Elevated serum S100B protein and neuron-specific enolase levels in carbon monoxide poisoning.

OBJECTIVE: Carbon monoxide (CO) poisoning causes cerebral and generalized hypoxia. This study aimed to assess the possible use of serum glial marker S100B protein and neuron-specific enolase (NSE) as biochemical markers of hypoxic brain damage in acute CO poisoning. METHODS: Patients with acute CO poisoning admitted to the ED of 2 training hospitals (Ankara, Turkey) were included in this cross-sectional study. Serum levels of S100B and NSE were measured on admission. The patients were divided into 2 groups (unconscious and conscious). Twenty healthy adults were included in the study to serve as controls. RESULTS: A total of 70 patients poisoned by CO (mean age +/- SD, 36.6 +/- 16.3 years; 64.3% women) were enrolled. Although S100B concentrations were higher in patients than in the control group (P = .018), no significant difference was determined between patient and control groups with respect to NSE concentrations (P = .801). A positive correlation was noted between levels of S100B and NSE (r = 0.388; P = .001). The S100B and NSE values were higher in unconscious patients than in the control group (P = .002 and P = .013, respectively). Furthermore, S100B and NSE values were higher in unconscious vs unconscious patients (P = .047 and P = .005, respectively). CONCLUSION: Elevated serum S100B and NSE levels were associated with loss of consciousness in CO poisoning in this series of patients. Serum S100B and NSE may be useful markers in the assessment of clinical status in CO poisoning.