Glutamine-Driven Metabolic Adaptation to COVID-19 Infection.

Background: COVID-19 is known to be transmitted by direct contact, droplets or feces/orally. There are many factors which determines the clinical progression of the disease. Aminoacid disturbance in viral disease is shown in many studies. In this study we aimed to evaluate the change of aminoacid metabolism especially the aspartate, glutamine and glycine levels which have been associated with an immune defence effect in viral disease. Methods: Blood samples from 35 volunteer patients with COVID-19, concretized diagnosis was made by oropharyngeal from nazofaringeal swab specimens and reverse transcriptase-polymerase chain reaction, and 35 control group were analyzed. The amino acid levels were measured with liquid chromatography-mass spectrometry technology. Two groups were compared by Kolmogorov-Smirnov analysis, Kruskal-Wallis and the Mann-Whitney U. The square test was used to evaluate the tests obtained by counting, and the error level was taken as 0.05. Results: The average age of the patient and control group were 48.5 ± 14.9 and 48.8 ± 14.6 years respectively. The decrease in aspartate (p = 5.5 × 10-9) and glutamine levels (p = 9.0 × 10-17) were significiantly in COVID group, whereas Glycine (p = 0.243) increase was not significiant. Conclusions: Metabolic pathways, are affected in rapidly dividing cells in viral diseases which are important for immun defence. We determined that aspartate, glutamine and glycine levels in Covid 19 patients were affected by the warburg effect, malate aspartate shuttle, glutaminolysis and pentose phosphate pathway. Enteral or parenteral administration of these plasma amino acid levels will correct the duration and pathophysiology of the patients' stay in hospital and intensive care.

Green complexity, economic fitness, and environmental degradation: evidence from US state-level data.

Green production is one of the major debates as environmental degradation poses threats globally. The paper attempts to explore the relationship between green production and environmental quality by using Economic Fitness approach. We develop a Green Complexity Index (GCI) dataset consisting of 290 traded green-labeled products and Economic Fitness Index (EFI) for the US states between 2002 and 2018. We analyze the environmental performance of green production using the GCI and EFI data at the sub-national level. Findings indicate that exporting more complex green products has insignificant effects on local (i.e., sulfur dioxide, particulate Matter 10) and global polluters such as carbon dioxide, even accounting for per capita income. Yet, economic fitness has a significant negative impact on the emission levels implying that sophisticated production significantly improves environmental quality in the USA. The insignificant impact of GCI on environmental degradation suggests that green product classifications should incorporate the production and end-use stages of goods to limit the adverse environmental effects of green-labeled products.

Evaluation of respiratory function in healthcare workers wearing face masks during the COVID-19 pandemic.

BACKGROUND: The COVID pandemic, which has caused high mortality rates worldwide, has mainly affected the working environment of healthcare workers. Metabolic and respiratory changes occur in healthcare workers working with surgical masks. OBJECTIVE: Our aim is to identify the metabolic and respiratory problems faced by healthcare personnel working with surgical masks and to produce solutions to minimize them. METHODS: The study was conducted among emergency service workers who used surgical masks for at least 8 h in the emergency room between June 2020 and July 2020. Venous blood gas samples were taken from the health personnel participating in the study and their vital signs were checked. RESULT: A total of 60 healthcare professionals with a mean age of 28.20 ± 6.30 years were included in the study. The distribution of men and women in the study was balanced with 30 (50.0%) men and 30 (50.0%) women. When the first and last vital signs (blood pressure, pulse, saturation) of the health workers participating in the study were examined, no statistically significant differences were found (p > 0.05). While there was no statistically significant difference in the Na, Chlorine, Ca values of metabolic indicators (p > 0.05), the first measurements of K (0.017) and Lactate (0.037) values were found to be higher than the last measurements (p > 0.05). The first measurements of the respiratory parameters pH (0.002), pCO2 (0.028), sO2 (0.045) and pO2 (0.048) were lower than the last measurements (p > 0.05). The first measurement value of pCO2 (0.028) was found to be higher than the last (p > 0.05). CONCLUSIONS: Regular and long-term use of surgical masks does not harm the body metabolically and respiratorily.

Eosinophil Cell Count Predicts Mortality in the Intensive Care Unit after Return of Spontaneous Circulation.

BACKGROUND: Eosinophils constitute 1%-5% of peripheral blood leukocytes, less in the presence of acute infections (referred to as eosinopenia). Studies indicate that eosinopenia can be used as a prognostic predictor for chronic obstructive pulmonary disease exacerbation, sepsis, or acute myocardial infarction disease. There are only a few studies about predicting mortality in emergency departments and intensive care units (ICUs). Prognostic studies about patients in ICUs are generally carried out using different scoring systems. We aimed to analyze if the eosinophil count can estimate the prognosis among non-traumatic patients who underwent cardiopulmonary resuscitation and were hospitalized in ICU thereafter. METHODS: The data were evaluated of 865 non-traumatic adult patients (>18 years of age) who were admitted with cardiopulmonary arrest or developed cardiopulmonary arrest during clinical follow-ups. Admission venous blood sample tests, complete blood count, and biochemical laboratory results were recorded. Arterial blood gas results were also evaluated. The mean results of the recorded laboratory results were compared between the surviving and non-surviving patients groups. RESULTS: There was a significant difference between the two groups in regard to platelet, eosinophil count, pH, PaO2, SaO2, and HCO3- (P<0.001 for all). In the multiple linear regression analysis, eosinophil counts were found to be an independent factor (odds ratio=0.03, 95% confidence interval 0.33-0.56, P<0.001) associated with the mortality after cardiopulmonary resuscitation. CONCLUSION: Because admission eosinophil counts can be measured easily, they are inexpensive biomarkers that can be used for predicting the prognosis among the patients who have return of spontaneous circulation and are treated in ICUs.

Frontal QRS-T angle as a predictive marker for myocardial damage in acute carbon monoxide poisoning.

INTRODUCTION: The present study was undertaken to investigate the prognostic value of the frontal QRS-T angle associated with adverse cardiac outcomes in patients with carbon monoxide (CO) poisoning in early stages in the emergency department. MATERIALS AND METHODS: The data of 212 patients with CO poisoning who were admitted to the ED between January 2010 and May 2020 were retrospectively analyzed. The frontal QRS-T angle was obtained from the automatic reports of the EKG device. RESULTS: Compared to patients without myocardial damage, among patients with myocardial damage, statistically high creatinine, creatine kinase MB, cardiac troponin I, and frontal QRS-T angle values were found (p < 0.001 for all parameters), while the saturation of arterial blood pH and arterial oxygen values were found to be lower (p = 0.002 and p < 0.001, respectively). The frontal QRS-T angle values were correlated with creatine kinase, creatine kinase-MB, cardiac troponin I, and oxygen saturation (SpO2) in arterial blood (r = 0. 232, p = 0.001; r = 0. 253, p = < 0.001; r = 0. 389, p = < 0.001; r = -0. 198, p = 0.004, respectively). The optimum cut-off value of the frontal QRS-T angle was found to be 44.5 (area under the curve: 0.901, 95% confidence interval: 0.814-0.988, sensitivity: 87%, specificity: 84%). CONCLUSIONS: The frontal QRS-T angle, a simple and inexpensive parameter that can be easily obtained from 12-lead surface electrocardiography, can be used as an early indicator in the detection of myocardial damage in patients with CO poisoning.

Serum TLR9 and NF-κB Biochemical Markers in Patients with Acute Pancreatitis on Admission.

AIM: The aim of this study was to investigate the serum TLR9 and NF-κB levels in patients for the diagnosis and prognostication of AP in the emergency department. METHODS: In the current study, we looked at the TLR9 and NF-κB levels in patients for the diagnosis and prognostication of AP in the emergency department. RESULTS: Of the patients with acute pancreatitis, 22 (49%) were male and 23 (51%) were female. The mean age of the patient group was 62 years, with a range of 25-95 years. The control group consisted of 19 (43.1%) male and 25 (56.9%) female patients. The serum TLR9 and NF-κB levels in patients for the diagnosis and prognostication of AP in the emergency department. p < 0.001 and 8.04 ± 1.76 vs. 4.76 ± 1.13; p < 0.001 and 8.04 ± 1.76 vs. 4.76 ± 1.13; κB levels in patients for the diagnosis and prognostication of AP in the emergency department. p < 0.001 and 8.04 ± 1.76 vs. 4.76 ± 1.13; κB levels in patients for the diagnosis and prognostication of AP in the emergency department. p < 0.001 and 8.04 ± 1.76 vs. 4.76 ± 1.13. CONCLUSION: We demonstrated that the TLR9 and NF-κB pathway is activated in acute pancreatitis and increases the inflammatory process. This may help to further understand the pathogenesis of disorder, diagnosis, and clinical severity. We proposed that blockage of these inflammatory pathways may play a role in the prevention of the disease progression and development of inflammatory complications.κB levels in patients for the diagnosis and prognostication of AP in the emergency department.

Concomitant Substance Use Increases the Toxic Effect of synthetic cannabinoid (Bonsai): A Prospective Study.

OBJECTIVE: In this study, we aimed to contribute to the literature by evaluating bonsai and additional drugs. MATERIALS AND METHODS: This prospective study was conducted on 217 patients who admitted to the emergency department (ED) with bonsai intake between December 20, 2014 and January 1, 2016, according to the patient history obtained from the patients. While 168 patients with negative urinary metabolites results were excluded from the study, 49 patients with positive urinary metabolites were included in the study. Patients were divided into two groups. The first group consisted of patients with only bonsai intake and the second group consisted of patients with bonsai and concomitant drug intake. The groups were compared in terms of symptoms, findings, blood gas values, duration of the symptoms, discharge time, hospitalization, and mortality rate. Data were analyzed using the Chi-square, the Fisher's exacttest, the Student t-test, and the Mann-Whitney U test. Data were evaluated at the 95% confidence interval. P<0.05 was considered statistically significant. RESULTS: The mean age of 49 patients included in the study was 26.7±8.9 years and 91.8% (n=45) of the patients were male. Concomittant drug intake was identified in 69.4% of patients. Concomitant drug use was as follows: cocaine (20.4%, n=10), amphetamines (14.3%, n=7), methamphetamines (8,2%, n=4,) tetrahydrocannabinol (32.7%, n=16), opiates (18.4%, n=9) and alcohol (30.6%, n=15). On admission, Glasgow Coma Score (GCS) of the bonsai with additional substance group was significantly higher (p=0,003). The most common symptom was palpitations (tachycardia) (75.5%, n=37). There were no patients hospitalized in Only Bonsai group (p=0,020). The median time to remission of symptoms and median follow-up time of the patients in the emergency room were 3 hours and 6 hours, respectively. Remission time of the symptoms and hospitalization rates were higher in patients with concomittant drug intake (p <0.05) Conclusion: While the bonsai intake alone is not considered mortal to the patients and most of them can be discharged from the ED after signs and symptoms disappear, concomitant drug use can increase the toxic effects of bonsai intake. That is why follow-up of patients taking concomitant drug and the treatment process should be carried out more carefully.

Predicting of neuropsychosis in carbon monoxide poisoning according to the plasma troponin, COHb, RDW and MPV levels: Neuropsychoses in carbon monoxide poisoning.

OBJECTIVE: Carbon monoxide (CO) poisoning is very common worldwide. In this study, we aimed to evaluate the predictivity of neuro psychosis in carbon monoxide poisoning by the admission levels of red cell distribution (RDW), mean platelet volume (MPV) and troponin I levels which can be measured quickly and easily in the emergency department (ED). PATIENTS AND METHODS: This single center observational study included a total of 216 consecutive patients who presented to the ED due to CO poisoning between January 2009 and December 2013. The diagnosis of CO poisoning was made according to the medical history and carboxyhemoglobin (COHb) level of >5%. According to the carboxyhemoglobin levels, the patients were classified as mildly (COHb < 20%) and severely poisoned (COHb > 20%). In addition, patients were divided into 2 groups, i.e., those with positive (>0.05 ng/mL for our laboratory) and negative (<0.05 ng/mL for our laboratory) troponin levels. RESULTS: Patients mean age was 52.58 ±â€¯10.58. 57.9% of the patients had high troponin levels and 51.9% were poisoned severely according to COHb levels. Patients with positive troponin and COHb had longer CO exposure time and higher neutrophil, lymphocyte, mean platelet volume (MPV), COHb and red cell distribution width (RDW) levels at the index admission following CO poisoning than patients with negative troponin (p < 0.05). Age, COHb level, CO exposure time, MPV and RDW (p = 0.001, p < 0.05) remained associated with an increased risk of troponin positivity following adjustment for the variables that were statistically significant. CONCLUSIONS: In patients presenting to the ED with CO poisoning, RDW and MPV can be helpful for risk stratification of neuropsychosis.

Serum Paraoxonase, Arylesterase, and Glutathione-S-Transferase Activities and Oxidative Stress Levels in Patients with Mushroom Poisoning.

OBJECTIVES: Consumption of toxic species of mushrooms may have detrimental effects and increase oxidative stress. Paraoxonase, arylesterase and glutathione-S-transferase are antioxidants that resist oxidative stress. In this study, we analyzed the changes in these enzymes during intoxication due to mushrooms. METHODS: The study enrolled 49 adult patients with a diagnosis of mushroom poisoning according to clinical findings and 49 healthy volunteers as the control group. The patients with mild clinical findings were hospitalized due to the possibility that the patient had also eaten the mushrooms and due to clinical findings in the late period, which could be fatal. Paraoxonase, arylesterase, and glutathione-S-transferase concentrations, as well as total antioxidant and oxidant status, were determined in the 49 patients and 49 healthy volunteers by taking blood samples in the emergency department. RESULTS: While paraoxonase, arylesterase, and total antioxidant status were significantly decreased in the patient group (p<0.05), glutathione-S-transferase, total oxidant status and the oxidative stress index were significantly higher (p<0.05). There was a positive correlation between the hospitalization time and the oxidative stress index (r=0.752, p<0.001), whereas a negative correlation was found with glutathione-S-transferase (r=-0.420, p=0.003). CONCLUSION: We observed a significant decrease in paraoxonase and arylesterase and an increase in glutathione-S-transferase and oxidative stress indexes in patients with mushroom poisoning, indicating that these patients had an oxidative status. In particular, a low total antioxidant status and high oxidative stress index may gain importance in terms of the assessment of hospitalization duration.

Serum paraoxonase, arylesterase, and glutathione-s-transferase activities and oxidative stress levels in patients with mushroom poisoning

OBJECTIVES: Consumption of toxic species of mushrooms may have detrimental effects and increase oxidative stress. Paraoxonase, arylesterase and glutathione-S-transferase are antioxidants that resist oxidative stress. In this study, we analyzed the changes in these enzymes during intoxication due to mushrooms. METHODS: The study enrolled 49 adult patients with a diagnosis of mushroom poisoning according to clinical findings and 49 healthy volunteers as the control group. The patients with mild clinical findings were hospitalized due to the possibility that the patient had also eaten the mushrooms and due to clinical findings in the late period, which could be fatal. Paraoxonase, arylesterase, and glutathione-S-transferase concentrations, as well as total antioxidant and oxidant status, were determined in the 49 patients and 49 healthy volunteers by taking blood samples in the emergency department. RESULTS: While paraoxonase, arylesterase, and total antioxidant status were significantly decreased in the patient group (p<0.05), glutathione-S-transferase, total oxidant status and the oxidative stress index were significantly higher (p<0.05). There was a positive correlation between the hospitalization time and the oxidative stress index (r=0.752, p<0.001), whereas a negative correlation was found with glutathione-S-transferase (r=-0.420, p=0.003). CONCLUSION: We observed a significant decrease in paraoxonase and arylesterase and an increase in glutathione-S-transferase and oxidative stress indexes in patients with mushroom poisoning, indicating that these patients had an oxidative status. In particular, a low total antioxidant status and high oxidative stress index may gain importance in terms of the assessment of hospitalization duration.

Comparison of trauma scores for predicting mortality and morbidity on trauma patients.

BACKGROUND: In this study, we compared the anatomical, and physiological scoring systems trauma revised injury severity score (TRISS), revised trauma score (RTS), injury severity score (ISS), new injury severity score (NISS) to each other, to find out the most accurate and reliable trauma score for the risk classification of morbidity and mortality among the trauma patients. METHODS: This is a cross-sectional study, which included 633 patients who admitted to our University Hospital Emergency Department during an 8-month period due to trauma. All blunt and penetrating traumas (traffic accident, assault, etc.) patients above 16 years were included. RESULTS: Arrival time trauma scores (ISS, NISS, RTS, and TRISS) of the patients was calculated. Mean trauma score for the mortality prediction was calculated, and the p value was equal for all (p=0.001). Trauma scores were also analyzed for the hospitalization time in intensive care unit (ICU). While NISS, RTS, and TRISS values were significant (p=0.048, p=0.048, and p=0.017, respectively), ISS value was not significant (p=0.257) for predicting the ICU hospitalization time. Only TRISS was a good predictor for the mechanically ventilation time in ICU patients (p=0.01). CONCLUSION: In conclusion, we determined that the anatomical trauma scores (NISS, ISS) predicted the hospitalization and ICU necessities better, whereas TRISS, an anatomo-physiological trauma score, defined the ICU hospitalization and mechanically ventilation time better.

The role of heparan sulphate in pathogenesis of Crimean-Congo hemorrhagic fever disease.

BACKGROUND & OBJECTIVES: Crimean-Congo hemorrhagic fever (CCHF) is a viral infection typically transmitted by tick bite. This study is to define the level of heparan sulphate (HS) in serum/urine since HS may play a role in the pathogenesis of hemorrhagic events in the patients with CCHF. METHODS: In this study, the patient group consisted of 79 cases with a positive diagnosis of CCHF according to PCR/ELISA outcome among the patients referred to Cumhuriyet University, School of Medicine in 2010. A total of 81 volunteers who had not any viral or metabolic disease were enrolled as the control group. The blood samples were centrifuged, and the serum and urine samples obtained were stored at - 80°C until they were studied. Then, these samples were simultaneously dissolved, and HS level was spectrophotometrically measured using glycosaminoglycans specific 1- 9, dimethyl-methylene blue (DMMB) stain. RESULTS: A statistically significant increase in the HSserum values was found both in the individuals under and above 16 yr old in the patient groups compared to the controls (p <0.05). Also there was a statistically significant increase in the urine levels of HS in the cases >16 yr old compared to the controls (p <0.05). INTERPRETATIONS & CONCLUSION: Increase of the serum/urine levels of HS was though to be due to vascular endothelium damage and to liver injury as well as vascular endothelium damage in the patients who died. Further, comprehensive studies are needed to demonstrate whether the serum/urine levels of HS are correlated to liver and vascular endothelium damage and prognosis of the disease.

Baseline characteristics and the association between hyponatraemia and pulmonary embolism prognosis.

OBJECTIVE: To evaluate the effect of hyponatraemia on pulmonary thromboembolism mortality rates. METHODS: The retrospective study was conducted at the Cumhuriyet University Medicine Faculty's Emergency Department, and involved the analysis of records related to all patients who were diagnosed with acute pulmonary thromboembolism between January 2005 and June 2011. Diagnoses were confirmed by pulmonary angiography, multi-slice computed tomography or high-probablity ventilation/perfusion scintigraphy. All patients (n=260) were over 16 years of age. SPSS 14 was used for statistical analysis. RESULTS: Plasma sodium level, platelet count and hospitalisation time were significiantly lower among those who died (n=16; 6.29) (p<0.005, p<0.035, p<0.035). Pearson correlation analysis found a negative correlation between plasma sodium level and C-reactive protein, white blood cells and pulmonary artery pressure (r = -0.238, p<0.001; r = -0.222, p<0.001; r = -0.444, p<0.018 respectively). A positive correlation was found between plasma sodium level and hospitalisation time (r=0.130; p<0.039). CONCLUSION: While mortality rates in hyponatraemic pulmonary thromboembolism patients increases, low plasma sodium is an easy parameter that should be kept in mind for the prognosis of pulmonary thromboembolism disease.

Investigation of wound healing in rat lung tissues in the postpartum period.

To assess the wound healing capabilities of damaged lung tissue in the postpartum period, we investigated the parameters related to wound healing in a rat model of lung damage. Rats were divided into six groups: IA, IB, II, IIIA, IIIB and IV (n=7 in each group). Group IA included rats not in the postpartum period that were sacrificed on the third day after lung injury, group IB included rats not in the postpartum period that were sacrificed on the tenth day after lung injury, group II included rats not in the postpartum period that did not receive lung injury, group IIIA included rats in the postpartum period that were sacrificed on the third day after lung injury, group IIIB included rats in the postpartum period that were sacrificed on the tenth day after lung injury and group IV included rats in the postpartum period without lung injury. Wound healing was evaluated histopathologically and measurements of hydroxyproline levels, serum alanine and glutamine were taken. A significant difference in serum alanine levels was evident between groups IA and IIIA. Significant differences were also observed between serum alanine and glutamine levels in groups IB and IIIB. In conclusion, we demonstrated that serum alanine levels were reduced in the postpartum period following lung injury, which may be expected to negatively impact wound healing in this period. The administration of exogenous alanine for traumatic events occurring during the postpartum period may thus contribute positively to wound healing capabilities during this period.

Quail consumption can be harmful.

BACKGROUND: Intoxication due to quail consumption is rarely seen. Such a toxicological syndrome (also called coturnism) occurs during the migration of quails from north to south, when they consume hemlock seeds. The clinical symptoms and laboratory results are indicative of acute rhabdomyolysis. OBJECTIVES: Acute rhabdomyolysis has a wide range of etiologies. Coturnism is a rare cause of acute rhabdomyolysis that can be lethal due to renal failure and shock. To avoid severe complications, coturnism may be considered if the history is appropriate. CASE REPORT: We report four cases of coturnism from quail consumption; the patients were admitted with some combination of symptoms including muscle tenderness, extremity pain, nausea, and vomiting. They were treated with vigorous isotonic crystalloid hydration and urine alkalinization. Consequently, the laboratory results returned to normal ranges and the clinical symptoms disappeared. CONCLUSION: Although coturnism is a rarely seen toxicological syndrome that causes rhabdomyolysis, we present this case to increase awareness that it may present with symptoms of muscle tenderness, extremity pain, nausea, and vomiting after quail consumption.

Mushroom poisoning: retrospective analysis of 294 cases.

OBJECTIVE: The objective of this study was to present special clinical and laboratory features of 294 cases of mushroom poisoning. MATERIALS AND METHODS: In this retrospective study, 294 patients admitted to the Pediatric and Adult Emergency, Internal Medicine and ICU Departments of Cumhuriyet University Hospital were investigated. RESULTS: Of 294 patients between the ages of 3 and 72 (28.97 +/- 19.32), 173 were female, 121 were male and 90 were under the age of 16 years. One hundred seventy-three patients (58.8%) had consumed the mushrooms in the early summer. The onset of mushroom toxicity symptoms was divided into early (within 6 h after ingestion) and delayed (6 h to 20 d). Two hundred eighty-eight patients (97.9%) and six (2.1%) patients had early and delayed toxicity symptoms, respectively. The onset of symptoms was within two hours for 101 patients (34.3%). The most common first-noticed symptoms were in the gastrointestinal system. The patients were discharged within one to ten days. Three patients suffering from poisoning caused by wild mushrooms died from fulminant hepatic failure. CONCLUSION: Education of the public about the consumption of mushrooms and education of health personnel working in health centers regarding early treatment and transfer to hospitals with appropriate facilities are important for decreasing the mortality.

Mushroom poisoning: retrospective analysis of 294 cases

OBJECTIVE: The objective of this study was to present special clinical and laboratory features of 294 cases of mushroom poisoning. MATERIALS AND METHODS: In this retrospective study, 294 patients admitted to the Pediatric and Adult Emergency, Internal Medicine and ICU Departments of Cumhuriyet University Hospital were investigated. RESULTS: Of 294 patients between the ages of 3 and 72 (28.97 ± 19.32), 173 were female, 121 were male and 90 were under the age of 16 years. One hundred seventy-three patients (58.8 percent) had consumed the mushrooms in the early summer. The onset of mushroom toxicity symptoms was divided into early (within 6 h after ingestion) and delayed (6 h to 20 d). Two hundred eighty-eight patients (97.9 percent) and six (2.1 percent) patients had early and delayed toxicity symptoms, respectively. The onset of symptoms was within two hours for 101 patients (34.3 percent). The most common first-noticed symptoms were in the gastrointestinal system. The patients were discharged within one to ten days. Three patients suffering from poisoning caused by wild mushrooms died from fulminant hepatic failure. CONCLUSION: Education of the public about the consumption of mushrooms and education of health personnel working in health centers regarding early treatment and transfer to hospitals with appropriate facilities are important for decreasing the mortality.