RESUMO
BACKGROUND: Pulmonary embolism (PE) is a common disease associated with high mortality and morbidity. Diagnosing PE is challenging due to diverse clinical presentations and the lack of specific biomarkers. OBJECTIVE: We hypothesized that plasma galectin-3 (Gal-3) levels might reflect the severity of acute PE and be useful for diagnostic assessment. METHODS: In this prospective study, 150 patients (100 patients with PE and 50 control patients) were included. Patients were stratified into high-risk, medium-risk, and low-risk groups according to the Wells and revised Geneva scoring systems, and Gal-3 levels were compared among the groups. PE was diagnosed by means of computed tomography pulmonary angiography. RESULTS: In this study, of the 100 PE patients included in the study, 69 patients recovered and were discharged and 31 patients died. Median Gal-3 value in the PE group was 27.0 ng/mL (range 11.5-35.0 ng/mL), whereas the median Gal-3 value in the control group was significantly lower at 8.8 ng/mL (range 1.0-21.0 ng/mL) (p < 0.001). When the Gal-3 values of the PE group and the control group were evaluated with the receiver operator characteristic curve, the area under the curve was calculated as 0.99 (95% confidence interval 0.979-1). At a Gal-3 cutoff value of 13.55 ng/mL, which was determined to be the most appropriate value for PE diagnosis, the sensitivity was 98% and the specificity was 92%. CONCLUSIONS: A biomarker that rapidly and accurately diagnoses acute PE in the emergency department can be an extremely useful tool. We concluded that plasma Gal-3 levels can be regarded as a promising marker of acute PE.
Assuntos
Galectina 3 , Embolia Pulmonar , Doença Aguda , Biomarcadores , Proteínas Sanguíneas , Serviço Hospitalar de Emergência , Produtos de Degradação da Fibrina e do Fibrinogênio , Galectinas , Humanos , Valor Preditivo dos Testes , Estudos Prospectivos , Embolia Pulmonar/diagnósticoRESUMO
The presence of air in the spinal canal is known as pneumorrhachis (PNR), aerorachia, intraspinal pneumocele, pneumosaccus, pneumomyelogra, or intraspinal air. Pneumorrhachis may be iatrogenic, traumatic, and nontraumatic. We treated 2 patients who had posttraumatic PNR in the cervical spine region after stab injuries. Case 1 was a 31-year-old man who was stabbed in the C5 to C6 region. He had muscle weakness (3/5) and numbness on the right side of the body. Brain computed tomographic (CT) scan showed pneumocephalus, and cervical CT scan showed PNR at the C6 level. Treatment included observation, and symptoms and weakness improved within 7 days. Case 2 was a 40-year-old man who was stabbed in the C3 to C4 region. He had muscle weakness (1/5) and numbness on the left side of the body. Brain CT scan showed pneumocephalus, and cervical CT scan showed PNR at the C3 level. Cerebrospinal fluid drainage persisted, and he was treated with surgical repair of a dural laceration. Muscle strength improved. In summary, PNR is a rare condition that usually is treated nonoperatively. However, surgical treatment may be indicated for persistent neurologic symptoms or signs; the air detected in the spinal canal with radiographic imaging may be associated with an active cerebrospinal fluid leak and may cause spinal compression.
Assuntos
Pneumorraque/etiologia , Traumatismos da Coluna Vertebral/complicações , Ferimentos Perfurantes/complicações , Adulto , Humanos , Masculino , Pneumorraque/diagnóstico por imagem , Pneumorraque/cirurgia , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/cirurgiaRESUMO
OBJECTIVES: To evaluate demographic and clinical characteristics of patients with poisoning at a community hospital. METHODS: The retrospective study comprised records of patients who were admitted to the emergency department of Konya Numune Hospital, Turkey, because of poisoning between January 1, 2009, and December 31, 2011. Data was evaluated for age, gender, educational status, occupation, arrival time, mechanism of intoxication , body temperature, pulse, respiratory rate, Glasgow Coma Scale score, treatment applied, duration of hospital stay, duration of follow-up, test results, final diagnosis, clinical disposition, and outcome. Agents causing the poisoning were also determined. RESULTS: Records of 1036 patients were evaluated. Of them, 764(74%) were female and 272(26%) were male. The predominant age range was 15-24 years in 617(60%) patients. The median time from substance exposure to admission to the emergency department was 2 hours. The most common cause of poisoning was attempted suicide in 955 [92%] patients and drug intoxication was the agent involved in 932 (90%). In the 15-24 year age range, there were 469 (76%) female patients. Of the total female population in the study, 716 (94%) attempted suicide. The median hospital stay was 24 hours. There were 908 (88%) patients who were advised to seek further evaluation at the psychiatry clinic, and 9 (0.9%) patients were admitted to the psychiatry inpatient units after medical treatment. In patients who were hospitalized and followed up, 1 (0.1%) died because of multiple drug poisoning. CONCLUSION: Most admissions to the emergency department for poisoning related to young women had used drugs during a suicide attempt.
Assuntos
Serviço Hospitalar de Emergência , Intoxicação/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Pressão Sanguínea , Feminino , Escala de Coma de Glasgow , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Intoxicação/etiologia , Estudos Retrospectivos , Turquia/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: The frequency of hemolysis of blood samples may be increased by transport in a pneumatic tube system. The purpose of this study was to evaluate the effect of pneumatic tube system transport on hemolysis of blood samples. METHODS: Blood samples were transported from the emergency department to the hospital laboratory manually by hospital staff (49 patients) or with a pneumatic tube system (53 patients). The hemolysis index and serum chemistry studies were performed on the blood samples and compared between the different methods of transport. RESULTS: The blood samples that were transported by the pneumatic tube system had a greater frequency of hemolysis and greater mean serum potassium and median creatinine, aspartate aminotransferase, and lactate dehydrogenase levels than samples transported manually. CONCLUSION: Blood samples transported from the emergency department to the hospital laboratory by a pneumatic tube system may have a greater frequency of hemolysis than samples transported manually. This may necessitate repeat phlebotomy and cause a delay in completing the laboratory analysis.
RESUMO
This study, which included patients over the age of 18 who were diagnosed with coronavirus disease 2019 (COVID-19) in the emergency clinic, aims to determine the relationship between coagulation parameters and mortality. Epidemiologic data such as age, gender, medical history, vital parameters at emergency department admission, clinical findings, coagulation parameters such as d-dimer, prothrombin time (PT), active partial thromboplastin time (aPTT), international normalized ration (INR), fibrinogen, and platelet were evaluated. Patients with positive computerized tomography (CT) findings and positive polymerase chain reaction (PCR) together were included in the study. It was revealed that d-dimer, fibrinogen, INR, and PT values were higher in the elderly group. It was shown that there was a significant relationship between hospitalization days (ward or intensive care unit) and d-dimer levels. It was observed that d-dimer, fibrinogen elevation was significantly associated with prognosis by increasing mortality, and that platelet and aPTT values were also associated with prognosis and were lower in the mortality group. On the other hand, in receiver operating characteristic (ROC) analysis, the sensitivity and specificity data were 80.3%/80.0% for d-dimer, 70.5%/72.2% for fibrinogen, 58.2%/59.4% for aPTT, and 59.7%/59.2% for platelet, respectively. The overall classification success was 88.6% and mortality prediction success was 37.7% in the regression model of some coagulation parameters (d-dimer, fibrinogen, aPTT, and platelet) which were effective on prognosis. In conclusion, it was determined that d-dimer, fibrinogen, aPTT, and platelet parameters were directly associated with mortality and when these coagulation parameters were used together with the clinical, vital, and demographic data of the patients, the success of mortality prediction increased significantly.
RESUMO
OBJECTIVE: To analyse the range of injuries associated with sternal fracture (SF) and their clinical features and outcomes. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Emergency Medicine, Faculty of Medicine, Selcuk University, Konya, Turkey, from July 2010 to July 2020. METHODOLOGY: Sternal fractures were considered in 330 patients with blunt trauma during the study period. They were categorised according to the Johnson and Branfoot classification and the Arbeitsgemeinschaft fur Osteosynthesefragen / Orthopaedic Trauma Association classification. Demographic data were collected, including age, gender, mechanism of injury, associated injuries, and the length of hospital stay. RESULTS: During the 10-year study period, a total of 4024 thoracic trauma patients were admitted to the emergency department. Of these, 330 (8.2%) had a sternal fracture. The median age of the patients was 41 (8-90) years, and 72.7% were male. Isolated sternal fractures occurred in 93 patients (28.2%). An additional thoracic injury was observed in 74 patients (22.4%) included in the study, and an accompanying extrathoracic injury was observed in 34 patients (10.3%). In 129 patients (39.1%), both thoracic and extrathoracic pathologies were detected, in addition to SF. The mortality rate among patients with isolated sternal fracture was 1.1%; the mortality rate among patients with sternal fracture accompanied by additional pathologies was 6.6%. CONCLUSION: Sternal fractures are frequently associated with other injuries. Although isolated sternal fracture has a good prognosis, careful evaluation and clinical observation are essential for additional injuries. KEY WORDS: Emergency medicine, Sternal fracture, Chest trauma.
Assuntos
Fraturas Ósseas , Traumatismos Torácicos , Ferimentos não Penetrantes , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas Ósseas/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esterno/lesões , Traumatismos Torácicos/complicações , Traumatismos Torácicos/epidemiologia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/epidemiologiaRESUMO
BACKGROUND: The present study aims to investigate the efficacy of ultrasound simulators in the training of the health staff working in the emergency department of a university hospital on Focused Assessment with Sonography for Trauma (FAST). METHODS: This study was conducted on emergency medicine residents, medical interns and paramedics of the emergency department of Selçuk University Medical Faculty, prospectively. The participants were given theoretical and practical training on FAST using the SonoSim® USG simulator. At the end of the training, all participants were requested to perform FAST for the pre-selected scenarios for five patients to find the ideal diagnostic window for each patient and declare the diagnosis. RESULTS: This study included 60 participants, including emergency medicine residents, medical interns and paramedics, each having 20 members. The rate of obtaining the correct image was 99.5%, and the rate of diagnosing correctly was 94% among resident physicians. For interns, these rates were 98.5% and 88%, respectively. For paramedics, the rates were 98% and 81.5%, respectively. CONCLUSION: It was observed that the theoretical knowledge level of the trainees did not affect the ability to obtain a correct image in the simulator. However, the skills of the trainees for correctly diagnosing via FAST were directly proportional to their theoretical knowledge levels. Our findings suggest that a short theoretical training followed by a simulator-guided practice would easily provide a sufficiency for FAST for the health workers.
Assuntos
Pessoal Técnico de Saúde/educação , Medicina de Emergência/educação , Avaliação Sonográfica Focada no Trauma , Treinamento por Simulação , Ferimentos e Lesões/diagnóstico por imagem , HumanosRESUMO
BACKGROUND: We determined the value of the inferior vena cava (IVC) diameter for predicting acute blood loss in control and blunt trauma patients and compared this with other parameters of hemorrhagic shock. METHODS: Fifty volunteers and 28 consecutive hemorrhagic shock patients were recruited prospectively to participate in the study. Vital signs, blood lactate, and serum bicarbonate were measured, and shock index and base excess were calculated. Anteroposterior (AP) and mediolateral (ML) IVC diameters during inspiration and expiration were measured in the right subcostal region. IVC diameters in hemorrhagic shock patients were compared with those of controls and were also compared with other hemorrhagic shock parameters. RESULTS: A significant relationship was determined between mean IVC AP and ML diameters during expiration and inspiration on admission in the study group and in the control group (p=0.000, p=0.000, p=0.000, p=0.000). Serum lactate levels correlated significantly with all IVC diameters (r=55), especially the IVC ML diameter during expiration. CONCLUSION: IVC diameter, as measured by transabdominal ultrasound, was more accurate than the shock index and other commonly used non-invasive predictors of acute blood loss (blood pressure, heart rate per minute, serum lactate level, base deficit).
Assuntos
Choque Hemorrágico/fisiopatologia , Veia Cava Inferior/anatomia & histologia , Veia Cava Inferior/diagnóstico por imagem , Adulto , Frequência Cardíaca , Humanos , Tamanho do Órgão , Pulso Arterial , Valores de Referência , Choque Hemorrágico/diagnóstico por imagem , Sístole , Ultrassonografia/métodos , Veia Cava Inferior/fisiologia , Veia Cava Inferior/fisiopatologiaRESUMO
OBJECTIVES: The aim of this study was to compare the effects of mannitol and melatonin on brain edema secondary to trauma using magnetic resonance imaging (MRI). METHODS: A mild traumatic brain injury with the Feeney method was performed upon twelve New Zealand rabbits. Three hours after the trauma was inflicted, MRI images were obtained, then the subjects were divided into two groups: a mannitol group and a melatonin group. The mannitol group (n = 6) was given 2 gr/kg of 20% mannitol IV over 10 minutes and the melatonin group (n = 6) received 100 mg/kg of melatonin IV over 30 minutes. Thirty-three hours after the first MRI, MRI was repeated. The 3-hour and 36-hour post-trauma MRI images in both groups were scored regarding signs of edema and extent of brain tissue protrusion in a blinded fashion by a staff radiologist. Intragroup and intergroup comparisons were made using the Fisher exact test and chi square test. Comparison of brain tissue protrusion measurements was done using the Mann Whitney U test. RESULTS: Signs of raised intraventricular pressure, contusion and parenchymal edema were more prevelant, and parenchymal protrusion was more prominent on the 36-hour MRI in both mannitol and melatonin groups. No significant difference was found between the melatonin and mannitol groups in any parameter in the MRI images performed 3 and 36 hours after the head trauma. CONCLUSIONS: In this animal model, melatonin and mannitol had similar effects on brain edema, as demonstrated on MRI 3 and 36 hours after head trauma.
Assuntos
Edema Encefálico/tratamento farmacológico , Edema Encefálico/patologia , Lesões Encefálicas/complicações , Encéfalo/patologia , Manitol/uso terapêutico , Melatonina/uso terapêutico , Animais , Edema Encefálico/etiologia , Lesões Encefálicas/patologia , Modelos Animais de Doenças , Feminino , Pressão Intracraniana/efeitos dos fármacos , Imageamento por Ressonância Magnética , Masculino , Fármacos Neuroprotetores/uso terapêutico , CoelhosRESUMO
The role of lactate composition of cerebrospinal fluid (CSF) with vasospasm severity and rabbit neurologic status in subarachnoid hemorrhage was determined. The neurologic status of 20 New Zealand rabbits were graded initially and then, anesthetized and basal angiograms were performed. Then 1.0 mL of CSF was withdrawn through cisterna magna and then 1 mL autologous arterial blood was injected in all rabbits over 1 minute. After 5 days, neurologic severity score (NSS) and vertebrobasilar angiograms of all rabbits were repeated. Rabbits without radiologic vasospasm or spasm under 50% (n=7) were termed as group 1. Rabbits whose cerebral vasospasm were 50% or over 50% (n=7) and NSS is lesser than 3 were termed as groups 2, and rabbits whose cerebral vasospasm were 50% or above 50% (n=7) and NSS is greater than 3 were termed groups 3. On day 7, the CSF lactate values of each group were significantly different (P<0.05) with each other. But when compared with only CSF baseline lactate values groups 2 and 3 were significantly different (P<0.05). However, the NSSs were similar in groups 1 and 2, but group 3 significantly differed from groups 1 and 2 (P<0.05). All groups significantly differed from baseline NSSs (P<0.05). The data showed clearly that the degree of vasospasm correlates not only with neurologic status but also with CSF lactate levels. We suggest that CSF lactate level may be useful as a surrogate marker of cerebral vasospasm degree after subarachnoid hemorrhage in clinics where invasive cerebral angiography could not be assessed for whatever reasons.
Assuntos
Ácido Láctico/líquido cefalorraquidiano , Doenças do Sistema Nervoso/líquido cefalorraquidiano , Hemorragia Subaracnóidea/líquido cefalorraquidiano , Hemorragia Subaracnóidea/complicações , Vasoespasmo Intracraniano/complicações , Animais , Artéria Basilar/diagnóstico por imagem , Biomarcadores/líquido cefalorraquidiano , Cisterna Magna , Modelos Animais de Doenças , Masculino , Coelhos , Radiografia , Índice de Gravidade de Doença , Vasoespasmo Intracraniano/diagnóstico , Artéria Vertebral/diagnóstico por imagemRESUMO
AIMS: To determine the usefulness of fibrinolytic markers as early prognostic indicators in patients with isolated head trauma. MATERIALS AND METHODS: Sixty-two consecutive patients (26 women and 36 men; mean age 61 years, range 2-76 years) with isolated head trauma seen within the first three hours of the trauma were included in the study. The Glasgow Coma score (GCS), platelet counts (Plt), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, fibrin degradation products (FDP) and D-dimer levels were measured. Head computerized tomography (CT) findings were categorized as brain edema, linear fracture, depressed fracture, contusion and bleeding. Plt counts, PT, PTT, fibrinogen, FDP, D-dimer levels and CT findings were compared with both GCS and mortality in the first week. Statistical significance was accepted at P Assuntos
Lesões Encefálicas/diagnóstico
, Lesões Encefálicas/terapia
, Fibrinólise/fisiologia
, Adolescente
, Adulto
, Idoso
, Biomarcadores
, Testes de Coagulação Sanguínea
, Lesões Encefálicas/sangue
, Criança
, Pré-Escolar
, Coagulação Intravascular Disseminada/sangue
, Feminino
, Escala de Coma de Glasgow
, Humanos
, Masculino
, Pessoa de Meia-Idade
, Prognóstico
, Resultado do Tratamento
RESUMO
Carbon monoxide intoxication is the most prevalent cause of death from carbon monoxide poisoning. We herein report the case of a 56-year-old man who was found unconscious and smelled of smoke after exposure to carbon monoxide from a heater. He scored 5 on the Glasgow Coma Scale, and had respiratory insufficiency and elevated troponin I, creatine kinase-MB fraction and carboxyhaemoglobin levels. He was treated by mechanical ventilation. After regaining consciousness, brain magnetic resonance imaging showed diffusion restriction in the left occipital lobe; there was a loss of vision (right temporal hemianopsia), which improved by the follow-up session. Carbon monoxide intoxication may cause neurologic and cardiac sequelae, and the initial treatment includes oxygen therapy. Acute carbon monoxide poisoning can cause serious injury to the brain, heart and other organs; the most severe damages that could be inflicted to the brain include cerebral ischaemia and hypoxia, oedema, and neural cell degeneration and necrosis.
Assuntos
Isquemia Encefálica/fisiopatologia , Intoxicação por Monóxido de Carbono/fisiopatologia , Monóxido de Carbono/química , Encéfalo/fisiopatologia , Carboxihemoglobina/química , Creatina Quinase Forma MB/sangue , Difusão , Escala de Coma de Glasgow , Humanos , Oxigenoterapia Hiperbárica , Hipóxia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Troponina I/sangueRESUMO
Pneumomediastinum is the presence of air in the mediastinum. It may occur as spontaneous, traumatic, or iatrogenic pneumomediastinum. Although spontaneous pneumomediastinum is usually observed in healthy young men, traumatic pneumomediastinum may be caused by blunt or penetrating trauma to the chest and neck. Pneumomediastinum is a clinical condition with potential complications that cause high morbidity and mortality rates. Pneumomediastinum also may develop without tracheal or oesophageal injury after spontaneous or blunt chest, neck and facial injuries, and it may be accompanied by pneumothorax. We treated two patients who had pneumomediastinum. Case 1 was a 20-year-old man who had pain and dyspnoea around the sternum for one hour, as a result of a blow from an elbow during a football match. Case 2 was a 23-year-old man who had a two-day history of dyspnoea and chest pain with no history of trauma. In both patients, diagnosis of pneumomediastinum was confirmed with thoracic computed tomography scans, and the condition resolved within five days of in-patient observation. In conclusion, the diagnosis of pneumomediastinum should be considered for all patients who present to the emergency department with chest pain and dyspnoea.
Assuntos
Dor no Peito/etiologia , Dispneia/etiologia , Enfisema Mediastínico/complicações , Dor no Peito/diagnóstico , Dispneia/diagnóstico , Humanos , Masculino , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/etiologia , Valor Preditivo dos Testes , Futebol/lesões , Traumatismos Torácicos/complicações , Fatores de Tempo , Tomografia Computadorizada por Raios X , Conduta Expectante , Ferimentos não Penetrantes/complicações , Adulto JovemRESUMO
Neuroprotective agents such as methylprednisolone and sildenafil may limit damage after spinal cord injury. We evaluated the effects of methylprednisolone and sildenafil on biochemical and histologic changes after spinal cord injury in a rabbit model. Female New Zealand rabbits (32 rabbits) were allocated to 4 equal groups: laminectomy only (sham control) or laminectomy and spinal trauma with no other treatment (trauma control) or treatment with either methylprednisolone or sildenafil. Gelsolin and caspase-3 levels in cerebrospinal fluid and plasma were determined, and spinal cord histology was evaluated at 24 hours after trauma. There were no differences in mean cerebrospinal fluid or plasma levels of caspase-3 between the groups or within the groups from 0 to 24 hours after injury. From 0 to 24 hours after trauma, mean cerebrospinal fluid gelsolin levels significantly increased in the sildenafil group and decreased in the sham control and the trauma control groups. Mean plasma gelsolin level was significantly higher at 8 and 24 hours after trauma in the sildenafil than other groups. Histologic examination indicated that general structural integrity was better in the methylprednisolone in comparison with the trauma control group. General structural integrity, leptomeninges, white and grey matter hematomas, and necrosis were significantly improved in the sildenafil compared with the trauma control group. Caspase-3 levels in the cerebrospinal fluid and blood were not increased but gelsolin levels were decreased after spinal cord injury in trauma control rabbits. Sildenafil caused an increase in gelsolin levels and may be more effective than methylprednisolone at decreasing secondary damage to the spinal cord.
Assuntos
Fármacos Neuroprotetores/uso terapêutico , Citrato de Sildenafila/uso terapêutico , Traumatismos da Medula Espinal/patologia , Traumatismos da Medula Espinal/prevenção & controle , Animais , Caspase 3/sangue , Caspase 3/líquido cefalorraquidiano , Feminino , Gelsolina/sangue , Gelsolina/líquido cefalorraquidiano , Modelos Animais , Necrose/patologia , Fármacos Neuroprotetores/farmacologia , Coelhos , Citrato de Sildenafila/farmacologia , Medula Espinal/efeitos dos fármacos , Medula Espinal/patologia , Traumatismos da Medula Espinal/metabolismoRESUMO
OBJECTIVES: The purpose of the present study was to evaluate the association between the red blood cell distribution width (RDW) and the Glasgow Coma Scale (GCS), Canadian Neurological Scale (CNS), and National Institutes of Health Stroke Scale (NIHSS) scores in patients who had acute ischemic stroke. METHODS: This prospective observational cohort study included 88 patients who have had acute ischemic stroke and a control group of 40 patients who were evaluated in the Emergency Department for disorders other than acute ischemic stroke. All subjects had RDW determined, and stroke patients had scoring with the GCS, CNS, and NIHSS scores. The GCS, CNS, and NIHSS scores of the patients were rated as mild, moderate, or severe and compared with RDW. RESULTS: Stroke patients had significantly higher median RDW than control subjects. The median RDW values were significantly elevated in patients who had more severe rather than milder strokes rated with all three scoring systems (GCS, CNS, and NIHSS). The median RDW values were significantly elevated for patients who had moderate rather than mild strokes rated by GCS and CNS and for patients who had severe rather than mild strokes rated by NIHSS. The area under the receiver operating characteristic curve was 0.760 (95% confidence interval, 0.676-0.844). Separation of stroke patients and control groups was optimal with RDW 14% (sensitivity, 71.6%; specificity, 67.5%; accuracy, 70.3%). CONCLUSION: In stroke patients who have symptoms <24 hours, the RDW may be useful in predicting the severity and functional outcomes of the stroke.
RESUMO
BACKGROUND: The aim of this study was to investigate the effects of antioxidant and resuscitation fluids which were used during haemorrhagic shock on tissue ischemia. METHODS: Forty New Zealand type rabbits were divided into four groups as C (control), I (hypertonic saline), H (HAES) and D (Dimethylsulphoxide-DMSO). Haemorrhagic shock was induced by bleeding from carotid artery. Thirty minutes after shock, Group C was not resuscitated while Group I was resuscitated with Hypertonic saline 7.2, Group H with 10 % HAES and Group D with HAES 10 % and DMSO. Thiobarbituric acid reactive substances (TBARS) and lactate levels in blood, liver and small bowel samples were measured. RESULTS: There were no significant differences among the groups tissue and plasma TBARS and lactate levels. CONCLUSION: Resuscitation fluids and addition of antioxidants to the resuscitation fluids do not have any superiorities over each other to prevent tissue ischemic insult in haemorrhagic shock.
Assuntos
Dimetil Sulfóxido/uso terapêutico , Sequestradores de Radicais Livres/uso terapêutico , Solução Salina Hipertônica/uso terapêutico , Choque Hemorrágico/terapia , Animais , Dimetil Sulfóxido/administração & dosagem , Modelos Animais de Doenças , Eritrócitos/metabolismo , Sequestradores de Radicais Livres/administração & dosagem , Infusões Intravenosas , Intestino Delgado/metabolismo , Ácido Láctico/sangue , Ácido Láctico/metabolismo , Fígado/metabolismo , Coelhos , Solução Salina Hipertônica/administração & dosagem , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismoRESUMO
PURPOSE: Trauma is a common cause of admission to the hospital emergency department. The purpose of this study was to evaluate the cause of admission, clinical characteristics, and outcomes of patients aged ≥65 years admitted to an emergency department in Turkey because of blunt trauma. MATERIALS AND METHODS: Medical records were retrospectively reviewed for 568 patients (314 women and 254 men) aged ≥65 years who were admitted to an emergency department of a tertiary care hospital. RESULTS: Trauma was caused by low-energy fall in 379 patients (67%), traffic accident in 79 patients (14%), high-energy fall in 69 patients (12%), and other causes in 41 patients (7%). The most frequent sites of injury were the lower extremity, thorax, upper extremity, and head. The femur was the most frequent fracture site. After evaluation in the emergency department, 377 patients (66%) were hospitalized. There were 31 patients (5%) who died. Risk of hospitalization after trauma was significantly associated with trauma to the lower extremity, thorax, and spine; fractures of the femur and rib; and intracranial injury. CONCLUSION: Emergency department admission after trauma in patients aged ≥65 years is common after low-energy falls, and most injuries occur to the extremities. It is important to focus on prevention of falls to decrease the frequency of trauma in the elderly.
Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Ferimentos não Penetrantes/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Estudos Retrospectivos , Fatores Sexuais , Turquia/epidemiologia , Ferimentos não Penetrantes/etiologiaRESUMO
BACKGROUND: Serum biomarkers may be useful for early diagnosis of acute ischemic stroke, exclusion of other diseases that may mimic stroke, and prediction of infarct volume. We evaluated serum high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-related phospholipase A2 (Lp-PLA2) in patients who had acute ischemic stroke. METHODS: In 200 patients who presented to an emergency service (acute ischemic stroke, 102 patients; control with no stroke, 98 patients), stroke patients were evaluated with the Canadian neurological scale and diffusion-weighted magnetic resonance imaging, and all patients were evaluated with the Glasgow coma scale and their serum hs-CRP level and Lp-PLA2 activity were assessed. The volume of stroke lesions was calculated from magnetic resonance images. RESULTS: Patients who had stroke had higher mean serum hs-CRP level (stroke, 7±6 mg/dL; control, mean ± standard deviation 1±1 mg/dL; P≤0.001) and Lp-PLA2 activity (stroke, mean ± standard deviation 113±86 nmol/min/mL; control, mean ± standard deviation 103±50 nmol/min/mL; P≤0.001) than control patients who did not have stroke. The mean hs-CRP level and Lp-PLA2 activity were higher in patients who had greater stroke severity (lower Canadian neurological scale score) and were higher in patients who had larger volume strokes. CONCLUSION: Higher hs-CRP level and Lp-PLA2 activity are significantly associated with more severe neurologic impairment and larger infarct size in patients who have acute ischemic stroke. These biomarkers may be useful for rapid diagnosis and prediction of ischemic tissue volume in the early stage of ischemic stroke. These findings may be important for health care facilities that have limited access to emergency computed tomography scanning for the diagnosis of stroke.
RESUMO
Black widow spiders (Latrodectus tredecimguttatus) are poisonous spiders endemic in Turkey. Latrodectus bites may cause myocarditis with increased cardiac enzymes. We treated two men (aged 20 and 33 years) who had myocarditis after black spider bites with leucocytosis and elevated levels of troponin I, creatine kinase and creatine kinase-MB fraction. Both patients had normal results on an ECG, and one patient had abnormal echocardiography with minimal left ventricular wall movement disorder. Both patients were hospitalised in the intensive care unit and treated with intravenous fluids, analgesics, spasmolytic drugs, tetanus prophylaxis and cardiac monitoring. The levels of troponin I, creatine kinase and creatine kinase-MB fraction improved, and the patients were discharged home on the third and fifth hospital day without complications. Myocarditis after a Latrodectus bite is rare, but may be associated with serious complications. Therefore, in regions endemic with Latrodectus spiders, prudent treatment of spider bites may include cardiac evaluation and monitoring.
Assuntos
Viúva Negra , Miocardite/induzido quimicamente , Miocardite/terapia , Picada de Aranha/complicações , Picada de Aranha/terapia , Venenos de Aranha/intoxicação , Adulto , Animais , Biomarcadores/sangue , Ecocardiografia , Eletrocardiografia , Humanos , MasculinoRESUMO
BACKGROUND: Bupropion is a new-generation monocyclic antidepressant that has been accidentally found to have potential effects on reducing nicotine addiction. It is structurally similar to stimulants such as amphetamine and inhibits dopamine and noradrenalin reuptake selectively. CASE REPORTS: We report two cases with no history of epilepsy who took oral bupropion for depression and had generalised tonic-clonic type of seizures in their follow-ups. CONCLUSION: After an overdose of bupropion, clinical effects are seen primarily on the neurological, cardiovascular, and gastrointestinal systems. Neurological effects can include tremor, confusion, agitation, hallucinations, coma, and seizures.