Thiol/disulfide homeostasis in patients treated with normobaric or hyperbaric oxygen for carbon monoxide poisoning.

OBJECTIVES: We aimed to determine the value of thiol/disulfide homeostasis (TDH) as an oxidative stress marker in hyperbaric oxygen therapy (HBOT) and normobaric oxygen therapy (NBOT) patients presenting with carbon monoxide poisoning. In addition, we compared the effect of HBOT and NBOT on thiol/disulfide parameters. METHODS: This prospective study included 66 patients and 67 healthy individuals who presented to the emergency department. We evaluated serum native thiol, disulfide, and total thiol levels in 8 patients who received HBOT and 58 who received NBOT. We also compared pre- and post-treatment levels of disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol. RESULTS: There was a statistically significant difference between the case and control groups in native thiol and total thiol before NBOT (p < 0.006, p < 0.006). We also found a statistically significant difference between the groups in pre- and post-NBOT levels of native thiol and total thiol (p < 0.002, p < 0.003). However, our comparison of HBOT and NBOT showed no significant difference in the levels of native thiol, total thiol, disulfide, disulfide/native thiol, disulfide/total thiol, or native thiol/total thiol (p < 0.544, p < 0.860, p < 0.644, p < 0.409, p < 0.409, p < 0.409, respectively). CONCLUSIONS: Although thiol/disulfide parameters increased in patients receiving HBOT or NBOT, changes in antioxidant levels did not differ significantly between NBOT and HBOT patients. This suggests that NBOT and HBOT have similar effects on thiol/disulfide parameters. NBOT alone may be effective in centers that do not have HBOT facilities.

Relationship of platelet counts, platelet volumes, and Curb-65 scores in the prognosis of COVID-19 patients.

OBJECTIVES: This study investigated the relationship between 28-day mortality in patients with COVID-19 pneumonia and the CURB-65 score, platelet count (PLT), mean platelet volume (MPV), and MPV/PLT ratio (MPR). METHODS: A total of 247 patients with COVID-19 pneumonia who presented to the emergency department between March 15, 2020 and May 15, 2020 were retrospectively analyzed. The age, gender, clinical presentation, history of chronic disease, thoracic computed tomography findings, MPV, PLT, MPR, CURB-65 scores, and 28-day mortality of patients were recorded. RESULTS: The patients had a mean age of 51 years (IQR: 39-63 years) and 55.5% were females. The most common symptom was cough (30.4% of patients). The most common comorbidity was hypertension (13.4%), 49.8% of the cases showed intermediate involvement, and 7.7% of patients died within the first 28 days. The mean MPV was 9.71 ± 1.15, the mean PLT was 226.68 ± 83.82, and the mean MPR was 0.056 ± 0.12. There were significant correlations of 28-day mortality with the CURB-65 score, MPV, and MPR levels (p = 0.000, p = 0.034, and p = 0.034, respectively). No significant correlation was found between the PLT count and 28-day mortality (p = 0.105). CONCLUSIONS: In addition to the CURB-65 score, MPV and MPR values can be used to predict 28-day mortality in patients with COVID-19 pneumonia.

Prognostic value of perihematomal edema area at the initial ED presentation in patients with intracranial hematoma.

OBJECTIVE: Intracerebral hemorrhage (ICH) is a potentially life-threatening condition. Interventions and treatments should be managed on time to reduce mortality. It has been put forth that perihematomal edema absolute volume (PHEAV) is related to mortality, however the effect of perihematomal edema absolute area (PHEAA) on mortality is unknown. The objective of this study was to evaluate the effect of PHEAA on 30-day mortality in patients with ICH. METHODS: Patients were screened with ICD-9, retrospectively. 106 patients were included in the study. Clinical data were obtained from the patient files. Computed tomography (CT) was acquired from the hospital imaging database. PHEAV and PHEAA were measured via CT by two clinicians blinded to the study protocol. The predictors of 30- day mortality were examined. RESULTS: Forty-three (40.6%) patients died within 30days. Older age, lack of trauma, low Glasgow coma scale and high blood glucose were associated with high mortality (P≤.001). PHEAV and PHEAA values were higher in nonsurvivors (P<.001). PHEAA was detected as an independent predictor of 30-day mortality. The cutoff value of PHEAA for mortality was 33.41cm(2) (sensitivity: 84.4%, specificity: 59.0%). There was no difference between receiver operating characteristic curves of PHEAA and PHEAV (P=.55). CONCLUSION: In contrast to PHEAV, PHEAA is a simple value which can be measured without the requirement of any additional techniques or extra costs which can be quickly applied and which is an independent indicator of 30-day mortality. PHEAA can accelerate physician interventions for patients with ICH within several hours of ED admission.

The effect of the shock index and scoring systems for predicting mortality among geriatric patients with upper gastrointestinal bleeding: a prospective cohort study.

BACKGROUND: Gastrointestinal (GI) bleeding is an important cause of mortality and morbidity among geriatric patients. OBJECTIVE: To investigate whether the shock index and other scoring systems are effective predictors of mortality and prognosis among geriatric patients presenting to the emergency department with complaints of upper GI bleeding. DESIGN AND SETTING: Prospective cohort study in an emergency department in Bursa, Turkey. METHODS: Patients over 65 years admitted to a single-center, tertiary emergency service between May 8, 2019, and April 30, 2020, and diagnosed with upper GI bleeding were analyzed. 30, 180 and 360-day mortality prediction performances of the shock index and the Rockall, Glasgow-Blatchford and AIMS-65 scores were evaluated. RESULTS: A total of 111 patients who met the criteria were included in the study. The shock index (P < 0.001) and AIMS-65 score (P < 0.05) of the patients who died within the 30-day period were found to be significantly different, while the shock index (P < 0.001), Rockall score (P < 0.001) and AIMS-65 score (P < 0.05) of patients who died within the 180-day and 360-day periods were statistically different. In the receiver operating characteristic (ROC) analysis for predicting 360-day mortality, the area under the curve (AUC) value was found to be 0.988 (95% confidence interval, CI, 0.971-1.000; P < 0.001). CONCLUSION: The shock index measured among geriatric patients with upper GI bleeding at admission seems to be a more effective predictor of prognosis than other scoring systems.

The effect of the shock index and scoring systems for predicting mortality among geriatric patients with upper gastrointestinal bleeding: a prospective cohort study

ABSTRACT BACKGROUND: Gastrointestinal (GI) bleeding is an important cause of mortality and morbidity among geriatric patients. OBJECTIVE: To investigate whether the shock index and other scoring systems are effective predictors of mortality and prognosis among geriatric patients presenting to the emergency department with complaints of upper GI bleeding. DESIGN AND SETTING: Prospective cohort study in an emergency department in Bursa, Turkey. METHODS: Patients over 65 years admitted to a single-center, tertiary emergency service between May 8, 2019, and April 30, 2020, and diagnosed with upper GI bleeding were analyzed. 30, 180 and 360-day mortality prediction performances of the shock index and the Rockall, Glasgow-Blatchford and AIMS-65 scores were evaluated. RESULTS: A total of 111 patients who met the criteria were included in the study. The shock index (P < 0.001) and AIMS-65 score (P < 0.05) of the patients who died within the 30-day period were found to be significantly different, while the shock index (P < 0.001), Rockall score (P < 0.001) and AIMS-65 score (P < 0.05) of patients who died within the 180-day and 360-day periods were statistically different. In the receiver operating characteristic (ROC) analysis for predicting 360-day mortality, the area under the curve (AUC) value was found to be 0.988 (95% confidence interval, CI, 0.971-1.000; P < 0.001). CONCLUSION: The shock index measured among geriatric patients with upper GI bleeding at admission seems to be a more effective predictor of prognosis than other scoring systems.