An investigation of the effects of the mean platelet volume, platelet distribution width, platelet/lymphocyte ratio, and platelet counts on mortality in patents with sepsis who applied to the emergency department.

AIM: The aim of this study is to examine the role of the mean platelet volume (MPV), platelet distribution width (PDW), platelet/lymphocyte ratio (PLR), and platelet values for predicting mortality in patients with sepsis. MATERIALS AND METHODS: This is a retrospective study, involving patients 18 years and above who were diagnosed with sepsis. Blood samples were analyzed for platelets characteristics (counts, MPV, PDW, and PLR). The patients were separated into two groups namely the survivors and deceased. The two groups' MPV, PDW, PLR, and platelet counts which were considered to have an effect on mortality, were compared. RESULTS: Three hundred and thirty patients who were diagnosed with sepsis in our emergency department and complying with the study participation criteria were studied retrospectively. Comparison of the MPV, PDW, PLR, and platelet counts of the deceased and survivors showed that the MPV, PDW, and PLR were higher in the deceased while the platelet counts were higher in the survivors. CONCLUSION: The low number of platelets in patients with sepsis at the moment of application and the high PDW and PLR values are valuable for predicting a high mortality.

Effect of L-ornithine L-aspartate on Liver Injury Due to Acute Ethyl Alcohol Intoxication in Rats.

OBJECTIVE: Ethyl alcohol is a substance that is widely used worldwide and known to exert toxic effects on liver. In this study, we aimed to examine the effect of L-ornithine L-aspartate (LOLA) on the toxicity of a single dose of ethyl alcohol in rats. SUBJECTS AND METHOD: We used 32 randomly selected male Sprague-Dawley rats weighing 200-250 g. The rats were grouped into four groups with each group containing eight rats: Group 1: the control group, Group 2: the ethyl alcohol group, Group 3: the LOLA group and Group 4: the ethyl alcohol+LOLA group. Ethyl alcohol was administered orally through a nasogastric tube at a dose of 6 g/kg after diluting with distilled water. One hour after ethyl alcohol administration, LOLA was administered to pre-specified groups orally through a nasogastric tube at a dose of 200 mg/kg after diluting with distilled water. Liver tissue and blood samples were obtained from all rats 24 hours later to study total antioxidant capacity (TAC), total oxidant status (TOS) and oxidative stress index (OSI) levels in liver samples, and aspartate aminotransferase (AST), alanine transferase (ALT), TAC, TOS and OSI levels in blood samples. RESULTS: Serum TAC, TOS and OSI levels were higher in the groups that were administered ethyl alcohol. In addition, tissue TAC level was higher and TOS and OSI levels were lower in groups that were given ethyl alcohol. No significant changes were observed in serum and tissue TAC, TOS, OSI, ALT and AST levels in the LOLA administered groups. CONCLUSION: This study showed that LOLA was not biochemically effective and exerts no oxidative stress reducing activity in liver injury due to acute ethyl alcohol toxicity.

Peripheral neuropathy after burn injury.

OBJECTIVES: Peripheral neuropathy is a well-documented disabling sequela of major burn injury. These lesions are associated with both thermal and electrical injuries that may be frequently undiagnosed or overlooked in clinical settings. The purpose of this study was to evaluate the prevalence of burn-related neuropathy in our database and to investigate the clinical correlates for both mononeuropathy and generalized peripheral polyneuropathy. PATIENTS AND METHODS: Out of 648 burn patients, admitted to our clinic forty-seven burn patients with the diagnosis of peripheral neuropathy were evaluated retrospectively. The demographic and clinical data collected were gender, age, degree, site and percent surface area of burn, type of burn, and the results of electrodiagnostic examination, including electromyography and nerve conduction assessments and associated pathology if existed. RESULTS: Peripheral neuropathy is the most frequent disabling neuromuscular complication of burn, that may be undiagnosed or overlooked. In current study, peripheral neuropathy associated with burn all of our patients were identified by electrodiagnostic study. After treatment in Burn Unit, clinical and electrodiagnostic studies were applied. Motor and sensory distal latencies were prolonged and sensory nerve action potentials reduced in amplitude. CONCLUSIONS: The findings of our study have shown that polyneuropathies and axonal neuropathy were more frequent than mononeuropathy and demyelination.  

Neutrophil lymphocyte ratios in stroke subtypes and transient ischemic attack.

OBJECTIVES: This investigation was conducted to test the value of Neutrophil Lymphocyte Ratio (NLR), which has been shown in some recent studies to be a prognostically important and an easy-to-measure inflammatory marker, in patients presenting to Emergency Service with stroke (ischemic and hemorrhagic) and transient ischemic attack. MATERIALS AND METHODS: A total of 868 patients were enrolled, who presented to our Emergency Service with cerebrovascular accident (stroke and transient ischemic attack) and admitted to Neurology Clinic. Demographic characteristics and comorbidities of patients were recorded. The patients were divided into 3 groups as acute ischemic stroke (AIS), acute hemorrhagic stroke (AHS) and transient ischemic attack (TIA). Patients with AIS were classified into subgroups in terms of TOAST (trial of 10172 stroke treatment) criteria. Admission NLR levels were compared across all groups. RESULTS: A total of 868 patients were enrolled, 51.6% of which were male and 48.4% were female. AIS rate was 75.3%, AHS rate was 14.3% and TIA rate was 10.7%. In all of patients, mortality rate was 10.7%. NLR was significantly higher in patients who died (p < 0.001). NLR level in patients with TIA was significantly lower than those of AIS and AHS groups (p < 0.001). Among AIS subgroups, NLR level was significantly higher in group with great artery atherosclerosis or atherothrombosis compared to other groups (p < 0.001). CONCLUSIONS: NLR may be used as a simple and easy-to-measure marker for prediction of short-term prognosis and in-hospital mortality in both ischemic and hemorrhagic stroke patients.

Benefit of hemodialysis in carbamazepine intoxications with neurological complications.

AIM: It is aimed to share the fact that hemodialysis is also useful in carbamazepine intoxications with prominent neurological side effects in cases hemoperfusion is not available. PATIENTS AND METHOD: Files of 49 patients presenting our Emergency Room with a prediagnosis of carbamazepine intoxication were analyzed retrospectively. Demographic and laboratory data of patients were recorded on study form. Patients were divided into two groups as those applied hemodialysis (Group 1) and those not applied hemodialysis (Group 2). Group 1 included 13 patients while group 2 did 36. RESULTS: Statistically significant differences were detected between groups in terms of heart rate, Glasgow Coma scale score, presence of convulsions, midriasis and blood carbamazepine levels at the time of presentation. It was observed that carbamazepine levels decreased by 58% via hemodialysis in those receiving hemodialysis. DISCUSSION: Hemodialysis is simple, cheap, widespread and easier to apply compared to hemoperfusion. It has been shown that acute carbamazepine intoxication can be treated with low flow-high activity standard hemodialysis and it is a good therapeutic option.

The role of serum D-dimer level in the diagnosis of patients admitted to the emergency department complaining of chest pain.

This study investigated D-dimer levels in 241 patients admitted to the emergency department with sudden-onset chest pain. The patient group included those diagnosed with acute coronary syndrome (ACS; i.e., unstable angina pectoris [USAP], non-ST elevated myocardial infarction [NSTEMI], ST-elevated myocardial infarction [STEMI]); the control group included those diagnosed with non-cardiac chest pain. Mean serum levels of D-dimer, creatine kinase-MB (CK-MB) and troponin I (TPI) were compared between the groups. Levels of D-dimer, CK-MB and TPI in the patient group were significantly higher than in the control group. There were also significantly higher D-dimer, CK-MB and TPI levels in the STEMI and NSTEMI patient subgroups compared with the control group. Only the D-dimer level was significantly higher in the USAP subgroup versus the control group. The sensitivity and specificity of D-dimer for ACS were 83.7% and 95.4%, respectively, suggesting that evaluating D-dimer levels might be useful in the emergency room for diagnosing ACS and predicting mortality in patients presenting with acute chest pain.

Trauma scores and neuron-specific enolase, cytokine and C-reactive protein levels as predictors of mortality in patients with blunt head trauma.

This study evaluated serum neuron-specific enolase (NSE), cytokine and high-sensitivity C-reactive-protein (hs-CRP) levels, along with the Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS), as predictors of mortality in the early posttraumatic period, in 100 Turkish patients with blunt head trauma. Overall patient mortality was 27%. There was a significant association between age and mortality, and mortality was negatively correlated with GCS and RTS. Head injury severity (GCS) was significantly related to NSE, hs-CRP, interleukin (IL)-6, IL-8 and tumour necrosis factor (TNF)-alpha levels. Mortality correlated positively with IL-6, IL-8, TNF-alpha and hs-CRP levels. NSE, hs-CRP, IL-6, IL-8 and TNF-alpha levels were significantly higher in non-survivors compared with survivors. GCS score < or =8, younger age and NSE levels were significant independent predictors of mortality. During the early post-traumatic period, NSE may be an objective alternative criterion to the GCS, in the management of patients with blunt head trauma.

The Effects of Corticosteroid Injection in the Healthy and Damaged Achilles Tendon Model: Histopathological and Biomechanical Experimental Study in Rats.

OBJECTIVE: To show the effects of corticosteroids on inflammatory reactions in the injured Achilles tendon in rats. MATERIAL AND METHOD: Thirty-two adult Wistar Albino rats were used in the study. The rats were divided into 4 groups. In the first group (Intact Saline), saline solution was injected to the intact Achilles tendon. In the second group (Intact Corticosteroid), corticosteroid was injected to the intact tendon. In the third group (Injured Saline), saline solution was injected to the injured Achilles tendon. In the fourth group (Injured Corticosteroid), corticosteroid was injected to the injured tendon. All groups were sacrificed on day 30 and Achilles tendons were taken and prepared for histological and biomechanical evaluation. RESULTS: According to the biomechanical test; mean load-to-failure of the Intact Saline group was significantly lower than the Intact Corticosteroid (p=0.016), Injured Saline (p=0.001) and Injured Corticosteroid) (p=0.012) groups. According to the histopathological evaluation, tenocyte mean of the Intact Saline group was statistically lower than the Injured Saline and Injured Corticosteroid groups. Tenocyte mean of the Intact Corticosteroid group was statistically significantly lower than the Injured Saline and Injured Corticosteroid groups. The ground substance mean of the Intact Saline group was significantly lower than the Injured Saline and Injured Corticosteroid groups. The ground substance mean of the Intact Corticosteroid group was significantly lower than the Injured Saline and Injured Corticosteroid groups. There was no statistically significant difference between the groups in terms of calcification. CONCLUSION: It has been found that there is biomechanical and histopathological significant benefit of intra-tendon corticosteroid administration in the experimentally generated Achilles tendon injury model.

Histological Comparison of Nanocomposite Multilayer Biomimetic Scaffold, A Chondral Scaffold, and Microfracture Technique to Repair Experimental Osteochondral Defects in Rats.

OBJECTIVE: We used biomimetic scaffolds, chondral scaffolds, and microfractures to repair experimentally created osteochondral defects in rat knees and then compared the results of each method. MATERIALS AND METHODS: We used a total of 56 female Wistar albino rats. The rats were grouped into 4 groups, with 14 rats each: biomimetic scaffold, chondral scaffold, microfracture, and control groups. Cylindrical full-thickness osteochondral defects 2.5 mm in diameter and 2 mm in depth were drilled into the right knees with the rats under general anesthesia. The knees of all rats were operated again after 4 weeks. Biomimetic and chondral scaffolds were classified into two groups. Microfractures 0.5 mm in diameter and 0.8 mm in depth were created in the rats of the microfracture group. The control group received no treatment. All the rats were observed for 6 weeks and then sacrificed, with samples subjected to macroscopic and histopathological examinations. RESULTS: The macroscopic and histopathological results in the biomimetic scaffold group differed significantly from those of the other treatment groups (p<0.05). When we compared the 3 treatment groups, the results of the chondral scaffold group were better than those of the microfracture group. The results of the microfracture group were somewhat better than those of the control group, but the result was not statistically significant (p>0.05). CONCLUSIONS: Nanocomposite multilayer biomimetic scaffolds were better than chondral scaffolds and microfractures when used to treat osteochondral defects.

Protective Effect of Montelukast Sodium in Acute Ethyl Alcohol-induced Hepatic Injury in Rats

ABSTRACT Objective: Ethyl alcohol (EA) is a substance that is used commonly worldwide and known to have toxic effects on the liver. The aim of this study was to investigate the effect of montelukast sodium (MK) on acute hepatopathy induced by a single dose of EA in rats. Methods: The study consisted of four groups each containing eight Wistar albino male rats. The groups were classified as follows: the control group received distilled water; the EA group received 6 g/kg EA diluted with distilled water orally by gavage; the MK group received 30 mg/kg MK orally by gavage; the EA + MK group received, 2 hours after the EA administration, ie 30 mg/kg MK orally by gavage. After 24 hours, all the rats were sacrificed, and their blood and liver tissue samples were taken for biochemical and histopathological examinations. Results: The administration of EA caused a statistically significant increase in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels compared with the control group (220.50 ± 66.90 and 92.38 ± 5.90 versus 84.88 ± 15.66 and 43.75 ± 10.22). The administration of EA + MK caused a statistically significant decrease in the AST and ALT levels compared with the EA alone group. Ethyl alcohol administered to the rats caused lesion in the liver including congestions, hydropic degeneration and irregular shaped area caused coagulation necrosis. The histopathological changes seen in the EA group were not detected in the EA + MK group. Conclusion: Consequently, these data suggested that MK had beneficial effects in alleviating EA-induced hepatotoxicity in rats.

Serum myeloperoxidase levels in predicting the severity of stroke and mortality in acute ischemic stroke patients.

OBJECTIVE: The aim of this study was to examine the level of myeloperoxidase (MPO) measured before specific treatment in patients presenting to the Emergency Department with acute ischemic stroke and its correlation to mortality and the severity of the stroke. PATIENTS AND METHODS: The study was carried out on 55 patients with a confirmed diagnosis of ischemic stroke, and on 44 healthy control group. Before specific intervention, serum samples were taken to measure levels of MPO. The medical records, demographic, clinical, laboratory and neuro-imaging data were noted.  The National Institutes of Health Stroke Scale was used to determine the severity of the stroke. RESULTS: A total of 55 patients, of whom 32 (58.2%) were male, who had presented within 24 hours of the onset of symptoms of acute ischemic stroke were included in the study. Fifteen of these patients (27.2%), of whom five were women, died. There was a statistically significant difference in the serum MPO levels of patients who survived and those who died. When the patients were grouped as high or normal in terms of plasma MPO levels, a significant correlation was found between MPO level, cortical + subcortical stroke location and strokes with a lesion diameter of more than 4 cm. In the high MPO group, Troponin T and CRP levels were significantly higher than those of the normal MPO group. CONCLUSIONS: The level of myeloperoxidase in the serum of acute ischemic stroke patients rises and there is a correlation between myeloperoxidase level and prognosis.

Bilateral femoral neck fractures after an epileptic attack: A case report.

INTRODUCTION: Bilateral femoral neck fractures can occur due to high- or low-energy trauma, in the presence of various predisposing factors, such as osteoporosis, renal osteodystrophy, hypocalcemic seizures, primary or metastatic tumors, electroconvulsive therapy, epileptic seizures, and hormonal disorders. PRESENTATION OF CASE: This report presents a case of bilateral femoral neck fractures that occurred during an epileptic attack in a 24-year-old male with mental retardation. His complaints had started after a grand mal epileptic attack 10 days earlier. Bilateral displaced femoral neck fractures (Garden type 4) were seen in lateral radiographs of both hips. The patient was operated on urgently, with closed reduction, three stainless steel cannulated screws, and internal fixation applied to both hips. At postoperative week 12, solid joining was achieved and active walking with complete loading was started. DISCUSSION: Bilateral femoral neck fractures can occur following a grand mal epilepsy attack in young patients. The use of antiepileptic drugs can also lead to the development of pathological fractures by reducing bone mineral density. CONCLUSION: Femoral neck fractures should be suspected in patients with epilepsy who present with severe pain in both hips and an inability to walk. Stainless steel implants can be used for treatment. The viability of the femoral head should be evaluated by scintigraphy. Bone mineral density should be monitored in patients who use anti-epileptic drugs, and internal fixation is preferred in the treatment of femoral neck fractures.

Is prematurity a risk factor for developmental dysplasia of the hip? : a prospective study.

The aim of this prospective study was to investigate prematurity as a risk factor for developmental dysplasia of the hip (DDH). The hips of 221 infants (88 female, 133 male, mean age 31.11 weeks; standard deviation (sd) 2.51) who were born in the 34th week of gestation or earlier, and those of 246 infants (118 female, 128 male, mean age 40.22 weeks; sd 0.36) who were born in the 40th week of gestation, none of whom had risk factors for DDH, were compared using physical examination and ultrasound according to the technique of Graf, within one week, after the correction of gestational age to the 40th week after birth or one week since birth, respectively. Both hips of all infants were included in the study. Ortolani's and Barlow's tests and restricted abduction were accepted as positive findings on examination. There was a statistically significant difference between pre- and full-term infants, according to the incidence of mature and immature hips (p < 0.001). The difference in the proportion of infants with an α angle < 60° between the two groups was statistically significant (p < 0.001). The incidence of pathological dysplasia (α angle < 50 º) was not significantly different in the two groups (p = 1.000). The Barlow sign was present in two (0.5%) pre-term infants and in 14 (2.8%) full-term infants. These results suggests that prematurity is not a predisposing factor for DDH.

The effect of gestational age on sonographic screening of the hip in term infants.

Several authors have suggested that the final five weeks of gestation are a critical period for the development of the hip. In order to test the hypothesis that gestational age at birth may influence the development of the hip joint, we analysed the sonographic findings in 1992 hips (in 996 term newborns) with no risk factor for developmental dysplasia of the hip. The 996 infants were born at a mean gestational age of 39 weeks (37 to 41). The mean bony roof angle (α), cartilage roof angle (ß) and the distribution of the type of hip were compared between the 37th, 38th, 39th, 40th and 41st birth week groups. There was a significant difference in the distribution of type of hip between the different birth week groups (p < 0.001), but no significant difference between the α angles of all groups (p = 0.32). There was no correlation between birth week and roof angle (p = 0.407 and p = 0.291, respectively) and no significant correlation between birth weight and roof angle (p = 0.735 and p = 0.132, respectively). The maturity of the infant hip, as assessed sonographically, does not appear to be affected by gestational age, and the fetal development of the acetabular roof appears to plateau from 37 weeks.

The role of serum osteoprotegerin and S-100 protein levels in patients with acute ischaemic stroke: determination of stroke subtype, severity and mortality.

This study investigated correlations between mortality, stroke subtype and stroke severity with serum osteoprotegerin (OPG) and S-100 protein levels prior to the treatment of patients admitted to the emergency department and diagnosed with ischaemic stroke. Pretreatment serum samples were collected from patients (n = 90) to determine OPG and S-100 protein levels. Age- and sex-matched healthy individuals (n = 16) served as controls. Compared with controls, OPG and S-100 protein levels were significantly higher in the cardioembolic and atherothrombotic stroke groups. Within the stroke group, OPG levels were significantly higher in the cardioembolic and atherothrombotic stroke groups compared with the transient ischaemic attack (TIA) group. S-100 protein levels were significantly higher in the atherothrombotic stroke group than in the lacunar stroke and TIA groups, and in the cardioembolic stroke group compared with the lacunar stroke group. Serum OPG and S-100 protein levels were significantly higher in patients who died compared with survivors. In predicting stroke subtype and severity, although both OPG and S-100 protein levels were indicators, S-100 protein was more valuable for mortality prediction.