Etomidate versus ketamine effective use in emergency procedural sedation for pediatric orthopedic injuries

PubMedID: 25834964Objectives: The aim of this study was to compare the induction and recovery times, postsedation observation durations, and adverse effects of etomidate and ketamine in pediatric patients with fractures and/or dislocations requiring closed reduction in the emergency department. Methods: Forty-four healthy children aged 7 to 18 years were included. The patients were randomly divided into 2 groups. Group 1 (24 patients) received etomidate and fentanyl, and group 2 (20 patients) received ketamine intravenously. The Ramsay Sedation Scale and American Pediatric Association discharge criteria were used to evaluate the patients. Results: There were 70 fractured bones and 3 joint dislocations. Except in 1 case (2.3%), all of the injuries were reducted successfully. The mean amount of drugs used to provide adequate sedation and analgesia were 0.25 mg/kg of etomidate and 1.30 µ g/kg of fentanyl in group 1 and 1.25 mg/kg of ketamine in group 2. Fourteen patients (31.8%) reported adverse effects, and none required hospitalization. There was no difference between the groups in the recovery times, occurrence of adverse effects, and postsedation observation durations (P > 0.05). The mean (SD) induction time for the patients in group 1 was 4.3 (1.0) minutes, whereas it was 2.2 (1.6) minutes in group 2 (P < 0.001). Conclusions: Etomidate induces effective and adequate sedation in the pediatric emergency department for painful orthopedic procedures. Ketamine, which has longer action times, might be preferred for reductions because orthopedic procedures could be lengthy. © 2016 Wolters Kluwer Health, Inc. All rights reserved

seizure and lethality in a mice cocaine toxicity model

Introduction: Acute cocaine intoxication is one of the important causes of admission to emergency department, especially in western countries. We aimed to compare the efficacies of tetracycline, minocycline, doxycycline in the prevention of seizures and deaths in mice due to cocaine intoxication.Methods: In the study, a total of 120 balb-c male mice weighing 25-30 g were randomized into 4 groups as tetracycline 255 mg/kg, minocycline 170 mg/kg, doxycycline 157 mg/kg, 0.5 ml saline (placebo). The doses of tetracycline, minocycline and doxycycline are the calculated ED50 values. The mice in the groups received 93 mg/kg cocaine intraperitoneally 10 min after drug administration. The dose of cocaine is 50% of the lethal dose. After cocaine injection, all mice were observed for 30 min in terms of cocaine toxicity findings. Mortality rates, death times, seizure activities, and seizure onset times of the mice were clinically evaluated in an observational way.Results: There were significant differences among all the groups in terms of seizure and lethality (p < 0.001). The ratio of animals with seizures was significantly lower in the minocycline (73.3%), and doxycycline (73.3%) groups (all p = 0.040). The ratio of animals with lethality was significantly lower in the minocycline (23.3%) group compared with vehicle (p < 0.001).Conclusion: In our acute cocaine intoxication model, minocycline was effective in terms of lethality and preventing seizures, doxycycline was effective in preventing seizures. (C) 2019 Elsevier Inc. All rights reserved.C1 [Bektas, Tarik] Yunus Emre State Hosp, Dept Emergency Med, TR-26190 Eskisehir, Turkey.[Erdur, Bulent; Yilmaz, Atakan; Ozen, Mert] Pamukkale Univ, Med Fac, Dept Emergency Med, TR-20070 Denizli, Turkey.[Yuksel, Aykut] Istanbul Medeniyet Univ, Dept Emergency Med, Gortepe Training & Res Hosp, TR-34730 Istanbul, Turkey.[Avci, Hasan] Afyonkarahisar State Hosp, Dept Emergency Med, TR-03030 Afyon, Turkey.[Uyanik, Aykut] Pamukkale Univ, TR-20070 Denizli, Turkey

Metabolic acidosis in a patient with type 1 diabetes mellitus complicated by methanol and amitriptyline intoxication

PubMedID: 19106720Diabetic ketoacidosis (DKA) is a widely known acute metabolic complication of diabetes mellitus (DM), which can be potentially fatal. It is not difficult to diagnose when a patient with DM comes with symptoms such as coma, fruity breath, hyperglycemia, acidosis, and tachypnea. If the patient has not been diagnosed with DM before, then other sicknesses characterized by an increased anion gap should be considered. A 12-year-old boy with type 1 DM and repeated earlier admissions for DKA was admitted to the emergency department in another apparent case of DKA with coma, hyperglycemia, and profound metabolic acidosis. When his condition did not improve with initial treatment, intoxication was suspected as an alternate cause of his condition. Further laboratory tests detected methanol and amitriptyline. The patient underwent hemodialysis and recovered completely. This case illustrates that a seemingly obvious medical condition can mask serious intoxication. This report is the only publication on two different entities characterized by an increased anion gap and at the end the patient has been cured completely without any complications. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

A comparative study on thyroid function in Alzheimer's disease: Results from a Turkish multi-centre study [Alzheimer hastalığında tiroid fonksiyonları üzerine karşılaştırmalı bir çalışma: Türkiye'den çok merkezli araştırma sonuçları öz]

Alzheimer's disease is a very severe degenerative disease that affects brain function. Neuronal loss, accumulation of extracellular amyloid ß containing plaques and accumulation of intracellular (tau) neurofibrillary tangles are the hallmarks of this disease. We aim to investigate serum thyroid function tests in Alzheimer's disease, in addition to other dementias, and geriatric Turkish patients. We evaluated patients from Ankara, Dokuz Eylul, Cukurova University Hospitals. 357 female and male geriatric subjects were enrolled. All the cases were selected from three different geographical regions irrespective of sex and socioeconomic status. In this study, we evaluated the results of thyroid functions in Alzheimer disease patients as well as in other dementias and geriatric patients. In patients from Ankara, Central Anatolia region, no significant difference between groups regarding the routine control of biochemical parameters was observed. However, thyroid function results revealed that hypothyroidism in Alzheimer's disease patients from Mediterranean region, Adana and Aegean region, İzmir is a recurrent medical condition and is often an embedded side of the normal aging process. We concluded that currently, routine thyroid functions tests should be a part of all geriatric patients for screening presymptomatic Alzheimer`s disease. There might be an interplay between reduced thyroid function and Alzheimer`s disease that could be exploited for diagnostic purposes. © 2015, Ege University Press. All rights reserved

A Turkish 3-center study evaluation of serum folic acid and vitamin B12 levels in Alzheimer disease

PubMedID: 26738362Background/aim: Alzheimer disease, a common proteopathy of advanced age, is characterized by cortical atrophy, neuron degeneration, neuronal loss, and accumulation of extracellular amyloid ß plaques. We aimed to investigate serum vitamin B12 and folic acid levels in Alzheimer disease and other dementia patients, as a potential screening test to detect presymptomatic Alzheimer disease in Turkish patients. Materials and methods: We evaluated folic acid and vitamin B12 levels in Alzheimer disease patients as well as in other dementia and geriatric patients from Ankara, Dokuz Eylül, and Çukurova university hospitals; 290 female and male geriatric subjects were enrolled. Vitamin B12 and folic acid levels were measured using Roche E170 and Beckman Coulter DXI 800 immunoassays (chemiluminescence) according to the manufacturers’ guideline in all centers. Results: We evaluated the results of folic acid and vitamin B12 in Alzheimer disease, other dementias and geriatric patients. No significant difference between the groups regarding the routine control of biochemical parameters was observed. Conclusion: Currently, serum folic and vitamin B12 levels are not diagnostically reliable tests for screening presymptomatic Alzheimer disease. However, the results may statistically be significant if we increase the sample size. © TÜBİTAK

The correlation between S-100B protein levels and prognosis in children with head trauma [Kafa Travmali Çocuklarda S-100B Protein Düzeyi ile Prognoz Arasindaki Iliski]

Objective: The goal of this study was to investigate the correlation between baseline S-100B protein levels and prognosis and the value of S-100B protein as a marker to determine the severity of head trauma in childhood. Material and Methots: The study included 75 patients aged 0-18 years presenting to the Pediatric Emergency Unit of Çukurova University Faculty of Medicine between November 2005 and August 2006 and 15 age-matched healthy controls. Patients were categorized as mild, moderate and severe head trauma according to their GCS (Glasgow Coma Scale) scores. Baseline blood samples were tested for S-100B protein levels within the first six hours. S-100B protein levels and the results of Pediatric Trauma Score (PTS), Revised Trauma Score (RTS), Injury Severity Score (ISS) and Glasgow Outcome Score (GOS) were compared. Results: S-100B protein levels were increased in patients with moderate and severe head trauma. There was a significant correlation between ISS, RTS and PTS scores and S-100B protein levels (r was 0.769, -0.821, -0.833 for ISS, PTS and RTS, respectively and p3 (p<0,001). Conclusion: S-100B protein level has a strong predictive value to determine the severity of brain damage in head trauma patients. Thus, S-100B protein supplies important information about the severity of primary brain damage following head trauma. © 2013 by Türkiye Klinikleri

LID - 10.1016/j.ajem.2020.11.058 [doi]

INTRODUCTION: In this study, we aimed to investigate and compare the prognostic impacts of C-reactive protein (CRP), white blood cell (WBC) count, neutrophil (NEU)-to-lymphocyte (LYM) ratio (NLR), platelet-to-lymphocyte ratio (PLR), Red Cell Distribution Width (RDW) biomarkers in laboratory-confirmed COVID-19 cases as well as to explore the most useful diagnostic biomarkers and optimal cutoff values in COVID-19 patients. METHODS: A total of 233 patients were admitted to Emergency Department (ED) of Pamukkale University Hospital during two months (March-April 2020) and underwent Sars CoV-2 PCR (Polymerase Chain Reaction), complete blood count (CBC), and CRP tests in sequence due to complaints of COVID-19. The laboratory results and demographic findings were collected from the public health management system retrospectively. The patients with positive Sars CoV-2 PCR test along with hospitalization data were also recorded. RESULTS: The CRP (p = 0.0001), lactate dehydrogenase (LDH) (p = 0.038), PLR (p = 0.0001) and NLR (p = 0.001) remained significantly higher in the patients with positive Sars CoV-2 PCR test result. By contrast, eosinophil (p = 0.0001), lymphocyte (p = 0.0001), platelet levels (p = 0.0001) were calculated as significantly higher in negative Sars CoV-2 patients. CONCLUSION: In the light of the obtained results, the CRP, LDH, PLR and NLR levels remained significantly higher in COVID-19 positive patients, while eosinophil, lymphocyte, and platelet levels were significantly elevated in COVID-19 negative patients