Thrombolysis in STEMI at Prehospital Settings

Thrombolysis is a rapidly available but semi-effective treatment, whereas percutaneous coronary intervention is a potentially delayed but highly effective therapy. What about thrombolysis in the prehospital setting for ST-elevated myocardial infarction? Does scientific evidence support or oppose? Which patient group is more eligible for prehospital thrombolysis? Is there any skirmish between emergency medicine and cardiovascular professionals? You can find a history of prehospital thrombolysis on the basis of scientific evidence in this writin

An experimental comparative study on classic tube thoracostomy and thoracostomy with a newly designed thorax drainage catheter

WOS:000368558600036PubMed ID: 27511340Background/aim: The collection of fluids, blood, pus, or air in the pleural cavity is a pathological condition requiring pleural drainage. A newly designed thorax drainage catheter in the prototype phase was used in this experimental study to test its efficacy. Materials and methods: A hemopneumothorax was first caused by a penetrating injury on the frontal axis of the sixth intercostal space on the right hemithorax with a scalpel on 6 female Sus domesticus swine subjects. After resting for 5 min, a tube or catheter was inserted. The same procedure with a tube thoracostomy or thorax drainage catheter was repeated on the left hemithorax. The time periods were recorded. After all procedures were completed, the thoracic organs were assessed for iatrogenic injuries. Results: In terms of time elapsed for procedure, statistically significant differences between the tube thoracostomy and thorax drainage catheter applications were identified (P > 0.05). Additional iatrogenic injuries were nonexistent for both groups. During the thorax drainage catheter application, a surgical set or the use of sutures was not required. Conclusion: This study showed promising results regarding the efficacy of the thorax drainage catheter for convenient use in prehospital and hospital settings by physicians with little experience with tube thoracostomy

Updated Management of Atrial Fibrillation

WOS:000365588000009Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. AF is also associated with increased mortality, stroke and other thromboembolic disorders, cardiac failure and hospital admission, diminished quality of life, exercise intolerance, and left ventricular dysfunction. In the literature, there are many reports about the updated management of AF. This report aims at evaluating the previous guidelines and summarizing the prominent point

Time-Dependent Changes Of Hematological Parameters In Patients With Acute Organophosphate Poisoning

Objective: To investigate the prognostic value of the time-dependent changes of hematological parameters in patients with acute organophosphate poisoning. Methods: All patients admitted to emergency departments from 2010 through 2013 due to organophosphate poisoning were enrolled in the study. Demographic data, route of exposure, serum cholinesterase levels, complete blood count results of 5 consecutive days, mechanical ventilation requirement, length of stay in hospital, and outcomes were recorded. Results: Mechanically ventilated patients had higher leukocyte and neutrophil counts than nonventilated patients during the whole follow-up period, and both of them had a trend of decrease in both patient groups. There was no difference between patient groups in terms of lymphocyte counts at day 1, but mechanically ventilated patients had lower lymphocyte counts than nonventilated patients after day 2. Hemoglobin levels had a trend of decrease during the whole follow-up period in both patient groups. Conclusion: The parameters obtained from complete blood count can be used as sensitive follow-up parameters in patients with acute organophosphate poisoning by serial measurement

The role of oxidative stress in ?-amanitin-induced hepatotoxicity in an experimental mouse model

Background/aim: This study aimed to evaluate oxidative stress markers of liver tissue in a mouse α-amanitin poisoning model with three different toxin levels. Materials and methods: The mice were randomly divided into Group 1 (control), Group 2 (0.2 mg/kg), Group 3 (0.6 mg/kg), and Group 4 (1.0 mg/kg). The toxin was injected intraperitoneally and 48 h of follow-up was performed before sacrifice. Results: Median superoxide dismutase activities of liver tissue in Groups 3 and 4 were significantly higher than in Group 1 (for both, P 0.001). The catalase activity in Group 2 was significantly higher, but in Groups 3 and 4 it was significantly lower than in Group 1 (for all, P 0.001). The glutathione peroxidase activities in Groups 2, 3, and 4 were significantly higher than in Group 1 (P 0.006, P 0.001, and P 0.001, respectively). The malondialdehyde levels of Groups 3 and 4 were significantly higher than Group 1 (P 0.015 and P 0.003, respectively). The catalase activity had significant correlations with total antioxidant status and total oxidant status levels (r 0.935 and r 0.789, respectively; for both, P > 0.001). Conclusion: Our findings support a significant role for increased oxidative stress in α-amanitin-induced hepatotoxicity

A pilot experimental study of a catheter to facilitate treatment for penetrating cardiac injury

Background/aim: Penetrating heart injuries result in high mortality. We designed a new catheter to facilitate the treatment of penetrating cardiac injuries and provide more effective initial bleeding control and fluid replacement. Materials and methods: The cardiac injury model was applied to 8 female 1-year-old Sus domesticus pigs. Subjects were grouped according to whether a Foley catheter or a newly designed catheter was placed into the heart through cardiac lacerations. Changes in systolic blood pressures, mortality, and problems encountered during surgery and other intraoperative findings were recorded. Results: There were higher mean blood pressure measurements in the newly designed catheter group during stages IV to VII. All subjects had tamponade and cardiac activity after completion of the repair of all lacerations in the catheter group, whereas in the other group only one subject did. Intraoperative direct fluid infusion to the heart through the catheters in the diastole was performed in all subjects of both groups. However, regurgitation from the cardiac cavity in the systole was seen only in the Foley catheter group. All of the intraoperative complications were seen in the same group. Conclusion: The newly designed catheter can provide effective initial bleeding control, better initial vital sign stabilization, and fewer intraoperative problems during primary repair of cardiac lacerations

Association of Severity of Coronary Lesion with Markers of Acute Infection and Inflammation in Patients with Acute Coronary Syndrome

Aim: Inflammation and some infectious agents play a key role in acute coronary syndrome (ACS) caused by atherosclerosis. The purpose of this study was to assess the effects of inflammatory markers and the positivity of Chlamydia pneumoniae (CP), Helicobacter pylori (HP), and Cytomegalovirus (CMV) on the level of atherosclerosis in patients with ACS. Materials and Methods: Patients (57) that were referred to the emergency unit with classic angina symptoms or angina equivalent symptoms and were determined to have critical lesions in the coronary angiography (0.001 and p0.030, respectively) at hour 48 than originally found at hour 0. Conclusion: There is no association between the severity of coronary lesions and cytokine levels and positivity of infectious agents in ACS since the levels of proinflammatory cytokines in ACS are higher than those in atherosclerosis. The changes in cytokine levels at hour 48 were found to be significan

Rhabdomyolysis Induced by Agaricus Bisporus

Mushroom poisoning may present with a variety of clinical conditions, extending from simple food poisoning to life-threatening liver and renal failure. Rhabdomyolysis is a recently described syndrome that is observed within the clinical spectrum associated with mushroom poisoning. In this report, we present two patients-one presenting with a state of rhabdomyolysis and the other case with simple symptoms only-following consumption of cultivated mushroom together in the same meal

Organofosfat Zehirlenmeli Hastalarda Kırmızı Küre DağılımGenişliğinin Prognostik Değeri

Amaç: Bu retrospektif çalışmada; organofosfat zehirlenmesi olan hastalarda, acil servise başvuru sırasında ölçülen kırmızı küre dağılım genişliği (RDW) ve diğer hematolojik parametrelerin prognostik değerinin araştırılması amaçlanmaktadır. Gereç ve Yöntemler: 2008 ve 2013 yılları arasında acil servise organofosfat zehirlenmesi nedeniyle başvuran 15 yaş ve üzeri tüm hastalar çalışmaya dahil edildi. Hastaların yazılı ve elektronik dosyaları gözden geçirildi. Hematolojik parametreler kaydedildi. Mekanik ventilasyon ihtiyacı ana sonlanım noktası olarak kullanıldı. Bulgular: Çalışmaya toplam 72 hasta dahil edildi. Mekanik ventilasyon desteği verilen hastalar, destek verilmeyen hastalardan istatistiksel anlamlı olarak daha yüksek lökosit ve RDW değerlerine sahipti (sırasıyla, p0,004 ve p0,001). Mekanik ventilasyon ihtiyacını tahmin etme gücü açısından, RDW'nin ROC eğrisi altında kalan alanı 0,716 (0,581-0,852 %95 güven aralığı ile, p0,010) idi. Mekanik ventilasyon ihtiyacını tahmin etmede organofosfat zehirlenmesi olan hastalarda; %14,5 kesim değeri ile RDW %73 sensitiviteye, %70 spesifisiteye ve %91 negatif prediktif değere sahipti. Sonuç: Organofosfat zehirlenmeli hastaların takibinde prognozu tahmin açısından RDW, kolay ve yararlı bir parametre olarak kullanılabilir.Aim: The aim of this retrospective study was to investigate the prognostic value of red cell distribution width (RDW) and other hematological parameters measured on admission to the emergency department in patients with organophosphate poisoning.Materials and Methods: All patients aged 0.001, respectively). The area under the receiver-operating characteristic curve of RDW levels for predicting mechanical ventilation requirement was 0.716 (95% CI: 0.581-0.852, p0.010). RDW had a sensitivity of 73%, specificity of 70%, and negative predictive value of 91% with a cut-off value of 14.5% in predicting mechanical ventilation requirement in patients with organophosphate poisoning. Conclusion: RDW can be a valuable and easy-to-use parameter in estimating prognosis in the follow-up of patients with organophosphate poisoning. Conclusion: RDW can be a valuable and easy-to-use parameter in estimating prognosis in the follow-up of patients with organophosphate poisoning

Prognostic Value of Red Cell Distribution Width in Critically Ill Patients and Comparison with Intensive Care Unit Scoring Systems

Aim: This study aimed to investigate the prognostic value of lactate and red cell distribution width (RDW) parameters of patients admitted to emergency service and critical care unit (CCU).Materials and Methods: A total of 147 patients hospitalized in the CCU of Necmettin Erbakan University, Meram Faculty of Medicine, Department of Emergency Medicine, were included in the study. Vital signs, laboratory results, lactate, and RDW values of the patients were recorded. Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were calculated. Duration of hospitalization and intensive care unit stay and mortalities were recorded. Chi-square, Fisher's exact chi-square, and Student t tests were used for statistical analyzes, and Mann-Whitney U test was used for comparing nonparametric data that were not compatible with a normal distribution. P>0.05 were accepted as statistically significant. Spearman correlation analysis was used to assess whether a linear correlation existed between the parameters. Results: A statistically significant correlation was found between the duration of stay in the CCU for >7 days and total duration of hospitalization (p>0.001). Also, statistically significant correlations were observed between mortalities of 28 days and 3 months, APACHE II and SOFA scores, and mean lactate (for 24 h and during hospitalization) and RDW values (p>0.001, p>0.001, p>0.001, and p>0.05, respectively). Moreover, correlations were noted between APACHE II scores, lactate value during the first admission, and SOFA scores (p>0.001). Correlations were also observed between 48-h SOFA scores and RDW and lactate values (p>0.001). Conclusion: SOFA and APACHE II are the scoring systems used in practice. Efficiencies for mortality assessment of critical patients were confirmed. This study showed that lactate and RDW values, which were compatible with the scoring systems, could be used for assessing prognosis. Wider and more comprehensive studies that can assess scoring systems and lactate and RDW values together for prognostic identification are required to validate the findings