Fall from heights among adults

Yüksekten düsme olayları ülkemiz için önemli ölüm ve yaralanma nedenleri arasında yer alır. Ulusal ve uluslar arası literatür taramasının gerçeklestirildigi bu derleme de yüksekten düsen eriskin olgulara tıbbi yaklasımın esasları gözden geçirildi. Çalısma pubmed taraması ile gerçeklestirildi. Ülkemizden yayınlanmıs ulusal yayınların verileri ile uluslararsı veriler tarandı ve degerlendirildi. Literatür bilgileri incelendiginde yas, yükseklik ve düsülen zeminin yapısının prognoz için iyi bir prediktör faktör oldugu; eriskin ve çocuk olguları arasında klinik patern olarak farklılıklar belirlendigi; düstükten sonra tüm olgularda önemli miktarda izole organ yaralanması gözlendigi tespit edildi. Mortalite ve morbidite oranları sıklıkla düsülen yükseklige ve düserken olgunun çarptıgı vücut yüzeyine baglı oldugu ve çocuklarda yüksekten düsmedaha sık gözlenmesine ragmen eriskinlerde daha fazla mortalite gözlendigi anlasıldı. Sonuç olarak yüksekten düsme olgularının travma olguları içinde ayrı bir antite olarak ele alınması ve klinik olarak ciddiyetle degerlendirilmesi ve bu konuda literatür bulguları esliginde klinik prospektif çalısmalar ile yeni yaklasımtarzları gelistirilmesi gerektigi kanaatine varıldı.Falls from heights are a common cause of death and disability in Turkey. The age, height and structure of the base of a fall is a good predictor of prognosis. There are differences between adult and paediatric cases and the high number of isolated organ injuries should not be underestimated. Mortality and morbidity change due to part of body which hits the surface initially, surface property and height of fall. This review aims to categorize and discuss the the patterns of injury of fall from heights among adult patients

Ozone Therapy and Hyperbaric Oxygen Treatment in Lung Injury in Septic Rats

Various therapeutic protocols were used for the management of sepsis including hyperbaric oxygen (HBO) therapy. It has been shown that ozone therapy (OT) reduced inflammation in several entities and exhibits some similarity with HBO in regard to mechanisms of action. We designed a study to evaluate the efficacy of OT in an experimental rat model of sepsis to compare with HBO. Male Wistar rats were divided into sham, sepsis+cefepime, sepsis+cefepime+HBO, and sepsis+cefepime+OT groups. Sepsis was induced by an intraperitoneal injection of Escherichia coli; HBO was administered twice daily; OT was set as intraperitoneal injections once a day. The treatments were continued for 5 days after the induction of sepsis. At the end of experiment, the lung tissues and blood samples were harvested for biochemical and histological analysis. Myeloperoxidase activities and oxidative stress parameters, and serum proinflammatory cytokine levels, IL-1β and TNF-α, were found to be ameliorated by the adjuvant use of HBO and OT in the lung tissue when compared with the antibiotherapy only group. Histologic evaluation of the lung tissue samples confirmed the biochemical outcome. Our data presented that both HBO and OT reduced inflammation and injury in the septic rats' lungs; a greater benefit was obtained for OT. The current study demonstrated that the administration of OT as well as HBO as adjuvant therapy may support antibiotherapy in protecting the lung against septic injury. HBO and OT reduced tissue oxidative stress, regulated the systemic inflammatory response, and abated cellular infiltration to the lung demonstrated by findings of MPO activity and histopathologic examination. These findings indicated that OT tended to be more effective than HBO, in particular regarding serum IL-1β, lung GSH-Px and histologic outcome

Burn Rehabilitation

Survival rates for burn injuries have been increasing, thanks to the progress of modern medicine, and rehabilitation activities have gained more significance. Burn rehabilitation begins with the admission of patients to the hospital and may require a long time. Good nursing care and a multidisciplinary approach are of primary importance during the acute phase of burn cases, whereas rehabilitation activities constitute a major part of the treatment following the healing of wounds. Positioning, exercises, splinting and pain control are the primary rehabilitation activities that need to be planned by a multidisciplinary team. The rehabilitation program should be designed in line with each individual case, and the treatment modelities should be reviewed in the follow-up period. This paper presents burn rehabilitation practices in the light of the current literature

Prospective Evaluation of Infection Episodes in Cancer Patients in a Tertiary Care Academic Center: Microbiological Features and Risk Factors for Mortality

Objective: We aimed to determine the frequency, type, and etiology of infections and the risk factors for infections and mortality in hospitalized cancer patients. Materials and Methods: We prospectively enrolled adult cancer patients hospitalized in the internal medicine wards of a tertiary care academic center between January and August 2004. Patients were followed during their hospitalization periods for neutropenia, infections, culture results, and mortality. Results: We followed 473 cancer patients with 818 hospitalization episodes and 384 infection episodes in total. Seventy-nine percent of the infections were nosocomial, and febrile neutropenia (FN) was observed in 196 (51%) of the infection episodes. Bacteremia was found in 29% of FN episodes and in 8% of nonneutropenic patients. Gram-positive bacteria were the leading cause of bacteremia in both neutropenic and nonneutropenic cases (70% and 58%, respectively). Presence of an indwelling central catheter increased bacteremia risk by 3-fold. The overall mortality rate was 17%, whereas 34% of the patients with bloodstream infections died. Presence of bacteremia and advanced disease stage increased overall mortality by 6.1-fold and 3.7-fold, respectively. Conclusion: Nearly half of the cancer patients developed an infection during their hospital stays, with gram-positive bacteria being the predominant etiologic microorganisms. This demonstrates the changing trends in infections considering that, until 2004, gram-negative bacteria were the most predominant microorganisms among cancer patients in our institute.PubMedWoSScopu

Comparison of permissive hypotensive resuscitation, low-volume fluid resuscitation, and aggressive fluid resuscitation therapy approaches in an experimental uncontrolled hemorrhagic shock model

6th Turkish Congress on Trauma and Emergency Surgery -- SEP 04-08, 2007 -- Antalya, TURKEYOzturk, Gurkan/0000-0001-8662-636XWOS: 000278128400001PubMed: 20517741BACKGROUND In this study, we aimed to compare the efficacy of aggressive fluid resuscitation, low-volume fluid resuscitation and permissive hypotensive resuscitation in an experimental uncontrolled hemorrhagic shock model. METHODS Forty-four male Guinea pigs were used in the study in an experimental uncontrolled shock model. Guinea pigs were split into six groups including normovolemic-normotensive fluid treatment group, normovolemic-permissive hypotensive fluid treatment group, low-volume normotensive fluid treatment group, low-volume permissive hypotensive fluid treatment group, no treatment (n=6), and sham-operated groups (n=6). Resuscitation was initiated when mean arterial pressure (MAP) reached 30 mmHg. In the permissive hypotensive resuscitation group, fluid treatment continued until MAP reached 45 +/- 5 mmHg and in the aggressive fluid groups until MAP reached 60 +/- 5 mmHg. Resuscitation fluid was hetastarch 6% (hydroxyethyl starch) in the low-volume fluid groups and Ringer's lactate in the normovolemic fluid groups. RESULTS Mean survival time was 122.75 +/- 4.83 min in the normovolemic-normotensive fluid group, 130.87 +/- 16.31 min in the normovolemic-permissive hypotensive group, 122.12 +/- 11.53 min in the low-volume-normotensive fluid group, and 152.25 +/- 9.10 min in the low-volume-permissive hypotensive fluid group. Survival time was found significantly higher in the group in which low-volume-permissive hypotensive fluid treatment was applied than in the other groups. CONCLUSION When pressure effect was compared during treatment, permissive-hypotensive resuscitation was found more effective in both groups that received colloid and crystalloid treatment

Sağkalım Göstergesi Olarak Erişkin Yüksekten Düşme Olgularına Ait Travma Skorlarının Karşılaştırılması

Sağkalım Göstergesi Olarak Erişkin Yüksekten Düşme Olgularına Ait TravmaSkorlarının KarşılaştırılmasıAmaç: Yüksekten düşmeler (YD) travmalara bağlı morbidite ve mortaliteler içinde önemli yer tutar. Olgularınmortalite öngörüsü genellikle travma skorları aracılığıyla yapılır. Çalışmamızda yüksekten düşen olgulara aitmortalite olasılıklarını değerlendirmede kullandığımız ISS, NISS, RTS ve TRISS değerleri analiz edildi.Yöntem ve Gereç: Kasım 1997-Ekim 2007 tarihleri arasında Ankara GATA acil servisine müracaat eden 87yüksekten düşme olgusuna ait kayıtlar geriye dönük olarak değerlendirildi. Olgular yaş, cins, düşmeyükseklikleri(0-2 m, 3-5 m ve 6 m-üstü), gelişen organ patolojileri, ISS, NISS, RTS ve TRISS gibi skorlar ilemortalite açısından değerlendirildi.Bulgular: Olguların yaş ortancası 25 (17-61) idi. % 33 oranında kadın idi. Sağ kalım oranları açısından yaşve cinse göre istatistiksel anlam bulunamadı (P &lt; 0.05). Düşme yüksekliği arttıkça organ patolojisi sıklığı arttı(P &lt; 0.001). Tüm travma skorlarının mortalite ile ilişkili olduğu, ISS, NISS ve TRISS’nin arttıkça, RTSdeğerinin ise azaldıkça mortalite oranlarının arttığı saptandı. ROC analizinde eğrinin altındaki alan TRISS için0.991, ISS için 0.910 ve NISS için 0.915 olarak bulundu (her biri için P &gt; 0.001). TRISS için kesim değeri73.5 olarak alındığında en iyi duyarlılık, özgüllük, pozitif ve negatif öngörü değerlerine sahip olduğu saptandı. Sonuç: Yüksekten düşen erişkin olgularımıza ait travma skorları geriye dönük olarak değerlendirildiğiçalışmamızda TRISS değerinin yüksek özgüllük ve mortalite için 73.5 kesim değerinin üzerinde yüksekgüvenirlikte kullanılabileceği doğrultusunda veri elde edilmiştir.Anahtar Sözcükler: Travma Skorları, Yüksekten Düşme, MortaliteAim: Falls from a height and their subsequent injuries and traumas can cause morbidity and death. In thepresent study, ISS, NISS, RTS, and TRISS values were analyzed to assess mortality probabilities of patientswho fell from a height. Materials and Methods: Patients' age, gender, height of falls (0-2 m, 3-5 m, and 6 m and above), organpathologies, and ISS, NISS, RTS, and TRISS scores were evaluated in terms of mortality. Results: Regarding the survival rate, no statistically significant difference was found between age and gender(P &gt; 0.05). We determined that all trauma scores were correlated with mortality, and that as Injury SeverityScore (ISS), New Injury Severity Score (NISS), and Trauma and Injury Severity Score (TRISS) values increased,and as Revised Trauma Score (RTS) values decreased, the mortality rate tended to increase. The area underthe curve in the Receiver Operating Characteristic (ROC) analysis was 0.991 for TRISS, 0.910 for ISS, and0.915 for NISS (P &gt; 0.001). The most satisfactory cut-off point for TRISS was 73.5 and at that point, wefound the best sensitivity, specificity, and positive and negative predictive values. Conclusions: In conclusion, the data showed that TRISS values can be used with high reliability when thisvalue is over 73.5 and any score above it has high specificity and mortality. Key Words: Trauma Scores, Fall from a height, Mortality</p

Topikal hemostatik ajanların travmalı olgularda güncel kullanım esasları

ÖZETSivil ve askeri travmalarda önlenebilir ölümlerin en sık nedeni kanamalardır. Özellikle ekstremitelerde meydanagelen yaralanmalarda basit kanama kontrolü ve turnike uygulanabilirken aksiller ve femoral bölge yaralanmalar›nda hemostaz zor sa¤lanmaktad›r. Bu yaz›da posttravmatik kanamal› olgularda kullan›lmas› önerilen topikal hemostatik ajanlar›n literatür eflli¤inde gözden geçirilmesi amaçland›. Topikal hemostatik ajanlarla ilgili mevcut bilgilerin,az say›da olgu sunumuna, ço¤unlu¤u deneysel çal›flmalardan elde edilen verilere ve sahraya ait baz› kiflisel yorumlara dayand›¤›, ürünler aras›nda klinik kullan›m›na ait ileriye dönük randomize kontrollü çal›flmalara rastlanmad›¤›gözlendi. Kanamaya ba¤l› geliflen mortaliteyi azaltmaya yönelik topikal hemostat uygulamas›na dair de¤erlendirmelerin yüksek kan›t düzeyli çal›flmalar ile desteklenmesine ihtiyaç duyulmaktadır. Anahtar sözcükler: Topikal hemostat; kanamaSUMMARYHemorrhage is the most common cause of preventable deaths both in civilian and military trauma. Simple hemorrhage control and tourniquets can be applied in extremity injuries but hemostasis in the axillary and femoralregion is rather challenging. In this study, results on the efficacy of topical hemostatic agents in post-traumatichemorrhages reported in the literature are reviewed. As conclusion, current information on topical hemostaticagents depend upon a few case reports, data from mostly experimental studies and subjective evaluations in thefield, but there are no prospective, randomized studies with control group. Evaluations regarding the use of topical hemostatic agents to reduce the mortality need to be supported by studies with higher level of evidence.Key words: Topical hemostat; hemorrhage.</p

Bir bina çökmesi nedeniyle edinilen tecrübeler

In this study, it has been purposed to share practice of event-scene administration, search and rescue and evacuation of injured and acquired experiences carried out throughout a building collapse. After an explosion at Diyarbakır Kurdo?lu housings at 11 December 2006 about 08:20AM, five flats of an apartment that has five floors-ten flats were collapsed. Local military hospital ambulances, city ambulances, and fire-fighting vehicles arrived to event-place 10 minutes later. It has been found out that there were 13 people inside, 6 of which were children. Army rescue team arrived event-place about 01:30PM, then all non-professional persons has been sent away from region. Eight dead including five children, and five injured including one child have been taken out. Two people from close area have been also injured mildly due to the explosion. It has been found out that accident caused by boiler tank exploding. Sixth of total eight injured had only superficial wounds. Other two injured have been followed because of head trauma at first one and hepatic contusion and rib fracture at the other one. No complication observed after follow-up. Building collapses can create disaster potential according to the number of people inside and facilities of nearby region of the place accident taken place. The evaluation of the direction of building collapse during search and rescue operation would enhance possibility to reach more living in shorter time. Building collapses which can be considered as a miniature of big disaster potentials like earthquakes can be appraised as an important practical training and experience source on event-place administration, search and rescue operations and injured evacuation. We believe that share of the analysis and acquired experiences of this kind of studies would contribute interfering big disaster potentials

Comparison of warm fluid and cold fluid resuscitation during uncontrolled hemorrhagic shock model in rats.

This study was designed to compare the effects of resuscitation with cold and warm fluid on survival time, rate and volume of hemorrhage, hemodynamics, hypothermia, coagulopathy, acid-base balance, hematocrit, lactate, and base deficit during uncontrolled hemorrhagic shock (HS) model in rats. METHODS:HS model was created with splenic vascular and parenchymal injury in 29 rats under ketamine and xylazine anesthesia. Thirty minutes after the hemorrhage, the rats were randomized to receive 14.5 mL/kg 0.9% sodium chloride solution at either 24ºC (Group 1; n=9) or 4ºC (Group 2; n=10) for 20 minutes. Groups 1 and 2 were compared with group that did not receive fluid (Group 3; n=10). Statistical data were represented as mean±SD. SPSS for Windows, Version 15.0 (SPSS, Inc., Chicago, IL, USA) software, Bonferroni-adjusted Mann-Whitney U test and Kaplan-Meier procedure were used to perform statistical data analysis. P value of ?0.05 was considered statistically significant.RESULTS:Cold fluid resuscitation decreased survival time due to increased rate and volume of hemorrhage, acidosis, hypothermia, lactate, and base deficit and decreased blood pressure and hematocrit.CONCLUSION:There is a great need for further experimental and clinical trials on fluid resuscitation in trauma in order to define which fluid should be administered, temperature of the fluid, quantity to be delivered, and duration

Efficacy and safety of an inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac): interim results of a double-blind, randomised, placebo-controlled, phase 3 trial in Turkey

Background CoronaVac, an inactivated whole-virion SARS-CoV-2 vaccine, has been shown to be well tolerated with a good safety profile in individuals aged 18 years and older in phase 1/2 trials, and provided a good humoral response against SARS-CoV-2. We present the interim efficacy and safety results of a phase 3 clinical trial of CoronaVac in Turkey. Methods This was a double-blind, randomised, placebo-controlled phase 3 trial. Volunteers aged 18-59 years with no history of COVID-19 and with negative PCR and antibody test results for SARS-CoV-2 were enrolled at 24 centres in Turkey. Exclusion criteria included (but were not limited to) immunosuppressive therapy (including steroids) within the past 6 months, bleeding disorders, asplenia, and receipt of any blood products or immunoglobulins within the past 3 months. The K1 cohort consisted of health-care workers (randomised in a 1:1 ratio), and individuals other than health-care workers were also recruited into the K2 cohort (randomised in a 2:1 ratio) using an interactive web response system. The study vaccine was 3 mu g inactivated SARS-CoV-2 virion adsorbed to aluminium hydroxide in a 0.5 mL aqueous suspension. Participants received either vaccine or placebo (consisting of all vaccine components except inactivated virus) intramuscularly on days 0 and 14. The primary efficacy outcome was the prevention of PCR-confirmed symptomatic COVID-19 at least 14 days after the second dose in the per protocol population. Safety analyses were done in the intention-to-treat population. This study is registered with ClinicalTrials.gov (NCT04582344) and is active but no longer recruiting. Findings Among 11 303 volunteers screened between Sept 14, 2020, and Jan 5, 2021, 10 218 were randomly allocated. After exclusion of four participants from the vaccine group because of protocol deviations, the intention-to-treat group consisted of 10 214 participants (6646 [65.1%] in the vaccine group and 3568 [34.9%] in the placebo group) and the per protocol group consisted of 10 029 participants (6559 [65.4%] and 3470 [34.6%]) who received two doses of vaccine or placebo. During a median follow-up period of 43 days (IQR 36-48), nine cases of PCR-confirmed symptomatic COVID-19 were reported in the vaccine group (31.7 cases [14.6-59.3] per 1000 person-years) and 32 cases were reported in the placebo group (192.3 cases [135.7-261.1] per 1000 person-years) 14 days or more after the second dose, yielding a vaccine efficacy of 83.5% (95% CI 65.4-92.1; p0.0001). The frequencies of any adverse events were 1259 (18.9%) in the vaccine group and 603 (16.9%) in the placebo group (p=0.0108) with no fatalities or grade 4 adverse events. The most common systemic adverse event was fatigue (546 [8.2%] participants in the vaccine group and 248 [7.0%] the placebo group, p=0.0228). Injection-site pain was the most frequent local adverse event (157 [2.4%] in the vaccine group and 40 [1.1%] in the placebo group, p0.0001). Interpretation CoronaVac has high efficacy against PCR-confirmed symptomatic COVID-19 with a good safety and tolerability profile. Copyright (C) 2021 Elsevier Ltd. All rights reserved.We are grateful to all participants who volunteered to be part of this study and to all members of the clinical research teams of the participating sites. We thank TUSEB for funding the study and Omega-CRO for the statistical analyses and production of figures, and providing the study protocol. We also thank the members of the data and safety monitoring board for their contributions in the safe execution of this study.TUSE