Comparison of single-dose pralidoxime and pralidoxime infusions for the treatment of organophosphate poisoning [Organofosfat zehirlenmesinin tedavisinde tek doz parlidoksim infüzyonunun karşılaştırılması]

Objective: Organic phosphates (OP) bind covalently to acetylcholinesterase (AChE) and acetylcholine (Ach) accumulates in the synaptic cleft. Administering oximes before aging process causes breakage of the covalent bond between OP-AChE, and allows reactivation of AChE. Pralidoxime (PAM) is the most commonly used oxime. The purpose of this study is to determine the best PAM regimen for the length of hospitalization, the need for mechanical ventilation and reduction of the duration of mechanical ventilation in patients presenting with OP poisoning. Material and Methods: Thirty four patients included in this study were organized according to the order of enrollment, randomized and divided into two groups. Seventeen patients in the group I were given a single dose of 2 g/20 min PAM infusion (bolus dose), while 17 patients in group II were administered a dose of 2 g/20 min followed by 6 g/24 hours PAM infusion (bolus and infusion). Clinical signs and symptoms as well as the serum butyrylcholinesterase (BCHE) levels were used to verify the patients' diagnoses. Results: There were no significant differences between the groups. Conclusion: We suggest that PAM bolus plus infusion therapy does not have any advantage over a single dose of bolus PAM therapy the in treatment of OP poisoning. © 2012 by Türkiye Klinikleri

A comparison of effectiveness of sodium bicarbonete in patients intoxicated by tricyclic antidepressants and Anticholinergic drugs other than tricyclic antidepressants which affected the heart [Kalp etkilenmesine sebep olan trisiklik antidepresan i·laçlar ve trisiklik antidepresan dışı diger antikolinerjik i·laçlar ile zehirlenmeye maruz kalan hastalarda sodyum bikarbonat tedavisinin etkinliginin karşılaştırılması]

Objective: Anticholinergic drug poisoning is among the life threatening poisonings frequently seen in emergency services. These drugs have serious side effects on heart like heart rate alterations, arrhythmias and conduction delays. The purpo-se of our study is to determine whether the other negative impacts of intoxication with tricyclic antidepressants (TCA) and antic-holinergic drugs other than TCAs on heart are similar in nature in patients with QTc ?45, and to compare the effectiveness of the standard NaHCO3 treatment on prolongation of QTc as well as QRS complex widening in patients intoxicated by anticholinergic drugs. Material and Methods: This prospective case-control study was planned to enroll patients who admitted to emergency ser-vice of Çukurova University Medical Faculty between June 06, 2005 and November 30, 2006 due to poisoning with TCA or anti-cholinergic drugs other than TCAs, and having a QTc interval ?0.45 on the electrocardiogram (ECG) taken at the time of admission. The patients were managed with a 2 mEq/kg dose of NaHCO3 treatment. In both groups, changes in QTc and QRS distances, car-diac biochemical parameters and systolic blood pressure and heart rate changes were compared with respect to time and the gro-ups. Biochemical parameters related to possible complications due to the given treatment were examined. Results: The patients' demographic, clinical, electrocardiographic and laboratory findings were recorded and analyzed. A total of 58 patients, 30 of whom were poisoned with TCA agents, and 28 were poisoned with other drugs with anticholinergic effects were enrolled in the study. All patients had prolonged QTc and tachycardia and in 64.9% of the patients (n=37) QRS was ?0.1. When we compared the QRS and QTc values at admission and at the sixtieth minute of the therapy, we observed a statistically significant decrease in both gro-ups. Hopwever this reduction did not differ significantly between the groups. No significant changes were observed in systolic blo-od pressures or cardiac biochemical parameters of the patients of during the time between admission and discharge. Treatment and follow-up of all patients were performed in the emergency observation unit. No mortality occurred among patients in both gro-ups. Conclusion: The fact that NaHCO3 treatment completely improved signs and symptoms and no treatment-related complica-tions like hypertension, metabolic alcalosis, hypernatremia, hypokalemia, hypocalcemia developed, we suppose that standard 2 meq/kg NaHCO3 treatment is valid, effective and reliable in anticholinergic drug poisonings. Copyright © 2012 by Türkiye Klinikleri

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

The role of oxidative stress markers in the pathophysiology of migraine and after treatment

Introduction: In this study, we investigated whether oxidant and antioxidant levels have a role in the pathophysiology of migraine and whether these measurements can be used effectively in the follow-up treatment.Materials and Methods: Thirty-one patients were admitted to the emergency department because of migraine attack and 30 healthy volunteers were enrolled in the study. The treatment was initiated with metoclopramide, and total antioxidant status (TAS), thiol, paraoxonase (PON), stimulated paraoxonase (St PON), arylesterase (ARE), and total oxidant status (TOS) were evaluated with the samples that were collected at the time of admission and at 30th and 60th minutes. Oxidative Stress Index (OSI) was calculated. Intensity of pain was assessed by the Visual Analogue Scale (VAS), simultaneously with sample collection. The results of patients were compared with those of healthy volunteers.Results: In the samples of patients collected at the time of admission, thiol and ARE levels were significantly low (226.6 ± 29 vs. 170.2 ± 52.2, P = 0.000 and 339.3 ± 47.9 vs. 278.0 ± 44.8, P = 0.000) and TOS and OSI were significantly high (2.1 ± 0.5 vs. 3.0 ± 1.8, P = 0.000 and 1.1 ± 0.3 vs. 1.6 ± 1.0, P = 0.000) when compared with the control group. There was no significant change in the levels of TAS, PON, and St PON (1.9 ± 0.3 vs. 1.8 ± 0.3, P = 0153 and 210.5 ± 135.9 vs. 164.5 ± 101.6, P = 0139 and 512.5 ± 353.3 vs. 419.8 ± 276.5, P = 0.262). VAS scores at 30th and 60th minutes were significantly decreased when compared with those at the time of admission. However, there was no correlation between the decrease in VAS score and TAS, thiol, PON, St PON, ARE, and TOS and OSI levels (P >0.05).Conclusions: The effect of oxidative stress in the pathophysiology of migraine is more likely to be an oxidant. These parameters alone are not sufficient to explain the pathophysiology of migraine because no significant changes were observed in either of antioxidant and oxidant levels, whereas a significant improvement in pain was achieved after the treatment of patients. Therefore, these results suggest that there are more than one mechanism in the pathophysiology of migraine. Copyright © 2013 by Lippincott Williams & Wilkins