Alkaline thermostable and halophilic endoglucanase from Bacillus licheniformis C108

An endoglucanase was purified from halophilic alkaline Bacillus  licheniformis isolated from soils of Lake Van in Turkey. The optimal pH and temperature of the endoglucanase produced by B.licheniformis C108 were 10.0 and 30°C, respectively. The enzyme was highly stable up to 100°C at pH 10.0 and the enzyme retained its complete activity for 6 h in 7 to10% of NaCl. The activity of the enzyme was significantly inhibited by sodium dodecyl sulfate (SDS), Triton X-100, zinc chloride (ZnCl2),phenylmethanesulfonylfluoride (PMSF) and Urea. The partially purified enzyme revealed that, products of carboxymethylcellulosic hydrolysis were glucose, cellobiose and other longer cellooligosaccharides. Thermostability, alkalinity, halostability and high hydrolytic capability make this enzyme a potential candidate for environmental bioremedetion and bioethanol production processes from cellulosic biomasses as well as waste treatment processes.Key words: Cellulose, Bacillus licheniformis, CMCase, endoglucanase, halostable

Spontaneous internal jugular vein thrombosis: A case report

Internal jugular vein thrombosis (IJVT) is an elusive vascular disease that is rarely seen, with potentially lethal complications such as sepsis and pulmonary embolism. Spontaneous IJVT is considered when no apparent predisposing cause of thrombosis is present. A previously healthy, 31-year-old woman presented to the university-based emergency department because of painless swelling in the right anterior side of her neck. Physical examination revealed a painless, soft and immobile mass in the right anterior side of her neck beneath the sternocleidomastoid muscle, without hyperemia or local heat. On ultrasonographic examination, a hyperechogenic mass was visualized around the thoracic entrance of the right internal jugular vein, which was suggestive of a thrombus. The patient was administered intravenous antibiotic and low-molecular-weight heparin followed by oral coumadin as anticoagulant therapy. Her complaints were relieved within 5 days. She was completely well after 6 months. Venous thrombosis generally results from impaired blood flow locally or systemically that leads to activation of coagulation. Primary care physicians should sustain a high index of suspicion in patients who present with undiagnosed swelling in the neck, or other signs and symptoms attributed to IJVT. © 2010 Elsevier. All rights reserved

Recognition and Management of Supraventricular Arrhythmias and Atrial Fibrillation in the Acute Setting

Supraventricular tachycardia (SVT) is a type of tachyarrhythmia with a narrow QRS complex and regular rhythm. These patients are often symptomatic and present to the emergency department (ED) due to acute attacks called paroxysmal SVT. Attacks of SVT start suddenly with the reentry mechanism in most patients. Anginal chest pain and dyspnea occur in patients due to tachycardia. Vagal manoeuvers and adenosine is the treatments of choice for termination of SVT. In multifocal atrial tachycardia (MAT), at least three different P wave morphologies are observed in the ECG, along with variable PP, PR and RR intervals. Treatment is to correct the underlying disease. Patients with atrial flutter (AFl) tend to come to the ED with unstable findings. Atrial fibrillation (AF) is the term used to define the inactive ‘worm bag-like’ oscillations of the atria, with an absence of true atrium contraction. Ruling out atrial or ventricular thrombi with echocardiography is important to avoid embolization. Priority should be given to hemodynamic stability and the determination of factors triggering the underlying disease. IV beta-blocker and diltiazem can be used for rate control in AF with rapid ventricular response

Burnout: need help?

<p>Abstract</p> <p>Background</p> <p>Burnout syndrome is a psychological situation induced with working, especially in high-risk parts of the hospitals that affects the physical and mental conditions of the staff. The aim is to identify the characteristics of the staff related to Burnout Syndrome in the Emergency Department (ED).</p> <p>Methods</p> <p>The study includes the Maslach Burnout Inventory and other new individual research questions. The responders were the volunteers and comprised physicians, nurses, nurses' aides from EDs of all urban state hospitals of Adana (43.3%). Burnout scores were analyzed with regard to individual characteristics; supplementary work, marital status, the number of children, occupation, salary, career satisfaction, satisfaction in private life. Mann-Whitney U test and Kruskall-Wallis test were performed using SPSS 15.00.</p> <p>Results</p> <p>There were no relation between Burnout scores and supplementary work, marital status, number of children, occupation, salary, private life satisfaction, except for career satisfaction.</p> <p>Conclusion</p> <p>Presence and severity of Burnout syndrome were linked to career satisfaction without personal features and salaries. All branches of healthcare occupations in ED seem to have been affected by Burnout Syndrome similarly.</p

Occupational hand injuries treated at a tertiary care facility in Western Turkey

The study was designed to investigate characteristics of work-related hand injuries (WRHI) referred to a University hospital emergency department (ED) in an industrialized region as well as to supply data for preventive strategies. All patients with WRHI referred to the University-based ED in the two-year period were investigated. Sociodemographic and injury-related clinical information were analyzed. Out of 746 patients who were admitted to the ED due to occupational injuries within the two-year study period, 244 (32.7%) with isolated wrist, hand and finger injuries were included in the study. Male patients constituted the majority 87.2% (n=213) and 57.0% (n=139) of the patients were between 25 and 34 yr of age. WRHI recorded in industries involving metal and machinery constituted 41.4% (n=101) of all injuries. The sites of injuries were not significantly affected by differences in age, social security status and sectors. The most common types of injury were lacerations, punctures, and abrasions (40.2%, n=98). There was a statistically insignificant rise in amputation injuries with increasing age. Incidences, etiologies and characteristics of WRHI should be highlighted and preventive strategies based on these facts be implemented due to higher level of suffering and more serious consequences attributed to this specific injury

Analysis of clinical and demographic characteristics of patients presenting with renal colic in the emergency department

<p>Abstract</p> <p>Background</p> <p>Renal colic (RC), is one of the most severe pain patterns which is most commonly diagnosed and managed in the emergency department (ED). This study is designed to evaluate the characteristics of adult patients presenting with pain and diagnosed with RC in the ED, length of stay in the ED and hospital and factors affecting these variables.</p> <p>Methods</p> <p>All consecutive adult patients who presented with side pain, flank pain, abdominal or groin pain and consequently diagnosed with urolithiasis or RC were analyzed retrospectively. Sociodemographic data, times of admission into and discharge from the ED, adjunctive complaints, results of laboratory investigations, findings on examination, treatment and drugs administered were noted.</p> <p>Results</p> <p>A total of 235 patients with a diagnostic code of urolithiasis were enrolled. Physicians were more likely to order radiological and laboratory investigations for female patients and those without hematuria in urinalysis. The peak incidence of patients diagnosed with RC (p = 0.001) was noted in August, while the winter had the lowest frequency of relevant admissions. The peak frequency was between 06:00 and 08:00. Women stayed longer in the ED (p = 0.001). Absence of hematuria in urinalysis was associated with increased length of stay (p = 0.007).</p> <p>Conclusion</p> <p>Although RC is a common ED presentation for which the emergency physician has no guidelines in terms of diagnosis and management, there is no exact pattern to guide ordering investigations. Patients with atypical presentations stay longer in the ED and are likely to undergo additional tests in management.</p

Diabetic Foot Due to Anaphylactic Shock: A Case Report

Introduction: Diabetic foot is a clinical disorder, which is commonly seen in patients with diabetes mellitus. It is also the major cause of below knee amputation in the world. There are many underlying causes such as neuropathic, ischemic, and infectious causes for diabetic foot. Local or systemic complications may develop after snake bite. Case Presentation: We reported a very rare case, involving a 78-year-old male admitted to the Emergency Department, who developed anaphylactic shock and diabetic foot after the snake bite. Conclusions: Reviewing the literature, this is the second reported case of snake bite associated with diabetic foot

Can drones be a solution for defibrillation and blood transfusions? A review on the impact of new technologies in emergency healthcare

Life-threatening arrhythmias, shock and airway compromise represent the most crucial situations to treat in the daily routine of acute medicine. Rapid access to automated external defibrillators (AEDs) and other necessary equipment increases survival rates significantly. The unmanned aerial vehicles (UAV) appear to revolutionize prehospital medicine enabling advanced health care delivery to those in austere environments and difficult regions for both defibrillators and blood products (BP). Although there are still many factors to consider, drone networks show potential to greatly reduce lifesaving equipment travel times for those with cardiac arrest (CA). More research should be performed to fill the gaps in routine practice of operating drones in different clinical scenarios, and geographical variations. As far as delivery of BP via drones, key benefits are minimized risk to human life, cost, speed of delivery and ability to cover areas beyond those of conventional planes. Challenges can be airspace management of BP, decisions on appropriate level of care to deliver during transit and user acceptability. Appropriate integration of drones to ambulances and emergency medical services facilitates efforts to improve healthcare, particularly in difficult and underserved regions. In brief, indications of drone use should be individualized to deliver vital equipment and care to the victim in emergency need, while the effectivity of UAVs must be evaluated case by case basis. This article aims to review the current status of above-mentioned technology and pluses and minuses of UAVs used worldwide, along with future projections