N′-[(2Z)-3-Allyl-4-oxo-1,3-thia­zolidin-2-yl­idene]-5-fluoro-3-phenyl-1H-indole-2-carbohydrazide

In the title compound, C21H17FN4O2S, the planar indole fused-ring [maximum deviation 0.009 (1) Å] makes dihedral angles of 54.75 (9) and 14.90 (9)°, respectively, with the phenyl ring and the dihydro­thia­zolyl ring. The –CH2CH=CH2 substituent is disordered over two positions in a 0.51 (1):0.49 (1) ratio. An intra­molecular N—H⋯S hydrogen bond generates an S(5) ring motif. The two independent mol­ecules are linked into a dimer by two N—H⋯O hydrogen bonds, forming an R 2 2(10) ring motif. The crystal structure features inter­molecular C—H⋯π and π–π stacking [centroid–centroid distance = 3.679 (1) Å] inter­actions. C—H⋯O and C—H⋯F inter­actions are also present

Vapocoolant spray for intravenous cannulation pain: a Prospective, randomized controlled trial

Introduction: Peripheral intravenous (IV) cannulation are routine procedures in emergency department (ED) admissions. Vapocoolant sprays have a potential advantage over other topical agents.We aimed to see how effective vapocoolant spray was in reducing pain during intravenous cannulation versus a control group in this study. Materials and Methods: This is a prospective, randomized control study consisting of patients who were admitted to the ED. The study included patients aged 18 and over who applied to the ED and had IV cannulation. The patients were divided into 2 groups as control and vapocoolant spray groups. Age, gender, and dominant hand status of all patient groups were recorded. Side effects were observed after the application. The Visual Analogue Scale (VAS), which is the most widely used scale to measure pain, was used. Results: 206 individuals were randomized. The mean age of the vapocoolant spray group was 46.40±16.44 years, while it was 46.75±17.49 years for the control group. The vapocoolant spray group was found to have significantly lower mean VAS values during IV cannulation than the control group (1.47±1.32 vs. 3.97±1.97 p<0.001). It was found that the vapocoolant spray-applied group had a significantly lower percentage in terms of moderate pain (VAS>3 cm) compared to the control group (7.8% vs 58.3%, p<0.001). Besides, the percentage of severe pain (VAS>5.4 cm) in the spray-applied group was found to be significantly lower than the control group (1% vs. 20.4%, p<0.001). Conclusion: The vapocoolant spray can be used effectively to mitigate the pain associated with the pre-IV cannulation procedure and can be an alternative method for reducing pain in emergency departments

Attitudes of non-physician health workers working in the Emergency Department towards euthanasia, death, and the terminally patient

Aim: The use of the right to die in the center of the individual's own decision is called euthanasia. This decision, was evaluated from legal, religious, and medical perspectives. In different countries applied euthanasia, which can be performed actively or passively. In our study, we planned to investigate the perspectives of healthcare professionals working in the emergency department about euthanasia and their thoughts on diseases that can be applied to euthanasia. Material and methods: A survey was conducted from June to October 2022 on non-physician health workers working in the Emergency department. A questionnaire including demographic data, professional knowledge, and Attitude Scale towards Euthanasia, Death, and the Terminally Patient was administered to the healthcare professionals who agreed to participate in the study. The obtained data were analyzed. Results: In the study, the feedback of 60 participants, 37 of whom were women, was evaluated. The mean age of the entrants was found to be 39.07±10.11 years. 60% of the participants had received cardiopulmonary resuscitation training in the past year. 70% of the participants stated that they could be euthanized for coma, 38.33% for severe disability, and 36.67% for severe and incurable neurological diseases. Conclusion: In the process of euthanasia, which does not have a legal infrastructure in our country, different perspectives are seen from different departments of health services. Key words: emergency department, euthanasia, non-health worker

Methods to introduce floating bridge motion and wind excitation on a model for the investigation of heavy vehicle dynamics

The proposed floating bridge solution at Bj\uf8rnafjorden in connection with the E39 infrastructure upgrade is an enabler to realize efficient transportation. This bridge and the vehicles shuttling on it will be exposed to inclement weather conditions. The waves and wind excite the floating bridge to induce compound motion in addition to the aerodynamic crosswinds directly interacting with the vehicles. Methods to introduce the complex motion of the floating bridge (multi-post test rig) and aerodynamic crosswinds on a tractor semi-trailer have been established and presented in this paper. The environment-vehicle-driver system is enabled through a co-simulation between MATLAB/Simulink (primary) and Adams (secondary). This complex interplay is studied on the intricate 627-DoF Adams vehicle model coupled with the Adams driver model. Numerical simulations are performed for multiple constant vehicle speeds under laden condition on a road with friction of 0.7 for the 1-year storm weather condition. Vehicle stability and safety assessments such as lane violation, path following ability, rollover risk, and lateral side slip limit are evaluated to draw inferences. Subsequently, permissible vehicle speed for a laden tractor semi-trailer to operate on the floating bridge is suggested. Furthermore, a simpler 9-DoF tractor semi-trailer vehicle model developed in MATLAB/Simulink combined with the pure pursuit tracking based driver model is compared with the Adams model under identical environmental conditions for an unladen case. The simpler vehicle-driver model is validated against the detailed Adams vehicle-driver model through numerical simulations for different constant vehicle speeds

Discovery of a small molecule that selectively destabilizes Cryptochrome 1 and enhances life span in p53 knockout mice

Cryptochromes are negative transcriptional regulators of the circadian clock in mammals. It is not clear how reducing the level of endogenous CRY1 in mammals will affect circadian rhythm and the relation of such a decrease with apoptosis. Here, we discovered a molecule (M47) that destabilizes Cryptochrome 1 (CRY1) both in vitro and in vivo. The M47 selectively enhanced the degradation rate of CRY1 by increasing its ubiquitination and resulted in increasing the circadian period length of U2OS Bmal1-dLuc cells. In addition, subcellular fractionation studies from mice liver indicated that M47 increased degradation of the CRY1 in the nucleus. Furthermore, M47-mediated CRY1 reduction enhanced oxaliplatin-induced apoptosis in Ras-transformed p53 null fibroblast cells. Systemic repetitive administration of M47 increased the median lifespan of p53−/− mice by ~25%. Collectively our data suggest that M47 is a promising molecule to treat forms of cancer depending on the p53 mutation

Association of Platelet to Lymphocyte and Neutrophil to Lymphocyte Ratios with In-Hospital Mortality in Patients with Type A Acute Aortic Dissection

Abstract Objective: To evaluate the relationship between neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) with in-hospital mortality in type A acute aortic dissection (AAD). Methods: A total of 96 patients who presented to the emergency department between January 2013 and June 2018 with a diagnosis of type A AAD were enrolled in this study. White blood cell count subtypes such as NLR and PLR were calculated at the time of admission. The end point was in-hospital mortality. Results: Of the 96 type A AAD patients included in this analysis, 17 patients (17.7%) died during hospitalization. NLR and PLR were significantly elevated in patients with type A AAD (P<0.001 and <0.001, respectively). Based on the receiver operating characteristic curve, the best NLR cut-off value to predict in-hospital mortality was 9.74, with 70.6% sensitivity and 76.8% specificity, whereas the best PLR cut-off value was 195.8, with 76.5% sensitivity and 78.1% specificity. Conclusion: Admission NLR and PLR levels were important risk factors and independently associated with in-hospital mortality of type A AAD patients

The Immature Granulocyte Count Is a New Predictor of the 30-Day Mortality in Intracerebral Haemorrhage Patients: Preliminary Study

Objectives Spontaneous intracerebral hemorrhage (ICH) accounts for 10 to 20% of all types of stroke and is associated with high mortality and morbidity rates. Neuroinflammation caused by intracerebral blood includes resident microglia activation, infiltration of systemic immune cells, and production of cytokines, chemokines, extracellular proteases, and reactive oxygen species. Despite several findings demonstrating that an immature granulocyte (IG) count can be a prognostic indicator as an inflammatory parameter in many diseases, no studies conducted on ICH patients are available in the literature. Therefore, in this study, we aimed to investigate the relationship between the 30-day mortality rate and the IG count obtained at the time of admission in ICH patients. Methods Demographic characteristics and laboratory test results of patients, who were diagnosed with ICH and hospitalized accordingly upon arrival at the emergency ward in our tertiary care hospital in the period from January 2019 and December 2019, were recorded. The endpoint of the study was the examination of the relationship between the short-term mortality (within 30 days after hospitalization) and the IG count at admission. Results Seventy patients, who met the inclusion criteria, were included in the study. Of these patients, 40 (57.1%) were males and the mean age was 68.04 ± 13.08 years. Patients with poor prognosis had higher IG counts (p = 0.001). The 30-day mortality rate was 33.3% (11/33) in the high IG count (≥0.6) group and 5.4% (2/37) in the low IG count (< 0.6) group (p = 0.004). In the regression analysis, we found out a significant relationship of the IG count to the 30-day mortality, with an odds ratio of 5.157(95% CI = 0.914–29.087, p = 0.029). Conclusion An IG count can be obtained from a simple full blood count, is easy to apply, does not result in extra costs, and is used as a marker to predict the 30-day prognosis

N '-[(2Z)-3-Allyl-4-oxo-1,3-thiazolidin-2-ylidene]-5-fluoro-3-phenyl-1H-indole-2-carbohydrazide

In the title compound, C(21)H(17)FN(4)O(2)S, the planar indole fused-ring [maximum deviation 0.009 (1) angstrom] makes dihedral angles of 54.75 (9) and 14.90 (9)degrees, respectively, with the phenyl ring and the dihydrothiazolyl ring. The -CH(2)CH = CH(2) substituent is disordered over two positions in a 0.51 (1):0.49 (1) ratio. An intramolecular N-H center dot center dot center dot S hydrogen bond generates an S(5) ring motif. The two independent molecules are linked into a dimer by two N-H center dot center dot center dot O hydrogen bonds, forming an R(2)(2)(10) ring motif. The crystal structure features intermolecular C-H center dot center dot center dot pi and pi-pi stacking [centroid-centroid distance = 3.679 (1) angstrom] interactions. C-H center dot center dot center dot O and C-H center dot center dot center dot F interactions are also present

N-[(2Z)-3-Allyl-4-oxo-1,3-thiazolidin-2-ylidene]-5-fluoro-3-phenyl-1H-indole-2-carbohydrazide

In the title compound, C(21)H(17)FN(4)O(2)S, the planar indole fused-ring [maximum deviation 0.009 (1) angstrom] makes dihedral angles of 54.75 (9) and 14.90 (9)degrees, respectively, with the phenyl ring and the dihydrothiazolyl ring. The -CH(2)CH = CH(2) substituent is disordered over two positions in a 0.51 (1):0.49 (1) ratio. An intramolecular N-H center dot center dot center dot S hydrogen bond generates an S(5) ring motif. The two independent molecules are linked into a dimer by two N-H center dot center dot center dot O hydrogen bonds, forming an R(2)(2)(10) ring motif. The crystal structure features intermolecular C-H center dot center dot center dot pi and pi-pi stacking [centroid-centroid distance = 3.679 (1) angstrom] interactions. C-H center dot center dot center dot O and C-H center dot center dot center dot F interactions are also present

Subclinical thyroid dysfunction in the first trimester and effects on obstetric outcomes

Amaç: Gebeliğin birinci trimesterinde saptanan subklinik tiroid fonksiyon bozukları ve Hashimoto tiroiditininin olumsuz gebelik sonuçları ile ilişkisinin araştırılması.Gereç ve Yöntemler: Çalışmaya, İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği Gebe Polikliniği'ne başvuran 288 gebe dahil edildi.Olgular tiroid fonksiyon testlerine göre, subklinik hipotiroid, subklinik hipertiroid ve ötiroid gruplarına ayrıldı.Tiroid otoantikor testi pozitif olan olgular Hashimoto tiroiditi olarak değerlendirildi ve tiroid fonksiyon testlerine göre ötiroid , sublinik hipotiroidi alt grupları oluşturuldu. Birinci trimester gebelik kaybı, preterm doğum, preeklampsi, gestasyonel hipertansiyon, gestasyonel diyabet, erken membran rüptürü, gebelik yaşına göre düşük doğum ağırlığı ve yenidoğan yoğun bakım ihtiyacı mevcut gebelikte kötü obstetrik sonuçlar olarak belirlendi. Yukarıda belirlenen gruplar ile bu obstetrik sonuçlar arasındaki ilişki araştırıldı. Bulgular: Olguların %75,3'ü ötiroidik, %19,4'ü subklinik hipotiroidik ve %5,2 'si subklinik hipertiroidik idi.Subklinik hipotiroidi olgularının %32,1'inde (18/56); ötiroidi olguların %24,9'unda (54/217) kötü obstetrik sonuç gelişti (p>0,05). Yenidoğan yoğun bakım ihtiyacı subklinik hipotiroidi ve ötiroidi grubunda %43,8 (20/56) ve %29,5 (61/217) oranında bulundu (p>0,05). Yenidoğan yoğun bakım ihtiyacı Hashimoto tiroiditli subklinik hipotiroidi grubunda %63.6 ve Hashimoto tiroiditli ötiroidi grubunda %43.2 oranında bulundu (p=0,009). Farklılığı yaratan grubu belirlemek amacıyla ikili karşılaştırmalar yapıldı. Yenidoğan yoğun bakım ihtiyacı subklinik hipotiroidik Hashimoto tiroidi olgularda ötiroid gebelerden yüksek bulundu(p=0,041).Sonuç: Gebeliğin birinci trimesterindeki subklinik tiroid fonksiyon bozuklukları kötü obstetrik sonuçları ile ilişki bulunmadı. Hashimoto tiroidit varlığında subklinik hipotiroidi yenidoğan yoğun bakım ünitesi ihtiyacında artışla ilişkilidir.Aim: To investigate the relationship between subclinical thyroid disfunctions and Hashimoto thyroiditis and adverse pregnancy outcomes in early pregnancy.Material and Methods: In this study 288 pregnant women who were examined at Medeniyet University Goztepe Education and Research Hospital Obstetrics and Gynecology Department were included. All cases were classified as subclinical hypothyroidism, subclinical hypertiroidism and euthyroidism according to their thyroid function tests. Cases with positive thyroid auto antibody tests were considered as Hashimoto thyroiditis and classified to subclinical hypothyroidism and euthyroidism subgroups. Adverse pregnancy outcomes were defined as first trimester pregnancy loss, preterm delivery, preeclampsia, gestational hypertension, gestasional diabetes, premature rupture of membranes , small for gestasyonel age and neonatal intensive care needs. Results: In this study euthyroidism ,subclinical hyperthyroidism and subclinical hyperthyroidism were 75.3%, 19.4%, 5.2% , respectively. Adverse pregnancy outcomes were occured in 32.1% of subclinical hypothroid (18/56) and 24.9% of euthyroid (54/217) patients. Neonatal intensive care need was found 43.8% (20/56) and 29.5% (61/217) at subclinical hypothroidism and euthyroid groups, respectively (p>0,05). Neonatal intensive care need was found 63.6% and 43.2% at subclinical hypothyroidism and euthyroidism subgroups of Hashimoto’s thyroiditis, respectively (p=0,009). Comparisons were performed to determine the group make all the difference. Neonatal intensive care need in subclinical hypothyroidism subgroup of Hashimoto’s thyroiditis was higher than euthyroid group (p = 0.041).Conclusion: Subclinical thyroid dysfunction in the first trimester of pregnancy was not associated with adverse pregnancy outcomes. Subclinical hypothyroidism with Hashimoto thyroiditis was associated with increased neonatal intensive care unit need