A needful, unique, and in-place evaluation of the injuries in earthquake victims with computed tomography, in catastrophic disasters! The 2023 Turkey-Syria earthquakes: part I

SUMMARY OBJECTIVE: This study was carried out to evaluate the injuries in pediatric earthquake victims due to the 2023 Turkey-Syria earthquakes with computed tomography and determine the anatomotopographic distribution of injuries. METHODS: The material of this retrospective study consisted of the computed tomography findings of 257 pediatric cases injured in the 2023 Turkey-Syria earthquakes, and those were divided into subgroups based on their age group, i.e., 0-4, 5-9, 10-14, and 15-18 years, and the type of injury, i.e., head, maxillofacial, thoracic, abdominal, pelvic, and spinal injuries. RESULTS: Earthquake-related injuries had been detected in 102 (39.6%) patients. Of the 29 patients with multiple injuries, 17, 10, and 2 had injuries in two, three, and four topographic regions, respectively. The most common injury was a head injury, which was detected in 48 (18.7%) cases, followed by thoracic injury, spinal injury, pelvic fracture, abdominal injury, and maxillofacial fracture, which were detected in 40 (15.6%), 22 (8.5%), 19 (7.4%), 10 (3.9%), and 6 (2.3%) patients, respectively. The cranial bone fractures and intracranial injuries were significantly more frequent in the 0-4 years age group compared with other age groups (p=0.028 and p=0.024, respectively). The rib fractures with spinal and pleural injuries were significantly more common in the 15-18 years age group compared with others (p=0.016, p=0.004, and p=0.002, respectively). CONCLUSION: The head injury was the most common earthquake-related injury in pediatric cases. Herein, it was more common in younger children compared with other age groups, whereas rib, spine, and pleural injuries were more common in older children.

RhoA/ROCK-1 Signaling Pathway and Oxidative Stress in Coronary Artery Disease Patients

Abstract Introduction: Coronary artery disease (CAD) is an ischemic condition that occurs as a result of partial or complete interruption of blood flow by narrowing or complete blockage of the vessels supplying the heart, which are called coronary arteries. Our objective in this study is to investigate the RhoA/Rho-associated kinase (ROCK)-1 signaling pathway and oxidative stress in CAD patients. Methods: A total of 81 individuals aged between 40-70 years - including 45 patients (15 females and 30 males) who were admitted to the Artvin State Hospital Cardiovascular Surgery Clinic and were diagnosed with CAD and 36 healthy volunteers (15 females and 21 males) - participated in this study. Serum samples were tested for total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, malondialdehyde (MDA), superoxide dismutase (SOD), RhoA, and ROCK-1 values. Results: Serum RhoA, MDA levels, and ROCK-1 activity in the CAD group were found to be statistically significantly higher than in the control group (P<0.001). Concordantly, serum SOD activity was found to be statistically significantly lower in the CAD group than in the control group (P<0.001). Conclusion: Inhibition of the activity of RhoA/ROCK-1 pathway would be beneficial in treating cardiovascular diseases since this pathway plays an important role in the development of these diseases.

Parameters affecting the period for being euthyroid in newly-diagnosed Graves’ disease treated with antithyroid agent

Background: There are limited data about the factors affecting the response time to medical treatment in Graves’ disease (GD) although many studies examined the predictors of the relapse after drug withdrawal. The aim of the current study was to evaluate the time for becoming euthyroid under antithyroid drug (ATD) therapy and the parameters influencing this period in patients diagnosed as GD.Methods: Patients with newly-diagnosed GD and decided to treat with ATD initially between March 2017 and September 2018 were retrieved retrospectively. Sociodemographic features as well as laboratory parameters like thyroid function tests and thyroid-stimulating hormone-receptor antibody (TRab) at the time of diagnosis were recorded.Results: Out of 41 patients, 63.4% (n=26) were female. The mean age was 36.1±11.7 years and 43.9% (n=18) of them were smoking. The time between the initiation of treatment and the duration of becoming euthyroid was 2.4±1.8 months. No significant difference was noted between age, gender, and smoking status and the time to become euthyroid under ATD treatment. This period was significantly positively correlated with levels of free triiodothyronine, free thyroxine, and negatively correlated with thyroid-stimulating hormone. Response to ATD therapy was higher in patients with pre-treatment TRab levels <10 IU/l than TRab ≥10 IU/l (p=0.011).Conclusions: Pretreatment thyroid function tests and TRab levels may be taken into consideration before deciding treatment in patients with newly diagnosed GD. It would be useful to design more comprehensive studies so that this proposal can find a response in clinical practice.

Retrospective Analysis of Vitamin D Levels with Respect to Age and Gender: Hopa State Hospital Example

Aim:The aim of this study was to determine the status of vitamin D insufficiency and deficiency in adults, which is very common today.Material andMethods:The patient data was retrospectively reviewed through the hospital information system for those patients who applied to Hopa State Hospital (Artvin, Turkey) from January to December 2014 having vitamin D test results in their files.Our study groups by age were specified as 18-29 years, 30-44 years, 45-59 years and ?60 years. Serum D vitamine levels were measured using immunoassay method on the autoanalyzer. Results:As for the gender, 1871 (78,68%) of the patients were women and 507 (21,32%) were men. When grouped with respect to gender, vitamin D values of women were determined as <20 ng/ml (deficiency) in 79.4%, as 20-30 ng/ml (insufficiency) in 12.8% and >30 ng/ml (sufficiency) in 7.8% while men displayed <20 ng/ml (deficiency) in 70.4%, 20-30 ng/ml (insufficiency) in 7.8% and > 30 ng/ml (sufficiency) in 7.5%. Conclusions:Vitamin D deficiency/insufficiency prevails in our city. As a result; we determined a vitamin D deficiency and insufficiency at a high rate in our study group. We think that nutritives enriched with vitamin D or vitamin D supplements would be appropriate particularly in the places like our city, where people cannot benefit from sunlight adequately

Long Term Exposure to Myrtucommulone-A Changes CD105 Expression and Differentiation Potential of Mesenchymal Stem Cells

Mesenchymal stem cells (MSCs) represent a heterogeneous group of multipotent stem cells that could be found in various somatic tissues. MSCs are defined by molecular and functional features including spindle-shape morphology, adherence to plastic surfaces, expression of specific surface markers and differentiation potential to chondrocytes, adipocytes and osteocytes. The surface markers were proposed to affect the differentiation potential of MSCs by a limited number of studies. Endoglin (CD105) is defined to be a significant marker for osteogenic and chondrogenic differentiation ability of MSCs. Low CD105 expression is associated with increased osteogenic potential while high CD105 expression is correlated with strong chondrogenic potential. Myrtucommulone-A (MC-A) is an active compound with various biological effects on different cell types but its effect on MSC differentiation has not been described yet. In the present study we aimed at investigating the longterm effects of MC-A on hMSCs. MC-A-treatment reduced CD105 expression in distinct human mesenchymal stem cell (hMSC) lines and gave rise to CD105(low) population but did not change CD44, CD90 or CD73 expression. The decrease in CD105 expression reduced the chondrogenic potential of hMSCs subsequently while adipogenic or osteogenic differentiation was not affected dramatically. MC-A-treatment also suppressed the NF-κB p65 activation which might be responsible for the reduced chondrogenic potential. Our findings suggest thatMC-Acould be used to enrichCD105(low)hMSCs without the need for cell sorting or changing culture conditions which could be utilised in targeted differentiation studies.

Importance of RIFLE [risk, injury, failure, loss, and end-stage renal failure] and AKIN [acute kidney injury network] in hemodialysis initiation and intensive care unit mortality

Our study evaluated the differences between early and late hemodialysis [HD] initiation in the intensive care unit [ICU] according to the RIFLE [Risk, Injury, Failure, Loss, and End-stage renal failure] and AKIN [Acute Kidney Injury Network] classifications. On the assumption that early initiation of HD in critical patients according to the RIFLE and AKIN criteria decreases mortality, we retrospectively evaluated the medical records of 68 patients in our medical ICU and divided the patients into 2 groups: Those undergoing HD in no risk, risk, or injury stage according to RIFLE and in stage 0, I, or II according to AKIN were defined as early HD and those in failure stage according to RIFLE and in stage III according to AKIN were defined as late HD. The median age of the patients was 66.5 years, and 56.5% were male. HD was started in 25% and 39.7% of the patients in the early stage in the RIFLE and AKIN classification, respectively. According to RIFLE, HD was started in 61.5% of the surviving patients in the early stage; this rate was 16.4% in the deceased patients [P=0.001]. HD was commenced in 69.2% of the surviving patients in AKIN stages 0, I, and II and in 32.7% of the deceased patients [P=0.026]. Sepsis [61.5% vs. 94.5%; P=0.001] and mechanical ventilation [30.8% vs. 87.3%; P<0.001] during HD increased ICU mortality, whereas HD initiation in the early stages according to RIFLE decreased ICU mortality [61.5% vs. 16.4%; P=0.001]. In conclusion, in critically ill patients, HD initiation in the early stages according to the RIFLE classification decreased our ICU mortality

Non-invasive mechanical ventilation after the successful weaning: a comparison with the venturi mask / Ventilação mecânica não invasiva após desmame bem-sucedido: uma comparação com a máscara de Venturi

Abstract Background and objectives: This study compared the rates of acute respiratory failure, reintubation, length of intensive care stay and mortality in patients in whom the non-invasive mechanical ventilation (NIMV) was applied instead of the routine venturi face mask (VM) application after a successful weaning. Methods: Following the approval of the hospital ethics committee, 62 patients who were under mechanical ventilation for at least 48 hours were scheduled for this study. 12 patients were excluded because of the weaning failure during T-tube trial. The patients who had optimum weaning criteria after the T-tube trial of 30 minutes were extubated. The patients were kept on VM for 1 hour to observe the hemodynamic and respiratory stability. The group of 50 patients who were successful to wean randomly allocated to have either VM (n = 25), or NIV (n = 25). Systolic arterial pressure (SAP), heart rate (HR), respiratory rate (RR), PaO2, PCO2, and pH values were recorded. Results: The number of patients who developed respiratory failure in the NIV group was significantly less than VM group of patients (3 reintubation vs. 14 NIV + 5 reintubation in the VM group). The length of stay in the ICU was also significantly shorter in NIV group (5.2 ± 4.9 vs. 16.7 ± 7.7 days). Conclusions: The ratio of the respiratory failure and the length of stay in the ICU were lower when non-invasive mechanical ventilation was used after extubation even if the patient is regarded as ‘successfully weaned’. We recommend the use of NIMV in such patients to avoid unexpected ventilator failure.

Resumo Justificativa e objetivos: Este estudo comparou as taxas de insuficiência respiratória aguda, reintubação, tempo de internação em UTI e mortalidade em pacientes sob ventilação mecânica não invasiva (VMNI) em vez da habitual máscara facial de Venturi (MV) após desmame bem-sucedido. Métodos: Após a aprovação do Comitê de Ética do hospital, 62 pacientes que estavam sob ventilação mecânica por no mínimo 48 horas foram inscritos neste estudo. Doze foram excluídos devido à falha de desmame durante o teste de tubo-T. Os que apresentaram critérios de desmame ótimos após o teste de tubo-T de 30 minutos foram extubados. Foram mantidos em MV por uma hora para observação da estabilidade hemodinâmica e respiratória. O grupo de 50 pacientes que obtiveram sucesso no desmame ventilatório foi alocado aleatoriamente para MV (n = 25) ou VNI (n = 25). Os valores de pressão arterial sistólica (PAS), frequência cardíaca (FC), frequência respiratória (FR), PaO2, PCO2 e pH foram registrados. Resultados: O número de pacientes que desenvolveu insuficiência respiratória no grupo VNI foi significativamente menor do que o do grupo MV (3 reintubações vs. 14 VNI + 5 reintubações no grupo MV). O tempo de permanência em UTI também foi significativamente menor no grupo NIV (5,2 ± 4,9 vs. 16,7 ± 7,7 dias). Conclusões: As taxas de insuficiência respiratória e do tempo de permanência em UTI foram menores quando a ventilação mecânica não invasiva foi usada após a extubação, mesmo se o paciente foi considerado como “desmame bem-sucedido”. Recomendamos o uso de VMNI em tais pacientes para evitar a falha inesperada do ventilador.

Assessment of fetal adrenal gland enlargement in term and preterm labor cases.

Background: The objective of this study was to compare the Fetal Zone Depth (FZD) of fetal adrenal gland in term and preterm labor cases. Methods: Twenty nine preterm pregnant women at 29-36 weeks of gestation with single pregnancy admitted with the clinical diagnosis of preterm labor and the comparison group of 33 pregnant women at 37-40 weeks with term pregnancy were included in this study. FZD and Total Gland Depth (TGD) of fetal adrenal gland of the entire fetuses in sagittal plane were ultrasonographically measured and FZD/TGD ratios were calculated. Demographic and clinical features, laboratory findings and fetal adrenal gland FZD/TGD ratios were compared between the two groups. Results: No difference was found between the two groups in respect of age, number of pregnancies and delivery method (P >0.05); yet preterm birth history and duration of hospital stay were higher in preterm group (P <0.05). Fetal adrenal gland FZD/TGD ratio was statistically significantly higher in preterm group compared to the term group (55.4% ± 4.9 vs. 47.7% ± 5.6; P <0.001). Conclusion: The growth in FZ as a fetal adaptation mechanism in increased fetal stress in preterm labor cases was at a significant level. Once supported by more comprehensive studies, we think that this result would be beneficial in the prediction of preterm labor in clinical practice.

Comparison of effects on the oxidant/antioxidant system of sevoflurane, desflurane and propofol infusion during general anesthesia / Comparação dos efeitos da perfusão de sevoflurano, desflurano e propofol sobre o sistema oxidante/antioxidante durante anestesia geral / Comparación de los efectos de la perfusión de sevoflurano, desflurano y del propofol sobre el sistema oxidante/antioxidante durante la anestesia general

BACKGROUND AND OBJECTIVES: Desflurane and sevoflurane are frequently used for maintenance of anesthesia and studies have shown that these anesthetics cause a variety of changes to the oxidative stress and antioxidative defense mechanisms. This study aims to compare the effects of sevoflurane, desflurane and propofol infusion anesthesia on the oxidant and antioxidant systems of patients undergoing laparoscopic cholecystectomy. METHODS: 45 patients between 18 and 50 years with planned laparoscopic cholecystectomy under general anesthetic were included in the study. Patients were divided into three groups on the way to surgery: propofol (group P n: 15), sevoflurane (group S n: 15) and desflurane (group D n: 15). All groups were given hypnotic 2 mg/kg propofol IV, 1 mcg/kg fentanyl IV and 0.1 mg/kg vecuronium IV for induction. For maintenance of anesthesia group S were ventilated with 2% sevoflurane, group D cases were given 6% desflurane and group P were given propofol infusions of 12 mg/kg/h for the first 10 min, 9 mg/kg/h for the second 10 min and 6 mg/kg/h after that. Before induction and after the operation venous blood samples were taken to evaluate the levels of glutation peroxidase, total oxidants and antioxidants. RESULTS AND CONCLUSIONS: The 45 patients included in the study were 22 male and 23 female patients. The demographic characteristics of the groups were similar. In the postoperative period we observed that while sevoflurane and propofol increased antioxidants by a statistically significant level, desflurane increased the total oxidants level by a significant amount compared to levels before the operation. .

JUSTIFICATIVA E OBJETIVOS: Desflurano e sevoflurano são usados com frequência para a manutenção da anestesia e estudos mostraram que esses anestésicos causam alterações variadas nos mecanismos de defesa antioxidante contra o estresse oxidativo. Este estudo teve como objetivo comparar os efeitos de anestesias com perfusão de sevoflurano, desflurano e propofol sobre os sistemas oxidante/antioxidante de pacientes submetidos à colecistectomia laparoscópica. MÉTODOS: Foram incluídos no estudo 45 pacientes entre 18 e 50 anos, agendados para colecistectomia laparoscópica sob anestesia geral. Os pacientes foram divididos em três grupos para receberem propofol (Grupo P, n = 15), sevoflurano (Grupo S, n = 15) e desflurano (Grupo D, n = 15). Todos os grupos receberam 2 mg/kg de propofol IV, 1 mcg/kg de fentanil IV e 0,1 mg/kg de vecurônio IV para indução. Para manutenção da anestesia, o Grupo S recebeu ventilação com sevoflurano a 2%, o Grupo D recebeu desflurano a 6% e o Grupo P recebeu propofol em perfusões de 12 mg/kg/h nos primeiros 10 minutos, 9 mg/kg/h nos 10 minutos seguintes e 6 mg/kg/h subsequentemente. Antes da indução e depois da cirurgia, amostras de sangue venoso foram colhidas para avaliar os níveis de glutationa peroxidase e o total de oxidantes e antioxidantes. RESULTADOS E CONCLUSÕES: Dos 45 pacientes incluídos no estudo, 22 eram do sexo masculino e 23 do feminino. As características demográficas dos grupos eram semelhantes. No período pós-operatório, observamos que enquanto sevoflurano e propofol aumentaram os antioxidantes a um nível de significância estatística, desflurano aumentou o nível total de oxidantes em quantidade significativa, em comparação com os níveis pré-operação. .

JUSTIFICACIÓN Y OBJETIVOS: El desflurano y el sevoflurano son usados a menudo para el mantenimiento de la anestesia, y hay estudios que mostraron que esos anestésicos causan diversas alteraciones en los mecanismos de defesa antioxidante contra el estrés oxidativo. El objetivo de este estudio es comparar los efectos de las anestesias con perfusión de sevoflurano, desflurano y propofol sobre los sistemas oxidante/antioxidante de pacientes sometidos a colecistectomía laparoscópica. MÉTODOS: Fueron incluidos en el estudio 45 pacientes entre 18 y 50 años programados para colecistectomía laparoscópica bajo anestesia general. Los pacientes fueron divididos en 3 grupos para recibir propofol (grupo P, n = 15), sevoflurano (grupo S, n = 15) y desflurano (grupo D, n = 15). Todos los grupos recibieron 2 mg/kg de propofol IV, 1 µg/kg de fentanilo IV y 0,1 mg/kg de vecuronio IV para inducción. Para el mantenimiento de la anestesia, el grupo S recibió ventilación con sevoflurano al 2%, al grupo D se le administró desflurano al 6% y el grupo P recibió propofol en perfusiones de 12 mg/kg/h en los primeros 10 min, 9 mg/kg/h en los 10 min siguientes y 6 mg/kg/h subsecuentemente. Antes de la inducción y después de la cirugía, fueron extraídas muestras de sangre venosa para evaluar los niveles de glutatión peroxidasa y el total de oxidantes y antioxidantes. RESULTADOS Y CONCLUSIONES: De los 45 pacientes incluidos en el estudio, 22 eran del sexo masculino y 23 del femenino. Las características demográficas de los grupos eran similares. En el período postoperatorio observamos que mientras el sevoflurano y el propofol aumentaron los antioxidantes a un nivel de significación estadística, el desflurano aumentó el nivel total de oxidantes en una cantidad significativa, en comparación con los niveles preoperatorios. .

Safety of recombinant human deoxyribonuclease as a rescue treatment for persistent atelectasis in newborns

Pulmonary problems are vitally important in newborns. Increased intense and mucoid secretions may lead to atelectasis, pulmonary infections, respiratory distress, prolonged mechanical ventilation or even death. The aim of this study was to evaluate the safety of recombinant human deoxyribonuclease [rhDNase] in the management of persistent atelectasis in term and preterm newborns, unresponsive to the conventional treatment. Prospective study of patients admitted to a general community setting of a neonatal intensive care unit between December 2007 and December 2009. The study included 22 patients [12 premature and 10 term] who were admitted to the neonatal intensive care unit because of respiratory distress and developed atelectasis, and were unresponsive to conventional treatment. Nebulized rhDNase was administered to all patients at a dose of 1 mg/m[2] twice daily for 3 days. In patients who did not respond to 3 days of treatment, endotracheal rhDNase was administered at a dose of 1 mg/m[2]. We assessed the clinical [respiratory rate and oxygen requirement] and radiologic responses [chest radiographic score], recurrence of atelectasis, the need for a repetitive treatment, and mortality rate. A clinical and radiologic improvement of atelectasis was observed in 18 of 22 patients following 3 days of nebulized rhDNase treatment. Atelectasis relapsed in 4 patients. Following the administration of combined endotracheal and nebulized rhDNase treatment, an improvement of atelectasis was noted in all four recurrent cases. No adverse events were observed in patients because of the rhDNase treatment. rhDNase treatment is a safe option and may be used as an effective method for the management of persistent atelectasis in newborns, which is resistant to other conventional treatment methods

Comparison of four malignancy risk indices in the detection of malignant ovarian masses / 부인종양

OBJECTIVE: The aim of this study was to evaluate the ability of four risk of malignancy indices (RMI) to detect malignant ovarian tumors. METHODS: This is a prospective study of 100 women admitted to the Department of Obstetrics and Gynecology of Gulhane Military Medicine Academy for surgical exploration of pelvic masses. To diagnose malignant ovarian tumors, the sensitivity, specificity, negative and positive predictive values and diagnostic accuracy of four RMIs (RMI 1, RMI 2, RMI 3, and RMI 4) were obtained. RESULTS: In our study we found that there is no statistically significant difference in the performance of four different RMIs in discriminating malignancy. We think that malignancy risk indices is more reliable than the menopausal status, serum CA-125 levels, ultrasound features and tumor size separately in detecting malignancy. CONCLUSION: We concluded that any of the four malignancy risk indices described can be used for selection of cases for optimal therapy. These methods are simple techniques that can be used even in less-specialized gynecology clinics to facilitate the selection of cases for referral to an oncological unit.

Impact of organophosphorus insecticide, malathion on the progeny sex ratio of Pimpla turionellae L.

The effects of 0.001, 0.01, 0.1 and 0.5 ppm concentrations of malathion, an organophosphorus insecticide, viewed over the course of the experiment, on adult emergence and sex ratios of emerging adults of the parasitic wasp, Pimpla turionellae L. (Hymenoptera: Ichneumonidae) were investigated. Diets which contain 0.001 and 0.01 ppm malathion significantly increased the total adult emergence on day 13, 28 and 31 when compared to control diet. Although 0.01 and 0.1 ppm malathion increased the female emergence, higher concentration of malathion (0.5 ppm) significantly decreased the female emergence. Adult female emergence significantly decreased on day 10, 16 and 25 in the group which was fed with the meridic diet containing 0.5 ppm malathion. This study indicated that orally administrated high concentration of malathion (0.5 ppm) significantly decreased female emergence of P. turionellae.

Study on time-space clustering regarding the distribution of visceral leishmaniasis in Kashgar Re-gion,Xinjiang / 中华流行病学杂志

Objective To probe time-space clustering on the distribution of visceral leishmaniasis (VL) in Kashgar Region.Methods Based on the geographic information system,a Poisson model of time-space statistical software was applied to analyze data over the past 11 years in the Kashgar Region.Zones with clustering phenomenon were conformed by geographic location and remote sensing images.Results There existed three high risk clustering zones and corresponding time frames of VL in Kashgar Region.The center location of zone A was located in E 76.08°,N 39.52°,with radius as 6.58 km.The high risk time frame was from January 1st of 1999 to December 31st of 2003.Within the zone and time frame,the relative risk (RR) of VL incidence was 45.98 times higher than those outside the scope (P＜0.0001).Zone B's center location was at E 79.20°,N 39.91°,with the radius as 4.93 km.Its high risk time frame was from January 1st of 2002 to December 31st of 2006.Within the zone and time frame,the RR of VL incidence was 9.58 times higher than those outside of the scope (P＜0.0001).Zone C's center location was in E 76.23°,N 39.40°,and the radius was 7.63 km,with the high risk time frame from January 1st of 2000 to December 31st of 2004.Within the zone and time frame,the RR of VL incidence was 5.18 times higher than the one from outside of the scope (P＜0.0001).Conclusion The incidence of VL in Kashgar Region was non-randomly distributed while there existed obvious time-space clustering,with all of three high risk clustering zones located in oasis area where appeared the focus area for control and surveillance of VL.