High or mid-flow oxygen therapy for primary headache disorders: A randomized controlled study.

BACKGROUND: Headache is one of the most common causes of emergency department (ED) visits. High-flow oxygen therapy is becoming more attractive as a treatment option because it is safe, effective, and cheap. We aimed to compare the effectiveness of high and medium-flow oxygen therapies with placebo for treating primary headache disorders among middle-aged patients. METHODS: This prospective, double-blind, placebo-controlled, crossover designed, randomized study was conducted at a regional tertiary hospital's ED. Patients who were treated for primary headache disorder in the ED were evaluated at the time of diagnosis and subsequently included in the study upon their next ED visit. Four different treatment methods were administered; 1) high-flow oxygen (15 L/min oxygen), 2) medium-flow oxygen (8 L/min oxygen), 3) high-flow room air as placebo (15 L/min room air), 4) medium-flow room air as placebo (8 L/min room air). All four treatment methods were administered to all patients included in the study, at four separate ED visits. Patients' data, including demographics, medical history, additional complaints, Visual Analogue Scale (VAS) score, and physical examination findings were recorded by the treating physician. RESULTS: One hundred and four patients with a mean age of 35.14 ± 9.1 years, were included in the study. Patients who received oxygen therapy had a significantly lower VAS score at all control points (15, 30, and 60 min) when compared with placebo (p < 0.001). This difference in scores reached its maximum at 30 min. There was not a significant statistical difference between the high-flow or mid-flow therapies (p > 0.05). It was determined that patients who received placebo therapy were more likely to revisit ED (p < 0.05). There was not a significant statistical difference between the high-flow or mid-flow therapy groups in terms of revisit (p > 0.05) and the 30th-minute analgesia requirement (p > 0.05). Pain duration was significantly less in patients who received oxygen therapy (p < 0.05). Patients who received high-flow oxygen therapy spent less time in the ED (p < 0.001). CONCLUSION: Oxygen therapy could be a beneficial treatment option for middle-aged patients with primary headache disorders. Based on the results obtained from high and mid-flow oxygen therapies, it may be more appropriate to begin treatment with mid-flow oxygen.

The Prognostic Value of C-Reactive Protein/Albumin Ratio in Acute Mesenteric Ischemia.

BACKGROUND: Diagnosis of acute mesenteric ischemia (AMI) in its early stages is important for reversing ischemic damage. The CRP to albumin (CRP/Alb) ratio has been defined as an inflammatory indicator and is associated with the severity of inflammation and mortality rates. However, the prognostic value of CRP/Alb has not been evaluated in patients with AMI. Here, we aimed to examine the prognostic significance of CRP/Alb and compare it with other inflammatory markers. MATERIALS AND METHODS: In this retrospective, case-control study, we included patients diagnosed with AMI at the emergency department between January 1, 2016, and December 31, 2020. In addition to demographic characteristics, lactate, D-dimer, white blood cell (WBC), CRP/Alb, and neutrophil/lymphocyte ratio (NLR) were recorded. Testing characteristics of CRP/Alb in predicting in-hospital mortality were studied. RESULTS: The mean age of 132 patients was 66.48 ± 15.95 years and 71 (53.8%) of them were male. The cut-off value obtained using the receiver operating characteristic (ROC) curve for in-hospital mortality was a CRP/Alb ratio of >1.32 (sensitivity, 93.65%; specificity, 69.57%; +LR, 3.08; -LR, .091; AUC, .782; 95% CI, .70-.85; P < .0001). The comparison of ROC curves between CRP/Alb and WBC, NLR, and lactate revealed a statistically significant difference (P < .05), whereas there was not any statistically significant difference between the ROC curves of CRP/Alb and D-dimer (P = .47). CONCLUSION: C-reactive protein/albumin ratio is a powerful predictor of in-hospital mortality for AMI patients. It was superior to WBC, NLR, and lactate. It could be used to determine low-risk patients and help clinicians with treatment options.

Symptoms Associated With Personal Protective Equipment Among Frontline Health Care Professionals During the COVID-19 Pandemic.

OBJECTIVE: Personal protective equipment (PPE) use is frequently construed as inconvenient and disturbing by health care professionals (HCPs). We hypothesized that new-onset symptoms among HCPs may be associated with extended use of PPE and aimed to investigate risk factors related with new-onset symptoms. In addition, the effects of new-onset symptoms on working performance were evaluated. METHODS: In this cross-sectional study, 315 participants filled out a questionnaire that contains 4 main parts: (1) demographics, (2) new-onset symptoms with PPE use, (3) PPE usage hours, and (4) personal opinion about the effect of sensed symptoms on working performance. RESULTS: The mean age was 31.58 ± 4.6 years, and 50.5% (n = 159) were female. New-onset symptom rate was 66% (n = 208). The most common new-onset symptom was headache (n = 115, 36.5%) followed by breathing difficulty-palpitation (n = 79, 25.1%), and dermatitis (n = 64, 20.3%). Extended use of PPE, smoking, and overweight were independently associated with developing new-onset symptoms. A clear majority of symptomatic participants pointed out the impact on working performance (193/208, 92.7%). CONCLUSION: Hospitals should take the necessary precautions (eg, shorter shifts and more frequent breaks) to prevent symptoms associated with PPE and ensure that HCPs comply with these precautions.

Impact of chronic medical conditions on mortality in geriatric trauma, 10-year analysis of a single centre in Turkey.

BACKGROUND: The healthy and active lifestyle adopted by the elderly as a result of improvements in the standards of living may lead to an increase in the risk of injury. Comorbidities increase the risk of posttraumatic complications and mortality. The aim of this study was to investigate the impact of chronic medical conditions (CMCs) on the risk of mortality in geriatric trauma patients. METHODS: All geriatric trauma patients admitted to emergency department over a 10-year period were retrospectively analysed. Patients were stratified by baseline characteristics, injury severity score (ISS), presence of CMCs, and in-hospital mortality. Multivariate logistic regression was used to determine variables significantly associated with in-hospital mortality. RESULTS: 9455 patients included in the study. The median age was 74 (10) years and 57% of them were female. The presence of ≥1 CMC and ≥2 CMCs increased the risk of mortality 5.64 and 2.38 times respectively in mild traumas and 2.67 and 2.59 times respectively in moderate traumas. Age, ISS and penetrating traumas had a significant impact on the risk of mortality in all ISS groups. In severe traumas, only renal disease had an impact on the risk of mortality (OR = 2.58, 95%CI = 1.03-6.43, p = 0.042). All other CMCs, ≥1 CMC, and ≥2 CMCs had no impact on the risk of mortality. CONCLUSION: The presence of CMCs in elderly patients with mild and moderate injuries increases the risk of mortality. Such patients should be diagnosed and treated more quickly and aggressively during the prehospital process and in the hospital.

Anxiety levels in patients admitted to the emergency department with myocardial infarction or COVID-19 pneumonia.

The COVID-19 related high morbidity and mortality have led to a common fear and anxiety. This study aimed to determine the state/trait and death anxiety levels of patients with myocardial infarction (MI) and COVID-19 pneumonia. The study was conducted at the emergency department of a tertiary hospital in Central Anatolia of Turkey. 120 patients with myocardial infarction , 120 patients with COVID-19 pneumonia, and 120 healthy volunteers as a control group were included in the study. The participants filled out the questionnaire that included the State-Trait Anxiety Inventory (STAI) and the Thorson-Powell's Revised Death Anxiety Scale (RDAS). All scores of patient groups were significantly higher than the control group. There was no significant difference in terms of STAI-S, STAI-T, and RDAS scores between COVID-19 pneumonia and MI groups. The anxiety risk increased 2.14-fold for STAI-T and 1.97-fold for STAI-S in patients with COVID-19 pneumonia compared to the control group. In this study, the state/trait and death anxiety levels of patients with COVID-19 pneumonia were as high as patients with myocardial infarction.COVID-19 pneumonia-related anxiety was associated with chronic diseases and smoking. Knowing the level of anxiety in these patients is important to provide better health services in the emergency departments.

Tombul hazelnut (Corylus avellana L.) peptides with DPP-IV inhibitory activity: In vitro and in silico studies.

Cold press technology generates high quality value-added oil products along with highly stable oilseed cakes. Hazelnut cakes are characterized by high protein concentrations that can be industrially valorized. Here, using an aqueous extraction scheme along with enzymatic proteolysis and FPLC (fast protein liquid chromatography)-based fractionation, a variety of hazelnut peptide fractions with varying bioactive properties were manufactured and their sequences were determined based on mass spectrometry. DPP-IV inhibitory attributes were determined based on an in vitro DPP-IV assay and in silico techniques were administered for for the analysis of overall bioactive potential and DPP-IV inhibitory characteristics of peptides. Based on these investigations, 256 peptides were identified in 81 different fractions. The majority of fractions were characterized with low to moderate DPP-IV inhibitory activity possibly due to their dilute nature. Some hazelnut peptides were characterized by comparable IC50 values as the positive control (Diprotin-A). The most influential 7 peptides were shown to generate higher docking scores than the control. The main interaction mechanism between hazelnut peptides and DPP-IV possibly depended on hydrophobic interactions. While further concentration could enhance the DPP-IV inhibitory potential of hazelnut peptides, hazelnut cakes represent a sustainable resource of potentially antidiabetic peptides.

The effect of personal protective equipment on cardiac compression quality.

INTRODUCTION: Cardiac compression is a cumbersome procedure. The American Heart Association suggests switching of cardiopulmonary resuscitation (CPR) provider every 2 min to prevent any decrease in resuscitation quality. High quality CPR is associated with improved outcomes. Previous studies have highlighted the difficulties in providing high quality CPR particularly while wearing personal protective equipment (PPE). This study aimed to evaluate the impact of personal protective equipment (PPE) use on CPR quality in prehospital cardiac arrest situations. METHODS: In this prospective simulation study, we compared the cardiac compression qualities and fatigue rates among prehospital health care professionals (HCPs) who were or were not using PPE. RESULTS: A total of 76 prehospital HCPs comprising 38 compression teams participated in this study. The mean compression rate was 117.71 ± 8.27/min without PPE and 115.58 ± 9.02/min with PPE (p = 0.191). Overall compression score was 86.95 ± 4.39 without PPE and 61.89 ± 14.43 with PPE (p < 0.001). Post-cardiac compression fatigue score was 4.42 ± 0.5 among HCPs who used their standard uniform and 7.74 ± 0.92 among those who used PPE (p < 0.001). The overall compression score difference between the two conditions was 25.05 ± 11.74 and the fatigue score difference was 3.31 ± 0.98. DISCUSSION: PPE use is associated with decreased cardiac compression quality and significantly higher fatigue rates than those associated with the use of standard uniforms. Routine use of mechanical compression devices should be considered when PPE is required for out-of-cardiac arrests.

Influence of Maillard reaction conditions and solvent extraction on the surface activity and foaming characteristics of black cumin protein concentrates.

Cold press manufacture of black cumin (BC) oil leads to the formation of BC press cakes that contain significant amounts of protein. Here, an attempt was made to enhance the functionality of BC protein concentrates obtained from cakes based on Maillard conjugation using 3 different of carbohydrates. Molecular weight distribution of the conjugates was determined via electrophoretic techniques. The extent of carbohydrate binding was measured by RP-HPLC-RID. Surface activity and elasticity was studied using drop shape tensiometry. The extent of glucose binding accounted for up to 85% for a protein:glucose ratio of 1:2. Foaming capabilities were moderately enhanced due to Maillard conjugation in the absence of solvent extraction, while due to solvent induced partial denaturation, further enhancement of foaming performance took place. Furthermore, sugar binding capabilities were enhanced upon solvent treatment, while surface pressure and foaming capacity were not necessarily improved. Adsorption rate at the air-water surface and dilational elasticity was highly dependent on molecular size of reacting sugars. In addition, oil remaining in the samples also had a bearing on the extent of Maillard conjugation. Consequently, tailoring of processing conditions could enhance foaming characteristics of BC proteins and ensure their utilization in food foams and other food dispersions.

A Retrospective Analysis of the Impact of the Coronavirus Disease 2019 Pandemic on Health Care Workers in a Tertiary Hospital in Turkey.

INTRODUCTION: Several vaccines have been developed and approved for use against severe acute respiratory syndrome coronavirus-2; however, the use of personal protective equipment remains important owing to the lack of effective specific treatment and whole community immunity. Hydroxychloroquine sulfate was a treatment option in the early days of the pandemic; however, it was subsequently removed owing to a lack of evidence as an effective treatment. We aimed to evaluate the testing and infection characteristics of coronavirus disease 2019 among health care personnel and determine the effectiveness of prophylactic hydroxychloroquine sulfate use to prevent transmission. METHODS: This retrospective observational study was conducted between May 1 and September 30, 2020. The health care personnel included in the study were physicians, nurses, and paraprofessional support personnel. The health records of health care personnel who had been tested for severe acute respiratory syndrome coronavirus-2 using polymerase chain reaction were retrospectively analyzed. RESULTS: In total, 508 health care personnel were included in the study. A total of 152 (29.9%) health care personnel were diagnosed with coronavirus disease 2019. The positive polymerase chain reaction rate was 80.3% (n = 122). A comparison of infected and uninfected health care personnel showed a difference in age and occupation and no difference in sex, working area, and prophylactic hydroxychloroquine sulfate use. DISCUSSION: Protective measures in low-risk areas of our hospital require improvements. All health care personnel should be trained on personal protective equipment use. There was no evidence to support the effectiveness of prophylactic hydroxychloroquine sulfate against severe acute respiratory syndrome coronavirus-2 transmission.

Jugular vein diameter: A new player in normotensive pulmonary embolism.

PURPOSE: The majority of the patients with pulmonary embolism (PE) are those with normotensive PE. Right ventricular dysfunction (RVD) and myocardial injury markers are associated with mortality although they have a low predictive impact. Here, we aim to study the performance characteristics of jugular vein diameter to predict 30-day mortality. MATERIALS AND METHODS: In this prospective, observational cohort study, we included normotensive patients who were diagnosed with PE using computed tomography angiography or scintigraphy in the emergency service. The demographic characteristics, blood pressures, pulses, shock indexes, troponin and lactate levels, echocardiography findings, and internal jugular vein diameters (IJV) of the patients were recorded. Testing characteristics of IJV in predicting 30-day mortality were studied. RESULTS: The mean age of the 81 patients was 66.8±16.9 years and 37% of them were male. Age, shock index, lactate, RVD, PESI, and IJV diameters during inspiration and expiration were indicators for 30-day mortality. The cut-off value obtained using the ROC curve for mortality was an IJV-exp-AP of ≤8.9 mm (sensitivity,73.3%; specificity,92.4%; +LR,9.68; -LR,0.29; NPD,93.8%; PPD,68.7%; area under the curve, 0.76; 95% confidence interval, 0.65-0.84; p=0.004). CONCLUSION: IJV diameter is an indicator of 30-day mortality. It can be used to detect low-risk patients.

Impact of personal protective equipment on prehospital endotracheal intubation performance in simulated manikin.

BACKGROUND: Tracheal intubation in COVID-19 patients is a potentially high-risk procedure for healthcare professionals. Personal protective equipment (PPE) is recommended to minimize contact with critical patients with COVID-19 infection. This study aimed to primarily examine the effect of PPE use on intubation time and success rate among prehospital healthcare professionals; additionally, we compared intubation times among prehospital health care professionals using PPE with direct laryngoscopy and video laryngoscopy assistance. METHODS: In this prospective simulation study, we compared the intubation times and success rates among prehospital healthcare professionals who were or were not using PPE. Furthermore, demographic data, previous intubation experience, and previous intubation experience with PPE were recorded. RESULTS: Overall time to intubation with PPE use was 51.28±3.89s, which was significantly higher than that without PPE use (33.03±2.65s; p<0.001). In addition, the overall success rate with PPE use was 74.4%, which was significantly lower than that without PPE use (93%;p<0.001). PPE use increased the average intubation time by 19.73±2.59s with direct laryngoscopy and by 16.81±2.86s with video laryngoscopy (p<0.001). CONCLUSIONS: PPE use is associated with increased intubation time and decreased success rate. Video laryngoscopy assistance in cases where PPE use is required facilitates faster endotracheal intubation than does direct laryngoscopy assistance.

A Turkish-Speaking Community Program in A Primary Care Psychotherapy Setting: How to Support and Engage A Complex Patient Population.

This paper presents a description of a multigroup-based psychotherapy program for Turkish-speaking individuals provided by an innovative primary care mental health service in London. As of 2021, the project offers two types of therapy: a year-long horticultural group, which is a blend between talking therapy and gardening, and a 20-week psychotherapy group. Both were designed to engage the particularly complex Turkish-speaking patient population in the London Borough of Hackney. The project is grounded in group psychotherapy and borrows elements from different theoretical orientations and therapeutic modalities including community psychology, group analytic therapy, horticultural therapy, attachment theory, and dynamic therapies. Here, we present how the program was created and developed and the specifics of the groups, together with the main themes and dynamics that emerged in the therapeutic process. The program evaluation and outcomes are illustrated by several clinical case vignettes throughout the paper.

Lipocalin-type prostaglandin D synthase levels are associated with the severity of pulmonary embolism.

Pulmonary thromboembolism (PTE) is an acute emergency with high mortality and morbidity rates. This study aimed to investigate the importance of Lipocalin-type prostaglandin D synthase (L-PGDS) in predicting mortality and prognosis in PTE. The study prospectively included 90 patients who were admitted to the emergency department and in whom PTE was confirmed by computed tomographic pulmonary angiography as well as 40 healthy volunteers with no disease. L-PGDS levels in the venous blood were measured and compared. Pulmonary embolism severity index (PESI) prognosis scores of all patients and 1-month mortality rate were calculated. There was a statistically significant difference between the L-PGDS levels of the patient and control groups (P = 0.024), and 1-month mortality of patients diagnosed with PTE was 20% (n = 18). Furthermore, the patients were divided into two groups: patients deceased within 1 month following the diagnosis and survivors. L-PGDS levels of the deceased patients were significantly higher than those of the survivors (P < 0.001). Age, systolic blood pressure, pulse, shock index, lactate, and PESI scores were significantly different between the survivors and deceased patients. The cut-off value for L-PGDS obtained using receiver operating characteristic (ROC) curve analysis for 1-month mortality was 815.26 ng/mL (sensitivity: 83.33%; specificity: 79.17%; area under the curve: 0.851; 95% confidence interval 0.760-0.917; P < 0.001). Based on this cut-off value, logistic regression analysis revealed that increased L-PGDS, together with PESI, was an independent indicator of 1-month mortality. L-PGDS is associated with short-term mortality in patients with PTE; therefore, it can be used to predict mortality risk in patients with PTE.

The reno-protective effects of atorvastatin in crush syndrome and rhabdomyolysis:is there a dilemma?

Background/aim: We aim to determine the effects of low-dose atorvastatin treatment together with crush fluid resuscitation on renal functions and muscle enzyme levels in a rat model of crush syndrome. Materials and methods: The study involved female Wistar Albino rats weighing 250-300 g that were housed with free access to food and water. The crush model was obtained by compression. Rats were randomly divided into four groups: control (C) group, atorvastatin + crush fluid (ACF) group, crush fluid (CF) group, and hypertonic saline (%3) + mannitol + sodium bicarbonate (SM) group. Blood was obtained at 24, 48, and 72 h, and serum creatinine kinase, myoglobin, urea, creatinine, and lactate dehydrogenase levels were studied.Results: All parameters were statistically significantly higher in the control group than in the treatment groups at all hours. However, there was no statistically significant difference among treatment groups regarding any of the parameters.Conclusion: This is the first study determining the role of atorvastatin in the treatment of renal ischemia/reperfusion injury in a crush syndrome and rhabdomyolysis model setting. Larger studies with different atorvastatin doses are required to define the role of this drug in the treatment of renal ischemia/reperfusion injury during crush syndrome.