Trauma patients and whole-body computerized tomography imaging: Location of CT-Scan and factors affecting mortality.

OBJECTIVE: : We aimed to study the factors affecting the mortality of trauma patients who underwent whole-body computerized tomography (CT) on Emergency department (ED) time frames in a developing emergency care system. Materials and Methods: This is a retrospective analysis of adult patients who received WBCT from August to November for two consecutive years (2014 and 2015). Non-parametric statistical methods were used to compare the patients who died and survived. The Backward logistic regression model was used to define factors significantly affecting mortality. RESULTS: : During 2014, 200 patients out of 827 (24.1%) received WBCT. During 2015, 263 patients out of 951 (27.6%) received WBCT. Four hundred sixteen patients were entered into the analysis. The overall mortality was 3.4% (7% in 2014 and 1% in 2015, P = 0.002). Significant factors found in backward logistic regression model defining factors affecting mortality were ISS (p < 0.0001), Glasgow Coma Scale (GCS) (p = 0.001). CT location (outside the ED in 2014, inside the ED in 2015) showed a very strong trend for affecting mortality (p = 0.054). Patients who had WBCT in the ED had lower ISS (p < 0.0001). CT imaging in the ED decreased ED to CT time 15.5 minutes (p < 0.0001), but admission time was 75.5 minutes longer. CONCLUSIONS: ISS and GCS were the main factors predicting mortality in patients who received WBCT. Patients received more WBCT imaging and physicians showed a tendency to order WBCT for less severe patients when the CT located in the ED. CT location did not show a significant effect on mortality, but on some operational time frames.

Searching for mortality predictors in trauma patients: a challenging task.

BACKGROUND: We aimed to study the value of new physiological variables compared with ISS and GCS as predictors for trauma mortality in a high-income developing country having a young population. METHODS: Data of 1008 consecutive trauma patients who were included in Al-Ain City Road Traffic Collision Registry were analyzed. Demography of patients, systolic blood pressure, heart rate, shock index, shock index age (SIA), blood pressure age index (BPAI), Glasgow Coma Scale (GCS), injury severity score (ISS), and in-hospital mortality were analyzed. Univariate analysis was used to compare those who died with those who survived. Significant factors were then entered into a backward logistic regression model to define factors predicting mortality. RESULTS: 80.3% of the patients were males. The median (range) age of patients was 26 (1-78) years. Significant factors that predicted mortality were GCS (p < 0.0001), SIA (p = 0.003), ISS (p = 0.007), and BPAI (p = 0.022). CONCLUSIONS: The physiological variables including GCS and shock index age were better predictors for trauma mortality comparted with ISS in our young population. A large global multi-centric study could possibly define an accurate global formula that uses both anatomical and physiological variables for predicting trauma mortality.

The synergistic effect of ω3 and Vit D3 on glycemia and TNF-α in islet transplantation.

The current treatment of type 1 diabetes consists of insulin administration. Transplantation of islets of Langerhans is considered very favorable because the full effect of insulin treatment cannot be obtained in severe cases. Although agents such as omega-3 (ω3) and vitamin D3 (Vit D3) are known to contribute to the success of islet allo-transplantation (ITX), in this study we aimed to experimentally determine their effects on glycemia and TNF-α production. Wistar albino rats, which were used as recipients, were given ω3, Vit D3, and islets by gavage, and intraperitoneal- and intraportal injections, respectively. Daclizumab (DAC) was used for immunosuppression. Glycemia levels decreased in rats treated with ω3 and vit D3. TNF-α increased in all groups due to application of STZ. After ITX (day +1), the weakest increase was observed in the ω3 + Vit D3 group. In the ITX+DAC group, compared with that of ITX only, DAC was shown to decrease levels of TNF- α following ITX, only in control group, however, similar levels of TNF-α were observed in other groups. The values in the treated groups were already lower than those of the controls in the ITX group and also remained almost equal in the ITX+DAC group. We suggest that the use of ω3 and Vit D3 together will improve the pro-inflammatory aspect encountered during and after ITXs, and contribute to the reduction of the dose of immunosuppressants in these procedures.

Prevalence and screening for risk factors of type 2 diabetes in Rize, Nourtheast Turkey: findings from a population-based study.

AIMS: We aimed to determine the prevalence of diagnosed and undiagnosed diabetes, risk factors affecting the healthy population, and factors that increase diabetes risk in the adult northeast Turkish population. METHODS: Using population proportional cluster sampling, 930 adults were selected. After excluding people with diabetes, risk screening was conducted in the healthy population (n: 825) using the Information Form and FINDRISK questionnaire. Fasting venous blood and biochemical parameters were measured. RESULTS: Prevalence of diabetes was 13.6% (new % 2.3), translating to approximately 44 thousand adults. Among the healthy population, 37.5% had high risk. Prevalence of not exercising (78.2%), obesity (36.1%), and hypertension (24.5%) were high. Predictors of risk of diabetes were aging (OR 1.09), low education (OR 0.51), familial diabetes history (OR 15.27), not exercising (OR 0.41), obesity (OR 5.17), high waist circumference (OR 1.05), heart disease (OR 4.81), and hypertension (OR 2.60). CONCLUSIONS: This study can stimulate early screening for cardiovascular diseases and hypertension and initiating aggressive treatments in people with high diabetes risk. In primary health services, number of doctors and nurses trained in diabetes should be increased and dieticians should be involved. People with high risk should receive lifestyle regulations training.

Quality of life in an ageing society : a comparative analysis of age cohorts in Turkey.

The aim of this study is to bring into focus the living conditions of the older adults in Turkey by using quality of life (QoL) criteria through which to highlight dimensions relating to their QoL status in comparison to other age cohorts. Are there specific QoL issues among older adults that would indicate that they display systematic differences in comparison to other age cohorts in Turkey? To what extent are there gender differences among older adults in QoL status? Data from the EQLS conducted in 2007 provided the information for understanding the self-reported conditions of older adults. Analysis shows that, for historical and contemporary reasons, older adults in Turkey form a disadvantaged cohort compared to other groups. The level of deprivation among a large segment of older adults is noteworthy in terms of income, health, material living conditions and social relations. Moreover, current social policies are blind to the low level of welfare, cultural capital, and connectedness of older women, resulting in unacceptable levels of alienation, unhappiness, and marginal status.

Prediction of early postoperative atrial fibrillation after cardiac surgery: is it possible?

BACKGROUND: Postoperative atrial fibrillation is common after cardiac surgery. In this study, we aimed to investigate the value of interatrial conduction time for the prediction of early postoperative atrial fibrillation, using intra-operative transoesophageal echocardiography. METHODS: A total of 65 patients undergoing cardiac surgery in our hospital between January and March 2007 were prospectively evaluated, and 59 patients with sinus rhythm were included in the study. We performed transoesophageal echocardiography on all patients, and intra-operatively measured the interatrial conduction time, as recently described. The patients with episodes of atrial fibrillation during the postsurgery hospitalisation period were defined as group 1 and those without episodes were defined as group 2. RESULTS: Mean interatrial conduction time was 74 ± 15.9 ms in group 1 and 54 ± 7.9 ms in group 2. The difference in interatrial conduction time between the two groups was statistically significant (p < 0.05). In this study we found a statistically significant interatrial conduction delay between the groups. Postoperative atrial fibrillation was more frequent in patients with a longer interatrial conduction time. CONCLUSION: Increased interatrial conduction time may cause postoperative atrial fibrillation and it can be measured intraoperatively by transoesophageal echocardiography.

A neonatal case of left ventricular noncompaction associated with trisomy 18.

A neonatal case of left ventricular non-compaction associated with trisomy 18: Left ventricular noncompaction (LVNC) is a rare congenital cardiomyopathy and exact etiology is still unknown. Trisomy 18 is the second most common autosomal trisomy in live-born infants. LVNC has been described in association with other dysmorphic features, association with trisomy 18 has not been reported previously in a neonate. LVNC broadens the cardiac anomalies associated with trisomy 18.

Evaluation of hormonal change, biochemical parameters, and histopathological status of uterus in rats exposed to 50-Hz electromagnetic field.

This study investigates the effects of the electromagnetic field (EMF) resulting from the 170 kV high-voltage power lines on hormonal status, on progesterone and 17-beta estradiol levels, and on morphology of the uterus and ovaries associated with biochemical parameters of adult Wistar female rats. The rats were assigned to experimental (21) and control groups (7). The rats in the experimental group were housed in a wooden barn with 7.5 m vertical distance to the power line. Groups 1, 2, and 3 were exposed continuously (24 h) to electric-electromagnetic fields (ELF-EMFs) (48.21 +/- 1.58 mG) for 1, 2, and 3 months, respectively. The rats of group 4 served as the control and were placed in laboratory conditions (The average value of the ELF was 0.75 +/- 0.05 V/m. The value of the EMF was calculated to be 0.48 +/- 0.05 mG.). Significant (P < 0.05) decreases were determined among the groups in terms of reproductive organ weights (uterus and ovaries) and progesterone and estrogen levels in relation to the varying periods of the estrous cycle. Although marked reductions (P < 0.05) were observed among the groups in relation to plasma catalase activity, depending on exposure time, no significant differences were found in terms of glutathione and malondialdehyde levels. It is concluded that exposure to the ELF-EMFs for different time periods produced significant decreases in plasma catalase activities in the 3-month exposure groups but no effects on progesterone level, on 17-beta estradiol level, or on the morphology and weight of uterus and ovaries.

Assessment of sexual dysfunction in patients with Parkinson's disease: a case-control study.

BACKGROUND: Sexual dysfunction (SD) in patients with Parkinson's disease (PD) has not been very well studied, as most of the research has methodological restrictions like having no control group, using invalid assessment tools, unidimensional investigation of sexual functions and inclusion of males/females only. This study aimed to examine different sexual functions in patients with PD and compare with matched non-parkinsonian controls by using a valid instrument. Predicting factors of SD in PD were also investigated. METHODS: The sample consisted of 45 patients with PD and 45 age- and sex-matched healthy controls. Sexual functions were evaluated by Arizona Sexual Experiences Scale (ASEX). RESULTS: Female patients had reduced sexual drive and they were less satisfied with orgasm, while male patients had easier orgasms than did the controls. Regression analysis identified increased age and female sex predictive of reduced sexual drive and sexual arousal. Ability to reach orgasm and satisfaction with orgasm were associated with female sex, while erection/lubrication was associated with marital status. The severity and duration of PD, as well as the severity of anxiety and depression were not associated with SD. CONCLUSION: Using ASEX in the detection of SD in PD might be important in directing patients to further evaluation and treatment.

Factors affecting morbidity in chronic tuberculous empyema.

BACKGROUND: Chronic empyema is not a rare complication of pulmonary tuberculosis. Various treatment modalities ranging from open drainage to pneumonectomy, depending on the status of the disease, have been used to treat this complication. However, the best strategy for this disease remains unknown. This study examined the results of different treatment strategies for chronic tuberculous empyema. METHODS: Between January 1993 and December 2002, 36 patients (29 male and 7 female) with an average age of 29.3 years (range 13 - 52 years) presented with chronic tuberculous empyema characterized by empyema cavity and persistent pleural infections that were secondary to tuberculosis. The series consisted of patients who had had tube thoracostomy and underwater drainage without complete re-expansion. All patients were treated with open drainage. Of these, 6 patients had Eloesser flap for complete drainage of pleural pus and resolution of pleural infection. RESULTS: Eloesser-flap drainage resulted in a higher morbidity compared to the open-drainage-only method ( P = 0.011). Pneumonectomy, used as a final therapeutic option, resulted in more complications postoperatively ( P = 0.034). Antituberculosis therapy lasting six months or longer reduced the morbidity rate (54 % vs. 33.3 %), but the difference was not significant. CONCLUSIONS: Our findings indicate that open drainage leads to better results compared to those of Eloesser flap in patients with chronic tuberculous empyema. Patients who underwent pneumonectomy were expected to have higher complication rates and the procedure must therefore be avoided when possible.

Use of emergency departments by elderly patients in a city of Western Turkey.

OBJECTIVE: To evaluate the reasons behind the demographic characteristics of patients presented to emergency departments. METHODS: The entire patient records of all the hospitals' emergency departments in the city of Eskisehir were retrospectively assessed in this study. The study was conducted between the years 1998 and 2000. Data were evaluated using chi2, t-tests, and percent rates. RESULTS: Of 608,528 patients visiting the emergency departments, 79 123 (13.0%) were elderly patients. The treatment and discharge rate was 78.3%. Mean admission rate was 21.2%. The death rate during the visits was 0.4%. The proportion of the five most frequently seen diseases was 41.9%. CONCLUSION: Demographical trends show that emergency department visits by elderly patients would increase in time. So, in Turkey, emergency department staff should be trained to provide for the special needs of this population in emergency departments.

Interrelation between the Poisoning Severity Score, carboxyhaemoglobin levels and in-hospital clinical course of carbon monoxide poisoning.

The aim of the present study is to evaluate the relationship between the Poisoning Severity Score (PSS) and carboxyhaemoglobin (COHb) levels in patients with carbon monoxide poisoning (COP) using outcome as the measure. The study was designed as a retrospective chart review of patients with final diagnosis of COP. Correlation of PSS and COHb levels at presentation was evaluated with collected data. Majority of the cases were grade 1 (minor) PSS (134 cases, 73.6%) and 93.4% of these patients made a complete recovery. There were six deaths (mortality 3.3%) and six in-hospital major complications (IHMCs) (3.3%) (please specify whether the complications were in the patients who died). There is moderate correlation between PSS and outcome (p < 0.001, r = 0.493). Grade 3 (severe) PSS was significantly different from other grades for outcome (six mortalities and three IHMCs). Patients classified as grade 3 and patients who died had a significantly higher mean age (p < 0.05, 41.8 +/- 23.6 and p < 0.01, 60.1 +/- 20.3, respectively). Mean COHb level of grade 3 (33.2 +/- 13.9%) was significantly higher than that of other grades (p < 0.05). COHb levels according to outcome were not different (? within the patients in grade 3). Decreased level of consciousness, acidosis, tachycardia, high glucose and leucocyte levels showed significant relation with higher PSS, COHb level and adverse outcome. We conclude that the PSS is a reliable guide in COP. Value of the PSS in COP may be enhanced if additional factors and investigations are included.

Adverse events associated with aggressive treatment of increased blood pressure.

Patients with severely increased blood pressure often present to the emergency department. Rapid lowering of blood pressure can precipitate or worsen end organ damage. We report two cases that developed cerebrovascular and cardiovascular adverse events associated with aggressive treatment of increased blood pressure by the use of sublingual nifedipine capsule. The first patient had developed ischaemic stroke; the second patient actually had acute left ventricular failure causing deteriorated, and required positive inotropic treatment for persistent hypotension. These cases emphasise that the pseudoemergency may rapidly progress into a real emergency when blood pressure is rapidly and aggressively reduced.

A detailed subgross morphometric study on the auditory ossicles of the New Zealand rabbit.

This study was designed to reveal, in detail, the features of the auditory ossicles of the New Zealand rabbit, one of the most frequently used animals in scientific researches. Heads of 10 dead adult New Zealand rabbits of both sexes weighing 2.5 +/- 0.2 kg were used in the study. The auditory ossicles were gently removed from their situs and observed. The auditory ossicles were three small bones: the malleus, the incus and the stapes. The lenticular bone seemed to be the lenticular process, as is in human beings. In general, macroanatomic features of the bones were similar to those reported in the literature. Findings in this study, however, differed greatly, especially in detail. There were statistically significant differences in the morphometric data of the features of the auditory ossicles between the right- and left-hand sides. Data from the right-hand side were significantly higher.

The origin and course of the greater, lesser and least thoracic splanchnic nerves in New Zealand rabbits.

In this study, the origin and course of the greater, lesser and least splanchnic nerves was investigated in 12 adult New Zealand rabbits with regard to sex and the side of the body. There were no significant differences between the female and male rabbits. The greater and lesser splanchnic nerves were present in all the cadavers examined. However, the least splanchnic nerve was found on the right side in 50% of the cadavers (nos. 2, 4, 6, 7, 11 and 12), and on the left side in 75% (1, 2, 4, 6, 7, 8, 9, 11 and 12). With regard to the origin and pattern of the greater, lesser and least splanchnic nerves, there were significant differences between the right and left sides of the body even in the same rabbit. No significant difference was observed between sexes.

Toxicity of dietary Heliotropium dolosum seed to Japanese quail.

Five groups of 30 male Japanese quail, each 7-w-old, were fed diets containing 0, 1, 3, 5, or 10% (w/w) of dehulled H dolosum seed. Half of the birds from the each group were killed at 6 and 24 w after beginning of the trial. At the end of 6th w, neither mortality nor clinical sign occurred in test groups. In the 5 and 10% inclusion levels, mild to moderate hepatic injury was detected as evidenced by mild karyomegaly, moderate fatty change, focal or portal fibrosis, bile duct hyperplasie, and ovalocyte proliferation along with lower serum protein and albumin levels. By the termination of the experiment (24 w), 5 birds died in the 10% dosed group. Hepatic cirrhosis was the most prominent finding in the 5 and 10% group; at these levels, serum protein and albumin values decreased significanty while billuribin and ALP levels increased. Based on relative weights and histological evaluations, testicularatrophywasdosedependent. These results partly affirm earlier studies that the quail is highly resistant to the toxic effects of H dolosumseed. However, the resistance to H dolosum is less than Senecio Jacobae and Crotalaria spectabilis when considering tissue injury.

[Acute appendicitis in pregnancy]. / Gebelikte akut apandisit.

BACKGROUND: Review of our cases of appendicitis with pregnancy. METHODS: Between june 1990 and may 2001, eighteen cases were investigated, retrospectively. RESULTS: Six patients were in first trimester, 10 in second trimester and 2 in third trimester. Mean age was 25. Sixteen cases (88.9%) were acute appendicitis and 2 cases (11.1%) were perforated appendicitis. The time interval between the onset of complaints and operation was 1.6 days. There were no fetal or maternal mortality. One of perforated appendicitis developed wound infection and two developed atelectasis. CONCLUSION: Early laparotomy in appendicitis with pregnancy will reduce the fetal and maternal morbidity and mortality.

Video-assisted repair of an eventrated left hemidiaphragm.

Video-assisted thoracoscopic surgery is emerging as a viable approach to increasingly complex intrathoracic therapeutic procedures. Here, we present a case of eventrated left hemidiaphragm caused by a blunt trauma in an elderly man. The diaphragm was repaired successfully using a video-assisted procedure, thus giving the patient the advantages of a minimally invasive operation.