The effects of adrenomedullin in traumatic brain injury.

Traumatic brain injury (TBI) is a common cause of death and disability throughout the world. A multifunctional peptide adrenomedullin (AM) has protective effects in the central nervous system. We evaluated AM in an animal model as a therapeutic agent that reduces brain damage after traumatic brain injury. A total of 36 rats was divided into 3 groups as sham, head trauma plus intraperitoneal (ip) saline, and head trauma plus adrenomedullin ip. The diffuse brain injury model of Marmarou et al. was used. Blood samples were taken from all groups at the 1st, 6th and 24th hours for analysis of TNF-α (tumor necrosis factor-α), IL-1ß (interleukin-1ß) and IL-6 (interleukin-6) levels. At the end of the study (at the 24th hour) a neurological examination was performed and half of the rats were decapitated to obtain blood and tissue samples, the other half were perfused transcardiacally for studying the histopathology of the brain tissue. There were no statistically significant changes in plasma levels of IL-1ß, IL-6 and TNF-α relative to the sham group. Also, changes in tissue levels of malonedialdehyde, myeloperoxidase and glutathione were not statistically significant. However, neurological scores and histopathological examinations revealed healing. AM individually exerts neuroprotective effects in animal models of acute brain injury. But the mechanisms of action remain to be assessed.

Endoscopic gastrostomy, nasojejunal and oral feeding comparison in aspiration pneumonia patients.

BACKGROUND: Aspiration pneumonia is a potentially preventable illness requiring attention to small details of patient care. The type, management, and care of feeding should be carried out properly. MATERIALS AND METHODS: This is a prospective clinical study of enteral feeding on patients admitted to hospital with aspiration pneumonia. The known enteral nutritional methods, advantages, and disadvantages were told to the patient or proxy. If they didn't accept Percutaneous endoscopic gastrostomy (PEG), nasojejunal tube (NJT) was advised. If they denied all of the procedures, oral feeding education was given. A total of 94 patients were enrolled to the study, 29 of them accepted PEG, 42 preferred NJT, and 23 preferred oral route. RESULTS: A total of 94 patients with a mean age of 77.84, standard deviation 10.784; 95% confidence interval (CI) 75.63-80.03 were enrolled to the study of which 27 (28.7%) patients had a history of aspiration pneumonia. Oral feeding was prominently preferred for patients nursed by a relative (15; 65.2% of Oral feeding group and 16% of total) or a caregiver (7; 30.4% of Oral feeding group and 7.4% of total) while only 1 (4.3% of Oral feeding group and 1.1% of total) with a health-care worker (P = 0.001). Overall re-aspiration rates at the 6(th) month were 58%, 78%, 91% in EG, NJT, oral groups, respectively. Sixth months' survival rates of the different feeding groups were not significantly divergent from each other. History of aspiration was also found to be a significant contributor of mortality. CONCLUSION: In aspiration pneumonia patients' long-term survival rates of the different feeding groups were not significantly divergent from each other.

Evaluation of non-urgent visits to a busy urban emergency department.

OBJECTIVE: To identify the proportion of patients who were taken into the emergency room on the basis of legal regulations and non-urgent medical procedures. METHODS: This prospective study was conducted in the Emergency Department, Toros State Hospital, Mersin, Turkey. Data were collected over 4 weeks (January 2011) and then analyzed using the Kolmogorov-Smirnov, Analysis of Variance, and Kruskal-Wallis H tests. RESULTS: During the study period, 21,014 patients visited the Emergency Department. The applications were measured during a 3-shift schedule (08-16, 16-00, 00-08 hours). The total number of ordinary emergency admissions was 16,370. Of the total, 4,644 (22.1%) of the visits were evaluated as inappropriate. According to our study, inappropriate use of the emergency department was 51.1% more frequent during the 08-16 hours shift than the others. CONCLUSION: Inappropriate use of EDs with non-urgent applications makes it difficult to guarantee access for real emergency cases, decreases the readiness for care, and produces negative spillover effects on the quality of emergency services.