The effects of cardiopulmonary resuscitation (CPR) performed out-of-hospital and in-hospital with manual or automatic device methods and laboratory parameters on survival of patients with cardiac arrest.

OBJECTIVE: Determining the predictive factors for cardiac arrest may be helpful in the management of in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) and in estimating the outcome. Therefore, in the present study, we aimed to investigate the effect of demographic data, cardiopulmonary resuscitation (CPR) initiating setting, compression method, and laboratory parameters on survival from cardiac arrest. METHODS: A total of 414 patients who met the inclusion criteria were included in the study. Patients were grouped into those who underwent out-of-hospital CPR and those who underwent CPR in the hospital and patients who received automatic compression and those who did not receive. In addition to pH, lactate and bicarbonate in arterial blood gas, CK-MB, troponin, urea, creatinine, calcium, potassium, and glucose were measured. RESULTS: The mean age of patients was 70.36±15.68 years, and 170 (41.1%) were female. Although the success rate of CPR in the OHCA group (22.2%) was lower than in the patients in the IHCA group (30.9%), the difference was not statistically significant. There was no difference between the two groups in the comparison of mechanical compression devices and manual compression. In the logistic regression analysis, high pH and low lactate values were found to be independent predictors of survival. CONCLUSION: The results of this study revealed no significant difference between IHCA and OHCA CPR applications and between manual and mechanical compressions in terms of survival in patients with cardiac arrest. In addition, higher pH levels and lower lactate levels measured during CPR were independent predictors of survival.

Chrysin mitigates diclofenac-induced hepatotoxicity by modulating oxidative stress, apoptosis, autophagy and endoplasmic reticulum stress in rats.

BACKGROUND: Diclofenac (DF) is a non-steroidal anti-inflammatory drug (NSAID) generally prescribed for the treatment of pain. In spite of the widespread use of DF, hepatotoxicity has been reported after its administration. The current study discloses new evidence as regards of the curative effects of chrysin (CHR) on DF-induced hepatotoxicity by regulating oxidative stress, apoptosis, autophagy, and endoplasmic reticulum (ER) stress. METHODS: The animals were separated into five different groups. Group-I was in control. Group-II received CHR-only (50 mg/kg bw, p.o.) on all 5 days. Group-III received DF-only (50 mg/kg bw, i.p.) on 4th and 5th day. Group-IV received DF (50 mg/kg bw) + CHR (25 mg/kg, bw) and group-V received DF (50 mg/kg, bw) + CHR (50 mg/kg, bw) for 5 days. RESULTS: DF injection was associated with increased MDA while reduced GSH level, activities of superoxide dismutase, glutathione peroxidase, and catalase and mRNA levels of HO-1 and Nrf2 in the liver. DF injection caused apoptosis and autophagy in the liver by up-regulating caspase-3, Bax, LC3A, and LC3B levels and down-regulating Bcl-2. DF also caused ER stress by increasing mRNA transcript levels of ATF-6, IRE1, PERK, and GRP78. Additionally, it was observed that DF administration up-regulated MMP2 and MMP9. However, treatment with CHR at a dose of 25 and 50 mg/kg considerably ameliorated oxidative stress, apoptosis, autophagy, and ER stress in liver tissue. CONCLUSION: Overall, the data of this study indicate that liver damage associated with DF toxicity could be ameliorated by CHR administration.

The impact of Nrf2/HO-1, caspase-3/Bax/Bcl2 and ATF6/IRE1/PERK/GRP78 signaling pathways in the ameliorative effects of morin against methotrexate-induced testicular toxicity in rats.

BACKGROUND: Methotrexate (MT) is a broadly used chemotherapeutic drug however its clinical use is confronted with several forms of toxicities containing testicular damage. The current study assessed the ameliorative effects of morin on MT-induced testicular damage with the investigation of its mechanism and the potential involvement of oxidative stress, inflammation, apoptosis and endoplasmic reticulum stress in such protection. METHODS: The animals were divided into 5 distinct groups (7 rats in each group). Group 1 was control group, group 2 received MT-only (20 mg/kg bw), group 3 received orally morin-only (100 mg/kg bw), group 4 received MT (20 mg/kg bw) + morin (50 mg/kg bw) and group 5 received MT (20 mg/kg bw) + morin (100 mg/kg). In this study, morin was administered orally for 10 days, while MT was administered intraperitoneally on the 5th day. RESULTS: MT intoxication was linked with augmented MDA while decreased GSH levels, the enzyme activities of glutathione peroxidase, superoxide dismutase, and catalase and mRNA levels of HO-1 and Nrf2 in the testis tissues. MT injection caused inflammation in the testicular tissue via up-regulation of MAPK14, NFκB, TNF-α and IL-1ß. MT application also caused apoptosis and endoplasmic reticulum stress in the testis tissue via increasing mRNA transcript levels of Bax, caspase-3, PERK, IRE1, ATF-6, GRP78 and down-regulation of Bcl-2. CONCLUSION: Treatment with morin at a dose of 50 and 100 mg/kg considerably mitigated oxidative stress, inflammation, apoptosis and endoplasmic reticulum stress in the testicular tissue indicating that testicular damage related to MT toxicity could be modulated by morin administration.

Hesperidin Attenuates Oxidative Stress, Inflammation, Apoptosis, and Cardiac Dysfunction in Sodium Fluoride-Induced Cardiotoxicity in Rats.

Excessive fluoride intake has been reported to cause toxicities to brain, thyroid, kidney, liver and testis tissues. Hesperidin (HSP) is an antioxidant that possesses anti-allergenic, anti-carcinogenic, anti-oxidant and anti-inflammatory activities. Presently, the studies focusing on the toxic effects of sodium fluoride (NaF) on heart tissue at biochemical and molecular level are limited. This study was designed to evaluate the ameliorative effects of HSP on toxicity of NaF on the heart of rats in vivo by observing the alterations in oxidative injury markers (MDA, SOD, CAT, GPX and GSH), pro-inflammatory markers (NF-κB, IL-1ß, TNF-α), expressions of apoptotic genes (caspase-3, -6, -9, Bax, Bcl-2, p53, cytochrome c), levels of autophagic markers (Beclin 1, LC3A, LC3B), expression levels of PI3K/Akt/mTOR and cardiac markers. HSP treatment attenuated the NaF-induced heart tissue injury by increasing activities of SOD, CAT and GPx and levels of GSH, and suppressing lipid peroxidation. In addition, HSP reversed the changes in expression of apoptotic (caspase-3, -6, -9, Bax, Bcl-2, p53, cytochrome c), levels of autophagic and inflammatory parameters (Beclin 1, LC3A, LC3B, NF-κB, IL-1ß, TNF-α), in the NaF-induced cardiotoxicity. HSP also modulated the gene expression levels of PI3K/Akt/mTOR signaling pathway and levels of cardiac markers (LDH, CK-MB). Overall, these findings reveal that HSP treatment can be used for the treatment of NaF-induced cardiotoxicity.

A fatal rabies case and experiences of a mass post exposure prophylaxis among healthcare workers.

We aimed to monitor the adverse effects (AE) and efficacy of post exposure prophylaxis (PEP) in health care workers (HCWs) exposed to a rabies patient. In this study 109 HCWs and eight household contacts were PEP candidates. Contact persons without infection control precautions were in Group I (high risk-82 cases). HCWs indirectly exposed to environmental surfaces were classified in Group II (low risk-35 cases). PEP schedule was rabies vaccine (RBV) + equine rabies immunoglobulin (eRIG) in Group I and only RBV in Group II. Local and systemic AE were observed in all cases. Efficacy of post exposure prophylaxis (PEP) was determined by rabies development in a six month follow-up. 585 doses of RBV have been used in 117 cases and eRIG has been used in 82 cases. 32 Nurses (39%); 22 emergency medicine technicians (26.8%); 12 doctors (14%); six laboratory technicians (0.07%); six radiology technicians (0.07%); four cleaners (0.05%) were in Group I (82 cases), respectively. One doctor, laboratory technician, nurse and radiology technician (0.02%); two emergency medicine technicians (0.04%) and nine cleaners (25.7%) were in Group II (35 cases), respectively. Routes of transmission were blood in five (0.06%); saliva in 14 (17%); sweat in 50 (61%); CSF/serum in five (0.06%); sexual intercourse in one (0.01%); personal equipment in seven (0.09%) in Group I, respectively. Indirect contact was the only route in Group II. The most common local and systemic AE were seen in Group I; pain at injection side (19 cases) and fever (13 cases). Both of them showed statistically significant difference (P<0.05). Allergic rash has been seen at only one case. PEP failed in one case where the possible exposure way was sexual intercourse. PEP is the safest way to prevent rabies. Infection control precautions were still not enough applied. eRIGs are also safe and have rare AE.

Comparison of Fatal Injuries Resulting from Tractor and High Speed Motorcycle Accidents in Turkey: A Multicenter Study.

AIM: Injuries are among the main causes of mortality and morbidity all over the world, and effective initial triage of these patients can determine the thin line between death and life. Tractor accidents and related injuries are significant problems particularly in rural areas. However, major trauma classification systems do not include tractor accidents as a criterion for trauma team activation or transportation of the patients to a trauma center. This study evaluated the general characteristics and outcomes of tractor accidents in comparison to motorcycle accidents, which are considered as a comparison criterion for major trauma. MATERIALS AND METHODS: This is a multicenter study conducted in 6 emergency departments in 4 cities over a six month period. All cases over 18 years of age who were admitted to emergency service due to tractor or motorcycle accidents and meet the criteria were included in the study. The general characteristics and outcomes of both trauma types were compared to determine whether tractor accident should be considered as major traumas. RESULTS: Eighty-eight patients had a tractor accident, and 339 patients had a motorcycle accident. The tractor accident victims were significantly younger (p<0.001), and the proportion of females was higher in this group (p=0.001). Glasgow coma score (p=0.062), revised trauma score (p=0.201), duration from incident to admission (p=0.481), and route of admission (p=0.810) were similar between both accident types. The rates of thoracic traumas (42% versus 23%, p<0.001) and spinal injuries (17% versus 5.9%, p=0.002) were significantly higher in tractor accidents. The hospitalization rates of the patients were significantly higher in tractor accidents (p=0.008). CONCLUSION: The findings of this study support the hypothesis that tractor accidents should be included in the criteria of ATLS major trauma classification system and trauma team activation procedures.

The Analysis of Poisoning Cases Presented to the Emergency Department within a One-Year Period.

OBJECTIVES: Intoxication is the emergence of unwanted signs and symptoms in an organism after exposure to potentially harmful chemical, physical or organic materials. In our study, we evaluated demographic and etiological factors of adult patients admitted to the emergency department with suicidal or accidental poisoning. METHODS: This study was conducted retrospectively by using data from the forensics books, protocol notebooks and patient files. Patients over the age of 14 years that were admitted to the Goztepe Training and Research Hospital during a 1-year period (September 2011-September 2012) with poisoning were included in the study. RESULTS: A total of 430 patients were included in the study and 278 of those patients were females (64.7%). The male/female (F/M) ratio was 1.82/1 and the mean age of the patients was 27.4±11.75 years. The analyses showed that in 348 patients (80.93%) the cause of poisoning was medicine, in 39 patients (9.06%) alcohol and drugs, in 37 patients (8.6%) rat poison, in 4 patients (0.93%) a caustic substance and organophosphates in 2 patients (0.46%). The highest rate of admittance due to poisoning was seen in July, followed by August and September. When the frequency of admittance was evaluated in terms of seasons: summer had the highest frequency with 35.6%, then autumn with 29.1%, spring with 19.8% and winter with 15.6%. CONCLUSIONS: The results of our studies are similar to previously reported studies in Turkey. Poisoning cases are more common in women and the most common way of poisoning is by medication. Unlike previous reports from the literature, we found that poisoning was most frequent in the summer.