Depression, anxiety, stress, and job performance among Turkish nurses in the early post-earthquake period.

BACKGROUND: Individual and social concerns can negatively affect nurses' mental health during a large-scale earthquake's early stages, making it challenging to perform their professional responsibilities. AIM: This cross-sectional correlational study aimed to examine the relationship between depression, anxiety, and stress levels Turkish nurses experienced during an earthquake's early period. The nurses participating in this study were not directly present in the earthquake-affected area. METHODS: The study was conducted on 232 nurses between February 10 and 25, 2023. The data were collected using the Depression, Anxiety, Stress-21 Scale and the Job Performance Evaluation Form developed by the researchers through a literature review. These were used to investigate nurses' work motivation changes due to the earthquake. The study followed the STROBE checklist for cross-sectional studies. RESULTS: The participants' depression levels were severe, anxiety levels were extremely severe, and stress levels were moderate following the earthquake. Nurses who felt exhausted experienced reduced energy levels toward their work and reported a decrease in their desire, effort, and work motivation to perform well. In addition, they had higher depression, anxiety, and stress scores (p < 0.005). CONCLUSION: Psychological difficulties, including depression, anxiety, and stress experienced by nurses not directly present in an earthquake-affected area, reduced their professional efforts and motivation and negatively affected the patient care process. Further studies should focus on conducting comparative studies in different cultures affected by natural disasters on the longitudinal analysis of the impacts of nurses' psychological distress on their job performance. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing policymakers should be aware of the negative psychological effects experienced by nurses during the early post-earthquake period, even if they are not directly present in the earthquake-affected area. The study recommended that nurses should be provided with psychological support to deal with the negative effects of natural disasters and maintain job performance, including the nursing care process.

Abdominal Pain Management and Point-of-care Ultrasound in the Emergency Department: A Randomised, Prospective, Controlled Study.

OBJECTIVE: To determine the effect of point-of-care ultrasound (POCUS) performed during the initial evaluation phase of patients with acute abdominal pain. STUDY DESIGN: Randomised controlled, parallel-group trial. PLACE AND DURATION OF STUDY: Sakarya University Training and Research Hospital, Sakarya, Turkey, from October 2019 to March 2020. METHODOLOGY: Patients who presented to the Emergency Department (ED) with acute abdominal pain were included in the study. Exclusion criteria were permanent mental disability, age <18 years, abdominal trauma within the last 24 hours, pregnancy, morbid obesity, repeated admissions, referral from an external centre to the ED, and missing patient information. Patients were divided randomly into two groups: The control group where standard diagnostic strategies were applied and the POCUS group where POCUS was performed together with standard diagnostic strategies. The length of stay (LOS), differential diagnoses, cost and hospitalisation or discharge from ED were compared. RESULTS: The application of POCUS reduced the average number of preliminary differential diagnoses from four to two (p <0.001). Regarding patient outcomes, POCUS reduced LOS in ED in both the discharged and hospitalised patients (p = 0.003, and p = 0.049, respectively). In all patients, POCUS reduced LOS in ED but led to no significant changes in cost (p <0.001, p = and 0.403, respectively). CONCLUSION: POCUS in patients with acute abdominal pain is very useful in reducing the number of differential diagnoses and LOS in ED. KEY WORDS: Abdominal pain, Cost, Emergency department, Length of stay, Point-of-care ultrasound.

Investigation of Early Diagnostic Value of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase Blood Levels in Minor Head Trauma in Turkey.

BACKGROUND: The aim was to investigate the early diagnostic value of serum glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase (UCH-L1) levels in adults with minor head trauma (MHT) and whether it could be an alternative diagnostic method to computed tomography (CT). This is the first study with the combination of GFAP and UCH-L1 in the first 3 hours of MHT. METHODS: The study comprised 88 patients, 60 patients and 28 controls, who were evaluated as having MHT, were admitted to the emergency department of our hospital within the first 3 hours of the trauma and met the inclusion criteria. CT was performed on all patients. Serum GFAP and UCH-L1 levels were measured within the first 3 hours of the trauma. RESULTS: The median serum GFAP level was 1.07 ng/mL in the group with pathology on CT and 0.42 ng/mL in the group with no pathology on CT. The median serum UCH-L1 level was 0.40 ng/mL in the group with pathology on CT and 0.39 ng/mL in the group with no pathology on CT. A statistically significant difference was found between the serum GFAP levels of the CT (+) group and the CT (-) group (p = 0.021). GFAP levels were compared according to the CT (+) and CT (-) groups with a cutoff value of ≥ 1.56 ng/mL for GFAP, which had 50% sensitivity and 97.5% specificity. This was statistically significant (p = 0.008). It was found that the UCH-L1 level of the control group was lower than the UCH-L1 levels of the CT (+) and CT (-) groups, and this difference was found to be statistically significant (p = 0.003 and p = 0.018, respectively). CONCLUSIONS: GFAP was found to be more specific than UCH-L1 in demonstrating the presence of intracranial pathology in patients with head trauma who were admitted to the emergency department in the first 3 hours after trauma.

The relationship of extent of initial radiological involvement with the need of intensive care, mortality rates, and laboratory parameters in Covid-19

Background/aim: It is very important for the efficient use of limited capacity and the success of treatment to predict patients who may need ICU with high mortality rate in the Covid-19 outbreak. In our study, it was aimed to investigate the value of the radiological involvement on initial CT in demonstrating the ICU transfer and mortality rate of patients. Materials and methods: All PCR-positive patients were included in the study, whose CT, PCR, and laboratory values were obtained simultaneously at the time of first admission. Patients were divided into 4 groups in terms of the extent of radiological lesions. These groups were compared in terms of intensive care transfer needs and Covid-related mortality rates. Results: A total of 477 patients were included in the study. Ninety of them were group 0 (no lung involvement), 162 were group 1 (mild lesion), 89 were group 2 (moderate lesion), and 136 were group 3 (severe lung involvement). A significant relationship was found between the extensiveness of the radiological lesion on CT and admission to intensive care and mortality rate. As the initial radiological involvement amounts increased, the rate of ICU transfer and mortality increased. The mortality rates of the groups were 0%, 3%, 12.3%, and 12.5%, respectively, and the difference was significant (p < 0.001). Similarly, the ICU transfer rates of the groups were 2.2%, 5.6%, 13.5%, and 17.7%, respectively, and the difference was significant (p < 0.001). Conclusion: In conclusion, in our study, the strong relationship between the initial radiological extent assessment and the need for intensive care and mortality rates has been demonstrated, and we believe that our results will make a significant contribution to increase the success of the health system in predicting patients who may progress, helping clinicians and managing pandemics.

Can COVID-19 Mortality be Predicted in the Emergency Room?

OBJECTIVE: To investigate the association ​of white blood cell (WBC) counts, neutrophil, platelets, lymphocyte counts, C-reactive protein (CRP), neutrophil / lymphocyte ratio (NLR), derived NLR ratio (d-NLR), and platelet / lymphocyte ratio (PLR) at the time of first admission for mortality caused by COVID-19. STUDY DESIGN:  Descritive, analytical study. PLACE AND DURATION OF STUDY: Department of Emergency Medicine, Sakarya University Training and Research Hospital, Turkey from  March 2020 to  May 2020. METHODOLOGY: One hundred and sixty-nine patients with the diagnosis of Covid-19 were retrospectively reviewed. Patients were divided into two groups as survivors and non-survivors. Inclusion criteria were age ≥18 years, RT-PCR test positivity, hospitalisation. Patients with missing data were excluded. Data regarding age, gender, WBC counts, neutrophil, platelets, and lymphocyte, CRP, NLR, d-NLR, PLR and comorbid conditions were analysed for mortality. All tests were done with a two-sided significance of 5%. For each endpoint, the absolute and relative effects and their corresponding 95% confidence interval  were calculated. RESULTS: There was a statistically significant association between neutrophil, lymphocyte, CRP, NLR, d-NLR and PLR values (p=0.005, p<0.001, p<0.001, p<0.001, p<0.001, and p<0.001, respectively) with mortality status of the patients. The cutoff values calculated by this analysis were 67.50 years for age, 5.12 K / µl for neutrophil, 1.12 K / µl for lymphocyte, 67.78 mg / dl for CRP, 3.9 for NLR, 2.55 for d-NLR, and 148.85 for PLR. CONCLUSION: Altered neutrophil and lymphocyte counts, NLR, d-NLR, PLR, and CRP values can be used as early predictors of mortality in Covid-19 patients. Key Words: Covid-19, Mortality, Emergency, NLR, d-NLR, PLR.

Comparison of saliva and oro-nasopharyngeal swab sample in the molecular diagnosis of COVID-19.

BACKGROUND: Healthcare personnel are at risk of becoming infected while taking upper and/or lower respiratory tract specimens. Therefore, there is a need for sampling methods that do not risk infecting them. In this study, we aimed to compare the saliva and Oro-Nasopharyngeal Swab (ONS) sampling methods. METHODS: Patients were divided into three groups. Group 1 included patients whose diagnosis of COVID-19 was confirmed by polymerase chain reaction (PCR). Group 2 included patients with COVID-19 compatible findings in lung computed tomography (CT), but with a negative PCR. Group 3 included patients who presented to the emergency department with COVID-19 compatible complaints but had normal CT. Saliva and ONS samples were taken on the third day of hospitalization in groups 1 and 2, whereas in group 3, they were taken at the time of admission to the hospital. RESULTS: A total of 64 patients were included in the study. The average age was 51.04 ± 17.9 years, and 37 (57.8%) were male. SARS-CoV-2 was detected in 27 (42.2%) patients' saliva samples. While the sensitivity and positive predictive value of saliva samples were 85.2%, specificity and negative predictive value were 89.2%. The value of kappa was in substantial agreement (0.744), and it was found statistically significant (<0.001). CONCLUSIONS: Saliva samples can be used instead of ONS samples in detecting SARS-CoV-2. Investigating SARS-CoV-2 with saliva is cheaper, easier for the patient and overall, and, most importantly, it poses much less risk of SARS-CoV-2 contamination to healthcare personnel.

Effect of COVID-19 on platelet count and its indices.

BACKGROUND: Easily accessible, inexpensive, and widely used laboratory tests that demonstrate the severity of COVID-19 are important. Therefore, in this study, we aimed to investigate the relationship between mortality in COVID-19 and platelet count, Mean Platelet Volume (MPV), and platelet distribution width. METHODS: In total, 215 COVID-19 patients were included in this study. The patients were divided into two groups. Patients with room air oxygen saturation < 90% were considered as severe COVID-19, and patients with ≥90% were considered moderate COVID-19. Patient medical records and the electronic patient data monitoring system were examined retrospectively. Analyses were performed using the SPSS statistical software. A p-value <0.05 was considered significant. RESULTS: The patients' mean age was 64,32 ± 16,07 years. According to oxygen saturation, 81 patients had moderate and 134 had severe COVID-19. Our findings revealed that oxygen saturation at admission and the MPV difference between the first and third days of hospitalization were significant parameters in COVID-19 patients for predicting mortality. While mortality was 8.4 times higher in patients who had oxygen saturation under 90 % at hospital admission, 1 unit increase in MPV increased mortality 1.76 times. CONCLUSION: In addition to the lung capacity of patients, the mean platelet volume may be used as an auxiliary test in predicting the mortality in COVID-19 patients.

The diagnostic process of covid-19 in the emergency department: laboratory and imaging methods.

OBJECTIVES: The 2019 Novel coronavirus disease puts a serious burden on the health system. Therefore, the detection of particularly serious patients at an early stage is extremely important in terms of controlling the outbreak and improving the prognosis. We investigated the role of inflammatory markers studied in patients suspected of COVID-19 at an emergency department in predicting PCR and CT results. METHODS: This retrospective study was carried out with 133 patients who were admitted between 13 March and 1st April 2020 with suspicion of COVID-19. The patients were divided into four groups according to CT and RT-PCR results and evaluated. RESULTS: Considering all patients, no specific findings were found in the hematological and biochemical values of patients in the laboratory analyses. Although all of the results remained within the reference range, there was a significant difference in white blood cell, neutrophil, platelet, and lymphocyte values when the groups were compared [p = 0.000; p = 0.004; p = 0.022; p = 0.023]. CONCLUSION: Laboratory is not specific enough in the pre-diagnosis. In addition, this result does not alter with PCR or CT positivity. However, minimal changes observed in laboratory results may be partially guiding in patients in whom both PCR and CT are positive.

Effect of COVID-19 on platelet count and its indices

SUMMARY BACKGROUND Easily accessible, inexpensive, and widely used laboratory tests that demonstrate the severity of COVID-19 are important. Therefore, in this study, we aimed to investigate the relationship between mortality in COVID-19 and platelet count, Mean Platelet Volume (MPV), and platelet distribution width. METHODS In total, 215 COVID-19 patients were included in this study. The patients were divided into two groups. Patients with room air oxygen saturation < 90% were considered as severe COVID-19, and patients with ≥90% were considered moderate COVID-19. Patient medical records and the electronic patient data monitoring system were examined retrospectively. Analyses were performed using the SPSS statistical software. A p-value <0.05 was considered significant. RESULTS The patients' mean age was 64,32 ± 16,07 years. According to oxygen saturation, 81 patients had moderate and 134 had severe COVID-19. Our findings revealed that oxygen saturation at admission and the MPV difference between the first and third days of hospitalization were significant parameters in COVID-19 patients for predicting mortality. While mortality was 8.4 times higher in patients who had oxygen saturation under 90 % at hospital admission, 1 unit increase in MPV increased mortality 1.76 times. CONCLUSION In addition to the lung capacity of patients, the mean platelet volume may be used as an auxiliary test in predicting the mortality in COVID-19 patients.

RESUMO OBJETIVO Testes laboratoriais de fácil acesso, baixo custo e amplamente utilizados capazes de demonstrar a gravidade da COVID-19 são importantes. Portanto, neste estudo, o nosso objetivo foi investigar a relação entre a mortalidade na COVID-19 e a contagem de plaquetas, volume plaquetário médio (VMP) e largura de distribuição de plaquetas. MÉTODOS No total, 215 pacientes com COVID-19 foram incluídos no estudo. Os pacientes foram divididos em dois grupos. Pacientes com saturação de oxigênio < 90% em ar ambiente foram considerados casos graves de COVID-19 e pacientes com valores ≥90% foram considerados casos moderados. Os registros médicos dos pacientes e o sistema eletrônico de monitoramento de dados de pacientes foram analisados retrospectivamente. As análises foram realizadas utilizando o software estatístico SPSS. Um valor de p <0,05 foi considerado significativo. RESULTADOS A média de idade dos pacientes foi de 64,32 ± 16,07 anos. Com base na saturação de oxigênio, 81 pacientes eram casos moderados e 134 tinham COVID-19 grave. Nosso estudo revelou que a saturação de oxigênio no momento da internação e a diferença nos valores de VPM entre o primeiro e terceiro dia de internação foram parâmetros significativos para predizer mortalidade de pacientes com COVID-19. A mortalidade foi 8,4 vezes maior nos pacientes com saturação abaixo de 90% no momento da internação, mas um aumento de apenas 1 unidade no valor de VPM aumentou a mortalidade 1,76 vezes. CONCLUSÃO Além da capacidade pulmonar dos pacientes, o volume plaquetário médio pode ser utilizado como um teste auxiliar para prever a mortalidade de pacientes com COVID-19.

Comparison of saliva and oro-nasopharyngeal swab sample in the molecular diagnosis of COVID-19

SUMMARY BACKGROUND Healthcare personnel are at risk of becoming infected while taking upper and/or lower respiratory tract specimens. Therefore, there is a need for sampling methods that do not risk infecting them. In this study, we aimed to compare the saliva and Oro-Nasopharyngeal Swab (ONS) sampling methods. METHODS Patients were divided into three groups. Group 1 included patients whose diagnosis of COVID-19 was confirmed by polymerase chain reaction (PCR). Group 2 included patients with COVID-19 compatible findings in lung computed tomography (CT), but with a negative PCR. Group 3 included patients who presented to the emergency department with COVID-19 compatible complaints but had normal CT. Saliva and ONS samples were taken on the third day of hospitalization in groups 1 and 2, whereas in group 3, they were taken at the time of admission to the hospital. RESULTS A total of 64 patients were included in the study. The average age was 51.04 ± 17.9 years, and 37 (57.8%) were male. SARS-CoV-2 was detected in 27 (42.2%) patients' saliva samples. While the sensitivity and positive predictive value of saliva samples were 85.2%, specificity and negative predictive value were 89.2%. The value of kappa was in substantial agreement (0.744), and it was found statistically significant (<0.001). CONCLUSIONS Saliva samples can be used instead of ONS samples in detecting SARS-CoV-2. Investigating SARS-CoV-2 with saliva is cheaper, easier for the patient and overall, and, most importantly, it poses much less risk of SARS-CoV-2 contamination to healthcare personnel.

RESUMO OBJETIVO Funcionários da saúde correm risco de infecção ao coletar amostras do trato superior e/ou inferior. Portanto, existe a necessidade de métodos de coleta de amostras que não representem um risco de infecção. Neste estudo, nosso objetivo foi comparar as métodos de coleta de saliva e swab de naso e orofaringe (ONS). MÉTODOS Os pacientes foram divididos em três grupos. O Grupo 1 incluiu pacientes cujo diagnóstico de COVID-19 foi confirmado por reação em cadeia da polimerase (PCR). O Grupo 2 incluiu pacientes com achados compatíveis com COVID-19 em exames de tomografia computadorizada (TC), mas com PCR negativo. O Grupo 3 incluiu pacientes que compareceram ao departamento de emergência com queixas compatíveis com COVID-19, mas TC normal. Amostras de saliva e ONS foram coletadas no terceiro dia de internação, nos Grupos 1 e 2, já no Grupo 3, foram coletadas no momento da internação. RESULTADOS Um total de 64 pacientes foram incluídos no estudo. A média de idade foi de 51,04 ± 17,9 anos, e 37 (57,8%) eram do sexo masculino. SARS-CoV-2 foi detectado em 27 (42,2%) amostras de saliva dos pacientes. A sensibilidade e valor preditivo positivo foi de 85,2% nas amostras de saliva, já a especificidade e o valor preditivo negativo foi 89,2%. O valor de Kappa estava substancialmente de acordo (0,744) e era estatisticamente significante (<0,001). CONCLUSÃO Amostras de saliva podem ser usada em vez de ONS na detecção de SARS-CoV-2. O uso de amostras de saliva para detecção de SARS-CoV-2 é mais barato, mais fácil para o paciente e em geral e, mais importante, representa um risco muito menor de contaminação de SARS-CoV-2 para os profissionais da saúde.

Effects of Point-of-care Ultrasonography on the Diagnostic Process of Patients Admitted to the Emergency Department with Chest Pain: A Randomised Controlled Trial.

OBJECTIVE: To evaluate the effect of point of care ultrasonography (POCUS) performed for heart, lung, aorta, hepatobiliary and deep veins on the diagnosis, length of stay (LOS) in emergency department (ED) and cost in patients admitted to the ED with chest pain. STUDY DESIGN: Prospective randomised controlled, parallel-group trial. PLACE AND DURATION OF STUDY: Sakarya University Training and Research Hospital, Sakarya Turkey, from September 2018 to March 2019. METHODOLOGY: Patients (≥18 years) with chest pain were randomly assigned at a 1:1 ratio to a standard diagnostic strategy (control group) or to standard diagnostic strategy supplemented with POCUS (POCUS group). Data obtained from the study were analysed using IBM SPSS Statistics 21. RESULTS: Two hundred and eight patients were randomly assigned to the control (n=104) and POCUS groups (n=104), respectively. The mean age was 50.42 ± 16.15, and 54% were men. The most common comorbidity was hypertension (43%). Non-ST elevation myocardial infarction and musculoskeletal pain were the most common presumptive diagnoses. POCUS significantly reduced the LOS in ED. Detection of pathology in the POCUS increased the rate of hospitalisation. In addition, POCUS significantly shortened the LOS in the ED in patients who were discharged. The median LOS in the ED for the POCUS group was 133 min (91-279), which was significantly shorter than that of the control group at 215 min (118-372) (p=0.006). Although the average costs were also reduced, the difference was not statistically significant (p=0.269). CONCLUSION: POCUS is a repeatable, practical imaging method which does not require radiation, reduces LOS in the ED statistically significant. However, further studies are needed to determine its usefulness in the ED. Key Words: Chest pain, Cost, Emergency medicine, Length of stay, Point of care ultrasound.

New Oxidative Stress Markers Useful in the Diagnosis of Acute Appendicitis in Children: Thiol/Disulfide Homeostasis and the Asymmetric Dimethylarginine Level.

OBJECTIVES: The aim of this study was to evaluate 2 new oxidative stress markers, thiol/disulfide homeostasis status and the asymmetric dimethylarginine (ADMA) level, in children with acute appendicitis (AA) and to evaluate their diagnostic utility. METHODS: This case-control study included 45 patients with AA and 35 healthy children. Age, sex, white blood cell count, neutrophil-to-lymphocyte ratio, high-sensitivity C-reactive protein (hs-CRP) level, ultrasonographic findings, thiol/disulfide homeostasis parameters (native and total thiol levels, native thiol/total thiol ratios [antioxidant parameters], and disulfide, disulfide/native thiol, and disulfide/total thiol ratios [oxidant parameters]), and the ADMA level were compared between the 2 groups. RESULTS: The native and total thiol levels, and the native thiol/total thiol ratio, were significantly lower, and the disulfide level and disulfide/native thiol and disulfide/total thiol ratios significantly higher, in the AA compared with the control group (all P < 0.001). The ADMA level was significantly higher in a perforated versus nonperforated subgroup of AA patients, but the thiol/disulfide homeostasis parameters did not differ significantly between the two subgroups. In addition, the hs-CRP level and appendiceal wall thickness were higher in the perforated subgroup. The thiol/disulfide antioxidant parameters and ADMA level correlated negatively with the white blood cell count, the neutrophil-to-lymphocyte ratio, and the hs-CRP level, in the AA group, but correlated positively with oxidant parameters. The sensitivity and specificity of the disulfide/native thiol and disulfide/total thiol ratios were high when used to diagnose AA, whereas the sensitivity of the ADMA level was high when used to diagnose perforated appendicitis. CONCLUSIONS: Thiol/disulfide homeostasis and the ADMA level, together with certain other parameters, may be useful biomarkers of AA in children.

The diagnostic process of covid-19 in the emergency department: laboratory and imaging methods

SUMMARY OBJECTIVES The 2019 Novel coronavirus disease puts a serious burden on the health system. Therefore, the detection of particularly serious patients at an early stage is extremely important in terms of controlling the outbreak and improving the prognosis. We investigated the role of inflammatory markers studied in patients suspected of COVID-19 at an emergency department in predicting PCR and CT results. METHODS This retrospective study was carried out with 133 patients who were admitted between 13 March and 1st April 2020 with suspicion of COVID-19. The patients were divided into four groups according to CT and RT-PCR results and evaluated. RESULTS Considering all patients, no specific findings were found in the hematological and biochemical values of patients in the laboratory analyses. Although all of the results remained within the reference range, there was a significant difference in white blood cell, neutrophil, platelet, and lymphocyte values when the groups were compared [p = 0.000; p = 0.004; p = 0.022; p = 0.023]. CONCLUSION Laboratory is not specific enough in the pre-diagnosis. In addition, this result does not alter with PCR or CT positivity. However, minimal changes observed in laboratory results may be partially guiding in patients in whom both PCR and CT are positive.

RESUMO OBJETIVOS A nova doença de coronavírus de 2019 coloca um fardo sério para o sistema de saúde. Portanto, a detecção de pacientes especialmente graves em um estágio inicial é extremamente importante em termos de controle do surto e melhoria do prognóstico. Investigamos o papel dos marcadores inflamatórios estudados em pacientes suspeitos de COVID-19 no pronto-socorro na previsão de resultados de PCR e CT. MÉTODOS Este estudo retrospectivo foi realizado entre 133 pacientes que foram admitidos entre 13 de março e 1o de abril de 2020 com suspeita de COVID-19. Os pacientes foram divididos em quatro grupos de acordo com os resultados da TC e RT-PCR e avaliados. RESULTADOS Considerando todos os pacientes, não foram encontrados achados específicos nos valores hematológicos e bioquímicos dos pacientes em análises laboratoriais. Embora todos os resultados tenham permanecido dentro do intervalo de referência, houve uma diferença significativa nos valores de glóbulos brancos, neutrófilos, plaquetas e linfócitos quando os grupos foram comparados [p = 0,000; p = 0,004; p = 0,022; p = 0,023]. CONCLUSÃO O laboratório não é suficientemente específico no pré-diagnóstico. Além disso, este resultado não se altera com a positividade para PCR ou CT. No entanto, alterações mínimas observadas nos resultados laboratoriais podem ser parcialmente norteadoras em pacientes com PCR e CT positivos.

The Effect of Concurrent Tetanus-diphtheria Vaccination on the Antibody Response to Rabies Vaccine: A Preliminary Study.

The number of studies in the literature investigating the effect of tetanus vaccination on rabies prophylaxis is rather limited. In this study, we aimed to investigate the effect of concurrent tetanus-diphtheria (Td) vaccination on the antibody response to rabies vaccine. The data of consecutive 80 patients who presented to Sakarya University Training and Research Hospital, Department of Emergency due to rabies suspected exposure between 15 October 2012 and 12 June 2013 were enrolled to this study. Postexposure rabies prophylaxis had been given to all cases, however concurrent tetanus vaccination had been administered to some of them according to their need. Cases were divided into two parts according to their receipt of tetanus prophylaxis as rabies only group (group R, n=37), and rabies and tetanus-diphtheria group (group R+Td, n=43). Rabies antibody levels were tested in sera of the cases at first and postvaccination 21st day. The median antibody levels of each group were measured and compared with each other statistically. In our study, postvaccination 21st day antibody level of group R was 0.68 IU/ml (IQR: 0.79), while the same for group R+Td was 0.52 IU/ml (IQR: 0.48) (p=0.022). Concurrent administration of Td vaccine was found to have a significant negative effect on the antibody response to rabies vaccine. Our results should be confirmed with further studies including more cases.

Thiol/disulfide homeostasis as a novel indicator of oxidative stress in children with simple febrile seizures.

Simple febrile seizures are generally benign, but during the seizure, elevated levels of glutamate and high levels of oxygen use due to the high metabolic brain activity result in oxidative stress. However, the relationship between febrile seizures and oxidative stress remains unclear. In this study, we investigated thiol/disulfide homeostasis as a new oxidative stress parameter in patients with simple febrile seizures. This study was performed between February 2016 and May 2016 at the Pediatric Emergency Unit. The study population consisted of 40 patients with a diagnosis of simple febrile seizure and 30 control participants aged 8-59 months. Total thiol, native thiol and disulfide levels, disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios were used as thiol/disulfide homeostasis parameters and were quantified in patient and control groups. Furthermore, correlations with seizure duration were investigated. In the patient group, native and total thiol levels and native thiol/total thiol ratios were low, and disulfide levels, disulfide/native thiol, and disulfide/total thiol ratios were significantly higher than in the control group. Negative correlations were observed between seizure duration, total and native thiol levels, and native thiol/total thiol ratio, whereas positive correlations were observed between seizure duration and disulfide/native thiol and disulfide/total thiol ratio. The sensitivities of both disulfide/native thiol and disulfide/total thiol ratios were high for simple febrile seizures. Simple febrile seizures may cause impairment in favor of disulfide bonds in thiol/disulfide homeostasis. Overall, these changes may contribute to neuronal cell damage after simple febrile seizures.

Effectiveness of GFAP in Determining Neuronal Damage in Rats with Induced Head Trauma.

AIM: To determine whether the serum level of glial fibrillary acidic protein (GFAP), an important indicator of neuron damage, correlates with the extent of tissue damage in the rat with induced head trauma and to obtain data in order to avoid unnecessary cranial computed tomography analyses. MATERIAL AND METHODS: Three-month-old male Sprague-Dawley rats were used. Rats were divided into 5 groups. The experimental head trauma model was examined in five groups (n=8) as follows: The control group had no intervention; Group 1: Head trauma was induced by dropping a 25 mg ball from a height of 20 cm; Group 2: Head trauma was induced by dropping a 50 mg ball from a height of 20 cm; Group 3: Head trauma was induced by dropping a 50 mg ball from a height of 80 cm; Group 4: Head trauma was induced by dropping a 100 mg ball from a height of 80 cm. Thus, according to the Newton's Law, respectively 0.05, 0.1, 0.2 and 0.4 N trauma was created. Serum GFAP levels were analyzed and the damage to cerebral tissues was evaluated in all groups. RESULTS: We determined that number of apoptotic cells and particularly the number of GFAP (+) protoplasmic astrocytes at the perilesional region of the cortex increased in association with the increased serum GFAP level as long as the severity of the trauma increased. CONCLUSION: Serum GFAP concentration can be used as a marker of the severity of head trauma and traumatic brain injury. However, more animal studies are required to reflect this result in clinical practice.

Antienflamatuar and antiadhesive effect of clioquinol.

BACKGROUNDS/AIMS: The aim of this study is to investigate the expected adhesion-modifying effect of clinoquinol which has metal-chelating feature that limits the inflammation and fibroblastic activity. METHODS: A total of 40 Wistar Albino rats were included, which were divided into 5 groups. Group-1 constituted the sham group. Other groups, adhesions were induced by performing cecal abrasion on the rats. For treatment, saline solution was added to Group-2, carboxymethylcellulose was added to Group-3, methylene blue was added to Group-4, and clioquinol was added to Group-5. Blood samples were obtained from the heart to measure IL-10 and TNF α-levels. Adhesions were evaluated both macroscopically and histopathologically. RESULTS: Clioquinol reduced adhesions at significant level via decreasing the inflammation and fibroblastic activity in the adhesion-induced rats. At macroscopic level, carboxymethylcellulose and clioquinol were the most potent agents in reducing adhesions. Nonetheless, significant foreign body-reaction was observed in the carboxymethylcellulose-treated group. CONCLUSIONS: Clioquinol could reduce the formation of intra-abdominal adhesions. It exerts this activity by limiting the inflammation and fibroblastic activity between the intestines and serous surfaces. Furthermore, it does not induce a foreign body reaction. Due to these properties, we conclude that clioquinol can be used as an alternative agent to prevent adhesions.

Evaluation of the relationship between heart type fatty acid binding protein levels and the risk of maternal cardiac ischemia in low risk obstetric population during delivery.

AIM: To investigate the heart type fatty acid binding protein (hFABP) changes during delivery in low-risk obstetric population. METHODS: Pregnant women who are at term and met the inclusion criteria were included the study. Maternal echocardiography, electrocardiography, arterial blood pressure monitoring, CK-MB, serum heart type fatty acid binding protein and troponin I levels were evaluated before and after delivery. Of the total of 100 pregnant women, mean age was 26.7±5, 51 pregnant had vaginal delivery and the remaining 49 had caesarean section. RESULTS: The h-FABP positivity was detected in nine (9%) subjects after the delivery as compared to values before the delivery (p=0.0035). Troponin levels were 0.013±0.001 before the delivery and 0.025±0.002 after the delivery (p= 0.0001). In the comparison of vaginal and Cesarean deliveries, h-FABP positivity was detected in five of 51 subjects in the vaginal delivery group and four of 49 subjects in the cesarean delivery group (p=0.95). The changes in troponin levels were 0.01 ng/mL (-0.02 to 0.2) in the vaginal delivery group and 0.01ng/mL (-0.07 to 0.06) in the cesarean delivery group (p= 0.24). CONCLUSION: Delivery stress is associated with maternal cardiac damage as evaluated by heart type fatty acid binding protein and troponin. There was no difference between the two delivery routes in the risk of maternal cardiac damage.