The prognostic value of the neutrophil/lymphocyte ratio in patients with snake bites for clinical outcomes and complications.

INTRODUCTION: Snake bites have cardiotoxicity, neurotoxic, myotoxic, nephrotoxic, and hemotoxic features. The neutrophil/lymphocyte ratio (NLR) provides valuable information for the determination of the diagnosis and prognosis of various diseases. In this study, we aimed to investigate the relationship between NLR with the development of complications and duration of hospital stay in snakebite cases. METHOD: In this study, 107 patients with snakebite complaints that applied to a tertiary care university hospital between 2011 and 2014 were retrospectively reviewed. The control group compromised of 107 age-and gender-matched healthy subjects. These patients were examined using their previous laboratory results, bite areas pictures, geographic location, and analysis of complications that developed during the hospitalization. RESULTS: Patients in our snake bites group (n = 107), included males (64%) and females (36%). When NLR1-NLR2, NLR1-NLR3, and NLR2-NLR3 were compared, a statistically significant difference was found (p < 0.001). No mortality was observed in our patients. In cases of snakebites, 4.67% of the patients underwent finger amputation. Compartment syndrome occurred in 3.73% of patients. In one case that developed compartment syndrome, a finger amputation was made. When 8 patients with a complication were compared with patients having snakebite but no complication, the initial NLR was found to be higher and statistically significant (p = 0.042). The average length of stay of patients in the hospital was 9 days. In the analysis of the correlation between the duration of hospitalization and NLR, the patients with a high level of NLR were found to have a longer hospital stay compared to lower NLR levels (p = 0.012). CONCLUSION: NLR was significantly increased in patients that developed complications and needed a longer stay in the hospital.

The effect of body mass index on trauma severity and prognosis in trauma patients.

BACKGROUND: As in the rest of the world, the prevalence of obesity in Turkey has been increasing in recent years and has become a major public health issue. Although many trials have been conducted to study the effects of obesity on internal diseases, there are few studies investigating the effects of obesity on prognosis of trauma patients. The present study analyzed the effects of body mass index (BMI) on trauma severity and prognosis in trauma patients. METHODS: This study was prospectively conducted with trauma patients older than 15 years of age who presented at the Dicle University Faculty of Medicine emergency medicine department trauma unit between June 1, 2013 and May 31, 2014. Patients were grouped into high-energy trauma and low-energy trauma groups based on trauma severity. In addition, 4 groups were made according to BMI value (kg/m2). Group I was defined as BMI <25 (normal weight). Group II patients had BMI of 25-29.9 (overweight). Group III had BMI of 30-34.9 (obese), and Group IV was made up of patients with BMI ≥35 (morbidly obese). RESULTS: Comparison of whole patient population for inter-group differences showed significant differences between rate of head injury, thoracic injury, extremity injury, multitrauma, clinic admission rate, and mortality rate (p<0.001). No significant difference was observed between groups in abdominal injury rate (p=0.347). CONCLUSION: Clinic admission rate, length of intensive care unit stay, mortality rate, multitrauma rate, and injury severity score increased in proportion to greater BMI.

Is montelukast as effective as N-acetylcysteine in hepatic injury due to acetaminophen intoxication in rats?

This study aims to investigate the acute protective effect of montelukast sodium in hepatic injury secondary to acetaminophen (APAP) intoxication. This study used 60 rats. The rats were grouped into 6 groups. The control group was administered oral distilled water 10 ml/kg, the APAP group oral APAP 1 g/kg, the montelukast sodium (MK) group oral MK 30 mg/kg, the acetaminophen+N-acetylcysteine (APAP+NAC) group oral APAP 1 g/kg, followed by a single dose of intraperitoneal NAC 1.5 g/kg three hours later, the acetaminophen+montelukast sodium (APAP+MK) group oral APAP 1 g/kg, followed by oral MK 30 mg/kg 3 h later, the acetaminophen+N-acetylcysteine+montelukast sodium (APAP+NAC+MK) group oral APAP 1 g/kg, followed by a single intraperitoneal NAC 1.5 g/kg plus oral MK 30 mg/kg 3 h later. Blood and liver tissue samples were taken 24h after drug administration. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin were studied from the blood samples. Liver tissue samples were used for histopathological examination. Compared with the control group, serum AST and ALT activities were higher in the APAP and APAP+NAC groups. APAP+NAC, APAP+MK, and APAP+NAC+MK groups had reduced serum ALT and AST activities than the group administered APAP alone. APAP+MK and APAP+NAC+MK groups had a lower serum ALP activity than the control group. Histopathologically, there was a difference between the group administered APAP alone and the APAP+MK and APAP+NAC+MK groups. MK is as protective as NAC in liver tissue in APAP intoxication in rats.

Malnutrition in Community-Dwelling Elderly in Turkey: A Multicenter, Cross-Sectional Study.

BACKGROUND: This study aimed to investigate the prevalence of malnutrition and explore the somatic, psychological, functional, and social or lifestyle characteristics linked to malnutrition in elderly people at a hospital in Turkey. MATERIAL AND METHODS: This study included 1030 patients older than 65 years of age who were seen at the internal medicine and geriatrics outpatient clinics of the study centers in Istanbul, Ankara, Duzce, Corum, Mardin, Malatya, and Diyarbakir provinces between January and December 2014. All patients underwent Mini Nutritional Assessment (MNA) and Geriatric Depression Scale (GDS) tests via one-on-one interview method. The demographic properties of the patients were also recorded during this interview. RESULTS: Among 1030 patients included in this study, 196 (19%) had malnutrition and 300 (29.1%) had malnutrition risk. The malnutrition group and the other groups were significantly different with respect to mean GDS score, income status, educational status, the number of children, functional status (ADL, IADL), the number of patients with depression, and the number of comorbid disorders. According to the results of the logistic regression analysis, age (OR=95% CI: 1.007-1.056; p=0.012), BMI (OR=95% CI: 0.702-0.796; p<0.001), educational status (OR=95% CI: 0.359-0.897; p=0.015), comorbidity (OR=95% CI: 2.296-5.448; p<0.001), and depression score (OR=95% CI: 1.104-3.051; p=0.02) were independently associated with malnutrition. CONCLUSIONS: Our study demonstrates that age, depression, BMI, comorbidity, and the educational status were independently associated with malnutrition in an elderly population.

Factors affecting mortality in patients with organophosphate poisoning.

OBJECTIVE: To investigate the relationship between clinical and demographic characteristics and mortality in patients with organophosphate poisoning. METHODS: The retrospective study was conducted at Dicle University,Diyarbakir,Turkey, and comprised data of patients who presented with organophosphate poisoning between April 2004 and April 2013. The records were assessed in two groups, with Group 1 having data related to recovery, and Group 2 having data related to mortality. SPSS 16 was used for statistical analysis. RESULTS: Of the 296 patients, 219(74%) were women. Mortality was the outcome in 41(13.9%) cases. In Group 2, mean age, marital status, rural origin, presence of psychiatric disease, being illiterate, presence of nicotinic symptoms, and late admission were significantly higher than Group 1 (p<0.05 each). Logistic regression analysis indicated bradycardia as the most prominent independent predictor of mortality (p<0.001). Other independent predictors were age, glucose level, lactate dehydrogenase, coma and acidosis (p<0.05 each). CONCLUSIONS: Independent predictors of mortality in patients with organophosphate poisoning as bradycardia, age, glucose, lactate dehydrogenase level and acidosis.

Lycium barbarum extract provides effective protection against paracetamol-induced acute hepatotoxicity in rats.

The aim of the present study was to investigate the hepatoprotective and antioxidant effects of Lycium barbarum (LB) extract against paracetamol-induced acute oxidative stress and hepatotoxicity in rats. The subjects were divided into 6 groups of 8 rats each. The rats in the LB group were administered a dose of 100 mg/kg LB extract dissolved in saline via the intraperitoneal route for 7 days. Subsequently, after last dose of LB, PCT was given in a single dose of 1 g/kg diluted in saline via the oral route. Twenty-four hours later, blood samples were drawn from all of the subjects for serum Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Total antioxidant status (TAS) and Total oxidant status (TOS) tests, and liver tissue samples were obtained for histopathological evaluation. The mean TAS level of the group that was subjected to PCT intoxication was significantly lower than those of the other groups. Additionally, the mean TOS, Oxidative stress index (OSI), ALT and AST values were significantly higher in this group. Though the mean TAS level in the PCT + LB group was significantly higher than that of the PCT group, the TOS, OSI, ALT, and AST levels were significantly lower. When the PCT + LB group and the PCT only group were compared in terms of liver damage during the histopathological evaluation, a statistically significant difference was observed in Grade I and Grade III damage (P=0.013 and P=0.038, respectively). We conclude that Lycium barbarum extract leads to a significant improvement in PCT-induced acute hepatotoxicity in terms of the histopathological results, serum oxidative stress parameters, and serum liver function marker enzymes.

The protective effect of goji berry extract in ischemic reperfusion in testis torsion.

This study investigated whether goji berry extract (GBE), a known antioxidant, reduces ischemic reperfusion injury when administered to rats exposed to experimental testis torsion. A total of 32 Sprague-Dawley male rats were randomized into 4 groups, including the control (sham), goji, torsion, and torsion-goji groups. The treatment groups received intraperitoneal GBE prior to torsion. The left testes of the animals were subjected to torsion via 5 hours of ischemia and 6 hours of reperfusion. TAC (total antioxidant capacity), TOS (total oxidant status) and OSI (oxidative stress index) levels were calculated. Approximately 5-µm-thick sections were stained with hematoxylin-eosin (H&E) and examined under a light microscope. Statistical analyses were performed with the SPSS 15 software package. The mean serum TAC level was significantly increased in Groups 2 and 4 compared with Groups 1 and 3 in biochemical analyses (for both P < 0.001). The mean serum TOS level was significantly increased in Group 3 compared with Groups 1, 2, and 4 (P < 0.001, P < 0.001, and P = 0.003, respectively). Comparison of the groups with regard to histopathological examination revealed that Group 4 exhibited a significantly higher rate of hemorrhage and congestion compared with Groups 1 and 2 (P = 0.038). The groups did not differ significantly with respect to degeneration. Ischemic reperfusion injury associated with testis torsion was reduced by the antioxidant effect of GBE. Further experimental and clinical studies are needed to confirm the agent's efficacy for this indication.

Fire disaster caused by LPG tanker explosion at Lice in Diyarbakir (Turkey): July 21, 2014.

A disaster can be defined as a situation where the affected society cannot overcome its own resources. Our aim was to present the case of a fire disaster caused by a liquefied petroleum gas (LPG) tanker-based explosion on the Diyarbakir-Bingöl road in Lice to determine the various kinds of challenges and patient groups that an emergency department faces and to discuss more effective interventions for similar disasters. This is a retrospective cross-sectional study. To find out the factors that affected mortality, we investigated the patient conditions presented at the time of admission. Among 69 patients included in the study, 62 were male (89.9%) and seven were female (10.1%). The average age of patients was 32.10±14.01 years, and the burn percentage was 51.1±32.2. One patient died during the first response, and a total of 34 patients (49.3%) died during the patient follow-up. Factors statistically related to mortality were determined to be inclusion in the severe burn group, presence of inhalation injuries, use of central venous catheter on patients, application of fasciotomy, presence of a tracheostomy opening, use of endotracheal intubation and sedoanalgesia, and transfer to centers outside the city (p-values <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, 0.001, and 0.003, respectively). In conclusion, although fire disasters caused by LPG tanker explosions are rare, the frequency of such disasters will increase with the increase in LPG use. The factors affecting mortality should be determined to decrease mortality. We recommend that all personnel members who engage in work related to LPG from production to use, in addition to rescue and first-response personnel, be trained comprehensively and that advanced technological fire equipment be used to prevent such disasters.

Glutamine provides effective protection against deltamethrin-induced acute hepatotoxicity in rats but not against nephrotoxicity.

BACKGROUND: The aim of this study was to investigate the protective effects of L-glutamine (GLN) against liver and kidney injury caused by acute toxicity of deltamethrin (DLM). MATERIAL AND METHODS: Thirty-two rats were indiscriminately separated into 4 groups with 8 rats each: control group (distilled water; 10 ml/kg, perorally [p.o.]), DLM group (35 mg/kg p.o. one dose.), GLN group (1.5 gr/kg, p.o. single dose.) and DLM (35 mg/kg p.o. one dose.) + GLN group (1.5 gr/kg, p.o. one dose after 4 hours.). Testing for total antioxidant status (TAS), total oxidant status (TOS), interleukin-1 beta (IL-1ß), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) analyses were performed on tissue samples, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), urea, and creatinine were analyzed on serum samples. Liver and kidney samples were histopathologically analyzed. RESULTS: The TOS level in liver was significantly higher in the DLM group than in the control group, and the level in DLM+GLN group was considerably lower than in the DLM group. The TAS level in the DLM+GLN group was considerably higher than in the control and DLM groups. The TAS level in kidney tissues was considerably lower in the DLM group than in controls, but was similar to other groups. Histopathological analyses of liver tissues established a significant difference between DLM and DLM+GLN groups in terms of grade 2 hepatic injury. However, no significant difference was found between DLM and DLM+GLN groups in terms of kidney injury. CONCLUSIONS: Glutamine leads to significant improvement in deltamethrin-induced acute hepatotoxicity in terms of histopathologic results, tissue oxidative stress parameters, and serum liver function marker enzymes.

Acute Pancreatitis and Splenic Vein Thrombosis due to Hypertriglyceridemia.

Acute pancreatitis (AP) is a condition characterised by the activation of the normally inactive digestive enzymes due to an etiological factor and digestion of the pancreatic tissues, resulting in extensive inflammation and leading to local, regional, and systemic complications in the organism. It may vary from the mild edematous to the hemorrhagic and severely necrotising form. The most common causes are biliary stones and alcohol abuse. In this case study, we would like to present a patient with AP due to hypertriglyceridemia (HPTG), which is a rare cause of pancreatitis, and splenic vein thrombosis, which is a rare complication of pancreatitis.

How was Felt Van Earthquake by a Neighbor University Hospital?

OBJECTIVES: Natural disasters, which are defined as events causing great damage or loss of life, are events of natural origin unpreventable by human beings that occur in a short period of time and lead to loss of life and property. The aim of the study is to analyze which patient groups and problems at a university hospital after the earthquakes in Van. METHODS: For the purposes of this study, 169 patients who presented to our emergency room following the earthquakes that occurred on the 23rd of October, 2011 and the 9th of November, 2011 in Van and were treated as an outpatient or inpatient were enrolled. Patients were divided into two groups. Patient data including the clinical and demographic characteristics were analyzed. RESULTS: Among the 169 patients included in our study, 97 (57.4%) were male and 72 (42.6%) were female. The mean age was 26.95±16.44 years in Group 1 and 39.80±23.08 years in Group 2. In our study, the majority of the patients in Group 1 had orthopedic injuries, while internal problems were more common in Group 2. The need for intensive care was greater among the patients in Group 1 compared to Group 2 (p<0.05). The leading cause of death in Group 1 was multi-systemic trauma in 7 out of the 10 patients (70%) and internal problems in Group 2 with 5 out of 12 patients (41.5%). CONCLUSIONS: Our country is in a geographical location where earthquakes are responsible for great losses of life and property. An efficient disaster relief plan may help to minimize the possible damage of earthquakes.

A Case of Uncorrected Tetralogy of Fallot Undiagnosed Until Adulthood and Presenting With Polycythemia.

Congenital heart defects with right-to-left shunt are one of the hypoxia-related causes of acquired secondary polycythemia (SP). Tetralogy of Fallot (ToF) is the most common congenital cyanotic heart disease in children. Cases of uncorrected ToF in adult ages are rare. This paper reports a woman detected with elevated hemoglobin level during routine tests performed for infertility therapy and subsequently diagnosed SP with related ToF.

[Evaluation of urogenital injuries in patients with trauma in the emergency department]. / Acil servise basvuran travmali olgularda Urogenital yaralanmalarin degerlendirilmesi.

BACKGROUND: The aim of this study was to investigate the characteristics of the patients admitted to the Emergency Department with urogenital system trauma and the factors affecting morbidity and mortality. METHODS: In this prospective, cross-sectional descriptive study, the demographic characteristics, trauma types, laboratory and radiologic results, hospitalization states, and the outcomes of patients with urogenital trauma were investigated. A total of 153 patients [108 (70.6%) male; 45 (29,4%) female] with major trauma were included in this study. RESULTS: Twenty-three (15.03%) had penetrating trauma and 130 (84.96%) blunt trauma. Seventy-nine presented with motor vehicle accidents, 42 with falls, 10 with gunshot wounds, and 10 with stab wounds. There were pelvic fractures in 60 patients, renal injuries in 35 patients, and bladder injuries in 4 patients. Twenty-one of the patients underwent surgery for any reason and 17 patients died. There was a significant relationship between hematuria and renal injury. CONCLUSION: Urogenital injuries are frequently seen with other system injuries, and deaths generally occur due to the other system injuries. The timely identification and management of genitourinary injuries with an in-depth clinical evaluation are important for preventing deaths due to urogenital region trauma.