The Impact of the COVID-19 Pandemic on Pre-Hospital Emergency Medical Services: The impact of the Covid-19 pandemic on pre-hospital services.

BACKGROUND: The novel coronavirus (COVID-19) disease outbreak started in China and went on to affect the entire world. Healthcare providers were among the communities that faced severe challenges during the pandemic, and this was especially true of Pre-Hospital Emergency Medical Services (PHEMS) providers. OBJECTIVES: This study aims to investigate the effect of the COVID-19 pandemic on service requests submitted to PHEMS providers via calls made to emergency hotlines. METHODS: Data were obtained on calls made to 112 (the emergency hotline) during March - August 2020 (i.e., during the pandemic) and the same period the previous year (i.e., the pre-pandemic period). These 2 data sets were analyzed and compared using the SPSS 26 software package (IBM Corp., Armonk, New York, USA). RESULTS: The results of the analysis indicated that the total number of emergency calls received during the pandemic period (11 745) increased compared to the pre-pandemic period (10 747), whereas there was a decrease in the proportion of trauma-related emergency calls during the pandemic period (5.3%) compared to the pre-pandemic period (6.8%). Furthermore, there was a higher proportion of extended service times among ambulances serving in PHEMS during the pandemic period (ambulance movements longer than 90 seconds: 15.6%) compared to the pre-pandemic period (ambulance movements longer than 90 seconds: 8.6%). Non-emergency ambulance usage rate was 44.90% in the pre-pandemic period and 38.90% in the pandemic period. CONCLUSIONS: As the study's results show that there was an increase in the number of calls to PHEMS during the pandemic period, especially given that a significant portion of these calls consisted of non-emergency calls, it is recommended that measures be taken to reduce the excessive load on PHEMS during a pandemic.

The relationship between electrocardiographic findings and left ventricular apical thrombus.

OBJECTIVE: Persistent ST segment elevation, fragmented QRS (fQRS), and prominent R wave in lead aVR (Goldberger sign) are the parameters associated with ventricular aneurysm. The goal of this report was to examine the association with electrocardiographic findings (persistent ST elevation, QRS duration, LBBB, and Fragmented QRS [fQRS]) and LV apical thrombus in subjects following anterior MI. PATIENTS AND METHODS: The study was a prospective and cross-sectional analysis that comprised of 220 consecutive subjects diagnosed after anterior MI. The echocardiographic features of patients were evaluated at least 6 weeks after anterior MI. A 12-point ECG was collected on all subjects admitted to the hospital. LBBB, persistent ST elevation, QRS duration and fQRS were evaluated in these patients. RESULTS: The LV ejection fraction (LVEF) was lower in the thrombus group compared to the non-thrombus group (27.2 ± 7.1/33.2 ± 10.0, p=0.008).  In patients with LV apical thrombus (LVAT); LBBB, persistent ST elevation, QRS duration and fQRS were higher compared to those without LVAT (p<0.05). CONCLUSIONS: We demonstrated that the electrocardiographic findings (persistent ST elevation, QRS duration, LBBB, and fQRS) were closely associated with LVAT, and these findings were used as indicators of LV thrombi in anterior MI patients.

Procalcitonin is a predictor of disseminated intravascular coagulation in patients with fatal COVID-19.

OBJECTIVE: The coagulopathies that present with COVID-19 are thrombotic microangiopathy and disseminated intravascular coagulopathy (DIC). Procalcitonin (PCT) levels have been shown to be significantly increased in COVID-19 patients in comparison with healthy subjects/asymptomatic coronavirus-positive patients. In this report, our aim was to assess the associations of the PCT level with DIC and the severity of COVID-19 infection. PATIENTS AND METHODS: In this cross-sectional, retrospective study, 71 consecutive patients with severe COVID-19 (21 with DIC and 50 without DIC) were enrolled in the study. The PCT level was obtained from hospital records. RESULTS: The PCT level was significantly higher in the patients with DIC than in those without DIC [1.9 (0.6-14.5) vs. 0.3 (0.2-0.4) (ng/mL), p<0.01]. The PCT level showed a positive and significant correlation with DIC (r=0.382, p=0.001) and was an independent predictor of DIC in patients with severe COVID-19 (OR: 6.685, CI: 1.857-24.063, p<0.01). CONCLUSIONS: In summary, the PCT level was increased in severe COVID-19 patients with DIC compared with those without DIC. An increased PCT level might suggest the presence of DIC and may help in predicting COVID-19 severity.

Do toxic metals and trace elements have a role in the pathogenesis of conotruncal heart malformations?

OBJECTIVE: The aim of the present study was to determine the role of toxic elements and trace elements in the pathogenesis of conotruncal heart defects by measuring their concentrations in the first meconium specimens of the affected newborns. METHODS: Concentrations of lead, cadmium, iron, zinc, and copper were measured in 1st-day meconium specimens that were collected from 60 newborns with conotruncal heart defects (Group I) and 72 healthy newborns (Group II). RESULTS: The newborns with conotruncal defects and the healthy newborns had statistically similar demographic and clinical characteristics. When compared with healthy newborns, mean concentrations of lead, cadmium, iron, zinc, and copper were significantly higher in newborns with conotruncal heart defects (p=0.001 for each). In total, 51 newborns with conotruncal heart defects had normal karyotype. These newborns had significantly higher concentrations of lead, cadmium, iron, zinc, and copper when compared with healthy newborns. There were significant and positive correlations between the concentrations of lead and cadmium (r=0.618, p=0.001), lead and iron (r=0.368, p=0.001), lead and zinc (r=0.245, p=0.005), lead and copper (r=0.291, p=0.001), cadmium and iron (r=0.485, p=0.001), cadmium and zinc (r=0.386, p=0.001), and cadmium and copper (r=0.329, p=0.001). CONCLUSION: Toxic metals and trace elements may disturb DNA repair mechanisms by impairing DNA methylation profiles, and thus have a role in the pathogenesis of conotruncal heart defects.

Synthesis and determination of some biological activities of novel 2,4-dinitrophenyl derivatives.

The antioxidant and radical scavenging activities of the synthesized compounds 3, 5, and 6 were determined by various in vitro assays such as 2,2-azino-bis(3-ethylbenzthiazoline-6-sulfonic acid radical (ABTS(·+) ) scavenging, ferric ion (Fe(3+) ) reducing power and ferrous ion (Fe(2+) ) chelating activities. Moreover, these activities were compared to those of standard antioxidants such as butylated hydroxyanisole, butylated hydroxytoluene, and trolox. The results showed that the new compounds (3, 5, and 6) had potential antioxidant activity. Besides, inhibition of the two human cytosolic carbonic anhydrase (hCA, EC 4.2.1.1) isozymes I and II with some nitrobenzene compounds was investigated. Compounds 1-6 showed Ki values in the range of 4.88-193.4 µM and 5.295-54.75 µM for hCA I and hCA II, respectively.