The Diagnostic Competence of Glial Fibrillary Acidic Protein in Mild Traumatic Brain Injury and Its Prognostic Value in Patient Recovery.

AIM: To show whether the glial fibrillary acidic protein (GFAP) levels are significantly higher in the serum of patients with mild traumatic brain injury or not. MATERIAL AND METHODS: The level of serum GFAP was measured in 176 patients suffering from brain trauma. The ability of GFAP in predicting the presence of intracranial lesions and the need for neurosurgical intervention was analyzed using the area under the receiver (AUC) operating characteristic (ROC). By passing three months from mild TBI, the Post-Concussion Symptoms Questionnaire (PCSQ) as well as the physical and mental evaluations were performed using the SF-36 questionnaire. RESULTS: Of 176 patients included, 79.5% had no complications and symptoms by passing three months from traumatic brain injury. The AUC for GFAP was 72.6%, which revealed a good accuracy in predicting the need for neurosurgical intervention. CONCLUSION: GFAP, as a predictive factor in people with mild TBI diagnosis who need neurosurgical operation, expressed a favorable diagnostic effect.

Intravenous furosemide vs nebulized furosemide in patients with pulmonary edema: A randomized controlled trial.

BACKGROUND AND AIMS: Pulmonary edema is one of the most common acute respiratory disorders that diagnosis and treatment of the disease still remain as a health problem. The aim of this study was to compare the efficacy of intravenous furosemide and nebulized furosemide in control of the symptoms of the patients with pulmonary edem. METHODS: In this clinical trial, 80 patients were enrolled with pulmonary edema. Patients were randomly divided into two groups. In the intervention group the patients received nebulized furosemide at a dose of 1 mg furosemide for 20 minutes in 2 mL of sodium chloride 0.9% and in the control group the patients received intravenous furosemide at a dose of 1 mg/kg. Then, hemodynamic parameters and estimation of the clinical severity of the pulmonary edema in both groups was performed for 2 hours. RESULTS: According to our results, we can say that nebulized furosemide is not superior to intravenous furosemide in reducing dyspnea and crackles in patients with acute pulmonary edema, but significantly improved respiratory rate and arterial blood oxygen and has less hemodynamic changes than the intravenous furosemide. CONCLUSIONS: The results of this study showed the beneficial effects of nebulized furosemide in the treatment of pulmonary edema, which can be prescribed as a treatment in addition to standard treatment and significantly lead in better control of pulmonary edema in the short term.

Effect of door-to-antibiotic time on mortality of patients with sepsis in emergency department: a prospective cohort study.

Sepsis constitutes an important cause of hospital admission with a high mortality rate. Appropriate antibiotic therapy is the cornerstone of therapy in patients with sepsis. Although numerous studies have recommended early antibiotic initiation in severe sepsis or septic shock stages of sepsis syndrome, its role in treatment of patients with sepsis who have not entered these stages remains to be investigated. The purpose of this study is to investigate the effect of door-to-antibiotic time in sepsis patients with various degrees of severity. This is a longitudinal prospective cohort study on adult patients admitted with sepsis to the emergency department. Sepsis was defined as presence of at least two criteria of systemic inflammatory response syndrome and procalcitonin levels ≥ 2µg/l. Severity of sepsis was determined using the APACHE II (Acute Physiology and Chronic Health Evaluation II) scoring system. Time to antibiotic administration was recorded and its relationship with mortality was assessed. A total of 145 patients were eligible for enrollment. The mean age was 60.4 years and the mean APACHE score was 13.7. The overall in-hospital mortality was 21.4%, and the mean length of stay in hospital was 211.9 hours. The mean door-to-antibiotic time for our patients was 104.4 minutes. Antibiotic administration time and mortality in patients with APACHE scores of 21 or higher (P=0.05) were significantly related; whereas such a relationship was not observed for patients with APACHE scores of 11- 20 (P=0.46). We observed early antibiotic initiation for patients in sepsis phase with higher severity scores was associated with significant improvement in survival rate.