The Anti-Apoptotic Effect of Ranolazine on Cerebral Protection during Cardiopulmonary Bypass and Carotid Artery Surgery.

Background: We aimed to determine the usability of ranolazine (Rn) as a neuroprotective during cardiac surgeries and carotid artery interventions where cerebral blood flow is interrupted. Methods: Female Wistar albino rats were used. The rats were divided into 4 groups of 8 rats each. The first group (Group 1) was the control group. Group 2 underwent ischemia induction but was not treated with Rn. Group 3 received 25 mg/kg/day and Group 4 50 mg/kg/day Rn intraperitoneally, starting 3 days before ischemia induction. Bilateral carotid arteries were explored and clamped simultaneously. Ischemia was induced for 15 minutes. After 72 hours, the experimental animals were sacrificed. Results: Superoxide dismutase, alkaline phosphatase, and interleukin 6 levels were similar among the 4 groups. Acetylcholine esterase (Group 3: p = 0.007, Group 4: p = 0.002), tumor necrosis factor-alpha (Group 4: p = 0.01), and annexin V (Group 3: p = 0.001) levels were statistically significantly lower in the Rn-treated groups. Malondialdehyde (Group 3: p = 0.003, Group 4: p = 0.009), reduced glutathione (Group 4: p = 0.04), acid phosphatase (Group 3: p = 0.04), noradrenaline (Group 3: p = 0.01), and Bcl-2 (Group 4: p = 0.004) levels were significantly higher in the Rn-treated groups. Conclusions: The results of this study demonstrated the antiapoptotic effect of Rn in a brain ischemia-reperfusion model of rats receiving Rn before the procedure.

Treatment of Aortic and Iliac Artery Aneurysms with Multilayer Flow Modulator: Single Centre Experiences.

OBJECTIVE: Presenting early and midterm results of aortic and iliac artery aneurysms treated with Multilayer Flow Modulators (MFM). METHODS: We retrospectively reviewed the medical records of 23 patients (19 males and 4 females) who are admitted to our clinic between April of 2014 and February of 2016, diagnosed with thoracoabdominal aortic aneurysm and/or iliac aneurysm, and treated using MFM. The patients were followed up for the development of potential clinical presentations for 12 months. RESULTS: MFM implantation was successfully completed in all the patients. During the process, two patients developed endoleak and so they were treated with postdilatation that was performed through balloon intervention, whereby the patients fully recovered. Although a short-term ischemic cerebrovascular event occurred in one of the patients 36 hours after the MFM, the patient recuperated without any noticeable neurological sequelae. Overall, three patients died after the procedure, one of whom died in hospital three days following the intervention due to acute renal failure, while the second one lost his life at the end of the first month due to the occlusion of superior mesenteric and celiac arteries. The third patient died at the end of the third month due to acute myocardial infarction. The rest of the patients developed no complications or had no mortality at their 12-month follow-ups. CONCLUSION: MFM can be preferred as an alternative approach in the treatment of aorta and iliac artery aneurysms including major lateral branches. The present results should be confirmed with additional future studies conducted with larger patient groups for longer periods.

Giant J (Osborn) Wave due to Bonsai Abuse: Comments on Clinical Practice.

BACKGROUND: Osborn wave, typically associated with hypothermia, is currently referred to as one of the J wave syndromes due to its clinical potential to develop lethal cardiac arrhythmia; it may rarely be observed in a non-hypothermic setting such as cannabis abuse. CASE REPORT: In this paper, we presented two young cases who presented to the emergency services with unconsciousness, drowsiness, and hypoxia, and also J wave on electrocardiography (ECG) due to Bonsai abuse. CONCLUSION: Osborn wave may be a significant criterion to initiate close monitoring in a coronary care unit, with supportive treatment and mechanical ventilation as necessary in those patients who abuse Bonsai.

Hot-press hand injury caused by roller type ironing machine.

Thermal crush burn injury due to roller type ironing press machine is relatively rare and can cause destructive effects with significant morbidity. These injuries can be avoided by taking some basic precautions. Early debridement after admission and definitive treatment after the extent of injury are delineated and these are the preferred approaches in the management. We present a case of thermal crush injury of the hand caused by laundry roller type ironing press machine.

Serum neuron-specific enolase and S-100ß levels as prognostic follow-up markers for oxygen administered carbon monoxide intoxication cases.

Serum neuron-specific enolase (NSE) and S-100ß levels are considered novel biochemical markers of neuronal cell injury. In this study, the initial and post-treatment levels of NSE and S-100ß were compared in carbon monoxide (CO) poisoning patients, who received normorbaric oxygen (NBO) or hyperbaric oxygen (HBO) therapy. Forty consecutive patients with acute CO poisoning were enrolled in this prospective, observational study. According to their clinical symptoms and observations, twenty patients were treated with NBO, and the other twenty with HBO. Serum S-100ß and NSE levels were measured both at time of admission and 6 h later (post-treatment). Serum NSE and S-100ß values decreased significantly in both of the therapeutic modalities. The initial and post-treatment values of NSE and S-100ß in NBO or HBO patients were comparable. A clear negative correlation was observed between the decrease of NSE and S-100ß levels and initial blood carboxyhemoglobin levels. In conclusion, the present results suggested the use of serum S-100ß and NSE levels as indicators for brain injury. Due to the significant increase of their values with oxygen therapy, they may also be useful as prognostic follow-up markers. However, the current findings reflected no difference between the efficacy of NBO or HBO therapy.

Neopterin, homocysteine, and ADMA levels during and after urticaria attack.

BACKGROUND/AIM: Urticaria is a vascular skin reaction characterized with papules and plaques. Neopterin is accepted as an immunologic marker and an indicator of activation of the immune system. Homocysteine and asymmetric dimethylarginine (ADMA) are the markers of increased vascular resistance. Alteration in vascular resistance has a role in the pathogenesis of urticaria. We aimed to investigate whether there is a relationship between urticaria and neopterin, homocysteine, or ADMA. MATERIALS AND METHODS: The study is designed as a prospective descriptive study and patients with a diagnosis of urticaria in the emergency department were included in the study. Demographic data and characteristics of the disease were recorded. Neopterin, homocysteine, and ADMA levels were measured both during and after urticaria attacks. All data were statistically analyzed. RESULTS: The differences between neopterin levels measured during and after urticaria attacks were statistically significant (P < 0.001). The differences between homocysteine and ADMA levels measured during and after urticaria attacks were not statistically significant (P > 0.05). CONCLUSION: Our results indicate that neopterin levels in patients with urticaria attacks are increased and the level of neopterin is also a useful parameter in acute urticaria. Further studies should clarify whether homocysteine levels contribute to diagnosis of acute urticaria. However, no relation was found between ADMA and urticaria.

Carbon monoxide poisoning increases Tpeak-Tend dispersion and QTc dispersion.

OBJECTIVES: Carbon monoxide (CO) poisoning leads to cardiac dysrhythmia. Increased heterogeneity in ventricular repolarisation on electrocardiogram (ECG) shows an increased risk of arrhythmia. A number of parameters are used to evaluate ventricular repolarisation heterogeneity on ECG. The aim of our study is to investigate the effect of acute CO poisoning on indirect parameters of ventricular repolarisation on ECG. METHODS: Sixty-seven patients were included in this case-control study. Thirty patients with acute CO poisoning were assigned to group 1 (19 females, mean age: 30.8 ± 11.3 years). A control group was formed with patients without known cardiac disease (group 2, n = 37; 25 females, mean age: 26.0 ± 5.2 years). Twelve-lead ECG and serum electrolyte levels were recorded in all patients. Also, carboxyhaemoglobin (COHb) levels were recorded in group 1. Tpeak-Tend (TpTe) interval, TpTe dispersion, TpTe/QT ratio, QT interval and QTd durations were measured as parameters of ventricular repolarisation. Corrected QT (QTc ) and QTc dispersion (QTcd) intervals were determined with the Bazett's formula. RESULTS: The mean COHb level in group 1 was 27.6 ± 7.4% and mean duration of CO exposure was 163.5 ± 110.9 min. No statistically significant difference was found in age, gender, serum electrolytes or blood pressure levels between the groups. QRS, QT, QTc, TpTe interval and TpTe/QT ratio were similar between the groups (p > 0.05). QTcd (65.7 ± 64.4 vs 42.1 ± 14.2 ms, p = 0.003) and TpTe dispersion (40.5 ± 14.8 vs 33.2 ± 4.9 ms, p = 0.006) were significantly longer in group 1 than group 2. COHb level was moderately correlated with TpTe dispersion (r = 0.29; p = 0.01). CONCLUSION: To our knowledge, this is the first study to investigate TpTe interval and dispersion in CO poisoning. Our results showed that TpTe dispersion and QTc dispersion increased after CO poisoning.

Effectiveness of hyperbaric oxygen and ozone applications in tissue healing in generated soft tissue trauma model in rats: an experimental study.

BACKGROUND: Soft tissue trauma is a type of acute traumatic ischemia. We investigated in this study whether the edema, inflammation and ischemia caused by the trauma could be affected positively by hyperbaric oxygen (HBO) and ozone therapy. METHODS: Soft tissue trauma was generated in a total of 63 adult male Sprague-Dawley rats. Subsequently, rats were divided into three groups. The first group was treated with ozone, the second group with HBO, and the third group served as controls. Tissue and blood samples were taken at the end of the procedures. Tissue lipid peroxidation (LPO), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), inducible nitric oxide synthase (iNOS), heme oxygenase (HO)-1, and hypoxia-inducible factor (HIF)-1 levels were detected. Hematoxylin-eosin staining was used to determine the inflammation and edema histopathologically. RESULTS: We also detected HIF-1 activity, which decreases when the oxygen concentration increases, HO-1 activity, which has anti-inflammatory effects, and iNOS activity, which releases in any type of acute case. We determined a statistically significant reduction in iNOS and LPO levels in both the HBO and Ozone groups. A significant decrease in inflammation was detected in both the Ozone and HBO groups compared with the Control group, and a significant decrease in edema was detected in all three groups. CONCLUSION: We think that HBO and Ozone therapy have beneficial effects on biochemical and histopathological findings. Related clinical trials will be helpful in clarifying the effects.

Effect of hyperbaric oxygen treatment in a rat model of abdominal aortic aneurysm.

Matrix metalloproteinase (MMP) plays a pivotal role in the pathophysiology of abdominal aortic aneurysms (AAA). Experimental studies have demonstrated that hyperbaric oxygen (HBO2) therapy decreases MMP levels in different tissues. However, the effect of HBO2 therapy on AAA has yet to be investigated. This study aimed to examine the effects of HBO2 on MMPs in an experimental AAA model. The model was implemented with CaCl2 in 12-week-old male Wistar albino rats. The rats were randomized into four groups: Group I: received NaCl (n = 6) (Sham group); Group II: received NaCl and were treated with HBO2 (n = 6); Group III: received CaCl2 (n = 6); and Group IV: received CaCl2 and were treated with HBO2 (n = 6). HBO2 therapy was applied for five of seven days over a period of six weeks. Although in the CaCl2 groups, aortic diameters were significantly higher than the NaCl groups (p < 0.05), there was no difference between pre- and post-HBO2 in the CaCl2 groups (p > 0.05). In the CaCl2 group, the MMP-2 and MMP-9 levels were significantly higher than those in the NaCl group (p < 0.05). HBO2 therapy had no statistically significant effect on the MMP-2 and MMP-9 levels in Groups III and IV. However, it was observed that both levels clearly decreased in Group IV. In conclusion, the study suggested that HBO2 may have favorable effects on MMP levels.

An analysis of firearms-related deaths between 1993-2010: a retrospective study.

BACKGROUND: Firearm injuries (FI) are the most common cause of death among military personnel. In this study, postmortem examination and autopsy records of deaths resulting from firearm injuries recorded in the Department of Forensic Medicine of Gulhane Military Medical Academy between 1993-2010 were examined retrospectively. METHODS: We evaluated the characteristics of 153 firearm deaths accounting for 36.6% of all medical-legal autopsies. The cases included 152 men (99.3%) and 1 woman (0.7%). RESULTS: The mean age of the cases was 23.1 years (±4.7; range, 20-43 years). The manner of death was determined in all cases with 41.8% of cases identified as suicide and 39.9% as homicide. The most common sites of firearm entrance wounds were the head and neck region (n=109, 71.2%), the chest (n=26, 17%), or the abdomen (n=14, 9.2%). The type of firearm was not clear in most cases. CONCLUSION: In conclusion, complete forensic and medical records will facilitate the rapid and accurate conclusion of the legal process and will enhance future retrospective studies.

The implications of the presence of osteomyelitis on outcomes of infected diabetic foot wounds.

AIM: To assess the effect of the presence of osteomyelitis in patients with a diabetic foot infection. METHODS: We reviewed the records of diabetic patients hospitalized at our medical center for a foot infection over a 2-y period. Using clinical, imaging, and microbiology results, we classified each patient as having diabetic foot osteomyelitis (DFO) or not. We then compared several outcome criteria of interest between the 2 groups. RESULTS: Among 73 eligible patients, 37 were in the DFO group (DFO group), while the other 36 were in the soft tissue infection group (STI group). In comparison to the STI group, the DFO group had a significantly longer length of stay (LOS) in the hospital (42 (28.5-51) days vs 19.5 (13.2-29.5) days, p < 0.001), longer duration of antibiotic therapy (46.6 ± 19.9 days vs 22.0 ± 14.6 days, p < 0.001), longer duration of intravenous antibiotic therapy (32.3 ± 16.3 days vs 13.6 ± 14.3 days, p < 0.001), longer duration of wound before admission (44 (31-64.5) days vs 33 (23-45.5) days, p = 0.034), and longer time to wound healing (239.8 ± 108.2 days vs 183.1 ± 73 days, p = 0.011). There were more surgical procedures in the DFO group than in the STI group (24/37 (64.8%) vs 11/36 (30.5%), p = 0.003), and during hospitalization, 22 patients in the DFO group and 5 patients in STI group underwent minor amputation (59.4% vs 13.8%, p < 0.001). CONCLUSION: The presence of osteomyelitis negatively affects both the treatment and outcome of diabetic foot infections.

Comparison of ketamine-low-dose midozolam with midazolam-fentanyl for orthopedic emergencies: a double-blind randomized trial.

OBJECTIVE: Most of the fractures and dislocations are reduced in the emergency setting. Many drugs are available for procedural sedation and analgesia in the emergency department (ED); however, the adverse effects are still a common problem. The aim of our study was to compare the 2 drug combinations. METHOD: We performed a prospective, randomized, double-blinded, placebo-controlled trial of patients presenting to the ED after a traumatic event and required urgent reduction either for a fracture or dislocation. Patients were randomized to midazolam-fentanyl (MF) group or ketamine-low-dose midazolam (KM) group. Hypoxia, duration of hypoxia, need for oxygen, time to onset of sedation, recovery time, pain scores during reduction, and sedation depth were set as primary outcome measures and were recorded. RESULTS: A total of 498 patients who presented to ED with extremity injury and required closed reduction were assessed; 130 of them were approached for eligibility and 69 patients were excluded. The remaining 61 patients were randomized to either KM group (n = 31) or MF group (n = 30). Hypoxia and duration of hypoxia were significantly lower in the KM group compared with the MF group. Patients in the KM group reported significantly lower pain scores during reduction; however, adverse effects were higher compared with MF group. CONCLUSION: Both drug combinations can be effectively used for procedural sedation and analgesia; however, with lower risk for hypoxia and lower pain scores, KM combination stands as a reasonable choice for orthopedic interventions in the emergency unit.

Transoral ultrasonography in the diagnosis and treatment of peritonsillar abscess.

PURPOSE: To evaluate the contribution of transoral ultrasonography (TUS) in the diagnosis and treatment of peritonsillar abscess. METHODS: We assessed the records of the patients who underwent TUS for suspected peritonsillar abscess. RESULTS: We identified a total of 26 patients with a prediagnosis of peritonsillar abscess. Following TUS examination, while the diagnosis was confirmed for 23 of the 26 patients (88.46%), the remaining 3 (11.53%) were diagnosed as having peritonsillar cellulitis. CONCLUSION: TUS allows the differentiation of peritonsillar abscess from cellulitis, hence to avoid an unnecessary invasive procedure in the case of a peritonsillar cellulitis.