Evaluation of the thiol disulfide homeostasis in patients with traumatic hemorrhagic shock.

BACKGROUND: Traumatic hemorrhagic shock is a condition associated with a high mortality rate in the absence of timely diagnose and intervention. The class and severity of hemorrhagic shock are the key factors that guide the decisions in the management of these patients. This study aims to provide guidance for the timely administration of an appropriate treatment to patients with traumatic hemorrhagic shock, and thus, decrease morbidity and mortality, by determining shock severity and class more clearly with the use of the thiol disulfide homeostasis balance, which is an objective criterion. METHODS: This controlled, prospective, and clinical study was conducted in the Emergency Medicine Clinic at the University of Health Sciences, Ankara Numune Training and Research Hospital between October 1, 2018 and April 30, 2019. Thiol disulfide homeostasis was assessed in blood collected from patients and healthy volunteers. A total of one hundred two patients were included; of whom 52 were female and male volunteer patients aged 18 or older who presented to the emergency department with traumatic hemorrhagic bleeding and fifty were control subjects. RESULTS: Patient and control groups demonstrated significantly different native thiol, total thiol, disulfide, disulfide/native thiol, and disulfide/total thiol levels (P-values for native thiol, total thiol, disulfide, disulfide/native thiol, and disulfide/total thiol: 0.001>, 0.001>, 0.018, 0.002, and 0.002, respectively). According to pairwise comparisons; Class-3 hemorrhagic shock was associated with significantly lower native thiol and total thiol levels compared to Class-1 and Class-2 hemorrhagic shock (Comparison of Class-1 and Class-3 hemorrhagic shock: p-value for native thiol = 0.001, p-value for total thiol = 0.002) (Comparison of Class-2 and Class-3 hemorrhagic shock: p-value for native thiol = 0.009, p-value for total thiol = 0.006). Total thiol levels were found to be lower in patients who died compared to those who survived (p=0.040). CONCLUSION: Thiol disulfide homeostasis data were found to be correlated with the shock class and mortality. The assessment of thiol disulfide homeostasis can serve as a guide in the determination of the severity and classification of the disease, evaluation of the prognosis, and management of the treatment in traumatic hemorrhagic shock patients.

Bedside measurement of the optic nerve sheath diameter with ultrasound in cerebrovascular disorders

Background/aim: We aimed to show the role of determination of optic nerve sheath diameter (ONSD) by bedside ultrasonography in an emergency department in the diagnosis of cerebrovascular disorders and its correlation with the clinical picture. Materials and methods: This prospective cross-sectional study included 55 patients with cerebrovascular disorders and 53 controls. Age, sex, ONSD, comorbid disease status, and multidetector computed tomography results of all subjects and application periods and National Institutes of Health Stroke Scale (NIHSS) scores of the patient group were evaluated. Results: The ONSD of the patient and control groups was determined as a median of 5.7 mm and 3.6 mm, respectively. The ONSD of the patient group was determined to be significantly higher than that of the control group (P < 0.05). A positive relationship was determined between NIHSS scores and ONSD values (P < 0.05). The specificity and sensitivity values were determined as 98.1% and 81.8%, respectively, for a cutoff value of 5 mm and as 100% and 72.7%, respectively, for a cutoff value of 6 mm. Conclusion: This study showed that bedside measurement of ONSD is an easy, cheap, and noninvasive method that can be used to support the diagnosis and evaluation of patients with acute stroke.

Antioxidant effects of curcumin in spinal cord injury in rats.

BACKGROUND: This experimental study was performed to investigate the benefit of curcumin via its antioxidant effect on spinal cord injury (SCI) in rats. METHODS: Twenty-four adult Wistar albino rats were randomized into three groups. SCI was performed by the weight-drop model. Group 1 underwent laminectomy followed by SCI and received no medication. Group 2 underwent laminectomy followed by SCI and received curcumin (200 mg/kg/day orally). Group 3 underwent laminectomy followed by SCI and received methylprednisolone (30 mg/kg intraperitoneally). Twenty-four hours later, blood samples were obtained from all rats; serum superoxide dismutase (SOD) and malondialdehyde (MDA) levels were determined, and the obtained results were compared. RESULTS: SOD level in the curcumin group was higher than in the control group (p < 0.000) and methylprednisolone group (p < 0.012). MDA level in the curcumin group was lower than in the control group (p < 0.042). Similarly, the MDA level in the methylprednisolone group was lower than in the control group (p < 0.001). CONCLUSION: The results of the present study show that curcumin effectively protects the spinal cord tissues against oxidative damage.

Our new stethoscope in the emergency department: handheld ultrasound.

BACKGROUND: The concept of Focused Assessment with Ultrasound for Trauma (FAST), which was introduced by Rozycki et al. in 1996, has started a new era in the management of trauma patients. Today, Advanced Trauma Life Support (ATLS) suggests bedside ultrasonography (USG) evaluation of trauma patients. We aimed to investigate the usability and the reliability of handheld ultrasound (Vscan) in determining free fluid during the initial evaluation of trauma patients. METHODS: This was a multi-center, prospective study involving multiple trauma patients who presented to three hospital emergency departments (EDs). FAST was completed using Vscan by an emergency physician and an abdominal USG was performed by a radiologist on all patients. Results of Vscan, abdominal USG and other radiological studies, if performed, were compared. RESULTS: A total of 216 patients were included in the study. Of those, 203 had negative Vscan results, while 13 had positive results. When USG performed by a radiologist was considered as the gold standard, Vscan sensitivity for FAST was 88.9%, specificity was 97.6%, negative predictive value was 99.5%, and positive predictive value was 61.5% in our study. CONCLUSION: Vscan, as the smallest portable imaging device, seems to have a promising future as an indispensable gadget, equal to stethoscopes, in evaluating trauma and other critical patients.