Ali Aygun

Examination using LC-MS/MS determination of grayanotoxin levels in blood, urine, and honey consumed by patients presenting to the emergency department with mad honey intoxication and relations with clinical data: a preliminary study.

BACKGROUND AND OBJECTIVE Intoxications related to ”mad honey” are frequently encountered in the Black Sea region of Turkey. Intoxication is established on the basis of whether honey was consumed when history was taken at presentation. The search for a simple and reliable method for showing the grayanotoxins (GTXs) in mad honey in body fluids and in honey consumed by patients is still at the research stage. The purpose of this preliminary study was to investigate GTX levels in blood, urine, and honey consumed by patients with mad honey intoxication and to determine whether there is an association with clinical status. DESIGN AND SETTINGS This descrptive study was conducted at the department of Emergency Medicine of Karadeniz Technical University Medical Faculty in Turkey. Mad honey, blood, and urine samples were obtained from patients between September 2013 and October 2014. METHODS Four cases presenting the Department of Emergency Medicine and diagnosed with mad honey intoxication were included in the study. GTX levels in blood, urine, and honey consumed by patients were determined using liquid chromatography–tandem mass spectrometry. RESULTS Patients’ mean blood GTX I level was 30.62 ng/mL, GTX III level 4.917 ng/mL, urine GTX I level 0.447 mg/mL, and GTX III level 1.998 mg/mL. The mean GTX I level in the honey samples consumed was 4.683 mg/g and GTX III level 8.423 mg/g. CONCLUSION The present study is unique in representing the first time that GTXs have been determined in human body fluids. There is now an urgent need for a large series of studies to provide statistical evidence whether there is a relationship between levels of toxins in human body fluids and clinical picture.

The diagnostic value of serum pentraxin 3 levels in pulmonary contusion

Purpose: To investigate the difference in pentraxin 3 (PTX 3) levels between patients with pulmonary contusion and healthy volunteers. Materials and methods: This study was conducted with a group of 20 trauma patients diagnosed with pulmonary contusion and 30 healthy individuals enrolled as a control group in a tertiary university hospital. Results: Median PTX 3 levels were 7.05 (3.29–13.1), ng/ml in the contusion group and 1.03 (0.7–1.58) ng/ml in the control group. PTX 3 titers were significantly higher in patients with pulmonary contusion compared to those of the control group (p < 0.001). An area under the curve (AUC) value of 0.968 investigated using ROC analysis to determine the diagnostic value of the PTX‐3 in pulmonary contusion patients was measured. A PTX‐3 cut‐off value of 2.06 produced 95.5% sensitivity and 86.7% specificity. Conclusion: PTX 3 levels in pulmonary contusion increased significantly compared to the healthy control group. If supported by wider series, PTX 3 may be expected to be capable of use as a marker in pulmonary contusion.

A retrospective analysis of nebulized versus intravenous fentanyl for renal colic

Study objective: To assess the effectiveness of nebulized fentanyl used for analgesia in renal colic. Materials/methods: This research was planned as a randomized, blinded study in which prospectively collected data were analyzed retrospectively to compare nebulized and intravenous (iv) fentanyl therapies. Patients with renal colic with ‘moderate’ or worse pain on a four‐point verbal pain score (VPS) or with pain of 20 mm or above on a 100‐mm visual analogue score (VAS) at time of presentation were randomized into iv fentanyl (n = 62) or nebulized fentanyl (n = 53) study groups. Decreases in VAS and VPS scores at 15 and 30 min compared to baseline, rescue analgesia requirements and side‐effects between the groups were compared. Results: Both iv fentanyl and nebulized fentanyl provided effective analgesia in renal colic patients at the end of 30 min. However, iv fentanyl provided more rapid and more effective analgesia than nebulized fentanyl. Patients receiving iv fentanyl had lower rescue analgesia requirements than those receiving nebulized fentanyl (37.1% vs 54.7%), although the difference was not statistically significant (p = 0.058). In addition, side‐effects were more common in the iv fentanyl group compared to the nebulized fentanyl group (22.1% vs 9.4%), although the difference was also not significant (p = 0.058). Conclusion: Nebulized fentanyl provides effective analgesia in patients with renal colic. However, iv fentanyl exhibits more rapid and more powerful analgesic effects than nebulized fentanyl. Nonetheless, due to its ease of use and few potential risks and side‐effects the nebulized form can be used as an alternative in renal colic.

Analysis of patients presenting to the emergency department with carbon monoxide intoxication

Objectives Carbon monoxide is a potentially fatal form of poisoning. The exact incidence is unclear, due to cases being undiagnosed or reported as fewer than the real number. Hyperbaric oxygen therapy (HBOT) is of proven efficacy in the treatment of CO intoxication. The purpose of this study was to describe the general characteristics of carbon monoxide (CO) intoxications presenting to the emergency department and to investigate troponin I values and the effectiveness of hyperbaric oxygen therapy (HBOT) in these patients. Material and methods Patients presenting to the emergency department with CO intoxication over one year and patients with such intoxications receiving HBOT were examined retrospectively. Results One hundred seventy-one patients were included; 140 (81.9%) were poisoned by stoves, 18 (10.5%) by hot water boilers and 10 in (5.8%) by fires. COHb levels were normal in 49 of the 163 patients whose values were investigated, and were elevated in 114 patients. Mean COHb value was 16.6. Troponin I values were investigated in 112 patients. These were normal in 86 patients and elevated in 26. Mean troponin I value was 0.38 ng/ml. One hundred twenty-three of the 171 patients in the study were discharged in a healthy condition after receiving normobaric oxygen therapy, while 48 patients received HBOT. Forty-two (87.5%) of the patients receiving HBOT were discharged in a healthy condition while sequelae persisted in five (10.4%). One patient died after 15 session of HBOT. Conclusion Although elevated carboxyhemoglobin confirms diagnosis of CO intoxication, normal levels do not exclude it. Troponin I levels may rise in CO intoxication. No significant relation was observed between carboxyhemoglobin and receipt of HBOT. A significant correlation was seen, however, between troponin I levels and receipt of HBOT.

Diagnostic Value of Plasma Pentraxin-3 in Acute Appendicitis

ABSTRACT Purpose: To measure serum PTX3 levels in patients admitted with right lower quadrant pain to emergency department and to investigate whether this parameter will be helpful for the diagnosis of acute appendicitis. Materials and methods: This study was conducted with a group of 89 patients over 17 years of age who were admitted with the complaint of right lower quadrant pain to ED and had a preliminary diagnosis of acute appendicitis clinically and the control group of 31 healthy volunteers in a tertiary university hospital for 3 months. Results: Median PTX3 levels were 3.28 (1.08-30.24) ng/mL in the acute appendicitis groups and 0.97 (0.34-2.62) ng/mL in the control group. A significant difference was observed between acute appendicitis groups and the control group (p < 0.05). Conclusion: PTX3 was found to be significantly higher in patient with acute appendicitis compared to the control group and the patients with non-specific abdominal pain. PTX3 can be used as an aid in the diagnosis of acute appendicitis.

Trauma-associated bleeding from the bilateral internal iliac arteries resolved with angiographic embolization

Pelvic fracture is associated with high mortality. The management of major pelvic injuries remains one of the most important issues in modern trauma care. A 39-year-old male patient presented at the emergency department after being hit with a 500 kg load. His general condition was average with unstable vital signs. Pelvic tomography revealed fractured bone structure, thickening secondary to hematoma in both iliopsoas muscles, and hemorrhage-related active extravasation in the left internal iliac trace. The patients hemodynamics worsened despite fluid and blood replacement, and angiographic embolization was scheduled. Bilateral embolization of the iliac artery was performed. Control angiography confirmed that full embolization was established. The patient was monitored in intensive care, but expired after three days due to acute kidney failure, disseminated intravascular coagulation, and multi-organ failure. Angiographic embolization is a technique improves hemorrhage control in pelvic trauma but can also increase risk of complications such as ischemia and necrosis.

A case of late diagnosis of chronic subdural hematoma following spinal anesthesia

Intracranial subdural hematoma developing following spinal anesthesia is a rare but serious complication. We describe a case of subdural hematoma developing following spinal anesthesia and diagnosed late. A female patient receiving spinal anesthesia for cesarean delivery 45 days prior to arrival at the emergency department presented to our hospital with non-severe headache persisting for 45 days after discharge. Computerized tomography (CT) of the brain performed due to long-term persisting headache resistant to medical treatment and a history of spinal intervention revealed a hypodense chronic subdural hematoma in the left frontoparietal area and a shift from left to right in midline structures. The patient was operated and discharged without sequelae on the 7th day postoperatively. Care must be taken over subdural hematoma in the presence of headache after spinal anesthesia persisting despite fluid intake and medical treatment and exceeding 48 h in duration, and diagnosis must not be delayed.