Arzu Denizbasi

Adrenomedullin reduces the severity of cerulein-induced acute pancreatitis.

We investigated the effect of Adrenomedullin (AM) on cerulein-induced acute pancreatitis in rats. AM treatment (100 ng/kg per rat, subcutaneous) after one hour of cerulein injection reduced the plasma amylase levels, pancreatic weight, pancreatic malondialdehyde (MDA) levels, and the severity of the lesions microscopically. These data suggest that AM has a protective effect on cerulein-induced acute pancreatitis. These could be due to anti-inflammatory properties of AM, inhibition of proinflammatory cytokine secretion, reducing the endothelial permeability increased by reactive oxygen species, endotoxins or cytokines.

Effects of recombinant human granulocyte colony-stimulating factor (filgrastim) on ECG parameters in neutropenic patients: a single-centre, prospective study.

AbstractBackground and objective: Human granulocyte colony-stimulating factor (G-CSF) is a haematopoietic hormone that promotes the growth, proliferation, differentiation and maturation of neutrophil precursors. Filgrastim is a recombinant human G-CSF. Myocardial infarction, atrial fibrillation and arrhythmia have been reported in several patients with malignancy receiving filgrastim, but a causal relationship with the drug has not been established. The purpose of this study was to investigate the changes in ECG parameters in neutropenic patients during treatment with filgrastim. Methods: This was a single-centre, prospective study carried out in a hospital emergency room. Patients with neutropenia and malignancy who were required to receive filgrastim were eligible for the study. After a reference ECG had been obtained, filgrastim was administered to all patients at a dose of 5 µg/kg/day subcutaneously for 2 days. Follow-up ECGs were then obtained at 12-hourly intervals. Continuous telemetric monitoring was conducted throughout hospitalization. Results: Serial ECG parameters were compared in 102 patients. There were no statistically significant differences between baseline and follow-up ECG measurements of rhythm, P-wave duration, PR interval, QRS-wave duration, corrected QT (QTc) interval, ECG axis, premature supraventricular events, ventricular arrhythmia, R-wave progression, right bundle branch block or left bundle branch block. There was a significant reduction in mean heart rate in subsequent ECGs compared with baseline (p≪0.05). Conclusion: This study did not demonstrate any ECG changes other than a significant reduction in mean heart rate in this selected population of neutropenic patients given 2 days’ treatment with subcutaneous 5 µg/kg/day of filgrastim.

The effects of adrenomedullin in traumatic brain injury.

Traumatic brain injury (TBI) is a common cause of death and disability throughout the world. A multifunctional peptide adrenomedullin (AM) has protective effects in the central nervous system. We evaluated AM in an animal model as a therapeutic agent that reduces brain damage after traumatic brain injury. A total of 36 rats was divided into 3 groups as sham, head trauma plus intraperitoneal (ip) saline, and head trauma plus adrenomedullin ip. The diffuse brain injury model of Marmarou et al. was used. Blood samples were taken from all groups at the 1st, 6th and 24th hours for analysis of TNF-α (tumor necrosis factor-α), IL-1β (interleukin-1β) and IL-6 (interleukin-6) levels. At the end of the study (at the 24th hour) a neurological examination was performed and half of the rats were decapitated to obtain blood and tissue samples, the other half were perfused transcardiacally for studying the histopathology of the brain tissue. There were no statistically significant changes in plasma levels of IL-1β, IL-6 and TNF-α relative to the sham group. Also, changes in tissue levels of malonedialdehyde, myeloperoxidase and glutathione were not statistically significant. However, neurological scores and histopathological examinations revealed healing. AM individually exerts neuroprotective effects in animal models of acute brain injury. But the mechanisms of action remain to be assessed.

Carbamazepine overdose after exposure to simethicone: a case report

IntroductionCarbamazepine is an anticonvulsant drug and is also used as a treatment for patients with manic-depressive illness, post-herpetic neuralgia or phantom limb pain. The drug itself has many drug interactions. Simethicone is an antifoaming agent and is reported to be an inert material with no known drug interaction with carbamazepine.Case presentationWe present a case of a patient who was routinely using carbamazepine 400 mg three times per day and levetiracetam 500 mg twice daily, and experienced carbamazepine overdose after exposure to simethicone. After cessation of simethicone therapy normal drug levels of carbamazepine were obtained again with the standard dose of the drug. The mechanism of interaction is unknown but the risk of overdose should be considered when prescribing simethicone to a patient who is using carbamazepine.ConclusionSimethicone and carbamazepine, when taken together, may be a cause of carbamazepine toxicity. The risk of carbamazepine overdose should be considered when prescribing simethicone to a patient who is using carbamazepine.

Assessment of ventricular wall motion with focused echocardiography during cardiac arrest to predict survival

Objectives Our primary goal is to investigate the hypothesis that in patients with a detectable ventricular wall motion (VWM) in cardiac ultrasonography (US) during cardiopulmonary resuscitation (CPR), survival rate is significantly more than in patients without VWM in US. Material and methods In our prospective, single center study, 129 adult cardiac arrest (CA) patients were enrolled. Cardiac US according to Focus Assessed Transthoracic Echo (FATE) protocol was performed before CPR. Presence of VWM was recorded on forms along with demographic data, initial rhythm, CA location, presence of return of spontaneous circulation (ROSC) and time until ROSC was obtained. Results 129 patients were included. ROSC was obtained in 56/77 (72.7%) patients with VWM and 3/52 (5.8%) patients without VWM which is statistically significant (p > 0.001). Presence of VWM is 95% (95% CI: 0.95–0.99) sensitive and 70% (95% CI: 0.58–0.80) specific for ROSC. 43/77 (55.8%) patients with VWM and 1 (1.9%) of 52 patients without VWM survived to hospital admission which was statistically significant (p < 0.001). Presence of VWM was 100% (95% CI: 0.87–1.00) sensitive and 54% (95% CI: 0.43–0.64) specific for survival to hospital admission. Conclusion No patient without VWM in US survived to hospital discharge. Only 3 had ROSC in emergency department and only 1 survived to hospital admission. This data suggests no patient without VWM before the onset of CPR survived to hospital discharge and this may be an indication to end resuscitative efforts early in these patients.

Normal values of cervical vertebral measurements according to age and sex in CT

Introduction: Atlantodental interval (ADI), basion‐dental interval (BDI) and the thickness of prevertebral soft tissue (TOPST) measured in lateral cervical radiographs were reported to be useful indicators and indirect signs of underlying cervical spine injuries. However, cervical computed tomography (MDCT) is the first method of imaging used in all trauma patients and upper normal limits (UNLs) of cervical distances according to age and sex are undetermined. Therefore, we aimed to calculate these metrics. Methods: 500 adult trauma patients with cervical MDCT at the time of admission were retrospectively selected. ADI, BDI, and TOPSTs were measured by two blinded researchers. Results: 488 cervical spine CT scans were reported to be normal and 12 has pathological findings. Mean ADI, BDI and TOPST of C1, C2, C6 and C7 were statistically significantly wider in males. In females, ADI and BDI were significantly narrower with the increase in age. In males, only ADI was significantly narrower, and TOPST of C6 and C7 vertebra were significantly wider with the increase in age. We found the optimal UNLs as follows: ADI 2.5 mm, BDI 8.5 mm, C1 6.5 mm, C2 5.7 mm, C3 6.3 mm (6 mm for C1–3 for practical purposes), C4 11.7 and C5–7 17 mm. Discussion: We believe that the increase in distances with age may be affected by the height losses of discs and vertebral bodies, formation of anterior osteophytes and regional kyphosis by age. Those results were compatible with the previous reports.

Heading the ball: a case of a Le Fort II fracture in a football match

Facial injuries can impair a patient’s ability to eat, speak and interact with others. Severe injuries occur as a result of interpersonal or domestic violence, or in motor vehicle collisions, including those involving motorcycles and all-terrain vehicles. The authors present a case of LeFort II fracture caused by a collision of opponents while heading the ball in a football match.

What is the meaning of “temporary” forensic reports for Emergency physicians? Self protection? Bias? Habit?...

Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi, Acil Tıp Kliniği, İstanbul; Toros Devlet Hastanesi, Acil Servis, Mersin; İskenderun Devlet Hastanesi, Acil Servis, Hatay Serkan Emre EROĞLU,1 Sıddıka Nihal TOPRAK,2 Aydın Deniz KARATAŞ,3 Özge ONUR,1 Çiğdem ÖZPOLAT,1 Emre SALÇIN,1 Arzu DENİZBAŞI1 Acil Hekimleri için “Geçici” Adli Raporların Anlamı Nedir? Kendini Koruma? Önyargı? Alışkanlık?...

Earliest electrocardiogram is golden for the diagnosis of Brugada Syndrome

Cardiac syncope can be classified as being either structural or dysrhythmogenic in origin, and it may be the only warning symptom of sudden cardiac death. One of the causes of dysrhythmic sudden cardiac death in young adults with structurally normal hearts is Brugada syndrome. Electrocardiogram (ECG) of Brugada syndrome is characterized by an ST-segment elevation in the right precordial leads. A 23-year-old man was presented to our emergency department (ED) with a history of syncope which has occurred 30 minutes before arrival and lasted for 10 minutes. Both physical and neurological examinations were unremarkable. Family history revealed coronary artery disease of his father and sudden death at 45. Initial ECG performed 3 minutes after his arrival showed a type 2 repolarization variant of Brugada syndrome. This pattern was reverted back to normal 5 minutes later and never showed up again on his future ECGs. In our case, it was only the earliest ECG that made the diagnosis possible since all future ECGs showed a perfectly normal pattern throughout the follow-up period. In all syncope patients, initial ECGs should be kept and filed to be reviewed again in case the primary physician is not competent enough for the evaluation of ECG.

Diagnostic utilities of tracheal ultrasound and USB-endoscope for the confirmation of endotracheal tube placement: A cadaver study

Objectives: Confirmation of the endotracheal tube placement (CoETP) has the utmost importance in the management of an airway. Visualization of tracheal rings or carina with a fiber‐optical bronchoscope (FOB) has considered to be a reliable method for the CoETP. However, FOB is expensive, time‐consuming, and not always practical. Inexpensive endoscopic USB‐cameras were shown to aid intubation successfully and reliably. On the other hand, there have been no studies investigating their use for the CoETP. Tracheal ultrasonography (TUS) is also a new, inexpensive and widely available alternative. A cadaver study has planned to evaluate the diagnostic utility of TUS and a USB‐camera. Methods: This study was conducted in the Anatomy Lab of a University on a fresh frozen female cadaver. Three senior Emergency Physicians have intubated the cadaver, and performed TUS or USB‐endoscopy. We have prepared a randomized intubation list (n = 96) in three blocks (3 times 32) as to include equal number of esophageal and tracheal intubations (48 for each). Each EP is performed all three interventions (intubation, TUS and USB‐endoscopy) in consecutive blocks of 32 intubations, in turn. The position of the tube has been verified from a 2 cm wide ostium on the proximal trachea. Results: In this study, all intubations (n = 96, 100%) were correctly identified as tracheal or esophageal with both TUS and USB‐camera. Both the sensitivity and specificity of TUS and USB‐endoscopy for the CoETP were 100.0%. Conclusion: The perfect accuracy of TUS and USB‐endoscopy, have placed those techniques in a unique position as an alternative in resource‐poor situations.