Celal Kati

Climatic and diurnal variation in suicide attempts in the ED

The aim of this study was to determine whether there is a relationship between climatic factors and suicidal behavior. A total of 1,119 suicide attempts were collected from hospital records between 1996 and 2001. A clear seasonal variation was seen in suicide attempts in the 15-24, 25-34, and over 65 age groups in men and in the 15-24, 25-34, and 35-44 age groups in women with peaks in the spring and summer. Suicide attempts were more frequent between the hours of 6:00-9:00 pm in males and 3:00-6:00 pm in females. People attempting suicide who have depression, anxiety, or a psychotic disorder usually attempt suicide in the summer. Whereas the monthly averages of humidity, ambient temperature, duration and intensity of sunlight were positively correlated with the number of monthly suicide attempts, cloudiness and atmospheric pressure were negatively correlated. In conclusion, we must keep in mind that suicides and suicide attempts are not only the effect of climatic changes and that the most important component is the individuals ability to deal with conflicts.

The role of S100B protein, neuron-specific enolase, and glial fibrillary acidic protein in the evaluation of hypoxic brain injury in acute carbon monoxide poisoning

The main purpose of this study was to assess the role of S100B protein, neuron-specific enolase (NSE), and glial fibrillary acidic protein (GFAP) in the evaluation of hypoxic brain injury in acute carbon monoxide (CO)-poisoned patients. This cross-sectional study was conducted among the patients with acute CO poisoning who referred to the emergency department in a 1-year period. Serum levels of S100B protein, NSE, and GFAP were determined on admission. A total of 55 CO-poisoned patients (mean age ± standard deviation, 45 ± 20.3 years; 60% women) were included in the study. The control group consisted of 25 healthy adults. The patients were divided into two groups according to whether they were conscious or unconscious. The serum levels of S100B, NSE, and GFAP were higher in patients than that in the control group. There was no significant difference between unconscious and conscious patients with respect to these markers. There was a statistically significant difference between the conscious and unconscious patients and the control group in terms of S100B and NSE levels. There was also a statistically significant difference between the unconscious patients and the control group in terms of GFAP levels. Increased serum S100B, NSE, and GFAP levels are associated with acute CO poisoning. These biomarkers can be useful in assessing the clinical status of patients with CO poisoning.

Serum prolidase enzyme activity and oxidative stress levels in patients with acute hemorrhagic stroke

Abstract Background. It has been indicated that oxidative damage contributes to secondary brain injury in both ischemic and hemorrhagic stroke patients. Collagen is a major component of the extracellular matrix, and prolidase plays a role in collagen synthesis. The aim of this study was to evaluate the serum prolidase activity, nitric oxide (NO) levels, total antioxidant capacity (TAC) and total oxidant status (TOS) in patients with acute hemorrhagic stroke. Methods. Twenty-five patients with acute hemorrhagic stroke and 25 controls were enrolled. Serum prolidase activity, catalase activity, NO levels, TAC and TOS were measured spectrophotometrically. Oxidative stress index (OSI) was calculated. Results. Serum TAC levels and catalase activity were significantly lower in acute hemorrhagic stroke patients than controls (both, p < 0.001), while NO levels, TOS levels, OSI values and prolidase activity were significantly higher (all, p < 0.01). When patients with acute hemorrhagic stroke were divided according to gender, no differences were observed between females and males in respect to serum prolidase enzyme activity, NO levels, TAC levels, TOS levels and OSI values (all, p > 0.05). Conclusions. Findings from the study suggest an association between increased oxidative stress levels, decreased antioxidant levels and increased prolidase enzyme activity in patients with acute hemorrhagic stroke compared with controls. More studies are needed to elucidate mechanistic pathways on oxidative stress in patients with acute hemorrhagic stroke.

Has admission blood pressure any prognostic value in patients with subarachnoid hemorrhage: an emergency department experience.

Hypertension is a well‐known risk factor for the development and rupture of cerebral aneurysms. The authors conducted a study to investigate the prognostic value of admission blood pressure (BP) on prognosis in patients with subarachnoid hemorrhage (SAH). Two hundred patients with SAH were divided into two groups according to Hunt Hess score (good prognosis: 1 to 3, and poor prognosis: 4 and 5) and according to death in hospital (surveyed and died). The prognostic factors of SAH and BP changes according to Hunt Hess scores in the acute stages of the event were evaluated. Admission mean arterial BP values of the patients who died in hospital were significantly lower than in the patients who were surveyed (P=.026). The admission mean arterial BP values were found to be lower in the poor prognostic patients (Hunt Hess score of 4 and 5) (P<.001). Decreased admission BP values were found to be associated with poor prognosis and mortality.

The evaluation of different treatment protocols for trauma-induced lung injury in rats

BACKGROUND Lung contusion is an important factor that affects mortality and morbidity of lung injury after blunt chest trauma (BCT). The present study aims to evaluate the effectiveness of different treatment regimens on BCT-induced lung injury. METHODS A total of 35 Sprague Dawley rats were divided into five experimental groups (n=7): sham, control; BCT; BCT + MP, BCT group treated with methylprednisolone (MP; 30 mg/kg on first day and 3 mg/kg/d on the following days); BCT + Q, BCT group treated with quercetin (Q; 50 mg/kg/d for seven days); and BCT + MP + Q, BCT group treated with the same doses of MP and Q. Serum Clara Cell Protein-16 (CC-16), thiobarbituric acid reactive substances (TBARS), and superoxide dismutase (SOD) levels were analyzed to determine histopathological changes in the lung tissues. RESULTS Elevated serum CC-16 and TBARS levels and reduced serum SOD levels were found in the BCT group compared to the Sham group. There was a significant change in the serum CC-16 levels in the BCT + MP group compared to the Sham group. Serum TBARS levels were significantly lower in the BCT + MP and BCT + Q group compared to the BCT group. The combined therapy regimen yielded significantly decreased CC-16 levels and increased serum SOD levels compared to the individual treatment groups. Serum TBARS levels did not significantly differ between the BCT + MP + Q group and the other treatment groups. Compared to the BCT + MP + Q group, the BCT + MP group showed significantly lower alveolar edema (AED) and alveolar exudate (AEX) scores, while the BCT + Q group showed significantly lower peribronchial inflammatory cell infiltration (PICI) and AED scores. CONCLUSIONS The combined usage of quercetin and low dose MP treatment after initial high dose MP at the early stage of lung injury after BCT is more effective.

Cerebral fat embolism syndrome after long bone fracture due to gunshot injury.

Cerebral fat embolism syndrome is a lethal complication of long-bone fractures and clinically manifasted with respiratory distress, altered mental status, and petechial rash. We presented a 20-year-old male admitted with gun-shot wounds to his left leg. Twenty-four hours after the event, he had generalized tonic clonic seizures, decorticate posture and a Glascow Coma Scale of seven with localization of painful stimuli. Subsequent magnetic resonance imaging of the brain showed a star-field pattern defining multiple lesions of restricted diffusion. On a 4-week follow-up, he had returned to normal neurological function. Despite the severity of the neurological condition upon initial presentation, the case cerebral fat embolism illustrates that, cerebral dysfunction associated with cerebral fat embolism illustrates reversible.

Role of ischemia-modified albumin in clinical practice

Abstract Difficulty in establishing a diagnosis of acute coronary syndrome (ACS) in the clinical setting has led researchers to investigate novel markers that show increased blood levels before the myocardial necrosis occurs. In ischemic conditions, some modifications occur in the amino acids located on the N-terminus of the human albumin molecule. Ischemia-modified albumin (IMA) is a marker formed after damage in the N-terminal region of albumin. The altered N-terminus can no longer bind transition metals, such as cobalt. The causes of the increases in IMA have been shown to be endothelial or extracellular hypoxia, acidosis, and free oxygen radicals. IMA, an early marker of ischemic disorders, is also a candidate marker for the detection of ACS. An assay measuring IMA might represent a promising marker for the identification of patients with myocardial ischemia. The aim of this study was to evaluate the clinical utility of IMA in the assessment of ACS as well as other medical disorders in light of the recent literature.

Acetaminophen intoxication is associated with decreased serum paraoxonase and arylesterase activities and increased lipid hydroperoxide levels

Background: Acetaminophen is at present one of the most commonly used analgesics and antipyretics. Recent evidence has suggested that oxidative stress is involved in the mechanism of acetaminophen intoxication. Paraoxonase-1 (PON1) plays an important role as an endogenous free-radical scavenging molecule. The aim of this study was to evaluate the influence of serum PON1 activity and oxidative stress in patients with acetaminophen intoxication. Methods: A total of 20 patients with acetaminophen intoxication and 25 healthy controls were enrolled. Serum total antioxidant capacity (TAC), lipid hydroperoxide (LOOH) levels, and paraoxonase and arylesterase activities were measured spectrophotometrically. Results: The serum TAC levels and the paraoxonase and arylesterase activities were significantly lower in patients with acetaminophen intoxication compared with controls (all, p < 0.001), while the serum LOOH levels were significantly higher (p < 0.001). Conclusions: Our results suggest that decreased PON1 activity seems to be associated with increased oxidative stress in patients with acetaminophen intoxication. Measuring serum PON1 activity may be useful in assessing the development of toxicity risk in acetaminophen toxicity. It would be useful to recommend vitamins with antioxidant effects such as vitamins C and E along with medical treatments.

Three-Year Experience in the Emergency Department: The Emergency Department Approach to the Patients with Spinal Trauma and Prognosis

BACKGROUND Spinal cord injuries result in critical pecuniary and/or non-pecuniary losses due to the developing neurological problems. The objective of this study was to evaluate spinal injuries in terms of clinical severity and prognosis. Spinal injuries lead to serious clinical results due to the high rates of morbidity and mortality; however, there is a lack of reliable information on spinal injuries in our country. METHODS Following the approval of the Faculty Ethics Committee, this retrospective study was conducted on 91 patients aged ?18 (59 male, 32 female) with spinal trauma who were admitted to the Emergency Department of Ondokuz Mayis University over three years. The patients were assessed in terms of demographics, clinical severity, developing complications, and mortality. RESULTS Forty-three patients had complete injuries, while 48 had incomplete injuries. Forty-six patients suffered spinal injuries due to fall from height, 35 patients due to traffic accidents, and 10 patients due to other reasons. Several complications were observed in 52 patients, while no complication occurred in 39 patients. We determined that 19 of 92 patients involved in this study died, while 72 were discharged from the hospital. CONCLUSION Spinal cord injuries generally result in unfavorable clinical results. Therefore, an appropriate approach (early diagnosis and true treatment) in emergency services has great significance.

Spontaneous Pneumomediastinum: Coexistence of Shortness of Breath and Hoarseness

DOI: 10.4328/JCAM.1241 Received: 05.08.2012 Accepted: 31.08.2012 Published Online: 31.08.2012 Corresponding Author: Hizir Ufuk Akdemir, Ondokuz Mayis Universitesi, Tip Fakultesi, Acil Tip AD, Samsun, Turkiye. T.: +905323331743 F.: +90 3624576041 E-Mail: hufukakdemir@hotmail.com Ozet Pnomomediastinum (PM) mediasten icinde hava bulunmasidir. Spontan pnomomediastinum (SPM) ise oldukca nadir gorulen, farkli klinik belirtilerle ortaya cikabilen iyi huylu ve genellikle kendisini sinirlayan bir durumdur. Bu olguda sunulan hastadaki gibi, nefes darligi ve ses kisikligi gibi nonspesifik bir takim sikayetlerle ortaya cikabilir. Spontan pnomomediastinum suphesi olan olgularin tanisi icin dikkatli bir fizik muayene ve radyolojik degerlendirme cok onemlidir. Hastalarin olasi komplikasyonlar acisindan yakin takibi gerekir.