Cem Zeren

Licorice induced hypokalemia, edema, and thrombocytopenia

Licorice originates from the root of Glycyrrhiza glabra, which has a herbal ingredient, glycyrrhizic acid, and has a mineralocorticoid-like effect. Chronic intake of licorice induces a syndrome similar to that found in primary hyperaldosteronism. Excessive intake of licorice may cause a hypermineralocorticoidism-like syndrome characterized by sodium and water retention, hypertension, hypokalemia, metabolic alkalosis, low-renin activity, and hypoaldosteronism. In this case report, an association of hypokalemia, edema, and thrombocytopenia that is developed due to the excessive intake of licorice is presented. There are case reports in the literature, which suggest that toxicity findings may emerge with hyperaldosteronism-like manifestations such as hypokalemia, edema, and hypertension. However, any knowledge of thrombocytopenia as a resultant was not encountered among these reported toxic effects. Our case is important because it shows that the excessive intake of licorice may cause a toxic effect in the form of thrombocytopenia. This report is the first presented case to show thrombocytopenia due to licorice syrup consumption.

Applicability of the Demirjian method for dental assessment of southern Turkish children

Age-related legal problems are especially common in underdeveloped parts of Turkey. In terms of civil and criminal law, the ages from 13 years to 18 years are critical in our country. Estimation of age is a very significant in aspect of accordance with laws. The aims of this study were to evaluate the applicability and accuracy of the Demirjian technique for assessing southern Turkish children; to analyze the sexual dimorphism of dental age in the studied groups; and to define the relationship between the dental age and the degree of mineralization in mandibular permanent tooth in southern Turkish children. This study was performed using panoramic radiographs from 932 healthy southern Turkish children, 444 girls and 488 boys aged between 4 and 18 years. Statistical evaluations were performed using SPSS (Statistical Package for Social Sciences) for Windows 13.0 software. The mean difference between dental and chronological age was calculated for each age and sex group. The paired t-test was used to compare all data. The chi-square test was used for between-group comparisons of categorical variables. Continuous variables were tested for normality using the Kolmogorov-Smirnov test. Relationships between continuous variables were examined using Pearsons correlation coefficient. The same observer re-examined 700 teeth three months after the first examination. The results were evaluated with the intraclass correlation test and both measurements were statistically significantly similar with each other(R = 0.982, p = 0.0001). .Dental age (DA) and chronological age (CA) were consistent for boys in the 16-16.9 age group and for girls in the 9-9.9 and 15-15.9 age groups. From this study, we can conclude that dental age varies across ethnic populations. Additionally, dental maturation varies across different regions of the same country. Because Demirjians standards are not suitable for all age groups of southern Turkish children, a new table is necessary for evaluating this population. Future studies using multi-ethnic population data are needed to establish the international applicability of Demirjians method.

The reflection of the Syrian civil war on the emergency department and assessment of hospital costs.

BACKGROUND In the present study, it was aimed to assess the demographics, clinical features, and treatment costs of cases referred to our hospital after the Syrian civil war. METHODS Of 1355 Syrian civil war victims referred to our hospital during the 14-month period between June 2011 and July 2012, 482 cases presenting to the emergency department were included in the study. The electronic data of these patients were retrospectively analyzed. RESULTS Of 482 cases, 428 were male (88.8%) and 54 (11.2%) were female, with a mean age of 30.4±14.9 years (1-79 years). The mean age was 30.8±17.2 years (1-79 years) in males and 27.3±16.9 years (1.5-66 years) in females. There was a significant difference in terms of sex (p=0.007). It was found that the majority of the cases (41.1%) were aged 21-30 years. The highest number of admissions was recorded in June 2011 (159 patients, 33%), whereas the lowest number of admissions was in September 2011 (5 patients, 1%). All cases were transported to our hospital from nearby district hospitals and camps by emergency medical services. The most frequent presenting complaint was gunshot injury (338 cases, 70.1%). The most common diagnosis was extremity injury (153 cases, 31.7%). The number of forensic cases was found as 364 (75.5%). Of all the cases, 136 cases (28.2%) were managed in the emergency service, and the remaining cases were admitted to other services. They were most frequently admitted to the orthopedics ward (146 cases, 30.3%). The mean length of the hospital stay was 9.9 days (1-141).Overall, 456 cases (94.6%) were discharged, 22 cases died, and 4 cases were transferred to other facilities. The mean cost per case was estimated as 3723Turkish lira (TL) (15-69556). A positive correlation was found between cost and length of hospital stay. CONCLUSION Among all Syrian cases, the majorities of young males and gunshot injuries was striking. Most of the cases were discharged after appropriate management. Preventive measures can avoid these negative outcomes and so avoidable costs will not occur, and this can preclude the damage to the budgets of the countries.

Demonstration of ethyl glucuronide in dental tissue samples by liquid chromatography/electro-spray tandem mass spectrometry.

INTRODUCTION Ethyl glucuronide (EtG) has been studied in various tissues and body fluid for determination of alcohol intake. However, no study, dealing with EtG analysis in dental tissue, was performed so far. In this study, we aimed to demonstrate EtG levels in dental tissue. MATERIALS AND METHODS Michigan Alcohol Screening Test (MAST) was performed to 29 participants. Following the test, cases were divided into three groups as non-hazardous alcohol users, alcohol abusers and 6 controls who verbally declared that they were abstainers. A total of 29 tooth specimens, obtained from participants, was included in the study. These specimens were analyzed using LC/MS/MS. RESULTS All of the participants included in the study were male. According to the MAST outcomes 14 of the participants were non-hazardous alcohol users, and 9 were alcohol abusers, while 6 patients verbally declared that they were abstainers. Dental tissue analyses revealed EtG levels ranging between EtG<LOD and 23.39 pg/mg. EtG levels were observed to be <LOD in dental specimens of 6 abstainer cases. A significant correlation was found between EtG levels measured in the dental tissues and MAST outcomes on the statistical analyses (r=0.914). CONCLUSION The findings of the present study demonstrated that dental tissue can be used for detection of alcohol intake, using LC/MS/MS.

Increased drug seizures in Hatay, Turkey related to civil war in Syria

BACKGROUND: Turkey is an important country for drug trafficking and the cultivation of cannabis. Opiates from Afghanistan are trafficked through Turkey on route to the Balkans. Currently Hatay, a Syrian neighborhood city of Turkey, is hosting over 85,000 Syrian refugees who are escaping from the civil war. In this short report, we document the potential effects of conflict and related refugee movements in Hatay, on the seizures of illicit drugs. METHODS: We collected records held by the Ministry of Justice, Hatay Court House, of drug seizures between 2008 and 2013. RESULTS: These records show an annual and stable number of drug indictments between 2008 and 2010 (N=67). However, this number rose exponentially after the start of the conflict in Syria: an increase of 84% from 2010 to 2011 (N=123), with continuing and significant increases in 2012 (N=240) and 2013 (N=211). CONCLUSION: The lack of security and the instability in Syria, and the flow of refugees from this country have resulted in an increasing number of illicit drug seizures. These findings suggest the need for better intervention and greater precautions taken against drug trading in conflict zones and the countries surrounding these zones. Language: en

Cases of organophosphate poisoning treated with high-dose of atropine in an intensive care unit and the novel treatment approaches

Organophosphate poisoning is a life-threatening condition, which is being responsible for the symptoms due to cholinergic effects. Clinical status and blood levels of cholinesterase are used its diagnosis. While atropine and pralidoxime (PAM) appear as essential medications, hemofiltration treatments and lipid solutions have been widely studied in recent years. In this study, the importance of high-dose atropine therapy and early intervention and novel treatment approaches are discussed. Records of a total of 25 patients treated for organophosphate poisoning in the intensive care unit (ICU) between April 2007 and December 2011 were evaluated retrospectively. Of the 25 patients, 14 (56%) were male and 11 (44%) were female with a mean age of 34.8 ± 17.66 years (range: 14–77 years). The patients were most frequently admitted in June (n = 4) and July (n = 4) (16%). Of the 25 patients, 22 patients (88%) were poisoned by oral intake, two (8%) by inhalation, and one (4%) by dermal route. Of them, 20 patients (80%) took organophosphates intentionally for suicidal purposes, while five (20%) cases poisoned due to accidental exposure. The scores of Glasgow Coma Scale of nine patients (36%) were below 8 point upon admission to hospital. The highest dose of atropine given was 100 mg intravenously on admission and 100 mg/h/day during follow-up. The total dose given was 11.6 g/12 days. A total of 11 patients (44%) were on mechanical ventilation for a mean duration of 5.73 ± 4.83 days. The mean duration of ICU stay was 6.52 ± 4.80 days. Of all, 23 patients (92%) were discharged in good clinical condition and one patient (4%) was referred to another hospital. This study suggests that atropine can be administered until secretions disappear and intensive care should be exerted in follow-up of these patients. In addition, in case of necessity for high doses, sufficient amounts of atropine and PAM should be available in hospitals.

A series of civilian fatalities during the war in Syria

BACKGROUND A considerable number of deaths due to firearm injuries have occurred during wars all over the world. In this study, it is aimed to evaluate demographic characteristics and injury properties of cases died during civil war in Syria. METHODS The postmortem examination and autopsy reports of 321 forensic deaths occurred between January and December 2012 were analyzed, retrospectively. Of the 321 forensic deaths,186 cases were injured and died in the civil war in Syria and, therefore, included in the scope of the study. Four cases died by natural causes or traffic accidents were excluded. RESULTS Cases were most commonly (n=73, 39.2%) aged between 21 and 30 years, and 21.5% (n=40) of cases aged under 20 years. Of females, 68.8% (n=11) were children and young adults under 20 years of age. An overwhelming majority of deaths (n=125, 67.2%) were caused by explosive and shrapnel injuries, followed by (n=49, 26.3%) gunshot injuries related deaths. CONCLUSION This study indicated that a significant proportion of those who died after being injured in the Syrian war were children, women and elderly people. The nature and localization of the observed injuries indicated open attacks by military forces regardless of targets being civilians and human rights violations.

Analysis of methanol and its derivatives in illegally produced alcoholic beverages

INTRODUCTION Illegal alcohol production remains as a common issue worldwide. Methanol poisoning mostly occurs because of the methanol used in production of counterfeit alcohol instead of ethyl alcohol due to its low price or by drinking the liquids containing methyl alcohol. Pectolytic enzymes results in an increase of methanol levels in many fermentation products such as ciders or wines. Methanol poisonings are infrequently encountered in forensic medicine practice. However, sporadic cases due to methanol intoxication as well as epidemic cases have been reported. In this study, we aimed to identify existence of methanol and its metabolites in illegally produced alcoholic beverages used in Antakya region. MATERIAL AND METHODS Twelve legally produced alcohol samples and Fifty-six different illegally produced alcohol samples were collected from the markets and local producers. Existence of methanol, formic acid, methyl amine, methyl formate and trioxan were determined using GC-MS method in these samples. RESULTS Fifty-six different illegal alcohol samples were analyzed in this study and methanol was detected in 39 (75%) of samples. Formic acid was detected in 3, formamide in 1, methyl amine in 6, methyl formate in 10 and trioxan in 2 samples. CONCLUSION Overwhelming majority of illegal alcoholic beverages was detected to contain methanol. Interestingly this study also revealed the presence of trioxane, which has not previously reported among toxic agents in illegal alcohol samples.

A 5-year retrospective evaluation of snakebite cases in Hatay, Turkey.

Snakebites are relatively rare medical emergency cases that might lead to serious consequences. This study aims to evaluate snakebite cases in terms of medical follow-up, antivenom therapy and antivenom reactions. Medical records of patients admitted to emergency department between January 1, 2006 and December 31, 2010 were retrospectively investigated. Snakebite-related cases of a total of 125 patients were included in the scope of the study. Of the total 125 cases, 54.4% were male and 45.6% were female. Most of cases (n: 65, 52%) were aged over 30 years, while the mean age was 34.87 ± 19.29 years. Snakebite-related applications to the emergency department were mostly seen in June with 27 cases. Upon admitting, all patients were recorded to be conscious and showing good general conditions; however, they suffered from pain and edema at the site of bite. Of all, 25 patients only suffered from bite injury and ecchymosis due to snakebite. The site of bite was upper extremities in 66 patients (52.8%), whereas it was lower extremities in 58 (46.4%). Of all, antivenom was unnecessary in 25 (20%) patients, while four antivenoms were administered to each of the 23 (18.4%) patients. Furthermore, six (4.8%) patients needed nine antivenom administrations for each. Anaphylaxis (n: 2, 1.6%), compartment syndrome (n: 2, 1.6%) and serum sickness (n: 1, 0.8%) encountered in remaining cases. Of all, 86 (68.8%) patients were hospitalized in the emergency department, while 25 (20.0%) patients were followed up by observation in emergency service. Only one patient was treated and followed up in intensive care unit. Implementation of antivenom therapy is considered unnecessary for the treatment of all snakebite cases. Antivenom reactions and number of related cases might be reduced by continuous close monitoring, appropriate prophylaxis and controlled slow infusion administration of medications.

Oxidative Status in Epileptic Children Using Carbamazepine

Background: There is an increasing attention towards the relationship between oxidative stress and epilepsy. The effect of antiepileptic drugs on oxidant status is of major interest. Antiepileptic drugs can increase levels of free radicals, which consequently might lead to seizures. Carbamazepine (CBZ) is an antiepileptic drug commonly used in childhood and adolescence. Objectives: Therefore we aimed to investigate the effects of CBZ on total antioxidant status, total oxidant stress, and oxidative stress index. Patients and Methods: The study included 40 epileptic patients and 31 healthy children between 4 and 12 years of age. Serum CBZ level, total antioxidant capacity and total oxidant status were measured. Oxidative stress index was also calculated both in controls and patients. Results: In the epileptic group, decreased levels of total antioxidant capacity, increased total oxidative stress and oxidative stress index levels were found. Positive correlation between plasma CBZ levels and total oxidant status was observed. Conclusions: Antioxidant action could not be playing any role in antiepileptic effect of CBZ. Furthermore, increased oxidative stress induced by CBZ could be the cause of CBZ-induced seizures. Therefore combining CBZ with antioxidants could be beneficial.