Sahin Aslan

EFFECTS OF SLEEP DEPRIVATION, NICOTINE, AND SELENIUM ON WOUND HEALING IN RATS

Effects of sleep deprivation (SD), nicotine, and selenium (Se) on wound healing were studied in 50 male rats (Sprague-Dawley strain). Full-skin-thickness burns were produced in animals. Then, SD, nicotine, and Se administrations were applied to animals in different groups. Wound healing was assessed by pathological analysis of wound by counting fibroblasts, capillary vessels, polymorphonuclear leucocytes (PNLs), and by measuring radiolabeled immunoglobulin G (IgG) amount in wound area by radio-pharmaceutical and immunoscintigraphic procedures. The number of fibroblasts and capillary vessels were higher in control and Se groups than in sleep deprivation and nicotine groups, and the number of PNLs and the radiolabeled polyvalent IgG levels were higher in SD and nicotine groups than in control and Se groups. The results suggest that SD and nicotine may delay wound healing and that Se supplementation may accelerate wound healing by preventing nicotine-induced oxidative stress and lipid peroxidation.

Reactive Airways Dysfunction Syndrome in Housewives Due to a Bleach–Hydrochloric Acid Mixture

The sudden onset of asthmalike symptoms and persistence of airway reactivity following an acute exposure to an irritant gas or vapor has been termed reactive airways dysfunction syndrome (RADS). A mixture of sodium hypochlorite (bleach, 40%) and hydrochloric acid (18%) is commonly used as a household cleaning solution in our region. From this mixture, chlorine gas is produced, which can cause airway damage and ensuing RADS. Here we describe findings of patients with RADS due to this cleaning mixture, and determine factors associated with a favorable outcome. Data were collected retrospectively on 55 symptomatic patients presenting to our emergency department after inhalation exposure to a mixture of bleach and hydrochloric acid. Symptoms, past medical and smoking history, details of the exposure, initial peak expiratory flow rate (PEFR) and oxygenation, and acute reversibility of airways obstruction were documented. All patients met previously defined criteria for the diagnosis of RADS, but did not undergo methacholine challenge testing and bronchoalveolar lavage or histopathologic study. Fifty patients were followed over the course of 3 mo. The majority of exposures (64%) occurred in the bathroom or kitchen. Only 21 of 55 (38%) patients showed an improvement in PEFR of 15% or greater following two β2-agonist inhalation treatments. In follow-up, 48 patients (87%) improved clinically and functionally (FEV1). Seven patients (13%) deteriorated, with ARDS developing in two, one of whom died from respiratory failure. Advanced age, initial low PEFR, exposure in a small enclosed area, use immediately after mixing, and prolonged short- and long-term exposures were associated with a poorer prognosis. This descriptive study is the largest case series in the literature of RADS developing after exposure to a bleach–hydrochloric acid mixture. The optimum acute treatment and long-term outcomes for patients with RADS due to this combination still need to be determined.

The evaluation of myocardial damage in 83 young adults with carbon monoxide poisoning in the East Anatolia region in Turkey

Carbon monoxide (CO) poisoning is the leading cause of death from intoxication. In CO poisoning, it is important to know if there are any symptoms regarding myocardial damage, which are usually unobserved as a result of hypoxia. This study was planned to assess myocardial damage in young healthy patients with CO poisoning. Eighty-three young healthy cases who had been exposed to CO were included in this study. The demographic and clinical characteristics, the origin of CO gas and smoking habits of the patients were recorded. The evaluation of ECG, peripheral ABG, complete blood count and serial cardiac biomarkers (creatine kinase, creatine kinasemyocardial band and troponin I) measurements were performed in all cases. Additionally, echocardiogram (ECHO) and myocardial perfusion single-photon emission computed tomography (SPECT) were performed at the appropriate times in all cases. The mean age of the patients was 27.39 /10.9 years. The main complaint of the patients was loss of consciousness with a 62.7% rate. The average carboxyhaemoglobin level of the patients was 34.49 /15.9%. Sinus tachycardia was present in 26.5% of patients. Diagnostic ischaemic ECG changes were present in 14.4% of patients. In myocardial SPECT, myocardial ischaemic damage was observed in 9 cases, in 6 of whom ECHO findings were also confirmed. Myocar-dial damage due to CO poisoning should not be ignored. If patients are at risk in terms of myocardial damage, further studies, such as ECHO and scintigraphy are needed to determine myocardial damage resulting from CO poisoning. However, in the young adults of the risk group, if the baseline ECG and serial cardiac biomarkers are normal, further studies such as ECHO and scintigraphy, considering the length of exposure and the severity of poisoning, may not be necessary for the evaluation of myocardial damage due to CO poisoning.

The Effect of Nebulized NaHCO3 Treatment on "RADS" Due to Chlorine Gas Inhalation

Chlorine is one of the most common substances involved in toxic inhalation. As with all irritant gases, the airway injuries caused by chlorine gas may result in clinical manifestations similar to those of asthma. In this study, we investigated the effect of nebulized sodium bicarbonate (NSB) on the treatment and quality of life (QoL) of victims exposed to chlorine gas. Forty-four consecutive patients with reactive airways dysfunction syndrome (RADS) due to chlorine inhalation (40 females and 4 males, age range 17–56 yr) were included in this study. Patients were placed in control and treatment groups in a sequential odd–even fashion based on their order of presentation. Treatment of all patients included corticosteroids and nebulized short-acting β2-agonists. Then the control group (n = 22) received nebulized placebo (NP), and the NSB group (n = 22) received NSB treatment (4 cm3 of 4.20% sodium bicarbonate solution). A quality of life (QoL) questionnaire and pulmonary function tests (PFTs) were performed before and after treatments in both groups. The most common symptoms were dyspnea (82%) and chest tightness (82%). Baseline characteristics of both groups were similar. Compared to the placebo group, the NSB group had significantly higher FEV1 values at 120 and 240 min (p < .05). Significantly more improvement in QoL questionnaire scores occurred in the NSB group compared to the NP group (p < .001). Thus, NSB is a clinically useful treatment, as tested by PFTs and QoL questionnaire, for patients with RADS caused by exposure to chlorine gas.

S-100β and neuron-specific enolase levels in carbon monoxide―related brain injury

INTRODUCTION Carbon monoxide (CO) toxicity may cause persistent injuries in tissues sensitive to hypoxia. Neuropsychiatric sequelae may be observed in about 67% of cases after severe CO exposure. AIM The aims of this study were to demonstrate the usefulness of S-100beta and neuron-specific enolase (NSE) in CO intoxications, show the degree of neurological response, and determine the indications for hyperbaric oxygen treatment (HBOT) as biochemical markers. RESULTS The S-100beta and NSE levels of the sera of 30 patients were studied upon admittance and at the third and sixth hours. S-100beta levels were found to be high in all 3 analyses. There was no significant change in NSE levels. When the S-100beta levels were compared with Glasgow Coma Scale levels, a strong negative correlation was found for all hours (r = -0.7, -0.8; P = .00). The correlation between S-100beta and carboxyhemoglobin levels at the initial hour was found to be statistically significant (r = 0.4; P = .01). The S-100beta levels in patients receiving HBOT showed a considerable decrease compared with those in patients not receiving the treatment. The same decrease was valid for NSE, although it was insignificant. CONCLUSION S-100beta may be useful in evaluating intoxications as an early biochemical marker in CO intoxications, as well as in the differential diagnosis due to other causes, and in determining HBOT indications.

The role of ischemic neurodegeneration of the nodose ganglia on cardiac arrest after subarachnoid hemorrhage: an experimental study.

BACKGROUND The heart is innervated by several systems that contribute to the control of the hearts rhythm. The cardiac fibers of the vagus nerve have an important role in the regulation of heart rhythm under many emotional and physical conditions. Severe electrocardiographic disturbances have been reported following subarachnoid hemorrhage (SAH), but ischemic neuronal degeneration of the nodose ganglion of the vagus nerve has not been previously investigated. We examined if there is a relationship between ischemic injury of the nodose ganglion of the vagus nerve and the severity of heart rhythm disorders after subarachnoid hemorrhage. METHODS This study was conducted on 20 rabbits. Four rabbits were used as a baseline group. Experimental subarachnoid hemorrhage was applied to half of the remaining animals (n = 8) by injecting homologous blood into the cisterna magna, and the others (SHAM group, n = 8) were injected with isotonic saline solution in the same manner. For 20 days after the injection, heart rhythm changes were observed daily. After the experiment, normal and ischemic neuron densities in the nodose ganglia of the vagus nerves were examined stereologically. The number of heart rhythm irregularities and the number of degenerated neurons in the nodose ganglia were compared statistically. RESULTS The normal heart rhythm rate was 280 ± 45/min. At the beginning of the SAH, the average heart rate was 220 ± 30/min; about 10 hours later, it decreased to 189 ± 30/min, indicating severe bradycardia. However, after 7 days, the average heart rate had increased to 350 ± 30/min. Six animals died due to irregularities in cardiac function and respiration. Histopathological examinations showed that the average density of normal neurons in the nodose ganglion was 10,500 ± 2500 in the baseline animals and the SHAM group, but the normal neuron density was 8250 ± 1500 in survivors and 6450 ± 1330 in dead animals. The ischemic neuronal degeneration in the nodose ganglia was more severe in the dead animals than in the survivors (p < 0.0001). CONCLUSION Afferent vagus nerves originating from the nodose ganglia have an important role in regulating heart rhythm via their afferent fibers and efferent connections. If neurons of the nodose ganglia are lesioned due to ischemic insult during subarachnoid hemorrhage, heart rhythm regulation by vagus afferent reflexes is disturbed. Vagus pathway paralysis may result in indirect sympathetic overactivity. The development of tachycardia causes depletion of the hearts reserves, and cardiac arrest may be inevitable following extensive subarachnoid hemorrhage.

Comparison of Clinical Characteristics and Outcomes of Patients with COPD Exacerbation with or without Venous Thromboembolism

Background: Although some studies evaluated venous thromboembolism (VTE) prevalence in patients with chronic obstructive pulmonary disease (COPD), they contain no detailed description of the patients’ characteristics. Objectives: It was the aim of this study to investigate the frequency and clinical characteristics and outcomes of VTE in patients with COPD exacerbation. Methods: Between October 2004 and February 2005, 120 consecutive patients were included in the study. On admission, Doppler examination of lower extremities in all cases and spiral computed tomography of the thorax in cases with a suspicion of pulmonary thromboembolism were performed. A questionnaire was used to take a detailed history. In addition to routine laboratory tests, chest X-ray, postbronchodilator spirometry, arterial blood gas analysis and serum levels of D-dimer and C-reactive protein were evaluated, as well as dyspnea score and performance status before exacerbation. The hospitalization durations and mechanical ventilation requirements were also recorded. Results: VTE was determined in 16 cases (13.3%). In patients with VTE, the travel history was higher (p < 0.001), the dyspnea score worse (p = 0.005), the duration of hospitalization longer (p < 0.001) and the mechanical ventilation requirement increased (p < 0.001); a change in mental status was highly associated with the presence of VTE (p < 0.001). Conclusions: It seems that VTE occurrence was higher in the presence of a risk factor causing immobility such as travel history and increased dyspnea. The cases with severe disease are more likely to have VTE. Preventive measures may be considered in such patients because their hospitalization stay and mechanical ventilation requirement are increased.

Predictors of missed injuries in hospitalized trauma patients in the emergency department

AimTo determine the extent of missed injuries in patients hospitalized with major trauma in a Turkish Level 1 emergency department. We also tried to identify the primary factors contributing to each missed injury and to determine their subsequent adverse short-term clinical outcomes.MethodsThis is a retrospective analysis of prospectively collected data on a cohort of trauma patients. Trauma patients were divided into two groups: patients with missed injury and others. Logistic regression was used to define factors affecting “missed injury”.ResultsA total of 670 hospitalized trauma patients were included. The incidence of missed injuries in the patients and the rate of missed injury per patient were 13.3% (95% CI 6–20) and 1.64, respectively. The most frequently missed diagnosis was injuries of the musculoskeletal system (38%; 95% CI 30–46). It was “clavicle fracture and/or dislocation” (35%; 95% CI 16–53) when the rate of missed diagnosis according to the frequency of the specific injury was calculated. A multiple logistic regression analysis showed that the predictors of missed injuries were patient’s age (OR 0.74, 95% CI 0.63–0.87), total number of injuries (OR 1.74, 95% CI 1.38–2.20), and ISS (OR 1.10, 95% CI 1.03–1.18). Radiological errors were prominent in almost 90% (95% CI 85–95). Missed injury caused additional hospital stay (30%; 95% CI 21–40) and additional surgery was required (15%; 95% CI 8–23).ConclusionThe study highlights the need for a trauma team approach and the need for support of radiological report in the ED.

Myocarditis due to oral flurbiprofen use.

We report a 23-year-old man presenting with chest pain. He denoted skin eruptions on his hands, lips, mouth, and penis 24 to 36 hours after he had taken flurbiprofen 10 days ago. Detailed examination showed an ulcerated, pitching lesion with a dimension of approximately 2x2 cm on his penis; however, other explained skin lesions were ameliorated. ST elevations were present in the electrocardiogram. Cardiac biomarkers gradually rose. The scintigraphy showed myocardial hypoperfusion in the inferoseptal wall. This phenomenon is a rare case of myocarditis due to hypersensitivity reaction. In the case of nonspecific angina pectoris accompanied by electrocardiogram changes, drug-induced myocarditis must hold a place in differential diagnoses.

Acute Abdomen Associated with Organophosphate Poisoning

BACKGROUND Pesticides are extensively used in developed and developing countries. OBJECTIVES The present study was designed to evaluate the clinical course of patients with carbamate or organophosphate poisoning presenting to a University-based emergency department (ED). METHODS All consecutive patients admitted to our ED due to intoxication with carbamate or organophosphate compounds over a 2-year period were enrolled prospectively. RESULTS A total of 49 consecutive patients (26 females) were diagnosed with carbamate or organophosphate poisoning in the 24-month study period. The mean age of the patients was 32±13.1 years (range 16-70 years). Signs and symptoms most frequently noted in patients with organophosphate or carbamate poisoning were perspiration, vomiting, and bronchorrhea. Abdominal pain was reported by 65.3% of the patients. Abdominal ultrasonography was performed in 22 patients who complained of abdominal pain as a leading symptom. Among these, 63.6% were found to have abdominal free fluid. Pancreatitis and peritonitis developed in one case. Atropine treatment was administered for approximately 24-36h, with a mean total dose of 13.75±6.75mg. Pralidoxime was administered to 70.9% of patients with organophosphate poisoning, but was not used in patients intoxicated with carbamates. Endotracheal intubation and mechanical ventilatory support were required in 14.2% of the patients. Mean duration of mechanical ventilation was 3.7±2.2 days. The overall mortality rate was 10.2%. CONCLUSION Patients with a diagnosis of organophosphate poisoning should be screened for acute abdomen. The findings in our study suggest that these patients should undergo routine abdominal ultrasonography, especially in cases with abdominal pain along with other abdominal complaints.