Yunus Karaca

A comparison of the effects of N-acetylcysteine and ethyl pyruvate on experimental testicular ischemia-reperfusion injury

OBJECTIVE To compare the effects of N-acetylcysteine (NAC) and ethyl pyruvate (EP) on experimental testicular ischemia-reperfusion (I/R) injury. DESIGN Randomized, controlled, experimental study. SETTING University hospital. ANIMAL(S) Twenty-four mature male Wistar rats. INTERVENTION(S) Rats were divided into four groups: control group, torsion-detorsion (T/D) group, EP group, and NAC group. In the pretreatment of the NAC and EP groups, 20 mg/kg NAC and 50 mg/kg EP were given intraperitoneally (IP) 30 minutes before detorsion. MAIN OUTCOME MEASURE(S) Serum ischemia-modified albumin (IMA), tissue and serum malondialdehyde, and myeloperoxidase activity levels and histopathological damage scores were then compared. RESULT(S) Ethyl pyruvate and N-acetylcysteine exhibited a protective effect against I/R injury. Of the biochemical parameters evaluated as a result of testicular I/R, only IMA levels were significantly elevated. There was a strong and significant correlation between serum IMA levels and histopathological injury scores, and the increase in serum IMA level exhibited a strong parallel with the increase in histopathological injury. In the EP group, although the histopathological injury score was similar to that of the control group, serum IMA levels were significantly elevated. CONCLUSION(S) Both NAC and EP, the effects of which on I/R injury are evaluated in the present study, reduce such injury in testicular torsion-detorsion. Comparing their effects on IMA levels, NAC may be regarded as a relatively more effective treatment than EP.

Syncope associated with water pipe smoking

The water pipe (narghile) in particular is widely used in the Arabian Peninsula and the Turkish world, and has also recently become an increasingly popular way of consuming tobacco in Europe. Contrary to popular belief, it contains more tar, carbon monoxide (CO) and toxic gases than cigarettes. This report describes a patient presenting to the emergency department with syncope as a result of water pipe use, with tests revealing toxically high CO levels.

A Wild Wolf Attack and Its Unfortunate Outcome: Rabies and Death

Wild animal attacks are potential occurrences in rural areas of Turkey. Wolf attacks, however, are rare this century, but there are many anecdotal reports from previous times. Attacks by wolves are generally directed against animals, such as cows and sheep, and for feeding purposes. Wolf attacks on humans are a little known and unexpected phenomenon. A 60-year-old man was brought to the emergency department with facial injuries caused by a wolf emerging from a rural area and leaping at his face as he was sitting in his garden. During the incident, the patient strangled the wolf to death. Despite postexposure prophylaxis the patient likely died because of rabies.

An Atropa Belladonna L. poisoning with acute subdural hematoma

Atropa belladonna L. is a plant long known to cause poisoning. But no cases of acute subdural hematoma resulting from such poisoning have been reported so far. Care must also be taken in terms of acute pancreatitis and rhabdomyolysis in cases of such poisoning. The plant may sometimes be mistaken for the Caucasian blueberry, V. arctostaphylos L. At least one anti-cholinesterase toxidrome finding was determined in all the nine cases of belladonna poisoning in this series. No elevated creatine kinase was reported in one case with acute subdural hematoma and hyperamylasemia.

The high risk of contrast induced nephropathy in patients with suspected pulmonary embolism despite three different prophylaxis: A randomized controlled trial.

OBJECTIVE The objective was to compare the protective effects of N-acetylcysteine (NAC) plus normal saline (NS), sodium bicarbonate (NaHCO3 ) plus NS, and NS alone in the prevention of contrast-induced nephropathy (CIN) after computed tomography pulmonary angiography (CTPA) in emergency patients. METHODS This study was planned as a randomized, controlled clinical research. Patients undergoing contrast-enhanced CTPA on suspicion of pulmonary embolism (PE) in the emergency department and with at least one risk factor for development of CIN were included in one of three different prophylaxis groups. The groups received 3 mL/kg intravenous (IV) NAC+NS or NaHCO3 +NS solution or NS alone 1 hour before CTPA and 1 mL/kg IV per hour for a minimum of 6 hours after CTPA. CIN was evaluated as the primary outcome and moderate or severe renal insufficiency and in-hospital mortality as secondary outcomes. RESULTS A total of 257 patients were enrolled in the study. The total level of CIN development was 23.7% (61/257), the level of moderate and severe renal failure was 12.5% (32/257), and the in-hospital mortality rate was 12.8% (33/257). Rates of CIN development in the drug groups were 23.5% in the NAC group (20/85), 21.2% (18/85) in the NaHCO3 group, and 26.4% in the NS group (23/87). Rates of development of moderate or severe renal insufficiency were 9.4% in the NAC group (8/85), 10.6% in the NaHCO3 group (9/85), and 17.2% in the NS group (15/87). In-hospital mortality rates were 12.9% in the NAC group (11/85), 11.8% in the NaHCO3 group (10/85), and 13.8% in the NS group (12/87). No difference was determined between the drug groups in terms of CIN, moderate or severe renal injury, or hospital mortality. CONCLUSIONS Our results indicate that there is a high risk of CIN in patients with suspected PE despite three different types of prophylaxis being administered, and no statistically significant differences were observed among prophylactic NAC, NaHCO3 , and NS in prevention of CIN following contrast-enhanced CTPA.

Diagnostic value of plasma signal peptide-Cub-Egf domain-containing protein-1 (SCUBE-1) in an experimental model of acute ischemic stroke

OBJECTIVES This study was intended to examine possible diagnostic value of plasma Signal Peptide-Cub-Egf domain-containing protein-1 (SCUBE1) levels in an experimental model of acute ischemic stroke. METHODS Twenty-four female Sprague Dawley rats were divided into four groups. Blood and brain tissue specimens were collected immediately following artery ligation (control; Group 1), 1h after ligation (Group 2), 2 h after ligation (Group 3) and 6h after ligation (Group 4). SCUBE1 levels were investigated in the serum specimens. The brain samples were examined histopathologically. Correlation analysis was performed between the values. RESULTS Median SCUBE1 values were 1.75 ng/ml in the control group, 3.80 ng/ml, 3.71 ng/ml and 4.19 ng/ml in the groups 2, 3 and 4, respectively (n=6 for each, P=0.004, for each group compared to control values). Histopathological analysis revealed median atrophic neuron percentages of 16% (in group 1), 42%, 55% and 76% in group 2, 3 and 4 respectively (n=6 for each, P=0.004, for each group compared to control group). A higly significant correlation was determined between SCUBE-1 levels and percentage of atrophic neurons (r=0.744 P=0.000). CONCLUSIONS In this experimental model of acute ischemic stroke plasma SCUBE1 levels rose from the 1st hour of induced stroke and remained high up to 6th hour tested. Results of this experimental study has a potential to become the basis for a clinical study to confirm whether SCUBE1 can be used as a biomarker in the early diagnosis of acute ischemic stroke patients.

The Diagnostic Value of Plasma SCUBE1, a Novel Biomarker of Platelet Activation, in Testicular Torsion: A Randomized, Controlled, Experimental Study.

OBJECTIVE To investigate the potential diagnostic value of plasma signal peptide, CUB (complement proteins C1r/C1s, Uegf, Bmp1) domain, epidermal growth factor (EGF)-like 1 (SCUBE1) protein in experimentally induced testicular torsion (TT). MATERIALS AND METHODS In this randomized, controlled, experimental study, 24 mature male Wistar rats were divided into four groups: 2- and 4-hour control (groups I and III, respectively), and 2- and 4-hour torsion (groups II and IV, respectively) groups. Torsion was performed by rotating the left testis 720° clockwise and maintained by fixing the testis. Plasma SCUBE1 levels and histopathological damage scores were compared. RESULTS There was significantly greater histopathological damage in the 4-hour torsion group compared with the other groups. SCUBE1 levels in this group were also higher than those in the other groups, and the difference was significant. There were significant correlations between histopathological scores and SCUBE1 levels. CONCLUSION SCUBE1, a novel marker of platelet activation, is elevated in TT. According to our results, platelet activation may play an important pathological role in tissue injury associated with testicular ischemia. Plasma SCUBE1 measurement may have diagnostic, therapeutic, or prognostic value in TT.

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.

Cerebellitis developing after tricyclic antidepressant poisoning

Acute cerebellitis is a rare inflammatory disease involving the cerebellum and is characterized by acute compromise of cerebellar functions. It most frequently originates from infectious causes, although cases of cerebellitis associated with other causes have also been reported. This report discusses a case of cerebellitis developing in a 4-year-old girl who had to be intubated after accidental ingestion of tricyclic antidepressant. There are no previous reports of cerebellitis after tricyclic antidepressant. This case shows that cerebellitis can develop in patients with poisoning of this kind.

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.