Aynur Sahin

We report a case of prolonged and successful resuscitation following cardiotoxicity-related arrest occurring after inhaling toluene and Skunk, which is an increasingly popular synthetic cannabinoid (SC). Following presentation to the emergency department because of lethargy, nausea and chest pain, a 28-year-old male user of Skunk and toluene suffered from cardiac arrest due to ventricular fibrillation (VF). Cardiogenic shock, severe metabolic acidosis and regular wide QRS tachycardia were observed in the patient, and he developed VF every 5–10 minutes over the course of 10 hours. The patient responded to prolonged resuscitation and was discharged on 8th day of his admission in a healthy condition. This case report is the first report that cardiac arrest occurring as a result of Skunk and toluene inhalation, which was resolved without sequelae after prolonged resuscitation.

Objective: The purpose of this study was to investigate the value of signal peptide-CUB-EGF domain-containing protein 1 (SCUBE1) in the diagnosis of angina pectoris in patients presenting to the emergency department.Material and Methods: This prospective research was planned as a cross-sectional, single-center clinical study. Patients presenting to the emergency department with angina pectoris symptoms over a period of five months from receipt of ethical committee approval were included. Patients presenting with ischemic chest pain were divided on the basis of etiology into stable angina pectoris (SAP), unstable angina pectoris (UAP), non-ST elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI) groups. Clinical, laboratory and demographic characteristics were recorded. SCUBE1 levels from each group were compared with a healthy control group.Results: 118 individuals were enrolled in the study, 78 patients meeting the inclusion criteria and 40 healthy controls. Patients’ mean age was 54.36 ± 14.03 years, and 88.5% (n=69) were male. Hypertension (59%) and smoking (62%) predomination over other risk factors. NSTEMI was the most common factor (46.1%) in patients enrolled due to ischemic chest pain. No statistically significant difference was determined between patients’ serum SCUBE1 levels at time of presentation and at 6 h and 12 h and the control group (p>0.05).Conclusion: On the basis of our study findings, SCUBE1 is of no value in the diagnosis of ischemic chest pain etiologies.

Objectives The aim of this study is to compare the diagnostic values of plasma levels of vascular adhesion protein-1 (VAP-1) and intestinal fatty acid-binding protein (I-FABP) for diagnosing acute mesenteric ischemia (AMI). Methods The study used a randomized, controlled experimental design. Forty-two female Sprague–Dawley rats were divided into three control groups and three ischemia groups. Plasma VAP-1 and I-FABP levels were measured, and the extent of ischemic damage was determined using a histopathological damage score in terminal ileum tissue samples. Results In the early phase of AMI (i.e. at the 30-min time point), VAP-1 levels did not differ between the control and ischemia groups (p > 0.05), but I-FABP levels were significantly higher in the ischaemia groups (p = 0.017). Although both VAP-1 and I-FABP levels increased in the ischaemia groups, only VAP-1 levels showed a significant increase compared to the control group at the 2-h time point (p = 0.011). Ischemic damages associated with AMI became the most prominent at the 6-h time point. During this phase, both VAP-1 and I-FABP levels were significantly higher in the ischemia groups than in the control groups (p = 0.007 and p = 0.002, respectively). Both VAP-1 and I-FABP levels showed a significant correlation with ischemic changes, but a higher correlation was observed for VAP-1 levels (r = 0.771). Conclusions Both I-FABP and VAP-1 levels were useful for diagnosing AMI, but VAP-1 levels correlated better with the extent of ischaemic damage.

Objectives: Delayed healing and non-union of fractures have a significant effect upon patient morbidity. Studies have therefore largely concentrated on accelerating fracture healing. This study was intended to compare the effect of “mad honey” and propolis on fracture healing using radiological and histopathological analysis. Subjects and Methods: Femur fracture was surgically performed on 48 rats, followed by fixation. Animals were then divided into 8 groups: 2 control groups (15- and 30-day) and 6 treatment groups (15- and 30-day normal honey, 15- and 30-day “mad honey,” and 15- and 30-day propolis). Rats were sacrificed at the end of these periods, and radiological and histological examinations were performed. Results: Radiological healing in the propolis group after 15-day therapy was statistically better than in the control (p = 0.004) and normal honey (p = 0.006) groups. After 30-day therapy, healing in the propolis group (p = 0.005) and grayanotoxin-containing “mad honey” group (p = 0.007) were significantly better than in the control group. Histologically, there was a statistically significant difference between the 15-day propolis group and the other groups (control, honey, mad honey: p = 0.003, p = 0.003, and p = 0.002, respectively). We also found a statistically significant difference when the 30-day propolis group (p = 0.005) and “mad honey” group (p = 0.007) were compared to the control group. Conclusions: This study shows that grayanotoxin-containing “mad honey” and propolis can accelerate fracture healing.

BACKGROUND: To evaluate the distribution of bite and sting cases presenting to a district public hospital and the use of antivenom in scorpion sting and snake bite cases. METHODS: The demographic characteristics of patients with bites/stings reporting to a public hospital in 2014, the agent involved, the season of reporting, severity of clinical findings during presentation, and use of antivenom in scorpion sting and snake bite cases were evaluated retrospectively. chi(2) test was used for statistical analysis. RESULTS: Bite and sting cases comprised 0.5% of all the patients reporting to the hospital's emergency department, with scorpion sting cases comprising almost half (54.2%) of these hospital presentations, followed by Hymenoptera (bee and wasp) sting (30.8%) and snake bite (5.5%) cases. Unnecessary antihistamine administration was found to be significantly high in asymptomatic patients (p=0.00006). Furthermore, antivenom use was found to be significantly high in patients with scorpion sting and snake bite despite the absence of systemic or local indications (p<0.0001, chi(2)=80.595). CONCLUSION: The study results showed that antivenom was used in scorpion sting and snake bite cases even when it was not indicated. Therefore, primary practitioners should be provided training for management of envenomation cases and should be made aware of the updated guidelines and references to raise their knowledge levels.

Neuroleptic malignant syndrome (NMS) is a neurological emergency rarely encountered in clinical practice but with a high mortality rate. Cases associated with atypical antipsychotic use or termination of dopamine agonists have been seen in recent years. The purpose of this study was to assess the presence of risk factors for mortality by investigating all clinical and laboratory characteristics of cases with NMS. This descriptive, cross-sectional study retrospectively investigated all clinical and laboratory characteristics by scanning the ICD-10 codes of patients presenting to the XXXX Faculty of Medicine Emergency Department and diagnosed with NMS between 2006 and 2016. Patients were divided into surviving and non-surviving groups, and the data elicited were subjected to statistical comparisons. The mean age of the 18 patients diagnosed with NMS was 46.9 ± 4.8 years, and 50% were women. In addition to antipsychotics among the drugs leading to NMS, the syndrome also developed as a result of levodopa withdrawal in three patients and metoclopramide use in one patient. Statistically significant differences were determined between the surviving and non-surviving patients in terms of blood pressure, blood urea nitrogen (BUN), creatine kinase (CK) and mean platelet volume (MPV) values (p ≤ 0.05). In this study the most common agent that cause NMS was atypical antipsychotics. Also advanced age, increased blood pressure and serum CK, BUN and MPV values were identified as potential risk factors for mortality in NMS.