The role of reactive oxygen products in myocardial damage caused by ischemia-reperfusion has been established in a number of studies performed in animals models. However, studies showing the development of increased free radicals following effective myocardial reperfusion in humans are scarce. In the present study, both the increase of lipid peroxidation (LPO) following early stage thrombolytic therapy which is the current treatment issue performed after acute myocardial infarct (AMI) and the plasma levels of vitamin E and C (chain braker antioxidants) were investigated parallel to time. Forty patients with AMI who were admitted to hospital within six hours from the beginning of symptoms were included in the study and divided into two groups; group 1 (recombinant tissue-Plasminogen Activator, rt-PA group) and group 2 (streptokinase group). Serial serum specimens were drawn before and 30, 90 minutes and 24 hours after thrombolytic therapy for the investigation of LPO, vitamin E and C levels. Echocardiographic examination was performed on the tenth day to evaluate the functions of the left ventricle. Plasma levels of lipid peroxides (LPO) were found to increase 90 minutes after thrombolytic therapy in each group, while the levels of vitamins E and C showed significant decreases. The difference between the two groups was not significant. Similar to this finding, no significant difference in the ejection fraction values was observed between the groups. Further, no correlation was observed between the ejection fraction and LPO values at the 90th minute which is considered to be the time of successful thrombolysis. In conclusion, the occurrence of a series of biochemical changes confirming an increase in free radical development of peripheral blood was observed. Although the decrease in vitamin E and C levels suggests the need for supplementation of these vitamins along with the thrombolytic therapy, the fact that at least a week is needed for an increase of tissue levels of vitamin E confirms the opinion that the daily prophylactic doses of these vitamins is suitable for the decrease of AMI risk.
To compare the differences between conventional radiography and digital computerized radiography (CR) in patients presenting to the emergency department.The study enrolled consecutive patients presenting to the emergency department who needed chest radiography. Quality score of the radiogram was assessed with visual analogue score (VAS-100 mm), measured in terms of millimeters and recorded at the end of study. Examination time, interpretation time, total time, and cost of radiograms were calculated.There were significant differences between conventional radiography and digital CR groups in terms of location unit (Care Unit, Trauma, Resuscitation), hour of presentation, diagnosis group, examination time, interpretation time, and examination quality. Examination times for conventional radiography and digital CR were 45.2 and 34.2 minutes, respectively. Interpretation times for conventional radiography and digital CR were 25.2 and 39.7 minutes, respectively. Mean radiography quality scores for conventional radiography and digital CR were 69.1 mm and 82.0 mm. Digital CR had a 1.05 TL cheaper cost per radiogram compared to conventional radiography.Since interpretation of digital radiograms is performed via terminals inside the emergency department, the patient has to be left in order to interpret the digital radiograms, which prolongs interpretation times. We think that interpretation of digital radiograms with the help of a mobile device would eliminate these difficulties. Although the initial cost of setup of digital CR and PACS service is high at the emergency department, we think that Digital CR is more cost-effective than conventional radiography for emergency departments in the long-term.
Dyslipidemia is a major complication of antiretroviral treatment. Aim of the present study was to screen baseline lipid levels and cardiovascular disease risk in HIV-positive patients and analyze change in those parameters after initiation of antiretroviral treatment (ART).HIV-positive patients who presented at our clinic between April 2011 and August 2012 were included. Study included 19 female (22.1%) and 67 male (77.9%) patients (mean age 39.5±10.3 years). Blood pressure, smoking habit, alcohol consumption, serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), glucose level, and antiretroviral treatment status data were reviewed retrospectively. Changes in lipid profile and lifetime risk for atherosclerotic cardiovascular disease (ASCVD) according to the American College of Cardiology guidelines were compared with baseline data and analyzed.At baseline, 13 (15.1%) patients were already receiving ART and 73 (84.9%) patients were treatment-naive or had stopped therapy ≥3 months prior to enrollment. At last visit, 73 (84.9%) patients were taking ART. Results of baseline and final visit TC levels were 175.5 mg/dL (range: 90-346 mg/dL) and 196.5 mg/dL (range: 104-317 mg/dL), respectively (p=0.001). HDL levels were 40 mg/dL (range: 21-81 mg/dL) and 35 mg/dL (range: 10-75 mg/dL; p=0.001), and LDL levels were 101.5 mg/dL (range: 32-191 mg/dL) and 120.5 mg/dL (range: 32-250 mg/dL; p<0.001). TG levels were 145.5 mg/dL (range: 43-2580 mg/dL and 152.5 mg/dL (range: 67-884 mg/dL; p=0.102). Baseline ASCVD risk score was 46% (range: 5-69%) while last visit ASCVD risk score was 50% (range: 5-69%; p<0.001).HIV infection has adverse effects on lipid profiles and cardiovascular risk of HIV-positive patients. Therefore, patients should be closely monitored for lifestyle interventions and lipid-lowering agents.
Introduction: This study aimed to evaluate the effectiveness of lung ultrasonography (US) in detecting the cause of acute respiratory distress in the emergency department. Methods: This cross-sectional analytical study was carried out on 195 adult patients who were admitted to the Emergency Department of a University Hospital with acute respiratory failure in 6months period. The validity of the US diagnoses was assessed by comparing the decisions made by researchers according to the BLUE protocol classification with the final judgments made by the primary doctors using gold-standard diagnostic techniques suggested by the guidelines. Results: The diagnostic accuracy of lung US was 89.7%. While Congestive Heart Failure (CHF) (n=91), Chronic Obstructive Pulmonary Disease (COPD) (n=53), pneumonia (n=69), and Pneumothorax (PTX) (n=5) could be diagnosed by ultrasound with high sensitivity and specificity, its specificity in the diagnosis of Pulmonary Thromboembolism (PTE)(n=18) was low (67%). Ultrasonography could also diagnose combined pathologies such as pneumonia associated with CHF, or pneumonia associated with COPD, with high sensitivity and specificity. It has been determined that the diagnostic accuracy of the routine physical examination and lung radiography used in the emergency room to assess bedside respiratory distress is lower than that of ultrasonography. Discussion: In this study, we found that lung US was effective in the diagnosis of CHF, COPD, pneumonia, PTE, and PTX. Compared to the gold standard tests, it shortened the duration of the diagnosis. Finally, US can also be applied safely in centers where advanced diagnostic facilities are not available.
We aimed to show the sensitivity of Extended Focused Assessment with Sonography for Trauma (e-FAST) for detection of pneumothorax, hemothorax and intraabdominal injury. We also investigated the relationship between e-FAST and need for invasive treatment.This study included patients who experienced multiple trauma. The emergency physician, who had no clinical information about the patient, performed e-FAST. Findings on a supine chest X-ray and invasive interventions were recorded. The results of abdomen and thorax computed tomography (CT) were reviewed (the size of the pneumothorax was scored).Compared with CT, the sensitivities of e-FAST for intraabdominal injury and hemothorax were 54.5% and 71%, respectively. The patients with hemothorax and intraabdominal injuries were not identified with e-FAST, didn't need for invasive intervention. Pneumothorax diagnosis was established in 27 patients with e-FAST (sensitivity 81.8%) from among 33 (30.8%) pneumothorax patients. According to the grading on CT, pneumothoraces less than 1 cm in width and not exceeding the midcoronal line in length were not identified. e-FAST was positive for all patients performed with tube thoracostomy.e-FAST can be used with high sensitivity for determination of pneumothorax requiring invasive procedure. It has low sensitivity in the diagnosis of intraabdominal injury and hemothorax; however, e-FAST can predict the need for invasive procedures.
As it is the case globally, cardiovascular diseases (CVD) make up the most frequent cause of death in Turkey also. Due to this fact, cardiac rehabilitation (CR) has gained a highly important role in the treatment of coronary artery diseases. In Turkey, mortality and morbidity rates among the elderly patients are significantly high. Disability due to coronary artery diseases is more frequent in the elderly compared to young patients. So, it is clear that CR has a considerable importance in this special group of patients. CR program consists the following core components; early initial assessment of the patient, nutritional counseling, management of lipid profiles, education to quit smoking, weight control, treatment and control of diabetes, emotional assessment and support, physical activity referral and exercise training. All cardiac patients, both the inpatient and outpatient groups can be recruited in the CR program. It is recommended to keep the exercise intensity between 40-80% of the patient's capacity. Exercise and aerobic training should be given together and while doing this, co-morbidities and the drugs currently used by the patient should be taken into account. In conclusion, CR is recommended to be started just after the acute phase of the disease has resolved or the patient is dismissed from the intensive care unit. Periodic follow up and 30 minute of aerobic exercise which is preffered and can be easily performed by the patient every two or three times a week will be adequate to keep the capacity regained. Especially for the patients over 75 years of age, CR program should be considered as a long-term condition management.
