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Objective Prehospital and hospital care during incidents of mass violence and civil conflict involve a number of aspects that distinguish it from care during times of peace. We aimed to analyze the dynamics and outcomes of prehospital and hospital care during ongoing conflicts. Study design Multicentric prospective observational study. Method Patients enrolled in the study, which was conducted in Turkey, were all injured in armed conflict and taken to level 1 trauma centers. On admittance, patients were requested to complete a semistructured questionnaire containing questions on patient demographics, transport type, weapons used, injury severity score (ISS), and other incident-related factors. We analyzed patient outcomes (mortality, morbidity, complications, and length of hospital stay) and transfers of patients between hospitals. The present study evaluated the cases of 390 victims enrolled over a 9-month period and followed up for 6 months. Results The majority of patients were transported by ambulances (n = 334, 85.6%); other transport modes were helicopters (n = 32, 8.2%) and private vehicles (n = 24, 6.2%). Nearly half of patients (48.7%) did not benefit by changing hospitals. During transport to hospitals, 4.1% of the vehicles in the study were involved in accidents. Using multiple regression analysis, only ISS (odds ratio [OR]: 1.098, 95% confidence interval [CI]: 1.044–1.156) and the Glasgow Coma Scale (OR: 0.744, 95% CI: 0.639–0.866) were found to affect mortality. In Receiver-operator characteristic analysis, a cutoff value of 22.5 for ISS had a sensitivity of 100% and a specificity of 89.6% for mortality. Conclusions Despite lower ISS values, patient outcomes were worse in terror incidents/civil conflicts. Transport modes did not significantly affect outcomes, whereas hospital transport was found to be inefficiently used. [ABSTRACT FROM AUTHOR]

Aim: We aimed to assess the utility of DN4 questionnaire (Douleur Neuropathique en 4 questions) to define the frequency and severity of neuropathic pain (NP) and also its clinical correlation to daily clinical practice.Methods: We included 1357 patients with diabetes (56.5% women, 90.4% type 2 diabetes) who were followed up in our diabetes outpatient clinic. Presence of NP was evaluated by performing simultaneous DN4 questionnaires and physical examination. Those who had a DN4 score ≥4 were considered to have NP.Results: The mean age was 58.2±12.1 years, mean duration was 12.5±7.5; (min-max: 1-45) years, mean HbA1c level was 7.8±1.6% (min-max: 5-16.2%), (61.7±6.0mmol/mol; min-max: 31.1-153.6mmol/mol). Three hundred thirteen patients (23%) were diagnosed with NP using the DN4 tool. Male gender (p=0.01), receiving antihypertensive treatment (p=0.01), presence of retinopathy (p<0.001), cardiovascular disease (CVD) (p=0.01) and previously diagnosed neuropathy (p<0.001) were significantly associated with higher NP scores. Those who had increased DN4 scores were more likely to be on oral hypoglycemic agents (OHA)+insulin combinations (p<0.001), had longer diabetes duration (p<0.001) and higher HbA1c levels (p=0.001). Logistic regression model revealed that diabetes duration (OR: 1.02, 95% CI: 1.00-1.04, p=0.007), elevated HbA1c levels (1.11, 1.02-1.21, 0.015), presence of retinopathy (1.41, 1.20-1.64, <0.001), management with at least one OHA (1.47; 1.12-1.92; 0.004) or any insulin regimen (1.62; 1.16-2.27; 0.005) (compared with diet only-regimens) were significantly associated with NP.Conclusion: Utilization of DN4 questionnaire in daily clinical practice is an effective tool in the identification of pain related with peripheral diabetic polyneuropathy. [ABSTRACT FROM AUTHOR]

Abstract: Background: Calcineurin inhibitor (CNI)–free immunosuppression is used increasingly after heart transplantation to avoid CNI toxicity, but in the absence of a randomized trial, concerns remain over an increased rejection risk. Methods: We studied the incidence of graft rejection episodes among all cardiac graft recipients, beginning with the first introduction of CNI-free protocols. We compared events during CNI-free and CNI-containing immunosuppression among 231 transplant recipients of overall mean age 55.2 ± 11.8 years, from a mean 5.2 ± 5.4 years after transplantation through a mean follow-up of 3.1 ± 1.4 years. We considered as acute rejection episodes requiring treatment those of International Society for Heart and Lung Transplantation. Results: During the total follow-up of 685 patient years (CNI-containing, 563; CNI-free, 122), we performed 1,374 biopsies which diagnosed 78 rejection episodes. More biopsies were performed in CNI-free patients: biopsies/patient-month of CNI-containing, 0.13 versus CNI-free, 0.22 (P < .05). The incidence of rejection episodes per patient-month was significantly higher on CNI-free compared with CNI therapy, among patients switched both early and later after heart transplantation, namely, within 1 year, 0.119 versus 0.035 (P = .02); beyond 1 year, 0.011 versus 0.004 (P = .007); beyond 2 years, 0.007 versus 0.003 (P = .04); and beyond 5 years: 0.00578 versus 0.00173 (P = .04). Conclusions: Rejection incidence during CNI-free immunosuppression protocols after heart transplantation was significantly increased in both early and later postoperative periods. Given the potentially long delay to rejection occurrence, patients should be monitored closely for several months after a switch to CNI-free immunosuppressive protocols. [Copyright &y& Elsevier]

Brucella species are able to survive and replicate within the phagocytic vacuole of macrophages that induce chronic infection in humans and domestic animals. The activation of oxidative bactericidal activity is one of the defense systems which protect the host from the toxic effects of pathogens, The aim of this study was to evaluate lipid peroxidation, NO production, antioxidative system and inflammation during a period of brucella infection in a rat model; in addition to investigate the role of elevated intracellular cyclic AMP on Brucella-induced events. Brucella significantly induced lipid peroxidation in plasma, liver and spleen by 3-5-fold at 7 days postinfection, NO concentration was significantly elevated in the liver and spleen while unchanged in plasma. Cyclic AMP elevating agent, rolipram, administration (1 mg/kg/day i.p., 3 days) gradually suppressed lipid peroxidation and NO formation to the basal level in plasma and spleen whilst only a slight decrease was observed in liver. Brucella considerably decreased SOD activity in the liver and spleen, with rolipram restoring the enzyme activity in liver and activity in spleen being unchanged. Reverse transcriptase PCR analyses showed that Brucella melitensis does not after TNF-α and IFN-γ transcriptions in liver and spleen. The pathogen did not consistently induce nitric oxide synthase mRNA transcriptions in animals; even in those housed in the same group, IL-10 transcription was induced by rolipram in spleen but not in liver. Our results suggest that activation of the cAMP/PKA pathway suppressed lipid peroxidation and the elevated NO concentrations caused by B. melitensis. Moreover, rolipram induced anti-inflammatory cytokine IL-10 transcription and SOD activity. albeit in a tissue dependent manner. [ABSTRACT FROM AUTHOR]

Summary Introduction The risk of kidney stone formation increases with urinary stasis, which is associated with decreased peristaltism. The relationship between nonobstructive kidney stone formation and ureteral jet dynamics, which can be measured with Doppler ultrasonography (US) and provide information about ureteral peristaltism, has been demonstrated in adults. Objective To investigate the relationship between ureteral jet dynamics, which provide information about ureteral peristaltism, and stone formation in children. Study design Children admitted to Dokuz Eylul University Hospital with flank pain, and asymptomatic age-matched children for the control group, were prospectively enrolled and underwent Doppler US for diagnostic reasons and bilateral ureteral jet flow measurements. Children diagnosed with unilateral nonobstructive lower pole kidney stones formed Group 1, and the control group, without any evidence of stone disease, formed Group 2. Ureteral jet dynamics were compared between the affected renal units in Group 1, and healthy renal units in Group 1 and Group 2. Results A total of 32 children were included for each group. The mean average jet flow-rate (JETave (cm/second)) in affected renal units in Group 1 was found to be significantly lower than in the healthy renal units in Group 1 and left and right healthy renal units in Group 2 ( P < 0.05). The continuous JETpattern rate in affected renal units in Group 1 was found to be significantly higher compared with healthy renal units in Groups 1 and 2 ( P = 0.012) (Table). The odds ratio for kidney stone formation was 5.6 for renal units with JETave <9.5 cm/s when compared with renal units with JETave ≥9.5 cm/s. Discussion In a recent study, it was demonstrated in adults that low ureteral jet flow-rate and continuous JETpattern were significantly higher in affected renal units. The findings in children were also similar to adults: the mean JETave was significantly lower and determination rate of continuous flow pattern was significantly higher in affected renal units. Conclusions Children with low JETave and continuous JETpattern as a sign of decreased ureteral peristaltism are at an increased risk of kidney stone formation. However, it is vital that further studies are conducted to elaborate on this topic. Summary Table Comparison of JETave and continuous jet flow pattern between affected renal units in Group 1, and healthy renal units in Group 1, healthy left renal units in Group 2 and healthy right renal units in Group 2. Group 1 affected renal units (n = 32) Group 1 healthy renal units (n = 32) P * Group 2 left healthy renal units (n = 32) P † Group 2 right healthy renal units (n = 32) P ° JETave (cm/second) (min–max) 8.6 ± 5.7 (1.5–22.6) 11.6 ± 5.5 (3.0–25.3) 0.038 12.8 ± 6.5 (3.6–28.6) 0.008 13.4 ± 10.2 (3.0–49.3) 0.023 Continuous JETpattern (%) 6 (18.7) 0 (0) 0.012 0 (0) 0.012 0 (0) 0.012 * P -value between affected and healthy renal units in Group 1. † P -value between affected renal units in Group 1 and left healthy renal units in Group 2. ° P -value between affected renal units in Group 1 and right healthy renal units in Group 2. [ABSTRACT FROM AUTHOR]