Vol 1-1 Case Report

Is Thrombolytic Therapy appropriate at the Late Phase of Cardiopulmonary Resuscitation for Massive Pulmonary Thromboembolism?

Abuzer Coskun1*, Sevki Hakan Eren2

1Department of Emergency, Sivas Numune Hospital, Sivas, Turkey

2Department of Emergency Medicine, Gaziantep University, Gaziantep, Turkey

Pulmonary thromboembolism in which hemostatic balance is disrupted is a disease with high morbidity and mortality rates with challenging diagnosis. A 73-year-old female patient presented to the emergency department with respiratory distress. She had undergone surgery for femoral neck fracture three months ago. She had gradually aggravating respiratory distress for the last 3-4 days. The patient was admitted to the hospital with the diagnosis of massive pulmonary embolism. She had a cardiac arrest after completion of thoracic computed tomography (thoracic CT). Cardiopulmonary resuscitation (CPR) was initiated. Alteplase (rt-PA) was infused at 100 mg/2 hours starting at the 37th minute of CPR in the late phase. As there was no room on the wards, she was admitted to the emergency room observation unit and extubated on the 9th day. Coumadin (warfarin) dose was adjusted and the patient was discharged on day 17 with an INR (International Normalized Ratio) of 2.3.

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Vol 1-1 Research Article

Can Platelet/Mean Platelet Volume ratio, Neutrophil/lymphocyte ratio, and Procalcitonin used for Predicting Prognosis in Acute Coronary Syndrome?

Sedat Özbay1, Abuzer Coskun1*, Sevki Hakan Eren2

1Department of Emergency, Sivas Numune Hospital, Sivas, Turkey

2Department of Emergency Medicine, Gaziantep University, Gaziantep, Turkey

Objective: This study aimed to evaluate acute coronary syndrome (ACS), serum procalcitonin levels, Platelet/Mean Platelet Volume ratio (PMR) and Neutrophil/lymphocyte ratio (NLR) concerning post-myocardial infarction (MI) complications, mortality, and morbidity.

Material and Method: The study included a total of 913 patients with ACS who presented to the emergency department with chest pain between January 2013 and December 2017. The patients were categorized as ST-elevated MI (STEMI), non-ST elevated MI (NSTEMI) and unstable angina (UA) according to the diagnosis. The demographic and laboratory characteristics of the patients were compared for three-vessel disease (TVD) and mortality rates.

Result: Post MI complications, TVD, and mortality were significant among acute coronary syndrome groups. The three-vessel disease was mostly observed in anterior MI with a maximum rate of 58 (39.7%). Mortality was found as 23 (16.3%) in anterior MI and 18 (12.2%) in NSTEMI. Serum procalcitonin levels were highest in anterior MI. Platelet to Mean Platelet Volume ratio was higher in UA, whereas it was lower in STEMI and NSTEMI. Neutrophil to lymphocyte ratio was the lowest in UA. The cTn I values of STEMIs at 0, 6, 12 hours were higher than UA, and the 12th-hour cTnI values in anterior MI were higher than NSTEMIs. It was found that procalcitonin and NLR had a positive correlation with post-MI complications, mortality, and TVD, whereas PMR exhibited a negative correlation.

Conclusion: The levels of procalcitonin, PMR, and NLR may be significant in respect of post-complications, mortality, and morbidity in acute coronary syndrome.

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Vol 1-1 Letter to the Editor

New Persistent Opioid Abuse and the Brain Reward Circuit

Ly Zhang*, Philip G. Boysen

Department of Anesthesiology, University of Mississippi Medical Center, The Mississippi Critical Care Organization, USA

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Vol 1-1 Original Article

The Use of Biologic Agents in the Treatment of Oral Lesions due to Pemphigus and Behcet's Disease: A Systematic Review

Gerald E. Davis II1,2, George Sarandev1, Alexander T. Vaughan1, Kamal Al-Eryani3, Reyes Enciso4*

1Advanced graduate, Master of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA

2Assistant Dean of Academic Affairs, Assistant Professor, Restorative Dentistry, Meharry Medical College, School of Dentistry, Nashville, Tennessee, USA

3Assistant Professor of Clinical Dentistry, Division of Periodontology, Dental Hygiene & Diagnostic Sciences, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA

4Associate Professor (Instructional), Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA

Background: Current treatments for pemphigus and Behcet's disease, such as corticosteroids, have long-term serious adverse effects.

Objective: The objective of this systematic review was to evaluate the efficacy of biologic agents (biopharmaceuticals manufactured via a biological source) on the treatment of intraoral lesions associated with pemphigus and Behcet's disease compared to glucocorticoids or placebo.

Methods: PubMed, Web of Science, Cochrane Library, and EMBASE were searched for randomized controlled studies up to January 2019. Bias was assessed with the risk of bias tool.

Results: Out of 740 references retrieved, only four randomized controlled trials (RCTs) were included, comprised of a total of 158 subjects (138 pemphigus and 20 Behcet's disease). All studies were assessed at high risk of bias. Heterogeneity of data prevented the authors from performing a meta-analysis. Infliximab or rituximab with short-term prednisone showed higher safety and lowered cumulative prednisone dose than prednisone alone in the treatment of pemphigus. Subcutaneous injection of etanercept provided 45% of patients free of ulcers compared to 5% in the placebo group in one study with Behcet's disease; however, no difference was found in pemphigus patients.

Conclusion: Though biological agents alone or in combination with prednisone showed favorable results in three RCTs compared to prednisone alone or placebo, a meta-analysis could not be undertaken due to high heterogeneity. Results are inconclusive, and larger, well-designed RCTs are needed.

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