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Background and Objectives: It is known that critical illness and associated neuromuscular problems begin to appear in patients hospitalized in the intensive care unit (ICU) for more than a week. The goal of this study was to research the role of hydroxychloroquine (HCQ) in the treatment of cytokine storm and critical illness neuromyopathy (CINM) in a rat sepsis model. Materials and Methods: Rats were assigned into three groups, and a feces intraperitoneal-injection group (FIP) procedure was carried out on 30 rats to induce a model of sepsis for critical illness polyneuromyopathy (CINM). The study groups were as follows: Group 1: control (nonoperative and orally fed control, n = 10), Group 2: FIP with 0.9% NaCl saline was given as 1 mL/kg/day by oral gavage ( n = 10), and Group 3: FIP with 10 mg/kg/day of hydroxychloroquine (Plaquenil 200 mg) administered by oral gavage ( n = 10). Electrophysiological recordings (EMG) were conducted six days after surgery. EMG was carried out three times on the right sciatic nerve, which was stimulated with supramaximal intensity utilizing a bipolar needle electrode at the sciatic notch. Tumor necrosis factor-alpha (TNF-α), malondialdehyde (MDA), lactic acid levels, and interleukin-6 (IL-6) were evaluated. Results: In terms of TNF-α, MDA, lactic acid levels, and IL-6, there was a statistically significant decrease in the CINM + 10 mg/kg HCQ group compared to the CINM and saline group ( p < 0.0001, p < 0.05, p < 0.05, and p < 0.05, respectively). Compound muscle action potentials (CMAPs) latency and duration were decreased in the CINM + 10 mg/kg HCQ group compared to other groups ( p < 0.01 and p < 0.001). However, CMAP amplitude was significantly higher in the CINM + 10 mg/kg HCQ group unlike the CINM and saline group ( p < 0.001). Conclusions: This is the first study to demonstrate the effects of HCQ on CINM in a rat model of sepsis. The findings of our research suggest that hydroxychloroquine may be used as a potential therapeutic agent in the treatment of sepsis. Hydroxychloroquine may have an important effect in the pathogenesis of sepsis-associated CINM by reducing cytokine production and oxidative stress.

This study was designed to investigate the effects of vitamin D and mannitol in an experimental rat ovarian torsion model. Thirty-two female Wistar albino rats were randomly classified as group 1: (sham), group 2: (detorsion), group 3: (detorsion + mannitol), group 4: (detorsion + vitamin D) and group 5: (detorsion + mannitol + vitamin D) (for each group n = 8). All groups were subjected to bilateral adnexal torsion for 2 h except for group 1. Bilateral adnexal detorsion was performed in all groups except for group 1. Groups 3 and 5 intraperitoneally received the injection of mannitol at a dose of 0.3 mg/kg 30 min before detorsion. Also, the group's 4 and 5 orally received vitamin D in a dose of 500 IU/kg/day for two weeks before torsion. Total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) and proliferating cell nuclear antigen (PCNA) levels were analyzed. According to the histopathological analyses, ovarian tissue damage and follicle counting were evaluated. TOS, OSI and histopathologic score values of ovarian tissue were significantly lower in group 5 than groups 2, 3 and 4 ( p < 0.05). The PCNA level was significantly higher in group 5 than in groups 2, 3 and 4 ( p < 0.05). A strong negative correlation was found between OSI and PCNA in groups 2, 3, 4 and 5 (r = -0.92, p = 0.01; r = -0.98, p < 0.0001; r = -0.98, p < 0.0001 and r = -0.96, p = 0.0002, respectively). The numbers of primordial follicles in group 5 ( p < 0.001) and primary follicles in group 4 ( p < 0.001) were significantly higher when compared to group 2. Based on the results of this study, it could be suggested that combination treatment of mannitol with vitamin D is more effective in reversing tissue damage induced by ischemia-reperfusion (I/R) injury in the ovarian torsion model than administration of only an agent.

Purpose: To investigate cytokine levels in peri-implant crevicular fluid and thus evaluate the effects of concentrated growth factor (CGF) on osseointegration., Materials and Methods: A total of 40 mandibular implants were symmetrically placed in a group of 20 systemically healthy patients enrolled in the study. In each patient, one implant wetted with liquid infiltrated from fibrin matrix was placed in the test side (Group L), and the other implant was placed in the control side without the application of any material (Group C). Peri-implant crevicular fluid was collected at 2, 4, and 12 weeks later. Marginal bone loss was measured with panoramic radiographs taken immediately after implant placement and at 12 weeks. Resonance frequency analysis (RFA) of the implants was performed intraoperatively and at 4 and 12 weeks., Results: Stability values of the implants in the CGF liquid-treated sites were higher than those of the control group at week 12 (P = .005). There was no statistically significant difference between the two groups in terms of marginal bone loss (MBL). Group L showed increased levels of tumor necrosis factor alpha (TNF-α) and receptor activator of nuclear factor kappa-B ligand (RANKL) at 2 and 4 weeks. Also, levels of osteoprotegerin (OPG) were higher in Group L at week 4 compared to Group C (P = .033)., Conclusions: The increased TNF-α, RANKL, and OPG levels in this study demonstrate that CGF liquid can be used to accelerate peri-implant bone remodeling in the early phase of osseointegration.

The hotel industry is essential for travelers, for both touristic and business purposes. Deaths in hotel rooms, which can occur in various manners from various causes, can result in serious problems for the industry. This study evaluated 8137 autopsies performed by the Antalya Group Administration of the Turkish Council of Forensic Medicine between January 1, 2010, and December 31, 2019. All deaths occurred during a hotel accommodation and within hotel borders, including their respective beach areas, and those who collapsed during their hotel stay and died shortly afterward in a hospital or on their way to a hospital were included. A total of 900 cases were identified and ultimately included in this study. According to the autopsy reports, the decedents who died during their stays were from 42 different countries and had a mean age of 54.3 ± 18.55 years. Most decedents were from Russia (n = 251, 27.9%). The most common manner of death was natural causes (n = 552, 61.3%) followed by accidents (n = 284, 31.6%), suicides (n = 40, 4.4%), and homicides (n = 7, 0.8%). Existing cardiovascular diseases (n = 379, 42.1%) were the leading cause of death, followed by drowning in the sea (n = 116, 12.9%) or a pool (n = 58, 6.4%). Most of the causes of deaths identified within this study are preventable with timely intervention or resuscitation. Providing medical personnel 24/7 with adequate equipment in accommodation options, and enabling hotels to take appropriate measures may decrease preventable deaths and improve international travel., (© 2021 American Academy of Forensic Sciences.)

Abstract: In swimming pools, malfunctions in the pool water drainage system can result with severe injuries, or even death, and mostly children are affected by these accidents. In this case report, the death scene and postmortem examination findings of a 12-year-old girl, who was trapped by her feet in the pool water drainage system, are reported. The external examination revealed ecchymotic areas with abrasions on both lower legs and both feet, suggesting suction of both feet through the uncovered pool drainage system opening. To prevent such accidents, safety practices related to the water circulation system should be developed in swimming pools and similar areas; children should be supervised at all times; and emergency medical teams, as well as lifeguards, should be available for immediate intervention., Competing Interests: The authors report no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Coronavirus disease (COVID-19) has spread rapidly, locally and internationally after it started in Hubei province of China in December 2019. During the spread of this infectious disease in the world, health care workers are taking place as the main people in the screening and treatment of the disease. The present study aims to evaluate the relationship between anxiety and depression levels with perceived stress and coping strategies in health care workers during the COVID-19 pandemic., Methods: In this study, 200 participants were included. Beck Anxiety Inventory (BDI), Beck Depression Inventory (BDI), Perceived Stress Scale-10 (PSS-10) and COPE (Coping Orientation to Problems Experienced) were applied., Results: Mean scores for BDI and BAI were 9.2±8.9 and 8.2±9.2, respectively. BDI scores of 33 (16.5%) of 200 participants were ≥17. 62% of the participants had minimal depression, 21.5% of the participants had mild depression, 13.5 % of the participants had moderate depression, and 3% of the participants had severe depression according to BDI scores. 60.5% of the participants had minimal anxiety, 25.5% of the participants had mild anxiety, 8.5% of the participants had moderate anxiety and 5.5% of the participants had severe anxiety according to BAI scores. BAI and BDI scores of the female participants were statistically higher than the male participants. A statistically significant positive correlation was found between BAI and BDI scores and PSS-10 scores. A statistically significant difference was found in the averages of BAI and BDI, PSS-10 COPE 3 (Focus on and venting of emotions), 7 (Religious coping) and 13 (Acceptance) subscales levels in occupational groups. A statistically significant difference was found in BDI levels in the clinical units during the pandemic., Conclusion: This study indicated that different coping strategies can be used in health care workers regarding anxiety, depression and stress levels during the COVID-19 pandemic. While problem-solving and emotion-focused adaptive coping mechanisms help reduce symptoms, maladaptive and negative coping mechanisms can cause symptoms to exacerbate. Thus, training should be given to developing attitudes of health care workers to cope with stress., Competing Interests: Conflict of Interest: No conflict of interest is declared by the authors., (Copyright: © 2021 by The Medical Bulletin of Sisli Etfal Hospital.)