OBJECTIVES: Previous studies have shown an association between systemic hypertension and intraocular pressure (IOP). We analyzed the relationship between the decreases of the blood pressure (BP) and IOP in hypertensive patients. METHODS: The study includes a total of 214 patients: 158 hypertensive and 56 normotensive patients as study and control groups, respectively. The IOP of each eye in both the groups was measured once with a noncontact tonometer at presentation and an hour after BP reduction to normal in the study group. We analyzed the reduction in IOP with decreasing BP. RESULTS: In the study group, the mean IOP was 15.29 ± 4.05 mmHg in the right and 15.11 ± 3.78 mmHg in the left eyes. The mean IOP measured an hour after the patients became normotensive was 13.78 ± 4.06 mmHg in the right and 13.51 ± 3.82 in the left eyes. There was a statistically significant decrease in the IOPs (P < 0.001). The mean IOP in the control group was 13.54 ± 3.51 mmHg in the right and 13.20 ± 3.33 mmHg in the left eyes. The mean IOP at presentation in the study and control groups was found to be significantly different (P < 0.001). CONCLUSIONS: Patients in the study group showed a significantly higher IOP compared to patients in the normotensive group. Furthermore, patients in the study group showed a significant reduction in IOP after BP reduction. This may indicate that uncontrolled hypertension poses a risk for prolonged higher IOP. Prolonged higher IOP can be considered a risk factor for the glaucoma.

Travmatik rabdomiyoliz (Crush yaralanması) vücudun bir bölümünün veya tamamının harici ezici bir güç altında ezilmesi sonucu ortaya çıkan kas hücresi yıkımına bağlı metabolik bozuklukları tanımlar. Özellikle ezici kuvvetin kaldırılması sonrası kas dokusunun reperfüzyonu ile ortaya çıkan serbest radikaller kas hücre yıkımına neden olur. Kas hücre yıkımı ile hücre içi elektrolitler ve enzimler dolaşıma geçer. Travmatik rabdomiyoliz sonucu serum potasyum, fosfat, myoglobin, kreatinin kinaz (CK), aspartat transferaz (AST) ve laktat dehidrogenaz (LDH) seviyeleri artar. Özellikle myoglobinin renal tübüllerde birikmesi sonucu akut böbrek hasarı, potasyum düzeyinin yükselmesi sonucu ise ölümcül disritmiler ve ani kardiyak ölüm gelişebilir. Travmatik rabdomiyoliz tanısında kullanılan klasik triyad kas ağrısı, kas zayıflığı ve koyu renkli idrar bulgularıdır. Serum kreatinin kinaz seviyesinin 1000 U/L nin üzerinde olması veya normal üst sınırının beş katından fazla olması rabdomiyoliz için tanı koydurucudur. Travmatik rabdomiyoliz tedavisinin ana hedefi yeterli ve uygun sıvı resüsitasyonudur. Özellikle ölümcül seyredebilecek durumların önlenmesi için hastaya ulaşılan ilk anda uygun sıvı tedavisi başlanmalıdır. Sıvı resüsitasyonunda öncelikli olarak kristaloid sıvılar tercih edilmelidir. Her ne kadar kristaloid sıvılar arasında bir ortak görüş sağlanamamış olsa da sıvı resüsitasyonunun izotonik salin ile yapılması yönünde yaygın bir görüş vardır. Hastaya ulaşıldığı ilk anda uygun damar yolu erişimi sağlanıp 1000 ml/saat hızında izotonik salin infüzyonu başlanmalıdır. Çocuklarda sıvı resüsitasyonu için önerilen başlangıç hızı 15-20 ml/kg/saattir. Sıvı resüsitasyonunun yeterliliğini değerlendirmek için hedeflenen idrar çıkışı miktarı ise 1-3 ml/kg/saat veya 300 ml/saattir. Travmatik rabdomiyolizin oluşturduğu en önemli elektrolit bozukluğu hiperpotasemidir. Yüksek serum potasyum düzeyleri ölümcül disritmilere ve ani kardiyak ölümlere neden olabilir. Bu sebeple hiperpotasemi tedavisinde insülin-glikoz infüzyonları, inhale beta 2 adrenerjik ajanlar kullanılmalıdır. Serum potasyum seviyesi 7 mmol/L nin üzerinde olan veya kardiyak etkilenim düşünülen hastalarda kardiyak uyarılabilirliği azaltmak için kalsiyum klorit veya kalsiyum glukonat kullanılabilir. Potasyum seviyesi kontrol altına alınamayan hastalarda hemodiyaliz uygulaması yapılmalıdır. Travmatik rabdomiyoliz tedavisinde ortak görüş sağlanamamış dahi olsa geçmiş çalışmalar ve elde edilen deneyimler standart hasta yönetiminin oluşturulmasını sağlamıştır. Bu yönetim planına uygun düzenlenecek olan tedavi şemaları mortalitenin ve morbiditenin azalmasına katkı sağlayacaktır.

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Aim: Attacks and bites of marine animals are very rare in Turkey. The highly venomous pufferfish (Lagocephalus sceleratus), which often causes systemic toxicity with its toxin (tetradotoxin), could also cause focal toxicity due to bites. Case: A 57-year-old healthy female patient was admitted to the ED with the complaints of inflammation and wounds on the anterior aspect of the leg after a fish bite. 15 days before the admission, complaints of inflammation and pain occurred because of a pufferfish bite in the sea near the shore. In this case, we aimed to present the clinical changes detected after the 6-week follow-up of the patient who presented to the emergency department (ED) after a pufferfish bite that showed a local course. Conclusion: The tetradotoxin (TTX), which is especially found in the liver and reproductive organs of puffer fish. acts through sodium channels. There is no treatment or antitoxin available for enteral systemic poisoning. Symptomatic supportive treatment is recommended. In this patient who did not have any chronic disease, the healing process took over 2 months after puffer fish bite. In countries with a coast to the sea such as Turkey, it is necessary to be careful about the clinical situations that may occur after contact with sea creatures. Global warming and illegal hunting, can cause sea creatures to reproduce and live, in unusual habitats. This leads to unconventional and unknown medical conditions after wilderness contacts.

Objectives The serum Insulin-like growth factor-binding protein 7 (IGFBP7) levels were tested to predict acute renal damage that may develop in patients with stage III–IV heart failure who were treated with intravenous diuretics in the emergency department. Method Patients with stage III–IV heart failure (n=84) were included in this prospective observational study. All patients were treated with IV diuretic therapy in accordance with a predetermined protocol. The serum IGFBP7 and creatinine levels were analyzed at the beginning of the treatment (0 h), 6th, and 12th hours. The creatinine level and glomerular filtration rate (GFR) at baseline were compared with the 12th hour values. The results were classified according to the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria for each patient. The patients were divided into two groups as those in any RIFLE group (RIFLE (+)) and those without (RIFLE (−)). The groups were compared in terms of IGFBP7 levels. Results and Discussion 0, 6th, and 12th hour levels of IGFBP7 were significantly different between the RIFLE + and RIFLE – groups. (p=0.036, 0.042, and 0.006, respectively). The IGFBP7 levels were higher in RIFLE (+) group. However, the IGFBP7 values did not increase with time. In the ROC curve analyze for IGFBP7 levels, the cutoff with the highest sum of sensitivity (0.80) and specificity (0.69) was 118.71. Conclusions The serum IGFBP7 levels can predict the risk of developing AKI before the diuretic treatment in the patients with stage III–IV heart failure.