Influenza and COVID-19 coinfection: Report of six cases and review of the literature.

Coronavirus disease 2019 (COVID-19) pandemic caused infection in a season when influenza is still prevalent. Both viruses have similar transmission characteristics and common clinical manifestations. Influenza has been described to cause respiratory infection with some other respiratory pathogens. However, the information of COVID-19 and influenza coinfection is limited. In this study, we reported our coinfected cases and reviewed the literature. We included all COVID-19 diagnosed patients. All patients with a presumed diagnosis of COVID-19 were routinely screened for influenza. Their thorax radiology was reviewed for COVID-19-influenza differentiation. During the study period, 1103 patients have been diagnosed with COVID-19. Among them, six patients (0.54%) were diagnosed coinfected with influenza. There have been 28 more coinfected patients reported. Laboratory-based screening studies reported more patients. Thorax radiology findings were compatible with COVID-19 in five and with influenza in one of our patients. Our cases were mild to moderate in severity. The reported cases in the literature included patients died (n = 2) and those living ventilator dependent or under mechanical ventilation. COVID-19 and influenza coinfection is rare. Screening studies report more cases, suggesting that unless screening patients with COVID-19, the coinfection remains undiagnosed and underestimated. Increasing experience in thoracic radiology may contribute to diagnose the responsible virus(es) from the clinical illness. Influenza vaccine for larger population groups can be recommended to simplify clinicians' work.

Treatment in carbon monoxide poisoning patients with headache: a prospective, multicenter, double-blind, controlled clinical trial.

BACKGROUND: There is a lack of specificity of the analgesic agents used to treat headache and underlying acute carbon monoxide poisoning. OBJECTIVE: To compare effectiveness of "oxygen alone" vs "metoclopramide plus oxygen" vs "metamizole plus oxygen" therapy in treating carbon monoxide-induced headache. DESIGN: A prospective, multicenter, double-blind, controlled trial. SETTING: Three emergency departments in Turkey. POPULATION: Adult carbon monoxide poisoning patients with headache. METHODS: A total of 117 carbon monoxide-intoxicated patients with headache were randomized into 3 groups and assessed at baseline, 30 minutes, 90 minutes, and 4 hours. MAIN OUTCOME MEASURE: The primary outcome was patient-reported improvement rates for headache. Secondary end points included nausea, need for rescue medication during treatment, and reduction in carboxyhemoglobin levels. RESULTS: During observation, there was no statistical difference between drug type and visual analog scale score change at 30 minutes, 90 minutes, or 4 hours, for either headache or nausea. No rescue medication was needed during the study period. The reduction in carboxyhemoglobin levels did not differ among the 3 groups. CONCLUSION: The use of "oxygen alone" is as efficacious as "oxygen plus metoclopramide" or "oxygen plus metamizole sodium" in the treatment of carbon monoxide-induced headache.

Uveitis attack and drug reaction due to cefuroxime axetil.

Antibiotics are natural or synthetic substances that are used to control bacterial infections because antibiotics are by definition only effective against bacteria. A 30-year-old female came to our emergency clinic complaining rubor in both eyes, especially in the left eye, with swelling, rubor and pain in ears, and eruption in lips extremities. In her anamnesis, it has been determined that she did not have any medical disease that requires regular utilization of drugs. After the patient received cefuroxime axetil for acute tonsillitis, she observed eruptions in lip extremities on the 3rd day, but she did not care about it. On the 5th day, rubor in both eyes and, especially in the left eye, have been developed, and complaints such as unable to look toward light and pain have started together with swelling, rubor, and pain in both ears. She came to our clinic because she was very much worried about the situation. In this study, we aimed to discuss a drug reaction characterized by face and ear skin observations, due to uveitis after the use of antibiotics including cefuroxime axetil for acute tonsillitis.

Protective effects of rosmarinic acid against renal ischaemia/reperfusion injury in rats.

OBJECTIVE: To investigate the potential protective effects of Rosmarinic acid (RA) on rats exposed to ischaemia/reperfusion renal injury. METHODS: The prospective study was conducted at Abant Izzet Baysal University, Turkey, and comprised 21 male Spraque Dawley rats weighing 250-270g each. They were divided into three equal groups. Unilaterally nephrectomised rats were subjected to 60 minutes of left renal ischaemia followed by 60 minutes of reperfusion. Group 1 had sham-operated animals; group 2 had ischaemia/reperfusion untreated animals; and group 3 had ischaemia/reperfusion animals treated with rosmarinic acid. Serum creatinine, blood urea nitrogen, tissue malondialdehyde, glutathione peroxidase, superoxide dismutase and myeloperoxidase (MPO) activities, and light microscopic findings were evaluated. SPSS 17 was used for statistical analysis. RESULTS: Treatment of rats with rosmarinic acid produced a reduction in the serum levels of creatinine and blood urea nitrogen compared to the other groups. However, no statistically significant difference was found. The levels of malondialdehyde and myeloperoxidase were decreased in the renal tissue of group 3, while glutathione peroxidose and superoxide dismutase levels remained unchanged. The injury score decreased in the treatment group rats compared to the untreated group. Rosmarinic acid significantly decreased focal glomerular necrosis, dilatation of Bowman's capsule, degeneration of tubular epithelium, necrosis in tubular epithelium, and tubular dilatation. CONCLUSIONS: Rosmarinic acid prevented ischaemia/reperfusion injury in the kidneys by decreasing oxidative stress.

Frequency of MEFV mutation and genotype-phenotype correlation in cases with dysmenorrhea.

AIM: We aimed to investigate the relation between mutations and polymorphisms playing roles in the onset of clinical findings of Familial Mediterranean Fever (FMF) and clinical phenotypic reflections manifesting with painful episodes, such as dysmenorrhea. MATERIAL AND METHODS: A total of 1000 female patients who had not responded well to non-steroidal anti-inflammatory drugs in the menstrual period, and who had presented to the emergency room with the complaint of recurrent pain episodes were included in the study. All the patients were Turkish women living in Istanbul. In this study, the mutations most frequently seen in the Mediterranean Fever Gene (MEFV), namely M694V, E148Q, M680I(G/C), V726A, P369S, R761H, A744S, M694I, K695R, F479L, M680I(G/A), and I692del were examined using the DNA sequence analysis following DNA isolation. RESULTS: The number of individuals who had a mutation in at least one allele for FMF was 511 out of 1000 patients. Of these 511 patients, homozygous mutations were found in 21% (n = 109), compound heterozygous mutations were found in 27% (n = 136), and heterozygous mutations were found in 52% (n = 266). The most frequent homozygous genotype seen in our study population was M694V/M694V. The most common compound heterozygote genotypes were M694V/M680I, M694V/V726A, M694V/E148Q, and M680I/V726A; and 11.7% (n = 60) of the families in whom mutations were found had consanguinity. CONCLUSION: Women who present to the emergency room with the complaint of dysmenorrhea that is irresponsive to non-steroidal anti-inflammatory drugs may have several types of MEFV mutations that are responsible for FMF.

Efficacy of aprotinin treatment on bilateral blunt chest trauma created in rabbits.

OBJECTIVES: To investigate the effects of aprotinin, on blood gasses, oxidant-antioxidant status, and lung histopathology in an experimental bilateral blunt chest trauma model. METHODS: Conducted at the Experimental Animal Laboratory of Meram Medical School at Selcuk University, Konya, Turkey, the study comprised 21 New Zealand female albino rabbits who were divided into three groups.Trauma was applied on the sham and aprotinin groups, which was administered intravenous Aprotinin 20.000 U/kg. Arterial blood samples were obtained from all rabbits at hours 0, 3, 24, and 96. At hour 96 after trauma, all rabbits were sacrificed using the decapitation method, and then blood and lung tissue samples were obtained. Blood nitric oxide, malondialdehyde and blood gas measurements were made. Histopathological changes in the lung were examined with a light microscope. RESULTS: While no positive effect of aprotinin was observed on nitric oxide malondialdehyde and partial pressure of carbon dioxide values, it was seen to have an increasing effect on partial oxygen pressure level. Aprotinin had a partial effect on lung histopathology. CONCLUSION: Aprotinin was determined to have a positive effect on PO2 levels. We could not find any positive effects especially on alveolar haemorrhage.

Patients admitted to emergency units with injuries related to the four Hajj-associated annual animal sacrifice feasts from 2010 to 2013.

BACKGROUND: During the Eid al-Adha ("Sacrifice Feast") religious holiday in Muslim communities animal sacrifices are made over a period of 3 days every year. OBJECTIVES: The aim of this study was to determine the type of sacrifice-related injuries, the characteristics of patients, treatments for injuries, and relationships between these factors to determine precautions that could be taken to avoid or mitigate sacrifice-related injuries. DESIGN: Retrospective study of medical records. SETTING: Emergency units at two hospitals from 2010 to 2013. PATIENTS AND METHODS: Patients admitted for treatment for injuries associated with sacrificial cutting during the four annual sacrifice feasts were classified as professional butchers, apprentice butchers, and third persons who were neither professional butchers nor apprentices. MAIN OUTCOME MEASURE(S): Injuries associated with animal sacrifice. RESULTS: Of 592 patients, 22 (3.7%) were professional butchers, 149 (25.2%) apprentice butchers, and 421 (71.1%) third persons. Significant relationships were found between the profession of the injured person and the injury and subsequent treatment (P < .05). CONCLUSION: To prevent and minimize the injuries associated with sacrificial cutting, there should be an area designated for sacrificing animals. Moreover, sacrifices should be performed by professionals in possession of a sacrificial cutting certificate. If owners of sacrificial animals insist on slaughtering animals, they should be trained by professional butchers who have a teaching certificate. To deal with an increasing number of such injuries during the sacrifice feast, hospital emergency units need to be adequately resourced with adequate equipment and staff. LIMITATIONS: Regional and local data could not be assessed completely. Patients who presented on the 4th day were not included in the study.

Interleukin 10 reduces testicular damage in experimental testicular ischemia/reperfusion injury.

OBJECTIVE: To evaluate the protective effect of interleukin 10 (IL-10) on biochemical and histopathologic changes in experimental testicular ischemia or reperfusion injury (RI) in rats. METHODS: Sprague-Dawley rats were randomly divided into 3 groups, each containing 7 rats; sham-control, I-R/untreated group, and I/R treated with IL-10. The ischemia period was 6 hours, and orchiectomy was performed after 1 hour of detorsion. IL-10 was given intraperitoneally in a period of 10 minutes before reperfusion. In all groups, ipsilateral orchiectomies were performed to make histologic examination and biochemical analysis such as malondialdehyde, glutathione peroxidase, and myeloperoxidase (MPO). RESULTS: IL-10 treatment significantly decreased the I-R-induced elevation in testes malondialdehyde levels. In the I-R/IL-10-treated group, testes glutathione peroxidase levels were increased compared with the I-R/untreated group rats. MPO activities were significantly increased in the testes tissues of the I-R/untreated group. However, in the I-R/IL-10-treated group, MPO levels significantly decreased. Histopathologically, in the I-R/untreated group rats, edema, congestion, hemorrhage among seminiferous tubules, and necrosis of the germinal cells were predominant features in sections. The testicular injury score was lower in the IL-10-treated group rats compared with the I-R/untreated group. CONCLUSION: IL-10 might play a protective role in reducing reperfusion injury.

Protective effects of montelukast and Hypericum perforatum against intestinal ischemia-reperfusion injury in hamsters.

AIM: To evaluate the effects of montelukast and Hypericum perforatum against ischemia/reperfusion (I/R)-induced intestinal damage. MATERIALS AND METHODS: Twenty-eight hamsters were divided into 4 groups following midline abdominal laparotomy: control group (n = 7), I/R group (n = 7), montelukast and I/R (MIR) group (n = 7), and Hypericum perforatum and I/R (HPIR) group (n = 7). After 60 min of ischemia through obstruction of the superior mesenteric artery, 24 h of reperfusion was maintained. Ten minutes prior to the reperfusion period, the MIR group received 7 mg/kg of intraperitoneal montelukast and the HPIR group received 7 mg/kg of intraperitoneal Hypericum perforatum. Malondialdehyde, glutathione, myeloperoxidase, and cardiotrophin-1 levels were measured from blood samples. A semiquantitative histological evaluation was performed. RESULTS: Montelukast and Hypericum perforatum significantly reduced malondialdehyde levels and increased glutathione levels compared to the I/R group (P < 0.008). A statistically significant difference was also found between the I/R group and MIR and HPIR groups in terms of myelqperoxidase levels (P < 0.008). The MIR and HPIR groups showed increased cardiotrophin- 1 levels compared to the control and I/R groups (P < 0.008 for all). The MIR and HPIR groups showed significantly lower histological scores compared to the I/R group (P = 0.03 and P = 0.007, respectively). CONCLUSION: This study demonstrated the preventive effects of montelukast and Hypericum perforatum on I/R-induced intestinal injury.

Lower Extremity Tissue Defect Caused by Mobile Phone Charger Explosion: A Case Report.

As the usage of cell phones is markedly increasing worldwide, accidental injuries and even lethal damages caused by cellular phone explosions have been reported lately. Although, cell phone charger explosion related scalding and tissue loss is extremely rare, they generally cause severe damage to tissues and cause severe complications, ending up in hospitalization. We are presenting a case of 9-year old female patient who was admitted to our emergency service due to a phone charger explosion that resulted in a lower extremity tissue defect.

Evaluation of patients with Tularemia in Bolu province in northwestern Anatolia, Turkey.

INTRODUCTION: Tularemia is a zoonotic disease caused by Francisella tularensis. Here we present an epidemic occurring in Bolu province, located in northwestern Anatolia in Turkey, and some features of the cases. METHODOLOGY: The data was provided by the Bolu Provincial Health Directorate. All of the antibody response tests were studied in the National Health Institute (formerly named Refik Saydam Hygiene Department), the reference laboratory of the Ministry of Health of the Turkish Republic. A total of 393 individuals were tested by microagglutination test (MAT) for tularemia between 2006 and 2011. A total of 218 patients whose demographical data were available were included in the study; 83 were accepted as the patient group and 135 were the controls. Of the patients, 31 (37.3%) were male and 52 (62.7%) were female. RESULTS: Fever (p < 0.001), URTI symptoms (p = 0.047), conjunctivitis (p = 0.004), and rash (p = 0.026) were significantly higher in the patient group. A positive association was found between MAT and fever (r = 0.324; p < 0.001), and a negative association was found between MAT and both lymphoadenopathy (r = -0.25; p = 0.013) and chills (r = -0.218; p = 0.035). Higher MAT titers were detected in oropharyngeal tularemia (r = 0.306; p = 0.003). CONCLUSIONS: In conclusion, tularemia must be considered in differential diagnosis in patients presenting with fever and LAP in non-endemic regions. Furthermore, water sources and contact with rodents must be investigated.

A new diagnostic marker for acute pulmonary embolism in emergency department: mean platelet volume.

OBJECTIVE: To investigate the diagnostic importance of mean platelet volume (MPV) on acute pulmonary embolism (APE) in the emergency Department (ED). METHODS: Subjects were selected from patients admitted to ED with clinically suspected APE. Demographic, anthropometric and serologic data were collected for each patient. RESULTS: A total of 315 consecutive patients were analyzed, including 150 patients (53.44 ± 15.14 y; 92 men/58 women) in APE group and 165 patients (49.80 ±13.76y; 94 men/71 women) in the control group. MPV in the APE group was significantly higher than in the control group (9.42±1.22 fl vs. 8.04±0.89 fl, p<0.0001). The best cut-off values for MPV when predicting APE in patients with clinically suspected APE presenting at the ED were 8.55 fl (sensitivity 82.2%; specificity 52.3%). CONCLUSIONS: MPV is a helpful parameter for the diagnosis of APE in ED, for the first time in the literature.

The importance of the mean platelet volume in the diagnosis of supraventricular tachycardia.

BACKGROUND: The diagnosis of palpitation can be difficult in the emergency department (ED) and the waiting time for a first appointment with an arrhythmia clinic can be very long. The inflammation is sufficient to facilitate the initiation of supraventricular tachyarrhythmia (SVT). The increased mean platelet volume (MPV) is closely correlated with inflammation and to reflect inflammatory burden in different condition. OBJECTIVE: In this study, we aimed to investigate the relation between MPV and SVT in patient with documented atrial tachyarrhythmia in ED. METHODS: Two study groups were compared; a SVT group with arrive at the ED with documented SVT (n=122) and 100 healthy adult without any palpitation symptom, arrhythmic disease, and with normal physical examination results that were brought for checkups to the cardiology polyclinic were classified as control group. Blood samples were obtained from all patients for determining the hematologic counts and MPV during first hour in ED period. RESULTS: In terms of the focus of the study, hemoglobin, neutrophil count, mean cell volume (MCV), red cell distribution width (RDW), platelet, white blood cell (WBC), and lymphocyte counts were similar in both group (p>0.05). MPV in the SVT group was signifi cantly higher than in the control group (9.12±1.22 fl vs 8.64±0.89 fl , p<0.001). Multivariate logistic regression analysis showed that just MPV was independent predictor of SVT in patients with palpitation in ED (odds ratio [OR] 8.497, 95% confidence interval (6.181 to 12.325), p=0.012). CONCLUSIONS: Our study described that MPV is helpful parameter for the diagnosis of SVT in emergency department, for the first time in the literature.

Emergency upper gastrointestinal endoscopy at the Emergency Department of Izzet Baysal Hospital: analysis of 263 patients.

To evaluate the epidemiological characteristics, etiology, and therapeutic outcome of gastrointestinal disorders in 269 patients who underwent emergency upper gastrointestinal (EUGI) endoscopy at the Emergency Department. Abdominal pain was the most common clinical indication, in 90 (33.5%) patients. The clinical reasons for emergency admission were significantly related to endoscopic diagnostic yield. Non-erosive gastritis was the most common diagnosis, in 76 (28.3%) of EUGIE patients. Erosive duodenitis and gastric ulcer were found to be the other most common clinical indications, in 69 (25.7%) and 31 (11.5%) of EUGIE patients, respectively. The majority of patients who presented with abdominal pain and loss of appetite were between the age of 41 and 60 years, while a significant number of patients presenting with the same symptoms did so during the winter season. Emergency endoscopy is a procedure of choice for the investigation of upper gastrointestinal complaints. Emergency endoscopy is not only a diagnostic tool but also a therapeutic modality.

Pseudo-subarachnoid hemorrhage and death after a bee sting.

We report a case of a 33-year-old woman who developed severe brain edema and pseudo-subarachnoid hemorrhage (SAH) at 36-hour follow-up after successful cardiopulmonary resuscitation for anaphylactic shock as a result of a bee sting. The patient died on the sixth day of the follow-up due to multiple organ failure and brain herniation. Our case suggests that the SAH-like findings on computed tomography scanning were not a new complication ("real" SAH) arising from the bee sting; rather, it was a pseudo-SAH related to prolonged cardiopulmonary resuscitation).

Torsades de Pointes due to ischemic stroke.

Cardiac and cerebrovascular illnesses are among the leading causes of mortality and morbidity today. Thromboembolic cases, which are the result of cardiac arrhythmia, are one of the important causes of cerebral stroke. However, various abnormalities, especially ST-T wave changes on electrocardiography can be seen in patients who do not have any heart disease history but had ischemic cerebral stroke. In this study, we have presented an interesting case of Torsades de Pointes due to ischemic cerebral stroke.

The diagnostic significance of NT-proBNP and troponin I in emergency department patients presenting with palpitations.

OBJECTIVE: This prospective study investigated the diagnostic significance of the N-terminal pro-brain natriuretic (NT-proBNP) and troponin I peptides in emergency department patients presenting with palpitations. METHODS: Two groups of patients with palpitations but without documented supraventricular tachycardia were compared: a group with supraventricular tachycardia (n = 49) and a control group (n = 47). Both groups were diagnosed using electrophysiological studies during the study period. Blood samples were obtained from all of the patients to determine the NT-proBNP and troponin I levels within the first hour following arrival in the emergency department. RESULT: The mean NT-proBNP levels were 207.74±197.11 in supraventricular tachyarrhythmia group and 39.99±32.83 pg/mL in control group (p<0.001). To predict supraventricular tachycardia, the optimum NT-proBNP threshold was 61.15 pg/mL, as defined by the receiver operating characteristic (ROC) curve, with a non-significant area under the ROC curve of 0.920 (95% CI, 0.86-0.97, p<0.001). The NT-proBNP cut-off for diagnosing supraventricular tachycardia had 81.6% sensitivity and 91.5% specificity. Supraventricular tachycardia was significantly more frequent in the patients with NT-proBNP levels ≥61.15 pg/mL (n = 44, 90.9%, p>0.001). The mean troponin I levels were 0.17±0.56 and 0.01±0.06 pg/mL for the patients with and without supraventricular tachycardia, respectively (p<0.05). Of the 96 patients, 21 (21.87%) had troponin I levels ≥0.01: 2 (4.25%) in the control group and 19 (38.77%) in the supraventricular tachycardia group (p<0.001). CONCLUSION: Troponin I and, in particular, NT-proBNP peptide were helpful for differentiating supraventricular tachycardia from non- supraventricular tachycardia palpitations. Further randomized, large, multicenter trials are needed to define the benefit and diagnostic role of NT-proBNP and troponin I in the management algorithm of patients presenting with palpitations in emergency departments.