Prospective interpretation of Covid vaccines. A cross sectional study, Ordu province experience.

During the pandemic period, many regulations were made to reduce the spread of the epidemic throughout the country and restrictions were applied. We aimed to interpret the effects of vaccination status, total number of vaccination doses and preferred vaccine type on the prognostic process of the patients we treated inpatients with the diagnosis of Covid-19 in our pandemic service. The present descriptive cross-sectional study was conducted in Ordu, Turkey. One hundred and fifty-two people participated. 80.9% (n = 123) of whom were vaccinated against SARS-Cov-2, and 19.1% (n = 29) were unvaccinated. When the treatment processes of the participants were analyzed in general, it was observed that the clinical condition of the individuals who received at least one dose of BNT162b2 vaccine did not worsen (χ2 = 40.080; p = .011). It was determined that BNT162b2 vaccine was not among the vaccine preferences of the cases who needed to be transferred to the intensive care unit in this process and whose clinical processes resulted in death during follow-up in intensive care or service after intensive care referral (χ2 = 64.417; p = .024). According to these results, our study proves once again the protective role of vaccines against epidemic diseases and their progression.

The Evaluation of Oxidative Stress in the Young Adults with COVID-19 mRNA Vaccines Induced Acute Pericarditis- Myopericarditis.

BACKGROUND: During COVID-19 pandemic, several vaccines have been developed such as mRNA vaccines. However, acute pericarditis and myocarditis/myopericarditis cases have been described after mRNA vaccination. The mechanism for the development of cardiac involvement is unknown. Potential mechanism for oxidative stress associated with vaccine-induced heart involvement is unidentified. This study aimed to examine the role of oxidative stress and the heart involvement in young adults vaccinated with COVID-19 mRNA vaccines. METHODS: In this cross-sectional study, a total of 23 participants were included and 10 of these participants were asymptomatic patients (control group). Comparison of the cardiac involvement and control group was made by using troponin I, C-reactive protein (hsCRP), D-dimer levels, and oxidative stress tests including nitric oxide, and imaging techniques (ECG, echocardiography, cardiovascular magnetic resonance). RESULTS: The median age of acute pericarditis group (10 patients) was 22 years (Q1-Q3: 18.5-31), and the mean age was 24.4±7.5 years. The median age of myopericarditis group (3 patients) was 22 years (Q1-Q3 18.0-25.0), and the mean age was 21.6 ±3.5 years. All the myopericarditis cases were male. The patients with myopericarditis had higher troponin I level, hsCRP, and D-dimer levels (troponin I level; 1600.00 ng/mL; D-dimer; 1.20 µg/mL, hsCRP; 3.0 mg/L, respectively; p < 0.05). Serum nitric oxide levels and OSI (total oxidant status, H2O2/total antioxidant status) were lower in myopericarditis group than the control and acute pericarditis group (p < 0.05). This shows inflammatory and procoagulant state. CONCLUSION: Vaccine-induced myopericarditis cases are associated with oxidative stress test abnormality (abnormal NO, OSI levels). However, there is no relationship between NO levels and other oxidative stress tests difference in vaccine-induced acute pericarditis. It is thought that vaccine-induced pericarditis and myopericarditis could have different pathogenesis. This could make it necessary to reassess the second dose of vaccination for vaccine-induced cardiac involvement cases.

Prisoners seeking healthcare in emergency department.

OBJECTIVE: To evaluate inmate referrals to emergency department of a tertiary healthcare facility in terms of demographical and clinical characteristics as well as their impact on the department. METHODS: The retrospective cross-sectional study was conducted at Ankara Numune Training and Research Hospital, Ankara, Turkey and comprised data of incarcerated patients who were brought to the emergency department from January 01, 2010, to December 31, 2012. Demographical characteristics, consultations, duration of hospitalisation, recurrent admissions, disposal and mortality rates were noted. The referrals were grouped as surgical conditions, medical disorders, Eye, Ear, Nose, Throat problems, injury and psychiatric disorders. The groups were then subdivided according to diagnosis. SPSS 22 was used for data analysis. RESULTS: Of the 856 patients, 804(93.4%) were men and 52(6.1%) were women. The overall mean age was 37.54±14.81 years (range: 15-83 years). The number of patients was the highest in the medical group 363(42.4%) and the lowest in the Eye, Ear, Nose, Throat group 56(6.5%). Mean age of the surgical group was significantly lower than the medical group (p<0.001) but significantly higher than that of the trauma group (p=0.001). CONCLUSIONS: Functional emergency response units, strict emergency triage of inmates and their rapid care and management in jails can help avoid referring these patients to already overcrowded emergency departments.

The efficiency of continuous positive airway pressure therapy in carbon monoxide poisoining in the emergency department.

OBJECTIVE: To determine whether oxygen therapy with continuous positive airway pressure (CPAP) is superior to normobaric oxygen therapy in carbon monoxide poisoning. METHODS: The study participants were 43 patients diagnosed with carbon monoxide poisoning between the dates 15 March and 30 June 2016 at the emergency department of an urban teaching hospital. The control group comprised patients who received normobaric oxygen therapy. The case group consisted of patients who underwent one-hour CPAP therapy. The primary outcome was the determination of the half-life of carboxyhemoglobin (COHb) with CPAP treatment. The CPAP and control groups were compared in terms of the reduction in COHb levels after 60 minutes of therapy. RESULTS: The COHb level among patients in the CPAP group was lower in the 30th and 60th minutes. The half-life of COHb was apparently decreased in the CPAP group compared with the control group (control and case groups mean plasma half-life of COHb were 80.26 ± 12.70 and 36.20 ± 4.58 minutes, respectively). CONCLUSION: The results of the present study demonstrate that CPAP therapy may be an effective option for oxygen therapy among patients with carbon monoxide intoxication; this is achieved by decreasing the half-life of COHb.

Is initial optic nerve sheath diameter prognostic of specific head injury in emergency departments?

BACKGROUND: Emergency departments (EDs) are typically the first medical contact for patients with traumatic brain injury (TBI) and early diagnosis and treatment of intracranial pressure (ICP) in patients with neurotrauma primarily falls under the liability of emergency doctors. Monitoring ICP with optic nerve sheath diameter (ONSD) via tools has gained popularity among emergency service doctors. In this study, we aimed to evaluate the predictive value of ONSD for specific head injury on initial cranial tomography. METHODS: CT scans of 176 patients with a known intracranial pathology were retrospectively analyzed and compared with normal control CTs of 182 patients presented to ED at the same time interval. The attending radiologist analyzed all initial brain CT scans and randomly sampled control CTs were similarly assessed by the second senior radiologist whom were blind to the patients' medical histories and circumstances of TBI at the time of measurement. ONSD was measured at a distance of 3 mm behind the eyeball, immediately below the sclera. RESULTS: Right ONSD value was significantly higher in patients with herniation and SAH (p = 0,024 and 0,028, respectively). Left ONSD values was at the level of statistical significance and mean ONSD values was significantly higher in patients with SAH (p = 0.05 and 0.026, respectively). Right-left-mean ONSD values were statistically higher in study group with bilateral lesions on brain CT (p < 0,001). ONSD measurements and patient age were higher in patients who died (p < 0,001). CONCLUSIONS: ONSD measurement on initial brain CT is lesion dependent and indicates mortality.

Delayed neurologic sequelae of carbon monoxide intoxication.

Altered consciousness and accompanying neurological symptoms are both complex and challenging cases for emergency physicians. These are not specific and may be a sign of a variety of medical conditions including stroke and delayed neurological sequelae (DNS) is a recurrent transient neuropsychiatric consequence of CO intoxication. DNS produces a spectrum of varying symptoms and the diagnosis is primarily made on the basis of clinical features and radiological findings from CT and conventional MRI. In clinical practice, serious CO intoxication is treated only with oxygen therapy although no effective treatment exists. Emergency physicians play a major role in managing patients presenting with CO intoxication and preventing DNS.

What's going wrong with this postpartum woman?

Peripartum cardiomyopathy (PPCM) is a left ventricular systolic dysfunction failure emerges during the antepartum or puerperal period, and can result in maternal death. Reported incidences are increasing and differing globally. Echocardiography is the cornerstone for the diagnosis. The immediate goals in acute management are the stabilization of the hemodynamic state, providing symptomatic relief, and ensuring fetal wellbeing. Emergency physicians should be aware of PPCM at the differential diagnosis of dyspnea in pregnancy related emergencies and play role in early diagnosis.

Primary headache associated with sexual activity: A case report.

Headaches provoked by triggering factors have been recognized for many decades. In many cases, the development of such headaches is secondary to an underlying pathology. However, in some cases, no abnormality can be identified. Primary headache associated with sexual activity (PHASA) is one of the subgroups of primary headaches. PHASA is a benign form of headache and lifetime prevalence is estimated to be 1% to 1.6% in the general population. A 38-year-old man was admitted to outpatient clinic reporting history of severe headaches during sexual intercourse for the last 2 months. Headaches occurred bilaterally in occipital area just after orgasm and lasted for about 2 hours. Propranolol 40 mg/ day was initiated and on followup, patient reported dramatic improvement in 2 weeks. Treatment was maintained for 6 months. Patient has been on regular follow-up for a year and had no recurrence of headache. This is a rare case PHASA. In this patient, prophylactic treatment with low dosage of propranolol was successful.

Tick Infestation of Eyelid: Two Case Reports.

Tick infestation of the eyelid is a rare but serious condition that can lead to Crimean-Congo hemorrhagic fever. In this report, we describe two cases who presented with tick infestation of the eyelid. Neither patient developed systemic disease or adverse sequelae after tick extraction. Complete mechanical removal of ticks located on the eyelid with blunt forceps is a safe and effective treatment method.

Relationship between red cell distribution width and stroke in patients with stable chronic heart failure: a propensity score matching analysis.

AIM: We aimed to investigate the association between baseline red cell distribution width (RDW) level and the risk of stroke in patients with heart failure (HF). METHODS: A total of 153 consecutive patients with HF (New York Heart Association [NYHA] I-III and left ventricular ejection fraction of <40%) were included in this prospective study. All the patients were followed up for 1 year, and during this period the cerebrovascular disease was questioned. RESULTS: In matched population, using propensity score matching comparing patients with HF having stroke with patients without stroke, we found significantly increased basal RDW and serum uric acid. The receiver-operating characteristic curves of RDW for predicting stroke are performed. An RDW ≥ 15.2% measured on admission had 87% sensitivity and 74% specificity in predicting stroke in patients with HF (area under the curve: 0.923, 95% confidence interval: 0.852-0.994, P < .001). CONCLUSION: In conclusion, this study demonstrated that RDW may be important hematological indices for stroke in patients with HF using propensity score analysis.

Comparison of TIMI and Gensini score in patients admitted to the emergency department with chest pain, who underwent coronary angiography.

BACKGROUND: In patients admitted to the emergency department with complaints of chest pain and unstable angina pectoris, ST-elevation MI scoring is done according to risk factors used to calculate risks of urgent revascularization, MI, and death within 14 days. For this calculation, the most widely used scoring system is TIMI risk score. MATERIAL AND METHODS: In this prospective, cross-sectional descriptive study, we evaluated and compared the effectiveness of TIMI and Gensini scores of patients with chest pain who were admitted to Hacettepe University Hospitals Emergency Department between March 2011 and September 2011 and who underwent coronary angiography. RESULTS: The mean (range) age of 165 patients was 62 (31-88) years. Moderate correlation between TIMI and Gensini scores was detected (mean values of Gensini score for TIMI 1 is 53.50, for TIMI 2 it is 52.09, for TIMI 3 it is 102.77, for TIMI 4 it is 113.70, and for TIMI 5 it is 115.43). There was also a positive correlation between TIMI score and the results. CONCLUSIONS: TIMI risk stratification score is safe and easy to use for rapid assessment of mortality and MI risk, despite its low possibility of predicting the outcome.