IL-33/sST2 signaling pathway in pulmonary thromboembolism: A clinical observational study.

BACKGROUND: Pulmonary thromboembolism (PTE) is a cardiovascular emergency that can result in mortality. In the interleukin-33 (IL-33) /soluble suppression of tumorigenicity 2 (sST2) signaling pathway, increased sST2 is a cardiovascular risk factor. This study aimed to investigate the effectiveness of biomarkers in the IL-33/sST2 signaling pathway in determining PTE diagnosis, clinical severity, and mortality. METHOD: This study was conducted as a single-center, prospective, observational study. Patients admitted to the emergency department and diagnosed with PTE constituted the patient group (n = 112), and healthy volunteers with similar sociodemographic characteristics constituted the control group (n = 62). Biomarkers in the IL-33/sST2 signaling pathway were evaluated for diagnosis, clinical severity, and prognosis. RESULTS: IL-33 was lower in the patient group than in the control group (275.89 versus 403.35 pg/mL), while sST2 levels were higher in the patient group than in the control group (53.16 versus 11.78 ng/mL) (p < 0.001 and p = 0.001; respectively). The AUC of IL-33 to diagnose PTE was 0.656 (95 % CI: 0.580-0.726). The optimal IL-33 cut-off point to diagnose PTE was ≤304.11 pg/mL (56.2 % sensitivity, 79 % specificity). The AUC of sST2 to diagnose PTE was 0.818 (95 % CI: 0.752-0.872). The optimal sST2 cut-off point to diagnose PTE was >14.48 ng/mL (83 % sensitivity, 71 % specificity). IL-33 levels were lower in patients with mortality (169.85 versus 332.04 pg/mL) compared to patients without mortality, whereas sST2 levels were higher in patients with mortality (118.32 versus 28.07 ng/mL) compared to patients without mortality (p > 0.001 for both). The AUC of IL-33 to predict the mortality of PTE was 0.801 (95 % CI: 0.715-0.870). The optimal IL-33 cut-off point to predict the mortality of PTE was ≤212.05 pg/mL (75 % sensitivity, 79.5 % specificity). The AUC of sST2 to predict the mortality of PTE was 0.824 (95 % CI: 0.740-0.889). The optimal sST2 cut-off point to predict the mortality of PTE was >81 ng/mL (95.8 % sensitivity, 78.4 % specificity). CONCLUSION: In the IL-33/ST2 signaling pathway, decreased IL-33 and increased sST2 are valuable biomarkers for diagnosis and prediction of mortality in patients with PTE.

A Rare Cause of Coagulopathy in the Emergency Department: Cefoperazone Use.

Cefoperazone (CPZ) is an antibiotic widely used for moderate to severe infections, especially in countries where resources are difficult to access. This case report aimed to draw attention to coagulopathy, a potential side effect of CPZ. This side effect can cause high mortality and morbidity in patients. In the mechanism of CPZ causing coagulopathy, it is reported that effects such as binding to vitamin K, disrupting vitamin K metabolism, and preventing platelet aggregation are responsible. In this presentation, a case who came to the emergency department with the complaint of hematuria caused by coagulopathy after the use of CPZ-containing antibiotics (CPZ + sulbactam) is presented.

Diagnostic accuracy of apple watch ECG outputs in identifying dysrhythmias: A comparison with 12-Lead ECG in emergency department.

BACKGROUND: Wearable devices, particularly smartwatches like the Apple Watch (AW), can record important cardiac information, such as single­lead electrocardiograms (ECGs). Although they are increasingly used to detect conditions such as atrial fibrillation (AF), research on their effectiveness in detecting a wider range of dysrhythmias and abnormal ECG findings remains limited. The primary objective of this study is to evaluate the accuracy of the AW in detecting various cardiac rhythms by comparing it with standard ECG's lead-I. METHODS: This single-center prospective observational study was conducted in a tertiary care emergency department (ED) between 1.10.2023 and 31.10.2023. The study population consisted of all patients assessed in the critical care areas of the ED, all of whom underwent standard 12­lead ECGs for various clinical reasons. Participants in the study were included consecutively. An AW was attached to patients' wrists and an ECG lead-I printout was obtained. Heart rate, rhythm and abnormal findings were evaluated and compared with the lead-I of standard ECG. Two emergency medicine specialists performed the ECG evaluations. Rhythms were categorized as normal sinus rhythm and abnormal rhythms, while ECG findings were categorized as the presence or absence of abnormal findings. AW and 12­lead ECG outputs were compared using the McNemar test. Predictive performance analyses were also performed for subgroups. Bland-Altman analysis using absolute mean differences and concordance correlation coefficients was used to assess the level of heart rate agreement between devices. RESULTS: The study was carried out on 721 patients. When analyzing ECG rhythms and abnormal findings in lead-I, the effectiveness of AW in distinguishing between normal and abnormal rhythms was similar to standard ECGs (p = 0.52). However, there was a significant difference between AW and standard ECGs in identifying abnormal findings in lead-I (p < 0.05). Using Bland-Altman analysis for heart rate assessment, the absolute mean difference for heart rate was 0.81 ± 6.12 bpm (r = 0.94). There was strong agreement in 658 out of 700 (94%) heart rate measurements. CONCLUSION: Our study indicates that the AW has the potential to detect cardiac rhythms beyond AF. ECG tracings obtained from the AW may help evaluate cardiac rhythms prior to the patient's arrival in the ED. However, further research with a larger patient cohort is essential, especially for specific diagnoses.

Assessing the precision of artificial intelligence in ED triage decisions: Insights from a study with ChatGPT.

BACKGROUND: The rise in emergency department presentations globally poses challenges for efficient patient management. To address this, various strategies aim to expedite patient management. Artificial intelligence's (AI) consistent performance and rapid data interpretation extend its healthcare applications, especially in emergencies. The introduction of a robust AI tool like ChatGPT, based on GPT-4 developed by OpenAI, can benefit patients and healthcare professionals by improving the speed and accuracy of resource allocation. This study examines ChatGPT's capability to predict triage outcomes based on local emergency department rules. METHODS: This study is a single-center prospective observational study. The study population consists of all patients who presented to the emergency department with any symptoms and agreed to participate. The study was conducted on three non-consecutive days for a total of 72 h. Patients' chief complaints, vital parameters, medical history and the area to which they were directed by the triage team in the emergency department were recorded. Concurrently, an emergency medicine physician inputted the same data into previously trained GPT-4, according to local rules. According to this data, the triage decisions made by GPT-4 were recorded. In the same process, an emergency medicine specialist determined where the patient should be directed based on the data collected, and this decision was considered the gold standard. Accuracy rates and reliability for directing patients to specific areas by the triage team and GPT-4 were evaluated using Cohen's kappa test. Furthermore, the accuracy of the patient triage process performed by the triage team and GPT-4 was assessed by receiver operating characteristic (ROC) analysis. Statistical analysis considered a value of p < 0.05 as significant. RESULTS: The study was carried out on 758 patients. Among the participants, 416 (54.9%) were male and 342 (45.1%) were female. Evaluating the primary endpoints of our study - the agreement between the decisions of the triage team, GPT-4 decisions in emergency department triage, and the gold standard - we observed almost perfect agreement both between the triage team and the gold standard and between GPT-4 and the gold standard (Cohen's Kappa 0.893 and 0.899, respectively; p < 0.001 for each). CONCLUSION: Our findings suggest GPT-4 possess outstanding predictive skills in triaging patients in an emergency setting. GPT-4 can serve as an effective tool to support the triage process.

Combined Use of Serum N-terminal Pro-B-Type Natriuretic Peptide and Glypican-6 in the Diagnosis of Heart Failure.

OBJECTIVE: The aim of this study was to investigate the efficacy of serum glypican-6 (GPC-6) levels and the combination of N-terminal pro-B-type natriuretic peptide (NT-ProBNP) and GPC-6 in the diagnosis of heart failure (HF). METHODS: In this prospective study, patients older than 18 years of age, admitted to the emergency department of our hospital between December 2021 and April 2022, diagnosed with heart failure (patient group), and healthy volunteers with similar sociodemographic characteristics (control group) were included. The disease severity classification of the patient group was made according to the 2021 ESC guidelines, using echocardiographic findings. Serum GPC-6 and NT-ProBNP levels were measured by the enzyme-linked immunosorbent assay (ELISA) method, which determines the antigen-antibody relationship. Optimal GPC-6 and NT-ProBNP levels for the diagnosis of HF were determined by receiver operating characteristic (ROC) analysis. The patients were divided into three groups according to these levels. Group 1 consisted of patients with both markers below the cutoff values, Group 2 consisted of patients with either of these markers above the cutoff values, and Group 3 consisted of patients with both markers above the cutoff values. RESULTS: The study included 65 heart failure patients and 20 healthy volunteers. When the patient and control groups were compared in terms of serum GPC-6 and serum NT-ProBNP levels, both parameters were evaluated as significantly higher in the patient group (p=0.038 and p<0.001; respectively). In the ROC analysis, it was determined that GPC-6 indicated HF with 58.46% sensitivity and 75% specificity for an optimal cutoff value of 390 pg/ml. In the ROC analysis, it was determined that serum NT-ProBNP indicated HF with 89.23% sensitivity and 70% specificity for an optimal cutoff value of 122 pg/ml. When the groups were compared according to the rate of HF, it was found to be higher in Group 3 compared to Group 2 (97.1% vs. 70.3%, p<0.002) and Group 1 (97.1% vs. 38.5%, p<0.001). This rate was seen to be significantly higher in Group 2 compared to Group 1 (70.3% vs. 38.5%, p=0.042). CONCLUSION: The combination of GPC-6 and NT-ProBNP may help diagnose HF patients admitted to the emergency department.

Evaluation of Serum Secretoneurin Levels in Patients With Ischemic Stroke Who Underwent Mechanical Thrombectomy.

Background Ischemic stroke is a focal or global cerebral dysfunction of vascular origin; its treatment aims to provide reperfusion. Secretoneurin is a hypoxia-sensitive biomarker found in high concentrations in brain tissue. We aim to determine secretoneurin levels in patients with ischemic stroke, examine how secretoneurin levels change in the mechanical thrombectomy group, and evaluate the correlation with disease severity and prognosis. Methods Twenty-two patients diagnosed with ischemic stroke in the emergency department underwent mechanical thrombectomy, and twenty healthy volunteers were included in the study. Serum secretoneurin levels were measured by the enzyme-linked immunosorbent assay (ELISA) method. Secretoneurin levels were measured at the 0th hour, 12th hour, and 5th day in patients who underwent mechanical thrombectomy. Results Serum secretoneurin levels were found to be statistically significantly higher in the patient group (7.43 ng/mL) compared to the control group (5.90 ng/mL) (p=0.023). The secretoneurin levels of the patients who underwent mechanical thrombectomy were 7.43 ng/mL, 7.04 ng/mL, and 8.65 ng/mL, measured at the 0th hour, 12th hour, and 5th day, respectively, and no significant difference was detected in all three time periods (p=0.142). Conclusion Secretoneurin appears to be a useful biomarker in the diagnosis of stroke. However, it was found that there was no prognostic value in the mechanical thrombectomy group, and it was not correlated with the severity of the disease.

Comparison of Pain Catastrophic Scale and Anxiety in Patients With Boxer's Fracture and Other Types of Hand Fractures.

OBJECTIVE:  The Pain Catastrophic Scale (PCS) is generally associated with high and low post-recovery satisfaction and measures the pain perception of patients in the literature. This study aims to evaluate the association of deliberate (as in a fight or anger causing punching a wall) boxer's fractures with catastrophic pain compared to accidental (as in a fall, accidental knocking it against a wall, etc.) fractures and evaluate the effect of anxiety about fracture union and functional recovery on clinical outcomes. MATERIALS AND METHODS:  A total of 62 male patients with metacarpal fractures, 31 as a result of deliberate punching (1st group) and 31 with metacarpal fractures as a result of an accident (2nd group), who applied to the emergency department or orthopedic clinic with the diagnosis of metacarpal fracture between January 2021 and October 2022, were included in the study. All patients were selected from patients who were followed up with conservative plaster/splint. The PCS scores of the patients were evaluated comparatively with the clinical results measured after at least six weeks. RESULTS:  The mean age of the patients was 30.8 (18-50) in the 1st group and 34.8 (18-64) in the 2nd Group, and no statistically significant difference was found (p=0.274). While the median PCS score was 10.5 (interquartile range {IQR}: 12.3) for the 1st group, the median PCS score was 17.5 (IQR: 14.5) for the 2nd group, and the PCS score was statistically significantly lower in group 1 (p=0.009). While the median Visual Analogue Scale (VAS) value was 0 (IQR: 0.3) for the 1st group, the median VAS value was 1 (IQR: 2.0) for the 2nd group, and the VAS score was statistically significantly lower in the 1st group (p<0.001). While the median 'quick disabilities of the arm, shoulder, and hand' (Q-DASH) value was 0 (IQR:2.3) for the 1st group, the median Q-DASH value was 3.4 (IQR:6.3) for the 2nd group, and the Q-DASH score was statistically significantly lower in the 1st group (p=0.001). No significant difference was observed between the 1st and 2nd groups in terms of grip strength values (p=0.815). CONCLUSION: The etiology of patients presenting with a boxer's fracture should be well understood, and if necessary, these patients should be treated multidisciplinary, with psychiatric help. Better satisfaction can be achieved with lower results in patients whose PCS scoring system has lost its eigenvalue.

Can lactate levels and lactate kinetics predict mortality in patients with COVID-19 with using qCSI scoring system?

INTRODUCTION: In this study, we aimed to investigate the relationship between blood lactate levels and lactate kinetics (lactate clearance and Δ lactate) for predicting mortality in patients with COVID-19 admitted to the emergency department. METHODS: This study was performed as a retrospective study that included patients admitted to the emergency department between March 1st, 2020, and January 1st, 2022. Lactate levels were recorded at the first admission (0 h lactate) and the highest blood lactate levels in the first 24 h of follow-up (2nd highest lactate). Lactate kinetics were calculated. Clinical severity was determined according to the quick COVID Severity Index (qCSI). RESULTS: 300 patients were included in the study. Lactate levels at admission were similar in groups with or without mortality, but 2nd highest lactate levels were found to be significantly higher in the group with mortality (p < 0.001). Lactate clearance and ∆ lactate levels were also found to be lower in the mortality group (p < 0.001). Lactate kinetics in patients in the clinically low severity group were lower in the mortality group (p = 0.02 and p = 0.039, respectively). In the low-intermediate and high-intermediate groups, 0-h lactate and 2nd highest lactate levels were found to be higher in the mortality group, and lactate kinetics were similar in the groups with and without mortality. In the group with high clinical severity, 2nd highest lactate levels were found to be higher in the group with mortality (p = 0.010). Lactate kinetics were also found to be significantly lower in the mortality group (p < 0.001). In the high qCSI group, based on ROC analysis, the AUC for 2nd highest lactate levels predicting mortality was 0.642 (95% CI: 0.548-0.728). The optimal cut-off value for mortality was greater than >2.4 mmol/L (60.6% sensitivity, 67.4% specificity). The AUC for lactate clearance was 0.748 (95% CI: 0.659-0.824). The lactate clearance cut-off value was ≤ -177.78% (49.3% sensitivity, 100% specificity). The AUC for ∆ lactate was 0.707 (95% CI: 0.616-0.787). The optimal ∆ lactate cut-off was ≤ -2 mmol/L (45.1% sensitivity, 93.5% specificity). CONCLUSION: In COVID-19, 2nd highest blood lactate and lactate kinetics were found to be prognostic indicators of the disease. High 2nd highest lactate levels and low lactate kinetics in patients with high clinical severity were guiding physicians regarding the outcome of the disease.

The Role of Serum Secretoneurin Levels in Patients with Traumatic Brain Injury.

BACKGROUND: Secretoneurin is a neuropeptide expressed from endocrine, neuroendocrine, and neural tissues. Our study aimed to investigate whether there was a relationship between secretoneurin levels and the severity of traumatic brain injury (TBI). METHODS: Ninety patients aged over 18 years who were admitted to the emergency department with head trauma between April 2020 and October 2020 and 20 healthy volunteers (control group) were included in the study. Patients were divided into three groups according to Glasgow Coma Scale scores: Mild TBI (n=33), moderate TBI (n=28), and severe TBI (n=29). The final status of the patients was evaluated in three groups: exitus, discharge with Glasgow Outcome Scale (GOS) ≤ 3 and discharge with GOS >3. RESULTS: The median secretoneurin levels of patients with severe TBI 31.71 (14.21-70.95) were found to be significantly higher than in those with moderate TBI [17.30 (10.71-69.27) (P=0.025), and patients with moderate TBI had a substantially higher level of secretoneurin than those with mild TBI 11.70 (6-16.25) (P<0.001). There was no statistically significant difference between the median secretoneurin levels in patients with mild TBI and the control group 10.73 (5.33-13.18) (P=0.999). The secretoneurin cut-off value of >18.13 ng/mL had a sensitivity of 83.87% and a specificity of 77.97% for poor neurologic outcomes (AUC 0.86, 95% CI: 0.77- 0.92). The secretoneurin cut-off value of >20.67 ng/mL had a sensitivity of 90.91% and a specificity of 74.68% for mortality (AUC 0.85, 95% CI: 0.76-0.92). CONCLUSION: Secretoneurin can be a useful biomarker in diagnosing patients with moderate-tosevere TBI. It may also guide physicians in predicting the clinical outcome of patients with TBI.

Simulation-Based Drone Assisted Search Operations in a River.

INTRODUCTION: Drones can transmit live video and geographic coordinates during the planning stages for search and rescue operations and the operations themselves. There are few simulation studies in which drones provided rescue support. However, the literature does not contain any simulation studies involving the use of drones to locate lost "victims" represented by dummies in rivers. We developed a simulation model to compare the first visual contact times for drone-assisted search techniques (DAST) and classic search techniques (CST). METHODS: In this prospective experimental simulation study, we used both DAST and CST to perform a series of river searches for unconscious victims (represented by dummies). We calculated the first visual contact times, total scanned area, scanned area per minute, flight-walking distances, and flight-walking speeds and compared the results between both groups. The data are presented as mean±SD. RESULTS: We performed 20 search and rescue operations, 10 with the CST and 10 with the DAST. The time to reach the victim was 823±177 s using CST and 80±14 s using DAST. The area scanned by unit time was 3091±54 m2·min-1 using CST and 22,640±1622 m2·min-1 using DAST. CONCLUSIONS: The drone-assisted search technique located a simulated victim drifting in a river faster than the classic search technique. The use of drones in search and rescue operations could improve the time to find victims.

The Effect of the COVID-19 Pandemic on Urine Culture Results and Resistance to Antibiotics in the Emergency Department.

BACKGROUND: This study aimed to investigate the effect of the COVID-19 pandemic on urine culture results and antibiotic sensitivities in patients with suspected urinary tract infections (UTI) admitted to the emergency department (ED) and determine more accurate treatment modalities for patients. The primary endpoint of our study was to determine the change in antibiotic resistance of UTI agents in the pre-and post-COVID period. METHODS: In the study, urine samples were sent from ED to the microbiology laboratory with a preliminary diagnosis of UTI between June 1, 2019, and July 1, 2021. Urine samples with the growth of 105 cfu/mL and above in urine cultures or with the growth of 103 cfu/mL and above in urine sample cultures taken from catheters were examined. At the end of the exclusions, the results of a total of 1,090 patients were evaluated. Urine cultures and an-tibiotic susceptibility tests of the patients included in the study were examined in two periods (pre-pandemic and post-pandemic). RESULTS: A total of 1,090 aerobic urine cultures sent from the ED between June 2019 and June 2021 were finalized in the microbiology laboratory. Of the 1,090 urine cultures sent from the ED within the 24 months included in the study, 497 (45.59%) were sent eight months before the COVID-19 pandemic. Growth was detected in 33 (6.63%) cultures. In the 16 months after the pandemic, 593 (54.41%) urine cultures were sent. Growth was seen in 69 (11.6%) cultures. The positivity rate obtained from urine cultures sent after the COVID-19 pandemic was significantly higher than those sent before the COVID-19 pandemic (p = 0.005). According to cultures and antibiogram results, resistance to ampicillin, cefuroxime, cefuroxime axetil, cefoxitin, cefixime, ceftazidime, ceftriaxone, and amoxicillin-clavulanic acid decreased significantly compared with pre-COVID-19 (p < 0.05). In addition, Extended Spectrum Beta-Lactamase (ESBL) resistance decreased significantly compared with the prepandemic period (p = 0.012). CONCLUSIONS: In this study, we found that the susceptible to antibiotics increased significantly in the post-COVID-19 period compared to the pre-COVID-19 period.

The Value of Serum I-FABP Level in the Diagnosis of Acute Appendicitis.

BACKGROUND: Acute appendicitis is one of the most common abdominal emergencies worldwide. Biomarkers and imaging are valuable adjuncts to history and examination. Differentiating complicated and uncomplicated appendicitis is essential. Our aim is to investigate whether serum I-FABP could be a suitable diagnostic biomarker in diagnosing acute appendicitis in which inflammation and ischemia play a role in the pathophysiology. METHODS: Sixty-six patients with histopathologically confirmed acute appendicitis were included in the study. Blood samples were taken from the patient and control groups to examine serum I-FABP, white blood cell (WBC) counts, C-reactive protein (CRP), and procalcitonin (PCT) levels. RESULTS: Twenty-six patients (39.3%) had complicated appendicitis. When the patient and control groups were compared in terms of I-FABP, WBC, neutrophil-lymphocyte ratio, (NLR) CRP, and PCT values, a significant difference was found in all biochemical parameters (p < 0.001). We compared the levels of patients with uncomplicated and complicated appendicitis in terms of serum I-FABP, WBC, NLR, CRP, and PCT levels and found that only the I-FABP level was significantly different (p < 0.001), and the diagnostic sensitivity was higher in patients with complicated appendicitis compared with uncomplicated patients (AUC; 0.89 for I-FABP, 0.55, 0.57, 0.61, and 0.59 for WBC, NLR, CRP, and PCT respectively). CONCLUSIONS: I-FABP has no diagnostic advantage over WBC, CRP, and PCT to diagnose acute appendicitis. However, it is more sensitive than other biomarkers in differentiating complicated from uncomplicated appendicitis.

Examination of the Effects of 4-Hour Nonvalved Filtering Facepiece Respirator Use on Blood Gas Values of Health Care Professionals: A Before and After Study.

INTRODUCTION: The use of personal protective equipment increased rapidly during the COVID-19 pandemic that began in 2019. The purpose of this study was to examine the effects of uninterrupted 4-hour use of internationally certified nonvalved filtering facepiece respirators on venous blood gas in health care workers during the COVID-19 pandemic. METHODS: A before-after design included venous blood gas analyses collected at the beginning of shifts before nonvalved filtering facepiece respirator had been put on and after 4-hour uninterrupted use of nonvalved filtering facepiece respirator. RESULTS: In this study, 33 volunteer health care workers took part. In terms of blood gas values, mean pCO2 values were 47.63 (SD = 5.16) before and 47.01 (SD = 5.07) after nonvalved filtering facepiece respirator use, mean HCO3 values were 23.68 (SD = 1.10) in first blood gas analysis and 24.06 (SD = 1.31) in second blood gas analysis, and no significant difference was observed between before and after the use of nonvalved filtering facepiece respirator (t = 0.67, P = .50, t = -2.0, P = .054, respectively). The only significant difference in parameters investigated between the groups was in pH levels, at pH = 7.35 (SD = 0.29) before and pH = 7.36 (SD = 0.20) after nonvalved filtering facepiece respirator use (t = -2.26, P = .03). CONCLUSION: Continuous nonvalved filtering facepiece respirator use for 4 hours was not associated with clinician impairment in blood gas and peripheral SpO2 levels during nonexertional clinical ED work.

Diagnostic and Prognostic Value of Serum Endocan Levels in Patients With COVID-19.

We aimed to evaluate whether there was a relationship between endocan (human endothelial cell-specific molecule-1) levels and disease prognosis in patients who presented to the emergency department with coronavirus disease 2019 (COVID-19). A total of 60 patients with COVID-19 who were hospitalized from the emergency department to clinical wards and a control group consisting of healthy adult individuals (n = 28), were included in the study. The majority (93.3%) of the patients were discharged after recovery; 6.7% died. The median endocan value was 243.5 ng/mL in the patient group versus 201.5 ng/mL in the control group (P = .002). The median endocan level was 240.5 ng/mL in those discharged with recovery and 558 ng/mL in those who died (P = .001). There was no significant relationship in hospitalization duration, sex, tomography findings, and clinical outcomes. A 202 ng/mL serum endocan level had 86.7% sensitivity and 50% specificity for COVID-19. Serum endocan levels may be a useful biomarker both for the diagnosis of COVID-19 and to predict mortality.

Potential therapeutic effects of ethyl pyruvate and N-acetyl cysteine in an experimental rat model of corrosive esophageal.

BACKGROUND AND STUDY AIMS: Esophageal burns due to ingestion of corrosive substances are frequently seen in both children and adults. However, there is no standard method of treatment to prevent associated mortality and morbidity. Therefore, this study aimed to evaluate the effects of known antioxidants, namely N-acetyl cysteine and ethyl pyruvate, on esophageal damage due to sodium hydroxide-induced corrosive burns. MATERIALS AND METHODS: Thirty-five female rats were randomly assigned to five equal groups. Group 1 was the sham group, while Group 2 was the control group. Group 3 received N-acetyl cysteine, Group 4 received ethyl pyruvate, and Group 5 received both N-acetyl cysteine and ethyl pyruvate. Rats in the "burn" groups were gavage-fed with 0.2mL of 25% NaOH. All esophagi were extracted on day 4 for histopathological evaluation. RESULTS: Total histopathological damage scores were evaluated at the end of the study. Groups 3 and 5 were significantly different from the control group in terms of total histopathological scores (p = 0.001), while no significant difference was seen with Group 4. Stenosis index results in groups 3 and 5 were similar to those seen with total histopathological scores (p = 0.004). CONCLUSION: N-acetyl cysteine, alone or in combination with ethyl pyruvate, may be useful in the treatment of esophageal damage associated with corrosive substances and in achieving histopathological improvement in an experimental setting.

Diagnostic Value of Plasma Pentraxin-3 in Acute Appendicitis.

PURPOSE: To measure serum PTX3 levels in patients admitted with right lower quadrant pain to emergency department and to investigate whether this parameter will be helpful for the diagnosis of acute appendicitis. MATERIALS AND METHODS: This study was conducted with a group of 89 patients over 17 years of age who were admitted with the complaint of right lower quadrant pain to ED and had a preliminary diagnosis of acute appendicitis clinically and the control group of 31 healthy volunteers in a tertiary university hospital for 3 months. RESULTS: Median PTX3 levels were 3.28 (1.08-30.24) ng/mL in the acute appendicitis groups and 0.97 (0.34-2.62) ng/mL in the control group. A significant difference was observed between acute appendicitis groups and the control group (p < 0.05). CONCLUSION: PTX3 was found to be significantly higher in patient with acute appendicitis compared to the control group and the patients with non-specific abdominal pain. PTX3 can be used as an aid in the diagnosis of acute appendicitis.

A novel method for improving chest tube insertion skills among medical interns. Using biomaterial-covered mannequin.

OBJECTIVES: To develop a low-cost biomaterial-covered chest tube simulation model and assess its possible usefulness for developing the chest tube insertion skills among medical interns. Methods: This mannequin-based interventional study was performed in a University hospital setting. We included 63 physicians performing emergency medicine internship at the Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey, between January 2015 and March 2015. A dummy was prepared for training simulation using a display mannequin. Medical interns received instruction concerning pneumothorax and the chest tube procedure. A total of 63 medical interns participating in this interventional study were asked to insert a chest tube in a biomaterial-covered mannequin. A senior trainee scored their performance using a check list and the mean of the total scores was calculated (21 items; total score, 42). Results: The mean procedural score was 40.9 ± 1.3 of a possible 42. The maximum score of 42 was achieved by 39.7% of the medical interns, while another 33.3% achieved a score of 41. Of the participants, 85% succeeded in inserting the tube via an appropriate technique, achieving a score of 40 or more. Conclusion: Our results indicated that this model could be useful for effective training of medical interns for chest tube insertion, which is an important skill in emergency medicine. This biomaterial-covered model is inexpensive and its use can potentially be widened to improve training methods without significant financial demand.