Use of the PaO2/FiO2 Ratio in Pulmonary Embolism: Evaluation of its Correlation with Pulmonary Arterial Computed Tomography Obstruction Index.

RATIONALE AND OBJECTIVES: The pulmonary arterial computed tomography obstruction index ratio (PACTOIR) is a parameter that provides an idea of the clinical severity of acute pulmonary embolism (APE). This study aimed to examine the correlation between the PaO2 /FiO2 ratio and PACTOIR in patients who presented to the emergency department and received a preliminary diagnosis of APE. MATERIALS AND METHODS: This study was conducted prospectively in the emergency department. The patients' sociodemographic characteristics, vital signs, PACTOIR, and PaO2 /FiO2 ratio were obtained. The correlation between PACTOIR and PaO2 /FiO2 ratio was then statistically evaluated. RESULTS: The study included 50 patients, of whom 31 (62%) were women, and 19(38%) were men. The female patients had a PaO2 /FiO2 ratio of 209 ± 67 and PACTOIR of 36.3 ± 15.5. The male patients had a PaO2 /FiO2 ratio of 169 ± 43 and PACTOIR of 39.7 ± 19. The PaO2 /FiO2 ratio of the patients with APE was negatively correlated with the PACTOIR value at a statistically significant level (r = -0.308, p = 0.031). The regression equation was as follows: PACTOIR = (-0.0869) x (PaO2 / FiO2) + (54.489). CONCLUSION: By calculating the PaO2 /FiO2 ratio in patients with APE, the degree of pulmonary artery obstruction and clinical severity can be predicted. Therefore, the ratio PaO2 /FiO2 can be used instead of PACTOIR.

Statherin and alpha-amylase levels in saliva from patients with gingivitis and periodontitis.

OBJECTIVES: Salivary statherin and alpha-amylase play significant roles in biofilm formation and pathogenic bacteria adhesion. Examination of these proteins may provide information on their roles in periodontal diseases. The present study was based on the hypothesis that; the salivary proteins -statherin and alpha-amylase- effective on biofilm formation, may play important roles in the etiology of periodontal disease. Therefore, we aimed to analyze the differences in periodontal diseases compared to periodontal health in order to search their roles in periodontal disease. METHODS: Patients with gingivitis (n = 26) and periodontitis (n = 20), and periodontally healthy individuals (n = 21) were included in this study. Unstimulated whole saliva samples were obtained from a total of 67 individuals. Salivary statherin level and alpha-amylase activity were determined using ELISA and enzymatic methods, respectively. RESULTS: Statherin levels in saliva were significantly higher in the periodontitis group compared to the gingivitis group (p = 0.014), while alpha-amylase activities and total protein levels were slightly higher in the periodontitis and gingivitis groups compared to controls, without significant differences among the groups (p = 0.295 and p = 0.019, respectively). Statherin levels showed positive correlations with gingival and plaque indices in the disease groups. CONCLUSIONS: The results suggest that statherin level in saliva increase to provide a protective effect against periodontitis, and higher salivary statherin level is related to the degree of gingival inflammation and plaque accumulation.

Targeting resources efficiently and justifiably by combining causal machine learning and theory.

Introduction: Efficient allocation of limited resources relies on accurate estimates of potential incremental benefits for each candidate. These heterogeneous treatment effects (HTE) can be estimated with properly specified theory-driven models and observational data that contain all confounders. Using causal machine learning to estimate HTE from big data offers higher benefits with limited resources by identifying additional heterogeneity dimensions and fitting arbitrary functional forms and interactions, but decisions based on black-box models are not justifiable. Methods: Our solution is designed to increase resource allocation efficiency, enhance the understanding of the treatment effects, and increase the acceptance of the resulting decisions with a rationale that is in line with existing theory. The case study identifies the right individuals to incentivize for increasing their physical activity to maximize the population's health benefits due to reduced diabetes and heart disease prevalence. We leverage large-scale data from multi-wave nationally representative health surveys and theory from the published global meta-analysis results. We train causal machine learning ensembles, extract the heterogeneity dimensions of the treatment effect, sign, and monotonicity of its moderators with explainable AI, and incorporate them into the theory-driven model with our generalized linear model with the qualitative constraint (GLM_QC) method. Results: The results show that the proposed methodology improves the expected health benefits for diabetes by 11% and for heart disease by 9% compared to the traditional approach of using the model specification from the literature and estimating the model with large-scale data. Qualitative constraints not only prevent counter-intuitive effects but also improve achieved benefits by regularizing the model.

Comparison of the Effects of Isokinetic, Isometric, and Isotonic Exercises on Knee Osteoarthritis Using Ultrasound.

INTRODUCTION: This study aims to investigate the effects of different types of exercise on pain, functional capacity, muscle strength measured by an isokinetic dynamometer, and femoral cartilage (FC) thickness measured using ultrasound in patients with knee osteoarthritis (KOA). METHODS: Sixty patients were randomized to isokinetic, isometric, and isotonic exercise groups, and exercise programs were completed five days a week over three weeks. The FC thickness for each knee was evaluated in medial, intercondylar, and lateral areas using ultrasound, and muscle strength was assessed by an isokinetic dynamometer. Activity levels were also measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). At three weeks from baseline, follow-up clinical measurements of knee muscle strength and FC thickness were performed. RESULTS: A significant decrease was observed in all three groups in post-treatment visual analog scale (VAS) pain scores. In terms of evaluation of WOMAC scores, no significant difference was observed between the groups. In the isokinetic group, a significant increase was detected in extensor and flexor muscle strength measurements at the angular velocities of 60º/s and 180º/s. In the isotonic group, a statistically significant increase was detected in peak torque values of extensor and flexor muscles at 60º/s in the left knee only. Regarding FC thickness, a significant increase was found in the intercondylar area and the lateral condyle measurements of the left knee in the isokinetic group and the intercondylar area measurements of the right knee in the isometric group. In the isokinetic group, a statistically significant decrease was detected in the medial condyle of the right knee. It was observed that isokinetic exercise ended up with a significant increase in FC thickness in the intercondylar area and the lateral condyle of the left knee and a significant decrease in the medial condyle of the right knee. CONCLUSION: Isokinetic exercise is functionally superior to isometric and isotonic exercise, providing more significant improvements in muscle strength measurements and FC thickness. Further research is needed to determine the interactions among therapeutic exercises in patients with KOA that impact knee cartilage quantities.

Ethyl chloride spray, a local anesthetic in arterial blood gas sampling: A randomized, controlled, double-blinded study.

AIM: Arterial blood gas sampling provides useful information on respiratory parameters and acid-base balance. However, this procedure is painful and uncomfortable for the patient. Therefore, this study aimed to examine the analgesic efficacy of ethyl chloride spray compared to a placebo during radial artery blood gas sampling. METHOD: This randomized, double-blind, placebo-controlled study was conducted at the emergency department of a tertiary hospital. A total of 202 patients were randomly divided into two groups: ethyl chloride spray (n = 101) and placebo (n = 101). The analgesic efficacy of ethyl chloride spray was compared with the placebo using the Visual Analog Scale (VAS). RESULTS: The VAS score was determined to be 4 [interquartile range (IQR): 1.0] for the ethyl chloride spray group and 5 (IQR: 1.0) for the placebo group. The analgesic efficacy of ethyl chloride spray in reducing pain was statistically significantly higher compared to the placebo (p = 0.000). CONCLUSION: Ethyl chloride spray has analgesic efficacy in arterial blood gas sampling. Therefore, the use of this spray provides an analgesic effect on patients during arterial blood gas sampling performed in the emergency department.

Neuropathic Pain and Its Relationship with Clinical Findings in Patients with Fibromyalgia.

Introduction: Fibromyalgia syndrome (FMS) is a clinical condition characterised by chronic generalised body pain, fatigue and presence of tender points. In this study, we hypothesized that FMS could be a type of neuropathic pain and investigated the relationship between neuropathic pain and sleep disturbance and depression. We also investigated the association between these clinical conditions and disease severity. Methods: Seventy-six patients who had FMS diagnosis according to 2010 ACR criteria were included in the study. Patients were evaluated by Fibromyalgia Impact Questionnaire (FIQ), Hamilton Depression Rating Scale (HAM-D), Pittsburgh Sleep Quality Index (PSQI), Douleur Neuropathique 4 Questions (DN4) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). Results: Patients had neuropathic pain in 92.1% of patients with LANSS and 82.9% of patients with DN4. According to the Pittsburg Sleep Quality Scale, 90.8% of patients had poor sleep quality. According to HAM-D, 82.9% of the patients had depression. The mean FIQ values of the patients were calculated as 63.16±10.73. There was a positive correlation between DN4 values and FIQ, PSQI, HAM-D and LANSS. There was a positive correlation between LANSS values and FIQ and PSQI values. Conclusion: In this study we found the frequency of neuropathic pain high in FMS. We also found a positive association between neuropathic pain scales and depression, sleep disturbance, and fibromyalgia impact score. Pain, functionality and psychosocial characteristics should be assessed extensively to understand fibromyalgia completely. Abnormal pain process and secondary clinical conditions should be considered together.

Evaluation of GCF IL-17, IL-10, TWEAK, and sclerostin levels after scaling and root planing and adjunctive use of diode laser application in patients with periodontitis.

BACKGROUND: The aim of the present study was to evaluate the clinical efficacy of the diode laser as an adjunct to scaling and root planing (SRP) and also determine the biochemical profile by evaluating the gingival crevicular fluid (GCF) levels of interleukin (IL)-17, IL-10, tumor necrosis factor-related weak inducer of apoptosis (TWEAK), and sclerostin. METHODS: A total of 40 systemically healthy, patients with Stage III periodontitis were included in this randomized controlled study. Participants were randomly divided into two groups as SRP + diode laser (L) (0.80W power, 940 nm wavelength and 0.80J/s energy level) and only SRP group. Recording of periodontal parameters and collecting GCF samples were performed at baseline, first and 3rd months. Biomarker levels in GCF were measured with ELISA RESULTS: At baseline, no significant difference was detected between groups in terms of both clinical and biochemical parameters. All biochemical parameters (except for IL-10 in control group), presented a statistically significant difference for 3 months study period in both groups. When laser and control groups were compared, significant differences were not observed, except the lower GCF IL-17 levels (P = 0.025), bleeding on probing (P = 0.028), and clinical attachment level (CAL) (P = 0.0002) values in laser group at third, first, and third months, respectively. Statistically significant correlations were also noted between biochemical parameters and clinical parameters. CONCLUSIONS: The GCF IL-17, TWEAK, and sclerostin levels may be useful for monitoring response to SRP+L therapy. However, long-term studies on higher populations are needed to evaluate the effectiveness of adjunctive use of diode laser application to SRP.

Characteristic Electrocardiography Findings of COVID-19 Patients.

BACKGROUND: Determining a relationship between coronavirus disease 2019 (COVID-19) and the ECG findings of the patients with this disease can assist in early diagnosis and patient management based on these findings. This study aimed to investigate whether COVID-19 patients had characteristic ECG findings in the acute period. METHODS: A total of 124 patients were divided into two groups as those diagnosed with COVID-19 and controls. The ECGs of these patients were evaluated in terms of rate, rhythm, presence of ST changes, PR interval, QRS width, QTc and QT interval, and presence of right and left bundle branch blocks. RESULTS: On the ECG, the median heart rate of the COVID-19 patients was 104/min (IQR: 99-114), and there was a significant difference compared to the control group (P<0.001). The median PR interval was 157/ms, the QRS width was 86 ± 9/ms in the COVID-19 patients, with no significant difference compared to the controls (P = 0.161 and P = 0.631, respectively). The median QT interval of the COVID-19 patients was normal (400/ms), but a significant difference was detected compared to the controls (P = 0.005). The QTc, ST change, AF, and presence of right and left bundle branch blocks were not significantly different between the two groups. CONCLUSION: Considering the importance of ECG findings in order to diagnose COVID-19 disease early, we can state that sinus tachycardia is very common in COVID-19 patients, but there is no characteristic ECG finding for COVID-19, including tachycardia.

Use of lower extremity orthoses in patients with cerebral palsy and related factors.

BACKGROUND: The purpose of this study was to investigate the frequency of using lower extremity orthosis prescribed for patients with cerebral palsy (CP) and to determine the factors associated with orthosis use. STUDY DESIGN: The study had a retrospective and descriptive design. METHODS: One hundred and twenty-nine patients with CP who were prescribed orthoses were included in this study. The sociodemographic data and orthosis use status of patients were questioned with telephone calls. Motor functions were evaluated with Gross Motor Function Classification System (GMFCS). Spasticity was evaluated with the modified Ashworth scale, and range of motion was evaluated by goniometry. The study had a retrospective and descriptive design and included 129 patients with CP (53 females and 76 males) who were prescribed orthosis. The sociodemographic data and orthosis use status of patients were questioned with telephone calls. Motor functions were evaluated with Gross Motor Function Classification System (GMFCS). Spasticity was evaluated with the modified Ashworth scale, and range of motion was evaluated by goniometry. RESULTS: A total of 53 patients who were included in the study were female, and 76 were male. The most commonly used orthosis was Ankle-Foot Orthosis. The number of patients who used orthosis every day was 45 (34.8%). The most common reason for not using orthosis was difficulty in wearing it. The mean age was significantly lower in the group that used orthosis regularly (P < 0.05). Spasticity and range of motion limitations were low in the group that used orthosis regularly at significant levels (P < 0.05). A significant relation was detected in logistic regression analysis between age and orthosis use (P < 0.05). CONCLUSION: Regular orthosis use is at quite low levels in patients with CP. The decision for prescribing orthosis should be made with a rehabilitation team, with the patient included before orthosis is prescribed. Problems related to orthosis use should be addressed at regular intervals after prescribing orthosis.

Analysis of Incidentally Diagnosed Patients with Coronavirus Disease 2019 at the Emergency Department: Single-Center Clinical Experience.

OBJECTIVE: Asymptomatic patients with coronavirus disease 2019 can present with signs of various diseases to hospitals. We aimed to present patients who presented to the emergency department without any coronavirus disease 2019 symptoms and were incidentally diagnosed with coronavirus disease 2019 in addition to the diagnosis related to their complaints on presentation. MATERIALS AND METHODS: The study included patients presented to the emergency department of a hospital in Erzurum (Turkey) with non-coronavirus disease 2019 symptoms and were incidentally diagnosed with coronavirus disease 2019 on the basis of their chest computed tomography findings. The patients' primary diagnoses were evaluated, and a reverse transcriptase-polymerase chain reaction was performed to confirm the incidental coronavirus disease 2019 diagnoses. RESULTS: The 42 patients included in the study had various complaints, and the most common complaint was abdominal pain in 8 patients (19%). The other complaints were at different rates. The most common diagnose was ST-elevated myocardial infarction in 6 patients (14.3%), and the other diagnoses were rib fracture in 3 patients (7.1%) and other similar diseases in the remaining patients. CONCLUSION: Patients with highly the contagious coronavirus disease 2019 can sometimes be asymptomatic and can be incidentally diagnosed with coronavirus disease 2019 after presenting to emergency departments with symptoms and manifestations other than those of coronavirus disease 2019. Therefore, healthcare professionals working in the emergency department should approach all patients who present to the emergency service as potential coronavirus disease 2019 carriers and wear their protective equipment and take necessary precautions.

10% Lidocaine spray as a local anesthetic in blood gas sampling: A randomized, double-blind, placebo-controlled study.

AIM: Radial artery blood gas sampling is a very common procedure undertaken in the emergency department to evaluate respiratory and metabolic parameters. This intervention causes both anxiety and pain for the patient. Therefore, the current study aimed to examine the analgesic efficacy of lidocaine spray compared to a placebo during radial artery blood gas sampling. METHODS: This study was conducted in the emergency department of a tertiary hospital with a randomized, double-blind, placebo-controlled design. A total of 144 patients were randomly divided into two groups: One group (n = 72) received 10% lidocaine spray and the other (n = 72) was the placebo group. The analgesic efficacy of the 10% lidocaine spray was compared with the placebo group using the Visual Analog Scale (VAS). RESULTS: In the evaluation of the analgesic efficacy of the 10% lidocaine spray, the VAS score was 1.5 [interquartile range (IQR): 2.0] for the lidocaine group and 5 (IQR: 2.0) for the placebo group. The role of lidocaine spray in reducing pain was statistically significant compared to the placebo (p = 0.000). CONCLUSION: In blood gas sampling, 10% lidocaine spray has analgesic efficacy. Therefore, we recommend the use of lidocaine spray while performing arterial blood gas sampling in emergency departments.

The effect of Pulmonary Rehabilitation Programme on work productivity and clinical parameters in patients with ankylosing spondylitis.

OBJECTIVE: The objective of the present study was to investigate the effect of the Pulmonary Rehabilitation Programme on work productivity, disease activity, functional status, quality of life, respiratory function tests (RFTs), physical capacity and depression in ankylosing spondylitis (AS) patients. METHOD: Twenty-five patients diagnosed with AS were included in this study. The disease severity was evaluated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional status was evaluated with Bath Ankylosing Spondylitis Functional Index (BASFI), quality of life was evaluated with AS-Related Quality of Life Scale (ASQOL), physical capacity was evaluated with the 6-min walking test (6MWT), depression level was evaluated with Beck Depression Scale (BDS) and work productivity was evaluated with Spondyloartropathy Work Productivity and Activity Impairment (WPAI-SpA) Survey. Finally, RFT was evaluated with spirometry measurement. The patients were included in the Pulmonary Rehabilitation Programme for 8 weeks. RESULTS: A total of 30% of the patients who were included in this study were unemployed, 35% of them were on and below the hunger limit, 25% were on and below the poverty line, and 40% were on the normal income line. No significant changes were detected in the RFTs after the exercise programme in AS patients (P > .05), but significant improvements were detected in the BASDAI, BASFI, WPAI, 6MWT, ASQOL and BDS (P < .001). CONCLUSION: Pulmonary Rehabilitation Programme was found to be an effective method of improving work productivity in AS patients. Also, the Pulmonary Rehabilitation Programme has positive effects on disease activity, functional status, physical capacity, depression level, and quality of life.

The effects of progressive muscle relaxation exercises on the anxiety and sleep quality of patients with COVID-19: A randomized controlled study.

PURPOSE: This study aimed to determine the effects of progressive muscle relaxation exercises on the anxiety and sleep quality of patients with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: This is an experimental study. Its data were collected in the infectious diseases clinic of a research hospital from May to August, 2020. This study was carried out with 67 COVID-19 patients (33 in the experimental group and 34 in the control group). The data were collected using a personal information form, the state-trait anxiety inventory, and the Richards-Campbell Sleep Questionnaire. The progressive muscle relaxation exercises were performed twice a day for 5 days with the researcher's supervision. The data were analyzed using means, numbers, percentage distributions, the χ 2 test, the dependent t test, and the independent t test. RESULTS: Statistically significant differences were found between the experimental and control groups' mean posttest scores on the State-Trait Anxiety Inventory and the Richards-Campbell Sleep Questionnaire (p < 0.05). The in-group comparison of the experimental group found a statistically significant difference between their mean pretest and posttest scores on the State Anxiety Scale (p < 0.05). The in-group comparison of the control group found no statistically significant changes in their mean pretest and posttest scores on the State Anxiety Scale (p > 0.05). CONCLUSION: The progressive muscle relaxation exercises effectively reduced the anxiety and improved the sleep quality of patients with COVID-19.

The effectiveness of intradermal sterile water injection for low back pain in the emergency department: A prospective, randomized controlled study.

AIM: Low back pain (LBP) is a common musculoskeletal complaint among emergency department (ED) admissions. In this study, it was aimed to compare the effectiveness of systemic treatment with intradermal sterile water injection (ISWI) treatment protocol combined with systemic therapy in patients with LBP of unclear chronicity. METHODS: A prospective randomized, unblinded, controlled clinical study was conducted on patients admitted to the ED for LBP of unclear chronicity. One hundred twelve patients were randomly assigned to two groups; Group ISWI (n = 56) administered ISWI in the LBP region of patients along with systemic intravenous dexketoprofen therapy, while the other group (n = 56) received only systemic intravenous dexketoprofen therapy. The treatment methods' effectiveness was compared by measuring the pain intensity with the Visual Analog Scale (VAS) at admission, 10th minutes, 20th minutes, 30th minutes, and 24 h later. Also, opioid and analgesic consumptions in 24 h after treatment and patient satisfactions were compared. RESULTS: In the treatment of LBP, ISWI treatment was found to be more effective in relieving pain than systemic therapy alone (p < 0.001). Also, it was observed that opioid consumption in the ED and analgesic consumption within 24 h after treatments were decreased in the ISWI group (p < 0.001). The patient satisfaction in the ED was statistically increased (p < 0.001). DISCUSSION: In this unblinded study, ISWI with systemic therapy improved pain outcomes more than systemic therapy alone. Further research is needed to determine whether this was due entirely to placebo effect.

Efficacy of high intensity laser therapy in knee osteoarthritis: a double-blind controlled randomized study.

OBJECTIVE: The aim of this study is to investigate the effectiveness of high intensity laser therapy on pain, functionality, flexion range of motion (FROM), and ultrasonographic cartilage measurement in patients with knee osteoarthritis. METHODS: This study was designed as a double-blind randomized placebo-controlled study. Forty patients diagnosed with knee osteoarthritis according to the American College of Rheumatology criteria were included in the study. After obtaining written informed consent, patients were randomized into high intensity laser therapy (HILT) + exercise therapy (ET), and placebo laser (PL) + ET groups. Each patient was treated five sessions per week for 2 weeks. The outcomes measured were pain level and functional disability using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. The femoral cartilage thickness measurement was made ultrasonographically, and FROM was measured with goniometry. RESULTS: Statistically significant improvements were detected in VAS, WOMAC scores, femoral cartilage thickness, and FROM at the end of the treatment (in week 2) compared to the pre-treatment period in both groups (p < 0.05). There were significant decreases in the VAS and WOMAC scores of both groups in the 6th week compared to the pre-treatment period, and the results of the FROM and femur cartilage thickness measurements were increased at statistically significant levels (p < 0.05). The VAS and WOMAC scores were significantly lower in the 6th week in HILT + ET group compared to the PL + ET group (p < 0.05). Similarly, statistically significant increases were detected in the FROM and femur cartilage thickness measurements in HILT + ET group (p < 0.05). CONCLUSION: HILT + ET combination was more effective in KOA than the PL + ET combination. Key Points • HILT is an effective modality on pain, functional status and FROM in patients with KOA. • HILT is a modality that increases femoral cartilage thickness in patients with KOA.

Alexithymia and attention deficit and their relationship with disease severity in fibromyalgia syndrome.

OBJECTIVES: The aim of this study was to investigate the frequency of alexithymia and attention deficit and to evaluate their relationship with the severity of disease in patients with fibromyalgia syndrome (FMS). PATIENTS AND METHODS: A total of 101 patients (6 males, 95 females; mean age 45.0 years; range, 33 to 56 years) who were admitted to Gaziantep University, Medical Faculty, Physical Medicine and Rehabilitation Department between January 2013 and December 2013 and were diagnosed with FMS and 40 healthy volunteers (4 males, 36 females; mean age 41.5 years; range, 31 to 51 years) were enrolled in this study. The Fibromyalgia Impact Questionnaire (FIQ), Hamilton Depression Scale (HAM-D), Toronto Alexithymia Scale-26 (TAS-26), and Jasper-Goldberg Attention Deficit Test (ADT) were applied. RESULTS: The rate of alexithymia and possible alexithymia was 56.4% and 20.8% in the patients with FMS and 2.5% and 5% in the control group, respectively. The mean TAS-26 score was 60.1±11.7 in the patients with FMS. According to the HAM-D, depressive symptoms were seen in 72.0% and 2.5% of the patients with FMS and healthy controls, respectively. CONCLUSION: Our study results confirm the presence of psychiatric comorbidities in patients with FMS and clearly suggest that depression, alexithymia, and attention deficit are high and mutually correlated in FMS patients. Therefore, all patients should be meticulously evaluated for these conditions at the treatment stage.

Evaluation of Factors Related to Mortality Caused by Firearm Injury: A Retrospective Analysis from Malatya, Turkey.

BACKGROUND: Firearm related injuries continue to increase throughout the world and they become the first or second cause of mortality in worldwide. The present study aimed to determine the factors that affect mortality in firearm injuries. METHODS: The patients which were admitted to emergency service between January 2011 and December 2015 due to firearm injuries, were reviewed from hospital records. The patients were evaluated in terms of their age, sex, event time, admission time, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), the reason of event, type of weapon, the region of the body that injured, department in which they were hospitalized, hospitalization duration and the relation between these parameters and mortality. RESULTS: A total of 174 patients (86.8% male, 13.2% female) were identified. The mean age of patients was 35.2 years and 30 patients (17.2%) died. Among the cases, 137 were attempted homicide (78.7%), 23 were accidents and the remaining 14 were suicides. The suicidal cases had significantly higher mortality rate than other causes (P=0.003). The most frequently used weapon was pistols (73.6%) and the events took place between 18.00 and 24.00 (36.2%) hours mainly. The injuries were mostly on extremities, however many of deaths were seen after head- neck injuries and the mortality rate of head and neck injuries was significantly higher than other regions (P<0.001). The mean of hospitalization duration was 9.1 days and it was 10.2 ± 11.7 days for survivors, 4 ± 7.3 days for died subjects. The hospitalization duration of died patients was significantly shorter than survivors (P=0.042). The GCS of died patients (4.4 ± 1.7) was significantly lower than those of survivors (13.3 ± 2.8) (P<0.001). The ISS score of died patients (49.7 ± 24.1) was significantly higher than those of survivors (13.6 ± 10.6) (P<0.001). CONCLUSION: It was determined that GCS, ISS, length of hospitalization, injuries due to suicide attempt, the department of hospitalization, injuries to head-neck regions affected mortality significantly.

Surgical Treatment of Cardiac Myxomas: A 23-Case Experience.

OBJECTIVE: Although seen rarely compared to all tumors, cardiac tumors are tumors which may have a mortal course with possible complications. The most common cardiac tumor in adults is myxoma with its benign character. The results of cardiac tumors resected with open cardiac surgery in our center are reported in this study. MATERIALS AND METHODS: Twenty-three cardiac tumor patients electively operated on in our clinic between January 2010 and August 2017 were retrospectively included in the study. Information of the patients participating in the study were registered. The patients were between 25 and 67 years of age, and 18 were female (72.3%), and 5 were male (21.7%). The average age of the patients was 42.1 ± 8.9 years. Echocardiography was used for diagnosis in all patients. There was no common complaint for the patients, with the complaints changing according to tumor location. All patients were operated on by means of cardiopulmonary bypass with aortic cross-clamp and bicaval cannulation. Preoperative demographical characteristics and perioperative and postoperative data were registered for the patients and were evaluated statistically. RESULTS: Nineteen of the tumors (82.6%) were in the left atrium, and 4 were (17.4%) in the right atrium. Diameter of the tumors changed between 2.5 × 1.5 and 8.5 × 6.5 cm. The tumoral structure was resected together with the solid tissue located in its root in all patients operated on. Pericardial patch was used for 11 (47.8%), and primary closure was used for 12 (51.2%) of the defects. Early and late mortality was not observed in any patient. CONCLUSION: To prevent possible complications of cardiac myxomas, they need to be resected together with the surrounding healthy tissue as soon as possible after the diagnosis. Cardiac myxomas can be operated on with a tolerable operation risk. Echocardiography should be made annually for any possible relapse after operation.