The effect of chronic carbon-monoxide exposure on the peak expiratory flow values of grill-kebab chefs.

OBJECTIVE: To determine the effect of chronic carbon-monoxide (CO) exposure on blood carboxy-hemoglobin (COHb) values in grill-kebab chefs, and if there is any subsequent airway obstruction. METHODS: The study was carried out in Sahinbey Hospital, Medical School of Gaziantep University, Gaziantep, Turkey, between March 2007 and November 2007. Forty male grill-kebab chefs, working in restaurants for at least 3 years, and 48 non-smoker, male healthy volunteers were gathered for this study. The ages, body mass indexes (BMI), blood pressure (BP), COHb, N-terminal pro brain natriuretic peptide (NT-proBNP), and peak expiratory flow (PEF) values of the grill-kebab chefs and controls was measured. Statistical analysis was carried out using the SSPS 13.0 software. RESULTS: The average age for the study group was 33.0 +/- 9.1, and for the control group was 34.7+/- 6.5 years. The average occupation time for the study group was 16.1+/-7.3 years. The clinical attributes, ages, BMI, BP, and NT-proBNP values of both groups were similar. The COHb (6.5+/-1.5/2.0+/-1.1%) values were higher in grill-kebab chefs compared with the control group. The NT-proBNP values were determined as normal (<60 microg/L) in both groups. A higher decrease in PEF speed (average: 65.1/7.1 L/min) was recorded in the grill-kebab chefs. CONCLUSION: Chronic exposure to CO decreases PEF, with narrowing of the airway in grill-kebab chefs.

Leech bites: massive bleeding, coagulation profile disorders, and severe anemia.

Leeches have been in use for centuries, especially in plastic and reconstructive surgery wound and flap healing, in venous insufficiencies, and in the treatment of many disorders such as hemorrhoids and varicosity. With this study, we aimed to discuss coagulation disorder due to uncontrolled leech bites, consequent excessive skin hemorrhage, and anemia requiring blood transfusion. A 65-year-old male patient was referred to the emergency department because of excessive intractable bleeding that had occurred after leech bites. On physical examination, a total of 130 bites were detected on various regions of the body. In the laboratory findings of the patient, hemoglobin and hematocrit levels were extremely low, and prothrombin time, international normalized ratio, and partial thromboplastin time were markedly increased. The patient received a total of 8 units of fresh frozen plasma and 6 units of erythrocyte suspension. Bleeding stopped by decreasing after the transfusion of fresh frozen plasma. Although the complications due to leech injuries are rare, they may be an important cause of morbidity and mortality when an injury or prolonged bleeding in an internal region occurs. Prolonged skin hemorrhages rarely cause anemia, and deaths are caused by intractable hemorrhages. However, a coagulation disorder and consequent intractable hemorrhage have not been reported previously in the literature. In conclusion, it should be known that uncontrolled, blind, and excessive leech use causes severe hemorrhage and excessive blood loss, causing significant morbidity and mortality. Therefore, the awareness of either physicians or people using or recommending alternative medicine should be raised on this subject.

A series of patients in the emergency department diagnosed with copper poisoning: recognition equals treatment.

Only scarce data are available on chronic copper poisoning in general toxicology literature. This paper reports four patients with chronic copper poisoning and one patient with acute poisoning. The cases with chronic poisoning in our study consisted of four members of a farmer family presenting to the emergency department (ED) with malaise, weakness, abdominal pain, headache, dizziness, tightness in the chest, leg and back pain, accompanied by significant anemia (hemoglobin [Hb]: 8.7 - 9.5 g/dl). They were hospitalized and investigated thoroughly, although there were no other findings or clues enlightening the etiology of anemia. The anemia was attributed to chronic copper exposure acquired from vegetables containing copper. The diagnosis was established by ruling out other possible etiologies and history coupled with laboratory findings. The patients were discharged with the recommendation on diet to avoid consumption of pesticide-treated vegetables. Their Hb values were between 10 and 11.4 g/dl on the 15th day, and between 12 and 14 g/dl after two months. Their symptoms had also resolved completely in two months. The patient with acute intoxication (5th case) had ingested copper oxychloride with suicidal intent. He was admitted with anuria and hemolytic anemia. After being hospitalized for fifteen days, he was diagnosed with chronic renal failure and was scheduled for a dialysis program. Acute poisoning is more deliberate, while chronic exposure may result in atypical findings. In conclusion, physicians working in primary care and EDs should consider copper poisoning in patients presenting with anemia, abdominal pain, headache, tightness in the chest, and leg and back pain.