Inferior vena cava collapsibility index and stroke volume as predictors of blood transfusion in upper gastrointestinal bleeding in the emergency department.

BACKGROUND AND AIM: This study investigates the effectiveness of bedside ultrasonography in predicting blood transfusion requirements in patients with upper gastrointestinal bleeding (UGIB). It focuses on evaluating the inferior vena cava (IVC) diameter, IVC collapsibility index (CI), and stroke volume (SV) as ultrasonographic measures. METHODS: A hundred adult patients enrolled in this prospective clinical study. The patients were divided into two groups (group 1: only saline administered group, group 2: saline and blood administered group). IVC diameter, IVC CI, and SV were measured at the time of admission and after treatment. RESULTS: At the initial admission, group 1 exhibited an IVC CI of 20.4% and an SV of 65.0 mL, whereas group 2 displayed an IVC CI of 26.6% and an SV of 58.0 mL. Upon analyzing the relationship between the Glasgow-Blatchford score (GBS) and SV, we identified a significant negative correlation (r = -0.7350; P < 0.001). Similarly, a weak negative correlation was observed between the Rockall score (RS) and SV (r = -0.4718; P < 0.001). It is worth noting that patients with UGIB require blood transfusion if their SV falls below 62.5 mL, with an area under the curve (AUC) of 89.1% and a 95% confidence interval (CI) ranging from 82.8% to 95.4%. CONCLUSION: IVC CI and SV can be used as parameters to predict the need for blood transfusion in the ED in patients with UGIB.

Investigation of highly cited publications related to vaccines against COVID-19: current state and future predictions.

BACKGROUND: Since the date of declaring the COVID-19 outbreak a pandemic by the World Health Organization (March 11, 2020), vaccine studies have been initiated. In this article, we aimed to investigate highly cited articles on vaccines and guide researchers for future studies. MATERIAL AND METHODS: Publications with 6 or more citations (highly cited publications) were extracted from Web of Science (WoS) database. These publications were investigated according to the number of citations, language, publication year, WoS categories, publication types, organizations involved, authors, countries and research areas. Additionally, top 20 articles were investigated in detail. RESULTS: A total of 126 publications were determined. When WoS categories were investigated, 18 pertained to immunology (14.2 %), 17 to biochemistry (13.4 %) and 17 to multidisciplinary sciences (13.4 %). There were three types of publications, namely 80 original articles (63.4 %), 46 reviews (36.5 %) and 11 early access publications (8.7 %). Top universities were Harvard University (n=9, 7.1 %), Chinese Academy of Medical Sciences (n=7, 5.5 %) and University of California system (n=7, 5.5 %). Top authors were Qin CF with 4 articles (3.1 %), Wang L with 4 articles (3.1 %) and Baric RS with 3 articles (2.3 %). Top journals with the highest number of publications were Journal of Biomolecular Structure Dynamics (n=8, 6.3 %), Nature (n=8, 6.3 %) and Science (n=6, 4.7 %). Top countries were the United States of America (USA) with 45 articles (35.7 %), People's Republic of China with 44 articles (34.9 %), and India with 15 articles (11.9 %). Research areas of the publications were science technology other topics (n=21, 16.6 %), immunology (n=18, 14.2 %) and pharmacology (n=18, 14.2 %). CONCLUSION: Vaccine studies play a pivotal role in the warfare against COVID-19. Our results revealed that under the leadership of the USA, China and India, the number of scientists focusing on vaccines is increasing and gratifying results are obtained from vaccine studies (Tab. 3, Ref. 40).

Comparison of performances of top emergency medicine journals in terms of COVID-19 publications in 2020.

INTRODUCTION: The aim of this study is to evaluate the qualitative and quantitative contribution of Emergency Medicine (EM) journals to scientific literature on COVID-19 and compare the journals in terms of publications. MATERIAL AND METHODS: We performed a comparison of top EM journals by hand-search in terms of COVID-19 publications and citations between January 1st and December 31st, 2020. Publications were also categorized according to research field, country and article types. Data were given as numbers and percentages. RESULTS: Among 18 EM journals, Resuscitation ranked in the first place and American Journal of Emergency Medicine ranked in the last place according to Impact Factor. In these journals, 512 (12.2%) articles related to COVID-19 were published. The American Journal of Emergency Medicine and Internal and Emergency Medicine published the greatest amount of publications related to COVID-19 (n = 71). The American Journal of Emergency Medicine was also the leading journal in terms of "Total Citations to COVID-19 Articles" (n = 1192). Western Journal of Emergency Medicine published the greatest proportion of COVID-19 articles (Total COVID-19 Articles/Total Articles = 0.3). World Journal of Emergency Surgery ranked in the first place in terms of citations per COVID-19 articles (n = 33.2). The most common studied field was Effects of COVID-19 on the Health System (n = 222). The US was the most productive country with 188 COVID-19 publications and 1411 citations to these publications, followed by Italy. CONCLUSION: The contribution of EM journals to COVID-19 literature is controversial. "Effects of COVID-19 on the Health System" is the most studied field. "Clinical Properties, Ethical Issues and Treatment Methods" are neglected fields in EM journals.

[Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)]. / Türkiye'de yogun bakim ünitelerinde hekimin mortaliteyi öngörebilme gücü.

INTRODUCTION: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up. MATERIALS AND METHODS: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017.The clinical research was planned as observational, multicenter, cross-sectional. RESULT: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p<0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% CI: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively. CONCLUSIONS: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.

How Prepared Are We for Possible Bioterrorist Attacks: An Approach from Emergency Medicine Perspective.

Preparedness for bioterrorist attacks and early recognition of specific agents are essential for public health. Emergency departments may play an important role in this field. The large spectrum of bioterrorism involves not only disastrous terrorism with mass casualties, but also microevents using low technology but producing civil unrest, disruption, disease, disabilities, and death. It aims not only to cause mortality and morbidity, but also to lead to social and political disruption. Preparedness appears to be the most potent defense against possible bioterrorist events. In this article, we aim to create awareness against biological agents and underline the importance of emergency departments in this public health problem.

Pentraxin 3, ischemia-modified albumin, and myeloperoxidase in predicting a cardiac damage in acute carbon monoxide poisoning.

BACKGROUND: Carbon monoxide (CO) poisoning is associated with cardiac injuries or manifestations, frequently attributing to direct hypoxic damage at cellular level. For this, the aims were to evaluate the role of serum pentraxin 3 (PTX 3), ischemia-modified albumin (IMA), and myeloperoxidase (MPO) as an early biomarker for cardiac damage when compared to cardiac troponin I (cTnI) and creatine kinase-MB fraction (CK-MB) in adult patients with acute CO poisoning. METHODS: Forty patients with acute CO poisoning admitted to the emergency department. The patients were divided into 2 main groups as follows: cardiac injury (group I, n=19) and nonsuspected cardiac injury (group II, n=21). Pentraxin 3, IMA, MPO, cTnI, CK-MB, and the other assays in the circulation were measured on admission. RESULTS: Upon measuring the serum PTX 3, IMA, MPO, cTnI, and CK-MB levels as well as large electrocardiography and echocardiography abnormalities of patients with cardiac injury on admission, no statistical difference for PTX 3, IMA, and MPO was found between the groups (P>.05). However, cTnI, CK-MB, and leukocyte count (white blood cell) were higher determined in patients of group I compared to group II (P<.05). Receiver operating characteristic curve was also performed to evaluate the diagnostic performance of these tests in patients with cardiac injury. CONCLUSIONS: Our results suggest that PTX, IMA, and MPO assays are not superior to cTnI and CK-MB in predicting a cardiac damage in patients with acute CO intoxication.

A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules.

INTRODUCTION: The aim of this study was to evaluate patients presenting to the emergency department (ED) with wrist trauma using physical examination findings and functional tests and to identify findings with high sensitivity and specificity among the parameters assessed in patients with fracture in the wrist. The ultimate objective was thus to establish a reliable and widely usable clinical decision rule for determining the necessity of radiography in wrist trauma. METHODS: This prospective, multicenter study was performed in 8 hospitals. The relation between radiologically determined fracture and clinical findings consisting of physical examination findings and functional tests was assessed in terms of whether or not these were markers of radiography requirement, with the aim of identifying predictive values for fracture. RESULTS: A total of 603 eligible trauma patients presented to the participating EDs during the study period. Fracture was identified in 24.5% of patients (n = 148). The 4-way combination with the highest sensitivity was identified as axial compression and the positive distal radioulnar drawer test, and pain with radial deviation and dorsal flexion. Sensitivity at distal ulna palpation was added as a fifth parameter, and sensitivity and negative predictive value thus increased to 100%. CONCLUSION: With their 100% sensitivity and 100% negative predictive values, the Karadeniz wrist rules may represent a clinical decision rule that can be used in practice in EDs. If all 5 findings are negative, there is no indication for wrist radiography.

The role of NT-proBNP and Apelin in the assessment of right ventricular dysfunction in acute pulmonary embolism.

OBJECTIVE: To investigate the role of N-terminal pro-brain natriuretic peptide and apelin in the assessment of right ventricular dysfunction in acute pulmonary embolism. METHODS: The prospective case-control study was conducted at Ondokuz Mayis University, Samsun, Turkey, from January 2008 to June 2009, and comprised adult patients with acute pulmonary embolism. A smaller group of healthy adults served as the control. Blood N-terminal pro-brain natriuretic peptide and apelin levels were measured on admission to the Emergency Department. SPSS 15 was used for data analysis. RESULTS: There were 56 cases and 20 controls in the study. Blood N-terminal pro-brain natriuretic peptide levels were higher in cases than the controls (p<0.05). Apelin levels were not different between the groups (p>0.05). Patients with right ventricular dysfunction had significantly higher peptide levels than those without the dysfunction (p<0.05). The cut-off value of peptide for the prediction of right ventricular dysfunction was 1000 pg/ml, with a sensitivity of 92.1% and specificity of 77.8%. CONCLUSIONS: There was no significant change in plasma apelin levels in acute pulmonary embolism. The blood N-terminal pro-brain natriuretic peptide maybe a useful parameter in the assessment of right ventricular dysfunction in acute pulmonary embolism.

Ischemia-modified albumin is not better than creatine kinase-MB and cardiac troponin I in predicting a cardiac injury in nontraumatic subarachnoid hemorrhage.

BACKGROUND: The aims were to investigate the role of serum ischemia-modified albumin (IMA), tumor necrosis factor α (TNF-α), and myeloperoxidase (MPO) and to evaluate the relationship between IMA and cardiac markers (creatine kinase myocardial isoenzyme [CK-MB] and cardiac troponin I [cTnI]) related to cardiac abnormalities in adult patients after nontraumatic subarachnoid hemorrhage (SAH). METHODS: Twenty-nine patients with nontraumatic SAH admitted to the emergency department and 20 healthy adults as the control group were included in the study. Ischemia-modified albumin, TNF-α, MPO, CK-MB, cTnI, and leukocyte count (white blood cell [WBC]) in the circulation were measured on admission. RESULTS: Ischemia-modified albumin, TNF-α, and MPO levels were higher by mean values of 11.6%, 9.5%, and 2.9%, respectively, in patients with SAH compared with control group. However, levels of these parameters were not statistically different between the groups (P > .05). However, WBC, CK-MB, and cTnI values were significantly higher in patients with SAH compared with healthy control (P < .001, P < .01, and P < .05, respectively). White blood cell and cTnI levels in the circulation were positively correlated with patients' clinical severity (r = 0.598, P = .001 and r = 0.461, P = .012, respectively). Ischemia-modified albumin has a poor diagnostic value in comparison with WBC, CK-MB, and cTnI tests to differentiate between patients after SAH and controls according to receiver operating characteristic curve. CONCLUSIONS: The results suggest that IMA is not better than CK-MB and cTnI in predicting a cardiac injury in patients after nontraumatic SAH.

Workplace violence in emergency department and its effects on emergency staff.

Workplace violence (WPV) is a growing problem for healthcare providers, particularly for those in the Emergency department (ED), with its increasing frequency and severity. Characteristics of WPV are similar in different parts of the World with different sociocultural and economic status. As this problem remains unsolved, its unwanted effects on mental and physical health of staff become more problematic. The most common psychological affects are reduced job satisfaction and fear. When the reasons of WPV are investigated; lack of preventive policies, educational inadequacy, unwillingness to report assaults as a result of a consideration of violence as a routine by the staff and unmet expectations of patients and their family may be listed. In the short-term, increasing the number of security personnel, flagging the names of the patients with a potential of aggression in the computer system and reducing length of stay in the ED are measures to implement immediately. In the long-term, governments must focus on this subject and develop necessary policies including educational programmes in order to reduce WP, before it is too late for another ED worker.

Diagnostic and prognostic efficacy of optic nerve sheath diameter in patients with dysnatremia.

AIM: This study aimed to investigate the diagnostic and prognostic value of optic nerve sheath diameter (ONSD) measurement in patients with dysnatremia. MATERIAL AND METHODS: This prospective clinical study included patients aged ≥18 years who were diagnosed with dysnatremia on admission to the emergency department. RESULTS: The present study included 65 patients (35 with hypernatremia [hypernatremia group] and 30 with hyponatremia [hyponatremia group]) and 14 healthy volunteers (control group). Comparison of these groups in terms of ONSD revealed that the right and left ONSDs were significantly higher in the hypernatremia and hyponatremia groups comparing to the control group (p<0.001). According to the optimal cutoff values determined, the right ONSD detected hypernatremia with 91.4% sensitivity and 92.9% specificity and the left ONSD detected the condition with 88.6% sensitivity and 85.7% specificity. Furthermore, the right ONSD detected hyponatremia with 83.3% sensitivity and 92.9% specificity, and the left ONSD detected it with 93.0% sensitivity and 86.0% specificity. Finally, ONSD was found to be an independent predictor of mortality in patients with hypernatremia. CONCLUSION: ONSD is a noninvasive, easy, cheap, and reproducible measurement and can be used as an effective and powerful tool for the diagnosis of patients with dysnatremia and the prognosis of patients with hypernatremia.

Heart-type fatty acid-binding protein as a potential biomarker of acute carbon monoxide poisoning.

BACKGROUND: The aim of this study was to investigate the role of serum heart-type fatty acid-binding protein (H-FABP) in the evaluation of patients with carbon monoxide (CO) poisoning. METHODS: Forty patients with acute CO poisoning admitted to the emergency department and 15 healthy adults as the control group were included in the study. Serum H-FABP levels of patients were studied on admission and at the 6th, 12th, and 18th hours. Patients were divided into 3 groups according to clinical severity as mild, moderate, and severe. Patients were also divided into 2 groups according to treatment with hyperbaric oxygen (HBO) or normobaric oxygen. RESULTS: Serum H-FABP levels of the patients were higher than those of the control group. There was a negative correlation between H-FABP levels and Glasgow Coma Scale score on admission. Heart-type fatty acid-binding protein levels were significantly higher in patients in the severe compared with mild group. Heart-type fatty acid-binding protein levels in patients treated with HBO were significantly higher than in those treated with normobaric oxygen. The cutoff value of serum H-FABP as an indicator for HBO treatment was determined as 1.5 ng/mL or higher, with a sensitivity of 85.7% and specificity of 69.7%. Serial measurement revealed that H-FABP level peaked at the sixth hour and reduced over time but remained higher than in the control group at the 18th hour. CONCLUSION: Heart-type fatty acid-binding protein may be a promising novel biomarker in the evaluation of clinical severity and in the selection of patients for HBO therapy in acute CO poisoning.

Usefulness of heart-type fatty acid binding protein in the emergency department.

The early diagnosis of many diseases is critical, especially in the Emergency Department. Biochemical markers can be helpful for emergency physicians in these critical situations. Heart-type fatty acid binding protein (H-FABP) is one of the promising plasma markers for the detection of tissue injury. H-FABP is known to be released from injured myocardium. It is also expressed in skeletal muscle, the kidney, brain, lactating mammary gland, and placenta. It can be useful in the management of acute coronary syndromes, heart failure, pulmonary embolism, renal and hepatic injury, and some cases of poisonings. In this review, an updated overview of the role of H-FABP in the management of diseases seen frequently in the Emergency Department is presented.

Evaluation of the Inferior Vena Cava Diameter in Dehydrated Children Using Bedside Ultrasonography.

Objective: Bedside ultrasonography (US) is a new imaging modality that has begun to be used in the Pediatric Emergency Unit to evaluate inferior vena cava (IVC) diameter for intravascular volume status. In this article, we aimed to evaluate IVC diameter with bedside US before and after the fluid therapy in dehydrated children. Methods: A total of 124 dehydrated patients were enrolled, aged 8 months to 17 years. The maximum diameters of the IVC and aorta (AO) were measured. IVC/AO ratio and IVC collapsibility index IVC-CI were calculated before and after the fluid therapy and correlation with the degree of dehydration and laboratory parameters was investigated. Results: Of the 124 patients, 49.2% (n = 61) were male, the mean age was 7.5 ± 4.94 years. The IVC/AOs ratio was increased in mild and moderate/severe groups after fluid therapy compared to before fluid administration. While the mean rate of heart rate, blood urea nitrogen (BUN), creatinine, and uric acid values were higher in the moderate/severe group, potassium and HCO3 were lower. There was no significant change in AO diameter and IVC-CI after fluid therapy in all groups. When the factors affecting the IVC/AOs ratio were analyzed with the logistic regression backward model; the IVC/AO ratio was found to increase as the degree of dehydration decreased (Adj.ß = -0.318) and as the age (Adj.ß = 0.242) and CRP (Adj.ß = 0.186) value increased. Conclusion: The IVC/AO ratio can be a promising index for the assessment and grading of dehydration in children, and cutoff values that vary according to age are necessary for a more objective assessment of dehydration.

Usefulness of S100B protein in neurological disorders.

In recent years, there has been an increased interest in the clinical use of brain markers. The S100B is a calcium-binding peptide and is used as a parameter of glial activation and/or death in many disorders of the central nervous system (CNS). It plays important roles in normal CNS development and recovery after injury. Although S100B is mainly found in astroglial and Schwann cells, it also has extracerebral sources. S100B is a useful neurobiochemical marker of brain damage such as in circulatory arrest, stroke and traumatic brain injury. S100B is also associated with neurodegenerative diseases like Alzheimer's disease or other chronic neurological diseases. Moreover, S100B may have a potential in predicting the efficiency of treatment and prognosis. In this review, an updated overview of the role of S100B in human neurological disorders is presented.

The Effect of Biomarkers and Optic Nerve Sheath Diameter in Determining Mortality in non-Traumatic Subarachnoid Hemorrhage.

AIM: Although radiological methods are sufficient for the diagnosis of spontaneous subarachnoid hemorrhage (SAH), additional biomarkers are needed to predict prognosis. The aim of this study was to investigate the effects of serum S100B protein, Glial Fibrillary Acidic Protein (GFAP) levels and, Optic Nerve Sheath Diameter (ONSD) on mortality and clinical severity in patients with spontaneous SAH. MATERIALS AND METHODS: Fifty-six patients who were diagnosed with SAH after first evaluation in the emergency department (ED) were included in the study group; Forty-six patients who were admitted to the ED with headache of non-intracranial etiology, were included as the control group. Cerebral computed tomography (CT) images and peripheral blood samples were obtained from all patients; at the time of diagnosis and 24 h after diagnosis. Serum S100B protein and GFAP levels were measured from the blood samples and ONSD was measured on CT. RESULTS: Serum S100B protein and GFAP levels and, ONSDs at the time of diagnosis and 24 h after diagnosis were significantly higher in the study group (p < 0.05). Both GFAP levels and ONSD at the time of diagnosis and 24 h after the diagnosis were found to be related with increased mortality (p < 0.05). A similar association was found for serum S100B protein levels 24 h after the diagnosis, but not at the time of diagnosis (p = 0.540). CONCLUSION: Serum S100B protein and GFAP levels and, ONSD were increased in patients with spontaneous SAH. All parameters were found to be associated with increased mortality.

Interleukin-33 (IL-33) as a Diagnostic and Prognostic Factor in Traumatic Brain Injury.

Interleukin-33 (IL-33) is a cytokine involved in interleukin-1 family. Role of IL-33 in immune system activation is well described in the literature. IL-33 has been identified as an endogenous alarm signal (alarmin) to alert various types of immune cells to trauma. In this narrative review, we aimed to underline the diagnostic and prognostic importance of IL-33 in trauma, particularly in brain trauma.

Platelet counts in adults with iron deficiency anemia.

In adults with iron deficiency anemia (IDA), abnormal platelet counts were seen in several studies. However we retrospectively examined the clinical records of a larger number of adults with IDA to assess abnormal platelet counts. From November 2006 to April 2008, 615 consecutive adults (73 men and 542 women; age range, 16-88 years) with IDA were included in this study. The mean initial hemoglobin was 9.0 +/- 1.8 g/dL (range 2.7-12.8 g/dL), and the mean initial platelet count was 304 x 10(3)/microL +/- 92.3 (range, 105-700 x 10(3)/microL). The initial platelet counts were normal in 520 (84.6%) adults with IDA. Thrombocytosis (>400 x 10(3)/microL) and thrombocytopenia (<150 x 10(3)/microL) were detected in 82 (13.3%) and 13 (2.1%) adults with IDA, respectively. In conclusion, thrombocytosis was seen at lower rates in our study. Furthermore, this study shows that mild thrombocytopenia is not so rare in adults with IDA.

Does mad honey poisoning require hospital admission?

BACKGROUND: The aim of this study was to describe current patterns of monitoring and treatment of mad honey intoxication to make recommendations for a more standardized approach to care of patients with mad honey poisoning. METHODS: Patients presenting to emergency departments because of honey poisoning between January and October 2007. Age, length of stay in the emergency department, pulse rate, and systolic and diastolic blood pressure are cited as mean +/- SD. RESULTS: Forty-seven cases presenting to the 3 health institutions during 2007 were investigated. It was determined that patients had ingested "mad" honey between 0.5 and 9 hours (mean +/- SD, 2.8 +/- 1.8 hours) before presentation. Patients' pulse rates were 30 to 77/min (mean +/- SD, 46.6 +/- 12.1/min), and systolic blood pressure ranged from 50 to 140 mm Hg (mean +/- SD, 46.6 +/- 12.1 mm Hg). Patient rhythms on arrival were determined as 37 (7.7%) sinus bradycardia, 6 (12.8%) nodal rhythm, 3 (6.4%) normal sinus rhythm, and 1 (2.1%) complete atrioventricular block. Lengths of stay in hospital were 3.6 +/- 2.2 hours in the first university hospital, 22.2 +/- 3.8 hours in the second university hospital, and 3.4 +/- 1.7 hours in the state hospital. A 0.5 to 2 mg of atropine was given to all patients. CONCLUSIONS: Our study did not reveal any difference in complications or mortality between patients cared for with brief emergency department observation when compared with patients cared for with 1 day inpatient observation.