Evaluation of the relationship between end-tidal carbon dioxide level and heart failure classification.

OBJECTIVE: Heart failure is a disease with cardiac dysfunction, and its morbidity and mortality are associated with the degree of dysfunction. The New York Heart Association classifies the heart failure stages based on the severity of symptoms and physical activity. End-tidal carbon dioxide refers to the level of carbon dioxide that a person exhales with each breath. End-tidal carbon dioxide levels can be used in many clinical conditions such as heart failure, asthma, and chronic obstructive pulmonary disease. The aim of the study was to reveal the relationship between end-tidal carbon dioxide levels and the New York Heart Association classification of heart failure stages. METHODS: This study was conducted at Kahramanmaras Sütçü Imam University Faculty of Medicine Adult Emergency Department between 01/03/2019 and 01/09/2019. A total of 80 patients who presented to the emergency department with a history of heart failure or were diagnosed with heart failure during admission were grouped according to the New York Heart Association classification of heart failure stages. The laboratory parameters, ejection fraction values, and end-tidal carbon dioxide levels of the patients were measured and recorded in the study forms. RESULTS: End-tidal carbon dioxide levels and ejection fraction values were found to be significantly lower in the stage 4 group compared to the other groups. Furthermore, pro-B-type natriuretic peptide (BNP) values were found to be significantly higher in stage 4 group compared to the other groups. CONCLUSION: It was concluded that end-tidal carbon dioxide levels could be used together with pro-BNP and ejection fraction values in determining the severity of heart failure.

The role of ischemia-modified albumin, presepsin, delta neutrophil index, and inflammatory markers in diagnosing acute cholecystitis.

BACKGROUND: The purpose of this study is to determine the significance of markers such as C-reactive protein, procalcitonin, complete blood count parameters, delta neutrophil index, ischemia-modified albumin, presepsin, and oxidative stress indicators, which are associated with inflammation, oxidative stress, and ischemia in the pathology and diagnosis of acute cholecystitis in adults. METHODS: Patients diagnosed with acute cholecystitis in the emergency department and healthy individuals in the control group were included in the study. Routine blood count and biochemistry analyses were performed on the participants. Blood serum was used to measure ischemia-modified albumin, presepsin, and oxidative stress indicators. RESULTS: White blood cell count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, delta neutrophil index, C-reactive protein, procalcitonin, ischemia-modified albumin, ischemia-modified albumin to albumin ratio, presepsin, and oxidative stress indicators were significantly higher in patients with cholecystitis compared to the control group. Measurements of white blood cell count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and delta neutrophil index can be included as part of the complete blood count. The complete blood count parameters are readily available and do not incur additional costs to the healthcare system. CONCLUSION: The authors believe that the neutrophil-to-lymphocyte ratio, delta neutrophil index, ischemia-modified albumin, ischemia-modified albumin to albumin ratio, and presepsin values can be used as new markers in the diagnosis of acute cholecystitis due to their high sensitivity, specificity, and low negative likelihood ratio.

Predictors of mortality in patients with geriatric trauma in the emergency service.

OBJECTIVE: In our study, it was aimed to compare the power of trauma scores (Glasgow Coma Score, Revised Trauma Score, Abbreviated Injury Scale, Injury Severity Score, and Trauma Score-Injury Severity Score) in order to predict mortality in patients with geriatric trauma and to determine the predictive values of these scores in mortality. METHODS: Demographic data, clinical features, etiological causes, laboratory results, and trauma scores of the patients were statistically analyzed. SPSS 20 for Windows was used for this evaluation. RESULTS: It was determined that as the Glasgow Coma Score value of the patients increased, the Abbreviated Injury Scale and Injury Severity Score scores decreased and the Trauma Score-Injury Severity Score score increased. Abbreviated Injury Scale and Injury Severity Score values increased and Revised Trauma Score and Trauma Score-Injury Severity Score values decreased as the lactate levels of the patients increased. It was determined that the Abbreviated Injury Scale and Injury Severity Score scores of the patients hospitalized in the intensive care unit were significantly higher, while their Trauma Score-Injury Severity Score scores were lower. CONCLUSION: Glasgow Coma Score, Revised Trauma Score, Trauma Score-Injury Severity Score, Abbreviated Injury Scale, and Injury Severity Score scores and blood lactate levels are important parameters that can be used in the emergency department for the early detection of high-risk patients in geriatric trauma and the evaluation of the prognosis of geriatric trauma patients.

Evaluation of patients of vaccine side effects after the COVID-19 vaccine.

OBJECTIVE: Postvaccine side effects were evaluated in patients presenting to our emergency department with complaints of vaccine side effects after taking COVID-19 vaccine, and new unknown side effects ranging from mild complaints to life-threatening risks, and frequency of all side effects were investigated. This study aimed to establish a scientific resource to identify the potential side effects of the vaccine. METHODS: Patients' demographic information, clinical characteristics, epicrisis reports, COVID-19 disease and vaccination histories, vital values, and blood values were examined. The SPSS 20.0 package program was used for statistical evaluation. p<0.05 was considered statistically significant. RESULTS: Notably, 13.1% of patients presenting to the emergency department started to have complaints after taking Sinovac vaccine, whereas 86.9% of them had complaints after taking BioNTech vaccine. Also, 36.9% of patients stated that they had COVID-19. All patients had a Glasgow coma scale score of 15 during admission. No patient was hospitalized, ventilator was not needed, and all patients were discharged. While the most common presenting complaint to the emergency department after vaccination was fatigue in 29.7%, the most common diagnoses after examination in the emergency department were myalgia in 32.1% and upper respiratory tract infection in 28.6%. CONCLUSION: Results and conclusions of our study will guide healthcare workers and patients on the side effects of COVID-19 vaccine.

Evaluation of patients of vaccine side effects after the COVID-19 vaccine

SUMMARY OBJECTIVE: Postvaccine side effects were evaluated in patients presenting to our emergency department with complaints of vaccine side effects after taking COVID-19 vaccine, and new unknown side effects ranging from mild complaints to life-threatening risks, and frequency of all side effects were investigated. This study aimed to establish a scientific resource to identify the potential side effects of the vaccine. METHODS: Patients' demographic information, clinical characteristics, epicrisis reports, COVID-19 disease and vaccination histories, vital values, and blood values were examined. The SPSS 20.0 package program was used for statistical evaluation. p<0.05 was considered statistically significant. RESULTS: Notably, 13.1% of patients presenting to the emergency department started to have complaints after taking Sinovac vaccine, whereas 86.9% of them had complaints after taking BioNTech vaccine. Also, 36.9% of patients stated that they had COVID-19. All patients had a Glasgow coma scale score of 15 during admission. No patient was hospitalized, ventilator was not needed, and all patients were discharged. While the most common presenting complaint to the emergency department after vaccination was fatigue in 29.7%, the most common diagnoses after examination in the emergency department were myalgia in 32.1% and upper respiratory tract infection in 28.6%. CONCLUSION: Results and conclusions of our study will guide healthcare workers and patients on the side effects of COVID-19 vaccine.

Predictors of mortality in patients with geriatric trauma in the emergency service

SUMMARY OBJECTIVE: In our study, it was aimed to compare the power of trauma scores (Glasgow Coma Score, Revised Trauma Score, Abbreviated Injury Scale, Injury Severity Score, and Trauma Score-Injury Severity Score) in order to predict mortality in patients with geriatric trauma and to determine the predictive values of these scores in mortality. METHODS: Demographic data, clinical features, etiological causes, laboratory results, and trauma scores of the patients were statistically analyzed. SPSS 20 for Windows was used for this evaluation. RESULTS: It was determined that as the Glasgow Coma Score value of the patients increased, the Abbreviated Injury Scale and Injury Severity Score scores decreased and the Trauma Score-Injury Severity Score score increased. Abbreviated Injury Scale and Injury Severity Score values increased and Revised Trauma Score and Trauma Score-Injury Severity Score values decreased as the lactate levels of the patients increased. It was determined that the Abbreviated Injury Scale and Injury Severity Score scores of the patients hospitalized in the intensive care unit were significantly higher, while their Trauma Score-Injury Severity Score scores were lower. CONCLUSION: Glasgow Coma Score, Revised Trauma Score, Trauma Score-Injury Severity Score, Abbreviated Injury Scale, and Injury Severity Score scores and blood lactate levels are important parameters that can be used in the emergency department for the early detection of high-risk patients in geriatric trauma and the evaluation of the prognosis of geriatric trauma patients.

Early effects of viper envenomation on retina and optic nerve blood flow: An optical coherence tomography angiography study.

In this study, the early retinal and optic nerve blood flows of patients exposed to Viper bite were evaluated with non-invasive optical coherence tomography angiography (OCTA) and compared with healthy controls. The retinal and optic disc OCTA data of 31 victims of viper bite (group S) without systemic envenomation clinical symptoms and 31 healthy controls (group C) were compared. Only patients with early signs of envenomation were included in the study. Optical coherence tomography angiographies were performed with RTVue XR Avanti with AngioVue software. Vascular densities in the whole image, foveal, parafoveal regions at the superficial and the deep capillary plexus segments were acquired and statistically analyzed. The flow area parameters were measured in the superficial retinal capillary plexus, deep retinal capillary plexus, outer retinal capillary plexus, and choriocapillaris layers of the macula in 1-mm and 3-mm diameter areas. The peripapillary flow areas were measured for the optic nerve head, vitreous, radial peripapillary capillary (RPC), and choroid in a 4.50-mm diameter area. Foveal and parafoveal thicknesses were also measured and compared. The average hospital admission time of the patients in group S was 1.24 ± 0.75 (0.50-3.00) hours. Age (p = 0.103) and gender (p = 0.714) were similar in both groups. Superficial (p = 0.010), deep flow areas (p = 0.034), and superficial parafoveal vascular density (p = 0.001) were significantly reduced in group S compared to group C. The outer retinal flow area (p < 0.001) increased significantly in group S. Nerve head flow area (p = 0.035), one of the optic disc flow areas, was found to be decreased in group S. Notably, foveal (p < 0.001) and parafoveal (p = 0.003) thicknesses and superficial (p = 0.001) and deep (p < 0.001) foveal vascular densities were greater in group S. Compared to group C, the superficial (p = 0.009) and deep (p = 0.009) foveal flow areas in the central foveal area with a diameter of 1 mm increased significantly in group S. Viper venom may cause blood flow changes in the retina and optic disc and an increase in retinal thickness in the early period although there are no signs of systemic envenomation.

Are Retinal and Peripapillary Blood Flows Affected during Migraine Attack?

Migraine pathophysiology is complex and partially includes the vasculature. This study compared retinal and peripapillary blood flow parameters in migraine patients during an attack with healthy controls using optical coherence tomography angiography (OCTA). A prospective clinical study was conducted including 52 eyes from 26 migraineurs and 48 eyes from 24 healthy controls. OCTAs were performed with RTVue XR Avanti using AngioVue software. OCTA imaging was performed during the attack period in migraineurs before any treatment for the attack. Vascular densities in the whole image, fovea, superior hemisphere, inferior hemisphere, and temporal, superior, nasal, and inferior regions of the parafoveal area and in the superficial and deep capillary plexuses were acquired and statistically analysed. The flow density parameters were measured in the superficial retinal capillary plexus, deep retinal capillary plexus, outer retinal capillary plexus, and choriocapillaris layers of the macula in a 3-mm diameter area. The peripapillary flow densities were measured for the optic nerve head, vitreous, radial peripapillary capillaries, and choroid in a 4.50-mm diameter area around the optic disc. Vascular density measurements in the superficial plexus were similar between migraineurs and controls (p > .05). Vascular densities in the deep capillary plexus were similar between groups (p > .05), except in the deep superior area (p = .05). Flow areas in the nerve head, vitreous, peripapillary capillary, and choroid segments were similar between migraineurs and controls (p > .05). Macular thickness parameters were also similar between groups (p > .05). The results suggest that an acute migraine attack does not affect retinal or peripapillary blood flow.

Evaluation and comparison of tick detachment techniques and technical mistakes made during tick removal.

BACKGROUND: Tick is among the important ectoparasites of humans and animals. Ticks may transmit disease-causing pathogens to humans. Tick contact may be resulted in several viral and bacterial infections, including Crimean-Congo Hemorrhagic Fever. Timely removal of ticks with appropriate methods is important in prevention of disease transmission. There are many methods reported for tick detachment. In this study, we aimed to evaluate two of them, suture lassoing and freezing and to compare both methods and to examine technical mistakes with these techniques. METHODS: This study was designed as a prospective cross-sectional study, and included the ticks detached by healthcare professionals or directly by patients who presented to the emergency department due to tick contact. The ticks were recorded as larvae, nymphs, and adults according to their growth period. Ticks detachment types with surgical sutures and removal mistakes were recorded. RESULTS: The majority (77.4%) of the ticks were removed by healthcare professionals and a lower rate by patients themselves with hand (22.6%). No technical mistake was found in 72 (77.4%) patients, and the tick was detached as a whole, while detached broken in 15 (16.1%) patients, and the tick was detached as a whole, but the sutures were attached wrong in six (6.5%) patients. Tick broken off due to technical mistakes was most commonly seen in the ticks removed by the individuals themselves. CONCLUSION: The results of this study suggest that when appropriately and correctly used, both suture lassoing and tweezers are effective in tick removal. Public awareness-raising and training programs should be increased on this issue.

Tetanus Immunoglobulin G Assessment in Adults Trauma Patients.

BACKGROUND: Clostridium tetani is an anaerobic, gram-positive bacillus that causes tetanus infection. It usually enters the body through injury with contaminated objects. Tetanus differs from other diseases that can be prevented by vaccination in that it is not contagious and does not spread from person to person. The aim of this study is to evaluate the levels of Tetanus IgG in trauma patients admitted to the emergency department (ED). METHODS: The study was planned as cross-sectional, prospective, and single-center. The study was conducted from January to July 2018 in the Kahramanmaras Sütçü Imam University Hospital. Totally, 178 patients aged ≥18 years were included. For measurement of the level of Tetanus IgG, Clostridium tetani toxin 5S IgG kit (NovaLisa, NOVATEC) was used to quantitatively detect IgG type antibodies by micro-ELISA method in accordance with the manufacturer's recommendation. RESULTS: In total, 143 cases were male and 35 were female. The mean age of the cases was 40 ± 16 years. Tetanus IgG levels were found to be 0.29 ± 0.6 IU/mL in cases from rural areas and 2.14 ± 1.64 IU/mL in cases from urban areas (P < 0.001). There was a negative correlation between age and Tetanus IgG level (r: (-) 0.479; P < 0.001). The protective level of Tetanus IgG was observed to be even lower, especially in patients aged ≥40 years (n = 43, 78.9%). CONCLUSION: Measurements of Tetanus IgG levels should be performed as far as possible in the ED. In this way, unnecessary vaccination can be avoided.

Assessment of complementary and alternative medicine use among patients admitted to the emergency room: a descriptive study from a Turkish hospital.

BACKGROUND: The main aim of this study was to assess the frequency of use of complementary and alternative medicine (CAM) in patients admitted to the emergency room (ER). Additionally, we aimed to evaluate the socio-demographic and clinical factors associated with CAM use. METHODS: This was a descriptive study. A total of 951 patients who were admitted to the ER of a tertiary hospital between October 2018 and November 2018 were enrolled. Data were obtained using a questionnaire that was prepared by the researchers considering the literature data. RESULTS: The mean age of the patients was 37.98 ± 15.65 years. Of the 951 patients, 48.4% (n = 460) were female and 51.6% (n = 491) were male. The rate of patients who used CAM at least once was 47.3% (n = 450). The most frequently used CAM methods were herbal therapy (68.9%), massage (40.7%), dietary supplements (24.7%), and hijama (24.2%). Being aged 64 years or younger (p = 0.001), having an education level of university or higher (p = 0.006), having an income more than minimum wage (p = 0.016), and having a chronic disease (p = 0.003) were found to be associated with CAM use in this study. DISCUSSION: CAM methods were used by a considerable proportion of patients admitted to the ER. Physicians should incorporate CAM use history in their patient assessments and should provide accurate and unbiased information about CAM methods.

The value of ischemia-modified albumin and oxidative stress markers in the diagnosis of acute appendicitis in adults.

INTRODUCTION: The present study evaluates the predictive value of such markers as ischemia-modified albumin (IMA), malondialdehyde (MDA) and glutathione peroxide (GSH-Px), in addition to parameters associated with inflammation, oxidative stress and ischemia, playing roles in the pathology of acute appendicitis (AA), including c-reactive protein (CRP), procalcitonin (PCT) and complete blood count (CBC) parameters and their ratios, for the diagnosis of AA in adults. MATERIAL AND METHODS: The study included 51 patients with histologically confirmed appendicitis and 45 healthy controls who referred to the emergency care unit between January and June 2018. The appendicitis cases were classified into two groups, as complicated and non-complicated, based on postoperative pathological investigations. RESULTS: Of all the appendicitis cases, 68.5% (n = 35) were non-complicated and 31.4% (n = 16) were complicated. IMA (positive LR = 3.0, negative LR = 0.1), GSH-Px (positive LR = 0.5, negative LR = 1.8), MDA (positive LR = 1.8, negative LR = 0.6), CRP (positive LR = 7.2, negative LR = 0.2), PCT (positive LR = 0.7, negative LR = 1.3), WBC (positive LR = 2.9, negative LR = 0.3), neutrophil-lymphocyte ratio (positive LR = 3.2, negative LR = 0.1) thrombocyte lymphocyte ratio (positive LR = 1.6, negative LR = 0.5) and IMA/albumin ratio (positive LR = 3.3, negative LR = 0.1) levels in the appendicitis cases were evaluated by a characteristic receiver operating characteristic (ROC) curve. In addition, IMA levels were significantly higher in the complicated cases (0.40 ±â€¯0.05 AbsU) than in the non-complicated cases (0.29 ±â€¯0.04 AbsU) (p < 0.0001). CONCLUSION: Our results showed that IMA (negative LR = 0.1), CRP (positive LR = 7.2, negative LR = 0.2), NLR (negative LR = 0.1) and IMA/albumin ratio (negative LR = 0.1) can serve as important diagnostic biomarkers for AA patients. We therefore believe that before clinically confirming an AA diagnosis, these parameters may be used as diagnostic tools in addition to CBC parameters, CRP levels and radiological imaging studies.

Prevalence of oral Candida carriage and Candida species among cigarette and maras powder users.

OBJECTIVE: The aim of this study was to determine the prevalence of Candida carriage and Candida species among cigarette and Maras powder (MP) users. MATERIAL AND METHODS: This study was conducted on 180 volunteering men in 20 cafehouses in the city of Kahramanmaras, Turkey. The sociodemographic characteristics of the participants and the behaviors of MP and cigarette usage were noted down. Culture specimens were obtained from bilateral buccal mucosa and dorsum of the tongue with a sterile cotton-tipped swap. RESULTS: The specimens were inoculated into Sabouraud Dextrose Agar. The mean age of the participants was 40.49 ± 12.89 years (min = 18, max = 87). Fifty-eight percent of the cigarette users, 56.7% of the MP users, and 36.7% of the control group were Candida carriers. The difference of Candida carriage between cigarette and MP users and the control group was statistically significant (P = 0.018 and P = 0.029 respectively). The prevalence of Candida carriage was similar between cigarette and MP users (P = 0.854). The most frequently isolated species was Candida albicans at a rate of 30% in the cigarette users' group, 28.3% in the MP users' group and at a rate of 18.3% in the controls. The prevalence of Candida tropicalis carriage was found to be at a rate of 20% in cigarette and 21.7% in the MP users' group compared to 11.7% in the nonusers. CONCLUSIONS: In the present study we found that the prevalence of oral Candida carriage was significantly higher among cigarette and MP users.