Demographic and Clinical Characteristics of Earthquake Victims Presented to the Emergency Department with and without Crush Injury upon the 2023 Kahramanmaras (Turkey) Earthquake.

INTRODUCTION: Earthquakes are sudden-onset natural disasters that are associated with substantial material damage, resulting in the collapse of built environment with a high rate of mortality, injury, and disability. Crush syndrome, which can be seen after devastating earthquakes, can lead to acute kidney injury (AKI) and patients may require amputation, fasciotomy, and dialysis. Supportive treatment has an important role in the prognosis of these patients. STUDY OBJECTIVE: The aim of this study was to investigate the demographic and clinical characteristics of traumatic earthquake survivors admitted to the emergency department (ED) of a hospital, which was close to the earthquake zone but not affected by the earthquake, after the February 6, 2023 Kahramanmaras (Turkey) earthquakes. MATERIALS AND METHODS: This study was conducted by retrospectively analyzing the data of 1,110 traumatized earthquake survivors admitted to the ED of a tertiary care university hospital from February 6th through February 20th, 2023. Age; gender; time of presentation; presence of comorbid diseases; ED triage category; duration of stay under debris; presence of additional trauma; laboratory tests; presence of AKI; presence of crush injury and injury sites; supportive treatment (fluid replacement and intravenous [IV] sodium bicarbonate); need for amputation, dialysis, and fasciotomy; duration of hospitalization; and outcome of ED were evaluated. RESULTS: Of the 1,110 traumatic victims in this study, 55.5% were female patients. The mean age of the patients was 45.94 (SD = 16.7) years; the youngest was 18 years old and the oldest was 95 years old. Crush injury was detected in 18.8% and AKI in 3.0% of the patients. Dialysis, amputation, and fasciotomy were required in 1.6%, 2.8%, and 1.4% of the patients, respectively. In total, 29.2% of patients were hospitalized, including 2.9% admitted to the intensive care unit (ICU) and 26.3% to the relevant ward. In total, 0.3% of the patients included in the study died at ED. CONCLUSION: Post-earthquake patients may present with crush injury, AKI may develop, and fasciotomy, amputation, and dialysis may be needed, so hospitals and EDs should be prepared for natural disasters such as earthquakes.

RELATION OF FEMUR FRACTURES LOCATION WITH CLINICAL OUTCOMES IN ELDERLY PATIENTS.

Objectives: This study was designed to investigate the possible relationship between the anatomical location of the PFF (head-neck fractures) and the demographic features, comorbidities, and risk factors of elderly patients. Methods: 233 patients aged 65 years and over, who were admitted to the emergency department with a diagnosis of proximal femur fracture were included in this study. Results: Most patients (59.6%) had a trochanteric fracture. The incidence of trochanteric fractures had a statistically significant positive correlation with age. Falls at ground level were found to be highly associated with trochanteric fractures (92,8%). At least one complication was observed in 57 (41,0%) cases and 31 (22,3%) died in one year, of the patients with trochanteric fractures. Comorbidity was not related to fracture location statistically. Fall ground level (p = 0.013), complication rate (73.7%; p <0.001), and Charlesen comorbidity index (p = 0.019) were statistically significantly associated with death. The logistic regression analysis of variables determined that only the quantity of comorbidities may be related to femoral neck fractures (p = 0.047). Conclusion: Female patients with trochanteric fractures were found to be older than male patients. Fall ground level, mortality, and complications were more frequently seen in patients with trochanteric fractures. Level of Evidence II, Retrospective study.

Objetivos: Este estudo foi desenhado para investigar a possível relação entre a localização anatômica da PFP (fraturas de cabeça e pescoço) e as características demográficas, comorbidades e fatores de risco de pacientes idosos. Métodos: Foram incluídos 233 pacientes com idade igual ou superior a 65 anos, admitidos no pronto-socorro com diagnóstico de fratura do fêmur proximal. Resultados: A maioria dos pacientes (59,6%) apresentou fratura trocantérica. A incidência de fraturas trocanterianas apresentou correlação positiva estatisticamente significativa com a idade. Verificou-se que as quedas no nível do solo estão altamente associadas às fraturas trocantéricas (92,8%). Pelo menos uma complicação foi observada em 57 (41%) casos e 31 (22,3%) morreram em um ano, dos pacientes com fraturas trocantéricas. A comoborbidade não foi realizada estatisticamente com a localização da fratura. Queda do nível do solo (p = 0,013), taxa de complicações (73,7%; p < 0,001), índice de comorbidade charlesen (p = 0,019) foram estatisticamente significativamente associados à morte. Na análise de regressão logística das variáveis, determinou-se que apenas a quantidade de comorbidades pode estar relacionada às fraturas do colo do fêmur (p = 0,047). Conclusão: Pacientes do sexo feminino com fraturas trocantéricas foram consideradas mais velhas do que pacientes do sexo masculino. Queda no nível do solo, mortalidade e complicações foram observadas com mais frequência em pacientes com fraturas trocantéricas. Nível de evidência II, Estudo retrospectivo .

Risk factors and mortality in elderly patients with severe hyponatremia admitted to the emergency department.

BACKGROUND: This study was aimed at determining the risk factors associated with mortality in elderly patients with severe hyponatremia admitted to the emergency department. MATERIALS AND METHODS: The data of patients aged ≥ 65 years who were admitted to the emergency department and whose serum sodium levels were < 125 mEq/L were retrospectively collected. RESULTS: Mortality was associated with chronic liver disease/cirrhosis (p = 0.036), metastatic tumor (p = 0.007) and solid tumor (p = 0.013) cancers, antiarrhythmic drug use (p = 0.003), potassium-sparing diuretic use (p = 0.044), antineoplastic drug use (p = 0.0029), and dialysis treatment (p = 0.015). The following cutoff values were determined to be predictive of mortality: urea > 63.6 (AUC: 0.771; p = 0.0001), creatinine > 1.39 (AUC: 0.675; p = 0.0003), potassium > 4.64 (AUC: 0.711; p = 0.0001), C-reactive protein > 44 (AUC: 0.765; p = 0.0001), white blood cell count > 12.21 (AUC: 0.688; p = 0.0001), hemoglobin < 11.2 (AUC: 0.611; p = 0.0103), and Charlson comorbidity index > 2 (AUC: 0.739; p = 0.0001). The use of antineoplastic drugs (OR: 4.502; p = 0.010) and increased values of the following were associated with an increased risk of mortality: urea (OR: 1.007; p = 0.024), C-reactive protein (OR: 1.005; p = 0.026), glucose (OR: 1.008; p = 0.001), and Charlson comorbidity index (OR: 1.198; p = 0.025). CONCLUSION: Malignancy; liver cirrhosis; dialysis treatment; increased Charlson comorbidity index, urea, and C-reactive protein values and the use of antineoplastic drugs are associated with mortality.

Antioxidant and Neuroprotective Effects of L-arginine Administration After Traumatic Brain Injury and Hemorrhagic Shock in Rats.

AIM: To investigate the effect of fluid resuscitation and L-arginine administration on oxidant status markers, blood gases, lactate and apoptosis in the brain tissue of a rat model of TBI with hemorrhagic shock. MATERIAL AND METHODS: A total of 60 rats were divided into six groups: control, isotonic saline-treated, 7.5% NaCl-treated (hypertonic saline), L-arginine-treated (100 mg/kg), saline + L-arginine-treated and 7.5% NaCl + L-arginine-treated groups. Closed head contusive weight-drop injuries were performed with hemorrhagic shock in all of the groups. Mean arterial pressure (MAP), pulse rate, lactate, malondialdehyde (MDA), total antioxidant capacity (TAC) and apoptosis were investigated. RESULTS: In a total of 48 rats, MAP levels remained higher than 60 mmHg for 3 hours in all of the treatment groups. The highest MAP values in each group were recorded. Higher MDA and lower TAC levels were observed in the control group than in all of the treatment groups (all p < 0.05). The number of apoptotic cells was highest in the control group and lowest in the L-arginine group. CONCLUSION: L-arginine administration may be an alternative treatment option for individualized fluid resuscitation in patients with TBI and hemorrhagic shock.

The effect of Ramadan on elderly patients presenting to the emergency department.

Background Patients visiting the emergency department (ED) may show variations by certain time periods such as Ramadan. We wished to ascertain whether Ramadan affects the ED presentations, clinical conditions and outcomes of patients aged 65 years or older. Methods . Patients aged 65 years or older who presented to ED in Ramadan and in the following month in 2018 were reviewed retrospectively. Results . A total of 1947 patients were enrolled, of whom 958 presented in Ramadan and 989 in the following month. The patients who presented in Ramadan most commonly (23.8%) presented between 8 p.m. and 11.59 p.m.; patients who presented in the following month most commonly (24%) presented between 8 a.m. and 11.59 a.m. (p=0.26). Complaints concerning the central nervous system (CNS) were more common in the month after Ramadan (p<0.0001). Diagnoses related to the cardiovascular system were more commonly made in Ramadan (p=0.037), whereas those related to CNS, otorhinolaryngology and oncology were more commonly made in the following month (p=0.0005, p=0.024 and p=0.003, respectively). No significant difference was found between the two groups with respect to outcomes (p=0.36). Compared to patients who presented in Ramadan, those that presented in the following month had a significantly longer ED stay (p=0.036). Conclusion . Our study detected no significant difference between the two groups with respect to the time of presentation and ED outcomes. Patients who presented in Ramadan had a lower incidence of CNS complaints; a higher incidence of cardiovascular diagnoses; lower incidences of CNS, oncological and otorhinolaryngological diagnoses and a significantly shorter length of ED stay.

Retrospective analysis of patients diagnosed with severe hyponatraemia in the emergency department.

Background . We investigated the demographic, aetiological and clinical characteristics of patients who presented to the emergency department and had severe hyponatraemia. Methods . We retrospectively evaluated 1171 patients who presented to the emergency department and were diagnosed with severe hyponatraemia. Results . Over half the patients studied were women (53.5%). The mean age of women was higher (p<0.0001). The most common complaint was dyspnoea (16.8%) and 42.5% of the patients had an oral intake disorder. In addition, 22.3% of the patients were on loop diuretics. About 76.3% of patients were conscious, and the mean sodium level of these patients was higher than the mean sodium level of those who responded to verbal and painful stimuli (p<0.001). Severe isolated hyponatraemia was observed in 61.8% of the patients. The mortality rate was 12.8%. There was no difference between the mean sodium levels of the deceased and discharged patients (p=1.0). The mortality rate was higher in patients who had a history of cirrhosis and cancer, but was lower in patients with a history of coronary artery disease (p=0.0002, p<0.0001 and p=0.04, respectively). Conclusion . Severe hyponatraemia was more prevalent in women, serum sodium levels were higher in conscious patients, and the mortality rate was higher in patients who had a history of cirrhosis and cancer. We found that the mean serum sodium levels did not help in distinguishing between the deceased and discharged patients.

Relation of femur fractures location with clinical outcomes in elderly patients / Relação da localização das fraturas de fêmur com desfechos clínicos em pacientes idosos

ABSTRACT Objectives: This study was designed to investigate the possible relationship between the anatomical location of the PFF (head-neck fractures) and the demographic features, comorbidities, and risk factors of elderly patients. Methods: 233 patients aged 65 years and over, who were admitted to the emergency department with a diagnosis of proximal femur fracture were included in this study. Results: Most patients (59.6%) had a trochanteric fracture. The incidence of trochanteric fractures had a statistically significant positive correlation with age. Falls at ground level were found to be highly associated with trochanteric fractures (92,8%). At least one complication was observed in 57 (41,0%) cases and 31 (22,3%) died in one year, of the patients with trochanteric fractures. Comorbidity was not related to fracture location statistically. Fall ground level (p = 0.013), complication rate (73.7%; p <0.001), and Charlesen comorbidity index (p = 0.019) were statistically significantly associated with death. The logistic regression analysis of variables determined that only the quantity of comorbidities may be related to femoral neck fractures (p = 0.047). Conclusion: Female patients with trochanteric fractures were found to be older than male patients. Fall ground level, mortality, and complications were more frequently seen in patients with trochanteric fractures. Level of Evidence II, Retrospective study.

RESUMO Objetivos: Este estudo foi desenhado para investigar a possível relação entre a localização anatômica da PFP (fraturas de cabeça e pescoço) e as características demográficas, comorbidades e fatores de risco de pacientes idosos. Métodos: Foram incluídos 233 pacientes com idade igual ou superior a 65 anos, admitidos no pronto-socorro com diagnóstico de fratura do fêmur proximal. Resultados: A maioria dos pacientes (59,6%) apresentou fratura trocantérica. A incidência de fraturas trocanterianas apresentou correlação positiva estatisticamente significativa com a idade. Verificou-se que as quedas no nível do solo estão altamente associadas às fraturas trocantéricas (92,8%). Pelo menos uma complicação foi observada em 57 (41%) casos e 31 (22,3%) morreram em um ano, dos pacientes com fraturas trocantéricas. A comoborbidade não foi realizada estatisticamente com a localização da fratura. Queda do nível do solo (p = 0,013), taxa de complicações (73,7%; p < 0,001), índice de comorbidade charlesen (p = 0,019) foram estatisticamente significativamente associados à morte. Na análise de regressão logística das variáveis, determinou-se que apenas a quantidade de comorbidades pode estar relacionada às fraturas do colo do fêmur (p = 0,047). Conclusão: Pacientes do sexo feminino com fraturas trocantéricas foram consideradas mais velhas do que pacientes do sexo masculino. Queda no nível do solo, mortalidade e complicações foram observadas com mais frequência em pacientes com fraturas trocantéricas. Nível de evidência II, Estudo retrospectivo.

Platelet Indexes for Predicting Disease Severity and Prognosis in Elderly Patients with Coronavirus Disease-19.

BACKGROUND: This study aimed to investigate the usefulness of platelet indices in predicting prognosis in coronavirus disease-19 (COVID-19). METHODS: Patients aged ≥ 65 years who presented to the emergency department with a positive polymerase chain reaction test were retrospectively analyzed. RESULTS: Significant differences were found in the mean values of platelet (PLT) and plateletcrit (PCT) parameters in those with severe disease, those who died, and those who required intensive care unit (ICU) admission. Mean PLT and PCT values were higher in patients with severe COVID-19 (p-values < 0.001, for both), those requiring ICU admission (p = 0.016; p = 0.006; respectively), and those who died (p = 0.015; p = 0.005, respectively). PLT and PCT were found to be statistically significant in predicting death [PLT (area under the curve (AUC): 0.598; p = 0.0145) and PCT (AUC: 0.617; p = 0.0034)], severity [PLT (AUC: 0.653; p = 0.0002) and PCT (AUC: 0.654; p = 0.0002)], and ICU admission [PLT (AUC: 0.598; p = 0.0235) and PCT (AUC: 0.605; p = 0.0148)]. CONCLUSIONS: PLT and PCT values were significantly higher in patients with high disease severity, those requiring ICU admission, and those who died. Furthermore, they were statistically significant in predicting disease severity, ICU admission, and death.

Analysis of Clinical and Radiological Findings in Oncology Patients Undergoing Thoracic Tomography for Suspected Pulmonary Embolism.

In the present study, we aimed to compare clinical and radiological findings between patients with and without pulmonary embolism (PE) and determine possible risk factors for PE development among patients with cancer. This was a retrospective study that examined the clinical features and tomographic findings of patients with cancer who underwent thoracic tomography for suspected PE. A total of 487 cases were included in the study. Of which, 45 (9.2%) patients were found to have PE. The effect of gender on PE was found to be significant (p = 0.018). Patients with PE compared to those without PE are 2.828 times more likely to be women than men. It was determined that the probability of not having a history of coronary artery disease (CAD) was 2.930 times (p = 0.036), probability of shortness of breath was 4.153 times (p < 0.001), syncope/presyncope was 6.859 times (p = 0.007), and palpitation was 5.613 times (p = 0.040) more in those with PE compared to those without PE. The mean pulse rate per minute was significantly higher in patients with PE than in those without (p = 0.009). Ninety-one percent of patients had parenchymal abnormalities, 43.7% had mediastinal and cardiovascular abnormalities, 35.5% had pleural abnormalities, 32.9% had thoracic wall abnormalities (p = 0.109, p < 0.001, p = 0.022, p = 0.685, respectively). Our study demonstrated that patients with PE were more likely to be women, patients with a history of palpitations, shortness of breath, syncope/presyncope, and those not having a history of CAD. More comprehensive studies are required in the future to clearly identify the risk factors for PE in patients with cancer and clarify the indications for tomography.

The Usefulness of Platelet Distribution Width and Platelet Distribution Width to Lymphocyte Ratio in Predicting Severity and Outcomes in Patients with Snakebite.

INTRODUCTION: Tissue damage, inflammatory response, and hematologic abnormalities may occur in snakebite envenomation. This study aimed to evaluate the predictive ability of platelet distribution width (PDW) and platelet distribution width to lymphocyte ratio (PDWLR) in the severity and outcome of envenomation in patients with snakebites in the emergency department (ED). METHODS: All adult patients admitted to the ED after a snakebite were retrospectively evaluated. Patients were classified according to the severity of envenomation. The relationship between the PDW and PDWLR and envenomation severity and patient outcomes was analyzed. Multivariate logistic regression analysis was performed to determine the predictors of severe envenomation. Results were presented as 95% CIs with odds ratios. Statistical significance was accepted at P<0.05. RESULTS: Envenomation was classified as none/minimal in 42 patients and moderate/severe in 29. PDW and PDWLR were significantly higher in the moderate/severe group (P=0.016 and P<0.001, respectively). Cut-off values of 16.5 for PDW and 6.15 for PDWLR were related to more severe envenomation (area under the curve 0.67, 95% CI 0.55-0.78 and area under the curve 0.85, 95% CI: 0.74-0.92, respectively). Blood product replacement, thrombocytopenia, hematologic abnormality, advanced local findings, compartment syndrome/fasciotomy, antivenom dosing, and moderate/severe envenomation were associated with PDWLR >6.15 (P<0.05). In multivariate analysis, PDWLR (odds ratio 1.19 [95% CI 1-1.4]; P=0.04) was an independent predictor of severe envenomation. CONCLUSIONS: Higher PDW and PDWLR were associated with severe envenomation in patients with snakebites in the ED. PDWLR may be used as a predictor of severe envenomation and adverse outcomes.

Skin Necrosis, Diffuse Urticaria, and Cellulitis Due to Presumed Loxosceles Spider Bite.

The clinical manifestations of a recluse spider bite range from local erythema to necrotic skin reactions; bites rarely lead to a systemic disease known as viscerocutaneous loxoscelism. A 29-y-old female patient was admitted to the emergency department with a wound, swelling, and pain on her left leg and a rash on her whole body as a result of a spider bite. On physical examination, a round, hard, black, irregularly shaped necrotic area was found in the bite zone on the lower posterior part of the left thigh, as were lesions in the form of erythematous papules around the area. There was a color change around the lesion, extending from posterior to medial of the thigh, and a papule on a diffuse erythematous surface on the trunk and arms. At follow-up, the necrotic area had become more apparent. After approximately 1 mo, the necrotic area was surgically debrided and a flap was formed on the necrotic tissue area. In this article, a case that was thought to be caused by a Loxosceles spider bite and which started with erythema, progressed to lymphangitis, cellulitis, and severe necrosis, and was surgically debrided, was evaluated in light of the clinical findings and previously reported cases of verified loxoscelism. In patients with a history suggestive of a bite and with these clinical findings, the diagnosis of a bite by Loxosceles spp. should be carefully considered based on clinical and epidemiologic findings.

Characteristics of the patients who admitted to the emergency department with seizures and the factors affecting the frequency of admission.

OBJECTIVES: To determine the features of patients applying to the emergency department (ED) with seizures and the factors affecting the frequency of admission. METHODS: This study was designed as a retrospective, cross-sectional study. The demographic and clinical characteristics, admission frequencies, diagnostic tests (laboratory and imaging methods) of the patients who were older than 18 years old and admitted to the ED between January 1, 2014 and January 1, 2017 with seizures were analyzed. RESULTS: The study included 867 patients with seizures. A comparison of the number of admissions by gender revealed a statistical significance (p=0.007). The number of admissions and the number of seizures until the time of admission were compared and found a statistical significance (p=0.002). In the logistic regression analysis of the factors affecting the frequency of admissions, seizure character [OR: 4.404 (%95 CI:1.761-11.015), p=0.002], comorbidity [OR: 2.021 (%95 CI:1.407-2.904), p<0.001], hospitalization [OR:1.893 (%95 CI: 1.259-2.847), p=0.002], concomitant injury [OR: 2.013 (%95 CI: 1.016-3.988), p=0.045], drug use (p<0.001), and possible etiology cerebrovascular disease (CVD) [OR: 2.763 (%95 CI: 1.327-5.752), p=0.007] were risk factors for frequent admission of patients applying to ED with seizures. CONCLUSION: Seizure character (first and known seizure), comorbidity status, hospitalization, concomitant injury, anti-epileptic drugs use, and possible etiology CVD are risk factors affecting the frequency of admission with seizure.

The Effect of Emergency Department Visits and Inflammatory Markers on One-Year Mortality in Patients with Heart Failure.

The neurohumoral and inflammatory pathways proposed for the development and progression of heart failure (HF) remain up-to-date. We aimed to investigate the effect of emergency department (ED) visits and inflammatory markers on mortality in HF patients. Two-hundred patients with stable chronic HF followed by the cardiology clinic were included in this study. The patients were divided into two groups as patients who had visited the ED due to worsening HF symptoms within the last 6 months (ED visit Group) and who had not (No ED visit Group). The demographical properties, clinical characteristics, and laboratory values including inflammatory markers of the patients were recorded. During the follow-up period, 38 patients (19%) died. In HF patients with previous ED visits, the mortality risk was 2.091 times higher (relative risk, RR). It was identified that the HF patients who died during the follow-up had higher initial NLR (p = 0.004), IG% (p = 0.029), hs-CRP (p = 0.001), and NT-proBNP (p = 0.004) values. It was observed that the area under the curve (AUC) values, NLR (AUC: 0.705, p < 0.001), IG% (AUC: 0.652, p = 0.003), and hs-CRP (AUC: 0.732, p < 0.001) were very strong predictors of the 1-year mortality. According to the cut-off points, the mortality risk (RR) was 3.39 times higher in patients with NLR > 3.7 (95% CI 1.783-6.444), 2.39 times higher when IG% > 0.4 (95% CI 1.16-4.957), and 4,2 times higher when hs-CRP > 9.9 mg/dl (95% CI 2.16-8.16) (p < 0.05). The patients with chronic stable HF who visited the ED within the last six months and having increased NLR, IG%, and CRP levels among inflammatory markers were associated with a higher mortality risk at 1 year.

Myopericarditis caused by severe acute respiratory syndrome coronavirus 2.

A 25-year-old man presented to the emergency department with acute-onset chest pain and shortness of breath. A physical examination revealed coarse crackles in the both lower lungs. Consolidation and ground-glass opacities suggesting viral infection were detected in the right lower lobe on chest computed tomography. Laboratory findings revealed elevated troponin, leukocytosis, and lymphopenia. Electrocardiography revealed ST segment elevation with PR depression in leads I, aVL, V5, and V6, and ST depression and PR elevation in aVR. Echocardiography revealed diffuse cardiac hypokinesia and a decreased left ventricular ejection fraction. Suspecting coronavirus disease 2019 (COVID-19)-related myopericarditis, the patient was hospitalized. After one week of empirical antibiotics, antivirals, and supportive therapy, his condition improved. Antibody testing for COVID-19 was positive on hospitalization day 8. The presentation of myopericarditis can be vague and mislead physicians during the COVID-19 pandemic. Myopericarditis should be included as a differential diagnosis for patients with suspected COVID-19.

The value of hematological parameters in acute pancreatitis.

BACKGROUND: Acute pancreatitis (AP) is a common inflammatory disease in the emergency department (ED). This study aims to assess the role of CRP and hematologic parameters in mild/severe AP patients and biliary/nonbiliary AP at the time of admission to the ED. METHODS: 168 patients who were diagnosed as AP in the ED, and as a control group, 100 patients were included in this study. At the time of application to the ED, the demographic information (age, sex) and the amylase, lipase, CRP, hematological parameters (WBC, MPV, RDW, PLT, NLR) of all patients and the control group were recorded and compared. According to the etiology of the patients, the patients were divided into biliary and nonbilary AP groups and according to the severity, they were divided into mild and severe AP groups, then, the same parameters were evaluated. RESULTS: Significant differences were found out between WBC, CRP, NLR, MPV and PLT values between patient and the control group (p<0.001). The length of hospitalization and the parameters were not significant between the biliary and the nonbiliary group. Ranson and APACHE II scores were correlated with WBC, CRP and NLR. There was a statistically significant difference between the mild and severe AP groups in terms of duration of the hospital stay, CRP, WBC and NLR values (p=0.003 for CRP, p<0.001 for the others). In severe AP, the cut-off value of NLR was found to be 8.05, sensitivity %93.48, specificity %86.89 and AUC 0.937 (p<0.001). CONCLUSION: The use of parameters, such as WBC, CRP, and NLR, in combination with other diagnostic and prognostic tools in emergency service can provide convenience to clinicians at the time of admission and prognosis.

A case of headache, double vision and ptosis in emergency department: Tolosa-Hunt syndrome.

Headache and double vision symptoms can be seen especially neurological and optical problems. We present Tolosa-Hunt syndrome in a 34-year-old female patient who presented to the emergency department (ED) with the complaints of unilateral severe headache, double vision and ptosis, presented asymmetric contrast enhancement in the right superior cavernous sinus on MR. This pain was reduced with steroid therapy. Pulse steroid therapy of 1 mg/kg/day was planned based on the patient's clinical manifestation, MRI findings and presumed diagnosis of THS. It was observed at patient's follow-up that there were occasional headache, ptosis and double vision were disappeared and MRI findings were regressed. In the differential diagnosis of patients presenting to the ED with the complaints of headache and double vision, rare pathologies such as THS should be considered in addition of common pathologies such as neurological and ocular diseases.

Validity of modified early warning, Glasgow Blatchford, and pre-endoscopic Rockall scores in predicting prognosis of patients presenting to emergency department with upper gastrointestinal bleeding.

BACKGROUND: GBS, MEWS, and PER scoring systems are not commonly used for patients presenting to emergency department with GIS bleeding. This study aimed to determine the value of MEWS, GBS, and PER scores in predicting bleeding at follow-up, endoscopic therapy and blood transfusion need, mortality, and rebleeding within a 1-month period. METHODS: A total of 202 consecutive patients with upper GIS bleeding between July 2013 and November 2014 were prospectively enrolled in the study. The relationship between MEWS, GBS, and PER scores and hospital outcome, bleeding at follow-up, endoscopic therapy, transfusion need, rebleeding, and death were examined. RESULTS: The study included a total of 202 subjects, with 84 (41.6 %) females and 118 (58.4 %) males. There was a significant correlation between GBS, MEWS, and PER scores and hospital outcomes (p <0.004, p <0.001, p <0.001, respectively). A GBS score greater than 11 succesfully predicted bleeding at follow-up (p = 0.0237). GBS score's sensitivity for predicting endoscopic therapy was greater than those of other scoring systems. The discriminatory power of each scoring system was significant for predicting transfusion (p <0.0001, p = 0.0470, and p = 0.0014, respectively). A GBS score greater than 13, a MEWS score greater than 2, and a PER score greater than 3 predicted death. A PER score greater than 3 predicted rebleeding (p <0.0001). CONCLUSION: The scoring systems in question can be easily calculated in patients presenting to ED with upper GIS bleeding and may be beneficial for risk stratification, determination of transfusion need, prediction of rebleeding, and decisions of hospitalization or discharge.