A new method: measurement of pancreas volume in computerised tomography as a diagnostic guide for acute pancreatitis.

OBJECTIVE: To investigate whether measuring pancreas volume with abdominal tomography in patients with severe abdominal pain can predict acute pancreatitis. METHODS: The case-control study was conducted at Adnan Menderes University from January 1, 2015, to January 1, 2017, and comprised patients who were diagnosed with acute pancreatitis. Pancreas volume measurements of patients and control group were made with Telemed Ekinoks software using freehand technique. Presence of a correlation between pancreas volume and pancreatitis was found in patients aged <57 years and a cut-off value was calculated for pancreatitis in this particular patient group. RESULTS: Of the 183 subjects, 132(72%) were patients with a mean age of 59.6±16.5 years, and 51(28%) were controls with a mean age of 55.8±18.6 years (p=0.170). The difference between the groups in terms of pancreas volume was significant (p<0.001). There was a negative correlation between age and pancreas volume among the patients (p<0.001), the correlation was not significant among the controls (p=0.898). Among the subjects aged <57 years, the cut-off value was calculated at 95.055, and sensitivity to pancreas volume was 70.91% while specificity was 82.14%. Positive predictive value was 88.6%. CONCLUSIONS: High pancreas volume with pancreatitis was observed in patients aged <57 years.

The predictive value of the inflammatory markers P-selectin and MCP1 in determining the length of stay and 30-day survival in the differentiation of sepsis patients.

OBJECTIVE: Sepsis is the leading disease that is diagnosed late and still has a mortal course in emergency departments. The primary factors that will reduce both morbidity and mortality are early diagnosis and an early treatment approach. Therefore, in this study, P-selectin and MCP1 levels, which are known to be markers of inflammation, were examined in patients being followed up in intensive care. METHODS: Patients evaluated with a preliminary diagnosis of sepsis in the emergency intensive care unit between September 2015 and August 2016 were classified as having sepsis or infection according to the Q- SOFA criteria, and the P- selectin values were compared. RESULTS: In the sepsis group, GCS was determined as 13 (12-13), SBP 90 (80-110), tachypnea 24 (22-26), lactate 3.8 (0.6-16.0), MAP 70 (60-77), and LOS 16 days (9.5-20.3). In the ROC analysis, the sensitivity of P-selectin and MCP1 in the differentiation of patients with and without sepsis was 95.7%, and 73.8%, and the specificity was 97.8% and 73.8%, respectively. According to the cutoff values, the sensitivity and specificity in the prediction of patient mortality were 71.4% and 65.6% in P- selectin and 78.6% and 65.6% in MCP1. CONCLUSIONS: The P-selectin and MCP1 values in the emergency department can differentiate sepsis patients according to the Q-SOFA criteria and showed 30-day mortality at a significant level. Therefore, in patients with suspected sepsis in an emergency department, MCP1 can be of benefit to physicians in their decisions regarding LOS and transfer to intensive care.

Treatment methods following suicidal self-administration of IV organophosphate: What can additional lipid administration change?

Organic phosphor compounds are highly toxic and life-threatening compounds that are widely used in agriculture, households and gardens worldwide. While oral intakes are observed frequently, toxic effects can also be seen through contract or inhalation. However, toxic cases through the parenteral route have rarely been reported. We had three main aims: first, to present a male patient who self-administered 2ml of monocrotophos intravenously to commit suicide. Our second goal was to present the current multiple treatment methods, such as fast general support, antidote treatment, lipid emulsion treatment, and plasmapheresis along with the literature. Third, we aimed to emphasize that with these treatments, patients' intensive care needs, intermediate symptoms, and hospitalization periods can be decreased and thus mortality and morbidity increase can be prevented.

A rare complication of scorpion venom: atrial fibrillation.

Although the clinical findings of scorpion stings are often mild, they may lead to multiorgan failure and even cardiogenic shock. The toxin has both local and systemic effects. Local effects include edema, bruising(ecchymosis), and burning pain,whereas systemic effects include nausea,vomiting, hypotension or hypertension, cardiovascular toxicity, renal failure,and hemorrhage at different areas. The toxins have been implicated in a number of cardiac arrhythmias, including torsade de pointes, long QT syndrome, and atrial fibrillation. Here, we present a 90-year-old woman with no history of drug use or complaints due to dysrhythmias who developed atrial fibrillation after being stung by a scorpion.

Prognostic value of neglected biomarker in sepsis patients with the old and new criteria: predictive role of lactate dehydrogenase.

OBJECTIVES: This study examined the pH, lactate dehydrogenase (LDH), and heart rate values on the first day of hospitalization in patients with a prediagnosis of sepsis and biomarkers that may predict mortality. METHODS: Patients hospitalized in an emergency intensive care unit with a diagnosis of systemic inflammatory response syndrome were classified as having sepsis (n = 28), septic shock (n = 8), or severe sepsis (n = 8) according to International Sepsis Guidelines (old criteria). Forty-four patients were classified as having sepsis (n = 4), septic shock (n = 30), or infection (n = 10) according to The Third International Consensus Definitions for Sepsis and Septic Shock (new criteria). The effects of these patients' laboratory values on survival between groups were compared. Significant values were evaluated by χ2 automatic interaction detection analysis. RESULTS: When the patients were categorized according to the new classification criteria, there was an increase in the number of septic shock patients and a decrease in the number of sepsis patients. In addition, 10 patients were removed from the sepsis category. There was a significant difference between ex and discharged patients in terms of heart rate, pH, sodium bicarbonate, lactate, and LDH (P= .007, P= .002, P= .034, P= .009, and P= .002, respectively). Based on a χ2 automatic interaction detection analysis of the significant values, pH, LDH, and heart rate were prominent predictors of prognosis. CONCLUSIONS: Systemic pH, LDH, and heart rate values may be used to determine the best time to discharge patients from intensive care to other, more affordable hospital units.

The overlooked side of convulsion: bilateral posterior fracture and dislocation of proximal humerus.

Injuries after an epileptic convulsion have been seen commonly such as burns, head injury and dislocation of the extremities. But fractures of the extremities due to convulsion are rare. External trauma mechanism is not necessary for extremity fractures. Muscle contractions can cause increased load on the skeleton and it can be complicated by dislocation andor fracture of extremities. Almost 1-4% of all the shoulder dislocations are posterior. In this case report we present a 32 year old male patient who had bilateral posterior fracture and dislocation of proximal humerus after convulsion. We would like to emphasize that it is so important to make systemic examination and evaluation of the patients who were admitted to emergency department after epileptic convulsion.

The relationship between vascular inflammation and target organ damage in hypertensive crises.

OBJECTIVE: Hypertensive crises, divided depending on the presence of target organ damage (TOD), are associated with increased cardiovascular mortality and morbidity. Monocyte chemoattractant protein-1 (MCP-1) is responsible for the recruitment of monocytes to sites of vascular inflammation. The aim of this study was to evaluate the role of vascular inflammation in development of TOD. METHOD: The patients were categorized according to the presence of TOD. Thirty-three patients (15 female; mean age, 68 ± 12 y) with TOD and 30 patients (14 female; mean age, 64 ± 12 y) without TOD were included to the study. In addition to routine laboratory parameters, neutrophil-lymphocyte ratio, uric acid, C-reactive protein (CRP), high sensitive CRP, and plasma MCP-1 levels were evaluated. RESULTS: Neutrophil counts, white blood cells, high sensitive CRP, and uric acid levels were higher in patients with hypertensive crises. More importantly, CRP (7.2 mg/dL [2-37.8 mg/dL] vs 4.6 mg/dL [1.5-14 mg/dL] vs 2.7 mg/dL [1-8.1 mg/dL], P < .01) and MCP-1 levels (546 pg/mL [236-1350 pg/mL] vs 407 pg/mL [78-942 pg/mL] vs 264 pg/mL [34-579 pg/mL], P < .01) were higher in the group with TOD compared with other groups. CONCLUSION: In conclusion, plasma MCP-1 levels were significantly higher in patients with TOD. According to our results, we suggest that increased vascular inflammation and MCP-1 levels might be associated with the development of TOD in hypertensive crisis.

The diagnostic role of signal peptide-C1r/C1s, Uegf, and Bmp1-epidermal growth factor domain-containing protein 1 in non-ST-elevation acute coronary syndrome.

OBJECTIVE: Chest pain and/or electrocardiogram changes in non-ST elevation or suspicious chest pain and cardiac marker elevations are defined as non-ST-elevation acute coronary syndrome (NSTE-ACS). Serial electrocardiogram and marker follow-up are needed to make a diagnosis of NSTE-ACS and to eliminate noncoronary chest pain (NCCP). Signal peptide-C1r/C1s, Uegf, and Bmp1-epidermal growth factor domain-containing protein 1 (SCUBE1) is stored within the α granules of inactive platelets and secreted at a high rate during thrombosis. We believe that SCUBE1 may be a sensitive early diagnostic indicator in distinguishing coronary-induced chest pain from noncoronary-induced chest pain. MATERIALS AND METHODS: The study included 190 patients with an initial diagnosis of acute coronary syndrome in the emergency department. Based on a definitive diagnosis, these patients were classified into 3 groups: ST-elevation myocardial infarction (STEMI), NSTE-ACS, and NCCP. RESULTS: Plasma SCUBE1 levels were significantly higher in the STEMI group when compared with those of the other groups (P < .05). They were also significantly higher in the NSTE-ACS group when compared with those of the NCCP group (P < .01). Troponin I, creatinine kinase, and creatinine kinase MB levels were significantly different in the NSTE-ACS group when compared with those of the NCCP group (P < .05). CONCLUSION: High rates of SCUBE1 were found both in the STEMI and NSTE-ACS patients. Furthermore, in the study group, SCUBE1 was an adequate marker for distinguishing NSTE-ACS from NCCP.

Pathognomonic symptom associated with lightning strike: Lichtenberg figure.

Lightning strikes especially occur during spring and summer months in the afternoons when there is heavy rain. In deaths resulting from lightning strike, there may either be no evidence on the dead person's clothes or body, or there may be burnt or torn patches on their clothes and lichtenberg figures specific to lightning strikes on their bodies. In such cases that also have a comorbid of cognitive dysfunction, since there is generally amnesia, having these figures during the physical examination has a valuable place in early diagnosis and quick treatment. This paper presents a case of lightning strike that was found to have Lichtenberg figures on the back and right leg after secondary examination.

Association between oxidative stress index and serum lipid levels in healthy young adults.

OBJECTIVES: To investigate the relationship between lipid levels and oxidative stress index in healthy young adults. METHODS: The study was camed out at the Department of Emergency Service, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey, between January 2011 and July 2012. A total of 100 healthy adult volunteers were enrolled in the study. Venous blood samples (10 ml) were collected from all individuals, and serum lipid parameters, total antioxidant capacity and total oxidative levels were studied. SPSS 15 was used for statistical analysis. RESULTS: Overall, there were 84 (84%) males and 16 (16%) females. The mean age fo the male population was 30 +/- 3 years, while that of the females was 31 +/- 3 years. Overall age ranged from 25 to 35 years. A statistically significant correlation was found between the oxidative stress index and serum cholesterol (p < 0.001; r = 0.596), triglyceride (p < 0.001; r = 0.476) and low-density lipoprotein levels (p < 0.001; r = 0.318). However, no significant correlation was found between oxidative stress index and serum high-density lipoprotein levels (p = 0.564; r = 0.058). CONCLUSION: The results showed that even at an early age, there is a direct linear correlation between oxidative stress and serum lipid levels.

Association of carbon monoxide poisonings and carboxyhemoglobin levels with COVID-19 and clinical severity.

BACKGROUND: Coronavirus disease 2019 (COVID-19), which recently spread throughout the entire world, is still a significant health issue. Additionally, the most common cause of risky poisoning in emergency services is carbon monoxide (CO) poisoning. Both disorders seem to merit more research as they have an impact on all bodily systems via the lungs. AIM: To determine how arterial blood gas and carboxyhemoglobin (COHb) levels affect the clinical and prognostic results of individuals requiring emergency treatment who have both COVID-19 and CO poisoning. METHODS: Between January 2018 and December 2021, 479 CO-poisoning patients participated in this single-center, retrospective study. Patients were primarily divided into two groups for analysis: Pre-pandemic and pandemic periods. Additionally, the pandemic era was divided into categories based on the presence of COVID-19 and, if present, the clinical severity of the infection. The hospital information system was used to extract patient demographic, clinical, arterial blood gas, COVID-19 polymerase chain reaction, and other laboratory data. RESULTS: The mean age of the 479 patients was 54.93 ± 11.51 years, and 187 (39%) were female. 226 (47%) patients were in the pandemic group and 143 (30%) of them had a history of COVID-19. While the mean potential of hydrogen (pH) in arterial blood gas of all patients was 7.28 ± 0.15, it was 7.35 ± 0.10 in the pre-pandemic group and 7.05 ± 0.16 in the severe group during the pandemic period (P < 0.001). COHb was 23.98 ± 4.19% in the outpatients and 45.26% ± 3.19% in the mortality group (P < 0.001). Partial arterial oxygen pressure (PaO2) was 89.63 ± 7.62 mmHg in the pre-pandemic group, and 79.50 ± 7.18 mmHg in the severe group during the pandemic period (P < 0.001). Despite the fact that mortality occurred in 35 (7%) of all cases, pandemic cases accounted for 30 of these deaths (85.7%) (P <0.001). The association between COHb, troponin, lactate, partial arterial pressure of carbon dioxide, HCO3, calcium, glucose, age, pH, PaO2, potassium, sodium, and base excess levels in the pre-pandemic and pandemic groups was statistically significant in univariate linear analysis. CONCLUSION: Air exchange barrier disruption caused by COVID-19 may have pulmonary consequences. In patients with a history of pandemic COVID-19, clinical results and survival are considerably unfavorable in cases of CO poisoning.

The relationship between D-dimer level and the development of atrial fibrillation in patients with systolic heart failure.

Heart failure (HF) is one of the most common and leading cause of death worldwide. Clinical trials provide evidence that the development of atrial fibrillation (AF) is a marker of poor prognosis in patients with HF. Furthermore, elevated D-dimer level is associated with increased cardiovascular mortality independent of AF in HF patients. We investigated whether plasma D-dimer levels in patients with hospitalized systolic HF could predict development of AF. A total of 150 consecutive patients with sinus rhythm who admitted to the emergency department with hospitalized systolic HF were evaluated. All hospitalized patients were obtained D-dimer levels within the first 24 h following admission. Atrial fibrillation developed in 31 (20.7%) patients during follow-up period of 6.3 ± 5 months. Patients who developed atrial fibrillation had significantly increased levels of D-dimer [608 (339-1,022) ng/ml versus 1,100 (608-2,599) ng/ml, P = 0.001]. Optimal cut-off level of D-dimer to predict development of AF was found to be >792 ng/ml. D-dimer >792 ng/ml, right ventricular dilatation, age, systolic pulmonary pressure, left atrium size, moderate to severe tricuspid regurgitation, and beta blocker usage were found to have prognostic significance in univariate analysis. In multivariate Cox proportional-hazards model, D-dimer levels >792 ng/ml (HR = 3.019, P = 0.006), and right ventricular dilatation (HR = 8.676, P = 0.003) were associated with an increased risk of new-onset AF. In conclusion, D-dimer could predict development of AF in patients with hospitalized systolic HF.

Usefulness of admission matrix metalloproteinase 9 as a predictor of early mortality after cardiopulmonary resuscitation in cardiac arrest patients.

BACKGROUND: Matrix metalloproteinases (MMPs) have a central role in disease progression after ischemia-reperfusion injury. However, its prognostic significance in cardiac arrest (CA) patients having cardiopulmonary resuscitation (CPR) is unknown. The aim of this study was to investigate the relation between admission MMP-9 level and early mortality in CA patients. METHODS: A total of 96 in-hospital or out-of-hospital CA patients and 40 age- and sex-matched healthy volunteers as the control group were evaluated prospectively. The patients were classified according to the CPR response into a successful group (n = 46) and a failed group (n = 50). RESULTS: The MMP-9 levels were detected to be 56.9 ± 4.3, 69.5 ± 7.4, and 92.7 ± 10.1 ng/mL in the control group, the successful CPR group (acute responders), and the failed CPR group, respectively (P < .001 for the 2 comparisons). The MMP-9 level on admission, presence of asystole, mean CA duration, out-of-hospital CPR, sodium and potassium levels, and arterial pH were found to have prognostic significance in univariate analysis. In addition, MMP-9 levels were correlated with age, troponin level, and oxygen saturation. In multivariate logistic regression analysis with forward stepwise method, only MMP-9 level on admission (odds ratio, 1.504; P < .001) and mean CA duration before CPR (odds ratio, 1.257; P = .019) remained associated with post-CPR early mortality after adjustment of other potential confounders. In addition, optimal cutoff value of MMP-9 to predict failed CPR was found as greater than 82 ng/mL, with 88% sensitivity and 97.8% specificity. CONCLUSIONS: High MMP-9 levels were associated with worse clinical and laboratory parameters, and it seems that MMP-9 helps risk stratification in CA patients.

Increased γ-glutamyl transferase levels predict early mortality in patients with acute pulmonary embolism.

BACKGROUND: Increased γ-glutamyl transferase (GGT) level is associated with increased oxidative stress, all-cause mortality, the development of cardiovascular disease, and metabolic syndrome. However, its role in acute pulmonary embolism (PE) is unknown. In this study, we aimed to investigate the relationship between GGT and early mortality in patients with acute PE. METHODS: A total of 127 consecutive patients with confirmed PE were evaluated. The optimal cutoff value of GGT to predict early mortality was measured as more than 55 IU/L with 94.4% sensitivity and 66.1% specificity. Patients with acute PE were categorized prospectively as having no increased (group I) or increased (group II) GGT based on a cutoff value. RESULTS: Of these 127 patients, 18 patients (14.2%) died during follow-up. Among these 18 patients, 1 (1.4%) patient was in group I, and 17 (30.9%) patients were in group II (P < .001). γ-Glutamyl transferase level on admission, presence of shock, heart rate, oxygen saturation, right ventricular dilatation/hypokinesia, main pulmonary artery involvement, troponin I, alanine aminotransferase, alkaline phosphatase, and creatinine levels were found to have prognostic significance in univariate analysis. In the multivariate Cox proportional hazards model, GGT level on admission (hazard ratio [HR], 1.015; P = .017), presence of shock (HR, 15.124; P = .005), age (HR, 1.107; P = .010), and heart rate (HR, 1.101; P = .032) remained associated with an increased risk of acute PE-related early mortality after the adjustment of other potential confounders. CONCLUSIONS: We have shown that a high GGT level is associated with worse hemodynamic parameters, and it seems that GGT helps risk stratification in patients with acute PE.

Disaster area triage in the first 24 h of earthquakes, evaluation of pre-hospital and hospital procedures: 6.6 Elazig earthquake.

BACKGROUND: Earthquakes are natural events, but the destruction they cause is quite high. Since it is not possible to prevent an earthquake, it is necessary to raise conscious and sensitive individuals about earthquakes and to seek solutions. It was aimed to present the triage, consumables, fluids, and drugs used in the 2020 Elazig earthquake. METHODS: After the earthquake, the epicenter of which was Sivrice/Elazig on January 24, 2020, all affected victims, pre-hospital triage status, management of emergency, and other inpatient services during the hospitalization, medical interventions including sur-geries, consumables, fluids, and drugs were evaluated retrospectively with the data in the first 24 h. RESULTS: The total number of injured after the earthquake in Elazig, which had a magnitude of 6.6 on the Richter scale and lasted for 22 s, was 974. While 37 (3.7%) people died, 18 (1.8%) of them were women. While 34 people died in the wreckage and 3 people in the emergency department, their mean age was 46.0±12.5 years. While 654 patients were registered in the first 24 h, 30 of them were by 112 Command and Control Center and 624 were outpatients. Temporary registration was provided to 320 people as they did not have their identity information. CONCLUSION: Being prepared and organized before an earthquake, and taking early intervention will provide significant success in the survival of the disaster victims.

Importance of Team Experience and Coordination in Disaster Response: Building Collapse.

OBJECTIVE: The objective of this study was to determine whether coordination of prehospital emergency health services and Disaster and Emergency Management Presidency (DEMP) and being prepared for disasters, such as building collapses, allow quick evaluation and fast intervention. METHODS: The information flow, hierarchy, treatment, and rehabilitation processes, and rescue organization and planning during the rescue attempt for 35 people who needed help due to this building collapse were reviewed. RESULTS: Of the 43 people who lived in this 8-story building, 35 were inside the building during the collapse; 40% of them were assessed as injured and 60% as exitus. Almost two-thirds (64.3%) of the injured individuals who were rescued were women. The mean duration until rescue was 330 (57.0-512.0) min. CONCLUSIONS: Leading and important factors that can increase the success rate in search and rescue interventions are informing official authorities as first early warning by individuals who can clearly define the situation, early security measures by security forces arriving before the health and search-rescue teams, accurate identification of estimated numbers of injured victims, and identifying and informing appropriate hospitals which victims rescued from the debris will be transferred to there.

Correct triage at the scene increases success in the ED: Sabiha Gökçen Airport plane accident.

BACKGROUND: Triage is the most important part of the management of events, such as accidents, earthquakes, fires, and floods, in which mass injuries occur. The aim of this study is to evaluate the effects of triage on patient outcomes, injuries, the role of trauma mechanisms, and spinal immobilization during transportation following the plane crash at the Istanbul Sabiha Gökçen airport that involved 183 patients on February 5, 2020. METHODS: Command control center data and ambulance and medical charts were examined retrospectively. The results were evaluated in terms of spinal immobilization, injury type, triage codes, and ISS values during emergency interventions and transportation. RESULTS: We received the first notice at 18: 21 about the plane that had landed and crashed at 18: 19 on February 5, 2020, and the first team reached the security gate at 18: 26. The first team arrived at the debris field and performed triage. On the airside of the airport, the first victims were taken at 18: 32, transferred at 18: 36, and reached the hospital at 18: 41. The first case was taken from the debris field at 18: 35 and transferred to the hospital. Of the 183 patients on the plane, three became exitus at the scene, 43.7% of the victims were female, and the mean age was 35.0±15.7. The mean systolic blood pressure of the victims was 122.0±17.4. The mean distance to hospitals, transportation time, intervention time, heart rate, and ISS levels were measured as 55.0 (23.0-79.0) km; 780.5 (390.0-1540.0) s; 817.0 (552.0-1200.0) s; 86.0 (78.0-100.0); and 4.5 (1.0-9.0), respectively. A positive significant correlation was found between ISS and the days of hospitalization (r=0.577; p<0.001). CONCLUSION: The fact that no patient was lost during the follow-up and treatment is an indication that triage, appropriate patient referral to the appropriate hospital, and primary and secondary care are well performed, as well as the crash of the plane while landing. Coordinated acts of the airport and 112 emergency health services and guidance for appropriate triage reduced both pre-hospital and hospital mortality.