Features of patients with upper gastrointestinal bleeding and factors affecting the re-bleeding risk.

BACKGROUND: The risk of re-bleeding in upper gastrointestinal bleeding (UGIB) is a major complication that can be mortal. In this study, we aimed to determine the factors that can predict the risk of re-bleeding in UGIB patients. METHODS: We retrospectively screened UGIB patients admitted in adult intensive care. Along with age and gender, complaints of admission, vital signs, comorbidities, laboratory findings, medications, endoscopy status, and re-bleeding status were recorded. According to these findings, Glasgow-Blatchford and AIMS65 scores of the patients were calculated. All statistical tests were performed with the Predictive Analytics Software (PASW®, version 18, SPSS Inc., Chicago, IL). RESULTS: A total of 241 patients were included in the study. Mean age of patients was 57.58±19.31, years and 176 (73.0%) of them were male. A total of 117 (48.5%) patients were Helicobacter pylori positive and re-bleeding occurred in 77 (32.0%) patients. Sclerotherapy was applied in 103 (42.7%) patients, while 5 (2.1%) underwent electrocoagulation, and 4 (1.7%) underwent hemoclips. There was a significant difference between patients with and without endoscopic intervention for re-bleeding (p<0.001). Hematocrit, urea values, Glasgow-Blatchford, and AIMS65 scores were statistically significant different between the groups with and without re-bleeding (p=<0.001, <0.001, <0.001, and 0.008, respectively). In the ROC analysis of Glasgow-Blatchford and AIMS65 scoring systems area, under the curve values were 0.700 (p=<0.001, 95% CI: 0.626-0.775), and 0.557 (p=0.194, CI 95%: 0.469-0.645), respectively. Mortality rate was 2.1% (n=5) among study population. CONCLUSION: Hematocrit and urea values seem beneficial among studied laboratory values, however, Glasgow-Blatchford scoring system performed better than AIMS65 in the prediction of re-bleeding risk in UGIB. The authors concluded that more specific predictive markers may be useful for clinicians.

Assessment of endotracheal intubation procedures following inadvertent esophageal intubation. A randomized crossover manikin trial.

OBJECTIVE: To evaluate the success, degree of difficulty and completion time of endotracheal intubation without removing the endotracheal tube in the event of an oesophageal intubation.. METHODS: The prospective, randomised crossover study was conducted at Gulhane Training and Research Hospital, Ankara, Turkey, from July 1, 2018, to August 31, 2018, and used a manikin model. Endotracheal intubation was performed using Miller, Macintosh blades and a video laryngoscope. The procedures were randomised into two groups, with group E+ being subjected to it while an endotracheal tube ETT was placed in the oesophagus (E+) simulating the oesophageal intubation, and control group E- getting the standard procedure without the endotracheal tube in the oesophagus. All methods were evaluated for their success, completion time, and degree of difficulty. Data was analysed using SPSS 22. RESULTS: There were 120 manikins, with 60(50%) in each of the two groups. The mean completion time with Miller in E+ group was 19.05±9.65 and for E- it was 17.55±11.95 seconds. With Macintosh, E+ had a mean completion time of 19.85±12.66 seconds and E- had 16.75±8.66. With video laryngoscope, E+ group had a mean completion time of 16.75±8.66 seconds, while E- had it 14.60±8.17. No significant difference was found in the paired group comparisons in terms of the degree of task difficulty (p>0.05). CONCLUSIONS: In case of inadvertent oesophageal intubation condition, leaving the tube in the oesophagus and performing subsequent endotracheal intubation attempts was not found to decrease the rate of success regardless of the laryngoscope type.

How reliable are electrolyte and metabolite results measured by a blood gas analyzer in the ED?

INTRODUCTION: Blood gas analysis is a frequently ordered test in emergency departments for many indications. It is a rapid technique that can analyze electrolyte and metabolites in addition to pH and blood gases. The aim of this study was to investigate the correlation of electrolyte and metabolite results measured by blood gas and core laboratory analyzers. METHODS: This was a prospective, single-center observational study conducted in a tertiary care center's emergency department. All adult patients requiring arterial/venous blood gas analysis and core laboratory tests together for any purpose were consecutively included in the study between April 2014 and July 2015. Patients younger than 16 years, having any intravenous infusion or blood transfusion prior to sampling, or who were pregnant were excluded. RESULTS: A total of 1094 patients' (male = 547, female = 547) paired blood samples were analyzed. The mean age was 58.10 ± 21.35 years, and there was no difference between arterial and venous sampling groups by age, pH, or sex (P = .93, .56, and .41, respectively). Correlation coefficients for hemoglobin, hematocrit, glucose, potassium, sodium, and chloride levels measured by blood gas analyzer and core laboratory analyzers were 0.922, 0.896, 0.964, 0.823, 0.854, and 0.791, respectively. CONCLUSION: Blood gas analysis results were strongly correlated for hemoglobin, hematocrit, glucose, potassium, and sodium levels but were only moderately correlated for chloride levels. These parameters as measured by a blood gas analyzer seem reliable in critical decision making but must be validated by core laboratory results.

[Contribution of Turkish Emergency Medicine to the international literature: evaluation of 15 years]. / Türk acil tibbinin uluslararasi literatüre katkisi: 15 yilin degerlendirilmesi.

BACKGROUND: The aim of this study was to present characteristics of internationally published articles originating from Turkish Emergency Medicine (EM) departments over the last 15 years. METHODS: The PubMed database was searched for all articles published from 1995 to 2010 that originated from Turkish EM departments. RESULTS A total of 514 articles were included. Of all articles, 77% (n=396) were published in the last five years. Publications were detected to increase at a rate of 6.2 articles per year. 58.7% (n=302) of the articles were published in non-EM journals. Advances in Therapy in the non-EM group, with 27 articles, and the Turkish Journal of Trauma & Emergency Surgery in the EM group, with 48 articles, were the preferred journals. The most popular subjects were toxicology, at 26% (n=134), followed by trauma, at 16% (n=86). 7.7% (n=40) of all articles were animal studies and 6% (n=31) were randomized controlled trials. CONCLUSION: Significant publication growth was detected related with the development of EM in Turkey. The preference for non- EM journals, toxicology as the most popular subject and the effect of university hospitals were the interesting results of this study. The low number of multicenter, randomized controlled trials and of published articles in high impact factor journals have led us to consider the importance of publication quality, which requires additional effort.