Genome-wide transformation reveals extensive exchange across closely related Bacillus species.

Bacterial transformation is an important mode of horizontal gene transfer that helps spread genetic material across species boundaries. Yet, the factors that pose barriers to genome-wide cross-species gene transfer are poorly characterized. Here, we develop a replacement accumulation assay to study the effects of genomic distance on transfer dynamics. Using Bacillus subtilis as recipient and various species of the genus Bacillus as donors, we find that the rate of orthologous replacement decreases exponentially with the divergence of their core genomes. We reveal that at least 96% of the B. subtilis core genes are accessible to replacement by alleles from Bacillus spizizenii. For the more distantly related Bacillus atrophaeus, gene replacement events cluster at genomic locations with high sequence identity and preferentially replace ribosomal genes. Orthologous replacement also creates mosaic patterns between donor and recipient genomes, rearranges the genome architecture, and governs gain and loss of accessory genes. We conclude that cross-species gene transfer is dominated by orthologous replacement of core genes which occurs nearly unrestricted between closely related species. At a lower rate, the exchange of accessory genes gives rise to more complex genome dynamics.

Adaptive evolution of hybrid bacteria by horizontal gene transfer.

Horizontal gene transfer (HGT) is an important factor in bacterial evolution that can act across species boundaries. Yet, we know little about rate and genomic targets of cross-lineage gene transfer and about its effects on the recipient organism's physiology and fitness. Here, we address these questions in a parallel evolution experiment with two Bacillus subtilis lineages of 7% sequence divergence. We observe rapid evolution of hybrid organisms: gene transfer swaps ∼12% of the core genome in just 200 generations, and 60% of core genes are replaced in at least one population. By genomics, transcriptomics, fitness assays, and statistical modeling, we show that transfer generates adaptive evolution and functional alterations in hybrids. Specifically, our experiments reveal a strong, repeatable fitness increase of evolved populations in the stationary growth phase. By genomic analysis of the transfer statistics across replicate populations, we infer that selection on HGT has a broad genetic basis: 40% of the observed transfers are adaptive. At the level of functional gene networks, we find signatures of negative, positive, and epistatic selection, consistent with hybrid incompatibilities and adaptive evolution of network functions. Our results suggest that gene transfer navigates a complex cross-lineage fitness landscape, bridging epistatic barriers along multiple high-fitness paths.

Predictive value of admission neutrophil/lymphocyte ratio in symptomatic intracranial hemorrhage after stroke thrombolysis.

BACKGROUND: Stroke is one of the most common causes of morbidity and mortality. The need for additional objective parameters as well as the existing criteria continues for eligible patients. The objective of this study is to determine whether the baseline neutrophil/lymphocyte ratio (NLR) predicts symptomatic intracranial hemorrhage (SICH) due to intravenous thrombolytic therapy. MATERIAL AND METHODS: One hundred thirty-three consecutive patients aged 18 years and over who were admitted to the emergency department of a training and research hospital for acute ischemic stroke and underwent intravenous thrombolytic therapy were retrospectively analyzed. For the definition of SICH, European Cooperative Acute Stroke Study III (ECASS III) classification was accepted. RESULTS: When the groups with and without intracranial hemorrhage were compared, there was a significant difference in terms of the initial National Institutes of Health Stroke Scale (NIHSS) score (p < 0.006), glucose level (p < 0.018), and systolic blood pressure (SBP) (p < 0.050). The NLR value of the patients ranged from 0.47 to 13.74. In the group with SICH, NLR was found to be higher but not statistically significant. (p = 0.125). CONCLUSION: For predicting SICH, NLR did not provide strong specificity and sensitivity. A precise cut-off value could not be found to predict the hemorrhagic transformation.

The prospective evaluation of the effectiveness of scoring systems in the emergency department in cases with suspected ureteral stones: STONE? CHOKAI?

INTRODUCTION: This study evaluates the effectiveness of CHOKAI and STONE scores in patients presenting to the emergency department with ureteral stones. METHODS: Patients over the age of 18 who were admitted to the emergency department with flank pain, groin pain, scrotal pain, and hematuria and who were performed non-contrast abdominal computed tomography (CT) for diagnostic imaging were included. The numeric pain, CHOKAI, and STONE scores of the patients were calculated. The effectiveness of these scoring systems in the presence of stones was examined. RESULTS: A total of 105 patients were included in the study. In the analysis performed to investigate whether there was a difference between the numeric pain, STONE, and CHOKAI scores in terms of the presence of stones on CT, it was seen that the CHOKAI score was significantly different from the others (p < 0.001). A significant positive correlation was found between the CHOKAI score and stone size (r = 0.343, p < 0.001).When the cut-off value of the CHOKAI score was >7, the sensitivity was found to be 60.49%, and specificity was 83.33%. The cut-off value for the STONE score was >8 with a sensitivity of 70.37% and specificity of 58.33%. The corresponding area under curve values for the CHOHAI and STONE scores was 0.788 (p < 0.0001) and 0.615 (p = 0.087). Male sex, the CHOKAI, and STONE scores were the independent risk factors for ureteral stone. A significant positive correlation was found between the CHOKAI score and stone size (r = 0.343, p < 0.001). CONCLUSION: The CHOKAI score has a higher performance than the STONE score in detecting the presence of ureteral stones. NEW KNOWLEDGE ADDED BY THIS STUDY: The CHOKAI score has a higher performance than the STONE score in detecting the presence of ureteral stones. Especially in countries such as Turkey, where there are no specific racial differences, the STONE score may be diagnostically insufficient. The CHOKAI score shows the presence of the patient's stone and positively correlates with the size of the stone and the stone location. IMPLICATION FOR CLINICAL PRACTICE OR POLICY: In the functioning of the emergency department, it is important to make the differential diagnosis of patients quickly and provide effective treatment. The use of diagnostic scoring systems saves time for the emergency physician in the differential diagnosis phase and guides in terms of applying for possible additional imaging methods.

Characteristics of the patients undergoing surgical treatment for pneumothorax: A descriptive study.

OBJECTIVE: To identify the characteristic features of pneumothorax patients treated surgically. METHODS: The retrospective study was conducted at Gazi Yasargil Education and Research Hospital Thoracic Surgery Clinic, Diyarbakir, Turkey and comprised records of pneumothorax patients from January 2004 to December 2014. They were divided into two groups as spontaneous and traumatic. Patients who had not undergone any surgical intervention were excluded. Mean age, gender distribution, location of the disease, type of pneumothorax, and treatment method were noted. Among patients with spontaneous pneumothorax, age and months distribution, smoking habits, pneumothorax size, and treatment method were assessed. The effect of gender, location, comorbid disease, smoking, subgroup of disease, and pneumothorax size on surgical procedures were also investigated. RESULTS: The mean age of the 672 patients in the study was 34.5±6.17 years. There were 611(91%) men and 61(9%) women. Disease was on the right side in 360(53.6%) patients, on the left side in 308(45.8%), and bilateral in 4(0.59%). Besides, 523(77.8%) patients had spontaneous, and 149(22.7%) had traumatic pneumothorax. Overall, 561(83.5%) patients had been treated with tube thoracostomy, whereas 111(16.5%) were treated with thoracotomy/thoracoscopic surgery. The presence of comorbid diseases, being primary, and being total or subtotal according to partial were found to create predisposition to thoracotomy/ thoracoscopic surgery (p<0.05 each). CONCLUSIONS: In the case of pneumothorax being total, the presence of comorbid diseases, and the increase in pneumothorax size, thoracotomy or thoracoscopic surgery is preferred.

Distribution of fitness effects of cross-species transformation reveals potential for fast adaptive evolution.

Bacterial transformation, a common mechanism of horizontal gene transfer, can speed up adaptive evolution. How its costs and benefits depend on the growth environment is poorly understood. Here, we characterize the distributions of fitness effects (DFE) of transformation in different conditions and test whether they predict in which condition transformation is beneficial. To determine the DFEs, we generate hybrid libraries between the recipient Bacillus subtilis and different donor species and measure the selection coefficient of each hybrid strain. In complex medium, the donor Bacillus vallismortis confers larger fitness effects than the more closely related donor Bacillus spizizenii. For both donors, the DFEs show strong effect beneficial transfers, indicating potential for fast adaptive evolution. While some transfers of B. vallismortis DNA show pleiotropic effects, various transfers are beneficial only under a single growth condition, indicating that the recipient can benefit from a variety of donor genes to adapt to varying growth conditions. We scrutinize the predictive value of the DFEs by laboratory evolution under different growth conditions and show that the DFEs correctly predict the condition at which transformation confers a benefit. We conclude that transformation has a strong potential for speeding up adaptation to varying environments by profiting from a gene pool shared between closely related species.

A prospective study of wake-up stroke patients presenting to the emergency department: a single-center cohort study.

INTRODUCTION: This study aims to prospectively examine patients with ischemic wake-up stroke (WUS) presenting to the emergency department, to investigate the risk factors affecting the mortality occurring within 28, 90, and 180 days, and to create a new scoring system for the prediction of 28-day mortality. MATERIALS AND METHOD: Patients who presented to the emergency department with WUS findings between 01.07.2019 and 30.06.2020 were prospectively analyzed. Logistic regression analysis was performed to determine the factors affecting mortality and the modified Rankin scale (mRS). RESULTS: A total of 161 patients were included. Of the patients, 22.4% died within 28 days and 40.4% within 180 days. The presence of coronary artery disease (CAD) increased the 28-day mortality risk (p = 0.009) 3.57 times, 90-day mortality risk 2.15 times (p = 0.033), and 180-day mortality risk 2.18 times (p = 0.045). In order to be used in the prediction of 28-day mortality in patients with WUS, we developed the ischemic WUS mortality score (IWUSMOS), which consists of the middle cerebral artery (45 points), internal carotid artery (60 points), basilar artery (39 points), superior cerebellar artery (66 points) occlusion, hypertension (33 points), CAD (28 points), malignancy (100 points), and arrhythmia (23 points). With this scoring system, the 28-day mortality risk was determined as 0.05% when the total score was "43" whereas the mortality risk was found to be 95.0% when the total score was "187." CONCLUSION: We propose that IWUSMOS, a new scoring system, can be used to predict the 28-day mortality risk of patients with WUS.

The effect of the shock index and scoring systems for predicting mortality among geriatric patients with upper gastrointestinal bleeding: a prospective cohort study.

BACKGROUND: Gastrointestinal (GI) bleeding is an important cause of mortality and morbidity among geriatric patients. OBJECTIVE: To investigate whether the shock index and other scoring systems are effective predictors of mortality and prognosis among geriatric patients presenting to the emergency department with complaints of upper GI bleeding. DESIGN AND SETTING: Prospective cohort study in an emergency department in Bursa, Turkey. METHODS: Patients over 65 years admitted to a single-center, tertiary emergency service between May 8, 2019, and April 30, 2020, and diagnosed with upper GI bleeding were analyzed. 30, 180 and 360-day mortality prediction performances of the shock index and the Rockall, Glasgow-Blatchford and AIMS-65 scores were evaluated. RESULTS: A total of 111 patients who met the criteria were included in the study. The shock index (P < 0.001) and AIMS-65 score (P < 0.05) of the patients who died within the 30-day period were found to be significantly different, while the shock index (P < 0.001), Rockall score (P < 0.001) and AIMS-65 score (P < 0.05) of patients who died within the 180-day and 360-day periods were statistically different. In the receiver operating characteristic (ROC) analysis for predicting 360-day mortality, the area under the curve (AUC) value was found to be 0.988 (95% confidence interval, CI, 0.971-1.000; P < 0.001). CONCLUSION: The shock index measured among geriatric patients with upper GI bleeding at admission seems to be a more effective predictor of prognosis than other scoring systems.

Evaluation of Syrian refugees' emergency service admissions in the western region of Turkey.

Immigration increases physical, mental, and social health problems. Emergency departments constitute resources that refugees can easily access and where they frequently present. Physicians from every specialty (chest diseases, thoracic surgery, internal diseases, etc.) may be consulted if needed. We aimed to compare demographic data and clinical characteristics of Syrian refugees and Turkish citizens in our emergency department. This study was an observational cross-sectional study. It included patients who presented to the Adult Emergency Department between April 1 and July 1, 2018. The patients were grouped into Syrian refugee and Turkish citizen groups. Patient age, gender, International Statistical Classification of Disease and Related Health Problems (ICD-10) diagnostic codes, and judicial case status were recorded from physician-patient outpatient clinic data records. Disease diagnoses and judicial cases were statistically compared between the two groups. A total of 30,749 patients presented to the emergency department during the study period. Of these, 999 were Syrian refugees. The mean ages of the Syrian refugees and Turkish citizens were significantly different. There were also differences between the two groups in the top five diagnostic codes (M79-Soft tissue disorders, J39-Other disorders of the upper respiratory tract; R51-Headache; R10-Abdominal and pelvic pain; M54-Dorsalgia). A comparison of the judicial cases also revealed a difference in mean age between the groups. Fewer specific disease diagnoses were identified among Syrian refugees. This may be explained by difficulties related to language barriers between the refugees and healthcare personnel.

Does protocatechuic acid, a natural antioxidant, reduce renal ischemia reperfusion injury in rats?

BACKGROUND: Protocatechuic acid (PCA), which has antioxidant property, is a simple phenolic compound commonly found in many plants, vegetables, and fruits, notably in green tea and almonds. Present study was an investigation of the effects of PCA on rat kidney with ischemia/reperfusion (IR) injury. METHODS: Sprague-Dawley rats were randomly divided into 4 groups: (1) Sham, (2) Renal IR, (3) Renal IR+Vehicle, and (4) Renal IR+PCA. Renal reperfusion injury was induced by clamping renal pedicle for 45 minutes after right nephrectomy was performed, followed by reperfusion for 3 hours. Dose of 80 mg/kg PCA was intraperitoneally administered to 1 group immediately before renal ischemia; 33% polyethylene glycol was used as vehicle. Total antioxidant status (TAS), malondialdehyde (MDA), superoxide dismutase (SOD), tumor necrosis factor alpha (TNF-α), and interleukin-6 levels were measured in blood and kidney tissue samples taken from sacrificed rats. Kidney tissue samples were examined and scored histopathologically. Terminal deoxynucleotidyltransferase-mediated dUTP digoxigenin nick end labeling assay method was used to detect apoptotic cells. RESULTS: It was found that PCA significantly reduced serum MDA, TNF-α, and kidney MDA levels, while it increased serum and kidney TAS and SOD levels. Histopathological scores were significantly higher for the group given PCA. CONCLUSION: PCA reduced oxidative stress and can be used as an effective agent in treatment of renal IR injury.

The effect of the shock index and scoring systems for predicting mortality among geriatric patients with upper gastrointestinal bleeding: a prospective cohort study

ABSTRACT BACKGROUND: Gastrointestinal (GI) bleeding is an important cause of mortality and morbidity among geriatric patients. OBJECTIVE: To investigate whether the shock index and other scoring systems are effective predictors of mortality and prognosis among geriatric patients presenting to the emergency department with complaints of upper GI bleeding. DESIGN AND SETTING: Prospective cohort study in an emergency department in Bursa, Turkey. METHODS: Patients over 65 years admitted to a single-center, tertiary emergency service between May 8, 2019, and April 30, 2020, and diagnosed with upper GI bleeding were analyzed. 30, 180 and 360-day mortality prediction performances of the shock index and the Rockall, Glasgow-Blatchford and AIMS-65 scores were evaluated. RESULTS: A total of 111 patients who met the criteria were included in the study. The shock index (P < 0.001) and AIMS-65 score (P < 0.05) of the patients who died within the 30-day period were found to be significantly different, while the shock index (P < 0.001), Rockall score (P < 0.001) and AIMS-65 score (P < 0.05) of patients who died within the 180-day and 360-day periods were statistically different. In the receiver operating characteristic (ROC) analysis for predicting 360-day mortality, the area under the curve (AUC) value was found to be 0.988 (95% confidence interval, CI, 0.971-1.000; P < 0.001). CONCLUSION: The shock index measured among geriatric patients with upper GI bleeding at admission seems to be a more effective predictor of prognosis than other scoring systems.

The Importance of Magnesium Values in Patients With STEMI Admitted to the Emergency Department.

AIM: The aim of this study is to examine the relationship between initial magnesium (Mg) levels, electrocardiographic no-reflow, and long-term mortality in patients who underwent primary percutaneous coronary intervention (pPCI) due to ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 111 patients with pPCI participated in the study. Magnesium and high-sensitive C-reactive protein (hs-CRP) were measured. The sum of ST-segment elevation was measured immediately before and 60 minutes after the restoration of coronary flow. The difference between the 2 measurements was taken as the amount of ST-segment resolution and defined as sum of ST-segment resolution (∑STR). The ∑STR <50% was determined as electrocardiographic sign of no-reflow phenomenon. After the patients were discharged, they were followed up for major adverse cardiac events for up to 51 months after discharge. RESULTS: Forty patients in the no-reflow group and 71 patients in the normal-flow group were included in the study. Magnesium value ≤1.87 mg/dL initially measured had 77% sensitivity and 59% specificity in predicting no-reflow on receiver operating characteristic curve analysis. In multivariate analyses, Mg (odds ratio [OR]: 0.01, <95% confidence interval [CI]: 0.01-0.12; P = .004), hs-CRP (OR: 1.06, <95% CI: 1.00-1.14; P = .05), left anterior descending artery lesion (OR: 6.66, <95% CI: 1.45-3.05; P = .01), and reperfusion time (OR: 1.01, <95% CI: 1.00-1.01; P = .03) were still independent predictors of electrocardiographic no-reflow, and only Mg (OR: 0.08, <95% CI: 0.01-1.03; P = .05) was still an independent predictor of long-term mortality. CONCLUSION: Serum Mg level is an independent predictor of electrocardiographic no-reflow and long-term mortality in patients with STEMI.

Analysis of Patients with Spontaneous Pneumomediastinum.

OBJECTIVES: Spontaneous pneumomediastinum is characterized by the presence of air in the mediastinum without any reason. The objective of this study is to report our experience in the diagnosis and treatment of this clinical condition. MATERIAL AND METHODS: 21 patients with spontaneous pneumomediastinum who were referred to our clinic between January 2010 and May 2015 were evaluated retrospectively. The presence of radiological pneumomediastinum and the absence a traumatic cause were taken as the basic criterion. RESULTS: The mean age of the patients was 24.78 ± 4.37 years. Thirteen patients were male, eight patients were female. The main complaints of the patients were chest pain, dyspnea, neck pain, sore throat and cough. Thirteen patients were smokers. Seven patients had a prior history of asthma, five patient had chronic bronchitis and one patient had cronic obstructive lung diseases. No precipitating factor was identified in 9 patients. While initial complaints was associated with physical effort in 7 patients, three patients cough and two patients had a history of severe crying. Pneumomediastinum was diagnosed by chest radiography in 8 patients, and with chest CT in 13 patients. All the patients were performed bronchoscopy and radiograph of esophagus. Electrocardiogram was taken for all patients. Arrhythmia was detected in 4 of the patients. Treatment included analgesia, rest and oxygen therapy. Mortalitiy and morbidity were not seen. The mean length of hospital stay was 4.4 ± 2.17 days. CONCLUSION: Spontaneous pneumomediastinum is a benign process. Despite its low incidence, it should be considered in the differential diagnosis of acute chest pain.

Fitness Trade-Offs in Competence Differentiation of Bacillus subtilis.

In the stationary phase, Bacillus subtilis differentiates stochastically and transiently into the state of competence for transformation (K-state). The latter is associated with growth arrest, and it is unclear how the ability to develop competence is stably maintained, despite its cost. To quantify the effect differentiation has on the competitive fitness of B. subtilis, we characterized the competition dynamics between strains with different probabilities of entering the K-state. The relative fitness decreased with increasing differentiation probability both during the stationary phase and during outgrowth. When exposed to antibiotics inhibiting cell wall synthesis, transcription, and translation, cells that differentiated into the K-state showed a selective advantage compared to differentiation-deficient bacteria; this benefit did not require transformation. Although beneficial, the K-state was not induced by sub-MIC concentrations of antibiotics. Increasing the differentiation probability beyond the wt level did not significantly affect the competition dynamics with transient antibiotic exposure. We conclude that the competition dynamics are very sensitive to the fraction of competent cells under benign conditions but less sensitive during antibiotic exposure, supporting the picture of stochastic differentiation as a fitness trade-off.

Diagnostic accuracy of noninvasive end-tidal carbon dioxide measurement in emergency department patients with suspected pulmonary embolism84-90.

BACKGROUND/AIM: Pulmonary embolism (PE) is a frequent health problem representing a diagnostic challenge with high mortality and morbidity rates. The aim of this study was to investigate the value of end-tidal carbon dioxide (ETCO2) and alveolar dead space fraction (ADSF) in the diagnosis of PE. MATERIALS AND METHODS: ETCO2 levels of patients with suspected PE were measured with a noninvasive mainstream sensor. ADSF of patients was calculated and PaCO2 levels were also obtained. ROC curve analysis was used to determine diagnostic values of ETCO2 and ADSF for PE. RESULTS: The study included 159 patients. The mean values for ETCO2 and ADSF were 16.27 (95% CI, 14.52-18.03) and 0.48 (95% CI, 0.43-0.539) in the PE group and 21.57 (95% CI, 20.52-22.639) and 0.35 (95% CI, 0.32-0.38) in the non-PE group. The area under the curve (AUC) and the cut-off point for ETCO2 were found as 0.751 and ≤19, with 83.8% sensitivity and 61.5% specificity. AUC and cut-off point for ADSF were found as 0.738 and >0.443, with 67.57% sensitivity and 73.77% specificity. CONCLUSION: The diagnostic value of calculated ADSF and noninvasive bedside ETCO2 for PE was found to be low.

Traumatic laceration of the portal vein.

Despite its relatively protected position, the liver is the most frequently injured solid intra-abdominal organ. 1 Most liver injuries can be managed conservatively, but about 5% to 10% require urgent laparotomy, usually when the mechanism of injury involves a vehicle accident and hemodynamic instability persists, in spite of 40 mL/kg of blood transfusion. 2 , 3 In particular, grades IV and V liver injuries may pose a challenge to the surgeon trying to control hemorrhage, the leading cause of mortality. 4 Traumatic injuries to the portal vein are rare but devastating. The mortality rate for portal vein injury ranges from 50% to 70%. A recent study of portal triad injuries has highighted the higher mortality rates associated with combination injuries involving multiple portal triad components, especially those that include portal vein injury. 5 This case study describes a unique case of relatively minor trauma in a child resulting in portal triad injury, sudden demise, and surgical repair.

An investigation of the emergency medicine journals published in Turkey.

INTRODUCTION: There are many academic journals in Turkey and the world. Medical journals have a significant place among those publications. The aim of this study is to examine qualitatively and categorize the scientific studies of the two journals in Turkey. It also aims to contribute the related literature in the area. MATERIAL-METHOD: Academic journals of medical emergencies published in Turkey between January 1, 2003 and December 20, 2014 were investigated in detail. All the works in journals were categorized briefly as research articles, case presentations, review articles, and other works. Moreover, research articles were investigated as observational and experimental, and discussed according to the including topics. RESULTS: 943 scientific works in 86 issues were fully investigated. The total number was found to be 472 for research articles (50.1%), 242 for case presentations (25.7%), 108 for review articles (11.5%), and finally it was 12.8% for other works. Research articles included 450 observational (95.3%) and 22 experimental studies (4.7%). The key topics covered in research articles were the management and training of medical emergencies, trauma 96 (20.3%), toxicology 50 (10.6%), and gastrointestinal tract 36 (7.6%). CONCLUSION: Despite its relatively short history, medical emergencies have improved progressively in Turkey. The number of domestic research articles has demonstrated an increase over the years. However, extra efforts are needed in order to improve the quality of articles. The most common contents encountered in research articles were the management and training of medical emergencies, trauma and toxicology.

Diagnostic value of S100B protein in the differential diagnosis of acute vertigo in the emergency department.

OBJECTIVES: Vertigo is a common presenting complaint resulting from central or peripheral etiologies. Because central causes may be life-threatening, ascertaining the nature of the vertigo is crucial in the emergency department (ED). With a broad range of potential etiologies, distinguishing central causes from benign peripheral causes is a diagnostic challenge. Cranial magnetic resonance imaging (MRI) is the recommended neuroimaging method when clinical findings are ambiguous. However, MRI scanning for every patient with an uncertain diagnosis may not be efficient or possible. Therefore, to improve ED resource utilization for patients with vertigo, there is a need to identify the subset most likely to have MRI abnormalities. It has previously been shown that S100B protein provides a useful serum marker of stroke, subarachnoid hemorrhage, and traumatic brain injury. This study evaluated whether S100B levels could predict central causes of vertigo as identified by cranial MRI in the ED. METHODS: This prospective, observational study was conducted with adult patients with acute-onset vertigo (within 6 hours) in the ED of a teaching hospital in Kocaeli, Turkey. Patients with nausea or dizziness complaints without previously known vertigo or cranial pathology, and who agreed to participate in the study, were included. Patients with trauma or with neurologic findings that developed concurrent with their symptoms were excluded. Serum levels of S100B were measured with an electrochemiluminescence immunoassay kit. All subjects underwent cranial MRI. The predictors of positive MRI results were evaluated using logistic regression analysis. Sensitivity and specificity of S100B​ levels for identifying subjects with central causes of vertigo on MRI were calculated with receiver operating characteristic (ROC) curve. RESULTS: Of the 82 subjects included in the study, 48 (58.5%) were female, and the mean (±SD) age was 51 (±16) years. Thirty-one (37.8%) subjects had positive MRI results. Median (with interquartile range [IQR]) serum S100B levels were significantly different between MRI-negative and MRI-positive groups (median = 27.00 pg/mL, IQR = 10.00 to 44.60 vs. median = 60.94 pg/mL, IQR = 38.25 to 77.95, respectively; p = 0.04). In logistic regression analysis, subjective "he or she is spinning" (p = 0.030, odds ratio [OR] = 1.63, 95% confidence interval [CI] = 1.38 to 2.49), systolic blood pressure (sBP; p = 0.045, OR = 1.044, 95% CI = 1.021 to 1.080), and serum S100B level (p = 0.042, OR = 1.22, 95% CI = 1.018 to 1.445) were found to be independent predictors of MRI abnormalities. In the ROC analysis, S100B > 30 pg/mL predicted the clinical outcome with 83.9% sensitivity (95% CI = 66.3% to 94.5%) and 51.0% specificity (95% CI = 36.6% to 65.2%). The area under the ROC curve was 0.774 (95% CI = 0.666 to 0.881). CONCLUSIONS: To the best of our knowledge this is the first study assessing the utility of serum S100B levels for diagnosis of acute-onset vertigo. Serum S100B levels are associated with the presence of central causes of vertigo on cranial MRI. However, serum S100B levels are not sufficiently sensitive to exclude candidates from cranial MRI.

Disparity between mainstream and sidestream end-tidal carbon dioxide values and arterial carbon dioxide levels.

BACKGROUND: Measuring and monitoring end-tidal carbon dioxide (PETCO2) is an important aspect of caring for critically ill patients. The 2 methods used for PETCO2 measurement are the mainstream and sidestream methods. OBJECTIVE: To assess the agreement between PETCO2 measurements performed by mainstream and sidestream methods with the PaCO2 values. METHODS: This was a prospective observational study. A total of 114 subjects were enrolled in the study. PETCO2 measurements using mainstream and sidestream methods were performed simultaneously with the arterial blood sampling in subjects who were observed in the emergency department and required arterial blood gas analysis. Agreement between the PETCO2 measurements and the PaCO2 values obtained from arterial blood gas analysis were evaluated using the Bland-Altman method. RESULTS: Sixty subjects (52.6%) were female, and the mean age was 60.9 years (95% CI 58.3-63.6). The mean PaCO2 was 35.16 mm Hg (95% CI 33.81-36.51), the mainstream PETCO2 was 22.11 (95% CI 21.05-23.18), and the sidestream PETCO2 was 25.48 (95% CI 24.22-26.75). Bland-Altman analysis showed an average difference between mainstream PETCO2 and PaCO2 values of 13 mm Hg (95% limits of agreement -0.6 to 25.5) and moderate correlation (r = 0.55, P < .001). The average difference between the sidestream PETCO2 and PaCO2 values was 9.7 mm Hg (95% limits of agreement -5.4 to 24.7) and poor correlation (r = 0.41, P < .001). CONCLUSIONS: PETCO2 values obtained by mainstream and sidestream methods were found to be significantly lower than the PaCO2 values. There was essentially no agreement between the measurements obtained by 2 different methods and the PaCO2 values.