Estimation of Cardiac Systolic Function Based on Mitral Valve Movements: An Accurate Bedside Tool for Emergency Physicians in Dyspneic Patients.

OBJECTIVES: The purpose of this study was to determine the success of mitral valve movements in the estimation of left ventricular ejection fraction (LVEF). METHODS: Adult patients whose principal symptom was dyspnea were included in this prospective observational study. The distance from the anterior mitral valve (AMV) to the interventricular septum (IVS) during early diastole was measured first in B-mode in the parasternal long axis (PLAX) named parasternal long axis-anterior leaflet septal separation. Second, the AMV-IVS distance was measured in M-mode in the PLAX named E-point septal separation. Third, AMV-IVS distance was measured in B-mode in the apical 4-chamber view named apical 4-chamber view-anterior leaflet septal separation. Finally, maximum distance between the 2 mitral leaflets in the apical 4-chamber view was measured and named mitral valve leaflet separation. Comprehensive echocardiography was performed by an experienced cardiologist. Correlation was calculated between mitral valve measurements and LVEF. Cutoff values were determined using receiver operating characteristic curves and the chi-square test. RESULTS: A total of 118 patients were included in the study. Parasternal long axis-anterior leaflet septal separation, E-point septal separation, and apical 4-chamber view-anterior leaflet septal separation were highly correlated with LVEF (correlation coefficient, -0.848, -0.833, and-0.822 [P < .001]). Parasternal long axis-anterior leaflet septal separation values less than 2.30 mm, E-point septal separation values less than 2 mm, and mitral valve leaflet separation values greater than 25.15 mm exhibited a 100% negative predictive value in excluding reduced LVEF. Parasternal long axis-anterior leaflet septal separation values less than 4.95 mm, EPSS values less than 5.85 mm, apical 4-chamber view-anterior leaflet septal separation values less than 6.95 mm, and mitral valve leaflet separation values greater than 24.05 mm exhibited a 100% negative predictive value in excluding severe reduced LVEF. CONCLUSIONS: Mitral valve measurement methods may be useful in predicting LVEF or values thereof as a complementary method of diagnosing challenging patients on echocardiographic images.

School Board Policies on Prevention and Management of Anaphylaxis in Istanbul: Where Do We Stand?

BACKGROUND: Allergic diseases with a potential for anaphylaxis pose a critical public health issue in schools. AIMS: This study was carried out to identify the current status of prevention and management of anaphylaxis in school children with the main goal of establishing such an action plan. STUDY DESIGN: Cross-sectional study. METHODS: Schools were randomly selected from 11 different regions of Istanbul. A questionnaire was filled out by 2596 teachers/school principals from 232 public schools. RESULTS: A school safety committee was absent in 80% of elementary schools (ES) and 60.8% of preschools (PS). Although some form of health recording system was available in many schools, no such system was available in 24.5% of ESs and 10% of PSs. A specific inquiry for detecting children with food allergies was a routine practice in only 4% of ES and 10% of PS. Approximately 27% of teachers stated that monitoring children in school places was not possible at all times. Eighty four percent stated that no written anaphylaxis treatment protocol was available in their school and only around 2.3% in ES and 3.1% in PS stated that they would perform an epinephrine injection in the event of anaphylaxis. CONCLUSION: Our survey demonstrated critical gaps in the organization of schools for the management of children at risk of anaphylaxis. Data derived from this study would provide the initiative for legislators to review the current situation of school health policies along with the relevant authorities to establish school anaphylaxis guidelines.

[Postoperative analgesic effect of acupuncture in laparoscopic cholecystectomy surgery]. / Laparoskopik kolesistektomi operasyonlarinda akupunktur uygulamasinin ameliyat sonrasi analjeziye etkisi.

OBJECTIVES: In surgery clinics, postoperative pain is a common occurrence and care is needed in its treatment. One form of treatment is various acupuncture techniques. This study investigated the effect of acupuncture on postoperative analgesia in patients undergoing laparoscopic cholecystectomy. METHODS: A total of 59 patients undergoing laparoscopic cholecystectomy were included in the study; 31 comprised the acupuncture group (Group A), and 29 constituted the control group (group C). All patients underwent standard anesthesia procedures. Patient-controlled analgesia with tramadol was administered postoperatively. Patients' postoperative pain scores, results of the satisfaction questionnaire and amounts of tramadol used were recorded. Postoperative 0, 1st, 2nd, 6th, 12th and 18th hour controls were performed. RESULTS: A comparison of the groups showed Group A pain scores to be significantly lower statistically than those of Group C at all postoperative controls. There was no statistically significant difference for postoperative analgesic consumption and satisfaction level between the groups. CONCLUSION: Despite detection of a reduction in postoperative pain scores, the application of acupuncture did not cause any change in the consumption of tramadol.

The role of inferior vena cava diameter in volume status monitoring; the best sonographic measurement method?

OBJECTIVES: This study aims to determine the site of and the best sonographic method for measurement of inferior vena cava (IVC) diameter in volume status monitoring. METHODS: This observational before-and-after study was performed at the intensive care unit of the emergency department. It included hypotensive adult patients with suspected sepsis who were recommended to receive at least 20 mg/kg fluid replacement by the emergency physician. The patients were fluid replaced at a rate of 1000 mL/h, and maximum and minimum IVC diameters were measured and the Caval index calculated sonographically via both B-mode and M-mode. Hence, IVC's volume response was assessed by a total of 6 parameters, 3 each in M-mode and B-mode. Freidman test was used to assess the change in IVC diameter with fluid replacement. Wilcoxon test with Bonferroni correction was used to determine which measurement method more sensitively measured IVC diameter change. RESULTS: Twenty-eight patients with a mean age of 71.3 were included in the final analysis.The IVC diameter change was significant with all 6 methods (P < .001). The IVC minimum diameter change measured on M-mode during inspiration (M-mode i) was the only measurement method that significantly showed diameter change with each 500-mL fluid replacements. The initial and the subsequent M-mode i values after each 500 mL of fluid were 5.65 ± 3.34; 8.05 ± 3.66; 10.16 ± 3.61, and 11.21 ± 2.94, respectively (P < .001, P < .002, and P < .003, respectively). CONCLUSION: Inferior vena cava diameter was changed by fluid administration. The M-mode i method that most sensitively measures that change may be the most successful method in volume status monitoring.

Determination of Factors Affecting Mortality of Patients with Sepsis in a Tertiary Intensive Care Unit.

OBJECTIVES: Sepsis is a disease with high mortality that is frequently observed in intensive care units. This study aimed to determine the risk factors affecting mortality of patients with sepsis who were followed up in the intensive care unit (ICU). We aimed to contribute to literature by evaluating the relationship between mortality and pro-brain natriuretic peptide (pro-BNP9), C-reactive protein (CRP), thrombocyte count, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, duration of hospitalization in the intensive care unit, and the presence of multidrug-resistant microorganism. MATERIAL AND METHODS: Patients hospitalized in ICU because of the diagnosis of sepsis and septic shock between December 2010 and June 2012 were included in this retrospective study. RESULTS: A total of 141 patients, including 74 male (52.5%) and 67 female (47.5%) patients, were involved in the study, and the median age was 66.8±17.9 years. Sixty-nine patients (48.9%) were discharged from the ICU; however, 72 patients (51.1%) were exitus. Multidrug-resistant microorganism was detected in 34 patients (24.1%). The patients' median SOFA score was 9.16±3.16, median APACHE-II score was 24.9±7.83, and median duration of hospitalization in the ICU was 8.44±11.61 days. It was found that mortality rate significantly increased in patients with the APACHE-II score of 24.5 and over, SOFA score of 8.5 and over, pro BNP value of 7241 ng/L and over, and CRP value of 96.5 mg/dL and over. Mortality rate was detected to be higher in patients undergoing invasive mechanical ventilation than in patients undergoing non-invasive mechanical ventilation. When thrombocyte count and mortality were associated with each other, it was found that the median value was 86000 mg/dL in exitus patients, whereas it was 185000 mg/dL in patients discharged from the ICU. CONCLUSION: It was revealed that increased APACHE-II score, increased SOFA score, increased pro BNP score, increased CRP, the presence of multidrug-resistant microorganism, and decreased thrombocyte count elevated the rate of mortality. However, no relationship was observed between the duration of hospitalization in the ICU and mortality.