The utility of capnography in determining the risk of major cardiac adverse events in patients with atypical chest pain.

INTRODUCTION: Various scoring systems have been developed to safely rule out the diagnosis of acute coronary syndrome. Furthermore, the efficacy of these scoring systems in predicting the risk of major adverse cardiac events (MACE) is debated. Our aim was to compare parameters such as Integrated Pulmonary Index (IPI) and End Tidal Carbon Dioxide (etCO2) measured in the emergency department with the HEART score in terms of its success in predicting the risk of major adverse cardiac events. METHOD: Patients with atypical chest pain were registered for the study by the emergency room physician. The patients were investigated regarding gender, age, background characteristics, prognostic accuracy of etCO2, IPI, MACE, and HEART scores. RESULTS: As a result of the analysis, higher HEART Score and lower etCO2 values were determined in the MACE group compared to the group without MACE. ROC analysis was performed to determine the power of IPI, HEART Score, and etCO2 to predict MACE. The findings revealed that IPI significantly predicted MACE with an AUC value of 0.737. CONCLUSION: In our study, although the highest sensitivity values in determining the risk of 30-day MACE belonged to the HEART score, etCO2 and IPI might be other parameters that could be used to determine the risk of 30-day MACE.

The impact of meteorological parameters on the number of applications to the emergency department with acute urticaria: A retrospective study.

The study aimed to investigate the relationship between the patients who applied to the emergency department with acute urticarial and meteorological factors and determine the associated weather conditions. The relationship between acute urticaria patients who applied to the emergency department of a training and research hospital in a city with high altitude and continental climate characteristics in the eastern part of Turkey between January 2019 and December 2019 and meteorological data was evaluated retrospectively. The necessary data for the weather were obtained from the data of the Erzurum Meteorology Directorate, and the patient data were obtained from the hospital information management system and patient files. The meteorological data of the patients at the date of admission and the characteristics of the patients at that date were compared. The study identified 691 patients who applied to the emergency department diagnosed with urticaria in 2019. According to the seasons, it was observed that the patients applied most frequently in the summer months [n = 239; 34.6%]. In the univariable regression model, which was created by taking the values of weather events as a reference on the days when the urticaria presentation was not observed (Group I), it was determined that every 1-hour increase in the sunshine hour increased the probability of urticaria by 7.4% (p = 0.018). When the meteorological parameters on the days without urticaria (Group I) and the days with urticaria presentation (Group II) were compared, the sunshine hours were 7.9 (4.0-10.6) hours in Group II and 6.65 (3.3-8.85) hours in Group I (p = 0.001). Regarding relative humidity, higher humidity rates were observed in Group I compared to Group II (p = 0.009). In terms of mean temperature, daily maximum, and minimum temperature, higher temperature rates were detected in Group II (p<0.001). A relationship was determined between urticaria attacks and relative humidity and daily maximum and minimum temperature in patients who applied to the emergency department with acute urticaria.

Which is the most appropriate anterior glenohumeral dislocation reduction technique among three different techniques? A prospective, randomized clinical trial.

OBJECTIVES: This study aims to compare three glenohumeral dislocation (GHD) reduction techniques in terms of pain and reduction time and to offer clinicians an idea of the selection of the most appropriate technique. PATIENTS AND METHODS: This multi-center, prospective, randomized clinical study included a total of 90 patients (55 males, 35 females; median age: 29 years; range, 22 to 41 years) who had isolated anterior GHD without complication between December 2019 and December 2021. The patients were divided into three equal groups (traction-countertraction [TCT], external rotation [ExR], and Cunningham) using the block randomization method, and reductions were performed. Pre-reduction, intra-reduction, and post-reduction Visual Analog Scale (VAS) scores, reduction times, success rates, and complication rates were analyzed. RESULTS: There was no statistically significant difference among the groups in terms of age (p=0.414), sex (p=0.954), pre-reduction VAS (p=0.175), and post-reduction VAS (p=0.204). The median intra-reduction VAS values in the TCT, the external rotation, and the Cunningham groups were 8 (range, 7 to 9), 5 (range, 4 to 7), and 4 (range, 2.75 to 5), respectively (p<0.001). The median reduction time and IQR were 105 (range, 82.5 to 120) sec for TCT, 270 (range, 232.5 to 300) sec for ExR, and 630 (range, 540 to 780) sec for Cunningham (p=0.001). CONCLUSION: The fastest, but most painful technique is TCT, while the longest and the least painful technique is Cunningham. An inverse relationship is found between time and pain. Based on these findings, it seems to be reasonable to leave the choice of the ideal reduction technique to the clinician. The clinician should choose the technique to be used according to the conditions in the emergency department.

A Comparative Study of the Registry System effect on Patients Satisfaction Rate in Two Emergency Department Settings.

OBJECTIVE: To assess the patient's satisfaction rate during two distinct registry procedures in the emergency department. METHODS: A cross-sectional study was conducted in educational hospitals with a high volume of patient's admission in Tabriz-Iran and Erzurum-Turkey. In this study, we used a Press Ganey questionnaire as a data collection tool that was filled out with patients or their companions before discharging or referred to other areas (wards). Finally, data were analyzed by using SPSS software version 16. RESULTS: The included patients were from three-admission time courses includes morning, evening, and night shifts. The present study results indicated that the total satisfaction score was two scores higher than the classic one (p<0.001) in the model registry system. Furthermore, the findings of the current study interestingly showed a correlation between satisfaction rate and education level as well as patient's location. Thus, patients with moderate education levels had a higher satisfaction rate in urban regions when compared with rural regions and higher/lower education levels (p=0.03). CONCLUSION: Patients' satisfaction rate with multiple variables can be improved by designing an appropriate registry procedure.

Serum vitamin D, vitamin D binding protein levels and leukocyte vitamin D receptor gene expression in patients with ischaemic stroke.

OBJECTIVE: To investigate the possible contributions of serum 25 hydroxyvitamin D and vitamin D binding protein levels along with leukocyte vitamin D receptor gene expression in patients with ischaemic stroke. METHODS: The randomised controlled single-blind study was conducted at the Mayo Hospital, Lahore, Pakistan, from September 2015 to September 2017, and comprised patients aged 40-75 years with Arbeitsgemeinschaft für Osteosynthesefragen type A2 and A3 per trochanteric fracture. The patients randomised into two equal groups. In Group A, patients were treated by closed reduction and internal fixation with dynamic hip screw, while those in Group B were treated by closed reduction and internal fixation by proximal femoral nail. Follow-up was done at 2nd, 6th and 12th weeks, and at 6th, 9th and 12th month post-operatively. Variables evaluated were frequency of union, surgical time, approximate amount of blood loss and complications. The functional assessment was done by using Harris hip score. SPSS 20 was used for data analysis. RESULTS: Of the 90 subjects, 51 (56.6%) were cases with a mean age of 65.2±14.3 years, and 39 (43.3%) were controls with a mean age of 61.1±16.7 years. There was no difference between the groups with respect to vitamin D deficiency, serum vitamin D binding protein levels and leukocyte vitamin D receptor gene expressions (p>0.05). A negative correlation was found between 25-hydroxyvitamin D levels and the severity of ischaemic stroke (p=0.0342). CONCLUSION: There was a correlation between serum 25-hydroxyvitamin D levels and severity of ischaemic stroke as assessed by the National Institutes of Health Stroke Scale.