The role of adropin, HIF-1α and apelin biomarkers in the diagnosis of acute mesentaric ischemia.

OBJECTIVE: The absence of a specific biomarker for acute mesenteric ischemia diagnosis results in a delay in diagnosis and treatment, as well as a high mortality rate. The current research examined whether the proteins adropin, HIF-1α, and apelin may be used to help in the early detection of acute mesenteric ischemia. MATERIALS AND METHODS: A total of 20 patients with acute mesenteric ischemia, 20 patients with abdominal pain, and 20 healthy controls were included in the study. The levels of adropin, HIF-1, and apelin in the serum were determined using the ELISA method. RESULTS: Adropin concentrations were significantly higher in the acute mesenteric ischemia group than in the abdominal pain and healthy control groups (p < 0.05). HIF-1α levels were considerably greater in patients with acute mesenteric ischemia compared to both the abdominal pain group and the healthy control group (p < 0.05). There was no difference in apelin levels between the acute mesenteric ischemia and abdominal pain groups (p > 0.05). HIF-1α was found to be moderate (AUC: 0.705) and adropin was found to be a weak biomarker (AUC: 0.692) in the ROC analysis for acute mesenteric ischemia. CONCLUSION: In this study of 20 patients with acute mesenteric ischemia, we found adropin and HIF-1α levels to be increased compared to patients with abdominal pain who did not have acute mesenteric ischemia.

Turkish Validity and Reliability Study of Jessa Atrial Fibrillation Knowledge Questionnaire (JAKQ).

OBJECTIVE: Atrial fibrillation (AF) is the most commonly encountered arhythmia in clinical practice and constitutes one-third of the hospitalizations related to cardiac dysrhythmia. Furthermore, it is the most common reason for hospital admissions involving dysrhythmia complaints and is associated with the decrease in quality of life, functional capacity, cardiac performance, and lifespan. MATERIALS AND METHODS: This methodological study, which aims to assess the validity and reliability of the JAKQ, was conducted with patients (n = 175) who were admitted to the emergency clinic of Atatürk University Research Hospital between December 2016 and June 2018 and who were diagnosed with atrial fibrillation and met the inclusion criteria. The data were collected using a "Personal Information Form" and the "Jessa Atrial Fibrillation Knowledge Questionnaire (JAKQ). RESULTS: The exploratory factor analysis carried out to determine the construct validity of the scale showed that it had a three-dimensional structure and that its factor loads were within the appropriate range. The internal consistency analyses of the scale revealed that the Cronbach's alpha coefficient was 0.84 and that the item-total score correlations were at an adequate level. The correlation value of the test-retest conducted to test the time invariance of the scale was found to be 0.87, and there was a statistically significant relationship between the two applications (P < .001). CONCLUSION: The study results showed that the structure of the Turkish version of the Jessa Atrial Fibrillation Questionnaire was similar to the structure of the original scale, that its validity and reliability were considerably high and that it could be used in Turkey.

Sensitivity and Specificity of the Platelet-Lymphocyte Ratio and the Neutrophil-Lymphocyte Ratio in Diagnosing Acute Mesenteric Ischemia in Patients Operated on for the Diagnosis of Mesenteric Ischemia: A Retrospective Case-Control Study.

Aim: The present study aims to determine whether various hematological parameters and ratios of patients could be used to diagnose AMI. Materials and Methods: The subjects of the study are the patients who were hospitalized with an acute mesenteric ischemia (AMI) pre-diagnosis and underwent surgery as a consequence. The patients who were determined to have the diagnosis of AMI intraoperatively are categorized in the AMI Group. The patients whose operations do not reveal AMI (negative exploration) are categorized in the Control Group. These two groups are compared in terms of hematological parameters and rates. Results: In the study, the PLR (p = 0.017), NLR (p = 0.33), PDW (0.023), RDW (p = 0.025) values are significantly higher in the AMI group compared to the control group while the LYMP (p = 0.023) count is significantly lower. Conclusions: For the patients admitted to the emergency clinics with suspected AMI, the increased PLR, NLR, PDW, and RDW values together with the reduced lymphocyte count can be used to support the diagnosis.

Prognostic value of blood gas parameters and end-tidal carbon dioxide values in out-of-hospital cardiopulmonary arrest patients

Background/aim: This study aimed to evaluate the usefulness of blood gas and end-tidal carbon dioxide (EtCO2) measurements for predicting return of spontaneous circulation (ROSC) and for evaluating post-ROSC neurological survival. Materials and methods: This was a prospective case control study utilizing Atatürk University's database of adult nontraumatic patients (over 18 years old) with out-of-hospital cardiac arrest (OHCA) over the course of a year. The neurological status of the patients was evaluated after 1 h at ROSC and at hospital discharge, as defined by the cerebral performance category score. The blood gas parameters pH, PO2, PCO2, lactate, and BE were compared with EtCO2 from capnography and arteriol/alveolar carbon dioxide difference (AaDCO2) by using both blood gas and capnography upon admission to the emergency department and at ROSC. Results: A total of 155 patients were included in the study to form the control group with ROSC. The PO2, PCO2, and AaDCO2 values showed a prognostic marker for the supply of ROSC (P < 0.05). The EtCO2,lactate, and BE values measured by the blood gas were found to be insignificant in the prediction of ROSC (P > 0.05). Conversely, AaDCO2 was found to be significant in ROSC estimation (P < 0.05), but not in neurological evaluation (P > 0.05). Conclusion: Blood gas parameters and EtCO2 are sufficient in predicting ROSC. The value of AaDCO2 calculated using EtCO2 and PO2may be used in predicting the prognosis of OHCA patients, but this value does not provide any conclusions concerning neurological survival.

Relief of refractory renal colic in emergency department: A novel indication for ultrasound guided erector spinae plane block.

Plane blocks have become very popular in recent years with the introduction of ultrasonography into the regional anesthesia and algology practice. Erector spinae plane (ESP) block involves injection of local anesthetics between erector spinae muscles and transverse process of vertebrae and can block the dorsal and ventral rami of thoracolumbar spinal nerves. The primary factor in the great popularity of this block is easy sonographic identification of landmarks and lower complication rate compared to paravertebral or central neuroaxial blocks. These characteristics mean that it will in all probability be widely used in the future, not just for anesthetists, but also for emergency physicians. Here we first report a novel indication for ESP block in emergency department; renal colic.

High-thoracic ultrasound-guided erector spinae plane block for acute herpes zoster pain management in emergency department.

Herpes zoster is a painful, eruptive, viral condition occurring with reactivation in immunosuppressed individuals. The selection of an effective analgesic method in the acute phase of herpes zoster can decrease the incidence of postherpetic neuralgia by reducing neural sensitization. The erector spinae plane block has been reported to provide diffuse and effective analgesia in the cervical, thoracic, and lumbar regions. We report an effective decrease in pain with the application of the high-thoracic erector spinae plane block in the emergency department in a patient with herpes zoster pain in the cervicothoracic and shoulder region.

Evacuation of Hospitals during Disaster, Establishment of a Field Hospital, and Communication.

The buildings, working personnel, and patients and their relatives may directly or indirectly be affected by the disasters. Here we will discuss evacuation, establishing a field hospital, communication, the role of the media in disasters, and defending against sabotage. The affected individuals should be evacuated and transferred to secure zones safely and rapidly. How the decision for evacuation should be made and how the evacuation triage should be performed are important issues. Field hospitals should be established within the bounds of possibility for continuation of the treatments of evacuated people. The standards for the field hospitals and its sections that may be created according to the needs will be explained. Undoubtedly, since one of the most important subjects in disasters is communication, the types of communication in disasters and their significance will be mentioned. How the relationships with the media should be an aspect of communication and how they can be beneficially used will also be mentioned. As in all organizations and institutions, sabotage attempts may also be present concerning health facilities. For this reason, during the preparation of the hospital disaster plan, defending against sabotage will be discussed, and what should be done at that stage will be mentioned.

Transient Ischemic Attack Versus Seizure: Use of Complete Blood Count Parameters for Differential Diagnosis.

INTRODUCTION: Seizures are an important group of diagnoses in the differential evaluation of Transient Ischemic Attack (TIA)because of their variable and temporary signs and symptoms. Physicians must frequently rule out TIA in asymptomatic patients with normal diagnostic neuroimaging. AIM: The current study aimed to investigate the efficacy of Complete Blood Count (CBC) components in the differential diagnosis of TIA and seizures. MATERIALS AND METHODS: Our study was a retrospective case-control study. Patients admitted to the Emergency Department (ED) and hospitalized with an initial diagnosis of TIA or seizure at the neurology clinic of Erzurum Ataturk University Training Hospital between January 1, 2012, and December 31, 2014, were recruited for the study. Patients with inaccessible or missing data were excluded. RESULTS: We identified 1,459 ED admissions that resulted in neurology clinic hospitalizations of patients with initial diagnoses of TIA (n=911) and seizure (n=420) over a 24-month time period. A total of 128 patients were excluded from the study. CONCLUSION: We conclude that CBC may have a diagnostic value on TIA and seizure differentiation, but this is limited because of statistical and clinical incompatibility. Elevated White Blood Cells (WBC) values of seizure patients compared with TIA patients' may help clinicians at the preliminary phase of diagnostic studies. We conclude that age is a remarkable and valuable demographic parameter in addition to physical examination, laboratory and imaging studies.

Laparascopic Splenectomy Due to Splenic Injury after Colonoscopy.

Colonoscopy, which is routinely performed in diagnosis and treatment of colorectal disorders, is a reliable procedure. Its most frequent complications are bleeding and perforation. Splenic rupture is a very rarely met complication of colonoscopy, and delay in its diagnosis leads to increased morbidity and mortality. We presented a 69 years old female patient, who was diagnosed by computerized abdominal tomography, performed for her abdominal pain, which started following the colonoscopy. After 15 days of medical treatment and follow-up, laparoscopic splenectomy was performed one month after her colonoscopy. The patient was discharged on her 4(th) postoperative day, with uneventful recovery. In patients who have complaint of abdominal pain following colonoscopy, an intraabdominal pathological condition should be considered and computerized abdominal tomography should be performed. If there is no detected intraperitoneal bleeding, in other words, if there is a sub-capsular hematoma of the spleen, medical management by monitoring the vital signs may be preferred. Then, splenectomy should be performed at an appropriate time.

Characteristics of Patients Who Admitted to the Emergency Department Because of Burns Due to Dens Liquids Such as Hot Milk/Oil.

OBJECTIVE: Burn is the tissue damage on body caused due to various reasons. Although all burns caused by hot liquids are investigated as scalding burns, dense liquid burns (DLB) caused by such as milk and oil are different from other burns. The aim of this study was to report the properties of DLB. MATERIALS AND METHODS: Patients admitted to the Emergency Service of Atatürk University Hospital, with DLB from June 2003 to December 2008, were examined retrospectively. RESULTS: During the study, 28 DLB patients were admitted to the emergency service. The most common admission were found in autumn 28.6% (n=8), and in May and June, 17.9% (n=5). The frequency of burns on the right upper extremity was seen in 50% (n=14) of the patients. The burn degree of all patients was determined as 2(nd) degree. Seventy-five percent (n=21) of the patients were discharged, 14.3% (n=4) were hospitalized. None of the patients died. CONCLUSION: Dense liquid burns is a burn type that is commonly seen in women, absolutely causing 2(nd) degree burns, frequently reported in upper extremity and head/neck regions, and in contrast to other studies, in our region it is completely seen in patients living in city centre.

The Evaluation of Serum Copeptin Levels and Some Commonly Seen Thrombophilic Mutation Prevalence in Acute Pulmonary Embolism.

Acute pulmonary embolism (PE) is a common, emergent condition and may affect a large number of patients. Copeptin has been indicated to be a sensitive biomarker of arginine vasopressin release, and has diagnostic and prognostic value in various clinical conditions. Genetic mutations are considerable components of thrombophilic diseases, and factor II gene G20210A, (FII20210A), factor V Leiden (FVL, G1691A) and methylenetetrahydrofolate reductase gene C677T (MTHFR677T) single nucleotide polymorphisms are the most common mutations of thrombophilic diseases. In this study, serum copeptin levels were determined in patients with PE and healthy controls, and the results were discussed. The prevalence of some commonly seen thrombophilic mutations was also evaluated in patients with PE. The study included 32 patients (18 male, 14 female) with PE and 24 (13 male, 11 female) age- and gender-matched healthy controls. A significant difference in serum copeptin levels was determined between the patient and control groups (8.58 ± 4.42 and 4.07 ± 1.02 pmol/L, respectively). Heterozygous mutant genotype for FII20210A and heterozygous mutant genotype for FVL were observed in 3.1 and 9.4% of patients, respectively. Mutant genotype of 49% was determined for MTHFR677T mutations. It was concluded that copeptin may have diagnostic value for PE.

Demographic and clinical differences of aggressive and non-aggressive suicide attempts in the emergency department in the eastern region of Turkey.

BACKGROUND: Worldwide, suicide ranks among the three leading causes of death among those aged 15-44 years. An estimated 800000 people die by committing suicide annually. OBJECTIVES: To better understand the association between aggressive suicidal attempt and non-aggressive suicidal attempt in patients with suicide attempt in the emergency department. PATIENTS AND METHODS: A cross-sectional observational study was conducted on suicide attempters of eastern region of Turkey between May 2008 and January 2012. Information of all adult suicide attempts was collected prospectively on a form. Suicide attempts were grouped as aggressive and non-aggressive attempts on a specially designed data-collection form. The aggressive suicide attempts contained violent suicide methods such as firearm, hanging, jumping, car exhaust or drowning. RESULTS: A total of 533 patients were included. Sixty-four of these patients admitted to ED with aggressive suicide attempt (12%). Non-aggressive suicide attempts were consulted to psychiatry more compared to aggressive ones (%73.6, n = 345 vs. %32.8, n = 21, P < 0.0001). Agitation in ED and being male increased aggressive suicide attempt risk by 3.5 (%95 CI: 1.6-7.6) and 3.2 times (%95 CI: 1.8-5.5), agitated patients in ED group and male group respectively. Patients with aggressive suicide attempt were statistically more frequent among these patients; patients with agitation, those hospitalized in intensive care or surgical services and those whose length of stay in the emergency department was less than one day (P < 0.05 for all). Patients with non-aggressive suicide attempt were statistically more frequent in these patients; patients complained of nausea, vomiting, stomach pain, fatigue, those with confusion, those tending to sleep, those hospitalized in internal services or emergency ward and finally those whose length of stay in the emergency department was more than one day (P < 0.05 for all). CONCLUSIONS: Patients with aggressive suicide attempt who have high risk of dying should be recognized and requested psychiatric consultation even if not in the emergency department.

Sensitivity and specificity of red cell distribution width in diagnosing acute mesenteric ischemia in patients with abdominal pain.

BACKGROUND: We investigated the utility of the red cell distribution width (RDW) in diagnosing acute mesenteric ischemia (AMI) in patients with abdominal pain. METHODS: The patients were divided into two groups in this retrospective case-control study: patients with AMI and patients with abdominal pain who did not require urgent surgery. Venous blood was collected from the patients upon admission to the emergency department, and abdominal computed tomography angiography was performed. The RDW and hematological and biochemical parameters of the groups were compared. The primary outcome was AMI among the patients with abdominal pain. The secondary outcome was mortality, complaint period, and size of ischemia/necrosis among the AMI patients. RESULTS: The RDW, white blood cell lactate dehydrogenase, and blood urea nitrogen of the patients with AMI were significantly different from those of the control group. When the average RDW (15.04 %) of the patients with AMI was used as a cut-off value, the sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood (-LR) were 40.8 %, 81.2 %, 2.17, and 0.73, respectively. When patients with AMI and anemia were included in the group, the sensitivity and specificity values did not change. There was no relation between the RDW and mortality, size of the ischemia/necrosis, and complaint period. Furthermore, there was no significant difference in the average RDW between the patients with ischemia/necrosis in the small intestine only and those with ischemia/necrosis in the colon. CONCLUSION: The RDW on admission is of marginal help to diagnose AMI among patients with abdominal pain.

Non-operative management (NOM) of blunt hepatic trauma: 80 cases.

BACKGROUND: Liver is the most frequently injured organ upon abdominal trauma. We present a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and/or surgical intervention. METHODS: A total of 80 patients with blunt liver injury who were hospitalized to the general surgery clinic or other clinics due to the concomitant injuries were followed non-operatively. The normally distributed numeric variables were evaluated by Student's t-test or one way analysis of variance, while non-normally distributed variables were analyzed by Mann-Whitney U-test or Kruskal-Wallis variance analysis. Chi-square test was also employed for the comparison of categorical variables. Statistical significance was assumed for p<0.05. RESULTS: There was no significant relationship between patients' Hgb level and liver injury grade, outcome, and mechanism of injury. Also, there was no statistical relationship between liver injury grade, outcome, and mechanism of injury and ALT levels as well as AST level. There was no mortality in any of the patients. CONCLUSION: During the last quarter of century, changes in the diagnosis and treatment of liver injury were associated with increased survival. NOM of liver injury in patients with stable hemodynamics and hepatic trauma seems to be the gold standard.

Obturator hernia, a rare cause of small bowel obstruction: case report.

Obturator hernia is a rare hernia in the world, diagnosed late since it has no specific symptoms and findings and generally occur in thin and old women with comorbidity.For this reason obturator hernia has high morbidity and mortality rates. In this study, we present an obturator hernia case that Howship-Romberg sign is positive and has typical appearance in computerized tomography. Laparotomy was performed on 89 years old female patient with body mass index 18.08 kg/m(2) by low middle line incision. Following the segmentectomy to the strangulated small bowel loop, obturator canal is repaired by retroperitoneal application. No complication occurred in the postoperative period. Obturator hernia should be taken into consideration in old and thin female patients with intestinal obstruction. Computerized tomography should be performed for early diagnosis of the obturator hernia.