Effects of age and comorbidities on prognosis and mortality in geriatric patient groups in intensive Care.

Backround: Treatment of geriatric intensive care patients is tiring and difficult for intensive care physicians due to comorbidities, accompanying acute illnesses and vulnerabilities. Aim: The aim of our study was to determine other factors affecting mortality and morbidity with age in geriatric intensive care patients. Patients and Methods: A total of 937 geriatric intensive care patients were divided into three groups as young-old (65-74 years), middle-old (75-84 years), and oldest-old (85 years and more). Demographic characteristics such as age, gender, and comorbid diseases (oncological malignancy, chronic renal failure, sepsis, chronic anemia, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, pulmonary embolism) were recorded. The number of patients who needed a mechanical ventilator, developed decubit ulcers, underwent percutaneous tracheostomy, and renal replacement therapy were recorded. In addition, the number of central venous catheter insertions for patients, Acute Physiology and Chronic Health Evaluation II scores (APACHE II), hospitalization days, and mortality rates were recorded and compared. Results: In the comparison between the groups in terms of gender, in the 65-74 years' age group, male gender was higher, while in the age group of 85 years and more, the female gender was found to be statistically higher. Among comorbid diseases, the rate of oncological malignancy was found to be statistically significantly lower in patients aged 85 years and more. Comparing the APACHE II scores of the patients as per the groups, scores were found to be statistically significantly higher in the oldest-old group. APACHE II Score, central venous catheter application, chronic obstructive pulmonary disease, chronic renal failure, sepsis, oncological malignancy, and renal replacement therapy were shown to be statistically significant as factors affecting death. The factors affecting the survival or hospitalization time of the patients of decubit ulcer, mechanical ventilator, percutaneous tracheostomy, chronic obstructive pulmonary disease, Sepsis, APACHE II Score, and age were shown to be statistically significant. Conclusion: Our study showed that not only age has an effect on mortality and morbidity in geriatric intensive care patients but also comorbidities and intensive care treatments of the patients are also effective in this process.

The effect of metal rate on the gamma shielding parameters of hydroxyapatite at medical treatment energies.

The hydroxyapatite (HAp) is a kind of biomaterial which is used for bone treatment applications. We have scrutinized the gamma attenuation parameters such as such as the effective atomic number (Zeff), electron density (Nel), mass attenuation coefficient (MAC), linear attenuation coefficient (LAC), half value layer (HVL), tenth value layer (TVL) and mean free path (MFP) for only single liquid gamma source and a narrow beam geometry for the energy (medical treatment energy) ranging from 778 keV to 1408 keV (Eu-152) for the animal bone, iron, cobalt, copper, and zinc decorated Nano hydroxyapatite (nFeHAp, nCoHAp, nCuHAp, and nZnHAp) artificial bone powders. The gamma-rays were counted with using Ultra Low Energy Germanium detection system with a resolution 150 eV at 5,95 keV and a high purity germanium detector with a resolution of 1.85 keV at 1.33 MeV experimentally. The gamma ray attenuation parameters are calculated for the metal doped hydroxyapatite and compare with the animal bone. The results were compared with the output XCOM NIST data. While the mass absorption coefficient values for animal bone range from 0.08 to 0.05 at current energy levels, the values for metal-added artificial bone powders range from 0.07 to 0.05. While the linear absorption coefficient values for existing energy values for animal bone range from 0.04 to 0.02, they range from 0.03 to 0.02 for metal-added artificial bone powders. Mean free path values for real bone range from 24 to 36 at current energies, while half value layer values range from 16 to 25 and tenth value layer values range from 56 to 83. For metal-doped artificial bone powders, these parameters range from 26 to 35, 18 to 24, and 61 to 80, respectively. The results points that, the data of the gamma ray attenuation parameters are very close to the value of the animal bone due to the removal of calcium atoms from the structure when metal is added.

The value of bedside ocular ultrasound assessment of optic nerve sheath diameter in the detection of increased intracranial pressure in patients presenting to the emergency room with headache.

INTRODUCTION: Headache is one of the most important complaints in emergency room (ER) admissions, and the rate of the increase in intracranial pressure in these cases should not be overlooked. This study was performed to investigate the value of the measurement of optic nerve sheath diameter (ONSD) by ocular ultrasound in ER patients with the complaint of headache and increase in intracranial pressure regarding this. MATERIALS AND METHODS: : A total of 100 patients who applied to the ER with the complaint of headache were included in this prospective study. Fifty patients with increased ONSD (≥5 mm) and 50 patients with normal ONSD (<5 mm) were obtained. ONSD measurements were performed with 7.5-10 MHz linear probe and closed-eye technique. In addition to this, all patients underwent cranial computerized tomography (CT) examinations, and CT results were compared with the results of the ocular ultrasound. RESULTS: The median right and left ONSD values were detected to be 4.3 mm (3.6-5.5 mm) and 4.4 mm (3.6-5.6 mm) in patients whose cranial CT results were within normal limits. However, the median right and left ONSD values were detected to be 5.5 mm (5.1-6.3 mm) and 5.5 mm (5.1-6.4 mm) in patients whose cranial CT examination results were abnormal. In all cases with abnormal CT findings, the right and the left ONSD measurements were significantly higher (P < 0.001). Furthermore, ONSD value in the ipsilateral side with the lesion was significantly higher than the contralateral side (P < 0.001). CONCLUSION: Bedside ocular ultrasound is a noninvasive and easily applicable method in ER for the detection and evaluation of intracranial hypertension with headache.

The comparison of modified early warning score and Glasgow coma scale-age-systolic blood pressure scores in the assessment of nontraumatic critical patients in Emergency Department.

INTRODUCTION: The purpose of this study is to assess and compare the discriminatory ability of the Glasgow coma scale (GCS)-age-systolic blood pressure (GAP) score and modified early warning scoring system (mEWS) score for 4-week mortality, for the patients being in the triage category 1 and 2 who refer to Emergency Department (ED). METHODS: Five hundred and two nontraumatic cases being in the triage category 1 and 2 who were ≥18-year-old and who referred to ED were assessed prospectively. Reason of referral, fashion of referral, age, gender, vital signs, GCS/alert/verbal/painful/unresponsive scores, consultations, diagnoses, and treatments and final outcome (hospitalization, transfer, discharge, treatment rejection, and exitus) were recorded. The mEWS and GAP scores and the mortality ratios of the cases were calculated by observing both in ED and 4-week survivals of the patients. RESULTS: When the mEWS and GAP scores were compared in the prediction of 4-week mortality, no statistically significant difference was found between them (P > 0.05). The power of mortality estimation was found significant for both scoring systems (for both; P< 0.001). CONCLUSION: GAP score with a simple use being a score developed for the estimation of mortality of trauma patients seems to be usable also for the nontraumatic patients with triage category 1-2 in the ED.

K Shell Fluorescence Parameters by Impact of 5.96 keV Photons on Ti and Its Compounds.

K shell fluorescence parameters of pure Ti and some of its compounds have been determined experimentally using an Ultra-LEGe detector with resolution 150 eV at 5.9 keV. The samples were excited 5.96 keV photons emitted from a (55)Fe radioisotope source with 50 mCi activity. The experimental values of the K shell fluorescence parameters have been compared with the experimental and theoretical values available in the literature for pure Ti.

Is there a relationship between the diameter of the inferior vena cava and hemodynamic parameters in critically ill patients?

INTRODUCTION: The early detection of critically ill patients together with the rapid initiation of effective treatment in emergency departments(ED) increase the survival rates. AIM: This study investigated whether a correlation exists between haemodynamic parameters of critically ill patients and the diameter of the inferior vena cava (IVC). MATERIALS AND METHODS: A cross-sectional study was performed included patients aged ≥18 years with an unstable haemodynamic and/or respiratory status who were referred to the ED for non-traumatic issues. IVC diameters were measured by ultrasound (US) and then central venous pressures (CVP) were measured. Anteroposterior (AP) and mediolateral (ML) diameters of the IVC, both in the inspirium (IAP, IML) and expirium (EAP, EML), were measured by US. RESULTS: 102 patients were evaluated with a median age of 59. The relationship between the diameters of IVC and CVP was evaluated and significant correlation was found in IAP, EAP according to CVP values (p<0.001). ROC analyses were performed and significant relationship was found between the EAP diameter with haemoglobin (Hmg), haemotocrit (Hct), and central venous oxygen saturation (ScvO2) and also significant correlation was detected between the IAP diameter and white blood cell (WBC). DISCUSSION: We detected significant correlation between the CVP and the IVC diameter in our study compatible with recent studies besides, significant correlation was found between the diameter of the IVC and CVP values as well as between the EAP diameter and Hmg, Hct, ScvO2 levels. CONCLUSION: Measurement of IVC diameters, especially EAP may be useful at the monitoring of critically ill patients in ED.

Measurement of L(III) Subshell Absorption Jump Parameters of Hafnium.

The L(III) subshell absorption jump ratio and jump factor of hafnium have been measured using two different ways which are X-ray attenuation method and Energy Dispersive X-ray Fluorescence technique. The results obtained both ways have been compared with theoretical values. They are in good agreement with each other.

Cathecol-O-methyl transferase Val158Met genotype is not a risk factor for conversion disorder.

Alterations in catechol-O-methyltransferase (COMT) activity are involved in various types of neurological disorders. We examined a possible association between the COMT Val158Met polymorphism and conversion disorder in a study of 48 patients with conversion disorder and 48 control patients. In the conversion disorder group, 31 patients were Val/Met heterozygotes, 15 patients were Val/Val homozygotes and 2 patients were Met/Met homozygotes. In the control group, 32 patients were Val/Met heterozygotes and 16 patients were Val/Val homozygotes. There was no significant difference between the groups. We conclude that the COMT Val158Met genotype is quite common in Turkey and that it is not a risk factor for conversion disorder in the Turkish population.

Performance of emergency medicine residents in the interpretation of radiographs in patients with trauma.

BACKGROUND: Radiographs are vital diagnostic tools that complement physical examination in trauma patients. A study was undertaken to assess the performance of residents in emergency medicine in the interpretation of trauma radiographs. METHODS: 348 radiographs of 100 trauma patients admitted between 1 March and 1 May 2007 were evaluated prospectively. These consisted of 93 cervical spine (C-spine) radiographs, 98 chest radiographs, 94 radiographs of the pelvis and 63 computed tomographic (CT) scans. All radiological material was evaluated separately by five emergency medicine residents and a radiology resident who had completed the first 3 years of training. The same radiographs were then evaluated by a radiologist whose opinion was considered to be the gold standard. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS: The mean (SE) age of the patients was 29 (2) years (range 2-79). There were no statistically significant differences in terms of pathology detection between the emergency medicine residents and the radiologist. The agreement between the emergency medicine residents and the radiology resident was excellent for radiographs of the pelvis and the lung (kappa (kappa) = 0.928 and 0.863, respectively; p<0.001) and good for C-spine radiographs and CT scans (kappa = 0.789 and 0.773, respectively; p<0.001). CONCLUSIONS: Accurate interpretation of radiographs by emergency medicine residents who perform the initial radiological and therapeutic interventions on trauma patients is of vital importance. The performance of our residents was found to be satisfactory in this regard.

Relationships between markers of inflammation, severity of injury, and clinical outcomes in hemorrhagic shock.

This study was performed to investigate the relationships between markers of inflammation in serum (interleukin-6 [IL-6], interleukin-10 [IL-10], and granulocyte elastase [GE]), severity of injury, and clinical outcomes, and to evaluate the predictive value of these markers for major complications and mortality. This study, which was conducted between August 2003 and May 2005, examined patients older than 16 y who were admitted to the Emergency Unit of the Uludag University Medical School within 12 h after trauma, and who had traumatic hemorrhagic shock (THS) at admission. Three groups were established: the THS group (n=20), the pure hemorrhagic shock (PHS) group (n=20), and the healthy control group (n=20). Demographic data were recorded for all subjects, and blood samples were taken for lactate, base excess, GE, IL-6, and IL-10 measurements. The Glasgow Coma Score, the Revised Trauma Score, the Injury Severity Score, the New Injury Severity Score, and the Trauma Score-Injury Severity Score were calculated; complications and final clinical outcomes were monitored. A total of 35 men and 25 women were included in the study; mean patient age was 41+/-17 y. In the THS group, scores were as follows: Revised Trauma Score, 10.2+/-2.2; Trauma Score-Injury Severity Score, 0.86+/-0.2; Injury Severity Score, 24.8+/-9.0; and New Injury Severity Score, 32.7+/-9.0. IL-6, IL-10, lactate, and base excess levels in the THS group were significantly higher than those in the PHS and healthy control groups. The serum GE level of the THS group was significantly higher than that of the healthy control group, but it did not differ significantly from that of the PHS group. Complications such as sepsis, acute respiratory distress syndrome, and multiple organ failure occurred in 50% of the THS group and in 20% of the PHS group. Mortality was 30% in the THS group and 10% in the PHS group. In the THS group, no significant differences were noted between markers of inflammation and trauma scores of patients who died and those who survived. The investigators concluded that although the levels of markers of inflammation increased in THS patients, they were inadequate for predicting mortality and the development of complications such as acute respiratory distress syndrome, multiple organ failure, and sepsis. A larger study based on the use of serial marker measurements is warranted.

Childhood falls: characteristics, outcome, and comparison of the Injury Severity Score and New Injury Severity Score.

OBJECTIVES: The aim of this study was to determine the general characteristics of childhood falls, factors affecting on mortality, and to compare the Injury Severity Score (ISS) and the New Injury Severity Score (NISS) as predictors of mortality and length of hospital stay in childhood falls. METHODS: We retrospectively analysed over a period of 8 years children aged younger than14 years who had sustained falls and who were admitted to our emergency department. Data on the patients' age, sex, type of fall, height fallen, arrival type, type of injuries, scoring systems, and outcome were investigated retrospectively. The ISS and NISS were calculated for each patient. Comparisons between ISS and NISS for prediction of mortality were made by receiver operating characteristic (ROC) curve and Hosmer-Lemeshow (HL) goodness of fit statistics. RESULTS: In total, there were 2061 paediatric trauma patients. Falls comprised 36 (n = 749) of these admissions. There were 479 male and 270 female patients. The mean (SD) age was 5.01 (3.48) years, and height fallen was 3.8 (3) metres. Over half (56.6%) of patients were referred by other centres. The most common type of fall was from balconies (38.5%), and head trauma was the most common injury (50%). The overall mortality rate was 3.6%. The cut off value for both the ISS and NISS in predicting mortality was 22 (sensitivity 90.5%, specificity 95.4% for ISS; sensitivity 100%, specificity 88.7% for NISS) (p>0.05). Significant factors affecting mortality in logistic regression analysis were Glasgow Coma Scale (GCS) <9, ISS >22, and NISS >22. There were no significant differences in ROC between three scoring systems. The HL statistic showed poorer calibration (p = 0.02 v p = 0.37, respectively) of the NISS compared with the ISS. CONCLUSIONS: In our series, the head was the most frequent site of injury, and the most common type of fall was from balconies. Scores on the GCS, NISS, and ISS are significantly associated with mortality. The performance of the NISS and ISS in predicting mortality in childhood falls was similar.

Tau protein as a serum marker of brain damage in mild traumatic brain injury: preliminary results.

The objective of this study was to investigate the diagnostic value of serum tau protein in determining the severity of traumatic brain injury in patients with mild traumatic brain injury (mTBI) and high-risk patients. Adult patients who presented to our emergency department (ED) with mTBI over 1 year were prospectively enrolled. Patients underwent cranial computed tomography (CT) and were subdivided into high- and low-risk groups, according to the probability of resultant intracranial injury. Serum tau levels of 60 patients and 20 healthy volunteers, who served as a control group, were measured. The mean age of the 60 patients (45 males, 15 females) was 32.5 years (range, 15-66 y). Mean Glasgow Coma Scale (GCS) score was 14+/-0.6. CT scans demonstrated intracranial injury in 11 patients (18.3%) and depressed fracture in 4 patients (6.7%). Serum tau levels of patients (188+/-210 pg/mL), compared with those of controls (86+/-48 pg/mL), were relatively higher; however, differences were not statistically significant (P=.445). Also, serum tau levels of high-risk patients (307+/-246 pg/mL) were significantly higher than those of low-risk patients (77+/-61 pg/mL) (P=.001). A total of 48 patients (80%) were accessible for follow-up after 6 months. Postconcussive syndrome was observed in 8 patients, 5 of whom had serum tau protein levels that were higher than those of the other 3 patients. However, no statistically significant difference was observed (P>.05). Investigators of the present study noted that serum tau levels in patients with mTBI were increased. Therefore, it is believed that this biomarker may prove helpful in identifying high-risk patients with mTBI. However, additional studies are needed to establish the diagnostic value of serum tau in detecting traumatic brain injury in patients with mTBI.

Four-point bending strength of transverse osteotomies stabilized with various Kirschner wire and tension wire band configurations.

Four different fixation configurations of K-wires of two different diameters were used to stabilize a transverse osteotomy in chicken humerus bones. Four-point bending was applied to these to assess their apex dorsal bending rigidity. The configurations of K-wires included intramedullary, crossed and two with different tension wire band designs. One of these consisted of two transverse K-wires which did not cross the fracture line, around which the tension wire band was placed. The results showed that there was no statistical significance between the two different tension band wiring techniques and that both were superior to the intramedullary and crossed K-wire fixation techniques.