Association of carbon monoxide poisonings and carboxyhemoglobin levels with COVID-19 and clinical severity.

BACKGROUND: Coronavirus disease 2019 (COVID-19), which recently spread throughout the entire world, is still a significant health issue. Additionally, the most common cause of risky poisoning in emergency services is carbon monoxide (CO) poisoning. Both disorders seem to merit more research as they have an impact on all bodily systems via the lungs. AIM: To determine how arterial blood gas and carboxyhemoglobin (COHb) levels affect the clinical and prognostic results of individuals requiring emergency treatment who have both COVID-19 and CO poisoning. METHODS: Between January 2018 and December 2021, 479 CO-poisoning patients participated in this single-center, retrospective study. Patients were primarily divided into two groups for analysis: Pre-pandemic and pandemic periods. Additionally, the pandemic era was divided into categories based on the presence of COVID-19 and, if present, the clinical severity of the infection. The hospital information system was used to extract patient demographic, clinical, arterial blood gas, COVID-19 polymerase chain reaction, and other laboratory data. RESULTS: The mean age of the 479 patients was 54.93 ± 11.51 years, and 187 (39%) were female. 226 (47%) patients were in the pandemic group and 143 (30%) of them had a history of COVID-19. While the mean potential of hydrogen (pH) in arterial blood gas of all patients was 7.28 ± 0.15, it was 7.35 ± 0.10 in the pre-pandemic group and 7.05 ± 0.16 in the severe group during the pandemic period (P < 0.001). COHb was 23.98 ± 4.19% in the outpatients and 45.26% ± 3.19% in the mortality group (P < 0.001). Partial arterial oxygen pressure (PaO2) was 89.63 ± 7.62 mmHg in the pre-pandemic group, and 79.50 ± 7.18 mmHg in the severe group during the pandemic period (P < 0.001). Despite the fact that mortality occurred in 35 (7%) of all cases, pandemic cases accounted for 30 of these deaths (85.7%) (P <0.001). The association between COHb, troponin, lactate, partial arterial pressure of carbon dioxide, HCO3, calcium, glucose, age, pH, PaO2, potassium, sodium, and base excess levels in the pre-pandemic and pandemic groups was statistically significant in univariate linear analysis. CONCLUSION: Air exchange barrier disruption caused by COVID-19 may have pulmonary consequences. In patients with a history of pandemic COVID-19, clinical results and survival are considerably unfavorable in cases of CO poisoning.

The Effect of Fetuin-A and Other Laboratory Paremeters on Prognosis and Mortality in Crimean-Congo Hemorrhagic Fever.

Background: Crimean-Congo Hemorrhagic Fever (CCHF) is a disease with high morbidity and mortality, which is an important health problem in the world. Therefore, we aimed to evaluate the effects of plasma fetuin-A (FA) level, which is a new parameter in terms of prognosis and mortality of CCHF. Methods: A total of 87 patients were included who presented to the Emergency Department, Bagcilar Training and Research Hospital, Istanbul, Turkey with the diagnosis of CCHF from Feb 1, 2019 to Feb 1, 2020. The patients were divided into three groups as tick bite, contact history, and endemic area travel according to the transmission type, and two groups according to the presence of mortality or not. The laboratory data of the patients were compared within these groups. Relationship of hemogram, C-reactive protein (CRP), D-Dimer, sedimentation, lactate, and FA levels between groups were evaluated. Results: The average age of the patients was 62.52±14.94 years and 27(31%) of them were women. Mortality rates were in 6(6.9%) patients from endemic areas (P=0.015). While the FA level of the mortality group was 171.6±30.0 mg/L, it was 230.3±25.0 mg/L in the survivors (P=0.001). There was a moderate and strong negative correlation of FA level with mortality, tick history, and hospitalization. In ROC curve analysis of mortality and FA levels, parameters were determined as sensitivity 97.4% and specificity 96.2%. Conclusion: In addition to FA levels, as anticipated by our hypothesis, lactate, CRP, and sedimentation values can be used to predict prognosis and mortality in cases of CCHF.

Effect of plasma carboxyhemoglobin level on gonadal hormone levels.

BACKGROUND: In emergency departments, carbon monoxide (CO) is a common cause of toxic poisoning. We aimed to determine the relationship between plasma carboxyhemoglobin (COHb) levels and late post-treatment gonadal hormone changes in CO poisoning. METHODS: The study included 237 patients older than 18 who presented to the Emergency Department due to CO intoxication between January 2008 and December 2016. Patients with a COHb level of less than 30% were classified as having mild-to-moderate disease, while those with a COHb level of more than 30% were classified as having severe disease. RESULTS: Of 41 (17%) patients with gonadal hormone change (GHC), 19 (46.3%) were females. In cases with GHC, the exposure time was 5.76±1.64 hours (P=0.001). COHb level was 50.46±4.43% in the severe group (P=0.001), while hormone levels were normal in women and men before CO poisoning. GHC within one month and two years after poisoning was significantly higher (P=0.001). There were 138 (58.2%) patients in the mild-to-moderate group, and 99 (41.8%) patients in the severe group. Of the gonadal hormones, LH2 (luteinizing hormone) was 13.54±3.40 mIU/mL, FSH2 (follicle-stimulating hormone) 16.69±4.35 mIU/mL, PRL2 (prolactin) 16.23±4.73 ng/mL, and TTN2 (testosterone) 644.06±120.40 (P=0.001). In addition, COHb was found to be 42.68±8.42% (P=0.001). In univariate and multivariate Cox regression analysis, gender, LH1, LH2, PRL2, TTN2 and COHb values were found to be prognostic signs in terms of endocrine gonadal hormone change (P<0.05). In the correlation of COHb level with GHC, positive moderate-strong correlation was found between LH2, FSH2, PRL2, TTN2 (P=0.001). CONCLUSIONS: In patients admitted to the emergency services due to CO poisoning, elevated COHb may help predict the risk for late gonadal hormone levels.

Relationship of V1 Derivation Biphasic P Waves with Morbidity and Mortality in Myocardial Infarction Cases.

OBJECTIVE: To evaluate the biphasic P (V1bP) wave in lead V1 in terms of three-vessel disease (TVD), bypass, and mortality in patients with acute coronary syndrome. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Department of Emergency Medicine, University of Health Sciences, Bagcilar Training and Research Hospital, Turkey, between January 2018 and December 2019. METHODOLOGY: A total of 497 patients were admitted to the emergency department due to acute coronary syndrome. Patients were grouped as the right atrium and the left atrium according to the direction of the V1bP wave. Gensini score (GS), left ventricular ejection fraction (LVEF), TVD, bypass, and mortality rates were compared according to these groups. RESULTS: According to the atrial involvement of the patients, the median age was 66 (58-74) years, 220 (44.3%) females and 277 (55.7%) males. In the left atrial group in the V1bP wave, anterior myocardial infarction was the most common in 128 (41.8%) patients, mortality in 17 (5.6%), TVD in 69 (22.5%), and bypass in 13 (4.2%) patients. In the right atrial group, it was found that 127 (66.5%) patients had inferior myocardial infarction, 34 (17.8%) mortality, 66 (34.6%) TVD, and 19 (9.9%) bypass TVD; GS was 89 (80-117) points and LVEF was 45 (36-55)%. In addition, a significant relationship was found with mortality (p=0.019), bypass (p<0.001) and complications (p=0.043). Although the variables showed differences in acute coronary syndrome, mortality, LVEF, GS, mild and/or moderate correlations were found. CONCLUSION: V1bP wave can be a determining parameter for acute coronary syndromes in terms of TVD, bypass, and mortality. KEY WORDS: Emergency department, Biphasic p in lead V1, Three-vessel disease, Bypass, Mortality.

Importance of red blood cell distribution width (RDW) in patients with upper gastrointestinal haemorrhage.

OBJECTIVE: To explore the effect of red blood cell distribution width levels on the diagnosis and management of upper gastrointestinal haemorrhage. METHODS: The retrospective study was conducted at Ankara Numune Education and Research Hospital, Turkey, and comprised record of patients diagnosed with upper gastrointestinal haemorrhage from January 1, 2013, to December 31, 2013. Factors analysed were age, gender, red blood cell distribution width level, admission haemoglobin and haematocrit levels, endoscopy findings classified according to the Forrest system, comorbid diseases, use of medications, unhealthy habits like alcohol usage and smoking, and mortality rate. RESULTS: Of the 147 patients, 93(64%) were men. The overall median age of the sample was 60 years. Besides, 117(79.6%) patients had comorbid diseases, of which hypertension 56(38.4%) was the most common. A total of 24(16.8%) patients were using antiplatelet or anticoagulant drugs, while 30(20.5%) were on non-steroidal anti-inflammatory drugs. Peptic ulcer in 128(87.1%) patients was the most common cause of haemorrhage. The median red blood cell distribution width level of the study population was 15.25% which was significantly higher compared to the reference values (p<0.05).. In contrast, haemoglobin 9.55% (3.7) and haematocrit 28.75% (10.8)were significantly lower (p<0.05). Mortality rates were significantly higher in patients with higher red blood cell distribution width values (p<0.05). CONCLUSIONS: Red blood cell distribution width levels were higher during the acute phase of upper gastrointestinal haemorrhage.

Analysis of the correlation between blood glucose level and prognosis in patients younger than 18 years of age who had head trauma.

OBJECTIVE: To analyze the correlation between early-term blood glucose level and prognosis in patients with isolated head trauma. METHODS: This study included a total of 100 patients younger than 18 years of age who had isolated head trauma. The admission blood glucose levels of these patients were measured. Age at the time of the incident, sex, mode of occurrence of the trauma, computed tomography findings, and GCSs were recorded. Kruskall Wallis test was used compare of groups. A p value less than 0.05 was considered statistically significant. RESULTS: The median age of the study population was 7 years and the median GCS was 11. There was a significant negative correlation between blood glucose level and GCS (p < 0.05). A significant correlation in the negative direction was observed between GCS and blood glucose level (r = -0.658, p < 0.05). Seventy-seven percent of the patients were admitted to hospital, while 6% died in ED. CONCLUSION: The results of the present study suggest that hyperglycemia at an early stage and a low GCS may be reliable predictors of the severity of head trauma and prognosis. A higher blood glucose level may be an ominous sign that predicts a poor prognosis and an increased risk of death.