The ROX, shock and diastolic shock indexes in the prediction of mortality in COVID-19.

OBJECTIVES: The aim of this study is to determine the role of Respiratory Rate Oxygenation (ROX), shock, and diastolic shock indexes ​​in predicting mortality in coronavirus disease 2019 (COVID-19) patients admitted to the emergency department. BACKGROUND: The COVID-19 spread worldwide in a short time and caused a major pandemic. The ROX, shock, and diastolic shock indexes are used in various life-threatening clinical situations. The use of these indexes in triage at emergency departments can accelerate the determination of COVID-19 patients' severity. METHODS: The ROX, shock and diastolic shock indices were calculated and recorded. Patients were divided into three groups; 1) who were discharged from the hospital, 2) who were admitted to the hospital and 3) who were admitted to the intensive care unit. RESULTS: Increased diastolic shock index and decreased ROX index were found to be independent risk factors for mortality. In the prediction of mortality, the sensitivity and specificity of the diastolic shock index were 61.2% and 60.8%, respectively. However, the sensitivity and specificity of ROX index was 73.1% and 71.5%, respectively. CONCLUSION: In conclusion, we found that the ROX index had higher sensitivity and specificity than other indexes in predicting mortality in the evaluation of COVID-19 patients (Tab. 3, Fig. 2, Ref. 18).

Effect of Target Temperature Management on Optic Nerve Sheath Diameter in Post-Cardiac Arrest Patients.

Target Temperature Management (TTM) is a procedure used in post-cardiac arrest (CA) patients to reduce mortality and morbidity. The goal of this study was to investigate the link between intracranial pressure (ICP) and optic nerve sheath diameter (ONSD) in this patient group, which has a high mortality rate, despite TTM, and to see if ONSD may be used to predict mortality. The research was designed to be a retrospective observational study. The study comprised patients who were followed up on in a tertiary intensive care unit, had post-CA TTM, and had brain computed tomography (BCT) before and 0-6 hours after TTM. ONSD measurements were acquired from patients' BCT images recorded before and after TTM. The difference in pre-TTM ONSD and post-TTM ONSD measurements in all post-CA patients, as well as the difference in pre-TTM ONSD and post-TTM ONSD measurements in surviving and deceased patients, was compared. The study involved 33 participants. The patients' average age was 60.58-12.39 years, and 75.8% were male. Around 51.5% of the patients died. When the pre-TTM and post-TTM ONSDs of all patients were compared, there was no statistically significant difference (p = 0.856). When the percentage change (Δ) values between the post-TTM ONSD and pre-TTM ONSD and post-TTM ONSD measures of the surviving patients and the deceased patients were compared, a difference was observed (p < 0.01). Increased ICP in post-CA patients is a significant clinical issue associated with mortality and poor neurological prognosis. ONSD measurement may be useful in monitoring ICP, which may rise, despite TTM, and higher ONSD measurements may be used as an indicator for mortality in post-CA patients, who have received TTM.

Evaluation of the relationship between Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) score and treatment modality and mortality in patients with ileus.

AMAÇ: Ileus, bagirsak geçisinin tikanmasi olarak tanimlanan ve bagirsaklarda mekanik obstrüksiyon veya paralitik nedenlere bagli olarak gelisen klinik durumdur. Ince bagirsak obstrüksiyonlari primer olarak cerrahi durumlar olarak anilsada, konservatif tedavi bazi hastalarda seçilen bir tedavi protokolüdür. Bu çalismanin amaci, ileus hastalarinda HALP skorunun konservatif-cerrahi tedavi kararini, mortaliteyi ve hastanede kalis süresini belirlemede efektivitesini ve enflamasyonla iliskili diger parametrelere üstünlügünü degerlendirmektir. GEREÇ VE YÖNTEM: Çalismaya ileus tanisi alan hastalar dahil edildi. Yas, cinsiyet, komorbiditeler, seçilen tedavi yöntemi (konservatif veya cerrahi), hastanede kalis süresi ve hastane içi mortalite kaydedildi. Biyokimya parametrelerinden beyaz kan hücresi, hemoglobin, trombosit, nötrofil, lenfosit, nötrofil, lenfosit, üre, kreatinin, aspartat aminotransferaz, bilirubin, albümin ve C-reaktif protein seviyeleri kaydedildi. HALP skoru hesaplandi ve mortalite, hastanede kalis süresi, konservatif ve cerrahi tedavi karari arasindaki iliski analiz edildi. BULGULAR: Çalismaya toplam 286 hasta alindi. 245 (%85.7) hastada konservatif tedavi uygulandi. 262 (%91.6) hastada mortalite izlenmedi, 24'ünde (%8.4) mortalite izlendi. HALP skoru mortalite izlenmeyen hastalarda anlamli olarak yüksekti (p=0.045). Mortalite izlenmeyen hastalarin medyan albümin degeri mortalite izlenen hastalardan daha düsüktü (p<0.001). Mortalite izlenen hastalarin yas, üre, kreatinin, AST ve CRP deger-leri, izlenmeyenlere göre anlamli olarak daha yüksekti (sirasiyla, p=0.002, p<0.001, p<0.001, p<0.001, p<0.001 ve p=0.001). Konservatif tedavi uygulanan hastalarin HALP skoru, cerrahi tedavi uygulananlara göre anlamli olarak yüksekti (p=0.003). Lenfosit degeri konservatif tedavi ile izlenen hastalarda anlamli olarak yüksekti (p=0.027). Ameliyat olan hastalarda yas, üre, kreatinin ve CRP skorlari daha yüksekti (sirasiyla, p=0.007, p<0.001, 0.003 ve p<0.001). Tedavi yöntemi ve HALP skoru için ROC analizi yapilip HALP skoru 28 olarak alindiginda konservatif tedaviyi saptamada du-yarlilik 50.6%, özgüllük 78.0%, pozitif LR 2.3 ve negatif LR 0.63 olarak tespit edildi. (EAA 0,645 [%95 güven araligi = 0.556-0.735) ]; p=0.003). SONUÇ: HALP skoru ileuslu hastalarda mortalite ve tedavi seklinin belirlenmesinde faydali olabilecek önemli bir skorlama sistemidir. HALP skoru-nun ileus tanili hastalarin yönetiminde, hem mortaliteyi azaltmada hem de uygun tedavi yöntemini belirlemede olumlu katki saglayacagi kanaatindeyiz.

The Effect of Urea/Albumin Ratio on Mortality in the Geriatric Patients Admitted in the Intensive Care Unit.

OBJECTIVE: To analyse the effect of urea albumin ratio on mortality in intensive care patients aged over 65 years. STUDY DESIGN: An observational study. Place and Duration of the Study: Health Sciences University, Ankara Training and Research Hospital, Emergency Critical Intensive Care Unit, from October 2021 to March 2022. METHODOLOGY: Patients over 65 years of age admitted in the intensive care unit were included in this study, and the laboratory and clinical data were recorded within the first 24 hours after the admission of the patient. The urea : albumin ratio was calculated using serum urea and albumin concentrations. All the patients were monitored during intensive care admission and mortality rates were recorded; additionally 1-month mortalities of the patients were also recorded. The data of the survivors and non-survivors were compared. RESULTS: There were 362 patients with mean age of 79.00±8.40 years; 53.9% were females. The median urea : albumin ratio was found to be 22.8 mg/gr. The area under curve, sensitivity and specificity values were found to be 0.631, 68%, and 56% at a cut-off value of 22.1 mg/gr for urea : albumin ratio, respectively. In addition, urea : albumin ratio >22.1mg/gr was found to be significant in univariate regression analysis (p<0.001) and multivariate regression analysis (p<0.002) for the predictive value of 1-month mortality. CONCLUSION: Urea : albumin ratio is a simple and potentially useful prognostic factor in the geriatric patient population admitted in the intensive care unit. KEY WORDS: Geriatrics intensive care unit, Urea:albumin ratio, Mortality (MeSH database).

Clinical Presentation, Electrocardiographic Findings, and Factors Related to the Hospitalization In Mad-Honey Intoxication.

Objectives: Mad-honey intoxication (MHI) often presents with all kinds of bradyarrhythmias. Despite numerous publications focused on clinical findings, we aim to evaluate poor prognostic implications, ischemia likely electrocardiography (ECG) changes, and detailed ECG findings of MHI in the largest series. Methods: This is a retrospective single-center study of 117 MHI patients admitted to emergency service. Results: The study had 26 (22.2%) females (median 52.5 years) and 91 (77.8%) males (median 51.0 years). Fifty-six (47.9%) patients had ischemia likely changes on ECG. Multivariate model demonstrated that beta-blocker usage (odds ratio (OR): 52.871; 95% confidence interval (CI): 3.618-772.554 (p=0.004)), atrioventricular junctional rhythm (AVJR) (OR: 5.319; 95%CI: 1.090-25.949 (p=0.039)), and quantity of mad-honey consumption (OR: 1.035; 95% CI: 1.008-1.063 (p=0.011)) are predictors of hospitalization. ROC curve analysis showed cutoff value of mad-honey consumption quantity 24.79 g had 57% sensitivity and 68% specificity for predicting hospitalization (AUC: 0.7, 95% CI: 0.55-0.816, p=0.027). In addition, all hospitalized cases were male. Conclusion: Our study has shown that male gender, AVJR, the quantity of mad-honey consumption, and beta-blocker usage are high-risk criteria for hospitalization in MHI patients. Furthermore, ischemia likely ECG changes is often observed with MHI even independently from hypotension or bradycardia.

Relationship between the neutrophil-to-lymphocyte ratio in acute pancreatitis and the severity and systemic complications of the disease.

BACKGROUND/AIMS: In 80% of the patients, Acute pancreatitis (AP) occurs as a self-limiting disease that does not require any specific treatment; however, in 20% of the cases it occurs in its clinically severe form that may lead to local or systemic complications. The aim of this prospective study was to examine the relationship between the neutrophil to lymphocyte ratio (NLR) and the systemic complications and severity of AP. MATERIALS AND METHODS: This prospective study included 100 patients with AP. Age, sex, NLR, Ranson scores and the revised Atlanta classification of the patients were recorded. The patients were divided into two groups according to the Ranson scores as mild and severe AP. According to the Revised Atlanta classification, the patients were divided into two groups as mild and moderate+severe AP. RESULTS: According to the Ranson score, NLR at the time of admission and at the 48th hour in the severe group was found to be statistically higher than the mild AP group (p<0.01). The receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off value of NLR at the emergency department in order for it to be used for distinguishing AP patients with and without systemic complications. The area under the ROC curve was 0.81. Sensitivity and specificity were 87.50% and 69.05%, respectively, when the NLR cut-off value was >7.13. CONCLUSION: Neutrophil to lymphocyte ratio is associated with severe AP. We also regard NLR as a valuable parameter for predicting the development of systemic complications in patients with AP.

Comparative effectiveness of standard CPR vs active compression-decompression CPR with CardioPump for treatment of cardiac arrest.

BACKGROUND: Despite all of the studies conducted on cardiopulmonary resuscitation (CPR), the mortality rate of cardiac arrest patients is still high. This has led to a search for alternative methods. One of these methods is active compression-decompression CPR (ACD-CPR) performed with the CardioPump. OBJECTIVE: The differences in the restoration of spontaneous circulation; the 1-, 7-, and 30-day survival rates; and hospital discharge rates between conventional CPR and ACD-CPR performed with CardioPump were investigated. In addition, the differences between the 2 methods with respect to complications were also investigated. METHODS: Our study was a prospective, randomized medical device study with a case-control group. Cardiac arrest cases brought to our emergency medicine clinic by the 112 emergency ambulances from out of hospital and patients who had developed cardiac arrest inhospital clinics between April 2015 and September 2015 were included in our study. For randomization, standard CPR was performed on odd days of each month, and CPR using CardioPump was performed on the even days of each month. RESULTS: A total of 181 patients were included in our study. The number of patients who received conventional CPR was determined as 86 (47.5%), and the number of patients who received CPR using the CardioPump was determined as 95 (52.5%). We did not identify any difference between conventional CPR and CardioPump ACD-CPR with respect to restoration of spontaneous circulation, discharge rates, and the 1-, 7-, and 30-day survival rates. (P=.384, P=.601, P=.997, P=.483, and P=.803, respectively) The complication rate was higher in the patient group that received conventional CPR (P<.001). CONCLUSION: As a result of our study, we did not obtain any evidence supporting the replacement of conventional CPR with ACD-CPR performed using CardioPump.

Intoxication due to Papaver rhoeas (Corn Poppy): Five Case Reports.

Introduction. In this paper, we aimed to present five Papaver rhoeas intoxication cases, which is very rare in the literature. Case 1. A 35-year-old female patient was admitted to our emergency room with the complaints of nausea, restlessness, and dyspnea developing 3 hours after eating Papaver rhoeas. On physical examination, her general condition was moderate; she was conscious and the vital findings were normal. The pupils were myotic. She was transferred to the toxicology intensive care unit as she experienced a generalized tonic clonic seizure lasting for three minutes. Case 2. A 41-year-old female patient was brought to our emergency room by 112 ambulance as she had contractions in her arms and legs, unconsciousness, and foam coming from her mouth two hours after Papaver rhoeas ingestion. On physical examination, she was confused, the pupils were myotic, and she was tachycardic. Arterial blood gases analysis revealed lactic acidosis. Case 3. A 38-year-old female patient was admitted to our emergency room with complaints of nausea and vomiting two hours after ingestion of Papaver rhoeas. Her physical examination and tests were normal. Case 4. A 34-year-old male patient was admitted to our emergency room with complaints of numbness and loss of power in his arms and legs one hour after Papaver rhoeas ingestion. He was hospitalized at the toxicology intensive care unit for follow-up and treatment. Dyspnea and bradycardia developed on the follow-up. The oxygen saturation without oxygen support was 90%. ECG revealed sinus bradycardia. The cardiac enzymes did not increase. Case 5. A 42-year-old female patient was brought to our emergency room by 112 ambulance with contractions in her arms and legs and unconsciousness two hours after Papaver rhoeas ingestion. On her physical examination, she was confused and the pupils were myotic. Arterial blood gases analysis revealed lactic acidosis. Conclusion. All patients were followed up for a few days and then discharged from the hospital with recovery. Unconscious consumption of Papaver rhoeas leads to a clinical condition resembling morphine intoxication, CNS depression, and epileptic seizures.

Antiepileptic drug poisoning: Three-year experience.

INTRODUCTION: Antiepileptic drugs, which are also called anticonvulsants, are used in the therapy and prophylaxis of epileptic seizures. The purpose of this paper was to investigate the relevant epidemiological data and to determine which of these drugs was the most frequent cause of intoxication. Another purpose of this study was to determine the neurological, cardiac, and biochemical problems caused by antiepileptics. MATERIAL AND METHOD: This retrospective study included 95 consecutive patients under 18 years of age with antiepileptic intoxication, presenting to and being followed-up in, the Toxicology Unit between January 2010 and February 2013. The data were obtained by screening the patient files. RESULTS: Of the cases, 67 (70.5%) were self-poisoned by first generation antiepileptics (FGAEs) and 28 (29.5%) by second generation antiepileptics (SGAEs). The Glasgow Coma Scale (GCS) scores and the serum lactate levels of the patients poisoned by FGAEs and SGAEs on admission to emergency department were 15 (25th: 12; 75th: 15; 95th: 15; IQR: 3) and 1.9 (25th: 1.4; 75th: 3.1; 95th: 5.6; IQR: 1.7), and 15 (25th: 14.3; 75th: 15; 95th: 15; IQR: 0.75) and 1.07 (25th: 0.9; 75th: 1.6; 95th: 5.5; IQR: 0.71), respectively. The serum lactate levels of patients poisoned by FGAEs were significantly higher (p < 0.001). Among the cases poisoned by carbamazepine, the most frequent cause of intoxication, the GCS score was significantly lower and serum lactate level was significantly higher in the group with high serum levels of carbamazepine (p = 0.004 and p < 0.001, respectively). In cases poisoned by valproic acid (VPA), the second frequent cause of intoxication, there was neither a significant association between the serum VPA level and the GCS score, nor between the serum lactate level and the systolic blood pressure (p = 0.470, p = 0.897, and p = 0.088, respectively). However, there was a positive correlation between the serum VPA level and the serum ammonia level (kk = 0.742, p < 0.001). CONCLUSION: First generation antiepileptics are more toxic than SGAEs. In patients with serum carbamazepine level, particularly those over 30 mg/L, serious disorders of consciousness, cardiovascular toxicity, and metabolic disorders may occur. In VPA intoxication, there is a positive correlation between the serum VPA levels and ammonia levels. On account of this finding, one should be more careful about hyperammonemic hepatic encephalopathy as the serum VPA level rises.

Prognostic importance of neutrophil-lymphocyte ratio in critically ill patients: short- and long-term outcomes.

STUDY OBJECTIVE: The number of critically ill patients admitted to the emergency department increases daily. To decrease mortality, interventions and treatments should be conducted in a timely manner. It has been found that the neutrophil-lymphocyte ratio (NLR) is related to mortality in some disease groups, such as acute coronary syndrome and pulmonary emboli. The effect of the NLR on mortality is unknown in critically ill patients who are admitted to the emergency department. Our aim in this study is to evaluate the effect of the NLR on mortality in critically ill patients. METHODS: This study was planned as a prospective, observational cohort study. Patients who were admitted to the emergency department because they were critically ill and required the intensive care unit were included in the study. Demographic characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sepsis-related Organ Failure Assessment, Glasgow Coma Score, and NLR values were recorded upon emergency department admission. The patients were followed up for sepsis, ventilator-associated pneumonia, multiorgan failure, in-hospital mortality, and 6-month mortality. RESULTS: The median (interquartile range) age of the 373 patients was 74 (190) years, and 54.4% were men. Neutrophil-lymphocyte ratio values were divided into quartiles, as follows: less than 3.48, 3.48 to 6.73, 6.74-13.6, and more than 13.6. There was no difference among these 4 groups regarding demographic characteristics, APACHE II score, Sepsis-related Organ Failure Assessment score, Glasgow Coma Score, and length of hospital stay (P>.05). In the multivariable Cox regression model, in-hospital mortality and 6-month mortality NLR were hazard ratio (HR), 1.63 (1.110-2.415; P=.01) and HR, 1.58 (1.136-2.213; P=.007), respectively, and APACHE II scores were detected as independent indicators. CONCLUSION: The NLR is a simple, cheap, rapidly available, and independent indicator of short- and long-term mortalities. We suggest that the NLR can provide direction to emergency department physicians for interventions, particularly within a few hours after admission, in the critically ill patient group.

Neutrophil-lymphocyte ratio in patients with pesticide poisoning.

BACKGROUND: Pesticides are highly toxic to human beings, and pesticide poisoning is associated with high morbidity and mortality. The identification of powerful prognostic markers is important for the management of patients with pesticide poisoning in emergency settings. OBJECTIVE: To investigate the prognostic value of the neutrophil-lymphocyte ratio and hematological parameters measured in patients with pesticide poisoning within the first 24 h after admission to the emergency department (ED). METHODS: All patients (≥15 years old) admitted to the ED from July 2008 through February 2013 due to pesticide poisoning were enrolled in the study. The written and electronic medical charts of patients were reviewed. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were calculated for each patient using absolute neutrophil, lymphocyte, and platelet counts. Mechanical ventilation requirement and mortality were used as the primary endpoints. RESULTS: A total of 189 patients were included in the study. The mechanically ventilated patients had significantly higher leukocyte and neutrophil counts, and neutrophil-lymphocyte and platelet-lymphocyte ratios (p < 0.001, p < 0.001, p < 0.001, p = 0.003, respectively), whereas they had significantly lower lymphocyte counts compared to nonventilated patients (p = 0.011). Survivors had significantly higher leukocyte and neutrophil counts, and neutrophil-lymphocyte ratios (p < 0.001, p < 0.001, p = 0.002, respectively), whereas there was no significant difference between groups in terms of lymphocyte counts (p = 0.463), compared to nonsurvivors. CONCLUSION: Leukocyte counts, neutrophil counts, and neutrophil-lymphocyte ratios measured within the first 24 h after admission to the ED are useful and easy-to-use parameters for estimating prognosis in the follow-up of patients with pesticide poisoning.

The Analysis of Escherichia Coli Resistance in Urine Culture and in Antibiograms as Requested by Emergency Service.

OBJECTIVES: The aim of this study was to determine the antibiotic resistance of infectious and non-infectious E. coli species in order to increase the success of empirical antibiotic treatment in urinary system infections. METHODS: The antibiotic susceptibility of 464 E. coli strains that were isolated from urine samples of patients who visited Derince Training and Research Hospital Emergency Department between January 1 and December 31, 2012 were retrospectively evaluated from records. The antibiogram results were classified as susceptible, moderately susceptible or resistant. Moderately susceptible strains were assumed to be resistant. RESULTS: Bacterial proliferation was seen in 563 (28.1%) of the 1998 urine cultures tested. One hundred and twelve cultures could not be evaluated due to contamination, and there was no proliferation in 1323 cultures. E. coli strains were isolated in 464 (82.4%) of the cultures in which proliferation was seen. Three hundred and sixty seven (79%) of the patients were female, 97 (21%) were male, and the mean age of all of the patients was 41.1±24.1 years (min: 1, max: 90). The antibiograms of the E. coli strains revealed that meropenem had the lowest resistance (0%), while ampicillin-sulbactam had the highest resistance (36.8%). CONCLUSIONS: In this study, we investigated the antibiotic resistance of E. coli strains isolated from urine cultures in our region. Future studies, perhaps similar to this one, can be performed in the future to increase the success of treatments.

Comparison of success and pain levels of supination-flexion and hyperpronation maneuvers in childhood nursemaid's elbow cases.

OBJECTIVE: The aim of this study was to compare the hyperpronation (HP) and the supination-flexion (SF) reduction techniques for reducing nursemaid's elbow in terms of efficacy and pain. METHODS: This prospective, pseudorandomized, controlled, nonblinded study was conducted in an urban tertiary care emergency department between October 1, 2009, and October 1, 2010. A total of 150 patients (51 males [34%] and 99 females [66%] between the ages of 0 to 6 years) were included in the study. When the first reduction attempt failed, second attempt was performed using the same technique. After failure of the second attempt, reduction technique was changed to an alternate technique. Level of pain was evaluated using the Modified Children's Hospital of Eastern Ontario Pain Scale in 113 patients older than 1 year who had a successful reduction process on the first attempt. RESULTS: Successful reduction was accomplished in 121 (80.7%) of the patients during the first attempt, in 56 (68.3%) of the patients using the SF technique and in 65 (95.6%) of the patients using the HP technique (P < .001). At the end of total attempts, we found that the SF (59/84) technique was less successful than the HP (91/93) technique (P < .001). The pain levels of the both techniques were not statistically different. CONCLUSION: The HP technique was found to be more successful compared with the SF technique in achieving reduction. We were unable to find any significant difference in pain levels observed between the 2 techniques.

Elevated serum S100B protein and neuron-specific enolase levels in carbon monoxide poisoning.

OBJECTIVE: Carbon monoxide (CO) poisoning causes cerebral and generalized hypoxia. This study aimed to assess the possible use of serum glial marker S100B protein and neuron-specific enolase (NSE) as biochemical markers of hypoxic brain damage in acute CO poisoning. METHODS: Patients with acute CO poisoning admitted to the ED of 2 training hospitals (Ankara, Turkey) were included in this cross-sectional study. Serum levels of S100B and NSE were measured on admission. The patients were divided into 2 groups (unconscious and conscious). Twenty healthy adults were included in the study to serve as controls. RESULTS: A total of 70 patients poisoned by CO (mean age +/- SD, 36.6 +/- 16.3 years; 64.3% women) were enrolled. Although S100B concentrations were higher in patients than in the control group (P = .018), no significant difference was determined between patient and control groups with respect to NSE concentrations (P = .801). A positive correlation was noted between levels of S100B and NSE (r = 0.388; P = .001). The S100B and NSE values were higher in unconscious patients than in the control group (P = .002 and P = .013, respectively). Furthermore, S100B and NSE values were higher in unconscious vs unconscious patients (P = .047 and P = .005, respectively). CONCLUSION: Elevated serum S100B and NSE levels were associated with loss of consciousness in CO poisoning in this series of patients. Serum S100B and NSE may be useful markers in the assessment of clinical status in CO poisoning.