Factors affecting seizure recurrence in the emergency department.

Background: Information on Emergency Department (ED) follow-up of patients presenting with epileptic seizures is limited. Objectives: It was planned to investigate the factors affecting the recurrence of epileptic seizures in the follow-up of patients presenting to the ED with the complaint of epileptic seizures. Materials and methods: This prospective, observational, single-center study was carried out in an adult population presenting to the ED. The study included patients older than 18 years of age presenting to the ED with the complaint of epileptic seizures. Results: Of the 205 patients included in the study, 68 (33.2%) had seizure recurrence during the 6 h. In the univariable analysis, advanced age, prolonged post-ictal duration, increased seizure duration, generalized tonic clonic seizure, alcohol consumption within past 24 h, hypertension, coronary artery disease, Alzheimer's disease, prior ischemic cerebrovascular disease, low Glascow Coma Scale (GCS), high glucose, high C-Reactive Protein, high phosphorus, low potassium, high blood urea nitrogen, high lactate, increased anion gap, high osmolarity were statistically significant in predicting recurrent seizure recurrence within 6 h. According to the logistic regression, postictal duration, GCS score, and age were independent predictors in our model. The cut-off value of postictal duration in predicting seizure recurrence at the highest sensitivity (66.2%) and specificity (89.8%) was 22.5 min. Conclusion: A prolonged postictal state, low GCS score, advanced age may be an indication of seizure recurrence. Therefore, patients with a long postictal duration, low GCS score, advanced age should be followed up more carefully in terms of recurrent seizures in the ED.

Evaluation of the Blood Urea Nitrogen-to-Left Ventricular Ejection Fraction Ratio in Predicting Mortality in Patients Presenting to the Emergency Department with Heart Failure Symptoms.

Heart failure is a clinical syndrome. In this study, the significance of the blood urea nitrogen-to-left ventricular ejection fraction (BUNLVEF) ratio in predicting short-term mortality in patients with heart failure symptoms was evaluated. This retrospectively designed study was conducted by evaluating the records of patients with a history of heart failure who presented to the emergency department with heart failure symptoms and signs from 01 January 2018 to 01 January 2020. One hundred and seventy-three patients were included in the sample within the last six months presented to the emergency department with the symptoms of acute heart failure. Blood urea nitrogen (BUN) and the BUNLVEF ratio had a significant relationship with mortality (p=0.004 and <0.010, respectively). In patients with a known history of heart failure presenting to the emergency department with heart failure symptoms, it would be more appropriate to evaluate poor outcomes with the BUNLVEF ratio rather than the LVEF or BUN value alone. Key Words: Blood urea nitrogen, Prognosis, Left ventricular dysfunction.

Investigating the association between various platelet indices and different clinical sub-groups of severe malaria.

Aim: To evaluate the ability of platelet count, mean platelet volume, platelet distribution width, and platelet mass index to predict the severity of malaria. Materials and Methods: This study was conducted as a retrospective cohort study at a tertiary hospital in Somali. Patients grouped as severe and non-severe malaria. We compared groups in terms of platelet count, mean platelet volume, platelet distribution width, and platelet mass index. Results: A total of 131 patients were included in the final analysis. Of the patients, 77 (58.7%) had non-severe malaria, and 54 (41.3%) had severe malaria. The multivariate analysis revealed that there was no significant difference between the groups in terms of platelet count, mean platelet volume, platelet distribution width, and platelet mass index (p: 0.183, 0.323, 0.204, and 0.139, respectively). In the receiver operating characteristic analysis, the area under the curve values for platelet count, mean platelet volume, platelet distribution width, and platelet mass index were 0.699, 0.619, 0.504, and 0.675, respectively. Conclusion: Of the platelet indices, platelet count, mean platelet volume, platelet distribution width, and platelet mass index were not clinically significant markers that could be used to predict the severity of malaria.

Comparison of the Arterial PaCO 2 Values and ETCO 2 Values Measured with Sidestream Capnography in Patients with a Prediagnosis of COPD Exacerbation.

Background Aim of this study is to investigate whether end-tidal carbon dioxide (ETCO 2 ) values can be used instead of partial pressure of carbon dioxide (PaCO 2 ) values in guiding treatment, and determining treatment benefits in patients that received a pre-diagnosis of chronic obstructive pulmonary disease (COPD) exacerbation at the emergency department. Methods This observational prospective study was conducted with patients who presented to the emergency department with the complaint of shortness of breath and were diagnosed with COPD exacerbation. ETCO 2 was measured with the sidestream method during blood gas analysis in patients with indications for this analysis. Measurements were repeated at hour 1 after treatment. Results The study included a total of 121 cases. There was a positive correlation between the PaCO 2 and ETCO 2 values measured before and after treatment ( r = 0.736, p < 0.01 and r = 0.883, p < 0.01, respectively). High ETCO 2 values were accompanied by high PaCO 2 values. When the measurements before and after treatment were evaluated using the Bland-Altman method, most of the result were within the limits of agreement (-4.9 and +31.4/- 2.6 and +9.4), with mean differences being calculated as 13.2 and 8.4, respectively. Conclusions Although ETCO 2 and PaCO 2 were statistically consistent according to the results of our study, due to the high averages of differences between these two parameters, the ETCO 2 value has limited clinical use in COPD cases compared to PaCO 2 . However, high ETCO 2 values may indicate that noninvasive mechanical ventilation should be included in the treatment of COPD cases without waiting for the results of blood gas analysis, and they can also be when needed for inpatient treatment.

Ethanol-Associated Prolonged Immobilisation as a Cause of Rhabdomyolysis.

Null.

Comparison of the Predictive Ability of the Blood Urea Nitrogen/Albumin, C-Reactive Protein/Albumin, and Lactate/Albumin Ratios for Short-Term Mortality in SARS-CoV-2-Infected Patients.

Background Hematological parameters and their ratios are the most studied biomarkers for prediction of mortality or severe illness in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aims to compare the power of the blood urea nitrogen (BUN)/albumin ratio, lactate/albumin ratio, and C-reactive protein (CRP)/albumin ratio, measured at the time of admission, in predicting 30-day mortality in SARS-CoV-2-infected patients presenting to the emergency department (ED). Materials and Methods This retrospectively designed, single-center, observational study was performed in the ED of a tertiary education health care center. We documented the data of patients admitted with a confirmed SARS-CoV-2 infection between September 1, 2020, and January 1, 2021. Results Of the 470 patients included in the study, 232 (49.4%) were female. The all-cause 30-day mortality rate was 23.8%. The area under the curve values for the BUN/albumin ratio, lactate/albumin ratio, and CRP/albumin ratio in the prediction of 30-day mortality were 0.725, 0.641, and 0.749, respectively. Sensitivity and negative predictive value for CRP/albumin ratio (≥0.049) and specificity for BUN/albumin ratio (≥1.17) were 92.86, 94.9, and 71.23, respectively. The odds ratio values of the BUN/albumin ratio (≥1.17), CRP/albumin ratio (≥0.049), and lactate/albumin ratio (≥0.046) for 30-day mortality were determined as 4.886, 9.268, and 2.518, respectively. Conclusion The BUN/albumin ratio and CRP/albumin ratio can be used to predict 30-day mortality in SARS-CoV-2-infected patients admitted to ED. Furthermore, CRP/albumin ratio had the highest sensitivity and negative predictive value, while BUN/albumin ratio had the highest specificity.

Leech Application-related Upper Gastrointestinal Bleeding: A Case Report.

Leech therapy (Hirudotherapy) is a method used in the treatment of many diseases since ancient times. Although many complications have been reported following the use of this method, no systemic life-threatening bleeding has yet been described. A-43-year-old male patient was diagnosed with upper gastrointestinal bleeding following leech application that he had received for infertility one week earlier. The complications of hirudotherapy typically spontaneously improve due to the local effects of this treatment. The most frequently reported complications are local infections, and less commonly allergies and prolonged local bleeding can occur. However, in this case report, we describe a life-threatening upper gastrointestinal bleeding as a new complication. Gastrointestinal bleeding appearing a week after leech therapy does not necessarily mean that leeches caused gastrointestinal bleeding in this case. Nevertheless, considering the development time of gastrointestinal bleeding, it can be deduced that it was possibly due to hirudotherapy. Patients should be informed about alarming symptoms that can indicate complications following leech application.

Comparison of the effects of different treatment protocols on mortality in patients presenting with an INR≥10 due to warfarin-associated over-anticoagulation.

Aim: One of the most anticipated adverse effects of warfarin is over-anticoagulation. There is little to no evidence on the treatment that should be administered in patients with an international normalized ratio (INR)≥10. The primary outcome of this study is to analyze the effects of various treatments on 30-day mortality in patients with INR≥10 and without major bleeding on 30-day all-cause mortality. The secondary outcome is to propose a model that predicts 30-day all-cause mortality in the same patient group. Methods: Patients older than 18 years of age using warfarin and who had an INR≥10 were included in this retrospective cohort study. Patients with major bleeding on admission were excluded. Patients treated with only cessation of warfarin were named as "Group-1", patients who were treated with vitamin-K in addition to cessation of warfarin were named as "Group-2", and patients who were treated with cessation of warfarin and vitamin-K and fresh frozen plasma or prothrombin complex concentrate were named as "Group-3". Results: 190 patients were included in the analysis. Seven (38.9%) patients in the first group, 3 (8.6%) in the second group, and 21 (15.3%) in the third group died within 30-days(p=0.015). In the post-hoc analysis, the difference between Group-1 and Group-2 was found to be significant(p=0.036, OR:0.147, 95%CI=0.032 to 0.671).The performance of the model in predicting 30-day all-cause mortality was high (AUC=0.818 (95%CI = 0.716 to 0.920) and found to be compatible with the validation dataset 0.806 (95%CI = 0.631 to 0.981). Administration of vitamin K in addition to the cessation of warfarin was found to be a strong contributor to the model and an independent predictor of survival within 30 days(p=0.006). Conclusions: Until randomized controlled studies are conducted, it may be reasonable to administer vitamin-K in addition to cessation of warfarin in non-bleeding patients with INR≥10.

Diagnostic Value of Lateral Ankle Radiography in Achilles Tendon Rupture.

INTRODUCTION: Achilles tendon rupture (ATR) is a common sports injury, but approximately 20% of acute ATR cases are misdiagnosed as ankle sprains at first presentation. This study aimed to investigate the diagnostic value of lateral ankle radiography in the diagnosis of acute ATR. METHODS: This was a retrospective case-control study in which the lateral ankle radiographs of patients who presented to the emergency department between January 1, 2015 and December 31, 2019 were examined. The study included a total of 154 patients with acute ATR, who underwent lateral ankle radiography at the presentation and were surgically or magnetic resonance imaging (MRI) confirmed to have ATR in our hospital. The lateral ankle radiographs of the patients were examined by 2 clinicians blinded to clinical data for the following 3 findings: Kager's fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle. The same procedure was repeated for 308 controls who underwent lateral ankle radiography and were diagnosed with ankle sprain. RESULTS: Kager's fat pad sign was detected in 133 (86.4%) of the 154 patients with ATR and 26 (8.4%) of the 308 patients in the control group. The Kager's fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle sensitivity values for the diagnosis of ATR were 86.4%, 61.7%, and 65.6%, respectively, and their specificity values were 91.6%, 78.9%, and 56.2%, respectively. Interobserver reliability was determined to be good for all 3 radiographic findings. CONCLUSION: Clinicians should be particularly aware of Kager's fat pad sign when examining lateral ankle radiographs for ankle injury. LEVELS OF EVIDENCE: Level IV: Case control study.

Report of a Case with Profound Anaemia from Health Literacy Perspective.

Null.

Serum SCUBE-1 Levels and Return of Spontaneous Circulation Following Cardiopulmonary Resuscitation in Adult Patients.

Background SCUBE 1-has been used as a biomarker for the diagnoses of myocardial infarction, stroke, mesenteric ischemia, and gastric cancer in some recent studies. In this study, we investigated the relationship between serum SCUBE-1 levels and return of spontaneous circulation (ROSC) in patients who received cardiopulmonary resuscitation (CPR). Methods Patients over 18 years of age who were not pregnant and received CPR were divided into two groups: those who achieved ROSC and those who died. There were 25 patients in each group. SCUBE-1 and other routine biochemical parameters were studied in blood samples taken at the time of admission. Results There was no significant difference between the age and gender distribution of the patients between the two groups. The SCUBE-1 value of the ROSC group was significantly higher than that of the non-survivor group ( p ˂ 0.05). At a cut-off value of 9 ng/mL, SCUBE-1 had a sensitivity of 100%, a positive predictive value of 65.8%, specificity of 48%, and a negative predictive value of 100% in predicting ROSC. Conclusions The SCUBE-1 values were found to be significantly higher in the ROSC group compared with the non-survivor group.

Effect of the COVID-19 Pandemic on Emergency Department Presentations with Mushroom Poisoning: A Report from Turkey.

Background In this study, we investigated the effect of the coronavirus disease 2019 (COVID-19) pandemic on emergency department admissions with mushroom poisoning in a tertiary hospital in Turkey. Materials and Methods This study was conducted as a retrospective cohort study to evaluate the data of patients admitted to the emergency department between January 1, 2018, and December 31, 2020. The patients diagnosed with the International Classification of Diseases-10 code T62.0 concerning the toxic effect of ingested mushrooms were identified through the computerized medical and laboratory record system of the hospital. The patients' demographic data, presentation seasons, laboratory findings, emergency department outcomes, and mortality due to mushroom poisoning were obtained. To reveal the effect of COVID-19 pandemic on emergency department presentations with mushroom poisoning, the means of the pre-pandemic period (2018-2019) and the pandemic period (2020) were compared. Results The data of a total of 171 patients were included in the final analysis. The number of patients diagnosed with the toxic effect of ingested mushrooms was 96 in 2018, 61 in 2019, and 14 in 2020. There was a 5.6-fold decrease during pandemic period in the number of patients presenting to the emergency department with mushroom poisoning. Conclusion The decrease in mushroom poisoning cases may be related to the changes in the eating habits of individuals during the pandemic and our study being conducted in a metropolitan city. We recommend that multicenter studies be performed to verify the data obtained from our study and increase their generalizability.

Characteristics of School Injuries Presenting to the Emergency Department.

Background School injuries account for approximately one-fifth of pediatric injuries. We aimed to investigate the frequency and severity of school injuries among school-aged children and determine clinical diagnoses and surgery requirement data. Methods In this prospective study, children who were admitted to the emergency department due to school accidents over a 5-month period were included. Demographics, activity during trauma, mechanism of trauma, nature, severity, emergency department outcomes, and surgery requirement were evaluated. Results The study included a total of 504 school-aged children, of whom 327 (64.9%) were male and 177 (35.1%) were female. Of the children, 426 (84.5%) had no evidence of injury or minor injury, while 78 (15.5%) had moderate or severe injury. There was a statistically significant difference between these two groups in terms of gender ( p = 0.031). Of the 78 children with moderate or severe injuries, 45 had extremity fractures, 18 had lacerations, 5 had maxillofacial injuries, 4 had cerebral contusion, 1 had lung contusion, and 1 had cervical soft-tissue damage. Two patients with fractures and two with eyelid lacerations were treated surgically, and four patients with brain contusion were hospitalized for a close follow-up. Conclusion This study revealed that the most common moderate or severe injuries in school accidents referred to emergency department were distal radius fractures and lacerations.

Predictive Ability of the MEWS, REMS, and RAPS in Geriatric Patients With SARS-CoV-2 Infection in the Emergency Department.

BACKGROUND: The aim of this study was to compare the ability of the Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) to predict 30-d mortality in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection aged 65 y and over. METHODS: This prospective, single-center, observational study was carried out with 122 volunteers aged 65 y and over with patients confirmed to have SARS-CoV-2 infection according to the reverse transcriptase-polymerase chain reaction (RT-PCR) test, who presented to the emergency department between March 1, 2020, and May 1, 2020. Demographic data, comorbidities, vital parameters, hematological parameters, and MEWS, REMS, and RAPS values of the patients were recorded prospectively. RESULTS: Among the 122 patients included in the study, the median age was 71 (25th-75th quartile: 67-79) y. The rate of 30-d mortality was 10.7% for the study cohort. The area under the receiver operating characteristic curve values for MEWS, RAPS, and REMS were 0.512 (95% confidence interval [CI]: 0.420-0.604; P = 0.910), 0.500 (95% CI: 0.408-0.592; P = 0.996), and 0.675 (95% CI: 0.585-0.757; P = 0.014), respectively. The odds ratios of MEWS (≥2), RAPS (>2), and REMS (>5) for 30-d mortality were 0.374 (95% CI: 0.089-1.568; P = 0.179), 1.696 (95% CI: 0.090-31.815; P = 0.724), and 1.008 (95% CI: 0.257-3.948; P = 0.991), respectively. CONCLUSIONS: REMS, RAPS, and MEWS do not seem to be useful in predicting 30-d mortality in geriatric patients with SARS-CoV-2 infection presenting to the emergency department.

Can 1st and 6th month pulmonary function test follow-ups give an idea about the long-term respiratory effects of COVID-19 pneumonia?

OBJECTIVE: The aim of this study was to ascertain the long-term respiratory effects of COVID-19 pneumonia through pulmonary function tests in follow-ups at 1 and 6 months. METHODS: Our study was conducted between August 1, 2020 and April 30, 2021. At 1 month after discharge, follow-up evaluations, PFTs, and lung imaging were performed on patients aged above 18 years who had been diagnosed with COVID-19 pneumonia. In the 6th month, the PFTs were repeated for those with pulmonary dysfunction. RESULTS: A total of 219 patients (mean age, 49±11.9 years) were included. Pathological PFT results were noted in the 1st month for 80 patients and in the 6th month for 46 (7 had obstructive disorder, 15 had restrictive disorder, and 28 had small airway obstruction) patients. A significant difference was found between abnormal PFT results and patient-described dyspnea in the 1st month of follow-up. The 6-month PFT values (especially those for forced vital capacity) were statistically significantly lower in the patients for whom imaging did not indicate complete radiological improvement at the 1-month follow-up. No statistically significant difference was found between the severity of the first computed tomography findings or clinical condition on emergency admission and pulmonary dysfunction (Pearson's chi-square test, P=0.904; Fisher's exact test, P=0.727). CONCLUSION: It is important that patients with COVID-19 pneumonia be followed up for at least 1 month after discharge to be monitored for potential long-term lung damage. PFTs should be administered to those in whom ongoing dyspnea, which started with COVID-19, and/or full recovery were not identified in pulmonary imaging.

Can 1st and 6th month pulmonary function test follow-ups give an idea about the long-term respiratory effects of COVID-19 pneumonia?

SUMMARY OBJECTIVE: The aim of this study was to ascertain the long-term respiratory effects of COVID-19 pneumonia through pulmonary function tests in follow-ups at 1 and 6 months. METHODS: Our study was conducted between August 1, 2020 and April 30, 2021. At 1 month after discharge, follow-up evaluations, PFTs, and lung imaging were performed on patients aged above 18 years who had been diagnosed with COVID-19 pneumonia. In the 6th month, the PFTs were repeated for those with pulmonary dysfunction. RESULTS: A total of 219 patients (mean age, 49±11.9 years) were included. Pathological PFT results were noted in the 1st month for 80 patients and in the 6th month for 46 (7 had obstructive disorder, 15 had restrictive disorder, and 28 had small airway obstruction) patients. A significant difference was found between abnormal PFT results and patient-described dyspnea in the 1st month of follow-up. The 6-month PFT values (especially those for forced vital capacity) were statistically significantly lower in the patients for whom imaging did not indicate complete radiological improvement at the 1-month follow-up. No statistically significant difference was found between the severity of the first computed tomography findings or clinical condition on emergency admission and pulmonary dysfunction (Pearson's chi-square test, P=0.904; Fisher's exact test, P=0.727). CONCLUSION: It is important that patients with COVID-19 pneumonia be followed up for at least 1 month after discharge to be monitored for potential long-term lung damage. PFTs should be administered to those in whom ongoing dyspnea, which started with COVID-19, and/or full recovery were not identified in pulmonary imaging.

A Case Report of Rare Adverse Events Associated with Venlafaxine Administration: Hypoglycemia and Lactic Acidosis.

We report the first case of hypoglycemia and lactic acidosis caused by the therapeutic doses of venlafaxine. A 19-year-old female patient had presyncope and she was taking venlafaxine 75 mg once a day because of major depression for a week and she had no history of any other drug use or disease. The blood gas analysis revealed hypoglycemia and lactic acidosis. Patient was treated with dextrose infusion and oral diet. Although hypoglycemia and lactic acidosis have been reported in overdose of venlafaxine in the literature, these effects were observed in therapeutic doses.

Effectiveness of the rapid emergency medicine score and the rapid acute physiology score in prognosticating mortality in patients presenting to the emergency department with COVID-19 symptoms.

OBJECTIVE: We investigated the effectiveness of the Rapid Emergency Medicine Score and the Rapid Acute Physiology Score in identifying critical patients among those presenting to the emergency department with COVID-19 symptoms. MATERIAL AND METHODS: This prospective, observational, cohort study included patients with COVID-19 symptoms presenting to the emergency department over a two-month period. Demographics, clinical characteristics, and the data of all-cause mortality within 30 days after admission were noted, and the Rapid Emergency Medicine Score and the Rapid Acute Physiology Score were calculated by the researchers. The receiver operating characteristic curve analysis was performed to determine the discriminative ability of the scores. RESULTS: A total of 555 patients with a mean of age of 49.4 ± 16.8 years were included in the study. The rate of 30-day mortality was 3.9% for the whole study cohort, 7.2% for the patients with a positive rt-PCR test result for SARS-CoV-2, and 1.2% for those with a negative rt-PCR test result for SARS-CoV-2. In the group of patients with COVID-19 symptoms, according to the best Youden's index, the cut-off value for the Rapid Emergency Medicine Score was determined as 3.5 (sensitivity: 81.82%, specificity: 73.08%), and the area under curve (AUC) value was 0.840 (95% confidence interval 0.768-0.913). In the same group, according to the best Youden's index, the cut-off value for the Rapid Acute Physiology Score was 2.5 (sensitivity: 90.9%, specificity: 97.38%), and the AUC value was 0.519 (95% confidence interval 0.393-0.646). CONCLUSION: REMS is able to predict patients with COVID-19-like symptoms without positive rt-PCR for SARS-CoV-2 that are at a high-risk of 30-day mortality. Prospective multicenter cohort studies are needed to provide best scoring system for triage in pandemic clinics.

Characteristics of injuries among infants who fall from bed.

INTRODUCTION: Accidental falls are the most common causes of injury among infants. Due to their limited ability to move independently, falling from bed or other types of furniture (such as sofas or armchairs) is considered the most common reason for such injury. However, little is known about the frequency and types of injury associated with this type of fall among infants. This study aimed to determine the incidence and characteristics of injury among infants presented at emergency departments (ED) after falling from bed or similar furniture. METHODS: The retrospective analysis of infants under one year old presenting at ED after falling from bed (or similar furniture) was performed over a four-year period (2016-2019). Patient demographics, incidence and patterns of injury, outcomes, and ED resources use were evaluated as part of the study. RESULTS: In total, 1,439 infants were included in the study, of whom 782 (54.3%) were male and 657 (45.7%) female. The median age of the patients was 7 months (interquartile range [IQR]: 6-9 months). More than half the infants (n = 812, 56.4%) had minor injuries, such as abrasions, bruising, contusions, and lacerations. There were significant injuries for 135 (9.4%) infants. The most common fracture was skull fracture (n = 59, 4.1%), followed by proximal fracture of the upper extremities (n = 26, 1.8%). Six (0.4%) patients had radial head subluxation. Traumatic brain injury featured for 30 (2.1%) infants (intracranial hemorrhage/cerebral contusion). While the majority of patients (n = 1352, 94%) were discharged from ED, 86 (6%) infants were hospitalized, all due to head injuries. A neurosurgical intervention was performed with three (0.2% of all patients) of the hospitalized patients. CONCLUSION: Falling from bed causes skull fractures, traumatic brain injury, and long bone fractures among infants. Therefore, campaigns should be organized to raise awareness of these risks among parents and caregivers of infants. In addition, the use of safety equipment (such as bed rails) and creating a safe environment can help prevent significant injuries.