C-reactive protein to albumin ratio may predict in-hospital mortality in non-ST elevation myocardial infarction.

Objective: The authors investigated the value of novel inflammatory markers, systemic immune-inflammation index and C-reactive protein to albumin ratio (CAR), to predict in-hospital mortality in patients with non-ST elevation myocardial infarction (NSTEMI). Materials & methods: A total of 308 patients who underwent percutaneous coronary intervention because of NSTEMI were retrospectively included in the study. Killip classification, Thrombolysis in Myocardial Infarction score, SYNTAX score, and CAR and systemic immune-inflammation index values were calculated. Results: CAR (cutoff: 0.0864; sensitivity: 94.1%; specificity: 40.5%; p = 0.008) and Killip classification (cutoff: 2.5; sensitivity: 64.7%; specificity: 8.9%; p = 0.001) were found to be significantly higher in determining in-hospital mortality. Conclusion: This study revealed that CAR is an inexpensive and significant factor in predicting in-hospital mortality in patients undergoing percutaneous coronary intervention for NSTEMI.

High or mid-flow oxygen therapy for primary headache disorders: A randomized controlled study.

BACKGROUND: Headache is one of the most common causes of emergency department (ED) visits. High-flow oxygen therapy is becoming more attractive as a treatment option because it is safe, effective, and cheap. We aimed to compare the effectiveness of high and medium-flow oxygen therapies with placebo for treating primary headache disorders among middle-aged patients. METHODS: This prospective, double-blind, placebo-controlled, crossover designed, randomized study was conducted at a regional tertiary hospital's ED. Patients who were treated for primary headache disorder in the ED were evaluated at the time of diagnosis and subsequently included in the study upon their next ED visit. Four different treatment methods were administered; 1) high-flow oxygen (15 L/min oxygen), 2) medium-flow oxygen (8 L/min oxygen), 3) high-flow room air as placebo (15 L/min room air), 4) medium-flow room air as placebo (8 L/min room air). All four treatment methods were administered to all patients included in the study, at four separate ED visits. Patients' data, including demographics, medical history, additional complaints, Visual Analogue Scale (VAS) score, and physical examination findings were recorded by the treating physician. RESULTS: One hundred and four patients with a mean age of 35.14 ± 9.1 years, were included in the study. Patients who received oxygen therapy had a significantly lower VAS score at all control points (15, 30, and 60 min) when compared with placebo (p < 0.001). This difference in scores reached its maximum at 30 min. There was not a significant statistical difference between the high-flow or mid-flow therapies (p > 0.05). It was determined that patients who received placebo therapy were more likely to revisit ED (p < 0.05). There was not a significant statistical difference between the high-flow or mid-flow therapy groups in terms of revisit (p > 0.05) and the 30th-minute analgesia requirement (p > 0.05). Pain duration was significantly less in patients who received oxygen therapy (p < 0.05). Patients who received high-flow oxygen therapy spent less time in the ED (p < 0.001). CONCLUSION: Oxygen therapy could be a beneficial treatment option for middle-aged patients with primary headache disorders. Based on the results obtained from high and mid-flow oxygen therapies, it may be more appropriate to begin treatment with mid-flow oxygen.

The Prognostic Value of C-Reactive Protein/Albumin Ratio in Acute Mesenteric Ischemia.

BACKGROUND: Diagnosis of acute mesenteric ischemia (AMI) in its early stages is important for reversing ischemic damage. The CRP to albumin (CRP/Alb) ratio has been defined as an inflammatory indicator and is associated with the severity of inflammation and mortality rates. However, the prognostic value of CRP/Alb has not been evaluated in patients with AMI. Here, we aimed to examine the prognostic significance of CRP/Alb and compare it with other inflammatory markers. MATERIALS AND METHODS: In this retrospective, case-control study, we included patients diagnosed with AMI at the emergency department between January 1, 2016, and December 31, 2020. In addition to demographic characteristics, lactate, D-dimer, white blood cell (WBC), CRP/Alb, and neutrophil/lymphocyte ratio (NLR) were recorded. Testing characteristics of CRP/Alb in predicting in-hospital mortality were studied. RESULTS: The mean age of 132 patients was 66.48 ± 15.95 years and 71 (53.8%) of them were male. The cut-off value obtained using the receiver operating characteristic (ROC) curve for in-hospital mortality was a CRP/Alb ratio of >1.32 (sensitivity, 93.65%; specificity, 69.57%; +LR, 3.08; -LR, .091; AUC, .782; 95% CI, .70-.85; P < .0001). The comparison of ROC curves between CRP/Alb and WBC, NLR, and lactate revealed a statistically significant difference (P < .05), whereas there was not any statistically significant difference between the ROC curves of CRP/Alb and D-dimer (P = .47). CONCLUSION: C-reactive protein/albumin ratio is a powerful predictor of in-hospital mortality for AMI patients. It was superior to WBC, NLR, and lactate. It could be used to determine low-risk patients and help clinicians with treatment options.

The association of nasal foreign bodies with type 1 hypersensitivity in children.

PURPOSE: This study aimed at investigating the type 1 hypersensitivity reaction frequency of children with nasal foreign body history. METHODS: From the medical records, we collected data regarding demographics (age and gender), symptoms, history of allergic diseases, physical examination, laboratory and test results, radiographic findings, the presence of any need for a second intervention, and complications. By reference to the presence of nasal foreign body history, two groups were constituted: the nasal foreign body group and the control group. Type 1 hypersensitivity frequency of the nasal foreign body group was compared with the control group. RESULTS: In the nasal foreign body group, 47 of 110 patients (42.7%) had a previous history of type 1 hypersensitivity reaction, while only 15 of 100 patients (15%) had a previous history of type 1 hypersensitivity reaction in the control group. The frequency of type 1 hypersensitivity reactions was significantly higher in patients with a history of nasal foreign body, compared to the patients without (p < 0.001, X2 = 19.35). CONCLUSION: Children with type 1 hypersensitivity reactions may be more likely to present with nasal foreign bodies. Physicians should pay more attention to the history of type 1 hypersensitivity reactions in children presenting with nasal foreign bodies.

Symptoms Associated With Personal Protective Equipment Among Frontline Health Care Professionals During the COVID-19 Pandemic.

OBJECTIVE: Personal protective equipment (PPE) use is frequently construed as inconvenient and disturbing by health care professionals (HCPs). We hypothesized that new-onset symptoms among HCPs may be associated with extended use of PPE and aimed to investigate risk factors related with new-onset symptoms. In addition, the effects of new-onset symptoms on working performance were evaluated. METHODS: In this cross-sectional study, 315 participants filled out a questionnaire that contains 4 main parts: (1) demographics, (2) new-onset symptoms with PPE use, (3) PPE usage hours, and (4) personal opinion about the effect of sensed symptoms on working performance. RESULTS: The mean age was 31.58 ± 4.6 years, and 50.5% (n = 159) were female. New-onset symptom rate was 66% (n = 208). The most common new-onset symptom was headache (n = 115, 36.5%) followed by breathing difficulty-palpitation (n = 79, 25.1%), and dermatitis (n = 64, 20.3%). Extended use of PPE, smoking, and overweight were independently associated with developing new-onset symptoms. A clear majority of symptomatic participants pointed out the impact on working performance (193/208, 92.7%). CONCLUSION: Hospitals should take the necessary precautions (eg, shorter shifts and more frequent breaks) to prevent symptoms associated with PPE and ensure that HCPs comply with these precautions.

Anxiety levels in patients admitted to the emergency department with myocardial infarction or COVID-19 pneumonia.

The COVID-19 related high morbidity and mortality have led to a common fear and anxiety. This study aimed to determine the state/trait and death anxiety levels of patients with myocardial infarction (MI) and COVID-19 pneumonia. The study was conducted at the emergency department of a tertiary hospital in Central Anatolia of Turkey. 120 patients with myocardial infarction , 120 patients with COVID-19 pneumonia, and 120 healthy volunteers as a control group were included in the study. The participants filled out the questionnaire that included the State-Trait Anxiety Inventory (STAI) and the Thorson-Powell's Revised Death Anxiety Scale (RDAS). All scores of patient groups were significantly higher than the control group. There was no significant difference in terms of STAI-S, STAI-T, and RDAS scores between COVID-19 pneumonia and MI groups. The anxiety risk increased 2.14-fold for STAI-T and 1.97-fold for STAI-S in patients with COVID-19 pneumonia compared to the control group. In this study, the state/trait and death anxiety levels of patients with COVID-19 pneumonia were as high as patients with myocardial infarction.COVID-19 pneumonia-related anxiety was associated with chronic diseases and smoking. Knowing the level of anxiety in these patients is important to provide better health services in the emergency departments.

The effect of personal protective equipment on cardiac compression quality.

INTRODUCTION: Cardiac compression is a cumbersome procedure. The American Heart Association suggests switching of cardiopulmonary resuscitation (CPR) provider every 2 min to prevent any decrease in resuscitation quality. High quality CPR is associated with improved outcomes. Previous studies have highlighted the difficulties in providing high quality CPR particularly while wearing personal protective equipment (PPE). This study aimed to evaluate the impact of personal protective equipment (PPE) use on CPR quality in prehospital cardiac arrest situations. METHODS: In this prospective simulation study, we compared the cardiac compression qualities and fatigue rates among prehospital health care professionals (HCPs) who were or were not using PPE. RESULTS: A total of 76 prehospital HCPs comprising 38 compression teams participated in this study. The mean compression rate was 117.71 ± 8.27/min without PPE and 115.58 ± 9.02/min with PPE (p = 0.191). Overall compression score was 86.95 ± 4.39 without PPE and 61.89 ± 14.43 with PPE (p < 0.001). Post-cardiac compression fatigue score was 4.42 ± 0.5 among HCPs who used their standard uniform and 7.74 ± 0.92 among those who used PPE (p < 0.001). The overall compression score difference between the two conditions was 25.05 ± 11.74 and the fatigue score difference was 3.31 ± 0.98. DISCUSSION: PPE use is associated with decreased cardiac compression quality and significantly higher fatigue rates than those associated with the use of standard uniforms. Routine use of mechanical compression devices should be considered when PPE is required for out-of-cardiac arrests.

A Retrospective Analysis of the Impact of the Coronavirus Disease 2019 Pandemic on Health Care Workers in a Tertiary Hospital in Turkey.

INTRODUCTION: Several vaccines have been developed and approved for use against severe acute respiratory syndrome coronavirus-2; however, the use of personal protective equipment remains important owing to the lack of effective specific treatment and whole community immunity. Hydroxychloroquine sulfate was a treatment option in the early days of the pandemic; however, it was subsequently removed owing to a lack of evidence as an effective treatment. We aimed to evaluate the testing and infection characteristics of coronavirus disease 2019 among health care personnel and determine the effectiveness of prophylactic hydroxychloroquine sulfate use to prevent transmission. METHODS: This retrospective observational study was conducted between May 1 and September 30, 2020. The health care personnel included in the study were physicians, nurses, and paraprofessional support personnel. The health records of health care personnel who had been tested for severe acute respiratory syndrome coronavirus-2 using polymerase chain reaction were retrospectively analyzed. RESULTS: In total, 508 health care personnel were included in the study. A total of 152 (29.9%) health care personnel were diagnosed with coronavirus disease 2019. The positive polymerase chain reaction rate was 80.3% (n = 122). A comparison of infected and uninfected health care personnel showed a difference in age and occupation and no difference in sex, working area, and prophylactic hydroxychloroquine sulfate use. DISCUSSION: Protective measures in low-risk areas of our hospital require improvements. All health care personnel should be trained on personal protective equipment use. There was no evidence to support the effectiveness of prophylactic hydroxychloroquine sulfate against severe acute respiratory syndrome coronavirus-2 transmission.

Impact of personal protective equipment on prehospital endotracheal intubation performance in simulated manikin.

BACKGROUND: Tracheal intubation in COVID-19 patients is a potentially high-risk procedure for healthcare professionals. Personal protective equipment (PPE) is recommended to minimize contact with critical patients with COVID-19 infection. This study aimed to primarily examine the effect of PPE use on intubation time and success rate among prehospital healthcare professionals; additionally, we compared intubation times among prehospital health care professionals using PPE with direct laryngoscopy and video laryngoscopy assistance. METHODS: In this prospective simulation study, we compared the intubation times and success rates among prehospital healthcare professionals who were or were not using PPE. Furthermore, demographic data, previous intubation experience, and previous intubation experience with PPE were recorded. RESULTS: Overall time to intubation with PPE use was 51.28±3.89s, which was significantly higher than that without PPE use (33.03±2.65s; p<0.001). In addition, the overall success rate with PPE use was 74.4%, which was significantly lower than that without PPE use (93%;p<0.001). PPE use increased the average intubation time by 19.73±2.59s with direct laryngoscopy and by 16.81±2.86s with video laryngoscopy (p<0.001). CONCLUSIONS: PPE use is associated with increased intubation time and decreased success rate. Video laryngoscopy assistance in cases where PPE use is required facilitates faster endotracheal intubation than does direct laryngoscopy assistance.