The relationship among plasma copeptin, carboxyhemoglobin, and lactate levels in carbon monoxide poisoning.

OBJECTIVE: The aim of our study is to determine whether there is a change in the plasma levels of copeptin and there is a relationship among the plasma levels of carboxyhemoglobin (COHb), lactate, and copeptin levels in patients presenting to the emergency department with carbon monoxide (CO) poisoning. METHODS: Fifty-seven patients admitted to the emergency department with CO poisoning were included in the study. The blood samples of the patients were collected on arrival 0th, 6th, and 12th hours for copeptin, lactate, and COHb levels. Data were analyzed using SPSS-17 statistical software. RESULTS: Arrival serum copeptin levels of the patients were compared to copeptin levels of healthy individuals and a statistically significant difference was found between them (p = 0.008). There was a statistically significant difference between the arrival levels of copeptin and 6th-hour (p = 0.006) and 12th-hour (p = 0.001) levels of copeptin. There was no significant difference between 6th-hour and 12th-hour copeptin levels (p = 0.51). In terms of serum lactate levels, there was a significant difference between arrival and 6th h (p < 0.001), arrival and 12th h (p < 0.001), and 6th and 12th h (p < 0.001). Likewise, in terms of serum COHb levels, there was a significant difference between arrival and 6th h (p < 0.001), arrival and 12th h (p < 0.001), and 6th and 12th h (p < 0.001). There was a positive correlation between COHb and lactate levels on arrival (r = 0.52; p = 0.001). CONCLUSION: Copeptin as a stress hormone can be used in the diagnosis and monitoring of patients with CO poisoning. However, the copeptin level was not superior to COHb and lactate levels.

BNP shows myocardial injury earlier than Troponin-I in experimental carbon monoxide poisoning.

OBJECTIVE: In this study, our purpose was to determine whether plasma BNP level can be useful or not in determining the severity of myocardial injury formed by CO poisoning and to compare plasma BNP level with serum cTnI level. MATERIALS AND METHODS: In the study, 46 female Wistar Albino rats were used. Rats were divided into four groups, one control group and three poisoning groups. The mixture of pure CO and air was injected for 60 minutes to provide 3000 ppm CO concentration. Blood samples of groups were collected to measure COHb, BNP and cTnI levels. Blood samples of poisoning groups were collected at the 1st, 6th and 12th hours after poisoning. After biochemical procedures, findings were analysed statistically and compared with each other. RESULTS: Eight rats which died in poisoning groups were excluded and 38 rats were evaluated. BNP levels were high in all poisoning groups compared to control group and the difference between them was statistically significant (p < 0.05). cTnI levels were high in 6th and 12th hours poisoning groups compared to control and 1st hour group but only 12th hour group had statistically significant difference (p < 0.05). A statistically positive relation was established between BNP and cTnI levels in 6th and 12th hour groups (R: 0.76 - p < 0.05 - n:38). CONCLUSIONS: It was found that BNP levels increased earlier than cTnI levels in acute severe CO poisoning. BNP levels of the cases which were determined to have increased cTnI levels showing myocardial injury increased as well. BNP can show myocardial injury and its severity in acute CO poisoning.

Comparison of hyperpronation and supination-flexion techniques in children presented to emergency department with painful pronation.

CONTEXT: Radial head subluxation, also known as 'pulled elbow', 'dislocated elbow' or 'nursemaid's elbow', is one of the most common upper extremity injuries in young children and a common reason to visit Emergency Department (ED). AIM: To compare supination of the wrist followed by flexion of the elbow (the traditional reduction technique) to hyperpronation of the wrist in the reduction of radial head subluxations (nursemaid's elbow) maneuvers in children presented to ED with painful pronation and to determine which method is less painful by children. SETTINGS AND DESIGN: This prospective randomize study involved a consecutive sampling of children between 1-5 year old who were presented to the ED with painful pronation. MATERIALS AND METHODS: The initial procedure was repeated if baseline functioning did not return 20 minutes after the initial reduction attempt. Failure of that technique 30 minutes after the initial reduction attempt resulted in a cross-over to the alternate method of reduction. STATISTICAL ANALYSIS USED: Datas were analyzed using SPSS for Windows 16.0. Mean, standard deviation, independent samples t test, Chi-square test, and paired t test were used in the assessment of pain scores before and after reduction. RESULTS: When pain scores before and after reduction were compared between groups to determine which technique is less painful by children, no significant difference was found between groups. CONCLUSIONS: It was found that in the reduction of radial head subluxations, the hyperpronation technique is more effective in children who were presented to ED with painful pronation compared with supination-flexion. However, there was no significant difference between these techniques in terms of pain.

Comparison of the effects of dexmedetomidine and remiphentanyl on emergence agitation after sevoflurane anesthesia in adults undergoing septoplasty operation: a randomized double-blind trial.

OBJECTIVES: Sevoflurane is an ideal agent for anesthesia since its respiratory irritant effect is minimal during mask induction. Emergence agitation (EA) is a common problem after anesthesia with sevoflurane. In this study it was aimed to compare the effects of dexmedetomidine and remifentanyl on emergence agitation after sevoflurane anesthesia in adults undergoing septoplasty operation. PATIENTS AND METHODS: This prospective, randomized, double-blind study was conducted in Yenimahalle State Hospital after obtaining local Ethics Committee approval and patient's written informed consent. The patients were randomized into dexmedetomidine and remifentanyl groups. Hemodynamic parameters including heart rat, Mean arterial pressure, and sPO2 were recorded. The patients were followed for 1 hour at the recovery room. Categorical data was analyzed using c2 test. Hemodynamic data was evaluated using unpaired t test for intergroup and paired t-test for within group comparisons. Data not normally distributed was compared using Mann Whitney U test. p < 0.05 was considered statistically significant. RESULTS: Demographic data were similar in both groups (p > 0.05). Riker score was similar in both groups. VAS score was also not significantly different between both groups at the recovery room. CONCLUSIONS: Our study demonstrated that Dexmedotimidine and Remifentanyl had equal effectiveness in reducing emergence agitation in patients undergoing septoplasty under Sevoflurane anesthesia.

A forgotten diagnosis in emergency department: tetanus.

INTRODUCTION: Tetanus is a serious and acute life-threatening disease caused by toxins of "Clostridium tetani". Although it is generally a disease of developing countries, its lower incidence is encountered also in developed countries. Since the principal treatment of this disease is known to be based on vaccination and wound care, the emergency physicians play a key role in its management. MATERIAL AND METHOD: In the present study, we reviewed its uncommon clinical course along with demographic and clinical features of five cases that have presented with various complaints to our Emergency Department. Presenting signs, demographic features, injury history, and the time from the occurrence of injury to the beginning of symptoms were evaluated. RESULTS: Four of five cases were female. The mean age of cases was 56.8 (34-73). Three of them had hand injury, one had foot injury, and the fifth case had facial injury. The initial symptoms included difficult jaw movement, back muscle spasm, and pain. Two cases died. CONCLUSION: Tetanus cases may present to ED with different symptoms. Therefore, physicians should be aware of the early signs of tetanus. Careful and meticulous wound management of cases presented to ED following an injury should be considered a significant factor, which can help in reducing the tetanus cases (Tab. 2, Ref. 18).

Value of biomarker-based diagnostic test in differential diagnosis of hemorrhagic-ischemic stroke.

BACKGROUND AND AIM: Stroke is an emergency which threatens life and the third leading cause of death in developed countries and the leading cause of long-term disability. By means of this study, it was aimed to evaluate the position of triage stroke panel in differential diagnosis of acute hemorrhagic stroke and ischemic stroke and sub-types of ischemic stroke. MATERIAL AND METHODS: Patients with acute stroke admitted to Emergency Department were prospectively recruited between June 2008-January 2009. BNP, D-dimer, MMP-9, S-100b levels were asseyed. Statistical significance for intergroup differences was assessed by Pearson's chi2 for categorical variables and Mann-Whitney U test or Kruskal-Wallis test for continuous variables. RESULTS AND CONCLUSION: A total of 100 consecutive patients with a diagnosis of stroke were evaluated. Of these, 29 (29%) patients had brain hemorrhages on the computed tomography scan performed the Emergency Department, 71 (71%) patients had ischemic stroke. It was observed that the intercept obtained as a result of jointly evaluating BNP, D-dimer, MMP9 and S100b is more important in differential diagnosis (p < 0.005). We suggest that using a combination of plasma biomarkers may be usefull to ischemic or hemorrhagic stroke for differential diagnosis (Tab. 4, Ref. 22).

Complications of misuse of Bacillus Calmette-Guerin.

Intravesical BCG is a good treatment choice for vesical carcinomas. Nevertheless, it can also become a mortal toxin when applied in a wrong way. The application routes of the prescribed drug should be rigorously described to patients and detailed instructions regarding the ways of application such as intravesical application should be given to the persons taking this medicine (Ref. 9).

Upper gastrointestinal system hemorrhage in the emergency department.

OBJECTIVE: In the present study, we aimed to investigate demographic and clinical characteristics of the cases presented to the Emergency Department with an acute upper gastrointestinal system hemorrhage, and to identify the initial evaluation and treatments along with explaining possible causes of hemorrhage. MATERIALS AND METHODS: This prospective study was conducted between October 1, 2006 and September 30, 2007. Characteristics of the patients were evaluated in terms of age, gender, presenting symptoms, medical history, risk factors, coexisting symptom and diseases, results of the rectal examination and nasogastric evaluation, endoscopy findings, received treatments, duration of Emergency Department stay, admitting departments, and outcomes. RESULTS: 128 patients who presented to the Emergency Department during the study period were included in the study. As 27.3 % of the patients were female, 72.7 % were male. The mean age was 59.3 (+/- 16). 51.6 % of patients had a history of NSAID and aspirin use. Endoscopy was performed in 111 (86.7 %) patients. The most common finding among endoscopy results was gastric ulcer with a rate of 20.4 % followed by duodenal ulcer in 18.3 %. The mean hospitalization period in the Emergency Department was found to be 18 hours. CONCLUSION: In conclusion, acute upper gastrointestinal hemorrhages are first evaluated and treated in Emergency Departments. Endoscopy was carried out on most of the patients during the monitoring in the Emergency Department. NSAIDs and aspirin are still the most important risk factors and peptic ulcer is the most frequently encountered underlying cause (Tab. 4, Fig. 1, Ref. 27). Full Text in free PDF www.bmj.sk.

Does Ramadan fasting increase acute upper gastrointestinal haemorrhage?

The epidemiological characteristics and clinical results of patients who presented with acute upper gastrointestinal haemorrhage (AUGIH) during the month of Ramadan (October 2007) were compared with those who presented with AUGIH during another, non-Ramadan, month (December 2007). The following were evaluated: age, gender, symptoms, gastrointestinal disease history, risk factors, co-existing diseases, results of rectal, nasogastric and endoscopic examinations, treatment modalities and clinical outcomes. Significantly more patients were diagnosed with AUGIH during Ramadan compared with the non-Ramadan month (43 versus 28, respectively). Significantly more patients diagnosed during Ramadan had a history of previous haemorrhage compared with the non-Ramadan month (72.1% versus 42.9%, respectively). Peptic ulcer was the most common event in both groups and overall endoscopy findings differed between the groups. No other significant differences were found. In conclusion, the number of patients presenting with AUGIH during Ramadan was significantly higher than that of an ordinary month, which suggests that fasting during Ramadan reactivates and aggravates pre-existing gastrointestinal diseases.

Poisoning from wild mushrooms in Eastern Anatolia region: analyses of 5 years.

The objective of this study was to describe the demographic and clinical features of patients who were admitted to the emergency department (ED) due to wild mushroom poisoning and to point the importance of mushroom poisonings in our area. This study was performed by examining the files of wild mushroom poisoning patients who were admitted to the ED of Firat University, Faculty of Medicine, between January 2000 and June 2004, retrospectively. Patients>or=16 years of age were included in the study. The frequency of wild mushroom poisoning, age and sex of the patients, season, place of the residence, laboratory findings, treatment and outcome of the patients were investigated. During the study period, 64 patients with wild mushroom poisoning were admitted to the ED. From 64 overall patients, 25 (39.1%) were males. The most common complaints during the admission were nausea, vomiting and abdominal discomfort. The duration of hospitalization was two (range 1-4 days) days. No death was observed. Severity of mushroom poisoning depends on the type of mushroom eaten, the time lag between the poisoning and admission to the hospital, and the rapid and correct treatment given to the patient either in the ambulance or at health centre.

A rare complication of chlorine gas inhalation: pneumomediastinum.

Chlorine gas is a potent pulmonary irritant that causes acute damage in both the upper and lower respiratory tract.