Can mean platelet volume be a prognosis predictor in viral infections: An example of Covid-19.

Purpose: This study revealed the utility of mean platelet volume (MPV) as a mortality marker in SARS-CoV-2 infection, as well as its connection with other inflammatory indicators such as procalcitonin (PCT) and neutrophil-lymphocyte ratio (NLR). Methods: A total of 1528 patients (853 males and 653 females; mean age: 64.33 ± 16.36 years; range, 18-100 years) were hospitalized with COVID-19 between March 2020 and December 2022. The patients' demographic and clinical information, including ward and critical care data, were gathered from their medical records. On the first and last days, the PCT, NLR, and MPV values of the patients, who were divided into groups based on their hospitalization and outcomes, were analyzed. Results: When the relevant laboratory data from the first and last days were compared, each group was statistically significant (p < 0.05). There was a moderate association between the final MPV values and the PCT and NLR values of the patients admitted to the ward (r = 0.448 and r = 0.397, respectively, where p < 0.01). There was also a substantial and moderate correlation between the final MPV levels and the PCT and NLR values of patients admitted to the intensive care unit (r = 0.613 and r = 0.361, respectively, p < 0.01). When compared to the patients' outcomes, the MPV had greater specificity and AUC values than the PCT and NLR (94.4 %, 0.968, 80.6 %, 0.923, 81 %, 0.845, respectively). Conclusion: In patients hospitalized with COVID-19, the specificity of MPV values at the point of sickness severity and outcome was shown to be greater than PCT and NLR values, and MPV values may be a more accurate predictor of mortality than PCR and NLR.

Clinical use of copeptin in migraine patients admitted to the emergency department.

PURPOSE: The purpose of this study was to investigate the clinical use of copeptin to evaluate migraine attacks in the Emergency Department. An additional aim was to detect changes in serum copeptin levels in migraine patients during attack and attack-free periods. METHODS: This prospective case-control study included 52 migraine patients and 51 healthy individuals with similar demographic characteristics. Blood samples were collected from migraine patients both in attack and attack-free periods. RESULTS: The mean copeptin levels in the patients group in the attack and attack-free periods were 689.28 and 576.68 pg/ml, respectively, whereas they were 608.68 pg/ml in the control group. There was a significant difference in the mean copeptin level in the attack period and attack-free periods (p = 0.026). The sensitivity and specificity of copeptin in detecting headache episodes in migraine patients were 58.8% and 60.7%, respectively, at a cut-off value of 388.67 pg/ml. CONCLUSION: This is the first study to investigate the diagnostic efficacy of serum copeptin levels in migraine patients. Although the diagnostic efficacy of serum copeptin levels for migraines was unsatisfactory, it could be helpful at management of migraine patients in ED.

A New Promising Treatment Strategy for Carbon Monoxide Poisoning: High Flow Nasal Cannula Oxygen Therapy.

BACKGROUND High-flow nasal cannula (HFNC) is an alternative to conventional normobaric oxygen therapy (NBO) for hypoxemic patients. Since nothing is known about its effect on carbon monoxide (CO) poisoning, we hypothesized that HFNC might be a useful device in the treatment of CO poisoning victims. MATERIAL AND METHODS We retrospectively reviewed the medical records of patients who were admitted consecutively to the emergency department with CO intoxication. Patients were divided into 2 groups: patients treated with HFNC and patients treated with conventional face mask (CFM). Demographic data, pretreatment, and control (after 1 hour) arterial blood gas analyses values of the patients were evaluated. RESULTS Sixty-eight patients (mean age 35.8±18.7 years) were included in this study. NBO was given via HFNC to 38 patients (55.9%), and via CFM to 30 patients (44.1%). The demographic characteristics and pretreatment values of carboxy-hemoglobin (COHb) were similar in the 2 groups. The mean COHb value of the HFNC group at the first hour was found significantly lower than the CFM group: 9.5±4.7 and 12.0±5.1, respectively (P=0.041). Improvement of COHb level was significantly higher in the HFNC group compared to the CFM group: 12.5±4.5 versus 6.7±3.7, respectively (P=0.001). CONCLUSIONS HFNC was superior than CFM in alleviating COHb levels in the victims of CO poisoning. We believe that using HFNC will increase patient comfort by shortening the duration of treatment in emergency department settings, especially in patients who have mild clinical findings of CO poisoning.

A Comparison of Dexmedetomidine, Moxonidine and Alpha-Methyldopa Effects on Acute, Lethal Cocaine Toxicity.

BACKGROUND: The treatment of cocaine toxicity is an important subject for emergency physicians. We investigated the effects of dexmedetomidine, moxonidine and alpha-methyldopa on acute cocaine toxicity in mice. OBJECTIVES: The aim of this study was to evaluate the effects of dexmedetomidine, moxonidine and alpha-methyldopa in a mouse model of acute cocaine toxicity. MATERIALS AND METHODS: We performed an experiment consisting of four groups (n = 25 each). The first group received normal saline solution, the second group received 40 µg/kg of dexmedetomidine, the third group received 0.1 mg/kg of moxonidine and the fourth group received 200 mg/kg of alpha-methyldopa, all of which were intraperitoneally administered 10 minutes before cocaine hydrochloride (105 mg/kg). All animals were observed for seizures (popcorn jumping, tonic-clonic activity, or a loss of the righting reflex) and lethality over the 30 minutes following cocaine treatment. RESULTS: The ratio of animals with convulsions was lower in all treated groups when compared to the control (P < 0.001). Furthermore, 68% (n = 17) of animals in the dexmedetomidine group, 84% (n = 21) of the alpha-methyldopa group, 92% (n = 23) of the moxonidine group and 100% (n = 25) of the control group showed evidence of seizure activity (P = 0.009). Cocaine-induced lethality was observed in 12% (n = 3) of the dexmedetomidine group, 48% (n = 12) of the alpha-methyldopa group, 52% (n = 13) of the moxonidine group, and 72% (n = 18) of the control group (P < 0.001). All treatments prolonged the time to seizure, which was longest in the dexmedetomidine group (P > 0.05). In addition, the time to lethality was also longer in the same group (P < 0.001). CONCLUSIONS: The present study provides the first experimental evidence in support of dexmedetomidine treatment for cocaine-induced seizures. Premedication with dexmedetomidine reduces seizure activity in a mouse model of acute cocaine toxicity. In addition, while dexmedetomidine may be effective, moxonidine and alpha-methyldopa did not effectively prevent cocaine-induced lethality.

Multi-detector angio-CT and the use of D-dimer for the diagnosis of acute mesenteric ischemia in geriatric patients.

BACKGROUND: There is no specific laboratory method for the diagnosis of acute mesenteric ischemia (AMI). In this study, we aimed to determine the efficacy of the D-dimer test in selected cases prior to multi-detector angio-CT, which is expensive and has side effects. METHODS: Patients, over 65, with abdominal pain were included in this study. The D-dimer test was applied to 230 (34%) of 676 abdominal pain patients admitted to our emergency service. The D-dimer levels of the patients diagnosed with AMI by angio-CT were compared. RESULTS: In AMI patients sensitivity of the D-dimer test was 84.6% and the specificity was 47.9%. Elevated D-dimer levels and AF were observed in 90.9% of the patients diagnosed with AMI by CT. CONCLUSION: D-dimer levels were elevated in the AMI patients. Patients suspected of having AMI with unclear clinical results and patients with D-dimer levels above 1000 ng/ml and AF should undergo further evaluation.

Effect of End-Tidal Carbon Dioxide Measurement on Resuscitation Efficiency and Termination of Resuscitation.

OBJECTIVES: In this study, the value of end-tidal carbon dioxide (ETCO2) levels measured by capnometry were evaluated as indicators of resuscitation effectiveness and survival in patients presenting to the emergency department with cardiopulmonary arrest. METHODS: ETCO2 was measured after 2 minutes of compression or 150 compressions. ETCO2 values were measured in patients that were intubated and in those who underwent chest compression. The following parameters were recorded for each patient: demographic data, chronic illness, respiration type, pre-hospital CPR, arrest rhythm, arterial blood gas measurements, ETCO2 values with an interval of 5 minutes between the measurement and the estimated time of arrest, time to return to spontaneous circulation. RESULTS: Cardiac arrest developed in 97 cases, including 56 who were out of the hospital and 41 who were in the hospital. Fifty of these patients returned to spontaneous circulation, and just one of these had an initial ETCO2 value below 10 mmHg. The mean of the final ETCO2 levels was 36.4±4.46 among Patients who Return to Spontaneous Circulation (RSCPs) and 11.74±7.01 among those that died. In all rhythms; Asystole, pulseless electrical activity (PEA) and VF/VT; Overall, RSCPs had higher ETCO2 levels than the cases who died. Among the PEA patients undergoing in-hospital arrests and those asystolic patients undergoing out of hospital arrest, the ETCO2 values of the RSCPs were significantly higher than those of the cases who died. CONCLUSIONS: ETCO2 levels predicted survival as well as the effectiveness of CPR for patients who received CPR and were monitored by capnometry in the emergency department. As a result, we believe that it would be suitable to use capnometry in all units where the CPR is performed.

Can mean platelet volume levels of trauma patients predict severity of trauma?

Abstract In this study, we aimed to evaluate the mean platelet voulme (MPV) levels of trauma patients who were admitted to our emergency department. Of the total 232 trauma patients, 40 females and 192 males over the age of 18 years were included in this study. Of them, 102 patients were mild trauma [Glasgow Coma Scale (GCS) 15-13)], 40 patients were moderate (GCS 12-9) and 90 patients were severe trauma (GCS 8-3) patients. We also calculated the Revised Trauma Score (RTS) of the patients. MPV levels were evaluated with GCS and RTS values. The control group was constituted of 100 healthy adults. Mean initial MPV value of GCS 15-13 patients was 8.25 fL, 8.25 fL in GCS 12-9 patients and 8.47 fL, in GCS 8-3 patients. Trauma severity was significantly related with initial MPV (iMPV) levels (p<0.05), initial Hb (iHb) levels (p<0.05), initial white blood count (iWBC) (p<0.05) and initial platelet (iPlt) levels (p<0.05). Severity of trauma was related with control MPV (kMPV) levels (p<0.05), control Hb (kHb) (p<0.05), control WBC (kWBC) (p<0.05), control Plt (kPlt) levels (p<0.05). MPV levels (p<0.05), Hb levels (p<0.05), WBC levels (p<0.05), Plt levels (p<0.05) were significantly different between trauma group and healthy group. IMPV and control kMPV levels were not related (p=0.149). But kHb - iHb levels (p<0.05), kWBC - iWBC levels (p<0.05), kPlt - iPlt levels (p<0.05), kGCS - iiGCS (p<0.05) were related to each other. We found a correlation between iMPV and iWBC levels (p<0.05, r=-0.342). Similarly, there was a correlation between severity of trauma and iMPV level (p<0.05, r=-0.224). We determined a significant correlation between iMPV and iPlt levels (p<0.05, r=-0.246). There was not a correlation between kMPV and kWBC (p>0.05, r=0.124). kMPV and kPlt levels (p<0.05, r=-0.174) were correlated. RTS was statistically related with GCS (p<0.05). Similarly, RTS was related with iMPV (p<0.05), iWBC(p<0.05) and iPlt (p<0.05) values, but there was not a relation with iHb (p>0.05). We found correlations between iMPV- trauma severity (p<0.05, r=-0.224), iMPV - RTS (p<0.05, r=0.134), iMPV - iWBC (p<0.05 r=-0.342), iMPV - iPlt (p<0.05, r=-0.246). Control RTS (seventh day of hospitalization) values were not related to kMPV (p>0.05), kHB (p>0.05), kWBC (p>0.05) and kPlt(p>0.05). There was a correlation between kRTS and kMPV (p<0.05, r=-0.169). Similarly, kMPV - kHb (p<0.05, r=-0.141), kMPV - kPlt (p<0.05, r=-0.174) were correlated. KMPV and kPlt were not correlated (p<0.05, r=0.124). Initial RTS and seventh day RTS values were significantly different (p<0.05). MPV may be helpful for emergency physicians for predicting the severity of trauma.

The significance of routine laboratory parameters in patients with sudden sensorineural hearing loss.

There are several factors (viral infections, metabolic and ototoxic disorders etc.) accused for the development of sudden sensorineural hearing loss. Some prognostic factors (late onset of treatment etc.) had been evaluated in the literature. There is no sufficient data on the effect of routine laboratory parameters on the development and/or prognosis of sudden sensorineural hearing loss. The aim of this study is to investigate the effects of routine blood chemistry and hematological parameters on the development and prognosis of disease in patients with idiopathic sudden sensorineural hearing loss. One hundred and forty-seven patients with the diagnosis of idiopathic sudden sensorineural hearing loss followed up during the periods of 2000-2010 years were included in this study. One hundred and three septoplasty patients with no otologic complaints were enrolled as control group. Following the clinical and demographic evaluations, patients with idiopathic sudden sensorineural hearing loss and control groups, and patients treated successfully and patients with poor outcome were compared with each other. Data were analyzed by T test. All hematological and biochemical parameters were compared. Hemoglobin, hematocrit, white blood cell count, total and direct bilirubin, fasting blood glucose level and aspartate aminotransferase were significantly different between idiopathic sudden sensorineural hearing loss and control groups. There was no significantly different parameter between patients treated successfully and patients with poor outcome. Hemoglobin, hematocrit, white blood cell count, total and direct bilirubin, fasting blood glucose level and AST all can be risk factors for SHL, or they can be the result of undetermined pathology, because these parameters have no effect on the prognosis. Other routine parameters seem to have no effect on the development and/or prognosis of idiopathic sudden sensorineural hearing loss.

Neuroprotective effects of raloxifene on experimental spinal cord injury in rats.

INTRODUCTION: The aim of this study was to evaluate the possible beneficial effect of raloxifene on cytokine production and ultrastructure of the spinal cord after spinal cord injury (SCI) in an animal model. METHODS: Forty-eight male, adult Wistar Albino rats were divided into 4 groups for this study: A (only laminectomy), B (trauma; laminectomy + spinal trauma), C (raloxifene group; laminectomy + spinal trauma + raloxifene treated) and D (vehicle group; laminectomy + spinal trauma + vehicle treated). SCI was achieved by compression of the spinal cord horizontally and extradurally for 1 minute with an aneurysm clip (Sugita no: 07-934-11, closing pressure of 1.37-1.72 N). Spinal cords were extirpated at T7-T12 level, and tissue samples of the spinal cord samples were gathered for tumor necrosis factor α (TNF-α)/protein and interleukin (IL)-1ß/protein measurements at first and sixth hours. Spinal cords harvested at sixth hour were evaluated for ultrastructural changes. RESULTS: Both TNF-α/protein and IL-1ß/protein levels in the samples harvested 6 hours after surgery in the group B (62.70 ± 6.67 pg/mg and 11.25 ± 1.37 pg/mg, respectively) were higher than those taken from group A (P = 0.002 and P = 0.041, respectively). Furthermore, TNF-α/protein and IL-1ß/protein levels in the samples of animals treated with raloxifene (23.27 ± 5.27 pg/mg and 6.09 ± 0.77 pg/mg, respectively) were significantly lower than those taken from group B (P = 0.002 and P = 0.002, respectively). In the trauma group, electron microscopic examinations revealed deformities inside the cells and severe edema in neuropil. Raloxifene seemed to attenuate these ultrastructural changes at sixth hour after SCI. CONCLUSION: A single dose of 3.0 mg/kg of raloxifene intraperitoneally given 30 minutes after the induction of SCI reduced the production of TNF-α and IL-1ß 6 hours after SCI and attenuated ultrastructural changes in a rat model.

The efficacy of single-dose 5-fluorouracil therapy in experimental caustic esophageal burn.

INTRODUCTION: Accidental ingestion of caustic substances may cause serious problems in children. Approximately 20% of caustic ingestions result in esophageal stricture formation, resulting from excessive collagen synthesis to the extracellular matrix by fibroblasts. Recent studies showed that a single application of 5-fluorouracil (5-FU) is a very effective inhibitor of fibroblast proliferation and differentiation for prolonged periods. Using an experimental model, we investigated the efficacy of single-dose 5-FU on stricture formation after caustic esophageal burn. MATERIALS AND METHODS: Forty Wistar-Albino rats were divided randomly into 4 equal groups: group 1 (sham-operated group), the esophagus was uninjured and untreated; group 2 (control group), the esophagus was injured and left untreated; group 3 (intraperitoneal treatment group), the esophagus was injured and treated immediately after the burn injury with a single intraperitoneal dose (20 mg/kg) of 5-FU; group 4 (local treatment group), the esophagus was injured and treated immediately after the burn injury with a single intraesophageal application of 5-FU at a concentration of 25 mg/mL. Caustic esophageal burn was produced by instilling 10% NaOH in the distal esophagus. The distal esophagi were harvested at 28 days postoperatively. Histologic sections were assessed by measuring the stenosis index (SI) and histopathologic damage score. Hydroxyproline (HP) levels in the tissues were determined biochemically. RESULTS: There were significant reductions in the SI (P < .05), histopathologic damage score (P < .05), and HP level (P < .05) in the intraperitoneal treatment group when compared with the control group. No significant differences in the SI and histopathologic damage score were detected between the control and local treatment groups (P > .05), whereas significant reduction in the HP level was determined between these groups (P < .05). CONCLUSION: A single intraperitoneal dose of 5-FU had a preventive effect on stricture formation after caustic esophageal burn. This observation suggests that 5-FU may prevent this undesirable complication in the clinical setting. Clinical studies are now required to verify this form of treatment. Local intraesophageal application of 5-FU immediately after the burn injury was not effective. Further investigations are required to determine the appropriate timing of application of 5-FU at the local site of injury.

Effects of postgraduate emergency training among general practitioners working in emergency units in Denizli, Turkey.

INTRODUCTION: Emergency medicine is characterised by rapid decision-making to help patients in life-threatening situations. For this purpose, special qualifications are necessary. The aim of our study was to evaluate the emergency medicine knowledge obtained during an obligatory postgraduate emergency medicine training programme that has been recently applied among Turkish physicians. METHODS: The training targeted all general practitioners (GPs) working in emergency units in the city hospitals, city-wide primary healthcare centres, public health offices, emergency services and private hospitals. Over an 8-month period between September 2004 and April 2005, seven individual groups of approximately 45 physicians were formed. Each group undertook an identical 5-day training programme and every participant completed identical pre-and post-training tests. RESULTS: Two-hundred and ninety-eight physicians participated in the training programme. The majority of participants were male (n=224, 75.2%), aged between 35 and 39 years (n=127, 42.6%), had been in the medical professional for 11 to 15 years (n=121, 40.7%), and were employed in city hospitals (n=102, 34.2%). Surprisingly, the majority of GPs had never participated in a postgraduate training programme before (n=166, 55.7%). Mean post-test scores of the participants were significantly higher than the pre-test scores (89.70%+/-12.41% vs 43.15%+/-10.47%, respectively; P<0.001). Mean pretest scores were significantly higher in the emergency services subgroup (51%, P=0.001) and in the subgroup of participants that had previously undertaken two or more postgraduate training courses (47.9%, P=0.004) compared with the mean pre-test scores of the other subgroups. However post-test scores were not statistically different between the groups. CONCLUSIONS: This postgraduate emergency medicine training programme appears to be effective in improving physicians' knowledge regarding emergencies. Any developing emergency medicine system in Turkey should include continuous, up-to-date, standardised educational programmes for emergency professionals. These may include postgraduate workshops to improve the knowledge and skill levels of emergency professionals.

Intravenous administration of metoclopramide by 2 min bolus vs 15 min infusion: does it affect the improvement of headache while reducing the side effects?

OBJECTIVE: To determine the therapeutic effect (alleviation of vascular type headache) and side effects of a slow intravenous metoclopramide infusion over 15 min compared with those effects of a bolus intravenous metoclopramide infusion over 2 min in the treatment of patients with recent onset vascular type headache. MATERIAL AND METHODS: All adults treated with metoclopramide for vascular type headache were eligible for entry into this clinical randomised double blinded trial. This study compared the effects of two different rates of intravenous infusion of metoclopramide over a period of 13 months at a university hospital emergency department. During the trial, side effects and headache scores were recorded at baseline (0 min), and then at 5, 15, 30 and 60 min. Repeated measures analysis of variance was used to compare the medication's efficacy and side effects. RESULTS: A total of 120 patients presenting to the emergency department met the inclusion criteria. Of these, 62 patients (51.7%) were given 10 mg metoclopramide as a slow intravenous infusion over 15 min (SIG group) and 58 patients (48.3%) were given 10 mg metoclopramide intravenous bolus infusion over 2 min (BIG group). 17 of the 58 patients in the BIG group (29.3%) and 4 of the 62 patients (6.5%) in the SIG group had akathisia (p = 0.001). There were no significant differences between the BIG and SIG groups in terms of mean headache scores (p = 0.34) and no adverse reactions in the study period. Metoclopramide successfully relieved the headache symptom(s) of patients in both the BIG and SIG groups. CONCLUSION: Slowing the infusion rate of metoclopramide is an effective strategy for the improvement of headache and reducing the incidence of akathisia in patients with vascular type headache.

First aid: level of knowledge of relatives and bystanders in emergency situations.

Bystanders who are able to provide immediate first aid to patients who require emergency care can make a big difference in the outcome. Thus, first-aid training should be made available to as many people as possible. The aims of this study were to assess the level of first-aid knowledge among bystanders in emergency situations and to identify factors that affected this level of knowledge. At Dokuz Eylul University Emergency Service between February 1 and February 15, 2002, 318 bystanders were given a questionnaire. The first part of the questionnaire was concerned with demographic characteristics and factors that would affect first-aid knowledge level. The second part consisted of 16 multiple choice questions about first aid. Bystanders answered an average of 7.16+/-3.14 questions correctly. Bystanders who had graduated from a university, were health care personnel, had taken a first-aid course, had a first-aid certificate, or had a driver's license were considered to be more successful.

Midazolam vs. diphenhydramine for the treatment of metoclopramide-induced akathisia: a randomized controlled trial.

OBJECTIVES: To compare the effects of midazolam, which is a fast and short-acting benzodiazepine, and diphenhydramine, which is a widely used anticholinergic agent, in clinical practice for the treatment of metoclopramide-induced akathisia. METHODS: All adults older than 17 years given metoclopramide for nausea and vomiting or for headache and who had akathisia were eligible for this clinical, randomized, double-blind trial. Patients were randomized to receive diphenhydramine or midazolam. Subjective, objective, and total akathisia scores and modified Ramsay Sedation Scale scores were recorded. Repeated-measures analysis of variance was used to compare the efficacy and side effects of the medications. RESULTS: Forty-one (73.3%) of the 56 enrolled patients were women. The mean (+/-SD) age was 39.9 (+/-15.7) years in the diphenhydramine group and 40.9 (+/-16.2) years in the midazolam group. Mean subjective, objective, and total akathisia scores in the first 5 minutes declined considerably in the midazolam group compared with the diphenhydramine group (p < 0.001). However, the mean Ramsay Sedation Scale score in the first 15 minutes increased significantly in the midazolam group compared with the diphenhydramine group (p < 0.001). CONCLUSIONS: Midazolam can correct the symptoms of metoclopramide-induced akathisia faster than diphenhydramine, but it causes more sedation.