Association of carbon monoxide poisonings and carboxyhemoglobin levels with COVID-19 and clinical severity.

BACKGROUND: Coronavirus disease 2019 (COVID-19), which recently spread throughout the entire world, is still a significant health issue. Additionally, the most common cause of risky poisoning in emergency services is carbon monoxide (CO) poisoning. Both disorders seem to merit more research as they have an impact on all bodily systems via the lungs. AIM: To determine how arterial blood gas and carboxyhemoglobin (COHb) levels affect the clinical and prognostic results of individuals requiring emergency treatment who have both COVID-19 and CO poisoning. METHODS: Between January 2018 and December 2021, 479 CO-poisoning patients participated in this single-center, retrospective study. Patients were primarily divided into two groups for analysis: Pre-pandemic and pandemic periods. Additionally, the pandemic era was divided into categories based on the presence of COVID-19 and, if present, the clinical severity of the infection. The hospital information system was used to extract patient demographic, clinical, arterial blood gas, COVID-19 polymerase chain reaction, and other laboratory data. RESULTS: The mean age of the 479 patients was 54.93 ± 11.51 years, and 187 (39%) were female. 226 (47%) patients were in the pandemic group and 143 (30%) of them had a history of COVID-19. While the mean potential of hydrogen (pH) in arterial blood gas of all patients was 7.28 ± 0.15, it was 7.35 ± 0.10 in the pre-pandemic group and 7.05 ± 0.16 in the severe group during the pandemic period (P < 0.001). COHb was 23.98 ± 4.19% in the outpatients and 45.26% ± 3.19% in the mortality group (P < 0.001). Partial arterial oxygen pressure (PaO2) was 89.63 ± 7.62 mmHg in the pre-pandemic group, and 79.50 ± 7.18 mmHg in the severe group during the pandemic period (P < 0.001). Despite the fact that mortality occurred in 35 (7%) of all cases, pandemic cases accounted for 30 of these deaths (85.7%) (P <0.001). The association between COHb, troponin, lactate, partial arterial pressure of carbon dioxide, HCO3, calcium, glucose, age, pH, PaO2, potassium, sodium, and base excess levels in the pre-pandemic and pandemic groups was statistically significant in univariate linear analysis. CONCLUSION: Air exchange barrier disruption caused by COVID-19 may have pulmonary consequences. In patients with a history of pandemic COVID-19, clinical results and survival are considerably unfavorable in cases of CO poisoning.

Disaster area triage in the first 24 h of earthquakes, evaluation of pre-hospital and hospital procedures: 6.6 Elazig earthquake.

BACKGROUND: Earthquakes are natural events, but the destruction they cause is quite high. Since it is not possible to prevent an earthquake, it is necessary to raise conscious and sensitive individuals about earthquakes and to seek solutions. It was aimed to present the triage, consumables, fluids, and drugs used in the 2020 Elazig earthquake. METHODS: After the earthquake, the epicenter of which was Sivrice/Elazig on January 24, 2020, all affected victims, pre-hospital triage status, management of emergency, and other inpatient services during the hospitalization, medical interventions including sur-geries, consumables, fluids, and drugs were evaluated retrospectively with the data in the first 24 h. RESULTS: The total number of injured after the earthquake in Elazig, which had a magnitude of 6.6 on the Richter scale and lasted for 22 s, was 974. While 37 (3.7%) people died, 18 (1.8%) of them were women. While 34 people died in the wreckage and 3 people in the emergency department, their mean age was 46.0±12.5 years. While 654 patients were registered in the first 24 h, 30 of them were by 112 Command and Control Center and 624 were outpatients. Temporary registration was provided to 320 people as they did not have their identity information. CONCLUSION: Being prepared and organized before an earthquake, and taking early intervention will provide significant success in the survival of the disaster victims.

Correct triage at the scene increases success in the ED: Sabiha Gökçen Airport plane accident.

BACKGROUND: Triage is the most important part of the management of events, such as accidents, earthquakes, fires, and floods, in which mass injuries occur. The aim of this study is to evaluate the effects of triage on patient outcomes, injuries, the role of trauma mechanisms, and spinal immobilization during transportation following the plane crash at the Istanbul Sabiha Gökçen airport that involved 183 patients on February 5, 2020. METHODS: Command control center data and ambulance and medical charts were examined retrospectively. The results were evaluated in terms of spinal immobilization, injury type, triage codes, and ISS values during emergency interventions and transportation. RESULTS: We received the first notice at 18: 21 about the plane that had landed and crashed at 18: 19 on February 5, 2020, and the first team reached the security gate at 18: 26. The first team arrived at the debris field and performed triage. On the airside of the airport, the first victims were taken at 18: 32, transferred at 18: 36, and reached the hospital at 18: 41. The first case was taken from the debris field at 18: 35 and transferred to the hospital. Of the 183 patients on the plane, three became exitus at the scene, 43.7% of the victims were female, and the mean age was 35.0±15.7. The mean systolic blood pressure of the victims was 122.0±17.4. The mean distance to hospitals, transportation time, intervention time, heart rate, and ISS levels were measured as 55.0 (23.0-79.0) km; 780.5 (390.0-1540.0) s; 817.0 (552.0-1200.0) s; 86.0 (78.0-100.0); and 4.5 (1.0-9.0), respectively. A positive significant correlation was found between ISS and the days of hospitalization (r=0.577; p<0.001). CONCLUSION: The fact that no patient was lost during the follow-up and treatment is an indication that triage, appropriate patient referral to the appropriate hospital, and primary and secondary care are well performed, as well as the crash of the plane while landing. Coordinated acts of the airport and 112 emergency health services and guidance for appropriate triage reduced both pre-hospital and hospital mortality.

Importance of Team Experience and Coordination in Disaster Response: Building Collapse.

OBJECTIVE: The objective of this study was to determine whether coordination of prehospital emergency health services and Disaster and Emergency Management Presidency (DEMP) and being prepared for disasters, such as building collapses, allow quick evaluation and fast intervention. METHODS: The information flow, hierarchy, treatment, and rehabilitation processes, and rescue organization and planning during the rescue attempt for 35 people who needed help due to this building collapse were reviewed. RESULTS: Of the 43 people who lived in this 8-story building, 35 were inside the building during the collapse; 40% of them were assessed as injured and 60% as exitus. Almost two-thirds (64.3%) of the injured individuals who were rescued were women. The mean duration until rescue was 330 (57.0-512.0) min. CONCLUSIONS: Leading and important factors that can increase the success rate in search and rescue interventions are informing official authorities as first early warning by individuals who can clearly define the situation, early security measures by security forces arriving before the health and search-rescue teams, accurate identification of estimated numbers of injured victims, and identifying and informing appropriate hospitals which victims rescued from the debris will be transferred to there.

A new method: measurement of pancreas volume in computerised tomography as a diagnostic guide for acute pancreatitis.

OBJECTIVE: To investigate whether measuring pancreas volume with abdominal tomography in patients with severe abdominal pain can predict acute pancreatitis. METHODS: The case-control study was conducted at Adnan Menderes University from January 1, 2015, to January 1, 2017, and comprised patients who were diagnosed with acute pancreatitis. Pancreas volume measurements of patients and control group were made with Telemed Ekinoks software using freehand technique. Presence of a correlation between pancreas volume and pancreatitis was found in patients aged <57 years and a cut-off value was calculated for pancreatitis in this particular patient group. RESULTS: Of the 183 subjects, 132(72%) were patients with a mean age of 59.6±16.5 years, and 51(28%) were controls with a mean age of 55.8±18.6 years (p=0.170). The difference between the groups in terms of pancreas volume was significant (p<0.001). There was a negative correlation between age and pancreas volume among the patients (p<0.001), the correlation was not significant among the controls (p=0.898). Among the subjects aged <57 years, the cut-off value was calculated at 95.055, and sensitivity to pancreas volume was 70.91% while specificity was 82.14%. Positive predictive value was 88.6%. CONCLUSIONS: High pancreas volume with pancreatitis was observed in patients aged <57 years.

Does MDR1 Analysis Predict Medical Therapy Modifications in Patients with Atrial Fibrillation?

OBJECTIVE: To evaluate the effects of multi-drug resistance gene (MDR1) gene factor which is significant in medicinereceptor relationship, on readmission to the emergency department (ED) and medical therapy modifications in patients with atrial fibrillation (AF) readmitting to the emergency department. STUDY DESIGN: Descriptive, analytical study. PLACE AND DURATION OF STUDY: Department of Emergency Medicine, Adnan Menderes University, Aydin, Turkey, from January 2016 to January 2017. METHODOLOGY: Fifty patients who did not have AF with rapid ventricular response, and 32 controls have been included in the study. Electronic recording system of the hospital was checked regularly to detect any readmission of these patients due to palpitation; and they were asked whether they had any ED readmission and any changes in medical therapy by calling them during the one-year period. Then, MDR1 1236TC, 2677TG and 3435TC gene analyses and medical treatment regimens of the patients after 1 year were compared. RESULTS: No significant differences were found neither between the study and the control group nor between the genders in the study group regarding the results of MDR1 gene analyses. Besides, there were no differences in medical treatment regimens compared to MDR1 gene analyses in the group with AF. There were no statistically significant differences in the results of MDR1 gene analysis in patients whose medical treatment regimen had been changed during the one-year period. CONCLUSION: MDR1 gene analyses did not have any significant effect on the development of AF, readmission to the ED and modification of the treatment regimenin the Turkish population.

Predicting critical duration and reversibility of damage in acute mesenteric ischemia: An experimental study.

BACKGROUND: The objective of the current study was to investigate the value of the ischemic biomarkers endothelial cell-specific molecule-1 (endocan) and signal peptide-CUB-EGF domain-containing protein-1 (SCUBE-1) in the diagnosis and assessment of earlystage and irreversible damage in acute mesenteric ischemia. METHODS: An experimental mesenteric ischemia reperfusion model was designed using 54 rats. Nine groups were created: Three sham groups [Groups I (30th minute), IV (2nd hour), and VII (6th hour)], in which only blood and tissue specimens were sampled; 3 ischemia groups [Groups II (30th minute), V (2nd hour), and VIII (6th hour)], in which blood and tissue specimens were sampled after ligation of the superior mesenteric artery (SMA); and 3 reperfusion groups [Groups III (30th minute), VI (2nd hour), and IX (6th hour)], in which blood and tissue specimens were sampled after declamping the SMA and reperfusion for 1 hour. SCUBE-1 and endocan samples obtained from blood and tissue were examined histopathologically. RESULTS: The SCUBE-1 level was higher in the ischemia groups when compared with the sham groups (p<0.05), and the endocan level was markedly different in the late ischemia (6th hour) group. When these 2 markers were used together to assess irreversible mesenteric damage in the histopathological examination, the sensitivity in distinguishing between reversible or irreversible damage was 94.1% with a specificity of 73.7%. CONCLUSION: The elevation of SCUBE-1 alone seems to be significant for predicting early mesenteric ischemia in laboratory rats. The combination of SCUBE-1 and endocan may be useful to detect irreversible intestinal damage.

The predictive value of the inflammatory markers P-selectin and MCP1 in determining the length of stay and 30-day survival in the differentiation of sepsis patients.

OBJECTIVE: Sepsis is the leading disease that is diagnosed late and still has a mortal course in emergency departments. The primary factors that will reduce both morbidity and mortality are early diagnosis and an early treatment approach. Therefore, in this study, P-selectin and MCP1 levels, which are known to be markers of inflammation, were examined in patients being followed up in intensive care. METHODS: Patients evaluated with a preliminary diagnosis of sepsis in the emergency intensive care unit between September 2015 and August 2016 were classified as having sepsis or infection according to the Q- SOFA criteria, and the P- selectin values were compared. RESULTS: In the sepsis group, GCS was determined as 13 (12-13), SBP 90 (80-110), tachypnea 24 (22-26), lactate 3.8 (0.6-16.0), MAP 70 (60-77), and LOS 16 days (9.5-20.3). In the ROC analysis, the sensitivity of P-selectin and MCP1 in the differentiation of patients with and without sepsis was 95.7%, and 73.8%, and the specificity was 97.8% and 73.8%, respectively. According to the cutoff values, the sensitivity and specificity in the prediction of patient mortality were 71.4% and 65.6% in P- selectin and 78.6% and 65.6% in MCP1. CONCLUSIONS: The P-selectin and MCP1 values in the emergency department can differentiate sepsis patients according to the Q-SOFA criteria and showed 30-day mortality at a significant level. Therefore, in patients with suspected sepsis in an emergency department, MCP1 can be of benefit to physicians in their decisions regarding LOS and transfer to intensive care.

Which is the best in carbamazepine overdose?

Intravenous lipid emulsion treatment is safer, faster, and easier to apply and could be a powerful alternative to extracorporeal treatment methods in carbamazepine intoxication.

Assessment of sphenoid sinus related anatomic variations with computed tomography.

INTRODUCTION: Frequent and broad application of endoscopic sinus surgery (ESS) in parallel with experience makes it imperative to know the anatomy and the existing pathology very well before surgery. This study examines the association between anomalies in the sphenoid sinus area in paranasal sinuses computed tomography (PNS-CT) and pathological findings and determines variations of sphenoid sinus. METHODS: A total of 200 cases (100 women, 100 men) who had PNS-CT in the emergency and radiology polyclinics within the period of one year were included in this study. Bone tissue anomalies and soft tissue pathologies were assessed in the CT. RESULTS: Pterygoid process was found in 36.75% of our cases, anterior clinoid pneumatization was found in 21.25%; vidian canal in 34.25%, foramen rotundum in 17.5% and ICA in 12.75% had protrusion into the sphenoid sinus; 8.25% were found to have onodi cell, 11.25% were found to have multiple septation, 16.75% were found to have mucosal thickening and 2.5% were found to have retention cyst. CONCLUSION: The importance of PNS-CT in terms of determining anatomic variations before ESC and predicting possible complications during surgery has been emphasized once more. In our study, as sphenoid sinus pneumatization increased, the projection of neighbouring vein and nerve structures into the sinus was found to increase as well.

Treatment methods following suicidal self-administration of IV organophosphate: What can additional lipid administration change?

Organic phosphor compounds are highly toxic and life-threatening compounds that are widely used in agriculture, households and gardens worldwide. While oral intakes are observed frequently, toxic effects can also be seen through contract or inhalation. However, toxic cases through the parenteral route have rarely been reported. We had three main aims: first, to present a male patient who self-administered 2ml of monocrotophos intravenously to commit suicide. Our second goal was to present the current multiple treatment methods, such as fast general support, antidote treatment, lipid emulsion treatment, and plasmapheresis along with the literature. Third, we aimed to emphasize that with these treatments, patients' intensive care needs, intermediate symptoms, and hospitalization periods can be decreased and thus mortality and morbidity increase can be prevented.

Effects of Hyperbaric Oxygen Treatment on Renal System.

INTRODUCTION: Hyperbaric oxygen (HBO) treatment is steadily increasing as a therapeutic modality for various types of diseases. Although good clinical outcomes were reported with HBO treatment for various diseases, the multisystemic effects of this modality are still unclear. This study aimed to investigate the renal effects of HBO experimentally. MATERIALS AND METHODS: Fourteen New Zealand White rabbits were divided into 2 groups randomly as the control group and the study group. The study group received HBO treatment for 28 days (100% oxygen at 2.5 atmospheres for 90 minutes daily) and the control group was used to obtain normal renal tissue of the animal genus. After the intervention period, venous blood samples were obtained, and renal tissue samples were harvested for comparisons. RESULTS: Normal histological morphology was determined with Masson trichrome staining and periodic acid-Schiff staining in the control group. Atrophic glomerular structures, vacuolated tubule cells, and degeneration were detected in the renal samples of the study group with Masson trichrome staining. Additionally, flattening was observed on the brush borders of the proximal tubules, and tubular dilatation was visualized with periodic acid-Schiff staining. The histopathologic disruption of renal morphology was verified with detection of significantly elevated kidney function laboratory biomarkers in the study group. CONCLUSIONS: Our findings suggests that HBO has adverse effects on renal glomerulus and proximal tubules. However, the functional effects of this alteration should be investigated with further studies.

The relationship between anemia and recurrence of ischemic stroke in patients with Trousseau's syndrome: A retrospective cross-sectional study.

OBJECTIVES: The relationship between cancer and thrombosis was first recognized by the French internist Armand Trousseau in 1865. Trousseau's syndrome is a spectrum of symptoms that result from recurrent thromboembolism associated with cancer or malignancy-related hypercoagulability. In this study, we investigated whether demographics, clinical features, or laboratory findings were able to predict recurrent stroke episodes in patients with Trousseau's syndrome. METHODS: In total, 178 adult patients were enrolled in this retrospective cross-sectional study. All patients had been admitted to the emergency room of our hospital between January 2011 and September 2014 and were diagnosed with acute ischemic stroke. Patients were divided into two groups: patients with malignancy (Trousseau's syndrome), and patients without malignancy. RESULTS: There were several significant differences between the laboratory results of the two patient groups. For patients with Trousseau's, the hemoglobin levels for those with one stroke was 12.29 ± 1.81, while those in patients who had experienced more than one stroke was 10.94 ± 2.14 (p = 0.004). CONCLUSIONS: Trousseau's syndrome is a cancer-associated coagulopathy associated with high morbidity and mortality rates. In this study, anemia was associated with increased stroke recurrence in patients with malignancy (Trousseau's syndrome).

Prognostic value of neglected biomarker in sepsis patients with the old and new criteria: predictive role of lactate dehydrogenase.

OBJECTIVES: This study examined the pH, lactate dehydrogenase (LDH), and heart rate values on the first day of hospitalization in patients with a prediagnosis of sepsis and biomarkers that may predict mortality. METHODS: Patients hospitalized in an emergency intensive care unit with a diagnosis of systemic inflammatory response syndrome were classified as having sepsis (n = 28), septic shock (n = 8), or severe sepsis (n = 8) according to International Sepsis Guidelines (old criteria). Forty-four patients were classified as having sepsis (n = 4), septic shock (n = 30), or infection (n = 10) according to The Third International Consensus Definitions for Sepsis and Septic Shock (new criteria). The effects of these patients' laboratory values on survival between groups were compared. Significant values were evaluated by χ2 automatic interaction detection analysis. RESULTS: When the patients were categorized according to the new classification criteria, there was an increase in the number of septic shock patients and a decrease in the number of sepsis patients. In addition, 10 patients were removed from the sepsis category. There was a significant difference between ex and discharged patients in terms of heart rate, pH, sodium bicarbonate, lactate, and LDH (P= .007, P= .002, P= .034, P= .009, and P= .002, respectively). Based on a χ2 automatic interaction detection analysis of the significant values, pH, LDH, and heart rate were prominent predictors of prognosis. CONCLUSIONS: Systemic pH, LDH, and heart rate values may be used to determine the best time to discharge patients from intensive care to other, more affordable hospital units.

Chronic anabolic androgenic steroid usage associated with acute coronary syndrome in bodybuilder.

INTRODUCTION: It has been argued in current studies that anabolic androgenic steroids (AAS) are misused by a great number of bodybuilders and athletes. However, there is diverse and often conflicting scientific data on the cardiac and metabolic complications caused by the misuse of AAS. There may be various reasons for myocardial infarction (MI) with normal coronary arteries. However, for the majority of patients, the exact cause is still unknown. CASE REPORT: A 32 year-old male who was complaining about severe chest pain was admitted to our emergency department. He had been taking methenolone acetate 200 mg weekly for a period of three years for body building. His cardiac markers were significantly elevated and electrocardiogram (ECG) showed peaked T waves in all derivations, which did not show ST elevation or depression. Both right and left coronary artery systems were found to be completely normal as a result of the angiogram. CONCLUSION: The purpose of this study is to show that AAS induced MI can be encountered with normal coronary arteries during acute coronary syndrome.

The overlooked side of convulsion: bilateral posterior fracture and dislocation of proximal humerus.

Injuries after an epileptic convulsion have been seen commonly such as burns, head injury and dislocation of the extremities. But fractures of the extremities due to convulsion are rare. External trauma mechanism is not necessary for extremity fractures. Muscle contractions can cause increased load on the skeleton and it can be complicated by dislocation andor fracture of extremities. Almost 1-4% of all the shoulder dislocations are posterior. In this case report we present a 32 year old male patient who had bilateral posterior fracture and dislocation of proximal humerus after convulsion. We would like to emphasize that it is so important to make systemic examination and evaluation of the patients who were admitted to emergency department after epileptic convulsion.

Oxidative status and lymphocyte DNA damage in patients with acute pancreatitis and its relationship with severity of acute pancreatitis.

BACKGROUND/AIMS: Acute pancreatitis (AP) is a life-threatening disease with a rising incidence. The aim of this study was to investigate the association between oxidative status, lymphocyte deoxyribonucleic acid (DNA) damage, and acute pancreatitis. MATERIALS AND METHODS: A total of 45 patients with AP and 35 healthy controls were included in the study. We assessed pancreatic enzymes, oxidative stress, and lymphocyte DNA damage. The severity of AP disease was determined by the Harmless Acute Pancreatitis Score (HAPS) and Balthazar scoring systems. RESULTS: In AP patients, lymphocyte DNA damage was significantly higher than in controls [49.84±25.48 arbitrary units (AU) vs. 28.80±13.98 AU, p<0.001]. The plasma total oxidative status (TOS) and oxidative stress index (OSI) were higher in patients than in healthy controls (10.36±5.54 vs. 8.47±2.66, p<0.05; 0.64±0.35 vs. 0.45±0.13 AU, p<0.001, respectively). The plasma total antioxidant status level in patients was lower than in healthy controls (1.66±0.19 vs. 1.86±0.18, p<0.001). Lymphocyte DNA damage was correlated with TOS, OSI, and HAPS and Balthazar scores. CONCLUSION: This study shows that patients with AP have higher lymphocyte DNA damage and more deteriorated oxidative status than healthy controls.