Coronavirus Disease 2019 Outcomes in Amyloid A Protein Amyloidosis Secondary to Rheumatic Conditions and Signs of Post- Coronavirus Disease 2019 Proteinuria Progression.

BACKGROUND: We aimed to investigate coronavirus diease 2019 (COVID-19) outcomes in patients with amyloid A protein (AA) amyloidosis secondary to rheumatic diseases and discuss factors associated with disease course. METHODS: A retrospective cohort was formed from adult patients with a diagnosis of AA amyloidosis. In patients with a positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction (PCR) test, rates of hospitalization, intensive care unit admission and mortality due to COVID-19 were collected from medical records. Data regarding to demographics, comorbidities, laboratory tests, medical treatments, adherence to previous treatments during COVID-19 and treatment administered for COVID-19 were collected from hospital databases and patient reviews. RESULTS: In 96 patients with AA amyloidosis, 16 had COVID-19 with a positive PCR. Ten (62.5%) patients were hospitalized, 2 (12.5%) were admitted to ICU, 1 (6.25%) was died. Hospitalized patients tended to be older. Comorbidities seemed to be more frequent in hospitalized patients. None of the patients had rapid progression to end-stage renal disease post-COVID-19. Seven patients had pre-COVID-19 and post-COVID-19 proteinuria levels. Three had notable increase in proteinuria after COVID-19 in 2 of which amyloidosis treatment was revised accordingly. CONCLUSION: Despite high rates of hospitalization in AA amyloidosis patients, mortality was observed only in 1 patient. Progression of proteinuria requiring treatment adjustment may be an issue in these patients. Cite this article as: Güven SC, Erden A, Küçük H, et al. Coronavirus disease 2019 outcomes in amyloid A protein amyloidosis secondary to rheumatic conditions and signs of post-coronavirus disease 2019 proteinuria progression. Eur J Rheumatol. Published online April 4, 2024. DOI:10.5152/eurjrheum.2024.23050.

Prehospital Emergency Service Use for Substance-Related Issues before and during COVID-19.

Objective: The COVID-19 pandemic disrupted the healthcare system and disproportionally affected individuals with substance use. This study aimed to evaluate the prehospital emergency medical service (EMS) use for substance-related health issues during the COVID-19 pandemic period and compare the changes with the pre-COVID-19 period. Methods: The prehospital EMS calls due to substance-related problems in overall Turkiye were analyzed retrospectively. The applications were categorized into the pre-COVID-19 period (May 11, 2019, to March 11, 2020) and the COVID-19 period (March 11, 2020, to January 4, 2021). These two periods were compared to if there were any changes in sociodemographic features of the applicants, the reason for EMS calls, and the dispatch results of the calls. Results: There were 6,191 calls in the pre-COVID-19 period and 4,758 calls in the COVID-19 period. According to the age groups, the number of applications of 18 years and under decreased, while the application of people 65 years and over increased during the COVID-19 period (p < 0.001). Considering the reasons for the EMS application, there was an increase in the calls due to suicide and transfers during the COVID-19 period. Besides, the EMS applications for court-ordered treatment decreased in the COVID-19 period (p < 0.001). There was no statistically significant difference in terms of dispatch results (p = 0.081). Conclusions: This study shows that the elderly group is at higher risk for substance-related medical problems. Suicide is an important risk among individuals with substance use. The increase in demand for ambulance transfer services can place a significant burden on prehospital emergency care. There is a need for measures to provide emergency and transport services, especially for the elderly and suicide attempts during any future case of emergency.

Analysis of Suicide Cases from Ankara Province: A 3-year Emergency Medical Services Experience.

AIM: While the term "completed suicide" refers to suicides that have resulted in death,"suicide attempts" refers to all attempts that do not result in death.Analyzing EMS cases is a reliable method of obtaining data on suicide attempts and completed suicides. We aimed to determine the relationship between the occurrence of cases on weekdays, weekends, public holidays or long holidays and case characteristics. METHODOLOGY: We evaluated EMS data of Ankara Province on completed suicide and suicide attempts including the date range 01.01.2017- 31.12.2019. We evaluated the data in terms of age, gender, mortality at the scene, and suicide method. In addition, we  evaluated the data according to the hour, day, month, season, and year of the cases. We classified the suicide cases according to their occurrence on weekdays, weekends, public holidays or long holidays. RESULTS: During the 3-year period included in the study, Ankara EMS assigned ambulances to a total of 940,546 cases. Of these cases, 8231 (0.875%) were suicide attempts and completed suicides. Suicide attempts were most frequent in males, in the 20-24 age group, in summer, in July, on Sundays, and between the hours 18:00 and 24:00. The most common method in suicide attempts was self-poisoning by drugs. Completed suicides were most frequent in males, in the 30-34 age group, in spring, in May, on Mondays and Tuesdays, and between the hours 18:00 and 24:00. CONCLUSION: We evaluated different characteristics of suicide cases of EMS. In Turkey, there are few studies in the EMS field on this issue. Therefore, we believe that this study will contribute to the epidemiological evaluation of suicides. We hope that results of this study will help to prevent both suicides and suicide attempts.

COVID-19 in patients with Behçet's disease: Outcomes and rate of Behçet's exacerbations in a retrospective cohort.

OBJECTIVES: The aim of this study is to investigate the outcomes of coronavirus disease 2019 (COVID-19) in our cohort of Behçet's disease (BD) patients and to reveal the rate of BD exacerbations due to COVID-19. METHODS: Patients who have been followed with a diagnosis of BD were retrospectively investigated for a positive severe acute respiratory syndrome-coronavirus 2 polymerized chain reaction (PCR) test. Data regarding demographics, clinical features and COVID-19 outcomes were collected from medical records for patients with a positive PCR. PCR-positive patients were reached via phone numbers, and 'Behçet's Disease Current Activity Form' (BDCAF) scores for pre- and post-COVID-19 BD symptoms were calculated. RESULTS: Out of a total 648 BD patients, 59 were detected to have a positive PCR test. Three of the 59 patients (5.0%) were found to be hospitalized, none of them was admitted to the ICU or died. An increasing trend in the frequency of comorbid diseases and older age was observed in hospitalized patients. 32.2% of BD patients suffered from exacerbation of at least one symptom related to BD. CONCLUSIONS: We observed no ICU admission or mortality with COVID-19 in our BD patient cohort. A substantial number of patients suffered from exacerbation of BD symptoms.

The role of trauma scoring systems and serum lactate level in predicting prognosis in thoracic trauma.

BACKGROUND: Chest trauma constitutes 10% of admissions due to trauma and causes 25-50% of trauma-related deaths. It is important to evaluate the level of thoracic trauma in patients accurately and early, start the correct treatment, predict the need for intensive care and mortality, and prevent complications that may develop. In this study, the predictive efficiency of the serum lactate level, shock index, and scoring systems regarding the prognosis in patients with major thoracic trauma were compared. METHODS: The files of the 683 patients who applied to the emergency department of our hospital due to trauma, between 2014 and 2020, were analyzed retrospectively. Patients with isolated thoracic trauma were included in the study. RESULTS: A total of 683 patients were included in the study. Of the patients, 34 (5%) were in the non-survivor group and 649 (95%) were in the survivor group. There was no statistically significant difference between the systolic blood pressure, diastolic blood pressure, pulse rate, respiratory rate, or shock index in either group (p>0.05). The Glasgow Come Scale (GCS) score in the non-survivor group was significantly lower than that in the survivor group (p=0.000). The lactate level, revised trauma score (RTS), injury severity score (ISS), and New ISS (NISS) in the non-survivor group were significantly higher than those in the survivor group. A significant difference was found in terms of age, lactate level, and the GCS, RTS, ISS, and NISS (p<0.05). In logistic regression analysis, it was found that a 1 unit increase in the lactate value increased the mortality rate by 1.19 times in terms of the effect of the trauma scores and numerical change in the lactate level on mortality. CONCLUSION: In patients with thoracic trauma, the NISS may be a useful factor that can be used in emergency rooms when a quick decision is required. However, increases in blood lactate levels during patient follow-up may also be a blood parameter that the clinician should pay attention to. In addition, further studies should be conducted on scoring in patients with thoracic trauma.

Manual cardiopulmonary resuscitation versus mechanical cardiopulmonary resuscitation: Which one is more effective during ambulance transport?

OBJECTIVES: Although studies in the field of emergency medical services (EMS) generally compare survival and hospital discharge rates, there are not many studies measuring the quality of cardiopulmonary resuscitation (CPR). In this study, we aimed to compare the mechanical chest compression device and paramedics in terms of CPR quality. METHODS: This is an experimental trial. This study was performed by the EMS of Ankara city (capital of Turkey). Twenty (ten males and ten females) paramedics participated in the study. We used LUCAS™ 2 as a mechanical chest compression device in the study. Paramedics applied chest compression in twenty rounds, whereas mechanical chest compression device applied chest compression in another set of twenty rounds. The depth, rate, and hands-off time of chest compression were measured by means of the model's recording system. RESULTS: The median chest compression rate was 120.1 compressions per minute (interquartile range [IQR]: 25%-75% = 117.9-133.5) for the paramedics, whereas it was 102.3 compressions per minute for the mechanical chest compression device (IQR: 25%-75% = 102.1-102.7) (P < 0.001). The median chest compression depth was 38.9 mm (IQR: 25%-75% = 32.9-45.5) for the paramedics, whereas it was 52.7 mm for the mechanical chest compression device (IQR: 25%-75% = 51.8-55.0) (P < 0.001). The median hands-off time during CPR was 6.9% (IQR: 25-75 = 5.0%-10.1%) for the paramedics and 9% for the mechanical chest compression device (IQR: 25%-75% = 8.2%-12.5%) (P = 0.09). CONCLUSION: During patient transport, according to the chest compression performed by the health-care professionals, it was found that those performed by the mechanical chest compression device were more suitable than that performed by the guides in terms of both speed and duration.

Comparison of Trauma Severity Scores (ISS, NISS, RTS, BIG Score, and TRISS) in Multiple Trauma Patients.

BACKGROUND: Trauma severity scoring systems are routinely used to monitor trauma patient outcomes. Yet, the most accurate scoring system remains an elusive target. OBJECTIVE: We aim to compare trauma severity scales (ISS, NISS, RTS, TRISS, and BIG) in multitrauma patients and investigate BIG as one of the new trauma severity scoring systems. METHODS: The demographic data of the patients, vital signs, injury mechanisms, body regions exposed to trauma, final diagnosis, the injury severity scales-Injury Severity Score (ISS), New Injury Severity Score (NISS), Revised Trauma Score (RTS), base deficit, international normalized ratio, and Glasgow Coma Scale (BIG), and Trauma and Injury Severity Score (TRISS)-the length of stay in hospital, and the progress of the patients were examined. RESULTS: A total of 426 cases were included in the study. The best performing score in determining mortality was TRISS (area under the curve [AUC]: 0.93, sensitivity 97.1% and specificity 76.7%). This was followed by the NISS, BIG, ISS, and RTS, respectively. For the prediction of intensive care unit admission, the NISS was the most successful with an AUC value of 0.81. There was a significant relationship in terms of the length of stay in all trauma scores (p < .05). CONCLUSIONS: The most successful score in predicting mortality in trauma patients was the TRISS, whereas the NISS was the most successful in predicting intensive care unit admission. The newly developed BIG score can be used as a strong scoring method for predicting prognosis in trauma patients.

COVID-19 outcomes in patients with familial Mediterranean fever: a retrospective cohort study.

Aim of this study is to investigate the course of coronavirus disease 2019 (COVID-19), in our cohort of familial Mediterranean fever (FMF) patients in means of mortality, admission to hospital and/or intensive care unit and length of hospital stay.A retrospective cohort was formed from patients who have previously been followed with a diagnosis of FMF. Patients of this cohort were retrospectively evaluated for a positive severe acute respiratory syndrome-coronavirus 2 (SARS-CoV 2) polymerized chain reaction (PCR) test result and information regarding hospitalisation, intensive care unit admission and mortality were collected from medical records.Out of a total 496 FMF patients, 34 were detected to have a positive SARS-CoV 2 PCR test. Eighty-five point three percent of these patients were under colchicine treatment and 17.6% were under interleukin (IL)-1 inhibitor treatment. Eight of the 34 patients (23.9%) were found to be hospitalized, one of them was admitted to the intensive care unit and died thereafter (2.9%). An increasing trend in the frequency of comorbid diseases (presence of at least one comorbidity 64.7% in all patients vs 75.0% in hospitalized patients) and IL-1 inhibitor usage (17.6% in all patients vs 50.0% in hospitalized patients) was observed in hospitalized patients.Rates of comorbid diseases and IL-1 inhibitor use for FMF were observed to be increased in FMF patients hospitalized for COVID-19.

The role of plasma presepsin levels in determining the incidence of septic shock and mortality in patients with sepsis.

INTRODUCTION: The present study aimed to investigate the role of plasma presepsin in the early detection of septic shock and in determining the prognosis and mortality of patients with sepsis. METHODOLOGY: The study was conducted in the emergency department between 1 January 2017 and 1 July 2017. A total of 106 patients 18 years of age or older who were diagnosed with sepsis according to the quick sequential organ failure assessment (qSOFA) criteria were included in this prospective study. The patients' symptoms, vital signs, additional diseases, demographic attributes, laboratory results, Mortality in Emergency Department Sepsis (MEDS) scores, imaging findings and treatments were recorded. Moreover, the patients' blood samples were collected to measure plasma presepsin, procalcitonin and CRP levels. RESULTS: In total, 55.7% of the patients were female. The median age of the patients was 78 (24-103) years, and their 30-day mortality rate was 67%. The presepsin level was significantly higher in the sepsis group than in the healthy control group (p < 0.001). The presepsin levels did not differ significantly between the sepsis and septic shock groups (p = 0.12). Similarly, the procalcitonin levels did not differ significantly between the sepsis and septic shock groups (p > 0.05). There was no significant difference in the presepsin, procalcitonin and CRP levels between survivor and non-survivor patients (p = 0.74). CONCLUSIONS: The plasma presepsin level was found to be ineffective in determining the incidence of septic shock and mortality in patients with sepsis in the emergency department.

Role of lung ultrasonography in the diagnosis of COVID-19 patients admitted to the emergency department.

Introduction: In this study, the use of lung ultrasonography (LUS) to diagnosis lung findings was evaluated in patients with suspected COVID-19 who were admitted to the emergency department (ED). Methods: This observational clinical study was conducted in the ED of the Ankara City Hospital during the period April 1-30, 2020. Patients who were admitted to the ED were triaged as COVID-19 infected and who agreed to undergo LUS/LCT (lung computed tomography) were included in the study. Results: Included in the study were 40 patients who had been prediagnosed with COVID-19. Pneumonia was detected with LCT in 32 (80%) patients, while the LUS examination identified pneumonia in 23 patients. The most common finding in LCT was ground-glass opacity (n = 29, 90.6%). Of the 23 patients with pneumonia findings in LUS, 15 (65.2%) had direct consolidation. Among the 32 patients who were found to have pneumonia as a result of LCT, 20 (62.5%) had signs of pneumonia on LUS examination, and 12 had no signs of pneumonia. In addition, 3 patients showed no signs of pneumonia with LCT, but they were misdiagnosed with pneumonia by LUS. The sensitivity of LUS in the diagnosis of pneumonia in the COVID-19 patients was 62.5%, while its specificity was 62.5%. In addition, its positive predictive value was 87.0%, and its negative predictive value was 29.4%. Conclusion: LUS may also be used in the diagnosis of pneumonia in COVID-19 patients because it is a valuable and accessible bedside diagnostic tool.

Effects of COVID-19 Pandemic on Emergency Medical Services.

INTRODUCTION: In this study, we aimed to analyse the changes that occurred after the COVID-19 pandemic using the data of EMS of Ankara province. MATERIALS AND METHODS: EMS data for the same time interval (March 11-April 24) in the last 3 years (2018, 2019 and 2020) were compared. RESULTS: While the number of calls increased by 90.9% during the pandemic period (from 2019 to 2020), the number of cases increased by 9.8%. Of all cases transported to hospital, 15.2% were suspected of and 2.9% were diagnosed with COVID-19. In the pandemic period, case frequency decreased in the 0-6 age group (-4.1%) and 7-18 age group (-39.9%) while the number of patients in the 19-65 age group (12.9%) and 65+ age group (21.5%) increased. There was a statistically significant difference between pre-pandemic and pandemic period in terms of rural area case frequency. During the pandemic period, case frequency of angina pectoris (-35.2%), myocardial infarction (-45%), acute abdomen (-23.8%) and cerebrovascular diseases (-2.9%) decreased contrary to pre-pandemic period (2019). During the same period, symptoms of fever (+14.1%) and cough (+956.3%) increased. There was a statistically significant difference between pre-pandemic and pandemic period in terms of forensic case frequency (P < .05). In addition, there was a statistically significant difference between these periods in terms of the frequency of patients who died at the scene. CONCLUSION: Although the use of ambulances has increased in the pandemic process, the use of EMS for time-sensitive diseases has decreased.

The role of the quick sequential organ failure assessment score (qSOFA) and modified early warning score (MEWS) in the pre-hospitalization prediction of sepsis prognosis.

OBJECTIVE: Many biomarkers and scoring systems to make clinical predictions about the prognosis of sepsis have been investigated. In this study, we aimed to assess the use of the quick sequential organ failure assessment score (qSOFA) and modified early warning score (MEWS) scoring systems in emergency health care services for sepsis to predict intensive care hospitalization and 28-day mortality. METHOD: Patients who arrived by ambulance at the Emergency Department (ED) of Diskapi YildirimBeyazit Training and Research Hospital between January 2017 and December 2019, and who were diagnosed with sepsis and admitted to the hospital were included in the study. Demographic data and physiological parameters from 112 ambulance case delivery forms were recorded.QSOFA and MEWS scores were calculated from vital parameters. RESULTS: Of the 266 patients diagnosed with sepsis, 50% (n = 133) were female, and the mean age was 74.8 ± 13. The difference between the rate of intensive care (ICU) hospitalization and mortality for patients with a high MEWS and qSOFA score and patients whose MEWS and qSOFA score were lower was found to be statistically significant (p < 0.05). Thus, the criteria for MEWS and qSOFA could determine ICU hospitalization and early mortality. Those with a high MEWS value had a mortality rate approximately 1.24 times higher than those with a low MEWS value (p < 0.001, 95% CI: 1.110-1.385), while those with a high qSOFA score had a mortality rate approximately 2.0 times higher than those with a low qSOFA score (p < 0.001, 95% CI: 1.446-2.693). Those with a high MEWS were 1.34 times more likely than hose with a lower MEWS to require ICU hospitalization (p < 0.001, 95% CI: 1.1773-1.5131), while patients with a high qSOFA score were 3.21 times more likely than those with a lower qSOFA score to require ICU care (p < 0.001, 95% CI: 2.2289-4.6093). CONCLUSION: Although qSOFA and MEWS are clinical scores used to identify septic patients outside the critical care unit, we believe that patients already diagnosed with sepsis can be assessed with qSOFA and MEWS prior to hospitalization to predict intensive care hospitalization and mortality. qSOFA was found be more valuable than MEWS in determining the prognosis of pre-hospitalization sepsis.

Comparison of pneumonia severity scores for patients diagnosed with pneumonia in emergency department.

BACKGROUND & OBJECTIVES: : Sepsis due to pneumonia or pneumonia itself is one of the main causes of deaths in patients despite the advanced treatment methods. The optimal prognostic tool in pneumonia is still not clear. This study was aimed to compare the pneumonia severity scores and the possibility of using the new scores in patients who were diagnosed with pneumonia in the emergency department. METHODS: : Demographic data, laboratory and imaging results, confusion, elevated blood urea nitrogen, respiratory rate and blood pressure plus age ≥65 yr (CURB-65), pneumonia severity index (PSI), national early warning score (NEWS), NEWS-lactate (NEWS-L) scores, hospitalization, referral, discharge and 30-day mortality of patients who were diagnosed with pneumonia in emergency department were recorded. RESULTS: : A total of 250 patients were included in the study. The most successful score in predicted mortality was found to be NEWS-L. This was followed by NEWS, CURB-65 and PSI, respectively. Most successful scores in anticipation of admission to the intensive care unit were NEWS-L followed by NEWS. This was followed by CURB-65 and PSI scores, respectively. The most successful score in anticipation of hospital admission was NEWS-L, followed by NEWS, CURB-65 and PSI, respectively. There was a significant difference between all pneumonia severity scores of the patients who died and survived within 30 days. There was a significant difference between the scores of patients in intensive care unit (ICU) and service, compared to non-ICU patients. INTERPRETATION & CONCLUSIONS: : NEWS-L score was found to be the most successful score in predicting mortality, ICU admission and hospitalization requirement. Both NEWS-L and NEWS scores can be used in determining the mortality, need for hospitalization and intensive care of the patients with pneumonia in the emergency department.

The Effect of the COVID-19 Pandemic on the Anxiety Level of Emergency Medical Services Professionals.

INTRODUCTION: Healthcare professionals are one of the groups most affected by a pandemic that affects the whole world. This study aimed to determine the anxiety level of emergency medical services professionals in Ankara, Turkey after the emergence of the COVID-19 pandemic. SUBJECTS AND METHODS: In the first part of the survey, the participants of the study were asked about their socio-demographic characteristics and their contact with the COVID-19 patients. In the second part, a survey with 20 questions that determined the state anxiety level derived from the State Anxiety Inventory was performed after obtaining verbal consent. RESULTS: The mean age of the participants was 33.1±6.9, while 52.7% of all participants were males. In this study, the mean STAI Anxiety Score was 50.7±11.6. Anxiety scores were higher in females and those who had family members at risk of COVID-19 infection (p<0.05). The majority of those who had family members at risk of the infection started to stay in guesthouses instead of going home. Participants were worried about transmitting the infection to their family members (p<0.05). They felt more anxious when treating COVID-19 diagnosed or other patients (p<0.05). In addition, they thought that their anxiety level increased in general (p<0.05). CONCLUSION: The COVID-19 pandemic caused an anxiety increase in EMS workers in Turkey. Protecting the physical and mental health of the EMS employees who work at the front line against the COVID-19 pandemic and who have a high risk of infection, and ensuring their efficient work should be the main priority.

Role of hematological parameters in COVID-19 patients in the emergency room.

Aim: In this study, the roles of biomarkers from a peripheral blood sample in the diagnosis of COVID-19 patients who have visited the emergency room have been evaluated. Materials & methods: Peripheral blood parameters, systemic inflammatory index (SII), neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio were compared in patients with and without confirmed COVID-19 infection. Results: Comparisons made according to real-time PCR test results revealed that while no statistically significant difference was observed between test groups (negative-positive) regarding lymphocyte and platelet lymphocyte ratio values (p > 0.05), a statistically significant difference (p < 0.05) was found between the test groups regarding platelet, hemoglobin, leukocyte, neutrophil, NLR and SII values. Conclusion: Leukocyte, neutrophil, platelet count, NLR and SII values can be used in the diagnosis of COVID-19.

Relationship between right ventricular dilatation and blood copeptin levels in patients with acute pulmonary embolism.

PURPOSE: In this study, we aimed to investigate the importance of copeptin in the diagnosis of acute pulmonary embolism, detection of right ventricular dilatation and clinical severity and prognosis of pulmonary embolism. MATERIALS AND METHODS: In the study three groups were created; Group 1: Pulmonary embolism patients with right ventricular dilatation in echocardiography, Group 2: Pulmonary embolism patients without right ventricular dilatation in echocardiography, Group 3: Healthy people. Five mL of venous blood was collected for the measurement of serum copeptin from the patients and control group. D-dimer and troponin were studied with routine blood samples. Complaints, symptom and physical examination findings, tomography and echocardiography results, laboratory results of patients and treatments they received were recorded for the statistical analysis. RESULTS: Copeptin levels of acute pulmonary embolism patients were significantly higher than healthy individuals (P < 0.001). Copeptin values of Group 1 patients were significantly higher than Group 2 patients and Group 3 patients (P < 0.001). There was a statistically significant difference the levels of copeptin, D-dimer and troponin between patients with right ventricular dilatation and patients without right ventricular dilatation (P < 0.05). AUC value in detecting right ventricular dilatation of copeptin was found to be 0.82, while specificity was 83.3% and sensitivity was 69.6%. Copeptin, D-dimer and troponin levels of patients with increased pulmonary artery pressure were statistically significantly higher than patients with normal pulmonary artery pressure (P < 0.05). CONCLUSION: Copeptin can be used in the diagnosis of acute pulmonary embolism and in the detection of right ventricular dilatation in pulmonary embolism.

The effect of meteorological variables on suicide.

We aimed to reveal the relationship between the meteorological variables and suicide rates (completed suicides and suicide attempts) independently of the seasonal cycle and holiday effects. This is an observational retrospective study. We collected the data on age, gender, and suicide method of all suicide cases transferred to hospitals from the scene by emergency medical services as well as those cases in which the victim died on the scene between January 1, 2017 and June 30, 2019. We also collected data on maximum, minimum, and average temperatures (°C), average humidity (%), and average actual pressure (hPa) measured daily in Ankara. The total number of cases due to suicide between the given dates was 6777. The suicide method in 60.1% of the cases was drug poisoning, which was the most common suicide method. Investigating the effect of meteorological variables on suicide cases (suicide attempts and completed suicides), the present study found that after smoothing the effect of the day of the week and seasonality, an increase in the minimum temperature on the day of the application by 1 unit (1°C degree) leads to an increase in the number of suicides by 0.01 point (0.01 ± 0.005, p = 0.046). There was no significant change in the variables other than the minimum temperature. We believe that the results of the present study will contribute to growing body literature about the epidemiology of suicide. We also believe that there is a need for large-scale studies that include individual data to reveal causality.

Elevated cardiac enzymes due to mushroom poisoning.

Mushroom poisoning is an important reason of plant toxicity. Wild mushrooms that gathered from pastures and forests can be dangerous for human health. The clinical outcomes and symptoms of mushroom toxicity vary from mild gastrointestinal symptoms to acute multiple organ failure. Toxic effects to kidney and liver of amatoxin are common but cardiotoxic effects are unusual. In this case, we reported the cardiotoxic effect of amatoxin with the elevated troponin-I without any additional finding in electrocardiography, echocardiography and angiography.