Emergency ultrasound of respiratory muscles: a promising tool for determining the outcomes of COPD exacerbations.

BACKGROUND: The respiratory muscles of patients with chronic obstructive pulmonary disease (COPD) exhibit structural and functional changes that can be evaluated and monitored by ultrasonography. METHODS: This single-center, prospective study was conducted in the emergency department (ED) of a tertiary care hospital over an eight-month period (September 2020-May 2021). Diaphragmatic excursions, end-expiratory thickness, and thickening fractions, as well as right and left intercostal muscle thicknesses, of all adult subjects manifesting COPD exacerbation, were assessed. The data were analyzed regarding ward/intensive care unit (ICU) hospitalization or discharge from the ED, mortality, and readmission within 15 days. RESULTS: Sixty-three subjects were recruited for the study. Diaphragmatic excursion, end-expiratory diaphragmatic thickness, and intercostal muscle thickness measurements were significantly different between the ward, ICU, and discharge groups (p < 0.001) but lower in the deceased subjects (all p < 0.05). The diaphragmatic excursion value of 3.25 cm was the threshold value measured for distinguishing discharge from ED, and 1.82 cm was measured for admission to the ICU, both with 100% sensitivity and selectivity (AUC = 1). DISCUSSION: Diaphragmatic excursion, diaphragmatic end-expiratory thickness, and right and left intercostal muscle thicknesses vary in the prognosis of subjects presenting with COPD exacerbation.

Diltiazem efficacy and CYP2D6 gene polymorphism in patients with atrial fibrillation with rapid ventricular response.

BACKGROUND: Diltiazem stands out as one of the front-line drugs administered in the emergency department to achieve acute rate control in patients suffering from atrial fibrillation with rapid Ventricular Response. One of the cytochrome enzymes involved in the metabolism of diltiazem is cytochrome P450 2D6 (CYP2D6). Interindividual differences can act on drug metabolism and thus drug efficacy due to the genetic polymorphism induced by the CYP2D6 enzyme. This study explores the association between the efficacy of diltiazem and the genetic polymorphism of CYP2D6 in patients with atrial fibrillation with rapid ventricular response. RESULTS: 87 out of 93 individuals with ventricular rate > 120 beats/min constituted the patient cohort. The patients were administered 0.25 mg/kg diltiazem intravenously. As a second dose, 0.35 mg/kg diltiazem was administered to patients who reportedly did not receive adequate drug efficacy. Heart rate control was considered to be achieved in patients whose heart rate fell below 110 beats/min and did not rise above 110 beats/min for 2 h. CYP2D6 *2, *3, *4 and *10 represent allele variants and *1 represents wild type (wt) allele. Achieving rate control after one or two doses of diltiazem in normal allele (wt/wt) carriers proved significantly higher than wt/*2, wt/*4 and wt/*10 heterozygous variant carriers. No significant difference was noted in wt/*3 heterozygous variant carriers. CONCLUSION: The presence of *2, *4 and *10 alleles was observed to significantly compromise the drug efficacy. *3 allele was found to bear no relation to the effect of diltiazem on achieving rate control.

Delayed postmortem cesarean section due to trauma.

Cardiopulmonary arrest is an occasional occurrence during pregnancy. As soon as maternal arrest is noticed in a woman in the second half of her pregnancy, medical teams should be called for perimortem cesarean (C/S). A 31-week-pregnant female patient was brought to our emergency department by the emergency medical service team with cardiopulmonary resuscitation (CPR) after a traffic accident. The patient, with no pulse or spontaneous breathing, was recognized as exitus. However, CPR was sustained to maintain fetal well-being. Before the arrival of the on-call gynecologist, we as emergency physicians initiated C/S both for fetal well-being and to avoid heighten-ing the risk of fetal mortality and morbidity. The Apgar scores were 0/3/4 and oxygen saturation values were 35/65/75% at 1/5/10 min, respectively. On the postnatal 11th day, the patient did not respond despite the advanced cardiac life support (ACLS) and thus was con-sidered exitus. The ACLS team should be knowledgeable and well-equipped to perform C/S, to do aftercare, to watch for related risks in the infant. In our case, it took 40 min for the fetus to be removed from the mother's womb, starting from the estimated time of exitus.

The effect of surgical masks on vital signs and EtCO2 in patients on oxygen therapy.

BACKGROUND: There are conflicting data on the effects of masks on vital signs and end-tidal CO2 (EtCO2) values in the literature. AIMS: This study aims to evaluate the changes in the vital parameters and EtCO2 values of the patients who were administered oxygen through nasal cannula (NC) and simple oxygen mask (SOM) and wore surgical masks (SM) on top during their treatment. METHODS: The prospective, observational study was conducted from January 2021, over consecutive 30 days, in the emergency department of a tertiary-care university hospital. The vital signs and EtCO2 values of the subjects administered O2 were noted at the time of arrival and at the 30th and 120th minutes of treatment. Changes in vital signs and EtCO2 values were compared with regard to NC-SM and SOM-SM applications over a 120-min study period. RESULTS: Sixty-eight subjects were included in two groups (NC-SM [n = 49] and SOM-SM [n = 19]). At the 120th minute, a decrease in systolic and diastolic blood pressure, heart rate, and respiratory rate and an increase in oxygen saturation were observed in the group including all subjects. After decreasing slightly in the first 30 min, the EtCO2 value remained stable. CONCLUSIONS: NC-SM and SOM-SM applications do not affect adversely, and even seem to lead to recovery of, the vital signs and EtCO2 values during 120 min in subjects with acute complaints.

The effect of N95 respirators on vital parameters, PETCO2, among healthcare providers at the pandemic clinics.

BACKGROUND: Wearing face shields and masks, which used to have very limited public use before the COVID-19 outbreak, has been highly recommended by organizations, such as CDC and WHO, during this pandemic period. AIMS: The aim of this prospective study is to scrutinize the dynamic changes in vital parameters, change in end tidal CO2 (PETCO2) levels, the relationship of these changes with taking a break, and the subjective complaints caused by respiratory protection, while healthcare providers are performing their duties with the N95 mask. METHODS: The prospective cohort included 54 healthcare workers (doctors, nurses, paramedics) who worked in the respiratory unit of the emergency department (ED) and performed their duties by wearing valved N95 masks and face shields. The vital parameters and PETCO2 levels were measured at 0-4th-5th and 9th hours of the work-shift. RESULTS: Only the decrease in diastolic BP between 0 and 9 h was statistically significant (p = 0.038). Besides, mean arterial pressure (MAP) values indicated a significant decrease between 0-9 h and 5-9 h (p = 0.024 and p = 0.049, respectively). In terms of the vital parameters of the subjects working with and without breaks, only PETCO2 levels of those working uninterruptedly increased significantly at the 4th hour in comparison to the beginning-of-shift baseline levels (p = 0.003). CONCLUSION: Although the decrease in systolic blood pressure (SBP) and MAP values is assumed to be caused by increased fatigue due to workload and work pace as well as increase in muscle activity, the increase in PETCO2 levels in the ED healthcare staff working with no breaks between 0 and 4 h should be noted in terms of PPE-induced hypoventilation.

Investigation of Serum Angiotensin-Converting Enzyme (ACE) Concentration and ACE Gene Polymorphism in Patients With SARS-CoV-2 Pneumonia Admitted to the Emergency Department.

Background This study seeks to investigate the distribution of the angiotensin-converting enzyme (ACE) gene polymorphism and serum levels in patients with viral pneumonia and predict which polymorphism will lead to severe progression of the disease. Methodology The serum ACE levels and ACE gene polymorphisms were successfully evaluated with respect to subsequent viral pneumonia using records of 100 patients with viral pneumonia and 100 healthy controls. Results ACE serum concentration was statistically significantly elevated. ACE serum concentration with a cut-off value of ≥5,256.05 pg/mL had 85.3% sensitivity and 83.2% selectivity. In addition, patients with ACE genotype D/D were 0.08 times more likely to manifest severe lung involvement than those with I/I, and patients with the I/D genotype were 0.02 times more likely than their counterparts with I/I. The computed tomography findings of the patients revealed that ACE serum concentration was significantly effective in discriminating between mild and moderate-to-severe lung involvement. No significant difference was observed between the blood parameters and ACE genotype distributions. Conclusions I/D polymorphism likely affects the expression of the ACE gene and/or the function of the angiotensin I converting enzyme. The D/D genotype is associated with vessel wall thickness and higher blood pressure. Strong evidence was found between D/D and I/D genotypes in the patient cohort concerning genotypes and ACE serum concentration. Further analysis showed that ACE serum levels were more elevated in the D/D genotype compared to the I/D genotype in the patient cohort.

It does Exist! Traumatic Hemorrhage in Septum Pellucidum.

Although bleeding into the septum pellucidum often occurs in the presence of a tumour, trauma-induced septal pellucidum hemorrhage has not been reported yet, as far as the current literature is concerned. The absence of hemorrhage on the first post-trauma imaging of the patient but the presence of hemorrhage in the brain tomography taken 12 hours later reveals the existence of trauma-induced septum pellucidum hemorrhage. Key Words: Head trauma, Brain injury, Septum pellucidum, Hemorrhage.

Evaluation of the Diagnostic Value of Hematologic Parameters and Ratios in SARS-CoV-2 VOC-202012/01 Mutant Population.

Introduction In this study, we set out to study possible differences between individuals with and without VOC 202012/01 variant by using less costly complete blood count analytes and quickly analyzing the samples and ratios derived from these analytes. For this purpose, we assessed neutrophil, lymphocyte, platelet, and Red Blood Cell Distribution Width-Standard Deviation (RDW-SD) levels among complete blood count parameters (CBC) (identification and count of red blood cell, neutrophil, eosinophil, basophil, lymphocyte, monocyte, platelet) as well as the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). Methods A retrospective cross-sectional study was performed over the course of two months (from May to June 2021) on 212 patients who presented to the emergency department of a tertiary hospital with Covid-19 symptoms and took SARS-CoV2 PCR and CBC tests. The polymerase chain reaction (PCR)-confirmed SARS-CoV2 positive patients and their hospitalization data were gathered from the public health management system. Their VOC-202012/01 mutation status was also confirmed by this system. Results RDW-SD, RDW, NLR, and PLR indexes, as well as C-reactive protein (CRP), and lactate dehydrogenase (LDH) values, were higher in the patients with VOC-202012/01 mutation (p<0.0001) than those without mutation, while hemoglobin and hematocrit counts and ratio, as well as eosinophil and lymphocyte counts, remained lower in the patients with mutation (p<0.0001). Conclusion NLR and RLP ratios derived from hematological parameters and models based on these ratios and RDW-SD are cheaper and more widely used. Our study suggests that the hematological analytes, the ratios obtained from these analytes, and the models created through these ratios in patients presenting to the ED with COVID-19-like symptoms and having positive reverse transcription polymerase chain reaction (RT-PCR) test results were significantly different in those with and without the VOC-202012/01 mutation. The bottom line is that they can serve as reliable predictors in the assessment of patients with the VOC-202012/01 mutation.

The Correlation Between Peroxisome Proliferator-Activated Receptor Alpha and Gamma Polymorphisms and Acute Coronary Syndrome.

OBJECTIVE: This study aims to evaluate the relationship between peroxisome proliferator-activated receptor (PPAR) alpha and gamma gene polymorphisms and acute coronary syndrome (ACS) clinically. SUBJECT AND METHODS: Peripheral blood samples were collected from a total of 200 people, including 100 acute coronary syndrome patients and 100 controls aged 19 to 93 years, admitted to the Pamukkale University Emergency Medicine Department. The healthy volunteers had no known chronic or acute diseases, no history of drug use, and no recent history of coronary artery disease (CAD). PPAR alpha L162V and PPAR gamma C161T gene polymorphic regions were detected using DNA sequencing analyses. In addition, data collected from the hemogram and biochemical parameters and comorbidities of the patients were statistically analyzed. RESULTS: PPAR gamma C161T polymorphisms were compared between groups. The CT heterozygous rate in the patient group (74%) was higher than in the control group (7%). The T allele was more common in the patient group (0.37) compared to the control group (0.03). When PPAR alpha L162V polymorphism was compared, VV homozygous individuals were %19 in the patient group and none in the control group. The V allele was found to be statistically higher in patients with ACS (p<0.01). CONCLUSION: The findings revealed that elevated PPAR alpha L162V and PPAR gamma C161T gene polymorphisms were associated with a progressive risk of ACS.

Predictive Values of Coagulation Parameters to Monitor COVID-19 Patients.

Aims: In this study, we aim to unravel the relationship between coagulation parameters together with D-dimer and the severity of coronavirus disease (COVID-19) during hospitalization as well as hospitalization in the intensive care unit (ICU). Methods: This retrospective study was conducted in the Emergency Department (ED) of Pamukkale University Hospital (Denizli, Turkey) between March 1 and April 30, 2020. SARS-CoV-2 polymerase chain reaction (PCR) tests and laboratory tests, including international normalized ratio (INR), prothrombin time (PT), D-dimer, and activated thromboplastin time (APTT), were requested from 289 people presenting to the ED with symptoms of upper respiratory tract infection (URTI), such as cough, fever, and sore throat. Results: While 110 patients turned out to be polymerase chain reaction (PCR) positive, 181 individuals were PCR negative. The mean D-dimer level of the patient group was 147 ng/ml DDU (min: 9, max: 2948), and their mean PT level was found as 12.8 seconds (min: 10.3, max: 34.7). Besides, the mean APTT was 31.25 seconds (min: 19, max: 46.9), and the mean INR level was calculated as 1.09 (min: 0.88, max: 2.93). 35 of the patients were not hospitalized, while 43 were admitted to the Infectious Diseases, 20 to the Chest Diseases, and 12 to the ICU. Conclusions: It can be concluded from our findings that D-dimer, PT, and INR levels remained elevated in the COVID-19-diagnosed patients, but these parameters were unable to discriminate accurately between the patients with positive and negative SARS-CoV-2 results. Our findings also suggest that coagulation parameters might occupy a critical role in documenting clinical severity in patients with COVID-19 infection and requiring hospitalization.

The Effect of Equipment-Based Pilates (Reformer) Exercises on Body Composition, Some Physical Parameters, and Body Blood Parameters of Medical Interns.

BACKGROUND: Pilates is a type of exercise that exerts positive effects on body composition and general health. This study set out to investigate the effects of equipment-based Pilates (reformer) exercise on body composition, some physical parameters, and blood parameters of medical interns showing a tendency toward sedentary life. MATERIALS AND METHODS: The experimental group (EG) comprising 22 healthy internship students in the medical faculty performed Pilates reformer exercises for nine weeks. The control group (CG) consisted of 18 students who did not engage in any exercise program. The baseline and final parameters of all the participants were measured. RESULTS: The mean age of the experimental group (EG) was 23.68±1.29 years, while that of the control group (CG) was 24.78±3.44 (p=0.089). A significant difference was evident between the performance pre-test and post-test scores of the EG (p<0.05). However, a significant positive difference was noted only between the waist pre-test and post-test results in the body composition measurements (p<0.05). A significant rise in HDL and fasting blood sugar levels and a decrease in insulin levels was observed in the post-exercise biochemical parameters measured in the EG (p=0.05). When the EG and CG were compared, a significant difference was found only in HDL cholesterol values in relation to the differences between the pre-test and the post-test groups (p=0.024). CONCLUSION: The positive data from performance tests, especially with its HDL-increasing and insulin-lowering effects in the EG, implicate that Pilates reformer exercises can produce a favorable effect on the healthy living standards of medical interns.

The impact of COVID-19 on social support perception and stress of prehospital care providers.

BACKGROUND: This study seeks to explore the impact of COVID-19 outbreak on the social support perception and acute stress disorder of prehospital care providers (PCPs) in the province of Denizli. METHODS: This descriptive and cross-sectional study was conducted between December 25, 2020 and January 25, 2021. Out of 510 ambulatory care staff constituting the study population, there were 287 PCPs (%56.2), including 13 physicians, 89 paramedics, 134 emergency medical technicians, and 51 individuals from other occupational groups (nurse, driver, cleaning staff, medical secretary) based at emergency health services. The data collection tools employed in the study include an introductory information form, Multidimensional Scale of Perceived Social Support (MSPSS), and National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS), which was organized as an online questionnaire. RESULTS: We analyzed the data from 287 PCPs that completed the form and scales. The mean score of the NSESSS was calculated as 1.53 ± 0.79. The PCPs who experienced health problems (1.85 ± 0.69), suffered from mental problems and received psychotherapy and medication (2.57 ± 0.57), encountered COVID-19 patients (1.58 ± 0.8), provided care for COVID-19 patients (1.59 ± 0.79), and took polymerase chain reaction (PCR) tests (1.68 ± 0.78) had higher acute stress symptom levels. The total mean score of MSPSS was calculated as 66.28 ± 17.22. Total MSPSS scores of the participants varied significantly in terms of age, marital status, taking a COVID-19 test, suffering from mental problems, status of encountering a COVID-19 patient, and workplace satisfaction (p < 0.05). CONCLUSIONS: The findings are suggestive of high perceptions of multidimensional social support and low acute stress symptom levels of the PCPs during the COVID-19 pandemic period.

Comparative evaluation of the effectiveness of intravenous paracetamol, dexketoprofen and ibuprofen in acute low back pain.

INTRODUCTION: Non-traumatic back pain constitutes roughly 5% of the admissions to emergency departments. This study seeks to compare the efficacy of intravenously administered paracetamol, dexketoprofen, and ibuprofen in patients with non-traumatic acute low back pain. METHODS: This study was designed as a randomized, double-blinded investigation and carried out at a tertiary hospital. 210 eligible patients without trauma who presented with low back pain were recruited for the study and randomized into paracetamol (n = 71), dexketoprofen (n = 70), and ibuprofen (n = 69) groups. The measurements at 0, 15, 30 and 60 min were noted down by using a 100 mm VAS, and the relevant comparisons were made. RESULTS: The VAS scores at 0 and 60 min in the paracetamol, dexketoprofen, and ibuprofen groups decreased on average by 40 mm, 42 mm, and 43 mm, respectively. The baseline and final pain scores of each drug group differed significantly (p < 0.05), though the between-group analysis revealed no significant difference (p > 0.05). CONCLUSION: Given the obtained data, we did not note a significant difference between intravenous paracetamol, dexketoprofen and ibuprofen with respect to pain efficacy in non-traumatic acute low back pain. Based on the patients' clinical conditions and histories, we concluded that the choice of medication might not change the efficacy of the treatment and patient comfort.

Comparative evaluation of the efficacy of intravenous paracetamol and ibuprofen on the treatment of tonsillopharyngitis with fever: A prospective, randomized controlled, double-blind clinical trial.

OBJECTIVE: Tonsillopharyngitis is one of the constituents of upper respiratory tract infection (URTI). Fever is a URTI symptom requiring treatment due to the occurrence of discomfort and high fever-based complications. This study primarily sets out to observe and compare the efficacy of intravenous administration of paracetamol and ibuprofen drugs on fever in adult patients with tonsillopharyngitis. METHODS: This study was performed in a prospective, randomized controlled, double-blind design. The study population was divided as Group 1 (treated with paracetamol) and as Group 2 (treated with ibuprofen). While the first group was treated with paracetamol as 1000 mg in 150 ml normal saline, the second group was treated with ibuprofen as 400 mg in 150 ml normal saline. The primary outcome was the decrease in fever at 15, 30, and 60 min, while the secondary outcome was the need for additional treatment after 60 min. RESULTS: One hundred and eighty-five patients were included in the final analysis. The mean age of the paracetamol group (57.4% male) was 28.36 ± 9.6, whereas that of the ibuprofen group (54.9% male) was 27.45 ± 7.98. Fever was reduced significantly between 0 and 60 min in both groups (P ≤ 0.001 and P ≤ 0.001, respectively). Although the antipyretic effect of ibuprofen was more pronounced in the early period than that of paracetamol, no significant difference was noted between the two groups in terms of fever drop between 0 and 60 min (P = 0.350). CONCLUSION: Although both drugs prove effective in controlling fever at the 60 min, stronger efficacy of ibuprofen in the first 15 min may enable rapid discharge from the emergency department.

The effect of Covid-19 on sleep quality, anxiety and depression on healthcare staff at a tertiary hospital in Turkey.

BACKGROUND: The Covid-19 pandemic has forced healthcare staff into an unprecedented situation, such as making tough decisions and practising under enormous pressure. AIM: This study was designed to investigate the effect of Covid-19 on sleep quality, anxiety and depression in healthcare staff at a tertiary hospital. METHODS: This descriptive and cross-sectional study recruited healthcare staff working at a tertiary hospital. Those who had given their informed consent participated in this study between April 17 and May 17, 2020. Data were collected using the introductory information form, the Pittsburg Sleep Quality Index (PSQI), and the Hospital Anxiety Depression Scale (HADS). The data were then analyzed on the Statistical Package for the Social Sciences (SPSS) v.24. RESULTS: The mean scores of the respondents derived from the HADS-Anxiety (HADS-A) and HADS-Depression (HADS-D) scales were 7.89 ± 4.60 and 7.22 ± 4.13, respectively. Their depression levels were established to be at risk, though their anxiety levels were not. The mean PSQI score turned out to be 8.42 ± 2.30 for the participants, most of whom (92.9%) experienced poor sleep quality. Total sleep quality of the respondents exhibited a moderate positive correlation with HADS-A scores and a weak positive correlation with HADS-D scores (p < 0.05). CONCLUSION: Our major conclusion from the collected data is that healthcare staff suffered from poor sleep quality, and that their depression levels, but not anxiety levels, were at risk. Providing appropriate information about the health care of patients diagnosed with Covid-19 as well as offering regular psychoeducation-psychological support services and resting areas can reduce the susceptibility of healthcare staff to anxiety and depression and improve their overall sleep quality.

Comparative evaluation of intravenous dexketoprofen and paracetamol in the management of pain induced by sore throat.

OBJECTIVES: Sore throat is one of the most prevalent causes of emergency visits. The chief purpose of this clinical report is to investigate the effectiveness of intravenous (IV) dexketoprofen and paracetamol drugs relative to each other in relieving the pain induced by sore throat in emergency visits. METHODS: This prospective, randomised, double-blind, controlled study was conducted at a tertiary-level emergency unit. The eligible population (n = 200) with confirmed pharyngitis diagnosis on the Tonsillo Pharyngitis Assessment and moderate to severe sore throat was randomly divided into two cohorts to be administered with 50 mg of dexketoprofen (n = 98) or 1000-mg paracetamol (n = 102). The study drugs dissolved in 150-mL saline were administered by rapid IV infusion. All the recruited patients were re-assessed by Sore Throat Pain Intensity Scale (STPIS), Difficulty Swallowing Scale (DSS) and Swollen Throat Scale (SwoTS) at 15, 30, 45, 60, 90 and 120 minutes. In addition, presence of sore throat was re-evaluated by Sore Throat Relief Scale (STRS) at these time points. RESULTS: A total of 200 patients completed the study. The median age in dexketoprofen and paracetamol cohort was 25 (18-57) and 29 (17-76), respectively. Dexketoprofen and paracetamol provided relief in sore throat pain, with Total Pain Relief scores (TOTPAR0-120 min ) being 5.68 ± 2.06 mm in the former case and 6.03 ± 1.76 mm in the latter (P > .05). The IV administration of paracetamol and dexketoprofen decreased STPIS, DSS and SwoTS scores over time, while increasing STRS scores. The average value of STRS was measured as 4.41 ± 1.18 in the paracetamol cohort and 4.15 ± 1.23 in the dexketoprofen cohort during 0-120 minutes (P = .545). CONCLUSION: In emergency department, IV dexketoprofen and paracetamol reduced sore throat pain equally, providing similar analgesic efficacy.

Importance of emergency department waiting period in Fournier's Gangrene; 10 years of experience.

BACKGROUND: Fournier's gangrene (FG) is a disease with high mortality rate. The first diagnosis is performed in the emergency department (ED). In this study, we investigated the importance of the time period for diagnosis in the ED. METHODS: The data of patients who were treated for FG between 1 January 2010 and 2020 were retrospectively analysed. Waiting period of the patients in ED was calculated. Risk factor score calculations were calculated to predict FG mortality and prognosis. The effects of the ED waiting period on the duration of admission to the hospital, the number of debridements and mortality status and relationship with FG mortality risk factor scores were investigated. RESULTS: In a 10-year period, a total of 66 patients were included in the study. It was found that the median age of the patients was 56 years. ED waiting period median (IQR) was 105 (115) minutes. It was observed that there was a significant positive correlation between the ED waiting period, duration of admission to hospital (rs: 0.537, P < .001) and patients mortality status (rs: 0.482, P < .001). The ED waiting period was higher in patients with FG mortality. It was observed that the ED waiting period holds a diagnostic value in predicting mortality (P < .001). The cut-off limit predicted for this value was determined as 136 minutes. CONCLUSION: FG is a urological emergency. ED waiting period affects mortality rate and length of hospital stay. The earlier the diagnosis and treatment is conducted in the ED, the lower the mortality rate and length of stay in the hospital will be.

Cardiac Arrest Due to Cyanide Intake.

Suicidal attempts are the primary cause of cyanide intake, and a majority of these attempts are fatal. Cyanide-induced cardiac arrest or hypotension is common, though the administration of antidotal therapy in patients is not. The patient drank the cyanide ordered from the internet in an unknown amount 10-15 min before being taken to the ED. He informed his friend after taking it, and he collapsed shortly after his friend notified the Emergency Medical Services (EMS). Acute cyanide poisoning, whose rapid detection is vital but difficult to diagnose, leads to rapid hemodynamic and neurological dysfunction. Bitter almond odor and cherry red skin appearance should be the warning signs in the diagnosis of acute cyanide toxicity.

Evaluation of the chest computed tomography and hemogram data in patients with COVID-19: the importance of thymus

Background/aim: To investigate the relationship between imaging findings and peripheral blood cell counts of COVID-19 patients and the degree of thymus fat involution of these patients. Materials and methods: Computed tomography (CT) images of 87 patients with COVID-19 positive through RT-PCR testing were evaluated retrospectively by two radiologists. Ground glass densities and other signs of viral pneumonia were recorded, lung involvement was scored quantitatively. The patients thymus fat involution was graded on CT. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratios (PLR), lymphocyte and platelet counts were calculated. Imaging findings and degrees of thymus fat involution were compared with laboratory data. Results: Quantitative scoring of lung involvement was calculated at mean 6.63 ± 4.70 (1­23) for observer 1 and mean 6.55 ± 4.65 (1­23) for observer 2 (K = 0.824­1.000). Statistical significance was determined between the increase in age and the increase in scores of lung findings (p = 0.003). Lymphocyte count (p = 0.0001) and PLR (p = 0.001) were significantly lower in patients with severe CT involvement. A statistically significantcorrelation was found between increased thymus fat component and presence of COVID-19 lung involvement in CT (r = 0.461). Conclusion: The severity of imaging findings for COVID-19 patients significantly correlates with the degree of fat involution in patients' thymus tissue.