The Evaluation of Different Treatment Approaches in Patients With Earthquake-Related Crush Syndrome.

BACKGROUND: On February 6, 2023, an earthquake occurred in Kahramanmaras, Turkey, resulting in loss of life, injuries, and the displacement of thousands of people. The aim of this study is to determine the factors affecting amputation and fasciotomy decisions in patients with crush syndrome, along with clinical laboratory parameters. MATERIALS AND METHODS: The study included patients over 18 years of age who presented with crush injuries and exhibited systemic symptoms. Inclusion criteria comprised patients with creatine kinase (CK) levels exceeding 1,000 IU/L, oliguria (urine output less than 400 mL per day), elevated blood urea nitrogen (BUN) levels surpassing 40 mg/dL, serum creatinine exceeding 1.5 mg/dL, potassium levels over 6 mEq/L, phosphorus levels surpassing 8 mg/dL, and serum calcium levels below 8 mg/dL. Multiple parameters were evaluated, including blood glucose, serum sodium, potassium, calcium, phosphorus, BUN, creatinine, uric acid, CK, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, direct bilirubin, prothrombin time (international normalized ratio (INR)), urinalysis, C-reactive protein (CRP), venous blood gas, ECG, and chest radiography. RESULTS: Following the Maras earthquake, a total of 3,184 patients were admitted to our hospital within the first seven days. Out of these patients, 2,216 received outpatient treatment, 639 were hospitalized in the general ward, and 128 were admitted to the intensive care unit. Among the admitted patients, 237 were diagnosed with crush syndrome, with 126 being male and 111 being female. The average duration of being trapped under debris was eight hours, ranging from four to 36 hours. In the study population, extremity trauma was observed in 84 patients, thoracic trauma in 32 patients, and abdominal trauma in 20 patients. Erythrocyte replacement was administered to 123 patients, while fresh frozen plasma was given to 69 patients, for a total of 1008 units utilized. Mannitol infusions were provided to 58 patients, while bicarbonate infusions were administered to 116 patients. Among the cohort, 71 patients underwent dialysis, with nine of them receiving hemodialysis along with mannitol. Additionally, 67 patients experienced stage 3 acute kidney injury, and 41 patients were deceased. None of the patients required permanent hemodialysis. CONCLUSION: Earthquakes are considered to be one of nature's most significant and inevitable disasters. While it is impossible to prevent them, effective management strategies are crucial in mitigating the ensuing chaos and reducing casualties. In order to achieve this, it is imperative to draw lessons from past seismic events and apply appropriate treatment protocols to the affected individuals.

Vaccination status among patients with the need for emergency hospitalizations related to COVID-19.

BACKGROUND: It is thought vaccines allowed for emergency use significantly reduce hospitalizations and emergency room visits. It is a matter of curiosity how many of the patients who come to the emergency department (ED) are vaccinated. We aimed to examine the characteristics of ED patients needing hospitalizations related to moderate and severe COVID-19 by vaccination status. METHODS: A retrospective study of 559 rRT-PCR-confirmed SARS-CoV-2 infection cases with moderate or severe COVID-19 needing hospitalization was performed in August 2021. Univariate and multivariate logistic regression analyses were performed for factors associated with mortality. RESULTS: The mean age of the patients was 60.8 ± 18.1 years old, and 54.2% (n = 303) of the patients were women. The most common comorbidities were hypertension (37.2%), diabetes mellitus (31.1%) and chronic obstructive pulmonary disease (13.8%), respectively. The number of patients with alpha variant was 399 (71.4%), and delta variant was 83 (14.8%). Fifty point 6% (n = 283) of the patients were fully vaccinated. The total number of patients who died in the study was 114 (20.4%), and the number of patients hospitalized in the intensive care unit was 168 (30.1%). The day between the last dose of vaccine and hospitalization was 117 ± 45.9 days. In multivariate logistic regression analysis: age (odds ratio (OR), 1.05; 95% confidence intervals (95% CI) 1.03-1.08- year increase), male gender (OR, 1.8; 95% CI, 1.1-2.9), presence of at least one comorbid disease (OR, 2; 95% CI, 1.1-3.7) and partial (OR, 0.24;95% CI, 0.09-0.6) and fully vaccinated status (OR, 0.1; 95% CI, 0.05-0.18) were associated with mortality among COVID-19 patients. CONCLUSIONS: In this study, age older than 65, unvaccinated, and comorbidities had significantly higher mortality. In multivariate regression analyses, age, vaccination status, comorbidities and the male gender were associated with mortality. Our study did not evaluate the vaccine efficacy but, a lower mortality rate was observed in those fully vaccinated with CoronaVac and Pfizer-BioNTech. Additionally, Alpha, Delta and other variants had the same mortality rates.

Comparison of femoral and carotid arteries in terms of pulse check in cardiopulmonary resuscitation: A prospective observational study.

BACKGROUND: There is no gold standard pulse localisation for pulse check in cardiopulmonary resuscitation. AIM: To compare the femoral and carotid arteries in terms of pulse check in cardiopulmonary resuscitation and recommend the most appropriate pulse localisation in advanced life support guidelines and cardiopulmonary resuscitation training programmes. MATERIALS AND METHODS: We prospectively conducted the study with patients who developed non-traumatic cardiopulmonary arrest between September 2018 and March 2019. The pulse check team was established and divided into two groups, A and B. Both carotid and femoral arteries were checked simultaneously for pulse by members of groups A and B, with the groups alternating between sites to avoid bias. We used some criteria to make pulse detection more effective. These were ETCO2, rhythm and cardiac ultrasonography. RESULTS: We evaluated 1289 pulse checks in 102 patients. As a result of the statistical analysis with manual palpations and pulses criteria, which we used to detected the presence of a pulse in CPR, we found that the sensitivity of the carotid artery was significantly higher than that of the femoral artery (p = 0.017), with almost identical specificities. CONCLUSION: The carotid artery should be recommended as the gold standard localisation for pulse checks in cardiopulmonary resuscitation in CPR training programmes and ACLS guidelines.

The detection of occult CO poisoning through noninvasive measurement of carboxyhemoglobin: A cross-sectional study.

OBJECTIVES: Carbon monoxide (CO) poisoning is one of the leading causes of preventable death in the world. Our primary objective was to identify and treat individuals who are unaware of their exposure to carbon monoxide in emergency departments (EDs). Our secondary goal was to reduce the costs of diagnosis and treatment by preventing unnecessary diagnostic testing in EDs. METHODS: In this cross-sectional study, carboxyhemoglobin (COHb) levels of patients presented with the signs of CO poisoning to the Emergency Department of Kayseri Training and Research Hospital between November 2012 and May 2013 were noninvasively measured during triage. Patients with elevated COHb levels were suspected of CO poisoning and subjected to further investigation. RESULTS: A total of 4073 patients were enrolled in the study, and 106 (2.6%) of them were diagnosed with CO poisoning. Initial evaluation revealed headache to be the most common presenting complaint in patients with occult CO poisoning. Further evaluations to determine the accuracy of noninvasive measurements showed that noninvasive pulse CO-oxymeter and arterial blood gas (ABG) measurement were compatible. CONCLUSIONS: The use of noninvasive pulse CO-oxymeter might reduce the morbidity and mortality associated with occult CO poisoning in patients presented with suspected CO poisoning in emergency settings.

Prevalence of hidden carbon monoxide poisoning in auto service workers; a prospective cohort study.

BACKGROUND: Carbon monoxide (CO) is formed as a result of the incomplete burning of hydrocarbon-containing fuels such as natural gas, coal, liquid petroleum gas, and wood. CO is a colorless, odorless, and poisonous gas that produces various acute and chronic effects in CO-exposed people. In this study, we aimed to measure CO levels in auto care repairmen with chronic CO-related illnesses using a serial, non-invasive method.A prospective cohort study. METHODS: A total of 99 people from six different auto-repair services were included in the study. Carboxyhemoglobin (COHb) levels were measured at four different times with 2-hour intervals starting at 08:00 AM. Data concerning employees' ages, working hours, smoking statuses, and types of home heating fuel were collected. A control group of 100 cases was created based on this data. The measurements were done on the control group in the morning with a Masimo Rad-57 CO-oximeter. RESULTS: The highest mean (± SD) COHb value was 7.04% ± 3.32% after the third measurement. The mean value for the control group was 1.61% ± 1.43%. A statistically significant difference between the groups was found for each value. DISCUSSION: We determined that the risk of being affected by CO is high in buildings in which the auto services were located. The effects of chronic or prolonged exposure to low amounts of CO were found to be ambiguous. However, in some studies, it was found that low-grade CO exposure could lead to coronary artery disease and some neurological complications. Therefore, it is necessary to be careful about the health of employees who have been exposed to CO. CONCLUSIONS: We concluded that there is a need for more detailed studies concerning chronic CO poisoning. Also, in workplaces in which there is high exposure to CO, proper workplace safety measures should be taken to reduce this gas's harmful effects to employees.

Role of circulating microRNAs in acute appendicitis.

BACKGROUND: Acute appendicitis (AA) is a momentous, emergency, surgical pathology that has still been investigated for both etiopathogenetic unknowns and challenges in diagnosis. Presently, there is little information about the role of microRNAs (miRNAs), which have basic biological functions in the cell, can be a marker, and are associated with various pathologies, in patients with AA. The aim of this study was to investigate the expressions of some miRNAs in AA. METHODS: Overall, 41 miRNAs were screened in 48 individuals comprising 24 patients with AA and 24 healthy controls at Erciyes University Genome and Stem Cell Center (GENKOK). The obtained data were analyzed using appropriate statistical methods. RESULTS: miR-29c-3p was found to be increased 2-fold during the first 4-6 h in AA, and this increase was revealed to be statistically significant compared with healthy individuals. Similarly, expressions of let-7b-5p, let-7i-5p, miR-30a-5p, miR-29b-3p, and miR-23a-3p also increased approximately 2-fold in AA, although not statistically significant. No significant differences were found in the screening of the remaining 35 miRNAs in patients with AA. CONCLUSION: Although there is little information about the relationship between AA and miRNAs currently, miR-29c-3p was reported to increase in the acute period of AA in this study. With the current results, it can be argued that miR-29c-3p bears the potential to be a marker in patients with AA. The present study may also be a basic research for more extensive and necessary miRNAs screening in this field.

A rare cause of fever in an adult: a case of familial Mediterranean fever.

BACKGROUND: Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease characterized by recurrent fever attacks and serositis. Nonspecific manifestations of the FMF can mimic many common acquired disorders such as infections and acute abdomen. This can delay recognition for many years and lead to comprehensive assessments and even unnecessary surgeries. Untreated FMF may lead to serious complications such as end-stage renal disease and malabsorption due to amyloid deposits in the kidneys and the digestive system. Colchicine has been used successfully to treat FMF since the 1970s. CASE PRESENTATION: A 30-year-old male was admitted to our hospital with the complaints of fever, nausea, vomiting, and generalized myalgia and weakness for 15 days. The day after hospitalization, the patient had abdominal pain. Approximately a month before, the patient was treated for a diagnosis of urinary tract infection, with similar complaints. MEFV gene mutation analysis revealed homozygosity for the R202Q mutation. FMF was considered in the patient due to the presence of recurrent febrile serositis attacks and R202Q homozygous mutation in the FMF gene analyses. Colchicine was started 3×0.5 mg/day by consulting rheumatology on day 8 of admission. After the colchicine treatment, the patient's complaints markedly improved and the inflammatory markers returned to normal levels. At his follow-up visit at 6 months, the patient remained asymptomatic. CONCLUSION: We present a case of adult-onset FMF accompanied by peritonitis as a disease among the rare causes of fever in an adult who was treated with colchicine. Based on this case, we suggest that FMF should be kept in mind in the differential diagnosis of patients with periodic fever syndromes.

A hidden household danger: Television.

BACKGROUND: Today, at least 1 television (TV) is owned in most households, and watching TV has become a significant part of daily life. Time spent in front of the TV has increased as its popularity has grown, which may pose a danger to children. The aim of the present study was to draw attention to cases of TV tip-over-related pediatric injuries. METHODS: Cases of TV tip-over injuries of pediatric patients admitted to the Emergency Department of Kayseri Training and Research Hospital recorded between June 1, 2011 and December 31, 2013 were included. Data were prospectively collected, including age and gender of patient, part(s) of the body affected, Glasgow Coma Scale score, TV screen size and brand, and whether the patient was hospitalized in the general ward or the intensive care unit (ICU). RESULTS: There were 53 pediatric patients enrolled in the study, including 30 males (56.6%) and 23 females (43.4%). Eight patients (17%) had a fracture somewhere in the body, whereas 45 patients (83%) had no fracture. Of patients with a fracture, 3 (2 males, 1 female) were treated in the general ward and 3 (male) in the intensive care unit. One male patient died. CONCLUSION: An increasing number of individuals present to emergency services with injuries sustained by TV toppling. Cases of injury, permanent disability, and even death associated with falling TVs suggest that awareness of the danger should be increased, as it may affect children in particular.

Role of endothelial nitric oxide synthases system on acute appendicitis.

BACKGROUND: Obstruction and inflammation of the appendix lumen is the leading physiopathological process during acute appendicitis (AA). Although the relationship between inflammation and endothelial nitric oxide synthases (eNOS) has been well described, no recent data describing the relationship between inflammation during AA and polymorphism of the eNOS gene has been reported. Given the limited data available, we believed that defining the relationship between AA and eNOS would be a beneficial contribution. METHODS: A total of 201 patients admitted to the emergency department with AA and 201 healthy volunteers selected from among the relatives of patients were included. Polymorphism of the eNOS was assessed. RESULTS: Intron 4a/4a was positive in 119 participants, genotype G894T GT was positive in 71 patients with AA, and 786-1 was positive in 71 patients with AA. These results suggest that no statistically significant correlation exists between genotypes of AA patients and control subjects regarding 4a/b, G894-GT, and 786-1 eNOS polymorphisms. CONCLUSION: Though the present results suggest that no statistically significant correlation exists between AA and eNOS gene polymorphism, to claim otherwise is also impractical. We believe that the present results will lay the groundwork for future, larger studies.

Pneumomediastinum after Tooth Extraction.

Pneumomediastinum is defined as the presence of air in mediastinum. Pneumomediastinum can sometimes occur after surgery. Pneumomediastinum seen after dental procedures is rare. We presented the case of subcutaneous emphysema developed in the neck and upper chest after tooth extraction and discussed the possible mechanisms of pneumomediastinum.