Effects of COVID-19 lockdown strategies on emergency medical services.

INTRODUCTION: The aim of this study is to evaluate the change in the number of EMS cases by comparing the lockdown period, the non-lockdown period, and the pre-pandemic period. METHODS: In our study, 3 periods of EMS cases were compared to evaluate the effect of lockdown. The first period (Period A) included in the study was the lockdown period (01-12-2020 and 31-01-2021. The second period (period B) is the period between 01 and 10-2020 and 30-11-2020, where there was no lockdown despite the pandemic. The third period (period C) in the study is the period between 01 and 12-2019 and 31-01-2020 before the pandemic. RESULTS: A total of 120,989 cases in 3 periods were included in the study. It was determined that the highest number of patients were in period C (42,703, 35.3%), while the least was in period A (39,054, 32.2%). On the other hand, it was found that the number of calls was highest in period A (246,200, 35.1%), while the least was in period C (212,267, 30.2%). Response times were longer in the pandemic period than in the pre-pandemic period. Mean talk time were longer during the pandemic period. The most frequent diagnosis in period A (21.6%) and B (42.2%) was COVID-19. The second most frequent disease group in these two periods was cardiovascular diseases. CONCLUSION: While the number of EMS cases decreased during the pandemic period, it decreased even more during the lockdown period. However, the number of calls increased significantly during the lockdown period, and the response times and talk times increased accordingly.

The role of pleural fluid thiol/disulphide homoeostasis in the differentiation between transudative and exudative pleural effusions.

OBJECTIVE: In the present study, we aimed to differentiate between transudative and exudative pleural effusions using thiol sulphide homoeostasis, an oxidative stress marker. DESIGN: This was a prospective study. SETTING: Emergency Department of Ankara City Hospital, between 1 January 2020 and 15 May 2020. SUBJECTS: Patients who were diagnosed with pleural effusion and underwent thoracentesis to make a differentiation between transudative and exudative pleural effusions. The patients were divided into two groups as those who have transudative pleural effusion and those who have exudative pleural effusion. These two groups were assessed with respect to demographic features and oxidative stress parameters. MAIN OUTCOME MEASURES: Oxidative stress parameters (The native thiol (NT), total thiol (TT), and disulphide (D) levels and their ratios to one another were calculated (index 1: D/NT, index 2:D/TT, index 3: NT/TT). RESULTS: This study enrolled a total of 50 patients with pleural effusion. Twenty patients (40%) were men, and 30 patients (60%) were women. In the transudative pleural effusion group, 14 patients (56%) had decompensated heart failure, 9 patients (36%) had hepatic cirrhosis, and 2 patients (8%) had hypoalbuminemia. In the exudative pleural effusion group, 17 patients (68%) had malignancy, 7 patients (28%) had parapneumonic effusion, and 1 patient (4%) had pulmonary embolism. TT (P < .001) and NT (P = .001) values were significantly lower in the transudative pleural effusion group compared with the exudative pleural effusion group whereas there was no significant difference between the two groups with respect to D (P = .489), index 1 (P = .07), index 2 (P = .064), and index 3 (P = .063) values. CONCLUSION: We believe that a differentiation can be made between transudative and exudative pleural fluids by using thiol sulphide homoeostasis, an oxidative stress marker.

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.