The role of neutrophil gelatinase-associated lipocalin in identifying contrast induced nephropathy development in the emergency department.

OBJECTIVE: To evaluate the diagnostic significance of neutrophil gelatinase-associated lipocalin in detecting the development of contrast-induced nephropathy in patients undergoing contrast imaging in an emergency department setting. METHODS: The case-control study was conducted at the emergency department of Uludag University, Turkey, between January 1 and July 1, 2012, and comprised patients who underwent a diagnostic thoracic or abdominal Computed Tomography examination with contrast agent. At 2 hours and 72 hours after the scan, control urea, creatinine, and neutrophil gelatinase-associated lipocalin values were recorded. Plasma lipocalin measurement was performed using fluorescence-detected immunoassay method. An increase in serum creatinine of more than 0.5 mg/dl or 25% elevation from the basal level was considered to be a marker for the occurrence of contrast-induced nephropathy. SPSS 13 was used for statistical analysis. RESULTS: Of the 80 subjects in the study, 60 (75%) were cases and 20 (25%) were controls. Contrast-induced nephropathy did not develop in any of the patients, and, accordingly, no significant increase of plasma urea, creatinine, or neutrophil gelatinase-associated lipocalin levels was observed. A significant positive relationship was found between urea and creatinine levels at 2 hours (p < 0.009) and at 72 hours (p < 0.001). CONCLUSIONS: Diagnostic contrast computed tomography examination in patients with normal renal function did not lead to Contrast-induced nephropathy or increased neutrophil gelatinase-associated lipocalin levels, an accepted early indicator of kidney injury.

Analysis of appropriate tetanus prophylaxis in an Emergency Department.

BACKGROUND: In this study, our aim was to identify the validity of the prophylaxis indications for patients who received tetanus prophylaxis, determine the ratio of high-risk wounds to the number of patients with immunity, and to evaluate the tetanus immunity of specific age groups. METHODS: Patients who applied to the Emergency Department (ED) between September 2009 and May 2010 and who were considered for tetanus prophylaxis by his/her primary care physician were included in the study. RESULTS: A total of 320 patients were evaluated. The average age of the patients was 40.87 ± 15.83 years. A total of 73.1% of the patients were male and 26.8% were female. A total of 40.3% of the patients knew their vaccination history, while 59.7% had no recollection of their vaccination history. 14.7% of the patients had received their last dose within 5 years and 48.1% within 5-10 years; 37.2% of the patients declared that more 10 years had passed since their last vaccination. In 75% of the patients, the tetanus immunoglobulin (Ig)G level was identified as >=0.1 IU/ml, while 25% of the patients had levels <0.1 IU/ml. The number of patients with protective levels was lower among those who were illiterate or who had only a primary school education, and this difference was statistically significant (p<0.001). CONCLUSION: The vaccination histories can be misleading. Certain equipment can be used at the bedside to determine a patient's tetanus immunization status.