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Introduction: Patients diagnosed with COVID-19 have presented to emergency departments (EDs) worldwide with a wide range of symptoms. In this study we reported the clinical, laboratory and radiological features of the cases diagnosed with COVID-19. Methods: This is a single-center, retrospective, descriptive, and observational study. The patients who have ad -mitted to ED between March 11 and May 31, 2020 and diagnosed COVID-19 infection. Results: 130 (73 male and 57 female) patients with COVID-19 polymerase chain reaction (PCR) positive test were included in the study. The average age of the study group was calculated as 52.63 +/- 17.95 year. While 15.4% of the patients were asymptomatic, the most common symptom was identified as cough (46.2%), followed by dys-pnea (23.1%), fever (17.7%). The computed tomography (CT) severity scores proved significantly higher in the patients with hypertension and coronary artery disease (CAD) than in those without these diseases (p = 0.010 and p = 0.042, respectively). The moderate positive correlation between serum ferritin level and CT sever-ity score is another finding worth noting (rho = 0.530 and p = 0.0001). In a similar vein, the high level of D-dimer in the CT-positive group and its positive moderate correlation with CT severity (rho = 0.375 and p = 0.0001). Conclusion: In our study, serum ferritin and D-dimer levels were observed to be high in the CT-positive group and have moderate positive correlation with CT severity. We thus argue that D-dimer and ferritin levels measured at the time of admission to the ED can be taken into consideration to predict radiological severity. (c) 2021 Elsevier Inc. All rights reserved.

Background/Aim: It is controversial whether intravenous recombinant tissue plasminogen activator (IV r-tPA) treatment outcomes in cardioembolic strokes differ from other types of strokes. This study aims to investigate the clinical data of patients with cardioembolic and large-vessel atherosclerosis who received IV r-tPA treatment and compare and discuss the results according to the literature. Methods: The data of the patients who were admitted within the first 4.5 hours following the onset of symptoms, diagnosed with acute ischemic stroke in the Neurology clinic of Kütahya Evliya Çelebi Training and Research Hospital and underwent IV r-tPA were evaluated in this retrospective cohort study. Demographic data, clinical and functional results of patients were compared between the two groups (cardioembolic and large vessel atherosclerosis). Results: Eighty-five patients with ischemic stroke who received IV r-tPA treatment due to cardioembolism and large-vessel atherosclerosis were included in the study. There were 51 patients (60%) in the cardioembolic stroke group and 34 patients (40%) in the large vascular atherosclerotic group. There was no significant difference in terms of functional results between the groups (62.7% vs 44.1%; P=0.09). While symptomatic intracerebral hemorrhage was not detected in the large-vessel atherosclerosis group, it occurred in 3.9% of the cardioembolic stroke group. Conclusion: This study proved that functional and clinical results are similar between cardioembolic and large-vessel atherosclerosis patients who were treated with IV r-tPA treatment. Regardless of the etiology, all suitable patients with acute ischemic stroke should be treated with thrombolytic therapy.

The pathophysiological mechanism of acute cholecystitis (AC), which is essentially the inflammation of the gallbladder, is blockage of the cystic duct, and its most common cause is gallstones. On the other hand, fasting held in Ramadan is a worship practised by Muslims within the period from dawn to sunset by avoiding any eating and drinking act. Within this framework, our study ultimately intends to reveal the variation of AC in two different time periods. We retrospectively compared the demographic characteristics, admittance times, biochemical parameters of the subjects diagnosed with AC and hospitalized in the general surgery between 2012 and 2018. We also evaluated diagnosis classification, length of hospitalization, presence of intensive care stay, presence of operation during hospitalization, and the underlying comorbid diseases of the subjects. 225 patients were hospitalized in the general surgery service after being diagnosed with AC in the ED over the course of six years, yet the total number of subjects recruited for the study is 46. Whereas 10 patients (21.7%) were admitted and hospitalized during the Ramadan month, 36 (78.3%) patients in the other group were hospitalized one month before and after the Ramadan. 16 (34.8%) of the hospitalized patients underwent emergency surgery, while 30 (65.2%) patients were operated electively. The comparison of the two cohorts in our study revealed no significant difference in relation to the demographic characteristics, laboratory findings, imaging methods, underlying comorbid diseases, and the length of hospital stay. Nevertheless, clinical investigations seem to have revealed a difference between groups.

WOS: 000487283000006, Objective: We aimed to evaluate the demographic, clinical, laboratory and electrophysiological findings of patients with inpatient Guillain-Barre syndrome in our clinics and to investigate the effect of these parameters on the prognosis of the disease. Materials and Methods: Between January 2014 and April 2018, file records of patients admitted to our clinics with the diagnosis of Guillain-Barre syndrome were retrospectively reviewed. Demographic characteristics, clinical, laboratory and electrophysiological findings of the patients at the time of admission were recorded. Patients were clinically graded according to the Hughes classification at the time of admission and on the 3rd month after discharge. Results: In the study, 25 of the 51 patients were male (49%) and 26 were female (51%) and the mean age was 54.21 +/- 17.32 years. According to clinical and electrophysiologic diagnosis, 34 patients (66.7%) had acute inflammatory demyelinating polyradiculoneuropathy, 9 patients (17.6%) had acute motor axonal neuropathy, 6 patients (11.8%) had acute motor sensory axonal neuropathy and 2 patients (3.9%) had Miller Fisher syndrome. According to Hughes scoring on the 3rd month after discharge, 31 patients (60.8%) had in good prognosis (Hughes score 2). In the comparison between the two groups according to clinical, demographic, and laboratory parameters, older age (>= 50), high Hughes score at admission, weakness in extremities as first complaint, the presence of complications, need for mechanical ventilation and presence of gastroenteritis as a leading infection were evaluated as prognostic factors. Conclusion: The most common variant of Guillain-Barre syndrome in our study was acute inflammatory demyelinating polyradiculoneuropathy. Older age (>= 50), high Hughes score at admission, weakness in extremities as the first symptom, presence of complications, need for mechanical ventilation, and presence of gastroenteritis as a precursor infection were poor prognostic factors.

Introduction This study seeks to determine the utility of D-dimer levels as a biomarker in determining disease severity and prognosis in COVID-19. Methods Clinical, imaging and laboratory data of 120 patients whose COVID-19 diagnosis based on RT-PCR were evaluated retrospectively. Clinically, the severity of COVID-19 was classified as noncomplicated or mild or severe pneumonia. Radiologically, the area of affected lungs compatible with viral pneumonia in each patient's computed tomography was classified as either 0–30% or ≥ 31% of the total lung area. The D-dimer values and laboratory data of patients with COVID-19 were compared with inpatient status, duration of hospitalization, and lung involvement during treatment and follow-up. To assess the predictive value of D-dimer, receiver operating characteristic (ROC) analysis was conducted. Results D-dimer elevation (> 243 ng/ml) was detected in 63.3% (76/120) of the patients. The mean D-dimer value was calculated as 3144.50 ± 1709.4 ng/ml (1643–8548) for inpatients with severe pneumonia in the intensive care unit. D-Dimer values showed positive correlations with age, duration of stay, lung involvement, fibrinogen, neutrophil count, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR). When the threshold D-dimer value was 370 ng/ml in the ROC analysis, this value was calculated to have 77% specificity and 74% sensitivity for lung involvement in patients with COVID-19. Conclusion D-Dimer levels in patients with COVID-19 correlate with outcome, but further studies are needed to see how useful they are in determining prognosis.

Introduction: In this study, we aimed to investigate and compare the prognostic impacts of C-reactive protein (CRP), white blood cell (WBC) count, neutrophil (NEU)-to-lymphocyte (LYM) ratio (NLR), platelet-to-lymphocyte ratio (PLR), Red Cell Distribution Width (RDW) biomarkers in laboratory-confirmed COVID-19 cases as well as to explore the most useful diagnostic biomarkers and optimal cutoff values in COVID-19 patients. Methods: A total of 233 patients were admitted to Emergency Department (ED) of XXXXXX Pamukkale University Hospital during two months (March–April 2020) and underwent Sars CoV-2 PCR (Polymerase Chain Reaction), complete blood count (CBC), and CRP tests in sequence due to complaints of COVID-19. The laboratory results and demographic findings were collected from the public health management system retrospectively. The patients with positive Sars CoV-2 PCR test along with hospitalization data were also recorded. Results: The CRP (p = 0.0001), lactate dehydrogenase (LDH) (p = 0.038), PLR (p = 0.0001) and NLR (p = 0.001) remained significantly higher in the patients with positive Sars CoV-2 PCR test result. By contrast, eosinophil (p = 0.0001), lymphocyte (p = 0.0001), platelet levels (p = 0.0001) were calculated as significantly higher in negative Sars CoV-2 patients. Conclusion: In the light of the obtained results, the CRP, LDH, PLR and NLR levels remained significantly higher in COVID-19 positive patients, while eosinophil, lymphocyte, and platelet levels were significantly elevated in COVID-19 negative patients. © 2020 Elsevier Inc.

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.

Background: Treatment provided in an emergency department is aimed at alleviating pain immediately with minimized adverse effects as well as warding off further migraine attacks. The primary aim of this article is to compare the effectiveness of oral paracetamol versus zolmitriptan in treating acute migraine attacks. Methods: This prospective, randomized, and controlled study was carried out at a tertiary care hospital visited by 95,000 patients annually. The study recruited 200 participants who were randomized into two groups. One group received 1000 mg paracetamol while the other group received 2.5 mg zolmitriptan orally. Baseline pain scores were recorded using the Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) at 15, 30 and at 60 min following administration of the study drugs. Patients requiring further treatment were provided fentanyl at a dosage of 1 µg/kg as a rescue therapy. Results: A significant decrease was evident in VAS and NRS scores following the administration of the study drugs in both groups (P < 0.001). The change in VAS pain scores after 15, 30 and 60 min was calculated as 17.0 ± 13.9, 41.2 ± 16.3 and 61.2 ± 17.5 mm, respectively, in the paracetamol group and 14.2 ± 11.7, 39.2 ± 17.9 and 59.2± 19.3 mm, respectively, in the zolmitriptan group, which did not indicate significant differences (P = 0.103, P = 0.425, P = 0.483, respectively). Likewise, NRS pain scores showed a downward trend in line with VAS pain scores and did not yield a significant difference (P = 0.422). No significant difference concerning rescue therapy was noted between the two groups (P = 0.596). Conclusion: Oral paracetamol and zolmitriptan prove to be similarly effective and have low incidence of acute side effects in treating acute migraine cases without aura.

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, randomized, 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 intravenous 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 min. 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>0.05). The IV administration of paracetamol and dexketoprofen decreased STPIS, DSS, and SwoTS scores over time, while increasing Sore Throat Relief Scale (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 min (p=0.545). Conclusion In emergency department, IV dexketoprofen and paracetamol reduced sore throat pain equally, providing similar analgesic efficacy.

Background This study aimed to compare the therapeutic efficacy of dimenhydrinate and metoclopramide in patients with nausea and vertigo. Methods A prospective, double-blind, randomized clinical trial was performed on patients who presented to the emergency department (ED) with nausea and vertigo in the six month period between Nov 1st 2012 and May 1st 2013. Adult patients who were 18 to 65 years old presenting to the ED with nausea and vertigo or motion sickness were included in the study. A total of 200 patients were divided into 2 groups who were admitted to ED with complaints of vertigo accompanied by nausea. In the first group, 50 mg dimenhydrinate and 10 mg metoclopramide infusions were given intravenously for 15 min. The efficacy of treatment was measured by using a 10 mm Visual Analog Scale (VAS) performed at 0, 15 and the 30th minute. The primary outcome variable was a reduction in vertigo intensity documented on the VAS at the 30th minute after medication administration. Results A total of 200 patients were included in the randomization (n=100 in both groups). The baseline vertigo VAS scores were 7.57±1.42 in the dimenhydrinate (DMT) group and 7.27±1.40 in the metoclopramide (MTP) group (p=0.09). In the 30th minute of treatment, the average vertigo VAS score was 2.46 ± 2.39 in the DMT group and 2.31±1.96 in the MTP group; no significant differences were detected between groups. The baseline nausea VAS scores were 7.62±1.48 in the DMT group and 7.45±1.27 in the MTP group (p=0.36). In the 30th minute of treatment the average vertigo VAS score decreased to 2.27±2.24 in the DMT group and 2.70±2.48 in the MTP group, no significant differences were detected between groups. No significant differences were detected between nausea VAS changes and vertigo VAS changes at 30th minutes of the treatment (p=0.06, p=0.85 respectively). Rescue medication need was similar in both treatment groups (p=0.94). No significant differences were detected about the side effects which are sedation (p=0.56) and hypotension (p=0.57). Conclusions In conclusion, this prospective, double-blind, randomized study showed that both DMT and MTP have similar efficacy in reducing nausea and vertigo symptoms in the ED.

Amaç: Pamukkale Üniversitesi (PAÜ) Hastanesinde çalışan sağlık profesyonelleri dışındaki personelin sosyodemografik özelliklerinin tanımlanması, Bruselloz ve Brusellozdan korunma hakkındaki bilgilerinin değerlendirilmesi, Brusella enfeksiyonuna yol açabilecek bazı riskli uygulamalarla olan ilişkilerinin belirlenmesi amaçlanmıştır. Gereç ve yöntem: Araştırmadaki veriler 25 soruluk anket formu ile, yüz yüze görüşme tekniği kullanılarak toplanmıştır. Anketler, PAÜ Hastanesinde uygulanmıştır. Bulgular: Bruselloz ülkemizde sık görülen bir hastalıktır. Çalışmamıza katılan kişiler farklı yaş gruplarında ve hastanede çalışmasına rağmen Brusellozun sadece hayvanlarla temas sonucu bulaşabildiği (%4,65) (%0,58- %8,72) oranında bilinmiştir. Yaş ve eğitim seviyesi artıkça Brusella hakkındaki bilgi, tutum ve davranışların çoğu zaman olumsuz yönde etkilendiği görülmüştür. Sonuç: Bruselloz hakkında hastane çalışanları dahil bilgilendirilmeli, hastalığın hayvanlar ve/veya çıkartılarıyla temas sonucu bulaşabileceği riski konusundaki bilinç artırılmalıdır.

The primary cause of cyanide intake is suicidal attempts, most of which result in death. People who interfere with suspicion of cyanide intoxication may also be exposed to cyanide poisoning. During the autopsy of the corpse in the morning of that day, five people in the autopsy room within the hospital were admitted to the ED with suspicion of cyanide intoxication. Meanwhile, a 36-year-old patient who had come into contact with the patient at night also presented to the ED. Some of the precautionary measures to be taken against inhalation of cyanide may be wearing appropriate masks as well as suitable clothes and keeping the surroundings below 28 °C when exposed to cyanide.

Objective: To determine the cost analysis of emergency department (ED) visits by geriatric patients living in nursing homes., Study Design: Cross-sectional study., Methodology: Medical records of geriatric patients living in nursing homes who were admitted to the emergency department of the Hospital, between 2011 and 2015, were retrospectively reviewed. Number of visits, reason, and cost of treatment was determined., Results: In total 63 patients (21 females [33.3%], 42 males [66.6%]) with mean age of 76.3 +/- 8.16 years were included. The total number of emergency department visits by those 63 patients was 243. Twenty-three (9.5%) of the total emergency department visits were due to trauma. Six patients (9.5%) were admitted to the emergency department with cardiopulmonary arrest. The mean cost of each patient was $358.30 (53.90 - 1734.10), the maximum cost was $10,095.10, and the minimum cost was $7.42., Conclusion: Emergency department visits and hospitalisation are common among elderly patients living in nursing homes. However, emergency department visits by this frail population put a heavy burden on the economy. Essential measures should be taken to reduce the financial burden of emergency department visits and hospitalisation of this geriatric population., C1 [Seyit, Murat; Yilmaz, Atakan; Ozen, Mert] Pamukkale Univ, Dept Emergency Med, Med Sch, Denizli, Turkey., [Seyit, Duygu Aras] Dumlupinar Univ, Evliya Celebi Res & Training Hosp, Dept Neurol, Kutahya, Turkey.

Introduction Musculoskeletal system traumas are among the most common presentations in the emergency departments. In the treatment of traumatic musculoskeletal pain, paracetamol and non-steroidal anti-inflammatory analgesics (NSAID) are frequently used. Our aim in this study is to compare the efficacy of intravenous dexketoprofen and paracetamol in the treatment of traumatic musculoskeletal pain. Methods This prospective, randomised, double blind, controlled study was conducted in a tertiary care emergency unit. The participating patients were randomised into two groups to receive either 50 mg of dexketoprofen or 1000 mg of paracetamol intravenously by rapid infusion in 150 mL of normal saline. Visual analogue scale (VAS), Numeric Rating Scala (NRS) and Verbal Rating Scale (VRS) was employed for pain measurement at baseline, after 15, after 30 and after 60 mins. Results 200 patients were included in the final analysis. The median age of the paracetamol group was 34 (24–48), while that of the dexketoprofen group was 35 (23–50), and 63% (n = 126) of them consisted of men. Paracetamol and dexketoprofen administration reduced VAS pain scores over time (p = 0.0001). Median reduction in VAS score at 60 min was 55 (IQR 30–65) for the paracetamol group and 50(IQR 30.25–60) for the dexketoprofen group. There was no statistically significant difference between the paracetamol and dexketoprofen groups in terms of VAS reductions (p = 0.613). Conclusion Intravenous paracetamol and dexketoprofen seem to produce equivalent pain relief for acute musculoskeletal trauma in the emergency department. CLINICALTRIALS.GOV NO: NCT03428503

Objective To assess the effectiveness of pre-treatment with aripiprazole and quetiapine to prevent acute cocaine toxicity in a mouse model of cocaine toxicity. Methods This experimental study included three groups ( n = 25 per group) of mice that were intraperitoneally injected with normal saline solution, 10 mg/kg quetiapine or 10 mg/kg aripiprazole 15 min before 105 mg/kg cocaine hydrochloride. When the cocaine administration was completed, researchers blinded to the study groups observed the mice in terms of seizures and death for a further 30 min. Results In the cocaine + quetiapine group, the mean ± SE time to the first seizure was 10.80 ± 2.27 min and seizure activity was detected in 18 mice (72%) by the end of the 30 min. In the cocaine + aripiprazole group, the mean ± SE time to the first seizure was 18.10 ± 1.94 min and seizure activity was detected in 15 mice (60%) by the end of the 30 min. When compared with the control group, there was a significant difference between the cocaine + quetiapine and cocaine + aripiprazole groups in terms of seizure activity. Survival time was increased in the cocaine + aripiprazole group compared with the control and cocaine + quetiapine groups. Conclusion Quetiapine and aripiprazole pre-treatment reduced seizure activity and delayed the onset of seizures compared with the control group.

Introduction: Although acute musculoskeletal pain has a wide range of causes from tendinitis, muscle spasm, to bone and joint injuries, it is a frequent occurrence in emergency services. Paracetamol and non-steroidal anti-inflammatory analgesics (NSAID) are common used in the treatment of musculoskeletal pain. This study sets out to compare the effectiveness of intravenous dexketoprofen and paracetamol in musculoskeletal pain relief. Methods: This prospective, randomized, double blind, controlled study was carried out in a university emergency room. The participating patients were randomized into two groups to receive either 50 mg of dexketoprofen or 1000 mg of paracetamol intravenously by rapid infusion in 150 ml of normal saline. Visual analogue scale (VAS), Numeric Rating Scala (NRS) was employed for pain measurement at baseline, after 15, after 30 and after 60 mins. Results: 200 patients were included in the study, excluding 7342 of them. The mean age of the patients was calculated as 32,6. Paracetamol and dexketoprofen intervention decreases NRS pain scores over time. When compared to all pain locations, the NRS pain score of the patients was found to be statistically more effective in dexketoprofen than in paracetamol (p = 0.001). Paracetamol and dexketoprofen intervention reduces pain VAS scores over time. When the VAS pain score of the patients was compared to all pain locations, dexketoprofen was found to be statistically more effective than paracetamol (p = 0.001). Conclusion: Intravenous dexketoprofen seemed to achieve superior analgesia to intravenous paracetamol when compared with all pain locations in patients with non-traumatic musculoskeletal pain. © 2019 Elsevier Inc.

WOS: 000473399000001, PubMed: 31186964, Aim. Injuries are among the main causes of mortality and morbidity all over the world, and effective initial triage of these patients can determine the thin line between death and life. Tractor accidents and related injuries are significant problems particularly in rural areas. However, major trauma classification systems do not include tractor accidents as a criterion for trauma team activation or transportation of the patients to a trauma center. This study evaluated the general characteristics and outcomes of tractor accidents in comparison to motorcycle accidents, which are considered as a comparison criterion for major trauma. Materials and Methods. This is a multicenter study conducted in 6 emergency departments in 4 cities over a six month period. All cases over 18 years of age who were admitted to emergency service due to tractor or motorcycle accidents and meet the criteria were included in the study. The general characteristics and outcomes of both trauma types were compared to determine whether tractor accident should be considered as major traumas. Results. Eighty-eight patients had a tractor accident, and 339 patients had a motorcycle accident. The tractor accident victims were significantly younger (p

Amac: Kardiyak arrest durumlarinda yasama tutunma sansi erken kardiyopulmoner resusitasyon (KPR)’a baglidir. Calismamizin amaci, gelecegin is sagligi ve guvenligi uzmanlari olacak ogrencilerin ani kardiyak arrest gelistigi durumlarda 112 acil yardim ambulans ekipleri olay yerine ulasmadan temel yasam destegi (TYD)’ne hemen baslayabilme ozguvenlerini ve bu konu ile ilgili bilgi ve beceri duzeylerini belirlemektir. Gerec ve Yontem: Calismamiza XXXXXX Universitesi is sagligi ve guvenligi bolumu 2014-2015 ve 2015-2016 ogretim yilinda 1. sinifta ogrenim goren 254 ogrenci alinmistir. Ogrencilerin cinsiyet, ehliyet sahibi olup olmama, sporla ilgilenme, universite oncesinde sozel veya maket uzerinde KPR egitimi alma, universitede sozel veya maket uzerinde KPR egitimi almis olmasinin basi yeri, basi derinligi, basi hizi, basi ritmi puanlarina etkisi ve egitim oncesi-sonrasinda KPR yapabilme ozguvenleri arastirilmistir. Bulgular: Ogrencilerin 209’u (%82.3) erkek, 45’i (%17.7) kadindi . Calismada egitim oncesi ve sonrasinda sorulan ‘’Su an KPR yapar misin?’’ sorusuna verilen cevaplardan yola cikildiginda kisilerin oz guvenlerinde anlamli fark bulundu ( p =0.0001). Universite oncesinde KPR konusunda maket uzerinde egitim alan ve almayan ogrenciler arasinda basi derinligi puani acisindan istatistiksel anlamli fark saptandi ( p =0.047). Calisma oncesinde universitede sozel olarak KPR egitimi alan ve almayan ogrencilerin basi derinligi puani acisindan istatistiksel anlamli fark saptandi ( p =0.037). Universitede maket uzerinde KPR egitimi alan ve almayan ogrencilerin basi yeri, basi derinligi ve ritm acisindan iki grup arasinda istatistiksel anlamli fark mevcut oldugu saptandi (p degerleri sirasiyla; p =0.028, p =0.022, p =0.025). Sonuc: Sonuc olarak yasadiklari ve calistiklari bolgelerde cogu zaman olay yerine saglik profesyonellerinden daha hizli ulasabilecek olan is sagligi guvenligi ogrencilerine TYD egitimleri ogrenim hayatlarinin ilk yillarindan baslayarak ozellikle maket uzerinde verilmeli, bilgi ve becerileri artirilmasi saglanmalidir.

The best surgical technique for pilonidal sinus disease (PSD) is still disputed. The objective of this prospective randomized study is to compare the short and long-term results of modified Limberg flap and Karydakis flap surgeries that have been widely used in recent years. Ninety one patients were included in the study. The patients were divided into two groups: modified Limberg flap (MLF; n = 46) and Karydakis flap (KF; n = 45). Preoperative findings of the patients, their surgical findings, and short and long-term postoperative findings were recorded and statistically compared. While no significant difference was discovered between the groups in terms of postoperative analgesic need, hospital stay, postoperative infection rate, drain stay time, painless sitting time, painless toilet-sitting time, and painless walking time, return to work or school time was shorter in the MLF group compared with the KF group (20.61 ± 7.89 days, 23.29 ± 6.42, respectively; P < 0.05). Cosmetically, the visual analog scale (VAS) of the KF group was significantly higher than that of the MLF group (VAS score 7.12 ± 1.28, 5.45 ± 1.77, respectively; P < 0.05). Considering recurrence rates, no statistically significant difference was found between the groups. Our study found out that short and long-term results of the MLF and KF procedures are similar. We believe both methods can be safely used in surgical PSD treatment given that in the MLF procedure, shorter return-to-work time is achieved, while the procedure provides better cosmetic results.

Objectives: Synthetic cannabinoid or “Bonzai” use is a public health issue as its use has increased in Turkey as well as all over the world. The aim of this study is to evaluate the effectiveness of the “Synthetic Cannabinoids Seminar” that was provided to physicians who work in emergency services, using multiple choice questionnaires before and after the seminar as a tool for evaluation. Material and method: Synthetic cannabinoids seminars were provided to physicians who work in emergency services in two different cities, with the participation of 20 physicians in each scheduled seminar. The seminars were instructed by emergency medicine specialists and psychiatrists who were certified as an instructor by the Turkish Ministry of Health, after receiving an instructor course in synthetic cannabinoids. In order to measure basal knowledge levels of the participants, a pretest was performed for all participants before the seminar. After the seminar, a posttest was performed using the same questions in the pretest. The number of correct answers in both tests was then compared. Results: In total, 85 individuals attended the seminars; 29 individuals from Dumlupınar University Evliya Çelebi Training and Research Hospital constituted first group, and 56 individuals from Denizli State Hospital constituted second group. In both groups, the ratios of correct answers in the posttest were determined to be higher when compared to the pretest. Conclusion: The seminars on synthetic cannabinoids are useful and necessary for physicians. Keywords: Cannabinoids, Emergency, Evaluation studies, Education

Objective: To evaluate the effects of etomidate, ketamine, phenytoin, and phenytoin/midazolam in a mouse model of acute cocaine toxicity. Methods: We performed a randomized controlled study consisting of five groups (n525 each) of rats that received intraperitoneal injections of normal saline solution, 5 mg/kg ketamine, 7.5 mg/kg etomidate, 40 mg/kg phenytoin, and 40 mg/kg phenytoin and 2 mg/kg midazolam 10 minutes before cocaine hydrochloride (105 mg/kg). Following cocaine administration, a blinded observer watched the animals for 30 minutes to assess seizures (popcorn jumping, tonic-clonic activity, or loss of righting reflex), and lethality for 30 minutes. Results: The number of animals with seizures was lower in the etomidate (60%), phenytoin (40%), and phenytoin/midazolam (40%) groups (P,0.001). The etomidate (24%) and phenytoin/midazolam (16%) treatments were most effective in preventing lethality (P,0.001). Conversely, compared to the vehicle group (72%), cocaine-induced lethality was higher in the ketamine (84%) and phenytoin (92%) groups. All treatments prolonged the time to seizure, but this effect was most pronounced in the etomidate and phenytoin/midazolam groups, which also had the longest average time to lethality. Discussion: The present study provides the first experimental evidence supporting the use of etomidate to treat cocaine-induced seizures. Notably, ketamine and phenytoin were ineffective. Our findings suggest that premedication with etomidate, phenytoin, and phenytoin/midazolam reduced seizure activity in an acute cocaine toxicity mouse model. © W. S. Maney & Son Ltd 2012.

Background: The treatment of cocaine toxicity is an important subject for emergency physicians. We investigated the effects of dexmedetomidine, moxonidine and alpha-methyldopa on acute cocaine toxicity in mice. Objectives: The aim of this study was to evaluate the effects of dexmedetomidine, moxonidine and alpha-methyldopa in a mouse model of acute cocaine toxicity. Materials and Methods: We performed an experiment consisting of four groups (n = 25 each). The first group received normal saline solution, the second group received 40 μg/kg of dexmedetomidine, the third group received 0.1 mg/kg of moxonidine and the fourth group received 200 mg/kg of alpha-methyldopa, all of which were intraperitoneally administered 10 minutes before cocaine hydrochloride (105 mg/kg). All animals were observed for seizures (popcorn jumping, tonic-clonic activity, or a loss of the righting reflex) and lethality over the 30 minutes following cocaine treatment. Results: The ratio of animals with convulsions was lower in all treated groups when compared to the control (P < 0.001). Furthermore, 68% (n = 17) of animals in the dexmedetomidine group, 84% (n = 21) of the alpha-methyldopa group, 92% (n = 23) of the moxonidine group and 100% (n = 25) of the control group showed evidence of seizure activity (P = 0.009). Cocaine-induced lethality was observed in 12% (n = 3) of the dexmedetomidine group, 48% (n = 12) of the alpha-methyldopa group, 52% (n = 13) of the moxonidine group, and 72% (n = 18) of the control group (P < 0.001). All treatments prolonged the time to seizure, which was longest in the dexmedetomidine group (P > 0.05). In addition, the time to lethality was also longer in the same group (P < 0.001). Conclusions: The present study provides the first experimental evidence in support of dexmedetomidine treatment for cocaine-induced seizures. Premedication with dexmedetomidine reduces seizure activity in a mouse model of acute cocaine toxicity. In addition, while dexmedetomidine may be effective, moxonidine and alpha-methyldopa did not effectively prevent cocaine-induced lethality. © 2015, Iranian Red Crescent Medical Journal.

Severe amitriptyline poisoning results in cardiac and neurological toxicity and continues to be a leading cause of significant morbidity and mortality both in children and adults. We present a case of severe amitriptyline poisoning successfully treated with plasma exchange. Due to high plasma protein binding property of amitriptyline, plasma exchange therapy should be considered in cases of severe amitriptyline intoxication as a life saving therapeutic modality. © 2011 Elsevier Ltd.

An 11-year-old boy was admitted to emergency department with abdominal pain, bilious vomiting and rectal bleeding one day after falling from bicycle. He stated that he landed directly onto the handlebar through his left lower quadrant of the abdomen. Physical examination revealed a soft tissue bulge, tenderness and defense in the left lower quadrant without any head or skeletal injury. His abdomen was soft with no evidence of peritoneal irritation. The patient’s vital signs, radiographs and blood tests (hemoglobin, 14.4 g/dl; hematocrit, 43.0%; wight blood cell count, 6×103/mm3; C-reactive protein, 10 mg/dl; Sodium (Na), 130 mmol/L) were within normal limits. Ultrasound demonstrated intra-abdominal fluid and herniation of a small bowel loop through the abdominal wall at left lower quadrant. Computed tomography (CT) of the abdomen revealed the herniation of jejunal loop through a defect in the left lower abdominal wall just lateral to the rectus muscle, segmental ileus due to the herniated bowel segment, intraperitoneal fluid and pneumoperitoneum (Figure). Based on these findings, the patient was referred to pediatric surgery service with the diagnosis of intestinal perforation and abdominal wall hernia. Surgical exploration of the injured area demonstrated the disruption of all layers of the abdominal wall, and perforation of the jejunum at 110 cm distal to Trietz ligament. The postoperative period was uneventful. Figure A Axial computed tomography demonstrates the anterior abdominal wall defect and the herniated small bowel segment (arrow) with segmental ileus presented as dilatation of small bowel (*). B. Pneumoperitoneum (arrows) and free peritoneal fluid around the ... Abdominal wall hernia and related visceral organ injuries should be considered following blunt abdominal trauma. In our case, high velocity impact by handlebar was able to disrupt abdominal muscle and fascia. In most handlebar hernias, the defect is in the lower abdominal wall and can be associated with intra-abdominal injury.1,2 Injuries to the small bowel may occur secondary to high impact blunt trauma in a variety of deceleration mechanisms such as high-speed motor vehicle crashes, handlebar injuries, and falls.3 Diagnosis is often delayed because there is usually no associated major blood loss. The small intestine is the most common site of perforation, and peritoneal irritation may not be evident initially. Plain radiograph is also unreliable in diagnosis.4 CT is useful to differentiate hernia and its content, to define the anatomy of disrupted abdominal wall layers, and to detect associated injuries accurately and surgery is the eventual management of these patients.