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Background: Headache is the most common symptom in carbon monoxide (CO) poisoning. While the mechanism of CO-induced headache is not well defined, it is felt that cerebral vasodilation plays a role. Clinical experience has demonstrated oxygen breathing is effective in resolving CO headache. However, the effectiveness of normobaric oxygen has never been compared to hyperbaric oxygen in this regard. Methods: A 2016 paper by Ocak, et al. reported the response of CO headache pain severity to four hours of normobaric oxygen breathing in 82 patients using a 0-10 analog scale. The demographics, carboxyhemoglobin levels and response to therapy from that report were compared to data obtained by Hampson, et al. in an earlier study, but never published, using the same pain assessment method in 73 patients with CO headache and treated with hyperbaric oxygen. Results: Comparing the normobaric and hyperbaric groups, neither average age nor presenting carboxy-hemoglobin levels were significantly different. Baseline pain intensity scores were 6.5 ± 3.1 vs. 6.2 ± 2.6 (p=0.444) and post-treatment scores 1.5 ± 2.6 vs. 1.0 ± 1.5 (p=0.184) respectively on a 0-10 scale. Conclusions: In these two well-matched populations of patients with CO-induced headache pain, degree of resolution was not significantly different between normobaric and hyperbaric oxygen treatment.

Background There is a lack of specificity of the analgesic agents used to treat headache and underlying acute carbon monoxide poisoning. Objective To compare effectiveness of “oxygen alone” vs “metoclopramide plus oxygen” vs “metamizole plus oxygen” therapy in treating carbon monoxide–induced headache. Design A prospective, multicenter, double-blind, controlled trial. Setting Three emergency departments in Turkey. Population Adult carbon monoxide poisoning patients with headache. Methods A total of 117 carbon monoxide-intoxicated patients with headache were randomized into 3 groups and assessed at baseline, 30 minutes, 90 minutes, and 4 hours. Main Outcome Measure The primary outcome was patient-reported improvement rates for headache. Secondary end points included nausea, need for rescue medication during treatment, and reduction in carboxyhemoglobin levels. Results During observation, there was no statistical difference between drug type and visual analog scale score change at 30 minutes, 90 minutes, or 4 hours, for either headache or nausea. No rescue medication was needed during the study period. The reduction in carboxyhemoglobin levels did not differ among the 3 groups. Conclusion The use of “oxygen alone” is as efficacious as “oxygen plus metoclopramide” or “oxygen plus metamizole sodium” in the treatment of carbon monoxide–induced headache.

Studies related to the epidemiology of trauma play a major role in determining the health status of the communities living in the vicinity of the centers that they are conducted. We have found no epidemiological study related to emergency service admission conducted only on preschool-aged children in the literature. Our aim was to determine characteristics of trauma in this age group, to analyze encountered trauma types, and to investigate possible associations among epidemiological factors, characteristics of the trauma victims, and trauma itself in pediatric patients admitted to our emergency service.We conducted a prospective study with patients aged 66 months and younger, admitted to Emergency Service of Istanbul Kanuni Sultan Suleyman Training and Research Hospital between July 1, 2015, and December 31, 2015. Data related to age, sex, occupational status of parents, number of siblings, Glasgow coma scale score, transport mode, admission time period of the day, general health status, type of trauma, the trauma site, involved body regions, radiologic imaging and laboratory results, consultations, clinical diagnosis and outcome, duration of emergency service stay, and treatment cost were collected and statistically analyzed.A total of 688 preschool-aged cases were admitted owing to trauma. The major mode of transport was a private vehicle (98.3%), and the major cause was falling (64.0%). The major traumatized body region was head and neck (51.0%), and the major diagnosis was soft tissue trauma (90.1%). The average duration of stay was 122.01 minutes and affected by sibling number, trauma type, and employment status. The total service fee was interrelated with the type of trauma and the site that trauma occurred; it also was strongly correlated with duration of emergency service stay.Our results suggest that both in-hospital and social/environmental aspects should be improved to reduce the clinical and social burden of trauma.

WOS:000384907000007 PubMed: 27090030 BACKGROUND: During the Eid al-Adha ("Sacrifice Feast") religious holiday in Muslim communities animal sacrifices are made over a period of 3 days every year. OBJECTIVES: The aim of this study was to determine the type of sacrifice-related injuries, the characteristics of patients, treatments for injuries, and relationships between these factors to determine precautions that could be taken to avoid or mitigate sacrifice-related injuries. DESIGN: Retrospective study of medical records. SETTING: Emergency units at two hospitals from 2010 to 2013. PATIENTS AND METHODS: Patients admitted for treatment for injuries associated with sacrificial cutting during the four annual sacrifice feasts were classified as professional butchers, apprentice butchers, and third persons who were neither professional butchers nor apprentices. MAIN OUTOME MEASRE(S): Injuries associated with animal sacrifice. RESULTS: Of 592 patients, 22 (3.7%) were professional butchers, 149 (25.2%) apprentice butchers, and 421 (71.1%) third persons. Significant relationships were found between the profession of the injured person and the injury and subsequent treatment (P

Aim: Crimean-Congo hemorrhagic fever (CCHF) is a disease caused by a virus. Early diagnosis of CCHF particularly in regions where the disease frequently occurs is important for taking necessary measures and for immediately starting the treatment process. This study aims to evaluate gastrointestinal system (GIS) findings in the patients.Materials and Methods: Patient history, such as nausea, vomiting, abdominal pain, diarrhea, values of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, and contact with tick, was recorded. Enzyme-linked immunosorbent assay and/or Polymerase Chain Reaction tests were used for diagnoses.Results: The ratio of tick bite history was found to be 73.1%. According to the GIS findings of the patients at the time of admission, the ratio of nausea and vomiting, abdominal pain, diarrhea, and elevated AST and ALT levels were 61.2%, 37.6%, 27.9%, and 78.4% respectively. Five of the 93 patients died, and the mortality rate was 5.4%.Conclusion: Considering that early diagnosis is vital for the clinical course of the patients and the prevention of hospital infections and that every patient may not have a history of tick bite, it should be kept in mind that the disease can occur particularly with GIS findings in high season living in endemic regions and thus CCHF should be suspected.

SUMMARY: As the usage of cell phones is markedly increasing worldwide, accidental injuries and even lethal damages caused by cellular phone explosions have been reported lately. Although, cell phone charger explosion related scalding and tissue loss is extremely rare, they generally cause severe damage to tissues and cause severe complications, ending up in hospitalization. We are presenting a case of 9-year old female patient who was admitted to our emergency service due to a phone charger explosion that resulted in a lower extremity tissue defect. ÖZET: Cep telefonu kullanımı dünya çapında belirgin bir şekilde arttıkça, yaralanmaların, hatta ölümcül hasarların olduğu kazalar son zamanlarda bildirilmiştir. Her ne kadar cep telefonu şarj aleti patlaması ile ilgili yanık ve doku kaybı oldukça nadir olsa da, komşu dokularda ciddi hasar yapıp problem oluşturabilirler. Bu yazıda, cep telefonu şarj aleti patlamasına bağlı alt ekstremitede doku defekti ile acil servise başvuran dokuz yaşında bir kız çocuğu olgusu sunuldu. Key words: Charger, explosion, tissue defect, Anahtar sözcükler: Şarj aleti, patlama, doku defekti

Antibiotics are natural or synthetic substances that are used to control bacterial infections because antibiotics are by definition only effective against bacteria. A 30-year-old female came to our emergency clinic complaining rubor in both eyes, especially in the left eye, with swelling, rubor and pain in ears, and eruption in lips extremities. In her anamnesis, it has been determined that she did not have any medical disease that requires regular utilization of drugs. After the patient received cefuroxime axetil for acute tonsillitis, she observed eruptions in lip extremities on the 3rd day, but she did not care about it. On the 5th day, rubor in both eyes and, especially in the left eye, have been developed, and complaints such as unable to look toward light and pain have started together with swelling, rubor, and pain in both ears. She came to our clinic because she was very much worried about the situation. In this study, we aimed to discuss a drug reaction characterized by face and ear skin observations, due to uveitis after the use of antibiotics including cefuroxime axetil for acute tonsillitis.

Aim We aimed to investigate the relation between mutations and polymorphisms playing roles in the onset of clinical findings of Familial Mediterranean Fever (FMF) and clinical phenotypic reflections manifesting with painful episodes, such as dysmenorrhea. Material and Methods A total of 1000 female patients who had not responded well to non-steroidal anti-inflammatory drugs in the menstrual period, and who had presented to the emergency room with the complaint of recurrent pain episodes were included in the study. All the patients were Turkish women living in Istanbul. In this study, the mutations most frequently seen in the Mediterranean Fever Gene (MEFV), namely M694V, E148Q, M680I(G/C), V726A, P369S, R761H, A744S, M694I, K695R, F479L, M680I(G/A), and I692del were examined using the DNA sequence analysis following DNA isolation. Results The number of individuals who had a mutation in at least one allele for FMF was 511 out of 1000 patients. Of these 511 patients, homozygous mutations were found in 21% (n = 109), compound heterozygous mutations were found in 27% (n = 136), and heterozygous mutations were found in 52% (n = 266). The most frequent homozygous genotype seen in our study population was M694V/M694V. The most common compound heterozygote genotypes were M694V/M680I, M694V/V726A, M694V/E148Q, and M680I/V726A; and 11.7% (n = 60) of the families in whom mutations were found had consanguinity. Conclusion Women who present to the emergency room with the complaint of dysmenorrhea that is irresponsive to non-steroidal anti-inflammatory drugs may have several types of MEFV mutations that are responsible for FMF.

Objective: In this study, we aimed to identify the difficulties encountered by the health teams and personnel working as volunteers or on assignment in the earthquake area, and to identify their experiences and recommendations regarding the disaster. Material and Methods: This study was conducted in October and November 2011 in Van, Turkey and the surrounding region with individuals, mainly health personnel, who arrived in the city as volunteers or on assignment to assist the relief efforts. The study was conducted as these individuals carried out their duties. Face-to-face interviews were conducted with volunteers and personnel who agreed to complete the questionnaires as required. Results: A total of 168 persons were included in the study. The mean age of these individuals was calculated as 31±8 (age range 17 to 56). Of the participants, 74 (44%) arrived in the city or the surrounding area as part of their official assignment, and 94 (56%) arrived as volunteers. During the study, 77 (46%) of the individuals experienced a health problem on at least one occasion. A job definition could be identified for 74% of the participants. Conclusion: The job definitions and required materials should be pre-determined and work hours rotated according to a shift system. We believe that this would allow relief efforts to be conducted more effectively. (JAEM 2013; 12: 66-70)

The woven coronary artery anomaly is a rare congenital anomaly in which a coronary artery is divided into thin channels that merge again into the distal lumen. Only a few cases of woven coronary artery have been reported in the literature. This anomaly is accepted as a benign condition. We describe a case of acute coronary syndrome in a patient with woven coronary artery anomaly.

Ischemia-reperfusion (I-R) injury of the intestine is a significant problem because the initial damage caused by ischemia is exacerbated by reperfusion. In this study, we examined the protective effect of montelukast against I-R-induced intestinal tissue damage.Eight-week-old male Sprague-Dawley rats were randomly divided into three treatment groups : a sham-operated group, a group receiving I-R, and a group receiving I-R plus montelukast (I-R/M). Tissue samples were evaluated and scored histologically. The blood levels of malondialdehyde (MDA), myeloperoxidase (MPO), glutathione (GSH), and cardiotrophin-1 (CT-1) were measured.In the I-R group, the histological score and the levels of serum MDA and MPO were increased compared with those in the control group. In the I-R/M group, the histological score and serum MDA and MPO levels were significantly decreased compared with those in the I-R group. Additionally, compared with the IR group, the I-R/M group had increased serum GSH and CT-1 levels and a decreased intestinal injury score. Ileal sections from the I-R/M group showed minimal alterations, characterized by moderate lifting of the epithelial layer from the lamina propria, and few apoptotic enterocytes were observed compare with the number in the I-R group.The findings of the present study demonstrated that montelukast can protect I-R-induced intestinal damage in rats.

Trauma is one of the foremost causes of death in children and young adults (1). A decrease in the time between trauma and hospital arrival has reduced mortality rates (2), and ambulance design is an important factor in patient and staff safety (3,4). Stretchers, chairs, and wheelchairs are the primary means of transporting patients in emergency departments (5). After a patient arrives in the emergency room, treatment priority is determined using a triage system, and a patient may receive treatment immediately or wait for days (6). Thus, emergency department stretchers must be ergonomic, safe, and reliable (7). Furthermore, it is important that patients can be easily transferred to a stretcher with a minimal amount of movement; thus, an appropriate stretcher makes the job easier for the emergency medical personnel. Stretchers must serve a number of functions, and several investigations have been undertaken to design ergonomic transport devices (8). Customer satisfaction is critical for service providers, and the provision of quality products and services is an important way to increase customer satisfaction. Customer demand for quality service has increased competition among service providers, and the demand for quality in the health sector is no different (9). Emergency departments are the hospital showcase and, as such, their services should be of the highest quality. Stretchers are an indispensable piece of emergency department equipment. Many factors play a role in the choice of stretchers. They can be expensive, particularly with added features in terms of material, utility, ergonomic design, and safety.The present study examined the relationship of stretcher ergonomics and cost with emergency department staff satisfaction and their ratings of patient safety and treatment.

Cardiac and cerebrovascular illnesses are major causes of mortality and morbidity. Thromboembolisms, which are the result of cardiac arrhythmia, are important causes of ischemic stroke. In this study, we present a rare case of multicentric ischemic stroke induced by Mobitz type II atrioventricular block.The Pan African Medical Journal 2016;24

Purpose To compare the diagnostic value of ultrasonography (USG), which is rapid, inexpensive, simple, and does not involve radiation, with that of direct radiography for identifying fractures in the nasal bones of pediatric patients presenting in the emergency department with nasal trauma. Equipment and methods Patients under 18years old presenting with nasal trauma at the emergency department included prospectively. The patients' age and sex distribution, trauma type, GCS, physical examination findings, direct radiography, and USG results were recorded. The physical examination made by the emergency medicine specialist on arrival was accepted as the gold standard for diagnosis. Findings In total, 133 patients, 34.6% female and 65.4% male, were included in this study. The average patient age was 7.44±5.05years, with the greatest proportion (21.8%, n =29) of patients in the age ranges of 0–2 and 6–8years. The most frequently observed finding on physical examinations was swelling (51.1%, n =68). In total, 50 (37.6%) patients had nasal fractures according to their first physical examination, which was performed by emergency medicine specialists. That is, fractures were detected by direct radiography in only 11 of the 34 cases who were diagnosed with fractures by USG. Conclusions We consider that USG should be preferred over direct radiography for use at the bedside of pediatric patients who present at emergency department with nasal trauma, because of its superior diagnostic ability and the lack of a requirement for radiation.

OBJECTIVE: 112 ambulance service in our country have a workload and too intense stress. Therefore it requires dedicated effort from staff. Employee morale, motivation and satisfaction is very important in operating scheme. We aimed to determine the satisfaction levels of ambulance service staff in Bolu province. METHODS: All participants fullfilled the "Application Procedures and Principles of Employee Satisfaction Survey" questionnaire between 6th -15th August in 2010. They answered 26 questions about working hours and corporate services; performance evaluation; occupational health and safety, occupational, work space and security, governance and management relations; of institutional commitment and other matters. RESULTS: 30% of the participants stated that resources are used effectively, 75.6% of them complaint of no rewarding. 90.2% stated that they have in service education programme in last six months but 59.5% pointed that they have not educated about employee and patient safety. 88.1% said that they have not received training about reporting system of patient and employee safety and about injury reporting system. They also stated there was no technical infrastructure about injuries. CONCLUSION: As a result of our suvey, 112 ambulance service employees are generally satisfied of their workplaces. However they want some regulations in workplace ergonomics in order of their recommendations and also they seek measures related to workplace safety. İf the conditions remains adverse, some staff even think to quit job., AMAÇ: Ülkemizde 112 ambulans servisleri, yoğun stres ve iş yükünün fazlaca etkin olduğu birimlerdendir. Bu nedenle çalışanlarının özverili olmasını gerektiren bir tempoya sahiptir. İşleyiş düzeninde, çalışanların moral motivasyon ve memnuniyetleri oldukça önemlidir. Çalışmamız Bolu ili Ambulans Servisi çalışanlarının memnuniyet düzeylerini belirlemek amacıyla planlanmıştır. YÖNTEMLER: Anketler, birim katılımcılarının 6-15 Ağustos 2010 tarihinde “Çalışan Memnuniyeti Anketi Uygulama Usul ve Esasları” temel alınarak anket formunu doldurması ile gerçekleştirilmiştir. Ankete katılan çalışanlara, çalışma saatleri ve kurumsal hizmetler; performans değerlendirmesi; iş sağlığı ve güvenliği; meslek, çalışma mekanı ve güvenlik; yönetim ve yönetim ile ilişkiler; kurumsal aidiyet ve diğer hususlar ile ilgili toplam 26 soru yöneltildi.BULGULAR: Çalışmaya katılanların % 30’u kaynakların etkin kullanıldığını, %75.6’sı ödüllendirmenin olmadığını, %90.2’si son altı ay içinde hizmet içi eğitim düzenlendiğini belirtmekle birlikte %59.5’i hasta ve çalışan güvenliğine yönelik eğitim verilmediğini, %88.1’ i hasta ve çalışan güvenliği raporlama sistemi hakkında eğitim almadıklarını ve yaralanmalara yönelik teknik bir alt yapı olmadığını belirtmişlerdir.SONUÇ: Çalışmamızda 112 Ambulans Servisi çalışanlarının genel olarak işyerlerinden memnun oldukları anlaşılmaktadır. Ayrıca kendi görüşlerinin alınarak işyeri ergonomisi ile ilgili düzenlemeler, işyeri güvenliği ile ilgili önlemlerin alınmasını istemektedirler. Olumsuz koşulların devamı halinde kurumdan ayrılmayı bile düşündükleri görülmektedir.

Aim: To evaluate the effects of montelukast and Hypericum perforatum against ischemia/reperfusion (I/R)-induced intestinal damage. Materials and methods: Twenty-eight hamsters were divided into 4 groups following midline abdominal laparotomy: control group (n = 7), I/R group (n = 7), montelukast and I/R (MIR) group (n = 7), and Hypericum perforatum and I/R (HPIR) group (n = 7). After 60 min of ischemia through obstruction of the superior mesenteric artery, 24 h of reperfusion was maintained. Ten minutes prior to the reperfusion period, the MIR group received 7 mg/kg of intraperitoneal montelukast and the HPIR group received 7 mg/kg of intraperitoneal Hypericum perforatum. Malondialdehyde, glutathione, myeloperoxidase, and cardiotrophin-1 levels were measured from blood samples. A semiquantitative histological evaluation was performed. Results: Montelukast and Hypericum perforatum significantly reduced malondialdehyde levels and increased glutathione levels compared to the I/R group (P < 0.008). A statistically significant difference was also found between the I/R group and MIR and HPIR groups in terms of myeloperoxidase levels (P < 0.008). The MIR and HPIR groups showed increased cardiotrophin-1 levels compared to the control and I/R groups (P < 0.008 for all). The MIR and HPIR groups showed significantly lower histological scores compared to the I/R group (P = 0.03 and P = 0.007, respectively). Conclusion: This study demonstrated the preventive effects of montelukast and Hypericum perforatum on I/R-induced intestinal injury

Beyin ve kalp gibi yüksek oksijen (O2 ) harcayan organlar çok kolay bir şekilde karbon monoksit (CO) toksisitesinden etkilenirler. Beyin dokusunda gri maddede ve özellikle globus pallidusta sıklıkla bilateral olan iskemik lezyonlar ve nekroz en sık görülen değişikliklerdir. Zehirlenmenin şiddetine bağlı olarak serebral, kardiyak bulgular oluşabileceği gibi nadiren de olsa görme kusurları oluşabilir. Görme bozuklukları genellikle komadan çıkan hastalarda görülür. Bu sunumda CO zehirlenmesi sonucu ileri derecede görme kaybı gelişen ve yapılan uzun süreli hiperbarik oksijen tedavisine tam yanıt veren bir olgudan bahsettik., High oxygen (O2) consuming organs such as the brain and the heart are easily affected by carbon monoxide (CO) intoxication. The most frequent changes are bilateral ischemic lesions and necrosis in the grey substance of brain tissue, particularly in the globus pallidus. Depending on the severity of intoxication, cerebral and cardiac findings may occur as well as visual impairment, although rare. Visual disorders may develop in patients recovering from coma. In this case report, we present a case with severe loss of vision consequent to CO intoxication, who demonstrated a complete response to long-term hyperbaric oxygen treatment

• Local anesthetic agent is usually used in the emergency department, and local anesthetic agent oxidizes hemoglobin and may cause methemoglobinemia.

Objective : There are many factors affecting the mortality of patients admitted to the intensive care unit (ICU). Among these are the patientsf age, diagnosis, and concomitant pathology. The aim of this retrospective study was to investigate whether there is an adverse effect of the time between admission to the Emergency Room (ER) and admission to the ICU on the mortality of these patients. Materials and Methods : The medical records of the patients who were admitted to the Emergency Department (ED) of the Bolu Izzet Baysal State Hospital and subsequently were admitted to the ICU between December 2009 and August 2011 were analyzed in terms of the time of admission, the season of admission, and the waiting and the stand.by times in the ER. Results : A total of 2380 patients, who were admitted to the ED of the Bolu -zzet Baysal State Hospital and subsequently to the ICU, were included in the study. The median waiting time in the ER was 1.23 h (10 min to 10.02 h). After completion of the admission procedures, the median hospitalization time in the ER was 0.16 h (3 min to 2.58 h). There was no statistically significant difference between the patients who died after admission to the ICU and the ones who survived, in terms of the waiting and the stand.by times in the ER (P > 0.05). Conclusion : The waiting times at the ED did not affect the mortality of the ICU patients. Key words : Intensive care, mortality, stand.by time

WOS:000339926700010 PubMed: 24619262 Introduction: Tularemia is a zoonotic disease caused by Francisella tularensis. Here we present an epidemic occurring in Bolu province, located in northwestern Anatolia in Turkey, and some features of the cases. Methodology: The data was provided by the Bolu Provincial Health Directorate. All of the antibody response tests were studied in the National Health Institute (formerly named Refik Saydam Hygiene Department), the reference laboratory of the Ministry of Health of the Turkish Republic. A total of 393 individuals were tested by microagglutination test (MAT) for tularemia between 2006 and 2011. A total of 218 patients whose demographical data were available were included in the study; 83 were accepted as the patient group and 135 were the controls. Of the patients, 31 (37.3%) were male and 52 (62.7%) were female. Results: Fever (p < 0.001), URTI symptoms (p = 0.047), conjunctivitis (p = 0.004), and rash (p = 0.026) were significantly higher in the patient group. A positive association was found between MAT and fever (r = 0.324; p < 0.001), and a negative association was found between MAT and both lymphoadenopathy (r = -0.25; p = 0.013) and chills (r = -0.218; p = 0.035). Higher MAT titers were detected in oropharyngeal tularemia (r = 0.306; p = 0.003). Conclusions: In conclusion, tularemia must be considered in differential diagnosis in patients presenting with fever and LAP in non-endemic regions. Furthermore, water sources and contact with rodents must be investigated.

Background: One of the most substantial factors affecting patient satisfaction in the Obstetrics–Gynecology and Children’s Hospital is the wait time in the emergency room. Objective : We retrospectively studied the waiting periods of patients visiting the emergency room patients in Bolu Izzet Baysal Obstetrics-Gynecology and Children’s hospital. Method: Using an automated documentation system for each patient that recorded the season in which the patients consulted the emergency room, the month, day, time, examination time, hospitalization decision time, the hospitalization clinic following the decision to hospitalize, and the time to hospitalization, we retrospectively studied the waiting periods of emergency room patients in Bolu Ýzzet Baysal Obstetrics–Gynecology and Children’s Hospital. Results : A total of 15,004 patients who consulted the hospital emergency room between November 24, 2009, and August 25, 2011, and who were hospitalized in a clinic were included in this study. The highest frequency of emergency room patient visits occurred during the summer season (28.1%), in the month of July (10.2%), on Mondays (16.1%), and between 8 and 11 AM (22.1%; p < 0.05). The emergency room wait time of patients consulting the pediatric clinic was (55 ± 67 min), which was significantly shorter than the wait time of patients consulting other clinics (p < 0.05). Conclusion: The majority of patients who were hospitalized in any clinic through the emergency room consulted the hospital during the daytime hours. The time to hospitalization for the admitted patients was within an acceptable time frame. We believe that conducting comprehensive research to determine whether it is possible to reduce wait times even further to increase patient satisfaction will be instructive. Keywords: Emergency Room, acceptance-waiting time, emergency-waiting time, hospitalization-waiting time African Health Sciences 2013; 13(4): 1162 - 1169

Hypercalcemic hyperparathyroid crisis is a infrequent but life threatening complication of main hyperparathyroidism. It is a infrequent manifestation for primary hyperparathyroidism by reason of parathyroid adenoma presenting with parathyroid storm. Acute hypercalcemic hyperparathyroid crisis is a rapidly developing syndrome characterised by severe hypercalcemia associated with life threatening disturbances in cardiac, renal, cerebral functions. This state should be doubted in acutely ill cases with gastrointestinal appearances, profound dehydration, changed mental state, urinary signs or cardiac arrhythmias. We offer this patients to give emphasis to the significance management of an acute hypercalcemic syndrome and early diagnosis as a result of primary hyperparathyroidism as a cause of an un defined adenoma of the parathyroid gland. We present this patients to give emphasis to the emphasis of early and rigorous treatment of hypercalcemic crisis as a result of parathyroid storm otherwise it could be fatal.

Intra-arterial catheterization is used for continuous pressure monitoring and blood gas analysis in intensive care units. Especially it is used routinely in patients that take inotropic agents. Radial artery is frequently preferred because of adequate collateral circulation and easy cannulation. During this procedure, risks of complication and failure are high. Catheterization may lead to complications such as peripheral neuropathy and cerebral embolization which can increase morbidity and mortality. Ultrasonography [USG]-guided arterial cannulation can prevent potential complications with an increased success. In this report, we aimed to present the USG-guided catheterization of radial artery in intensive care patients.

WOS:000335444500040 PubMed: 26060489 Background: The diagnosis of palpitation can be difficult in the emergency department (ED) and the waiting time for a first appointment with an arrhythmia clinic can be very long. The inflammation is sufficient to facilitate the initiation of supraventricular tachyarrhythmia (SVT). The increased mean platelet volume (MPV) is closely correlated with inflammation and to reflect inflammatory burden in different condition. Objective: In this study, we aimed to investigate the relation between MPV and SVT in patient with documented atrial tachyarrhythmia in ED. Methods: Two study groups were compared; a SVT group with arrive at the ED with documented SVT (n=122) and 100 healthy adult without any palpitation symptom, arrhythmic disease, and with normal physical examination results that were brought for checkups to the cardiology polyclinic were classified as control group. Blood samples were obtained from all patients for determining the hematologic counts and MPV during first hour in ED period. Results: In terms of the focus of the study, hemoglobin, neutrophil count, mean cell volume (MCV), red cell distribution width (RDW), platelet, white blood cell (WBC), and lymphocyte counts were similar in both group (p>0.05). MPV in the SVT group was significantly higher than in the control group (9.12 +/- 1.22 fl vs 8.64 +/- 0.89 fl, p

Background : Crimean-Congo hemorrhagic fever (CCHF), which is associated with a high mortality rate in the Black Sea region of Turkey, has received increasing attention. Objective : In this study, the epidemiological features, clinical and laboratory findings, treatments, and outcomes of patients diagnosed with CCHF between 2006 and 2012 based on data obtained from the Bolu Provincial Directorate of Health (BPDH) were evaluated. Methods : BPDH data were reviewed for the period between 1 January 2006 and 31 July 2012. The locations where the tick had attached to the patient, the site of the tick bite on the patient’s body, the dates of tick bite and removal, and the demographic characteristics of each patient were recorded. BPDH data on the total number of tick bites, patients with confirmed CCHF, and deaths due to CCHF in Bolu Province during the study period were also evaluated. Results : A total of 46 patients with CCHF and 38 patients without CCHF but who had been bitten by ticks were admitted to the BPDH. Of the patients with CCHF, 54.3% were female. The mean age of the patients was 46.88 ± 2.05 years (range, 1–79 years). The mortality rate was 8.82%. Patients were predominantly observed in June and July. When the patients were distributed according to their occupations, the majority was houswife (48.6%), followed by animal husbandry worker (27.0%), farmer (10.8%), health worker (5.4%), and other (8.1%). The symptoms of the patients with CCHF included fatigue (60.9%), fever (60.9%), and myalgia (60.9%). Of those patients with CCHF, 41.3% were determined to have a high fever. Conclusions : The probability of developing CCHF decreased as the duration of tick attachment increased. Moreover, although the clinical presentation is important, it is not diagnostic. Physical examination and laboratory findings become more specific in later stages. Keywords : Black Sea, Crimean-Congo hemorrhagic fever virus

In Wolff-Parkinson-White Syndrome (WPW), presence of accessory conduits causes various signs and clinical conditions in patients. WPW syndrome is presently defined as a congenital defect involving the occurrence of abnormal conductive tissue between the atria and the ventricles in relation to supraventricular tachycardia (SVT). SVT is observed in this group of patients. WPW syndrome at high rates can be mixed with SVT. Calcium channel blockers (diltiazem, verapamil) that are one of the most preferred medicines for rate control in patients with SVT may lead to fatal risks in individuals with WPW syndrome. In our presentation, we studied, in parallel to the literature, the case of a patient who presents the WPW syndrome but who is followed as a SVT without performing the electrophysiological tests in parallel to the literature. J. Exp. Clin. Med., 2013; 30:357-359

OBJECTIVE: This prospective study investigated the diagnostic significance of the N-terminal pro-brain natriuretic (NT-proBNP) and troponin I peptides in emergency department patients presenting with palpitations. METHODS: Two groups of patients with palpitations but without documented supraventricular tachycardia were compared: a group with supraventricular tachycardia (n = 49) and a control group (n = 47). Both groups were diagnosed using electrophysiological studies during the study period. Blood samples were obtained from all of the patients to determine the NT-proBNP and troponin I levels within the first hour following arrival in the emergency department. RESULT: The mean NT-proBNP levels were 207.74±197.11 in supraventricular tachyarrhythmia group and 39.99±32.83 pg/mL in control group (p0.001). The mean troponin I levels were 0.17±0.56 and 0.01±0.06 pg/mL for the patients with and without supraventricular tachycardia, respectively (p

Hyponatremia; a serious electrolyte disorder, frequently develops in the elderly and hospitalized patients with heart failure. Hyponatremia in patients with heart failure is usually in hypervolemic form characterized by increased total body sodium and water. However, rarely, hypovolemic hyponatremia associated with actual sodium loss may occur in the clinical course. We present an extremely hypovolemic hyponatremia case in a patient with severe heart failure. Serum sodium value of the patient was 101mEq/L; which is exceptionally compatible with life. J. Exp. Clin. Med., 2013; 30:89-91

The diaphragm provides the progression between certain structures and the chest cavity by means of an anatomic hiatus. The diaphragm is the second most functional muscle structure of the body after the heart. Diaphragm injuries may result from serious blunt or penetrating injuries. While most of the blunt diaphragm infuries are caused by traffic accidents and falls from heights, some may occur as a result of other blunt traumas to the lower chest or epigastrium. Diaphragm injuries may be seen in t 0.8-1.6% of the patients hospitalized due to blunt abdominal trauma. In this study, we will report that a diaphagm injury of a patient who has a history of blunt abdominal trauma was diagnosed six months after the trauma when he was admitted to hospital because of stomach ache and pain in his left chest., The diaphragm provides the progression between certain structures and the chest cavity by means of an anatomic hiatus. The diaphragm is the second most functional muscle structure of the body after the heart. Diaphragm injuries may result from serious blunt or penetrating injuries. While most of the blunt diaphragm infuries are caused by traffic accidents and falls from heights, some may occur as a result of other blunt traumas to the lower chest or epigastrium. Diaphragm injuries may be seen in t 0.8-1.6% of the patients hospitalized due to blunt abdominal trauma. In this study, we will report that a diaphagm injury of a patient who has a history of blunt abdominal trauma was diagnosed six months after the trauma when he was admitted to hospital because of stomach ache and pain in his left chest

In this letter, we wanted to show that acute pulmonary embolism may be observed as a complication in patients with traumatic rib fracture and to emphasize on the importance the early diagnosis examinations in suspicious cases.

Lightning strikes may cause serious injury such as burns and cardiac rhythm disorders or death through the powerful electric current. Lichtenberg figures, also known as the “picture of the lightning” are the important clues for lightning strikes. They look like the fern image on the skin and they are pathognomonic for the lightning strikes. In this report, two cases of lightning strikes and Lichtenberg figures were presented.

Necrotizing fasciitis is characterized by progressive tissue necrosis and a life-threatening severe soft-tissue infection of skin, subcutaneous tissue and fascia. The etiology includes trauma, surgery and injection. In this report, we aimed to present a morbid obese female patient diagnosed with incarcerated umbilical hernia and subsequent severe necrotizing fasciitis during follow-up and discuss with the literature.

Fentanyl is a pure and selective ? opioid receptor agonist that was discovered to identify an improved analgesic over morphine, an opioid frequently associated with histamine-release, bradycardia, hyper- or hypotension, and prolonged postoperative respiratory depression. It is 80-100 times more potent and has less adverse effect than morphine. The formulations are intravenous, transmucosal, and transdermal. Besides its efficacy, the transdermal route is safe, since with it the plasma concentration of fentanyl can be adequately maintained at a steady level. Transdermal fentanyl patch has been increasingly used recently for the management of chronic pain. This brings about increased rates of misuse or addiction in general population. Transdermal fentanyl patch may produce respiratory arrest as all other opioids do. Herein, we describe a woman with meperidine dependence who developed respiratory arrest after cutaneous application of 4 transdermal fentanyl patches, with relevant literature review.

Objectives: The patients applying to a emergency service may stay longer than necessary for diagnosis, monitoring and treatment. This can be due to the inadequacy of the treatment performed in emergency department or to the absence of the required unit in the hospital. In this study, we analyzed the waiting period of the patients who have not been hospitalized. Methods: The patients applying to Bolu Izzet Baysal Public Hospital Emergency Unit between 24.11.2009 and 25.08.2011 have been studied regarding their application date, the season, and their waiting period in the emergency unit. The data have been analyzed using the statistics software Package for the Social Sciences (SPSS, Inc., Chicago, IL), version 17.0 for Windows. The chi-square χ 2 test has been used for the determination of the percentage distribution and significance and p

The abuse of hydrocarbon by inhalation in adolescent ages has increased in last years due to the euphoric effect it provokes. Butane, which is a kind of hydrocarbon compound, may be abused by inhalation and thus lead to addiction. Inhaling lighter fluid containing butane can cause lung toxicity, brain damage, myocardial effects, and neurologic problems. We reported, in parallel to literature, a 19-year-old patient who inhaled lighter fluid and who presented with lung hemorrhage, hypoxia and acute coronary syndrome.

Kounis syndrome is a life-threatening medical condition that causes severe allergic reaction and acute coronary syndrome. Benzathine penicillin G is one of the most widely used antibiotics in clinical practice, but it can enhance both allergic and hypersensitivity complications. In this report, we describe the case of a 42-year-old man admitted to our hospital who presented with cryptic tonsillitis accompanied by angioneurotic edema, chest pain, and electrocardiographic variations. The patient was diagnosed with Kounis syndrome and treated with oral antihistamines and prednisolone. He was discharged following a complete recovery and regression of electrocardiographic abnormalities within 72 hours.

OBJECTIVE: In this study, aimed to investigate the level of knowledge and approaches of the general population outside the health sector on the recognition of myocardial infarction and first intervention.METHODS: A questionnaire was created by researcher showing the first treatment should be done in patients with MI. Questionnaire was completed by 250 volunteers. Volunteers were particularly selected from outside the health sector. The participating individuals had no history of MI or met with in their immediate vicinity care was given to a patient with MI. Those who are illiterate were excluded.RESULTS: The mean age of respondents to the questionnaire were 36.09 ± 12.09. The participants of 52.8% were women n = 132 and 47.2% were male n = 128 . These people 30.8% of primary school n = 77 , 28.4% of high school n = 71 , 40.8% percent of the university graduates n = 102 . Percent of 56.6% participants described themselves middle-income group. When asked to participants "Do you think what is the most common mortality due to diseases?" Women said that 45.1% of heart attack, 47.2% of cancers, in men said that 63.9% of heart attack, 22.2% of cancer. When asked "what do you do encounter with one of the people around you think having a MI?" to the participants, the answer of 92.4% of participant seek emergency service women 57%, men 40.7% , 31.2% of participant said that would provide ventilation to the room and women 31.7%, men 30.6% , 20.4% of participant said that would give aspirin to the patient women 21.8%, men 18.5% , 7.6% of participant said that would stated they had no information women 7.2%, men 4.3% . Who expressed had no knowledge 78.9% of the primary school, while 21.1% were high school graduates.CONCLUSION: As a result of this study, especially in women were found to be less awareness about the prevalence and mortality of MI. About typical symptoms of MI other than chest pain concluded that the findings is not known enough. The normal population encounters with MI have not enough information on what to do other than call the emergency services have been discovered. Constitute the most important part of the diagnosis, and early intervention in acute myocardial infarction and it is necessary to consider that the implementation of community-wide education programs., AMAÇ: Çalışmamızda, sağlık sektörü dışındaki genel popülasyonun miyokart enfarktüsü MI geçiren hastaların tanınması ve yapılması gereken ilk müdahale konusunda bilgi düzeyi ve yaklaşımlarını incelemeyi amaçladık.YÖNTEMLER: Araştırmacılar tarafından, MI geçiren kişilerdeki klinik bulgular ile ilk müdahalede yapılması gerekenleri sorgulayan bir anket oluşturuldu ve 250 gönüllü kişi tarafından doldurulması sağlandı. Gönüllüler özellikle sağlık sektörü dışından seçildi. Gönüllü kişilerin özgeçmişinde MI geçirmemiş yada yakın çevrelerinde MI geçiren bir hasta ile karşılaşmamış olmalarına özen gösterildi. Okur-yazar olmayanlar çalışma dışı bırakıldı. BULGULAR: Çalışma kapsamında anket sorularına cevap verenlerin yaş ortalaması 36.09 ±12.09’dir. Çalışma grubunun % 52.8’i kadın n=132 , %47.2’si erkek dir n=128 .Bu kişilerin %30.8’i ilköğretim n=77 , %28.4’ü lise n=71 , %40.8’i ise üniversite mezunuydu n=102 . Katılımcıların %56.6’sı kendilerinin orta gelir grubunda tanımlıyordu. Katılımcılara sorulan "Sizce hastalıklara bağlı en sık ölüm nedir ? " sorusuna kadınların %45.1’i kalp krizi, %47.2’si kanser derken aynı soruya erkeklerin ise % 63.9’u kalp krizi, %22.2’si kanser cevabı verdiler. Katılımcılara sorulan "Yalnız başınıza çevrenizde MI geçirdiğini düşündüğünüz biri ile karşılaşırsanız ne yaparsınız? " sorusuna %92.4’ü acil servisi arayacağını kadınlarda %57, erkeklerde %40.7 , %31,2’si hastanın bulunduğu odayı havalandıracağını kadınlarda %31.7, erkeklerde %30.6 , %20.4’ü hastaya aspirin vereceğini kadınlarda %21.8, erkeklerde %18.5 , %7.6’sı ise ne yapacağı konusunda bilgisi olmadığını ifade etti kadınlarda %7.2, erkeklerde %4.3 . Bilgisi olmadığını ifade eden grubun %78.9’u ilköğretim, %21.1 ise lise mezunu idiler.SONUÇ: Bu çalışmanın sonucunda MI yaygınlığı ve mortalitesi konusunda özellikle kadınlarda farkındalığın daha az olduğu görülmüştür. MI’daki tipik bulgular konusunda göğüs ağrısı dışında diğer bulguların yeterince bilinmediği kanısına varılmıştır. MI ile karşılaşılacak bir durumda ise popülasyonun acil servisi arama dışında yapılması gerekenler konusunda yeterli bilgi seviyesine sahip olmadığı anlaşılmıştır. MI’ne müdahalede en önemli kısmı oluşturan tanı ve ilk müdahale konusunda toplum çapında yaygın eğitim programlarının uygulanması gerekli olduğunu düşünmekteyiz.