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Introduction: A country’s development level is measured with a quantitative parameter called the human development index (HDI). The present study researched the effects of HDI parameters (such as healthcare standards, income, and education level) on the incidence of tuberculosis. Methodology: HDI data of 36 provinces of Turkey and the tuberculosis surveillance data were obtained from the Ministry of Development and the Ministry of Health, respectively. The associations between the incidence of tuberculosis and other HDI parameters were analyzed. Results: Higher population density (n/km2) (CI = 0.05 to 0.40) and higher relapse rate of tuberculosis (CI = 0.36 to 1.48) were identified to be independent predicting factors that increased the incidence of tuberculosis, whereas higher gross national product (CI = -0.06 to 0.00), the population that holds a green Medicare card (CI=-0.58 to -0.04), increased general practitioners per 100,000 people (CI=-0.66 to -0.01), female population (CI = -0.70 to -0.06), married population (CI = -1.34 to -0.03), were found to be significant negative predicting factors that were relevant to the incidence (protective against tuberculosis). Conclusions: Tuberculosis is a disease that is affected by multiple factors, including the components of HDI. Improvement of income level, facilitation of access to health services via health insurance, urbanization with lower population density strategy, and provision of enough general practitioners may be useful in reducing the incidence of TB' in provinces of developing countries such as Turkey.

A disaster can be defined as a situation where the affected society cannot overcome its own resources. Our aim was to present the case of a fire disaster caused by a liquefied petroleum gas (LPG) tanker-based explosion on the Diyarbakir-Bingol road in Lice to determine the various kinds of challenges and patient groups that an emergency department faces and to discuss more effective interventions for similar disasters. This is a retrospective cross-sectional study. To find out the factors that affected mortality, we investigated the patient conditions presented at the time of admission. Among 69 patients included in the study, 62 were male (89.9%) and seven were female (10.1%). The average age of patients was 32.10±14.01 years, and the burn percentage was 51.1±32.2. One patient died during the first response, and a total of 34 patients (49.3%) died during the patient follow-up. Factors statistically related to mortality were determined to be inclusion in the severe burn group, presence of inhalation injuries, use of central venous catheter on patients, application of fasciotomy, presence of a tracheostomy opening, use of endotracheal intubation and sedoanalgesia, and transfer to centers outside the city (p-values

Background: This study aimed to investigate the prevalence of malnutrition and explore the somatic, psychological, functional, and social or lifestyle characteristics linked to malnutrition in elderly people at a hospital in Turkey. Material/Methods: This study included 1030 patients older than 65 years of age who were seen at the internal medicine and geriatrics outpatient clinics of the study centers in Istanbul, Ankara, Duzce, Corum, Mardin, Malatya, and Diyarbakir provinces between January and December 2014. All patients underwent Mini Nutritional Assessment (MNA) and Geriatric Depression Scale (GDS) tests via one-on-one interview method. The demographic properties of the patients were also recorded during this interview. Results: Among 1030 patients included in this study, 196 (19%) had malnutrition and 300 (29.1%) had malnutrition risk. The malnutrition group and the other groups were significantly different with respect to mean GDS score, income status, educational status, the number of children, functional status (ADL, IADL), the number of patients with depression, and the number of comorbid disorders. According to the results of the logistic regression analysis, age (OR=95% CI: 1.007-1.056; p=0.012), BMI (OR=95% CI: 0.702-0.796; p

The main objective of this study was to describe the characteristic imaging features of cerebral and spinal hydatid disease (HD) in magnetic resonance imaging (MRI) and computed tomography (CT) in order to provide more effective differential diagnoses in endemic regions. We also aimed to use MRI and CT to evaluate whether the World Health Organization's (WHO) new classification of hepatic cystic echinococcosis (CE) could be used in the classification of cerebral HD.We retrospectively reviewed the CT and MR images of 30 patients who were diagnosed with cerebral and spinal HD between 1990 and 2014. The imaging findings were noted. All hydatid cysts were classified according to the WHO classification of hepatic CE, consisting of six types.The study group consisted of 49 CEs in 27 patients with cerebral HD and 12 CEs in three patients with spinal HD. Of the cysts, 14 were type CL (cystic lesion), 29 were type CE1, 11 were type CE2 and seven were type CE3. In other words, 54 cysts were in the active group and seven were in the transition group. Most of the cysts were type CL and CE1.Even though characteristic imaging features could be used in the differential diagnosis of HD, sometimes the differentiation of HD from other cystic lesions may be difficult. The use of WHO classification will provide standardisation of uniform treatment modality, as the treatment of HD, according to the stage of the disease, may be surgical or medical.

Central venous catheterization, an effective method for intravenous therapy, is commonly used at emergency departments and intensive care units. In this study, we aimed to assess the complications of central venous catheterization procedure in pediatric patients at emergency department and to seek possible risk factors for complications. This study included a total of 64 patients (41 males (64.1%) and 23 females (35.9%)) who underwent central venous catheterization between January 1, 2011 and May 31, 2013. Personal records of the patients were retrospectively assessed using the hospital records system. A total of 64 catheters [53 (%82.8) femoral, 5 (%7.8) subclavian, and 6 (%9.4) jugular] were inserted in all cases. One arrhythmia episode, one pneumothorax, five arterial punctures, and 4 hematomas were observed, making up a total of 11 complications (17.2%). No statistically significant relationship was observed between development of complications and age, gender, indication for central venous catheterization, anatomical site preferred for catheter insertion, time of the day of performance of the procedure, and the level of training of the performing resident (p>0.05). Hypovolemic shock as an indication for the procedure and three or more attempts to access target vein during insertion were significantly correlated with complications (p=0.015 and p=0.025, respectively). Three or more attempts to access the target vein, as well as hypovolemic shock as an indication of the procedure, were risk factors for complications.J. Exp. Clin. Med., 2013; 30:345-348

A 28-year-old man was admitted with symptoms of heart failure. Echocardiography revealed severe left ventricular dysfunction, apical aneurysm, and a 40 × 11 mm sized mobile thrombus attached to apical septum with a narrow stalk. The patient had anterior myocardial infarction two years ago. Heparin infusion was started at 1000 IU/hour for 48 hours. There was no detected change on the size of the thrombus. Surgery recommended to the patient was refused by him because of the procedural risks. Tirofiban infusion was started. Repeat echocardiography showed significant reduction in thrombus size after 24 hours, and complete resolution of the thrombus after 48 hours. To our knowledge, this is the first case with left ventricular mobile thrombus treated successfully with tirofiban infusion.

Intestinal bacterial overgrowth (IBO) and increased mucosal permeability are suggested to increase bacterial translocation (BT) in liver injury. Rifaximin (RIF) is a minimally absorbed oral antimicrobial agent that restores gut microflora imbalance. The aim of the present study was to investigate the effects of RIF on BT frequency in thioacetamide (TAA)-induced liver injury. Group 1 was the control. In group 2 (TAA), rats received TAA daily for 3 days. In group 3 (TAA + RIF), RIF was commenced on the same day as the first dose of TAA. In group 4 (RIF), rats received only RIF. Ileal aspirate Escherichia coli counts were significantly lower in the TAA + RIF group than in TAA group. There was no difference in BT frequency between the TAA and TAA + RIF groups. Our results suggest that factors such as intestinal barrier dysfunction and impaired host immune shield, apart from IBO, play an important role in BT in this model.

Introduction: Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening idiosyncratic reaction during the use of antipsychotic drugs, usually beginning in the first 2 weeks of the treatment. NMS is generally manifested by muscle rigidity, hyperthermia, autonomic instability, altered mental status, tremors, elevated serum creatinine phosphokinase, and leukocytosis. Case Report: A 26-year-old male patient who had a ventriculoperitoneal (V-P) shunt was admitted to the emergency department with complaints of loss of consciousness, fever, respiratory distress, and palpitations. In his history, we learned that treatment of quetiapine 25 mg/day was initiated 6 months ago. After physical examination and laboratory results, the patient, who had a V-P shunt, was primarily considered shunt dysfunction or infection. But, with laboratory parameters and radiographic examinations, we moved away from this diagnosis. He was evaluated as NMS due to the history of antipsychotic drug using, fever, rigidity, tachycardia, tachypnea, confusion, and increase of creatine phosphokinase for the preliminary diagnosis. Since there was no any etiological factor that could explain the clinical process, he was admitted to the medical intensive care with a diagnosis of NMS.Conclusion: NMS is a disorder that can be life-threatening and must be recognized by clinicians

Introduction: Adult-onset Still’s disease (ASD) is a systemic inflammatory disease of unknown etiology and pathogenesis. ASD, one of the most important causes of fever of unknown origin, is diagnosed after ruling out infection, malignancy, and rheumatologic diseases. It may also present with fever alone, without typical skin rash and articular manifestations. Case Report: There are no pathognomonic laboratory findings in ASD. In this paper, we report a case that presented to the emergency department with fever, malaise, and joint pain for 5 days and was subsequently diagnosed with ASD. Conclusion: In patients with prolonged fever combined with musculoskeletal symptoms and macular rash, the differential diagnosis should include ASD. Timely diagnosis and treatment of the disease can prevent complications and lead to a favorable prognosis, Introduction: Adult-onset Still’s disease (ASD) is a systemic inflammatory disease of unknown etiology and pathogenesis. ASD, one of the most important causes of fever of unknown origin, is diagnosed after ruling out infection, malignancy, and rheumatologic diseases. It may also present with fever alone, without typical skin rash and articular manifestations.Case Report: There are no pathognomonic laboratory findings in ASD. In this paper, we report a case that presented to the emergency department with fever, malaise, and joint pain for 5 days and was subsequently diagnosed with ASD. Conclusion: In patients with prolonged fever combined with musculoskeletal symptoms and macular rash, the differential diagnosis should include ASD. Timely diagnosis and treatment of the disease can prevent complications and lead to a favorable prognosis

Objective: In the present study, determination of symptoms, clinical characteristics, prevalence and recovery rates was aimed in patients who applied to the emergency service and diagnosed with hypernatremia.Methods: Patients who applied to Dicle University Medical School Emergency Service during January 2013-December 2014 and whose serum Na>148 mEq/L were included in the study. The study was conducted retrospectively.Results: Hypernatremia prevalence was determined as 0.21% in the cases who applied to the emergency service. The average age in all patients was 69±22 and the median age was 72 years. The average hospitalization period was 13.3±10.9 days. The mortality rate was 75.7% and male gender domination (56%) was determined in patients who developed mortality. When mortality and recovery groups were compared statistically; significant difference was determined (p, Amaç: Bu çalışmada acil servise başvuran ve hipernatremi tespit edilen hastalarda semptomlar, klinik özellikler, prevalans ve sağ-kalım oranlarının belirlenmesi amaçlanmıştır. Yöntemler: Çalışmaya, Ocak 2013-Aralık 2014 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi acil servisine başvuran, serum Na>148 mEq/L üzerinde olan hastalar dahil edildi. Çalışma retrospektif olarak gerçekleştirildi. Bulgular: Acil servise başvuran olgularda hipernatremi prevalansı %0,21 olarak tespit edildi. Tüm hastaların yaş ortalaması 69±22, median yaş 72 yıl idi. Ortalama hastanede kalma süresi 13,3±10,9 gün idi. Mortalite oranı %75,7 ve mortalite gelişen hastalarda erkek cinsiyet hakimiyeti (%56) tespit edildi. Mortalite ile şifa grubu istatistiksel olarak karşılaştırıldığında; hastanede kalma süresi, glukoz, üre, kreatinin ve kalsiyum ortalamaları açısından anlamlı fark tespit edildi (p< 0.05). Hastalarımızın acil servise başvuru yakınmaları sıklık sırasına göre bilinç değişikliği (%92,7), oral alım bozukluğu (%82,4), ateş (%48,6) idi. Eşlik eden komorbid durumlar ise sıklık sırasına göre serebrovasküler hastalık (%36,9), Demans/Alzheimer (%32,4), Hipertansiyon (%28,9) idi. Sonuç: Sonuç olarak hipernatremi yaşlı, oral alımı bozuk, serebrovasküler hastalığı ve demansı olanlarda daha sık görülebilen ve yüksek mortaliteyle seyreden bir sıvı-elektrolit bozukluğudur

Hypokalemic periodic paralysis (HPP) is a disorder that characterized by attacks of skeletal muscle paralysis depending on the changes in serum potassium levels, and can occur due to primary and secondary causes. One of the secondary causes of HPP is distal renal tubular acidosis (DRTA). DRTA is a disorder that characterized by hypokalemia or hyperkalemia hypercalciuria, metabolic acidosis and alkaline urine. DRTA's clinical symptoms are listed as constipation, nausea, vomiting, kidney and skeletal muscle complications, nephrocalcinosis, urolithiasis and severe hypokalemia crisis. In this case report, we reported a patient who admitted to emergency department with complains of nausea, vomiting, and periodic muscle weakness and was diagnosed with hypokalemic periodic paralysis due to DRTA was presented.

Congenital heart defects with right-to-left shunt are one of the hypoxia-related causes of acquired secondary polycythemia (SP). Tetralogy of Fallot (ToF) is the most common congenital cyanotic heart disease in children. Cases of uncorrected ToF in adult ages are rare. This paper reports a woman detected with elevated hemoglobin level during routine tests performed for infertility therapy and subsequently diagnosed SP with related ToF.

Toxic epidermal necrolysis (TEN) is a rare, life-threatening condition that is usually associated with medication use and characterized by separation of epidermis and dermis and a scalded skin appearance. A 71-year-old man presented to emergency department with fever, malaise, and hyperemic skin eruptions and bullae. Skin lesions covered more than 70% of total body surface area. Nikolsky sign was positive. He had been begun ceftriaxone for pneumonia before. TEN was considered as the initial diagnosis; the medication he used was stopped, appropriate supportive treatment was begun, and the patient was admitted to intensive care unit. He was discharged on 8th day after skin epithelization occurred. Toxic epidermal necrolysis is a highly fatal syndrome, in which early diagnosis, stopping the offensive drug, and administering appropriate supportive treatment are important components of the management. Toksik epidermal nekrolizis (TEN) nadir görülen, hayatı tehdit eden, ciltte epidermis dermis ayrışması yapan ve haşlanmış deri görünümü veren, genellikle ilaç kullanımı ile ilişkili bir klinik durumdur. Acil servise 71 yaşında erkek hasta ateş, halsizlik, ciltte hiperemik erüpsiyonlar ve büller ile başvurdu. Cilt lezyonları total vücut alanının %70’inden fazlaydı. Nikolsky bulgusu pozitifti. Hastaya 3 gün önce pnömoni tanısıyla seftriakson başlanmıştı. Hastada TEN düşünüldü. Kullandığı ilaç kesildi. Uygun destek tedavisi başlandı. Yoğun bakım ünitesine yatırıldı. Hasta 8. günde ciltte epitelizasyon gelişince tabucu edildi. TEN mortalitesi yüksek bir sendrom olup acil serviste erken tanı, sebep olan ilacın erken kesilmesi ve uygun destek tedavisinin verilmesi önemlidir.

Background: Early prediction of disease severity in acute pancreatitis (AP) is crucial. The aim of this study was to investigate the body-mass index (BMI), plasma leptin, nesfatin-1 and ghrelin levels as potential markers predicting peripancreatic necrosis and severity in acute pancreatitis. Methods: In the study period, 97 consecutive patients with AP were prospectively analysed. Severe AP was defined according to the Atlanta Criteria. BMI was also calculated. To measure plasma Leptin, Nesfatin-1 and Ghrelin concentrations, the blood samples were obtained from patients within 24 hours of admission. Results: Out of 97 patients, 92(70 females, 22 males) were considered eligible for analysis. Of the 92 patients, 30 patients (32.6%) were assessed as severe pancreatitis. BMI and leptin levels were significantly higher in patients with severe pancreatitis. The pooled sensitivity and specificity of BMI as a predictor for the development of pancreatic necrosis were 0.90(95%CI = 0.56–0.99) and 0.70(95%CI = 0.58–0.79), respectively; with an overall area under curve value of 0.78.The pooled sensitivity and specificity of leptin levels as a predictor for development of pancreatic necrosis were 1(95%CI = 0.69–1) and 0.73(95%CI = 0.62–0.82),respectively; with an overall area under curve value of 0.82.Nesfatin-1 and ghrelin levels showed no significant difference in patients with mild pancreatitis (6.97 ± 0.84 ng/ml and 2.3(1.0–9.9);respectively) and severe pancreatitis (6.74 ± 0.65 ng/ml and 2.0(1.9–9.9); respectively) (p = 0.1923 and 0.8531;respectively). Conclusion: BMI and plasma leptin levels both were correlated with the severity of pancreatitis. Leptin levels showed better area under the curve, sensitivity and specificity values compared to BMI in prediction of pancreatic necrosis.Nesfatin-1 and ghrelin levels were not found to be predictors of the severity of disease.

Aims: Our study was undertaken to examine the laboratory and clinical features of pernicious anemia patients presenting initially at the Turgut Ozal Medical Center, which serves as an important tertiary health center in Eastern Anatolia. Study Design: Among patients evaluated for etiology of anemia, we analysed the clinicopathological characteristics of 300 (158 females and 142 males) patients with pernicious anemia retrospectively. Place and Duration of Study: Department of Internal Medicine and Division of Hematology, Inonu University School of Medicine, between 1996 and July 2011. Methodology: Full blood counts, thyroid hormone levels, liver function tests and LDH levels Original Research Article British Journal of Medicine & Medical Research, 4(3): 807-815, 2014 808 were reviewed for 300 patients with pernicious anemia retrospectively. Peripheral blood smears and bone marrow biopsies were reviewed by a hematologist. Endoscopic examination and ultrasonographic inspection were performed for atrophic gastritis, gallbladder stones and hepatosplenomegaly for all patients. Laboratory values, ages, signs and symptoms of patients at the time of diagnosis were compared between genders. Results: The mean age of the female patients was 50.56 ± 17.75 years (17–84), while that of the male patients was 57.24 ± 15.78 (20–95) years. At the time of diagnosis, the male patients were older than the females (p = 0.002). LDH levels were significantly higher for females (p = 0.043). The incidence of gallstones was significantly higher in females (25.4%) than in males (10.7%) (p = 0,001). Pancytopenia was defined as a hemoglobin level lower than 10 gr/dl, leukocytes lower than 1.500/μL and platelets lower than 150.000/μL and the incidence of pancytopenia was 41.3% (n = 65) and 50.7% (n = 71) in the female and male patients, respectively, and the difference was not statistically significant. There was no statistically significant difference for frequency of thyroid disease or symptoms and signs at the time of diagnosis between genders. Conclusions: Pernicious anemia is not a disease of only elderly women; it can be seen in both men and women of younger ages. It is seen nearly as often in women as in men. Gallstones and abnormal thyroid activity can be observed at these patients at the time of diagnosis; therefore, these findings should be considered.

Aim: To investigate the relationship between mean platelet volume (MPV) and in-hospital deep venous thrombosis (DVT). Material and methods: 147 patients with the diagnosis of DVT and 149 control participants were included in the study. For all participants, clinical risk factors, smoking status, and other demographic data were recorded from hospital registries. The data of patients with DVT were compared with the control participants. Results: Mean MPV was significantly higher in patients with DVT than the control group (8.91 ± 1.86 vs 7.86 ± 0.9; P < .001). Body mass index, smoking frequency, hematocrit, and platelet count were significantly correlated with MPV. Independent predictors of in-hospital DVT were MPV (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.2-1.87; P ≤ .001), body mass index (OR = 1.17; 95% CI = 1.04-1.34; P = .012), and smoking (OR = 1.83; 95% CI = 1.09-3.08; P = .023). Conclusion: Mean platelet volume was significantly higher in patients with DVT, and it is an independent predictor of in-hospital DVT.