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Copyright of Southern Clinics of Istanbul Eurasia is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Chronic kidney disease (CKD) is the chronic and progressive deterioration of metabolic and endocrine functions together with the inability to adjust the fluid-solute balance of the kidney. In our study, the values of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) before and after dialysis were compared in patients with chronic renal failure, except for patients with infection clinic admitted to the emergency department. Our aim is to examine the changes in the parameters of complete blood count (hemogram) before and after dialysis, which is a fast and inexpensive test, to discuss whether these changes will give an idea in determining the need for urgent dialysis. Methods: The CKD patients who received a routine dialysis program in the Nephrology Clinic Dialysis Unit of Istanbul Haydarpaşa Numune Training and Research Hospital were examined. Among the patients with CKD who received routine dialysis in our hospital, patients who presented to the emergency department for various reasons between January 2016 and January 2018 were included in our study. Laboratory examinations were made with MINDRAY BC6800 brand hemogram device. As a statistical analysis, the mean values, standard deviations, median values of the data were calculated. Student's t-test was used to compare the Chi-square test variants. Results: Between January 2016 and January 2018 a total of 458 CKD patients applied to our emergency department. The pre-dialysis and post-dialysis NLR ratios of the patients show a statistically significant change in all age groups (p<0.05). Postdialysis values in patients over 52 years of age in PLR ratios decreased significantly compared to pre-dialysis values (p<0.05). On the other hand, there was no statistically significant change in PLR ratios in patients under 52 years of age. Discussion and Conclusion: In determining the need for urgent dialysis, the increase in NLR and PLR ratios can be helpful in making an emergency dialysis decision together with clinical evaluation. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to investigate the predictive power of serum corin levels for distinguishing between hypertensive urgency (HU) and hypertensive emergency (HE) in patients with hypertensive crisis (HC) admitted to the emergency department. Methods: A total of 120 consecutive consenting adult patients diagnosed with HC and 55 age- and sex-matched healthy controls were enrolled. Blood pressure measurements [(systolic, diastolic, and mean arterial pressure (MAP)] and the evidence of end-organ damage at the first admission were recorded. Patients with HC were classified as patients with HE or HU according to the presence or absence of acute end-organ damage. Serum corin levels were compared between the 2 groups. Results: The mean serum corin level was significantly lower in the HC group than in the control group; it was also lower in the HE group than in the HU group (p<0.001 for all). In the HE group, clinical features associated with end-organ damage included ST-elevation myocardial infarction (n=28, 46.7%), hemorrhagic stroke (n=11, 18.3%), ischemic stroke (n=11, 18.3%), and non-ST-elevation myocardial infarction (n=10, 16.7%). The receiving operator characteristic (ROC) analysis identified a serum corin cutoff value of 45 pg/mL for distinguishing patients with HE from patients with HU with 98.3% sensitivity and 95% specificity. Conclusion: Our findings suggest that serum corin levels play an important role in regulating blood pressure and are involved in the pathogenesis of HC. Low serum corin levels may predict end-organ damage and serve as a guide for diagnostic decision making in patients with HC. [ABSTRACT FROM AUTHOR]

Aim: In this study, we aimed to analyze the level of knowledge about Coronavirus disease-2019 (COVID-19) in patients and their relatives presented to the emergency department. Methods: In this study, a 25-item questionnaire was applied to patients and their relatives. The participants were stratified into three groups as primary-secondary school, high school or university graduation. The responses were analyzed among education groups at a significant level of p<0.05. Results: In this study, of the 212 participants, 62.7% were male. The proportion of the participants thinking "COVID-19 also affected younger individuals" was higher in participants having an education level of high school or higher (p=0.009). The willingness to receive the vaccine was significantly high among all education levels. The idea that traditional soups and gargling with salty water prevent disease was found to be more common among participants with an education level of high school or lower (p<0.05). The benefit from the opinion of the expert on media about protection against the virus was significant in participants with an education level below high school (p<0.05). Conclusion: The revision of key messages of public health specialists according to education levels will have an important role in reorganizing inaccurate knowledge in the community. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Metformin is first-line therapy in diabetes mellitus treatment. Metformin intoxication may cause lactic acidosis. A 29-year-old woman presented to our emergency department with loss of consciousness. Arterial blood gas revealed severely increased anion gap lactic acidosis. Continuous venovenous hemofiltration was performed for 39 h. After extracorporeal treatment, the acidosis resolved and the patient became conscious. There is no specific treatment for metformin intoxication; current treatment is supportive only. Our aim is to highlight the diagnosis, chromatographic measurement of the drug blood level, and management of metformin overdose. [ABSTRACT FROM AUTHOR]

Objective: Esophageal variceal bleeding is the most important and common complication of cirrhosis. Predicting the indication of emergency transfusion in patients with esophageal variceal hemorrhage is controversial. The aim of this study is to identify predictors of emergency transfusion by comparing the differences in demographic characteristics, vital signs, complete blood count, biochemistry, Partial thromboplastin time values, use of medication, and the insertion of nasogastric tubes in transfused and non-transfused esophageal variceal bleeding patients. Material and Methods: The files of 51 esophageal variceal bleeding patients admitted to the emergency department between 2000 and 2009 were reviewed retrospectively. Vital signs of the patients, whole blood counts, biochemistry, PTT, INR values, emergency department blood transfusion, medications, and mortalities were recorded. Data were analyzed with SPSS version 17.0. Categorical variables were analyzed with chi-square test, and nonparametric data were analyzed with Mann-Whitney U-test. Results: The incidence of transfusion was significantly higher (p=0.02) in patients with a decreased albumin/globulin ratio. Patients requiring emergency transfusion had significant tachycardia (p=0.016). Age (p=0.026) and hematocrit value (p=0.00001) also predicted the need for emergency transfusion. Conclusion: Low albumin/globulin ratio, tachycardia, and age over 60 in patients with esophageal variceal hemorrhage predict the indication of emergency transfusion. [ABSTRACT FROM AUTHOR]

The aims of this study were to investigate the epidemiological features of warfarin overdose and evaluate the efficacy of prothrombin complex concentrate (PCC) for overdose treatment. The hospital records of 106 patients admitted to the emergency department (ED) for warfarin overdose during a two-year period were evaluated retrospectively. Demographic and epidemiological data as well as treatments were recorded. The data from 15 patients administered PCC were compared with those of other patients. The patient population consisted of 53 (50%) males and 53 (50%) females with a mean age of 70.2±14.5 years. Forty-five (42.4%) patients were admitted to the ED with bleeding disorders; 61 (57.6%) patients were admitted for other symptoms such as headache, syncope, trauma related injuries. Atrial fibrillation (n=50, 47.1%) was the most common indication for treatment with a vitamin K antagonist (VKA). Other common indications were transient ischemic attack, stroke (n=43, 40.5%) and valvular heart disease (n=17, 16%). Vitamin K was the preferred treatment for VKA reversal in 32 (30.2%) patients. Fresh-frozen plasma (FFP) was preferred in 23 (21.7%) patients. Fifteen (14.1%) patients required acute reversal of VKA with PCC. The anticoagulant drug was discontinued in 58 (54.7%) patients. Erythrocyte suspension (ES) and thrombocyte suspension (TS) transfusion rates were higher in the PCC-administered group; hospitalization rates were also higher in this group. ED length of stay (LOS) was shorter in this group. Initial international normalized ratio (INR) levels were significantly higher in the PCC group (5.68±3.74 versus 13.17±5.15). As the elderly population increases, warfarin and VKArelated complications will be a more significant portion of ED practice.ED physicians should be experienced in acute reversal of VKA with PCC, and be familiar with the possible complications of FFP and PCC. [ABSTRACT FROM AUTHOR]

Introduction: Although shoulder dislocations are common dislocations, posterior dislocations of the shoulder with fracture are rare. Seizures are the most common etiology for posterior dislocations. Diagnosing posterior dislocations is challenging in emergency departments. For this reason, emergency department physicians might not evaluate musculoskeletal injuries correctly. In addition, x-rays are not diagnostic for posterior dislocations. Late diagnosis may lead to humerus head necrosis, major complications, and malpractice. Case Report: Our patient, who was brought due to electrical shock, had bilateral posterior dislocation and unilateral humeral head fracture. Conclusion: In this case report, we evaluated a patient with bilateral posterior dislocation. [ABSTRACT FROM AUTHOR]

Uterine myoma is a benign tumor of the uterus and clinically apparent in up to 25% of reproductive-age women. Emerged silent uterine bleedings are commonly seen with myoma. Although therapies via surgical and radiological way are frequently used for the management of the tumor, medical therapies are considered as initial treatment. When the anemia diagnosis cannot be made and cannot properly treated; it is not only reduces the patient's life quality, but also threatens the patient's life. In this case report; we aim to present a rare case of the lowest hemoglobin level in the literature by a value of 1.2 g/dL hemoglobin due to anemia resulted myoma uteri patient admitted to the emergency department by walk. All case with severe anemia at a level lower than 4 g/dL is rarely seen in the hospital emergency. Sometimes there are complaints of dysphagia, fragile nails, relative impotence, fatigue and cramps in the calves on climbing stairs, which are disproportionate to their anemia. In contrast to all recent reports, our case had the lowest hemoglobin levels reported ever, without a noisy clinical table indicating anemia. [ABSTRACT FROM AUTHOR]

Retrobulbar haemorrhage is a rare emergency condition usually associated with trauma. Major clinical features are loss of visual acuity, eye pain and increasing propitosis. Several spontaneous cases were also reported in literature. We present a 36 years old case of a spontaneus retrobulbar haemorrhage associated with subarachnoid haemorrhage. Patient underwent a lateral canthotomy and cantholysis (LCC) and intravenous corticosteroids, mannitol, topical timolol and acetazolamide were administered. The aim of this study was to increase the awareness of retrobulbar haemorrhage in emergency staff. This will prevent the delay in treatment that will lead to the situation whereby the patient is left permanently blind. Retrobulbar haemorrhage is an ophtalmic acute surgical emergency that emergency physicians have to be familiar with. [ABSTRACT FROM AUTHOR]

The most severe airbag-related injuries occur in the orbital region. Eye injuries related with airbag deployment is usually defined under two headings as mechanical injury and alkali chemical injury. In addition to two types of injuries, there may be penetrating injuries accompanying them. Although eye injuries related to airbag deployment are rarely seen, they are extremely important that may result in potential poor clinical results. Treatment of eye injuries depends on the size and type of injury. A case who had monocular injury related to airbag deployment after a motor vehicle accident was presented in this article. Fourtytwo- years old male patient was admitted to our emergency room after a motor vehicle accident. He had complaints of pain in the face and neck. On his physical examination, there was a patchy lesion compatible burn injury in the right half of face and minimal redness in the right eye and periorbital area. In the follow-up of the patient had no radiological evidence of pathology requiring surgical intervention, an increase of redness in the right eye and a swelling of lower-right eyelid were detected. His cornea was found to be intact, but there was a minimal subconjunctival bleeding in the eye examination of the patient who had a normal visual acuity and intraocular pressure. The patient was discharged on the second day of admission after symptomatic treatment. [ABSTRACT FROM AUTHOR]

Acquired pulmonary stenosis is very rare in adults and diagnosis requires a high index of suspicion. Malignant mediastinal masses may compress cardiac structures and great vessels.45- year-old female patient was admitted to the emergency department with dyspnea and chest pain. Arterial blood gas analysis revealed hypoxia and respiratory alkalosis (pH 7,51, pCO2 65 mmHg, pO2 65, HCO3 26 mEq/L, lactate 6 mmol/L).patient had decreased breath sounds in the right hemithorax, 2-3/6 apical systolic ejection murmur, pretibial edema, jugular venous pressure. Electrocardiogram revealed right axis deviation and sinus tachycardia. D-dimer value was 300 ng/ml. Thorax computed tomography angiography revealed no thrombus or dissection. CT revealed soft tissue mass compressing right pulmonary artery and right pleural effusion. External compression of pulmonary artery may clinically mimic pulmonary thromboembolism. Low D-dimer levels may rule out pulmonary thromboembolism. External pulmonary artery compressions may not increase D-dimer levels.Tomographic imaging should be preferred in patients with unexplained dyspnea. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to investigate the predictive power of serum corin levels for distinguishing between hypertensive urgency (HU) and hypertensive emergency (HE) in patients with hypertensive crisis (HC) admitted to the emergency department., Methods: A total of 120 consecutive consenting adult patients diagnosed with HC and 55 age- and sex-matched healthy controls were enrolled. Blood pressure measurements [(systolic, diastolic, and mean arterial pressure (MAP)] and the evidence of end-organ damage at the first admission were recorded. Patients with HC were classified as patients with HE or HU according to the presence or absence of acute end-organ damage. Serum corin levels were compared between the 2 groups., Results: The mean serum corin level was significantly lower in the HC group than in the control group; it was also lower in the HE group than in the HU group (p<0.001 for all). In the HE group, clinical features associated with end-organ damage included ST-elevation myocardial infarction (n=28, 46.7%), hemorrhagic stroke (n=11, 18.3%), ischemic stroke (n=11, 18.3%), and non-ST-elevation myocardial infarction (n=10, 16.7%). The receiving operator characteristic (ROC) analysis identified a serum corin cutoff value of 45 pg/mL for distinguishing patients with HE from patients with HU with 98.3% sensitivity and 95% specificity., Conclusion: Our findings suggest that serum corin levels play an important role in regulating blood pressure and are involved in the pathogenesis of HC. Low serum corin levels may predict end-organ damage and serve as a guide for diagnostic decision making in patients with HC.

Background: A coup attempt against the government took place in Turkey on July 15, 2016. This attempt caused serious injuries and deaths in the country. In this study, the data of patients referred to all hospitals in Istanbul during the attempt were evaluated, and differences between natural disasters, other terrorist actions, and coup attempts were analyzed., Methods: In total, 1104 patients were injured in the abovementioned coup attempt. In this study, the demographic and health information of 882 coup victims who were admitted to all hospitals (state and private) in Istanbul on July 15 and 16, 2016 and registered at the Crisis Center of Istanbul Provincial Health Directorate was analyzed., Results: Of the 882 patients evaluated, 97.27% were male and 2.73% were female. The mean age of the patients was 34.12 years. Most (82.43%) patients were admitted to state hospitals, and 17.57% were admitted to private hospitals. The total mortality rate due to the abovementioned coup attempt was 10.4% (9.76% in state hospitals and 13.54% in private hospitals). Of the 882 patients evaluated, 65.07% had gunshot injuries, 11.11% had been assaulted, 7.70% had experienced tank/motor vehicle accidents, 5.44% had other penetrating injuries, 5.32% had soft-tissue trauma, 2.83% had experienced falls (including falls from heights), 0.33% had psychiatric disorders, and 2.15% were admitted for other reasons., Conclusion: The patterns of injury and mortality resulting from the July 15, 2016 coup attempt differed from those resulting from natural disasters and terrorist acts and were similar to those encountered during wars: the victims were predominantly male, similar to those in wars. Following a coup attempt, an increase in the number of patients with post-traumatic stress disorder can be expected. Further studies focusing on the incidence of this disorder due to the abovementioned coup attempt in Turkey are needed. Hospital disaster plans need to include information and plans related to terrorist acts, such as coup attempts.