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Objective: To investigate the predictive power of the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/eosinophil ratio (MER), and C-reactive protein (CRP) levels, as well as the harmless acute pancreatitis score (HAPS) and modified computed tomography severity index (mCTSI) score, in patients with acute pancreatitis (AP). Materials and Methods: This retrospective study included adult patients hospitalized for AP. Patients were classified according to disease severity using HAPS and mCTSI. Systemic inflammatory parameters and demographic data were compared among patients to identify factors associated with disease severity. Results: A total of 442 patients, 199 males (45%) and 243 females (55%), were enrolled in the study. Patients with severe disease had significantly higher mean NLR, PLR, MER, and CRP values than those with mild or moderate disease according to HAPS and mCTSI classifications. Positive correlations were observed between serum NLR, PLR, MER, CRP, and mCTSI. HAPS was correlated with NLR, MER, and CRP. Elevated NLR, MER, and CRP levels were independent predictors of disease severity in patients with AP according to HAPS and mCTSI. Conclusion: NLR, MER, and CRP levels, but not PLR, in conjunction with HAPS or mCTSI may be useful for clinical decision-making regarding AP severity. [ABSTRACT FROM AUTHOR]

This study investigated the demographic and clinical characteristics of measles patients who presented to the emergency department, analyzing the relationship with their vaccination status. This single-center and retrospective study included 110 patients with confirmed measles. The patients were categorized based on their clinical outcomes (ambulatory monitoring and inpatient) and vaccination status (≥2 doses vs. <2 doses). We compared demographic and clinical characteristics between these patient groups. Our study included 57 females (51.82%) and 53 males (48.18%), with a mean age of 9.32±10.47 years. Seventy percent of patients were aged ≤10 years. The most common symptoms upon admission were fever (77.27%), fatigue (49.09%), and cough (35.45%). Complications included otitis media (6.36%), pneumonia (2.73%), and seizure (0.91%). Despite no significant differences in hospitalization and severe disease between those who received ≥2 doses of the measles vaccine and those who did not, all hospitalized patients were unvaccinated. Furthermore, 81.8% of complicated measles cases occurred in patients who were not vaccinated with the effective dose. Our study indicates that measles is more severe in unvaccinated patients compared to vaccinated cases. All hospitalizations and most complications were observed in the unvaccinated group. Additionally, most cases were in the pediatric age group. [ABSTRACT FROM AUTHOR]

This case report describes a 32-year-old male who underwent ketamine procedural sedation and experienced a generalized tonic-clonic seizure. Despite its rapid onset and favorable tolerance profile, this case emphasizes the potential convulsive side effects of ketamine, which is commonly used for procedural sedation. While ketamine has shown promise in treating acute pain, refractory status epilepticus, and treatment-resistant depression and schizophrenia, it is associated with side effects such as hallucinations, visual disturbances, dizziness, nausea, and vomiting. The patient in this case received a carefully titrated dose of 40 mg of ketamine intravenously and underwent successful shoulder reduction while under sedation. However, within 60 s of receiving the ketamine, the patient experienced a 60-s seizure that was stopped with the administration of 5 mg of diazepam intravenously. The patient was hospitalized for further evaluation, including an electroencephalography (EEG) that showed no abnormalities. This case highlights the need for health-care professionals to be aware of the potential convulsive side effects of ketamine and to carefully monitor patients who receive ketamine sedation. [ABSTRACT FROM AUTHOR]

Introduction: We evaluated the predictive power of systemic inflammatory parameters, including the neutrophil/lymphocyte ratio, C-reactive protein/albumin ratio, monocyte/eosinophil ratio, and platelet/lymphocyte ratio, for allcause in-hospital mortality in elderly. Materials and Method: This single-center and retrospective study enrolled 46,563 patients aged =65 years who presented to the emergency department due to various complaints from June 2019 to June 2022. We evaluated the demographics, clinical characteristics, laboratory data, and clinical outcomes of the patients. Results: A total of 3,385 hospitalized patients, 1,808 males and 1,577 females, were included in the study. The average age was 76.25±7.35 years. The overall mortality rate was 11.73%. Nonsurvivors had significantly elevated neutrophil/lymphocyte, C-reactive protein/albumin, monocyte/eosinophil, and platelet/lymphocyte ratios compared to survivors (p=0.0001 for all comparisons). Elevated neutrophil/lymphocyte and C-reactive protein/albumin ratios were determined as independent predictors of mortality. A neutrophil/lymphocyte ratio =9.41 had 46.97% sensitivity and 79.99% specificity for predicting mortality. While the positive predictive value was 23.7%, the negative predictive value was 91.9%. Additionally, a C-reactive protein/albumin ratio =13.18 was identified as the cut-off for mortality, with 57.07% sensitivity and 69.91% specificity. Its positive and negative predictive values were 20.1% and 92.5%, respectively. Conclusion: Mean serum neutrophil/lymphocyte and C-reactive protein/albumin ratios on hospital admission were associated with all-cause mortality in hospitalized patients aged =65 years. However, their sensitivity and positive predictive value were relatively low. Nevertheless, negative predictive value for both were significantly high. This implies that these parameters could be used to determine the elderly at a lower risk of mortality. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We explored the epidemiological characteristics of suicide attempts and identified suicide trends and associated factors. METHODS: This retrospective, cross-sectional, observational, and single-center study included consecutive 412 patients who were admitted to Emergency Department for follow-up and treatment after a suicide attempt between June 2019 and June 2022. We assessed patient demographics, suicidal behavior, previous suicide attempts, psychiatric disorders, drug use, visits to the psychiatry clinic within the past 6 months, the persistence of suicidal ideation, and clinical outcomes. RESULTS: The study population consisted of 259 females (62.86%) and 153 males (37.14%), with a mean age of 29.50±11.51 (range: 13-72) years. Females attempted suicide more often than males, but suicide completion was more common in males. Overall, 79.37% (n=327) of the suicide attempters were aged <40 years and most were 20-29 years old (n=147, 35.68%). Non-fatal suicide attempts were more common in single, unemployed, and poorly educated individuals, but this was not the case for suicide completers. However, there was no significant difference in marital status, education, and occupation among suicide completers. Drug poisoning was the major form of suicide attempt (n=345, 83.74%). Mental disorders, family or relationship conflicts, and separation from a partner were common causes of suicidal ideation. Patient numbers were particularly high in the autumn (i.e., September), and at night. CONCLUSION: Females, young adults, singletons, the unemployed, and individuals with psychiatric disorders and low education levels are more likely to attempt suicide, particularly during hours when they are likely to be alone. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We compared the 15-variable trauma-specific frailty index and traditional injury scoring systems to determine trauma severity and predict discharge disposition in geriatric trauma patients based on the old and new World Health Organization age classifications. METHODS: This prospective, observational, single-center study included geriatric patients aged =65 years with blunt trauma. We categorized patients as elderly based on the old or new World Health Organization age classification into group I (aged 65-79 years) and group II (aged =80 years), respectively. At admission, we used traditional injury scoring systems (e.g., the Glasgow coma scale, injury severity score, and revised trauma score) to determine trauma severity. We compared the Trauma-Specific Frailty Index and traditional injury scoring systems between the patient groups and evaluated them for correlations. RESULTS: We included 169 geriatric patients (80 and 89 in groups I and II, respectively). The mean Trauma-Specific Frailty Index score was significantly higher among females than males (p=0.025) and group II than group I (p=0.021). No significant correlations were observed in terms of the Trauma-Specific Frailty Index and traditional injury scoring systems in both groups. The mean Trauma-Specific Frailty Index score was significantly different between the hospitalized and discharged patients in group I (p=0.005), but not in group II (p=0.526). CONCLUSION: The 15-variable Trauma-Specific Frailty Index score is superior to traditional injury scoring systems for managing and predicting discharge disposition in geriatric trauma patients aged 65-79 years. [ABSTRACT FROM AUTHOR]

Copyright of Anatolian Clinic Journal of Medical Sciences is the property of Hayat Saglik ve Sosyal Hizmetler Vakfi 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.)

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.)

OBJECTIVE: This study aimed to investigate the predictive power of serum systemic inflammatory markers including neutrophil- lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-eosinophil ratio (MER), and C-reactive protein (CRP) levels for distinguishing uncomplicated and complicated acute appendicitis in adult patients admitted to the emergency department (ED). METHODS: This retrospective, cross-sectional, observational, and single-center study enrolled 212 consecutive adult patients with acute appendicitis who were admitted to the ED of our tertiary care university hospital between January 1, 2019 and December 31 2021. Patients were divided into two groups (Group I, uncomplicated acute appendicitis; Group II, complicated appendicitis) according to their surgical findings and histopathological examination. Systemic inflammatory markers measured on admission were compared among patients to identify factors associated with complicated acute appendicitis. RESULTS: A total of 132 patients, 83 male (62.9%) and 49 female (37.1%), were included in the study. The mean age was 34.7±13.40 years. Based on the histopathological examination, the number of patients in Group I was 103 (78.03%) and 29 (21.96%) in Group II. Laboratory findings on admission revealed no significant differences between Groups I and II patients in terms of mean serum NLR, MER, and CRP values (p=0.096, p=0.248, and p=0.297, respectively). However, the mean serum PLR in Group II patients was statistically significantly higher than those in Group I (p=0.032). The mean serum monocyte and monocyte fraction (%) values were significantly lower, and the mean serum neutrophil fraction (%) value was higher in Group II patients compared to those with Group I. Receiving operator characteristic (ROC) analysis identified a serum PLR cutoff value of ≥133.73 for distinguishing uncomplicated and complicated acute appendicitis in adult patients, with 60% sensitivity and 58.4% specificity. In addition, ROC analysis revealed a cutoff monocyte fraction (%) level of ≤6, with 72% sensitivity and 64% specificity, for distinguishing uncomplicated and complicated acute appendicitis in adult patients. CONCLUSION: Our findings indicate that the mean serum NLR, MER, and CRP values measured on admission to ED in adult patients with acute appendicitis could not predict complicated acute appendicitis. However, mean serum PLR and neutrophil and monocyte counts can be useful in distinguishing complicated cases. [ABSTRACT FROM AUTHOR]

Objective: This study analyzed the demographic and clinical characteristics of patients who were admitted to the emergency department (ED) with stab wounds and compared the Glasgow coma scale (GCS), Revised Trauma Score (RTS), Shock Index (SI), Modified Shock Index (MSI), and Age-Adjusted Shock Index (ASI) between patients who received a blood transfusion and those who did not. Methods: This retrospective, cross-sectional, single-center study included 308 consecutive patients admitted to the ED due to stab wounds. We assessed patients' demographics and clinical features, trauma scores (GCS and RTS), SIs (SI, MSI, and ASI), the timing of trauma, intervention and blood transfusion need, and clinical outcomes. Data were compared among the groups who received blood transfusions and those who did not. Results: A total of 308 patients, 288 male (93.5%) and 20 female (6.5%), were included in the study. The mean age was 28.30±11.90 years. 235 (76.3%) cases were admitted due to assaults, 64 (20.8%) traffic accidents, and 9 (2.9%) self-harm. The most common anatomical site of injury was the lower extremity (39%). The soft tissue repairs were done in 173 (56.20%), vascular surgical repair in 22 (7.10%), laparotomy in 22 (7.10%), and tube thoracostomy in 18 (5.80%). The highest number of patients (n=38, 12.3%) were in July and August and (n=153, 49.7%) between 18:01 and 00:00. The mean GCS and RTS values were significantly lower, and mean SI, MSI, and ASI values were higher in patients who received blood transfusions (p<0.001 for all comparisons). Finally, elevated SI, ASI, and MSI remained independent predictors of the need for blood transfusion. Conclusion: The most common anatomical site for stab wounds was extremities and the most common required procedure was soft tissue repairs. In addition, elevated SI, MSI, and ASI were independent predictors for blood transfusion requirement in patients admitted to the ED with stab wounds. [ABSTRACT FROM AUTHOR]

Copyright of Anatolian Clinic Journal of Medical Sciences is the property of Hayat Saglik ve Sosyal Hizmetler Vakfi 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.)

Copyright of Anatolian Clinic Journal of Medical Sciences is the property of Hayat Saglik ve Sosyal Hizmetler Vakfi 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.)

Copyright of Turkiye Klinikleri Journal of Medical Ethics-Law & History / Türkiye klinikleri tıp Etiği, Hukuku ve Tarihi Dergisi is the property of Turkiye Klinikleri 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.)

The COVID-19 outbreak spread like a forest fire in the first quarter of 2020. Until September, more than 26 million people were affected by this epidemic. It has been 9 months since the first case was seen. However, a curative treatment method or vaccine has not been developed yet. Today, the only approach that can prevent the outbreak is classical epidemic control approaches such as hygiene, case isolation, contact tracing and quarantine. Contact tracing aims to reduce the spread of the epidemic by trying to analyze the potential transmission routes of the infection at the individual level. In addition, it will be possible to prevent official measures such as the curfew taken to prevent the epidemic from spreading. However, when considering ways of communication between people, the epidemic knows no boundaries. Mobile applications and artificial intelligence can be successful in analyzing this contact chain. Even if protecting human life is the highest degree moral duty, these methods contain many ethical problems. The most violated ethical values because of these practices are privacy, confidentiality of information, civil freedom and autonomy. In this study, we will try to analyze the ethical problems that arise with contact tracing mobile applications in the context of COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Introduction: Large vessel and cardiac injuries may also be seen in high-energy blunt traumas such as traffic accidents. This report describes a multitrauma patient with vena cava isthmus inferior injury brought to the emergency department following high-energy blunt trauma. Case Report: A 33-year-old woman was brought to the emergency department following an invehicle traffic accident. On arrival, her general condition was poor, and she was unconscious and hemodynamically unstable. Physical examination revealed that the left hemithorax was enlarged compared to the right, was distorted, and did not contribute equally to respiration. Injury to the isthmus of the vena cava inferior and bleeding in the pericardial cavity were observed in addition to abdominal injury symptoms at thoracoabdominal computerized tomography. The patient was taken for abdominal surgery. After surgical intervention, she was transferred to the intensive care unit. Conclusion: It should not be forgotten that major vascular and cardiac injuries such as vena cava inferior isthmus injury may also accompany other systemic injuries in patients subjected to highenergy trauma. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the efficacy and safety of a high-flow nasal cannula (HFNC) at different flow rates compared to noninvasive ventilation (NIV) in patients with acute chronic obstructive pulmonary disease (COPD) exacerbations., Methods: This prospective, randomized, single-blind study assigned patients to one of three study groups. The NIV group (n = 47) received bilevel positive airway pressure. The HFNC-30 (n = 44) and HFNC-50 (n = 46) groups received HFNC therapy at flow rates of 30 and 50 L/min, respectively. Demographic and clinical characteristics and arterial blood gas parameters before and 30, 60, and 120 min after treatment were compared among the treatment groups., Results: This study included 137 consecutive patients with acute exacerbations of COPD, comprising 90 males and 47 females, with a mean age of 68.1 ± 10.5 years. A total of 21 patients (15.33 %) were intubated, and the overall mortality rate was 10.2 %. The mean PaCO 2 levels on admission were 64.69 ± 10.81, 61.51 ± 9.03, and 62.29 ± 9.87 in the NIV, HFNC-30, and HFNC-50 groups, respectively, with no significant differences observed (p = 0.372). A significant reduction in mean PaCO 2 was observed in all treatment groups at 30, 60, and 120 min (p < 0.05 for all). However, the ΔPaCO 2 at 60 min was significantly higher in the HFNC-30 group compared to the NIV group (p = 0.042). Additionally, neither intubation rates nor 28-day mortality differed among the treatment groups (p = 0.368 and p = 0.775, respectively)., Conclusion: HFNC was not inferior to NIV in improving arterial blood gas parameters, particularly PaCO 2 in patients with COPD exacerbations, especially those with hypercarbia. Moreover, HFNC at a flow rate of 30 L/min was superior to NIV for reducing PaCO 2 levels at 60 min., Trial Registry: National Library of Medicine Clinical Trial Registry; No.: NCT06495086; URL: https://clinicaltrials.gov/study/NCT06495086., Competing Interests: Declaration of competing interest All authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: The BIG score (base deficit + [2.5 × international normalized ratio] + [15 - Glasgow Coma Score]) was compared with the Pediatric Trauma Score (PTS) for predicting mortality in pediatric patients with multiple trauma., Methods: This retrospective, single-center study included 318 consecutive pediatric patients (aged 1-18 years) with multiple trauma who were admitted to the emergency department between January 1, 2021, and December 31, 2023. The demographic characteristics, clinical characteristics, and trauma scores (BIG score and PTS) were compared between survivors and nonsurvivors to identify factors associated with mortality., Results: A PTS of 7 had 100% sensitivity and 81.03% specificity for predicting mortality, with an area under the curve of 0.97 (95% confidence interval 0.9-0.99). Although the positive predictive value (PPV) was low (33.7%), the negative predictive value (NPV) was 100%. A BIG score of 13.7 was identified as the cutoff for mortality, with 92.86% sensitivity and 95.52% specificity (area under the curve 0.98, 95% confidence interval 0.96-0.99). The PPV was 66.7% and the NPV was 99.3%., Conclusions: Both the PTS and the BIG score were strong predictors of mortality in pediatric patients with multiple trauma. The BIG score had a higher specificity and PPV, whereas a PTS of 7 had 100% sensitivity and a higher NPV., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)