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Sodium valproate and ibuprofen are drugs with known efficacy in the treatment of headache associated with acute migraine attacks. In this study, our aim was to compare the efficacy of these two drugs in the treatment of acute migraine attacks when administered as a single intravenous (IV) dose in the emergency department.This study was designed as a prospective, randomized controlled, double-blinded study and included patients aged 18 to 65 years who presented to the emergency department with acute headache and met the criteria of 'migraine without aura' according to the International Classification of Headache Disorders. The patients were randomized into two groups and given a single dose of 800 mg sodium valproate or 800 mg ibuprofen in 150 mL of normal saline by IV infusion over five minutes. Changes in pain levels were assessed using the Numerical Rating Scale (NRS) for pain over a two-hour period.Ninety-nine patients (49 patients in the sodium valproate group and 50 in the ibuprofen group) completed the trial, and their data were included in the statistical analysis. The mean decrease in the post-treatment delta NRS values was statistically significantly higher in the sodium valproate group than in the ibuprofen group. The mean differences were 1.69 [confidence interval (CI): 1.02-2.37, p0.001], the mean difference between N0 and N2 was 3.61 (CI: 2.96-4.26, p0.001), the mean difference between N0 and N3 was 4.11 (CI: 3.54-4.67, p0.001), and the mean difference between N0 and N4 was 3.92 (CI: 3.67-4.46, p0.001). The number of patients who achieved the primary endpoint of pain relief was significantly higher in the sodium valproate group than in the ibuprofen group (p0.001). According to the Kaplan-Meier analysis showing the rates of reaching the targeted endpoint, there was a significant difference in the efficacy of the two-treatment group (χ2 = 79.98, CI: 80.35-99.65; p = 0.000).

Introduction and aim. This study aimed to compare the hospitalization rate, mortality rate and morbidity status of patients hospitalized with stroke and diabetic ketoacidosis (DKA) before and during the COVID-19 pandemic. Material and methods. The data of 2522 patients who applied to the emergency department (ED) before and during the pandemic were evaluated. A Poisson regression analysis was used to examine the number of presentations between two different periods. Results. Stroke cases during the pandemic era were compared to those during the pre-pandemic period, and it was shown that the mortality rate for stroke patients during the pandemic period was much higher. Treatment-related ED presentations decreased significantly during the pandemic period, particularly among patients aged 75–84 years. Rates of ED presentation decreased by 84 percent (IRR: 0.14, 95 percent CI: 0.03-0.59) in those with DKA and by 37 percent (IRR: 0.67, 95 percent CI: 0.53- 0.75) in those with stroke during the pandemic period. Conclusion. Conclusion: Stroke and DKA admissions decreased during the pandemic, but the rate of stroke mortality increased statistically 3.375 times. Getting emergency medical care increases their chances of survival. Even in a COVID-19 outbreak, treatment is critical.

Introduction and aim. The aim of this study is to evaluate the effects of topical lidocaine application for nasopharyngeal sampling, on pain perception, the comfort of the patients, and the application difficulty for healthcare staff. Material and methods. This study conducted with 100 healthy volunteers (50 participants in Lidocaine group and 50 participants in Placebo group). Two ml of a solution containing 10 mg/ml of lidocaine was applied to each nostril of the participants in the Lidocaine group, and the same dose of 0.9% NaCl to the Placebo group. We compared the changes in pain intensity and discomfort intensity using two numerical rating scales, the frequency of undesirable reactions, and the judgment of the practitioner staff. Results. There were statistically significant decreases in pain and discomfort scores in the Lidocaine group. Similarly, there were statistically significant decreases in the frequency of all undesirable reactions except “grimace”, in the second sampling in the Lidocaine group, however, there was a statistically significant decrease only in “holding staff’s hand” in second sampling in the Placebo group. Conclusion. Intranasal lidocaine application reduces the pain that occurs during nasopharyngeal sampling and makes the procedure easier for the patient and the healthcare worker.

ÖZET Giriş: COVID-19 pnömonisi olan yaşlı hastalarda hastalığın ciddiyetini ve mortalitesini erken bir aşamada tahmin etmek için acilen bir prognostik ölçüme ihtiyaç vardır. Amacımız, COVID 19 pnömonisi olan ileri yaştaki hastalarda mortalitenin erken tahmininde şok, modifiye şok ve yaş şok indeksinin rolünü araştırmaktı. Gereç ve yöntem: Çalışmaya, pozitif RT-PCR testi ile doğrulanmış COVID-19 pnömonisi olan 65 yaş üstü hastalar dahil edildi. Dahil edilen tüm hastalar için her üç indeks de hesaplandı. Mortaliteyi belirlemede indekslerin prediktif değerlerini belirlemek için ROC analizi kullanıldı. Bulgular: Dahil etme ve hariç tutma kriterleri değerlendirildikten sonra toplam 134 hasta ile çalışma tamamlandı. Mortaliteyi öngörmede şok indeksi ve yaş şok indeksinin istatistiksel olarak anlamlı farklılık göstermediği bulundu (sırasıyla p=0.23 ve p=0.06). Mortaliteyi tahmin etmede modifiye şok indeksinin ROC analizinde eğrinin altında kalan alan 0.658 (%95 CI 0.572-0.738) ve Youden indeksi 0.35 (p=0.02) idi. Daha yüksek modifiye şok indeks değerlerine sahip vakaların, düşük değerlere sahip olanlara göre ölümle sonuçlanma olasılığı 86 kat daha fazla bulundu. Sonuç: Modifiye şok indeksi, RT-PCR ve tomografi ile doğrulanmış COVID-19 pnömonisi olan 65 yaş üstü hastalarda acil serviste triyaj sırasında mortaliteyi tahmin etmek için kullanılabilecek hızlı, basit ve etkili bir yöntemdir. Anahtar kelimler: Koronavirüs, Kovid-19, Modifiye şok indeksi, Şok indeksi, Yaş şok indeksi ABSTRACT Introduction: A prognostic measure is urgently needed to predict the severity and mortality of the disease at an early stage in elderly patients with COVID-19 pneumonia. We aimed determine the shock, modified shock and age shock indexes in the early prediction of mortality in advanced-age patients with COVID 19 pneumonia. Material and Method: The study included patients over 65 years of age with COVID-19 pneumonia confirmed with a positive RT-PCR test. All three indexes were calculated for all the included patients. The ROC analysis was used to determine the predictive values of the indexes in determining mortality. Results: After evaluating the inclusion and exclusion criteria, the study was completed with a total of 134 patients. It was found that the shock index and age shock index did not statistically significantly differ in predicting mortality (p=0.23 and p=0.06, respectively). In the ROC analysis of the modified shock index in predicting mortality, the area under the curve was 0.658 (95% CI 0.572-0.738) and the Youden index was 0.35 (p=0.02). Cases with higher modified shock index values were found to be 86 times more likely to result in mortality than those with lower values. Conclusion: The modified shock index is a fast, simple and effective method that can be used to predict mortality during triage in the emergency department in patients aged over 65 with COVID-19 pneumonia confirmed by RT-PCR and tomography. DESIGN: Observational, retrospective medical record review. Keywords: Age shock index, Coronavirus, Covid-19, Modified shock index, pneumonia, shock index

SUMMARY OBJECTIVE: While abdominal pain is one of the most prevalent reasons for seeking medical attention, diagnosing elderly adults with acute appendicitis (AA) may be difficult. In this study, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado ratings were evaluated for diagnostic accuracy in patients who reported to the emergency department complaining of abdominal pain and received surgery for AA. METHODS: The data of patients over the age of 65 years who reported to the ER and had appendectomy after being diagnosed with AA were evaluated in this retrospective cohort study. For each patient, the diagnostic accuracy of the Alvarado and RIPASA scores was determined individually. RESULTS: A total of 86 patients were included in the research. The average patient was 71.2 years old, with a male preponderance of 46.5%. Alvarado’s score was found to have an area under the curve (AUC) of 0.799, the Youden’s index of 0.549, and a p-value of 0.001 after a receiver operating characteristic (ROC) study of the Alvarado score in identifying the diagnosis of AA. The AUC was 0.886 (95%CI 0.799–0.944), the Youden’s index was 0.642, and a p-value of 0.001 was found in the ROC analysis of the RIPASA score in identifying the diagnosis of AA. CONCLUSIONS: When comparing the two scores used to diagnose AA, we found no statistically significant difference between the RIPASA and Alvarado scores (p=0.09), although the Youden’s index for the RIPASA score was higher.

BACKGROUND: The present study aims to examine the characteristics of patients with trauma who applied to the emergency department in parallel periods before and after the novel Coronavirus Disease 2019 (COVID-19) outbreak and analyze the effects of social change on traumatic injuries.METHODS: In this study, medical records of patients who presented to the emergency departments of seven hospitals operating as a tertiary training and research hospital in Istanbul between March-June 2018, March-June 2019, and March-June 2020 are due to trauma were retrospectively analyzed. The clinical and demographic characteristics of traumatic injuries before and after the pandemic were compared.RESULTS: In our study, 4088 trauma patients' data were reviewed; 1279 in March-June 2018, 1684 in March-June 2019, and 1125 in March-June 2020. When the total number of patients was examined, it was noticed that the number of patients decreased significantly during the COVID-19 pandemic. No significant difference was found between the periods regarding sex and trauma mechanisms of the patients. The mean age was higher in patients admitted in 2020 compared to previous years. In our study, incidences of intracranial hemorrhage, femur fracture, lung injuries, and mortality rates were higher in March-June 2020 compared to previous parallel years. CONCLUSION: In March-June 2020, compared to the previous year, there was a 34% decrease in trauma cases admitted to the emergency department. Albeit no difference was found between the periods regarding trauma mechanisms, the higher mortality in the March-June 2020 period indicates that trauma continues to be one of the major causes of death despite the pandemic.

Introduction Football is the most popular sport in the world with its wide audience and important economic effects. This game is mainly played by professional football players, it is also an activity that is frequently played by non-professionals. Although members of the public mostly engage in this sport as a hobby and to develop a healthy lifestyle, vital injuries, such as head and thorax trauma can also occur during these recreational activities. In this study, our aim was to identify these severe traumas, investigate their causes and mechanisms, and make suggestions to reduce trauma among recreational football players. Methods This prospectively designed study included players aged over 14 years who presented to the emergency department with an injury incurred during a recreational football match activity. The demographic characteristics of the patients, warm-up status, match conditions, field conditions, and injury mechanisms, as well as post-injury outcomes, were recorded and analyzed with appropriate statistical methods. Results There were 167 patients included in the study and 140 of these patients were eligible for the study. We identified 45 cases with poor outcomes such as pneumocephalus, rib fractures, pneumothorax, Achilles tendon rupture, and bone fractures. (32.1%). Factors that could have an effect on poor outcomes were determined as a pre-match warm-up, pre-match sleep duration, and suitability of equipment. Player-to-player contact was determined as a mechanism of head and thorax trauma. Conclusions It may be beneficial to inform recreational football players about how player-to-player contact can cause head and thoracic trauma and establish a database of sports injuries in hospitals.

Public knowledge and recognition of stroke and prompt calls to ambulance services when stroke is suspected are vital to the survival of stroke patients and to minimize their disability. In this study, our aim was to investigate the effectiveness of an online education session to increase middle school (11-14-year-old) students' awareness of stroke.An interactive education session was organized for students using the online education portal of a local middle school. The effectiveness of this intervention was measured using knowledge measurement tests before, immediately after, and three months after the session. The compliance of the data with the normal distribution was checked with the Kolmogorov-Smirnov test. The McNemar chi-square analysis was used to compare the distribution of correct and incorrect answers among the tests, and one-way analysis of variance was conducted to compare the mean values of correct answers.The students' stroke knowledge levels were found to be higher in both tests applied after the educational session and all the questions compared to the baseline evaluation. Stroke awareness was also determined to be higher among the students living with a family member aged over 65 years.Online interactive education can increase students' awareness of stroke. Such programs can be included in the education curriculum of schools. Public awareness of vital diseases should continue even in extraordinary situations, such as pandemics.

Purpose Among patients with breast cancer, pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) is an important prognostic predictor of survival. This study aimed to investigate the relationship between platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) along with overall pCR. Method A total of 150 patients with breast cancer who were first administered NAC and then operated on were retrospectively evaluated. Neutrophil-lymphocyte ratio and PLR obtained from the complete blood count analysis performed immediately before NAC treatment were analyzed. The cut-off value was calculated as 150 for PLR and 2.24 for NLR. We studied the predictive value of NLR and PLR levels for the pathologic response of breast cancer to NAC. Results Pathological complete response was observed in 34.7% (n = 52) of the patients, pCR in the breast in 42.7% (n = 64), and that in the axilla in 44% (n = 66). There was a statistically significant difference between the pCR rates according to the PLR levels (p = 0.013). In addition, a statistically significant difference was found in the pCR rates in the breast and axilla according to PLR levels (p = 0.018, p = 0.009). Patients with low PLR in the human epidermal growth factor receptor 2 (HER-2) group had significantly higher axillary pCR rates than in those with high PLR (p = 0.019). Conclusions A low PLR level showed high chemotherapy sensitivity independent of molecular subtypes in the treatment of breast cancer with NAC. The PLR level can serve as a predictive marker of the therapeutic effect of NAC on the breast and axilla. Low PLR levels in HER-2 enriched groups can predict pCR in the axilla.

OBJECTIVE This study assessed whether lactate clearance (LC) during the first 2 hours after admission to the emergency department can be used to predict the 30-day mortality of patients diagnosed with diabetic ketoacidosis (DKA). MATERIAL AND METHODS This was a retrospective observational cohort study of patients admitted to the hospital between January 2014 and January 2019. We identified patients with diabetes who had blood gas test results at the time of admission and 2 hours thereafter. We then calculated the LC in these patients. Patients were divided into groups based on mortality and length of stay (LOS). The groups were compared in terms of age, blood gas pH, osmolarity, glucose level, lactate level on admission and 2 hours thereafter, LC, and bicarbonate (HCO3- ), blood urea nitrogen, sodium, and potassium levels. RESULTS The overall mortality rate was 7.54% (8/107). Age, pH, osmolarity, the HCO3- , and sodium levels, the lactate level 2 hours after admission, and LC differed significantly between the groups (Mann-Whitney U test, P

The primary purpose of this trial is to evaluate the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) therapy application in the emergency department.The patients were divided into 2 groups: a sham group, and a verum group. Patients in the verum group include those who use the device for the first time. Both groups were connected to visually indistinguishable devices. Both groups underwent therapy for a total of 20 min. Using the Visual Analog Scale (VAS), the patients' perceived changes in pain intensity were recorded at the 20th and 120th minutes after initiation therapy. After the 120th minute, patients' individual needs for additional treatment were assessed. Additionally, their self-reported well-being was assessed using a Likert-type verbal scale.In total 151 patients that were admitted to the emergency ward were assessed, with the sham and verum group being assigned 39 patients each from this pool. For the verum group the VAS change from 0 to 120 min was -65 ± 25 and for the sham group it was -9 ± 2 (p 0.001). Verbal scores in the 120th minute were found to be 1.2 for sham group and 4.5 in the verum group (p 0.001). Thirty patients (76.92%) in the sham group and 1 (2%) in the verum group had additional analgesic requirement after 120 min.TENS therapy is a fast-acting, effective therapy for the treatment of acute migraine in the emergency department.