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Background/Aim: A temporary influenza-like condition, called acute-phase reaction (APR), is commonly observed with intravenous (IV) administration of nitrogen-containing amino bisphosphonates, such as zoledronic acid (ZOL). This single-center study aimed to evaluate the incidence of APR symptoms after intravenous (IV) ZOL administration in patients with postmenopausal osteoporosis who were admitted to emergency department (ED). Methods: In this cross-sectional study, 107 osteoporotic patients who were diagnosed with post-menopausal osteoporosis (bone mineral density T-score equal to or below −2.5 with/without prevalent fractures) and who had an ED admission in the first 72 h after intravenous injection of ZOL were included in the study. The patient’s pre-treatment blood sample measurements, presenting symptoms (such as fever, fatigue, hyperpyrexia, headache), family history, previous medical treatment, and adverse effects caused by osteoporosis drugs, in addition to information on co-morbidities and comedications were obtained from clinical records. Results: One-hundred seven osteoporotic patients (19.56%) patients experienced APR and were admitted to the ED after IV-ZOL administration. The mean age was 64.58 (11.15) years (n = 107). The three most commonly reported symptoms were diffuse musculoskeletal symptoms, influenza-like illness, and gastrointestinal symptoms (34.5%, 21.5%, and 18.5%, respectively). Seventy percent of the patients who presented to the ED with APR symptoms were prescribed drugs only, and 30% of the patients received treatment specific for their symptoms in the ED. Most of the diffuse musculoskeletal symptoms consisted of myalgia (22.4%). A positive correlation between the onset time of APR symptoms and the number of IV bisphosphonate (BP) doses was found (r = 0.597; P = 0.032). Conclusion: Our study indicates that as the number of IV-ZOL administrations increase yearly in patients with osteoporosis, symptom onset time occurs later. A linear relationship was found between the number of drug applications and the duration of symptoms. Also, the incidence of APR following IV-ZOL administration was 19% in the osteoporotic patient population who presented to the ED or to other clinics according to the symptoms.

Background This study was conducted to determine the frequency and clinical features of patients who were diagnosed incidentally as having diabetes mellitus (DM) in the emergency department. Aim Our aim was to investigate the ratio of DM in patients whose high blood glucose levels (hyperglycemia) were detected, and to examine the subsequent treatment these patients. Methods The participants were selected from among patients who had a glucose level of ≥200 mg/dL and admitted to emergency department with symptoms of hyperglycemia in the past 1 year. Age, gender, presence of chronic disease, and the laboratory blood parameter results of the patients were recorded. We divided the patients into three groups as those who had never been admitted to clinics for treatment, those who were admitted and given treatment, and not given treatment. Results According to their genders, 73 (52.1%) were male and 67 (47.9%) were female. It was determined that 86 of the 140 patients included in the study were admitted to clinics for control. It was determined that no medication was given to 50 of these patients, but treatment was initiated in 36. Patients with glucose level ≥300 mg/dL were found to be receiving more treatment significantly (p=0.031). There were significantly fewer patients with renal disease in the group in which medication was initiated than in the group for which medication was not initiated. Conclusions Patients with blood sugar ≥200mg/dL in the emergency department should be sent to the DM outpatient clinic. It was observed that regular drug use after the diagnosis of DM had a protective effect on renal disease.

Background: This study was conducted to determine the frequency and clinical features of patients who were diagnosed incidentally as having diabetes mellitus (DM) in the emergency department. Aim: Our aim was to investigate the frequency of DM in patients whose high blood glucose levels were detected, and to examine the subsequent treatment these patients. Methods: The participants were selected from among patients who had a glucose level of ≥200 mg/dL and admitted to emergency department with symptoms of hyperglycemia in the past 1 year. Age, sex, presence of chronic disease, and the laboratory blood parameter results of the patients were recorded. We divided the patients into three groups as those who had never been admitted to clinics for treatment, those who were admitted and given treatment, and not given treatment. Results: According to their sexes, 73 (52.1%) were male and 67 (47.9%) were female. It was determined that 86 of the 140 patients included in the study were admitted to clinics for treatment. It was determined that no medication was given to 50 of these patients, but treatment was initiated in 36. Patients with glucose level ≥300 mg/dL were found to be receiving more treatment significantly (p=0.031). Conclusions: In this study, diabetic patients whose blood sugar is between 200-300 mg/dL should be sent to the DM related clinic immediately when diagnosed in the emergency department.

Background Telephones, internet-connected devices (phablets, personal computers), chat platforms, and mobile apps (eg, Skype, Facebook Messenger, WhatsApp) can be exploited for telemedicine applications. WhatsApp and similar apps are also widely used to facilitate clinical communication between physicians. Moreover, WhatsApp is used by emergency department (ED) physicians and consulting physicians to exchange medical information during ED consultations. This platform is regarded as a useful app in the consultation of dermatological and orthopedic cases. Preventing overcrowding in the ED is key to reducing the risk of disease transmission, and teleconsulting practice is thought to be effective in the diagnosis, treatment, and reduction of transmission risk of disease, most notably during the COVID-19 pandemic. Video consultation is highly recommended in some countries on the grounds that it is likely to reduce the risk of transmission. WhatsApp-like apps are among the video consultation platforms that are assumed to reduce the risk of contamination by minimizing patient-physician contact. Objective The aim of this study was to investigate the effects of WhatsApp video consultation on patient admission and discharge times in comparison to bedside consultation in the evaluation of potential patients with COVID-19 visiting a COVID-19 outpatient clinic during the pandemic. Methods Patients who presented to the ED COVID-19 outpatient clinic between March 11 and May 31, 2020, and for whom an infectious disease specialist was consulted (via WhatsApp or at bedside) were included in the study in accordance with the inclusion and exclusion criteria. Eventually, 54 patients whose consultations were performed via WhatsApp and 90 patients whose consultations were performed at bedside were included in our study. Results The median length of stay in the ED of discharged patients amounted to 103 minutes (IQR 85-147.75) in the WhatsApp group and 196 minutes (IQR 141-215) in the bedside group. In this regard, the length of stay in the ED was found to be significantly shorter in the WhatsApp group than in the bedside group (P Conclusions Consultation via WhatsApp reduces both contact time with patients with COVID-19 and the number of medical staff contacting the patients, which contributes greatly to reducing the risk of COVID-19 transmission. WhatsApp consultation may prove useful in clinical decision making as well as in shortening process times. Moreover, it does not result in a decreased accuracy rate. The shortened discharge and hospitalization timespans also decreased the length of stay in the ED, which can have an impact on minimizing ED crowding. Trial Registration ClinicalTrials.gov NCT04645563; https://clinicaltrials.gov/ct2/show/NCT04645563.

BACKGROUND Telephones, internet-connected devices (phablets, personal computers), chat platforms, and mobile apps (eg, Skype, Facebook Messenger, WhatsApp) can be exploited for telemedicine applications. WhatsApp and similar apps are also widely used to facilitate clinical communication between physicians. Moreover, WhatsApp is used by emergency department (ED) physicians and consulting physicians to exchange medical information during ED consultations. This platform is regarded as a useful app in the consultation of dermatological and orthopedic cases. Preventing overcrowding in the ED is key to reducing the risk of disease transmission, and teleconsulting practice is thought to be effective in the diagnosis, treatment, and reduction of transmission risk of disease, most notably during the COVID-19 pandemic. Video consultation is highly recommended in some countries on the grounds that it is likely to reduce the risk of transmission. WhatsApp-like apps are among the video consultation platforms that are assumed to reduce the risk of contamination by minimizing patient-physician contact. OBJECTIVE The aim of this study was to investigate the effects of WhatsApp video consultation on patient admission and discharge times in comparison to bedside consultation in the evaluation of potential patients with COVID-19 visiting a COVID-19 outpatient clinic during the pandemic. METHODS Patients who presented to the ED COVID-19 outpatient clinic between March 11 and May 31, 2020, and for whom an infectious disease specialist was consulted (via WhatsApp or at bedside) were included in the study in accordance with the inclusion and exclusion criteria. Eventually, 54 patients whose consultations were performed via WhatsApp and 90 patients whose consultations were performed at bedside were included in our study. RESULTS The median length of stay in the ED of discharged patients amounted to 103 minutes (IQR 85-147.75) in the WhatsApp group and 196 minutes (IQR 141-215) in the bedside group. In this regard, the length of stay in the ED was found to be significantly shorter in the WhatsApp group than in the bedside group (PP=.62). The median length of stay of the inpatients in the ED was found to be 116.5 minutes (IQR 85.5-145.5) in the WhatsApp group and 132 minutes (IQR 102-168) in the bedside group. The statistical analysis of this time difference revealed that the length of stay in the ED was significantly shorter for patients in the WhatsApp group than in the bedside group (P=.04). CONCLUSIONS Consultation via WhatsApp reduces both contact time with patients with COVID-19 and the number of medical staff contacting the patients, which contributes greatly to reducing the risk of COVID-19 transmission. WhatsApp consultation may prove useful in clinical decision making as well as in shortening process times. Moreover, it does not result in a decreased accuracy rate. The shortened discharge and hospitalization timespans also decreased the length of stay in the ED, which can have an impact on minimizing ED crowding. CLINICALTRIAL ClinicalTrials.gov NCT04645563; https://clinicaltrials.gov/ct2/show/NCT04645563.

Background This study aimed to compare the therapeutic efficacy of dimenhydrinate and metoclopramide in patients with nausea and vertigo. Methods A prospective, double-blind, randomized clinical trial was performed on patients who presented to the emergency department (ED) with nausea and vertigo in the six month period between Nov 1st 2012 and May 1st 2013. Adult patients who were 18 to 65 years old presenting to the ED with nausea and vertigo or motion sickness were included in the study. A total of 200 patients were divided into 2 groups who were admitted to ED with complaints of vertigo accompanied by nausea. In the first group, 50 mg dimenhydrinate and 10 mg metoclopramide infusions were given intravenously for 15 min. The efficacy of treatment was measured by using a 10 mm Visual Analog Scale (VAS) performed at 0, 15 and the 30th minute. The primary outcome variable was a reduction in vertigo intensity documented on the VAS at the 30th minute after medication administration. Results A total of 200 patients were included in the randomization (n=100 in both groups). The baseline vertigo VAS scores were 7.57±1.42 in the dimenhydrinate (DMT) group and 7.27±1.40 in the metoclopramide (MTP) group (p=0.09). In the 30th minute of treatment, the average vertigo VAS score was 2.46 ± 2.39 in the DMT group and 2.31±1.96 in the MTP group; no significant differences were detected between groups. The baseline nausea VAS scores were 7.62±1.48 in the DMT group and 7.45±1.27 in the MTP group (p=0.36). In the 30th minute of treatment the average vertigo VAS score decreased to 2.27±2.24 in the DMT group and 2.70±2.48 in the MTP group, no significant differences were detected between groups. No significant differences were detected between nausea VAS changes and vertigo VAS changes at 30th minutes of the treatment (p=0.06, p=0.85 respectively). Rescue medication need was similar in both treatment groups (p=0.94). No significant differences were detected about the side effects which are sedation (p=0.56) and hypotension (p=0.57). Conclusions In conclusion, this prospective, double-blind, randomized study showed that both DMT and MTP have similar efficacy in reducing nausea and vertigo symptoms in the ED.