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OBJECTIVE: Carbon monoxide (CO), a toxic gas, poses a significant threat to human health. Children, pregnant women, and elderly individuals are particularly vulnerable to this toxicity. This study aims to evaluate the demographic and clinical characteristics of pediatric, pregnant, and geriatric patients. PATIENTS AND METHODS: The study included pediatric, pregnant, and geriatric patients with a confirmed diagnosis of CO poisoning, excluding those with complete file data and those with carboxyhemoglobin (COHb) levels below 5% (for children and pregnant patients) and 10% (for elderly patients). Patients aged < 18 years, > 65 years, and pregnant patients admitted to the adult and pediatric emergency departments were included in the study; statistical analyses were conducted using SPSS Inc., with a p-value of < 0.05 considered statistically significant. RESULTS: For pediatric patients, a statistically significant difference was observed between the two groups in terms of their main complaints, which were primarily attributed to neurological and general symptoms. A positive correlation was found between follow-up time and several factors, including white blood cell (WBC) count and troponin, lactate, lactate dehydrogenase (LDH), and COHb levels. For pregnant patients, no in-hospital mortality was observed in the patients included in this study. A significant negative correlation was identified between age and both COHb and hemoglobin (Hb) levels. A strong positive correlation was found between the COHb levels and hospital follow-up time. For elderly patients, no significant differences were found between the two treatment modalities. Notably, higher COHb levels on admission were associated with a more fatal in-hospital course, with COHb levels > 40% of all patients requiring intubation. CONCLUSIONS: Vulnerable populations are at increased risk of exposure to CO, and the study results emphasize the necessity of heightened awareness and preventive measures to safeguard these individuals from CO poisoning. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Our aims were to determine whether the levels of plasma monocyte chemotactic protein-1 (MCP-1), fetuin-A, serum total antioxidant status (TAS), and serum total oxidant status (TOS) are cardiac biomarkers and to clarify their relationship with each other in acute myocardial infarction (AMI). PATIENTS AND METHODS: The study included 90 participants: 60 patients with AMI [30 with and 30 without ST-segment elevation myocardial infarction (STEMI)] and 30 cardiac patients without AMI. The diagnostic values of serum Hs-cTnT, MCP-1, fetuin-A, TAS, and TOS levels in predicting AMI were evaluated statistically. RESULTS: Median levels of MCP-1 [120.10 ng/L (interquartile range: 76.94-230.54 ng/L)] and TOS [2.89 U/MI (IQR: 2.31-3.94 U/Ml)] were statistically higher, and median levels of fetuin-A [433.52 mg/L (IQR: 387.89-584.49 mg/L)] and TAS (3.10 ± 0.86 U/mL) were lower in patients with AMI than in controls. The parameter with the area under the curve (0.815), sensitivity (73.3%), and specificity (66.7%) closest to those of Hs-cTnT was fetuin-A, followed by MCP-1, TOS, and TAS, respectively. A one-unit increase in MCP-1 levels increased the probability of AMI by 1.023 times (p = 0.002). A one-unit increase in fetuin-A levels decreased the probability of AMI by 0.995 times (p = 0.003). A one-unit increase in serum TOS levels was 1.29 times more characteristic of STEMI than of NSTEMI (p = 0.044). CONCLUSIONS: MCP-1, oxidative stress parameters, and fetuin-A might support Hs-cTnT levels in the early diagnosis of AMI. Fetuin-A and MCP-1 levels may be independent risk factors for AMI, whereas TOS could be used to distinguish STEMI from NSTEMI. [ABSTRACT FROM AUTHOR]

This pilot study aimed to evaluate the efficacy of the 4-h mean lactate clearance (LACclr) level as a predictive factor for in-hospital outcomes, 30-day mortality, and treatment success in patients with acute cardiogenic pulmonary edema (ACPE), a significant clinical form of acute heart failure (AHF).

Background: Carbon monoxide (CO) results from incomplete combustion of carbon-based materials, causing symptoms such as headaches, dizziness, nausea, chest pain, confusion, and, in severe cases, unconsciousness. Normobaric oxygen therapy (NBOT) is the standard therapy, whereas hyperbaric oxygen therapy (HBOT) is recommended in severe cases of organ damage. This study examined the early and late adverse outcomes in patients with severe CO poisoning., Materials and Methods: This study analyzed severe cases of CO poisoning among patients admitted to the emergency department between January 2020 and May 2022. The demographic, clinical, and laboratory data of symptomatic individuals and those requiring HBOT were examined. The study recorded early outcomes, such as intubation and in-hospital mortality, and late outcomes, such as delayed neurological sequelae and 1-year mortality. Chi-square tests, Spearman's rho correlation tests, and logistic regression analyses were performed to identify factors affecting these outcomes., Results: Patients who received HBOT showed a significant difference in delayed neurological sequelae (DNS) compared to those who received NBOT (p = 0.037). Significant differences were observed in the need for intubation, in-hospital mortality, and 1-year mortality between patients based on COHb levels, but no significant differences were found in DNS. The 1-year mortality probability was significantly influenced by COHb level (odds ratio = 1.159, 95% CI [1.056-1.273]). Patients receiving NBOT had a higher odds ratio for DNS risk than those receiving HBOT (odds ratio = 8.464, 95% [1.755-40.817], p = 0.008)., Conclusion: The study showed no differences in intubation, in-hospital mortality, and 1-year mortality rates between the HBOT and NBOT groups. However, significant differences in DNS suggest that treatment modalities have different effects on neurological outcomes. High COHb levels are associated with an increased risk of intubation, and mortality underscores the significance of monitoring COHb levels in clinical evaluations., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Vural, Dolanbay. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: The objective of this study was to evaluate the usefulness of the serum biomarkers myeloperoxidase (MPO), paraoxonase (PON), and plasma asprosin in acute myocardial infarction (AMI) diagnosis and assess their compatibility with routinely screened cardiac biomarkers., Methods: This study was conducted using a prospective cross-sectional design and included 90 patients, consisting of 60 patients diagnosed with AMI (30 with ST-segment elevation and 30 with non-ST-segment elevation on ECG) and 30 controls (without a diagnosis of AMI). Changes in the levels of cardiac biomarkers (Hs-cTnI, CK, CK-MB), lipid profile (TC, TG, LDL, HDL), MPO, PON, asprosin, and routine biochemical parameters of patients were evaluated. Furthermore, receiver operating characteristic curve analysis revealed the diagnostic value of Hs-cTnI, MPO, PON, and asprosin in predicting AMI. Binary logistic regression analysis of cardiac marker concentrations was used to predict the presence of AMI. In contrast, multinomial logistic regression analysis was conducted to predict the type of AMI and the control group., Results: The median levels of MPO and plasma asprosin were found to be higher in the patient group (3.22 [interquartile range {IQR}: 2.4-4.4] ng/ml and 10.84 [IQR: 8.8-17.8] ng/ml, respectively) than in the control group (2.49 [IQR: 1.9-2.9] ng/ml and 4.82 [IQR: 4.6-8.0] ng/ml, respectively) (p = 0.001 and p < 0.001, respectively). The median levels of PON were 8.94 (IQR: 7.6-10.4) ng/ml in the patient group and 10.44 (IQR: 9.1-20.0) ng/ml in the control group (p < 0.001). In the binary logistic regression model, compared with the control group, a 1 ng/ml increase in MPO level increased the odds of having AMI by 3.61 (p = 0.041, 95% CI: 1.055-12.397), whereas a 1 ng/ml increase in asprosin level increased the odds of having AMI by 2.33 (p < 0.001, 95% CI: 1.479-3.683). In the multinominal logistic regression model, compared with the control group, a 1 ng/ml increase in the MPO level increased the odds of having NSTEMI by 4.14 (p = 0.025, 95% CI: 1.195-14.350), whereas a 1 ng/ml increase in asprosin concentrations increased the odds of having NSTEMI by 2.35 (p < 0.001, 95% CI: 1.494-3.721)., Conclusion: Herein, MPO and asprosin concentrations increased with Hs-cTnI, and a decrease in PON concentration indicated that oxidant-antioxidant parameters and adipokines were related to AMI pathogenesis., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Objectives: Diclofenac sodium (DS) is a widely used nonsteroidal anti-inflammatory drug. Although its high doses are known to cause toxic effects in many tissues including liver and kidney, the effects on the cardiovascular system (CVS) have not been fully elucidated yet. Therefore, this study aimed to investigate the effect of DS on CVS., Methods: The Control group did not receive medication; however, a single dose of 240 mg/kg DS was administered orally to the DS group. Electrocardiography (ECG) measurements were performed in all animals before (0thhour) and after (1st,6th,12th,24thhour) intoxication. After 24 h, All animals were sacrificed. Biochemical (malondialdehyde [MDA], and glutathione (GSH), Apelin, Elabela, Meteorin, Endoglin, Keap1, and Nrf2) and histopathological analyzes were performed on heart tissue samples., Results: ECG results showed that there was a statistically significant increase in QTc, QRS, and heart rate at the 12th and 24th hours in the DS group. The biochemical analysis showed that GSH, Apelin, Keap1, and NRF2 values decreased significantly while Meteorin and Endoglin levels increased in the DS group. When histopathological results were evaluated, distinct lesions were observed in the DS group., Conclusion: In conclusion, high doses of DS intake can cause adverse effects on and damage to CVS., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of competing interest The authors declare no competing interests to disclose.

Aim: To investigate the effects of trauma type and survival on biochemical parameters including blood urea, creatinine, and glucose levels on patients with traumatic brain injury (TBI)., Material and Methods: The medical records of 102 patients with TBIs who were admitted to the emergency department and/ or hospitalized in the neurosurgery department between 2016 and 2019 were examined retrospectively., Results: Types of trauma included: 19 cases of subarachnoid hemorrhage, 25 cases of subdural hemorrhage, 9 cases of epidural hemorrhage, 28 cases of intracerebral hemorrhage, 4 cases of multiple hemorrhage, and 12 cases with other hemorrhages. We examined the effects of trauma type and survival on a total of 17 blood test parameters, but only three (blood urea, creatinine, and glucose) showed significance for the overall model, meaning that either trauma type or survival or an interaction between the two had significant effects on these three blood parameters., Conclusion: Our findings imply that the risk of fatality due to TBI might be deduced from observation of the patient?s blood urea and glucose levels as these two parameters differed significantly in fatal versus surviving cases. Blood urea and creatinine levels were different for different trauma types and may be useful in distinguishing the type of injury.

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<.001). Among the consulted and discharged patients, 1 patient in each group tested positive for SARS-CoV-2 by polymerase chain reaction test and thus was readmitted and hospitalized (P=.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., Trial Registration: ClinicalTrials.gov NCT04645563; https://clinicaltrials.gov/ct2/show/NCT04645563., (©Ramazan Sabırlı, Emre Karsli, Omer Canacik, Dogan Ercin, Handan Çiftçi, Levent Sahin, Turgut Dolanbay, Emin Ediz Tutuncu. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 11.12.2020.)

Introduction: Accidental head injuries are known to cause serious traumatic brain injury (TBI). Children younger than 2 years of age build a separate group that is more difficult to assess clinically. Investigations targeting TBIs in pediatric cases, particularly in those between 0 and 2 years of age, are limited., Objective: In this study, we reviewed a number of severe accidental head injuries in a cohort of children aged 0-2 years to evaluate the relative incidence, distribution, and clinical success in determining the nature of the cases in the Kars Province of Turkey., Methods: The study targeted 26 -cases who presented to the Emergency Department of Kars Harakani Hospital for TBI between 2017 and 2019 through retrospective chart review., Results and Conclusions: Among the children who presented to the emergency clinic, 2 were newborns, 7 were <1 year of age, and the remaining 17 cases were between 1 and 2 years old. The number of male and female patients was equal, and 5 fatality cases were observed. The most frequent cause of head trauma were falls. We deduced that 6 cases had subarachnoid hemorrhage, 2 cases had subdural hemorrhage, 3 cases had epidural hemorrhage, and 4 cases had contusion. We compared the mean level of the two blood parameters hemoglobin (HGB) and hematocrit (HCT) between fatal and surviving cases and detectedthat both values decreased dramatically in exitus cases. The higher fatality rate in the present study could be attributed to the fact that we targeted only the severe TBI cases. Severe TBI in children younger than 2 years results in a life-threating situation. The risk of fatality might be deduced from the reduction of the HGB and HCT levels as it is significantly lower in fatal cases than in surviving cases., (© 2020 S. Karger AG, Basel.)