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Background Tracheal intubation is a procedure that may cause various complications. The primary aim of this study is to investigate whether the Bispectral Index™ (BIS) can predict tracheal intubation complications sooner than other monitoring parameters. Methods A total of 55 consecutive patients were intubated. Sociodemographic data, the reason for tracheal intubation, diagnosis, starting dose or dose increase of a vasopressor drug, use of sedatives and muscle-relaxing agents, vital signs, BIS scores, and end-tidal CO2 values before the procedure, during laryngoscopy, and within 30 min after tracheal intubation were recorded along with their tracheal intubation-related complications. Results The mean age of the patients was 75.1 ± 14.4 years. Pneumonia (n = 17, 30.9%) and sepsis (n = 14, 25.5%) were found to be the two most prominent diagnoses. The most common indications for intubation were a low Glasgow Coma Scale score of ≤8 (67.3%) and respiratory failure (61.8%). Postintubation hemodynamic instability developed in 38 patients (69.1%).The BIS value obtained at minute 3 was the lowest among all measurements. Significantly lower values of BIS (minute 3) were found for patients with postintubation hemodynamic instability (46 vs. 72, p = 0.039). Using ketamine (OR = 8.99, 95% CI: 1.60–50.47, p = 0.013) and systoloc blood pressure (OR = 1.03, 95% CI: 1.01–1.05, p = 0.017) were found to be significant risk factors for the development of postintubation hemodynamic instability. Conclusion In this study, the lowest BIS values were detected at minute three after intubation. The BIS values obtained at minute three were found to be significantly associated with the development of postintubation hemodynamic instability.

Wearing face shields and masks, which used to have very limited public use before the COVID-19 outbreak, has been highly recommended by organizations, such as CDC and WHO, during this pandemic period.The aim of this prospective study is to scrutinize the dynamic changes in vital parameters, change in end tidal COThe prospective cohort included 54 healthcare workers (doctors, nurses, paramedics) who worked in the respiratory unit of the emergency department (ED) and performed their duties by wearing valved N95 masks and face shields. The vital parameters and PETCOOnly the decrease in diastolic BP between 0 and 9 h was statistically significant (p = 0.038). Besides, mean arterial pressure (MAP) values indicated a significant decrease between 0-9 h and 5-9 h (p = 0.024 and p = 0.049, respectively). In terms of the vital parameters of the subjects working with and without breaks, only PETCOAlthough the decrease in systolic blood pressure (SBP) and MAP values is assumed to be caused by increased fatigue due to workload and work pace as well as increase in muscle activity, the increase in PETCO

Background Recent studies have investigated the importance of Galetin-3 in inflammation, fibrosis, cell proliferation, cardiac disease, diabetes, and tumor formation. Aims This study aims to investigate the role of the Galectin-3 level in the diagnosis of COVID-19 pneumonia and the value of the Galectin-3 level in predicting the clinical course of the patient. Methods This study employed a prospective, case-control study design and was conducted at Bakircay University Ciğli Training and Research Hospital. A total of 100 patients (40 had moderate and 60 had severe/critical COVID-19 disease according to World Health Organisation guidelines) and 50 non-symptomatic healthy volunteers participated in the study. Blood samples were taken from patients at the time of hospital admission, after which serum was isolated. Following the isolation of serum, Galectin-3 levels were evaluated using the enzyme-linked immunosorbent assay (ELISA) method. Results The serum Galectin-3 level was measured as 13.57 (10.9-16.4) ng/mL in the control group, 13.52 (10.69-16.6) ng/mL in the moderate disease group, and 11.65 (6.09-14.33) ng/mL in the severe/critical disease group. Serum Galectin-3 levels were significantly lower in the severe/critical disease group compared to the control and moderate disease groups (p=0.001 and p=0.019, respectively). Using ROC analysis, a larger area under the curve (AUC) for the serum Galectin-3 levels of the control group (AUC=0.622, 95% CI =0.529-0.714; p=0.015) was calculated compared to the COVID-19 patient group for the diagnosis of COVID-19 disease. The Galectin-3 level was found to be 75% sensitive and 50% specific at a cut-off level of 11.3 ng/mL in predicting the need for ICU treatment. Conclusion Galectin-3 levels may be a beneficial biomarker in predicting the clinical severity of COVID-19 disease when used in conjunction with other known biomarkers, at the time of admission to the emergency department (ED).

Background Wearing face shields and masks, which used to have very limited public use before the COVID-19 outbreak, has been highly recommended by organizations, such as CDC and WHO, during this pandemic period. Aims The aim of this prospective study is to scrutinize the dynamic changes in vital parameters, change in end tidal CO2 (PETCO2) levels, the relationship of these changes with taking a break, and the subjective complaints caused by respiratory protection, while healthcare providers are performing their duties with the N95 mask. Methods The prospective cohort included 54 healthcare workers (doctors, nurses, paramedics) who worked in the respiratory unit of the emergency department (ED) and performed their duties by wearing valved N95 masks and face shields. The vital parameters and PETCO2 levels were measured at 0-4th-5th and 9th hours of the work-shift. Results Only the decrease in diastolic BP between 0 and 9 h was statistically significant (p = 0.038). Besides, mean arterial pressure (MAP) values indicated a significant decrease between 0-9 h and 5-9 h (p = 0.024 and p = 0.049, respectively). In terms of the vital parameters of the subjects working with and without breaks, only PETCO2 levels of those working uninterruptedly increased significantly at the 4th hour in comparison to the beginning-of-shift baseline levels (p = 0.003). Conclusion Although the decrease in systolic blood pressure (SBP) and MAP values is assumed to be caused by increased fatigue due to workload and work pace as well as increase in muscle activity, the increase in PETCO2 levels in the ED healthcare staff working with no breaks between 0 and 4 h should be noted in terms of PPE-induced hypoventilation.

Background: Annexin A1 (AnxA1) is an important endogenous glucocoticoid protein that contributes to the suppression of inflammation by limiting the production of neutrophil and pro-inflammatory cytokines. This study aims to determine the clinical predictivity value of blood AnxA1 levels in patients with mild and severe–critical pneumonia induced by COVID-19. Methods: This study employed a prospective, case–control study design and was conducted at Ankara Training and Research hospital between 10 February 2021 and 15 March 2021. A total of 74 patients (42 of whom had moderate and 32 of whom had severe/critical cases of COVID-19 disease according to World Health Organization guidelines) and 50 nonsymptomatic healthy volunteers participated in the study. Blood samples were taken from patients at the time of hospital admission, after which serum was isolated. Following the isolation of serum, AnxA1 levels were evaluated using the enzyme-linked immunosorbent assay method. Results: The serum AnxA1 levels were measured as 25.5 (18.6-38.6) ng/ml in the control group, 21.2 (14.7-32) ng/ml in the moderate disease group, and 14.8 (9.7-26.8) ng/ml in the severe/critical disease group. Serum AnxA1 levels were significantly lower in the severe/critical disease group compared with the control and moderate disease groups (P =.01 and P =.0001, respectively). Using receiver operating characteristic analysis, a larger area under the curve (AUC) for the serum AnxA1 levels of the control group (AUC = 0.715, 95% CI = 0.626-0.803; P =.0001) was calculated compared with the COVID-19 patient group for the diagnosis of COVID-19 disease. The AnxA1 level was found to be 80% sensitive and 54.1% specific at a cut-off level of 18.5 ng/ml for the diagnosis of COVID-19 disease. Moreover, the AnxA1 level was found to be 69.8% sensitive and 58.1% specific at a cut-off level of 17.2 ng/ml in predicting the need for intensive care unit (ICU) treatment. Conclusion: AnxA1 levels may be a beneficial biomarker in the diagnosis of COVID-19 pneumonia and in predicting the need for ICU treatment in patients with COVID-19 pneumonia at the time of admission to the emergency department. © 2021 John Wiley & Sons Ltd

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.

Subgaleal hematom, saçlı derideki gevşek gözenekli dokuda kan birikimi olarak tanımlanmaktadır. Çocuklarda subgaleal hematomun en önemli nedeni hafif kafa travmasıdır. Saçlı deride sütür hatlarını geçen ve kendiliğinden gerileyen şişlik ile karakterizedir. Çocuklarda önemsiz travmalar sonrası gelişen subgaleal hematomlarda altta yatan koagülasyon bozukluğu varlığı araştırılmalıdır. Bu olgularla karşılaşan hekimlerin dikkat etmesi gereken diğer bir nokta ise subgaleal hematomun propitozis, keratit ve hatta havayolu tıkanıklığı gibi yaşamı tehdit eden komplikasyonlardır. Burada komplikasyonsuz iyileşen saç çekmeye bağlı bir subgaleal hematom olgusu sunulmuştur. Subgaleal hematoma is defined as blood collection within the loose areolar tissue of the scalp. The major cause of subgaleal hematoma in children is minor head trauma. It is characterized by diffuse scalp swelling crossing the suture lines which usually results in spontaneous recovery. Underlying coagulopathy should be evaluated in case of subgaleal hematoma after a trivial trauma. Another consideration for physicians, who face with a case of subgaleal hematoma, is complications such as proptosis, keratitis, and even airway compromise as a life-threatening event. Here, we present a case of uneventfully resolved subgaleal hematoma related with hair pulling.

Objectives: Although road bicycle races have been held for more than a century, injury and illness patterns during multi-day bicycle events have not been widely studied. The aim of this study was to determine the incidence of injury and illness among riders and describe the medical care interventions provided to participants of cycling road races. Methods: A prospective observational study was conducted on the Presidential Cycling Tour of Turkey, which was held between April 26 and May 3, 2015. The race lasted 8days and covered 1258km of road. There were 166 elite cycling athletes representing 21 teams from various countries. Data collected pertaining to incidents involving injury or illness included the following: type of injury; anatomical location of injury; details of the medical encounter; location of the intervention; treatment provided; medication administered and disposition of the rider. An injury was defined as a physical complaint or observable damage to the body produced by the transfer of energy of the rider. An illness was defined as a physical complaint or presentation not related to injury. Results: The overall incidence (injury and illness) was 5.83 per 1000 cycling hours. (Injury incidence was 2.82 vs illness incidence of 3.01 per 1000hours cycling). A total of 31 incidents occurred. Of these, 15 were injuries, while 16 were complaints of a non-traumatic nature. A total of 43 interventions were made in the 15 cases of injury. The most commonly injured body regions were limbs; the majority of injuries involved the skin and soft tissue. The most common medical intervention was wound care (64% of all interventions). Two riders had to withdraw from the race, and one was hospitalized due to a traumatic pneumothorax. None of the non-traumatic cases resulted in withdrawal from the race. Conclusions: A broad spectrum of illness and injury occurs during elite multi-day road races, ranging from simple skin injuries to serious injuries requiring hospital admission. Most injuries and illnesses are minor; however, medical teams must be prepared to treat life-threatening trauma.

Objective: In this study, we aimed to identify the properties of patients who visited the emergency department and left of their own accord., Material and Methods: Patients who visited the emergency department and left by their own choice for any reason were evaluated retrospectively., Results: In this study, 1140 patients (57.7% male) were enrolled with a mean age of 40.5 +/- 14.9 years. Patients were admitted due to poisoning, abdominal pain and chest pain at rates of 23.2%, 16.4% and 15.1% respectively. It was found that 673 patients (59.0%) left because of being denied medical observation or treatment, and 215 patients (18.9%) left because of consultants running late., Conclusion: Necessary arrangements must be put in place to reduce the number of patients who leave the emergency department by choice, prior to being discharged by a clinician.

The Presidential Cycling Tour of Turkey (TUR) is a multi-day, prestigious, annual bicycle road race organized by the Turkish Cycling Federation with increasing popularity among elite athletes. The race started in Alanya, and it followed Mediterranean and Aegean coasts to Izmir. Istanbul is home to the spectacular finish. There were 166 athletes representing 21 teams, and they covered 1260 km over 8 days (124–185 km/day) (1). The 51st TUR was held between April 26 and May 3, 2015. A health team was organized by an emergency medicine (EM) residency-trained physician who is an associate professor and has participated in TUR for the past 4 years as well as by two senior residents from Dokuz Eylul University. In addition, 112 teams from Izmir with ambulances participated in the health team. Medical care was provided before and after the race at the start and finish lines, respectively, as well as during the race by physicians in moving vehicles (riders were re-examined after the stage) and on the scene of crashes. It is known that emergency physicians and residents provide health care for several mild to severely traumatized patients in their daily practice. Hence, bicycle-related injuries are referred to emergency departments, and emergency residents and attendants treat these patients. Based on this observation, it can be indicated that emergency experts are familiar with bicycle race-related injuries. On the other hand, non-traumatic medical problems are common in these types of organizations (2). Even simple diarrhea can be troublesome for athletes during race; hence, the management of non-traumatic medical complaints is also essential. Riders are different from patients in an emergency department. The riders do not have a tendency to worry much about minor injuries and mostly wish to continue racing. Most injuries require rapid and minimal interventions on the track, and the finish zone is more appropriate for advanced interventions. The abovementioned situations need the agility of emergency physicians. Although minor injuries are common in these races, life-threatening accidents as well as trauma-associated fatalities can be seen in elite bicycle races on roads. Cyclists ride at a speed of 40–50 km/h on a straight road, and they reach a speed of approximately 90–100 km/h downhill; hence, one can estimate the severity of injury. In this race, after an accident, one of the athletes had multiple rib fractures; in addition, pneumothorax needed tube thoracostomy. This indicates the importance of an emergency expert who can manage patients with a holistic approach. Although not seen in this race, it is known that sudden cardiac event may occur during elite organizations (3). These kinds of severe cases need the intervention of qualified physicians; hence, specific procedures including airway management, defibrillation, and cardiopulmonary resuscitation must be performed by experienced specialists. Emergency medicine has various patients and field diversity. In the United States (US), there are several fellowship training programs for EM Residency Graduates. Sport medicine is becoming the center of attention for emergency physicians in the US (4, 5). Sport medicine is still not popular in the EM community of Turkey, but sport-related traumas are already treated in emergency departments; thus, emergency physicians are familiar with these injuries. Although in Turkey, sport medicine is not yet a fellowship program of EM, it seems to be an interesting and unexplored area. Thus, sport medicine as well as the fellowship program of EM in Turkey must be taken into consideration.