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IntroductionThe accuracy and reliability of health information disseminated through news is crucial, as it directly impacts both individual and societal health outcomes. This study aims to analyze the publication process of health content in Türkiye and its implications for public health. By examining the perspectives of various health communication stakeholders, the study seeks to identify existing issues and propose potential solutions.MethodsThe research uses a mixed-methods approach, including baseline content analysis of 846 news by 133 criteria, quantitative research with 78 participants encompassing bureaucrats, academics, journalists, and health association members, and 15 in-depth interviews for comprehensive insights.ResultsThe content analysis indicated that 23.2% of the analyzed news articles lacked credible sources, while 63% did not mention the author’s name. A striking 96.2% of respondents stated that inaccurate health news poses a risk to public health, emphasizing the urgent need for standardized reporting practices. The majority (90.9%) pinpointed the media as the primary catalysts for infodemic spread, with 93.5% citing gatekeepers as barriers to accurate information. Eroding trust in media, fueled by unethical practices, harms both media credibility and effective public health interventions.DiscussionThe study underscores the necessity for a collaborative approach among public institutions, academia, and media, focusing on responsibility, regulation, and sanctions against the infodemic. The research advocates for a balanced approach that prioritizes health rights and press freedom within a stakeholder-driven framework, highlighting that legislation alone cannot fully enhance the digital information ecosystem.

This study focuses on the classification of six different macrofungi species using advanced deep learning techniques. Fungi species, such as Amanita pantherina, Boletus edulis, Cantharellus cibarius, Lactarius deliciosus, Pleurotus ostreatus and Tricholoma terreum were chosen based on their ecological importance and distinct morphological characteristics. The research employed 5 different machine learning techniques and 12 deep learning models, including DenseNet121, MobileNetV2, ConvNeXt, EfficientNet, and swin transformers, to evaluate their performance in identifying fungi from images. The DenseNet121 model demonstrated the highest accuracy (92%) and AUC score (95%), making it the most effective in distinguishing between species. The study also revealed that transformer-based models, particularly the swin transformer, were less effective, suggesting room for improvement in their application to this task. Further advancements in macrofungi classification could be achieved by expanding datasets, incorporating additional data types such as biochemical, electron microscopy, and RNA/DNA sequences, and using ensemble methods to enhance model performance. The findings contribute valuable insights into both the use of deep learning for biodiversity research and the ecological conservation of macrofungi species.

Quantification and evaluation of carbon sequestration in forests within the scope of macro-scale planning is important in terms of maintaining and monitoring forestry activities. These sustainable and carbon-optimized forestry activities increase carbon sequestration without damaging the natural ecosystem structure, in areas where carbon sequestration is low, and contribute additionally to the mitigation of greenhouse gases. In this study, carbon sequestration for forests in the Mediterranean Ecoregion of Türkiye was calculated and mapped using stand volume values and internationally accepted coefficients. In this study, (1) average carbon stock per hectare for deciduous and coniferous trees at the forestry administrative borders, (2) average carbon stock per hectare for deciduous (pure or mainly deciduous tree species) and coniferous (pure or mainly coniferous tree species) stands in the region; and (3) average biomass carbon stock according to stand age and canopy for Turkish red pine (Pinus brutia Ten.) and black pine (P. nigra Arnold) were calculated. The average above-ground biomass carbon stock according to forest stand types in Forest Sub-District Directorates is 36.12 tons C/ha for normal closed (more than 10% covered) coniferous stands and 20.13 tons C/ha for normal closed deciduous stands. Çzde3 and Çze3 stands for Turkish red pine, and Çkde3 and Çke3 stands for black pine, which provide the highest carbon sequestration. The results of this study can be used for the selection of species and silvicultural practices in terms of carbon stock, taking into account the natural structure of ecosystems. In addition, the carbon stock potential of non-dominant species in the stand was evaluated for the first time in this study. This information will support the conservation of these species in mixtures. Finally, it will also ensure that the stand carbon stock differences between the forestry sub-districts are taken into account in activities such as increasing carbon sequestration and carbon management efforts, taking measures, or intervening in problems.

“Inappropriate thyroid stimulating hormone (TSH)” refers to an elevation in TSH levels that does not match the clinical findings and free T3 and free T4 levels. Several conditions can cause this, such as pituitary tumors that produce TSH, resistance to thyroid hormones, macro-TSH, and antibody interference. Macro-TSH is a condition that causes TSH to be measured high in the blood for a long time by forming a complex with immunoglobulins, mostly IgG. However, patients are clinically euthyroid because macro-TSH is not a bioactive complex. It is essential to exclude the diagnosis of falsely elevated TSH to protect patients from unnecessary or high-dose levothyroxine therapy. In our first case, we presented a patient in whom subclinical hypothyroidism was detected during in vitro fertilization treatment, and levothyroxine was started. The other case was an operated papillary thyroid cancer patient. In both cases, although the dose of levothyroxine was increased, insufficient TSH response to increased fT4/fT3 levels suggested inappropriate TSH elevation. The polyethylene glycol (PEG) precipitation method was used to detect the assay variability. TSH recovery after PEG was 0.96% and 21%, respectively, supporting the diagnosis of macro-TSH. In both cases, detecting Macro-TSH was crucial in preventing thyrotoxicosis caused by excessive levothyroxine dosage. In addition, delay in treatment for infertility was prevented in the first case.

Wheat powdery mildew is a fungal disease that significantly impacts wheat yield and quality. Controlling this disease requires the use of resistant varieties, fungicides, crop rotation, and proper sanitation. Precision agriculture focuses on the strategic use of agricultural inputs to maximize benefits while minimizing environmental and human health effects. Object detection using computer vision enables selective spraying of pesticides, allowing for targeted application. Traditional detection methods rely on manually crafted features, while deep learning-based methods use deep neural networks to learn features autonomously from the data. You Look Only Once (YOLO) and other one-stage detectors are advantageous due to their speed and competition. This research aimed to design a model to detect powdery mildew in wheat using digital images. Multiple YOLOv8 models were trained with a custom dataset of images collected from trial areas at Tekirdag Namik Kemal University. The YOLOv8m model demonstrated the highest precision, recall, F1, and average precision values of 0.79, 0.74, 0.770, 0.76, and 0.35, respectively.

Plant diseases reduce yield and quality in agricultural production by 20–40%. Leaf diseases cause 42% of agricultural production losses. Image processing techniques based on artificial neural networks are used for the non-destructive detection of leaf diseases on the plant. Since leaf diseases have a complex structure, it is necessary to increase the accuracy and generalizability of the developed machine learning models. In this study, an artificial neural network model for bean leaf disease detection was developed by fusing descriptive vectors obtained from bean leaves with HOG (Histogram Oriented Gradient) feature extraction and transfer learning feature extraction methods. The model using feature fusion has higher accuracy than only HOG feature extraction and only transfer learning feature extraction models. Also, the feature fusion model converged to the solution faster. Feature fusion model had 98.33, 98.40 and 99.24% accuracy in training, validation, and test datasets, respectively. The study shows that the proposed method can effectively capture interclass distinguishing features faster and more accurately.

In this research, the use of the motosoyar, which was previously developed by mounting a peeling device on a brush cutter, in the field and the determination of the resulting efficiency; in addition, it was aimed to determine the implementation potential of the motosoyar by comparing the work productivity of the motosoyar with the chainsaw-mounted debarking equipment and the axe. In addition, it was aimed to compare the debarking quality of these three tools by accepting the amount of bark remaining on the log surface as an indicator. A certified employee; in the same field conditions, in the same stand, in the same tree species (Pinus brutia Ten.), cut and sorted on the same dates, the bark of logs of similar height and different diameters was stripped with these three tools. Work efficiency was determined through time studies; debarking quality was calculated over the amount of bark remaining on the log. In debarking operations of logs with an average diameter of 25 cm, medium diameter and 3 m length, the chainsaw was more efficient in all time periods (3.65 m3/h), motosoyar (3.06 m3/h) was found to be efficient compared to the axe (1.25 m3/h), but inefficient compared to the chainsaw. In terms of debarking quality, it has been determined that the axe peels more cleanly (remaining shell amount; 1.65%), the chainsaw follows it with a rate of 2.73%, and the motosoyar peels at a level of 3.42%. With the improvement of the system structure (arrangement of belt and shaft arm) of motosoyar, it has shown a performance that can be as efficient and useful as a chainsaw. It has been revealed that Motosoyar has implementation potential as well as theoretical, technical, economic and ergonomic potential in debarking works.

ObjectivesMitsugumin 53 (MG53) is a myokine that acts as a membrane repair protein in tissues. Data on the effect of MG53 on insulin signaling and type 2 diabetes mellitus (T2 DM) are still unknown; most are from preclinical studies. Nevertheless, some researchers have argued that it may be a new pathogenic factor, and therapies targeting MG53 may be a new avenue for T2 DM. Our study aims to evaluate the relationship of circulating MG53 levels with the presence of diabetes, diabetic complications, and glycemic control.MethodsWe conducted a case-control study with 107 patients with T2 DM and 105 subjects without insulin resistance-related disease. Concurrent blood samples were used for serum MG53 levels and other biochemical laboratory data. MG53 concentration was measured using Human-MG53, an enzyme-linked immunosorbent assay kit (Cat# CSB-EL024511HU).ResultsWe found no difference in MG53 levels between the diabetic and control groups (p = 0.914). Furthermore, when the subjects were divided into tertiles according to their MG53 levels, we did not find any difference between the groups in terms of the presence of diabetes (p = 0.981). Additionally, no correlation was observed between weight, BMI, waist circumference, systolic and diastolic blood pressure, fasting blood glucose, HbA1c, albumin excretion in the urine, e-GFR levels, and MG53. Finally, MG53 levels were similar between the groups with and without microvascular and macrovascular complications of diabetes.ConclusionOur research finding provides insightful clinical evidence of lack of association between the levels of MG53 and T2 DM or glycemic control, at least in the studied population of Turkeys ethnicity. However, further clinical studies are warranted to establish solid evidence of the link between MG53, insulin resistance and glycemic control in a wider population elsewhere in the world.

Aim:We aimed to investigate the effect of rosmarinic acid (RA) on cell viability, steatosis, paraoxonase (PON)1, and PON3 protein levels in palmitate-induced non-alcoholic fatty liver disease (NAFLD) model in HepG2 cells.Materials and Methods:To induce an experimental steatosis model, HepG2 cells were incubated with 1 mM palmitate for 24 hours. For the treatment, non-toxic RA concentrations were added to the cell culture medium simultaneously with the palmitate. Cell viability was evaluated by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide assay. To evaluate steatosis, intracellular triglyceride levels were measured and the cells were examined microscopically with Oil-Red O staining. PON1 and PON3 protein levels were measured by Western blotting.Results:1 mM palmitate caused a significant decrease in cell viability and a significant increase in triglyceride levels, but it did not significantly change PON1 and PON3 protein levels. RA caused a significant increase in cell viability and a significant decrease in triglyceride levels in the palmitate-treated cells. Similar findings with the triglyceride levels of cells were shown in microscopic examination of cells that were stained with Oil-Red O. RA did not significantly change PON1 and PON3 protein levels in neither non-treated cells nor treated cells with palmitate.Conclusion:Our study showed that RA increases cell viability and decreases steatosis, but it does not change PON1 and PON3 protein levels in palmitate-induced NAFLD model in HepG2 cells.

Background: Apolipoprotein A-1, paraoxonase-1 and paraoxonase-3 are antioxidant and anti-atherosclerotic structural high-density lipoprotein proteins that are mainly synthesized by the liver. No study has ever been performed to specifically examine the effects of caffeine on paraoxonase enzymes and on liver apolipoprotein A-1 protein levels. Aims: To investigate the dose-dependent effects of caffeine on liver apolipoprotein A-1, paraoxonase-1 and paraoxonase-3 protein levels. Study Design: In vitro experimental study. Methods: HepG2 cells were incubated with 0 (control), 10, 50 and 200 μM of caffeine for 24 hours. Cell viability was evaluated by 3-(4,5-Dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide assay. Apolipoprotein A-1, paraoxonase-1 and paraoxonase-3 protein levels were measured by western blotting. Results: We observed a significant increase on apolipoprotein A-1 and paraoxonase-1 protein levels in the cells incubated with 50 µM of caffeine and a significant increase on paraoxonase-1 protein level in the cells incubated with 200 µM of caffeine. Conclusion: Our study showed that caffeine does not change paraoxonase-3 protein level, but the higher doses used in our study do cause an increase in both apolipoprotein A-1 and paraoxonase-1 protein levels in liver cells

Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous unit. Although some mechanisms have been suggested in the etiopathogenesis of AV in several studies, they have not yet been clarified. This study aims to investigate the level of 8-hydroxy-2-deoxyguanosine (8-OHdG) in acne vulgaris and its relationship with disease severity. Thirty-five patients with mild to moderate acne vulgaris and 30 healthy control participants were included in the study. The clinical severity of AV was determined by using the global acne score (GAS). The 8-OHdG level was measured by an enzyme-linked immunosorbent assay (ELISA). Total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) scores were measured as oxidative stress markers. Levels of 8-OHdG were higher in AV compared to healthy controls (P = 0.036). A strong positive correlation between GAS and 8-OHdG was found in those with AV (p = 0.007, r = 0.444). And while TAS and TOS levels were significantly lower in AV patients, OSI levels were found to be significantly higher compared to healthy controls (p [Med-Science 2018; 7(2.000): 319-21]

Background: Deciding on triage in emergency departments is difficult and requires comprehensive knowledge and experience., Purpose: This study was conducted to evaluate the effect of a "computer-based emergency department triage decision support system (DSS)," which was designed and integrated into the hospital information management system, on triage decision accuracy and triage duration by using real patient data., Methods: Single-group, pretest-posttest non-randomised clinical trial. The study was conducted with the real data of patients who had been triaged in the adult emergency department of a university hospital. The pretest was applied between July 16 and September 16, 2019, and the post-test on September 1 and October 31, 2020. In the pre-test and post-test phases of the study, triage decision accuracy rates, and triage duration were evaluated. In the post-test phase, Emergency Triage Decision Support System (ETDSS) was prepared with a rule-based decision trees method using the Emergency Severity Index Version 4 and The Australasian Triage Scale and was integrated into the hospital information management system. The effect of the developed ETDSS was evaluated. The mean, standard deviation, frequency and percentage values were calculated for the descriptive characteristics. Independent samples t-test, analysis of variance, Sidak paired comparison, and Bonferroni tests were applied., Results: The effect of the computer-based emergency triage DSS on triage management was tested based on the data of 16,409 patients in the pretest phase and 7,765 patients in the posttest phase. While the accuracy rate of nurses' triage decisions was 57.8% in the pretest, it was found to increase to 64.9% in the posttest. The mean duration of triage was 1.47 ± 0.72 in the pretest and 1.79 ± 0.85 min in the posttest., Conclusions: The DSS increased triage decision accuracy independently of professional and triage experience and brought the triage duration closer to the time recommended in the literature. Clinically, this is associated with patient safety, quality improvement processes, and professional accountability., Competing Interests: Declaration of Competing Interest 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., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: The increasing number of patients admitted to emergency departments (EDs) and overcrowding of EDs lead to a global problem. Advanced nursing triage is an important solution in facilitating patient and time management, also increasing the efficiency of the ED. This study was conducted to predict the possible effects of applying advanced nursing triage modeling with predetermined protocols during the current nursing triage in the ED., Methods: This was a descriptive and cross-sectional study. An advanced "triage assessment protocol," which was developed previously, was hypothetically applied for 5 days by triage nurses in the adult ED of a university hospital. The hypothetical application was tested by triage nurses in all shifts. The nurses recorded the examination or treatment options which they thought to apply for the patient on the study form. The data recorded on the advanced triage evaluation protocol form by the triage nurses were compared with the patient outcomes and physician examination/treatment requests in the Hospital Information Management System by the researchers., Results: In the study, it was determined that the rate of examination/treatment that could be requested according to the advanced nursing triage protocol was 46%. There were a good level of agreement on X-ray and a moderate level of agreement on urinary test and urinary beta- Human chorionic gonadotropin (hCG) test between physicians and triage nurses regarding examination/treatment requests. In addition, it was found that there was a 61.2% of agreement on decisions made for patients aged between 18 and 35. The rate of agreement between doctors and nurses regarding a gluco-stick request for patients admitted outside the prime time (92.2%) was found to be significantly higher (87.9%) than for patients admitted during prime time ( P = 0.046)., Conclusion: "Advanced triage" practices recommended for busy EDs were tested "hypothetically" at the national level due to the lack of legal regulations and were found to be compatible with the actual results of physicians' practices at an acceptable level, especially for selected medical conditions. The method used in this study can be useful in planning the transition to "advanced triage" practices. These results can show the readiness of nurses for the transition to this practice., Competing Interests: None declared., (Copyright: © 2022 Turkish Journal of Emergency Medicine.)

Background: The performance of the Quick Sequential Organ Failure Assessment (qSOFA) score needs to be explored further in the emergency triage room. This study aims to explore the performance of triage (tqSOFA) versus the dichotomized triage score (DTS) in patients admitted to the emergency room triage with fever., Methods: This research was designed as a prospective, observational study within a six-month period, including patients who presented to the emergency room triage with infrared fever ≥ 37.5 °C., Results: 771 patients were analyzed.The highest sensitivity for predicting overall hospitalization and intensive care admission was seen for DTS (95.4 %, 100 %; p < 0.0001, p < 0.0001, respectively) (AUC:0.697, 95 % CI 0.663 to 0.730; AUC:0.684, 95 % CI 0.650 to 0.717, respectively). The highest sensitivity for predicting 1st week and 1st month mortality was found for DTS (100 %, 96.3 %; p < 0.0001, p < 0.0001, respectively). However, the highest specificity for predicting 1st week and 1st month mortality was observed in tqSOFA (94.1 %, 95.16; p = 0.0845, p < 0.0001, respectively) (AUC:0.658, 95 % CI 0.623 to 0.691; AUC:0.698, 95 % CI 0.664 to 0.730, respectively)., Conclusion: We found DTS to be as effective as tqSOFA and SIRS in determining all hospitalization times and mortality., Competing Interests: Declaration of Competing Interest 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., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: For identifying hemorrhagic shock in trauma patients, some objective data are needed. The use of base excess (BE) and lactate values have been originated. In this study, it was aimed to determine the usability of end tidal carbon dioxide (ETCO₂) in patients with multiple trauma for recognizing hemorrhagic shock., Methods: Patients who were admitted to the emergency department between June 2019 and February 2020 with highenergy multiple trauma were included in the study. ETCO₂ and BE values were measured. Correlation coefficients were calculated to determine correlations between ETCO₂ and BE levels., Results: One hundred and twenty-two patients were included in the study. Eighty-nine (73%) were men and 33 (27%) were women, and the mean age of the study population was 38.70 ± 19.18. The mortality rate was 14.8% in the study population. The correlation between ETCO₂ and BE values was significant (r: 0.27) and in the same range in the Bland-Altmann analysis. ETCO₂ levels above 35 were specific for stage 1 hemorrhagic shock. ETCO2 levels below 30 were sensitive for stage 2 and 3 hemorrhagic shocks and when the levels were measured below 22 it was found specific for stage 4 shock. The specificity increased to 99% at levels below 18. The sensitivity for ETCO₂ values below 22 for predicting mortality was 33.33%, the specificity was 89.42%, the positive predictive value was 35.29% and the negative predictive value was 88.57%. The sensitivity for BE values below -10 for predicting mortality was 50%, the specificity was 93.27%, the positive predictive value was 56.25% and the negative predictive value was 91.51%.

Background: Venous oxygen saturation reflects venous oxygenation status and can be used to assess treatment and prognosis in critically ill patients. A novel method that can measure central venous oxygen saturation (ScvO2) non-invasively may be beneficial and has the potential to change the management routine of critically ill patients., Objective: The study aims to evaluate the potential of sublingual venous oxygen saturation (SsvO2) to be used in the estimation of ScvO2., Methods: We have developed two different approaches to calculate SsvO2. In the first one, near-infrared spectroscopy (NIRS) measurements were performed directly on the sublingual veins. In the second approach, NIRS spectra were acquired from the sublingual tissue apart from the sublingual veins, and arterial oxygen saturation was measured using a pulse oximeter on the fingertip., Results: Twenty-six healthy subjects were included in the study. In the first and second approaches, average SsvO2 values were 75.0% ± 1.8 and 75.8% ± 2.1, respectively. The results of the two different approaches were close to each other and similar to ScvO2 of healthy persons (> 70%)., Conclusion: Oxygen saturation of sublingual veins has the potential to be used in intensive care units, non-invasively and in real-time, to estimate ScvO2.

Background: Assessment of nurse triage decision accuracy and triage times is currently carried out through paper-based methods. This quality improvement study aims to develop a method that can assess the accuracy and duration of nurse triage decisions based on a computerized system and to share an example of the application of this method., Methods: This is a descriptive quality improvement study. The study was carried out in two stages between March and May 2019. The functionality of the developed method was examined using 3835 patients' triage data, which were obtained between June 1 and 14, 2019., Results: With this study, the determination of the accuracy and duration of nurse triage decisions was accomplished with a computerized process based on real patient outputs, and the accuracy and duration of these decisions were continuously measured, monitored, and assessed, which is different from paper-based methods. The functionality of the method was evaluated with data from 3835 real patients. The triage decision accuracy rate was 64.4%, and the average duration of triage was 81.3s. Positive feedback on the method was received from all triage nurses., Conclusion: The study result outputs can be integrated into quality processes and can be used internationally as performance assessment criteria and quality indicators for triage nursing., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: The accuracy and duration of triage is vital in emergency departments. However, patient density, diversity of cases, and time pressure make triage difficult. Triage performed properly and at the right time prevents patients from experiencing any untoward incidents that may occur because of waiting. Therefore, the study aimed to share the data obtained from the Hospital Information Management System (HIMS) regarding the accuracy and duration of nurse triage in an adult emergency department., Methods: This descriptive and cross-sectional study evaluated the accuracy and duration of triage decisions made by nurses for patients admitted to an adult emergency department between June 15 and July 15, 2019. Statistical analysis was performed using Statistical analysis was performed using SPSS software version 23.00., Results: The study included the data of 7705 adult patients. The accuracy rate of nurse triage was 59.3% ( n = 4566), and the average duration of triage was 1.52 ± 2.10 min. It was observed that the average duration of accurate triage decisions was longer in patients with triage category 3. A statistically significant relationship was determined between the accuracy of nurse triage and the duration of triage, years of seniority of the nurse, and shifts ( P < 0.05)., Conclusions: The accuracy and duration of nurse triage in the hospital where the study was conducted can be evaluated via the HIMS. In order to increase the accuracy of nurse triage in the emergency department, it is necessary to employ experienced and trained nurses, develop computer-based support systems, and increase the number of nurses working in shifts providing care to a large number of patients., Competing Interests: Conflicts of interest None Declared., (Copyright: © 2020 Turkish Journal of Emergency Medicine.)

Objective: Critically ill patients have high mortality and admission rates requiring early recognition and a rapid management. In the present study, we evaluated the prognostic parameters in these patients and the value of perfusion index measurement as a novel tool for accomplishing emergency department (ED) triage., Methods: Seven hundred seventy patients admitted to the critical care area of the ED in a month composed the study population. Perfusion index and vital signs (blood pressure, pulse rate, body temperature, pulse oximeter, and respiration rate) of the study patients were recorded to the study form. The communication data, admitting time, comorbidities, capillary refilling time, and blood gas analysis findings if obtained were recorded. Outcome of patients at the end of the ED period such as discharge, admission to the hospital, and death were also recorded. Outcome of patients at 15th and 30th days was identified by telephone call follow-up or from hospital records., Results: Two hundred seventy-eight patients (36.1%) were admitted to the hospital, 454 patients (59%) were discharged, 3 patients (0.4%) died in the ED, 25 patients (3.2%) were transferred to another hospital, and 10 patients (1.3%) refused treatment and left the ED. Sixty patients (7.8%), 39 (5.1%) of whom had died in 15 days' period, were dead at the end of 30-day follow-up period. Respiratory rate and pulse oximetry were significant parameters in hospital admission. Systolic blood pressure, diastolic blood pressure, pulse rate, respiratory rate, pulse oximetry, lactate levels in blood gas analysis, and ED length of stay were significant variables in 30-day mortality rate. Patients who were admitted to the hospital had higher rates of fever and diabetes. Patients who had died in the 30-day follow-up period had higher rates of diabetes and malignancy. In logistic regression analysis, the predictors of hospital admission were hypotension, fever, and pulse oximetry, whereas the predictors of 30-day mortality were systolic blood pressure, respiratory rate, pulse oximetry, and presence of malignancy., Conclusions: Perfusion index as a novel triage instrument was found to be an insignificant tool in predicting hospital admission and mortality of critically ill patients in the ED. However, diabetes and malignancy were found to be independent factors in determining the prognosis of these patients in addition to vital signs and should be considered by ED physicians either in triage field or inside the ED., (Copyright © 2015. Published by Elsevier Inc.)

Background: Chronic obstructive pulmonary disease (COPD) is associated with high mortality and morbidity., Objective: The aim of the present study was to determine the role of nitric oxide (NO) and other possible factors in predicting the revisit of patients with COPD exacerbation to the emergency department (ED)., Methods: This is a prospective cohort study on patients with exacerbated COPD in the ED setting. Bedside nasal NO values were measured with a hand-held analyzer device. Revisit to the ED has been defined as any unscheduled visit to an ED or to primary physician's office within 2 weeks of the initial ED visit for worsening COPD symptoms. A follow-up survey via telephone was conducted on all patients at the end of 2 weeks., Results: The data from 64 patients who visited the ED once was compared to 28 revisits. Total of 92 patients were analyzed and variables were compared. The rate of revisits to the ED was 30%. Nasal NO measurement could not predict the revisits of patients with COPD exacerbation to the ED. The mean respiratory rate, exacerbations in previous year, home nebulizer therapy, prescribed antibiotic at discharge, home oxygen therapy, and abnormal chest x-ray studies were associated with increased rate of revisits to ED in univariate analysis. After multivariate analysis, only the mean respiratory rate at presentation and the prescribed antibiotic at discharge were significant determinants., Conclusions: There was no statistically significant difference measured in NO level at presentation or before discharge between the groups. The mean respiratory rate at presentation and the prescribed antibiotic at discharge may predict the return of a COPD-exacerbated patient within 14 days to ED., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Study Objective: Although electroencephalography (EEG) is a useful diagnostic tool for patients with a suspected seizure, its value in informing the acute care of patients in the emergency department (ED) remains unclear. The aim of this study is to determine the effects of EEG results on subsequent patient management in or from the ED., Materials and Methods: This prospective observational study was carried out in the ED of a tertiary-care university hospital. All patients presenting to the ED with seizure or seizure-mimicking symptoms were included in the study. EEG was advised for all patients after an initial evaluation. Before EEG, the ED physician and neurologist were asked clinical questions about the patient. The consistency between the clinical decision of emergency physicians before the EEG report and the final management of patients determined by the consultant neurologist was analyzed. The interobserver reliability of the physicians was determined., Results: Overall, 110 patients were enrolled in the study. The sensitivity and specificity of ED physicians' diagnosis of the presence of seizure were both 88% (95% confidence interval, 79-93 and 62-97%). The interobserver reliabilities and κ values of ED physicians and neurologists were found to be 'moderate'. Patients with abnormal EEG results were prescribed new medication (P=0.003) and changes in therapy (P=0.59) were more than for patients with normal results., Conclusion: As seizure is a clinical event, EEG is not essential for diagnosing the presence of a seizure clinically in the ED. However, the results of EEG provide useful information especially for treatment choices. As the timing of the study affects the diagnostic efficacy of the test, EEG recordings should be performed within 24 h either in ED or in the epilepsy clinic.

Background and Aim: Seizure-related visits are common in the emergency department (ED) but the clinical situations for ordering emergency electroencephalography (EEG) are unclear. The aim of this study is to identify which clinical conditions meet with the pathological EEG and whether patient management is changed by abnormal results., Methods: A retrospective chart review study of all patients visiting the ED with a seizure or symptoms mimicking a seizure was performed. Patients who recorded an EEG within 16 h after the initial event were enrolled. Demographic data and EEG results of patients with provoked and unprovoked seizures were recorded and related factors were analysed., Results: A total of 449 patients (219 men) of mean ± SD age of 45.48 ± 21.83 years were evaluated. The seizure was thought to be provoked in 98 patients (21.8%) and unprovoked in 352 (78.2%) patients (31.2% remote symptomatic and 47.4% idiopathic). The EEG results of 281 patients (62.6%) revealed an abnormality, and the abnormal EEG ratio was high in patients with presumed seizure (p<0.001). One hundred and thirty-eight patients (30.7%) were hospitalised and the remainder (n=311, 69.3%) were discharged from the ED. An abnormal EEG was found in 98 (71%) of the hospitalised patients and in 183 (59.5%) of those discharged (p=0.019)., Conclusion: EEG provides useful diagnostic information and should be considered in all patients presenting to the ED with a seizure. Since the timing of the study affects the diagnostic efficacy of the test, EEG recordings might be done within 24 h either in the ED or epilepsy clinic.

We aimed to determine the value of sidestream end-tidal carbon dioxide (SS-ETCO2) measurement in patients with chronic obstructive pulmonary disease (COPD) in the emergency department. Cross-sectional associations between ETCO2 and PaCO2 were examined in the study. This prospective cross-sectional study has been carried out over a 3-month period in a tertiary care university hospital emergency department with an annual census of 75 000 visits. During the study period, simultaneous SS-ETCO2 measurement using a Medlab Cap 10 sidestream capnograph was performed on every COPD patient requiring arterial blood gas analysis. The demographics, diagnosis, vital signs, laboratory test results and clinical outcomes of the patients were recorded. SS-ETCO2 measurement and arterial blood gas analysis were carried out on 118 patients. Mean arterial PCO2 levels were 43.24±14.73 and mean ETCO2 levels were 34.23±10.86 mmHg. Agreement between PCO2 and ETCO2 measurements was 8.4 mmHg and a precision of 11.1 mmHg.As there is only a moderate correlation between PCO2 and ETCO2 levels in COPD patients, ETCO2 measurement should not be considered as a part of the decision-making process to predict PaCO2 level in COPD patients.

Objectives: The purpose of this study is to examine the relation between end-tidal carbon dioxide (ETCO₂) measurement and bicarbonate (HCO₃) level reflecting the patient's metabolic status., Method: This prospective cross-sectional study has been carried out during a 3-month period in a tertiary care university hospital's emergency department (ED). During the study period, every spontaneously ventilating ED patient requiring arterial blood gas analysis for any medical indication, regardless of presenting symptoms, had a simultaneous ETCO₂ measurement using a Medlab Cap 10 side stream capnograph. The demographics and clinical outcomes of the patients were recorded., Results: Of 399 eligible patients, 240 with possible metabolic disturbance were enrolled into the study. There was a statistically significant correlation between the value of ETCO₂ and HCO₃ levels (r = 0.506). The mean ET(CO)₂ level was statistically significantly lower in patients who died (26.5 ± 7.2, 95% confidence interval [CI], 24.2-28.6, vs 30 ± 7.5, 95% CI, 29-31; P = .007) and who had low bicarbonate levels (25.7 ± 6.7, 95% CI, 24.3-27.1, vs 31.6 ± 7.1, 95% CI, 30.4-32.8; P = .000). The value of ET(CO)₂ measurement to detect low bicarbonate level was found to be significant. The area under the receiver operating characteristic curve was 0.734, the (+) likelihood ratio for ETCO₂ less than or equal to 25 was 2.7, and the (-) likelihood ratio for ETCO₂ greater than or equal to 36 was 0.05., Conclusion: ETCO₂ values correlate moderately with HCO₃ levels and thus might predict mortality and metabolic acidosis. Therefore, side stream capnograph can be used as a noninvasive diagnostic tool for ruling out suspected severe metabolic disturbance in the ED., (Copyright © 2011 Elsevier Inc. All rights reserved.)