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Özet Amaç: Bu çalışmada, travma nedeniyle acil servise getirilen ve çekilen KBT’de tespit edilen rastlantısal (insidental) bulguların neler olduğunu, yaygınlığını ve klinik önemini değerlendirmek; bu bulguların tespiti sonrasında acil hekimlerinin izlemesi gereken yolu tartışmak amaçlanmıştır. Materyal-Metot: Acil Serviste KBT çekilen 2399 hastanın travmatik etiyolojiye sahip olan 1100’ünün epikrizleri ve PACS kayıtları retrospektif olarak incelendi. Bulgular: Hastaların 755 (%68,6)’i erkektir. Ortalama yaş 21,69±19,58 (0-101) olup, yaş gruplarında en yüksek payın 422 (%38,4) hasta ile 10 yaş altı olduğu gözlenmiştir. Başvuru nedenleri düşme (%50,1), trafik kazası (%19,0), kafa travması (%18,9), darp edilme (%10,4) ve iş kazası (%1,6) olarak bulunmuştur. Hastaların %22,3 (245 kişi)’ünde en az bir insidental bulgu görülmüş olup bu hastaların 29’unda ikinci ve 4’ünde üçüncü bir insidental bulgu olduğu tespit edilmiştir. Grup-1 bulgular içinde en sık sinüzit (115; %10,4), nazofaringeal adenoid hipertrofi (35; %3,1), sinüs retansiyon kisti (32; %2,9) ve üst solunum yolu anatomik bozukluğu (27; %2,4) tespit edilmiştir. Grup-2 bulgularda ise en sık araknoid kist (10; %0,9), mastoidit (5; %0,4), menenjiom (3; %0,2) ve hipofizer makroadenom (2; %0,1) tespit edilmiştir. Sonuç: İnsidental bulguların büyük kısmı benign özellikte olsa da az bir kısmı ciddi ve araştırma gerektirecek özellikler göstermektedir. Hekim insidental bulgu tespit ettiği hastaların doğru yönetimini sağlamalı, malpraktis davaları açısından hastaları insidental bulgular konusunda yeteri kadar bilgilendirmeli ve yaptığı bilgilendirme ile yönlendirmelerini eksiksiz biçimde hasta dosyasına kayıt etmelidir. Anahtar kelimeler: Kafa Travması, İnsidental Bulgular, Bilgisayarlı Tomografi, Acil Servis, Malpraktis

Background: Gunshot injuries (GSIs), a serious public health problem, can affect the pediatric age group and adults. Objectives: This study aimed to describe the injuries that occurred in children aged 0-16 years who were brought to the emergency department (ED) of Şehitkamil State hospital in Gaziantep, Turkey, due to GSIs. Methods: This descriptive-retrospective study was conducted in the ED of the child trauma center of Gaziantep. This study retrospectively reviewed the records of children aged 0 - 16 years admitted to the ED with GSIs from 01/01/2014 to 30/09/2020. Results: A total of 66 GSI cases were included in the study. The most common injury was in the abdominal region. Internal organ/vessel/bone injuries were detected in 59.1% of the cases (n = 39). Surgical treatment was applied to 60.6% of the cases (n = 40) within 7 days. The mortality rate was 12.1% (n = 8). The length of stay in the trauma unit was 4.34 ± 4.33 days. Conclusion: Most injuries are detected in the abdomen. GSI was more common in boys. The prognosis is worse in those with internal organ/vascular/bone injuries. These patients have higher mortality, longer hospital stay, and a higher rate of surgical operation.

Amaç: Kafatası kırıkları çocukluk çağında sık görülen yaralanmalardandır, basit travmalarla oluşan izole lineer kırıklardan yüksek enerjili travmalara oluşan intrakraniyal kanamayı da içeren çökme kırıklarına kadar değişen derecelerde görülebilmektedir. Bu çalışmanın amacı kafa travması sonrası acil servise başvuran, 16 yaş ve altı çocuklarda tespit edilen kafatası kırıklarının mortalite ve morbiditesini araştırmaktır. Materyal ve Metot: Kafatası kırığı nedeniyle travma ünitesine alınan 16 yaş ve altı çocuk hastalar çalışmaya dahil edilmiştir. Bulgular: Hastaların (toplam 113 vaka) yaş ortalaması 4,163,71 (0-15), %64,6’sı erkek ve geliş nedenleri en sık yüksekten düşmeydi (%69). Kafatası kırığı en sık sağ tarafta (%54), en sık frontal kemikte (%31) ve en sık lineer kırık (%78,8) izlenmiştir. Hastaların %68,1’inde kırığa eşlik eden intrakraniyal kanama izlenmemiştir. Travma ünitesinde takibe alınan hastaların ortalama yatış süreleri 3,424,52 (0-25) gündüz, 53 hastaya (%46,9) kontrol bilgisayarlı beyin tomografisi (BBT) çekilmiş, bunlardan 24(%45,3)’ünde kontrol BBT’de yeni gelişen intrakraniyal patoloji (6 hastada yeni gelişen kanama, 10 hastadan mevcut kanamda artış, 3 hastada yeni gelişen ödem, 4 hastada mevcut ödemde artış, bir hastada orta hat yapılarında yeni gelişen şift) izlenmiştir. 4 hasta nöroşirürjik operasyona alınırken, mortalite izlenmemiştir. Sonuç: Çocukluk çağı kafa travmalarında radyolojik görüntülemede fraktür izlense dahi mortalite ve cerrahi oranları düşüktür. Ancak düşük GKS, deplase fraktür (çökme kırığı gibi) ve kırıkla birlikte olan kanamalar cerrahiye gidişi artırabilmektedir.

Background and objectives: Science congresses have begun to be recognized as a tourism model that named as congress tourism. The hotels where the National Emergency Medicine Congresses are hosted, which are held once a year, contribute to congress tourism.The aim of this study is to find out views of attendees of emergency medicine congresses about the congress and presentations. Methods: A survey form consisting of 16 questions (without demographic question) was shared with participants attending the 14th National Emergency Medicine Congress of the Association of Emergency Medicine Specialists (EPAT) by SMS, e-mail, and social media messenger programs (WhatsApp, etc.). Results: A total of 238 participants took part in the study of whcih73.9% (n = 176) were male. The age of the majority (68, 28.6%) participants was between 35 to 39 years. Maximum participants (n = 95, 39.9%) were specialist titleholders and the majority's (n = 81, 34.0%) length of service was 6-10 years. Of the total particinats, 73.1% and 65% expressed that curiosity about the scientific content and refreshing the knowledge respectively were the reasons for attending the conferences. Conclusion: Even if congresses are held in holiday hotels, participants are more interested in scientific content. Paramedical activities and visuals used in presentations are viewed positively. Although there are very intense programs in the congress, the majority of the participants stated that they would listen to eight presentations most efficiently. Ibrahim Med. Coll. J. 2021; 15(2): 38-43

Background and objectives: The COVID-19 pandemic has affected face to face medical education and training activities around the world. The aim of this study was to provide remote practical handwashing training to health sciences students and to measure the effectiveness of the training provided and to create a feedback model. Methods: Students of the Paramedic department were included in the study. Two virtual classrooms were created via Zoom Video Communication system. An 11-step handwashing algorithm was developed. Two hours of remote handwashing training was given. Participants were asked to apply the handwashing application they learned at their own location and to record videos. Application videos were evaluated and scored. Results: A total of 135 Term-1 and Term 2 students of the Paramedic department participated in the study. The duration of the evaluated videos was on average 57.67 ± 12.69 (34-95) seconds. Fifty five (40.7%) of the participants successfully completed all the steps and their average success score was 10.3 ± 0.67 (8-11). The most failure (33.3%) in the process steps was the 9th step in which the wrists are rubbed with soap. Conclusion: Suitable teaching and feedback methods are required for medical and health science students who receive education and practical training remotely from home. IMC J Med Sci 2021; 15(2): 003 *Correspondence: Hasan Gümüşboğa, Emergency Department of Sehitkamil State Hospital, Pirsultan, Cetin Emec cad. 27500, Sehitkamil/Gaziantep, Turkey. E-mail: profhasan@hotmail.com

Bacground: Nucleated red blood cells (NRBCs) are immature erythrocytes that are not normally detected in the blood of healthy adults. The detection of these cells in peripheral blood is associated with increased mortality and poor prognosis. In this study, we aimed to investigate whether NRBCs predict for all causes of death in patients admitted to the emergency department (ED). Method: This study was conducted retrospectively between January 2019 and December 2019 in academic emergency department, faculty of medicine. We included all patients who died of non-traumatic causes and The control group consisted of patients discharged from the ED. NRBCs and other laboratory parameters were compared between the two groups. The primary outcome is all-cause mortality in the ED. Multivariate logistic analysis was performed. Results: A total of 204 patients (119 male) were included in the study. The mean age of the patients was 66.7 ± 14.6 years. NRBC value was higher in those who died (678.43 ± 655.16/ μl) compared to the control group (22.55 ± 57.86/ μl) (P < 0.001). According to receiver operating characteristic curve analysis (ROC) performed for the prediction all cause mortality in the ED, the best cut-off point for NRBC was >0 /μl (sensitivity 94,12%, specificity 82,35%, Area Under Curve (AUC) =0.97). In the multivariate logistic regression analysis, the NRBC was associated with all-cause mortality in the ED (odds ratio,OR = 1.020, confidence interval, CI = 1.012–1.028). Conclusıons: High blood levels of nucleated red blood cells at admission to the emergency department may be associated with increased mortality. © 2020 Elsevier Inc.

Objective: We sought to describe injuries related to the sacrificial slaughtering of animals during the Eid holiday. Methods: We conducted a centered prospective observational cohort study during the Eid (August 21-24, 2018) at 5 emergency departments in Gaziantep, Turkey. Descriptive statistics of injuries collected included the injury location, involvement of dominant or non-dominant hand, cause of injury (instrument vs animal), type of instrument causing injury, surgical interventions performed, and professional occupations of patients. Results: We included two hundred seventy-seven patients with injuries who fulfilled the criteria and excluded injuries not related to animal slaughter. Most injuries (91%) occurred in people who were not professional butchers (n=252) and simple laceration (not involving vessels or tendons) was the most common injury type (95.3%; n=265). Those who were injured and had no experience were mostly injured during the processing of the meat (butchering) and while helping others. Lacerations were most commonly observed in the upper extremity (83.4%; n=231), on the non-dominant side (67.5%; n=187), in the hand (78.7%, n=218), and specifically in the index finger (23.1%; n=64). A surgery was performed on 8 patients. Conclusion: The first day of Eid is associated with an increase in mostly non-dominant upper extremity injuries among inexperienced people slaughtering animals. Further education and safety measures may reduce such injuries. Emergency departments serving larger Muslim communities may benefit from anticipating an uptick in these injuries.

Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic has necessitated the switch to distance education by abandoning face-to-face education worldwide. This study aimed to investigate whether it is possible for practical education and performance measurements through distance education. Methods: The application video and the application steps were sent to the participants through their smartphone by WhatsApp messenger. Grade 1 students in the Physiotherapy Section (Group A) and Grade 1 students in the Paramedic Section (Group B) voluntarily participated in the study. The participants were asked to apply simulation applications and record the simulation applications' video clips with their smartphones. Results: The mean age of the 123 participants was 20.11 ± 2.03 (18-33) years, and 56 (45.5%) were in Group A, and 67 (54.5%) were in Group B. While the participants in Group A were successful at a rate of 35.7% (n = 20) in the head tilt-chin lift maneuver, this rate was 65.7% (n = 44) for Group B (p = 0.001). For the jaw thrust maneuver, the success rate was 21.4% (n = 12) for Group A and 31.3% (n = 21) for Group B. Conclusion: In this study, the participants used family members as a live simulation model in our research. The participants who were given face-to-face education before were more successful on head tilt chin lift maneuver. Jaw thrust maneuver was more challenging to learn and practice by distance education. The academicians interested in medical education should keep in mind that the outcomes of the COVID-19 pandemic have permanent effects on education systems. IMC J Med Sci 2021; 15(1): 001 *Correspondence: Mustafa Boğan, Emergency Department, Health Research and Application Hospital, Düzce University, Düzce, Turkey, Posta code: 81620. Email: mustafabogan@hotmail.com

Aim: The majority of acute strokes (cerebrovascular event) are ischemic. The aim of this study was to investigate the diagnostic value of Platelet Count (PC), Mean Platelet Volume (MPV) and the MPV/PC ratio in acute ischemic cerebrovascular event (CVE).Materials and Methods: Patients were searched on the electronic records of hospital by ICD codes and epicrises. The patients who detected were divided in two group that group 1 (CVE group) and group 2 (non-CVE group).Results: The PC value in the group 1 was determined as (250.67±93.16×103/L) and in the group 2 as (226.53±57.86×103/L). The mean PC value of the group 1 was found to be higher (p0,05). Conclusion: MPV and the MPV/PC ratio, which are not distinguished parameters for CVE.

Background: Globally, 1.5 to 3 million people are exposed to snakebites each year. More than 100,000 of these cases, primarily in the tropics, result in death. This study includes an analysis of a university hospital's three-year experiences of distal extremity snakebites. Methods: This study includes 68 patients presented at the Emergency Department (ED) of Gaziantep University Hospital with snakebites on distal extremities (hands, fingers, and feet) between 01/03/2014 and 01/03/2017. Results: A total of 68 patients had wet snakebites on their distal extremities. Forty-seven patients (69%) were male, 21 (30.9%) were female, and the mean age was 43.03 ± 18.13 years. Snakebites most commonly occurred in September (26.5%, n = 18). Twenty-five (36.76%) patients had systemic symptoms (grades 2, 3, and 4). Also, 98.5% (n = 67) of patients received only antivenom therapy. Compartment syndrome was observed in one patient (1.5%), and this patient was treated with antivenom therapy and plasmapheresis. The most common local finding was pain (88.2%, n = 60). Also, 2.94 ± 2.5 vials of antivenom (range 0 - 10) were used per person on average, whereas the mean duration of hospitalization was 2.51 ± 1.5 (range 1 - 8) days. Conclusions: This study focused on hands, fingers, and feet because these parts can be protected (ie, preventing bites) by wearing shoes and protective gloves. Also, there was no mortality due to extremity snakebites. The most common long-term complications were paresthesia and movement limitation. It is recommended that high-risk populations (like agricultural laborers, nature travelers, and documentary teams) be taught appropriate first aid practices after snake bites.

Background Studies on workplace violence against physicians in emergency departments (EDs) in Turkey are lacking. Methods To describe the frequency and types of workplace violence, a 34-question online survey of the past 12 months was sent to physicians working in EDs in Turkey. Types of violence were categorized as verbal threats, physical assaults, confrontation, stalking, and sexual harassment. Results A total of 366 physicians completed the survey; 4 were excluded (minimum 20 hours/week). Sixty-two percent of respondents were men. Ninety-nine percent reported verbal abuse and 54% reported physical violence. Family members, not patients, were the most common perpetrators of every form of workplace violence. Hospitals limiting the number of visitors and loitering had 14% reduction in physical threats. Only 23% of respondents indicated that their hospital offered information about preventing and managing workplace violence even though 86% noted interest. Only 1% never had fear, even though 89% indicated they had security staff. Over 89% felt that hospital security was lacking in number and ability to protect. For 82%, workplace violence affected their ability to provide patient care. Ninety percent indicated that current laws do not adequately protect them. There was also no statistically significant difference in any type of workplace violence based on the timing or length of shifts, type of hospital, or number of hours worked. Of all types of violence reported, only stalking demonstrated a statistically significant difference between men and women. Conclusion Workplace violence is a real danger for physicians working in EDs in Turkey, similar to other countries, demonstrating that this problem transcends borders. Further studies should assess root causes of violent behaviors of patients and their visitors, as well as possible (administrative, social, and legal) mechanisms to minimize such violence. Hospitals that limited the number of visitors and empowered security officers were associated with decreased violence.

Objective: This study is unique as it examines biological materials brought to the emergency department. The purpose of this study was to investigate the reasons behind the presence of nonhuman biological material in the emergency department. Methods: The materials brought were photographed and a pre-prepared survey form was filled in following examination. Results: A total of 46 biological materials were brought to the emergency department within a 12-month period. Ticks were the most frequently brought material, and the most common reason for bringing them was to get the creature removed from the body. Situations in which the physician did not have knowledge about the material were more frequent among those that were neutral about being satisfied with the attitude of the physician towards the material brought, and satisfaction was higher in cases when the physician was knowledgeable, although this was not statistically significant. Conclusion: Physicians should not condemn biological materials brought into the department after exposure. If possible, they should try to gain more knowledge about them. If the material is not to be stored, once it is made sure that it is not dangerous, it should be disposed of in a medical waste bin. Physicians should be knowledgeable toward the frequency and the types of such agents in their region.

WOS: 000489681000004 Aim: We believe that automatic external defibrillators are not common in our country and aimed to compare the knowledge and skills of senior students in paramedical, nursing and medical faculties on recognizing cardiopulmonary arrest (CPA) case, providing proper chest compression and maintenance of ventilation as well as evaluating cardiopulmonary resuscitation (CPR) cycle one month before starting profession. Materials and Methods: Fifty senior students from paramedic department, 50 senior students from nursing department and 50 senior students from medical school were included in the study. The participants were asked 10 theoretical questions to evaluate their basic resuscitation knowledge. Each participant was then asked to intervene in a suspicious CPA case using Prestan Adult CPR Manikin alone in a separate room. Results: The highest rate of correct answers given to theoretical questions related to CPR was in paramedic students with a mean score of 7.34 +/- 1.99 points among the students of these three departments (p=0.001). The mean scores of both theoretical and practical application of paramedic students were found to be significantly higher than the students of the nursing and medical faculties, when all three groups were compared with each other with regard to their mean success scores of theoretical and practical applications. Conclusion: In our study, the mean scores of both theoretical and practical application of paramedic students were found to be significantly higher than the other groups.

Objective: The objective of this study is to determine the effect of epinephrine administration on the return of spontaneous circulation (ROSC) and one-month mortality in patients with cardiopulmonary arrest.Methods: We conducted this study between August 1, 2016 and May 31, 2017. Importantly, we included the witnessed cases (?18years) of in-emergency department cardiopulmonary arrest (IEDCA) and out-of-hospital cardiopulmonary arrest (OHCA) in thestudy. We divided the patients into two groups: the adrenaline group (Group 1) and the non-adrenaline group (Group 2). Thereafter, we investigated ROSC and one-month mortality in them.Results: We included 183 patients (50.3% of males and 49.7% of females with a mean age of 64.2±16.8 years) in the study. Thepercentages of IEDCA and OHCA cases were 25.1% and 74.9%, respectively. Epinephrine was administered to 100 (54.6%) patients(Group 1). Among these patients, 15.9% (n=29) of the patients had shockable rhythms (ventricular fibrillation, pulseless ventriculartachycardia) and 84.1% (n=154) of them had non-shockable rhythms (asystole, pulseless electrical activity) as the initial rhythm.ROSC and one-month mortality rate of these patients were 24% (n=44) and 72.8% (n=36), respectively. The one-month mortalityrates of Group 1 (30% of patients had IEDCA and 70% of patients had OHCA) and Group 2 were 43.8% and 56.2%, respectively(p=0.0231). The ROSC and one-month mortality rates of Group 1 and Group 2 cases, whose initial rhythm was a shockable rhythm,were 26.6% and 50% vs. 42.8% and 66.6%, respectively.Conclusion: In this study, we found no significant difference in terms of obtaining ROSC between the shockable rhythm and ROSCin the IEDCA and OHCA cases (p=0.963 and p=0.141, respectively). The effect of epinephrine administration on patients with IEDCA and OHCA whose ROSC was obtained on one-month mortality was not statistically significant (p>0.05). WOS:000574459200005

INTRODUCTION: Homophobia can be defined as fear, hatred, discrimination, and even violent feelings and behaviors developed towards individuals with sexual orientations different to other individuals of the same sex. Our study was conducted to assess the levels of homophobia among emergency medicine specialists, practitioners, nurses, and other health care professionals working in the emergency department (ED). MATERIAL AND METHODS: This study was carried out as a descriptive survey study in Gaziantep, Turkey, between July 7, 2018 and August 30, 2018. The data was collected using a Google survey form link sent to volunteers via mobile phone. RESULTS: The mean age of the patients was 30.85 ± 7 (20-53) years. While 77.5% (n = 117) of the volunteers who participated in the study worked in state hospitals, 11.3% (n = 17) worked in a private hospital. The Cronbach's Alpha value was calculated as 92.3 and the scale average score as 85.42 ± 12.33 as a result of the evaluation of the Likert-type scale. While 69 (45.7%) people were lower in homophobia, 82 (54.3%) were higher in homophobia. A difference in attitudes towards homosexuals was only observed between those who had a homosexual friend or acquaintance and those who did not (p = 0.009). Accordingly, those with homosexual friends were determined to be less homophobic. On the other hand, it was observed that those with a homosexual acquaintance and those with no homosexual acquaintances were more homophobic. CONCLUSION: In our study, it was shown that emergency medicine specialists and other health professionals working in the ED exhibit high levels of homophobic attitudes and behaviors. Including lesbian, gay, bisexual, transgender, intersex (LGBT-I) health problems in in-service trainings may contribute to the improvement of homophobic attitudes. Copyright © 2021 Via Medica

Objective. This study was designed to investigate the effects of Desert Dust Storms and Climatological Factors on Mortality and Morbidity of Cardiovascular Diseases admitted to emergency department in Gaziantep. Method. Hospital records, obtained between September 01, 2009 and January 31, 2014, from four state hospitals in Gaziantep, Turkey, were compared to meteorological and climatological data. Statistical analysis was performed by Statistical Package for the Social Science (SPSS) for windows version 24.0. Results. 168,467 patients were included in this study. 83% of the patients had chest pain and 17% of patients had cardiac failure (CF). An increase in inpatient hospitalization due to CF was observed and corresponded to the duration of dust storms measured by number of days. However, there was no significant increase in emergency department (ED) presentations. There was no significant association of cardiac related mortality and coinciding presence of a dust storm or higher recorded temperature. The association of increases in temperature levels and the presence of dust storms with “acute coronary syndrome- (ACS-) related emergency service presentations, inpatient hospitalization, and mortality” were statistically significant. The relationship between the increase in PM10 levels due to causes unrelated to dust storms and the outpatient application, admission, and mortality due to heart failure was not significant. The increase in particle matter 10 (PM) levels due to causes outside the dust storm caused a significant increase in outpatient application, hospitalization, and mortality originated from ACS. Conclusion. Increased number of dust storms resulted in a higher prevalence of mortality due to ACS while mortality due to heart failure remained unchanged. Admission, hospitalization, and mortality due to chest pain both dependent and independent of ACS were increased by the presence of dust storms, PM10 elevation, and maximum temperature.

Objective: In this study, we aimed to compare the analgesic efficacy of intravenous dexketoprofen trometamol, fentanyl, and paracetamol in patients presenting to the emergency department with renal colic. Materials and method: Data obtained from the emergency departments of Gaziantep University's Hospital for Research and Practice along with two other state hospitals in Gaziantep, Turkey between January 2016 and January 2017 was used for this study. A total of three hundred patients (n = 300), who presented to the ER with complaints most common to renal colic whose diagnoses were subsequently confirmed with Computerized Tomography were included in the study. Patients’ pain scores were recorded using the Visual Analogue Scale, at admission (immediately before drug administration), then at the 15th, and 30th minutes. SPSS 22.0 software package was used for analysis. p < 0.05 was considered significant. Results: At the 15th minute comparison, the efficacies of the three groups of drugs were not superior to one other, but at the 30th minute, dexketoprofen trometamol was statistically more effective than paracetamol and fentanyl. There was no statistically significant difference between fentanyl and paracetamol. The need for additional analgesia in the group receiving dexketoprofen trometamol was found to be lower. Dexketoprofen trometamol was statistically superior to the other two agents in achieving full analgesia at the end of the thirty-minute period. Fentanyl was found to be statistically significant in achieving moderate analgesia. Conclusion: As a Non-steroidal antiinflammatory drug dexketoprofen trometamol is superior to paracetamol and fentanyl in achieving analgesia and reducing the need for additional drugs for the treatment of renal colic.

Background: Both minor and major head traumas constitute an important proportion of childhood emergency admissions. In this study, the findings of cranial computed tomography (CCT) scans performed as a result of the parental pressure were evaluated. Methods: The frequency and findings of CCT scans performed as a result of parental pressure were examined in a separate subgroup. Results: A total of 227 patients were included in the study; 158 (69.9%) patients had undergone CCT scans; a pathological finding was detected in 24 (10.6%) of these patients and undergone a consultation by the neurosurgeon (most common finding was isolated linear fracture; n = 12; 50%). The patients undergoing CCT scans were divided in two subgroups: the PECARN group [n = 123 (77.8%)] and the Parental pressure group [n = 33 (22.2%)]. Conclusion: One third of the parents of children who presented to the emergency department with head trauma and had no indication for CCT according to PECARN rules insisted on CCT imaging, and none of these cases showed ciTBI, surgical operation, or mortality. None of the patients in the parental pressure group had a history of surgical intervention or mortality within one month after discharge. (c) 2020 Elsevier Inc. All rights reserved. WOS:000659352600064 2-s2.0-85085300528 PubMed: 32471780

Aim: In this study, we randomized the patients without known hepatitis-B, hepatitis C and HIV infection who presented to the emergency department (ED). We measured the serum levels of HBsAg, Anti-HCV and Anti-HIV antibodies besides biochemical tests regarding the diagnostic process of the main complaint resulting in presentation to the ED. In this way, we aimed to determine the prevalence of occult chronic viral diseases among patients presenting to the ED and the risk of ED employees was evaluated.Materials and Methods: The study included 800 patients who had presented to the ED for any reason over two month and who had no history of infectious viral disease. Results: Four hundred and thirthy-four (54.2%) of the patients were male, 366 (45.8%) were female, and the mean age was 32.7 (±16.9) years. The rate of presence of a person with an infectious viral disease at the patient’s home was 1%, 0.5% and 0.0% for HBV, HCV, and HIV, respectively. The overall history of HBV vaccination was 15.5% in our study sample. HBsAg, anti-HCV and HIV-positivity were 2%, 0.8% and 0.0%, respectively.Conclusion: The prevalence of HBV- and HCV-positivity in patients admitted to the ED who did not have any known chronic viral disease was consistent with the general population prevalence. No significant change in the prevalence of HCV compared to previous years can be explained by the absence of a protective vaccine. The absence of HIV-positivity can be explained by the low rate of HIV-positivity in our country. WOS:000598269400009

Epidemiological studies have suggested an association between particulate air pollution, increased temperatures, and morbidity related to pregnancy outcomes. However, the roles of desert dust storms and climatological factors have not been fully addressed. The objectives of the present study were to investigate the association between desert dust storms, particulate matter with a diameter

ObjectiveAbdominal examination findings in pediatric acute appendicitis (AA) significantly vary by age. Therefore, grading systems have been developed for diagnosing pediatric appendicitis, and laboratory and radiological findings have an important role in this diagnosis. However, there is a need to develop new parameters for diagnosing AA. This study aimed to investigate the diagnostic value of platelet indices in AA.MethodsThis retrospective, observational study included 207 pediatric patients who were admitted to the Emergency Department and operated on for AA. The patients were divided into three groups on the basis of their surgical and histopathological findings (non-AA, uncomplicated AA, and complicated AA).ResultsThere was no significant difference in the mean platelet volume/platelet count (MPV/PC) ratio among the groups. The white blood cell (WBC) count and the MPV/PC ratio showed a significant negative relationship (r = −0.239). The specificity for MPV was 61.8% and the sensitivity was 68.8%. Receiver operating curve analysis of WBC and MPV showed significance for diagnosing AA.ConclusionThere is a negative, but weak, relationship between the WBC count and the MPV/PC ratio. However, the MPV/PC ratio could be a useful parameter for diagnosing pediatric AA according to receiver operating curve analysis.

Introduction: Ricinus communis is used as a decoration in landscape gardening in Turkey. In industrialized countries, however, it is used in many sectors, including the chemical, pharmaceutical, and fertilizer sectors; it is also used in cosmetics and biodiesel fuel production. In this presentation, 17 patients who ingested R. communis seeds are examined. Cases: Seventeen patients who ate the seeds of an unknown plant that grows in their gardens came to the emergency department with nausea, vomiting, and stomach ache complaints 4 h after ingesting the seeds. All patients were admitted to the critical care unit, monitored, and started on supportive treatment. After the treatment, patients’ vital signs and laboratory parameters were stable. Seven patients were discharged the next day upon the regression of symptoms. The remaining 10 patients were successfully discharged 2 days after the treatment. There are cases in medical literature where consumption of one-half of a R. communis seed resulted in death. In our presentation, each patient consumed one to four (2.18 on average) R. communis seeds, and the symptoms were over within 2 days. The clinical course ended without any cases of death, and all patients were discharged in good condition. Conclusion: Emergency physicians have to know the clinical course and medical methods regarding intoxication due to oral consumption of toxic plants. Severe toxicity and even mortality can be observed with the ingestion of the seeds of the plant. Similar symptoms (nausea, vomiting, and abdominal pain) were observed in all our cases, but no mortality was observed.

WOS: 000352110200003 PubMed: 25420891 Fine needle aspiration biopsy (FNAB) of the thyroid gland is an important tool for preoperative diagnosis; however, its benefit is limited for follicular lesions. Nucleolar organizer regions (NORs) are ribosomal gene regions that stain with silver (Ag) when they are active. These regions can be used to differentiate neoplastic and non-neoplastic lesions. We used a new AgNOR technique to investigate FNAB of cases diagnosed as follicular adenoma and carcinoma. Fourteen cases of follicular thyroid carcinoma (FTC) and 28 cases of thyroid follicular adenomas (FA) were stained using the silver NOR-associated protein (AgNOR) technique. One hundred nuclei per sample were examined, AgNORs were counted, and the total AgNOR area/nuclear area (TNORa/Na) ratio of each cell was calculated. We found that cases with FTC had significantly higher TNORa/Na than cases of FA. Also, cases with FTC had significantly higher AgNOR counts than cases with FA. AgNOR counting may help discriminate FTC and FA by routine cytopathology before surgery.

Purpose: Main diagnostic method of thyroid nodules is fine needle aspiration biopsy (FNAB), but sensitivity of this method in the evaluation of follicular lesions is low. We reevaluated patients who underwent operation with FNAB reports of follicular neoplasm, Hurthle cell neoplasm and oncocytic changes. Postoperative histopathological examination and thyroid ultrasound (TUS) results, scintigraphic features of nodules were reevaluated. Material and Method: One hundred and three patients who were diagnosed with FNAB as follicular neoplasm, Hurthle cell neoplasm, oncocytic changes and who underwent thyroidectomy were reevaluated, retrospectively. FNAB and postoperative histopathological thyroidectomy specimen results were compared. Results: Comparison results of FNAB cytologic evaluation and postoperative histopathological examination of those nodules were as follows. Eight patients who were diagnosed as follicular lesion in FNAB were papillary carcinoma, 6 were follicular carcinoma. One patients who were diagnosed as Hurthle cell neoplasm in FNAB was papillary carcinoma. Six patients who were diagnosed as oncocytic changes in FNAB were papillary carcinoma. According to postoperative histopathology results, all patients’ diagnoses were as follows: 21 patients (20.4%) were diagnosed with thyroid malignancy in which 15 patients (14.6%) were papillary carcinoma, 6 patients (5.8%) were follicular carcinoma. Hypoechoic appearance of nodule in TUS was found to be the only independent risk factor in prediction of malignancy. Discussion: One fifth of the patients who were reported as follicular neoplasm, Hurthle cell neoplasm and oncocytic changes in FNAB were consistent with malignancy. Hypoechoic appearance of these nodules in TUS was found to be an independent risk factor in prediction of malignancy. Turk Jem 2014; 1: 5-12

PubMed ID: 24374200 The formation of epidural fibrosis adjacent to the dura mater is a complex multi-step process that is associated with a marked reduction in tissue cellularity and the excessive deposition of extracellular matrix components. Extensive epidural fibrosis is a major cause of post-laminectomy syndrome. Decorin strongly inhibits fibrosis formation in various tissues via blockade of transforming growth factor-?1. The aim of this study was to investigate the effects of a topical application of decorin on the formation of epidural fibrosis in a rat laminectomy model. Twenty-four female Wistar albino rats (250-350 g) were equally and randomly divided into three groups (control, spongostan and decorin). Laminectomy was performed between the L3 and L5 levels in all rats. The dura mater was directly exposed to spongostan soaked with saline (2 cc/kg) or decorin (100 ?g/kg). Four weeks later, the laminectomized spine of the rats was completely removed between the L3 and L5 levels. The extent of the epidural fibrosis and arachnoidal involvement was histopathologically evaluated and graded. Our data revealed that epidural fibrosis was significantly reduced in the group treated with decorin compared to the spongostan and control groups (P

Research Forum of the American-College-of-Emergency-Physicians (ACEP) -- OCT 01-03, 2018 -- San Diego, CA

WOS: 000353553700074 PubMed: 25910343 Bone metastasis is common in patients with lung, prostate, and breast cancers but it isn't common in stomach cancer. Gastric carcinoma infrequently metastasizes to the bone and rarely in an osteoblastic form. Herein we presented a rare case of signet ring cell gastric adenocarcinoma in early stage with osteoblastic metastasis. To our knowledge our case was the youngest signet cell gastric cancer patient with osteoblastic bone metastasis reported in literature.

Yaykasli, Kursat/0000-0001-7550-6370; Kaya, Ertugrul/0000-0003-0081-682X WOS: 000336731700015 PubMed: 23763309 The fungus Amanita phalloides is known to contain two main groups of toxins: amanitins and phallotoxins. The amanitins group effectively blocks the RNA polymerase II enzyme found in eukaryotic cells. As alpha amanitin has a lethal effect on the majority of eukaryotic cells, it can be valuable as an antiparasitic or antifungal drug. It can be used externally against ectoparasites. It is critical that percutaneous applications of the alpha amanitin toxin are not harmful to the recipient. In this study, the absorption and the toxicity of percutaneous and intraperitoneal (ip) applications of 1 mg/kg alpha amanitin to mice were compared. Potential skin, liver and kidney toxicities were investigated through pathological examination. HPLC analysis was used to determine the amount of the toxin. No toxicity or toxin were found in the skin, liver, or kidneys of the mice in the control group. Interestingly, the percutaneous application group also showed no toxicity, and the toxin was not present in this group. After 24 h, Councilman-like bodies and pyknotic cells were observed in the mice in which alpha amanitin was applied intraperitoneally, demonstrating the presence of toxicity. Peak levels of alpha amanitin (mu g/mL) in the liver, kidney, and blood in the ip application group were measured at 3.3 (6 h), 0.2 (6 h) and 1.2 (1 h), respectively. The results demonstrated that the toxin was not absorbed through the skin of the mice and that the percutaneous application of alpha amanitin did not have any toxic effects. Thus, alpha amanitin may be administered percutaneously for therapeutic purposes. Duzce University Scientific Research Coordinator (Duzce Universitesi Bilimsel Arastirma Projeleri Koordinatorlugu, DUBAP)Duzce University [2011.04.HD.042] This study was financially supported by a research grant from Duzce University Scientific Research Coordinator (Duzce Universitesi Bilimsel Arastirma Projeleri Koordinatorlugu, DUBAP, 2011.04.HD.042).

Objectives: Despite decreasing incidence of gastric cancerin worldwide, it is still a major health problem. Everyyear, 30.000 new gastric cancer cases emerging, and itis the second most common cancer in Turkey. Gastriccancer is a complex multifactorial disease, emerging byinteraction between genetic and environmental factors.Survivin, apoptosis inhibitory protein is over-expressed incancer tissue. In this study, association between Survivin-31G/C polymorphism and gastric carcinoma was investigated.Materials and Methods: 46 gastric carcinoma patientswho had been admitted at Düzce University Researchand Practice Hospital, Laboratory of Pathology and 42healthy individuals have been included in the study. Sampleshave been subjected to genetic analysis by PCRRFLPmethod in Medical Genetics Department laboratoryat Düzce University.Results: GG genotype was found in 16 (34.8%), GCgenotype in 21 (45.7%), CC genotype in 9 (19.6%) in patientgroup. In control group, genotype distribution werefound 13 (31%), 26 (61.9%) and 3 (7.1%) respectively.The statistically significant difference was not found whencompared between patient and control groups. However,we observed the increased occurrence of gastric cancerassociated with CC genotype (OR=1.52).Conclusions: In our knowledge, this study is the first toevaluate the relationship between gastric carcinoma andSurvivin -31G/C polymorphism in Turkish population. Ourresults show that there is no any association betweengastric carcinoma and Survivin -31G/C polymorphismin the community which is represented by our study andcontrol groups. However, it was concluded that CC genotypemay create the susceptibility to gastric cancer.Key words: Polymorphism, gastric carcinoma, survivinggene, apoptosis

The breast cancers were placed in first rank among other cancer types in women, and second rank after lung cancer in terms of death in the World. It is estimated that this cancer has 20/100.000 frequency in east region and 40-50/100.000 frequency west region according to present data in Turkey. Matrix Metalloproteinase (MMP), proteolytic enzymes involve in the breakdown of proteins located in the cell membrane and intercellular matrix such as collagen, elastin, proteoglycans, and gelatin. The tissue inhibitors of metalloproteinases (TIMPs) are proteins which are specific and natural inhibitor for MMPs. Its primary tasks regulate the activation of MMPs by suppress. The destruction of the balance between MMPs and TIMPs, may lead the emergence of pathological processes. In this study, the effect of TIMP2 (-418) G/C andTIMP2 (303) G/A polymorphisms in breast cancer patients in Turkish population were analyzed by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP).The statistically significant difference was found between the control group and patients with breast cancer. However it is found that TIMP2 (303) GA genotype increases the risk of developing breast cancer at 1.486fold (p=0519), TIMP2 (-418) CC genotype increases the risk of developing breast cancer at 3.719-fold (p=0.519). In our knowledge, this study is the first to evaluate the relationship between breast cancer and TIMP2 gene polymorphisms in Turkish population. Our results show that there is no any association between breast cancer and TIMP2 gene polymorphisms in the community which is represented by our study and control groups. It was concluded from results that TIMP2 (303) GA genotype ile TIMP2 (-418) CC genotype may create the susceptibility to breast cancer.

Spindle cell carcinoma is a rare biphasic tumor consisting of epithelial and mesenchymal components. Presence of this tumor type in the tongue has rarely been reported. Herein, a case of 55-year-old woman who presented with a polypoid lesion at her tongue has been reported. Surgery was performed and pathologic examination revealed a spindle cell carcinoma. We present this rare tumor with an unusual location to contribute in part to the better understanding and awareness of this rare malignancy.

Objectives To investigate the expression of sex-specific hormone receptors in normal bladder urothelium and urothelial carcinomas (UCs) of the bladder, and to analyze clinicopathological features and survival outcomes according to receptor expression. Methods We evaluated the clinical data and tumor specimens of 139 patients with bladder cancer (BC). In addition, 72 samples of normal urothelium were included. Immunohistochemistry was performed using streptavidin-biotin peroxidase method, a monoclonal androgen receptor (AR), and an estrogen receptor-β (ERβ) antibody on paraffin-embedded tissue sections. Expression levels of each receptor were assessed by evaluating 500 tumor cells for each case and the percentage of positively-stained nuclei was recorded. Results None of the 58 male control cases showed any AR and ERβ expression. Five (35, 71%) of the 14 female control cases expressed ERβ. Of the 139 patients with UCs, 71 (51, 07%) expressed AR (62 male vs. 9 female; P = 0.413) and 44 (31, 65%) (39 male vs. 5 female; P = 0.402) showed ERβ expression (P < 0.001). No significant relationship was found between ERβ expression levels and tumor grades, and stages (P = 0.441; P = 0.247). AR expression was significantly lower in T2-tumors (21%) than in Ta-tumors (60%) and T1-tumors (60%) (P < 0.001). It was significantly higher in low-grade papillary UCs (64%) compared with high-grade papillary UCs (44%) and infiltrative high-grade UCs (17%) (P = 0.039; P < 0.001). Data of 79 patients with noninvasive BC were eligible to present, with a median 29 months follow-up. AR expression level did not influence recurrence-free survival (RFS) and progression-free survival (PFS) (P = 0.095; P = 0.110). No significant association was found between ERβ expression level and RFS (P = 0.293). PFS in patients with lower ERβ-expressing tumors was significantly better than that in patients with higher ERβ-expressing tumors (P = 0.035). Multivariate analysis confirmed this significant influence on PFS (P = 0.025). Conclusions Although ERβ expression had no impact on histopathological tumor characteristics, decrease in its expression may be associated with better PFS rates in patients with noninvasive BC. Conversely, loss of AR expression was associated with higher grade UCs and invasive UCs, but had no prognostic effect on survival. Finally, sex-specific hormone receptors alone cannot be responsible for gender differences in BC rates because they were expressed in similar rates in both sexes.

ABS TRACT Acute generalized exanthematous pustulosis is a rare cutaneous reaction characterized by generalised non-follicular, pinhead-sized, sterile pustules on an erythematous background. The eruption is usually related to drug administration and appears suddenly 7-10 days after the med ication is started. Although many medications can cause acute generalized exanthematous pustu losis, the most common group is antibiotics, especially s-lactams and macrolids. The acute onset of disease is accompanied by typical histological changes, fever greater than 38 °C, raised neutrophil count (> 7x109 /L), and spontaneous and rapid resolution in less than 15 days. Histopathology shows subcorneal pustules with a background of dermal edema and spongiosis, leukocytoclastic vasculi tis, perivascular eosinophils, or focal necrosis of keratinocytes. We present a case of acute general ized exanthematous pustulosis due to Ultravist ® (Iopromide) use for thoracic computerized

WOS: 000439240200015 Discoid lupus erythematosus (DLE) is the most frequent form of cutaneous lupus erythematosus. It is typically located on sun-exposed areas, such as forehead, nose, cheeks, eyelids, scalp, neck, presternal area, and the extensor aspects of extremities. Eyelid involvement is rare and usually it is accompanied with skin lesions elsewhere on the body. On this localization, DLE can mimic blepharoconjunctivitis, allergic dermatitis, psoriasis, lichen planus, basal cell carcinoma, granuloma annulare, tinea faciale, and eyelid edema. On the periorbital region, therefore, if one of these diseases is pre-diagnosed but there is no response to the treatment, DLE should be considered in the differential diagnosis. Here, the case of a 25 year-old male patient with discoid lupus erythematosus that has a peri-orbital location is presented, along with the response to topical tacrolimus cream treatment.