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Introduction: Non-traumatic back pain constitutes roughly 5% of the admissions to emergency departments. This study seeks to compare the efficacy of intravenously administered paracetamol, dexketoprofen, and ibuprofen in patients with non-traumatic acute low back pain. Methods: This study was designed as a randomized, double-blinded investigation and carried out at a tertiary hospital. 210 eligible patients without trauma who presented with low back pain were recruited for the study and randomized into paracetamol (n = 71), dexketoprofen (n = 70), and ibuprofen (n = 69) groups. The measurements at 0, 15, 30 and 60 min were noted down by using a 100 mm VAS, and the relevant comparisons were made. Results: The VAS scores at 0 and 60 min in the paracetamol, dexketoprofen, and ibuprofen groups decreased on average by 40 mm, 42 mm, and 43 mm, respectively. The baseline and final pain scores of each drug group differed significantly (p < 0.05), though the between-group analysis revealed no significant difference (p > 0.05). Conclusion: Given the obtained data, we did not note a significant difference between intravenous paracetamol, dexketoprofen and ibuprofen with respect to pain efficacy in non-traumatic acute low back pain. Based on the patients' clinical conditions and histories, we concluded that the choice of medication might not change the efficacy of the treatment and patient comfort. © 2022 Elsevier Inc.

Background This study seeks to investigate the distribution of the angiotensin-converting enzyme (ACE) gene polymorphism and serum levels in patients with viral pneumonia and predict which polymorphism will lead to severe progression of the disease. Methodology The serum ACE levels and ACE gene polymorphisms were successfully evaluated with respect to subsequent viral pneumonia using records of 100 patients with viral pneumonia and 100 healthy controls. Results ACE serum concentration was statistically significantly elevated. ACE serum concentration with a cut-off value of ≥5,256.05 pg/mL had 85.3% sensitivity and 83.2% selectivity. In addition, patients with ACE genotype D/D were 0.08 times more likely to manifest severe lung involvement than those with I/I, and patients with the I/D genotype were 0.02 times more likely than their counterparts with I/I. The computed tomography findings of the patients revealed that ACE serum concentration was significantly effective in discriminating between mild and moderate-to-severe lung involvement. No significant difference was observed between the blood parameters and ACE genotype distributions. Conclusions I/D polymorphism likely affects the expression of the ACE gene and/or the function of the angiotensin I converting enzyme. The D/D genotype is associated with vessel wall thickness and higher blood pressure. Strong evidence was found between D/D and I/D genotypes in the patient cohort concerning genotypes and ACE serum concentration. Further analysis showed that ACE serum levels were more elevated in the D/D genotype compared to the I/D genotype in the patient cohort.

This study aims to evaluate the relationship between peroxisome proliferator-activated receptor (PPAR) alpha and gamma gene polymorphisms and acute coronary syndrome (ACS) clinically.Peripheral blood samples were collected from a total of 200 people, including 100 acute coronary syndrome patients and 100 controls aged 19 to 93 years, admitted to the Pamukkale University Emergency Medicine Department. The healthy volunteers had no known chronic or acute diseases, no history of drug use, and no recent history of coronary artery disease (CAD). PPAR alpha L162V and PPAR gamma C161T gene polymorphic regions were detected using DNA sequencing analyses. In addition, data collected from the hemogram and biochemical parameters and comorbidities of the patients were statistically analyzed.PPAR gamma C161T polymorphisms were compared between groups. The CT heterozygous rate in the patient group (74%) was higher than in the control group (7%). The T allele was more common in the patient group (0.37) compared to the control group (0.03). When PPAR alpha L162V polymorphism was compared, VV homozygous individuals were %19 in the patient group and none in the control group. The V allele was found to be statistically higher in patients with ACS (p0.01).The findings revealed that elevated PPAR alpha L162V and PPAR gamma C161T gene polymorphisms were associated with a progressive risk of ACS.

Introduction: Endometriosis affects approximately 10% of the reproductive age woman. Although the most common affected sites are ovaries, sacrouterine ligament, rectovaginal septum, and pelvic peritoneum, it can be located in any organ. Endometriosis of rectus abdominal muscle independent from the cesarean section incision is extremely rare. Case Presentation: A 31-years-old female was admitted to the emergency department with periodical abdominal pain and distension complaints. Ultrasonography and computed tomography revealed a heterogeneous mass in the rectus abdominis muscle. Surgical excision was performed. Histopathologic examination showed endometrial tissue with glandular and stromal elements within the muscularis propria. Conclusion: Endometriosis should be kept in mind in the differential diagnosis of atypical pain and mass of the abdominal wall in the emergency settings.

Introduction: Patients diagnosed with COVID-19 have presented to emergency departments (EDs) worldwide with a wide range of symptoms. In this study we reported the clinical, laboratory and radiological features of the cases diagnosed with COVID-19. Methods: This is a single-center, retrospective, descriptive, and observational study. The patients who have ad -mitted to ED between March 11 and May 31, 2020 and diagnosed COVID-19 infection. Results: 130 (73 male and 57 female) patients with COVID-19 polymerase chain reaction (PCR) positive test were included in the study. The average age of the study group was calculated as 52.63 +/- 17.95 year. While 15.4% of the patients were asymptomatic, the most common symptom was identified as cough (46.2%), followed by dys-pnea (23.1%), fever (17.7%). The computed tomography (CT) severity scores proved significantly higher in the patients with hypertension and coronary artery disease (CAD) than in those without these diseases (p = 0.010 and p = 0.042, respectively). The moderate positive correlation between serum ferritin level and CT sever-ity score is another finding worth noting (rho = 0.530 and p = 0.0001). In a similar vein, the high level of D-dimer in the CT-positive group and its positive moderate correlation with CT severity (rho = 0.375 and p = 0.0001). Conclusion: In our study, serum ferritin and D-dimer levels were observed to be high in the CT-positive group and have moderate positive correlation with CT severity. We thus argue that D-dimer and ferritin levels measured at the time of admission to the ED can be taken into consideration to predict radiological severity. (c) 2021 Elsevier Inc. All rights reserved.

Background/Aim: It is controversial whether intravenous recombinant tissue plasminogen activator (IV r-tPA) treatment outcomes in cardioembolic strokes differ from other types of strokes. This study aims to investigate the clinical data of patients with cardioembolic and large-vessel atherosclerosis who received IV r-tPA treatment and compare and discuss the results according to the literature. Methods: The data of the patients who were admitted within the first 4.5 hours following the onset of symptoms, diagnosed with acute ischemic stroke in the Neurology clinic of Kütahya Evliya Çelebi Training and Research Hospital and underwent IV r-tPA were evaluated in this retrospective cohort study. Demographic data, clinical and functional results of patients were compared between the two groups (cardioembolic and large vessel atherosclerosis). Results: Eighty-five patients with ischemic stroke who received IV r-tPA treatment due to cardioembolism and large-vessel atherosclerosis were included in the study. There were 51 patients (60%) in the cardioembolic stroke group and 34 patients (40%) in the large vascular atherosclerotic group. There was no significant difference in terms of functional results between the groups (62.7% vs 44.1%; P=0.09). While symptomatic intracerebral hemorrhage was not detected in the large-vessel atherosclerosis group, it occurred in 3.9% of the cardioembolic stroke group. Conclusion: This study proved that functional and clinical results are similar between cardioembolic and large-vessel atherosclerosis patients who were treated with IV r-tPA treatment. Regardless of the etiology, all suitable patients with acute ischemic stroke should be treated with thrombolytic therapy.

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: This study seeks to explore the impact of COVID-19 outbreak on the social support perception and acute stress disorder of prehospital care providers (PCPs) in the province of Denizli. Methods: This descriptive and cross-sectional study was conducted between December 25, 2020 and January 25, 2021. Out of 510 ambulatory care staff constituting the study population, there were 287 PCPs (%56.2), including 13 physicians, 89 paramedics, 134 emergency medical technicians, and 51 individuals from other occupational groups (nurse, driver, cleaning staff, medical secretary) based at emergency health services. The data collection tools employed in the study include an introductory information form, Multidimensional Scale of Perceived Social Support (MSPSS), and National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS), which was organized as an online questionnaire. Results: We analyzed the data from 287 PCPs that completed the form and scales. The mean score of the NSESSS was calculated as 1.53 +/- 0.79. The PCPs who experienced health problems (1.85 +/- 0.69), suffered from mental problems and received psychotherapy and medication (2.57 +/- 0.57), encountered COVID-19 patients (1.58 +/- 0.8), provided care for COVID-19 patients (1.59 +/- 0.79), and took polymerase chain reaction (PCR) tests (1.68 +/- 0.78) had higher acute stress symptom levels. The total mean score of MSPSS was calculated as 66.28 +/- 17.22. Total MSPSS scores of the participants varied significantly in terms of age, marital status, taking a COVID-19 test, suffering from mental problems, status of encountering a COVID-19 patient, and workplace satisfaction (p < 0.05). Conclusions: The findings are suggestive of high perceptions of multidimensional social support and low acute stress symptom levels of the PCPs during the COVID-19 pandemic period. (c) 2022 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

There are conflicting data on the effects of masks on vital signs and end-tidal COThis study aims to evaluate the changes in the vital parameters and EtCOThe prospective, observational study was conducted from January 2021, over consecutive 30 days, in the emergency department of a tertiary-care university hospital. The vital signs and EtCOSixty-eight subjects were included in two groups (NC-SM [n = 49] and SOM-SM [n = 19]). At the 120th minute, a decrease in systolic and diastolic blood pressure, heart rate, and respiratory rate and an increase in oxygen saturation were observed in the group including all subjects. After decreasing slightly in the first 30 min, the EtCONC-SM and SOM-SM applications do not affect adversely, and even seem to lead to recovery of, the vital signs and EtCO

Introduction In this study, we set out to study possible differences between individuals with and without VOC 202012/01 variant by using less costly complete blood count analytes and quickly analyzing the samples and ratios derived from these analytes. For this purpose, we assessed neutrophil, lymphocyte, platelet, and Red Blood Cell Distribution Width-Standard Deviation (RDW-SD) levels among complete blood count parameters (CBC) (identification and count of red blood cell, neutrophil, eosinophil, basophil, lymphocyte, monocyte, platelet) as well as the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). Methods A retrospective cross-sectional study was performed over the course of two months (from May to June 2021) on 212 patients who presented to the emergency department of a tertiary hospital with Covid-19 symptoms and took SARS-CoV-2 PCR and CRC tests. The polymerase chain reaction (PCR)-confirmed SARS-CoV-2 positive patients and their hospitalization data were gathered from the public health management system. Their VOC-202012/01 mutation status was also confirmed by this system. Results RDW-SD, RDW, NLR, and PLR indexes, as well as C-reactive protein (CRP), and lactate dehydrogenase (LDH) values, were higher in the patients with VOC-202012/01 mutation (p

Aims. In this study, we aim to unravel the relationship between coagulation parameters together with D-dimer and the severity of coronavirus disease (COVID-19) during hospitalization as well as hospitalization in the intensive care unit (ICU). Methods. This retrospective study was conducted in the Emergency Department (ED) of Pamukkale University Hospital (Denizli, Turkey) between March 1 and April 30, 2020. SARS-CoV-2 polymerase chain reaction (PCR) tests and laboratory tests, including international normalized ratio (INR), prothrombin time (PT), D-dimer, and activated thromboplastin time (APTT), were requested from 289 people presenting to the ED with symptoms of upper respiratory tract infection (URTI), such as cough, fever, and sore throat. Results. While 110 patients turned out to be polymerase chain reaction (PCR) positive, 181 individuals were PCR negative. The mean D-dimer level of the patient group was 147 ng/ml DDU (min: 9, max: 2948), and their mean PT level was found as 12.8 seconds (min: 10.3, max: 34.7). Besides, the mean APTT was 31.25 seconds (min: 19, max: 46.9), and the mean INR level was calculated as 1.09 (min: 0.88, max: 2.93). 35 of the patients were not hospitalized, while 43 were admitted to the Infectious Diseases, 20 to the Chest Diseases, and 12 to the ICU. Conclusions. It can be concluded from our findings that D-dimer, PT, and INR levels remained elevated in the COVID-19-diagnosed patients, but these parameters were unable to discriminate accurately between the patients with positive and negative SARS-CoV-2 results. Our findings also suggest that coagulation parameters might occupy a critical role in documenting clinical severity in patients with COVID-19 infection and requiring hospitalization.

Background There are conflicting data on the effects of masks on vital signs and end-tidal CO2 (EtCO2) values in the literature. Aims This study aims to evaluate the changes in the vital parameters and EtCO2 values of the patients who were administered oxygen through nasal cannula (NC) and simple oxygen mask (SOM) and wore surgical masks (SM) on top during their treatment. Methods The prospective, observational study was conducted from January 2021, over consecutive 30 days, in the emergency department of a tertiary-care university hospital. The vital signs and EtCO2 values of the subjects administered O-2 were noted at the time of arrival and at the 30th and 120th minutes of treatment. Changes in vital signs and EtCO2 values were compared with regard to NC-SM and SOM-SM applications over a 120-min study period. Results Sixty-eight subjects were included in two groups (NC-SM [n = 49] and SOM-SM [n = 19]). At the 120th minute, a decrease in systolic and diastolic blood pressure, heart rate, and respiratory rate and an increase in oxygen saturation were observed in the group including all subjects. After decreasing slightly in the first 30 min, the EtCO2 value remained stable. Conclusions NC-SM and SOM-SM applications do not affect adversely, and even seem to lead to recovery of, the vital signs and EtCO2 values during 120 min in subjects with acute complaints.

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.

WOS: 000487283000006, Objective: We aimed to evaluate the demographic, clinical, laboratory and electrophysiological findings of patients with inpatient Guillain-Barre syndrome in our clinics and to investigate the effect of these parameters on the prognosis of the disease. Materials and Methods: Between January 2014 and April 2018, file records of patients admitted to our clinics with the diagnosis of Guillain-Barre syndrome were retrospectively reviewed. Demographic characteristics, clinical, laboratory and electrophysiological findings of the patients at the time of admission were recorded. Patients were clinically graded according to the Hughes classification at the time of admission and on the 3rd month after discharge. Results: In the study, 25 of the 51 patients were male (49%) and 26 were female (51%) and the mean age was 54.21 +/- 17.32 years. According to clinical and electrophysiologic diagnosis, 34 patients (66.7%) had acute inflammatory demyelinating polyradiculoneuropathy, 9 patients (17.6%) had acute motor axonal neuropathy, 6 patients (11.8%) had acute motor sensory axonal neuropathy and 2 patients (3.9%) had Miller Fisher syndrome. According to Hughes scoring on the 3rd month after discharge, 31 patients (60.8%) had in good prognosis (Hughes score 2). In the comparison between the two groups according to clinical, demographic, and laboratory parameters, older age (>= 50), high Hughes score at admission, weakness in extremities as first complaint, the presence of complications, need for mechanical ventilation and presence of gastroenteritis as a leading infection were evaluated as prognostic factors. Conclusion: The most common variant of Guillain-Barre syndrome in our study was acute inflammatory demyelinating polyradiculoneuropathy. Older age (>= 50), high Hughes score at admission, weakness in extremities as the first symptom, presence of complications, need for mechanical ventilation, and presence of gastroenteritis as a precursor infection were poor prognostic factors.

Introduction This study seeks to determine the utility of D-dimer levels as a biomarker in determining disease severity and prognosis in COVID-19. Methods Clinical, imaging and laboratory data of 120 patients whose COVID-19 diagnosis based on RT-PCR were evaluated retrospectively. Clinically, the severity of COVID-19 was classified as noncomplicated or mild or severe pneumonia. Radiologically, the area of affected lungs compatible with viral pneumonia in each patient's computed tomography was classified as either 0–30% or ≥ 31% of the total lung area. The D-dimer values and laboratory data of patients with COVID-19 were compared with inpatient status, duration of hospitalization, and lung involvement during treatment and follow-up. To assess the predictive value of D-dimer, receiver operating characteristic (ROC) analysis was conducted. Results D-dimer elevation (> 243 ng/ml) was detected in 63.3% (76/120) of the patients. The mean D-dimer value was calculated as 3144.50 ± 1709.4 ng/ml (1643–8548) for inpatients with severe pneumonia in the intensive care unit. D-Dimer values showed positive correlations with age, duration of stay, lung involvement, fibrinogen, neutrophil count, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR). When the threshold D-dimer value was 370 ng/ml in the ROC analysis, this value was calculated to have 77% specificity and 74% sensitivity for lung involvement in patients with COVID-19. Conclusion D-Dimer levels in patients with COVID-19 correlate with outcome, but further studies are needed to see how useful they are in determining prognosis.

Introduction: In this study, we aimed to investigate and compare the prognostic impacts of C-reactive protein (CRP), white blood cell (WBC) count, neutrophil (NEU)-to-lymphocyte (LYM) ratio (NLR), platelet-to-lymphocyte ratio (PLR), Red Cell Distribution Width (RDW) biomarkers in laboratory-confirmed COVID-19 cases as well as to explore the most useful diagnostic biomarkers and optimal cutoff values in COVID-19 patients. Methods: A total of 233 patients were admitted to Emergency Department (ED) of XXXXXX Pamukkale University Hospital during two months (March–April 2020) and underwent Sars CoV-2 PCR (Polymerase Chain Reaction), complete blood count (CBC), and CRP tests in sequence due to complaints of COVID-19. The laboratory results and demographic findings were collected from the public health management system retrospectively. The patients with positive Sars CoV-2 PCR test along with hospitalization data were also recorded. Results: The CRP (p = 0.0001), lactate dehydrogenase (LDH) (p = 0.038), PLR (p = 0.0001) and NLR (p = 0.001) remained significantly higher in the patients with positive Sars CoV-2 PCR test result. By contrast, eosinophil (p = 0.0001), lymphocyte (p = 0.0001), platelet levels (p = 0.0001) were calculated as significantly higher in negative Sars CoV-2 patients. Conclusion: In the light of the obtained results, the CRP, LDH, PLR and NLR levels remained significantly higher in COVID-19 positive patients, while eosinophil, lymphocyte, and platelet levels were significantly elevated in COVID-19 negative patients. © 2020 Elsevier Inc.

Suicidal attempts are the primary cause of cyanide intake, and a majority of these attempts are fatal. Cyanide-induced cardiac arrest or hypotension is common, though the administration of antidotal therapy in patients is not. The patient drank the cyanide ordered from the internet in an unknown amount 10-15 min before being taken to the ED. He informed his friend after taking it, and he collapsed shortly after his friend notified the Emergency Medical Services (EMS). Acute cyanide poisoning, whose rapid detection is vital but difficult to diagnose, leads to rapid hemodynamic and neurological dysfunction. Bitter almond odor and cherry red skin appearance should be the warning signs in the diagnosis of acute cyanide toxicity.

Background: Treatment provided in an emergency department is aimed at alleviating pain immediately with minimized adverse effects as well as warding off further migraine attacks. The primary aim of this article is to compare the effectiveness of oral paracetamol versus zolmitriptan in treating acute migraine attacks. Methods: This prospective, randomized, and controlled study was carried out at a tertiary care hospital visited by 95,000 patients annually. The study recruited 200 participants who were randomized into two groups. One group received 1000 mg paracetamol while the other group received 2.5 mg zolmitriptan orally. Baseline pain scores were recorded using the Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) at 15, 30 and at 60 min following administration of the study drugs. Patients requiring further treatment were provided fentanyl at a dosage of 1 µg/kg as a rescue therapy. Results: A significant decrease was evident in VAS and NRS scores following the administration of the study drugs in both groups (P < 0.001). The change in VAS pain scores after 15, 30 and 60 min was calculated as 17.0 ± 13.9, 41.2 ± 16.3 and 61.2 ± 17.5 mm, respectively, in the paracetamol group and 14.2 ± 11.7, 39.2 ± 17.9 and 59.2± 19.3 mm, respectively, in the zolmitriptan group, which did not indicate significant differences (P = 0.103, P = 0.425, P = 0.483, respectively). Likewise, NRS pain scores showed a downward trend in line with VAS pain scores and did not yield a significant difference (P = 0.422). No significant difference concerning rescue therapy was noted between the two groups (P = 0.596). Conclusion: Oral paracetamol and zolmitriptan prove to be similarly effective and have low incidence of acute side effects in treating acute migraine cases without aura.

Objectives Sore throat is one of the most prevalent causes of emergency visits. The chief purpose of this clinical report is to investigate the effectiveness of intravenous (IV) dexketoprofen and paracetamol drugs relative to each other in relieving the pain induced by sore throat in emergency visits. Methods This prospective, randomized, double-blind, controlled study was conducted at a tertiary-level emergency unit. The eligible population (n=200) with confirmed pharyngitis diagnosis on the Tonsillo Pharyngitis Assessment and moderate to severe sore throat was randomly divided into two cohorts to be administered with 50 mg of dexketoprofen (n=98) or 1000 mg paracetamol (n=102). The study drugs dissolved in 150 ml saline were administered by rapid intravenous infusion. All the recruited patients were re-assessed by Sore Throat Pain Intensity Scale (STPIS), Difficulty Swallowing Scale, (DSS), and Swollen Throat Scale (SwoTS) at 15, 30, 45, 60, 90 and 120 min. In addition, presence of sore throat was re-evaluated by Sore Throat Relief Scale (STRS) at these time points. Results A total of 200 patients completed the study. The median age in dexketoprofen and paracetamol cohort was 25 (18-57) and 29 (17-76), respectively. Dexketoprofen and paracetamol provided relief in sore throat pain, with Total Pain Relief scores (TOTPAR0-120 min ) being 5.68±2.06 mm in the former case and 6.03±1.76 mm in the latter (p>0.05). The IV administration of paracetamol and dexketoprofen decreased STPIS, DSS, and SwoTS scores over time, while increasing Sore Throat Relief Scale (STRS) scores. The average value of STRS was measured as 4.41±1.18 in the paracetamol cohort and 4.15±1.23 in the dexketoprofen cohort during 0-120 min (p=0.545). Conclusion In emergency department, IV dexketoprofen and paracetamol reduced sore throat pain equally, providing similar analgesic efficacy.

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

Amaç: Pamukkale Üniversitesi (PAÜ) Hastanesinde çalışan sağlık profesyonelleri dışındaki personelin sosyodemografik özelliklerinin tanımlanması, Bruselloz ve Brusellozdan korunma hakkındaki bilgilerinin değerlendirilmesi, Brusella enfeksiyonuna yol açabilecek bazı riskli uygulamalarla olan ilişkilerinin belirlenmesi amaçlanmıştır. Gereç ve yöntem: Araştırmadaki veriler 25 soruluk anket formu ile, yüz yüze görüşme tekniği kullanılarak toplanmıştır. Anketler, PAÜ Hastanesinde uygulanmıştır. Bulgular: Bruselloz ülkemizde sık görülen bir hastalıktır. Çalışmamıza katılan kişiler farklı yaş gruplarında ve hastanede çalışmasına rağmen Brusellozun sadece hayvanlarla temas sonucu bulaşabildiği (%4,65) (%0,58- %8,72) oranında bilinmiştir. Yaş ve eğitim seviyesi artıkça Brusella hakkındaki bilgi, tutum ve davranışların çoğu zaman olumsuz yönde etkilendiği görülmüştür. Sonuç: Bruselloz hakkında hastane çalışanları dahil bilgilendirilmeli, hastalığın hayvanlar ve/veya çıkartılarıyla temas sonucu bulaşabileceği riski konusundaki bilinç artırılmalıdır.

The primary cause of cyanide intake is suicidal attempts, most of which result in death. People who interfere with suspicion of cyanide intoxication may also be exposed to cyanide poisoning. During the autopsy of the corpse in the morning of that day, five people in the autopsy room within the hospital were admitted to the ED with suspicion of cyanide intoxication. Meanwhile, a 36-year-old patient who had come into contact with the patient at night also presented to the ED. Some of the precautionary measures to be taken against inhalation of cyanide may be wearing appropriate masks as well as suitable clothes and keeping the surroundings below 28 °C when exposed to cyanide.

Objective: To determine the cost analysis of emergency department (ED) visits by geriatric patients living in nursing homes., Study Design: Cross-sectional study., Methodology: Medical records of geriatric patients living in nursing homes who were admitted to the emergency department of the Hospital, between 2011 and 2015, were retrospectively reviewed. Number of visits, reason, and cost of treatment was determined., Results: In total 63 patients (21 females [33.3%], 42 males [66.6%]) with mean age of 76.3 +/- 8.16 years were included. The total number of emergency department visits by those 63 patients was 243. Twenty-three (9.5%) of the total emergency department visits were due to trauma. Six patients (9.5%) were admitted to the emergency department with cardiopulmonary arrest. The mean cost of each patient was $358.30 (53.90 - 1734.10), the maximum cost was $10,095.10, and the minimum cost was $7.42., Conclusion: Emergency department visits and hospitalisation are common among elderly patients living in nursing homes. However, emergency department visits by this frail population put a heavy burden on the economy. Essential measures should be taken to reduce the financial burden of emergency department visits and hospitalisation of this geriatric population., C1 [Seyit, Murat; Yilmaz, Atakan; Ozen, Mert] Pamukkale Univ, Dept Emergency Med, Med Sch, Denizli, Turkey., [Seyit, Duygu Aras] Dumlupinar Univ, Evliya Celebi Res & Training Hosp, Dept Neurol, Kutahya, Turkey.

Introduction Musculoskeletal system traumas are among the most common presentations in the emergency departments. In the treatment of traumatic musculoskeletal pain, paracetamol and non-steroidal anti-inflammatory analgesics (NSAID) are frequently used. Our aim in this study is to compare the efficacy of intravenous dexketoprofen and paracetamol in the treatment of traumatic musculoskeletal pain. Methods This prospective, randomised, double blind, controlled study was conducted in a tertiary care emergency unit. The participating patients were randomised into two groups to receive either 50 mg of dexketoprofen or 1000 mg of paracetamol intravenously by rapid infusion in 150 mL of normal saline. Visual analogue scale (VAS), Numeric Rating Scala (NRS) and Verbal Rating Scale (VRS) was employed for pain measurement at baseline, after 15, after 30 and after 60 mins. Results 200 patients were included in the final analysis. The median age of the paracetamol group was 34 (24–48), while that of the dexketoprofen group was 35 (23–50), and 63% (n = 126) of them consisted of men. Paracetamol and dexketoprofen administration reduced VAS pain scores over time (p = 0.0001). Median reduction in VAS score at 60 min was 55 (IQR 30–65) for the paracetamol group and 50(IQR 30.25–60) for the dexketoprofen group. There was no statistically significant difference between the paracetamol and dexketoprofen groups in terms of VAS reductions (p = 0.613). Conclusion Intravenous paracetamol and dexketoprofen seem to produce equivalent pain relief for acute musculoskeletal trauma in the emergency department. CLINICALTRIALS.GOV NO: NCT03428503

Objective To assess the effectiveness of pre-treatment with aripiprazole and quetiapine to prevent acute cocaine toxicity in a mouse model of cocaine toxicity. Methods This experimental study included three groups ( n = 25 per group) of mice that were intraperitoneally injected with normal saline solution, 10 mg/kg quetiapine or 10 mg/kg aripiprazole 15 min before 105 mg/kg cocaine hydrochloride. When the cocaine administration was completed, researchers blinded to the study groups observed the mice in terms of seizures and death for a further 30 min. Results In the cocaine + quetiapine group, the mean ± SE time to the first seizure was 10.80 ± 2.27 min and seizure activity was detected in 18 mice (72%) by the end of the 30 min. In the cocaine + aripiprazole group, the mean ± SE time to the first seizure was 18.10 ± 1.94 min and seizure activity was detected in 15 mice (60%) by the end of the 30 min. When compared with the control group, there was a significant difference between the cocaine + quetiapine and cocaine + aripiprazole groups in terms of seizure activity. Survival time was increased in the cocaine + aripiprazole group compared with the control and cocaine + quetiapine groups. Conclusion Quetiapine and aripiprazole pre-treatment reduced seizure activity and delayed the onset of seizures compared with the control group.

Introduction: Although acute musculoskeletal pain has a wide range of causes from tendinitis, muscle spasm, to bone and joint injuries, it is a frequent occurrence in emergency services. Paracetamol and non-steroidal anti-inflammatory analgesics (NSAID) are common used in the treatment of musculoskeletal pain. This study sets out to compare the effectiveness of intravenous dexketoprofen and paracetamol in musculoskeletal pain relief. Methods: This prospective, randomized, double blind, controlled study was carried out in a university emergency room. The participating patients were randomized into two groups to receive either 50 mg of dexketoprofen or 1000 mg of paracetamol intravenously by rapid infusion in 150 ml of normal saline. Visual analogue scale (VAS), Numeric Rating Scala (NRS) was employed for pain measurement at baseline, after 15, after 30 and after 60 mins. Results: 200 patients were included in the study, excluding 7342 of them. The mean age of the patients was calculated as 32,6. Paracetamol and dexketoprofen intervention decreases NRS pain scores over time. When compared to all pain locations, the NRS pain score of the patients was found to be statistically more effective in dexketoprofen than in paracetamol (p = 0.001). Paracetamol and dexketoprofen intervention reduces pain VAS scores over time. When the VAS pain score of the patients was compared to all pain locations, dexketoprofen was found to be statistically more effective than paracetamol (p = 0.001). Conclusion: Intravenous dexketoprofen seemed to achieve superior analgesia to intravenous paracetamol when compared with all pain locations in patients with non-traumatic musculoskeletal pain. © 2019 Elsevier Inc.

WOS: 000473399000001, PubMed: 31186964, Aim. Injuries are among the main causes of mortality and morbidity all over the world, and effective initial triage of these patients can determine the thin line between death and life. Tractor accidents and related injuries are significant problems particularly in rural areas. However, major trauma classification systems do not include tractor accidents as a criterion for trauma team activation or transportation of the patients to a trauma center. This study evaluated the general characteristics and outcomes of tractor accidents in comparison to motorcycle accidents, which are considered as a comparison criterion for major trauma. Materials and Methods. This is a multicenter study conducted in 6 emergency departments in 4 cities over a six month period. All cases over 18 years of age who were admitted to emergency service due to tractor or motorcycle accidents and meet the criteria were included in the study. The general characteristics and outcomes of both trauma types were compared to determine whether tractor accident should be considered as major traumas. Results. Eighty-eight patients had a tractor accident, and 339 patients had a motorcycle accident. The tractor accident victims were significantly younger (p

Amac: Kardiyak arrest durumlarinda yasama tutunma sansi erken kardiyopulmoner resusitasyon (KPR)’a baglidir. Calismamizin amaci, gelecegin is sagligi ve guvenligi uzmanlari olacak ogrencilerin ani kardiyak arrest gelistigi durumlarda 112 acil yardim ambulans ekipleri olay yerine ulasmadan temel yasam destegi (TYD)’ne hemen baslayabilme ozguvenlerini ve bu konu ile ilgili bilgi ve beceri duzeylerini belirlemektir. Gerec ve Yontem: Calismamiza XXXXXX Universitesi is sagligi ve guvenligi bolumu 2014-2015 ve 2015-2016 ogretim yilinda 1. sinifta ogrenim goren 254 ogrenci alinmistir. Ogrencilerin cinsiyet, ehliyet sahibi olup olmama, sporla ilgilenme, universite oncesinde sozel veya maket uzerinde KPR egitimi alma, universitede sozel veya maket uzerinde KPR egitimi almis olmasinin basi yeri, basi derinligi, basi hizi, basi ritmi puanlarina etkisi ve egitim oncesi-sonrasinda KPR yapabilme ozguvenleri arastirilmistir. Bulgular: Ogrencilerin 209’u (%82.3) erkek, 45’i (%17.7) kadindi . Calismada egitim oncesi ve sonrasinda sorulan ‘’Su an KPR yapar misin?’’ sorusuna verilen cevaplardan yola cikildiginda kisilerin oz guvenlerinde anlamli fark bulundu ( p =0.0001). Universite oncesinde KPR konusunda maket uzerinde egitim alan ve almayan ogrenciler arasinda basi derinligi puani acisindan istatistiksel anlamli fark saptandi ( p =0.047). Calisma oncesinde universitede sozel olarak KPR egitimi alan ve almayan ogrencilerin basi derinligi puani acisindan istatistiksel anlamli fark saptandi ( p =0.037). Universitede maket uzerinde KPR egitimi alan ve almayan ogrencilerin basi yeri, basi derinligi ve ritm acisindan iki grup arasinda istatistiksel anlamli fark mevcut oldugu saptandi (p degerleri sirasiyla; p =0.028, p =0.022, p =0.025). Sonuc: Sonuc olarak yasadiklari ve calistiklari bolgelerde cogu zaman olay yerine saglik profesyonellerinden daha hizli ulasabilecek olan is sagligi guvenligi ogrencilerine TYD egitimleri ogrenim hayatlarinin ilk yillarindan baslayarak ozellikle maket uzerinde verilmeli, bilgi ve becerileri artirilmasi saglanmalidir.

The best surgical technique for pilonidal sinus disease (PSD) is still disputed. The objective of this prospective randomized study is to compare the short and long-term results of modified Limberg flap and Karydakis flap surgeries that have been widely used in recent years. Ninety one patients were included in the study. The patients were divided into two groups: modified Limberg flap (MLF; n = 46) and Karydakis flap (KF; n = 45). Preoperative findings of the patients, their surgical findings, and short and long-term postoperative findings were recorded and statistically compared. While no significant difference was discovered between the groups in terms of postoperative analgesic need, hospital stay, postoperative infection rate, drain stay time, painless sitting time, painless toilet-sitting time, and painless walking time, return to work or school time was shorter in the MLF group compared with the KF group (20.61 ± 7.89 days, 23.29 ± 6.42, respectively; P < 0.05). Cosmetically, the visual analog scale (VAS) of the KF group was significantly higher than that of the MLF group (VAS score 7.12 ± 1.28, 5.45 ± 1.77, respectively; P < 0.05). Considering recurrence rates, no statistically significant difference was found between the groups. Our study found out that short and long-term results of the MLF and KF procedures are similar. We believe both methods can be safely used in surgical PSD treatment given that in the MLF procedure, shorter return-to-work time is achieved, while the procedure provides better cosmetic results.

Objectives: Synthetic cannabinoid or “Bonzai” use is a public health issue as its use has increased in Turkey as well as all over the world. The aim of this study is to evaluate the effectiveness of the “Synthetic Cannabinoids Seminar” that was provided to physicians who work in emergency services, using multiple choice questionnaires before and after the seminar as a tool for evaluation. Material and method: Synthetic cannabinoids seminars were provided to physicians who work in emergency services in two different cities, with the participation of 20 physicians in each scheduled seminar. The seminars were instructed by emergency medicine specialists and psychiatrists who were certified as an instructor by the Turkish Ministry of Health, after receiving an instructor course in synthetic cannabinoids. In order to measure basal knowledge levels of the participants, a pretest was performed for all participants before the seminar. After the seminar, a posttest was performed using the same questions in the pretest. The number of correct answers in both tests was then compared. Results: In total, 85 individuals attended the seminars; 29 individuals from Dumlupınar University Evliya Çelebi Training and Research Hospital constituted first group, and 56 individuals from Denizli State Hospital constituted second group. In both groups, the ratios of correct answers in the posttest were determined to be higher when compared to the pretest. Conclusion: The seminars on synthetic cannabinoids are useful and necessary for physicians. Keywords: Cannabinoids, Emergency, Evaluation studies, Education

Objective: To evaluate the effects of etomidate, ketamine, phenytoin, and phenytoin/midazolam in a mouse model of acute cocaine toxicity. Methods: We performed a randomized controlled study consisting of five groups (n525 each) of rats that received intraperitoneal injections of normal saline solution, 5 mg/kg ketamine, 7.5 mg/kg etomidate, 40 mg/kg phenytoin, and 40 mg/kg phenytoin and 2 mg/kg midazolam 10 minutes before cocaine hydrochloride (105 mg/kg). Following cocaine administration, a blinded observer watched the animals for 30 minutes to assess seizures (popcorn jumping, tonic-clonic activity, or loss of righting reflex), and lethality for 30 minutes. Results: The number of animals with seizures was lower in the etomidate (60%), phenytoin (40%), and phenytoin/midazolam (40%) groups (P,0.001). The etomidate (24%) and phenytoin/midazolam (16%) treatments were most effective in preventing lethality (P,0.001). Conversely, compared to the vehicle group (72%), cocaine-induced lethality was higher in the ketamine (84%) and phenytoin (92%) groups. All treatments prolonged the time to seizure, but this effect was most pronounced in the etomidate and phenytoin/midazolam groups, which also had the longest average time to lethality. Discussion: The present study provides the first experimental evidence supporting the use of etomidate to treat cocaine-induced seizures. Notably, ketamine and phenytoin were ineffective. Our findings suggest that premedication with etomidate, phenytoin, and phenytoin/midazolam reduced seizure activity in an acute cocaine toxicity mouse model. © W. S. Maney & Son Ltd 2012.

Background: The treatment of cocaine toxicity is an important subject for emergency physicians. We investigated the effects of dexmedetomidine, moxonidine and alpha-methyldopa on acute cocaine toxicity in mice. Objectives: The aim of this study was to evaluate the effects of dexmedetomidine, moxonidine and alpha-methyldopa in a mouse model of acute cocaine toxicity. Materials and Methods: We performed an experiment consisting of four groups (n = 25 each). The first group received normal saline solution, the second group received 40 μg/kg of dexmedetomidine, the third group received 0.1 mg/kg of moxonidine and the fourth group received 200 mg/kg of alpha-methyldopa, all of which were intraperitoneally administered 10 minutes before cocaine hydrochloride (105 mg/kg). All animals were observed for seizures (popcorn jumping, tonic-clonic activity, or a loss of the righting reflex) and lethality over the 30 minutes following cocaine treatment. Results: The ratio of animals with convulsions was lower in all treated groups when compared to the control (P < 0.001). Furthermore, 68% (n = 17) of animals in the dexmedetomidine group, 84% (n = 21) of the alpha-methyldopa group, 92% (n = 23) of the moxonidine group and 100% (n = 25) of the control group showed evidence of seizure activity (P = 0.009). Cocaine-induced lethality was observed in 12% (n = 3) of the dexmedetomidine group, 48% (n = 12) of the alpha-methyldopa group, 52% (n = 13) of the moxonidine group, and 72% (n = 18) of the control group (P < 0.001). All treatments prolonged the time to seizure, which was longest in the dexmedetomidine group (P > 0.05). In addition, the time to lethality was also longer in the same group (P < 0.001). Conclusions: The present study provides the first experimental evidence in support of dexmedetomidine treatment for cocaine-induced seizures. Premedication with dexmedetomidine reduces seizure activity in a mouse model of acute cocaine toxicity. In addition, while dexmedetomidine may be effective, moxonidine and alpha-methyldopa did not effectively prevent cocaine-induced lethality. © 2015, Iranian Red Crescent Medical Journal.

Severe amitriptyline poisoning results in cardiac and neurological toxicity and continues to be a leading cause of significant morbidity and mortality both in children and adults. We present a case of severe amitriptyline poisoning successfully treated with plasma exchange. Due to high plasma protein binding property of amitriptyline, plasma exchange therapy should be considered in cases of severe amitriptyline intoxication as a life saving therapeutic modality. © 2011 Elsevier Ltd.