[Show abstract][Hide abstract] ABSTRACT: Background:
Cardiovascular or cerebrovascular events associated with drug abuse have been frequently reported, particularly in young patients. The drugs include generally cocaine, heroin, and amphetamines. Although marijuana is among the widely used narcotics in the world, stroke associated with the marijuana use is infrequently reported.
Stroke caused by the use of marijuana was investigated in a 23-year-old man and the importance of inquiry of drug abuse in case of stroke was emphasized.
The patient was treated for 7 days in a follow-up, but he was not recovered. The patient was discharged in his existing condition and was directed for physiotherapy and rehabilitation.
Ischemic stroke is associated with drug abuse and/or substance use, mainly cannabinoids and amphetamines, particularly in young patients.
[Show abstract][Hide abstract] ABSTRACT: Background:
The purpose of this study is to detect the mortality predictive power of new Glasgow coma scale, age, and arterial pressure (GAP) scoring system in major trauma patients admitted to the emergency department (ED).
A total of 100 major trauma patients admitted to Uludağ University Faculty of Medicine ED who were 18 years of age or more were included in the study. In this prospective study, revised trauma score (RTS), injury severity score (ISS), trauma-related ISS (TRISS), Mechanism, GAP (MGAP) and GAP scores of the patients were calculated.
A significant positive correlation was established between ISS, TRISS, MGAP, and GAP in predicting in-hospital mortality (p<0.0001). Short-term (24 hours) and long-term (4-week) mortality prediction rates and area under the curve in receiver operating characteristics analysis were 0.727-0.680 for RTS, 0.863-0.816 for ISS, 0.945-0,911 for TRISS, 0.970-0.938 for MGAP, and 0.910-0.904 for GAP. All calculated trauma scoring systems revealed a significant mortality prediction power (p<0.001). GAP score was found statistically and significantly selective and sensitive in predicting both in-ED and in-hospital mortality (p=0.0001).
In major trauma patients, GAP score is an easily calculable system both in the field and at the time of admission in the EDs by providing emergency physicians with future decision-making schemes by means of mortality prediction of the patients.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 07/2014; 20(4):241-7. DOI:10.5505/tjtes.2014.76399 · 0.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Stroke is the most common neurologic cause for patient admission to the emergency department (ED) and the risk of stroke increases with age. This study aimed to determine the clinical and demographical characteristics of stroke-mimicking patients 65 years or older who were admitted to the ED for stroke.
After the retrospective file examination, patients 65 years and older who were admitted to the ED with an established final diagnosis of stroke as a result of history, physical examination, imaging, and required consultations were included in the study.
After scanning 671 records of patients 65 years or older, 87.3% (n = 586) were diagnosed with stroke and 12.7% (n = 85) received different diagnoses mimicking stroke. Of these 85 patients, 91.8% (n = 78) and 8.2% (n = 7) were prediagnosed with ischemic stroke and transient ischemic attack, respectively, by the ED physicians. After complete evaluations and consultations, the patients with stroke were typically diagnosed with vertebrobasilar insufficiency (n = 16, 18.8%). Of the patients, 76.5% (n = 65) were discharged after treatment and follow-up in the ED, and 21.1% (n = 18) were hospitalized.
In older patients, stroke-mimicking conditions can cause signs and symptoms indistinguishable from true stroke, representing about 12.7% of elderly patients admitted to an ED with these diagnoses.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 07/2013; 22(8). DOI:10.1016/j.jstrokecerebrovasdis.2013.05.029 · 1.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this study, our aim was to identify the validity of the prophylaxis indications for patients who received tetanus prophylaxis, determine the ratio of high-risk wounds to the number of patients with immunity, and to evaluate the tetanus immunity of specific age groups.
Patients who applied to the Emergency Department (ED) between September 2009 and May 2010 and who were considered for tetanus prophylaxis by his/her primary care physician were included in the study.
A total of 320 patients were evaluated. The average age of the patients was 40.87±15.83 years. A total of 73.1% of the patients were male and 26.8% were female. A total of 40.3% of the patients knew their vaccination history, while 59.7% had no recollection of their vaccination history. 14.7% of the patients had received their last dose within 5 years and 48.1% within 5-10 years; 37.2% of the patients declared that more 10 years had passed since their last vaccination. In 75% of the patients, the tetanus immunoglobulin (Ig)G level was identified as >=0.1 IU/ml, while 25% of the patients had levels <0.1 IU/ml. The number of patients with protective levels was lower among those who were illiterate or who had only a primary school education, and this difference was statistically significant (p<0.001).
The vaccination histories can be misleading. Certain equipment can be used at the bedside to determine a patient's tetanus immunization status.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 07/2013; 19(4):320-6. DOI:10.5505/tjtes.2013.05014 · 0.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Alterations in catechol-O-methyltransferase (COMT) activity are involved in various types of neurological disorders. We examined a possible association between the COMT Val158Met polymorphism and conversion disorder in a study of 48 patients with conversion disorder and 48 control patients. In the conversion disorder group, 31 patients were Val/Met heterozygotes, 15 patients were Val/Val homozygotes and 2 patients were Met/Met homozygotes. In the control group, 32 patients were Val/Met heterozygotes and 16 patients were Val/Val homozygotes. There was no significant difference between the groups. We conclude that the COMT Val158Met genotype is quite common in Turkey and that it is not a risk factor for conversion disorder in the Turkish population.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND:
This study aimed to determine the necessity of pregnancy test in women of reproductive age admitted to emergency department (ED) in routine practice.
We retrospectively reviewed the records of patients who presented to the ED between January 1, 2006 and December 31, 2010 and received a pregnancy test.
The median age of 1 586 patients enrolled into the study was 27 years. Of these patients, 19.55% had a positive result of pregnancy test. The most common complaint at admission was abdominal pain in 60.15% of the patients, and pregnancy test was prescribed. 15.83% of the patients with abdominal pain had a positive result of pregnancy test. Of the patients, 30.64% had nausea-vomiting at admission, and 11.52% had a positive result of pregnancy test. When other complaints were considered, the most commonly observed complaints were non-specific symptoms such as dizziness, malaise and respiratory problems. Of the patients, 70.93% were not remembering the date of last menstruation, and 9.51% showed a positive result of pregnancy test. Urinary tract infection (UTI) was commonly diagnosed with an incidence of 17.65%, which was followed by non-specific abdominal pain (NSAP) (16.77%) and gastrointestinal disorders such as gastritis and peptic ulcer (6.87%). Of the patients, 88.40% were discharged from ED, and 11.60% were hospitalized.
Pregnancy test should be given to women of reproductive age as a routine practice in ED in developing countries like Turkey.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND:
Fluid and electrolyte balance is a key concept to understand for maintaining homeostasis, and for a successful treatment of many metabolic disorders. There are various regulating mechanisms for the equilibrium of electrolytes in organisms. Disorders of these mechanisms result in electrolyte imbalances that may be life-threatening clinical conditions. In this study we defined the electrolyte imbalance characteristics of patients admitted to our emergency department.
This study was conducted in the Emergency Department (ED) of Uludag University Faculty of Medicine, and included 996 patients over 18 years of age. All patients had electrolyte imbalance, with various etiologies other than traumatic origin. Demographic and clinical parameters were collected after obtaining informed consent from the patients. The ethical committee of the university approved this study.
The mean age of the patients was 59.28±16.79, and 55% of the patients were male. The common symptoms of the patients were dyspnea (14.7%), fever (13.7%), and systemic deterioration (11.9%); but the most and least frequent electrolyte imbalances were hyponatremia and hypermagnesemia, respectively. Most frequent findings in physical examination were confusion (14%), edema (10%) and rales (9%); and most frequent pathological findings in ECG were tachycardia in 24%, and atrial fibrillation in 7% of the patients. Most frequent comorbidity was malignancy (39%). Most frequent diagnoses in the patients were sepsis (11%), pneumonia (9%), and acute renal failure (7%).
Electrolyte imbalances are of particular importance in the treatment of ED patients. Therefore, ED physicians must be acknowledged of their fluid-electrolyte balance dynamics and general characteristics.
[Show abstract][Hide abstract] ABSTRACT: Objective: Tick-borne diseases and especially Crimean-Congo Hemorrhagic Fever (CCHF) are serious epidemiological problems in many parts of the world. In this study, we aimed to emphasize the importance of an emergency approach to treat these diseases and to stress the importance of identifying characteristics of patients who are admitted to the hospital for tick attachment. Material and Methods: This study included 336 patients who admitted to Uludag University Medical Faculty Hospital Emergency Department (ED) and presented with tick attachment between April 2009 and May 2010. Patient demographics, clinical and laboratory findings and follow-up data were recorded. Laboratory parameters of hospitalized patients and non- hospitalized patients were statistically compared. Results: The mean age of the patients was 43.85±13.88 years. Males comprised %50.9 of the patients. The most common months for hospital admission for tick attachment were July (33.0%) and August (32.4%). Of total, %49.1 of the patients acquired the tick in urban areas while %35.4 of them acquired it in the rural areas such as picnic areas, forest, field or animal shelters. The tick attachments were found in the lower extremities in 27.4% of the patients. In 65.5% of patients, the tick was removed by a physician in the ED using a forceps (54.2%) which was the most commonly used tool for tick removal. Laboratory parameters [aspartate transaminase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH), creatine phosphokinase (CK), white blood cell, neutrophil and platelet counts, prothrombin time (PT), activated partial thromboplastin time (aPTT) and the international normalized ratio (INR)] of the hospitalized patients who were suspected CCHF were statistically significantly different when compared to the ones who were not hospitalized. Conclusion: In tick attachment cases who admitted to the ED, decreased levels of thrombocyte, leukocyte and neutrophil counts and increased levels of AST, ALT, LDH, CK, aPTT, PT and INR are significant for CCHF. An emergency department physician should be alert for these results.
Turkiye Klinikleri Journal of Medical Sciences 01/2013; 33(5):1209-1215. DOI:10.5336/medsci.2012-31397 · 0.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background/aims:
This study aimed to allow decision-making about hospitalization or discharge using the Glasgow Blatchford Scoring system, a risk analysis performed using basic laboratory and clinical variables, in patients presenting to the Emergency Department with upper gastrointestinal system bleeding.
Materials and methods:
This prospective, observational study conducted in the Emergency Department of a university hospital enrolled patients aged ≥18 years, who presented to the Emergency Department with upper gastrointestinal system bleeding between June 2009 and December 2010. For all patients, Glasgow Blatchford Scoring scores were calculated, and the patients were classified into two groups as high-risk and low-risk patients.
A total of 160 subjects with upper gastrointestinal system bleeding were enrolled in the study. Mean Glasgow Blatchford Scoring scores were 7.1 ± 3.8 for 71 low-risk subjects and 11.7 ± 2.9 for 89 high-risk subjects, and the difference between the two groups was statistically significant (p<0.001). When the performance of the Glasgow Blatchford Scoring system was evaluated in the determination of high risk, the sensitivity and specificity were 100% and 1.41%, respectively, for a cut-off value of Glasgow Blatchford Scoring >0, 100% and 16.9% for a cut-off value of Glasgow Blatchford Scoring >3, 96.63% and 36.62% for a cut-off value of Glasgow Blatchford Scoring >5, and 86.52% and 69.01% for a cut-off value of Glasgow Blatchford Scoring >8. In the receiver operating characteristic curve analysis, for Glasgow Blatchford Scoring in the high-risk estimation, the area under the curve was found to be 0.82 (95% CI: 0.75-0.88), and this value was statistically significant (p=0.0001).
The Glasgow Blatchford Scoring system, which may be easily calculated based on laboratory and clinical variables, seems to be a useful scoring system for risk analysis of all patients with upper gastrointestinal system bleeding admitted to the Emergency Department.
The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2012; 23(5):Isayfa-Ssafya. DOI:10.4318/tjg.2012.0385 · 0.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aim: To analyze the characteristics of patients transferred by air ambulance in the eastern Anatolia region of Turkey. Materials and methods: We retrospectively evaluated the records of patients transferred by air ambulance between January 2010 and December 2010. Demographics and medical data of the patients, geographic conditions, and fl ight duration data were all analyzed. Results: A total of 241 patients were included in the study, of whom 51% were men and 49% were women. Th e majority of the patients were between 0 and 1 year old (40.2%). In the adult patients, the most commonly seen diagnoses were trauma (31.6%), obstetric problems (24.7%), cerebrovascular events (12.4%), and myocardial infarction (9%). It was determined that in terms of medical disciplines the patients were most commonly transferred to the clinics of pediatrics (45.2%), neurosurgery (9.1%), gynecology (9.1%), cardiology (6.2%), neurology (5%), and general surgery (5%). Th e total fl ight time was 115.3 ± 4.7 min and the patients were most commonly transferred to a university hospital. Conclusion: Th e decision to use an air ambulance may be made based on the distance, the length of the transfer and transportation, the resources of the health institutions located in the relevant region, and the environmental and climatic conditions. However, the association between the likelihood of survival, the therapeutic benefi ts of the patient, and the cost should be analyzed.
Turkish Journal of Medical Sciences 01/2012; 42(5). DOI:10.3906/sag-1107-22 · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Arsenic is a classical poison that has been historically used since ancient times for homicidal purposes. More recently, episodes of deliberate or unintentional arsenic self-poisoning have been increasingly reported. We describe here a case of a 77-year old male patient with a history of major depression, who attempted suicide by ingestion of 4 g of arsenic trioxide. The man, a dentist by profession, used arsenic preparations for pulp devitalization. The patient was admitted to our hospital 5 h after arsenic ingestion with nausea and vomiting. Plain radiograph of the abdomen showed radio-opaque material in the stomach and small intestine. Nasogastric lavage, activated charcoal, and chelators were used to remove arsenic. On day 3, endoscopy disclosed the presence of gastritis and superficial ulcers. The patient developed significant anemia (Hb: 8.7 g/dL on day 7) without significant signs of hemolysis. He gradually recovered from anemia within 5 months. The patient did not suffer any adverse outcome in spite of having ingesting 4 g of arsenic, approximately 20 times the lethal dose.
[Show abstract][Hide abstract] ABSTRACT: The modified Early Warning Score (mEWS) is a triage instrument that promises to predict patient disposition and clinical outcome in emergency departments (EDs). We investigated whether mEWS can predict death, hospital admission, intensive care unit (ICU) admission, and in-hospital deaths in a Turkish setting.
We conducted an ED-based prospective study of 309 patients who presented to an academic medical center. The mEWS was recorded in all patients on ED admission. A mEWS >4 was used to define patients at high-risk for the study outcomes.
Patients categorized as being at high-risk either were admitted to ICU (n=23) or to hospital (n=37) 56.6% of the time, or died in ED (n=16) or in hospital (n=29) 42.4% of the time. Patients categorized as being at low-risk either were admitted to ICU (n=25) or to hospital (n=52) 37.4% of the time, or died in ED (n=1) or in hospital (n=4) 2.5% of the time. In multivariate regression analysis, patients with a mEWS of 5 or more were 1.95 times more likely to be admitted to ICU than those with a score less than 5. Patients with high-risk mEWS were 35 times more likely to die in ED and 14 times more likely to die in hospital than those presenting with a low-risk score.
We conclude that scores on the mEWS predict ICU admission as well as ICU and in-hospital deaths.
European Journal of Emergency Medicine 12/2008; 15(6):338-40. DOI:10.1097/MEJ.0b013e3283034222 · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to evaluate the frequency of posttraumatic stress disorder (PTSD) among the participants of the Turkish Red Crescent Disaster Relief Team after the Tsunami in Asia.
The Clinician Administered PTSD Scale-1 (CAPS-1) was administered to 33 of 36 team members one month after their Disaster Relief Team duty. Along with the CAPS-1 interview, demographic features, profession, previous professional experience, previous experience with traumatic events and disasters also were recorded. To be classified as present, a symptom must have a frequency score of "1" and an intensity score of "2" at the CAPS-1 interview. For a diagnosis of PTSD, at least one re-experiencing, three avoidance and numbing, and two increased arousal symptoms should be present.
The PTSD was diagnosed in eight of the 33 (24.2%) participants. No significant difference was detected in the distribution of PTSD diagnosis according to gender, age, profession, professional experience, previous disaster experience, and/or previous experience of traumatic events. However, the severity of PTSD symptoms as measured by the CAPS-1 score was significantly higher in women, nurses, and participants with <3 previous disaster duty experiences.
Post-traumatic stress disorder is prevalent within disaster teams and healthcare workers, and measures should be taken to prevent PTSD within this group.
Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation 06/2006; 21(3):168-72. DOI:10.1017/S1049023X00003630