Inferior vena cava collapsibility index and stroke volume as predictors of blood transfusion in upper gastrointestinal bleeding in the emergency department.

BACKGROUND AND AIM: This study investigates the effectiveness of bedside ultrasonography in predicting blood transfusion requirements in patients with upper gastrointestinal bleeding (UGIB). It focuses on evaluating the inferior vena cava (IVC) diameter, IVC collapsibility index (CI), and stroke volume (SV) as ultrasonographic measures. METHODS: A hundred adult patients enrolled in this prospective clinical study. The patients were divided into two groups (group 1: only saline administered group, group 2: saline and blood administered group). IVC diameter, IVC CI, and SV were measured at the time of admission and after treatment. RESULTS: At the initial admission, group 1 exhibited an IVC CI of 20.4% and an SV of 65.0 mL, whereas group 2 displayed an IVC CI of 26.6% and an SV of 58.0 mL. Upon analyzing the relationship between the Glasgow-Blatchford score (GBS) and SV, we identified a significant negative correlation (r = -0.7350; P < 0.001). Similarly, a weak negative correlation was observed between the Rockall score (RS) and SV (r = -0.4718; P < 0.001). It is worth noting that patients with UGIB require blood transfusion if their SV falls below 62.5 mL, with an area under the curve (AUC) of 89.1% and a 95% confidence interval (CI) ranging from 82.8% to 95.4%. CONCLUSION: IVC CI and SV can be used as parameters to predict the need for blood transfusion in the ED in patients with UGIB.

Bioactive apatite-wollastonite glass ceramics coating on metallic titanium for biomedical applications: effect of boron.

Metallic titanium (Ti) implant surfaces need improvement for bioproperties and antibacterial behavior. For this purpose, a new boron-doped bioactive apatite-wollastonite (AW) coating was successfully developed on the Ti plate surface. The effects of boron addition on the microstructure, mechanical properties, and bioproperties of the AW coating were investigated. With the addition of boron (B), the AW coating morphology became less porous and compact. In terms of bio properties, the rate of apatite formation increased with the addition of B, and the cell viability rate increased from approximately 66-81%. B addition increased the elastic modulus of the AW coating from about 24-46 GPa and increased its hardness about 2.5 times. In addition, while no antibacterial activity was observed in the AW coating, the addition of boron slightly introduced antibacterial properties. The novel AW/B composite coating obtained is promising for Ti implant surfaces.

Pre-operative predictors of mortality in ruptured abdominal aortic aneurysms: is the Harborview Medical Center mortality risk score enough?

BACKGROUND: We aimed to evaluate the reliability of the Harborview Medical Center (HMC) mortality risk scoring system in predicting post-operative in-hospital mortality after open repair (OR) of a ruptured abdominal aortic aneurysm (rAAA) and to inves-tigate the presence of other possible mortality risk factors. METHODS: Patients who underwent OR for rAAA between January 01, 2004, and December 31, 2021, were retrospectively included in this single-center cohort study. The 30-day hospital mortality risk was calculated using the HMC risk scoring system. We as-sessed the relationship between mortality and other perioperative variables. Logistic regression analysis was performed to determine the factors affecting mortality. Receiver operating characteristic curve analysis was utilized to obtain the predictive value of the HMC mortality risk score. RESULTS: A total of 91 patients were included in this study. A statistically significant difference existed between the patients who survived and those who died. Univariate logistic regression analysis of the pre-operative patient data revealed that the hematocrit, lactate, shock index values, admission type, loss of consciousness, and HMC risk score significantly affected post-operative mortal-ity. However, in the multivariate logistic regression analysis, only the HMC risk score was associated with post-operative mortality (P<0.001). The HMC risk score could predict 30-day mortality, with an AUC of 0.912 for all patients. CONCLUSION: Our study showed that the HMC risk score could reliably predict in-hospital mortality, but it did not reveal any other parameters that further increased the reliability of this scoring system without compromising on its straightforward and practical calculation.

The Importance of Neutrophil Gelatinase - Associated Lipocalin and Liver Type Fatty Acid Binding Protein in Acute Kidney Injury.

BACKGROUND: The most important factor in the diagnosis of AKI is to accurately and early detect the damage that occurs in the kidney before the filtration capacity of the kidney decreases. Therefore, we discussed the use of NGAL and L-FABP in the early diagnosis of acute kidney injury, evaluation of clinical severity and prognosis as well as prediction of hemodialysis decision in this prospective study. METHODS: We studied 82 participants which included 41 patients aged 18 years and older with the diagnosis of acute kidney injury. We compared the renal function tests collected at 0 and 6 hours with the plasma NGAL and LFABP levels measured using ELISA. Acute kidney injury was defined as serum creatinine increase of 0.3 mg/dL in the last 48 hours, or an increase more than 1.5 times, or an increase in the basal serum creatinine value in the last seven days, or less than 0.5/mL/kg of urine volume within six hours. We tested the power of these new biomarkers in the early diagnosis, and prediction of hemodialysis and survival of the patients with AKI using ROC analysis. RESULTS: Fifteen (36.6%) of the patients were anuric and 26 (63.4%) were oliguric. Twenty-one (51.2%) patients were KDIGO Stage 3. Seventeen (41.5%) patients underwent hemodialysis. In the patient group, the mean NGAL level was 289.7 ± 117.4 ng/mL and the mean L-FABP level was 232.7 ± 72.8. Eleven (26.9%) of 41 patients died within the first 24 hours. In the dead patients, the mean plasma NGAL level was statistically significantly high (p = 0.005). The mean NGAL level was found to be statistically increased in correlation with the severity of acute kidney injury in patients (p < 0.05). To predict acute kidney injury, the ROC analysis showed that the area under the curve (AUC) was 0.819 (95% confidence interval (CI): 0.729 - 0.909) (p < 0.001) for plasma NGAL level, and the area under the curve (AUC) was 0.891 (95% confidence interval (CI): 0.822 - 0.959) for plasma L-FABP level (p < 0.001). CONCLUSIONS: Our study provides evidence that NGAL and L-FABP are effective biomarkers for early detection of AKI as well as predicting clinical severity and hemodialysis.

Evaluation of the Inferior Vena Cava Diameter in Dehydrated Children Using Bedside Ultrasonography.

Objective: Bedside ultrasonography (US) is a new imaging modality that has begun to be used in the Pediatric Emergency Unit to evaluate inferior vena cava (IVC) diameter for intravascular volume status. In this article, we aimed to evaluate IVC diameter with bedside US before and after the fluid therapy in dehydrated children. Methods: A total of 124 dehydrated patients were enrolled, aged 8 months to 17 years. The maximum diameters of the IVC and aorta (AO) were measured. IVC/AO ratio and IVC collapsibility index IVC-CI were calculated before and after the fluid therapy and correlation with the degree of dehydration and laboratory parameters was investigated. Results: Of the 124 patients, 49.2% (n = 61) were male, the mean age was 7.5 ± 4.94 years. The IVC/AOs ratio was increased in mild and moderate/severe groups after fluid therapy compared to before fluid administration. While the mean rate of heart rate, blood urea nitrogen (BUN), creatinine, and uric acid values were higher in the moderate/severe group, potassium and HCO3 were lower. There was no significant change in AO diameter and IVC-CI after fluid therapy in all groups. When the factors affecting the IVC/AOs ratio were analyzed with the logistic regression backward model; the IVC/AO ratio was found to increase as the degree of dehydration decreased (Adj.ß = -0.318) and as the age (Adj.ß = 0.242) and CRP (Adj.ß = 0.186) value increased. Conclusion: The IVC/AO ratio can be a promising index for the assessment and grading of dehydration in children, and cutoff values that vary according to age are necessary for a more objective assessment of dehydration.

The knowledge level and perceptions toward COVID-19 among Turkish final year medical students.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has upended medical education as well as the lives of healthcare professionals. Higher education institutions have a crucial role in the solution of public health problems by training young doctor candidates, and it is also essential to increase the knowledge level of physician candidates about the epidemic. So, in this study, we aimed to examine Turkish final year medical students' knowledge level and perceptions toward the COVID-19 pandemic. METHODS: The present descriptive multicentered study was conducted with the medical students in the final year of six medical schools located in six geographic regions of Turkey. After ethical approval, data were gathered using an online questionnaire through Google forms between 10 April 2020, and 20 April 2020. RESULTS: In this national survey study, 860 volunteers answered the questions thoroughly. The median age was 24 (22-38) years. A total of 55.3% of the participants were female. The median knowledge level score was 69.0 (0-93.1). The knowledge level was moderate. A total of 34.2% of the participants had a high level of knowledge. A total of 48.7% of participants stated that they felt the most competent about performing CPR. Updates about COVID-19 were followed regularly by 84.5% of the participants. CONCLUSION: We determined that final year medical students are knowledgeable and aware of this pandemic. We, medical educators, should inculcate relevant knowledge and educate the medical students to improve practices in the current pandemic, as well as for future epidemics. Different learning techniques should be added to the curriculum, especially at the time which widespread panic and uncertainty are prevalent.

The Blunt Abdominal Trauma Bedside Ultrasonography Comparison with Trauma Severity Scores and Computerized Tomography.

OBJECTIVE: To investigate the accuracy of focussed assessment sonography for trauma (FAST) bedside ultrasonography application in patients with blunt abdominal trauma and patient management, clinical outcome, and trauma severity scores. STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Department of Emergency Medicine, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey, from April 2013 to June 2017. METHODOLOGY: The presence of intraperitoneal free fluid (FF) was investigated by FAST application by emergency physicians. Abdominal computed tomography (CT), which was considered the gold standard, was made use of for evaluating intraperitoneal FF presence. Patients were evaluated for urgent surgical intervention, requirement of blood transfusion, and mortality status. The relationship between the FF presence / absence in FAST practice and revised trauma score (RTS), injury severity score (ISS) and trauma injury severity score (TRISS) was statistically analysed. RESULTS: All 28 FAST (+) patients also had intraperitoneal FF in gold standart CT. Although the gold standart CT detected intraperitoneal FF in 6 (4.2%) of 140 FAST (-) patients, the compatibility between FAST and CT in the detection of intraperitoneal FF in patients with blunt abdominal trauma was statistically significant (k: 0.882, p<0.001). RTS and ISS scores were 6.24 ± 1.74 and 44.0 ± 15.7 in eleven (3.5%) dead patients. The sensitivity, specificity, positive predictive value, and negative predictive value were found to be 82.3% (95% CI: 65.4-93.2), 100% (95% CI: 97.2-100), 100% and 95.7% (95% CI: 91.5-97.8), respectively. CONCLUSION: FAST had a high accuracy compared to gold standard CT in detecting FF. Low RTS and high ISS are associated with impaired hemodynamic parameters and detected FF [FAST (+)].

Rivaroxaban-induced severe diffuse intracerebral hemorrhage.

Bleeding, the most frightening adverse effect of anticoagulants,may occur in different parts of the body.When intracerebral hemorrhage in individuals used anticoagulant drugs is compared with normal coagulation function, the volume of bleeding is increased and the prognosis is worse. There are few studies in the literature regarding the presence of intracerebral hemorrhage and the volume and prognosis of bleeding associated with rivaroxaban, a new oral anticoagulant.Therefore, the clinical and radiologic findings and follow-up of an 80-year-old male patient with intracerebral hemorrhage who uses rivaroxaban for anticoagulation are presented in this article.

Computer-based simulation training in emergency medicine designed in the light of malpractice cases.

BACKGROUND: Using computer-based simulation systems in medical education is becoming more and more common. Although the benefits of practicing with these systems in medical education have been demonstrated, advantages of using computer-based simulation in emergency medicine education are less validated. The aim of the present study was to assess the success rates of final year medical students in doing emergency medical treatment and evaluating the effectiveness of computer-based simulation training in improving final year medical students' knowledge. METHODS: Twenty four Students trained with computer-based simulation and completed at least 4 hours of simulation-based education between the dates Feb 1, 2010 - May 1, 2010. Also a control group (traditionally trained, n =24) was chosen. After the end of training, students completed an examination about 5 randomized medical simulation cases. RESULTS: In 5 cases, an average of 3.9 correct medical approaches carried out by computer-based simulation trained students, an average of 2.8 correct medical approaches carried out by traditionally trained group (t = 3.90, p < 0.005). We found that the success of students trained with simulation training in cases which required complicated medical approach, was statistically higher than the ones who didn't take simulation training (p ≤ 0.05). CONCLUSIONS: Computer-based simulation training would be significantly effective in learning of medical treatment algorithms. We thought that these programs can improve the success rate of students especially in doing adequate medical approach to complex emergency cases.

Charcoal hemoperfusion in bupropion overdose.

Bupropion is a relatively new and popular medication for depression, with seizures as its major side effect. In the literature, there are insufficient data about hemodialysis following bupropion overdose. A 23-year-old female patient was brought to our emergency department with acute change in mental status and seizure after deliberate self-poisoning with approximately 25-30 tablets of bupropion hydrochloride. Her Glasgow coma scale score was 8/15. The patient underwent hemodialysis about 4 hours later. After 4 hours of extracorporeal treatment, she became conscious and was extubated. We present a case of full recovery after charcoal hemoperfusion following a bupropion overdose.