Evaluation of the relationship between Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) score and treatment modality and mortality in patients with ileus.

AMAÇ: Ileus, bagirsak geçisinin tikanmasi olarak tanimlanan ve bagirsaklarda mekanik obstrüksiyon veya paralitik nedenlere bagli olarak gelisen klinik durumdur. Ince bagirsak obstrüksiyonlari primer olarak cerrahi durumlar olarak anilsada, konservatif tedavi bazi hastalarda seçilen bir tedavi protokolüdür. Bu çalismanin amaci, ileus hastalarinda HALP skorunun konservatif-cerrahi tedavi kararini, mortaliteyi ve hastanede kalis süresini belirlemede efektivitesini ve enflamasyonla iliskili diger parametrelere üstünlügünü degerlendirmektir. GEREÇ VE YÖNTEM: Çalismaya ileus tanisi alan hastalar dahil edildi. Yas, cinsiyet, komorbiditeler, seçilen tedavi yöntemi (konservatif veya cerrahi), hastanede kalis süresi ve hastane içi mortalite kaydedildi. Biyokimya parametrelerinden beyaz kan hücresi, hemoglobin, trombosit, nötrofil, lenfosit, nötrofil, lenfosit, üre, kreatinin, aspartat aminotransferaz, bilirubin, albümin ve C-reaktif protein seviyeleri kaydedildi. HALP skoru hesaplandi ve mortalite, hastanede kalis süresi, konservatif ve cerrahi tedavi karari arasindaki iliski analiz edildi. BULGULAR: Çalismaya toplam 286 hasta alindi. 245 (%85.7) hastada konservatif tedavi uygulandi. 262 (%91.6) hastada mortalite izlenmedi, 24'ünde (%8.4) mortalite izlendi. HALP skoru mortalite izlenmeyen hastalarda anlamli olarak yüksekti (p=0.045). Mortalite izlenmeyen hastalarin medyan albümin degeri mortalite izlenen hastalardan daha düsüktü (p<0.001). Mortalite izlenen hastalarin yas, üre, kreatinin, AST ve CRP deger-leri, izlenmeyenlere göre anlamli olarak daha yüksekti (sirasiyla, p=0.002, p<0.001, p<0.001, p<0.001, p<0.001 ve p=0.001). Konservatif tedavi uygulanan hastalarin HALP skoru, cerrahi tedavi uygulananlara göre anlamli olarak yüksekti (p=0.003). Lenfosit degeri konservatif tedavi ile izlenen hastalarda anlamli olarak yüksekti (p=0.027). Ameliyat olan hastalarda yas, üre, kreatinin ve CRP skorlari daha yüksekti (sirasiyla, p=0.007, p<0.001, 0.003 ve p<0.001). Tedavi yöntemi ve HALP skoru için ROC analizi yapilip HALP skoru 28 olarak alindiginda konservatif tedaviyi saptamada du-yarlilik 50.6%, özgüllük 78.0%, pozitif LR 2.3 ve negatif LR 0.63 olarak tespit edildi. (EAA 0,645 [%95 güven araligi = 0.556-0.735) ]; p=0.003). SONUÇ: HALP skoru ileuslu hastalarda mortalite ve tedavi seklinin belirlenmesinde faydali olabilecek önemli bir skorlama sistemidir. HALP skoru-nun ileus tanili hastalarin yönetiminde, hem mortaliteyi azaltmada hem de uygun tedavi yöntemini belirlemede olumlu katki saglayacagi kanaatindeyiz.

Do we feel safe and confident about workplace violence in the emergency departments?

STUDY OBJECTIVE: This study aimed to determine the relationship of safety and safety perception of physicians working in emergency departments with socio-demographic characteristics and working conditions. METHOD: The study included physicians who work in the emergency department. An online questionnaire with two sections was used to collect data. The first section comprised 11 questions about the socio-demographic characteristics and working conditions. The second section comprised the Safety and Confidence Scale for Health Professionals (SCSHP) that assessed how safe physicians felt and how confident they were in the face of violence. RESULTS: A total of 402 participants were included in the study. The median score of the participants with less than one year of work experience was significantly lower than the other subgroups (p < 0.001). There was no significant difference in the SCSHP score among other subgroups. The median SCSHP score of the male participants was higher than that of the female participants (p < 0.001). The median score of married participants was significantly higher than that of unmarried participants (p = 0.007). However, other characteristics didn't have a significant effect on SCSHP scores (p > 0.05). When the relationship between the working title and SCSHP score was examined, significant differences were found between faculty members and specialist doctors vs general practitioners (p = 0.005, 0.001, respectively), whereas no significant difference was found in SCSHP scores among other subgroups (p > 0.0125). CONCLUSION: Among physicians working in the emergency department, those with less work experience, female physicians, and those who are unmarried feel less safe and confident about workplace violence.

Utility of non-invasive synchronized intermittent mandatory ventilation in acute cardiogenic pulmonary edema.

BACKGROUNDS: Acute cardiogenic pulmonary edema (ACPE), one of the outcomes of acute heart failure (AHF), is a common reason in a critical condition with respiratory distress. Non-invasive synchronized intermittent mandatory ventilation(nSIMV) mode, which includes inspiratory pressure in addition to positive end expiratory pressure with/without pressure support provided in the non-invasive continuous positive airway pressure plus/pressure support(nCPAP/PS) mode can be effective in hypercarbia and the associated changes in consciousness. This study aimed to demonstrate the efficacy of nSIMV in ACPE. METHODS: Patients who presented with clinical acute respiratory failure and were admitted to the critical care unit of the emergency department with the diagnosis of ACPE were included. Patients were placed on non-invasive mechanical ventilators with an oronasal mask under the nCPAP/PS and nSIMV modes. Pulse and respiratory rate, systolic and diastolic blood pressure and Glasgow Coma Scores(GCS), HACOR(heart rate, acidosis, consciousness, oxygenation and respiratory rate) scores, pH, PaCO2, PaO2/FiO2 and lactate at the time of admission and at 30 and 60 min were evaluated. RESULTS: Twenty-two patients were recruited, nCPAP/PS mode was 10 and nSIMV mode was 12. Although there was no statistically significant difference between the two groups in terms of the change in the relevant parameters from admission to 60 min, the decreases in PaCO2 and lactate levels (31.4% vs. 21.2%, p = 0.383; 68.8% vs. 47.1%, p = 0.224; respectively) and the increase in PaO2 and PaO2/FiO2 values (34% vs. 14.2%, p = 0.710 and 132.1% vs. 52.7%, p = 0.073; respectively) were higher in the nSIMV group. CONCLUSION: The nSIMV mode is as effective as the nCPAP/PS mode in the treatment of patients with ACPE. We believe that the nSIMV mode can be preferable, particularly in patients with hypercarbia who have relatively lower GCS and oxygenation.

Effectiveness of the Full Outline of UnResponsiveness Score in Patients With Acute Ischemic Stroke.

Background Predicting the mortality and prognosis of patients with stroke is one of the commonly studied topics. Various scoring systems have been used in this regard. One of them is the Full Outline of UnResponsiveness (FOUR) score. In this study, we aimed to investigate the utility of the FOUR scores in terms of their ability to predict hospital stay duration and mortality in patients who were diagnosed with ischemic stroke upon their admission to the emergency department. Methods Our study is a prospective observational study. Patients who were admitted to the emergency department of a tertiary hospital and diagnosed with ischemic stroke between August 1, 2020, and August 1, 2021, were included in the study. The inclusion criteria were as follows: being over the age of 18, being diagnosed with ischemic stroke, having symptoms that started within the last 48 hours, and patient consent approved by the patients themselves or their relatives. The patients were divided into two groups according to the FOUR scores (FOUR score = 16 and FOUR score < 16). Patients' demographic information, vital parameters, symptoms, time to admission, comorbidities, laboratory parameters, length of hospitalization, mortality, and Glasgow Coma Scale (GCS), FOUR, and National Institutes of Health Stroke Scale (NIHSS) scores were recorded. Results A total of 79 patients were included in the current study, of which 47 (59.5%) were male. The patients included in the present study had a mean age of 66 ± 13 years. When the two groups of patients with a FOUR score of 16 and a FOUR score of below 16 were compared, the mean platelet count was found to be 248 ± 70 × 103/L in the former group and 170 ± 84 × 103/L in the latter (p = 0.004). Sixty-five (91.5%) of the patients in the group with a FOUR score of 16 and three (37.5%) of the patients in the group with a FOUR score of less than 16 stayed for more than six hours in the hospital (p < 0.001). When the patients were evaluated for intensive care unit (ICU) admission rates, five (62.5%) patients with a FOUR score of <16 were admitted to the ICU. This rate was 2.8% (n = 2) in the group of patients with a FOUR score of 16 and was found to be significantly lower (p < 0.001). Conclusion The FOUR score was found to be useful in predicting the ICU admission rate of patients with ischemic stroke. It has also been shown that the admission time was shorter in patients with a lower FOUR score, and platelet counts were also lower in this group.

Gender disparity in medicine and where are we now in emergency medicine?

BACKGROUND: Studies show that although the presence of women in the medical field has risen, there is a lesser representation of women within editorial boards of journals. Studies on this subject have mostly been carried out related to the medical field of the researcher. It is not known what position the emergency medicine department is in this regard compared to other departments. We aimed to investigate whether gender disparity exists within the editors and editorial board members of medical journals, especially in those related to emergency medicine. METHODS: In the present cross-sectional study, we searched medical journals using the Scimago Journal/Country Rank journal system for comparison. The websites of the journals included in the study were searched, and gender data of the editor and editorial board, associate editors, consultant editors, and section editors for each journal were obtained. RESULTS: The total number of journals examined in this study was 276. The median percentage of female editorial board members (20.8%; 50-100) was lower in emergency medicine journals compared to other branches of medicine (31%; 0-100) (p < .001). The median percentage of female editorial board members and editors was also lower in the emergency medicine field (20.6%; 0-50) (p < .001) than in other branches of medicine. The percentage of female editorial board members of emergency medicine journals was 19.5% with the third-lowest ranking among 26 branches. When both the editors and editorial board members were considered, the highest female percentage was found in pediatrics (50.7%) followed by geriatric medicine (43.4%). CONCLUSION: There is a significant gender disparity within editors and editorial board members in emergency medicine journals. The proportion of women within the editorial board was found to be lower in emergency medicine journals among all the journals included in the study.

A new biomarker in the differential diagnosis of epileptic seizure: Neurogranin.

AIM: The aim of this study was to determine the level of serum NGRN in epilepsy patients presenting at the Emergency Department with complaints of an epileptic seizure, and to thus evaluate the utility of this biomarker in the differentiation of epilepsy and PNES patients from each other. MATERIAL METHODS: The study included patients aged >18 years who had experienced an epileptic seizure or were experiencing an epileptic seizure proven with EEG. All patients with brain disease of structural or infectious cause were excluded from the study (dementia, stroke, intracranial mass, meningitis, encephalitis, Creutzfeldt-Jacobs disease, abscess, etc). Patients were also excluded if they had traumatic brain injury or a severe systemic disease such as sepsis, which was thought to impair brain blood flow. The control group was formed of completely healthy volunteers. RESULTS: Evaluation was made of a total of 49 patients, comprising 19 (38.78%) males and 30 (61.22%) females, and a control group of 53 healthy volunteers comprising 28 (52.83%) males and 25 (47.17%) females. The serum neurogranin value was median 184.16 ng/dl (range: 110.1-1172.98) in the patient group and 97.90 ng/dl (range: 73.71-282. 11) in the control group. The serum neurogranin value was determined to be statistically significantly higher in the patient group than in the control group (p < 0.005). CONCLUSION: The differential diagnosis of ES from PNES remains a challenging situation for emergency service physicians. Based on the findings of this study, it can be said that the serum NRGN level is high in patients who have experienced an epileptic seizure. Therefore, this new biomarker can be considered for use in the differential diagnosis of epileptic seizure and PNES.

Comparison of CATCH, PECARN, and CHALICE clinical decision rules in pediatric patients with mild head trauma.

PURPOSE: The present study compares the most frequently used the CATCH, PECARN, and CHALICE clinical decision protocols with an aim to evaluate their effectiveness from the population perspective. METHODS: This study included all patients under 18 years of age presenting with blunt head trauma and a Glasgow Coma Scale score of 13 and higher for whom the attending physician decided to order head computed tomography scans, and the legal representative provided an informed consent for inclusion in the study. The PECARN, CATCH, and CHALICE clinical decision rules were applied to the participating patients, and the data for each of the three international clinical decision rules were recorded. These data were then compared to head CT results. RESULTS: Based on the head CT positivity, the sensitivity and specificity values for the PECARN were 82.76 and 45.03%; the sensitivity and specificity values for CATCH were 89.29 and 47.44%, showing statistical significance in predicting CT positivity; the CHALICE did not show statistical significance in detecting a pathological CT result. In terms of evaluating the need for hospitalization, the PECARN had a sensitivity of 83.87% and a specificity of 45.12%; the CATCH had a sensitivity of 90% and a specificity of 47.54%, showing statistical significance while the CHALICE did not significantly detect the need for hospitalization. CONCLUSIONS: The present study found that the PECARN and CATCH rules in children with minor head injury were significantly sensitive in detecting CT positivity and the need for hospitalization.

The role of neutrophil-albumin ratio in the diagnosis of acute appendicitis and its efficacy in predicting perforation.

BACKGROUND: Acute appendicitis (AA) is one of the most common causes of abdominal pain in patients presenting to the emergency department with abdominal pain, and despite developments in radiological imaging for its diagnosis, researchers are still in pursuit of a simpler, cheaper, and safer biomarker. Our study investigated the usability of the neutrophil-albumin ratio, a biomarker that predicts prognosis in cases with severe inflammation, in diagnosing AA and anticipating perforation. METHODS: Our study is a retrospective and cross-sectional study. The study was conducted with patients who presented to the emergency department between January 2018 and December 2020 and were hospitalized with a preliminary diagnosis of AA. The cases were first divided into two groups as 'Not appendicitis' and 'AA,' and then the patients with 'AA' were divided into two subgroups as 'Perforated' and 'Non-perforated.' The demographic data of the patients, their symptoms, physical examination findings, and the decision-making process for surgery were noted. The neutrophil count and albumin levels detected in the blood samples obtained at the time of admission to the emergency department were noted. Afterward, the neutrophil-albumin ratio (NAR) was calculated and the cutoff level was determined to predict the diagnosis of AA and the development of perforation. RESULTS: The rate of complaints of pain in the periumbilical region was significantly higher in the patient group without AA compared to the patients in the AA group (70.6% and 40.3%, p=0.034). Although the leukocyte count, neutrophil count and percentage, and NAR were significantly higher in the AA group, the lymphocyte count was found to be significantly lower (p=0.005). However, no significant correlation was found between the NAR and the development of perforation (p=0.697). CONCLUSION: The NAR is useful for the diagnosis of AA. Nevertheless, it is not a sufficient biomarker for detecting perforation.

Chest compression quality during CPR of potential contagious patients wearing personal protection equipment.

AIM OF THE STUDY: In this study we aimed to investigate whether changing rescuers wearing N95 masks every 1 min instead of the standard CPR change over time of 2 min would make a difference in effective chest compressions. METHODS: This study was a randomized controlled mannequin study. Participants were selected from healthcare staff. They were divided into two groups of two people in each group. The scenario was implemented on CPR mannequin representing patient with asystolic arrest, that measured compression depth, compression rate, recoil, and correct hand position. Two different scenarios were prepared. In Scenario 1, the rescuers were asked to change chest compression after 1 min. In Scenario 2, standard CPR was applied. The participants' vital parameters, mean compression rate, correct compression rate/ratio, total number of compressions, compression depth, correct recoil/ratio, correct hand position/ratio, mean no-flow time, and total CPR time were recorded. RESULTS: The study hence included 14 teams each for scenarios, with a total of 56 participants. In each scenario, 14 participants were physicians and 14 participants were women. Although there was no difference in the first minute of the cycles starting from the fourth cycle, a statistically significant difference was observed in the second minute in all cycles except the fifth cycle. CONCLUSION: Changing the rescuer every 1 min instead of every 2 min while performing CPR with full PPE may prevent the decrease in compression quality that may occur as the resuscitation time gets longer.

Factors Predicting the Frequency of Second Seizures in Patients Presenting to the Emergency Department With Seizures: A Prospective Observational Study.

Introduction This study aimed to determine the factors that trigger seizures in patients reporting to our emergency department (ED) with seizures and the factors that affect recurrent seizures during the emergency department stay. Materials and methods This study was designed prospectively and was conducted among patients over the age of 18 years who reported to the ED of the Education and Research Hospital with complaints of epileptic seizure between July 01, 2020 and July 01, 2021. In addition to the sociodemographic information of the patients, the time of admission after the seizure, the medications used, comorbidities, the treatment given in the ED, history of trauma, previous epilepsy diagnosis, time of last seizure, alcohol use in the last 24 hours, insomnia, presence of infective symptoms in the past week, vital parameters, blood tests, and presence of recurrent seizure during hospital follow-up were recorded. Results The median age of the 102 patients included in the statistical analysis was 37 (25%-57%), and 61 (59.8%) were men. Patients who came to the ED with the complaint of seizures were divided into two groups, namely, those who had recurrent seizures and those who did not. When the differences between the groups in terms of various variables were examined, no statistically significant difference was found in the univariate analysis, except for WBC, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) values. The diagnostic value of WBC, AST, and ALT levels in predicting recurrent seizures in emergency follow-up was analyzed using a receiver operating characteristic curve. Conclusion In this study, we could not find a parameter that can predict the probability of recurrent seizures in the ED in patients presenting with epileptic seizures.

Healthcare workers' sleep quality after COVID-19 infection: A cross-sectional study.

INTRODUCTION: The COVID-19 pandemic not only affected physical health but also caused high levels of mental health problems including sleep disturbances, depression and post-traumatic stress symptoms. The aim of this study was to examine the sleep parameters of healthcare workers before COVID-19 infection and after recovery. MATERIALS AND METHODS: Healthcare workers who were infected with COVID-19 and whose treatment was completed at least 30 days ago were included in the study. A web-based cross-sectional survey was conducted on the participants. RESULTS: The median PSQI score increased significantly after COVID-19 infection (7.0) compared with the level before COVID-19 infection (5.0). The increases in median scores for subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleeping medication and daytime dysfunction were all significant. CONCLUSION: Sleep quality decreased during the convalescence period from COVID-19 infection as compared with the pre-COVID-19 period.

Stent Graft Expulsion Outside the Skin: A Rare Case.

Patients who undergo stent grafting may present to the ED some time after the procedure with various related symptoms. The most common of these are stent graft occlusions or hematoma, although infection or abscess also may develop. In this case report, a 58-year-old man presented to the ED with a purulent wound on the stump of an amputated leg and a foreign body protruding from the wound site. The patient had a history of stent insertion with femoropopliteal bypass 11 years before this incident and an above-the-knee amputation because of stent occlusion 8 years prior. This wound had appeared with reddening of the skin 1 month before presentation, followed by the emergence and protrusion of a foreign body.