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.

Demographic and Clinical Characteristics of Migrant Patients Visiting the Emergency Department.

Introduction Disasters, war, violence, and famine have driven people to migrate in search of a better life, resulting in an increasing number of health issues related to migration. Turkiye has historically been a host country for migration due to its geopolitical location for economic and educational reasons, among other reasons. Migrants frequently visit emergency departments (EDs) regarding their chronic or acute diseases. Understanding the characteristics and admission diagnosis in EDs can help healthcare providers identify areas that require attention. This study aimed to determine the demographic characteristics and most frequent reasons for migrant patients visiting the ED. Methods This retrospective cross-sectional study was conducted in the ED of a tertiary hospital in Turkiye between January 1, 2021, and January 1, 2022. Sociodemographic data and diagnoses were obtained from the hospital information system and medical records. Migrant patients who visited the ED for any reason were included, while patients with inaccessible data, no diagnosis code, or missing information were excluded. Data were analyzed using descriptive statistical methods and compared using the Mann-Whitney U test, Student's t-test, and Chi-squared test. Results Out of 3865 migrant patients, 2186 (56.6%) were male, and the median age was 22 (17-27) years. Most patients (74.5%) were from the Middle East, and 16.6% were from Africa. The most common reasons for visiting the hospital were R00-99 "Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified" (45.6%); M00-99 "Diseases of the musculoskeletal system and connective tissue" (29.2%); and J00-99 "Diseases of the respiratory system" (23.1%). Among the African patients, 82.7% were students, while 85.4% of Middle Eastern patients were non-students. The number of visits differed significantly between regions, with Middle Easterners visiting more frequently than Africans and Europeans. Conclusion The majority of the patients were from the Middle East. Also, patients from the Middle East had more visits and a higher likelihood of being hospitalized than patients from other regions. The sociodemographic characteristics of migrant patients visiting ED and information about their diagnoses can help determine the profile of patients that emergency physicians are likely to encounter.

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.

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.

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.