Evaluation of firearm injuries by trauma scoring systems in a secondary health care institution.

BACKGROUND: Scoring systems are widely used in trauma patients and are very important in the care of trauma patients. The objective of this study was to investigate the effectiveness of scoring systems in evaluating the patients who were brought to a hospital without a trauma center due to firearm injuries (FIs) using scoring systems, and the efficacy of these systems in identifying patients who should be treated in a trauma center. METHODS: Patients brought to Hakkari Yüksekova State Hospital due to FIs between January 2010 and December 2019 were retrospectively investigated. Patients aged 16 and over were included in the study. Patients who were brought to the hospital while deceased and those who did not respond to cardiopulmonary resuscitation in the hospital were excluded from the study. In addition, patients who underwent simple outpatient medical intervention were not included in the patient group. Patients were evaluated demographically. The mortality predictions of trauma scoring systems, which are widely used in the evaluation of trauma patients, were examined. In addition, the effectiveness of scoring systems in identifying patients who should be treated in trauma centers was investigated. RESULTS: In the study, 331 patients, 96.9% of whom were male, were evaluated. The patient group consisted of young patients and the median age was 27 (IQR, 24-29) years. A total of 74 (22.4%) patients were referred to trauma referral hospitals for diagnosis and treatment. Mortality occurred in 46 (13.9%) patients. Glasgow coma scale, injury severity score (ISS), revised trauma score, new trauma score, and trauma revised ISS were found effective for predicting mortality in patients, and scoring systems were correlated with each other. However, scoring systems were not found effective in distinguishing patients who should be treated in a trauma center. CONCLUSION: Scoring systems are significant in predicting mortality of patients with gunshot wounds. However, trauma scoring systems have not been found to be effective in distinguishing patients who require referral to a trauma center.

Can omentin-1 be a prognostic marker in surgical intensive care patients?

Background/aim: A member of the adipokine family, omentin-1 is selectively secreted from visceral fat tissue and the omentum. It has been shown that omentin-1 is involved in the pathogenesis of certain diseases and can be used as a prognostic marker. This study first investigated the prognostic significance of omentin-1 in surgical intensive care patients. In addition, the relationship between omentin-1 and laboratory and clinical parameters commonly used in intensive care units (ICUs) was evaluated. Materials and methods: One hundred and fifty-four patients hospitalized in the surgical ICU were included in the study. Blood samples for omentin-1 were collected from the patients displaying clinical condition changes. Changes in omentin-1 levels were observed during the hospital stay of the patients. A total of 423 blood samples were evaluated. Omentin-1 levels were compared to the laboratory parameters routinely monitored in the ICU and the prognostic significance of omentin-1 for surgical intensive care patients was investigated. Results: The median APACHE II score of all patients was (median-IQR, 8.0­6.0 ng/mL). Omentin-1 levels of the alive patients in the ICU (median-IQR, 339.04­407.68 ng/mL) were significantly higher compared to dead patients (median-IQR, 166.40­363.60 ng/mL). Omentin-1 levels were higher in nonsepsis patients compared to the levels of the patients in sepsis and septic shock (p < 0.001). Omentin-1 values were negatively correlated with the C-reactive protein and procalcitonin levels, body temperature, and the SOFA (sequential organ failure assessment score) scores and they were positively correlated with albumin, prealbumin, and glucose levels. Conclusion: Omentin-1 may play a role in the complex constructs of inflammation and metabolic events in intensive care patients. Reduced omentin-1 levels in surgical intensive care patients were associated with poor prognosis and increased mortality.

Doppler ultrasonography criteria of superior mesenteric artery stenosis.

PURPOSE: The techniques mostly used for the diagnosis of superior mesenteric artery (SMA) stenosis are computed tomography angiography (CTA), and magnetic resonance angiography. We aimed to evaluate color-coded Doppler Ultrasonography (CDUS) for the detection of SMA stenoses and to determine Doppler criteria. METHODS: We identified retrospectively 65 patients with CTA images of SMA stenosis and examined them with CDUS for the Doppler measurement of SMA peak systolic flow velocity (PSV), end-diastolic velocity (EDV), and mesenterico-aortic ratio (MAR). Results were analyzed with receiver-operating characteristic curve analysis. RESULTS: The optimal threshold values for determining 50%-69% SMA stenoses were PSV >280 cm/s, EDV >45 cm/s, and MAR >3.6. For identifying 70%-99% SMA stenoses, they were PSV >395 cm/s, EDV >74 cm/s, and MAR >3.6. CONCLUSION: CDUS is a convenient method with high accuracy for identifying SMA stenosis. PSV yielded better results than EDV and MAR.

The value of D-dimer test in the diagnosis of patients with nontraumatic acute abdomen.

BACKGROUND: A patient with acute abdominal pain requires rapid evaluation. In these patients, it is very important to distinguish between surgical and nonsurgical pathology. Our aim was to compare the accuracy of the leukocyte count and D-dimer test in the diagnosis of acute abdomen. METHODS: In this prospective study, 225 patients admitted to the emergency unit due to nontraumatic acute abdomen between June 2006 and November 2007 were evaluated. The patients were divided into two groups: Group 1 patients who needed immediate laparotomy and Group 2 patients who did not. Age, gender, leukocyte count, D-dimer level, causes of acute abdominal pain, and operative findings were investigated. P values of <0.05 were considered statistically significant. RESULTS: There was a positive correlation between the plasma D-dimer level and leukocyte count. D-dimer acted similarly to the leukocyte count in emergency abdominal conditions. The area under the receiver operating characteristic curve was statistically higher with the D-dimer test (p<0.0001). Additionally, in patients needing immediate laparotomy, the sensitivity of the D-dimer test was 95.7% versus 74.8% for leukocyte counts. CONCLUSION: In a patient with acute abdomen, D-dimer test may be a strong alternative or an adjuvant to the leukocyte count.