Infectious diseases and clinical microbiology consultations in the emergency department: A cross-sectional study at a tertiary-care hospital.

BACKGROUND: Although there is limited data about the role of infectious diseases and clinical microbiology (IDCM) consultations in the Emergency Department (ED), they have a key role in deciding on hospitalization and appropriate use of antibiotics. OBJECTIVES: To evaluate demographic and clinical characteristics of patients who visited the ED of our hospital and underwent an IDCM consultation. MATERIAL AND METHODS: In this cross-sectional study, we reviewed the medical records of adult patients who visited the ED of our hospital between May and August 2021 and needed IDCM consultation. The demographic data, the date and time of admission and consultation, the departments that were consulted before IDCM, laboratory results, diagnosis, and outcome were recorded. RESULTS: Out of 42,116 ED visits, 1,007 (2.4%) IDCM consultations were requested. The median time between admission and IDCM consultation was 239 min (150.0-373.5). Before 56.9% of IDCM consultations, pre-consultations were requested from other departments, and the time interval was significantly longer. The median age of patients was 68 years (51-77 years). Infections were confirmed by the IDCM physician in 79.6% of the consultations. The most diagnosed infections were urinary tract infections (32.4%), skin-soft tissue infections (16.9%) and lower respiratory tract infections (10.3%), whereas 9.3% of the consultations resulted in hospitalization to the infection ward, 25.1% to other wards, and 5% to the intensive care unit (ICU). CONCLUSIONS: Two of 3 consultations resulted in hospitalization in other wards, and this shows that IDCM consultations are beneficial for managing patients with infectious diseases hospitalized in other departments. Communication between IDCM specialists and ED colleagues is important, especially in the management of elderly patients who require a multidisciplinary approach.

Vaccination Status and Outcome of Hospitalized Patients with Coronavirus Disease 2019 Before and After the Spread of Omicron Variant: An Observational Study from Izmir, Turkey.

OBJECTIVE: Despite the efforts in vaccination against coronavirus disease 2019 (COVID-19), breakthrough infections occur and the need for hospitalization continues. We aimed to determine the relationship between severe acute respiratory syndrome coronavirus 2 vaccination and the severity of COVID-19 and mortality among hospitalized patients with COVID-19. MATERIAL AND METHODS: This cross-sectional study was conducted between September 2021 and February 2022 in a university hos- pital in Turkey. Hospitalized patients with COVID-19 (both in clinics and in intensive care units), ≥18 years old, and who had no previous COVID-19 were included in the study. The demographic characteristics, clinical data, vaccination status, and outcome of the patients were analyzed retrospectively and the relationship between vaccination status and mortality was determined statistically. RESULTS: Of the 674 patients, 180 (26.7%) had no vaccination, 282 (41.8%) had incomplete vaccination, and 212 (31.5%) were fully vaccinated according to the updated vaccination recommendations. While 44.0% of the patients were fully vaccinated before the occur- rence of omicron variant, 15.9% of the patients were fully vaccinated during the wave of the omicron variant. The patients with no vaccination were younger and had fewer comorbidities. The overall mortality was 31.8%. Under 50 years old, all the patients with fully vaccination survived and the patients with no vaccination or incomplete vaccination had higher (10.1%) mortality. During the omicron period, mortality was lower in fully vaccinated pateints. CONCLUSION: Immunization with and booster doses of BNT162b2 should be encouraged to protect both healthy and vulnerable populations.

A bibliometric study on the publication errors in emergency medicine journals from 2000 to 2020.

BACKGROUND: The literature on scientific publication errors in medical research is limited, and no studies on emergency medicine publications have been conducted yet. This study aimed to investigate the characteristics of the publication errors in emergency medicine literature. METHODS: This bibliometric study reviewed intervened publication errors in the manuscripts of seven high-impact emergency medicine journals from 2000 to 2020, covering twenty years, and evaluated the corrections in the forms of an erratum, corrigendum, addendum, and retracted papers. The detected publication error rate and the trend, error severity, and error types were calculated. RESULTS: We detected 257 intervened scientific papers consisting of 251 corrections due to one or more publication errors and six retractions. Authors were the primary source of the errors (93.2%). Most of the errors were in the author attribution section (40.5%). The published errors of 7.2% had an impact on the paper's conclusion. Simple typographic errors were the most common error type (62.5%). The corrected publication error rate was 1.3%, with a steady trend over the twenty years. CONCLUSIONS: Publications errors are inevitable, but it is possible to minimize them. The number of corrections in emergency medicine literature is at a low rate and show many similarities with the previous literature.

Bedside Temporary Transvenous Pacemaker Insertion in the Emergency Department: A Single-Center Experience.

OBJECTIVES: Insertion of a temporary transvenous pacemaker (TTPM) is one of the life-saving interventions performed in the emergency department (ED). The aim of the study was to determine demographic, clinical characteristics, and in-hospital outcomes of patients who underwent TTPM insertion due to hemodynamically unstable bradyarrhythmia in the ED. METHODS: In our study, 234 consecutive patients who underwent TTPM insertion at the bedside in the ED between January 2014 and October 2019 were included in the study. Etiological characteristics, electrocardiographic (ECG) findings, requirements for permanent pacemaker (PPM), and in-hospital mortality of the patients were analyzed retrospectively. RESULTS: Extrinsic causes were the most common etiology of unstable bradyarrhythmia (57.6%). Most extrinsic causes were drug therapy-related factors (60.7%). Bradyarrhythmia persisted in 60% of patients after extrinsic causes were eliminated. The most common ECG finding was a high-degree atrioventricular block (62%). PPM was implanted in 44% of patients. In-hospital mortality rate was 19.7%. In the multivariate regression analysis, the left ventricular ejection fraction (LVEF) and diastolic blood pressure (DBP) measured at admission (p<0.001 and p<0.001, respectively) were determined to be independent predictors for in-hospital mortality. CONCLUSION: First diagnosis and intervention in the ED are of great importance for patients with unstable bradyarrhythmia. The fastest possible TTPM insertion in the ED can reduce mortality by reducing the exposure time to hypoperfusion of vital organs, especially in patients with reduced LVEF and low DBP. Furthermore, it should be kept in mind that an underlying latent conduction system disease can also be present in bradyarrhythmias thought to occur potentially due to extrinsic factors.

Women's representation in emergency medicine journals across two decades: 2000-2019.

OBJECTIVES: The primary aim was to determine women's representation as authors in emergency medicine journals in various authorship positions over the last 20 years. The secondary aim was to compare the two decades to analyze the development over time. METHOD: We conducted a retrospective bibliometric analysis of three emergency medicine journals from the online archives of 2000-2019. RESULTS: We analyzed a total of 7939 original research and review articles. Female authorships at the first (25,8%), last (18,7%), and corresponding (21,6%) positions were limited, despite the relatively high presence rate (72,5%). Women authored 13,1% of all single-authored publications. When the number of authors increased, the odds for women as co-authors increased. However, the odds for last and corresponding authorship decreased, while the odds for the first authorship remained unchanged. When two decades were compared, we found that proportions of women as first and corresponding authorship increased ([23,8% vs. 27,0%] p = 0.001 and [20,0% vs. 22,6%] p = 0.228, respectively) while the representation as the last author remained unchanged ([19,4% vs 18,3%] p = 0.006). The presence of women in any authorship position also increased significantly ([66,1% vs. 76,5%] p = 0.000) across two decades, with similar trends for the different journals studied. However, the yearly analysis shows that women's representation follows a fluctuating pattern with a minimal increase. When analyzing specific journals, we found that the increase in female authors as first and corresponding authors was limited to Academic Emergency Medicine ([24,7% vs 34,5%] p = 0.000 and [21,4% vs 32,1%] p = 0.000). CONCLUSIONS: Results of this study are promising in showing that the representation of women in emergency medicine publications is rising during the recent decade. Although the academic gender gap has not been closed, steps taken for gender equality in academic emergency medicine are clearly notable.

How were Non-COVID pulmonary patients and diseases affected from COVID-19 pandemic period?

OBJECTIVE: This study aimed to focus on non-COVID-19 patients during the process when all physicians focused on COVID-19 patients. Patients with pulmonary diseases in the COVID-19 pandemic period were analyzed. MATERIAL AND METHODS: Non-COVID-19 cases who were hospitalized in the pulmonology clinic, outpatients, and patients who applied to the non-COVID-19 emergency service and requested a pulmonology consultation in the period from March 16, 2020 to May 15, 2020 and in the same period of the previous year (i.e., from March 16, 2019 to May 15, 2019) were included in this study. RESULTS: In the pandemic period, it was found that there was an 84% decrease in outpatient admissions, a 43% decrease in inpatients, and a 75% decrease in emergency services. During the pandemic period, in outpatient setting, male and younger case admissions increased, admissions with chronic obstructive pulmonary disease (COPD), and interstitial lung diseases decreased, whereas the frequency of admission to asthma, pneumonia, and pulmonary thromboembolism increased. In the period of the pandemic, patients with asthma, COPD, and lung cancer were less hospitalized, whereas patients with pulmonary thromboembolism, pneumonia, and pleural effusion were hospitalized more. In non-COVID-19 patient treatments during the pandemic period, usage of a metered dose inhaler increased. CONCLUSION: During the COVID-19 pandemic, non-COVID pulmonary pathologies decreased significantly, and there was a change in the profile of the patients. From now on, to be prepared for pandemic and similar extraordinary situations, to organize hospitals for the epidemic, to determine health institutions to which nonepidemic patients can apply, to make necessary plans in order not to neglect the nonepidemic patients, and to develop digital health service methods, especially telemedicine, would be appropriate.

The Diagnostic Value of sTWEAK in Acute Ischemic Stroke

Background: Considering the critical role of early diagnosis and management of acute ischemic stroke, biomarkers that can reliable assist in the diagnosis are still needed. These biomarkers should rapidly analyze, have high specificity for brain damage, and be available in the emergency settings for early diagnosis and exclusion of other conditions that mimic acute ischemic stroke. Soluble tumor necrosis factor-like weak inducer of apoptosis, a protein involved in the regulation of several biological functions, could be a potential acute ischemic stroke biomarker. Aims: To investigate the diagnostic value of soluble tumor necrosis factor-like weak inducer of apoptosis in patients with acute ischemic stroke and examine the relationship between ischemic area volume determined at diffusion-weighted magnetic resonance imaging and soluble tumor necrosis factor-like weak inducer of apoptosis. Study Design: A prospective, case-control study. Methods: This case-control prospective study included 36 patients with acute ischemic stroke and 36 healthy volunteers. Information on age, sex, presence of chronic disease, neurological examination findings, times of presentation to the emergency department after acute ischemic stroke, soluble tumor necrosis factor-like weak inducer of apoptosis levels, ischemic area volumes at diffusion-weighted magnetic resonance imaging, and 6-month mortality rates after stroke were recorded. The results were analyzed on SPSS 22.0 software (SPSS Inc., Chicago, IL, USA), and p<0.05 was considered statistically significant. Results: A soluble tumor necrosis factor-like weak inducer of apoptosis cut-off value of 995.5 pg/mL exhibited a sensitivity of 80.5% and a positive predictive value of 82.5% with an area under the curve of 0.84 (95% confidence interval: 0.74-0.94; p<0.001). The mean soluble tumor necrosis factor-like weak inducer of apoptosis levels in the acute ischemic stroke group (1968.08±1441.99 µg/L) were significantly higher than those in the control group (704.81±291.72 µg/L) (p<0.001). No correlation was observed between soluble tumor necrosis factor-like weak inducer of apoptosis levels and ischemic area volume measured at diffusion-weighted magnetic resonance imaging (r=-0.008; p=0.07). The mean ischemic area volume was 505.68±381.10 and 60.96±80.89 mm3 in the nonsurviving and surviving patients, respectively (p=0.002). Conclusion: Soluble tumor necrosis factor-like weak inducer of apoptosis can be used in the diagnosis of acute ischemic stroke. However, it is inconclusive in estimating ischemic area volume and early mortality following acute ischemic stroke. Ischemic area volume measured at diffusion-weighted magnetic resonance imaging is a marker of poor prognosis and can be used in predicting early mortality.

Significance of Intra-abdominal Free Fluid Detected in Ultrasonography in the Clinical Assessment and Outcomes of Adult Patients Presenting to the Emergency Department Due to Abdominal Pain.

Objective The aim of the study was to evaluate the diagnostic process and clinical course in adult patients who presented to the emergency department (ED) with acute abdominal pain (AAP) and were found to have intra-abdominal free fluid (FF) on ultrasonography (USG). Methods This prospective observational study was conducted in a training and research hospital adult emergency department between March 15, 2013, and April 15, 2013. The study included 252 patients aged above 18 years, who were admitted to the emergency room complaining of non-traumatic acute abdominal pain and provided consent for the study. Results The most common diagnoses were acute, nonspecific abdominal pain (37.3%), acute appendicitis (19%), and urinary tract pathology (15.9%). Intra-abdominal free fluid was detected with ultrasonography in 42.5% of patients. Patients with intra-abdominal free fluid were younger than the other patients. The emergency department length of stay was longer in patients with intra-abdominal free fluid (p=0.011). Of the 252 patients enrolled in the study, 32.9% were admitted to the hospital, 21.4% of whom underwent surgery and 11.5% received medical therapy. Most of the patients (64.5%) who were discharged home had no intra-abdominal free fluid in the ultrasonography (p<0.001). Conclusion The presence of intra-abdominal free fluid alone did not guide the clinical decision regarding the diagnostic evaluation of adult patients that presented to the emergency department complaining of non-traumatic acute abdominal pain.

The relation between scapula fracture and the severity of trauma in blunt thoracic trauma

Background/aim: The aim of this study was to determine the level of presence of scapula fractures (SFs) in cases of blunt thoracic trauma and to identify other injuries accompanying SF. Materials and methods: Blunt thoracic trauma cases with SF determined on direct radiography or computerized tomography (CT) were categorized as Group 1. Group 2 was constituted by selecting cases with high injury severity score (ISS) with no SF. The demographic characteristics and all injuries of the patients were evaluated. Results: SF was determined in 77 (11.3%) patients (Group 1), and Group 2 consisted of 607 patients. The ISS was significantly higher in Group 1 (27.7 ± 16.1) than Group 2 (15.9 ± 9.5) (P < 0.001). The rate of SF with direct radiography was only 9.1%, and more than 90% of patients were evaluated using CT. The most common accompanying injury to SF was rib fracture (44.2%), and the odds ratio was 2.4 (95% CI: 1.51­3.72). Conclusion: The incidence of SF in cases of blunt trauma was higher than in previous studies. The use of CT in blunt trauma can determine SF that cannot be identified through physical examination or radiography, and the most commonly observed accompanying damage in these patients is rib fracture.

Medical students' knowledge of ultrasonography: effects of a simulation-based ultrasound training program.

INTRODUCTION: The use of simulation devices in medical education is becoming more prevalent with each passing day. The present study aimed to teach medical students to perform ultrasonography via a simulation-based ultrasound training program. METHODS: The study was prospectively conducted on final year medical students who had not received previous ultrasound training and who came to the Emergency Department of the Kirikkale University Faculty of Medicine between July 2015 and July 2016. Ultrasound training was provided by two emergency department specialists who are qualified in this field. The training time was determined to be 20h (4h for theoretical lessons, 16h for hands-on). The students were evaluated by a theory test and practical application exam both before and after training. RESULTS: Obtained were compared using the paired sample t-test, and p < 0.05 was considered to be significant. Results: Ninety-six final year medical students were included. Their mean age was 24.1 ± 2.1 years. The mean test score obtained in the theoretical exam before training was 7.9 ± 2.2, while that after training was 17.1 ± 1.6 (p < 0.0001). The mean score obtained in the practical application exam before training was 1.1 ± 0.9 points and that after training was 10.9 ± 0.2 points (p < 0.0001). CONCLUSION: Medical students can learn to use an ultrasound device within a short period of time via simulation-based training programs. New studies must be conducted for the inclusion of ultrasound training programs in the medical education curriculum.

The predictive value of Alvarado score, inflammatory parameters and ultrasound imaging in the diagnosis of acute appendicitis.

OBJECTIVE: Acute appendicitis (AA) is one of the most common surgical emergencies. Despite extraordinary advances in modern investigations, the accurate diagnosis of AA remains an enigmatic challenge. The aim of this study was to compare and evaluate the diagnostic accuracy of inflammatory parameters [C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR)], ultrasound (US) and Alvarado score (AS) in reducing the rate of negative appendectomies. MATERIAL AND METHODS: Two hundred seventy-eight patients were included in this study. Patients were separated into two main groups as the surgery group (n=184) and non-operative group (n=94). Complete blood count, ESR and PCT levels were assessed, abdominal US was performed and AS was calculated for all patients. RESULTS: In the surgery group, clinical predictive factors for histopathologic results such as AS ≥7, AA signs on US, neutrophilia and leukocytosis were significant. Neutrophilia and leukocytosis had the highest accuracy rate among these factors. Inflammatory parameters were not predictive for histopathologic results, although higher CRP and PCT levels were significant in perforated and necrotizing appendicitis. Multifactorial regression analyses showed that AS was not of significant predictive value in the non-operative group. CONCLUSION: There was no superiority of AS and/or US in the diagnosis of AA. Recent findings have shown the most reliable parameters in the diagnosis of AA to be primarily 'neutrophilia' and secondarily 'leukocytosis'. Other results of this study indicated that inflammatory parameters (CRP, PCT, ESR) were not superior to other parameters but CRP and PCT levels were significantly high in complicated cases.

Role of Procalcitonin in Evaluation of the Severity of Acute Cholecystitis.

OBJECTIVE: The aim of this study is to investigate the relationship between procalcitonin (PCT) level and the severity of acute cholecystitis. MATERIALS AND METHODS: This study included 200 patients diagnosed with acute cholecystitis. To diagnose and assess the severity of acute cholecystitis; physical examination and abdominal ultrasound findings were evaluated and blood samples were taken to determine white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and levels of coagulation factors, blood gas, C-reactive protein (CRP) and PCT. Patients were classified into three stages, namely, mild, moderate, and severe, according to the severity of acute cholecystitis using the Tokyo guidelines. The role of PCT level in the assessment of severity of acute cholecystitis and the correlation between the stages and PCT level were statistically analyzed. RESULTS: Among patients with acute cholecystitis, 110 (55%) were classified as mild, 61 (30.5%) as moderate, and 29 (14.5%) as severe. Leukocytosis or leukopenia was positive in 48.5%, ESR elevation was found in 72.5%, CRP positivity in 55.5%, PCT elevation in 27%, and positive findings of ultrasonographic imaging in 54.5% of the patients. Serum WBC count, ESR, and CRP and PCT levels increased as the severity of disease increased (p<0.05). PCT could discriminate grade I from grade II-III with 95.45% sensitivity and 46.67% specificity at the best cut-off value of ≤0.52 (p<0.001). PCT could also discriminate grade III from grade I-II with 72.4% sensitivity and 90.06% specificity at the best cut-off value of >0.8 (p<0.001). CONCLUSION: PCT level may be considered to be a parameter that could be added to the assessment of the severity of acute cholecystitis in the Tokyo guidelines, although further studies are needed to support our findings.

Acute carbon monoxide poisoning alters hemorheological parameters in human.

Acute carbon monoxide (CO) poisoning seriously hinders oxygen delivery to tissues. This harmful effect of CO may be aggravated by accompanying changes in the viscosity of blood. We had previously reported increased plasma viscosity in people chronically exposed to CO. This study was planned to test our hypothesis that acute CO poisoning increases blood viscosity. For this purpose four main parameters contributing to blood viscosity - hematocrit, erythrocyte deformability, erythrocyte aggregation and plasma viscosity - were determined in patients with acute CO poisoning and compared with healthy controls. Plasma viscosity and erythrocyte aggregation tendency were lower in the CO group (p <  0.05). Erythrocyte deformability was also lower in CO group (p <  0.05). Our results indicate that acute CO poisoning has diverse effects on hemorheological parameters such as attenuating hematocrit value, plasma viscosity, erythrocyte aggregation tendency and erythrocyte deformability.

A potentially fatal complication that may occur during dental treatment: "foreign body aspiration".

Numerous systemic emergency situations, such as hypotension or allergic reactions, may be encountered during dental treatment. In addition, rare but life-threatening complications such as foreign body aspiration in the air passages may also be seen. Aspirated foreign bodies include teeth, implants, mechanical supports or materials used during procedures. We report two separate cases of aspiration risk developing during the course of dental treatment.

Warning: This may be as dangerous as firearm injuries;"grease-gun injury": A case report.

High-pressure injection gun (Grease-gun) injuries mainly occur with industrial labourers. Injuries associated with high pressure grease guns are very rare and frequently involve the hand and chest. The non-dominant hand is generally injured since the grease gun is usually held in the dominant hand. Even if high-pressure injection injury causes only a small lesion in the skin, it is still characterized by severe damage to subcutaneous tissue. Since initial presentation may be deceptive, treatment is frequently delayed. The characteristics of the material injected need to be known as a priority, and systemic intoxication must be ruled out. The risk of amputation is 16-55%. With solvents it goes up to 50-80%. Surgical treatment must be performed immediately, under general anesthesia or plexus block. Foreign material and necrotic tissue must be early debrided with wide microsurgical exploration. Positive outcomes in reacquisition of hand functions can be obtained with long-term and early physiotherapy.

Mean platelet volume and red cell distribution width as a diagnostic marker in acute appendicitis.

BACKGROUND: Acute appendicitis (AA) is one of the most common causes of emergent surgeries. Many methods are used for its diagnosis. OBJECTIVES: This study was conducted to investigate the diagnostic value of MPV and RDW in acute appendicitis. PATIENTS AND METHODS: This study was a retrospective multi-center cross sectional planned study. The study included 260 patients operated for AA and 158 patients as the control group. Groups were compared in terms of MPV, RDW, white blood cell count (WBC), neutrophil predominance (NP) and platelet count (PC). RESULTS: MPV was significantly lower in AA group, compared to the control group (P < 0.001). The best cut-off level for MVP in AA was ≤ 7.3 fL and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy ratio were 45%, 89.2%, 87.3%, 49.6% and 61.7%, respectively. There was no significant difference between the two groups in terms of RDW and platelet values. CONCLUSIONS: MPV is a routinely measured parameter in complete blood count (CBC) and requires no additional cost. It significantly decreased in AA, having a greater sensitivity and NPV when combined with WBC and NP.

Comparison of end-tidal carbon dioxide levels with cardiopulmonary resuscitation success presented to emergency department with cardiopulmonary arrest.

OBJECTIVE: To measure end-tidal carbon dioxide pressure (PetCO2) in preset interval in order to evaluate the efficiency of cardiopulmonary resuscitation (CPR) performed on patients in cardiopulmonary arrest, evaluate the validity of PetCO2 in predicting the mortality and finally assess the PetCO2 levels of the patients in cardiopulmonary arrest based on the initial presenting rhythm. METHODS: This prospective study was conducted at the Ankara Training and Research Hospital on patients who presented with cardiopulmonary arrest. Standard ACLS (Advanced Cardiac Life Support) protocols were performed. Patients were categorized in two groups based on their rhythms as Ventricular Fibrillation and Asystole. Patients' PetCO2 values were recorded. RESULTS: PetCO2 levels of the Return of Spontaneous Circulation (ROSC) group in the 5th, 10th, 15th and 20th minutes were significantly higher compared to the exitus group (p<0.001). In distinguishing ROSC and exitus, PetCO2 measurements within 5-20 minute intervals showed highest performance on the 20th and lowest on the 5th minutes. CONCLUSION: PetCO2 values are higher in the ROSC group. During the CPR, the most reliable time for ROSC estimation according to PetCO2 values is 20th minute. None of the patients who had PetCO2 levels less than 14 mmHg survived.

Comparison of the effectiveness of intravenous piracetam and intravenous dimenhydrinate in the treatment of acute peripheral vertigo in the emergency department.

INTRODUCTION: We aimed to compare the effectiveness of intravenous piracetam with that of intravenous dimenhydrinate in the treatment of acute peripheral vertigo in the emergency department. METHODS: This double-blind study comprised a total of 200 patients, aged between 18 and 70 years, who had presented to the emergency department of Ankara Training and Research Hospital and were diagnosed with peripheral vertigo. Evaluation of the severity of the patients' vertigo was performed using a visual analogue scale, before and after drug administration. RESULTS: Both drugs were found to be effective (p < 0.001) and had comparable effects (p < 0.474). Dimenhydrinate was also found to have about two times the side effects of piracetam. Drowsiness was found to be the most common side effect of these two drugs. CONCLUSION: Dimenhydrinate and piracetam have similar levels of effectiveness with regard to acute vertigo. We conclude that piracetam, which has fewer side effects than dimenhydrinate, better vestibular compensation, and is effective for both acute and chronic vertigo, could be more frequently used in the emergency treatment of acute vertigo.

Hepatic toxocariasis: a rare cause of right upper abdominal pain in the emergency department.

Toxocara canis and Toxocara cati are common helminths that reside in the intestinal tract of cats and dogs. Toxocariasis and, commonly, T. canis, is a disease commonly seen in children, which is characterised by hypereosinophilia, hepatomegaly, fever, transient pulmonary infiltration, and hypergammaglobulinaemia. Humans, who are not the actual host for these parasitic worms, are infected following oral intake of the infective eggs. Radiological differentiation of hepatic toxocariasis can be difficult, as liver lesions, which present as multiple hypoechoic lesions with regular borders, can look like a tumour, an infarction or an infection. We report on a case that presented to our emergency department (ED) with abdominal pain. During the initial review, the pathology in the liver was thought to be an infarction or an infection; however, the patient was diagnosed with hepatic toxocariasis following further evaluation.

Comparison of success and pain levels of supination-flexion and hyperpronation maneuvers in childhood nursemaid's elbow cases.

OBJECTIVE: The aim of this study was to compare the hyperpronation (HP) and the supination-flexion (SF) reduction techniques for reducing nursemaid's elbow in terms of efficacy and pain. METHODS: This prospective, pseudorandomized, controlled, nonblinded study was conducted in an urban tertiary care emergency department between October 1, 2009, and October 1, 2010. A total of 150 patients (51 males [34%] and 99 females [66%] between the ages of 0 to 6 years) were included in the study. When the first reduction attempt failed, second attempt was performed using the same technique. After failure of the second attempt, reduction technique was changed to an alternate technique. Level of pain was evaluated using the Modified Children's Hospital of Eastern Ontario Pain Scale in 113 patients older than 1 year who had a successful reduction process on the first attempt. RESULTS: Successful reduction was accomplished in 121 (80.7%) of the patients during the first attempt, in 56 (68.3%) of the patients using the SF technique and in 65 (95.6%) of the patients using the HP technique (P < .001). At the end of total attempts, we found that the SF (59/84) technique was less successful than the HP (91/93) technique (P < .001). The pain levels of the both techniques were not statistically different. CONCLUSION: The HP technique was found to be more successful compared with the SF technique in achieving reduction. We were unable to find any significant difference in pain levels observed between the 2 techniques.