Vital indicators in predicting burn mortality: A comparison of shock indices and burn shock indices.

Background/aim: In many studies, shock indices have proven to be good tools for predicting mortality. In the present study, burn shock index (BSI), percentage of total body surface area burned (TBSA%) multiplied by shock index; burn modified shock index (BMSI), TBSA% multiplied by modified shock index; burn age shock index (BASI), TBSA% multiplied by age shock index; burn rivers shock index (BrSI), TBSA% multiplied by rivers shock index; burn rivers shock index multiplied by Glasgow Coma Scale score (BrSIG) were examined in burn patients. We defined these burn shock indices for the first time. This study aimed to evaluate the effectiveness of shock indices and burn shock indices in predicting mortality in burn patients. Materials and methods: This study examines retrospectively of burn patients admitted to the emergency department of Dicle University Hospital between January 2010 and December 2022. The patients' vital signs were obtained at the time of presentation to the emergency department, and shock indices were calculated. The effectiveness of shock indices in predicting mortality was compared. Results: A total of 2445 patients were included in the study. Of the patients, 1793 were pediatric, and 652 were adults. BSI (AUC: 0.872, 95% confidence interval (CI): 0.812-0.931, p < 0.001) had the highest area under the curve (AUC) value in predicting mortality in children. The optimal cut-off value for BSI in children was 21.79 and its was sensitivity 83.05%, specificity 79.64%, positive predictive value (PPV) 12.19%, negative predictive value (NPV) 99.28%. In adults, BASI had the highest value of AUC (AUC: 0.936, 95% CI: 0.887-0.984, p < 0.001). The optimal cut-off value for BASI in adults was 62.5 and its sensitivity was 86.49%, specificity was 91.71%, PPV was 38.55%, and NPV was 99.12%. Conclusion: Shock indices are easy to calculate and effective in predicting mortality in burn patients admitted to the emergency department. Among the shock indices in the study, BSI was the best in predicting mortality in children, and BASI was the best in adults.

The effect of body mass index on trauma severity and prognosis in trauma patients.

BACKGROUND: As in the rest of the world, the prevalence of obesity in Turkey has been increasing in recent years and has become a major public health issue. Although many trials have been conducted to study the effects of obesity on internal diseases, there are few studies investigating the effects of obesity on prognosis of trauma patients. The present study analyzed the effects of body mass index (BMI) on trauma severity and prognosis in trauma patients. METHODS: This study was prospectively conducted with trauma patients older than 15 years of age who presented at the Dicle University Faculty of Medicine emergency medicine department trauma unit between June 1, 2013 and May 31, 2014. Patients were grouped into high-energy trauma and low-energy trauma groups based on trauma severity. In addition, 4 groups were made according to BMI value (kg/m2). Group I was defined as BMI <25 (normal weight). Group II patients had BMI of 25-29.9 (overweight). Group III had BMI of 30-34.9 (obese), and Group IV was made up of patients with BMI ≥35 (morbidly obese). RESULTS: Comparison of whole patient population for inter-group differences showed significant differences between rate of head injury, thoracic injury, extremity injury, multitrauma, clinic admission rate, and mortality rate (p<0.001). No significant difference was observed between groups in abdominal injury rate (p=0.347). CONCLUSION: Clinic admission rate, length of intensive care unit stay, mortality rate, multitrauma rate, and injury severity score increased in proportion to greater BMI.

Is montelukast as effective as N-acetylcysteine in hepatic injury due to acetaminophen intoxication in rats?

This study aims to investigate the acute protective effect of montelukast sodium in hepatic injury secondary to acetaminophen (APAP) intoxication. This study used 60 rats. The rats were grouped into 6 groups. The control group was administered oral distilled water 10 ml/kg, the APAP group oral APAP 1 g/kg, the montelukast sodium (MK) group oral MK 30 mg/kg, the acetaminophen+N-acetylcysteine (APAP+NAC) group oral APAP 1 g/kg, followed by a single dose of intraperitoneal NAC 1.5 g/kg three hours later, the acetaminophen+montelukast sodium (APAP+MK) group oral APAP 1 g/kg, followed by oral MK 30 mg/kg 3 h later, the acetaminophen+N-acetylcysteine+montelukast sodium (APAP+NAC+MK) group oral APAP 1 g/kg, followed by a single intraperitoneal NAC 1.5 g/kg plus oral MK 30 mg/kg 3 h later. Blood and liver tissue samples were taken 24h after drug administration. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin were studied from the blood samples. Liver tissue samples were used for histopathological examination. Compared with the control group, serum AST and ALT activities were higher in the APAP and APAP+NAC groups. APAP+NAC, APAP+MK, and APAP+NAC+MK groups had reduced serum ALT and AST activities than the group administered APAP alone. APAP+MK and APAP+NAC+MK groups had a lower serum ALP activity than the control group. Histopathologically, there was a difference between the group administered APAP alone and the APAP+MK and APAP+NAC+MK groups. MK is as protective as NAC in liver tissue in APAP intoxication in rats.

Malnutrition in Community-Dwelling Elderly in Turkey: A Multicenter, Cross-Sectional Study.

BACKGROUND: This study aimed to investigate the prevalence of malnutrition and explore the somatic, psychological, functional, and social or lifestyle characteristics linked to malnutrition in elderly people at a hospital in Turkey. MATERIAL AND METHODS: This study included 1030 patients older than 65 years of age who were seen at the internal medicine and geriatrics outpatient clinics of the study centers in Istanbul, Ankara, Duzce, Corum, Mardin, Malatya, and Diyarbakir provinces between January and December 2014. All patients underwent Mini Nutritional Assessment (MNA) and Geriatric Depression Scale (GDS) tests via one-on-one interview method. The demographic properties of the patients were also recorded during this interview. RESULTS: Among 1030 patients included in this study, 196 (19%) had malnutrition and 300 (29.1%) had malnutrition risk. The malnutrition group and the other groups were significantly different with respect to mean GDS score, income status, educational status, the number of children, functional status (ADL, IADL), the number of patients with depression, and the number of comorbid disorders. According to the results of the logistic regression analysis, age (OR=95% CI: 1.007-1.056; p=0.012), BMI (OR=95% CI: 0.702-0.796; p<0.001), educational status (OR=95% CI: 0.359-0.897; p=0.015), comorbidity (OR=95% CI: 2.296-5.448; p<0.001), and depression score (OR=95% CI: 1.104-3.051; p=0.02) were independently associated with malnutrition. CONCLUSIONS: Our study demonstrates that age, depression, BMI, comorbidity, and the educational status were independently associated with malnutrition in an elderly population.

Lycium barbarum extract provides effective protection against paracetamol-induced acute hepatotoxicity in rats.

The aim of the present study was to investigate the hepatoprotective and antioxidant effects of Lycium barbarum (LB) extract against paracetamol-induced acute oxidative stress and hepatotoxicity in rats. The subjects were divided into 6 groups of 8 rats each. The rats in the LB group were administered a dose of 100 mg/kg LB extract dissolved in saline via the intraperitoneal route for 7 days. Subsequently, after last dose of LB, PCT was given in a single dose of 1 g/kg diluted in saline via the oral route. Twenty-four hours later, blood samples were drawn from all of the subjects for serum Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Total antioxidant status (TAS) and Total oxidant status (TOS) tests, and liver tissue samples were obtained for histopathological evaluation. The mean TAS level of the group that was subjected to PCT intoxication was significantly lower than those of the other groups. Additionally, the mean TOS, Oxidative stress index (OSI), ALT and AST values were significantly higher in this group. Though the mean TAS level in the PCT + LB group was significantly higher than that of the PCT group, the TOS, OSI, ALT, and AST levels were significantly lower. When the PCT + LB group and the PCT only group were compared in terms of liver damage during the histopathological evaluation, a statistically significant difference was observed in Grade I and Grade III damage (P=0.013 and P=0.038, respectively). We conclude that Lycium barbarum extract leads to a significant improvement in PCT-induced acute hepatotoxicity in terms of the histopathological results, serum oxidative stress parameters, and serum liver function marker enzymes.

The protective effect of goji berry extract in ischemic reperfusion in testis torsion.

This study investigated whether goji berry extract (GBE), a known antioxidant, reduces ischemic reperfusion injury when administered to rats exposed to experimental testis torsion. A total of 32 Sprague-Dawley male rats were randomized into 4 groups, including the control (sham), goji, torsion, and torsion-goji groups. The treatment groups received intraperitoneal GBE prior to torsion. The left testes of the animals were subjected to torsion via 5 hours of ischemia and 6 hours of reperfusion. TAC (total antioxidant capacity), TOS (total oxidant status) and OSI (oxidative stress index) levels were calculated. Approximately 5-µm-thick sections were stained with hematoxylin-eosin (H&E) and examined under a light microscope. Statistical analyses were performed with the SPSS 15 software package. The mean serum TAC level was significantly increased in Groups 2 and 4 compared with Groups 1 and 3 in biochemical analyses (for both P < 0.001). The mean serum TOS level was significantly increased in Group 3 compared with Groups 1, 2, and 4 (P < 0.001, P < 0.001, and P = 0.003, respectively). Comparison of the groups with regard to histopathological examination revealed that Group 4 exhibited a significantly higher rate of hemorrhage and congestion compared with Groups 1 and 2 (P = 0.038). The groups did not differ significantly with respect to degeneration. Ischemic reperfusion injury associated with testis torsion was reduced by the antioxidant effect of GBE. Further experimental and clinical studies are needed to confirm the agent's efficacy for this indication.

Fire disaster caused by LPG tanker explosion at Lice in Diyarbakir (Turkey): July 21, 2014.

A disaster can be defined as a situation where the affected society cannot overcome its own resources. Our aim was to present the case of a fire disaster caused by a liquefied petroleum gas (LPG) tanker-based explosion on the Diyarbakir-Bingöl road in Lice to determine the various kinds of challenges and patient groups that an emergency department faces and to discuss more effective interventions for similar disasters. This is a retrospective cross-sectional study. To find out the factors that affected mortality, we investigated the patient conditions presented at the time of admission. Among 69 patients included in the study, 62 were male (89.9%) and seven were female (10.1%). The average age of patients was 32.10±14.01 years, and the burn percentage was 51.1±32.2. One patient died during the first response, and a total of 34 patients (49.3%) died during the patient follow-up. Factors statistically related to mortality were determined to be inclusion in the severe burn group, presence of inhalation injuries, use of central venous catheter on patients, application of fasciotomy, presence of a tracheostomy opening, use of endotracheal intubation and sedoanalgesia, and transfer to centers outside the city (p-values <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, 0.001, and 0.003, respectively). In conclusion, although fire disasters caused by LPG tanker explosions are rare, the frequency of such disasters will increase with the increase in LPG use. The factors affecting mortality should be determined to decrease mortality. We recommend that all personnel members who engage in work related to LPG from production to use, in addition to rescue and first-response personnel, be trained comprehensively and that advanced technological fire equipment be used to prevent such disasters.

Glutamine provides effective protection against deltamethrin-induced acute hepatotoxicity in rats but not against nephrotoxicity.

BACKGROUND: The aim of this study was to investigate the protective effects of L-glutamine (GLN) against liver and kidney injury caused by acute toxicity of deltamethrin (DLM). MATERIAL AND METHODS: Thirty-two rats were indiscriminately separated into 4 groups with 8 rats each: control group (distilled water; 10 ml/kg, perorally [p.o.]), DLM group (35 mg/kg p.o. one dose.), GLN group (1.5 gr/kg, p.o. single dose.) and DLM (35 mg/kg p.o. one dose.) + GLN group (1.5 gr/kg, p.o. one dose after 4 hours.). Testing for total antioxidant status (TAS), total oxidant status (TOS), interleukin-1 beta (IL-1ß), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) analyses were performed on tissue samples, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), urea, and creatinine were analyzed on serum samples. Liver and kidney samples were histopathologically analyzed. RESULTS: The TOS level in liver was significantly higher in the DLM group than in the control group, and the level in DLM+GLN group was considerably lower than in the DLM group. The TAS level in the DLM+GLN group was considerably higher than in the control and DLM groups. The TAS level in kidney tissues was considerably lower in the DLM group than in controls, but was similar to other groups. Histopathological analyses of liver tissues established a significant difference between DLM and DLM+GLN groups in terms of grade 2 hepatic injury. However, no significant difference was found between DLM and DLM+GLN groups in terms of kidney injury. CONCLUSIONS: Glutamine leads to significant improvement in deltamethrin-induced acute hepatotoxicity in terms of histopathologic results, tissue oxidative stress parameters, and serum liver function marker enzymes.

Acute Pancreatitis and Splenic Vein Thrombosis due to Hypertriglyceridemia.

Acute pancreatitis (AP) is a condition characterised by the activation of the normally inactive digestive enzymes due to an etiological factor and digestion of the pancreatic tissues, resulting in extensive inflammation and leading to local, regional, and systemic complications in the organism. It may vary from the mild edematous to the hemorrhagic and severely necrotising form. The most common causes are biliary stones and alcohol abuse. In this case study, we would like to present a patient with AP due to hypertriglyceridemia (HPTG), which is a rare cause of pancreatitis, and splenic vein thrombosis, which is a rare complication of pancreatitis.

How was Felt Van Earthquake by a Neighbor University Hospital?

OBJECTIVES: Natural disasters, which are defined as events causing great damage or loss of life, are events of natural origin unpreventable by human beings that occur in a short period of time and lead to loss of life and property. The aim of the study is to analyze which patient groups and problems at a university hospital after the earthquakes in Van. METHODS: For the purposes of this study, 169 patients who presented to our emergency room following the earthquakes that occurred on the 23rd of October, 2011 and the 9th of November, 2011 in Van and were treated as an outpatient or inpatient were enrolled. Patients were divided into two groups. Patient data including the clinical and demographic characteristics were analyzed. RESULTS: Among the 169 patients included in our study, 97 (57.4%) were male and 72 (42.6%) were female. The mean age was 26.95±16.44 years in Group 1 and 39.80±23.08 years in Group 2. In our study, the majority of the patients in Group 1 had orthopedic injuries, while internal problems were more common in Group 2. The need for intensive care was greater among the patients in Group 1 compared to Group 2 (p<0.05). The leading cause of death in Group 1 was multi-systemic trauma in 7 out of the 10 patients (70%) and internal problems in Group 2 with 5 out of 12 patients (41.5%). CONCLUSIONS: Our country is in a geographical location where earthquakes are responsible for great losses of life and property. An efficient disaster relief plan may help to minimize the possible damage of earthquakes.

Factors affecting mortality caused by falls from height.

BACKGROUND: Falls from height are among the most common trauma cases presenting to emergency departments and often cause mortality and morbidity. In the present study, we aimed to determine the factors that effectively reduce mortality caused by falls from height. METHODS: Data from 2252 trauma patients who presented to Dicle University Emergency Service between January 2005 and December 2008 due to falling from height in the Southeastern Anatolia region were retrospectively analyzed. We analyzed the parameters that are considered to have a positive effect on mortality, which included the following: month of fall; age; gender; etiology; place of fall; type of ground on which the patient fell; height of fall; intubation; hypotension; tachycardia; neck, head, thoracal, abdominal, pelvic, and extremity injuries; Glasgow Coma Score (GCS); Injury Severity Score (ISS); and Revised Trauma Score (RTS). RESULTS: There were 1435 males (63.7%) and 817 females (36.3%) included in the study. Two thousand thirty-one (94.6%) patients survived the fall while 121(5.4%) died. The mean age of the surviving patients was 15.55±18.60 years, while the patients who died had a mean age of 29.59±28.93 years. The mean height of the fall of the survivors' was 3.09 meters, and the mean height of the fall for those that died was 6.61±5.73 meters (p<0.001). CONCLUSION: The mean fatal height of the fall in falls from height is 6.61 m. Age, attempted suicide, height of fall, type of ground on which the patient fell, place of fall, and head, thoracic, and abdominal trauma are the primary factors affecting mortality caused by falls from height.

Comparative diagnostic accuracy of serum levels of neutrophil activating peptide-2 and pentraxin-3 versus troponin-I in acute coronary syndrome.

OBJECTIVE: We measured the levels of neutrophil activating peptide-2 (NAP-2) and pentraxin-3 (PTX-3) in acute coronary syndromes (ACS) patients and compared their diagnostic accuracy with cardiac troponin I (cTnI). METHODS: We conducted a prospective cohort study to determine the diagnostic accuracy of PTX-3, NAP-2 and cTnI for the prediction of ACS. Consecutively eighty-three patients with sudden chest pain admitted to Dicle University Emergency Department within the first six hours of symptom onset were included in our study. Mean serum levels of PTX-3, NAP-2 and cTnI were compared between control and patient groups and ACS subgroups. Their sensitivities and specificities in early diagnosis of ACS were identified. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic validity of the markers, and areas under the ROC curve (AUC) were compared. RESULTS: In the patient group, mean serum concentrations of NAP-2 (53.03+22.77 ng/ml) and PTX-3 (1.73+0.82 ng/ml) were considerably higher than those of the control group (24.54+9.50 and 0.50+0.39 ng/ml, respectively) (p<0.01). When compared with the control group, PTX-3 levels of all three ACS subtypes (unstable angina pectoris (USAP) - 1.62+0.41 ng/ml, non-ST elevation myocardial infarction (NSTEMI) -1.63+0.31 ng/ml and ST-elevation myocardial infarction (STEMI) - 1.75+0.89 ng/ml) were higher, whereas NAP-2 levels were higher in USAP (56.29+22.60 ng/ml) and STEMI (52.05+20.99 ng/ml) patients (p<0.01). For diagnosing ACS within the first six hours of presentation, PTX-3 sensitivity was 98.5% and specificity was 92.3%, and NAP-2 sensitivity - 98.1% and specificity - 41.3%. The ROC curve AUC values were: 0.962 for PTX-3 (95% CI 0.802 - 1.073), 0.840 for NAP-2 (95% CI 0.684 - 0.991), and 0.683 for cTnI (95% CI 0.610 - 0.940). CONCLUSION: Pentraxin-3 is a sensitive and specific marker for ACS diagnosis when compared with cardiac markers in patients admitted to the emergency department (ED) within the first six hours of onset of chest pain.

Analysis of amitriptyline overdose in emergency medicine.

INTRODUCTION: Amitriptyline is a tricyclic antidepressant. In general, toxicity effects develop within 30 min of overdose and peak from 2 h to 6 h. Anticholinergic effects predominate in cases of low dose ingestion. In cases of high dose ingestion, marked depression of the central nervous system is coupled with cardiotoxicity, seizures and hypotension. PATIENTS AND METHODS: Amitriptyline-intoxicated patients admitted to the emergency department (ED) of Dicle University Hospital were evaluated between January 2005 and April 2007. Social and demographic status, clinical and laboratory findings, treatments and outcomes were recorded. Age, sex, marital status, time of hospital admission, consciousness levels, ECG findings, requirement for respiratory support, follow-up periods and antidepressant overdose risk assessment (ADORA) criteria were analysed using SPSS software. RESULTS: A total of 110 cases of overdose by amitriptyline was evaluated. Suicide attempts by amitriptyline overdose in adult single women were the commonest finding. The commonest symptoms seen during initial examinations were sinus tachycardia (66.3%), altered mental state (78.1%) and hypotension (7.3%). Mechanical ventilatory support was required in 9.1% of cases. Most patients (n=76, 69.1%) were treated in the ED (p=0.001). 60 (54.5%) patients were discharged from the ED within 24 h after admission (p<0.0001). CONCLUSION: Most of the patients were young single women. Altered mental state and tachycardia were the commonest symptoms. The initial symptoms of amytriptyline overdose patients may be life threatening, but effective supportive treatments were helpful. There was high correlation between ADORA criteria and the dose ingested.

Relation between serum Pro-Brain natriuretic peptide, myoglobin, CK levels and morbidity and mortality in high voltage electrical injuries.

OBJECTIVE: In our study, in addition to evaluating the relation between Pro-Brain natriuretic peptide (Pro-BNP), myoglobin and creatinine kinase (CK) levels and morbidity and mortality, we aimed at identifying the demographic characteristics of patients admited to emergency service after exposure to high electrical voltage. METHODS: In this prospective study, 48 emergency service patients exposed to high electric voltage were included; 19 healthy individuals were included as the control group. Their blood samples and electrocardiographies (ECG) were taken at the time of recourse upon their written approval. Demographic data and laboratory data were checked and compared among the patient group. We investigated the correlation between inpatients that had special clinical manifestations (escaratomy, fasciotomy, exitus, myoglobulinuria, third-degree burn, arrhythmia and etc.) and serum Pro-BNP, myoglobin and CK levels. RESULTS: When serum Pro-BNP, myoglobulin and CK levels were compared for the special clinical manifestations; the pro-BNP levels were statistically significantly higher in patients who had arrhythmia than in those without arrhythmia, and significantly higher in patients who died than in those who healed (respectively p=0.002 and p=0.007). In contrast, serum CK and myoglobin levels were not statistically significant. The serum CK and myoglobin levels were statistically significantly higher in patients who had third-degree burn than the others (p<0.001). CONCLUSION: Serum pro-BNP level is a marker that can be used for mortality and morbidity with patients exposed to high voltage electrical injuries.

The role of the heart-type fatty acid binding protein in the early diagnosis of acute coronary syndrome and its comparison with troponin I and creatine kinase-MB isoform.

OBJECTIVES: The aim of this study was to research the effectiveness of the heart-type fatty acid binding protein (H-FABP) in the early diagnosis of acute coronary syndrome (ACS) in patients admitted to emergency service (ES) within 6 hours of onset of chest pain. EQUIPMENT AND METHOD: A total of 83 patients admitted with chest pain to our ES were included in this study. The patients were divided into 2 groups: those with a diagnosed ACS and those diagnosed with non-cardiac-related chest pain. Patients were also were divided into 2 groups according to the time of admission: those admitted within 0 to 3 hours and 3 to 6 hours of onset of chest pain. Peripheral venous blood samples were obtained from all patients for H-FABP, troponin I, and creatine kinase-MB (CK-MB) serum concentration measurements. RESULTS: Of a total of 83 patients, 21.6% (n = 18) were in the control group and 78.3% (n = 65) were in the ACS group. The average H-FABP value for the patients in the control group was 0.86 ± 0.54 ng/mL. When the ACS and control groups were compared in means of cardiac markers for CK-MB (P = .000) and H-FABP (P = .000), there was a statistically significant difference, whereas no difference was observed for troponin I (P = .013). In the ACS group, H-FABP sensitivity for diagnosis was found to be 98% and specificity was 71%; CK-MB sensitivity was 86% and specificity was 52%; and troponin I sensitivity was 77% and specificity was 20%. CONCLUSIONS: For patients admitted with chest pain to ES, H-FABP was found to be more sensitive and specific than troponin I and CK-MB in the early diagnosis of ACS.

Snakebites in adults from the Diyarbakir region in southeast Turkey.

BACKGROUND: Snake venom poisoning is a medical emergency requiring immediate attention. Bites from poisonous Turkish snakes can lead to local tissue damage and systemic symptoms. The Vipera ammodytes species accounts for the majority of envenomation in southeast Turkey. METHODS: The demographic and epidemiological characteristics, clinical symptoms and signs, laboratory findings, treatment, and outcome of 79 consecutive victims of V. ammodytes poisoning admitted to our hospital from 2003 to 2005 were reviewed and analyzed prospectively. RESULTS: The most common symptoms and signs included fang marks (100%), pain (100%), swelling (83.5%), ecchymosis (92.4%), tachycardia (24.1%), fainting or dizziness (14.5%), fever (19.0%), enlargement of regional lymph nodes (43.0%), nausea (70.9%), hypotension (21.5%), vomiting (36.7%), and dyspnea (3.2%). The main complications were thrombophlebitis, reduced range of motion, local hemorrhagic blister formation, bleeding from skin, rhabdomyolysis, reduced sensation, acute renal failure, necrosis with tissue loss, digit amputation, carpal tunnel syndrome, and compartment syndrome. CONCLUSION: A V. Ammodytes bite is a potentially serious event that requires immediate hospital care. Nevertheless, the majority of victims can be treated successfully with conservative methods. No deaths occurred in our series.

Clinical importance of ultrasonographic pelvic fluid in pediatric patients with blunt abdominal trauma.

BACKGROUND: The aim of this study was to evaluate the significance of the ultrasonographic finding of pelvic fluid as a predictor of organ injury in pediatric patients with blunt abdominal trauma. METHODS: We reviewed retrospectively the medical records of 85 consecutive pediatric patients who admitted to the Emergency Department of Dicle University from January 2008 to December 2008 with blunt abdominal trauma. Age, gender, mechanism of injury, isolated injuries, surgical interventions, hospitalization, and mortality were evaluated according to the location of fluid. RESULTS: A total of 85 pediatric patients (63 male, 22 female; mean age: 7.88+/-3.403 years) with blunt abdominal trauma were included in the present study. Forty percent of the patients had intraperitoneal fluid, while 60% had pelvic fluid. The majority (35.3%) of patients applied due to falling from height. The difference between the mechanism of the injuries and location and presence of the fluid was not statistically significant (p>0.05). Twenty-nine patients had solid organ injuries. Splenic injuries showed the highest association with intraperitoneal fluid (p<0.001). Of the patients, 15.3% underwent exploratory laparotomy and 44.7% required blood transfusion. The presence of intraperitoneal fluid statistically increased the probability of the exploratory laparotomy and necessity of blood transfusion (p<0.001). Mortality rate was 4.8%. CONCLUSION: In ultrasound examination, it was determined that the probability of solid organ injury was lower in the presence of pelvic fluid, while it was higher in the presence of intraperitoneal fluid outside the pelvis.

Tandir burns in and around Diyarbakir, Turkey.

BACKGROUND: Tandir is the name given to a special oven used for baking bread in the eastern and southeastern part of Anatolia. Tandir burn is a unique trauma in that it involves primarily women and young children falling into the in-ground ovens and suffering deep extensive burns. In this study, we aimed to evaluate the tandir burns occurring in the Diyarbakir region. METHODS: The records of 21 patients with tandir burn who were treated in our Burn Center between May 2003 and February 2006 were reviewed. Patients with tandir burns accounted for 2.14% of all burned patients. The mean age was 10.7 years (1hyphen;47 years). Of the patients, 71.43% were female, and 61.90% were under six years old. The mean total body surface area (TBSA) burned was 22.33% (8-75), and 71.43% of the patients had third-degree burns. RESULTS: Three patients required amputation of an extremity. Eight patients had fasciotomies, 16 eschar excision, and 5 partial thickness skin grafts. The mean hospitalization period was 16.90 days (5-34 days). Five patients (23.81%) died. CONCLUSION: Tandir burn is a severe burn with a higher morbidity and mortality.

Mortality and morbidity in children caused by falling televisions: a retrospective analysis of 71 cases.

OBJECTIVES: To quantify injuries in children that result from toppled televisions. METHODS: Children presenting directly to emergency department due to injuries caused by falling televisions were identified from our digital patient database, and a retrospective chart review of 71 children was performed.Descriptive statistics were applied. RESULTS: 71(1.8%) out of 3856 admissions due to injuries sustained at home were TV-related injuries. There were 50 (70.4%) boys and 21(29.6%) girls. Mean age was 39.79 ± 20.14 SD months. Almost three quarters of the children (49/71) sustained various head and facial injuries. There was traumatic brain injury in 14 patients,extremity injuries in 30 patients, thoracic injuries in 13 patients and abdominal injuries in ten patients. 16 patients were hospitalized. 14 of them required follow-up in intensive care unit. Two patients (one with epidural hematoma and one with subdural hematoma) underwent surgical intervention. Four patients with subarachnoid bleeding died. The mean length of hospital stay was 71.25 hours (range, 48-168) in hospitalised patients. The overall mortality rate was 5.6%. CONCLUSIONS: Falling TVs may cause significant morbidity and mortality in children particularly those younger than 3 years old. Head and facial injuries are the most common body region involved and traumatic brain injury is the major cause of death.

[Mortality factors in flame and scalds burns: our experience in 816 patients]. / Alev ve haslanma yaniklarinda mortalitede etkili faktörler: 816 hastada deneyimlerimiz.

BACKGROUND: Our aim was to evaluate the effective factors on mortality in flame and scald burns in the Diyarbakir region. METHODS: The data of 816 patients who applied to the Dicle University Emergency Department between January 2001 and May 2005 with flame and scald burns were investigated retrospectively. The patients were separated into two groups as alive or deceased. Gender, age, burns shapes, burn degrees and rates, burn regions, admission periods, hospitalization times, complications, and the treatments were analyzed. RESULTS: 43.5% of the patients were female and 57.5% were male. Six hundred fifty-eight patients were under 6 years old. 70.5% of burns occurred as a result of negligence; 76.5% occurred due to scald and 23.5% due to flame. In cases of death, 39 patients were under 10 years old. The mean age was 9.32 years. The average hospitalization period was 10.37 days. The most common complication was wound infection. The mortality rate was 6.1%. CONCLUSION: The mortality rate was higher among patients who were hospitalized longer than 15 days (p = 0.030); whose burns were due to suicide attempt (p = 0.002); who used shoe paint on the burn wounds instead of treatment (p = 0.000); who had more than 40% second-degree burns (p = 0.000) or more than 20% third-degree burns (p = 0.000); and among those with acute respiratory failure, compartment syndrome, hypoalbuminemia, and sepsis (p = 0.000).