Demographic and Clinical Characteristics of Earthquake Victims Presented to the Emergency Department with and without Crush Injury upon the 2023 Kahramanmaras (Turkey) Earthquake.

INTRODUCTION: Earthquakes are sudden-onset natural disasters that are associated with substantial material damage, resulting in the collapse of built environment with a high rate of mortality, injury, and disability. Crush syndrome, which can be seen after devastating earthquakes, can lead to acute kidney injury (AKI) and patients may require amputation, fasciotomy, and dialysis. Supportive treatment has an important role in the prognosis of these patients. STUDY OBJECTIVE: The aim of this study was to investigate the demographic and clinical characteristics of traumatic earthquake survivors admitted to the emergency department (ED) of a hospital, which was close to the earthquake zone but not affected by the earthquake, after the February 6, 2023 Kahramanmaras (Turkey) earthquakes. MATERIALS AND METHODS: This study was conducted by retrospectively analyzing the data of 1,110 traumatized earthquake survivors admitted to the ED of a tertiary care university hospital from February 6th through February 20th, 2023. Age; gender; time of presentation; presence of comorbid diseases; ED triage category; duration of stay under debris; presence of additional trauma; laboratory tests; presence of AKI; presence of crush injury and injury sites; supportive treatment (fluid replacement and intravenous [IV] sodium bicarbonate); need for amputation, dialysis, and fasciotomy; duration of hospitalization; and outcome of ED were evaluated. RESULTS: Of the 1,110 traumatic victims in this study, 55.5% were female patients. The mean age of the patients was 45.94 (SD = 16.7) years; the youngest was 18 years old and the oldest was 95 years old. Crush injury was detected in 18.8% and AKI in 3.0% of the patients. Dialysis, amputation, and fasciotomy were required in 1.6%, 2.8%, and 1.4% of the patients, respectively. In total, 29.2% of patients were hospitalized, including 2.9% admitted to the intensive care unit (ICU) and 26.3% to the relevant ward. In total, 0.3% of the patients included in the study died at ED. CONCLUSION: Post-earthquake patients may present with crush injury, AKI may develop, and fasciotomy, amputation, and dialysis may be needed, so hospitals and EDs should be prepared for natural disasters such as earthquakes.

The usefulness of the percentage of immature granulocytes in predicting in-hospital mortality in patients with upper gastrointestinal bleeding.

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is an important health problem with a potentially life threatening course. Measurement of immature granulocytes percentage (IG %), reflecting the fraction of circulating immature granulocyte (IG), is associated with increased mortality in patients with systemic inflammation, or distress. The aim of this study was to evaluate whether the IG% is an effective predictive marker for estimating the in-hospital mortality for patients with UGIB admitting to the emergency department (ED). METHOD: This retrospective study included patients with UGIB who admitted to the ED, between 01.01.2019 and 31.12.2019. The patients were divided into two groups as discharged and dead. The IG% and other parameters were recorded. The primary end point of the study was in-hospital mortality. Logistic regression model was used to determine the factors affecting mortality. RESULTS: This study included 149 patients, 94 of whom were men. The mean age of the patients was 64.5 ± 14.2. Twenty patients died during hospitalization and 129 were discharged. IG% was significantly higher in patients who died compared with patients who discharged. In the receiver operating characteristic (ROC) curves analysis to determine the in-hospital mortality, the cut-off value (>1%) for IG% level was found specificity (93.8%), sensitivity (100%), positive predictive value (PPV = 71.43%), negative predictive value (NPV = 100.00%) and area under curve (AUC = 0.98). Univariate logistic regression analysis showed that IG% was predicting in-hospital mortality (odds ratio, OR = 65.6, confidence interval, CI = 2.00-2152.6). CONCLUSiONS: High IG% levels may be used as a predictor of in-hospital mortality in patients with UGIB.

The prognostic value of immature granulocyte in patients with acute pancreatitis.

BACKGROUND: Acute pancreatitis is the inflammation of the pancreas. It can range from mild forms to life-threatening severe cases. There is not yet a marker that can detect severe cases in the early period. Early diagnosis and treatment of this disease has critical importance for prognosis. In this study, we aimed to investigate the percentage of immature granulocyte (IG %) in patients with acute pancreatitis in order to predict the severity of the disease and in-hospital mortality. METHOD: This study was carried out retrospectively in academic emergency department (ED), faculty of medicine between 01.01.2017 and 30.06.2019. The patients were divided into three groups as mild, moderate and severe. In addition, the patients were divided into two groups: those discharged from the hospital and those who died in the hospital. IG % and other laboratory parameters of the patients were recorded in the study form. The primary outcome for this study is the value of IG% in predicting severity in AP patients. A receiver operating characteristic (ROC) curve analysis was performed. RESULTS: A total of 218 patients (107 male) were included in the study. The mean age of the patients was 56.9 ± 18.3 years. It was found that IG% levels were higher in patients with severe pancreatitis (p = .018). In the ROC analysis that was done to determine the severity of the disease, the cut-off value of IG% was found as >1.1. As such case, specificity was %38.89, sensitivity was 95.00%, positive predictive value (PPV) was 41.18% and negative predictive value (NPV) was found as 94.53% (Area Under Curve (AUC) = 0.698). In ROC analysis that was performed to determine in-hospital mortality, the cut-off value of IG level was found as >1.8, sensitivity was 50.00%, specificity was 97.12%, PPV was 45.45% and NPV was found as 97.58% (AUC = 0.708). CONCLUSiONS: This study shows that higher IG% levels may correlate with higher disease severity and in-hospital mortality in patients with acute pancreatitis.

Nucleated red blood cells as predictor of all-cause mortality in emergency department.

BACGROUND: Nucleated red blood cells (NRBCs) are immature erythrocytes that are not normally detected in the blood of healthy adults. The detection of these cells in peripheral blood is associated with increased mortality and poor prognosis. In this study, we aimed to investigate whether NRBCs predict for all causes of death in patients admitted to the emergency department (ED). METHOD: This study was conducted retrospectively between January 2019 and December 2019 in academic emergency department, faculty of medicine. We included all patients who died of non-traumatic causes and The control group consisted of patients discharged from the ED. NRBCs and other laboratory parameters were compared between the two groups. The primary outcome is all-cause mortality in the ED. Multivariate logistic analysis was performed. RESULTS: A total of 204 patients (119 male) were included in the study. The mean age of the patients was 66.7 ±â€¯14.6 years. NRBC value was higher in those who died (678.43 ±â€¯655.16/ µl) compared to the control group (22.55 ±â€¯57.86/ µl) (P < 0.001). According to receiver operating characteristic curve analysis (ROC) performed for the prediction all cause mortality in the ED, the best cut-off point for NRBC was >0 /µl (sensitivity 94,12%, specificity 82,35%, Area Under Curve (AUC) =0.97). In the multivariate logistic regression analysis, the NRBC was associated with all-cause mortality in the ED (odds ratio,OR = 1.020, confidence interval, CI = 1.012-1.028). CONCLUSiONS: High blood levels of nucleated red blood cells at admission to the emergency department may be associated with increased mortality.

Emergency department presentation of hemoptysis due to nail gun injury.

Nail guns are cheap and easy-to-access devices that are common in the industry and personal use and are widely used by untrained people. Life-threatening injuries may occur after a self-accident due to the use of these devices. We report the case of a 47-year-old man who had hemoptysis due to a lung parenchymal injury after nail gun use. Computed tomography revealed focal alveolar hemorrhage. Hemodynamically stable, the patient underwent surgery. Nail guns penetrating the chest can cause life-threatening situations. In the emergency department, rapid diagnosis and treatment is vital in preventing fatal outcome.

Mean platelet volume and the ratio of mean platelet volume to platelet count in the diagnosis of acute appendicitis.

BACKGROUND: Mean platelet volume (MPV) is an inflammatory marker. Recent studies have shown that there is a negative correlation between platelet count (PC) and MPV and that the ratio of these two values may be more meaningful. The aim of our study was to investigate the diagnostic value of MPV and the MPV/PC ratio in acute appendicitis. METHODS: Patients who were admitted to the emergency department and underwent appendectomy for acute appendicitis between January 2013 and May 2016 were evaluated retrospectively. The patients were divided into three groups based on their histopathological findings: the control group (negative appendicectomy) and the uncomplicated and complicated appendicitis groups. Leukocyte count, CRP (C-reactive protein) levels, PC, MPV and the MPV/PC ratio were compared among the groups. RESULTS: A total of 424 patients, including 231 men, were included in the study. The average age of all patients was 34.9 ±â€¯13.2 years. There was no statistically significant difference between the uncomplicated appendicitis, complicated appendicitis and control groups in terms of MPV, PC and the MPV/PC ratio. Leukocyte count had a strong discriminatory property based on the area under curve (AUC) 0.73, (p < 0.001). CRP levels, MPV, PC and the MPV/PC ratio had weak discriminatory power with AUC values <0.65. Using receiver operating characteristic (ROC) analysis, the sensitivity and specificity of MPV were 83.79% and 23.21%, respectively, and 66.48% and 48.21%, respectively, for the MPV/PC ratio. CONCLUSIONS: In our study, MPV and the MPV/PC ratio were not useful in the diagnosis of acute appendicitis.

Does brucellosis cause arterial stiffness and ventricular remodelling through inflammation?

BACKGROUND: Like other acute and chronic infections, Brucella infection leads to endothelial dysfunction. Furthermore, it has been suggested that the chronic inflammatory state present in chronic infectious diseases leads to an acceleration in atherosclerosis. For the prediction of CAD, it is possible to use epicardial fat thickness (EFT) as an adjunctive marker beside the classical risk factors, as it is easily and non-invasively evaluated by transthoracic echocardiography. The purpose of this study was to investigate the presence of impaired myocardial performance as well as of increased arterial stiffness and EFT in patients who had been infected with brucellosis in the past. METHODS: Included in the study were twenty-seven brucellosis patients and twenty-six healthy volunteers. Using EFT and transthoracic echocardiography, which included Doppler echocardiography in combination with tissue Doppler imaging (TDI), all the patients were examined to measure their aortic stiffness index (AoSI), aortic distensibility (AoD), and aortic elastic modulus (AoEM) values. RESULTS: A statistically significant increase was observed in hs-CRP, aortic stiffness index, aortic elastic modulus and EFT in brucellosis patients when compared with the controls (2.46 +/- 1.40 vs. 1.71 ? 0.61, P=0.016; 9.69 +/- 6.99 vs. 2.14 +/- 0.72, P < 0.001; 11.17 +/- 8.60 vs 2.18 +/- 0.90, P < 0.001; 0.76 +/- 0.08 vs. 0.63 +/- 0.10, P < 0.001). On the other hand, there was a significant decrease in aortic strain and aortic distensibility (7.41 ? 6.82 vs 18.26 +/- 5.83, P < 0.001; 1.83 +/- 1.71 vs. 5.22 +/- 1.72, P < 0.001, respectively). No difference was observed between the two groups with respect to the left ventricular myocardial performance index (MPI) (0.62 +/- 0.15 vs. 0.61 +/- 0.13, P=0.859). CONCLUSIONS: In this study, we demonstrated for the first time in the literature thatthere was impaired aortic elasticity and increased EFT in patients with brucellosis, while the myocardial performance index remained unaffected. We also determined that these effects had a significant correlation with inflammation.

COEXISTENCE OF GRAVES' DISEASE AND TOXIC ADENOMA: A RARE PRESENTATION OF MARINE-LENHART SYNDROME.

Both Graves' disease and Toxic Nodules cause thyrotoxicosis, albeit by different mechanisms. Their coexistence is called Marine-Lenhart syndrome, the prevalence of which has been reported 2.7-4.1%. In many cases with Marine Lenhart syndrome Graves' disease is accompanied by multiple hyperfunctioning nodules, although it is accompanied by a solitary hyperfunctioning nodule in rare cases. We here in reported a rare presentation of Marine Lenhart syndrome and its treatment.

The impact of acute brucellosis on mean platelet volume and red blood cell distribution.

BACKGROUND: Brucellosis is an inflammatory disease which may infect any organs or systems in the body. Mean Platelet Volume (MPV) is one of the most frequently used surrogate markers of platelet function. It reveals the presence of disease activity in many inflammatory diseases. Red blood cell distribution width (RDW) is a parameter that measures variation in red blood cell size or red blood cell volume. Its predictive value approves inflammatory and infectious diseases. OBJECTIVES: The current study aimed to determine the assessment levels of red blood cell distribution in cases with acute brucellosis. PATIENTS AND METHODS: The current study investigated whether MPV and RDW played any roles in acute brucellosis diagnosis. The study was conducted from 2008 to 2014 through prospective examination of the inflammatory markers found in adult patients with acute brucellosis. RESULTS: The follow-up within the year after treatment was examined. The values of age, gender, leukocyte count, C-reactive protein, RDW and MPV were recorded. The study included 351 subjects, 250 of them in the acute brucellosis group and 101 in the control group. The mean MPV levels were 7.64 ± 1.30 fL, and 7.67 ± 1.29 fL in the acute brucellosis and control groups, respectively (P > 0.05). The mean CRP levels were 32.57 ± 53.20 mg/dL, and 4.81 ± 4.89 mg/dL in the acute brucellosis and control groups, respectively (P < 0.05). There was no statistically significant difference between the two groups regarding the RDW level and the mean leukocyte count (P > 0.05). CONCLUSIONS: While the CRP value was in patients with acute brucellosis in the current study, the MPV, RDW and leukocyte counts were within the normal range. CRP value remains the most valuable inflammatory marker in cases of acute brucellosis.

The value of serum mean platelet volume in testicular torsion.

OBJECTIVE: To compare the serum mean platelet volume (MPV) in patients with testicular torsion and healthy control subjects. METHODS: This retrospective study compared clinical and demographic data from patients who underwent surgery for testicular torsion and healthy controls. Testicular torsion was diagnosed with a physical examination and Doppler ultrasonography. Age, leukocyte count, platelet count and MPV were recorded for all participants. RESULTS: A total of 50 patients with testicular torsion and 51 healthy control subjects were enrolled. There was no significant difference in age and platelet count between the two groups. Patients with testicular torsion had a significantly higher leukocyte count and MPV, compared with controls. According to receiver operating characteristic curve analysis performed for the prediction of testicular torsion, the best cut-off point for MPV was 7.7 fl (sensitivity 62%, specificity 96%), and the best cut-off point for leukocyte count was 9.5 × 10(9)/l (sensitivity 58%, specificity 80%). CONCLUSIONS: The MPV may be useful as an ancillary test for the diagnosis of testicular torsion. Further studies are needed in order to confirm these preliminary results.

Retrospective analysis of poisoning cases admitted to the emergency medicine.

BACKGROUND: We aimed herein to assess demographic, etiological, and clinical characteristics of patients presenting to our hospital's emergency department with acute poisoning. METHOD: This study included a total of 509 (0.27%) patients diagnosed with poisoning at our emergency department within a 3-year period. This was a retrospective study.  RESULTS: Seventy-one point three (n = 363) percent of the patients were female. The majority of the victims were in the 18-25 years age group (P < 0.001). The poisoning incident was for suicidal purposes in 83.7% of patients. Among the patients presenting with prescription drug poisoning, 92.9% were poisoned in a suicide attempt while 73.2% of patients presenting with poisoning with non-medical substances were poisoned accidentally. Suicidal poisonings were more common in young age group and females (P < 0.001). The most common poisoning agent was antidepressants (17.6%) followed by analgesics (12.8%), and other psychotropic drugs (6.1%). Antidepressant drugs were the most common prescription drugs taken for suicidal purposes (P < 0.001). Poisonings occurred with a single agent in 72.5% of cases and with two or more agents in 27.5% of cases.  Analysis of duration of hospital stay revealed that 52.6% (n = 60) of patients stayed in hospital for 2 days. The mortality rate was 0.4%. CONCLUSION: The majority of poisonings were with prescription drugs, for suicidal purposes, in young age group, and in females. In our study, the three most common agents causing poisoning were antidepressants, analgesics, and other psychotropic substances.

Could there be an association between chronic brucellosis and endothelial damage?

INTRODUCTION: In this study, we examined the effects of Brucella infection on endothelial dysfunction. Flow-mediated dilatation (FMD) measurement is indicator of the endothelial function, and abnormal values indicating endothelial dysfunction are accepted as the first stage of atherosclerosis. METHODOLOGY: Twenty-four patients who had been treated for acute brucellosis two years before, and who had had no relapses in the follow-up, were prospectively included in the study, along with 30 healthy individuals in the control group. RESULTS: While the highly sensitive C-reactive protein (hs-CRP) value was 2.42 ± 1.45 in the patient group, it was 1.72 ± 0.61 in the control group (p = 0.025). While the FMD value was 3.50 ± 1.58 in the patient group, it was 5.88 ± 1.88 in the control group (p < 0.001). While the percentage increase in FMD was 9.88 ± 4.92 in the patient group, it was 17.49 ± 6.3 in the control group (p < 0.001). It was observed that FMD value, the percentage increase in FMD, and basal radius were correlated with hs-CRP (r = -0.644, p < 0.001; r = - 0.558, p = 0.002; r = 0.444, p = 0.018, respectively). The carotid artery intima media thickness (IMT) value was found to be 0.61 ± 0.17 in the patient group and 0.49 ± 0.12 in the control group (p = 0.004). CONCLUSIONS: The abnormal FMD and IMT values observed in brucellosis patients might be an indicator of more frequent arterial dysfunction, increased cardiovascular risk, and atherosclerosis.

Retrospective analysis of whole-body multislice computed tomography findings taken in trauma patients.

OBJECTIVES: Using whole-body multislice computed tomography (MSCT) excessively or with irrelevant indications can be seen in many centers. The aim of this study was to analyze retrospectively the MSCT findings in trauma patients admitted to the emergency department. METHODS: Records of the patients who have applied to the emergency department due to blunt trauma in a 12 month period and whose whole body MSCT images have been taken, were evaluated using the "Nucleus Medical Information System". RESULTS: The most frequent type of trauma was traffic accidents in 61.4%, falling down from the height in 22.4%, and motorcycle accidents in 11.4% of patients. Of the patients, 25.2% were discharged from the emergency, while 73.8% were hospitalized. At least one CT findings associated with trauma was present in 61.4% of our patients. Pathological findings in MSCT were most frequently detected in the head and face (35.3%) and thoracic (28.6%) regions, respectively. The most common finding in the head and face region was fractures. The most common pathological findings in the thoracic region were pulmonary contusion and rib fractures. A significant relationship was detected between trauma type and spinal MSCT result (p < 0.001). In a large percentage of the patients, MSCT findings were normal in the abdominal region and genitourinary system. Vertebral fractures were most frequently detected in the thoracolumbar region. CONCLUSIONS: In our study, our rate of negative CT was found to be 38.6%, which is a higher ratio compared to other studies conducte on this topic.

Association between red blood cell distribution width and acute pancreatitis.

BACKGROUND: We aimed to determine whether there are any alterations in red blood cell width in patients diagnosed with acute pancreatitis. MATERIAL/METHODS: This was a retrospective study of records of patients treated in emergency units and diagnosed with acute pancreatitis between January 2011 and April 2013. Records were investigated regarding patient age, sex, and causes of acute pancreatitis. Red blood cell width and amylase values obtained from the patients during diagnosis and after a full recovery from acute pancreatitis were added to the records. RESULTS: Recorded red blood cell width and amylase values of 104 patients diagnosed with acute pancreatitis were statistically compared according to the time of sample collection. Samples were collected in the post-diagnostic period and after full recovery. Values of red blood cell width and amylase were found to be significantly higher in samples collected during hospital admission in comparison to those obtained from patients after fully recovering from acute pancreatitis (p<0.05). CONCLUSIONS: An increase in red blood cell width value is a marker of acute pancreatitis; therefore, we suggest that red blood cell width can be used as a tool for the early diagnosis and assessment of disease progression.

Determining risk factors of bleeding in patients on warfarin treatment.

Background. Warfarin is a commonly used oral anticoagulant agent. The most common adverse effects of warfarin are bleeding complications. Methods. We performed a 1-year retrospective chart review of emergency department patients using warfarin. A total of 65 patients with bleeding disorder (study group) and 63 patients without bleeding (control group) were included, making up a total of 128 subjects. Demographic data, frequency of international normalized ratio (INR) checks, and routine blood results were extracted. Logistic regression analysis was used to determine which factors were most closely associated with bleeding complications. Results. Median age was 62.0 ± 14.4 and 61.9 ± 14.5 for study group and control group, respectively. Educational status and frequency of INR checks were similar in both groups (P = 0.101 and P = 0.483, resp.). INR levels were higher in the study group (5.45 ± 3.98 versus 2.63 ± 1.71, P < 0.001). Creatinine levels were also higher in the study group (1.14 ± 0.57 mg/dL versus 0.94 ± 0.38 mg/dL, P = 0.042). Acetylsalicylic acid use was more frequent in the study group and was associated with a 9-fold increase in bleeding complications (P < 0.001). Conclusions. High INR levels, high creatinine levels, and acetylsalicylic acid use were associated with bleeding complications in ED patients using warfarin.

The role of red cell distribution width in the diagnosis of acute appendicitis: a retrospective case-controlled study.

PURPOSE: The aim of this study was to seek whether red cell distribution width (RDW) has a role in the diagnosis of acute appendicitis. It was also aimed to show the relationship of RDW with leukocyte count and C-reactive protein (CRP) level. METHODS: This study was conducted via retrospective assessment of the hospital records of the adult patients who were operated for acute appendicitis between January 2010 and February 2013 and had a pathology report that confirmed the diagnosis of acute appendicitis. The patients in the control group were selected from healthy adults of similar age who applied to check-up clinic. Age, gender, leukocyte count, CRP, and RDW values were recorded. This study is a case controlled retrospective clinical study. RESULTS: A total of 590 patients in the acute appendicitis group and 121 patients in the control group were included, making up a total of 711 subjects. The mean RDW levels were 15.4 ± 1.5% in the acute appendicitis group, while 15.9 ± 1.4% in the control group. CRP, leukocyte count were significantly higher in the acute appendicitis group, and RDW level were significantly lower in the acute appendicitis group (p < 0.001, p < 0.001, p = 0.001, respectively). RDW, leukocyte count, and CRP had a sensitivity and specificity of 47% and 67%; 91% and 74%; and 97% and 41%, respectively in acute appendicitis. RDW was not correlated with CRP and leukocyte levels. However, we found a correlation between CRP and leukocyte levels. CONCLUSION: RDW level was lower in patients with acute appendicitis. The magnitude of difference in RDW seen between acute appendicitis and controls was so slight as to be of no utility in diagnostic testing.