The impact of fever on myocardial repolarization parameters.

BACKGROUND: It has been reported in the literature that the increase in body temperature shortens QT interval on electrocardiogram through heart rate modulation. However, the effects of fever on ventricular repolarization are not clearly known. This study elaborates on QT interval of isolated fever, corrected QT (cQT), Tp-e interval, the ratio of corrected Tp-e (cTp-e) and Tp-e/QT, and their impacts on arrhythmia potential. METHODS: This prospective study was performed on 74 patients without any active and chronic diseases other than fever and upper respiratory tract infection. The study included patients at the age of 18-50 years suffering from fever above 38.2 °C. QT and Tp-e intervals of the patients were measured from their ECGs taken in febrile and afebrile periods. cQT and cTp-e values were calculated according to Bazett, Fridericia, and Framingham formulations. RESULTS: QT and Tp-e intervals were observed to be shorter in the febrile period (p < 0.001 and p = 0.006 respectively). cTp-e was found to be longer in the febrile period according to Bazett, Fridericia, and Framingham formulations (p < 0.001, p = 0.002, p < 0.001, respectively). Tp-e/QT ratio was found to be higher in the febrile period than in the afebrile period (p < 0.001). CONCLUSION: Although QT, cQT, and Tpe intervals were shorter, cTpe interval and Tpe/QT ratio were longer and higher in the febrile period, respectively. These findings may indicate that fever may create a proarrhythmic effect by causing variability in the transmural distribution of myocardial repolarization.

Ability of Bedside Ultrasonography to Detect Pediatric Nasal Bone Fractures.

OBJECTIVES/HYPOTHESIS: The aims of this study were to evaluate the diagnostic test features of bedside ultrasonography in pediatric patients with nasal trauma and to investigate whether it is a preferable alternative method to conventional radiography (CR). STUDY DESIGN: Cross-sectional prospective study. METHODS: This prospective study was conducted from March 1, 2019, through November 1, 2019. Thirty-one patients under the age of 18 years who had nasal trauma were consecutively included. CR and ultrasonographic imaging tests were investigated in patients with clinical indications for nasal bone fracture. The sensitivity, specificity, and accuracy of ultrasonography and CR were calculated with respect to detecting nasal fractures according to the gold standard method. RESULTS: Participants were between 3 and 16 years old and the median age was 8 (5-13) years. Nasal bone fracture was clinically detected in 18 patients. While 13 of these fractures were detected with ultrasonography, only 11 were also detected with CR. The sensitivity and specificity of ultrasonography and CR in detecting nasal fractures were 72.2% (95% confidence interval [CI]: 46.5-90.3) and 76.9% (95% CI: 46.2-95.0) for ultrasonography and 61.1% (95% CI: 35.8-82.7) and 69.2% (95% CI: 38.6-90.9) for CR. CONCLUSIONS: According to the results of this study, ultrasonography may be used with confidence as a first imaging method in the investigation of nasal fractures, particularly with consideration for avoiding the effects of radiation as much as possible. Our findings point to the next step of conducting trials with a greater number of patients in order to define the diagnostic test features of ultrasonography in pediatric patients. LEVEL OF EVIDENCE: 2 Laryngoscope, 131:1398-1403, 2021.

Kounis syndrome due to hirudotherapy (leech therapy) in emergency department; a case report.

Kounis Syndrome is the development of acute coronary syndrome (ACS) because of allergic reactions; allergens, such as foods, insect venom, iodine contrast agent or drugs can cause this syndrome. Hirudotherapy (leech therapy) is increasingly used as a useful therapeutic option in a variety of medical and surgical procedures, and potential complications related to this therapy include Aeromonas species infections, bleeding, anemia and allergic reactions. Here, we present a patient diagnosed as Type 1 Kounis Syndrome after using hirudotherapy for her knee aches. 41-year-old woman admitted to emergency department with sudden onset of face edema, shortness of breath and chest pain complaints and diagnosed as an allergic reaction and anaphylaxis due to leech therapy. Kounis Syndrome should be considered in acute coronary syndrome patients who were admitted to emergency department with anaphylaxis clinic.

Alterations in optic nerve sheath diameter according to cerebrovascular disease sub-groups.

BACKGROUND: ONSD (optic nerve sheath diameter) is a method used for indirect measurement of the increased intracranial pressure. In previous studies, the relation between the increased intracranial pressure and ONSD was analyzed in the patients suffering from cerebrovascular diseases (CVD). In our study, the patients suffering from ischemic CVD were categorized into 4 subgroups according to Oxfordshire Community Stroke Project classification (OCSP); the relationship between each group and ONSD, and the influence on each eye were analyzed. METHODS: The study included the patients over the age of 18 applying to the emergency department of Malatya State Hospital with the symptoms of stroke between the dates of 1/1/2015 and 1/9/2016. The patients diagnosed with stroke by means of clinical and neuroradiological imaging were examined in 4 subgroups according to Oxfordshire Community Stroke Project. The aim of the study is to predict the intracranial pressure (ICP) levels of the patients through ONSD measurement and CT images. RESULTS: In the comparison of the right and left optic nerve sheath diameters of CVD group and control group, the obtained results were found to be statistically significant (p<0.001). When the CVD subgroups were compared with the control group in terms of right and left optic nerve sheath diameters, the highest right-left optic nerve sheath diameter was detected to be in TACI (Total Anterior Circulation Infarction) group (p<0.001). DISCUSSION/CONCLUSION: In the early cases of CVD, mortality and morbidity can be decreased through the early diagnosis of the possible existence of ICP increase according to ONSD level.

Comparison of the factors affecting neurological outcome in out-of vs in-hospital cardiac arrest cases.

Objective: To determine the differences between the factors such as return of spontaneous circulation positivity, duration of cardiopulmonary resuscitation, and cardiac rhythm at first arrival affecting neurological outcomes in cardiac-arrest cases. Methods: This study was conducted at the Malatya State Hospital, Malatya, Turkey, from January to December 2014, and comprised patients who had received cardiopulmonary resuscitation. Patients were divided into two groups; in-hospital cardiac arrest and out-of-hospital cardiac arrest. The groups were compared in terms of gender, age, initial rhythm, cardiopulmonary resuscitation durations, cardiopulmonary resuscitation results (exitus, return), return of spontaneous circulation rates observed after cardiopulmonary resuscitation, and neurological outcome responses of the cases in which return of spontaneous circulation was observed. SPSS 22 was used for data analysis. RESULTS: Of the 321 cases, 88(27.41%) were in-hospital and 233(72.59%) were out-of-hospital cardiac arrest cases. Besides, 189(58.9%) of the patients were men and 132(41.1%) were women with an overall mean age of 67.21±15.25 years (range: 18-98 years). Moreover, 16(18.2%) in-hospital cases and 47(20.2%) out-of-hospital cases had shockable rhythms at the time of arrival. Cardiopulmonary resuscitation was applied to 74(23%) patients for less than 20 minutes and to 247(76.9%) for more than 20 minutes. Return of spontaneous circulation positivity was recorded in 134(41.7%) patients, of whom 62(70.5%) were in-hospital and 72(30.9%) were out-of-hospital cases. Moreover, 19(5.9%) patients were discharged with good neurological outcome. In cases where cardiopulmonary resuscitation was applied for less than 20 minutes, return of spontaneous circulation positivity was present in 43(100%) in-hospital and 31(100%) out-of-hospital cases. Return of spontaneous circulation positivity and good neurological outcome rate of the patients having shockable rhythms was 48(76.2%) and 8(12.7%), respectively. CONCLUSIONS: Return of spontaneous circulation positivity, favourable neurological outcome response and survival rates were significantly higher among in-hospital cardiac arrest cases.