Heavy metal and trace element alterations in patients during a migraine attack.

OBJECTIVE: The aim of the study was to determine the heavy metal and trace element (HMTE) profile in patients with migraine (PwM) and to compare it to that of healthy individuals without migraine. BACKGROUND: Migraine is a universal disease that affects more than 10% of the world's population; however, its pathophysiology is still obscure. METHODS: A total of 100 participants were included in this prospective matched case-control study (50 PwM during acute attack and 50 age- and sex-matched healthy controls). The study was conducted in the university hospital in Yozgat, Turkey, where the inductively coupled plasma mass spectrometry system was used to measure the HMTE profile. The calibration curve was created with 11 points for heavy metals (arsenic [As], cadmium [Cd], cobalt [Co], lead [Pb], mercury [Hg], nickel [Ni], and tin [Sn]) and trace elements (antimony [Sb], chromium [Cr], copper [Cu], iron [Fe], magnesium [Mg], manganese [Mn], molybdenum [Mo], and zinc [Zn]). RESULTS: The median age was 27 (23-37) years, and the female/male ratio was 37/13 for both groups. The PwM group had significantly higher As, Co, Pb, and Ni levels among the heavy metals (p = 0.033, 0.017, 0.022, and 0.021, respectively). Also, PwM had significantly lower Cr, Mg, and Zn levels among the trace elements (p = 0.007, 0.024, and < 0.001, respectively). The only trace element that was elevated in the PwM group was Mn (p = 0.001). The PwM and control groups did not differ in terms of Cd, Sn, Sb, Cu, Fe, and Mo (p = 0.165, 0.997, 0.195, 0.408, 0.440, and 0.252, respectively). CONCLUSION: Some HMTE parameters are altered in PwM, which may provide additional insight into understanding migraine etiology.

Adalimumab (Humira®) Induced Recurrent Peritonsillar Abscess in A Patient Received Three Different Anti-TNF Therapies: A Case Report.

Anti-tumor necrosis factor agents are widely used in treating ankylosing spondylitis, but they increase the risk of infection by suppressing the immune response. Therefore, physicians should be careful about recurrent infections in patients under anti-tumor necrosis factor agents.

The diagnostic and prognostic value of serum neurogranin in acute ischemic stroke.

OBJECTIVES: Stroke is a frequently encountered life-threatening medical condition in emergency departments (EDs). Despite all worldwide efforts, a reliable circulating biomarker has not been identified yet. This study investigates the diagnostic and prognostic value of neurogranin (Ng) in acute ischemic stroke (AIS). METHODS: This prospective case-control study was conducted on ED patients with AIS and healthy volunteers. We collected the basic demographics, measured serum Ng levels of the patients vs. controls, and followed up the patient group for 6-month by phone or clinical notes to assess the functional outcomes. RESULTS: Data analysis was completed with 142 subjects (86 patients vs. 55 controls). The groups did not differ in terms of age and gender. The median serum Ng level of the patient group was significantly higher compared to the control group [160.00 (75.93) vs. 121.26 (90.35) ng/mL and p Ë‚ 0.001, respectively]. Serum Ng level of 25 patients admitted to the ED within the first 6 hours from the onset of AIS was 177.93 (24.03) ng/mL, while serum Ng level of 61 patients admitted to the ED within 6-24 hours was 131.84 (76.44) ng/mL. AUROC results were 0.717 vs. 0.868 vs. 0.874 for stroke patients admitted during the first 24 hours, 6 hours, and 4.5 hours after the onset, respectively. Lesion volume, NIHSS, and modified Rankin Scale scores (mRS) at admission showed no significant correlation with Ng levels as well as 6-month mortality and 6-month mRS. CONCLUSIONS: Timely AIS diagnosis is still a challenge for emergency departments due to the dependency on imaging. Serum Ng can be a promising diagnostic biomarker for AIS patients admitted in the first 24 hours. Even it outperformed in the first 4.5 and 6-hour time windows. However, it did not show a significant prognostic value.

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.

Can calcitonin gene-related peptide (CGRP) and pentraxin-3 (PTX-3) be useful in diagnosing acute migraine attack?

PURPOSE: Even if migraine is not fatal, it is a common and challenging disease with adverse effects on individuals' lives. The lack of objective diagnostic tools causes delays in diagnosis and treatment initiation. The primary aim of this study is to reveal the diagnostic value of Calcitonin Gene-Related Peptide (CGRP) and Pentraxin-3 (PTX-3) in acute migraine. To this aim, we compared the serum CGRP and PTX-3 levels of migraine patients with acute attacks to those in healthy individuals. MATERIAL AND METHOD: A total of 135 individuals (85 patients with migraine attacks with or without aura and 50 healthy controls) participated in the study. Serum CGRP and PTX-3 levels were measured with ELISA analysis. A p value less than 0.05 was considered significant. RESULTS: Serum CGRP [146.70 (21.52-413.67) vs. 65.90 (3.80-256.60) pg/mL] and PTX-3 levels [12.71 (0.62-33.97) vs. 1.01 (0.06-9.48) ng/mL] were higher in patients with migraine attack than the control group (p < 0.01 and p < 0.01, respectively). ROC analysis showed that the cutoff value for serum CGRP was 121.39 pg/mL (AUC: 0.751, Sen:%61, Spe:%64) whereas the cutoff value for PTX-3 was 4,06 ng/mL (AUC:0.876, Sen:%73, Spe:%76). Serum CGRP levels were positively correlated with pain intensity. Serum CGRP and PTX-3 levels did not differ across gender groups and presence of aura in subgroup analysis. CONCLUSION: Patients with acute migraine attacks have higher serum CGRP and PTX-3 levels than controls. Both biomarkers show high potential for the diagnosis of a migraine attack.

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.

The diagnostic value of neurogranin in patients with carbon monoxide poisoning: Can it show early neurological damage?

BACKGROUND AND AIM: Carbon monoxide poisoning is a toxicological emergency that causes neurological complications. High serum neurogranin can be detected in acute or chronic conditions where brain tissue is damaged. This study aimed to investigate the diagnostic value of serum neurogranin level and its role in demonstrating neurological damage in patients admitted to the emergency department with carbon monoxide poisoning. MATERIALS AND METHODS: The study was conducted prospectively on patients with carbon monoxide poisoning (patient group) and healthy volunteers (control group). Demographic characteristics and serum neurogranin level of all participants and symptoms at admission, neurological examination findings, laboratory results, and Diffusion-Weighted Magnetic Resonance Imaging results of the patient group were recorded. We used an independent sample t-test to compare neurogranin levels and bivariate correlation analysis to compare the relationship between serum neurogranin levels and data belonging to the patient group. RESULTS: Sixty eight participants (patient group, n = 36; control group, n = 32) were included in the study. Serum neurogranin level was significantly higher in patients with carbon monoxide poisoning (0.31 ± 0.16 ng/ml) compared to control group (0.22 ± 0.10 ng/ml) (p = 0.015). The mean Glasgow Coma Scale of the patients with carbon monoxide poisoning was 14.59 ± 0.23, and of Diffusion Weighted Magnetic Resonance Imaging results were completely normal in 94.4% (n = 34). There was no correlation between serum neurogranin level and Diffusion Weighted Magnetic Resonance Imaging results (r = -0.011; p = 0.953). CONCLUSION: Serum neurogranin level may be a new diagnostic biomarker in patients admitted to the emergency department with carbon monoxide poisoning. The high serum neurogranin levels detected in patients with normal diffusion-weighted imaging after carbon monoxide poisoning suggest that there is neurological damage in these patients, even if imaging methods cannot detect it.

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.

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.

Simultaneous Presence of Juxtafacet Cyst and Ligamentum Flavum Hematoma.

Juxtafacet cysts and ligamentum flavum hematoma have the potential to cause acute root or spinal cord compression despite their low incidences. Their simultaneous presence with acute nerve compression has not been reported. Herein, we present a case who reported with low back and leg pain to the emergency department.

High-Grade Diffuse Large B-Cell Lymphoma of the Dura with Skull and Scalp Involvement with Simultaneous Sternum Involvement.

Diffuse large B-cell lymphoma (DBCL) is the largest subgroup of non-Hodgkin's lymphomas. Primary dural lymphoma, primary skull vault lymphoma, and primary sternum lymphoma are the rare lymphomas. We present the case of a 69-year-old patient with scalp, skull, and dura involvement that accompanying sternum involvement. It should be kept in mind that in the differential diagnosis of high-grade diffuse large B-cell lymphoma in patients presenting with a mass in the skull or sternum.

The Role of Temporal Lobectomy as a Part of Surgical Resuscitation in Patients with Severe Traumatic Brain Injury.

BACKGROUND: Traumatic brain injuries (TBIs) are serious morbidity and mortality risk for especially in the young population. Primary and secondary injury mechanisms may cause cerebral edema and intracranial hypertension. The target point of the TBI treatment is lowering the intracranial pressure medically or surgically if indicated. METHODS: The files of the patients with severe brain injury admitted between January 2015 and December 2017 were reviewed retrospectively. Patients who underwent decompression surgery due to severe brain injury ([The Glasgow Coma Scale [GCS] score] <8) and additional temporal lobectomy were included in the study group. RESULTS: Ten patients were included in the study during the 3 years. All the patients were suffering from blunt severe TBI. Traumatic etiology was vehicle traffic accident in six cases, nonvehicle traffic accident in two cases, and falling from height in two cases. All the cases suffered from blunt trauma. The admission GCS of the patients was 4-7 (mean = 5.5). Right-sided decompression surgery and lobectomy were performed for seven patients and left-sided in three cases. The postoperational survival was 60%. All the survivors were functionally independent with mild cognitive disturbances. CONCLUSION: Temporal lobectomy might be added to the surgery to apply all the interventions available in combat with progressively increasing intracerebral pressure as a part of surgical resuscitation.

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.