Correlation of CAT Score With Peak Expiratory Flow in Acute Exacerbation of COPD Patients.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) leads to physical activity limitation and a significant reduction in quality of life. This study aimed to investigate the correlation between The COPD Assessment Test (CAT) score and peak expiratory flow (PEF), and the factors effecting hospital admission rates of patients with COPD. METHODS: This observational study was conducted prospectively. CAT score was calculated and PEF measured at the time of emergency department admission. Descriptive statistics were expressed as number (n), percentage (%), and mean ± standard deviation. Chi-Square and correlation tests were used for statistical analyses. A p value of less than 0.05 was considered statistically significant. RESULTS: Of 123 patients included in the study, 85 (69.1%) were male and 38 (30.9%) were female. Pulse pressure, pH, blood urea nitrogen, oxygen saturation measured by pulse oximetry (SpO2), PO2, PCO2, and SpO2 values on arterial blood gas analysis, and PEF value were significantly correlated to CAT score (p < 0.05). CONCLUSION: High CAT score and low PEF value can be used to make the decision of hospitalization from emergency department in acute exacerbations of COPD.

Importance of red blood cell distribution width (RDW) in patients with upper gastrointestinal haemorrhage.

OBJECTIVE: To explore the effect of red blood cell distribution width levels on the diagnosis and management of upper gastrointestinal haemorrhage. METHODS: The retrospective study was conducted at Ankara Numune Education and Research Hospital, Turkey, and comprised record of patients diagnosed with upper gastrointestinal haemorrhage from January 1, 2013, to December 31, 2013. Factors analysed were age, gender, red blood cell distribution width level, admission haemoglobin and haematocrit levels, endoscopy findings classified according to the Forrest system, comorbid diseases, use of medications, unhealthy habits like alcohol usage and smoking, and mortality rate. RESULTS: Of the 147 patients, 93(64%) were men. The overall median age of the sample was 60 years. Besides, 117(79.6%) patients had comorbid diseases, of which hypertension 56(38.4%) was the most common. A total of 24(16.8%) patients were using antiplatelet or anticoagulant drugs, while 30(20.5%) were on non-steroidal anti-inflammatory drugs. Peptic ulcer in 128(87.1%) patients was the most common cause of haemorrhage. The median red blood cell distribution width level of the study population was 15.25% which was significantly higher compared to the reference values (p<0.05).. In contrast, haemoglobin 9.55% (3.7) and haematocrit 28.75% (10.8)were significantly lower (p<0.05). Mortality rates were significantly higher in patients with higher red blood cell distribution width values (p<0.05). CONCLUSIONS: Red blood cell distribution width levels were higher during the acute phase of upper gastrointestinal haemorrhage.

Smart-Grid Backbone Network Real-Time Delay Reduction via Integer Programming.

This research investigates an optimal delay-based virtual topology design using integer linear programming (ILP), which is applied to the current backbone networks such as smart-grid real-time communication systems. A network traffic matrix is applied and the corresponding virtual topology problem is solved using the ILP formulations that include a network delay-dependent objective function and lightpath routing, wavelength assignment, wavelength continuity, flow routing, and traffic loss constraints. The proposed optimization approach provides an efficient deterministic integration of intelligent sensing and decision making, and network learning features for superior smart grid operations by adaptively responding the time-varying network traffic data as well as operational constraints to maintain optimal virtual topologies. A representative optical backbone network has been utilized to demonstrate the proposed optimization framework whose simulation results indicate that superior smart-grid network performance can be achieved using commercial networks and integer programming.

Infections of Ligula intestinalis on Freshwater Fish in Kars Plateau of North-Eastern Anatolia, Turkey.

OBJECTIVE: This study was conducted to determine the prevalence of Ligula intestinalis and infections caused by these on freshwater fish in rivers and streams in the Kars plateau of north-eastern Anatolia, Turkey. METHODS: This research was conducted between April and July 2011. Fish samples were caught via a casting net and an electro-shocker. The samples were immediately examined to determine the prevalence of L. intestinalis plerocercoids. RESULTS: In this research, 310 stream fishes were studied to determine the prevalence of L. intestinalis plerocercoids. Detected fishes included 55.8% Capoeta capoeta, 24.2% Squalius cephalus, 11.0% Alburnus filippii, 5.8% Barbus plebejus lacerta, and 3.2% Alburnoides bipunctatus. L. intestinalis plerocercoids were found in 2.6% (8/310) of the examined fishes. The percentage of this parasite was found to be 38.9% (7/18) on B. plebejus lacerta and 0.6% (1/173) on C. capoeta. L. intestinalis plerocercoids were not observed on the other three fish species (S. cephalus, A. filippii, and Al. bipunctatus). CONCLUSION: In this study, L. intestinalis plerocercoids were reported for the first time in the Kars stream and its distributaries on the Kars plateau in north-eastern Anatolia, Turkey.

Analysis of the correlation between blood glucose level and prognosis in patients younger than 18 years of age who had head trauma.

OBJECTIVE: To analyze the correlation between early-term blood glucose level and prognosis in patients with isolated head trauma. METHODS: This study included a total of 100 patients younger than 18 years of age who had isolated head trauma. The admission blood glucose levels of these patients were measured. Age at the time of the incident, sex, mode of occurrence of the trauma, computed tomography findings, and GCSs were recorded. Kruskall Wallis test was used compare of groups. A p value less than 0.05 was considered statistically significant. RESULTS: The median age of the study population was 7 years and the median GCS was 11. There was a significant negative correlation between blood glucose level and GCS (p < 0.05). A significant correlation in the negative direction was observed between GCS and blood glucose level (r = -0.658, p < 0.05). Seventy-seven percent of the patients were admitted to hospital, while 6% died in ED. CONCLUSION: The results of the present study suggest that hyperglycemia at an early stage and a low GCS may be reliable predictors of the severity of head trauma and prognosis. A higher blood glucose level may be an ominous sign that predicts a poor prognosis and an increased risk of death.

The value of serum NGAL in determination of dialysis indication.

OBJECTIVE: To investigate if Neutrophil Gelatinase-associated Lipocalin can be used or not as a biochemical marker to determine the indications for emergency dialysis treatment. METHODS: The study was conducted at the Emergency Department of Numune Taraining and Research Hospital, Ankara, Turkey, in 2012, and comprised 60 patients who had uraemic symptoms and abnormal laboratory tests, including elevated potassium, blood urea nitrogen, and creatinine level or lowered pH and bicarbonate. They were divided in to 2 equal groups as those having indication for dialysis (Group 1) and those not having such indications (Group 2). Relevant values, including that of Neutrophil Gelatinase-associated Lipocalin, were compared between the two groups. To assess the utility of Neutrophil Gelatinase-associated Lipocalin measurements at varying cut-off values to predict indications for dialysis, a conventional receiver operating characteristic curve was generated and the area under the curve was calculated. P < 0.05 was considered statistically significant. RESULTS: The mean age of the 30 patients in Group 1 was 68.29 +/- 16.9 years, while in Group 2 it was 66.47 +/- 14.2 years (p < 0.65). The mean Neutrophil Gelatinase-associated Lipocalin level was 817.65 +/- 334.76ng/mL in Group 1 and 398.97 +/- 202.42 ng/mL in Group 2 (p < 0.001). The best cut-off level for Neutrophil Gelatinase-associated Lipocalin to predict emergency haemodialysis indication was 615 ng/mL with a sensitivity of 82% and a specificity of 80%, and the areas under curve was 0.84. CONCLUSION: Serum Neutrophil Gelatinase-associated Lipocalin level may be a determining parameter for indication of emergency haemodialysis.

The value of Serum BNP for diagnosis of intracranial injury in minor head trauma.

OBJECTIVE: Head injury is the main cause of death among individuals younger than 45 years old. Cranial Computerized tomography (CT) is commonly used for diagnosis of head injury. Brain Natriuretic Peptide (BNP) is a peptide originally isolated from brain ventricles. The main aim of this study is to investigate BNP as an indicator of head injury among patients presenting to emergency department (ED) with minor head trauma. METHODS: This was a prospective study conducted at the emergency department of the Numune Training and Research Hospital. A total of 162 patients who presented to the ED with minor head injury were enrolled. The patients were categorized into 2 groups as the cranial CT-negative and positive groups. The normality of the data was tested using One Sample Kolmogorov Smirnov test. Mann-Whitney U test was used to compare 2 independent groups while the Kruskal-Wallis test was utilized for comparison of more than 2 groups. A p-value of <0.05 was considered to be significant. RESULTS: Ninety-six (59.3%) patients were male and 66 (40.7%) were female. The cranial CT-negative group had a median BNP level of 14.5 pg/ml while the cranial CT-positive group had a median BNP level of 13 pg/ml. There was no statistically significant difference between these two groups for serum BNP levels (p > 0.05). CONCLUSION: This study suggested that serum BNP level wasn't used in defined of intracranial injury.

Occupational injury patterns of Turkey.

INTRODUCTION AND AIM: Each year, a significant number of people die or become handicapped due to preventable occupational accidents or occupational diseases. The aim of this study was to investigate socio-demographic features, mechanism, causes, injury area, and sectoral features of occupational accidents in patients presented to our department. MATERIALS AND METHODS: The study was carried out retrospectively after local ethics committee approval. Age and sex of the patients, mechanism of injury, type and exact location of injuries were all evaluated. The groups were compared using Chi-Square test, Student's T test and Kruskall-Wallis test. p value <0.05 was accepted as statistically significant. RESULTS: Totally 654 patients were included in the study. 93.4% of patients were male, and mean age was 32.96 ± 5.97 (18-73) years. Sectoral distribution of accidents was statistically significant and mostly occurred in industrial and construction workers (p < 0.05, respectively). There is a statistically significant relationship between educational level and sector of the worker (p < 0.05). While the most frequent cause of admission to emergency department was penetrating injuries (36.4%), the least was due to multiple traumas (0.5%). Distribution of occupational accidents according to injury type was statistically significant (p < 0.05). The mean Injury Severity Score (ISS) was 9.79 ± 8.1. The mean cost of occupational injury was $1729.57 ± 8178.3. There was statistically significant difference between the sectors with respect to cost. Seventy-one patients (10.9%) recovered with permanent sequel and two (0.3%) died in hospital. CONCLUSION: Occupational accidents are most commonly seen in young males, especially in primary school graduated workers, and during daytime period.

Epidemiologic and clinical characteristics and outcomes of scorpion sting in the southeastern region of Turkey.

BACKGROUND: Scorpion sting resulting in envenomation is a life-threatening emergency and causes serious health problems in tropical and subtropical regions. The aim of this study was to present the epidemiologic and clinical features of 123 cases presenting with symptoms of scorpion poisoning, a cause of preventable mortality and morbidity. METHODS: This study retrospectively analyzed the epidemiologic and demographic features of a total of 123 patients who presented to Diyarbakir State Hospital Emergency Service with scorpion sting between January 2008 and December 2009. RESULTS: Among 123 patients who presented to Diyarbakir State Hospital Emergency Service with scorpion sting between January 2008 and January 2009, 62.6% (n=77) were female and 37.4% (n=46) were male. The mean age of the patients was 33.5±17.3 years (2-80), and 27 (22%) patients were younger than 18 years. The place of residence was rural region in 98 (79.7%) patients and the city center in 25 (20.3%). The majority of victims were stung by scorpions while they were at active work (42.3%) or asleep (19.5%) in bed. Eleven (8.95%) patients were stung by a scorpion while putting on their own clothes. CONCLUSION: This simple descriptive study will hopefully help healthcare providers take measures to prevent scorpion stings, which should take into consideration local epidemiological features.

An unusual presentation of ruptured abdominal aorta aneurysm.

PATIENT: Female, 65 FINAL DIAGNOSIS: Ruptured abdominal aorta aneursym Symptoms: - MEDICATION: - Clinical Procedure: After surgery the patient was discharged without sequelae Specialty: Surgery. OBJECTIVE: Unusual clinical course. BACKGROUND: Rupture of an abdominal aortic aneurysm is the most frightening and potentially life threatening complication of an abdominal aorta aneurysm (AAA). PATIENTs present with atypical symptoms such as abdominal or flank pain, gastrointestinal hemorrhage, or shock. CASE REPORT: A 65-year-old woman presented to our emergency department with gradually increasing left flank pain for 4-5 days. Her laboratory, radiologic, and physical examination revealed no significant pathology, so she was discharged, but 3 days later she was readmitted because her symptoms returned. Further research revealed a ruptured AAA and the patient was hospitalized for surgical intervention. CONCLUSIONS: Emergency physicians should keep in mind that AAA and its rupture can present with a wide range of symptoms that appear to be simple.

The value of serum mean platelet volume in ischaemic stroke patient.

OBJECTIVE: To investigate the value of serum Mean Platelet Volume in acute ischaemic stroke patients. METHOD: The retrospective case-control study was conducted at Ankara Numune Training and Research Hospital in Turkey and comprised record of patients of acute ischaemic stroke admitted to the Emergency Department between June 2010 and January 2012. The two groups were statistically compared using SPSS 18.0. RESULT: Overall, there were 482 stroke patients (Group 1) and 315 subjects as controls (Group 2). The median value in Group 1 was 9.0 (2.1) (fL), while in Group 2 it was 8.80 (2.4) (fL).The difference was statistically significant (Z = -2.80; p < 005). CONCLUSION: Mean Platelet Volume increased in the stroke patients.

Biometry of the fishes Barbus plebejus and Barbus capito from Coruh Basin, Turkey.

Metric and meristic characters are important to identify fish species and their habitat peculiarities. There are many species that belong to the fish genus Barbus, which is found in tropical and extratropical regions, but there are few studies covering the Coruh basin. Two subspecies of Barbus were found in the Coruh River system of Eastern Anatolia, Turkey: Barbus plebejus escherichi and Barbus capito capito. We collected specimens in seven localities for measurement. The number of vertebra were determined radiographically. Some specimens of B. capito capito have a sharper snout in the segments of Coruh where the water flows faster, suggesting a modification related to current. The biometric measurements vary geographically and could be related to abiotic and biotic factors in the habitat.

Biometry of the fishes Barbus plebejus and Barbus capito from Coruh Basin, Turkey

Metric and meristic characters are important to identify fish species and their habitat peculiarities. There are many species that belong to the fish genus Barbus, which is found in tropical and extratropical regions, but there are few studies covering the Coruh basin. Two subspecies of Barbus were found in the Coruh River system of Eastern Anatolia, Turkey: Barbus plebejus escherichi and Barbus capito capito. We collected specimens in seven localities for measurement. The number of vertebra were determined radiographically. Some specimens of B. capito capito have a sharper snout in the segments of Coruh where the water flows faster, suggesting a modification related to current. The biometric measurements vary geographically and could be related to abiotic and biotic factors in the habitat. Rev. Biol. Trop. 57 (1-2): 159-165. Epub 2009 June 30.