RESUMEN
BACKGROUND: In earthquakes and other natural disasters, there is a significant number of injuries directly resulting from trauma. Additionally, due to the disaster's impact on overloaded health institutions, healthcare providers face significant challenges during earthquakes. In this context, nearby hospitals providing health services play a crucial role. Nonetheless, with proper planning, the health crisis can be managed in the best possible way. METHODS: A single-center retrospective study was conducted on patients admitted to Mersin City Training and Research Hospital due to injuries attributed to the earthquake that occurred in the southern and mid-eastern regions of Türkiye on February 6, 2023. A total of 2,155 patients meeting the study criteria were included in the analysis. RESULTS: Of the 2,155 patients enrolled in the study, 46.8% (n=1009) were male, with a mean age of 45.86±17.68 years. Falls (57.2%, n=1233) were the most common mechanism of injury, and 71.9% (n=1550) of cases presented to the hospital on their own. Among the head injuries, the most common types were soft tissue injury and lacerations, while soft tissue injury and rib fractures were most common in the thoracic region. Soft tissue injury and retroperitoneal bleeding were the most commonly recorded types among abdominal injuries, whereas soft tissue injury and fractures were most common in the upper and lower extremities. Fractures were identified in 11.1% (n=240) of cases in the upper extremities and 21.3% (n=458) in the lower extremities. Rhabdomyolysis was one of the most frequently observed injury types (n=443, 20.6%). Crush syndrome and acute kidney injury were recorded in 9.2% (n=198) of cases, leading to a total of 46 amputations in 40 (1.8%) patients and 164 fasciotomies in 132 (6.1%) patients. The orthopedics department performed the most frequent surgical interventions and hospitalizations. Mortality was noted in 2.87% (n=62) of cases. CONCLUSION: This study demonstrated a significant increase in workload and patient volume following the earthquake. There is a need for a large number of healthcare professionals for expedient intervention in conditions such as fractures, crush syndrome, amputation, and fasciotomy in disasters with a high risk of serious trauma, such as earthquakes. Disaster planning and preparedness for possible consequences will mitigate the healthcare crisis involving the hospitals and lead to significant reductions in mortality and morbidity.
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Terremotos , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Turquía/epidemiología , Heridas y Lesiones/epidemiología , Anciano , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Emergency departments (EDs) are typically the first medical contact for seizure patients, and early diagnosis and treatment is primarily the responsibility of emergency physicians. OBJECTIVES: Demonstrate the efficacy of bedside ocular ultrasonography for optic nerve sheath diameter (ONSD) measurement in differentiating provoked seizure from unprovoked seizure in the ED. DESIGN: Prospective observational study SETTINGS: Tertiary care hospital PATIENTS AND METHODS: Patients presenting to the ED with seizure were divided into two groups according to medical history, physical examination, laboratory results, cranial computed tomography findings and electroencephalography results. Patients with seizures that did not have a specific cause (unprovoked) were compared with patients who had seizures caused by underlying pathology (provoked). The measurement of the ONSD was taken at the bedside within 30 minutes of arrival. The study compared the ONSD values, age, sex, type of seizure, and Glasgow Coma Score between the two groups. MAIN OUTCOME MEASURE: Efficacy of ONSD to distinguish between provoked and unprovoked seizures. SAMPLE SIZE: 210 patients RESULTS: One hundred and fourteen (54.3%) patients were in the provoked seizure group and 96 (45.7%) were in the unprovoked seizure group. The ONSD measurements were significantly higher in the provoked seizure group compared with the unprovoked seizure group (median 6.1 mm vs. 5.2 mm, P<.001). The cut-off value of ONSD higher than 5.61 was significantly associated with the prediction of the provoked seizure (P<.001). The area under the curve value was 0.882 (95% CI: 0.830-0.922) with a sensitivity of 86.5 and specificity of 78.9%. CONCLUSIONS: Bedside ONSD measurement by means of ocular ultrasound is an effective method for differentiating provoked seizure from unprovoked seizure. LIMITATIONS: Statistical significance of age on ONSD and exclusion of pediatric patients. CONFLICT OF INTEREST: None.
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Hipertensión Intracraneal , Humanos , Niño , Hipertensión Intracraneal/diagnóstico , Hipertensión Intracraneal/etiología , Hipertensión Intracraneal/patología , Nervio Óptico/diagnóstico por imagen , Nervio Óptico/patología , Convulsiones/diagnóstico por imagen , Convulsiones/complicaciones , Servicio de Urgencia en Hospital , Ojo , UltrasonografíaRESUMEN
Background: Nonalcoholic fatty liver disease (NAFLD) has shown to be associated with coronary artery disease (CAD). Objectives: The aim of our study was to evaluate the association between the presence and severity of CAD and NAFLD. Methods: The study group consisted of 153 patients who underwent coronary angiographies. Patients were categorized into CAD and non-CAD groups. CAD severity was determined by the number of CAD-involved arteries and the vessel score multiplied by Gensini score, the latter judging CAD severity. Fatty liver was diagnosed by abdominal ultrasonography (USG), with the patients being categorized by the degree of hepatosteatosis, as Grade 0, Grade 1, and Grade 2-3. Results: Among the whole study population, 47.1% of patients (n=72) were female and 52.9% of patients (n=81) were male. Forty-three patients had normal coronary arteries; 27 patients had non-critical CAD and side branch disease; and 83 patients had clinically significant CAD (stenosis>50%). The rate of CAD and Gensini score were significantly different between Grade 0, 1 and 2-3 hepatosteatosis groups (p<0.05). Patients with CAD had a significantly higher AST level than those without (p< 0.05). Conclusions: Ultrasonographically detected hepatosteatosis independently predicts the presence and severity of CAD.
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Enfermedad de la Arteria Coronaria , Enfermedad del Hígado Graso no Alcohólico , Humanos , Masculino , Femenino , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Enfermedad del Hígado Graso no Alcohólico/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Angiografía Coronaria , UltrasonografíaRESUMEN
OBJECTIVE: In this study, we aimed to contribute to the literature by evaluating bonsai and additional drugs. MATERIALS AND METHODS: This prospective study was conducted on 217 patients who admitted to the emergency department (ED) with bonsai intake between December 20, 2014 and January 1, 2016, according to the patient history obtained from the patients. While 168 patients with negative urinary metabolites results were excluded from the study, 49 patients with positive urinary metabolites were included in the study. Patients were divided into two groups. The first group consisted of patients with only bonsai intake and the second group consisted of patients with bonsai and concomitant drug intake. The groups were compared in terms of symptoms, findings, blood gas values, duration of the symptoms, discharge time, hospitalization, and mortality rate. Data were analyzed using the Chi-square, the Fisher's exacttest, the Student t-test, and the Mann-Whitney U test. Data were evaluated at the 95% confidence interval. P<0.05 was considered statistically significant. RESULTS: The mean age of 49 patients included in the study was 26.7±8.9 years and 91.8% (n=45) of the patients were male. Concomittant drug intake was identified in 69.4% of patients. Concomitant drug use was as follows: cocaine (20.4%, n=10), amphetamines (14.3%, n=7), methamphetamines (8,2%, n=4,) tetrahydrocannabinol (32.7%, n=16), opiates (18.4%, n=9) and alcohol (30.6%, n=15). On admission, Glasgow Coma Score (GCS) of the bonsai with additional substance group was significantly higher (p=0,003). The most common symptom was palpitations (tachycardia) (75.5%, n=37). There were no patients hospitalized in Only Bonsai group (p=0,020). The median time to remission of symptoms and median follow-up time of the patients in the emergency room were 3 hours and 6 hours, respectively. Remission time of the symptoms and hospitalization rates were higher in patients with concomittant drug intake (p <0.05) Conclusion: While the bonsai intake alone is not considered mortal to the patients and most of them can be discharged from the ED after signs and symptoms disappear, concomitant drug use can increase the toxic effects of bonsai intake. That is why follow-up of patients taking concomitant drug and the treatment process should be carried out more carefully.
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Cannabinoides , Trastornos Relacionados con Sustancias/complicaciones , Adolescente , Adulto , Cannabinoides/efectos adversos , Servicio de Urgencia en Hospital , Femenino , Hospitalización , Humanos , Masculino , Estudios Prospectivos , Adulto JovenRESUMEN
OBJECTIVE: It was aimed to compare the efficacy of point-of-care ultrasonography (POCUS) with radiography in the diagnosis and management of metatarsal fracture (MTF). METHODS: Patients aged 5-55 years admitted to emergency room due to low-energy, simple extremity trauma and had a suspected MTF, were included in this prospective study. Patients were evaluated by two different emergency physicians in the emergency room. The first physician performed POCUS examination. Second physician evaluated the radiography images. The obtained results were compared. RESULTS: Seventy-two patients were enrolled in the study. Fracture was detected in 39% by radiography and in 43% of patients by POCUS. Multiple MTFs were identified in 5% of patients. Compared with radiography, POCUS had a sensitivity of 93%, specificity of 89%, positive predictive value of 84% and a negative predictive value of 95% (95% CI, 83-98%) in the detection of fractures. While soft tissue edema was seen in 61% of patients by POCUS, soft tissue edema with hematoma was detected in 14%. Compared with radiography, the sensitivity and specificity of POCUS in the decision for surgery were 100% and 98% (95% CI, 97-100%), respectively, whereas its sensitivity and specificity were both 100% in the decision for reduction. CONCLUSION: In our study, we demonstrated that POCUS could be applied with success in the diagnosis and treatment of MTF in low-energy injuries. POCUS can be used as an alternative to radiography in the emergency rooms due to being easy to learn and practice and availability of soft tissue examination along with bone tissue examination.
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Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/terapia , Huesos Metatarsianos/diagnóstico por imagen , Sistemas de Atención de Punto , Radiografía , Ultrasonografía , Adolescente , Adulto , Niño , Preescolar , Femenino , Fracturas Óseas/diagnóstico , Fracturas Óseas/patología , Humanos , Masculino , Huesos Metatarsianos/lesiones , Huesos Metatarsianos/patología , Persona de Mediana Edad , Sistemas de Atención de Punto/estadística & datos numéricos , Estudios Prospectivos , Sensibilidad y Especificidad , Turquía , Adulto JovenRESUMEN
Acute pulmonary embolism (PE) carries a high risk of morbidity and mortality. Delays in diagnosis or therapy may result in sudden, fatal deterioration; therefore, rapid diagnosis and an appropriate therapeutic approach are needed. We aimed to investigate the effect of delaying thrombolytic administration on the mortality rate in a suspected PE. We retrospectively analyzed 49 consecutive patients who were aged 18 years or older and received thrombolysis for a high-risk PE without a major contraindication. All patients were classified according to the time of onset of the thrombolytic therapy. Patients experiencing cardiopulmonary arrest were analyzed from the time of admission to thrombolytic administration with 10-minute cutoff values. Data were analyzed by a regression analysis and a receiver operating characteristic (ROC) analysis for significant and independent associated risk factors and in-hospital mortality. Mortality was seen in 17 of the 49 cases. Thirteen of these had received thrombolytic therapy 1 hour after their emergency department (ED) admission. Among all cases, the mortality rate was 35%. The ROC analysis indicated that a > 97-second delayed thrombolytic administration time was associated with mortality with 53% sensitivity and 91% specificity (area under the curve, 0.803; 95% confidence interval, 0.668-0.938). In the logistic regression, a 5-minute delay in thrombolytic therapy (beta = 1.342; 95% confidence interval, 1.818-2.231; p = 0.001) was associated with in-hospital mortality in the multivariable model. No major bleeding complications were seen in PE survivors. We conclude that early onset thrombolytic therapy in the ED for high-risk and hemodynamically worsening patients appears safe and life-saving.
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Servicio de Urgencia en Hospital , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/mortalidad , Terapia Trombolítica , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Demografía , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Pulmonar/patología , Embolia Pulmonar/diagnóstico por imagen , Curva ROC , Análisis de RegresiónRESUMEN
OBJECTIVE: In this study, emergency physicians and on-call radiologists were compared regarding identification of fatal injuries on computed tomographic (CT) scans in patients with trauma. MATERIALS AND METHODS: Multiply injured patients who were older than 18 years and underwent CT scanning were included in the study. The CT scans were interpreted by the responsible emergency physician. At the same time, these images were also evaluated by the on-call radiologist. Final evaluation was done 1 week later by a radiology instructor who knew the clinical follow-up of the patient. RESULTS: The study included 156 patients. The mean age of the patients included in the study was found to be 41.6 years. Less than half (33.5%) of the patients were female and 86.5% were male. A total of 482 CT scans were performed in the patients. Regarding brain CTs, the concordance rate for emergency physicians was 98%, whereas it was 94% for on-call radiologists. Regarding thoracic CTs, the concordance rate for emergency physicians was 91%, whereas was 93% for on-call radiologists. There was a perfect concordance (κ value > 0.75) for on-call radiologists and emergency physicians in terms of brain and thoracic CTs. Regarding abdominal-pelvic CTs, the concordance rate for emergency physicians was 97%, whereas it was 98% for on-call radiologists. Moderate concordance (κ range = 0.40-0.75) was detected for emergency physicians in terms of identification of liver, spleen, kidney, and intra-abdominal/retroperitoneal hemorrhages. There was a perfect concordance (κ value > 0.75) for pelvic fractures. CONCLUSION: In this study, it was shown that emergency physicians were successful in identifying fatal injuries on trauma CT images after a short-term training on interpretation of trauma CTs.
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Traumatismos Abdominales/diagnóstico por imagen , Medicina de Emergencia , Hemorragia/diagnóstico por imagen , Traumatismo Múltiple/diagnóstico por imagen , Radiología , Tomografía Computarizada por Rayos X , Adulto , Lesiones Encefálicas/diagnóstico por imagen , Competencia Clínica , Servicio de Urgencia en Hospital , Femenino , Fracturas Óseas/diagnóstico por imagen , Humanos , Riñón/diagnóstico por imagen , Riñón/lesiones , Hígado/diagnóstico por imagen , Hígado/lesiones , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/lesiones , Bazo/diagnóstico por imagen , Bazo/lesiones , Traumatismos Torácicos/diagnóstico por imagen , Adulto JovenRESUMEN
OBJECTIVE: In this study, we aimed to identify oxidative stress and the disruption in the oxidant-antioxidant balance in the acute phase of stroke and, therefore, to detect markers that will guide in the diagnosis and treatment of stroke. MATERIALS AND METHODS: Eighty-six patients who were admitted to Antalya Training and Research Hospital Emergency Department between June 2013 and December 2013 and who were diagnosed as having stroke were enrolled in this study. The control group consisted of 40 healthy volunteers. Blood samples collected from all participants were screened for albumin, ischemic modified albumin (IMA), IMA/albumin ratio (IMAR), total antioxidant status, total oxidant status (TOS), and oxidative stress index (OSI). RESULTS: Sixty (70%) patients were diagnosed as having acute cerebral infarction (ACI) and 26 (30%) as having acute intracerebral hemorrhage (AIH). Statistically significant difference was found between AIH and control groups in terms of albumin, IMAR, TOS, OSI levels (P < .001, P < .001, P < .001, and P < .001, respectively). Statistically significant difference was found between ACI and control groups in terms of albumin, IMA, IMAR, TOS, and OSI levels (P < .001, P = .045, P < .001, P < .001, and P < .001, respectively). There was no difference between ACI patients with detected acute infarcts on cranial computed tomographic scans (n = 31) and ACI patients with normal cranial computed tomography results (n = 29) in terms of oxidant-antioxidant levels. There was a significant difference between patients admitted within 3 hours and healthy adults regarding the levels of IMAR, TOS, and OSI (P < .001, P < .001, and P < .001, respectively). DISCUSSION AND CONCLUSION: It was seen that oxidant-antioxidant balance was impaired in favor of oxidants in ACI and AIH. In addition, impairment in oxidant-antioxidant balance was found in the early stages of ACI. Therefore, these biomarkers can be used especially in the early diagnosis of thrombolytic therapy candidates in ACI.
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Antioxidantes/química , Oxidantes/sangre , Estrés Oxidativo , Accidente Cerebrovascular/sangre , Adulto , Biomarcadores/sangre , Estudios de Casos y Controles , Servicios Médicos de Urgencia , Femenino , Humanos , Masculino , Albúmina Sérica/química , TurquíaRESUMEN
OBJECTIVE: The objective of the study was to compare the efficacy of point-of-care ultrasound (POCUS) and computed tomography (CT) in the diagnosis of the fracture of the bones that form the elbow joint and the determination of treatment method in elbow injuries. METHODS: Forty-nine patients aged 5 to 65 years, who were admitted with low-energy elbow injuries, had at least 1 fracture of the elbow joint bones, and underwent CT scanning, were included in this study. Before the initiation of the study, orthopedic surgeons and emergency physicians determined a common treatment based on the fracture characteristics. Patients were first evaluated with direct radiography, and then with POCUS by trained emergency physicians. Emergency physicians made treatment decisions based on the ultrasonography results. Then, CT scans were performed. The CT images were interpreted by radiologists. Orthopedic surgeons made treatment decisions based on the CT interpretations. RESULTS: Forty-nine patients with elbow injury were included in the study. Eighteen (37%) patients were women, and 31 (63%) were men. The mean age was 21 ± 15 years. Compared with CT, sensitivity, specificity, positive predictive value, and negative predictive value of POCUS in fracture detection were 97%, 88%, 94%, and 93%, respectively. Although the sensitivity and specificity of POCUS in the decision for reduction were 95% and 100%, respectively, it was 93% and 100% in the decision for surgery. CONCLUSION: In conclusion, POCUS was shown to be successfully applied in the diagnosis and management of elbow injuries, in which direct radiography was inefficient and CT scans were required.
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Lesiones de Codo , Fracturas Óseas/diagnóstico por imagen , Sistemas de Atención de Punto , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodos , Adolescente , Adulto , Niño , Preescolar , Articulación del Codo/diagnóstico por imagen , Femenino , Fracturas Óseas/terapia , Humanos , Fracturas del Húmero/diagnóstico por imagen , Fracturas del Húmero/terapia , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/terapia , Fracturas del Cúbito/diagnóstico por imagen , Fracturas del Cúbito/terapia , Adulto JovenRESUMEN
OBJECTIVE: The aim of this study is to detect the value of point-of-care ultrasound (POCUS) for diagnosing a nail bed injury and fracture of distal phalanx in patients presenting with distal finger trauma to the emergency department (ED). METHODS: Patients, 18 to 65 years old, presenting with a blunt trauma of distal finger and diagnosed with subungual hematoma were eligible for the study. Subungual hematoma extending over more than 50%, fracture of distal phalanx, and disruption of periungual tissue or nail integrity were accepted as the indications for nail bed inspection. All the study patients underwent POCUS to detect the existence of a distal phalanx fracture or nail bed injury. X-ray was also obtained from all the patients. RESULTS: Nail bed was visualized in 45 patients. Squeezing and crush injury were the most reported trauma mechanism in study patients (66.7%). The sensitivity and specificity of POCUS in detecting nail bed injury were 93.4% (95% CI, 80%-99%) and 100% (95% CI, 74%-100%), respectively. The sensitivity was 100% (95% CI, 79%-100%), and specificity was 98.4% (95% CI, 91%-100%) for distal phalanx fracture. CONCLUSION: Point-of-care ultrasound is a promising tool in detecting the nail bed injury and distal phalanx fractures in patients presented with distal finger trauma. Further studies with bigger sample size are needed to reveal the diagnostic ability of POCUS before using it regularly in the ED.
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Servicio de Urgencia en Hospital , Traumatismos de los Dedos/diagnóstico , Uñas/lesiones , Sistemas de Atención de Punto , Ultrasonografía/métodos , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Uñas/diagnóstico por imagen , Proyectos Piloto , Estudios Prospectivos , Reproducibilidad de los Resultados , Adulto JovenAsunto(s)
Electrocardiografía/estadística & datos numéricos , Embolia Pulmonar/diagnóstico , Enfermedad Aguda , Electrocardiografía/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Embolia Pulmonar/fisiopatología , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Ocular ultrasonography of optic nerve sheath diameter (ONSD) to determine intracranial pressure (ICP) has become favorable in recent years. OBJECTIVE: To demonstrate the efficacy of ONSD measurement in determining the ICP increase due to nontraumatic events in the emergency department. METHODS: A total of 100 patients with suspected nontraumatic intracranial event were enrolled in this prospective study. Patients were divided equally into 2 groups including 50 patients as group I with pathology on cranial computed tomography (CT) and group II with normal cranial CT. Prior to CT scans, patients underwent ONSD measurement by a radiologist using 11- and 14-MHz transducers. RESULTS: The ONSD values of groups I and II were 5.4±1.1and 4.1±0.5mm, respectively. Optic nerve sheath diameter was found to be larger on the side of lesion in patients with a lesion (P<.05). The cutoff value of the difference between ONSD values of both eyes in the presence of pathology was determined as 0.45 (sensitivity, 80%; specificity, 60%; the area under the curve, 0.794; 95% confidence interval, 0.705-0.883). The between-ONSD and midline shift size was statistically significant (r=0.366, P=.009). The cutoff value of ONSD for the detection of midline shift was determined as 5.3mm (sensitivity, 70%; specificity, 74%; the area under the curve, 0.728; 95% confidence interval, 0.585-0.871). CONCLUSION: Optic nerve sheath diameter measurement via bedside ocular ultrasonography in patients with suspected intracranial event in the emergency department is a useful method to determine ICP increase and its severity.
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Servicio de Urgencia en Hospital , Hipertensión Intracraneal/diagnóstico por imagen , Nervio Óptico/diagnóstico por imagen , Pruebas en el Punto de Atención , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
OBJECTIVE: To evaluate the effect of hyponatraemia on pulmonary thromboembolism mortality rates. METHODS: The retrospective study was conducted at the Cumhuriyet University Medicine Faculty's Emergency Department, and involved the analysis of records related to all patients who were diagnosed with acute pulmonary thromboembolism between January 2005 and June 2011. Diagnoses were confirmed by pulmonary angiography, multi-slice computed tomography or high-probablity ventilation/perfusion scintigraphy. All patients (n=260) were over 16 years of age. SPSS 14 was used for statistical analysis. RESULTS: Plasma sodium level, platelet count and hospitalisation time were significiantly lower among those who died (n=16; 6.29) (p<0.005, p<0.035, p<0.035). Pearson correlation analysis found a negative correlation between plasma sodium level and C-reactive protein, white blood cells and pulmonary artery pressure (r = -0.238, p<0.001; r = -0.222, p<0.001; r = -0.444, p<0.018 respectively). A positive correlation was found between plasma sodium level and hospitalisation time (r=0.130; p<0.039). CONCLUSION: While mortality rates in hyponatraemic pulmonary thromboembolism patients increases, low plasma sodium is an easy parameter that should be kept in mind for the prognosis of pulmonary thromboembolism disease.
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Hiponatremia/complicaciones , Embolia Pulmonar/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Angiografía , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Embolia Pulmonar/diagnóstico por imagen , Cintigrafía , Estudios Retrospectivos , Estadísticas no Paramétricas , Tomografía Computarizada por Rayos X , Turquía/epidemiologíaRESUMEN
BACKGROUND: Pregnancy can precipitate cardiac arrhythmias not previously present in seemingly well individuals. Atrial and ventricular premature beats are frequently present during pregnancy and are usually benign. Supraventricular tachycardia and malignant ventricular tachyarrhythmias occur less frequently. Maternal and fetal arrhythmias occurring during pregnancy may jeopardize the life of the mother and the fetus. CASE REPORT: A 32-year-old pregnant women at 26 weeks gestation presented to the emergency department with palpitation. She had mild chest discomfort after a supraventricular tachycardia (SVT) episode but did not have syncope. After monitoring and access of an IV line, vagal manoeuvres were applied but the rhythm was resistant. Then she was treated with 5 mg metoprolol IV, but the SVT persisted. Then after IV infusion of adenosine triphosphate 6 to 12 mg, the rhythm was resistant. Synchronized cardioversion with 100 joules was performed. Patients' rhythm was normalized to a sinus rhythm. She was discharged from hospital without any adverse effects following 24-hour monitoring. CONCLUSIONS: All pregnant patients with SVT require careful maternal and fetal monitoring during treatment, and close collaboration between the managing obstetrician and the cardiologist is essential.
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Molecular biology tools targeting 16S ribosomal RNA (16S rRNA) were used to identify a predominant bacterial population in a full-scale dairy wastewater activated sludge system suffering from poor biosolids separation. Gram and acridine orange staining indicated that viable, Gram-positive microorganisms were present in samples removed from the influent waste stream and represented approximately 50% of total cell counts in samples removed from the mixed liquor. Subsequently, the "full-cycle 16S rRNA approach" showed that phylogenetic relatives of Paenibacillus spp., a low guanine-plus-cytosine percent DNA-content, Gram-positive microorganism, represented up to 30% of total 4,6-diamidino-2-phenylindole (DAPI)-stained cell counts in samples of mixed liquor. Although fluorescent in situ hybridizations with 16S rRNA-targeted oligonucleotide hybridization probes identified Paenibacillus-like spp. in samples removed from the influent waste stream, their abundance was less than 10% of total stained cell counts. Results of this study suggest that Paenibacillus-like spp. were present in low abundance in the influent waste stream, increased in relative abundance within the treatment system, and should be examined further as a candidate bacterial population responsible for poor biosolids separation. This study demonstrates that the full-cycle 16S rRNA approach can be used to identify candidate bacterial populations that may be responsible for operational upsets in full-scale activated sludge systems without prior information from cultivation or microscopic analyses.