Exemplar deep and hand-modeled features based automated and accurate cerebral hemorrhage classification method.

BACKGROUND: Cerebral hemorrhage (CH) is a commonly seen disease, and an accurate diagnosis of the type of CH is a very crucial step in treatment. Therefore, CH requires a prompt and accurate diagnosis. To simplify this process, an accurate CH classification model is presented using a machine learning technique. MATERIAL AND METHOD: A computed tomography (CT) image dataset was collected retrospectively in this research. This dataset contains 9818 images with five categories. An exemplar fused feature generator is presented to classify these features. This generator uses pre-trained AlexNet, local binary pattern (LBP), and local phase quantization (LPQ). The neighborhood component analysis (NCA) method selects the top features, and the chosen feature vector is classified on the support vector machine. RESULTS: Six validation methods are utilized to calculate the performance of the presented exemplar fused features and NCA-based CH classification model. This model attained 97.47%, 96.05%, 95.21%, 93.62%, 91.28% and 96.34% accuracies using five hold-out validations and ten-fold cross-validation respectively. CONCLUSIONS: The calculated results clearly demonstrate the success and robustness of the introduced exemplar fused feature generation and NCA-based model. Furthermore, this model can be used in emergency services to overcome a prompt diagnosis of CH.

Y-stent assisted coiling of ruptured wide neck intracranial aneurysm in the acute phase.

BACKGROUND: The objective of the present study is to analyze the outcomes of patients with subarachnoid hemorrhage (SAH) in the acute phase after treatment with Y-stent-assisted coiling (YSAC) embolization. METHODS: This retrospective study assessed of 30 patients with acutely ruptured wide-neck aneurysms following YSAC treatment between April 2013 and October 2019. The demographic data, aneurysm occlusion grade, procedural and periprocedural complications, and clinical outcomes were assessed. RESULTS: The procedure was completed in 30 cases (90.1%) and technical failure occurred in 3 cases (9.1%). Immediate control angiography revealed that total occlusion Raymond-Ray Class 1 (RR1) was achieved in 21 (70%), neck filling (RR2) in eight (26.6%) and sac filling (RR1) in one (3.3%) aneurysm. Upon angiographic follow-up, RR1 occlusion was observed in 15 (71.4%) patients, RR2 in three (14.3%) patients and RR3 in three (14.3%) patients. In-stent thrombus developed in five (16.6%) patients; procedural ischemic events were observed in four (13.3%) patients; and two (6.6%) patients were symptomatic. A periprocedural asymptomatic intracranial hemorrhage was detected in two patients. At discharge, 17 (56.6%) patients were in good clinical condition, six (20%) were in a severe disability condition, and seven (23.3%) patients had died. At the final follow-up visit (mean: 18.9 months), 16 (76,2%) of 21 patients were in a good clinical condition and five (23.8%) had severe disabilities. CONCLUSIONS: Y-stent assisted coiling in might be a feasible and promising option for treatment in acute phase in selected wide-necked ruptured intracranial aneurysms.

Hoeing machine accident: a case report.

CONTEXT: Agricultural accidents are a prominent cause of mortality and morbidity in the literature despite few studies. The machines and equipments used in this sector frequently cause agricultural accidents. One of these, the hoeing machine, can cause tragic and severe injuries. ISSUE: We present a case of subtotal leg amputation that occurred after a hoeing machine accident in 2015 in Malatya, eastern Turkey. We monitored the patient and started initial therapies according to advanced trauma life support in the emergency service. However, his right leg was severely injured and had to be amputated. LESSONS LEARNED: Hoeing machine accidents lead to physical disabilities due to extreme injury and amputation.

Falls from height: A retrospective analysis.

BACKGROUND: Emergency services manage trauma patients frequently and falls from height comprise the main cause of emergency service admissions. In this study, we aimed to analyse the demographic characteristics of falls from height and their relationship to the mortality. METHODS: A total of 460 patients, who admitted to the Emergency Department of Inonu University between November 2011 and November 2014 with a history of fall from height, were examined retrospectively. Demographic parameters, fall characteristics and their effect to mortality were evaluated statistically. RESULTS: The study comprised of 292 (63.5%) men and 168 (36.5%) women patients. The mean age of all patients was 27±24.99 years. Twenty-six (5.6%) patients died and the majority of them were in ≥62 years old group. The highest percentage of falls was at 0-5 years age group (28.3%). People fell mainly from 1.1-4 metres(m) level (46.1%). The causes of falls were ordered as unintentional (92.2%), workplace (8.1%) and suicidal (1.7%). Skin and soft tissue injuries (37.4%) were the main traumatic lesions. CONCLUSION: Age, fall height, fall place, lineer skull fracture, subarachnoidal hemorrhage, cervical fracture, thoracic vertebra fracture and trauma scores had statistically significant effect on mortality. The casualties died because of subarachnoid hemorrhage mostly.

Falls from height: A retrospective analysis / 世界急诊医学杂志（英文）

BACKGROUND:Emergency services manage trauma patients frequently and falls from height comprise the main cause of emergency service admissions. In this study, we aimed to analyse the demographic characteristics of fal s from height and their relationship to the mortality. METHODS:A total of 460 patients, who admitted to the Emergency Department of Inonu University between November 2011 and November 2014 with a history of fall from height, were examined retrospectively. Demographic parameters, fall characteristics and their effect to mortality were evaluated statistically. RESULTS:The study comprised of 292 (63.5％) men and 168 (36.5％) women patients. The mean age of all patients was 27±24.99 years. Twenty-six (5.6％) patients died and the majority of them were in ≥62 years old group. The highest percentage of falls was at 0–5 years age group (28.3％). People fell mainly from 1.1–4 metres(m) level (46.1％). The causes of falls were ordered as unintentional (92.2％), workplace (8.1％) and suicidal (1.7％). Skin and soft tissue injuries (37.4％) were the main traumatic lesions. CONCLUSION:Age, fall height, fall place, linear skull fracture, subarachnoidal hemorrhage, cervical fracture, thoracic vertebra fracture and trauma scores had statistically significant effect on mortality. The casualties died because of subarachnoid hemorrhage mostly.

Prognostic Value of Procalcitonin, CRP, Serum Amyloid A, Lactate and IL-6 Markers in Liver Transplant Patients Admitted to ED with Suspected Infection.

BACKGROUND/AIM: Infections are one of the most important causes of mortality and morbidity after liver transplantation as in all transplantations. Infectious complications are known to be among the preventable causes with appropriate diagnosis and treatment. So early prediction of the risk of infections will provide an effective approach to determine the local antimicrobial resistance and prevention of specific risk factors. The aim of this study was to deterimne whether specific markers are useful or not to deterimne a suspected infection in patients that have undergone liver transplantation. PATIENTS AND METHODS: The study included 65 patients with liver transplantation admitted to emergency room with suspicion of infection. These patient's CRP, procalsitonin (PCT), lactate, SAA and IL-6 levels were initially measured in the emergency department. The patients were classified to three categories according to culture results; culture-negative, culture-positive and control group. Studying parameters were investigated according to whether the culture was positive or negative in these patients. RESULTS: CRP, PCT, lactate, SAA and IL-6 levels were significanlty high in patients with suspected infeciton when compared to the control group (p<0.05). CRP, PCT and IL-6 levels were higher in the culture-positive group than in the culture-negative group and there was a significant variation (p<0.05). When suspecting an infection evaluating the parameters CRP, PCT and IL-6 was very meaningfull (p<0.05). CONCLUSION: We can use CRP, PCT, lactate, SAA and IL-6 parameters to identify presence of infection at the liver transplantation patients admitted to the emergency department with suspected infection. If CRP, PCT and IL-6 levels are significantly high we can guess the patient's positive culture.

Acute patellar dislocation with multiple ligament injuries after knee dislocation and single session reconstruction.

Knee dislocation is a relatively rare condition of all orthopaedic injuries. Accompanying multiple ligament injuries are common after knee dislocations. A 41-year-old male presented to the emergency department suffering from right knee dislocation in June 2013. The patient had anterior cruciate ligament, medial collateral ligament (MCL), medial patellofemoral ligament (MPFL) rupture, and lateral meniscal tear. A single-bundle anatomic reconstruction, medial collateral ligament reconstruction, medial patellofemoral ligament reconstruction and meniscus repair were performed in single session. At twelve months follow-up; there was 160º flexion and 10° extension knee range of motion. Lysholm knee score was 90. Extensive forces can cause both MCL and MPFL injury due to overload and the anatomical relationship between these two structures. Therefore, patients with valgus instability should be evaluated for both MPFL and MCL tears to facilitate successful treatment.

Paraoxonase-1 gene in patients with chronic obstructive pulmonary disease investigation Q192R and L55M polymorphisms.

BACKGROUND: The effect of increased oxidative stress on the development of chronic obstructive pulmonary disease (COPD) is well known. One of the antioxidative systems against oxidative stress in human body is paraoxonase (PON) enzyme that protects low density lipoproteins (LDL) against oxidation. This study aimed to explore the polymorphisms on PON1, Q192R, L55M genes of patients with COPD. METHODS: DNAs extraction was obtained from blood samples of 50 patients diagnosed with COPD and 50 patients as a control group who were presented to emergency clinic. Genotypes were obtained with polymerase chain reaction (PCR) and AIw I and Hsp92II restriction enzymes were used for Q192R and L55M polymorphisms, respectively. Analysis of data was done with the Chi-square test and Fisher's exact test. RESULTS: A statistically significant difference in Q192R polymorphism was found between the COPD patients and the control group (P=0.05). There was no statistically significant difference in L55M polymorphisms between the patient and control groups (P>0.05). Q192R polymorphism was significantly correlated with the PON1 gene and cigarette smoking; however other risk factors did not show any significant correlation with this polymorphism. Though L55M polymorphism was significantly correlated with family history and tuberculosis, there was no significant correlation with other risk factors. CONCLUSION: We believe that more studies are needed to study the correlation of L55M polymorphism with other factors.

Meteorologic parameters and migraine headache: ED study.

AIM: Migraine is common in society and is one of the primary causes of chronic headache with episodes. In this study, we aimed to determine the role of meteorologic parameters and moon phase on triggering migraine attacks and effects on the number of patients presenting to the emergency department with migraine headaches. MATERIALS AND METHODS: Patients admitted to the emergency department due to a migraine headache during a 1-year period were studied retrospectively. Correlation between moon phases, pressure, temperature, humidity, wind speed values of meteorologic observation, and recording station located in the same city and daily number of patients was analyzed. RESULTS: A total of 3491 patients, of whom 72% (n = 2518) were women, were enrolled. The average daily number of patients was 9.6 ± 4 (3-24). A statistically significant correlation was found between the number of daily patients and daily maximum temperature (P = .005), mean temperature (P = .013), minimum temperature (P = .041), and daily temperature change (P = .003). In addition, a negative correlation was found between the daily number of patients presenting to the emergency department and daily relative humidity (in percentage; P = .031). No significant relationship was found between moon phases and the number of patients. CONCLUSION: We have determined that the number of patients admitted to the emergency department with migraine headache has increased with high temperature and low humidity and that there is no relationship between the number of patients and moon phases.

Spontaneous subscapular haematoma in a patient using warfarin therapy.

Warfarin is widely used. Spontaneous bleeding is one of the complications of warfarin treatment. A 70-year-old man was admitted to the emergency room with right back pain. There was no history of trauma. He was using warfarin following a bypass graft. The patient's vital signs were stable. On physical examination, swelling at the level of the right scapula was detected. Laboratory findings showed that the international normalised ratio (INR) was ↑↑ (a very high reading) (1.47 1 month previously). There was no melena on rectal examination. A chest CT was performed to differentiate the swelling of the right scapula. Warfarin was stopped and vitamin K was administered. Fresh frozen plasma was initiated and the patient was hospitalised to the cardiovascular surgical service. The fact that use of warfarin in the elderly may increase the risk of spontaneous bleeding should be especially kept in mind.