Aim: To compare blood parameters between patients with status epilepticus (SE) and those with non-SE epileptic seizures at presentation to the emergency department, and to evaluate the prognostic value of immature granulocytes (IG). Materials and Methods: This retrospective study included adult patients presenting with seizures. Hematological and biochemical parameters, including C-reactive protein (CRP), white blood cell count (WBC), blood gas parameters, IG, and IG% were analyzed. Results: A total of 634 patients were screened; 68 hospitalized patients who met the inclusion criteria were analyzed (SE: n=37; non-SE: n=31). Significant differences between groups were observed for WBC, lactate, pH, bicarbonate (HCO3-), base deficit, CRP, IG, and IG% (p<0.05 for all). An IG cut-off value of 0.045 predicted clinical outcomes with 95.8% sensitivity and 97.7% specificity. Conclusion: IG and IG% are promising, rapid, and cost-effective inflammatory biomarkers with high diagnostic accuracy in SE. Their use may support early risk stratification, guide clinical decision-making, and improve timely intervention in emergency settings.
Aim: Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. The identification of novel biomarkers reflecting the inflammatory and thrombotic mechanisms involved in acute coronary syndromes may improve diagnostic accuracy and risk stratification. Semaphorins are a family of proteins involved in immune regulation, vascular biology, and platelet activation, suggesting a potential role in cardiovascular disease. This study aimed to investigate serum semaphorin levels in patients with AMI and to evaluate their potential diagnostic and prognostic value. Materials and Methods: In this prospective case-control study, 62 participants were enrolled: 31 patients diagnosed with AMI and 31 age- and sex-matched control subjects. Among the AMI patients, 19 had ST-segment elevation myocardial infarction (STEMI) and 12 had non-STEMI (NSTEMI). Serum semaphorin levels were measured using an ELISA. Clinical, demographic, and angiographic data were recorded and analyzed. Results: The mean serum semaphorin level was 0.21±0.12 in the AMI group and 0.26±0.17 in the control group, with no statistically significant difference between groups (p=0.556). Semaphorin levels were also comparable between male and female participants (0.23±0.14 vs. 0.26±0.18, p=0.662). Subgroup analysis demonstrated mean semaphorin levels of 0.21±0.16 in NSTEMI patients and 0.21±0.07 in STEMI patients. Although semaphorin levels tended to be lower in AMI patients than in the control group, no significant difference was observed among the control, NSTEMI, and STEMI groups(p=0.081). Conclusion: Serum semaphorin levels were not significantly associated with the presence or subtype of AMI in the present study. These findings suggest limited diagnostic utility of circulating semaphorin levels in AMI. Further multicenter studies with larger sample sizes are needed to clarify the role of semaphorins in the pathophysiology and clinical assessment of acute coronary syndromes.
Aim: To compare the performance of hemoglobin, albumin, lymphocyte, and platelet (HALP), modified HALP (mHALP), and modified Rapid Emergency Medicine score (mREMS) in predicting 30-day mortality in geriatric patients presenting to the emergency department (ED) with hip fractures. Materials and Methods: This prospective, observational cohort study included 63 geriatric patients with hip fractures who presented to the ED. Demographic characteristics, vital signs, laboratory parameters, and clinical outcomes were recorded. The predictive performance of HALP, mHALP, and mREMS scores for mortality was evaluated using ROC analysis, and the area under the curve (AUC) were compared using the DeLong test. Results: The mean age of the patients was 78.59±6.81 years, and 63.5% were female. The 30-day mortality rate was 6.3% (n=4). In patients who died, heart rate and mREMS score were significantly higher, while oxygen saturation was significantly lower. ROC analysis showed that the mREMS score had apparent discriminative performance (AUC: 0.981; 95% confidence interval: 0.942-1.00; p<0.001); however, this estimate should be interpreted cautiously given the low number of mortality events (n=4). For mREMS, at a cut-off value of 7.5, sensitivity was 100% and specificity was 84.7%. HALP (AUC: 0.581; p=0.690) and mHALP (AUC: 0.513; p=0.942) scores showed no significant predictive value for mortality. The DeLong test results showed a statistically significant difference between mREMS and mHALP scores (p=0.009). Conclusion: The mREMS score showed apparent superiority over HALP and mHALP in predicting 30-day mortality; however, these findings should be considered exploratory and require confirmation in larger studies.
Aim: To evaluate provincial variation in false emergency medical service (EMS) call rates across T & uuml;rkiye and to examine the association between education indicators and these rates after accounting for EMS accessibility and primary care availability. Materials and Methods: This ecological study analyzed province-level data for 2024 from all 81 Turkish provinces using official datasets from the Ministry of Health General Directorate of Emergency Health Services, the Turkish Statistical Institute, and the Health Statistics Yearbook 2024. The dependent variable was the provincially reported false alarm rate (%), defined as a composite administrative measure including non-emergency conditions manageable in primary care, hoax or malicious calls, and refused transport after ambulance arrival. These three components likely reflect distinct underlying mechanisms: non-emergency calls may represent barriers to primary care access, hoax calls may reflect behavioral and social factors, and refused transport may indicate that the caller has reassessed urgency or is seeking alternative care. Because these components could not be analyzed separately in the available aggregated data, the composite outcome was interpreted cautiously as a system-level operational indicator, rather than as a homogeneous clinical or behavioral construct. Inter-provincial differences in triage protocols and documentation practices may further affect the consistency of classification. Education indicators, EMS accessibility measures, and primary care availability were examined. Pearson correlation analyses, independent-samples t-tests, and multiple linear regression analyses with robust standard errors were performed. Results: The mean false alarm rate was 8.75%+/- 2.86% (range 4.2%-14.7%). Metropolitan provinces had significantly higher rates than nonmetropolitan provinces (10.12%+/- 3.45% vs. 7.88%+/- 1.89%, p<0.001). The university education rate showed a weak, non-significant correlation with the false alarm rate (r=0.13, p=0.258). Population per family physician unit showed a moderate positive correlation with the false alarm rate (r=0.545, p<0.001). In the multiple linear regression model (R-2=0.378, p<0.001), the university education rate was not independently associated with false alarm rates (beta=-0.062, p=0.434), although the association's direction was negative (suggesting lower false alarm rates with higher education). Population served per EMS station (beta=0.134, p=0.006) and population per family physician unit (beta=7.317, p<0.001) showed independent, statistically significant associations. The number of EMS stations was not independently associated (beta=0.006, p=0.477). Conclusion: In this nationwide ecological analysis, provincial education levels were not independently associated with rates of false EMS calls after adjustment for EMS accessibility and primary care availability. Both EMS accessibility and primary care availability showed significant, independent associations with false alarm rates, suggesting that structural factors related to access to healthcare services are more strongly associated with provincial variation than educational indicators. The findings are consistent with the possibility that limited access to primary care may contribute to increased non-urgent EMS utilization at the population level.
Aim: Prolonged fasting impacts chronic diseases. This study aimed to describe the clinical, laboratory, radiological, and disposition characteristics of fasting patients with known biliary system disease who presented to the emergency department during Ramadan. Materials and Methods: In this prospective descriptive study, we included fasting patients with known biliary diseases who presented to the emergency department during Ramadan with acute right upper quadrant pain, nausea, and/or vomiting. We recorded demographics (age, gender), laboratory parameters, and hospitalization/discharge status. Patients were categorized into four groups based on radiological imaging: normal findings, common bile duct (CBD) dilatation, cholelithiasis, and biliary sludge. Results: The study included 37 patients. The most frequent pathological finding on radiological imaging was CBD dilatation (27%). Aspartate transaminase levels were significantly higher in females than in males (p<0.05). Furthermore, total and direct bilirubin levels were significantly elevated in patients with abnormal imaging findings and in those requiring hospitalization or referral (p<0.001). The hospitalization rate was also significantly higher for female patients (p=0.007). Conclusion: Consuming high-calorie meals after prolonged Ramadan fasting may trigger symptomatic exacerbations in patients with biliary tract pathology. Elevated C-reactive protein and bilirubin levels were correlated with disease severity and the need for hospitalization. Patients with a history of biliary disease should consult their physician before fasting. Because the study was descriptive and lacked a control group, no definitive causal relationship can be established.
Aluminum phosphide (AlP) is a pesticide widely used by farmers in certain Asian countries for its high efficacy in protecting crops from pests. However, misuse in both intentional and unintentional poisoning cases has raised major public health concerns. Despite extensive research into treatments for AlP poisoning (AlPP), no specific antidote exists, and management remains largely supportive. This review examined successful treatment cases reported in the literature. A targeted search was conducted using the keywords “AlP”, “phosphine”, “antidote”, “case report”, and “treatment” in the scientific databases Scopus, Web of Science, and PubMed. The identified treatments include disinfection of the digestive tract (including gastric disinfection); prevention of phosphine gas release; administration of coconut oil and olive oil; magnesium sulfate; thyroid hormones; extracorporeal membrane oxygenation; continuous renal replacement therapy (including continuous veno-venous hemofiltration); high-dose insulin; red blood cell exchange; dihydroxyacetone; and antioxidant therapy. These therapeutic approaches may serve as supportive therapy by reducing the harmful effects of AlP. This article evaluates medications and chemical substances proposed for the targeted treatment of AlPP and examines their protective mechanisms and the primary consequences of their use.
Aim: Assault-related injuries constitute a significant burden on emergency departments and may be influenced by environmental factors. This study aimed to explore the association between meteorological parameters and assault-related emergency department presentations in an urban, upper-middle-income setting, and to describe temporal and clinical characteristics relevant to emergency service planning. Materials and Methods: This retrospective observational study included adult patients presenting with assault-related injuries to a tertiary emergency department between January 1 and December 31, 2023. Demographic characteristics, injury mechanisms and types, clinical outcomes, and time of presentation were recorded. Meteorological data, including daily mean temperature, wind speed, and precipitation status, were obtained from official records. Associations between weather variables, temporal factors, and clinical outcomes were analyzed. Results: A total of 4,042 patients were included: 2,606 (64.5%) were male, and the median age was 32 years. Nearly half of the presentations occurred between 16:00 and 23:59 (48.6%), with the highest frequency observed on Sundays (16.1%) and during the summer (31.4%). Physical assault was the predominant mechanism of injury (88.3%), and soft tissue injury was the most common injury type (78.9%). Assault-related presentations peaked when daily mean temperatures ranged between 20 degrees C and 30 degrees C, while wind speed and precipitation showed no significant pattern with presentation frequency. Stab/cut-related and firearm-related injuries were significantly more frequent among patients who required hospitalization, who had life-threatening conditions, or who required surgery (p<0.001). Conclusion: Assault-related emergency department presentations demonstrate distinct temporal and environmental patterns in an upper-middle-income urban setting. An increased frequency of presentations within specific temperature ranges and during predictable time periods highlights the importance of incorporating environmental and temporal factors into emergency department resource planning and violence prevention strategies.
The erector spinae plane block (ESPB) is a simple regional anesthetic technique that is applied in various surgical procedures and has an excellent safety profile. Although primarily used for perioperative pain relief, it has also emerged as a useful opioid-sparing analgesic technique in emergency settings. Nevertheless, its application as the primary anesthetic technique for emergency surgical procedures is limited. We report a case of a penetrating lateral chest wall injury, which was successfully managed with an ultrasound-guided ESPB as the principal anesthetic technique for wound exploration and repair, obviating the need for general anesthesia or systemic opioids. The hemodynamics were stable overall, except for mild hypotension and tachycardia at initial presentation. This case highlights the potential use of ESPB as a safe alternative technique in emergency thoracic trauma surgery where neuraxial techniques or general anesthesia are contraindicated or unsafe.
Aim: To examine the association between anxiety, depression, and tendency toward violence among relatives of patients in emergency departments. Materials and Methods: The study was conducted among 371 relatives of patients in the emergency department of a district state hospital between February and May 2025. Data were collected using a personal information form the Hospital Anxiety and Depression scale (HADS), and the Violence Tendency scale (VTS). Results: The mean HADS-anxiety score of patient relatives was 8.16 +/- 3.93, and the mean depression score was 7.10 +/- 3.66. The mean VTS score was 36.97 +/- 9.19. Analysis showed a positive, weak, and statistically significant association between the VTS and the HADS-anxiety subscale (r=0.254; p<0.001), and between the VTS and the HADS-depression subscale (r=0.218; p<0.001). Multiple linear regression analysis showed that anxiety and depression scores were significantly associated with a tendency toward violence. Conclusion: Anxiety and depression levels among relatives of patients were significantly associated with their tendencies toward violence. Emergency department staff and administrators should develop strategies to prevent violence and to reduce the anxiety of patients' relatives.
Aim: While carbon monoxide is a gas that is toxic when introduced exogenously into the body, it also functions as a signaling molecule with regulatory roles in many physiological processes within the cardiovascular system. The aim of this study is to investigate the utility of endogenous carboxyhemoglobin (COHb) for estimating mortality within the first three months after admission among patients with acute coronary syndrome. Materials and Methods: Our study was conducted on patients who came to the emergency service with a complaint of chest pain, met the inclusion criteria, were hospitalized in the cardiology clinic. Patients' demographic characteristics, coronary angiography results, electrocardiogram, blood gas assessment, and blood tests' prognosis were recorded. Results: The average age was 61.52 +/- 13.19 (min: 21-max: 93) and 164 (71.9%) patients were male. Angiography results showed that 110 (48.2%) patients had obstruction of the left anterior descending artery, and 82 (36%) patients had obstruction of the right coronary artery. In the analysis conducted after excluding patients who had been exposed to cigarette smoke before hospital admission, endogenous COHb level was not a statistically significant predictor of in-hospital mortality (p=0.248) or three-month mortality (p=0.26). Conclusion: No statistically significant relationship was found between endogenous COHb levels and predicted mortality in patients diagnosed with acute coronary syndrome who were neither exposed to cigarette smoke nor had a history of smoking before hospital admission. However, we think that the small patient population, together with limitations in the study may have limited the findings.
Aim: Vital signs, blood parameters, and some blood biomarkers in patients with gastrointestinal (GI) bleeding vary depending on the severity of the bleeding. The aim of this study is to investigate the association of vital signs and copeptin levels with transfusion requirements, and patient prognosis, including hospitalization duration and 30-day mortality. Materials and Methods: Prospective, cross-sectional, observational study, conducted in the emergency department (ED) of a tertiary care university hospital, between June 2021 and May 2022. Admission serum copeptin levels and vital parameters of patients with a diagnosis of GI bleeding were noted and evaluated in terms of outcome measures. Results: The study included 118 patients, 75 (63.6%) of whom were male. The median age was 72 years (interquartile range: 58-83). A total of 18 (15%) patients died within 30 days. Serum copeptin levels did not differ between deceased patients and survivors. Logistic regression analysis showed that a shock index above 0.70 and patients aged 75 years and older together [p=0.017, odds ratio (OR)=6.824; 95% confidence interval (CI): (1.419-32.811)1 lead to an increase in 30-day mortality. Lower systolic blood pressure at the admission to the ED was associated with increased 30-day mortality [p=0.003, OR=0.952; 95% CI: (0.922-0.983)1. Conclusion: Although serum copeptin levels failed to predict 30-day mortality in patients admitted to the ED due to GI bleeding, our models demonstrated that age over 75 years, lower systolic blood pressure, and the shock index, were superior predictors of mortality.
Aim: This study aimed to evaluate the demographic and clinical characteristics and reasons for emergency department (ED) visits among patients receiving home health care services and to investigate the impact of comorbidity burden on 30-day ED revisits. Materials and Methods: This retrospective study was conducted in the ED of Mamak State Hospital. Patients receiving home health care services who presented to the ED between August 2023 and December 2024 were included. Demographic and clinical data of 299 patients were obtained from hospital records. Comorbidity burden was assessed using the Charlson Comorbidity index (CCI). The primary outcome was an ED revisit within 30 days. Statistical analyses included Mann-Whitney U test, chi-square test, ROC analysis, and logistic regression. Results: Among 299 patients, 62 (20.7%) had a 30-day ED revisit. Patients with revisits had significantly higher CCI scores than those without revisits [median 6 (4-8) vs. 5 (3.5-6); p <0.001)]. ROC analysis showed that the CCI had moderate discriminative ability to predict revisits (area under the curve= 0.626). At a cut-off value of CCI >6, specificity was 78.1% and sensitivity was 40.3%. In multivariate analysis, CCI was an independent predictor of 30-day revisits (odds ratio: 1.231; 95% confidence interval: 1.075-1.410; p=0.003). Infectious causes were more frequent among patients with revisits, although the difference was of borderline statistical significance (p=0.057). Conclusion: Comorbidity burden is an important predictor of 30-day ED revisits among patients receiving home health care services. The CCI may help identify high-risk patients and guide closer follow-up with the aim of reducing recurrent ED visits.
Massive pulmonary embolism (PE) is uncommon but potentially fatal, requiring immediate thrombolytic therapy. Thrombolysis, however, carries a significant bleeding risk and is generally contraindicated in cases of active bleeding, which is an important differential to consider in patients with severe anaemia. Physicians must balance possible bleeding against the risk of rapid clinical deterioration. We report a case of autoimmune haemolytic anaemia presenting with massive PE and profound anaemia successfully treated with thrombolysis.
Aim: Cardiac arrests are a critical public health issue, especially in developing countries like India, where access to timely advanced medical care is limited. This study aims to determine the predictors of mortality among patients sustaining in-hospital cardiac arrest (IHCA). Materials and Methods: This retrospective observational cohort study in a tertiary hospital emergency department analyzed one-year IHCA patients. Demographics, causes, and outcomes were recorded from institutional database. Data entered in Excel were analyzed using SPSS version 25.0. Multivariate logistic regression was used to identify independent predictors of mortality among patients presenting with IHCA. Results: Among 267 IHCA patients (mean age 52 +/- 17 years, male preponderance), hypoxia (43.44%) and coronary thrombosis (25.84%) were the most common reversible causes. Return of spontaneous circulation (ROSC) was achieved in 214 (80.14%) patients, while only 22 (8.23%) had favorable neurological outcomes (mRS <3) at hospital discharge. Logistic regression identified inability to attain ROSC and prolonged resuscitation (>20 minutes) as independent predictors of mortality. Conclusion: Our study underscores the critical importance of achieving ROSC within 20 minutes, through early management of reversible causes, and consistent high-quality chest compressions, which are pivotal for favorable neurological outcomes among survivors.
Posterior circulation stroke affecting thalamo-cortical arousal networks may present with increased sleepiness, with a lack of motor symptoms. Here, we present the case of a 41-year-old man with acute-onset hypersomnolence, without focal neurological deficits. The initial computed tomography (CT) brain was normal. Metabolic and infectious workup were negative. Magnetic resonance imaging (MRI) of brain was performed and revealed bilateral paramedian thalamic infarcts with hemorrhage and a left occipital infarct. MRI angiography demonstrated reduced flow in the posterior cerebral artery segments. This case highlights the prominent clinical feature of profound hypersomnolence in thalamic stroke and emphasizes how such patients are easily misdiagnosed when early CT imaging is unrevealing. Recognition of this pattern is critical to avoid delays in the diagnosis of thalamic infarction.
Aeromedical patient transfer plays a crucial role in ensuring continuity of time-sensitive care in health systems characterized by high patient volumes, geographic diversity, and regional disparities in access to healthcare. This review examines the core organizational and governance principles of aeromedical patient transfer systems and evaluates the centrally coordinated aeromedical model implemented in Türkiye, in the context of the global literature, to generate context-sensitive policy insights for high-volume health systems. A narrative, policy-informed review approach was adopted. The global literature on aeromedical patient transfer was examined, with a focus on organizational models, central coordination mechanisms, clinical prioritization, medical leadership, and safety-oriented governance. Türkiye’s air ambulance system was analyzed against national regulatory frameworks and operational structures and contextualized through comparison with international practices. Türkiye has developed a centrally coordinated aeromedical model integrating air ambulance services into the national emergency medical services system. The model is characterized by centralized decision-making, standardized clinical indications, strong medical leadership, and systematic integration of operational safety and risk management. Aeromedical resources are treated as limited, high-value health assets, with deployment guided by clinical benefit and system-level priorities rather than transport speed alone. The Turkish experience suggests that the effectiveness of aeromedical patient transfer in high-volume health systems depends more on governance, coordination, and rational resource allocation than on fleet size or technological capacity. While not intended for direct replication, this centrally coordinated model offers adaptable principles that may support coordinated access to specialized care in other middle-income countries
Aim: This study aimed to evaluate the association between systemic inflammatory indices, including the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), and the Alvarado score for risk stratification in patients presenting to the emergency department with a diagnosis of acute appendicitis (AA). Materials and Methods: This retrospective descriptive study was approved by the Tekirda & gbreve; Nam & imath;k Kemal University Faculty of Medicine Ethic Committee (approval number: 2025.70.04.06, date: 30.07.2025). A total of 69 adult patients who met inclusion criteria and presented with abdominal pain to the emergency department between January 1, 2023, and January 1, 2024 were enrolled. Among the patients, 53.6% were female and 46.4% male, with a mean age of 41.25 +/- 17.46 years. No significant age difference was observed between genders (p=0.8). The diagnosis of AA was confirmed by contrast-enhanced abdominal computed tomography in all cases. Results: ROC curve analysis was performed to assess the ability of inflammatory indices to discriminate among Alvarado score-defined risk categories. According to these analyses, NLR showed significant discriminatory performance across Alvarado score-defined high-risk categories with p=0.004 and [area under the curve (AUC)=0.81 95% confidence interval (CI): 0.71-0.91], and SII did so with p=0.009 and AUC=0.78 (95% CI: 0.66-0.90), whereas PLR was less predictive (p=0.16, AUC=0.65). Conclusion: Our findings suggest that SII shows meaningful association with Alvarado score-based risk stratification and should not be interpreted as a standalone diagnostic marker. However, these markers should be used in conjunction with clinical assessment, and larger, multicenter prospective studies are needed to confirm their usefulness.
