Abstract Background Ventricular premature contractions (PVCs) are the most common ventricular arrhythmias. However, to date, no risk stratification tool exists to assess response to medical therapy in patients with frequent PVCs (>5% per 24 hours). We aimed to develop and validate a clinical prediction model evaluating response to medical therapy in frequent PVCs. Methods We conducted a retrospective cohort study of patients with frequent PVCs who were considered for medical treatment. The study outcome was unresponsiveness to the medical treatment (24-hour PVC count not diminishing by at least 80%) in patients with frequent PVCs at 3-6 months follow-up. Potential predictors were, age (years), PVC burden (%), LVEF % (<55, ³55), PVC QRS width (msec), mean heart rate (beat/min), sinus beat QTc (msec), PVC coupling interval, gender, presence of multifocal PVC and Non-sustained VT. Binary logistic regression analyses were performed to develop and internally validate the model. Finally, we used internal-external cross validation using leave-one-out center. Results 1644 patients were included in the study (mean age 52.2±13.5 years and 56.3% male). The frequency of unresponsiveness to the medical treatment in patients with frequent PVC was 31.2% (n=513). In the model, PVC burden (%), LVEF% (<55, ³55) and PVC QRS width were found to be the three strongest predictors. The apparent and internal validation discriminations of the model (C-statistics in internal validation 0.910) were quite satisfactory. Model discriminations and calibration metrics with internal-external cross validation were similar to the apparent model and were deemed acceptable (https://demonoreflow.shinyapps.io/dynnomapp/). Conclusions We developed and validated a model that accurately predicts unresponsiveness to medical treatment in patients with frequent PVC. Our model, once externally validated, has the potential to facilitate management decisions by providing individualized risk estimates in patients with frequent PVC for whom ablation may be suggested as a first line treatment modality.Figure-1Figure-2

Aims Ulcerative colitis and Crohn’s disease are chronic inflammatory bowel diseases.The effect of inflammation on atrial and ventricular conduction defects is known,however,different results have been obtained in many studies on the effectiveness of anti TNFs and biological agents on cardiac conduction. We aimed to evaluate the effects of biological agents on atrial and ventricular conduction in IBD through ECG parameters.

Rapid and easy applicable hypothermia techniques have a great value on therapeutic hypothermia. A novel method with cooled oxygen inhalation has been described and tested in a pilot study previously. In this study, we aimed to compare the efficiency of this novel method over current hypothermia techniques in a rat model.

Background and aims Childhood accidents are the leading cause of health problems, death and disability that can be prevented. Accidents can be predicted and avoided by identifying the risks. The aim of this study is to investigate the characteristics of paediatric forensic cases and to reveal the relationship between judicial decisions and trauma scores. Methods Forensic reports of the Children under 18 admitted to our emergency department of Van Military Hospital, a second level hospital, between January and November 2013 were retrospectively evaluated. Demographic data of the patients and life threat decisions were investigated and trauma scores were calculated. P-value under 0,05 was considered to be significant. Results Forty-four (15.1%) of 290 forensic cases admitted to our emergency department were under 18. Of the patients, 43.2% (19) were female and the mean age was 8.7 ± 5.41 (min-max: 0–17). Ten (22.7%) of them were traffic accident, 8(18.2%) were falling from height, 12 (27.3%) were assault, 2(4.5%) were burn, 10 (22.7%) were poisoning and suicide. Four of all patients (9.1%) were having life threat and 9 (20.5%) patients were having no injury requiring simple medical intervention. In the evaluation of the cases; Injury Severity Score (ISS) was 1.93 ± 2.27 (1–16), Revised Trauma Score (RTS) was 99.72 ± 0.17 (99–99.83), Trauma score- injury severity score (TRISS) was 7,082 ± 0.15 (7,108–7,841) and New Injury Severity Score (NITS) was 2.55 ± 3.52 (1–16). Conclusions Traffic accidents, falls, assaults and poisonings are the most common forensic cases in childhood and we found a significant relationship between life threat decision and anatomical and physiological trauma scores.

Catamenial pneumothorax (CP) is defined as recurrent spontaneous pneumothorax occurring within 72 hours before or after onset of menstruation. The aetiology of this syndrome is unknown, although many theories have been proposed to explain it. A 43-year-old female presented to our emergency room with a complaint of left sided chest pain. She had no dyspnoea or haemoptysis during the admission. She had a history of pelvic endometriosis without any complaints for three years. Pneumothorax or pneumonia was not detected on chest X-ray. Blood tests and electrocardiogram findings did not support any cardiac or infectious cause. Computed tomography showed a pneumothorax on the mediastinal side of left hemithorax. The patient was referred to a thoracic surgeon. A thoracoscopy for histological confirmation was performed and the diagnosis of CP was made with a histological intervention.

Ranitidine is a H2 receptor blocker and rarely cause bradycardia. A 28 years old male patient attended the emergency department for urticaria. He was given 45 mg of phenyramine and 50 mg of ranitidine intravenously. He then complained of dizziness and developed bradycardia and hypotension. Electrocardiogram detected junctional bradycardia rhythm. He was given 0.5 mg atropine intravenously and his rhythm then returned to normal. His symptoms subsided and the blood pressure improved. Ranitidine is a frequently used medication and this case illustrated a rare but serious side-effect of the medication.

Narghile known in different names as shisha, hookah, hubble‐bubble, waterpipe has been smoked widely in Middle East countries traditionally and recently began to spread to European countries and USA. Narghile is consumed particularly by university youth in cafes as a social activity in Turkey. We report a case series of five patients presented with narghile induced carbon monoxide (CO) poisoning. We believe that this problem might be overlooked and underreported. We want to emphasize that, in the differential diagnosis of nonspecific neurological complaints (especially headache, nausea, vomiting and vertigo) CO poisoning must be considered and patient must be questioned about the usage of narghile smoking especially in areas popular of it.

Objective: We aimed to assess the efficacy of oxygen inhalation therapy in emergency department (ED) patients presenting with all types of headache.Method: We performed a prospective, randomized, double-blinded, placebo-controlled trial of patients presenting to the ED with a chief complaint of headache. The patients were randomized to receive either 100% oxygen via nonrebreather mask at 15 L/min or the placebo treatment of room air via nonrebreather mask for 15 minutes in total. We recorded pain scores at 0, 15, 30, and 60 minutes using the visual analog scale. At 30 minutes, the patients were assessed for the need for analgesic medication. Patient headache type was classified by the treating emergency physician using standardized diagnostic criteria.Results: A total of 204 patients agreed to participate in the study and were randomized to the oxygen (102 patients) and placebo (102 patients) groups. Patient headache types included tension (47%), migraine (27%), undifferentiated (25%), and cluster (1%). Patients who received oxygen therapy reported significant improvement in visual analog scale scores at all points when compared with placebo: 22 mm vs 11 mm at 15 minutes (P < .001), 29 mm vs 13 mm at 30 minutes (P < .001), and 55 mm vs 45 mm at 60 minutes (P < .001). When questioned at 30 minutes, 72% of patients in the oxygen group and 86% of patients in the placebo group requested analgesic medication (P = .005).Conclusion: In addition to its role in the treatment of cluster headache, high-flow oxygen therapy may provide an effective treatment of all types of headaches in the ED setting. (C) 2012 Elsevier Inc. All rights reserved.

Background: In nucleoside-naive patients, HBV-DNA viral load at week 48 (w48DNA) predicts the development of resistance in patients treated with adefovir (ADV).Whether the same holds true in lamivudine-resistant (LAM-R) patients treated with adefovir is unknown.Aim: To determine the factors predictive of virological breakthrough (VB) and ADV genotypic resistance (ADV-gR) in LAM-R chronic hepatitis B. Patients and Methods: 128 patients with LAM-VB received ADV, added to LAM (combination therapy, n = 90) or switched for LAM (monotherapy, n = 38).Serum HBV-DNA was measured by a b-DNA assay (LLOQ = 3.3 log 10 copies/mL) at baseline and every 3 months during treatment.ADV-gR was looked for by sequencing at baseline and every 6 months for the first 2 years, and in cases with VB after the first 2 years.Results: The mean HBV-DNA was 7.79 log 10 copies/mL at baseline (range = 3.3-10.28)and 4.92 log 10 copies/mL at w48 (range = 3.3-7.92).28 patients (22%) had w48DNA <3.3 log 10 copies/mL, 76 (59%) between 3.3 and 6 log 10 copies/mL, and 24 (19%) >6 log 10 copies/mL.Low baseline HBV-DNA was predictive of undetectable w48DNA.At baseline, no patient had N236T mutation, and 2 had A181V without developing VB.During follow-up (mean = 40 months), 11 patients developed VB.ADV-gR was documented in 6 of the 11 patients with VB (4 monotherapy, 2 combination therapy): 3 with A181V + N263T mutation, 2 with N236T alone and 1 with A181V alone.The risk of subsequent development of gADV-R was higher in patients with w48DNA >6 log 10 copies/mL (12.5%) than in those with w48DNA <6 log 10 copies/mL (2.9%, p < 0.05) and in patients receiving monotherapy (10.5%) compared to combination therapy (2.2%, p < 0.05).Neither w48DNA nor monotherapy were predictive of VB.Conclusion: Viral load at 48 weeks >6 log 10 copies/mL and ADV monotherapy are associated with a higher risk of subsequent development of ADV-gR in LAM-R patients.Because a low baseline HBV-DNA is predictive of undetectable w48DNA, ADV should be added to LAM at the time of genotypic LAM-R to minimize the risk of ADV-resistance.