BACKGROUND:Osborn wave, typically associated with hypothermia, is currently referred to as one of the J wave syndromes due to its clinical potential to develop lethal cardiac arrhythmia; it may rarely be observed in a non-hypothermic setting such as cannabis abuse.CASE REPORT:In this paper, we presented two young cases who presented to the emergency services with unconsciousness, drowsiness, and hypoxia, and also J wave on electrocardiography (ECG) due to Bonsai abuse.CONCLUSION:Osborn wave may be a significant criterion to initiate close monitoring in a coronary care unit, with supportive treatment and mechanical ventilation as necessary in those patients who abuse Bonsai.

Aim: According to the data on global terrorism, in our world, 1970–2014 in between than 58,000 of the bombing was faced with terrorist attacks 140.000. 1 Global Terrorism Database. 2017 Google Scholar

Thermal crush burn injury due to roller type ironing press machine is relatively rare and can cause destructive effects with significant morbidity. These injuries can be avoided by taking some basic precautions. Early debridement after admission and definitive treatment after the extent of injury are delineated and these are the preferred approaches in the management. We present a case of thermal crush injury of the hand caused by laundry roller type ironing press machine.

Incidences of drug abuse and synthetic cannabinoid have increased in young population, recently. One of those illicit synthetic cannabinoid is Bonsai. Recently, it has been the most popular one due its high potential to cause sudden death. However it has not been clarified how sudden cardiac death among young subjects developed. The aim of this study was to assess and demonstrate the abnormalities of P wave, QT interval and Tpeak-Tend (Tp-Te) in young bonsai abusers.

The main cause of cardiac arrest in pediatric patients is respiratory failure.To test the ability of paramedics to intubate the trachea of a child by means of the standard Macintosh [MAC] laryngoscope vs the Clarus Leviatan fiberoptic stylet (FPS) during 3-airway scenarios.This was a randomized crossover manikin study involving 89 paramedics. The participants performed tracheal intubations using the MAC laryngoscope and the Clarus Leviatan FPS in 3 pediatric airway scenarios: scenario A, normal airway without chest compression (CC); scenario B, normal airway with CC; and scenario C, difficult airway with CC.A total of 89 paramedics participated in this study. In scenario A, the FPS maintained a better success rate at first attempt (97.8% vs 88.9%; P = .73) and time required to intubate (17 [interquartile range, 15-21) seconds vs 18 [interquartile range, 16-22] seconds; P = .67) when compared with MAC. In scenarios B and C, the results with FPS were significantly better than those with MAC (P < .05) for all analyzed variables.This study suggested that the FPS could be used as an option for airway management even for paramedics with little experience. Future studies should explore the efficacy of FPS in pediatric clinical emergency settings.

DOI: 10.4328/JCAM.1048 Received: 26.04.2012 Accepted: 15.05.2012 Printed: 01.05.2015 J Clin Anal Med 2015;6(3): 384-6 Corresponding Author: Murat Eroglu, Selimiye Mah., Tibbiye Cad. Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi Acil Servis 34668 Uskudar, Istanbul, Turkiye. T.: +9

Serum neuron-specific enolase (NSE) and S-100β levels are considered novel biochemical markers of neuronal cell injury. In this study, the initial and post-treatment levels of NSE and S-100β were compared in carbon monoxide (CO) poisoning patients, who received normorbaric oxygen (NBO) or hyperbaric oxygen (HBO) therapy. Forty consecutive patients with acute CO poisoning were enrolled in this prospective, observational study. According to their clinical symptoms and observations, twenty patients were treated with NBO, and the other twenty with HBO. Serum S-100β and NSE levels were measured both at time of admission and 6 h later (post-treatment). Serum NSE and S-100β values decreased significantly in both of the therapeutic modalities. The initial and post-treatment values of NSE and S-100β in NBO or HBO patients were comparable. A clear negative correlation was observed between the decrease of NSE and S-100β levels and initial blood carboxyhemoglobin levels. In conclusion, the present results suggested the use of serum S-100β and NSE levels as indicators for brain injury. Due to the significant increase of their values with oxygen therapy, they may also be useful as prognostic follow-up markers. However, the current findings reflected no difference between the efficacy of NBO or HBO therapy.

We have read the article of Nazerian et al.,1 entitled “Diagnostic performance of focused cardiac ultrasound performed by emergency physicians for the assessment of ascending aorta dilation and aneurysm,” with great interest. Doctors working in the emergency department (ED) usually face a tough and complicated profile of patients. The first step in diagnosing the patient is history and physical examination, but often these provide inadequate information and need to be supported by appropriate diagnostic methods. Especially for the patient group where aortic pathologies are in question, cardiac ultrasound (U/S) can provide important hints to the physician in the ED during the process of critical decision. Nazerian et al. have found out that cardiac U/S measurements in patients with dilatation or aneurysm of the ascending aorta can diagnose the pathology with 78.6% sensitivity and 92% specificity, when compared to computed tomography angiography. The proximal ascending aorta is composed of the aortic annulus, sinus of Valsalva, sinotubular junction, and tubular ascending aorta. Standard transthoracic echocardiogram (TTE) is used in routine evaluation of aorta but it is not a method of choice to evaluate all segments of the aorta.2 The most common method of measurement of segments of proximal ascending aorta in clinical practice is TTE, which has parasternal long axis superior axial image resolution for this evaluation. It is advised to evaluate the right parasternal long axis in individuals with aortic dilatation to measure the actual diameters of the ascending aorta. Nazerian et al. have considered only the images from standard parasternal long axis while measuring aortic calibers. They would have had a higher sensitivity and specificity if they included right parasternal long axis images. Moreover, it is known that measurement of aortic sizes, when indexed according to the age and body surface area, would give better results. They would have obtained more accurate results if aortic analyses were made considering age and body surface area.3, 4 As a conclusion, evaluation made while considering the aforementioned factors would improve the power of TTE to show aortic pathologies and would render the study more valuable.

Introduction: The number of geriatric patients presenting to the emergency department increases every year. In addition, it is known that the mental status of geriatric patients may deteriorate as they age. In the emergency department, one of the main premises of patient management is anamnesis. However, impairments in mental status of geriatric patients decrease the reliability of anamnesis. In this study, we aimed to determine the mental status of elderly patients who presented to the emergency department, the relationship between mental status and patients' complaints, and last diagnoses and mortality.Materials and Methods: The study was planned to be prospective. The mental status of geriatric patients who presented to the emergency department was evaluated with a six-question screening test. Complaints, final diagnosis information, hospitalization department, duration of hospitalization, judicial status and mortality information were recorded. Consistency between patients' complaints and symptoms determined in physician examination was evaluated. Symptom-finding consistency levels based on mental status were compared. Kappa tests for consistency assessments and chi-square test for intergroup comparisons were used.Findings: The match between patient complaints and final diagnosis of 755 patients was evaluated by two independent specialist physicians. As a result of the six-question screening test, a mismatch between patient complaint and final diagnosis was found in 16.2% of 204 patients with abnormal screening tests (n=33) compared to 0.4% of 551 patients, who had a normal screening test (n=2). Mortality was found to be 9.8% in patients with abnormal test results while it was found to be 2.0% in patients with normal screening tests.Conclusion: Mental status variance determined in elderly patients appears to be a risk factor in terms of mortality. Complaints in geriatric patients having mental status variance can be deceptive in terms of pointing to the current disease. Exploring this relationship in detail with further studies should be considered, in order to make a significant contribution to the service provided to this patient group.

In this study, bodily injuries related to chest compression were examined in non-traumatic death cases that underwent autopsy. This study aimed to evaluate factors that can affect these injuries. Data were collected retrospectively, and injuries related to chest compression during cardiopulmonary resuscitation were determined over a 10-year period. Age, gender and cause of death were determined, and when cardiopulmonary resuscitation was performed, cardiopulmonary resuscitation duration, intubation and the injury that occurred due to chest compression were also determined. The study included data from 203 cases. The most frequent injuries were a single fracture in the left ribs (19.7%). Only the duration of cardiopulmonary resuscitation was determined to be associated with injuries. Ventricle rupture in 1 case and liver laceration in 2 cases were the most significant injuries. It has been shown that during cardiopulmonary resuscitation, severe injuries can occur due to thoracic compression. Only a positive correlation with the duration of cardiopulmonary resuscitation was found in our study.

Background/aim: Urticaria is a vascular skin reaction characterized with papules and plaques. Neopterin is accepted as an immunologic marker and an indicator of activation of the immune system. Homocysteine and asymmetric dimethylarginine (ADMA) are the markers of increased vascular resistance. Alteration in vascular resistance has a role in the pathogenesis of urticaria. We aimed to investigate whether there is a relationship between urticaria and neopterin, homocysteine, or ADMA.Materials and methods: The study is designed as a prospective descriptive study and patients with a diagnosis of urticaria in the emergency department were included in the study. Demographic data and characteristics of the disease were recorded. Neopterin, homocysteine, and ADMA levels were measured both during and after urticaria attacks. All data were statistically analyzed.Results: The differences between neopterin levels measured during and after urticaria attacks were statistically significant (P < 0.001). The differences between homocysteine and ADMA levels measured during and after urticaria attacks were not statistically significant (P > 0.05).Conclusion: Our results indicate that neopterin levels in patients with urticaria attacks are increased and the level of neopterin is also a useful parameter in acute urticaria. Further studies should clarify whether homocysteine levels contribute to diagnosis of acute urticaria. However, no relation was found between ADMA and urticaria.

Matrix metalloproteinase (MMP) plays a pivotal role in the pathophysiology of abdominal aortic aneurysms (AAA). Experimental studies have demonstrated that hyperbaric oxygen (HBO2) therapy decreases MMP levels in different tissues. However, the effect of HBO2 therapy on AAA has yet to be investigated. This study aimed to examine the effects of HBO2 on MMPs in an experimental AAA model. The model was implemented with CaCl2 in 12-week-old male Wistar albino rats. The rats were randomized into four groups:Group I: received NaCl (n=6) (Sham group);Group II: received NaCl and were treated with HBO2 (n=6);Group III: received CaCl2 (n=6); andGroup IV: received CaCl2 and were treated with HBO2 (n=6).HBO2 therapy was applied for five of seven days over a period of six weeks. Although in the CaCl2 groups, aortic diameters were significantly higher than the NaCl groups (p<0.05), there was no difference between pre- and post-HBO2 in the CaCl2 groups (p>0.05). In the CaCl2 group, the MMP-2 and MMP-9 levels were significantly higher than those in the NaCl group (p<0.05). HBO2 therapy had no statistically significant effect on the MMP-2 and MMP-9 levels in Groups III and IV. However, it was observed that both levels clearly decreased in Group IV. In conclusion, the study suggested that HBO2 may have favorable effects on MMP levels.

BACKGROUND Soft tissue trauma is a type of acute traumatic ischemia. We investigated in this study whether the edema, inflammation and ischemia caused by the trauma could be affected positively by hyperbaric oxygen (HBO) and ozone therapy. METHODS Soft tissue trauma was generated in a total of 63 adult male Sprague-Dawley rats. Subsequently, rats were divided into three groups. The first group was treated with ozone, the second group with HBO, and the third group served as controls. Tissue and blood samples were taken at the end of the procedures. Tissue lipid peroxidation (LPO), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), inducible nitric oxide synthase (iNOS), heme oxygenase (HO)-1, and hypoxia-inducible factor (HIF)-1 levels were detected. Hematoxylin-eosin staining was used to determine the inflammation and edema histopathologically. RESULTS We also detected HIF-1 activity, which decreases when the oxygen concentration increases, HO-1 activity, which has anti-inflammatory effects, and iNOS activity, which releases in any type of acute case. We determined a statistically significant reduction in iNOS and LPO levels in both the HBO and Ozone groups. A significant decrease in inflammation was detected in both the Ozone and HBO groups compared with the Control group, and a significant decrease in edema was detected in all three groups. CONCLUSION We think that HBO and Ozone therapy have beneficial effects on biochemical and histopathological findings. Related clinical trials will be helpful in clarifying the effects.

Objective: In this study, we aimed to assess the epidemiology of suicide attempts, especially focusing on rates and trends in Northeastern Turkey.Materials and Methods: This is a cross-sectional study including 893 pa rasuicide events recorded prospectively in 17 emergency rooms of state hospitals in two neighboring counties over three years. Information on each case was recorded on a standardized monitoring form that covered a series of sociodemographic and psychosocial features.Results: In 2007, parasuicide rates per 100,000 inhabitants were 47.7 for females, 17.7 for males, and 32.5 for both genders. Suicide attempts were more common in women in all age groups except. years. The most common methods of deliberate self-harm were as follows: medical drug/toxic substance ingestion (93.3%), hanging (1.7%), and cutting or stabbing (3.6%). Housewives (53.8%) formed the largest group among women. Physical domestic violence was a common reason for suicide attempts in women aged 15-34 years. The only cited reason for suicide attempts that was predominant in males was financial difficulties. A previous psychiatric diagnosis was present in 19.5% of parasuicide cases, and the rate of seeing a doctor for psychiatric reasons in the last 6 months prior to the suicide attempt was 15.8%.Conclusion: Self-poisoning is the most common method for attempted suicide. The risk groups in our region appeared to be younger and married females. The epidemiology of suicide attempt cases in our region resembles a mixture of both European and Asian communities' parasuicide patterns.

Purpose: To determine the relationship between the dental root indentation and maxillary sinusitis. Methods: We assessed the records of the patients who underwent paranasal sinus computed tomography imaging for suspected sinusitis. Results: We identified a total of 52 patients with a pre-diagnosis of maxillary sinusitis. Dental indentation was detected in 58 of 104 (55.7%) sinuses. Forty six of 58 sinuses (79.3%) with dental indentation had mucosal thickening higher than 2 mm. The difference between the groups was statistically significant (p = 0.007). Conclusion: Dental indentation should be kept in mind as a reason for chronic maxillary sinus inflammation, if an underlying cause cannot be identified.

Purpose: The diagnosis of appendicitis usually based on the clinical findings. Some laboratory tests may be helpful in diagnosis. White blood cell (WBC) count is not sensitive or specific in the diagnosis of acute appendicitis and it could not be considered as a reliable test for deciding surgery. In this study, we aimed to evaluate if the neutrophil/lymphocyte ratio (NLR) is superior to WBC in detecting the severity of the inflammation. Methods: A total of 153 patients operated for acute appendicitis were included into the study. Preoperative clinical and laboratory parameters of the patients were recorded and these were then compared to postoperative histology. Diagnosis was stratified into three groups according to pathology reports (normal histology, acute appendicitis, phlegmonous appendicitis). Receiver operating characteristics (ROC) curve analysis was made to determine the discriminatory ability of NLR. A threshold NLR value for phlegmonous appendicitis was 8. Results: A total of 153 patients (14 female and 139 male) were operated for acute appendicitis between January, 2012 and February, 2013. Median age was 22 years with a range of 17-83 years. The ratio of negative appendectomy was 8.5% (13 patients) according to histopathologic examination. The area under ROC curve for NLR was 0.923, compared to 0.667 for WBC and 0.881 for percent of neutrophils. The sensitivity and specificity of NLR with a threshold of 8 were 100% and 81.6%, respectively. Conclusion: The results of this study suggest that NLR may provide more helpful information than WBC or percent of neutrophils in the complete blood count.

Purpose: Although physiopathology of acute pancreatitis (AP) is not fully understood, the roles of reactive oxygen species (ROS) and changes of cytokines have been determined. The aim of this study was to investigate anti-inflammatory and anti-oxidant effects of glycyrrhizin (GL) on taurocholate-induced AP in rats. Methods: Thirty six rats were randomly divided into three groups: group I, group II, and group III were enrolled as sham, AP and AP+GL, respectively (n=12 per group). AP was induced by 1 ml/kg body weight using 5% taurocholate injection into the biliopancreatic duct in groups II and III after clamping the hepatic duct. In groups III, GL (20 mg/kg) was given by oral gavage twice daily for 4 days. Group I and II did not receive any treatment. On the fifth day of induction, the rats were killed; blood samples were taken to measure amylase, lipase, calcium, albumin, urea, glucose, aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) assays before killing. Pancreatic tissue samples were also taken for biochemical analyses and histopathology. Results: The serum amylase, lipase, AST and urea levels were significantly lower in the AP+GL group than in the AP group. The serum cytokines including IL-6, TNF-α and MPO levels were significantly lower in the AP+GL group than in the AP group. Even so there is no statistically difference between in the AP+GL group and the AP group in terms of pancreatic tissue IL-1β, IL-6 and TNF-α levels. GL treatment significantly decreased pancreatic tissue MPO activities and MDA levels in the AP+GL group compared with the other groups (p=0.001 and p=0.05, respectively). The histopathologic evaluations of the groups determined that acinar cell necrosis, hemorrhage, and edema were significantly lower in the AP+GL group than in the AP group (p<0.001).Table 1: Biochemical parameters in the all experimental groupsConclusion: GL treatment following taurocholate-induced acute necrotizing pancreatitis in rats suppressed the levels of pro-inflammatory cytokines, and caused a clear recovery of histological changes.

Leptospirosis, a worldwide zoonosis manifesting itself in various types, is difficult to diagnose because of non-specific symptoms. A ninety-two year-old geriatric male patient was admitted to GATA Haydarpasa Training Hospital Emergency Department with complaints of high fever, sweating, fatigue, headache, muscle aches, nausea, vomiting and the inability to walk that continued for two days. In his anamnesis, he had been on vacation to Antalya, which is a coastal province on the southern coast of Turkey. Whilst on holiday, one of his activities was to walk on the beach for several hours barefoot. His complaints started 3 days on his return to Istanbul. Blood samples were sent to spirochete laboratory of Etlik Central Veterinary Control and Research Institute. He was discharged from the Institute on 100 mg of doxycycline and 500 mg of ciprofloxacin (bid, per oral). One week later, Institute reported that the antibodies for leptospira were positive. A microagglutination test confirmed the serovar Leptospira icterohaemorrhagiae, with the titers of 1:400. After two weeks of treatment, his physical examination and laboratory tests were found to be normal. In conclusion, a careful assessment of risk factors in the case history of the patient with non-spesific symptoms such as high fever, frontal headache, myalgia and conjunctival hyperemia will assist the diagnosis of leptospirosis. Laboratory results such as neutrophilia, thrombocytopenia, high degree of creatine kinase also play an important role in the diagnosis of the disease. Early treatment should be started as soon as possible to prevent further aggravation of the disease.