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Objective Near-infrared spectroscopy (NIRS) is frequently used to predict the return of spontaneous circulation (ROSC) and evaluate the oxygenation of organs. The aim of this study was to predict ROSC by assessing extremity oxygenation during cardiopulmonary resuscitation (CPR). Methods This prospective observational study was conducted between March 2019 and March 2020 at the emergency department (ED). The extremity and brain oxygen saturation data of patients with out-of-hospital cardiac arrest (OHCA) were collected from 66 patients aged >18 years who were transported to the ED by ambulance or by relatives due to non-traumatic OHCA. After excluding 40 patients, analysis was performed for the data of 26 patients who met the study inclusion criteria. Results The 26 patients included in the study comprised 11 males and 15 females with an average age of 65.27±12.44 years. ROSC was achieved in 15 patients. No statistically significant difference was found between the initial and final NIRS scores of patients without ROSC (p>0.05). A statistically significant difference was found between the initial and final NIRS scores at all measurement points in patients with ROSC (p<0.05). The initial and final NIRS values at all measurement points were significantly higher in patients with ROSC than in those without ROSC (p<0.05). Conclusion The return rate of spontaneous circulation was higher in patients with better extremity oxygenation and increased extremity oxygenation during CPR. Evaluating extremity oxygenation with NIRS during resuscitation can help predict ROSC in patients with OHCA. Keywords:Near-infrared spectroscopy, cardiopulmonary resuscitation, return of spontaneous circulation: [ABSTRACT FROM AUTHOR]

Objective: In our study, it was aimed to determine the diagnostic and prognostic value of lactate level in patients with gastrointestinal bleeding. Methods: This study was performed by retrospective screening of the information of patients who applied to the tertiary education and research hospital with acute gastrointestinal bleeding. Data such as lactate level, age, gender, application complaint, known diseases, medications used, physical examination symptoms and findings, laboratory results, endoscopy and/or colonoscopy reports, treatment were collected and their effects on prognosis and mortality were evaluated. Results: The median age of 506 patients included in the study was 67 (IQR: 53-80) and 61.3% of the patients were male. 87.5% of the patients were upper and 12.5% lower gastrointestinal bleeding. No relation was found between bleeding region and lactate level (p=0.759). The lactate level of patients who needed erythrocyte suspension, who underwent intensive care and died, was found to be high (p<0.001, p=0.009, p<0.001, respectively). When the test performance of lactate in predicting mortality was evaluated, the AUC value was calculated as 0.714 cm² according to the ROC curve (p<0.001). When the cut-off value was taken as 4 mmol/L, the sensitivity of lactate in predicting mortality was 29%, specificity was 91%, positive predictive value was 31%, negative predictive value was 90%, positive likelihood ratio was 3.22 and negative likelihood ratio was 0.78. Conclusion: Lactate level is a test that can be used as a follow-up parameter in both upper and lower gastrointestinal system hemorrhage cases to confirm diagnosis and predict prognosis. In the cases with high lactate value, more hospitalization time, more erythrocyte suspension supplement requirement, increased risk of hospitalization and death were determined. [ABSTRACT FROM AUTHOR]

Background: Studies show that although the presence of women in the medical field has risen, there is a lesser representation of women within editorial boards of journals. Studies on this subject have mostly been carried out related to the medical field of the researcher. It is not known what position the emergency medicine department is in this regard compared to other departments. We aimed to investigate whether gender disparity exists within the editors and editorial board members of medical journals, especially in those related to emergency medicine.Methods: In the present cross-sectional study, we searched medical journals using the Scimago Journal/Country Rank journal system for comparison. The websites of the journals included in the study were searched, and gender data of the editor and editorial board, associate editors, consultant editors, and section editors for each journal were obtained.Results: The total number of journals examined in this study was 276. The median percentage of female editorial board members (20.8%; 50-100) was lower in emergency medicine journals compared to other branches of medicine (31%; 0-100) (p < .001). The median percentage of female editorial board members and editors was also lower in the emergency medicine field (20.6%; 0-50) (p < .001) than in other branches of medicine. The percentage of female editorial board members of emergency medicine journals was 19.5% with the third-lowest ranking among 26 branches. When both the editors and editorial board members were considered, the highest female percentage was found in pediatrics (50.7%) followed by geriatric medicine (43.4%).Conclusion: There is a significant gender disparity within editors and editorial board members in emergency medicine journals. The proportion of women within the editorial board was found to be lower in emergency medicine journals among all the journals included in the study. [ABSTRACT FROM AUTHOR]

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Introduction: The COVID‐19 pandemic not only affected physical health but also caused high levels of mental health problems including sleep disturbances, depression and post‐traumatic stress symptoms. The aim of this study was to examine the sleep parameters of healthcare workers before COVID‐19 infection and after recovery. Materials and Methods: Healthcare workers who were infected with COVID‐19 and whose treatment was completed at least 30 days ago were included in the study. A web‐based cross‐sectional survey was conducted on the participants. Results: The median PSQI score increased significantly after COVID‐19 infection (7.0) compared with the level before COVID‐19 infection (5.0). The increases in median scores for subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleeping medication and daytime dysfunction were all significant. Conclusion: Sleep quality decreased during the convalescence period from COVID‐19 infection as compared with the pre‐COVID‐19 period. [ABSTRACT FROM AUTHOR]

Background: SARS-CoV-2 has caused an outbreak all over the World. Age is the most important factor for mortality. However, it is not known exactly why SARS-CoV-2 infections are more severe and fatal in the elderly population. We examined the clinical course and the causes of increasing mortality in all hospitalized patients diagnosed with COVID-19 over 65 years of age. Methods: Hospitalized elderly patients diagnosed with COVID-19 were examined in this retrospective observational study. The blood results, length of stay, comorbid diseases, admission symptoms, clinical results and demographic data of the patients were recorded. It was examined whether there was a significant difference between surviving and non-surviving patients in terms of comorbid diseases and symptoms. The effects of these parameters on the 30-day mortality alone were investigated. Results: A total of 263 patients (125 males) were included in the study. Cough (53.2%) followed by dyspnea (35.7%) were the two most common symptoms. There was no statistically significant difference age or sex distribution between survivor and nonsurvivor patients. Patients with dyspnea had a significantly lower survival rate compared to patients who did not have dyspnea at presentation and patients who have chronic obstructive pulmonary disease and cerebrovascular disease were associated with a significantly increased risk of mortality Conclusions: It has been shown that there is a significant increase in the risk of mortality in COVID-19 patients with chronic obstructive pulmonary disease and cerebrovascular diseases. Additionally, Dyspnea, as an admission symptom, were found to have an effect on mortality and clinical outcomes in our study. [ABSTRACT FROM AUTHOR]

Background: Several drug intoxications can affect both pulmonary and cellular respiration. We therefore think that assessing blood lactate levels can provide information about prognosis. Blood lactate levels have provided information about prognosis in several diseases involving hypoxia at the cellular level, such as sepsis and trauma. The purpose of this study was to determine whether there is any relation between blood lactate levels and mortality, morbidity, and prognosis in patients presenting to the emergency department with drug intoxication. Methods: This retrospective cross-sectional study involved patients admitted to the emergency department due to suicidal drug intoxication over a one-year period (January to December 2016). The primary outcome measure was the relationship between serum lactate concentrations and patient discharge or hospitalization, and if hospitalized, the duration of stay. The secondary outcome measure was the relationship between serum lactate concentrations and toxic dose intake in single-drug intoxication. Results: We enrolled 372 patients, of whom 192 were analyzed after exclusion criteria application. The mean blood lactate level in the total patient group was 2.6±1.46, and 2.7±1.9 in the single drug group and 2.5±1.3 in the multidrug group. Also, blood lactate levels in the overdose group and toxic dose group were 3.4±3.0 and 2.4±0.9, respectively. No significant differences were determined in the lactate level, discharge, hospitalization and the length of hospital stay between the single drug and multidrug groups. In the toxic dose group, patient ages and number of admissions to intensive care unit were significantly higher than in the overdose group. The number of discharges was significantly lower in the toxic dose group. No correlation was determined between the serum lactate level and the length of hospital stay. Conclusion: Lactate level is not a useful parameter for predicting hospitalization in drug intoxication patients. [ABSTRACT FROM AUTHOR]

Kounis syndrome (KS) is described as the provocation of an acute coronary syndrome through activation of mast cells resulting in allergy, hypersensitivity, anaphylaxis, or anaphylactoid reaction. The case is here presented of a patient who developed KS with retrosternal chest pain and ST-segment elevation myocardial infarction 30 minutes after the ingestion of gold dust. A 40-year-old male without a history of allergy or atopy was admitted to the emergency room with complaints of red, itchy skin, chest pain, and shortness of breath 30 minutes after exposure to gold dust. Arterial blood pressure was 129/72 mmHg, pulse rate was 94 bpm, and oxygen saturation was 98%. On physical examination, urticarial lesions were observed on the anterior chest wall without uvula edema and pulmonary bronchospasm. Electrocardiogram (ECG) showed ST elevation in the V1-V6 and aVL leads. High sensitivity Troponin I level was measured as 12.1 ng/L (reference=0-19.8 ng/L), and the Troponin I levels increased to 229.7 ng/L two hours later. KS was considered because of the findings of chest pain, urticaria on the body, and lack of cardiac disorder. KS should be kept in mind in cases that present with allergic reactions together with chest pain following exposure to agents to which the immune system may be allergic. Cardiac enzymes can either be normal or elevated in these patients. ECG usually has ST, and the T wave changes. [ABSTRACT FROM AUTHOR]

Stingray is a demersal sea fish that causes widespread injury around the world. Stingray envenomation may cause local tissue injury as well as systemic effects. Although immersion of the injured area in hot water is effective in the treatment, this treatment does not provide complete relief in cases where there is a foreign body in the tissue. We presented about a case of a 22-year-old male patient with stingray tail detected in x-ray images taken after complete relief was not provided after treatment. [ABSTRACT FROM AUTHOR]

Isolated motor nerve paresis can occur due to central nervous system lesions. This condition is extremely rare, they are often misdiagnosed as a peripheral nerve lesion. 83-year-old male, applied to our hospital with 4th and 5th digit weakness. Neuroimaging revealed cortical-subcortical diffusion restriction in the medial gyrus of the precentral gyrus. The patient was diagnosed as ischemic stroke. In this article, we presented a case of ischemic stroke that mimics ulnar nerve paresis and be easily overlooked. [ABSTRACT FROM AUTHOR]

Introduction Tracheal intubation is a high-risk airway management protocol frequently applied in patients with critical illnesses. Numerous parameters have been suggested to predict mortality in these patients. Blood gas analysis, electrolyte levels, enzyme activities, and other biochemical measurements provide insights into a patient's metabolic status and organ functions. Accordingly, it is considered that these parameters have a significant potential for predicting the clinical outcomes of intubated patients. The study aimed to investigate the role of biochemical parameters in determining the 24-hour mortality risk of patients intubated in the emergency department and understand the potential significance of these parameters in predicting the clinical prognosis of these patients. Methods The present study was conducted on 1,236 patients who were intubated within a 1.5-year period at the Emergency Medicine Clinic of a tertiary Education and Research Hospital. Lactate, hemoglobin (Hgb), platelets (PLT), pH, HCO 3 , K, urea, creatinine, high-sensitivity troponin I (HS troponin I), and serum sodium levels were recorded for each patient in a data form. The 24-hour mortality rates were then analyzed based on these test results and comorbidities in the patients, and the data were recorded. Results The study included 702 patients after reviewing 1,236 cases. The median/mean values of HCO 3 , PLT, and pH were significantly higher in survivors compared to those who did not survive within 24 hours. Conversely, the median/mean values of lactate, creatinine, potassium, and HS troponin I were significantly higher in the patients who lost their lives within 24 hours than in the survivors. Epilepsy status, HCO 3 , lactate, potassium, and PLT values were statistically significant in the multivariate model in predicting 24-hour mortality. Conclusion The results of this study indicate that specific laboratory values, particularly blood gas analysis, play a significant role in predicting mortality among patients who present to the emergency department and undergo rapid sequence intubation. Patient prognosis can be predicted using these parameters, and treatment can be planned accordingly. Future multicenter prospective studies using standardized patient-specific intubation could provide further evidence for using the parameters in question in predicting mortality., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Prof. Dr. Cemil Taşcıoğlu City Hospital Clinical Research Ethics Committee issued approval 350. The documents related to the application file given above have been examined and found appropriate, taking into account the justification, purpose, approach and methods of the research/study, and it has been decided by the majority of the ethics committee members who attended the meeting that there is no ethical or scientific harm in conducting the research/study in the centers specified in the application file. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Koca et al.)

Background Predicting the mortality and prognosis of patients with stroke is one of the commonly studied topics. Various scoring systems have been used in this regard. One of them is the Full Outline of UnResponsiveness (FOUR) score. In this study, we aimed to investigate the utility of the FOUR scores in terms of their ability to predict hospital stay duration and mortality in patients who were diagnosed with ischemic stroke upon their admission to the emergency department. Methods Our study is a prospective observational study. Patients who were admitted to the emergency department of a tertiary hospital and diagnosed with ischemic stroke between August 1, 2020, and August 1, 2021, were included in the study. The inclusion criteria were as follows: being over the age of 18, being diagnosed with ischemic stroke, having symptoms that started within the last 48 hours, and patient consent approved by the patients themselves or their relatives. The patients were divided into two groups according to the FOUR scores (FOUR score = 16 and FOUR score < 16). Patients' demographic information, vital parameters, symptoms, time to admission, comorbidities, laboratory parameters, length of hospitalization, mortality, and Glasgow Coma Scale (GCS), FOUR, and National Institutes of Health Stroke Scale (NIHSS) scores were recorded. Results A total of 79 patients were included in the current study, of which 47 (59.5%) were male. The patients included in the present study had a mean age of 66 ± 13 years. When the two groups of patients with a FOUR score of 16 and a FOUR score of below 16 were compared, the mean platelet count was found to be 248 ± 70 × 10 3 /L in the former group and 170 ± 84 × 10 3 /L in the latter (p = 0.004). Sixty-five (91.5%) of the patients in the group with a FOUR score of 16 and three (37.5%) of the patients in the group with a FOUR score of less than 16 stayed for more than six hours in the hospital (p < 0.001). When the patients were evaluated for intensive care unit (ICU) admission rates, five (62.5%) patients with a FOUR score of <16 were admitted to the ICU. This rate was 2.8% (n = 2) in the group of patients with a FOUR score of 16 and was found to be significantly lower (p < 0.001). Conclusion The FOUR score was found to be useful in predicting the ICU admission rate of patients with ischemic stroke. It has also been shown that the admission time was shorter in patients with a lower FOUR score, and platelet counts were also lower in this group., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Atiş et al.)

Introduction This study aimed to determine the factors that trigger seizures in patients reporting to our emergency department (ED) with seizures and the factors that affect recurrent seizures during the emergency department stay. Materials and methods This study was designed prospectively and was conducted among patients over the age of 18 years who reported to the ED of the Education and Research Hospital with complaints of epileptic seizure between July 01, 2020 and July 01, 2021. In addition to the sociodemographic information of the patients, the time of admission after the seizure, the medications used, comorbidities, the treatment given in the ED, history of trauma, previous epilepsy diagnosis, time of last seizure, alcohol use in the last 24 hours, insomnia, presence of infective symptoms in the past week, vital parameters, blood tests, and presence of recurrent seizure during hospital follow-up were recorded. Results The median age of the 102 patients included in the statistical analysis was 37 (25%-57%), and 61 (59.8%) were men. Patients who came to the ED with the complaint of seizures were divided into two groups, namely, those who had recurrent seizures and those who did not. When the differences between the groups in terms of various variables were examined, no statistically significant difference was found in the univariate analysis, except for WBC, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) values. The diagnostic value of WBC, AST, and ALT levels in predicting recurrent seizures in emergency follow-up was analyzed using a receiver operating characteristic curve. Conclusion In this study, we could not find a parameter that can predict the probability of recurrent seizures in the ED in patients presenting with epileptic seizures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Bozan et al.)