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Objectives: To evaluate the diagnostic accuracy of carotid artery compression using a point-of-care ultrasound probe (POCUS-CAC) in reducing pulse check times and facilitating the detection of the return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR) compared to manual palpation (MP). The secondary aim of the study is to assess the ability of POCUS-CAC to detect ROSC during ongoing chest compressions. Methods: This prospective study was conducted in a tertiary emergency department between January and June 2023. During CPR, POCUS-CAC was performed by placing a linear ultrasound probe transversely on the lateral neck to assess the compressibility of the carotid artery. Complete compression of the artery without any visible pulsation indicated no ROSC, while resistance to compression or partial compression suggested the presence of ROSC. Simultaneously, another clinician performed manual palpation of the femoral artery. The primary outcome assessed in this study was comparing ROSC detection between POCUS-CAC and traditional methods, and the secondary outcome was comparing the time taken to detect ROSC with each method, and the ability to detect ROSC during ongoing chest compressions. Results: The study included 41 cardiac arrest patients and analyzed 496 MP pulse and 1984 POCUS-CAC checks. The mean time to identify a pulse using POCUS-CAC was significantly shorter, at 2.3 (0.5–7.8, SD ± 1.2, 95% CI [2.25, 2.35]) s, compared to 4.7 (2.0–10.5, SD ± 1.8, 95% CI [4.54, 4.86]) s with MP (p = 0.004). Additionally, 52.9% of ROSC cases were detected earlier using POCUS-CAC, even during ongoing chest compressions. The sensitivity of POCUS-CAC was 100% (95% CI [80.5–100%]) and the specificity was 87.5% (95% CI [67.6–97.3%]). The POCUS-CAC method required less than 5 s in 99.996% of cases. Conclusions: POCUS-CAC significantly reduces pulse check times and enhances the early detection of ROSC during CPR, offering a reliable and rapid alternative to traditional manual palpation methods in emergency settings. [ABSTRACT FROM AUTHOR]

Background and Objectives: Acute cardiorespiratory failure disrupts the delicate balance of energy supply, demand, and consumption, with elevated lactate levels and decreased blood pH serving as crucial indicators. Acute cardiogenic pulmonary edema (ACPO), a common cause of acute respiratory failure, poses a substantial mortality risk. Lactate, a byproduct of pyruvate reduction, is a pertinent marker in perfusion assessment. Lactate clearance (LC) has proven prognostic efficacy in various conditions but lacks consensus on its predictive power in acute cardiogenic pulmonary edema. Materials and Methods: This prospective observational study, conducted in a metropolitan area's third-level emergency department, involved patients with cardiogenic pulmonary edema from May 2021 to August 2023. The inclusion criteria specified acute cardiogenic pulmonary edema, excluding patients with incomplete data or other respiratory conditions. Lactate clearance, calculated at presentation and after 6 h, served as the primary outcome predictor. Our data analysis employed logistic regression, the ROC curve, and statistical tests. Results: The cohort of 106 patients revealed that a lactate clearance below 14.29% was significantly associated with mortality. While 51.6% of survivors were discharged, LC's predictive success for discharge was inconclusive. Logistic regression underscored the significance of lactate clearance, with a one-unit increase yielding a 5.55-fold probability of survival. The AUC for LC was 0.759. Conclusions: This study pioneers the exploration of lactate clearance in patients with acute cardiogenic pulmonary edema. LC below 14.29% signifies a poor prognosis, emphasizing its potential as an early treatment initiation marker. While acknowledging this study's limitations, we advocate for further multicenter research to refine the understanding of lactate clearance in this context. [ABSTRACT FROM AUTHOR]

Background: Radiation-induced lung injury (RILI), a serious side effect of thoracic radiotherapy, can lead to acute radiation pneumonitis (RP) and chronic pulmonary fibrosis (PF). Despite various interventions, no effective protocol exists to prevent pneumonitis. Oxytocin (OT), known for its anti-inflammatory, antiapoptotic, and antioxidant properties, has not been explored for its potential in mitigating RILI. Materials and Methods: This study involved 24 female Wistar albino rats, divided into three groups: control group, radiation (RAD) + saline, and RAD + OT. The RAD groups received 18 Gy of whole-thorax irradiation. The RAD + OT group was treated with OT (0.1 mg/kg/day) intraperitoneally for 16 weeks. Computerizing tomography (CT) imaging and histopathological, biochemical, and blood gas analyses were performed to assess lung tissue damage and inflammation. Results: Histopathological examination showed significant reduction in alveolar wall thickening, inflammation, and vascular changes in the RAD + OT group compared to the RAD + saline group. Biochemical analysis revealed decreased levels of TGF-beta, VEGF, and PDGF, and increased BMP-7 and prostacyclin in the RAD + oxytocin group (p < 0.05). Morphometric analysis indicated significant reductions in fibrosis, edema, and immune cell infiltration. CT imaging demonstrated near-normal lung parenchyma density in the RAD + oxytocin group (p < 0.001). Conclusion: Oxytocin administration significantly mitigates radiation-induced pneumonitis in rats, implying that is has potential as a therapeutic agent for preventing and treating RILI. [ABSTRACT FROM AUTHOR]

Objectives: Diabetic ketoacidosis (DKA) poses a life-threatening risk in uncontrolled diabetes. Current diagnostic criteria rely on invasive measures, leading to potential delays in treatment initiation. This study aimed to assess the diagnostic utility of noninvasive end-tidal carbon dioxide (EtCO2) measurements in DKA patients. Methods: A prospective, cross-sectional study was conducted in a tertiary-level Emergency Medicine Clinic from January 2021 to January 2023. Participants included adults with DKA symptoms and those with stable vital signs as controls. EtCO2 levels were measured using a capnograph device. Diagnostic criteria for DKA were blood glucose ≥250 mg/dL, ketonuria, ketonemia, and metabolic acidosis (pH<7.3 or bicarbonate <15 mEq/dL). Statistical analysis was performed using SPSS Statistics. Results: Of 730 participants, 120 had DKA, 410 did not, and 200 served as controls. EtCO2 levels significantly differed between DKA, non-DKA, and control groups (P<0.05). EtCO2 correlated with pH, lactate, base deficit, and bicarbonate (P<0.05). ROC analysis showed an AUC of 0.86 for EtCO2 in diagnosing DKA (P<0.01), with 91.67% sensitivity and 74.39% specificity at a cut-off value 23.7. Conclusion: This study suggests that EtCO2 measurement is a valuable noninvasive tool for diagnosing and assessing the severity of DKA in the emergency department. An EtCO2 threshold of <23.7 could prompt consideration of DKA in patients with elevated blood glucose levels. More extensive multicenter studies are warranted to validate these findings further. EtCO2 measurement could facilitate early DKA diagnosis and improve patient outcomes. [ABSTRACT FROM AUTHOR]

The success of the manual pulse check method frequently employed during cardiopulmonary resuscitation (CPR) is controversial due to its subjective, patient- and operator-dependent, and time-consuming nature. Carotid ultrasound (c-USG) has recently emerged as an alternative, although there are still insufficient studies on the subject. The purpose of the present study was to compare the success of the manual and c-USG pulse check methods during CPR. This prospective observational study was conducted in the critical care area of a university hospital emergency medicine clinic. Pulse checks in patients with non-traumatic cardiopulmonary arrest (CPA) undergoing CPR were performed using the c-USG method from one carotid artery and the manual method from the other. The gold standard in the decision regarding return of spontaneous circulation (ROSC) was the clinical judgment made using the rhythm on the monitor, manual femoral pulse check, end tidal carbon dioxide (ETCO 2), and cardiac USG instruments. The success in predicting ROSC and measurement times of the manual and c-USG methods were compared. The success of both methods was calculated as sensitivity and specificity, and the clinical significance of the difference between the methods' sensitivity and specificity was evaluated Newcombe's method. A total of 568 pulse measurements were performed on 49 CPA cases using both c-USG and the manual method. The manual method exhibited 80% sensitivity and 91% specificity in predicting ROSC (+PV: 35%, −PV: 64%), while c-USG exhibited 100% sensitivity and 98% specificity (+PV: 84%, −PV: 100%). The difference in sensitivities between the c-USG and manual methods was −0.0704 (95% CI: −0.0965; −0.0466), and the difference between their specificities was 0.0106 (95% CI: 0.0006; 0.0222). The difference between the specificities and sensitivities was statistically significant at analysis performed adopting the clinical judgment of the team leader using multiple instruments as the gold standard. The manual method yielded an ROSC decision in 3 ± 0.17 s and c-USG in 2.8 ± 0.15 s, the difference being statistically significant. According to the results of this study, the pulse check method with c-USG may be superior to the manual method in terms of fast and accurate decision making in CPR. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Aim: With the COVID-19 pandemic, the increase in the number of patients admitted to the emergency department has led to an increase in the need for intensive care and mechanical ventilation. Methods that can predict the development of serious disease will allow for a more accurate use of resources. This study was conducted to test the ability of the Quick COVID-19 Severity Index and the COVID-GRAM Critical Illness Risk Score to predict serious disease development and mortality. Methods: This is a prospective cohort study. Among the patients admitted to the emergency department, those hospitalized due to COVID-19 were included in the study. The Quick COVID-19 Severity Index and COVID-GRAM Critical Illness Risk Scores of the patients were calculated, and the ability of these scores to predict serious illness and mortality was investigated. Results: A total of 556 patients were included in this study. Development of critical illness, described as the need for non-invasive / invasive ventilation or the need for intensive care unit admission, was found significant when the Quick COVID-19 Severity Index was above 5 and the COVID-GRAM Critical Illness Risk Score showed high risk (AUC: 0.927; P < 0.001, AUC: 0.986; P < 0.001, respectively). A Quick COVID-19 Severity Index over 6 and COVID-GRAM Critical Illness Risk Score indicating high risk were found to be associated with mortality (AUC: 0.918, P < 0.001, AUC: 0.982, P < 0.001, respectively). Conclusion: Both the Quick COVID-19 Severity Index and the COVID-GRAM Critical Illness Risk Score can be used to assess severity in COVID-19 patients in the emergency room. However, the COVIDGRAM Critical Illness Risk Score was more successful in differentiating low-and high-risk patients. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus disease-2019 (COVID-19) pandemic was the leading cause of high mortality and morbidity in the previous two years. Rapid determination of the severity of the disease is important in terms of reducing the intensity and initiating effective treatment. Although the pneumonia severity index (PSI) and CURB-65 classifications are widely employed to predict mortality and morbidity in patients diagnosed with pneumonia, biomarkers predicting the mortality and severity of COVID-19 in the emergency department (ED) are also needed. This study investigated the relationship between the blood urea nitrogen (BUN)/albumin ratio (BAR) and mortality and disease severity. Methods: Five hundred eighty-one patients presenting to the ED between March 2020 and January 2022 and diagnosed with COVID pneumonia were included in this observational study. Patients' BUN and albumin levels, and PSI and CURB-65 scores were calculated, and in-hospital mortality was recorded. The power of BAR in predicting mortality was compared with that of PSI and CURB-65 by using statistical analysis. Results: A significant association was determined between increased BAR and mortality. The area under the curve (AUC) value of BAR was 0.684, with 76.6% selectivity and 53.4% sensitivity at a cut-off point of 6.85. The CURB-65 score AUC value was 0.571, with 56% selectivity and 55.9% sensitivity at a cut-off point of 1.5. The AUC value for the PSI score was 0.609, with 63.3% selectivity and 50.3% sensitivity at a cut-off point of 107.5. Conclusion: BAR is a simple but independent marker of mortality and severity in COVID-19 viral pneumonia. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cumhuriyet Medical Journal is the property of Cumhuriyet Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The aim of this study was to investigate the effects of Ramadan model intermittent fasting (IF) on acute pancreatitis, acute cholecystitis, and acute cholangitis, which is closely related to nutrition. Materials and Methods: This retrospective research study was conducted from 2014 to 2018. Patients over 18 years old with acute pancreatitis, acute cholecystitis, and acute cholangitis were included in the study. Patients with lipid metabolism disorders such as hyperlipidemia, pregnant women, malignancies, viral infections, hepatic insufficiency, and cirrhosis were excluded from the study. A total of 3940 patients were included in the study. Hospital applications in Ramadan were compared with the rest of the year. Results: One thousand eight hundred and sixteen male and 2124 female patients were included in the study. 1797 patients (45.6%) with pancreatitis, 1032 patients (26.2%) with cholangitis and 1015 patients (25.8%) with cholecystitis. Pancreatitis (46.4%), cholangitis (29.8%), and cholecystitis (19.3%) were the most frequently diagnosis in Ramadan. The monthly admission rates were calculated in a 5-year period. It was found that the admission rates were 26.6% more in Ramadan than other months. Ramadan fasting significantly increased acute pancreatitis and acute cholangitis. However, cholecystitis decreased. Both sexes were similarly affected from the Ramadan period. Conclusion: Ramadan model of IF induces an increase in the incidence of acute pancreatitis and acute cholangitis and a decrease in acute cholecystitis. Ramadan model may not be a suitable model for a healthy diet. [ABSTRACT FROM AUTHOR]

Copyright of Acibadem Saglik Bilimleri Dergisi is the property of Acibadem University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Turkey is one of the most popular immigration countries because of the wars that are ongoing in its southern border and its location on access routes to Europe. Migrations continue because of wars and political turmoil. The increasing number of migrants requires revising the public healthcare planning. In our study, we compared the behaviors of immigrants and local people. We examined to which extent immigrants used the clinics of our hospital. We interpreted the adequacy of the current healthcare system for migrants. We analyzed the hospital admissions of migrants and local residents who applied to our hospital between January 2014 and December 2018 in retrospective fashion. We determined the rates of referral to clinics. We determined that the highest referral rates of the migrants were made to emergency services, gynecology and obstetrics. We observed that the birth rates increased in migrants in the following period. However, despite the traumas, immigrants did not use psychiatric units. The existing healthcare and social policies must be revised by considering especially the needs of immigrants and their use of healthcare systems. We believe that primary healthcare services must be delivered equally to all individuals to reduce the intensity of emergency services, gynecology and obstetrics departments, and pediatric services. We also believe that the trauma that iscaused by immigration must not be underestimated. [ABSTRACT FROM AUTHOR]

The clinical course of COVID-19 presents a broad spectrum, being asymptomatic in some individuals while following a severe course and resulting in mortality in others. It is known that such factors as age and chronic diseases can result in a different clinical courses in individuals, however, variable clinical courses among the similar individuals in terms of age and chronic diseases are also seen. Other possible factors affecting the course of the disease that are mostly speculative or under investigation are genetic factors and the origin of transmission or possible subtype of novel coronavirus. Whether the source of transmission is important in the clinical course of the disease is unknown. A case series composed of seven individuals in a similar age group, with different lines of descent and different genetic structures, but who were infected from the same source is presented here. The similar and different clinical, laboratory and radiological findings of the cases residing in the same nursing home, who presented to the hospital altogether, were evaluated. The aim of the study was to analyze whether the source of transmission is influential in the clinical course of the disease. [ABSTRACT FROM AUTHOR]

Introduction: Diagnosing aortic dissection (AD) in emergency services still represents a challenging issue as it may manifest not only well-known clinical findings such as sudden onset and severe chest pain but also atypical findings similar to ST elevation myocardial infarction or renal colic. Contrast-enhanced imaging investigations, which are expensive and risky due to possible complications, are necessary for diagnosis. Ultrasonography is not always reliable, which necessitates noninvasive diagnostic tests to support a clinical suspicion. Signal peptide-CUB (complement C1r/C1s, Uegf, and Bmp1)-EGF (epidermal growth factor) domain-containing protein 1 (SCUBE-1) is a cell surface protein produced during embryogenesis. This study was conducted to compare the levels of this novel biomarker between patients with AD and healthy volunteers. Methods: This prospective study was conducted on 20 patients diagnosed with AD using contrast-enhanced thoracoabdominal computed tomography angiography. Average agematched 20 healthy subjects as a control group were included as a reference for biochemical parameters. Results: The mean SCUBE-1 levels were significantly higher in patients with AD [24.51 ( ± 3.01) ng/dL] than in the control group [12.11 ( ± 5.31) ng/dL] (p < 0.001). Receiver-operating characteristic (ROC) curve was plotted to analyze the specificity and sensitivity of AD diagnosis (with 95% confidence intervals), which revealed 95% sensitivity and 76% specificity when the SCUBE-1 level was > 19.75 ng/dL. A significant correlation was also observed between dissection types and mortality, as well as extravasation state. Conclusions: This preliminary study demonstrated that plasma SCUBE-1 level is a better and specific biomarker for AD and may be used for diagnosing AD in emergency services. Wider case series and further clinical studies are required to confirm these findings. [ABSTRACT FROM AUTHOR]