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Acil servise başvuran kritik hastalıkların özelliklerinin bilinmesi, en kısa sürede tanı alması ve doğru tedavilerinin başlamasında hayati öneme sahiptir Çalışmamızda acil servise başvuran hastaların demografik ve klinik özelliklerini incelemeyi amaçladık. Ocak 2015 ile Aralık 2019 tarihleri arasında hastanemiz üçüncü basamak acil servisine başvuran tüm erişkin ve çocuk hastalar retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, hastalık tanıları ve yıllara göre başvuru oranları değerlendirildi. Acile servise beş yıl içerisinde başvuran hasta sayısı 2.254.302 olarak tespit edildi. Hastaların %50.9’u erkek ve %49.1’i kadındı ve yaş gruplarına göre başvuru sıklığı değerlendirildiğinden yoğun grubun %26.73 ile 10 yaş ve altı olduğu görüldü. En çok başvuru %51 ile 16:00-24:00 saatleri arasında idi. Hastaların en sık solunum sistemi problemleri(%24,71) ile acile başvurduğu tespit edildi. Acil servise başvuran hastaların %2.24’ü ilgili bölümlere, %0.77’sinin ise yoğun bakım ünitesine yatırıldığı tespit edildi. Acil servislere başvuru oranının yüksek olması beraberinde aşırı hasta yoğunluğuna neden olmaktadır. Acil servise başvuran hasta profilinin belirlenmesi, verilecek hizmet sunumu ve hasta bakım kalitenin artırılmasında faydalı olacaktır., It is vital to know the characteristics of critical diseases admitted to the emergency department, to diagnose as soon as possible and to start the right treatment. In our study, we aimed to examine the demographic and clinical characteristics of the patients admitted to the emergency department. All adult and pediatric patients who admitted to the tertiary care emergency department of our hospital between January 2015 and December 2019 were evaluated retrospectively. The demographic characteristics of the patients, diagnoses and application rates according to the years were evaluated. The number of patients admitted to the emergency department within five years was 2,254,302. 50.9% of the patients were male and 49.1% were female. When the frequency of application was evaluated according to the age groups, it was seen that the most intense group was those aged 10 and below with 26.73%. The highest application rate was between 4 p.m-12 p.m. with 26.73%. It was found that the patients were admitted to the emergency department most frequently with respiratory system problems (24.71%). It was determined that 2.24% of the patients admitted to the emergency department were hospitalized in the relevant wards and 0.77% were transferred to the intensive care unit. The high rate of admission to emergency departments also causes excessive patient density. Determining the patient profile that admitted to the emergency department will be useful in increasing the quality of service delivery and patientcare.

Aim: This study aimed to determine the anxiety level in pre-hospital emergency medical services personnel (PHEMSPs) and investigate the factors that potentially affect the anxiety level during the pandemic. Materials and Methods: This cross-sectional survey was conducted with PHEMSPs during the Coronavirus Disease-2019 (COVID-19) pandemic. A 60-item survey, including socio-demographic characteristics, anxiety-related demographic factors, and State-Trait Anxiety Inventory (STAI) scale scores was used. Results: Among 586 PHEMSPs participating in the study, 50.5% were female, with median age of 30 years. The mean STAI-S value was 42.2, and the median STAI-T value was 48. The anxiety levels of female PHEMSPs (STAI-S=51 and STAI-T=44.14) were higher than male (STAI-S=44 and, STAI-T=40.26). The anxiety level of patients with chronic diseases (STAI-S=56 and, STAI-T=45.77) was significantly higher than those without chronic diseases. State anxiety scores in married individuals (STAI-S=49) were higher than those unmarried individuals. Conclusion: Clearly, people who provide this service should be psychologically healthy to efficiently provide healthcare for the benefit of the people. All types of media assume a great responsibility in reducing the unrest or anxiety that may occur in humans, especially because of their potential to reach many parts of the society.

Objective: Pneumothorax is one of the life-threatening differential diagnoses of patients presenting to emergency department (ED) with shortness of breath and chest pain. The place of dynamic electrocardiography (ECG) changes in diagnosis of pneumothorax was not well defined. The aim of our study was to reveal the clinical importance of ECG in pneumothorax. Methods: Between 01.04.2014 and 01.04.2017, 147 patients who applied to our ED and take a diagnosis of pneumothorax were retrospectively examined. The patients were divided as Group 1 (with pneumothorax volume 0.05). When the ECG data was analyzed, a difference was found between the two groups. While 52.8% of the patients in group 1 had ECG changes, all of the patients in group-2 (100%) had unusual ECG findings (p = 0.004). Conclusions: Pneumothorax is a condition that should not be overlooked at ED. Pneumothorax especially with large volume size (size≥20%) should be remembered in cases with abnormal findings in their ECG., Amaç: Pnömotoraks, nefes darlığı ve göğüs ağrısı ile acil servise başvuran hastaların hayatı tehdit eden ayırıcı tanılarından biridir. Dinamik elektrokardiyografi (EKG) değişikliklerinin pnömotoraks tanısındaki yeri iyi tanımlanmamıştır. Çalışmamızın amacı, pnömotoraksta EKG'nin klinik önemini ortaya çıkarmaktır. Gereç ve Yöntem: 01.04.2014 – 01.04.2017 tarihleri arasında acil servisimize başvuran ve pnömotoraks tanısı alan 147 hasta geriye dönük olarak incelendi. Hastalar Grup 1 (pnömotoraks hacmi 0.05). EKG verileri incelendiğinde iki grup arasında fark bulundu; Grup 1'deki hastaların% 52,8'inde EKG değişiklikleri varken, grup-2'deki tüm hastaların (% 100) olağandışı EKG bulguları vardı (p = 0,004). Sonuç: Pnömotoraks acil serviste gözden kaçırılmaması gereken bir durumdur. EKG'sinde anormal bulgular olan durumlarda pnömotoraks (Klinik olarak anlamlı pnömotoraks, boyut≥% 20) hatırlanmalıdır.

Background: Mad honey is the type of honey made by bees that are nourished from the plants of Rhododendron (Rh.) family, and it contains grayanotoksin (GTX). The most significant types of Rh family, which contain GTX, are Rh. The purpose of this study was to analyze the cases which came to the emergency room because of GTX intoxication in detail in order to help diagnosis, treatment, follow-up and prognosis in daily emergency medicine practice. A total of 36 patients with the symptoms and diagnosis of intoxication after consuming mad honey, were included in the study. Ten healthy individuals who did not have a history of taking mad honey were included in the control group. The study is designed as a prospective case control study. The average GTX level of the group who ate mad honey (studygroup) was 7.88 ng/ml (min: 0.00/max: 30.47). At control group, GTX level was 0 ng/ml. There was no statistically significant relationship between the symptoms (dizziness, nausea, vomiting, weakness, deterioration, angina) and blood GTX level in the study group. Also statistic value reflects relationship between kidney function tests, troponin and control troponin levels in case group. The patients who have absolute decrease in blood pressure and pulse should be questioned by emergency medicine doctors about consuming mad honey. Further studies are needed to demonstrate the relationship between symptoms and GTX poisoning.

WOS: 000477724100005 PubMed: 31358088 Objective: To evaluate whether the complete blood count parameters can be used to predict patients who will have positive troponin levels during emergency department observation, and to establish whether any single parameter or combination of parameters has sufficiently good diagnostic test criteria results to be recommended for use in daily clinical practice. Study Design: An observational study. Place and Duration of Study: Department of Emergency Medicine, Duzce University School of Medicine, Duzce, Turkey, from October 2015 to October 2016. Methodology: Study group had patients with positive troponin levels during observation in the emergency department. The control group had normal troponin levels. Their complete blood count parameters were compared individually and in combination. Results: Total white blood cell count, neutrophil count, red cell distribution width, neutrophil-to-lymphocyte ratio, and some combinations of these parameters were found to be predictive of troponin elevation. The best one was combination of white blood cell count, red cell distribution width and neutrophil-to-lymphocyte ratio. Conclusion: Some of the complete blood count parameters may provide some clues when predicting troponin elevation in patients with chest pain. However, none of these parameters or no combination of them have sufficiently good diagnostic test criteria results to safely predict non-ST segment elevation myocardial infarction.

Basically, acute coronary syndrome (ACS) is caused by the partial or total occlusion of coronary arteries because of platelet activation and aggregation. Hence, one of the major components of ACS treatment is the inhibition of platelet activation and aggregation. New studies performed in recent years have led to the update of guidelines for the usage of antiplatelet agents (APA) in the treatment of ACSs. This paper aims to compare the European Society of Cardiology (ESC) and American Heart Association (ACCF/AHA) guidelines, by summarizing the key points, regarding the usage of oral APA in patients admitted to emergency departments due to ACS.

This study aims to evaluate possible effects of chronic carbon monoxide (CO) exposure on argyrophilic nucleolar–organizer region (AgNOR)-associated protein synthesis in striated muscle cells. Eighteen rats were randomly divided into three groups. Rats in group II and group III were given CO gas (1000 and 3000 ppm, respectively) for 30 min a day for 7 d. Mean AgNOR number per nucleus and ratio of total AgNOR area to nuclear area (TAA/NA) were determined. Both TAA/NA ratio and mean AgNOR number provided information about the existence or absence of exposure. TAA/NA ratio was also an indicator of the level of exposure. © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.

TURAN SONMEZ, Feruza/0000-0001-8817-8521 WOS: 000407941000056 PubMed: 28460803 Sick sinus syndrome is a disorder of sinus node function characterized by various dysrhythmias such as sinus bradycardia or pause, paroxysmal regular or irregular atrial tachycardia, tachycardiabradycardia attacks or atrial fibrillation with slow ventricular response. Ventricular asystole with preserved atrial electrical activity is a rarely seen presenting rhythm in the ED and an extremely rare cause of syncope. A 67-year-old male having a syncope attack was admitted to the emergency department. His Glasgow coma scale score was 15 on admission. He became unconscious during his observation in the emergency department, and cardiopulmonary resuscitation was initiated because he was seen to be apneic; his arterial pulse was impalpable, and ventricular asystole with preserved atrial electrical activity was seen on the monitor. He regained consciousness and normal sinus rhythm was seen on the monitor after 2 min of cardiopulmonary resuscitation. Then, an alternating rhythm with short periods of bradycardia and tachycardia suggesting sick sinus syndrome was developed. A dualchamber pacemaker was placed, and he was discharged after 2 days of in patient follow-up. His symptoms have not recurred after placement of the pacemaker device. When sudden changes in vital parameters and/ or consciousness develop during observation of a patient with sick sinus syndrome, although it is not a common circumstance, accompanying high degree atrioventricular block and simultaneous ventricular asystole should be considered, and cardiopulmonary resuscitation should be initiated immediately because cardiopulmonary arrest is inevitable when ventricular asystole develops even if the atrial electrical activity is maintained. (C) 2017 Elsevier Inc. All rights reserved.

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 parasuicide 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 ≥50 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. KEYWORDS: suicide attempt, parasuicide, sociodemographic findings, epidemiology. Language: en

Yaykasli, Kursat/0000-0001-7550-6370; Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; Kaya, Ertugrul/0000-0003-0081-682X WOS: 000328658600028 PubMed: 24139877 Although rarely seen, Amanita phalloides var. alba, a variety of A. phalloides type mushrooms, causes mushroom poisoning resulting in death. Since it is frequently confused with some edible mushrooms due to its white colored cap and macroscopic appearance, it becomes important in toxicological terms. Knowledge of the toxin amount contained in this mushroom type is invaluable in the treatment of cases involving poisoning. In this study, we examined the toxin levels of various parts of the A. phalloides var. alba mushroom growing Duzce region of Turkey. Toxin analyses were carried out for A. phalloides var. alba, which were collected from the forests Duzce region of Turkey in 2011, as a whole and also separately in its spore, pileus, gills, stipe and volva parts. The alpha amanitin, beta amanitin, gamma amanitin, phalloidin and phallacidine analyses of the mushrooms were carried out using the RP-HPLC method. A genetic analysis of the mushroom showed that it had similar genetic characteristics as A. phalloides and was a variety of it. The lowest toxins quantity was detected in spores, volva and stipe among all parts of the mushroom. The maximum amount of amatoxins was measured in the gills. The pileus also contained a high amount of amatoxins. Generally, amatoxins and phallotoxin concentrations were lower as compared to A. phalloides, but interestingly all toxins other than gamma toxin were higher in the spores of A. phalloides var. alba. The amount of toxin in all of its parts had sufficient concentrations to cause death. With this study, the amatoxin and phallotoxin concentrations in A. phalloides var. alba mushroom and in its parts have been revealed in detail for the first time. (C) 2013 Elsevier Ltd. All rights reserved.

Saritas, Ayhan/0000-0002-4302-1093; Yaykasli, Kursat/0000-0001-7550-6370; Saritas, Ayhan/0000-0002-4302-1093; Kaya, Ertugrul/0000-0003-0081-682X WOS: 000365745600013 PubMed: 23719849 Most of the fatal cases of mushroom poisoning are caused by Amanita phalloides. The amount of toxin in mushroom varies according to climate and environmental conditions. The aim of this study is to measure -, -, and -amanitin with phalloidin and phallacidin toxin concentrations. Six pieces of A. phalloides mushrooms were gathered from a wooded area of Duzce, Turkey, on November 23, 2011. The mushrooms were broken into pieces as spores, mycelium, pileus, gills, stipe, and volva. -, -, and -Amanitin with phalloidin and phallacidin were analyzed using reversed-phase high-performance liquid chromatography. As a mobile phase, 50 mM ammonium acetate + acetonitrile (90 + 10, v/v) was used with a flow rate of 1 mL/min. C18 reverse phase column (150 x 4.6 mm; 5 mu m particle) was used. The least amount of -amanitin toxins was found at the mycelium. The other toxins found to be in the least amount turned out to be the ones at the spores. The maximum amounts of amatoxins and phallotoxin were found at gills and pileus, respectively. In this study, the amount of toxin in the spores of A. phalloides was published for the first time, and this study is pioneering to deal with the amount of toxin in mushrooms grown in Turkey.

Geriatrik hastalar acil servisler için özel bir topluluğu temsil etmektedir. Yaşlı insanlar genellikle gençlere göre daha sık ve ağır durumda acil servislere başvurmaktadır. Geriatrik popülasyondaki hızlı artışa bağlı olarak acil servislerin bu hastaların bakımını karşılayacak destekleri geliştirmesi önem kazanmaktadır. Bu yazımızda acil servis çalışanlarına acil servislere başvuran geriatrik yaş grubundaki hastalara yaklaşımda önem arz eden ve dikkat edilmesi gereken noktaları bir bütün halinde sunmayı amaçladık. Acil hekimlerinin geriatrik hastalar ile ilgili düşünceleri; eğitimleri sırasında geriatrik sorunlar üzerine yetersiz zaman harcanması ve geriatri konusunda acil tıp araştırmalarının yetersiz olmasıdır. Sonuç olarak, yaşlı istismarı, düşme, depresyon, alkolizm ve malnütrisyon gibi önemli konuların ortaya çıkarılmasında acil servis hekimleri anahtar rol oynayabilir. Acil servis çalışanları için geriatrik acil durumları tanımaya yönelik eğitim modellerinin ve protokollerin oluşturulmasının acil servislerde geriatrik hastalara bakımın kalitesini artıracağını düşünmekteyiz. (JAEM 2013; 12: 93-7) Geriatric patients represent a special group for emergency services. Geriatric patients usually apply to emergency services in more frequent and more severe situations than younger patients. Due to the rapid rise in the geriatric population, development of reinforcements in order to supply care for these patients becomes a more urgent issue for emergency services. In this paper, we aimed to present points which are important considerations in the management of geriatric group patients admitted to emergency room for emergency service workers, as a whole. It has been shown in many studies that there has been inadequate information and education for emergency physi- cians and nurses in identifying geriatric emergency situations. The majority of emergency physicians feel that inadequate time is spent on geriatric issues in residency, and that research in geriatric emergency medicine is inadequate. As a result, emergency physicians may play a key role in detecting important issues such as elder abuse, falling down, depression, alcoholism and malnutrition. We think that the creation of educational models and protocols for the recognition of geriatric emergency situations for emergency service workers will improve the quality of care given to geriatric patients in emergency services. (JAEM 2013; 12: 93-7)

Background: Despite the developments in medicine in recent years, people in many regions of the world still tend to use alternative, or non-medical, folkloric treatment methods for many different health problems. One of these methods is “rope wrapping to the back,” which is considered to be therapeutic for patients with lumbar disc hernias or low back pain. This method is practiced by local individuals without medical training. Case Report: Over the course of 3 years, 14 patients, 8 women and 6 men, presented to Ataturk University and Erzurum state hospitals in eastern Turkey after undergoing the folk treatment known as “rope wrapping to the back” for low back pain. One of the patients, who had symptoms of systemic infection, later died. Of the other patients, 4 had local infections, 6 had unresolved complaints, and 3 had other complaints. Nine of the patients were treated in the emergency department and 4 required surgery. Two case reports are provided as examples. Conclusion: Improvements are needed to increase the accessibility of health care, improve physician–patient communication, and provide information to people, so as to prevent the use of folk remedies, which can have serious complications, sometimes resulting in death.

Introduction: This study aims to evaluate the relationship between increased B-type natriuretic peptide (BNP) levels in stroke patients and clinical parameters such as age, sex, medical history, blood pressure, Glasgow Coma Score (GCS) and National Institutes of Health Stroke Scale (NIHSS). Materials and Methods: This is a prospective study of 123 stroke patients at the Emergency Department. The patients were divided into 3 groups according to the NIHSS scores. The analysis of the mean difference between continuous variables and plasma BNP levels was assessed using the Mann-Whitney and Kruskal-Wallis. Spearman correlation analysis was performed for BNP and other clinical parameters. Results: The BNP levels of patients who had a medical history of hyperlipidaemia, chronic obstructive pulmonary disease, diabetes mellitus and coronary artery disease were significantly higher than in patients without these diseases. Patients who had atrial fibrillation (AF) in their electrocardiography had significantly higher BNP levels than patients with sinus rhythm. A positive correlation was found between plasma BNP levels with age, blood urea nitrogen (BUN) and NIHSS and a negative correlation was found between plasma BNP levels and GCS. There was a significant difference between the BNP levels of NIHSS groups. Conclusion: We consider that plasma BNP levels could help us in interpreting the general clinical severity, functional capacity and clinical progress of stroke patients at the time of admission in the Emergency Department. In evaluating the high BNP levels in stroke patients, we must keep in mind that age, AF, BUN and medical history can affect the BNP levels. Key words: Emergency Department, Progress, Relationship

Aim: To study brain natriuretic peptide (BNP) levels in three subgroups: patients having stroke with hypertension (HT), those having stroke without HT, and those with HT alone. We also tried to identify whether BNP levels predict the length of stay in hospital and mortality. Materials and Methods: The groups were formed by patients who had been admitted to the emergency department in the first 4-12 h after the onset of symptoms. There were 30 stroke patients with a history of HT (group I), 30 stroke patients without a history of HT (group II), and 20 HT patients without stroke (group III). Patients with congestive heart failure, chronic cor pulmonale, severe valvular heart disease, chronic renal failure, liver insufficiency, diabetes mellitus, atrial fibrillation, and those with a history of stroke were excluded from the study since these diseases can affect the plasma BNP levels. Results: The demographic characteristics, except the age distribution, were similar among the groups. The mean BNP levels in the three groups were 168.8 ± 223.9 pg/ml, 85.0 ± 75.1 pg/ml, and 84.8 ± 178.3 pg/ml, respectively. The differences between the groups were statistically significant. Conclusion: The mean BNP levels were affected by HT and/or stroke. The simultaneous presence of HT and stroke results in a more significant increase BNP than the presence of either stroke or HT alone. When diseases that can affect the plasma BNP levels are excluded, the BNP levels in stroke patients without a history of HT are similar to the levels seen in patients with only HT.

The aim of this study was to investigate beneficial effects of erdosteine in the alpha amanitine-induced hepatotoxicity in mice. Three hours after giving alpha amanitin (0.5 mg/kg, i.p.) to the mice, they were administered silibinin (50 mg/kg/d, i.p.) or erdosteine (100 mg/kg/d, oral) therapies once a day for 3 d. A histopathological examination of their liver tissues was carried out 24 h after the last treatment; transaminase levels, blood urea nitrogen, urea, and creatinine were analyzed in serum. Erdosteine showed a beneficial effect by significantly improving the functional parameters particularly in alpha amanitin-induced hepatotoxicity and partially in renal toxicity. In the histopathological evaluation, the toxicity that was generated with alpha amanitin was significantly reduced by erdosteine, showing a possible hepatoprotective effect. © 2016 Informa UK Limited, trading as Taylor & Francis Group.

The aims of the study are to detect whether there are any possible effects of chronic carbon monoxide (CO) exposure on the argyrophilic nucleolar-organizing region (AgNOR)–associated protein synthesis and evaluate any possible relationship between the amount of AgNOR protein and the level of myocardial injury also and between AgNOR and histopathological evaluation methods. Adult male albino Wistar rats ( n = 18) were randomly divided into three groups (groups A, B, and C). Group A served as control, while groups B and C were rats exposed to CO gas chronically (1000 and 3000 ppm CO concentration with a flow rate of 4 L/min for 30 min/day for 7 days, respectively). Total AgNOR area/nuclear area (TAA/NA) and the mean AgNOR numbers for each myocyte nucleus were determined. There were significant differences among all groups for TAA/NA ratio. These differences were not significant for mean AgNOR numbers. According to the histopathological evaluation scores, there were significant differences between the groups. The differences were significant among the groups for loss of sarcomere pattern. A strong positive correlation between histopathological injury scores and TAA/NA ratio was found ( Rsq = 0.48; p = 0.002), however, the correlation was not significant for mean AgNOR numbers ( Rsq = 0.08; p = 0.25). In conclusion, TAA/NA ratio can be used as an indicator for obtaining information about the level of myocardial damage instead of histopathological evaluation scores.

Central venous catheters are a commonly used medical device which may sometimes cause complications. We present first case who had an asystolic cardiac arrest during insertion of a central venous catheter, needed cardiopulmonary resuscitation (CPR), and was resuscitated successfully. A46-year lady presented to the emergency department due to mushroom poisoning. Acentral venous catheter was inserted through the internal jugular vein. However, the patient suddenly lost consciousness and asystole was seen on the monitor immediately after the insertion of the catheter. Cardiopulmonary resuscitation was started, and the catheter was withdrawn nearly 5 cm. Spontaneous circulation returned 2 minutes later. The patient was hospitalised, hemodialysis was performed, and she was discharged the next day. Emergency physicians should be prepared for dysrhythmias and asystole during insertion of a central venous catheter. If cardiac arrest develops, the catheter should be withdrawn a few centimeters while CPR continues.

Usage of energy drinks has been increasing in our country in recent years as it has been in the whole world. We aimed to present ingredients and side effects of energy drinks which are consumed mostly by adolescents and young adults. Additionally, we aimed to discuss recent literature related to energy drinks which are thought to serve as a step in the way of alcohol consumption and addiction in recent years.

Retinal migren, migren hastalığının bir alt grubudur. Retinal migren tanım olarak; migren baş ağrıları ile birlikte veya migren hikayesi olan bir hastada eş zamanlı görülebilen geçici monooküler görme bozuklukları ile seyreden bir durumdur. Retinal migren ya gözün ya da optik sinirin hipoperfüzyonu nedeni ile görülmektedir. Yirmi sekiz yaşında bayan hasta sağ gözde görmede azalma ve baş ağrısı şikâyetleri ile acil servisimize başvurdu. Nörolojik ve diğer sistem muayeneleri normal idi. Hastaya göz konsültasyonu yaptırıldı. Göz muayenesinde; görme keskinliği 20/20, her iki gözde intraoküler basınçlar normal sınırlar içerisinde idi. Renkli görme testi, fundus muayenesi ve ekstra oküler kas fonksiyonları iki taraflı normaldi. Görme alanı konfrontasyonu sol temporal hemianopsiyi düşündürdü. Otomatik perimetri testinde sol temporal hemianopsi doğrulandı. Anamnez ve fizik muayene bulguları ışığında hastada retinal migren tanısı konuldu. Acil servisteki takibi sırasında hastanın baş ağrısı ve göz ile ilgili şikayetleri geriledi. Hasta yatışının 2. gününde tam iyileşme ile taburcu edildi. Sonuç olarak, acil servise görme bozuklukları ile birlikte baş ağrısı şikayetleri ile başvuran hastalarda, acil hekimleri retinal migren açısından uyanık olmalı ve hastalar bu açıdan ayrıntılı bir şekilde değerlendirilmelidir., Retinal migraine is a subgroup of migraine. Retinal migraines are transient monocular visual disturbances that can occur simultaneously with migraine headaches or in a patient with a prior history of migraines. Retinal migraines occur because of hypoperfusion of either the eye or the optic nerve. A 28-year woman was admitted to the emergency department with decreased vision in the right eye and headache. Neurologic and other systemic examinations were normal. Ophthalmologist consultation was performed. Her best corrected visual acuity was 20/20 and the intraocular pressures in both eyes were within normal limits. Color vision testing, fundus examination, and extra ocular muscle function were normal bilaterally. Visual field to confrontation suggested a left temporal hemianopia. Left temporal hemianopia was confirmed by the automatic perimetry test. The diagnosis was retinal migraine in the light of the anamnesis and physical exam findings. Headache and visual complaints had resolved during the follow up in the emergency department. The patient was discharged on the 2nd day of admission with full recovery. As a result, for patients presenting with complaints of headache and visual disturbances, emergency physicians should be alert in terms of retinal migraine, and patients should be considered comprehensively for this reason

Introduction: Carbon monoxide (CO) is a colorless, tasteless, odorless, nonirritant gas and CO poisoning affects all organ systems. Aim: We aimed to detect any possible effects of CO exposure on the argyrophilic nucleolar organizing region (AgNOR)-associated protein synthesis of heart cells and whether there is any relationship between AgNOR protein amount and both carboxyhemoglobin (COHb) level and histopathological evaluation methods used for the detection of damage in heart tissue after CO exposure. Materials and Methods: The rats were divided into four groups (control, 1000, 3000, and 5000 ppm), each containing six rats. After CO intoxication, COHb levels were measured and the animals were killed on the 7th day. AgNOR staining was performed in the heart tissue. One hundred nuclei per rat were evaluated, and total AgNOR area/nuclear area and mean AgNOR number were analyzed for each nucleus. The CO exposure groups had significantly higher AgNOR values than the control group ( p < 0.0001). According to cardiomyopathy (CMY) scoring methods, the differences between groups 3 and 4 and groups 1 and 2 were significant ( p < 0.05). A significant positive correlation between AgNOR values and both CMY and COHb levels were detected. Conclusion: The detection of AgNOR protein amount may give information about the CMY levels and be used to detect the CO intoxication levels instead of COHb in later periods.

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; WOS: 000360920700067 PubMed: 25779962 …

Cost-effective use of cardiac markers for the evaluation of ischemic chest pain (CP) patients at the emergency department (ED) is attracting the attention of researchers. The aim of this study is to define how cost-effective an approach should be for evaluate CP patients and to evaluate whether testing for cardiac markers is done cost-effectively in CP patients.In this retrospective study, 1028 ischemic CP patients (aged from 17-89 years, 389 female, 639 male) with non-diagnostic electrocardiography (ECG) who were admitted to the ED between September 2002 and September 2003 were enrolled into the study.The conditions of how diagnostic tests were actually ordered for these patients and how they should have been ordered cost-effectively were assessed and both the cost and effectiveness were compared. The actual total cost of the diagnostic tests ordered to investigate ischemic CP was $42,476. The cost would have been $32,342 if they had been ordered in the most cost-effective manner, for a total savings of $10,134. The ED cost, the calculated cost-effective cost and the lost amount were compared with the Student's t-test, and the differences between them was found to be statistically significant (p0.001). The effectiveness was compared using the chi-square test and was found to be significant (χ(2)= 12.20, SD= 1, p0.001).In conclusion, fast and effective evaluation of ischemic CP in the ED and correct management of patients by correct determination of the risk factors provides a high level of cost-effectiveness. Every ED should determine an algorithm for patients admitted with CP and physicians should obey this algorithm.Acil servislerde iskemik göğüs ağrılı (GA) hastaların değerlendirilmesinde kardiyak belirteçlerin bedel etkin kullanımı araştırıcıların dikkatini çekmektedir. Bu çalışmanın amacı, iskemik GA’lı hastalarda bedel etkin yaklaşımın nasıl olması gerektiğini belirlemek ve bu hastalarda kardiyak belirteçlerin bedel etkin olarak istenip istenmediğini değerlendirmektir.Bu retrospektif çalışma eylül 2002 eylül 2003 tarihleri arasında acil servise kabul edilen tanısal olmayan EKG’si olan 1028 iskemik göğüs ağrılı hasta (17–89 yaş arası, 389 kadın, 639 erkek) dahil edilmiştir. Bu hastalara tanısal testlerin nasıl istendiği araştırılmış, bedel-etkin yöntemle nasıl test isteneceği belirlenerek iki yöntemin bedeli ve etkinliği ayrı ayrı kıyaslanmıştır.Başvuran hastalara iskemik göğüs ağrısı yönünden istenen tetkiklerin toplam bedelinin 42476$ olduğu görülmüştür. Bedel etkinlik kurallarına göre tetkik istenmiş olsa idi 32342$ olacağı hesaplanmış ve ikisi arasındaki fark 10134$ bulunarak acil servis bedeli, bedel-etkin olacağı düşünülen bedeli ve bedel kaybı Student’s t testi ile kıyaslanmış anlamlı bulunmuştur (p0,001). Hastaların acil servis etkinliği, bedel-etkin olduğu düşünülen etkinlikle Chi-Square testi ile kıyaslanmış olup χSonuç olarak, akut travmatik olmayan göğüs ağrısının acil servislerde değerlendirilmesinde hızlı ve etkin bir hasta triajıyla, doğru risk ayrımı yapılarak hastaların doğru bir şekilde yönlendirilmesi, üst seviyede bedel-etkinlik sağlayabilir. Göğüs ağrılı hastaların acil serviste bedel-etkin değerlendirilmesi için, her acil servisin önceden belirlenmiş bir algoritimi olması gerektiğini göstermektedir.

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093 WOS: 000347340800043 PubMed: 25074693 Energy drinks have become a popular beverage especially among young individuals. The growing literature sheds light on acute health problems associated with these products, although they have not yet been in existence long enough to build a solid, evidence-based appreciation of potential long-term effects. Perhaps the greatest concern about energy drinks is the amount of caffeine they contain, which generally far exceeds that in other beverages. A transient ischemic attack (TIA) has been traditionally defined as an episode of neurologic dysfunction caused by focal cerebral ischemia with complete recovery within 24 hours. We report a patient who had a TIA after intake of an energy drink without alcohol. To the best of our knowledge, the following case is the first report of TIA after intake of an energy drink.

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093 WOS: 000361839300037 PubMed: 26306432 …

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; WOS: 000356604000053 PubMed: 25935813 Morel-Lavallee syndrome is a posttraumatic soft tissue injury in which the subcutaneous tissue is broken off from the underlying fascia, creating a cavity filled with hematoma and liquefied fat. It commonly occurs over the greater trochanter and, rarely, may also occur in the lumbal region. Morel-Lavallee syndrome can be often diagnosed late because of ommitted diagnosis in emergency services. The emergency physician and radiologist must keep this syndrome in mind because early diagnosis can enable conservative management, whereas delayed diagnosis may lead to surgical exploration. In this article, we present the clinical and radiologic features of 2 cases of lumbar Morel-Lavallee syndrome detected after trauma.

Deli balı zehirlenmesi nadir ve yerel görülen hafif düzeyden ciddi hayatı tehdit eden kardiyak aritmilere neden olabilmektedir. Olgumuz 52 yaşında bayan bir hasta deli balı alımı sonrası, yorgunluk, sersemlik ve baş dönmesi şikayeti ile acil servisimize başvurdu. Yapılan fizik muayenesinde tansiyonu 70/40 mmHg, nabzı 45/dk idi. Öncesinde kardiyak hastalığı ve ilaç kullanımı olmayan hastanın elektrokardiografi (EKG) kaydında atriyal fibrilasyon ve atriyoventriküler (AV) tam blok gözlendi. Hasta acil müdahale sonrası takibe alındı. Takiplerinde şikayetleri gerileyen ve genel durumu stabil olan hasta öneriler ile taburcu edildi. Sonuç olarak, deli balı alımı sonrası hayati tehdit eden aritmiler oluşabilmektedir. Bu sağlık problemi sadece Türkiye’de bazı bölgelerle sınırlı değildir, besin taşıyıcılığı ile bütün dünyada artış göstermektedir. Klin Deney Ar Derg 2011;2(2):216-8 Mad honey intoxication is rarely and locally seen, and it can cause cardiac arrhythmias from mild to life threatening health problems. A 52 year-old female patient admitted to our emergency room with dizziness and fatigue after ingestion of bitter honey. On examination in emergency room, her blood pressure was 70/40 mmHg and pulse value was 45/min. Atrial fibrillation and AV complete block rhythm was detected on her Electrocardiography (ECG) recording. She had no history of known-cardiac disease and use of medicine. On follow-up, her general health status got back to normal. The patient was discharged after her medical status was improved. In conclusion bitter honey intoxication can be life-threatening arrhythmias in people after ingestion of it. It is not restricted health problem to only that region of Turkey, but also to worldwide due to increase in people movement and international nutrition transport. J Clin Exp Invest 2011;2(2):216-8

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; Kandis, Hayati/0000-0001-9151-6050; afacan, mustafa ahmet/0000-0003-1045-0681; Kaya, Ertugrul/0000-0003-0081-682X; Erdogan, Mehmet Ozgur/0000-0001-7325-6646 WOS: 000356420700005 PubMed: 25378094 Objective: This study aimed to assess the demographic characteristics, emergency department (ED) complaints, laboratory findings, and latent phase periods of patients who presented to the ED due to mushroom poisoning (MP) as well as the efficacy of conventional and hemofiltration therapies. Method: The study was conducted on patients who presented to the ED with MP between 2010 and 2012. The patient's demographic characteristics, complaints at the ED, latent phases, laboratory findings, and treatments of MP cases were evaluated. Results: The mean age of patients was 38.03 15.96, where 63.8% of them were female and 36.2% were male. Visits occurred most frequently in the autumn (32.6%). When presenting to the ED, the most frequent complaint was nausea-vomiting. The aspartate aminotransferase (AST), alanine aminotransferase (ALT), international normalised ratio (INR), and blood urea nitrogen values of patients with a latent phase between 0 h and 5 h were significantly lower than the values of patients with a latent phase between 6 h and 24 h. In this study, 62% of the patients (n = 36) had stomach lavage and received activated charcoal. Altogether, 55.2% of the patients had received conventional therapy, 37.9% of them received hemofiltration, and all of them received supportive treatment. The AST, ALT, and INR values of those who had received hemofiltration and conventional therapies were significantly higher than of those who received only supportive treatment (p < 0.01). Conclusion: Hemofiltration, in combination with conventional therapy, seems to be an effective treatment for reducing mortality in suspected MP cases involving late acting toxins.

Yaykasli, Kursat/0000-0001-7550-6370; Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; Kaya, Ertugrul/0000-0003-0081-682X; Kandis, Hayati/0000-0001-9151-6050 WOS: 000346643700003 PubMed: 24812150 In carbon monoxide (CO) poisoning, CO affects the oxygen-carrying capacity of the hemoglobin molecule. Nucleolar-organizing regions (NORs) are genetic loci on chromosomes that are composed of ribosomal DNA and proteins. NORs can be stained with silver. A total of 18 rats were exposed to CO in three different concentrations (1000, 3000, and 5000 ppm) with 6 rats as controls. The animals were euthanized 7 days after CO intoxication. Lung tissues were taken, embedded in paraffin blocks, and sectioned at 5 m thickness. Argyrophilic nucleolar-organizing region (AgNOR) staining was carried out. One hundred nuclei per individual were evaluated, and total AgNOR number per total nuclear number and total AgNOR area per nuclear area (TAA/NA) for each nucleus were analyzed. The CO exposure groups had significantly higher TAA/NA values and AgNOR numbers than the control group (p < 0.05). Although the differences between 1000 ppm and the other two CO-exposed groups were meaningful (p < 0.05) in the TAA/NA values, there were no differences among the CO exposure groups for the AgNOR number (p > 0.05). The increase in TAA/NA value depends on the increase in the CO exposure. Significant correlations between both the AgNOR values and histopathological scoring methods were found. Therefore, AgNOR staining method may be used as an indirect indicator for evaluating the degree of cell damage rate.

Trigeminal neuralgia (TN) is a neuropathic pain described as intense and electric shock-like pain episodes in the trigeminal nerve territory. Most of the time, trigeminal neuralgia is called as idiopathic TN since the cause is not known. Sometimes, space occupying lesions such as meningiomas, trigeminal neuromas and aneurysms may trigger TN. Cerebellopontine angle’s tumors are 6-10% of all intracranial tumors (1). Epidermoid cyst is the most common cause of TN and meningiomas and neurinomas can also cause TN (2). These tumors can cause trigeminal neuralgia in 3 ways; aThe tumor presses on the nerve directly, bThe tumor compresses the nerve root by pushing arterial vessels, cCompression of tumor to pons can cause irritation of the trigeminal nerve nuclei (2). The tumors which are causing TN have different Magnetic resonance imaging (MRI) characteristics. For instance, epidermoids usually do not compression to adjacent structures, no enhancement and bright on DWI. Schwannomas expand the nerve and extend into the internal auditory canal. Meningiomas have dural tail, generally strong and homogeneous contrast enhancement (3).

KARA, ISMAIL HAMDI/0000-0003-2022-1882 WOS: 000382241200010 PubMed: 25802568 BACKGROUND: This study aimed to describe the clinical and socio-demographic aspects of acute poisoning in 2010 in Duzce City, Northwest Anatolian Region of Turkey. METHODS: Acute poisoning was due to the intentional ingestion of drugs in young and adult people (>= 16), who were treated at the Emergency Service of Duzce University Medical Hospital, Turkey from January 1, 2010 to December 31, 2010. In this retrospective and descriptive study, 95 patients were diagnosed with intoxications and 30 of them intentionally ingested drugs to commit suicide. Records of the patients diagnosed with intoxication were obtained from the Clinical Archive of the hospital. Their diagnoses were established according to the International Statistical Classification of Diseases and Related Health Problems. Codes X60-X84 of this classification were used to classify self-infringed drug injuries and drug poisoning. RESULTS: In this series, 35 (36.8%) patients were male and 60 patients (63.2%) female. The male/female ratio was 1.0/1.7. The mean age of the patients was 33.1 +/- 14.2 years; 17 (17.9%) patients were below 20 years old and 9 (9.5%) were older than 50 years. Of these patients, 29 (30.5%) were single, 7 (7.4%) divorced or separated, and 59 (62.1%) married. Their mean time for admission to the emergency service after the incident was 208 +/- 180 (15-660) minutes. The mean time for admission to the emergency service for patients with food intoxication after the incident was 142 +/- 160 minutes, for those with drug intoxication 173 +/- 161 minutes, for those with carbon monoxide (CO) intoxication 315 +/- 209 minutes, and for those with undefined intoxication 289 +/- 166 minutes (P=0.005). Most of the intoxication cases occurred in winter (41.1%, 39 of 95 patients). Admissions to the emergency service were most common in December and April (21 and 16 of 95 patients, respectively). Sixty-five (68.4%) cases were involved in non-deliberate poisoning, whereas 30 (31.6%) were involved in deliberate poisoning. Twenty-six of the 95 patients with acute poisonings had mortality risk at admission, however only one died from CO intoxication in the emergency service (1.1%). Suicide attempts were more common in females than in males (21 of 30 patients, 70%, P

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; Ozturk, Gurkan/0000-0001-8662-636X; Kandis, Hayati/0000-0001-9151-6050 WOS: 000332462600008 PubMed: 23728930 This study aims to analyze the epidemiological characteristics and predictors of mortality from burn injuries in childhood patients admitted to our hospital during an eight-year period. The medical records of acute childhood burn patients were reviewed retrospectively. All variables thought to be associated with mortality were entered in a multiple binary logistic regression model (method = stepwise). The magnitude of risk was measured by the odds ratio, and the 95% confidence interval was estimated. A total of 2269 acute childhood burn patients were admitted during the study period. A total of 86 (3.8%) children died due to burn injuries. Deaths were seen 1.849 times more in males than in females. According to the 1%-10% total body surface area (TBSA) burned group, mortality occurred 121.116 times more in the >41% TBSA burned group. Most burn injuries can be avoided by keeping children away from hazardous and dangerous environments. Also, requiring a multidisciplinary management in these patients, quality of care services given by physicians and nurses certainly will create a positive impact on patients' outcomes.

KARA, ISMAIL HAMDI/0000-0003-2022-1882; KARA, ISMAIL HAMDI/0000-0003-2022-1882; karakus, ali/0000-0003-1358-3201; Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; Kandis, Hayati/0000-0001-9151-6050 WOS: 000340203500009 PubMed: 23070635 Objective: This study is aimed to investigate the efficacy of erdosteine usage in acetaminophen-induced liver damage and to compare it with N-acetyl cysteine (NAC) in the treatment and prevention of liver toxicity due to overdose of acetaminophen. Methods: The rats were separated into the following six groups of seven rats each: control group; acetaminophen (1 g/kg, orally); acetaminophen (1 g/kg, orally) + erdosteine (150 mg/kg/day, orally); acetaminophen (1 g/kg, orally) + NAC (140 mg/kg loading dose, followed by 70 mg/kg, orally); NAC (140 mg/kg loading dose, followed by 70 mg/kg, orally); erdosteine (150 mg/kg/kg, orally), subsequently. In all the groups, potential liver injuries were evaluated using biochemical and hematological analyses, oxidant-antioxidant parameters and histopathological parameters. Results: In acetaminophen-treated group, levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total oxidant status (TOS) in the blood, prothrombin time (PT) and international normalized ratio (INR) were significantly increased when compared with controls. However, total antioxidant capacity (TAC) and glutathione (GSH) levels were decreased in group treated with acetaminophen, when compared with control group. Levels of AST, ALT and TOS, PT and INR were decreased in groups treated with NAC and erdosteine after acetaminophen administration, but the levels of TAC and GSH were increased. Histopathological improvements were observed in the groups treated with NAC and erdosteine after acetaminophen administration. Conclusion: The present study demonstrated that, in the prevention of liver damage induced by acetaminophen intoxication, an early treatment with a single dose of erdosteine was beneficial instead of NAC administration. Emergency Physicians Association of Turkey The authors thank the Emergency Physicians Association of Turkey for the financial support and its valued contribution.

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; Kandis, Hayati/0000-0001-9151-6050 WOS: 000343316000049 PubMed: 24768227 Allergic reactions due to drug intake are responsible from an important amount of emergency admissions. Patients mostly complain of urticarial lesions. But clinical picture may sometimes include a large scale of signs and symptoms ranging from a simple confusion to serious conditions like coma and even cardiopulmonary arrest. In this article, a case of anaphylactic shock and respiratory arrest after lansoprazole intake is presented. Delays in reaching basic and advanced life support decrease chance of positive results of life support in anaphylactic shock victims. It is important to remember that any medication we usually prescribe in our daily practice for treatment of any disease has a potential to kill the patient.

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093 WOS: 000351751700030 PubMed: 24906273 A 28-year-old man was admitted to the emergency department with lumbar pain owing to a motorbike accident. On clinical examination, abdominal tenderness, pelvic and left cruris pains were present. Erythrocytes, leucocytes and protein was found to be positive in urine analysis. Abdominal computed tomography with intravenous contrast solution showed contrast enhancement in 80% of right kidney, and 30% of left kidney; some intra-abdominal free fluid was also seen. Conservative management was planned for bilateral renal infarction. Urine output was 1.1 L per day. He was discharged on the seventh day of the hospital stay. The patient had not got any problems on the sixth month follow-up. Urine output is a very important parameter for multiple trauma patients. Any decrease in urine output may not be seen inspite of the presence of bilateral renal damage as in the case of the patient, and this situation does not allow ruling out renal injury completely. Hence, emergency physician should still be careful about the risk of renal injury.

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; Kandis, Hayati/0000-0001-9151-6050 WOS: 000345628900020 PubMed: 25256411 …

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093 WOS: 000334583100037 PubMed: 24370067 Clivus fracture (CF), which is usually reported to accompany with head trauma, has high mortality rates. Early diagnosis of CF is rare because of high mortality rates and inadequate urgent radiologic techniques; however, diagnosis rates are increasing with computed tomography images obtained in high resolution and thin sections. In this article, radiologic and clinical features of 2 patients who were detected to have longitudinal CF after head trauma are presented and accompanying pathologies and its importance for prognosis are discussed under the light of literature data composed of a small number of reports.

Saritas, Ayhan/0000-0002-4302-1093; Montaner, Joan/0000-0003-4845-2279; Saritas, Ayhan/0000-0002-4302-1093; GARCIA-BERROCOSO, TERESA/0000-0001-8072-8533; Whiteley, William/0000-0002-4816-8991; Khedri Jensen, Jesper/0000-0001-7426-4437 WOS: 000330771700007 PubMed: 24186915 Objective: To measure the association of B-type natriuretic peptide (BNP) and N-terminal fragment of BNP (NT-proBNP) with all-cause mortality after stroke, and to evaluate the additional predictive value of BNP/NT-proBNP over clinical information. Methods: Suitable studies for meta-analysis were found by searching MEDLINE and EMBASE databases until October 26, 2012. Weighted mean differences measured effect size; meta-regression and publication bias were assessed. Individual participant data were used to estimate effects by logistic regression and to evaluate BNP/NT-proBNP additional predictive value by area under the receiver operating characteristic curves, and integrated discrimination improvement and categorical net reclassification improvement indexes. Results: Literature-based meta-analysis included 3,498 stroke patients from 16 studies and revealed that BNP/NT-proBNP levels were 255.78 pg/mL (95% confidence interval [CI] 105.10-406.47, p = 0.001) higher in patients who died; publication bias entailed the loss of this association. Individual participant data analysis comprised 2,258 stroke patients. After normalization of the data, patients in the highest quartile had double the risk of death after adjustment for clinical variables (NIH Stroke Scale score, age, sex) (odds ratio 2.30, 95% CI 1.32-4.01 for BNP; and odds ratio 2.63, 95% CI 1.75-3.94 for NT-proBNP). Only NT-proBNP showed a slight added value to clinical prognostic variables, increasing discrimination by 0.028 points (integrated discrimination improvement index; p < 0.001) and reclassifying 8.1% of patients into correct risk mortality categories (net reclassification improvement index; p = 0.003). Neither etiology nor time from onset to death affected the association of BNP/NT-proBNP with mortality. Conclusion: BNPs are associated with poststroke mortality independent of NIH Stroke Scale score, age, and sex. However, their translation to clinical practice seems difficult because BNP/NT-proBNP add only minor predictive value to clinical information. Instituto de Salud Carlos IIIInstituto de Salud Carlos III [FI09/00017]; FIS [11/0176]; Chief Scientist's Office [CAF/06/30]; UK Medical Research Council Clinician Scientist FellowshipMedical Research Council UK (MRC) [G0902303]; Medical Research CouncilMedical Research Council UK (MRC) [G0902303]; Chief Scientist Office [CAF/06/30] T. Garcia-Berrocoso is supported by a predoctoral fellowship (FI09/00017) from the Instituto de Salud Carlos III. Neurovascular Research Laboratory takes part in the Spanish stroke research network INVICTUS (RD12/0014/0005) and is supported on stroke biomarkers research by FIS 11/0176. D. Giralt, A. Bustamante, T. Etgen, J. Jensen, J. Sharma, K. Shibazaki, A. Saritas, and X. Chen report no disclosures. W. Whiteley was supported by the Chief Scientist's Office (CAF/06/30) and is now funded by a UK Medical Research Council Clinician Scientist Fellowship (G0902303). J. Montaner reports no disclosures. Go to Neurology.org for full disclosures.

Objective: The aim of this study is to evaluate and draw attention to sacrification injuries that occurred during the Feast of Holy Sacrifice. Methods: Two hundred and sixty-two patients who were admitted to the emergency services in the city of Kirikkale with sacrification injuries during four consecutive Feast of Holy Sacrifice holidays between 2008 and 2011 were evaluated according to age, sex, admission day and time, experience level, type and mechanism of injury and treatment type. Results: Average age was 43 ± 14 and 83 % of were male. Only 7 patients (2.7 %) were professional butchers, while 155 patients had sacrificed previously. Eighty-three patients had not sacrificed previously and 24 patients had only witnessed sacrification. Penetrating injuries were 81 % (206 cases from knives and 6 cases from animals' horns) and 19 % were blunt. The admittance to the EDs was highest on the first day. Upper extremity trauma constituted for 80 % of cases (n = 209) and 197 (94 %) were hand injuries, whereas 39 patients (15 %) had lower extremity injury. While 174 patients (67 %) injuries were self-inflicted with a knife, 32 (12 %) were injured by the knife of another and 50 (21 %) were injured by animal aggression. Primary suture (155 patients), splint and tendon repairing were undertaken. No deaths occurred. Conclusions: Sacrification injuries can sometimes be serious with the injuries consisting mainly of tendon cuts and bone fractures. Preliminary arrangements with medical staff and equipment support should be provided during the Feast of Holy Sacrifice, especially on the first day. The butchering jobs during this period should be given to professionals. © 2013 Springer-Verlag Berlin Heidelberg.

BACKGROUND Potassium permanganate is used clinically as an antiseptic and antifungal agent. Ingestion of potassium permanganate may result in damage to the upper gastrointestinal tract. Burns and ulceration of the mouth, esophagus and stomach occur due to its action. Emergency endoscopy is useful to assess the severity of damage and also to guide management. METHODS We reported a patient presenting to the emergency department after suicidal ingestion of potassium permanganate. RESULTS After treatment, the patient was discharged home on the 7th day after admission. CONCLUSION Early emergency endoscopy should be considered to determine the extent of upper gastrointestinal damage in the emergency department.