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WOS: 000340310900008, PubMed ID: 23995315, Background & objectives: Crimean-Congo hemorrhagic fever (CCHF) is a viral infection typically transmitted by tick bite. This study is to define the level of heparan sulphate (HS) in serum/urine since HS may play a role in the pathogenesis of hemorrhagic events in the patients with CCHF. Methods: In this study, the patient group consisted of 79 cases with a positive diagnosis of CCHF according to PCR/ELISA outcome among the patients referred to Cumhuriyet University, School of Medicine in 2010. A total of 81 volunteers who had not any viral or metabolic disease were enrolled as the control group. The blood samples were centrifuged, and the serum and urine samples obtained were stored at -80 degrees C until they were studied. Then, these samples were simultaneously dissolved, and HS level was spectrophotometrically measured using glycosaminoglycans specific 1-9, dimethyl-methylene blue (DMMB) stain. Results: A statistically significant increase in the HSserum values was found both in the individuals under and above 16 yr old in the patient groups compared to the controls (p 16 yr old compared to the controls (p

WOS: 000322308100021, In Crimean-Congo Hemorrhagic Fever (CCHF), the main target of the virus is endothelial cells, monocytes and hepatocytes. The virus in these cells leads to the development of capillary vessels dysfunction, which induces clinical and pathological changes during the disease. Increase in capillary permeability and coagulation dysfunction constitute a tendency to bleed. In the current study, we aimed to investigate the relationship between VKORC1 and bleeding tendency in CCHF. Forty-eight consecutive patients with a laboratory-confirmed diagnosis of CCHF were treated with blood products, and 37 healthy volunteers as the control group were prospectively enrolled into the study. The DNA was obtained from each sample using PCR amplification method, and VKORC1 1639 G>A gene polymorphisms were scanned in the DNA samples. In CCHF group of patients with bleeding VKORC1 gene were analyzed. Normal genotype was detected in 5 (22.7%) patients, homozygote mutation was detected in 2 (9.1%) patients and heterozygote mutation was detected in 15 (68.2%) patients, respectively. Furthermore, the G allele frequency was statistically higher in study group (51 [53%] vs. 27 [36%]) (p

WOS: 000290498200013, Aim: Trauma is the major mortality cause in pediatric patients living in developed countries. The aim of this study was to evaluate the child trauma cases who were admitted to our emergency unit. Material and Method: Study data was obtained as a result of a retrospective review of the files of child trauma cases admitted to our emergency department between January 2006-December 2007. The child trauma cases were evaluated in terms of age, sex, application time, type of trauma, injury type, radiological findings and hospitalization rates. Results: Within age range 0-16 years, accessed records of 1293 trauma cases that admitted to the emergency deparment were 69% male, 31% female. Most of the applications were in August. Among the causes of injury, at the primary ordinal were falling down/crash into the flat. Out of vehicle traffic accidents were the fastest group who admitted to the emergency department. Within overall trauma types, rate of trauma exposure with 43.8% was the highest in 2-6 ages. In the exposed areas of injury, head zone with 42% took part in the first ordinal. Conclusions: In this study; we wanted to draw attention to the problem of trauma highlighting some features of pediatric injuries in our country. (Turk Arch Ped 2011; 46: 164-7)

WOS: 000296315000017, Background: Patients with ST segment elevation in the aVR lead were divided into major and minor groups and compared with respect to blood lipid levels, admission glucose levels, angiography results and prognosis. Methods: The clinical data of the study was obtained by a retrospective review of the charts of 887 patients (550 males, 337 females) with aVR elevation, who were admitted to our emergency department between January 2004 and December 2008 with chest pain and hospitalized in the cardiology ward. The patients were divided into minor (group 1; 0.5-1 mm) and major (group 2; >1 mm) groups according to the ST segment elevation in aVR and compared with respect to age, gender, emergency room arrival time, blood glucose level, lipid profile, ejection fraction (EF), angiography results, Gensini score, and mortality rates. Results: Group 2 had a significant correlation with male gender, increased Gensini score, low EF, high blood glucose level, number of myocardial infarction patients with ST segment elevation, three-vessel disease and high mortality (p

WOS: 000342567300001, Patients presented with poisoning-related suicide attempts is one of the most problematic cases of the emergency services. The most important reason for this being the failure to decide the department of the hospital in which these patients should be admitted to, following consultation. The objective of this study is to emphasize the cost-lowering effect of treatment and follow-up of such suicide cases in Emergency Departments (ED) instead of intensive care units. A total of 791 adult patients with suicidal attempts were retrospectively examined and their clinical and demographic data were included. In addition, the costs of their treatment in the ED, Intensive Care Unit (ICU) and Psychiatric Clinic between 01/01/2007 and 31/12/2011were compared. When patients were classified by their month of birth it was found that patients who born in January had the maximum tendency to commit suicide (n:227, 28.7%), while those born in December were the least to do so (n: 30, 3.8%). Of all the patients, 122 (15.4%) were followed-up in Anesthesia Intensive Care (AIC), 639 (80.8%) in the Emergency Department Observation Unit and 30 (3.8%) in the Psychiatric Clinic. When costs of the patients who could receive the same medical treatment in case of necessity were compared; mean cost of the patients were found to be $ 665.44 for the patients treated in AIC, $ 204.09 for patients treated in EDs and $ 186.85 for those received treatments in the psychiatric clinic. We defined that it would be profitable if the intoxication cases were followed-up in the ED observation units and that ED's could be used more effectively than ICUs.

WOS: 000304300200032, The aim of our study was to analyze if we have a seasonal or circadian distribution of acute upper gastrointestinal bleeding (AUGIB) patients, and to evaluate the laboratory and demographic risk factors on mortality rates. We scanned all of the files of the patients who had been diagnosed with AUGIB, for a ten year period. Datas' about seasonal distribution, circadian rhythm, admission hemoglobin, blood urea nitrogen and demographic variables were extracted from the charts. We didn't observed a seasonal distribution for AUGIB inspite of we excluded the drug effect by analyzing its seasonal distribution. Also our patients were admitted mostly nights which was compatible with the literature. Whereas our admission rate between 24 and 06 hour period was low. Admission low hemoglobin level, impaired blood urea nitrogen and creatinine level, and patients with advanced age has a higher mortality rate (p=0.03, p=0.003, p=0.02, p=0.001 respectively). Climatic factors effect on the seasonal distribution among AUGIB patients is not observed. Other risk factors (mental-physical) should also be evaluated. Low hemoglobin level, impaired renal functions and advanced age are bad risk factors for prognosis.

WOS: 000287769300020, Introduction: Penetrating traumas are life-threatening situations which can be encountered in emergency services. In this study, epidemiological data, treatment approaches and the results pertaining to penetrant abdominal and/or thoracic injuries, which occured due to gunshot or stab wounds, are evalauted retrospectively. Material-method: Two hundred and sixty four patients who admitted to emergency department with penetrating thoracic and/or abdominal trauma between 2002 and2009 were retrospectively analyzed. Patients were divided into 3 groups according to their shock indexes including Low risk ( 0.5- 1) groups. Results: The study group included 244 male (92.4%) and 20(7.6%) female participants. Age distribution of the groups was as follows; 58 (22.0%) patients were in the 0-19 years group, 139 patients (52.6%) were in the 20-40 years group and 67 patients (25.4%) were over 40 years. Two hundred and fifteen injuries (81.4%) were caused by stab wounds and 49 (18.6%) were due to gunshots. When the patients were evaluated considering the injury site, isolated thoracic trauma was seen in 93 patients (35.3%) and isolated abdominal injuries were found in 74 patients (28.0%). The most common organ injuries among the patients who underwent laparotomy (n=73) were as follows; bowel injury in 28 patients (38.3%), stomach injuries in 20 patients (27.4%) and liver-spleen injuries in 17 patients (23.28 %). Of 189 patients with thoracic trauma, 17 patients (8.9 %) had hemothorax, 44 (23.28 %) had pneumothorax, 46 (24.33 %) had hemopneumothorax and 2 patients (1.05 %) had pulmonary contusion. Seven patients (2.65 %) died. Two patients were considered as exitus in the initial examination. Two of the 5 exitus cases had shock index ranging within the medium risk group and 3 were in the high-risk group. Conclusion: It must be considered that penetrating trauma patients with medium or high shock index have a higher mortality rate. Therefore, those patients must be closely monitored and the health services should be improved for immediately and appropriately transferring them.

WOS: 000402084500006, Objective: To determine the general characteristics of urogenital trauma, and the factors that impact on mortality. Methods: Patients who were over 18 years of age admitted to the emergency service with urogenital injury between 1 January 2010 and 31 December 2014 were evaluated retrospectively. Age, gender, type of trauma, injured urogenital organs, vital parameters, additional organ injuries and mortality rate were investigated. Categorical variables were compared by using Chi-square test and comparing to groups data were performed with the Mann-Whitney and Kruskal-Wallis tests. P < 0.05 was considered statistically significant. Results: The median age of 174 patients was 35 years (interquartile range: 22), and 150 patients (86.2%) were males. It was determined that the incidence of urogenital trauma increased in August and September. The kidney was the most frequently injured organ (41.4%) and the most common cause of injury was traffic accidents (49.4%). Mean arterial pressure and revised trauma score were the lowest while pulse rate was the highest in renal trauma patients (P < 0.05). Mean arterial pressure, revised trauma score and respiratory rate were low in mortal group while pulse rate and Glasgow coma scale scores were significantly higher (P < 0.05). Conclusions: It is determined that the most common injured organs in trauma patients are kidneys and bladder and also no single factor is effective on mortality.

WOS: 000438381200001, PubMed ID: 29995097, OBJECTIVES: Consumption of toxic species of mushrooms may have detrimental effects and increase oxidative stress. Paraoxonase, arylesterase and glutathione-S-transferase are antioxidants that resist oxidative stress. In this study, we analyzed the changes in these enzymes during intoxication due to mushrooms. METHODS: The study enrolled 49 adult patients with a diagnosis of mushroom poisoning according to clinical findings and 49 healthy volunteers as the control group. The patients with mild clinical findings were hospitalized due to the possibility that the patient had also eaten the mushrooms and due to clinical findings in the late period, which could be fatal. Paraoxonase, arylesterase, and glutathione-S-transferase concentrations, as well as total antioxidant and oxidant status, were determined in the 49 patients and 49 healthy volunteers by taking blood samples in the emergency department. RESULTS: While paraoxonase, arylesterase, and total antioxidant status were significantly decreased in the patient group (p

WOS: 000307124100007, PubMed ID: 22695238, Background: Crimean-Congo hemorrhagic fever (CCHF) is characterized by vascular dysfunction, indicating the involvement of endothelial cells. C-type natriuretic peptide (CNP) plays a critical role in the coordination of vascular tone and is associated with the prognosis in critically ill patients such as those with sepsis and septic shock. We investigated whether CNP is related to the severity of CCHF. Methods: Forty-eight consecutive patients with a laboratory confirmed diagnosis of CCHF and 40 age-sex-matched healthy volunteers as the control group were prospectively enrolled into the study. CCHF patients were classified according to the disease severity into a non-severe group (n = 28) and a severe group (n = 20). Results: The CNP levels were detected to be 0.43 (0.4-0.7) ng/ml in the control group, 0.87 (0.7-1.0) ng/ml in the non-severe CCFH group, and 1.27 (0.8-1.7) ng/ml in the severe CCHF group. According to the receiver operating characteristics curve analysis, the optimal cut-off value of CNP to predict disease severity was >1.22 ng/ml, with 89.3% specificity and 55% sensitivity. CNP >1.22 ng/ml, lactate dehydrogenase >480 IU/l, and aspartate aminotransferase >202 IU/l were found to have prognostic significance in the univariate analysis. In the multivariate logistic regression analysis by forward stepwise method, CNP >1.22 ng/ml (odds ratio 8.336, p = 0.016) and lactate dehydrogenase > 480 IU/l (odds ratio 16.206, p = 0.002) remained associated with disease severity after adjustment for confounding variables. Conclusions: CNP measurement could help in the risk stratification of patients with CCHF. (C) 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

WOS: 000311997600021, PubMed ID: 22633700, Background: Matrix metalloproteinases (MMPs) have a central role in disease progression after ischemia-reperfusion injury. However, its prognostic significance in cardiac arrest (CA) patients having cardiopulmonary resuscitation (CPR) is unknown. The aim of this study was to investigate the relation between admission MMP-9 level and early mortality in CA patients. Methods: A total of 96 in-hospital or out-of-hospital CA patients and 40 age-and sex-matched healthy volunteers as the control group were evaluated prospectively. The patients were classified according to the CPR response into a successful group (n = 46) and a failed group (n = 50). Results: The MMP-9 levels were detected to be 56.9 +/- 4.3, 69.5 +/- 7.4, and 92.7 +/- 10.1 ng/mL in the control group, the successful CPR group (acute responders), and the failed CPR group, respectively (P < .001 for the 2 comparisons). The MMP-9 level on admission, presence of asystole, mean CA duration, out-of-hospital CPR, sodium and potassium levels, and arterial pH were found to have prognostic significance in univariate analysis. In addition, MMP-9 levels were correlated with age, troponin level, and oxygen saturation. In multivariate logistic regression analysis with forward stepwise method, only MMP-9 level on admission (odds ratio, 1.504; P < .001) and mean CA duration before CPR (odds ratio, 1.257; P = .019) remained associated with post-CPR early mortality after adjustment of other potential confounders. In addition, optimal cutoff value of MMP-9 to predict failed CPR was found as greater than 82 ng/mL, with 88% sensitivity and 97.8% specificity. Conclusions: High MMP-9 levels were associated with worse clinical and laboratory parameters, and it seems that MMP-9 helps risk stratification in CA patients. (C) 2012 Elsevier Inc. All rights reserved.

WOS: 000298900400023, PubMed ID: 21958741, Red cell distribution width (RDW) is strongly associated with prognosis in cardiopulmonary disorders such as coronary artery disease, acute myocardial infarction, acute and chronic heart failure, and pulmonary hypertension. However, its prognostic significance in acute pulmonary embolism (PE) is unknown. The aim of this study was to investigate the relation between admission RDW and early mortality in patients with acute PE. One hundred sixty-five patients with confirmed acute PE were included. Patients with previous treatment for anemia, malignancy, or chronic liver disease, those with dialysis treatment for chronic renal failure, and those who received erythrocyte suspension for any reason were excluded. A total of 136 consecutive patients with acute PE were evaluated prospectively. According to receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict early mortality was >14.6%, with 95.2% sensitivity and 53% specificity. Patients were categorized prospectively as having unchanged (group 1) or increased (group 2) RDW on the basis of a cut-off value of 14.6%. The mean age of patients was 63 +/- 15 years. The mean follow-up duration was 11 +/- 7 days, and 21 patients died. Among these 21 patients, 1 (1.6%) was in group 1 and 20 (27%) were in group 2 (p 14.6% on admission, age, presence of shock, heart rate, oxygen saturation, and creatinine level were found to have prognostic significance in univariate Cox proportional-hazards analysis. Only increased RDW >14.6% on admission (hazard ratio 15.465, p.= 0.012) and the presence of shock (hazard ratio 9.354, p

WOS: 000297233300010, PubMed ID: 18963719, Background: Intoxication due to quail consumption is rarely seen. Such a toxicological syndrome (also called coturnism) occurs during the migration of quails from north to south, when they consume hemlock seeds. The clinical symptoms and laboratory results are indicative of acute rhabdomyolysis. Objectives: Acute rhabdomyolysis has a wide range of etiologies. Coturnism is a rare cause of acute rhabdomyolysis that can be lethal due to renal failure and shock. To avoid severe complications, coturnism may be considered if the history is appropriate. Case Report: We report four cases of coturnism from quail consumption; the patients were admitted with some combination of symptoms including muscle tenderness, extremity pain, nausea, and vomiting. They were treated with vigorous isotonic crystalloid hydration and urine alkalinization. Consequently, the laboratory results returned to normal ranges and the clinical symptoms disappeared. Conclusion: Although coturnism is a rarely seen toxicological syndrome that causes rhabdomyolysis, we present this case to increase awareness that it may present with symptoms of muscle tenderness, extremity pain, nausea, and vomiting after quail consumption. (C) 2011 Elsevier Inc.

WOS: 000278590700012, In recent years, Crimean Congo haemorrhagic fever disease (CCHF) has created a serious health problem in our country. The disease takes place among haemorrhagic viral diseases. This study was made with CCHF diagnosed patients accepted in emergency services to determine the diagnostic criteria and cost effectivness for CCHF. CCHF patients who were accepted in our emergency service between 2004 and 2008 were analyzed retrospectively. Sensitivity, specificity, positive predictive and negative predictive value was calculated only for the patients who had 5 pathological laboratory parameters together (thromobcytopenia, high LDH, AST, ALT and CPK), and cost effectiveness analysis was made. During the five-year period, 687 patients had been evaluated. Significant pathologic results were established for alanine amino transferase (ALT), aspartate amino transferase (AST), creatine phosphokinase (CPK) enzymes, platelet counts and lactate dehydrogenase (LDH). Fatigue, fever, bleeding, gastro intestinal symptoms and diffuse pain were the symptoms seen according to their frequencies. The patients were frequently admitted in July. Mortality, costs per patient and emergency service's crowdedness can be reduced by rapid diagnosis which can easily be made with a brief history of the patient's occupation, physical examination and mentioned laboratory results sensitivity, specificity, positive predictive and negative predictive value.

WOS: 000315242400009, PubMed ID: 23914632, Objective: To evaluate the effect of hyponatraemia on pulmonary thromboembolism mortality rates. Methods: The retrospective study was conducted at the Cumhuriyet University Medicine Faculty's Emergency Department, and involved the analysis of records related to all patients who were diagnosed with acute pulmonary thromboembolism between January 2005 and June 2011. Diagnoses were confirmed by pulmonary angiography, multi-slice computed tomography or high-probablity ventilation/perfusion scintigraphy. All patients (n=260) were over 16 years of age. SPSS 14 was used for statistical analysis. Results: Plasma sodium level, platelet count and hospitalisation time were significiantly lower among those who died (n=16; 6.29) (p