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KARA, ISMAIL HAMDI/0000-0003-2022-1882 WOS: 000394362200017 PubMed: 27495248 Carbon monoxide (CO) is a colourless and odourless gas appearing as a result of incomplete combustion of carbon-containing fuels. Many domestic or occupational poisonings are caused by CO exposure. Malfunctioning heating systems, improperly ventilated motor vehicles, generators, grills, stoves and residential fires may be listed in the common sources of CO exposure. The aim of this study was to emphasize the significance of early diagnosis of CO poisoning with non-invasive measurement of CO levels of the patients with nonspecific symptoms using a pulse oximeter device in the triage. Our study was a cross-sectional study. Patients who presented to the emergency department (ED)due to non-specific symptoms and had a Canadian Triage and Acuity scale level of 4 or 5 were included in the study; 106 (5.9%) of 1788 patients admitted during the study period were diagnosed with CO poisoning. Patients with CO poisoning and the other patients had statistically significant differences in terms of presenting symptoms, namely, headache, dizziness, nausea, and vomiting. More CO poisoning cases were admitted in the fall and winter compared to the spring and summer. The number of CO poisoning victims can be decreased if preventive measures like CO monitoring systems and well-designed ventilation systems are generalized at homes and workplaces. Measurement of carboxyhaemoglobin levels of patients presenting to ED due to non-specific symptoms like headache and dizziness during cold seasons and winter months using a pulse CO-oximeter should be a part of the routine of emergency medicine triage.

Kounis syndrome refers to acute coronary syndromes of varying degrees (myocardial ischaemia to infarction) induced by mast cell activation as a result of allergic and anaphylactic reactions. Following subclinical, acute or chronic allergic reactions, it has a clinical spectrum ranging from chest pain to ST segment elevated myocardial infarction. The trigger of the allergic reaction can be drugs, food, environmental factors (insect bite, bee sting, pollen, latex contact). We present a case of a patient who developed Kounis syndrome as a result of anaphylactic reaction to Voltaren (Diclofenac sodium) which is one of the drugs widely used in the emergency departments as intramuscular pain killer., Kounis sendromu mast hücrelerinin etkinleşmesi ile seyreden alerji, hipersensitivite, anaflaksi veya anaflaktoid reaksiyonlarla ilişkili olarak akut koroner sendromun değişik derecelerini ifade eder. Subklinik olarak akut veya kronik alerjik reaksiyona eşlik eden ve göğüs ağrısından başlayıp ST elavasyonlu miyokard enfarktüsü kadar uzanan bir klinik spektruma sahiptir. İlaçlar, yiyecekler, çevresel etkenler (böcek ısırması, arı sokması, polenler, lateks teması gibi) alerjik reaksiyonu tetikleyen neden olabilir. Burada, acil servislerde yaygın olarak kullanılan Voltaren’e (Diklofenak sodyum) bağlı gelişen anafilaktik reaksiyonu olan bir Kounis sendrom vakasını sunuyoruz.

Background and objectives: Desflurane and sevoflurane are frequently used for maintenance of anesthesia and studies have shown that these anesthetics cause a variety of changes to the oxidative stress and antioxidative defense mechanisms. This study aims to compare the effects of sevoflurane, desflurane and propofol infusion anesthesia on the oxidant and antioxidant systems of patients undergoing laparoscopic cholecystectomy. Methods: 45 patients between 18 and 50 years with planned laparoscopic cholecystectomy under general anesthetic were included in the study. Patients were divided into three groups on the way to surgery: propofol (group P n: 15), sevoflurane (group S n: 15) and desflurane (group D n: 15). All groups were given hypnotic 2 mg/kg propofol IV, 1 mcg/kg fentanyl IV and 0.1 mg/kg vecuronium IV for induction. For maintenance of anesthesia group S were ventilated with 2% sevoflurane, group D cases were given 6% desflurane and group P were given propofol infusions of 12 mg/kg/h for the first 10 min, 9 mg/kg/h for the second 10 min and 6 mg/kg/h after that. Before induction and after the operation venous blood samples were taken to evaluate the levels of glutation peroxidase, total oxidants and antioxidants. Results and conclusions: The 45 patients included in the study were 22 male and 23 female patients. The demographic characteristics of the groups were similar. In the postoperative period we observed that while sevoflurane and propofol increased antioxidants by a statistically significant level, desflurane increased the total oxidants level by a significant amount compared to levels before the operation. Resumo: Justificativa e objetivos: Desflurano e sevoflurano são usados com frequência para a manutenção da anestesia, e estudos mostraram que esses anestésicos causam alterações variadas nos mecanismos de defesa antioxidante contra o estresse oxidativo. Este estudo teve como objetivo comparar os efeitos de anestesias com perfusão de sevoflurano, desflurano e propofol sobre os sistemas oxidante/antioxidante de pacientes submetidos à colecistectomia laparoscópica. Métodos: Foram incluídos no estudo 45 pacientes entre 18 e 50 anos, agendados para colecistectomia laparoscópica sob anestesia geral foram incluídos no estudo. Os pacientes foram divididos em três grupos para receberem propofol (Grupo P, n: 15), sevoflurano (Grupo S, n: 15) e desflurano (Grupo D, n: 15). Todos os grupos receberam 2 mg/kg de propofol IV, 1 mcg/kg de fentanil IV e 0,1 mg/kg de vecurônio IV para indução. Para manutenção da anestesia, o Grupo S recebeu ventilação com sevoflurano a 2%, o Grupo D recebeu desflurano a 6% e o Grupo P recebeu propofol em perfusões de 12 mg/kg/h nos primeiros 10 min, 9 mg/kg/h nos 10 min seguintes e 6 mg/kg/h subsequentemente. Antes da indução e depois da cirurgia, amostras de sangue venoso foram colhidas para avaliar os níveis de glutationa peroxidase e o total de oxidantes e antioxidantes. Resultados e conclusões: Dos 45 pacientes incluídos no estudo, 22 eram do sexo masculino e 23 do sexo feminino. As características demográficas dos grupos eram semelhantes. No período pós-operatório, observamos que enquanto sevoflurano e propofol aumentaram os antioxidantes a um nível de significância estatística, desflurano aumentou o nível total de oxidantes em quantidade significativa, em comparação com os níveis pré-operação. Keywords: Oxidant, Antioxidant, Propofol, General anesthesia, Palavras-chave: Oxidante, Antioxidante, Propofol, Anestesia geral

ResumenJustificación y objetivosEl desflurano y el sevoflurano son usados a menudo para el mantenimiento de la anestesia, y hay estudios que mostraron que esos anestésicos causan diversas alteraciones en los mecanismos de defesa antioxidante contra el estrés oxidativo. El objetivo de este estudio es comparar los efectos de las anestesias con perfusión de sevoflurano, desflurano y propofol sobre los sistemas oxidante/antioxidante de pacientes sometidos a colecistectomía laparoscópica.MétodosFueron incluidos en el estudio 45 pacientes entre 18 y 50 años programados para colecistectomía laparoscópica bajo anestesia general. Los pacientes fueron divididos en 3 grupos para recibir propofol (grupo P, n=15), sevoflurano (grupo S, n=15) y desflurano (grupo D, n=15). Todos los grupos recibieron 2mg/kg de propofol IV, 1μg/kg de fentanilo IV y 0,1mg/kg de vecuronio IV para inducción. Para el mantenimiento de la anestesia, el grupo S recibió ventilación con sevoflurano al 2%, al grupo D se le administró desflurano al 6% y el grupo P recibió propofol en perfusiones de 12mg/kg/h en los primeros 10min, 9mg/kg/h en los 10min siguientes y 6mg/kg/h subsecuentemente. Antes de la inducción y después de la cirugía, fueron extraídas muestras de sangre venosa para evaluar los niveles de glutatión peroxidasa y el total de oxidantes y antioxidantes.Resultados y conclusionesDe los 45 pacientes incluidos en el estudio, 22 eran del sexo masculino y 23 del femenino. Las características demográficas de los grupos eran similares. En el período postoperatorio observamos que mientras el sevoflurano y el propofol aumentaron los antioxidantes a un nivel de significación estadística, el desflurano aumentó el nivel total de oxidantes en una cantidad significativa, en comparación con los niveles preoperatorios.AbstractBackground and objectivesDesflurane and sevoflurane are frequently used for maintenance of anesthesia and studies have shown that these anesthetics cause a variety of changes to the oxidative stress and antioxidative defense mechanisms. This study aims to compare the effects of sevoflurane, desflurane and propofol infusion anesthesia on the oxidant and antioxidant systems of patients undergoing laparoscopic cholecystectomy.Methods45 patients between 18 and 50 years with planned laparoscopic cholecystectomy under general anesthetic were included in the study. Patients were divided into three groups on the way to surgery: propofol (group P n: 15), sevoflurane (group S n: 15) and desflurane (group D n: 15). All groups were given hypnotic 2mg/kg propofol iv, 1μg/kg fentanyl iv and 0.1mg/kg vecuronium iv for induction. For maintenance of anesthesia group S were ventilated with 2% sevoflurane, group D cases were given 6% desflurane and group P were given propofol infusions of 12mg/kg/h for the first 10min, 9mg/kg/h for the second 10min, and 6mg/kg/h after that. Before induction and after the operation venous blood samples were taken to evaluate the levels of glutation peroxidase, total oxidants and antioxidants.Results and conclusionsThe 45 patients included in the study were 22 male and 23 female patients. The demographic characteristics of the groups were similar. In the postoperative period we observed that while sevoflurane and propofol increased antioxidants by a statistically significant level, desflurane increased the total oxidants level by a significant amount compared to levels before the operation.

BACKGROUND AND OBJECTIVES: Desflurane and sevoflurane are frequently used for maintenance of anesthesia and studies have shown that these anesthetics cause a variety of changes to the oxidative stress and antioxidative defense mechanisms. This study aims to compare the effects of sevoflurane, desflurane and propofol infusion anesthesia on the oxidant and antioxidant systems of patients undergoing laparoscopic cholecystectomy. METHODS: 45 patients between 18 and 50 years with planned laparoscopic cholecystectomy under general anesthetic were included in the study. Patients were divided into three groups on the way to surgery: propofol (group P n: 15), sevoflurane (group S n: 15) and desflurane (group D n: 15). All groups were given hypnotic 2 mg/kg propofol IV, 1 mcg/kg fentanyl IV and 0.1 mg/kg vecuronium IV for induction. For maintenance of anesthesia group S were ventilated with 2% sevoflurane, group D cases were given 6% desflurane and group P were given propofol infusions of 12 mg/kg/h for the first 10 min, 9 mg/kg/h for the second 10 min and 6 mg/kg/h after that. Before induction and after the operation venous blood samples were taken to evaluate the levels of glutation peroxidase, total oxidants and antioxidants. RESULTS AND CONCLUSIONS: The 45 patients included in the study were 22 male and 23 female patients. The demographic characteristics of the groups were similar. In the postoperative period we observed that while sevoflurane and propofol increased antioxidants by a statistically significant level, desflurane increased the total oxidants level by a significant amount compared to levels before the operation. JUSTIFICATIVA E OBJETIVOS: Desflurano e sevoflurano são usados com frequência para a manutenção da anestesia e estudos mostraram que esses anestésicos causam alterações variadas nos mecanismos de defesa antioxidante contra o estresse oxidativo. Este estudo teve como objetivo comparar os efeitos de anestesias com perfusão de sevoflurano, desflurano e propofol sobre os sistemas oxidante/antioxidante de pacientes submetidos à colecistectomia laparoscópica. MÉTODOS: Foram incluídos no estudo 45 pacientes entre 18 e 50 anos, agendados para colecistectomia laparoscópica sob anestesia geral. Os pacientes foram divididos em três grupos para receberem propofol (Grupo P, n = 15), sevoflurano (Grupo S, n = 15) e desflurano (Grupo D, n = 15). Todos os grupos receberam 2 mg/kg de propofol IV, 1 mcg/kg de fentanil IV e 0,1 mg/kg de vecurônio IV para indução. Para manutenção da anestesia, o Grupo S recebeu ventilação com sevoflurano a 2%, o Grupo D recebeu desflurano a 6% e o Grupo P recebeu propofol em perfusões de 12 mg/kg/h nos primeiros 10 minutos, 9 mg/kg/h nos 10 minutos seguintes e 6 mg/kg/h subsequentemente. Antes da indução e depois da cirurgia, amostras de sangue venoso foram colhidas para avaliar os níveis de glutationa peroxidase e o total de oxidantes e antioxidantes. RESULTADOS E CONCLUSÕES: Dos 45 pacientes incluídos no estudo, 22 eram do sexo masculino e 23 do feminino. As características demográficas dos grupos eram semelhantes. No período pós-operatório, observamos que enquanto sevoflurano e propofol aumentaram os antioxidantes a um nível de significância estatística, desflurano aumentou o nível total de oxidantes em quantidade significativa, em comparação com os níveis pré-operação. JUSTIFICACIÓN Y OBJETIVOS: El desflurano y el sevoflurano son usados a menudo para el mantenimiento de la anestesia, y hay estudios que mostraron que esos anestésicos causan diversas alteraciones en los mecanismos de defesa antioxidante contra el estrés oxidativo. El objetivo de este estudio es comparar los efectos de las anestesias con perfusión de sevoflurano, desflurano y propofol sobre los sistemas oxidante/antioxidante de pacientes sometidos a colecistectomía laparoscópica. MÉTODOS: Fueron incluidos en el estudio 45 pacientes entre 18 y 50 años programados para colecistectomía laparoscópica bajo anestesia general. Los pacientes fueron divididos en 3 grupos para recibir propofol (grupo P, n = 15), sevoflurano (grupo S, n = 15) y desflurano (grupo D, n = 15). Todos los grupos recibieron 2 mg/kg de propofol IV, 1 µg/kg de fentanilo IV y 0,1 mg/kg de vecuronio IV para inducción. Para el mantenimiento de la anestesia, el grupo S recibió ventilación con sevoflurano al 2%, al grupo D se le administró desflurano al 6% y el grupo P recibió propofol en perfusiones de 12 mg/kg/h en los primeros 10 min, 9 mg/kg/h en los 10 min siguientes y 6 mg/kg/h subsecuentemente. Antes de la inducción y después de la cirugía, fueron extraídas muestras de sangre venosa para evaluar los niveles de glutatión peroxidasa y el total de oxidantes y antioxidantes. RESULTADOS Y CONCLUSIONES: De los 45 pacientes incluidos en el estudio, 22 eran del sexo masculino y 23 del femenino. Las características demográficas de los grupos eran similares. En el período postoperatorio observamos que mientras el sevoflurano y el propofol aumentaron los antioxidantes a un nivel de significación estadística, el desflurano aumentó el nivel total de oxidantes en una cantidad significativa, en comparación con los niveles preoperatorios.

Background and Aims Obstructive sleep apnoea syndrome (OSA) and aortic stiffness are associated with an increased risk of cardiovascular morbidity and mortality. Although aortic stiffness increased in patients with OSA, the relationship between severity of OSA indicated with apnoea–hypopnea index (AHI) and aortic stiffness was not investigated in previous studies. The aim of this study is to investigate the relationship between the severity of OSA and aortic stiffness. Methods In the present study, 90 consecutive OSA patients definite diagnosed with sleep test were prospectively included (mean age 54.5 ± 11.6 years). Aortic pulse wave velocity (PWV) and augmentation index (AIx) were calculated using the single-point method via the Mobil-O-Graph® ARCsolver algorithm. Aortic distensibility (AD) was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. Overnight full-laboratory polysomnography examination was conducted on each subject. Patients were classified into two groups according to their median AHI values (AHIlow and AHIhigh groups). Results PWV values were higher and AD values were lower in AHIhigh group compared with AHIlow group (P

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)

Introduction: Although shoulder dislocations are common dislocations, posterior dislocations of the shoulder with fracture are rare. Seizures are the most common etiology for posterior dislocations. Diagnosing posterior dislocations is challenging in emergency departments. For this reason, emergency department physicians might not evaluate musculoskeletal injuries correctly. In addition, x-rays are not diagnostic for posterior dislocations. Late diagnosis may lead to humerus head necrosis, major complications, and malpractice. Case Report: Our patient, who was brought due to electrical shock, had bilateral posterior dislocation and unilateral humeral head fracture. Conclusion: In this case report, we evaluated a patient with bilateral posterior dislocation.

KARA, ISMAIL HAMDI/0000-0003-2022-1882; KARA, ISMAIL HAMDI/0000-0003-2022-1882; Kandis, Hayati/0000-0001-9151-6050 WOS: 000294473300023 PubMed: 21115557 Aim: The aim of the present study was to investigate the therapeutic and preventive effects of N-acetyl cysteine and erdosteine on renal injury associated with paracetamol (acetaminophen) intoxication. Materials and methods: Female albino Wistar rats were divided into six groups: control; paracetamol (1 g/kg, oral); paracetamol (1 g/kg, oral) + erdosteine (150 mg/kg/day, oral); paracetamol (1 g/kg, oral) + N-acetyl cysteine (140 mg/kg bolus, followed by 70 mg/kg, oral); N-acetyl cysteine control (140 mg/kg bolus, followed by 70 mg/kg, oral); and erdosteine control (150 mg/kg/day, oral). Potential renal injury was assessed using biochemical analyses, radionuclide imaging, and histopathological parameters. Results: In the paracetamol group, blood urea nitrogen and creatinine levels were significantly increased compared with controls. Histopathological examination showed tubular vacuolization, tubular necrosis, and remarkable interstitial inflammation. The excretion function was observed to be insufficient on radionuclide imaging. However, in the groups treated with erdosteine or N-acetyl cysteine after paracetamol, biochemical analyses, radionuclide imaging, and histopathological parameters showed significantly less evidence of renal toxicity than that observed in the group receiving paracetamol alone. Less renal toxicity was detected in rats receiving N-acetyl cysteine than in those receiving erdosteine. Conclusion: Renal injury may develop after paracetamol overdose. Erdosteine and N-acetyl cysteine are both effective in the prevention of renal injury when given in the early phase of paracetamol nephrotoxicity. N-acetyl cysteine is more protective than erdosteine.

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.

Aim: Skiing is an entertaining winter sport with its known risks. Although the injury rates are relatively low in this sport, they can be seen in 2 to 6 skiers per thousand. We report herein the skiing injuries occurred at Palandokens ski Centre during the last season. Methods: The patients admitted to our hospital due to injuries secondary to ski sport at the winter season of 2004-2005 were included in the study. Demographic, radiological and laboratory data, the mechanism and localization of the trauma, initial Glasgow Comma Score (GCS) and trauma scores were recorded. Results: A total of 156 patients injured during skiing admitted to the ER at 2004-2005 winter seasons were taken. A hundred and five patients were male and 51 were female and mean age was 29.3 (8-60). All traumatized patients had special gear for skiing, but only 28 patients used helmets. In 136 cases, the injury was secondary to falling whereas in 20 cases the reason was crashing. Isolated injuries occurred in 145 patients, and multiple injuries in 11. The injuries were mainly minor, and they were mostly at the extremities (109), followed by head and neck (15), thorax (8), abdomen (6) and urinary system (2) injuries. One-hundred and forty patients were managed at the emergency room (ER) ambulatory and 15 were hospitalized at different clinics with several diagnoses. Only one patient died due to traumatic intracerebral bleeding. Conclusion: In conclusion, injuries due to skiing are relatively rare and usually minor and not life-threatening. Traumas secondary to skiing consist of approximately 2 % of all traumas admitted to the ER yearly. Skiing is an entertaining and healthy sport if it is done appropriately. But the skiing individuals have to be informed about the risks of this sport. To make skiing safer it is essential to train the individuals.

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.

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

Intracranial subdural haematoma occurring after spinal anaesthesia is very uncommon but is a serious complication that can be fatal if treatment is not administered. Cerebrospinal fluid (CSF) leakage originating from a dural puncture may cause haemorrage by dehiscence of the meningeal vessels. In this article, a case of a subdural haematoma following spinal anaesthesia is presented. Subdural bleeding should be considered in cases of a headache occurring after spinal anaesthesia.

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.

Although paracetamol and diclofenac sodium are most commonly used drugs and considered as safe, they are also frequently become a current issue with complications in therapeutic doses or overdose situations. Both drugs can cause bleeding disorders as a result of platelet dysfunction and can be presented as an atypical clinical situation such as subconjunctival hemorrhage. In these presented cases, the subconjunctival hemorrhage seen after ingestion of paracetamol and diclofenac sodium in toxic doses for the purpose of suicide, is considered as related with the bleeding disorder that is associated with drug side effect. For these patients who do not have any known co-morbidities, the reasons that can cause subconjunctival hemorrhage other than drugs such as trauma, infections, thrombocytopenia, malignant blood disorders, septicemia, hypertension, severe cough are excluded. Although hepatic and renal toxicities are commonly known side effects that are related with high doses of these drugs, in our cases there were not any impairment of hepatic or renal function tests other than compensated metabolic acidosis. In this report, the relationship of parasetamol and diclofenac sodium with bleeding disorders is discussed over two cases which presented as subconjunctival hemorrhage., Parasetamol ve diklofenak çok sık kullanılan ve güvenli kabul edilen ilaçlar olmasına rağmen terapötik ve aşırı dozlarında gelişen komplikasyonlarla sıkça karşılaşılır. Her iki ilaç da trombosit fonksiyon bozukluğu yaparak kanama bozukluklarına sebep olabilir ve subkonjunktival hemoraji gibi atipik bir klinikle kendini gösterebilir. Sunulan olgularda intihar amacı ile primer olarak toksik dozda parasetamol ve ilk olguda ek olarak yüksek dozda diklofenak alımı sonrasında gelişen subkonjunktival kanama, ilaç yan etkisi ile ilişkili kanama bozukluğuna bağlandı. Bilinen komorbiditesi olmayan hastalar için subkonjunktival kanamaya neden olabilecek ilaç kullanımı dışındaki; travma, enfeksiyonlar, trombositopeni, malign kan hastalıkları, septisemi, hipertansiyon, siddetli öksürük gibi nedenler dışlandı. Karaciğer ve böbrek toksisitesi yaygın olarak bilinen bu ilaçların yüksek dozlarda alımı söz konusu olmasına rağmen kompanse metabolik asidoz dışında karaciğer ve böbrek fonksiyon testlerinde bozukluk görülmedi. Yazıda parasetamol ve diklofenak\'ın kanama bozuklukları ile ilişkisi subkonjunktival kanama ile ortaya çıkan iki olgu üzerinden tartışılmıştır.

Yaykasli, Kursat/0000-0001-7550-6370; Kandis, Hayati/0000-0001-9151-6050; Kaya, Ertugrul/0000-0003-0081-682X WOS: 000367634100003 PubMed: 26067853 Backround: Erythropoietin (EPO), regulating erythropoiesis, is used to provide protective and regenerative activity in non-haematopoietic tissues. There is insufficient knowledge about the role of EPO activity in tendon healing. Therefore, we investigated the effect of EPO treatment on healing in rat patellar tendons. Methods: One hundred and twenty-six, four-month-old male Sprague-Dawley rats were randomly assigned to three experimental groups: 1, no treatment; 2, treatment with isotonic saline (NaCl) and 3, treatment with EPO. Each group was randomly subdivided into two groups for sacrifice at three (1a, 2a, 3a) or six weeks (1b, 2b, 3b). Complete incision of the left patellar tendon from the distal patellar pole was performed. We applied body casts for 20 days after the incised edges of the patellar tendon were brought together with a surgical technique. Both legs were harvested and specimens from each group underwent histological, biomechanical, and protein mRNA expression analyses. Results: There were statistically significant differences in the ultimate breaking force between the EPO group and others at both weeks three and six (p

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.

Obstructive sleep apnoea syndrome (OSA) and aortic stiffness are associated with an increased risk of cardiovascular morbidity and mortality. Although aortic stiffness increased in patients with OSA, the relationship between severity of OSA indicated with apnoea-hypopnea index (AHI) and aortic stiffness was not investigated in previous studies. The aim of this study is to investigate the relationship between the severity of OSA and aortic stiffness.In the present study, 90 consecutive OSA patients definite diagnosed with sleep test were prospectively included (mean age 54.5 ± 11.6 years). Aortic pulse wave velocity (PWV) and augmentation index (AIx) were calculated using the single-point method via the Mobil-O-Graph® ARCsolver algorithm. Aortic distensibility (AD) was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. Overnight full-laboratory polysomnography examination was conducted on each subject. Patients were classified into two groups according to their median AHI values (AHIlow and AHIhigh groups).PWV values were higher and AD values were lower in AHIhigh group compared with AHIlow group (P 0.05, for all). AHI was associated with body mass index (BMI), systolic blood pressure, pulse pressure, aortic diameter, AD, AIx and PWV in bivariate analysis (P 0.05, for all). Multivariate linear regression analysis showed that AHI was independently associated with BMI (β = 0.175, P = 0.047), PWV (β = 0.521, P 0.001) and aortic distensibility (β = -0.223, P = 0.020).Aortic stiffness is associated both with the presence and the severity of OSA.

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.

Familial hypokalemic periodic paralysis is an autosomal dominantly inherited congenital diseasecharacterized by intermittent attacks of muscle weakness lasting for a few hours to a few daysand occurring a few times a year or once a day. Due to the shift of potassium into muscle cells,serum potassium level is decreased during attacks and it is in the normal range between twoattacks. A 21 year old male patient seen in the emergency department due to a hypokalemicparalysis attack occurring without any obvious triggering factor was presented in this article.

Tum dunyada ve ulkemizde lunaparklar cocuklar basta olmak uzere tum yas gruplarin ilgi gosterdigi eglence merkezleridir. Eglence merkezi araclarinin duzenli araliklarla kontrollerinin yapilmasi gerekir. Bakimi ve guvenlik onlemleri yetersiz olanlarin kullanilmasina izin verilmemelidir. Aksi takdirde cok ciddi sonuclar dogurabilecek siddette Lunapark kazalari olusabilir. Bu calismada lunaparkta bulunan “ahtapod” olarak adlandirilan eglence aracindan dusme sonrasinda acil servise basvuran uc olgunun sunulmasi amaclandi

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; Kandis, Hayati/0000-0001-9151-6050 WOS: 000345628900020 PubMed: 25256411 …

Charcot’s arthropathy which occurs due to loss of pain and proprioceptive sensation is a chronic, destructive joint disease affecting bone, joint and soft tissues. Although it may be seen as a part of many diseases which cause peripheral neuropathy, most common cause is diabetic neuropathy. In this report a case with neuropathic arthropathy of right foot occuring due to diabetic neuropathy is presented, and current literature is reviewed. Charcot’s neuroarthropathy which is generally seen as a complication of diabetes mellitus is even more important today because uncontrolled diabetes incidence tends to increase. Early diagnosis and treatment of that situation which should be included in differential diagnosis of a diabetic patient with an edematous foot without any pain provide opportunity to prevent neuroarthropathies that decrease quality of life. J. Exp. Clin. Med., 2013; 30:381-383

The purpose of this study is to determine the demographic characteristics of forensic reported patients who entered to emergency service with orthopedic injuries, the problems of doctors responsible for these people’s treatment and to contribute the extremity trauma data literature in our country during 12 months. Between 1 January 2010-31 December 2010; In the Duzce University School of Medicine Research and Training Hospital Emergency Department treated and examined 600 patients who were forensic reported and have orthopedics injuries (soft tissue injury, fractures, dislocations, tendon injury, skin and subcutaneous incision, vascular- nerve injuries and amputations) were analyzed from computer data and forensic reports. Quantitative data were presented with mean ± standard deviation, while qualitative data were presented as frequencies and percentages. For the analysis of categorical variables Chi-square test (and/or Fisher’s exact test) was chosen. Four hundred sixty eight patients (78%) were male and 132 (22%) were female. The mean age was 33.7±17.7. 162 patients (27.0%) were hospitalized. Patients hospitalized mostly in the orthopedics clinic (n=90, 55.6%), second in plastic surgery (n=57, 35.2%). All of the types of injuries were seen more frequently in males, and this difference was statistically significant (p

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.

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; Kandis, Hayati/0000-0001-9151-6050 WOS: 000312954600078 PubMed: 22867827 Energy drinks are popular among young individuals and marketed to college students, athletes, and active individuals between the ages of 21 and 35 years. We report a case that had ischemic stroke and epileptic seizure after intake of energy drink with alcohol. To the best of our knowledge, the following case is the first report of ischemic stroke after intake of energy drink. A previously healthy 37-year-old man was brought to the emergency department after a witnessed tonic-clonic seizure. According to his wife's testimony, just before loss of consciousness, the patient had been drinking 3 boxes of energy drinks (Redbull, Istanbul, Turkey, 250 mL) with vodka on an empty stomach. He did not have a history of seizures, head trauma, or family history of seizures or another disease. In cranial diffusion magnetic resonance imaging, there were hyperintense signal changes in bilateral occipital area (more pronounced in the left occipital lobe), right temporal lobe, frontal lobe, and posterior parietal lobe. All tests associated with possible etiologic causes of ischemic stroke in young patients were negative. Herein, we want to attract attention to adverse effect of energy drink usage.

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; Kandis, Hayati/0000-0001-9151-6050 WOS: 000309813900075 PubMed: 22100477 A person consists of a variety of immune reactions as a result of bee stings, depending on his/her immunologic structure. A 49-year-old male patient was brought to the emergency department because of generalized tonic clonic seizure and loss of consciousness after an hour of wild bee bite from the anterior abdomen in a rural area. After cardiopulmonary resuscitation, he was admitted to intensive care unit. Although cranial computed tomography taken in the emergency department was normal, control cranial computed tomography at the 36th hour after admission was consisted with subarachnoid hemorrhagia (SAH). The patient was diagnosed as SAH due to exposure to bee stings. The patient was treated for a month in an intensive care unit and discharged in a vegetative state. We present and discuss the case that had epileptic seizures and SAH after a bee bite, with the review of the literature.

Kandis, Hayati/0000-0001-9151-6050 WOS: 000291038300002 PubMed: 21088053 Neuropsychiatric sequelae may be observed in the late phases of carbon monoxide (CO) intoxication. Establishing a link between CO-related neuropsychiatric disorders and associated risk factors may decrease morbidity and mortality by means of appropriate treatment and counseling. The aim of the present study was to determine the relationship between neuropsychiatric outcomes of CO intoxication and demographic and clinical variables. Thirty patients who presented with CO intoxication and had no known neuropsychiatric disease, and 30 healthy controls were included. Physical examinations and laboratory tests were performed. Following the 1st therapy, they underwent mental and psychiatric tests 5 times (the time of discharge, during the 1st week, and during the 1st, 3rd, and 6th months). They underwent cerebral magnetic resonance imaging (MRI) at the end of the 1st month. They were evaluated by cognitive function tests at the 6th month. Lesions relevant to CO intoxication were detected in 46.7% of the patients via cranial computed tomography and in 13.3% via MRI. Evaluation of psychiatric tests revealed a clear decrease in cognitive functions, such as immediate memory, learning, reaching the criterion, spontaneous recall, attention, visual memory, and logical memory. It was found that the patients had anxiety within the 1st month, and the frequency of anxiety reached to the value of the control group by the end of the 6th month. In conclusion, we suggested that CO intoxication might lead to neuropsychiatric disorders. Our results emphasized that in addition to standard treatment, neuropsychiatric evaluation should also be performed in patients with CO intoxication.

Background Carbon dioxide (CO2) pneumoperitoneum facilitates the visualization of abdominal organs during laparoscopic surgery. However, the associated increase in intra-abdominal pressure causes oxidative stress, which contributes to tissue injury. Objective We investigated the ability of the antioxidant and anti-inflammatory drug Erdosteine to prevent CO2 pneumoperitoneum-induced oxidative stress and inflammatory reactions in a rat model. Methods Fourteen female adult Wistar albino rats were divided into a control group (Group A, n = 7) and an Erdosteine group (Group B, n = 7). Group A received 0.5 cc/day 0.9% NaCl, and Group B received 10 mg/kg/day Erdosteine was administered by gavage, and maintained for 7 days prior to the operation. During the surgical procedure, the rats were exposed to CO2 pneumoperitoneum with an intra-abdominal pressure of 15 mmHg for 30 min. The peritoneal gas was then desufflated. The rats were sacrificed following 3 h of insufflation. Their lungs were removed, histologically evaluated, and scored for intra-alveolar hemorrhage, alveolar edema, congestion, and leukocyte infiltration. The results were statistically analyzed. A value of P < 0.05 was considered statistically significant. Results Significant differences were detected in intra-alveolar hemorrhage (P < 0.05), congestion (P < 0.001), and leukocyte infiltration (P < 0.001) in Group A compared with Group B. However, the differences in alveolar edema were not statistically significant (P = 0.698). Conclusions CO2 pneumoperitoneum results in oxidative injury to lung tissue, and administration of Erdosteine reduces the severity of pathological changes. Therefore, Erdosteine may be a useful preventive and therapeutic agent for CO2 pneumoperitoneum-induced oxidative stress in laparoscopic surgery.

Urakus mesane çatısı ile umbilikus arasında uzanan embriyolojik dönemdeki allantois ve fetal mesanenin artığıdır. Urakus kisti olarak ortaya çıkabildiği gibi ürogenital anomaliler, enfeksiyonlar, neoplaziler gibi patolojiler olarak da karşımıza çıkabilir. Urakus kisti acil servislerde nadir görülür ve tanı konur. Tanıda düşünülmediği takdirde atlanabilir. Tanı için genelikle batın ultrasonografisi ve batın tomografisi yeterlidir. Özellikle acil servislere orta hatta karın ağrısı, umbilikal akıntı ve umbilikus altında kitle ile başvurabilir. Biz burada 21 yaşında acil serviste urakus kist enfeksiyonu tanısı alan olguyu, literatür eşliğinde tartışmayı amaçladık., Urachus lies between the umbilicus and the bladder dome and is the remnant of the allantois of the embriologic period and the fetal bladder. It may appear both as urachus cyst and also as pathologies like urogenital anomalies, infections and neoplasias. The urachus cyst is rarely seen and diagnosed in emergency departments. If it is not suspected, it may be skipped. Ultrasonography and computed tomography of the abdomen are usually enough for diagnosis. They may admit to emergency departments especially with abdominal pain in the midline, umbilical leakage and a mass inferior to the umbilicus. We aimed to discuss a 21 year old urachus cyst case diagnosed in the emergency department in association with the literature.

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; Kandis, Hayati/0000-0001-9151-6050 WOS: 000293076200001 PubMed: 21699689 Background: Accidents caused by motorized vehicle in the agricultural sector are frequently observed. In Turkey; accidents arising from motorized vehicles, named Pat-Pat, which are used by farmers in the Western Black Sea region is not unusual. Methods: One hundred five patients who were brought into the Emergency Department of Duzce University, Medical Faculty Hospital between September 2009 and August 2010 due to Pat-Pat related accidents were evaluated. Results: The cases consisted of 73 (69.5%) males and 32 (30.5%) females, ranging from 2 to 73 years of age. In the 10-39 age group, a total of 63 (60.0%) cases were determined. The months when the greatest rate of cases applied to the hospital consisted of July, August, September and the season is summer. The cases were exposed to trauma in roads in 54 (51.4%), and 51 (48.6%) occurred in agricultural area without roads. Eighty seven (82.9%) cases were injured due to the overturning of vehicle. The patients were brought to the hospital using a private vehicle in 54 (51.4%) of the cases and in 51 (48.6%) cases, 112 ambulance system was used. The cases were determined to apply to the hospital most frequently between 6 pm-12 am. The injuries frequently consisted of head-neck and spine traumas, thorax traumas and upper extremity traumas. In 55 (52.4%) cases, open wound-laceration was determined. Seventy five (71.4%) cases were treated in the Emergency Department, and 28 (26.7%) were hospitalized. Three (2.9%) cases were deceased. Conclusions: Serious injuries can occur in Pat-Pat related accidents, and careful systematic physical examination should be conducted. In order to prevent these accidents, education of farm operators and engineering studies on the mechanics and safety of these vehicles should be taken and legal regulations should be created.

KARA, ISMAIL HAMDI/0000-0003-2022-1882; KARA, ISMAIL HAMDI/0000-0003-2022-1882; Kandis, Hayati/0000-0001-9151-6050 WOS: 000288949000001 PubMed: 20858650 The aim of this study was to evaluate indoor air quality and factors affecting expired carbon monoxide (CO) levels in a coffeehouse environment. This cross-sectional study was conducted at 16 randomly selected coffeehouses in Duzce, Turkey, during November 2007 to March 2008. A total of 547 people, average age 46.72 +/- 17.03 (19-82) years, participated. The selected coffeehouses were divided into four groups: (1) smoking, (2) nonsmoking, (3) old-style and (iv) new-style coffeehouses. Prior to entering the coffeehouse, exhaled CO levels in smokers (mean 21.17 +/- 6.73 parts per million [ppm]) were significantly higher than those for nonsmokers (6.51 +/- 4.56 ppm; p < 0.001). Measurements taken after 2 hours in the coffeehouse also showed significantly higher CO concentrations for smokers (22.72 +/- 5.31 ppm), compared to nonsmokers (6.51 +/- 4.56 ppm; p < 0.001). It was determined that CO levels inside coffee shops were above the WHO guidelines. Exhaled CO levels in nonsmokers are influenced by the ambient CO levels as a result of the use of cigarettes in coffeehouses in addition to the structure of coffeehouses.

Background: Pesticides are extensively used in developed and developing countries. Objectives: The present study was designed to evaluate the clinical course of patients with carbamate or organophosphate poisoning presenting to a University-based emergency department (ED). Methods: All consecutive patients admitted to our ED due to intoxication with carbamate or organophosphate compounds over a 2-year period were enrolled prospectively. Results: A total of 49 consecutive patients (26 females) were diagnosed with carbamate or organophosphate poisoning in the 24-month study period. The mean age of the patients was 32 ± 13.1 years (range 1670 years). Signs and symptoms most frequently noted in patients with organophosphate or carbamate poisoning were perspiration, vomiting, and bronchorrhea. Abdominal pain was reported by 65.3% of the patients. Abdominal ultrasonography was performed in 22 patients who complained of abdominal pain as a leading symptom. Among these, 63.6% were found to have abdominal free fluid. Pancreatitis and peritonitis developed in one case. Atropine treatment was administered for approximately 2436 h, with a mean total dose of 13.75 ± 6.75 mg. Pralidoxime was administered to 70.9% of patients with organophosphate poisoning, but was not used in patients intoxicated with carbamates. Endotracheal intubation and mechanical ventilatory support were required in 14.2% of the patients. Mean duration of mechanical ventilation was 3.7 ± 2.2 days. The overall mortality rate was 10.2%. Conclusion: Patients with a diagnosis of organophosphate poisoning should be screened for acute abdomen. The findings in our study suggest that these patients should undergo routine abdominal ultrasonography, especially in cases with abdominal pain along with other abdominal complaints. © 2011 Elsevier Inc. All rights reserved.

Haemodialysis that involves diffusion of solutes across a semi-permeable membrane allows excretion of harmful solutes and excess fluids. All dialysis machines are disinfected by chemical agents (e.g. sodium hypochlorite, formaldehyde, glutaraldehyde, peroxyacetic acid). Sodium hypochlorite (NaOCl), which is known as household bleach, is a whitening agent and used in medical treatment and disinfection of tap water. Herein, we present a 66-year-old female patient who was inadvertently connected to NaOCl solution infusion in a routine haemodialysis session. By the time the accident was noticed, approximately 200 ml of undiluted NaOCl cleaning solution (concentration 1.21-1.23 g/ml) had been added to the dialysis bath, soaking the membrane fibres. The patient was admitted to the hospital about 30 minutes after the exposure, and her Glasgow Coma Scale score was recorded as 5/15 (E1, V1, M3). In conclusion, more stringent standards should be enforced in the sterilization of haemodialysis machines and related equipments. Accidental contacts with disinfectants should be prevented in dialysis units.

Kandis, Hayati/0000-0001-9151-6050 WOS: 000291979600011 PubMed: 20660896 Background Congestive heart failure (CHF) is a major public health problem that is related to substantial morbidity, impaired quality of life and diminished survival. Mean platelet volume (MPV) is an indicator of platelet activation. Aim To investigate whether there is a difference of MPV in patients with decompensated and stable heart failure (SHF), and test the prognostic value of MPV in decompensated heart failure (DHF). Methods 136 consecutive patients with DHF were enrolled. 71 with SHF were also enrolled for comparison. Patients were followed up for a mean of 18612 months. The primary endpoint was death from any cause. Clinical characteristics of patients with DHF who died during follow-up were compared with the those of the survivors. Results MPV was significantly higher in DHF group than in the SHF group. 71 patients died during the follow-up period (18612 months). Comparison with survivors revealed that mortality was associated with age, systolic blood pressure, pulmonary artery pressure, serum creatinine, urea and MPV. MPV was determined as an independent risk factor for mortality (OR 1.553, 95% CI 1.024 to 2.354, p = 0.038). Receiver operating characteristic analysis showed that MPV level on admission was a predictor of mortality (area under the curve (AUC) for in-hospital mortality was 0.716 (95% CI 0.632 to 0.789, p = 0.003) and AUC for 6-month mortality was 0.815 (95% CI 0.74 to 0.877, p < 0.001), respectively). Conclusion MPV is increased in patients with DHF. Also, MPV on admission is an independent predictor of in-hospital mortality and 6-month mortality.

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; Kandis, Hayati/0000-0001-9151-6050 WOS: 000288493400021 PubMed: 21340227 OBJECTIVES: To evaluate the effects of Urtica dioica on hepatic ischemia-reperfusion injury. METHODS: Thirty adult male Wistar albino rats were divided into three groups: sham group (group 1), control group (group 2), and Urtica dioica group (group 3). All the rats were exposed to hepatic ischemia for 60 min, followed by 60 min of reperfusion. In group 2, a total of 2 ml/kg 0.9% saline solution was given intraperitoneally. In group 3, a total of 2 ml/kg Urtica dioica was given intraperitoneally. At the end of the procedure, liver tissue and blood samples were taken from all rats. Serum aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, ceruloplasmin, catalase, paraoxonase, arylesterase, and lipid hydroperoxide levels were measured. Liver tissue histopathologies were also evaluated by light microscopy. RESULTS: Serum aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase levels were significantly higher in group 2 than in group 1, and significantly lower in group 3 than in group 2. Also, group 2 had higher serum lipid hydroperoxides and ceruloplasmin levels but lower catalase, paraoxonase, and arylesterase levels than group 1. In group 3, serum lipid hydroperoxides and ceruloplasmin levels were significantly lower, and catalase, paraoxonase, and arylesterase levels were higher than those in group 2. Histopathological examination showed that liver tissue damage was significantly decreased in group 3 compared with group 2. CONCLUSIONS: Urtica dioica has a protective effect on the liver in hepatic ischemia-reperfusion-injured rats.

Dear Editor;A 79-year-old male patient was admitted to our emergency department with a complaining of eruption over his face for 10 days and inability to open his eyes for a few days. The patient had hypertension and diabetes mellitus. He had no history of smoking, alcohol. On examination, there was vesicular cutaneous eruption, erosions and crusts, as well as ptosis, in some areas in the ophthalmic division of the trigeminal nerve on the left side of his face (Figure 1). The patient did not have extraocular muscle palsy. Patient was cachectic and dehydrated appearance. Other systemic examinations were unremarkable. Laboratory investigations showed total white cell count of 16500 (neutrophil: 15000, N: 5200–12400), and CRP: 15 mg/dL (N: 0.1–0.5). A clinical diagnosis of ophthalmic zoster with occulomotor nerve palsy was made and the valasiclovir 3g/d was given to patient, wet dressing with an aluminum acetate solution 0,5%. The patient’s lesions had markedly improved within 10 days.

Fever may appear due to known causes such as infections, but may sometimes occur as a result of unknown pathologies. These pathologies can be included in a miscellaneous group of fever of unknown origin. We report one case of bladder stone including a foreign body in a 40-year-old man with a stroke admitted for high fever, blocked miction and bladder symptoms.