Evaluation of scoring systems in terms of early prediction of severe acute pancreatitis and mortality in patients over 65 years of age.

Purpose: The aim of this study is to investigate the power of disease severity scores to predict the development of Severe Acute Pancreatitis (SAP) and mortality in the early period over 65 years old diagnosed with acute pancreatitis in the emergency department. Materials and Methods: We calculated RANSON (on admission) and Computed Tomography Severity Index (CTSI) in addition to Bedside Index for Severity in Acute Pancreatitis (BISAP) score on admission to the emergency department. Results: One hundred and sixty patients (46.9% over 80 years of age) were included in the study. We observed statistically higher length of hospitalization, longer duration of stay in the intensive care unit, SAP and higher mortality in patients over 80 years of age. When we examined the ROC curve, we determined that the AUC values of the BISAP score were highest in both SAP and mortality estimation (AUC: 0.911, 95% CI 0.861-0.962; AUC: 0.918, 95% CI 0.864-0.9722, respectively). Binary logistic analysis indicated a 4.7-fold increased risk for SAP and a 12.3-fold increased mortality for each unit increase in BISAP score value. Conclusion: BISAP may be a good predictor for SAP and mortality estimation on admission to the emergency department in patients over 65 years of age with acute pancreatitis

Therapeutic Hypothermia

It is agreed that early application of therapetic hypotehermia to cardiac arrest patients prevents the chemical reactions occured with reperfusion injury and contributes and prevents the neurologic injury. In this review we tried to discuss the thepeutic hypothermia using areas in the emergency department and intensive care under the light of the last literatures. [Archives Medical Review Journal 2011; 20(1.000): 20-35

Emergency medicine admissions of pediatric intoxicated cases

Objective: In this study, we aimed to analyze the demographic features and mortality rates of pediatric patients admitted to the emergency department and diagnosed with intoxication. Material and Methods: Patients admitted to the pediatric emergency department and diagnosed with intoxication between December 01, 2009 and Decem- ber 31, 2010 were included in the study. Patients were evaluated through the examination of registration forms and hospitalization files. The characteristics, including age, sex, admission type to the emergency department, treatment before admission, time passed before admission, consciousness level at the time of admission, cause of poisoning, toxic agent, treatment administered after admission, outcome, and mortality rates, were recorded. Results: In our study, 1029 cases were included; 66.47% of the patients were female, and the female/male ratio was found to be 1.98/1. Poisoning was most fre- quently seen in the group of 13-18-year-old patients (56.17%). Patients were admitted mostly in the spring. The most frequent cause of poisoning was adminis- tration of drugs (81.8%), among which paracetamol was the most common and antidepressants were the second most common drugs. Suicide rate was 56.07%, and 54 patients (5.2%) had attempted suicide for the second time. Also, 85.71% of the patients were admitted to the emergency room within the first 2 hours. Conclusion: In order to minimize the rate of poisoning cases, preventive measures, education of the family, more secure storage of drugs, more prudent production of drugs in boxes by pharmaceutical companies, and prevention of childhood poisoning by regional epidemiological studies should be promoted.(JAEM 2014; 13: 67-70)Objective: In this study, we aimed to analyze the demographic features and mortality rates of pediatric patients admitted to the emergency department and diagnosed with intoxication. Material and Methods: Patients admitted to the pediatric emergency department and diagnosed with intoxication between December 01, 2009 and Decem- ber 31, 2010 were included in the study. Patients were evaluated through the examination of registration forms and hospitalization files. The characteristics, including age, sex, admission type to the emergency department, treatment before admission, time passed before admission, consciousness level at the time of admission, cause of poisoning, toxic agent, treatment administered after admission, outcome, and mortality rates, were recorded. Results: In our study, 1029 cases were included; 66.47% of the patients were female, and the female/male ratio was found to be 1.98/1. Poisoning was most fre- quently seen in the group of 13-18-year-old patients (56.17%). Patients were admitted mostly in the spring. The most frequent cause of poisoning was adminis- tration of drugs (81.8%), among which paracetamol was the most common and antidepressants were the second most common drugs. Suicide rate was 56.07%, and 54 patients (5.2%) had attempted suicide for the second time. Also, 85.71% of the patients were admitted to the emergency room within the first 2 hours. Conclusion: In order to minimize the rate of poisoning cases, preventive measures, education of the family, more secure storage of drugs, more prudent production of drugs in boxes by pharmaceutical companies, and prevention of childhood poisoning by regional epidemiological studies should be promoted.(JAEM 2014; 13: 67-70

Elder Abuse and Neglect

Abuse and neglect are preventable societal problems that influence elderly individuals physically, spiritually and socially. Elder abuse is neglected for many years and is a growing problem all over the world. The aim of this article is to review the evaluation of elderly individuals who are exposed to abuse and neglect with systematic detailed history and physical examination and to describe individual, familial, and social measures that should be taken to prevent these abuses. [Archives Medical Review Journal 2013; 22(3.000): 393-407

Acil servisten dahiliye yoğun bakıma yatan 55 yaş üzeri hastalarda inflamatuvar belirteçler ile mortalite arasındaki ilişki

Amaç: Çalışmamızda acil servisten yoğun bakıma yatışı uygun görülen 55 yaş üzeri hastalarda akut faz reaktanları, inflamatuvar belirteçler, APACHE-II, SAPS-II ve GKS skorları ile mortalite arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntemler: Prospektif, randomize olarak acilden dahiliye yoğun bakım ünitesine yatırılan 55 yaş üzeri hastaların alınmasının planlandığı çaışmamıza Etik Kurul onayı alındıktan sonra başlandı. Araştırmamızda verilein standart bir şekilde toplanabilmesi amacıyla standart veri toplama formu oluşturuldu. Çalışmamıza, 48’i (%65.8) erkek, 25’i (%34.2) kadın olmak üzere oplam 73 hasta alındı. Dahiliye yoğun bakıma yatmadan önce çalışmada kullanılmak üzere kan örneği alınarak serumda lökosit sayısı, hemoglobin, c reaktif protein (CRP), interlökin-1 (IL-1), interlökin-6 (IL-6), interlökin-10 IL-10), tümör nekroz faktör-alfa (TNF-alfa), protrombin zamanı (PTZ), aktive parsiyel tromboblastin zamanı (aPTT), albumin, ferritin düzeyleri labarauarda çalışıldı. Hastaların Glaskow koma skalası, SAPS -II skoru, APACHE-II skorları hesaplandı. Elde edilen hasta verileri SSPS 18.0 programı ile değerendirildi. Kategorik ölçümlerin gruplar arasında karşılaştırılmasında Ki Kare esti, gruplar arasında sayısal ölçümlerin karşılaştırılmasında Mann-Whitney U testi ve T testi kullanıldı. Bulgular: Eksitus ve taburcu olan hastalar arasında istatistiksel olarak anamlı bir yaş ortalaması farkı yoktu. Ortalama yatış süresi ise eksitus olan hasta grubunda daha azdı ve istatistiksel olarak anlamlı fark mevcuttu. Prognostik belirteçlerden ferritin, aPTT, SAPS-II’nin yüksekliği, GKS ve albümin düşüklüğü ile mortalite arasında istatistiksel olarak anlamlı ilişki saptandı. APACHE II skoru, lökosit sayısı, hemoglobin düzeyi, PTZ, CRP, TNF-alfa, IL-1, L-6, IL-10. Sonuç: DYBÜ’ne yatan yaşlı hastaların mortalite tahmininde; SAPS-II, GKS, erritin, albümin, aPTT ölçümlerinin kullanılabileceği tespit edildi. JAEM 2013; 12: 13-8)Objective: In this study, we tried to determine the relationship between inlammatory reagents, acute phase reactants, GCS, APACHE-II, SAPS-II scores and mortality of the patients over the age of 55 hospitalised inthe internal medicine intensive care unit. Material and Methods: This study was planned as a prospective, randomized study and the patients hospitalized in the intensive care unit from the emergency medicine department were enrolled in this study following the ethics committee approval. A standard data collection form was prpeared to collect he data in a standard way. 48 (%65.8) male, 25 (%34.2) women and a total of 73 patients were included in our study. Blood samples were taken from each patient and white blood cell (WBC), hemoglobin, c-reactive protein (CRP), nterleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis actor-alpha (TNF-alpha), prothrombin time (PTZ), activated partial thromboplastin time (aPTT), albumin and ferritin levels were studied in our laboratory. Glasgow Coma Scale, SAPS-II and APACHE-II scores were calculated for each patient. “SPSS for Windows version 18” package program was used for staistical analysis of the data. Chi square test was used to compare categorical measures between the groups. Mann-Whitney U test and T-test were used to compare quantitative measurements between the groups. Results: There was no statistically significant difference in mean age among patients who died and survived . Mean duration of hospitalization inthe pa- ient group who died was less than for the survived patients group but there was no statistically significant difference between groups. A significant relaionship was found between mortality and the high levels of ferritin, aPTT, SAPS-II and the low levels of albümin, GCS. No significant relationship was ound between mortality and leukocyte count, haemoglobin, PTZ, CRP, TNF- alpha, IL-1, IL-6, IL-10 and APACHE-II score. Conclusion: SAPS-II, GCS, ferritin, albumin, aPTT measurements were determined to be used in the mortality estimation of the patients hospitalised in he intensive care unit. (JAEM 2013; 12: 13-8

Detection of the awareness rate of abuse in pediatric patients admitted to emergency medicine department with injury

Objective: It was aimed to investigate whether neglected and abused pediatric patients are properly recognized and reported by emergency physicians in the emergency department (ED). Methods: This prospective study was conducted on patients between 0 and 6 years of age presenting with trauma to ED. Patients were examined again by an emergency medicine specialist independent from the physician who did the first intervention during clinical follow-up phase after notification of patients presenting with trauma to emergency physician. Asked radiological examinations and clinical follow-up were performed. The suspected abuse evaluation form, consisting 12 items, which was formed by considering the forms used in previous studies was used to examine the awareness of physicians in cases of abuse suspicion. Results: A total of 126 patients were included in our study. 54% of cases (n = 68) were male and mean age was determined to be 31.3 ± 18.9 months. It was found that no judicial records were written to 35.7% (n = 45) of our patients and that 11.1% (n = 5) of these patients were hospitalized. In 51.1% (n = 23) of patients without judicial records, multiple suspected abuse findings were identified. According to evaluation of first physician, it was found that 75.9% (n = 41) of discharged patients had no judicial records and was not considered as neglect and abuse. Conclusion: We conclude that detection rates of abuse can be increased by developing child abuse screening forms and ensuring the continuity of the necessary training programs. Keywords: Neglect, Abuse, Pediatri

Analysis of judicial cases at emergency department

Aim: In this study, we aimed to analyze the demographic and epidemiological features of judicial cases admitted to emergency department, the content of life-threatening of forensic reports, the status of simple medical intervention and outcomes in the emergency department. Material and Methods: Judicial cases, admitted to the emergency department between 01.12.2009 - 31.12.2010 were included in the study. Patients were evaluated from the patient cards retrospectively. Categorical data summarized as number and percentage, numerical measurements summarized as mean and standard deviation. SPSS 17.0 package program was used for statistical analysis of data. The statistical significance level of all tests was p <0.05. Results: Of the 5870 judicial cases, 63.78 % were male and 36.22 % were female. Mean age of patients were 33.75 &#177; 12.4 years. Traffic accident (27.3 %), intoxication (24.3 %) and to be beaten (17.6 %) were the first three judicial events. Traffic accidents were seen in males between 26-33 ages mostly and intoxications were seen in females between 18-25 ages commonly. The most reason of injuries were limb injuries with 2404 cases. 73.3 % of patients were discharged and 26.3 % of patients were hospitalized. 0.3% of forensic cases (19 patients) died in the emergency department, 0.1% (4 patients) died before hospital admission. Death was mostly seen as traffic accidents and fall from height. When forensic reports were evaluated, 28.8 % of males and 11.3 % of females were not resolved with simple medical intervention. Only 3336 (56.8%) forensic reports of all forensic cases were stated in a life-threatening situation. 21.1 % of the patients with a life-threatening situation of the current was life-threatening. Conclusion: Forensic cases are most commonly seen in young adult males and ages between 26-33. The frequency of diagnoses in male and female patients are different. Forensic cases require hospitalization rate as high as 26.3%, although the danger of life in 21% percent, the mortality rate is 0.3 % in emergency department. The life-threatening condition is necessary to define in reports, but in nearly half of the forensic reports it is not written. In order to prevent the victimization of individuals and unnecessary loss of benefits, the physicians also must write appropriate, clear and understandable forensic reports as well as the best treatment responsibility. [Cukurova Med J 2013; 38(2.000): 250-260

THE RELATIONSHIP BETWEEN NONSPECIFIC INFLAMMATION MARKERS AND COMPUTERIZED TOMOGRAPHY IMAGING IN NON-TRAUMATIC ACUTE ABDOMEN

Aims: The purpose of the study was to establish whether the patients presenting with abdominal pain should undergo to contrast enhanced CT (Computed tomography). For this purpose, we have investigated the possible relationship between CRP (C-reactive protein),WBC (White blood cell), neutrophil levels and the presence of pathological findings determined on abdominal pelvic CT images

Suicide attempts via drug intake

Amaç: Bu çalışmada ilaç alımı yoluyla özkıyım girişiminde bulunan hastaların sosyodemografik ve psikiyatrik açılardan değerlendirilmesi amaçlandı. Gereç ve Yöntem: İleriye dönük olarak Ocak 2009-Ocak 2011 tarihleri arasında acil servise başvuran 18 yaş üstü, çalışmamıza katılmayı kabul eden, bilinçli olarak özkıyım davranışında bulunan hastalar bu çalışmaya dahil edildi. Bulgular: Çalışmaya toplam 122 hasta alındı. Hastaların büyük çoğunluğunun kadın cinsiyette (%68.9), 18-24 yaş grubunda, bekar, işsiz, ilköğretim veya lise mezunu, 4-5 kişiden oluşan kalabalık aile mensubu, 1000 TL altında aylık gelire sahip ve ekonomik sıkıntısı olan bireylerden oluştuğu belirlendi. Kronik sistemik hastalık, geçmişte psikiyatrik hastalık ve özkıyım girişimi, ailede özkıyım girişimi öyküsü varlıklarının özkıyım düşüncesini istatistiksel olarak anlamlı derecede arttırdığı saptandı. Hastaların büyük kısmına psikiyatrist tarafından depresyon ve anksiyete bozukluğu tanıları konularak destek ilaç tedavisi başlandı ve psikiyatri takibine gelmeleri önerildi. Sonuç: Bireyin yaşadığı toplumsal, ekonomik, ailesel ve psikiyatrik sorunlar sonucu başvurduğu bir yöntem olan özkıyım davranışı, bireye göre alternatif bir çözüm yolu veya kendini ifade etme biçimidir. Özkıyım davranışında bulunan bireylere verilecek maddi ve manevi destekler ile bu kişilerin özkıyım riskinde azalma sağlanabilir. Özkıyım girişiminde bulunan hastaların sosyodemografik özelliklerinin bilinmesi önemlidir ve bu hastalar psikiyatri tarafından mutlaka değerlendirilmelidir.Objective: In this study, socio-demographic and psychiatric evaluation of the patients who attempted suicide by drug intake was aimed. Material and Methods: Patients over the age of 18, who agreed to participate in our study, and admitted to the emergency department with conscious suicidal behavior between January 2009-January 2011 were enrolled in this prospective study. Results: A total of 122 patients were enrolled in the study. The most majority of the patients were consisted of female gender (68.9%), in the 18-24 age group, single, unemployed, graduate from elementary or high school, a member of a large family including 4-5 people, with a monthly income below TL 1000, and the individuals were found to be in economic distress. Chronic systemic disease, psychiatric disorders, and suicide attempts in the past, and a family history of suicide attempts were statistically significantly increased the assets of suicidal thinking. Most of the patients were diagnosed as depression and anxiety disorders, and they were recommended to use psychiatric drug therapy and psychiatric follow-up support to come again. Conclusion: Suicide motion, a method that is applied as a result of the social, economic, familial and psychiatric problems, with which individual faces, is a way of expressing oneself or a way of alternative solution according to the individual. Through the support given to individuals having suicide tendency, a decrease in suicide risk among the mentioned people can be actualized. For this purpose, the socio -demographic features of patients attempted suicide must be well known and must be evaluated by psychiatr