Epidemiology of pemphigus in Turkey: One-year prospective study of 220 cases

Pemphigus is a group of rare and life-threatening autoimmune blistering diseases of the skin and mucous membranes. Although they occur worldwide, their incidence shows wide geographical variation, and prospective data on the epidemiology of pemphigus are very limited. Objective of this work is to evaluate the incidence and epidemiological and clinical features of patients with pemphigus in Turkey. All patients newly diagnosed with pemphigus between June 2013 and June 2014 were prospectively enrolled in 33 dermatology departments in 20 different provinces from all seven regions of Turkey. Disease parameters including demography and clinical findings were recorded. A total of 220 patients were diagnosed with pemphigus during the 1-year period, with an annual incidence of 4.7 per million people in Turkey. Patients were predominantly women, with a male to female ratio of 1:1.41. The mean age at onset was 48.9 years. Pemphigus vulgaris (PV) was the commonest clinical subtype (n=192; 87.3%), followed by pemphigus foliaceus (n=21; 9.6%). The most common clinical subtype of PV was the mucocutaneous type (n=83; 43.2%). The mean Pemphigus Disease Area Index was 28.14±22.21 (mean ± Standard Deviation).  The incidence rate of pemphigus in Turkey is similar to the countries of South-East Europe, higher than those reported for the Central and Northern European countries and lower than the countries around the Mediterranean Sea and Iran. Pemphigus is more frequent in middle-aged people and is more common in women. The most frequent subtype was PV, with a 9-fold higher incidence than pemphigus foliaceus.   </p

Isolated Pancreas Fracture after a Go-Kart Accident

Isolated pancreatic trauma is extremely rare because of pancreas’ anatomic localization. Also, diagnosis of pancreatic injury may be difficult due to lack of sensitivity of initial clinical findings, laboratory and imaging examinations in emergency department. Morbidity and mortality is much higher in delayed presentation or if the trauma is unrecognized. In this paper we report a 20-year-old female with isolated pancreas fracture after a blunt abdominal trauma due to a go-kart accident. Repeated evaluation of patient by taking into account of mechanism of trauma and suspicion of pancreatic injury is essential for early diagnosis

Demographic and Clinical Characteristics of Mushroom Poisonings Presenting to Emergency Department

Aim: To emphasize the significance of mushroom poisonings in terms of their wide clinical spectrum and potentially lethal feature. Material and Method: In this retrospective study 135 cases of mushroom poisoning admitted to emergency departments of two major hospitals in Central Anatolian Region between 2010 and 2012 were evaluated. Results: 121 (89.6%) of 135 patients were adult and 14 were in pediatric age group. The mean age was 41.5 +/- 18.4. A hundred twenty-six of patients had poisoned after consuming wild mushrooms. The most frequent symptoms were nause, abdominal pain, fatigue and vomiting. Patients were admitted most commonly within the 6 hours after ingestion. Fifty percent of patients were hospitalized. Mortality was seen in 3 patients. Discussion: Mushroom poisoning still remains as an important public health problem. Due to the diversity and non-specificity of symptoms diagnosis is confounding and should be kept in mind of emergency physicians especially in rainy weather

The value of Serum BNP for diagnosis of intracranial injury in minor head trauma

Objective: Head injury is the main cause of death among individuals younger than 45 years old. Cranial Computerized tomography (CT) is commonly used for diagnosis of head injury. Brain Natriuretic Peptide (BNP) is a peptide originally isolated from brain ventricles. The main aim of this study is to investigate BNP as an indicator of head injury among patients presenting to emergency department (ED) with minor head trauma. Methods: This was a prospective study conducted at the emergency department of the Numune Training and Research Hospital. A total of 162 patients who presented to the ED with minor head injury were enrolled. The patients were categorized into 2 groups as the cranial CT-negative and positive groups. The normality of the data was tested using One Sample Kolmogorov Smirnov test. Mann-Whitney U test was used to compare 2 independent groups while the Kruskal-Wallis test was utilized for comparison of more than 2 groups. A p-value of <0.05 was considered to be significant. Results: Ninety-six (59.3%) patients were male and 66 (40.7%) were female. The cranial CT-negative group had a median BNP level of 14.5 pg/ml while the cranial CT-positive group had a median BNP level of 13 pg/ml. There was no statistically significant difference between these two groups for serum BNP levels (p > 0.05). Conclusion: This study suggested that serum BNP level wasn't used in defined of intracranial injury

An Analyses of Bicycle Accidents in Ankara: Analyses of 5 Years

Aim: Bicycles are used for transportation, exercise and recreation. In this study we aimed to investigate the epidemiological, clinical and economic aspects of bicycle injuries. Material and Method: We included in the study who admitted to the Emergency Department with a bicycle accident between January 2008 and July 2012. Patient age and sex, accident pattern, presence of personal protective measures, injured body part, Glasgow Coma Scale (GCS) score, Revised Trauma Score (RTS), radiological findings, requested consultations, duration of hospital stay, season of injury, and average cost rates were recorded. The study population was divided into 2 age groups as 0-14 years and over 14 years. Results: A patients were 238 (81.2%) male and their mean age was 31.5 +/- 14.1 years. Fifty-five (18.8%) patients were female and their mean age was 34.5 +/- 15.9 years. Males had significantly higher rate of bicycle injury (p<0.001). The most common injuries occured to lower and upper extremities. Inspection of hospital bills revealed that median patient cost was $175. Discussion: In this study bicycle accidents were more common occured in males and during summer months. The most common injuries was in the lower extremities

Comparison of the Canadian CT head rule and the new orleans criteria in patients with minor head injury

Aim: The aim of the study was to compare the New Orleans Criteria and the New Orleans Criteria according to their diagnostic performance in patients with mild head injury. Methods: The study was designed and conducted prospectively after obtaining ethics committee approval. Data was collected prospectively for patients presenting to the ED with Minor Head Injury. After clinical assessment, a standard CT scan of the head was performed in patients having at least one of the risk factors stated in one of the two clinical decision rules. Patients with positive traumatic head injury according to BT results defined as Group 1 and those who had no intracranial injury defined as Group 2. Statistical analysis was performed with SPSS 11.00 for Windows. ROC analyze was performed to determine the effectiveness of detecting intracranial injury with both decision rules. p < 0.05 was considered statistically significant. Results: 175 patients enrolled the study. Male to female ratio was 1.5. The mean age of the patients was 45 +/- 21,3 in group 1 and 49 +/- 20,6 in group 2. The most common mechanism of trauma was falling. The sensitivity and specificity of CCHR were respectively 76.4% and 41.7%, whereas sensitivity and specificity of NOC were 88.2% and 6.9%. Conclusion: The CCHR has higher specificity, PPV and NPV for important clinical outcomes than does the NOC

Assessment of maxillofacial trauma in emergency department

Introduction: The incidence and epidemiological causes of maxillofacial (MF) trauma varies widely. The objective of this study is to point out maxillofacial trauma patients' epidemiological properties and trauma patterns with simultaneous injuries in different areas of the body that may help emergency physicians to deliver more accurate diagnosis and decisions. Methods: In this study we analyze etiology and pattern of MF trauma and coexisting injuries if any, in patients whose maxillofacial CT scans was obtained in a three year period, retrospectively. Results: 754 patients included in the study consisting of 73.7% male and 26.3% female, and the male-to-female ratio was 2.8:1. Mean age was 40.3 +/- 17.2 years with a range of 18 to 97. 57.4% of the patients were between the ages of 18-39 years and predominantly male. Above 60 years of age, referrals were mostly woman. The most common cause of injuries were violence, accounting for 39.7% of the sample, followed by falls 27.9% and road traffic accidents 27.2%. The primary cause of injuries were violence between ages 20 and 49 and falls after 50. Bone fractures found in 56,0% of individuals. Of the total of 701 fractured bones in 422 patients the most frequent was maxillary bone 28,0% followed by nasal bone 25,3%, zygoma 20,2%, mandible 8,4%, frontal bone 8,1% and nasoethmoidoorbital bone 3,1%. Fractures to maxillary bone were uppermost in each age group. 8, 9% of the patients had brain injury and only frontal fractures is significantly associated to TBI (p < 0.05) if coexisting facial bone fracture occurred. Male gender has statistically stronger association for suffering TBI than female (p < 0, 05). Most common cause of TBI in MF trauma patients was violence (47, 8%). 158 of the 754 patients had consumed alcohol before trauma. No statistically significant data were revealed between alcohol consumption gender and presence of fracture. Violence is statistically significant (p < 0.05) in these patients. Conclusion: Studies subjected maxillofacial traumas yield various etiologic factors, demographic properties and fracture patterns probably due to social, cultural and governmental differences. Young males subjected to maxillofacial trauma more commonly as a result of interpersonal violence