EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Poisoning and primary approachs to the poisoned patient [Zehirlenme ve zehirlenen hastaya temel yaklaşim]

Poison and its therapy is old as human history. Manuscripts dating back to 15th century BC had been found and still today detailed investigations are continued. Due to the fact the patient population in this group is large 5-30 % of multidiciplinary intensive care units are used for poisoning treatment. Poisoned cases may attend to the emergency units for various reasons and because of this fact emergency doctors need to work like a dedective using a multidiciplinary approach. With appropriate symptomatic and supportive therapy the morbidity and mortality of patients who has taken large doses of drugs, decrease. Specific antidotes can be found for a small number of substances and quick stabilization, resusication and evaluation of toxic syndrome, with the aid of laboratory tests may guide the emergency doctor for the management of these patients. Fifty percent of the patients admitted to emergency room in comatose state without a known cause are poisoned cases. Primary approach to patients with acute poisoning is to collect the poison or eliminate the toxic substrates and to stabilize the vital functions. In the management of the patients, with high intake of drugs the most important factors are ventilation and the aggressive support of cardiovascular, metabolic and neurologic functions. In serious cases the emergency service personnel need to protect to themselves against toxic substance contamination. In this article we reviewed the pertinent literature for the general management of poisoning. Here we present the recent therapy protocols and managements for poisoning and what the emergency doctor has to consider in the management of these cases

Serum IL-6, TNF? levels in snakebite cases occurring in Southern Turkey

PubMedID: 20595711Objective: The snake species Vipera ammodytes meridionalis and Vipera lebetina obtuse are often seen in Southern Turkey and have venom that causes serious systemic and tissue damage. The aim of our study is to assess the relationship between tumour necrosis factor ? (TNF?) and interleukin 6 (IL-6) serum levels, and clinical and laboratory findings in the snakebite patients. Methods: 26 patients who had received snakebites were included in a prospective study. Patients were grouped according to their clinical presentations in order to plan treatment. Results: TNF? serum levels of most patients who went to the emergency room to receive treatment for snakebite were high. This increase was most likely to be related to the clinical severity of the snakebite and the length of time between the snakebite and their arrival at the hospital. In contrast to TNF?, there was no relationship between serum IL-6 levels and clinical and laboratory parameters. Conclusions: Snakebites from Vipera ammodytes meridionalis and Vipera lebetina obtuse lead to increased levels of serum TNF?. However, serum TNF? and IL-6 levels depend on various factors such as the kind of snake, the area the venom was injected into, the amount of venom and the body size of the patients

Apical hypertrophic cardiomyopathy coexisting with coronary artery disease: A case report [Koroner arter hastaligina eşlik eden apikal hipertrofik kardiyomiyopati: Bir olgu sunumu]

Apical hypertrophic cardiomyopathy is a rare form of hypertrophic cardiomyopathy and may mimic coronary artery disease. There are very limited data about apical hypertrophic cardiomyopathy coexisting with coronary artery disease in the literature. We present an interesting case of coronary artery disease who was later found to have apical hypertrophic cardiomyopathy and a decrease in T wave negativity after coronary artery bypass grafting. © Gülhane Askeri Ti{dotless}p Akademisi 2010

Comparison of single-dose pralidoxime and pralidoxime infusions for the treatment of organophosphate poisoning [Organofosfat zehirlenmesinin tedavisinde tek doz parlidoksim infüzyonunun karşılaştırılması]

Objective: Organic phosphates (OP) bind covalently to acetylcholinesterase (AChE) and acetylcholine (Ach) accumulates in the synaptic cleft. Administering oximes before aging process causes breakage of the covalent bond between OP-AChE, and allows reactivation of AChE. Pralidoxime (PAM) is the most commonly used oxime. The purpose of this study is to determine the best PAM regimen for the length of hospitalization, the need for mechanical ventilation and reduction of the duration of mechanical ventilation in patients presenting with OP poisoning. Material and Methods: Thirty four patients included in this study were organized according to the order of enrollment, randomized and divided into two groups. Seventeen patients in the group I were given a single dose of 2 g/20 min PAM infusion (bolus dose), while 17 patients in group II were administered a dose of 2 g/20 min followed by 6 g/24 hours PAM infusion (bolus and infusion). Clinical signs and symptoms as well as the serum butyrylcholinesterase (BCHE) levels were used to verify the patients' diagnoses. Results: There were no significant differences between the groups. Conclusion: We suggest that PAM bolus plus infusion therapy does not have any advantage over a single dose of bolus PAM therapy the in treatment of OP poisoning. © 2012 by Türkiye Klinikleri

Evaluation of the process and effectiveness of consultation system in the Department of Emergency Medicine [Acil Tip Anabilim Dali'nda konsültasyon sisteminin işleyişi ve etkinliginin degerlendirilmesi]

PubMedID: 19562540BACKGROUND: Triage, consultations, and radiological and laboratory test processes have different effects on the total waiting time in the emergency department (ED). Under these circumstances, the importance of the consultation system process and effectiveness of consultation becomes very clear. Our aim in this study was to verify the process of the consultation system. METHODS: This prospective and defining study was performed with 276 patients admitted to the ED. A total of 342 consultations were requested. These patients were classified as very urgent, urgent and non-urgent according to their problems, and a survey form was completed by the ED resident. RESULTS: The most frequently requested consultation was to the Department of Internal Medicine (72%). Mean time for reply to the consultation was 29±43 minutes. The earliest reply to the consultation was from Cardiology while the latest responders were the general surgeons. Timeline for replying to the consultation was shorter depending on the urgency of the case. CONCLUSION: In our study, we determined that the most important factor for the effectiveness of consultation was the definition of the urgency of the patients by the residents in the ED. Since the number of patients admitting to the ED will continue to increase in the future, more detailed prospective studies are needed about the efficiency of consultation in the ED

Systemic lupus erythematosus-nephrotic syndrome and mediastinal lymphadenopathy mimicking lymphoma

PubMedID: 8852505[No abstract available

Asthma and its management at emergency department [Astim ve acil serviste tedavisi]

Asthma is a cronical disease which is frequently seen with excerbations. Because of not early diagnosis, lack of patient education and inadequate medical theraphy administrations with excerbations to emergency departments become more frequently. Since insufficient theraphy, incorrect hospitalization indications and delays in transport systems mortality rate is increased. In this paper, we evaluate asthma and its management at emergency departments in order to be a guide to the staff at emergency departments in the lightness of recent literatures

Etiological and demographical characteristics of acute adult poisoning in Adana, Turkey

PubMedID: 17623764The objective of this study is to define the etiological and demographical characteristics of the patients applying to the emergency department in Faculty of Medicine, Çukurova University because of poisoning. This retrospective study was carried out by examining the records of 491 people who applied to the main emergency department in Faculty of Medicine, Cukurova University, with the complaint of poisoning between January 1, 2004 and December 31, 2004. It was determined that the reason why 491 of 20 817 persons (2.4%) applied during this term was because of poisoning: 159 (32.4%) of such patients were male and 332 of them (67.6%) were female. It was found that the average age of men was 27.1 ± 10.5 years and that of women was 24.4 ± 9.5 years (P = 0.005); 427 of poisoning cases (87.0%) happened intentionally as suicide attempts and 64 of them (13.0%) were accidental. The rate of suicide-purposed poisoning was higher in women and the rate of unintentional poisoning was higher in men (P ± 0.001). The drugs were accountable for 71.1% of all poisoning cases and the pesticides were accountable for 18.9% of such cases. Poisonings increase during summers. The mortality rate in poisonings was found as 0.8%. The drugs and pesticides in Cu¸kurova region constitute 90.0% of all poisoning cases. The mortality rate in poisoning will be decreased by training the physicians employed in the emergency department about poisoning by drugs and pesticides. © 2007 SAGE Publications

The efficacy of low-dose antivenom therapy on morbidity and mortality in snakebite cases

PubMedID: 18410806Similar to the cases seen around the world, snakebite causes mortality and morbidity in Turkey. The venom of different types of snake in the region of Çukurova causes serious systemic and local tissue damage. Methods: We performed this prospective study on 45 patients who complained of snakebite. We grouped the patients according to their clinical presentations to facilitate treatment and follow-up period procedures. Results: Whereas the patients with grade 1 envenomation did not receive any antivenom, grades 2 and 3 patients received 2.70 ± 0.77 and 4.88 ± 1.65 vials of antivenom, respectively. One of our patients had to undergo finger amputation but there were no deaths. Allergic reactions developed after antivenom therapy in 8 patients (17.8%). Conclusions: When we considered the cost and complications of the antivenom treatment, it was seen that low-dose antivenom treatment effectively treated the patients with venomous snakebite injuries in our region. © 2008 Elsevier Inc. All rights reserved