Bedside echocardiography in acute myocardial infarction patients with hemodynamic deterioration

Ventricular septal (VS) rupture after acute myocardial infarction (AMI) is an uncommon complication in the reperfusion era. Bedside echocardiography (BECH) continues to be a strong diagnostic tool for emergency physicians treating dyspneic patients, especially for decisionmaking on the management strategies to use with these unstable patients. In the case we present here, a patient is diagnosed with a delayed mechanical complication after AMI, and a swift management plan is made with the aid of point-of-care BECH. The patient is a 72-year-old man with dyspnea who was admitted to the ED 5 days after receiving a primary percutaneous cronary intervention with stent implantation for AMI; in the ED, the patient was diagnosed. via BECH, with a VS rupture. On arrival, his vital signs and the results of his physical examination depicted shock and low perfusion with wet lung. A cardiac examination revealed a new 2/6 harsh holosystolic murmur along the left sternal border without pretibial oedema. Emergency physicians performed BECH, and subcostal views of the heart revealed a wide interventricutar septal rupture and left-to-right shunting with minimal pericardial effusion. The patient underwent surgery immediately to repair the defect. The post-operative course was uneventful, and he was discharged in stable condition on the seventh day after the surgery. The use of BECH to recognize a VS rupture is critical because such a defect may be the most important determinant of mortality in AMI patients who are in shock. BECH thus can influence clinicians' acute management and disposition decisions

The assessment of maternal deaths between 2015 and 2020 in Elazığ, Turkey

Objective: To determine the maternal deaths and the factors affecting them in our city. Methods: The maternal deaths occurred in our city between January 2015 and June 2020 were reviewed retrospectively. The review was conducted by checking “Maternal Death Registry Forms” of the Provincial Directorate of Health. In cases where additional data related with the cause of death were required, the relatives of the cases, associated family practitioner, The Council of Forensic Medicine or local authorities were contacted. The data of the cases including age, gravida, parity, abortion, delivery type, week of gestation during delivery, period of death and maternal deaths due to direct, indirect and incidental causes were recorded. Based on total live births and maternal deaths within 6.5 years, maternal mortality rate was found as the maternal death number per 100,000 live births. Descriptive statistics were used for the statistical analysis of the data. Results: A total of 46.618 live births occurred between 2015 and 2020 in Elazığ. The number of maternal deaths due to direct and indirect causes is 7, and maternal mortality rate was found 15.01/100,000. Hypertensive diseases during pregnancy (n=3, 42.8%), pulmonary embolism (n=1, 14.3%) and cerebral thrombosis (n=1, 14.3%) were among the natural causes of maternal deaths. Indirect cause for maternal death was cardiac diseases (n=2, 28.6%). When they were categorized according to the Three Delays Model, there were 3 death cases in the first delay model and 2 death cases in the third delay model, but there was no maternal death in the second delay model. Conclusion: Maternal death is an significant public health issue which develops due to the generally preventable causes and maintains its importance. The factors contributing to death should be paid attention in order to decrease maternal death rates

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning

Objective: We aim to evaluate the demographic and clinical characteristics of patients withacute carbon monoxide (CO) poisoning, who had a Glasgow Coma Score (GCS) below 15,and who had cerebral lesions detected in magnetic resonance imaging (MRI).Methods: The age, gender, causes of CO intoxication, clinical signs, neurological findings,GCS, blood carboxyhemoglobin level (COHb), serum pH, lactate, creatine kinase (CK),creatinine kinase-myocardial band MB (CK-MB), troponin-I level, brain MRI (T1-weighted, T2-weighted, FLAIR and diffusion-weighted imaging), treatment, and mortalitystatus of 327 patients were evaluated retrospectively.Results: The median age of patients was 31.5 years (IQR=19.5 years), 72.2% of the patientswere women. Neurological findings were detected in 34 (10.4%) of the patients. Thefrequency of dyspnea was significantly higher in patients with neurological findings(p0.05). Patients with neurological findings were found to have asignificantly longer follow-up period, more frequently received hyperbaric oxygen therapy(p0,05). Nörolojik bulgusu olan hastaların, takip süresi anlamlı olarak uzun olduğu, daha sıklıkla hiperbarik oksijen tedavisi aldığı saptandı (p<0,05). Çalışmamızda olguların yatış oranı % 10,7, mortalite oranı % 0,9 olarak saptandı. Nörolojik bulgusu olan hastalarda yatış ve mortalite oranları anlamlı olarak yüksek saptandı (p<0,05). MRG çekilen 32 olgunun (resistasyona yanıt vermeyen 2 hasta haricinde) 13’ünde (%40,6) patolojik bulgulara rastlandı. Sonuç: Akut karbonmonoksit zehirlenmelerinin akut beyin hasarına yol açabileceği, klinik bulgu veren bu hastalarda akut dönemde çekilen MRG’sinde %40,6 oranında bulgu vereceği saptandı.WOS:00061311550000

Lipedematous scalp: A rare entity

kavak, ayse/0000-0002-4679-1181WOS: 000252965600008PubMed: 18271806Lipedematous scalp is characterized by increased subcutaneous thickness of the scalp without any hair change. A 50-year-old female presented with thickening of the scalp without alopecia. She had no disorder other than hypertension. Monthly sonographic measurements without any treatment showed a resolution tendency in some areas and an increased thickness in others. We discuss the characteristics of this rare and possibly underestimated entity, including differential diagnoses

Impact of NEXUS Low-Risk Criteria on Cervical Injuries in a Turkish Tertiary-Care Hospital

Aim: In the present study, we aimed to determine the amount of unnecessary X-ray graphics that could lead to cost-load and radiation side effects using NEXUS Low-Risk Criteria (NLC) that was applied and evaluated in patients with cervical spine trauma in the Izmir Ataturk Training and Research Hospital’s emergency department.Materials and Methods: Between June 2010 and September 2010, the trauma patients admitted to the emergency department were evaluated retrospectively. The age, sex, NLC, mechanisms of trauma, radiological imaging, cost, radiation load, and degree of cervical injuries were assessed.Results: In the present study, 1317 patients with a possible cervical spine injury were included. It was confirmed that the numbers of excluded and included patients according to NLC were 1014 and 303, respectively. In excluded patients, 479 (36.3%) did not have any radiology, but in 535 (52.7%) of them, unnecessary radiological imaging studies were administered. The trauma mechanism was crash at the same level in 310 (23.5%) of the total and 267 (26.3%) of the excluded patients. In addition, in-vehicle traffic accident was observed in 64 (21.1%) included patients. It was found that the number of cervical spine injuries was four in the excluded and 10 in the included groups, which was confirmed according to NLC.Conclusion: The increase in the use of NLC leads to a decrease in both the cost and amount of radiation exposure in patients and health workers. In addition, the number of cancers due to iatrogenic etiologies in humans will be lower

Neuron-specific enolase and S100B protein in children with carbon monoxide poisoning: children are not just small adults

Introduction: The aim of this study was to evaluate the role of S100B protein and neuron-specific enolase (NSE) in children with carbon monoxide (CO) poisoning