Brucellar Testicular Abscess Presenting as a Testicular Mass: Can Color Doppler Sonography be used in Differentiation?

SUMMARYBrucellosis is an endemic disease in various regions of the world. Testicular abscess is a very rare complication of brucellosis which can be misdiagnosed as a testicular mass and may lead to unnecessary orchiectomy. To our knowledge there are only eight reported cases in the literature of a brucellar testicular abscess. We present a case of testicular abscess due to brucellosis diagnosed with serologic tests and color Doppler sonography, and treated with antibiotics and fine needle aspiration

Analysis of clinical and demographic characteristics of patients presenting with renal colic in the emergency department

<p>Abstract</p> <p>Background</p> <p>Renal colic (RC), is one of the most severe pain patterns which is most commonly diagnosed and managed in the emergency department (ED). This study is designed to evaluate the characteristics of adult patients presenting with pain and diagnosed with RC in the ED, length of stay in the ED and hospital and factors affecting these variables.</p> <p>Methods</p> <p>All consecutive adult patients who presented with side pain, flank pain, abdominal or groin pain and consequently diagnosed with urolithiasis or RC were analyzed retrospectively. Sociodemographic data, times of admission into and discharge from the ED, adjunctive complaints, results of laboratory investigations, findings on examination, treatment and drugs administered were noted.</p> <p>Results</p> <p>A total of 235 patients with a diagnostic code of urolithiasis were enrolled. Physicians were more likely to order radiological and laboratory investigations for female patients and those without hematuria in urinalysis. The peak incidence of patients diagnosed with RC (p = 0.001) was noted in August, while the winter had the lowest frequency of relevant admissions. The peak frequency was between 06:00 and 08:00. Women stayed longer in the ED (p = 0.001). Absence of hematuria in urinalysis was associated with increased length of stay (p = 0.007).</p> <p>Conclusion</p> <p>Although RC is a common ED presentation for which the emergency physician has no guidelines in terms of diagnosis and management, there is no exact pattern to guide ordering investigations. Patients with atypical presentations stay longer in the ED and are likely to undergo additional tests in management.</p

The effect of N95 respirators on vital parameters, PETCO2, among healthcare providers at the pandemic clinics

Background Wearing face shields and masks, which used to have very limited public use before the COVID-19 outbreak, has been highly recommended by organizations, such as CDC and WHO, during this pandemic period. Aims The aim of this prospective study is to scrutinize the dynamic changes in vital parameters, change in end tidal CO2 (PETCO2) levels, the relationship of these changes with taking a break, and the subjective complaints caused by respiratory protection, while healthcare providers are performing their duties with the N95 mask. Methods The prospective cohort included 54 healthcare workers (doctors, nurses, paramedics) who worked in the respiratory unit of the emergency department (ED) and performed their duties by wearing valved N95 masks and face shields. The vital parameters and PETCO2 levels were measured at 0-4th-5th and 9th hours of the work-shift. Results Only the decrease in diastolic BP between 0 and 9 h was statistically significant (p = 0.038). Besides, mean arterial pressure (MAP) values indicated a significant decrease between 0-9 h and 5-9 h (p = 0.024 and p = 0.049, respectively). In terms of the vital parameters of the subjects working with and without breaks, only PETCO2 levels of those working uninterruptedly increased significantly at the 4th hour in comparison to the beginning-of-shift baseline levels (p = 0.003). Conclusion Although the decrease in systolic blood pressure (SBP) and MAP values is assumed to be caused by increased fatigue due to workload and work pace as well as increase in muscle activity, the increase in PETCO2 levels in the ED healthcare staff working with no breaks between 0 and 4 h should be noted in terms of PPE-induced hypoventilation

Association of IL-1Β (-511 C /T) and IL-1Β (-31 T / C) gene polymorphism with endoplasmic reticulum stress marker levels in acute decompensated heart failure with low ejection fraction

Inflammatory processes play an important role in the pathogenesis of heart failure. The accumulation of unfolded protiens in the endoplasmic reticulum lumen and the unfolded protien response signal path is activated. The IL-IB gene is located in the Chromsone 2.q14 region. -31 and -511 single nucleotide polymorphisms (SNPs) were detected in the IL-IB Promoter region. These two SNPs affect IL-1expression. This Study aims to investigate the presence of IL-IB (-511 C / T) and IL-IB (-31 T / C) gene polymorphisms and the relationship between ER Stress markers and the inflammatory markers. Patients who applied to the department of emergency medicine with the findings of acute decompensated heart failure. Polymorphic sites of the IL-IB gene were determined by DNA sequencing. In all study, individuals with IL-IB (-31 T / C) T allele have higher serum PERK, GRP-78, CHOP AND CRP levels median values than individuals with IL-IB (-31 T/C) C allele (p = 0.00001, p = 0.0002, p = 0.002 and p = 0.011, respectively). Serum ERK and GRP-78 Values in HF Group were higher in individuals with IL-IB (-31 T / C) T allele compared to individuals with C alle (p = 0.0001 and p = 0.0006). There was a statistically difference in serum CHOP levels in the control group with the IL-IB (-511 C / T) T allele and the individuals with the C allele in the HF group (p= 0.002). In Cnclusion we consider that the inflammatory response caused by IL-IB (-31 T / C) gene polymorphism increased and the ER stress response increased, inflammatory pathway and stress of having IL-IB (-31 T / C) T / T genotype or T allele

Determination of advanced life support knowledge level of residents in a Turkish university hospital

The aim of the study was to determine the advanced cardiac life support (ACLS) knowledge level of residents and related factors in the departments of Anesthesiology, Emergency Medicine, Internal Medicine, and Cardiology in a university hospital. For this cross-sectional study, a total of 20 multiple-choice questions were prepared concerning several different topics, including: fatal dysrhythmias, oxygenation, ventilation and airway control, asystole, and pulseless electrical activity. Questions were given to residents before their periodic training meetings and collected in 30 min. There were 101 of 120 residents from four clinical departments (participation rate 84%) tested. Average point total and standard deviations of all residents were 66.3 :L 17 out of 100 points. On a departmental basis, statistically significant differences were found in the knowledge level of residents (Emergency Medicine: 86.2 8.2, Cardiology: 66.7 12.9, Anesthesiology: 59.3 16.2, Internal Medicine: 56.1 13.5, F: 28.6, p < 0.0001). The factors that affect ACLS knowledge level of residents were "postgraduate ACLS training..... awareness of guidelines," and "resuscitation frequency." Postgraduate training and the frequency of ACLS practice seem to increase the ACLS knowledge level of residents. The present study emphasizes the necessity for a standardized systematic postgraduate ACLS training program for the residents of related medical disciplines. Further studies with larger groups are needed to investigate theoretical knowledge, resuscitation skill competency, and related factors. (c) 2008 Elsevier Inc

A Hypertrophic Spinal Pachymeningitis Patient With Factor V Leiden (G1691A), MTHFR C677T, MTHFR A1298C, PAI- 1 4G-5G, Glycoprotein IIIa L33P Gene Mutations

Hypertrophic pachymeningitis (HP) is a rare clinical entity of diverse etiology, characterized by a chronic inflammation that causes dura thickening. Reports of Idiopathic hypertrophic cranial pachymeningitis (IHCP) were related to infections, trauma, tumors, and rheumatologic conditions. It was first described by Charcot and Joffroy regarding spinal meninges in 1869. HP has three stages; progressive radicular symptoms begin first, then muscle weakness and atrophy start. Findings such as paraplegia, loss of bladder and bowel control, and respiratory distress caused by intercostal and diaphragmatic denervation are considered the third stage of the disease. Especially in the cranial form of the disease, nerve ischemia and various cranial neuropathic findings may occur. Factor V Leiden (G1691A), MTHFR C677T, MTHFR A1298C, and PAI-1 4G-5G gene mutation analysis were measured with an ABI Prism. In this case report, the authors present a case of hypertrophic mutations pachymeningitis with Factor V Leiden (G1691A), MTHFR C677T, MTHFR A1298C, PAI-1 4G-5G, Glycoprotein IIIa L33P gene. In conclusion, we report a case of HP with Factor V Leiden (G1691A), MTHFR C677T, MTHFR A1298C, PAI-1 4G-5G, and Glycoprotein IIIa L33P gene mutations. We emphasize that the identification of pachymeningitis can be easily bypassed with the application of limited laboratory techniques. As in this case report, we think that these mutations should be analyzed in patients diagnosed with pachymeningitis

Do we really need plain and soft-tissue radiographies to detect radiolucent foreign bodies in the ED?

Objective: The objective of this study was to compare 3 imaging techniques-p lain radiography, soft-tissue radiography, and ultrasonography-in detecting nonradiopaque foreign bodies in soft tissue

Intravenous administration of metoclopramide by 2 min bolus vs 15 min infusion: does it affect the improvement of headache while reducing the side effects?

Objective: To determine the therapeutic effect ( alleviation of vascular type headache) and side effects of a slow intravenous metoclopramide infusion over 15 min compared with those effects of a bolus intravenous metoclopramide infusion over 2 min in the treatment of patients with recent onset vascular type headache.Material and methods: All adults treated with metoclopramide for vascular type headache were eligible for entry into this clinical randomised double blinded trial. This study compared the effects of two different rates of intravenous infusion of metoclopramide over a period of 13 months at a university hospital emergency department. During the trial, side effects and headache scores were recorded at baseline ( 0 min), and then at 5, 15, 30 and 60 min. Repeated measures analysis of variance was used to compare the medication's efficacy and side effects.Results: A total of 120 patients presenting to the emergency department met the inclusion criteria. Of these, 62 patients ( 51.7%) were given 10 mg metoclopramide as a slow intravenous infusion over 15 min ( SIG group) and 58 patients ( 48.3%) were given 10 mg metoclopramide intravenous bolus infusion over 2 min ( BIG group). 17 of the 58 patients in the BIG group ( 29.3%) and 4 of the 62 patients ( 6.5%) in the SIG group had akathisia ( p = 0.001). There were no significant differences between the BIG and SIG groups in terms of mean headache scores ( p = 0.34) and no adverse reactions in the study period. Metoclopramide successfully relieved the headache symptom( s) of patients in both the BIG and SIG groups.Conclusion: Slowing the infusion rate of metoclopramide is an effective strategy for the improvement of headache and reducing the incidence of akathisia in patients with vascular type headache