IMMIGRATION AND CHILDREN

  Various economic, political, environmental and social reasons can force people to migrate, leaving their home. Migration, which is as old as human history, has increased because of some reasons such as globaliza­tion, wars and natural disasters. Children have constituted a significant proportion of immigrants. According to the report of the United Nations Children’s Fund for 2015, the number of immigrant children living in a different country from the country of their birth is approximately 31 million, of whom about 10 million are refugees around the world. Children have been obliged to deal with many problems such as hunger, thirst and illness during their migratory journey. In countries to which children migrated to seek asylum, children have been exposed to a great deal of abuse and exploitation, including violence, human trafficking and participation in criminal organisations. Unaccompanied children are especially vulnerable to all these hazards. The physical and mental health of immigrant children is affected by cultural, geographical and climatic changes. Not knowing the language of the destination country and being unable to communicate with their peers causes an impact of psychological trauma on children. In addition, refugee children living in difficult conditions for a long time are at risk of mental problems and behavioural disorders

Risk factors for adverse events in patients administered intravenous tramadol hydrochloride in Emergency Department

INTRODUCTION: The aim of the present study was to assess the adverse events developing in patients treating with intravenous(iv) tramadol to provide moderate to severe pain control in emergency department (ED) and to investigate the association of these adverse events with age, sex and vital signs and to compose a set of rules for the identification of patients in the risk group.  MATERIAL AND METHODS: In this prospective cohort study, patients older than 18 years, admitted to ED during a 1-year period and administered iv tramadol were included in a secondary care public hospital. Information about age, sex, vital signs and adverse events were recorded. Patients defined as group 1 or group 2 with respect to adverse event development status and the groups were compared in terms of age, sex and vital signs.  RESULTS: A total of 408 patients were included in the study. Adverse events ratio after treatment was 21.1%. Adverse events were nausea, dizziness and vomiting. The age and the pulse rate per minute of the patients in group 1 were found to be higher and systolic blood pressure (SBP) was found to be lower than the patients in group 2.  CONCLUSİONS: The risk of adverse events development is higher in patients who are hypotensive, tachycardic and older than 56 years. Multicenter, prospective studies with larger patient groups are needed to support our results

Urine dipstick of sputum for the rapid diagnosis of community acquired pneumonia

Abstract: Introduction: Community acquired pneumonia (CAP) is responsible for an important part of treatment costs across the world. Even though posterioranterior lung radiography (PALG) and direct sputum smear microscopy are required or routine diagnoses. The purpose of this study is to determine the diagnostic value of the bedside urine strip tests in CAP. Methods: Patients who attended the emergency department (ED) between from February 2016 to September 2016 with expectoration complaints and suspicion of pneumonia. The sensitivity, specificity, and accuracy rate of the urine strip tests, direct sputum smear microscopy, and PALG were calculated and analyzed using SPSS 15.0. Results: During the study period, 100 patients with pneumonia suspicion were evaluated in the ED. The sample was divided into two groups: negative and positive diagnosis of CAP. The leukocytes detecting by urine strip tests are statistical differences between the two groups (p: 0.003). The results show that the sensitivity, specificity, and accuracy rate of leukocytes detected in sputum with urine strip tests in the pneumonia diagnosis were 83.3%, 44.2% and 63% respectively. Conclusion: According to the study, it is believed that the method of determination of leukocytes with urine strip tests in sputum combined with more detailed results. They can become part of CAP diagnosis methods

Is there a difference between the readabilities of informed consent forms used for procedures in the emergency services of state and university hospitals in Turkey?

Aim: The aim of the present study was to evaluate the readability levels of informed consent forms (ICFs) used for procedures in the emergency services of state and university hospitals by comparing through readability formulas. Materials and Methods: ICFs used in emergency medicine clinics in different university and state hospitals in Turkey were collected, and forms that were the same were included in the evaluation only once. A total of 32 ICFs, with 15 from university hospitals and 17 from state hospitals, were evaluated. Average word number, syllable number, and words with syllable number of four and above were calculated. Different formulas were used to determine readability levels. Results: Although the readability of ICFs used in university hospitals was found to be better than those in state hospitals, the readability levels of the ICFs for both groups were detected to have medium difficulty according to the Atesman formula, very difficult according to the Flesch-Kincaid formula, difficult according to the Gunning-Fog formula, and at high school level according to the Bezirci-Yilmaz formula. Conclusion: In conclusion, the readability rates of emergency procedure ICFs in both state hospitals and university hospitals were detected to be rather low according to the present study. The education level of our country and the local environment should be considered while preparing these ICFs

The impact of lung ultrasound on coronavirus disease 2019 pneumonia suspected patients admitted to emergency departments

Objective The aim of this study was to identify the sensitivity and specificity of lung ultrasound (LUS) and show its place in diagnosing patients with known coronavirus disease 2019 (COVID-19) pneumonia, according to chest computed tomography and the COVID-19 reporting and data system (CO-RADS). Methods Nineteen patients who admitted to a single university hospital emergency department between March 5, 2020, and April 27, 2020, describing dyspnea were included in the study and underwent LUS by a single emergency specialist. The patient population was divided into 2 groups, COVID-19 positive and negative, and the sensitivity and specificity of LUS according to chest computed tomography were calculated for COVID-19 pneumonia diagnosis. In the subgroup analysis, the patient group was divided into real-time reverse transcription-polymerase chain reaction positive (n = 7) and negative (n = 12), and sensitivity and specificity were calculated according to the CO-RADS. Results According to the CO-RADS, significant differences were detected between the LUS positive and negative groups in terms of COVID-19 pneumonia presence. Only 1 patient was evaluated as CO-RADS 2 in the LUS positive group, and 2 patients were evaluated as CO-RADS 4 in the LUS negative group (P = 0.04). The sensitivity of LUS according to the CO-RADS for COVID-19 pneumonia diagnosis was measured to be 77.78% (95% confidence interval [CI], 39.9%-97.1%), specificity was 90% (95% CI, 55.5%-99.75%), positive predictive value was 87.5% (95% CI, 51.35%-97.8%), and accuracy was 84.21% (95% CI, 60.4%-96.62%; P = 0.004). Conclusions In conclusion, LUS is easily used in the diagnosis of COVID-19 pneumonia because it has bedside application and is fast, easy to apply, reproducible, radiation free, safe for pregnant women, and cheap

Analysis of Patients Who Present to Emergency Departments During Ramadan

INTRODUCTION: Fasting is one of the five basic obligations of Islam. Muslims fast during the month of Ramadan according to the lunar calendar. Fasting during Ramadan involves abstinence from food and drinks from sunrise to sunset. The present study investigated the effect of fasting during Ramadan in patients who presented to emergency departments. Results of this study may guide healthcare authorities in countries that provide health services to Muslim communities because of increased migration. MATERIAL AND METHODS: This is the first prospective multicentre study to examine emergency department applications for Ramadan. The study was performed between 05.26.2017 and 06.24.2017. Patients were classified according to cardiopulmonary complaints, trauma-associated complaints, neurological complaints, gastrointestinal complaints, headache, renal colic, upper respiratory tract complaints, and malaise. Vital signs, age, gender, presentation type, complaint type, hospital stay duration, requested laboratory examination, radiological examination, treatment outcomes, application time, smoking status, and fasting status of the study patients were recorded by using a questionnaire. RESULTS: Fasting and non-fasting patients showed a significant difference with respect to presentation type, gastrointestinal complaints, upper respiratory tract complaints, hospitalization status, requested radiological and biochemical examinations, hospitalization duration, and application time (p < 0.05). CONCLUSIONS: To the authors’ knowledge, the present study is the first to compare the complaints of fasting and non-fasting patients during Ramadan. The authors feel that this study is superior to several previous studies because it has been performed using a different perspective and provides more accurate and objective data than those reported in previous studies

The value of carotid intima-media measurements during the periods of attack and remission of migraine disease and tension-type headache in differential diagnosis

INTRODUCTION: In Turkey, 2% of emergency department admissions are migraine and there is no specific biomarker with differential diagnostic value in patients presenting with headache. There are studies showing that the blood-brain barrier deteriorates during migraine attacks, the risk of atherosclerosis is increased in migraine patients and it is associated with cardiovascular and cerebrovascular diseases. In light of this information, the value of carotid intima-media thickness (CIMT) measurements in the differential diagnosis of tension and migraine headache was investigated.  MATERIAL AND METHODS: The study group consisting of 20 tension headache, 23 migraine attacks, 20 remission migraine patients admitted to the emergency department and neurology outpatient clinic of Ridvan Ege Hospital between February and September 2017 and control group of 21 healthy volunteers were compared. Carotid intima-media thickness (CIMT) of all participants was measured by specialist radiologist. The data obtained were analysed using SPSS 15.0 statistical program.  RESULTS: There was no significant difference between the participants in terms of age and gender. When the carotid intima-media thickness was analysed between the four groups and according to the presence and type of migraine, no significant difference was found (p = 0.489).  CONCLUSIONS: This is the first study in the literature which evaluates the relationship between subclinical atherosclerosis and tension-type headache and migraine by examining patients with tension-type headache and migraine disease in both episode and remission period. According to the results obtained, migraine and tension headache is not associated with subclinical atherosclerosis. However, larger-scale studies are required in this sense

Relationship of serum pentraxin-3 with peripheral arterial disease

Aim: Since atherosclerosis is a chronic inflammatory process associated with peripheral artery disease (PAD), the inflammatory marker pentraxin (PTX) may increase in PAD. Materials and Methods: This cross-sectional clinical study was performed at the tertiary university hospital emergency department and cardiovascular surgery departments in Turkey. The purpose was to determine the value of PTX3 in the diagnosis of PAD. This study was performed on 43 symptomatic patients aged >18 years and diagnosed with PAD. Results: Median PTX3 value was 1.027 (25–75th percentile: 0.395–2.902) in the control group and 0.585 (25–75th percentiles: 0.406–5.467) in the PAD group (p=0.913). A comparison of PTX3 with ankle brachial index (ABI) values revealed a weak and non-significant correlation (rho: 0.016, p=0.886). Analysis of PTX3 values with other parameters (age, systolic and diastolic blood pressure, heart rate, respiratory rate, temperature, and SpO2) revealed no significant correlation with any of the other parameters. Conclusion: Our findings indicate that PTX3 levels cannot be used as a marker in patients with the chronic process of PAD

Can hematological and biochemical parameters fasten the diagnosis of COVID-19 in emergency departments?

INTRODUCTION: The primary aim of the study was to compare the laboratory and radiological parameters of COVID-19 positive and negative patients confirmed by Real-Time Reverse Transcription Polymerase Chain Reaction (RT-PCR), and Chest Computed Tomography (CCT) of patients admitting with the suspicion of COVID-19. The secondary purpose of the study was to find objective parameters to speed up the clinician for further examination, treatment or referral decision in COVID-19 suspicion.   MATERIAL AND METHODS: A total of 61 COVID-19 suspected patients were evaluated in the study. Swab samples were taken for RT-PCR analysis. CCT was taken for 42 patients who described dyspnea. According to CCT and RT-PCR results, the patient population was divided into 2 groups as COVID-19 positive group (n = 32); and COVID-19 negative group (n = 29). Between two groups; demographic, clinical, laboratory and radiological parameters were compared.   RESULTS: Male gender (p = 0.03), PLR value (p = 0.021) and CO-RADS scores were higher in the COVID-19 positive group. Oxygen saturation (SaO2) (p = 0.027) and PCT, WBC, Neutrophil count, Lymphocyte count values were significantly low in COVID-19 positive group (p = 0.03, p = 0.001, p = 0.017, p = 0.021, respectively). PLR showed a positive correlation with fever, CRP, neutrophil count and NLR, which are indicators of inflammation.   CONCLUSIONS: SaO2, WBC, lymphocyte count, neutrophil count and low PCT levels, and PLR elevation showed a significant difference in COVID-19 patients in our retrospective cohort study examining the Turkish population. We believe that these results will allow clinicians to make quick decisions in patient management more simply

Evaluation of hematological parameters in migraine attack in emergency room

Aim: Migraine headaches are one of the serious complaints of patients seeking emergency department (ED) with symptoms of manyhealth problems. In this study, we aimed to examine predictive values of hematological parameters on chronic migraine.Material and Methods: The files of patients admitted to ED of Ufuk University Hospital between January 2016 and November 2016with a headache and who underwent hematological analyses at emergency admission were analyzed retrospectively. After exclusioncriteria were applied, 55 patients with migraine attacks who were previously diagnosed with migraine by a neurologist included inthis study.Results: There was not a statistically significant difference between age and sex distribution of groups (p>0.05), whereas astatistically significant difference was found for family history between patient and control groups (p<0.05). Attack frequency wasabove 3 in most patients (74.5%), and mean migraine duration was 9.00±9.49 years. Red blood cell count (RBC), hemoglobin andhematocrit levels of patient groups were significantly higher than the control groups (p<0.05). Receiver operating characteristic(ROC) analysis showed that hematocrit was the most important parameter for migraine, followed by RBC and hemoglobin. In binarylogistic regression analysis, high hematocrit level is an effective factor for migraine with controlled multi-parameter regressionanalysis (OR=0.601; p<0.05).Conclusion: The results of this study show that hematocrit levels of patients can be used to predict or distinguish migraine attack inED in order to provide fast and correct treatment.Keywords: Migraine; pain; headache; hematocrit; emergenc