Evaluation of scoring systems in terms of early prediction of severe acute pancreatitis and mortality in patients over 65 years of age.

Purpose: The aim of this study is to investigate the power of disease severity scores to predict the development of Severe Acute Pancreatitis (SAP) and mortality in the early period over 65 years old diagnosed with acute pancreatitis in the emergency department. Materials and Methods: We calculated RANSON (on admission) and Computed Tomography Severity Index (CTSI) in addition to Bedside Index for Severity in Acute Pancreatitis (BISAP) score on admission to the emergency department. Results: One hundred and sixty patients (46.9% over 80 years of age) were included in the study. We observed statistically higher length of hospitalization, longer duration of stay in the intensive care unit, SAP and higher mortality in patients over 80 years of age. When we examined the ROC curve, we determined that the AUC values of the BISAP score were highest in both SAP and mortality estimation (AUC: 0.911, 95% CI 0.861-0.962; AUC: 0.918, 95% CI 0.864-0.9722, respectively). Binary logistic analysis indicated a 4.7-fold increased risk for SAP and a 12.3-fold increased mortality for each unit increase in BISAP score value. Conclusion: BISAP may be a good predictor for SAP and mortality estimation on admission to the emergency department in patients over 65 years of age with acute pancreatitis

İskemik İnmede TOAST ve BANFORD Sınıflaması ile Hemogram Parametrelerinin Mortalite Açısından Karşılaştırılması

Purpose: Patients with ischemic stroke who attends emergency departments frequently and have high mortality and morbidity. Purpose of this study is to determine risk groups of ischemic stroke patients by using TOAST and Banford classifications and search whether is there a relationship between red cell distribution width (RDW), mean platelet volume (MPV) and mortality. Methods: We included patients older than 18 years old and who attend-ed XXX Numune Research and Training Hospital Emergency Department throughout two years between 01.07.2014-30.06.2016, patients aged 18 years and older who were diagnosed with ischemic stroke and hospitalized and had sufficient file information were included. Results: We included 404 patients this study. In our study 53.2% (n=215) of all cases were male, 46.8% (n=189) were female. When we look patients age distribution range the biggest group was over 65 years group with 57.7% (n=233) rate. Patients were groupped according to TOAST and Banford classification. MPV and RDW values of patients according to TOAST classification were low risk group 8.3±1.6, 15.7±2.3 and high risk group 8.0±1.5, 16.0±2.4 (p=0,096, p=0,054) respectively. MPV and RDW values were 7.9±1.5, 15.8±2.1 and 8.2±1.6, 15.9±2.6 (p=0,167, p=0,943) respectively in low risk group and high risk group according to Banford classification of patients. Conclusion: There are current studies investigating the utility of hematologic parameters in predicting mortality in emergency department management of patients with ischemic stroke. In the light of the data we obtained in our study, it was concluded that hematological parameters, especially MPV and RDW values were not an effective parameter in determining the prognosis

Proline and antioxidant enzyme activities in some strawberry cultivars under drought and recovery

This study examines the molecular effects of drought and recovery applications on four strawberry (Fragaria x ananassa Duch) cultivars known as relatively heat-tolerant ['Redlands Hope' ('R. Hope') and 'Camarosa'] and heat-sensitive ['Festival' and 'Cal. Giant-3' ('CG-3')]. After frigo seedlings were grown in a greenhouse for eight weeks (until they had five-six leaves) in a pot, 10% Poliethyleneglycol 6000 (PEG) was applied in order to compose drought condition for 15 days. Following PEG application, plants were watered without PEG for 15 days to observe the recovery. Leaf relative water content (RWC), loss of turgidity, cell membrane injury, proline content and the activities of ascorbate peroxidase (APX, EC 1.1.11.1), glutathione reductase (GR, EC 1.6.4.2) and peroxidase (PRX, EC 1.11.1.7) were determined in leaf tissues taken from plants at the end of the drought and recovery applications. Although membrane injury was increased by the PEG application, it reduced almost to the control levels at the end of the recovery period. Proline contents were found higher in cvs. 'R. Hope' and 'Camarosa' than cvs. 'Festival' and 'CG-3' under drought conditions. APX and GR enzymes showed great activities in drought applied plants of heat-tolerant cultivars. Native polyacrylamide gel electrophoresis (PAGE) of basic PRX isozymes yielded three protein bands with Rf = 0.45, Rf = 0.55 and Rf = 0.60 that were sharply increased their activities by PEG and recovery applications in cvs. 'R. Hope' and 'Camarosa'. In addition, leaves of all cultivars exposed to drought rolled up and had brown colour in various level as an indication of tolerance. Indeed 'Camarosa' and 'R. Hope' showed better recovery performance after rewatering than 'Festival' and 'CG-3'. All data indicated that heat-tolerant cultivars showed relatively drought tolerance in this study

Tıbben Açıklanamayan Somatik Semptomlar için Bilinçli Farkındalık Temelli Terapiler: Sistematik Bir Gözden Geçirme

Mindfulness is a new therapeutic approach. Over the last years, it is found to be effective in treating many psychological and somatic symptoms. Somatic symptom disorder was characterized by chronic, recurring and clinically significant somatic symptoms. It is known that these symptoms cannot be fully explained by general medical condition and might significantly interfere with a person's general functioning. It is understood that some somatic symptoms which can not medically explained but thought having a psycho-somatic based are also provided from psychological treatments like somatic symptom disorder. Surprisingly, mindfulness-based intervention studies of somatic symptom disorder are especially focused on these medical conditions including chronic fatigue syndrome, irritable bowel syndrome and fibromyalgia. To systematically review these studies, PsycINFO and PsycARTICLES databases were assessed

Emergency medicine admissions of pediatric intoxicated cases

Objective: In this study, we aimed to analyze the demographic features and mortality rates of pediatric patients admitted to the emergency department and diagnosed with intoxication. Material and Methods: Patients admitted to the pediatric emergency department and diagnosed with intoxication between December 01, 2009 and Decem- ber 31, 2010 were included in the study. Patients were evaluated through the examination of registration forms and hospitalization files. The characteristics, including age, sex, admission type to the emergency department, treatment before admission, time passed before admission, consciousness level at the time of admission, cause of poisoning, toxic agent, treatment administered after admission, outcome, and mortality rates, were recorded. Results: In our study, 1029 cases were included; 66.47% of the patients were female, and the female/male ratio was found to be 1.98/1. Poisoning was most fre- quently seen in the group of 13-18-year-old patients (56.17%). Patients were admitted mostly in the spring. The most frequent cause of poisoning was adminis- tration of drugs (81.8%), among which paracetamol was the most common and antidepressants were the second most common drugs. Suicide rate was 56.07%, and 54 patients (5.2%) had attempted suicide for the second time. Also, 85.71% of the patients were admitted to the emergency room within the first 2 hours. Conclusion: In order to minimize the rate of poisoning cases, preventive measures, education of the family, more secure storage of drugs, more prudent production of drugs in boxes by pharmaceutical companies, and prevention of childhood poisoning by regional epidemiological studies should be promoted.(JAEM 2014; 13: 67-70)Objective: In this study, we aimed to analyze the demographic features and mortality rates of pediatric patients admitted to the emergency department and diagnosed with intoxication. Material and Methods: Patients admitted to the pediatric emergency department and diagnosed with intoxication between December 01, 2009 and Decem- ber 31, 2010 were included in the study. Patients were evaluated through the examination of registration forms and hospitalization files. The characteristics, including age, sex, admission type to the emergency department, treatment before admission, time passed before admission, consciousness level at the time of admission, cause of poisoning, toxic agent, treatment administered after admission, outcome, and mortality rates, were recorded. Results: In our study, 1029 cases were included; 66.47% of the patients were female, and the female/male ratio was found to be 1.98/1. Poisoning was most fre- quently seen in the group of 13-18-year-old patients (56.17%). Patients were admitted mostly in the spring. The most frequent cause of poisoning was adminis- tration of drugs (81.8%), among which paracetamol was the most common and antidepressants were the second most common drugs. Suicide rate was 56.07%, and 54 patients (5.2%) had attempted suicide for the second time. Also, 85.71% of the patients were admitted to the emergency room within the first 2 hours. Conclusion: In order to minimize the rate of poisoning cases, preventive measures, education of the family, more secure storage of drugs, more prudent production of drugs in boxes by pharmaceutical companies, and prevention of childhood poisoning by regional epidemiological studies should be promoted.(JAEM 2014; 13: 67-70

Effects of high temperature stress on enzymatic and nonenzymatic antioxidants and proteins in strawberry plants

The mechanism of tolerance to high temperatures was investigated in two strawberry (Fragaria x ananassa Duch) cultivars, ‘Redlands Hope’ (‘R. Hope’, heat tolerant) and ‘Cal. Giant 3’ (‘CG3’, heat sensitive). Leaves were collected from plants that were exposed to gradual heat stress and heat-shock stress separately. The contents of nonenzymatic antioxidants such as ascorbic acid (AsA) and glutathione (GSH) and the activities of enzymatic antioxidants such as ascorbate peroxidase (APX) (EC 1.11.1.11), catalase (CAT) (EC 1.11.1.6), and glutathione reductase (GR) (EC. 1.6.4.2) were measured followed by heat treatments. Additionally, proline content was determined, and heat shock proteins (HSPs) were analyzed with an immunoblotting method to investigate protein markers involved in the heat-stress tolerance of strawberry plants. The contents of AsA and GSH did not change depending on heat stress type, temperatures, or cultivars. While APX and CAT activities increased with high temperatures, GR activity was almost unchanged. The proline content of the cultivars increased in both treatments. Anti-HSP60 immunoblots revealed that a 23 kDa polypeptide was detected during the heat acclimation of strawberry cultivars. The intensity of the heat shock protein in ‘R. Hope’ plants was more than in ‘CG3’ plants. Thus, the accumulation of 23 kDa heat shock protein was correlated with the heat tolerance of the cultivars. In conclusion, strawberry leaf tissues of ‘R. Hope’ were found to enhance the structural stability of cellular membranes under high temperature by increasing both the activity of such enzymes as CAT and APX to activate the antioxidative systems and the expression of 23 kDa HSP.The mechanism of tolerance to high temperatures was investigated in two strawberry (Fragaria x ananassa Duch) cultivars, ‘Redlands Hope’ (‘R. Hope’, heat tolerant) and ‘Cal. Giant 3’ (‘CG3’, heat sensitive). Leaves were collected from plants that were exposed to gradual heat stress and heat-shock stress separately. The contents of nonenzymatic antioxidants such as ascorbic acid (AsA) and glutathione (GSH) and the activities of enzymatic antioxidants such as ascorbate peroxidase (APX) (EC 1.11.1.11), catalase (CAT) (EC 1.11.1.6), and glutathione reductase (GR) (EC. 1.6.4.2) were measured followed by heat treatments. Additionally, proline content was determined, and heat shock proteins (HSPs) were analyzed with an immunoblotting method to investigate protein markers involved in the heat-stress tolerance of strawberry plants. The contents of AsA and GSH did not change depending on heat stress type, temperatures, or cultivars. While APX and CAT activities increased with high temperatures, GR activity was almost unchanged. The proline content of the cultivars increased in both treatments. Anti-HSP60 immunoblots revealed that a 23 kDa polypeptide was detected during the heat acclimation of strawberry cultivars. The intensity of the heat shock protein in ‘R. Hope’ plants was more than in ‘CG3’ plants. Thus, the accumulation of 23 kDa heat shock protein was correlated with the heat tolerance of the cultivars. In conclusion, strawberry leaf tissues of ‘R. Hope’ were found to enhance the structural stability of cellular membranes under high temperature by increasing both the activity of such enzymes as CAT and APX to activate the antioxidative systems and the expression of 23 kDa HSP

Geriatric patient admissions to the emergency service

Objective: In this study, we aimed to analyze the demographic features of patients older than 65 years admitted to the emergency department. Material and Methods: All patients who were over 65 years old and admitted to a tertiary care emergency department were included in this retrospective study. Information, including admission dates (month, season), age, sex, admission type, diagnosis, duration of hospitalization, and outcome in the emergency department of the patients, was evaluated. The obtained data were analyzed with student t-test and chi-square test by using SPSS 17.0 software. Results: Of 238,222 patients admitted to the emergency department, 8793 (3.6%) were over 65 years old; 58% of the patients were female and 42% were male. The rate of chronic obstructive pulmonary disease (COPD) among respiratory problems in males and the rate of hypertension among cardiac problems in females were found to be significantly high. The highest admission rate was in the autumn months (32.6%). The most common reason for admission to the emergency department was cardiac problems (21.7%). This was followed by neurological problems, trauma, respiratory system problems, and urinary tract infections, respectively. The highest mortality rate was 45% in the general intensive care unit. The most frequent cause for mortality was cardiac problems. Conclusion: Cardiac problems were the most common cause of admissions to the emergency department, hospitalization, and mortality in geriatric patients. Future studies for determining the admission rate and most frequently observed illnesses of geriatric patients might be helpful in developing special care areas and special scanning tests for geriatric patients. (JAEM 2014; 13: 53-7)Objective: In this study, we aimed to analyze the demographic features of patients older than 65 years admitted to the emergency department. Material and Methods: All patients who were over 65 years old and admitted to a tertiary care emergency department were included in this retrospective study. Information, including admission dates (month, season), age, sex, admission type, diagnosis, duration of hospitalization, and outcome in the emergency department of the patients, was evaluated. The obtained data were analyzed with student t-test and chi-square test by using SPSS 17.0 software. Results: Of 238,222 patients admitted to the emergency department, 8793 (3.6%) were over 65 years old; 58% of the patients were female and 42% were male. The rate of chronic obstructive pulmonary disease (COPD) among respiratory problems in males and the rate of hypertension among cardiac problems in females were found to be significantly high. The highest admission rate was in the autumn months (32.6%). The most common reason for admission to the emergency department was cardiac problems (21.7%). This was followed by neurological problems, trauma, respiratory system problems, and urinary tract infections, respectively. The highest mortality rate was 45% in the general intensive care unit. The most frequent cause for mortality was cardiac problems. Conclusion: Cardiac problems were the most common cause of admissions to the emergency department, hospitalization, and mortality in geriatric patients. Future studies for determining the admission rate and most frequently observed illnesses of geriatric patients might be helpful in developing special care areas and special scanning tests for geriatric patients. (JAEM 2014; 13: 53-7

Pregnancy with cabergoline treatment in a woman with bromocriptine resistant macroprolactinoma : case report

Bromokriptin ve kabergolin prolaktinoma tedavisinde kullanılan en yaygın dopamin agonistleridir. Dopamin agonistlerine direnç %10-15 civarında görülmektedir. Kliniğimize amenore ve baş ağrısı şikayeti ile başvuran 19 yaşında kadın hastaya yapılan tetkikler sonucu makroprolaktinoma tanısı konuldu. Başlangıç tedavisine kabergolin ile yanıt alınan hastanın takibinde gebelik istemi olması nedeniyle ilacı kesilip bromokriptin tedavisine geçildi. Bromokriptin 15 mg/gün yaklaşık 1 yıl kullanan hastada tedaviye cevapsızlık görüldüğü için bromokriptin direnci düşünülerek kabergolin tedavisine tekrar geçildi. Kabergolin tedavisi altında gebelik oluşan bu vakada, bromokriptin direncinin makroprolaktinoma takip ve tedavisini güçleştirebileceği ve direnç gelişen hastalarda alternatif ilaçlara geçilerek başarının sağlanabileceği vurgulanmak istenmiştir.Bromocriptine and cabergoline are the most preferred dopamine agonists in the therapy of prolactinomas. Primary resistance to dopamine agonists is usually seen in 10-15 % of the patients. Here, we described a case of a 19 year-old woman who was presented with amenorrhea and headache and then was diagnosed with macroprolactinoma. She was initially treated with cabergoline with a perfect response. We had switched cabergoline to bromocriptine because of the desire for pregnancy. After one year of 15 mg/day of bromocriptine treatment, the patient reported irregular menses with elevated prolactin levels. There with we changed bromocriptine to cabergoline because the cabergoline response was perfect at the beginning. We would like to emphasize that the resistance to bromocriptine therapy is not uncommon and may complicate the follow up of the patients with prolactinomas and in case of resistance, it is important to keep in mind to switch agents

Investigation of the Relationship between Thyroid Hormone Levels and Mortality in Old Patients Hospitalized in an Internal Medicine Intensive Care Unit from the Emergency Service

Objective: In our study, the purpose was to determine the relationship between thyroid hormones and mortality of patients over the age of 55 who were hos- pitalized in an intensive care unit from the emergency service. Material and Methods: This study was planned as a prospective, randomized study, and patients hospitalized in an intensive care unit from the emergency medicine department were enrolled in this study following ethics committee approval. A standard data collection form was used to collect the data. After con- firmation from the patients and their relatives, we included 73 patients in our study: 48 (65.8%) males and 25 (34.2%) females. Blood samples were taken from each patient, and thyroid hormone levels were studied in our laboratory. The “SPSS for Windows version 18” program was used for statistical analysis of the data. Chi-square test was used to compare categorical measures between the groups. Mann-Whitney U-test and t-test were used to compare quantitative measure- ments between the groups. The log-rank test was performed under Kaplan-Meier survival analysis to determine the relationship between the estimated lifetime and free T3 (fT3), free T4 (fT4), and thyroid-stimulating hormone (TSH). Results: There was no statistically significant difference in mean ages and genders of patients who died and survived. The mean duration of hospitalization in the deceased patient group was lower than in the surviving patient group, but there was no statistically significant difference between the groups. According to the Kaplan-Meier survival analysis, the patients with low or high levels of fT3 were found to have a shorter median life expectancy. No significant relationship was found between mortality and fT4 TSH. Conclusion: According to our study, increased or decreased levels of fT3 in patients over the age of 55 without known thyroid disease, hospitalized in an inten- sive care unit from the emergency department, showed increased mortality. This study will be useful for emergency medicine physicians to be able to predict the mortality of patients and contribute to more clinical experience. FT3 levels can be used as a prognostic indicator after more detailed studies are completed. (JAEM 2014; 13: 71-4)Objective: In our study, the purpose was to determine the relationship between thyroid hormones and mortality of patients over the age of 55 who were hos- pitalized in an intensive care unit from the emergency service. Material and Methods: This study was planned as a prospective, randomized study, and patients hospitalized in an intensive care unit from the emergency medicine department were enrolled in this study following ethics committee approval. A standard data collection form was used to collect the data. After con- firmation from the patients and their relatives, we included 73 patients in our study: 48 (65.8%) males and 25 (34.2%) females. Blood samples were taken from each patient, and thyroid hormone levels were studied in our laboratory. The “SPSS for Windows version 18” program was used for statistical analysis of the data. Chi-square test was used to compare categorical measures between the groups. Mann-Whitney U-test and t-test were used to compare quantitative measure- ments between the groups. The log-rank test was performed under Kaplan-Meier survival analysis to determine the relationship between the estimated lifetime and free T3 (fT3), free T4 (fT4), and thyroid-stimulating hormone (TSH). Results: There was no statistically significant difference in mean ages and genders of patients who died and survived. The mean duration of hospitalization in the deceased patient group was lower than in the surviving patient group, but there was no statistically significant difference between the groups. According to the Kaplan-Meier survival analysis, the patients with low or high levels of fT3 were found to have a shorter median life expectancy. No significant relationship was found between mortality and fT4 TSH. Conclusion: According to our study, increased or decreased levels of fT3 in patients over the age of 55 without known thyroid disease, hospitalized in an inten- sive care unit from the emergency department, showed increased mortality. This study will be useful for emergency medicine physicians to be able to predict the mortality of patients and contribute to more clinical experience. FT3 levels can be used as a prognostic indicator after more detailed studies are completed. (JAEM 2014; 13: 71-4