Learning lessons from the 2011 Van Earthquake to enhance healthcare surge capacity in Turkey

Historically, Turkey has adopted a reactive approach to natural hazards which resulted in significant losses. However, following the 1999 Kocaeli Earthquake, a more proactive approach has been adopted. This study aims to explore the way this new approach operates on the ground. A multinational and multidisciplinary team conducted a field investigation following the 2011 Van Earthquake to identify lessons to inform healthcare emergency planning in Turkey and elsewhere. The team interviewed selected stakeholders including, healthcare emergency responders, search and rescue services, ambulance services, and health authority representatives, in addition to conducting a focus group. Data were analysed according to an open coding process and SWOT (strength, weakness, opportunity, and threat) analysis. The findings suggest that the approach succeeded in developing a single vision by consolidating official efforts in a more structured way, mobilising many governmental and non-governmental organisations, securing significant amounts of resources including physical and human, and increasing the resilience and flexibility of infrastructure to expand its capacity. However, more attention is required to the development of stronger management procedures and acquisition of further resources

Evaluation of the relationship between osteoporosis and musculoskeletal deformities in leprosy patients through the DXA procedure

The aim of the present study was to analyze the relationship between musculoskeletal deformities and osteoporosis in patients with leprosy. This study included 87 patients with leprosy who were admitted to the Leprosy, Skin and Venereal Diseases Hospital affiliated to the Association of Public Hospitals in Bakirkoy, Istanbul between the years of 2010 and 2014 and 85 healthy controls showing similar demographical characteristics with the leprosy patients. Osteoporosis-related bone density test was performed in both groups using the Dual-Energy X-Ray Absorptiometry (DXA). The mean age of the 172 patients (female: 69; male: 103) included in the study was 62.930+/-12.135 years. According to the T scores obtained from the DXA measurements, the osteoporotic changes occurred at a higher rate both in femoral and lumbar regions in leprosy patients as compared to non-leprosy patients (38 versus 24 and 25 versus 12, respectively). Additionally, the BMD measurements in femoral and lumbar regions were lower in leprosy patients (0.712+/-0.156 versus 0.830+/-0.108 and 0.847+/-0.153 versus 1.024+/-0.182, respectively). It was established that whereas leprosy patients tended to develop osteoporosis in femoral region, non-leprosy patients tended to develop osteoporosis in the lumbar region at a younger age. While "osteoporosis" occurred after the age of 40 years in the patients both with and without leprosy, "osteopenia" was observed to appear at younger ages (at the age of 27 years) in the patients that have leprosy. Osteoporotic changes are more common and develop at younger ages in the patients with leprosy. Early treatment that may be initiated after DXA measurement at femur may increase the quality of life of the leprosy patients by decreasing their osteoporosis-related health problems

Spontaneous Rectus Sheath Hematoma Presenting With Acute Abdominal Pain: A Case Series And Review Of The Literature

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Evaluation of the Affecting Factors for Pediatric Trauma Patients in the Adult Emergency Medicine Department: Preliminary Study

Amaç: Bu çalışmanın amacı, Acil Tıp Kliniğinde, pediatrik travmayı etkileyen faktörlerin değerlendirmektir. Gereç ve Yöntemler: Üç ay süresince 18 yaş ve altı travma şikayeti ile Acil Tıp Kliniğine başvuran çocuklar kesitsel olarak değerlendirildi. Bulgular: Tüm hastaların yaş ortalamaları 7,44±4,54 ve kız çocukların yaş ortalaması erkeklerden istatistiksel olarak daha düşüktü. Travma mekanizmaları karşılaştırıldığında düşmenin diğer tüm mekanizmalarından daha sık (%60,7) gerçekleştiği bulundu. Araç dışı trafik kazaları motorlu taşıt yaralanmalarının %87,5'ini oluşturdu. Ekstremite fraktürü tanısı alan hastaların ortalama vücut ağırlıkları diğer hastaların ortalama vücut ağırlıklarından istatistiksel olarak anlamlı yüksek bulundu. Kafa travması şikayeti ile başvuran hastaların ortalama yaşı diğer hastalardan anlamlı olarak düşüktü. Televizyon düşmesi sebebiyle yaralanan hastaların GKS, RTS, PTS skorları diğer travma mekanizmaları ile karşılaştırıldığında istatistiksel olarak anlamlı düşük bulundu. Ebeveynlerin eğitim durumları ile hastaneye yatış oranı karşılaştırıldığında anlamlı fark mevcuttu. (5,80±3,31'e karşı 6,91±3,29 yıl). Hastaların %73'ünün ortalama aylık gelirleri 1000'dan düşüktü. Sonuç: Yaş, cinsiyet, vücut ağırlığı, travma mekanizmaları, ebeveynlerin düşük eğitim ve sosyoekonomik düzeyleri pediatrik travmayı etkileyen faktörler olarak görülmektedir. Düşme en sık meydana gelen travma mekanizması iken, TV düşmesi ölümcül yaralanma sebebiydi. Ayrıca araç dışı trafik kazaları tüm motorlu taşıt yaralanmaları içinde en sık görülendiAim: To evaluate the factors that affect pediatric trauma in the emergency department. Materials And Methods: Injured children aged 18 and younger presented to a community hospital-based ED during 3 months were analyzed as cross-sectional. Results: Mean age of overall sample was 7.44±4.54 and female victims were significantly younger than males. When compared the mechanisms of pediatric trauma, ground-level fall was found more often (60.7%) than other mechanisms. Pedestrian trauma was found 87.5% of Motor Vehicle Injury (MVI). Mean body weight of patients diagnosed with extremity fractures was significantly higher than the others. Mean age of patients suffered from head trauma was significantly lower than the others. Children hurt by falling TV, had significantly lower Glasgow Coma Scale (GCS), Revised Trauma Score (RTS) and Pediatric Trauma Score (PTS) scores when compared to those with other mechanisms of injury. There was significant relation between the parents' mean education times and the rates of admission into the hospital (5.80±3.31 versus 6.91±3.29 years). Mean monthly household income of 73% of patients was found to be less than 1000. Conclusion: Age, sex, body weight, trauma mechanisms, low educational and socio-economic level of parents were seemed to be affecting factors of pediatric trauma. While ground-level fall was found the most common of trauma mechanism, TV falling was found as mortal injury in pediatric trauma. Also, pedestrian trauma was most common causes of MVI

Learning lessons from the 2011 Van Earthquake to enhance healthcare surge capacity in Turkey

Historically, Turkey has adopted a reactive approach to natural hazards which resulted in significant losses. However, following the 1999 Kocaeli Earthquake, a more proactive approach has been adopted. This study aims to explore the way this new approach operates on the ground. A multinational and multidisciplinary team conducted a field investigation following the 2011 Van Earthquake to identify lessons to inform healthcare emergency planning in Turkey and elsewhere. The team interviewed selected stakeholders including, healthcare emergency responders, search and rescue services, ambulance services, and health authority representatives, in addition to conducting a focus group. Data were analysed according to an open coding process and SWOT (strength, weakness, opportunity, and threat) analysis. The findings suggest that the approach succeeded in developing a single vision by consolidating official efforts in a more structured way, mobilising many governmental and non-governmental organisations, securing significant amounts of resources including physical and human, and increasing the resilience and flexibility of infrastructure to expand its capacity. However, more attention is required to the development of stronger management procedures and acquisition of further resources

A comparison of the outcome of CPR according to AHA 2005 ACLS and AHA 2010 ACLS guidelines in cardiac arrest: multicenter study

The aim of this study was to evaluate whether there is a difference in the return of spontaneous circulation (ROSC) and survival with sequel-free recovery rates between the patients who underwent cardiopulmonary resuscitation (CPR) according to 2005 and 2010 guidelines. This study was conducted in the Bakirkoy Dr. Sadi Konuk and Kartal Lutfi Kirdar Training and Research Hospital between dates of October 2010 and 28 February 2011 after approval of Ethics Committee. In the first months of the study, CPR was performed according to AHA 2005 ACLS guidelines (Group-1), while CPR was performed according to AHA 2010 ACLS guidelines after November 2010 (Group-2). Patients were assessed for neurological deficit with Cerebral Performance Categories Scale. Mean age was found as 69.01 +/- 13.05 (minimum: 21, maximum: 92) in 86 patients included. Of the 33 patients underwent CPR in the Group 1, ROSC was achieved in 51.5%; and 6.1% of these patients were discharged. Of the 53 patients underwent CPR in the Group 2, ROSC was achieved in 37.7%; and 9.4% of these patients were discharged. Although the number of living patients in Group 2 was higher than Group 1, the difference was not found statistically significant (5 versus 2), (P>0.05). But, neurological outcomes were found better with 2010 compared to 2005 guidelines (3/7 versus 0/2 good cerebral performance). It was found that the 2005 CPR guidelines practices in ED were more successful than the 2010 CPR guidelines practices in ROSC, but less successful in the rate of discharge from hospital and neurological sequel-free discharge rate

N-terminal pro-B-type natriuretic peptide as a marker of blunt cardiac contusion in trauma

Cardiac contusion is usually caused by blunt chest trauma and, although it is potentially a life-threatening condition, the diagnosis of a myocardial contusion is difficult because of non-specific symptoms and the lack of an ideal test to detect myocardial damage. Cardiac enzymes, such as creatine kinase (CK), creatine kinase MB fraction (CK-MB), cardiac troponin I (cTn-I), and cardiac troponin T (cTn-T) were used in previous studies to demonstrate the blunt cardiac contusion (BCC). Each of these diagnostic tests alone is not effective for diagnosis of BCC. The aim of this study was to investigate the serum heart-type fatty acid binding protein (h-FABP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), CK, CK-MB, and cTn-I levels as a marker of BCC in blunt chest trauma in rats. The eighteen Wistar albino rats were randomly allocated to two groups; group I (control) (n=8) and group II (blunt chest trauma) (n=10). Isolated BCC was induced by the method described by Raghavendran et al. (2005). All rats were observed in their cages and blood samples were collected after five hours of trauma for the analysis of serum hFABP, NT-pro BNP, CK, CK-MB, and cTn-I levels. The mean serum NT-pro BNP was significantly different between group I and II (10.3 +/- 2.10 ng/L versus 15.4 +/- 3.68 ng/L, respectively; P=0.0001). NT-pro BNP level >13 ng/ml had a sensitivity of 87.5%, a specificity of 70%, a positive predictive value of 70%, and a negative predictive value of 87.5% for predicting blunt chest trauma (area under curve was 0.794 and P=0.037). There was no significant difference between two groups in serum h-FABP, CK, CK-MB and c Tn-I levels. A relation between NT-Pro BNP and BCC was shown in this study. Serum NT-proBNP levels significantly increased with BCC after 5 hours of the blunt chest trauma. The use of NT-proBNP as an adjunct to other diagnostic tests, such as troponins, electrocardiography (ECG), chest x-ray and echocardiogram may be beneficial for diagnosis of BCC

New synthetic cannabinoid intoxications in emergency department (it's grass, it's no sin)

Objective: The aim of this study is to evaluate prognosis and clinical futures of the subjects who use new synthetic cannabinoid products (SCPs) with Poisoning Severity Score (PSS) in the Emergency Department (ED). Methods: We retrospectively reviewed 272 cases which resorted, to our ED between 2012 and 2014. All patients' clinical, laboratory levels and the PSS were studied. Results: The average age of the subjects was 25.08 +/- 7.07 years and 97.4% of them were male. 44.11% of all SCPs patients came to hospital during Ramadan. Of the 272 patients using SCPs, 83.5% used Bonsai-18 while 16.2% of them used Jamaica gold. Agitation was the most common psychoactive finding while dizziness was the most common physical finding. The most common symptoms and findings were seen in the gastrointestinal system. Most of the patients were found to be in the moderate PSS group. There was no patient in the non PSS group. While one patient in the fatal PSS group died in the 96th hour due to failure of multiple organs, the others had been discharged. Conclusion: SCPs cases have been increasing gradually in EDs including Ramadan. Our study has shown that SCPs have different physical and psychoactive effects, changeable from minor-PSS to fatal PSS (death). Therefore ED and psychiatry physicians should have much more knowledge about these new SCPs

The ill child in the emergency department and the accompanying people: a cross-sectional analysis

Objective: The objective of this study is to investigate relationship between the number of the family members visiting the emergency department with pediatric patients and patient characteristics such as age, insurance status, traumatic complaint, whether event was acute or not, and to estimate number of family members who had any time off from their work among this group. Method: A prospective cross-sectional study was performed using a questionnaire which included demographic characteristics, number of family members, number of family members who were taking hours off from work. In the 15-day period (1-15 August 2003), all persons who accompanied the children to the university-based PED (annual volume: 18,000) were asked to participate in the study. Results: A total of 575 persons accompanied the 300 children seen in PED (1.92 persons per child). Number of persons accompanying the children was found to be inversely related to age (Pearson correlation, P = 0.000). Seventy-nine children (32.1%) of those with acute complaints had family members who took time off from their work, whereas 29 (53.70%) of those with chronic illnesses had such family members (P = 0.003). The mean number of family members of children who had been referred from another healthcare institution was 2.06 ± 0.77, whereas the mean number of family members of patients who presented directly to the PED was 1.85 ± 0.63 (P = 0.013). The mean number of family members of patients who had insurance for their child and those who do not have were 1.84 ± 0.66 and 2.06 ± 0.71, respectively, (P = 0.001). Conclusions: Numbers of family members were positively associated with a history of referral to another institution for the same reason, and inversely related to the parents' age and insurance status