Evaluation of Emergency Interhospital Patient Transfers from Province of Mardin to Out-of-Province Hospitals in a Year

Abstract Objective: This study aimed to assess patients who were transferred from emergency services throughout the province of Mardin to out-of-province hospitals by ambulance in a year. Material and Methods: In this study, all patients transferred from emergency services in the province of Mardin to out-of-province hospitals via ambulances by the Patient Referral Assessment Committee, founded under the Provincial Directorate of Health, between the dates of December 31, 2010 and December 31, 2011 were evaluated retrospectively. No exclusion criteria were used. Patients were grouped and analyzed according to their demographic characteristics, transport properties, and reasons for referral. Results: The total number of the patients included in the study was 1518 (55.8% males, 41±27 mean age). Of all, 621 patients (40.9%) were transferred from the center of Mardin province, and the other patients were transferred from 8 district hospitals and two private hospitals. It was found that the patients were transferred to 37 hospitals in 8 provinces, and a total of 562 patients (37%) were transferred to private hospitals. Cardiology (23.3%), pediatrics (11.5%), and obstetrics and gynecology (8.8%) departments were the first three clinics that patients were transferred to frequently, respectively. In total, 274 patients (18.1%) were transferred inappropriately. There was a statistically significant difference between patients' transfer hospitals (state hospital/private hospital) and the age of the patients (younger than 18 years/18 years or older) (p<0.001). In addition, the rate of adult patients' transfers to tertiary healthcare centers was significantly higher (p<0.001). Conclusion: In Mardin, cardiology, pediatrics and obstetrics and gynecology patients are the most common group of emergency patients transferred by 112 ambulances to out-of-province hospitals. Approximately 40% of the patients were transferred to private hospitals. Inappropriate patient transfers seem to be a major problem in this study, as in other studies conducted in Turkey. (JAEM 2014; 13: 62-6

The importance of head-thrust test in differential diagnosis of peripheral and central vertigo in patients presenting to emergency service with dizziness

Giriş: Baş dönmesi ayaktan hasta başvurularının en sık sebeplerinden biridir[3] ve acil servis (AS) başvurularının %1.3-2.5 ini oluşturur.[4,5] Şikayetin hasta tarafından tarifi zor, fizik muayene bulguları ile uyumsuz veya güvenilmez olabilir.[1,2] Uygulaması kolay, ucuz, non invaziv, fazla zaman almayan yatakbaşı testlerin özellikle santral vertigo ayırıcı tanısı için acil tıp hekimi için önemi büyüktür. Çalışmada, AS ye baş dönmesi şikayeti ile başvuran hastalarda, periferik ve santral vertigo ayırıcı tanısında head-thrust (baş çevirme) testinin (HTT) yerinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Prospektif gözlemsel klinik bir çalışma olarak dizayn edilmiş, acil servisimizde 01.02.2011-31.07.2011 tarihleri arasında yapılmıştır. Periferik vertigo grubundaki tüm hastalara odyovestibüler testler, santral vertigo grubundaki hastaların hepsine nörogörüntüleme yapılmıştır. Bulgular: AS başvurularının %0.78 ini baş dönmesi/vertigo hastaları oluşturmaktadır. Santral vertigo grubu hastalar istatistiksel anlamlı olarak daha yaşlı (Mann-Whitney U, p=0.007), özgeçmişinde HT ve antiagregan kullanımına sahip (Fisher in kesin testi, sırasıyla p=0.026 ve p<0.001), baş dönmesi baş hareketleri ile &#8243;tetiklenmeyen&#8243; (Pearson &#967;² testi, p<0.001), vertikal nistagmus paternine sahip (Pearson &#967;² testi, p<0.001), HTT sonuçları normal (Pearson &#967;² testi, p<0.001), tandem yürüyüş, Romberg ve diz-topuk testleri bozuk olan (Fisher in kesin testi, sırasıyla p<0.001, p<0.001 ve p=0.026) hastalardır. HTT nin normal olmasının santral vertigo için duyarlılığı %95, özgüllüğü ise %75.6 olarak saptanmıştır. Yine bu hastalarda hastane yatışı, AS de nörogörüntüleme oranları ve ortalama SKB değerleri daha yüksek bulunmuştur. Periferik vertigo grubunda en sık üç tanı BPPV, meniere hastalığı ve vestibüler nörittir. Sonuç: HTT nin acil tıp hekimlerince kullanılması ayırıcı tanı açısından önem taşıyabilir. Testin kolay uygulanabilirliği, kısa sürmesi, ek ekipman gerektirmemesi, tekrar edilebilirliği ve hastanın tedavisini geciktirmemesi gibi avantajları da düşünülürse AS de vertigo başvurularında kullanılması uygun görünmektedir.Introduction: Dizziness is among the most common reasons that patients present for an evaluation[3] and its presentation at the emergency room (ER) with an incidence of 1.3-2.5%.[4,5] The report of symptoms can be vague, inconsistent, or unreliable.[1,2] Non-invasive, inexpensive, not time consuming, and easy to apply bedside testing is important for emergency medicine physician especially for the differential diagnosis of central vertigo. We aimed to investigate the role of the head-thrust test (HTT) in the differential diagnosis of peripheral and central vertigo in patients presenting to the ER with complaint of dizziness. Material and Method: This prospective observational clinical study has been carried out between 01.02.2011 to 31.07.2011 in Gazi University, Faculty of Medicine, Department of Emergency Medicine. Audiovestibular tests were performed in all patients in peripheral vertigo group and neuroimaging studies were performed in all patients in central vertigo group. Results: Dizziness/vertigo presentations have constituted 0.78% of all ER presentations. Patients in central vertigo group were significantly older (Mann-Whitney U, p=0.007) and with a diagnosis of hypertension and using antiagregant (Fisher s exact test, respectively p=0.026 and p<0.001) compared with those in peripheral vertigo group. Their vertigo complaints were not significantly triggering with head movements (Pearson &#967;² test, p<0.001) compared with peripheral vertigo group. They also had vertical nystagmus pattern (Pearson &#967;² test, p<0.001) and normal HTT results (Pearson &#967;² test, p<0.001) significantly. Patients in central vertigo group were also had significantly more deficits in neurological examination (Fisher s exact test, respectively p<0.001, p<0.001, and p=0.026 for tandem walking, Romberg, and knee-heel tests). Furthermore hospitalization rates, number of neuroimaging studies performed in the ER, and mean systolic blood pressure values were higher in central vertigo group. Benign paroxysmal positional vertigo, Meniere disease, and vestibular neuritis were the first three most frequent diagnosis in peripheral vertigo group. Conclusion: Using of the HTT by emergency medicine physicians may be important in terms of differential diagnosis. HTT is easy applicable, repeatable, and short duration test. This test does not require additional equipment or delay the patient s treatment. Given the advantages of the HTT, it seems to be appropriate for the use of vertigo presentations in the ER

Meme kanserinde siklooksijen az-2 ekspresyonu artışının sağkalım üzerine etkisi

ÖZETMeme kanseri kadınlarda görülen en sık kanserdir. Bu kanserin görülme hızı hergeçen gün daha da artmaktadır. Prostaglandin sentezinde görevli ana enzim olansiklooksijenaz-2 (COX-2) enziminin bir çok kanser tipinde olduğu gibi memekanserinde de ekspresyonunun arttığı gösterilmiĢtir. Günümüzde meme kanserinindeğerlendirilmesinde ve tedavisinde kullanılan bazı prognostik ve prediktif faktörlervardır. ÇalıĢmalar COX-2’nin meme kanseri sağkalımını da tahmin ettirebilecekprognostik ve prediktif bir faktör olabileceği konusunda iĢaretler ortaya koymuĢtur.Bu çalıĢmanın amacı meme kanseri sağkalımı ile COX-2 ekspresyonundakiartıĢ arasındaki iliĢkiyi göstermektir. ÇalıĢmanın hipotezi, COX-2 ekspresyonundakiartıĢın meme kanseri sağkalımı ile ters orantılı olduğudur.ÇalıĢmada COX-2 ekspresyonunun genel sağkalım (GS), hastalıksız sağkalım(HS) ve meme kanserine özgün sağkalım (MKÖS) üzerine etkileri ortayakoyulmuĢtur. COX-2 ekspresyonu ile meme kanserinin prognostik faktörleriarasındaki iliĢki, GS, HS ve MKÖS’yi etkileyen bağımsız faktörler ve moleküler altgruplarda COX-2 ekspresyonunun GS, HS ve MKÖS üzerine etkileri gösterilmeyeçalıĢılmıĢtır.ÇalıĢmanın sonucunda COX-2 ekspresyonunun GS, HS ve MKÖS üzerineanlamlı bir etkisinin olmadığı gösterilmiĢtir. Buna rağmen takip süreleri ilerledikçeGS ve MKÖS için COX-2 ekspresyonu pozitif olan hastaların sağkalımlarının dahakötüye gittiği görülmüĢtür. COX-2 ekspresyonu ile Ki67 ekspresyonu arasındaanlamlı bir iliĢki olduğu, Ki67’si pozitif hastaların COX-2 ekspresyon düzeyinin deyüksek olduğu gösterilmiĢtir. Sadece progesteron reseptör pozitifliğinin GS veMKÖS’yi etkilediği, PR negatif olmasının GS ve MKÖS’yi azalttığı gösterilmiĢtir.Tümör çapının artmasının ve moleküler alt gruplandırmada luminal B tip ve bazal tipolmanın HS’yi azalttığı gösterilmiĢtir. Moleküler alt gruplar değerlendirmesinde iseher alt grup içinde COX-2 ekspresyonunun negatif veya pozitif olmasının o altgrubun sağkalımı üzerine etkisinin olmadığı görülmüĢtür.ANAHTAR SÖZCÜKLER : meme kanseri, sağkalım, siklooksijenaz-2 enzimi,prognostik faktör, prediktif faktörSUMMARYBreast cancer is the most common cancer in Turkish women and its incidence isincreasing in time. Overexpression of cyclooxygenase-2 (COX-2), a major enzymefor prostaglandin synthesis, is also found in breast cancer. There are currentpredictive and prognostic factors of breast cancer which are taken underconsideration for treatment assignment. Previous data revealed that COX-2expression is also a promising predictive and prognostic factor for breast cancer.Aim of this present study is to assess the impact of COX-2 expression onbreast cancer survival. Hypothesis was determined as COX-2 overexpression isrelated with poor prognosis in breast cancer patients.The study assessed rates of overall (OS), disease free (DFS) and breast cancerspecific survival (BCSS) in patients with and without COX-2 overexpression inretrospective manner. In addition, relation between COX-2 expression and otherconventional prognostic factors such as tumor size, grade and hormone receptorexpression for breast cancer was assessed. Independent factors for OS, DFS andBCSS and the impact of COX-2 expression on OS, DFS as well as BCSS wasanalyzed in each molecular subgroup of breast cancer.As result, OS, DFS and BCSS rates were not different in patients with COX-2negative and positive breast cancer. Ki67 expression was significantly increased inCOX-2 overexpressed patients. Progesteron receptor expression was found to be theindependent factor for both OS and BCSS, in which progesteron receptor negativepatients had significantly poorer survival rates. Additionally, increasing tumor sizeand molecular subtypes of luminal B and basal types were the independent predictivefactors for poorer DFS. Survival rates were also similar within each molecularsubgroup irrespective of their COX-2 overexpression.KEY WORDS : breast cancer, survival, cyclooxygenase -2 enzyme, prognosticfactors, predictive factor

Senkopta nadir tanı: tip 2 Brugada sendromu

Brugada syndrome (BS) is an autosomal-dominant inherited genetic disorder characterized by mutations in cardiac sodium-channel genes, characteristic changes in electrocardiography (ECG) and associated with increased risk of ventricular arrhythmia and sudden cardiac death. BS mostly affects Asian races and its prevalence varies in different societies. Although it is a rare disease, it should be considered in patients admitted to the emergency department (ED) with the complaint of syncope. In a study, it was revealed that the main complaint in 28% of patients with BS was syncope. Here, we present a 19-year-old male patient who admitted to ED with the complaint of syncope and was diagnosed with BS.Brugada Sendromu (BS), kardiyak sodyum kanal genlerindeki mutasyonlar, elektrokardiyografide (EKG) tipik değişiklikler ile karakterize ve artmış ventriküler aritmi ve ani kardiyak ölüm riski ile ilişkili otozomal-dominant kalıtsal bir genetik hastalıktır. Brugada Sendromu çoğunlukla Asya ırklarını etkiler ve toplumdan topluma görülme sıklığı farklılıklar gösterir. Nadir bir hastalık olmasına rağmen acil servise (AS) senkop şikayeti ile başvuran hastalarda akılda tutulmalıdır. Yapılan bir çalışmada BS’li hastaların %28’inde ana şikayetin senkop olduğu ortaya konmuştur. Burada AS’ye senkop şikayeti ile başvuran ve BS tanısı konan 19 yaşındaki erkek hastayı sunuyoruz

Second Kidney Transplant in a Patient with Artificial Urinary Sphincter

Artificial urinary sphincter (AUS) is regarded as the gold standard treatment for post-prostatectomy urinary incontinence. Kidney transplantation is gold standard treatment for end stage renal disease. Since both AUS implantation and renal transplant surgeries are relatively common, a co-occurrence is likely and a patient with AUS may need a kidney transplant. Herein, we report a patient with an AUS who underwent second kidney transplantation. Since the iliac fossa ipsilateral to the AUS parts had to be preferred for the second kidney transplant, risks of AUS damage and infection were higher. This report illustrates the precautions taken to minimize these risks

Cost of Inpatient Treatment of Patients with Status Epilepticus in Turkey

Objectives:Status epilepticus (SE) is a neurological emergency with high mortality. As there are no data on the cost of treatment of SE in this country, the aim of this study was to investigate and analyze these costs.Methods:Patients who were hospitalized in the neurology intensive care unit between January and August 2018 were retrospectively evaluated. Demographic data, SE type, etiological factors, antiepileptic drugs used, duration of hospitalization, total cost of hospitalization, and the cost of medication(s) were recorded.Results:The records of 15 patients (male/female: 4/11) with a mean age of 46.73 years were examined. Seven patients had no previous history of epilepsy and their first seizure was SE-like. The seizures were classified as primary generalized convulsive (n=5), focal onset generalized convulsive (n=6), focal motor (n=1), and non-convulsive (n=3) SE. Medication mismatch (n=4), systemic infection (n=4), previous stroke (n=2), acute stroke (n=3), metabolic causes (n=1), and iatrogenic causes (n=1) were found in the seizure etiology. Two patients died during followup. The mean length of time of hospitalization in the neurology service and intensive care unit was 5.7 and 13.2 days, respectively. The mean total cost of the treatment per patient was TL 22,202.86 and the mean drug cost was TL 4,630.73.Conclusion:The presence of an acute central nervous system etiology and advanced age of the patient are 2 important factors that significantly increased the cost. More comprehensive data are needed to investigate the risk factors that contribute to the cost of larger patient numbers in our country