Are scoring systems sufficient for predicting mortality due to sepsis in the emergency department?

Objectives: Scoring systems have been used to risk stratify in intensive care units (ICU), but not routinely used in emergency departments. The aim of this study was to determine accuracy for predicting mortality in emergency medicine with Sequential Organ Failure Assessment (SOFA), Mortality in ED Sepsis (MEDS) score and Simplified Acute Physiology Score (SAPSII). Methods: This is a prospective observational study. Patients presenting with evidence of sepsis were all included. SAPSII, MEDS, and SOFA scores were calculated. Analysis compared areas under the receiver operator characteristic (ROC) curves for 28-day mortality. Results: Two hundred patients were included; consisting of 31 (14.3%) septic shock. 138 (69%) severe sepsis and 31 (15.5%) infection without organ dysfunction. 53 (26.5%) patients died within 28 days.Area under the ROC curve for mortality was 0.76 for MEDS (0.69–0.82), 0.70 for SAPSII (0.62–0.78); and 1.68 for SOFA (0.60–0.76) scores. Pair wise comparison of AUC between MEDS, SAPSII, SOFA and Lactate were not significant. Conclusion: According to our results; SOFA, SAPSII and MEDS were not sufficient to predict mortality. Also this result, MEDS was better than other scoring system. Keywords: Sepsis, Septic shock, Scoring systems, SOFA, SAPSII, MEDS, Lactate, Emergency medicin

Stabilisation of expansive clays using granulated blast furnace slag (GBFS) and GBFS-Cement

Expansive clays undergo swelling when subjected to water. This can cause damage, especially to light weight structures, water conveyance canals, lined reservoirs, highways, and airport runways unless appropriate measures are taken. In this study, granulated blast furnace slag (GBFS) and GBFS-cement (GBFSC) were utilized to overcome or to limit the expansion of an artificially prepared expansive soil sample (sample A). GBFS and GBFSC were added to sample A in proportions of 5–25% by weight. The effects of these stabilizers on grain size distribution, Atterberg limits, swelling percentage and rate of swell of soil samples were determined. GBFS and GBFSC were shown to successfully decreasing the total amount of swell while increasing the rate of swell

The Analysis of Poisoning Cases Presented to the Emergency Department within a One-Year Period

SUMMARY: Objectives: Intoxication is the emergence of unwanted signs and symptoms in an organism after exposure to potentially harmful chemical, physical or organic materials. In our study, we evaluated demographic and etiological factors of adult patients admitted to the emergency department with suicidal or accidental poisoning. Methods: This study was conducted retrospectively by using data from the forensics books, protocol notebooks and patient files. Patients over the age of 14 years that were admitted to the Goztepe Training and Research Hospital during a 1-year period (September 2011-September 2012) with poisoning were included in the study. Results: A total of 430 patients were included in the study and 278 of those patients were females (64.7%). The male/female (F/M) ratio was 1.82/1 and the mean age of the patients was 27.4±11.75 years. The analyses showed that in 348 patients (80.93%) the cause of poisoning was medicine, in 39 patients (9.06%) alcohol and drugs, in 37 patients (8.6%) rat poison, in 4 patients (0.93%) a caustic substance and organophosphates in 2 patients (0.46%). The highest rate of admittance due to poisoning was seen in July, followed by August and September. When the frequency of admittance was evaluated in terms of seasons: summer had the highest frequency with 35.6%, then autumn with 29.1%, spring with 19.8% and winter with 15.6%. Conclusions: The results of our studies are similar to previously reported studies in Turkey. Poisoning cases are more common in women and the most common way of poisoning is by medication. Unlike previous reports from the literature, we found that poisoning was most frequent in the summer. ÖZET: Amaç: Zehirlenme potansiyel olarak zarar verebilen herhangi bir kimyasal, fiziksel veya organik maddeye maruziyet sonrası organizmada bazı istenmeyen belirti ve bulguların ortaya çıkmasıdır. Biz bu çalışmamızda intihar amaçlı veya kazara zehirlenme nedeniyle acil servisimize başvuran erişkin hastaların demografik ve etiyolojik faktörlerini araştırdık. Gereç ve Yöntem: Çalışma geriye dönük bir çalışma olup veriler adli defter, protokol defteri ve hasta dosyalarından elde edilmiştir. Bir yıllık süre içerisinde (Eylül 2011-Eylül 2012) Göztepe Eğitim ve Araştırma Hastanesi'ne zehirlenme ile başvuran 14 yaş üstü hastalar çalışmaya dahil edildi. Bulgular: Çalışmaya toplam 430 hasta dahil edildi. Olguların 278'i kadın (%64.7), 152'si erkekti (%35.3). Kadın/erkek (K/E) oranı 1.82/1, yaş ortalaması 27.4±11.75 idi. Zehirlenme nedeni incelendiğinde; 348'inin (%80.93) ilaç, 39'unun (%9.06) alkol ve ilaç, 37'sinin (%8.6) fare zehiri, dördünün (%0.93) kostik madde, ikisinin (%0.46) organofosfat olduğu görüldü. En yüksek başvurunun sırasıyla temmuz, ağustos, eylül aylarında olduğu görüldü. Mevsimlere göre başvuru sıklığına bakıldığında %35.6 yaz, %29.1 sonbahar, %19.8 ilkbahar ve %15.6 kışın başvuru olduğu tespit edildi. Sonuç: Çalışmamızın sonuçları literatürde Türkiye'de daha önce yapılan çalışmalarla benzerlik göstermektedir. Zehirlenme olguları kadınlarda daha sık olup en sık ilaç alımı yolu ile olmaktadır. Literatürden farklı olarak en sık yaz mevsiminde zehirlenme tespit edildi. Key words: Emergency services, poisoning, suicide, Anahtar sözcükler: Acil servis, zehirlenme, intiha

A case of acute hepatitis following mad honey ingestion

Acute hepatitis is characterized by liver inflammation and liver cell necrosis. The most frequently observed underlying cause thereof is viruses, but various other causes, such as alcohol, medication, or toxins may also lead thereto.In this paper, a case of acute hepatitis presenting with bradycardia, hypotension, and a prominent increase in liver enzymes following mad honey ingestion is discussed. Since there are only few cases of acute hepatitis following mad honey ingestion in the literature, we want to present this subject matter. Keywords: Mad honey poisoning, Mad honey intoxication, Bradycardia, Hypotension, Acute hepatiti