UTILITY OF COMPUTED TOMOGRAPHY IN ELBOW TRAUMA PATIENTS WITH NORMAL X-RAY STUDY AND POSITIVE ELBOW EXTENSION TEST

Background: Elbow fractures are a common injury seen among emergency department trauma patients. Despite its high frequency, there is no standardized method of diagnosis using conventional x-ray imaging for trauma patients presenting with elbow pain and restricted elbow movement. Objective: We aimed to assess trauma patients, using computed tomography (CT), who present with a positive elbow extension test and have no evident fracture on x-ray study. Methods: Patients presented to our emergency department with elbow trauma and were evaluated between April 2010 and March 2011. A CT scan of the injured elbow was ordered for patients with pain on elbow extension (a positive elbow extension test) and no evidence of fracture on x-ray study. All CT and x-ray images were evaluated by a designated radiologist. Results: One hundred and forty-eight patients presented to our emergency department with elbow trauma. Two patients were excluded from the study, one with former motion disability and another with an open fracture. In the remaining patients, there were 32 fractures in total. Forty-three of 114 patients without fracture signs had a positive elbow extension test and 4 of these patients refused CT imaging. Fractures were found in 5 (12.8%) of the 39 patients assessed with CT. CT imaging found that two of these patients had a radial head fracture, two others had an olecranon fracture, and one patient had a coronoid fracture. Conclusions: We recommend CT as an additional evaluation imaging study for trauma patients who have a positive elbow extension test and who present with no apparent fracture on x-ray imaging. (C) 2016 Elsevier Inc

Synthesis, crystal structures, characterization and antimicrobial activities of 5-hydroxyisophthalate complexes

WOS: 000393592600011Two 5-hydroxyisophthalate complexes of nickel(II), formulated as [Ni(mu-Hhip)(2-hepy)(2)] (n) (1) and [Ni-2(mu-Hhip)(2)(dap)(4)] (n) (2) (H(3)hip = 5-hydroxyisophthalic acid, 2-hepy = 2-(2-hydroxyethyl)pyridine, dap = 1,3-diaminopropane), have been synthesized and characterized by chemical and spectroscopic methods. The molecular structures of the complexes have been determined by single-crystal X-ray diffraction analysis. The Ni(II) centres have distorted octahedral geometries in both crystals. Furthermore, both complexes have 1D chain structures in which the individual chains are linked together via hydrogen bonds to give 3D frameworks. Evaluation of the complexes by the agar diffusion method showed that they have weak antibiotic activities against the tested microorganisms

Assessment of prehospital medical care for the patients transported to emergency department by ambulance

Objectives: In our study we aimed to investigate the quality and quantity of medical management inside ambulances for 14 and over 14 years old patients transported to a level three emergency department (ED). Material and methods: Our study was conducted prospectively at a level three ED. 14 and over 14 years old patients who were transported to the ED by ambulance were included in the study consecutively. “Lack of vital rate” was described as missing of one or more of five vital rates during ambulance transportation. Both of two attending emergency physicians evaluated the medical procedures and management of patients at the ambulance simultaneously and this was recorded on the study forms. Results: Four hundred and fifty six patients were included in the study. Missing vital signs were identified for 90.1% (n = 322) of the patients that were transported by physicians and 92.4% (n = 73) of the patients that were transported by paramedics. For five patients with cardiac arrest two (33.3%) had cardiopulmonary resuscitation (CPR), one (20%) was intubated, one (20%) received adrenaline. Out of 120 patients, needed spinal immobilization, 69 (57.5%) had spinal board. Cervical collar usage was 65.1% (n = 69) We have revealed that 316 (69.3%) patients did not receive at least one of the necessary medical intervention or treatment. Conclusion: During ambulance transportation, life-saving procedures like cardiopulmonary resuscitation, vital sign measurement, crucial treatment administration, endotracheal intubation, defibrillation, fracture immobilization were not performed adequately. Increasing the training on the deficient interventions and performing administrative inspections may improve quality of patient care. Keywords: Emergency department, Ambulance, Prehospital emergency car

Are Red Blood Cell Distribution Width and RDW/Hemoglobin Ratio Predictable in Mortality Among Patients with Chronic Obstructive Pulmonary Disease?

Objective: Chronic obstructive pulmonary disease (COPD), the third most common cause of death in the world, is a multi-component disease with pulmonary and extrapulmonary manifestations. The red blood cell distribution width (RDW) conveys important information for short- and long-term prognosis through a variety of medical conditions. Anemia can be seen in patients with COPD due to systemic inflammation and malnutrition. The aim of this study was to evaluate the role of RDW and RDW/Hgb in the prediction of mortality in patients with exacerbated COPD. Materials and Methods: Between December 2015 and December 2017, 97 patients admitted to the Department of Chest Diseases at the Ufuk University Medical Faculty, with a diagnosis of COPD exacerbation were evaluated retrospectively. The demographic, clinical, laboratory characteristics, pulmonary functional tests, and arterial blood gases were noted. The RDW values and RDW/Hgb ratios were compared between patients who had died and those who were still alive. Results: About 79.4% of the patients (n=77) were male and the rest of them 20 (20.6%) were female. The mean age was 73.01 +/- 9.54 years. The RDW values of patients with mortality were higher than the living COPD patients (p<0.001). The RDW/Hgb ratio was found to be higher in patients who had died than those who were living (p<0.001). The levels of C-Reactive protein were significantly higher in patients with COPD with mortality (p=0.034). Conclusion: The elevated RDW levels and the RDW/Hgb ratio were associated with an increased annual number of attacks, comorbidities, and an increased PO2 and PCO2 mortality risk in patients with COPD

Vesiculobullous eruption of the right arm after intravenous clarithromycin

Clarithromycin is a macrolide antibiotic. In clinical trials, adverse drug reactions of clarithromycin are usually mild and transient. Only 1% of the adverse reactions are severe. Herein, we present a case with vesiculobullous skin reaction and vein thrombosis caused by administration of intravenous clarithromycin

Impact of multimedia information on bronchoscopy procedure: is it really helpful?

Aim: In this study, we aimed to investigate the effect of written informed consent and comprehensive multimedia information on the anxiety level of patients, consumption of sedatives, difficulties during bronchoscopy, complications and duration of procedure. Methods: 150 patients undergoing bronchoscopy were included to this study. They were randomized into two groups Multimedia information group (MIG, n = 75) and written-informed consent group (WICG, n = 75)). Signed written informed consent was obtained from all patients. Patients in MIG group watched comprehensive multimedia presentation. State anxiety scores of all patients were evaluated with State and Trait anxiety inventory (STAI-S). Results: STAI-S score of patients in MIG (40.31 ± 8.08) was lower than patients in WICG (44.29 ± 9.62) (P = 0.007). Satisfaction level was higher in MIG (P = 0.001). Statistically higher difficulties during "passage through vocal cords" and "interventions during bronchoscopy" were present in WICG group (P = 0.013 and P = 0.043, respectively). Total midazolam dose during bronchoscopy, and duration of bronchoscopy were statistically lower in MIG patients (P < 0.001 and P = 0.045, respectively). Difficulties during "waiting period", "passage through nasal/oral route", "applications of local anesthesia" and "complication frequency" were similar in both groups. Conclusion: Besides reducing the state anxiety, multimedia information can reduce the dose of sedation, shorten the processing duration and reduce the difficulties during bronchoscopy