Birdal Yıldırım

Is there a potential role for echocardiography in adult patients with CAP

BACKGROUND The role of echocardiography in adult patients with community-acquired pneumonia (CAP) has not been tested in a clinical trial. The aim of the study was to assess the cardiac changes secondary to CAP by echocardiography and to find out the correlation between echocardiographic findings and the severity of CAP. METHODS A total of 111 unselected consecutive adult patients hospitalized with CAP were enrolled. The control group consisted of 100 consecutive sex- and age-matched patients. The severity of CAP was evaluated with the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, arterial blood pressure and age) score. Blood samples were taken and echocardiography was performed within the first 48 hours. RESULTS White blood count, N-terminal pro-brain natriuretic peptide, and red blood cell distribution width were significantly higher in the CAP group compared with the control group. The 2 groups did not differ in terms of left and right ventricle ejection fraction, left atrial diameter, pulmonary artery systolic pressure, and left ventricular end-diastolic and end-systolic diameter. However, tricuspid annular plane systolic excursion (21.1 ± 4.3 vs 22.3 ± 4.1 mm; P = .04), aortic distensibility (2.5 ± 0.9 vs 3.5 ± 0.9 cm(2):dyne:10, P < .001), and aortic strain (5.8% ± 2% vs 6.5% ± 1.9%, P = .009) were significantly reduced in CAP group than in controls. The plasma concentration of N-terminal pro-brain natriuretic peptide correlated with aortic strain, aortic distensibility, tricuspid annular plane systolic excursion, pneumonia severity index score, and CURB-65 score. CONCLUSIONS Tricuspid annular plane systolic excursion and elastic properties of aorta may play a role in the diagnosis and clinical assessment of CAP severity, which could potentially guide the development of new prognostic models.

Evaluation of cancer patients admitted to the emergency department within one month before death in Turkey: what are the problems needing attention?

BACKGROUND Although previously studies have reported that most patients with malignancy prefer to die at home, this is not the real situation in clinical practice. AIM In this study, we aimed to determine the characteristics of Turkish cancer patients admitted to the emergency department (ED) within one month before death. MATERIALS AND METHOD This descriptive retrospective study focused on questions about how often and why patients with cancer visited the ED before death. A total of 107 individuals with cancer were divided into 2 groups: Group 1, patients with at least one visit in the final 4 weeks; and Group 2, patients with no visit to ED. Demographic and clinical features were compared between the two groups. STATISTICAL ANALYSES Descriptive statistical methods, statistical analysis for correlation, Students t-test, chi-square tests and logistic regression were used. RESULTS At least one visit to ED within one month before death was reported for 64 (60%) of the 107 cases. Of these 64 (Group 1), 38% (n=24) were discharged and 9% (n=6) died in the ED. The most common site of the primary tumor was the lung (n=24, 38%) and the most common symptom was dyspnea (92%). With the other 43 (40%) cancer patients not presenting to the ED within one month before death, they were more likely to be female with another type of cancer. CONCLUSIONS Guidelines are needed for better management of cancer patients benefiting from visits to ED within the last month of life .

Single Center Experience on Causes of Cancer Patients Visiting the Emergency Department in Southwest Turkey

BACKGROUND Emergency departments are visited by cancer patients for palliation of cancer-related symptoms, management of treatment-related side effects, oncologic emergencies, co-morbidities, and/or end of life care. In this study, we aimed to identify the characteristics of cancer patients admitted to an emergency medicine department in Southwest Turkey. MATERIALS AND METHODS In this retrospective descriptive study, a total of 304 emergency department admissions of 102 patients with cancer due to medical conditions were evaluated. Descriptive statistical methods, statistical analysis for correlation, Students t-test, chi-square tests and logistic regression test were used. RESULTS The majority of patients visiting to emergency departments were male (n=66, 65%) and over 65 years of age (53, 52%). Some 30% (n=31) had a lung cancer diagnosis, 32% (n=33) presentation with dyspnea, 53% (n=55) with metastasis, 30% (n=16) with multiple metastatic lesions in lung, and 68% (n=70) had a poor ECOG performance status (score 3 to 4). CONCLUSIONS Emergency departments have valuable roles in managing and caring for patients with malignancies.

Treatment of Prosthetic Valve Thrombosis: Current Evidence and Future Directions.

Prosthetic heart valve thrombosis (PVT) is a rare but serious complication with high morbidity and mortality. The optimal treatment of the PVT is controversial and depends on thrombus location and size, the patient’s functional class, the risk of surgery or thrombolysis, and the clinician’s experience. Although surgical therapy has been the traditional therapeutic approach, studies with low-dose and slow-infusion rates of thrombolytic agents have revealed excellent results. This article reviews the various treatment options in patient with PVT.

Are Heimlich maneuver videos on YouTube accurate and reliable

Introduction. First aid for airway obstruction is a life-saving maneuver that can be implemented by anyone. In this study, we determined the accuracy of Heimlich maneuver videos posted on the Internet.Materials and methods. Heimlich maneuver videos uploaded on to YouTube were evaluated. We recorded by whom the video was uploaded, upload time, the number of viewers, and to whom it was intended. Scores from 0 to 7 were used to evaluate video suitability. Data were analyzed using SPSS 20.0 for Windows software. A p-value < 0.05 was considered to indicate significance.Results. A total of 640 videos were evaluated; 466 (72.8%) videos were excluded because their content was primarily for entertainment purposes. In total, 174 videos met the inclusion criteria and were subjected to analysis. Of the 174 videos analyzed, 54(31%) were uploaded anonymously, the mean number of viewers was 26,814 ± 4,860, and the median video duration was 4.19 min (range, 0.06–114 min). The mean video score was 2.7 ± 1.6. Using this value as a cut-off, a significant relationship between reliability and uploading institution was detected (p≤ 0.05), but not between the number of views and reliability (p = 0.428).Conclusion. Our results suggest that Heimlich maneuver videos uploaded to YouTube were not particularly educational because only 13% of the videos received an above-average score.

A Case Report of Prilocaine-Induced Methemoglobinemia after Liposuction Procedure

Prilocaine-induced methemoglobinemia is a rarely seen condition. In this paper, a case is presented with methemoglobinemia developed secondary to prilocaine use in a liposuction procedure, and the importance of this rarely seen condition is emphasized. A 20-year-old female patient presented with complaints of prostration, lassitude, shivering, shortness of breath, and cyanosis. It was learned that the patient underwent nearly 1000 mg prilocaine infiltration 8 hours priorly during a liposuction procedure. At admission, her blood pressure (130/80 mmHg), pulse rate (140 bpm), body temperature (36°C), and respiratory rate (40/min) were recorded. The patient had marked acrocyanosis. The arterial blood gas methemoglobin level was measured as 40%. The patient received oxygen therapy with a mask and was administered vitamin C in normal saline (500 mg tid), N-acetylcysteine (300 mg tid), and 50 mg 10% methylene blue in the intensive care unit of the internal medicine department. Methemoglobin level dropped down to 2% after her treatment with methylene blue and she was clinically cured and discharged 2 days later. Emergency service physicians should remember to consider methemoglobinemia when making a differential diagnosis between dyspnea and cyanosis developing after prilocaine infiltration performed for liposuctions in the adult age group.

A small pericardial effusion is a marker of complicated hospitalization in patients with community-acquired pneumonia

Objective: Although often asymptomatic, presence of small pericardial effusion (SPE) is shown to be associated with adverse events and increased mortality in various conditions. This study aimed to evaluate the frequency and prognostic importance of SPE in a cohort of patients hospitalized for community‐acquired pneumonia (CAP). Methods: We prospectively followed 154 consecutive adult patients hospitalized with CAP. The severity of CAP was evaluated with the pneumonia severity index (PSI) and the CURB‐65 (confusion, urea, respiratory rate, arterial blood pressure and age) score. All patients underwent transthoracic echocardiography within the first 48 h of admission. Patients were followed‐up until hospital discharge or death. The outcomes of interest were length of stay in hospital and complicated hospitalization (CH) which is defined as intensive care unit admission, need for mechanical ventilation or in‐hospital mortality. This study was registered with ClinicalTrials.gov, number NCT02441855. Results: A total 34 episodes of CHs occurred in 21 (13.6%) patients. Older patients and those with more co‐morbid conditions such as diabetes, coronary artery diseases, cerebrovascular diseases, and chronic obstructive pulmonary diseases tended to have a higher rate of CH. Patients with CH had higher N‐terminal pro‐brain natriuretic peptide, troponin and creatinine levels on admission compared to patients without CH. Patients with CH had also higher CURB‐65 and PSI scores and had longer durations of stay compared to patients with uncomplicated course. SPE was noted in 24 (15.6%) of the patients in our study cohort. Incidence of CH was greater for patients with a SPE (26 CHs occurred in 14 of the 24 patients) compared to those without an effusion (8 CHs occurred in 7 of the 130 patients, p < 0.001). Logistic multivariate analysis revealed that the presence of SPE was an independent predictor of CH (OR: 3.26; 95% CI: 2.19–8.71; p = 0.008). Conclusion: This study is the first to demonstrate that the presence of SPE is associated with increased adverse events in patients with CAP. HighlightsAlthough often asymptomatic, presence of small pericardial effusion is shown to be associated with increased mortality in patients with human immunodeficiency virus infection, in a cohort of patients undergoing transthoracic echocardiography, in patients with lung cancer and acute ischemic stroke. However, there is no data in the literature regarding the prevalence and importance of pericardial effusion in patients with community‐acquired pneumonia.Regardless of the underlying mechanism involved, our data suggest that the use of small pericardial effusion as an prognostic marker may improve the detection of patients at risk for complications in community‐acquired pneumonia.The increased risk of adverse events associated with a small pericardial effusion may be used along with other clinical and biochemical characteristics when estimating a patients prognosis.

Impact of Pre-operative Cardiology Consultation Prior to Intermediate-risk Surgical Procedures

Patients undergoing noncardiac, nonvascular surgery (NCNVS) are at risk of perioperative cardiovascular events. However, benefits of cardiology consultation (CC) in patients with known or suspected cardiac disease undergoing intermediate‐risk NCNVS is unknown.