Erden Kilic

Can mainstream end-tidal carbon dioxide measurement accurately predict the arterial carbon dioxide level of patients with acute dyspnea in ED.

OBJECTIVE This study was designed to determine whether the mainstream end-tidal carbon dioxide (ETCO2) measurement can accurately predict the partial arterial carbon dioxide (Paco2) level of patients presented to emergency department (ED) with acute dyspnea. METHODS This prospective, observational study was conducted at a university hospital ED, which serves more than 110 000 patients annually. Nonintubated adult patients presented with acute dyspnea who required arterial blood gas analysis were recruited in the study for a 6-month period between January and July 2010. Patients were asked to breathe through an airway adapter attached to the mainstream capnometer. Arterial blood gas samples were obtained simultaneously. RESULTS We included 162 patients during the study period. The mean ETCO2 level was 39.47 ± 10.84 mm Hg (minimum, 19 mm Hg; maximum, 82 mm Hg), and mean Paco2 level was 38.95 ± 12.27 mm Hg (minimum, 16 mm Hg; maximum, 94 mm Hg). There was a positive, strong, statistically significant correlation between ETCO2 and Paco2 (r = 0.911, P < .001). The Bland-Altman plot shows the mean bias ± SD between ETCO2 and Paco2 as 0.5 ± 5 mm Hg (95% confidence interval, -1.3165-0.2680) and the limits of agreement as -10.5 and +9.5 mm Hg. Eighty percent (n = 129) of the ETCO2 measurements were between the range of ±5 mm Hg. CONCLUSION Mainstream ETCO2 measurement accurately predicts the arterial Paco2 of patients presented to ED with acute dyspnea. Further studies comparing mainstream and sidestream methods in these patients are required.

Supramolecular GAG-like Self-Assembled Glycopeptide Nanofibers Induce Chondrogenesis and Cartilage Regeneration.

Glycosaminoglycans (GAGs) and glycoproteins are vital components of the extracellular matrix, directing cell proliferation, differentiation, and migration and tissue homeostasis. Here, we demonstrate supramolecular GAG-like glycopeptide nanofibers mimicking bioactive functions of natural hyaluronic acid molecules. Self-assembly of the glycopeptide amphiphile molecules enable organization of glucose residues in close proximity on a nanoscale structure forming a supramolecular GAG-like system. Our in vitro culture results indicated that the glycopeptide nanofibers are recognized through CD44 receptors, and promote chondrogenic differentiation of mesenchymal stem cells. We analyzed the bioactivity of GAG-like glycopeptide nanofibers in chondrogenic differentiation and injury models because hyaluronic acid is a major component of articular cartilage. Capacity of glycopeptide nanofibers on in vivo cartilage regeneration was demonstrated in microfracture treated osteochondral defect healing. The glycopeptide nanofibers act as a cell-instructive synthetic counterpart of hyaluronic acid, and they can be used in stem cell-based cartilage regeneration therapies.

Comparison of ketamine–low-dose midozolam with midazolam-fentanyl for orthopedic emergencies: a double-blind randomized trial

OBJECTIVE Most of the fractures and dislocations are reduced in the emergency setting. Many drugs are available for procedural sedation and analgesia in the emergency department (ED); however, the adverse effects are still a common problem. The aim of our study was to compare the 2 drug combinations. METHOD We performed a prospective, randomized, double-blinded, placebo-controlled trial of patients presenting to the ED after a traumatic event and required urgent reduction either for a fracture or dislocation. Patients were randomized to midazolam-fentanyl (MF) group or ketamine-low-dose midazolam (KM) group. Hypoxia, duration of hypoxia, need for oxygen, time to onset of sedation, recovery time, pain scores during reduction, and sedation depth were set as primary outcome measures and were recorded. RESULTS A total of 498 patients who presented to ED with extremity injury and required closed reduction were assessed; 130 of them were approached for eligibility and 69 patients were excluded. The remaining 61 patients were randomized to either KM group (n = 31) or MF group (n = 30). Hypoxia and duration of hypoxia were significantly lower in the KM group compared with the MF group. Patients in the KM group reported significantly lower pain scores during reduction; however, adverse effects were higher compared with MF group. CONCLUSION Both drug combinations can be effectively used for procedural sedation and analgesia; however, with lower risk for hypoxia and lower pain scores, KM combination stands as a reasonable choice for orthopedic interventions in the emergency unit.

Comparison of GlideScope video laryngoscope and intubating laryngeal mask airway with direct laryngoscopy for endotracheal intubation.

The aim of this study was to determine whether GlideScope video laryngoscope (GVL) and intubating laryngeal mask airway (i-LMA) improve the intubation success rate and could be easily learned and performed by paramedic students when compared with the direct laryngoscopic (DL) method. The study was designed as a prospective randomized crossover trial that included 121 paramedic students. All participants were asked to intubate each Ambu Airway Management Trainer manikins after the lecture and demonstration. Successful intubation was defined as the passage of the tube through the vocal cord within 60 s. At the end of the study, a questionnaire survey was given to all participants about their preferences, and they were requested to define each method on an easy–difficult scale. Successful intubation was achieved by 95 students (78.5%) with DL, 112 students (92.6%) with i-LMA, and 111 students (91.7%) with GVL. Mean time of intubation was 25.06±14 s for DL, 22.32±12 s for i-LMA, and 22.63±10 s for GVL. Success rates of i-LMA and GVL were significantly higher compared with DL (P=0.005 and P=0.006, respectively). No significant difference was determined between i-LMA and GVL in terms of successful intubation (P>0.05). This study showed that GVL and i-LMA provided better intubation success rates and were easier for paramedic students when compared with the classic DL method.

Communication skills training for emergency medicine residents.

Objective To determine the effects of a communication skills training program on emergency medicine residents and patient satisfaction. Materials and methods Twenty emergency medicine residents attended a 6-week psychoeducation program that was intended to improve their communication skills. The first three sessions of the psychoeducation program consisted of theoretical education on empathy and communication. Other sessions covered awareness, active communication, and empathic skills on a cognitive behavioral basis using discussion, role play, and homework within an interactive group. The effects of the program were assessed using a communication skills scale, empathy scale, and patient satisfaction survey and were reflected by the reduction in the number of undesirable events between doctors and patients in the emergency department. Results The mean communication skills score increased from 178.7±19 to 189.2±16 after training (P<0.02). Empathy score also increased from 29.5±9 to 30.7±8, but this difference was not statistically significant (P=0.1). The patient satisfaction survey of 576 patients demonstrated increased scores on confidence in the doctor (88.2±14.6–93.6±10.3; P<0.01); the doctors respect, kindness, and thoughtfulness (90.3±10.8–94.1±16.5; P<0.01); individualized attention (86.7±9.4–93.9±11.1; P<0.01); devotion of adequate time to listening (88.6±12.3–90.8±14.1; P=0.04); and counseling and information delivery (90.1±11.3–92.2±11.7; P=0.02). The number of undesirable events between doctors and patients decreased 75% from 12 to three. Conclusion Participation in a communication skills training program was associated with improved communication skills of emergency medicine residents, increased patient satisfaction, and decreased complaints.

Stress fracture of bilateral tibial metaphysis due to ceremonial march training: a case report

Stress fractures are caused by repetitive microtraumas that occur during unusual or increased activities. Clinical suspicion is essential for the diagnosis. A twenty-years old soldier was presented with bilateral knee pain and restriction of knee movements after a period of training for ceremonial march. Although plain X-rays were normal, scintigraphy and MRI revealed stress fractures at metaphyseal region of both tibias. History of a patient presenting with persisting joint or bone pain after an unusual repetitive activity should be delicately inquired. Typical history, although pain might be localized to unusual sites, should raise the suspicion of a stress fracture.

Evaluation of quality of life of female patients after bilateral total knee arthroplasty

OBJECTIVES We evaluated the quality of life of female patients following total knee arthroplasty. METHODS The study included 50 women (mean age 67 years; range 52 to 84 years) who underwent bilateral total knee arthroplasty for primary osteoarthritis of the knee. All the patients were administered the Medical Outcomes Study Short Form-36 (SF-36) and the Knee Society Clinical Rating System (KSCRS) preoperatively and at six weeks, three and six months postoperatively. Particular attention was given to provide patients with sufficient information on surgery and postoperative rehabilitation program. RESULTS Compared to preoperative scores, all the subscales of both instruments showed significant improvement at six weeks and six months (p<0.05). After six weeks, however, only SF-36 physical function scores continued to improve significantly till the final assessment (p<0.05), whereas the other subscales reflected only maintenance of improvement. Conversely, a consistent significant improvement after six weeks was seen in the pain score of the KSCRS, while the function score representing only maintenance of improvement. CONCLUSION Significant improvement is achieved in the quality of life of female patients within six weeks after total knee arthroplasty. It appears that, beyond six weeks, this improvement continues to be significant only in the physical function score of the SF-36 and pain score of the KSCRS.

Fluoroscopy for transpedicular screw placement in scoliosis: to what extent can radiation exposure be reduced by the freehand technique?

AIM In spinal surgery, high doses of radiation are delivered during surgical procedures that require fluoroscopic control. The aim of this study was to determine the amount of radiation delivered from the fluoroscopic unit and also the factors to reduce the amount of radiation during the surgery of adolescent idiopathic scoliosis patients. MATERIAL AND METHODS In this retrospective study 21 patients with adolescent idiopathic scoliosis treated by transpedicular screws between 2009 and 2012 were enrolled the study. Dose Area Product (DAP) values , number of views obtained during screw placement and other data were retrieved from the medical records of the patients. RESULTS The mean number of transpedicular screws used was 18. An average of 10,1 vertebrae were instrumented. The mean number of images obtained was 7.76. Mean fluoroscopy time was 7.95 seconds. The total mean DAP was 64.6 cGy.cm < sup > 2 < /sup > . CONCLUSION The amount of ionizing radiation transmitted to the patient and the surgical team can be reduced by freehand insertion, confirmation of screw position by AP and lateral fluoroscopic views including more than one segment, the use of K-wires as a guide in spinal segments with abnormal pedicular anatomy and neuromonitorization of the patient during the surgical correction of adolescent idiopathic scoliosis.

Ecchymosis Due to Sertraline Use: A Case Report

Sertraline is a widely used antidepressant due to its low adverse effect profile. Hematological adverse effects related to sertraline are uncommon. This report includes a case which presented to an emergency department with a large ecchymotic lesion on the left flank due to sertraline use and a review of the relevant literature.

The relationship between chondromalacia patella, Q angle and patella type in young male adults with anterior knee pain

In this study we aimed to define the frequency of disorders that present with anterior knee pain among young male individuals. Study included 121 patients with no history of knee trauma or surgery whom were presented to Orthopedics department with anterior knee pain. All patients were examined and Q angle of each was measured. Anteroposterior, lateral and tangential knee radiography was obtained to define patellar alignment and patella types. Magnetic resonance imaging (MRI) with PD fat-suppression T2 sequence was used to evaluate cartilage and soft tissues. As for the patella types, right knees were Baumgartle type 2 in 66.11 % (n=80) of the patients, while left knees were Baumgartle type 2 in 63.63 % (n=77) of the patients. MRI showed chondromalacia patella in 5 patients (0.04 %), meniscal tear in 4 patients (0.03 %), Quadriceps fat sign in 4 patients (0.03 %), medial plica in 3 patients (0.02 %) and Osgood-Schlatter disease 1 patient (