Hayati Kandis

The Effect of Nebulized NaHCO3 Treatment on "RADS" Due to Chlorine Gas Inhalation

Chlorine is one of the most common substances involved in toxic inhalation. As with all irritant gases, the airway injuries caused by chlorine gas may result in clinical manifestations similar to those of asthma. In this study, we investigated the effect of nebulized sodium bicarbonate (NSB) on the treatment and quality of life (QoL) of victims exposed to chlorine gas. Forty-four consecutive patients with reactive airways dysfunction syndrome (RADS) due to chlorine inhalation (40 females and 4 males, age range 17–56 yr) were included in this study. Patients were placed in control and treatment groups in a sequential odd–even fashion based on their order of presentation. Treatment of all patients included corticosteroids and nebulized short-acting β2-agonists. Then the control group (n = 22) received nebulized placebo (NP), and the NSB group (n = 22) received NSB treatment (4 cm3 of 4.20% sodium bicarbonate solution). A quality of life (QoL) questionnaire and pulmonary function tests (PFTs) were performed before and after treatments in both groups. The most common symptoms were dyspnea (82%) and chest tightness (82%). Baseline characteristics of both groups were similar. Compared to the placebo group, the NSB group had significantly higher FEV1 values at 120 and 240 min (p < .05). Significantly more improvement in QoL questionnaire scores occurred in the NSB group compared to the NP group (p < .001). Thus, NSB is a clinically useful treatment, as tested by PFTs and QoL questionnaire, for patients with RADS caused by exposure to chlorine gas.

Do energy drinks cause epileptic seizure and ischemic stroke

Energy drinks are popular among young individuals and marketed to college students, athletes, and active individuals between the ages of 21 and 35 years. We report a case that had ischemic stroke and epileptic seizure after intake of energy drink with alcohol. To the best of our knowledge, the following case is the first report of ischemic stroke after intake of energy drink. A previously healthy 37-year-old man was brought to the emergency department after a witnessed tonic-clonic seizure. According to his wifes testimony, just before loss of consciousness, the patient had been drinking 3 boxes of energy drinks (Redbull, Istanbul, Turkey, 250 mL) with vodka on an empty stomach. He did not have a history of seizures, head trauma, or family history of seizures or another disease. In cranial diffusion magnetic resonance imaging, there were hyperintense signal changes in bilateral occipital area (more pronounced in the left occipital lobe), right temporal lobe, frontal lobe, and posterior parietal lobe. All tests associated with possible etiologic causes of ischemic stroke in young patients were negative. Herein, we want to attract attention to adverse effect of energy drink usage.

Neuropsychiatric disorders and risk factors in carbon monoxide intoxication

Neuropsychiatric sequelae may be observed in the late phases of carbon monoxide (CO) intoxication. Establishing a link between CO-related neuropsychiatric disorders and associated risk factors may decrease morbidity and mortality by means of appropriate treatment and counseling. The aim of the present study was to determine the relationship between neuropsychiatric outcomes of CO intoxication and demographic and clinical variables. Thirty patients who presented with CO intoxication and had no known neuropsychiatric disease, and 30 healthy controls were included. Physical examinations and laboratory tests were performed. Following the 1st therapy, they underwent mental and psychiatric tests 5 times (the time of discharge, during the 1st week, and during the 1st, 3rd, and 6th months). They underwent cerebral magnetic resonance imaging (MRI) at the end of the 1st month. They were evaluated by cognitive function tests at the 6th month. Lesions relevant to CO intoxication were detected in 46.7% of the patients via cranial computed tomography and in 13.3% via MRI. Evaluation of psychiatric tests revealed a clear decrease in cognitive functions, such as immediate memory, learning, reaching the criterion, spontaneous recall, attention, visual memory, and logical memory. It was found that the patients had anxiety within the 1st month, and the frequency of anxiety reached to the value of the control group by the end of the 6th month. In conclusion, we suggested that CO intoxication might lead to neuropsychiatric disorders. Our results emphasized that in addition to standard treatment, neuropsychiatric evaluation should also be performed in patients with CO intoxication.

An unusual presentation of bee sting: subarachnoid hemorrhagia.

A person consists of a variety of immune reactions as a result of bee stings, depending on his/her immunologic structure. A 49-year-old male patient was brought to the emergency department because of generalized tonic clonic seizure and loss of consciousness after an hour of wild bee bite from the anterior abdomen in a rural area. After cardiopulmonary resuscitation, he was admitted to intensive care unit. Although cranial computed tomography taken in the emergency department was normal, control cranial computed tomography at the 36th hour after admission was consisted with subarachnoid hemorrhagia (SAH). The patient was diagnosed as SAH due to exposure to bee stings. The patient was treated for a month in an intensive care unit and discharged in a vegetative state. We present and discuss the case that had epileptic seizures and SAH after a bee bite, with the review of the literature.

Acute Abdomen Associated with Organophosphate Poisoning

BACKGROUND Pesticides are extensively used in developed and developing countries. OBJECTIVES The present study was designed to evaluate the clinical course of patients with carbamate or organophosphate poisoning presenting to a University-based emergency department (ED). METHODS All consecutive patients admitted to our ED due to intoxication with carbamate or organophosphate compounds over a 2-year period were enrolled prospectively. RESULTS A total of 49 consecutive patients (26 females) were diagnosed with carbamate or organophosphate poisoning in the 24-month study period. The mean age of the patients was 32±13.1 years (range 16-70 years). Signs and symptoms most frequently noted in patients with organophosphate or carbamate poisoning were perspiration, vomiting, and bronchorrhea. Abdominal pain was reported by 65.3% of the patients. Abdominal ultrasonography was performed in 22 patients who complained of abdominal pain as a leading symptom. Among these, 63.6% were found to have abdominal free fluid. Pancreatitis and peritonitis developed in one case. Atropine treatment was administered for approximately 24-36h, with a mean total dose of 13.75±6.75mg. Pralidoxime was administered to 70.9% of patients with organophosphate poisoning, but was not used in patients intoxicated with carbamates. Endotracheal intubation and mechanical ventilatory support were required in 14.2% of the patients. Mean duration of mechanical ventilation was 3.7±2.2 days. The overall mortality rate was 10.2%. CONCLUSION Patients with a diagnosis of organophosphate poisoning should be screened for acute abdomen. The findings in our study suggest that these patients should undergo routine abdominal ultrasonography, especially in cases with abdominal pain along with other abdominal complaints.

The relationship between ischemic stroke and weather conditions in Duzce, Turkey

BACKGROUND Weather conditions are thought to increase the risk of stroke occurrence. But their mechanism has not yet been clarified. We investigated possible relationships between ischemic stroke and weather conditions including atmospheric pressure, temperature, relative humidity, and wind speed. METHODS One hundred and twenty-eight patients with ischemic stroke who had been admitted to our hospital between January 1 and December 31, 2010 were enrolled in this study. We investigated the relationship between daily cases and weather conditions the same day or 1, 2, and 3 days before stroke. RESULTS A negative correlation was found between maximum wind speed and daily cases 3 days before stroke. As the relationship between daily cases and changes of weather conditions in consecutive days was evaluated, a negative correlation was found between daily cases and change of atmospheric pressure in the last 24 hours. CONCLUSIONS The maximum wind speed 3 days before stroke and change of atmospheric pressure in the last 24 hours were found to increase the cases of ischemic stroke. We recommend that individuals at risk of ischemic stroke should pay more attention to preventive measures, especially on days with low maximum wind speed, on subsequent 3 days, and on days with low atmospheric pressure in the last 24 hours.

Neuropsychiatric side effects due to a transdermal fentanyl patch: hallucinations.

Opioid analgesics are used commonly in end-stage cancer patients for pain treatment. Central nervous system adverse effects are rare. A73-year-old female patient was admitted to the emergency department for auditory and visual hallucinations. The patient had been receiving palliative treatment for liver, cervical, and lumbar bone metastases from an unknown origin. The patient used a transdermal fentanyl patch for palliative pain management and metoclopramide hydrochloride for nausea and vomiting. The patient had suffered weight loss of 10 kg within 5 months, and laboratory findings revealed hypoalbuminemia. The patient was considered to have experienced a fentanyl overdose, and the transdermal fentanyl patch treatment was stopped. The hallucinations improved during follow-up, and the patient was discharged with a dose adjustment. End-stage cancer patients with weight loss and hypoalbuminemia may be more prone to opioid adverse effects, such as hallucinations. The dose of fentanyl must be adjusted for weight loss, and correction of hypoalbuminemia may also lower the incidence of such adverse effects.

Floating Forearm: Perilunar and Elbow Dislocation Without a Fracture

Traumatic perilunar and elbow dislocation is rarely seen together. There are only a few reported cases in the literature. Limitation of joint movement, deformity and pain are generally the presenting symptoms. A case of perilunar and elbow dislocation without fracture admitted to the emergency department due to a traffic accident and treated with closed reduction after sedoanalgesia and benefited from closed reduction.

Diklofenak sodyum kullanımı sonrası anafilaktik reaksiyon sonucu gelişen Kounis sendromu: Olgu sunumu

Kounis sendromu mast hucrelerinin etkinlesmesi ile seyreden alerji, hipersensitivite, anaflaksi veya anaflaktoid reaksiyonlarla iliskili olarak akut koroner sendromun degisik derecelerini ifade eder. Subklinik olarak akut veya kronik alerjik reaksiyona eslik eden ve gogus agrisindan baslayip ST elavasyonlu miyokard enfarktusu kadar uzanan bir klinik spektruma sahiptir. Ilaclar, yiyecekler, cevresel etkenler (bocek isirmasi, ari sokmasi, polenler, lateks temasi gibi) alerjik reaksiyonu tetikleyen neden olabilir. Burada, acil servislerde yaygin olarak kullanilan Voltaren’e (Diklofenak sodyum) bagli gelisen anafilaktik reaksiyonu olan bir Kounis sendrom vakasini sunuyoruz.

Ani Kardiyak Arrestle Başvuran Konjenital Uzun QT Sendromu

Amac: Bu calismanin amaci high-grade displazi (HGD) ve invaziv kanser ( “ilerlemis patoloji (IP)” olarak tanimlanmistir) ile iliskili multipl hasta ve adenom karakterlerini degerlendirmektir. Materyal ve Metod: Toplam 6250 islem sonunda 894 hastada 1379 (% 22.06) polip mevcuttur. Biz patoloji sonuclarina ulasabildigimiz 914 polipi degerlendirmeye aldik. Bulgular: 914 polipte toplam 699 adenom tespit edildi. A total of 699 adenomas were detected from 914 polyps. Sag kolon yerlesimli poliplerde sola gore daha yuksek oranda IP ozellikleri bulundu (% 18.5 vs % 7.1 p: 0.002). Lojistik regresyon analizi sonucunda; erkek cinsiyet, 2 cm’e esit ya da buyuk boyut, villoz histoloji ve non-dimunitif gorunum adenomlardaki IP ozellikleri icin bagimsiz risk faktorleri olarak bulundu. Sonuc: Calismamizda, diger calismalara benzer olarak, erkek cinsiyet, 2 cm’e esit ya da buyuk boyut, villoz histoloji ve non-dimunitif gorunum adenomlardaki IP ozellikleri icin bagimsiz risk faktorleri olarak bulundu. Fakat diger bircok calismanin aksine biz sag kolon yerlesimli poliplerde sol taraf yerlesimli poliplere gore daha yuksek oranda IP ozellikleri bulduk.The long QT syndrome (LQTS) is characterized with arrhythmic attacks, repeating syncopes,seizures, and ventricular arrhythmias leading to sudden death. Arrhythmias with a potential ofmortal course develop due to elongation of ventricular repolarization, either acquired or inborn.Herein the present paper, a case of congenital LQTS, admitted after a sudden cardiac arrest andtotally recovered with implantable cardiac defibrillator (ICD), was focused on