İlhan Korkmaz

Mushroom poisoning: retrospective analysis of 294 cases

OBJECTIVE The objective of this study was to present special clinical and laboratory features of 294 cases of mushroom poisoning. MATERIALS AND METHODS In this retrospective study, 294 patients admitted to the Pediatric and Adult Emergency, Internal Medicine and ICU Departments of Cumhuriyet University Hospital were investigated. RESULTS Of 294 patients between the ages of 3 and 72 (28.97 ± 19.32), 173 were female, 121 were male and 90 were under the age of 16 years. One hundred seventy-three patients (58.8%) had consumed the mushrooms in the early summer. The onset of mushroom toxicity symptoms was divided into early (within 6 h after ingestion) and delayed (6 h to 20 d). Two hundred eighty-eight patients (97.9%) and six (2.1%) patients had early and delayed toxicity symptoms, respectively. The onset of symptoms was within two hours for 101 patients (34.3%). The most common first-noticed symptoms were in the gastrointestinal system. The patients were discharged within one to ten days. Three patients suffering from poisoning caused by wild mushrooms died from fulminant hepatic failure. CONCLUSION Education of the public about the consumption of mushrooms and education of health personnel working in health centers regarding early treatment and transfer to hospitals with appropriate facilities are important for decreasing the mortality.

Comparison of trauma scores for predicting mortality and morbidity on trauma patients.

BACKGROUND In this study, we compared the anatomical, and physiological scoring systems trauma revised injury severity score (TRISS), revised trauma score (RTS), injury severity score (ISS), new injury severity score (NISS) to each other, to find out the most accurate and reliable trauma score for the risk classification of morbidity and mortality among the trauma patients. METHODS This is a cross-sectional study, which included 633 patients who admitted to our University Hospital Emergency Department during an 8-month period due to trauma. All blunt and penetrating traumas (traffic accident, assault, etc.) patients above 16 years were included. RESULTS Arrival time trauma scores (ISS, NISS, RTS, and TRISS) of the patients was calculated. Mean trauma score for the mortality prediction was calculated, and the p value was equal for all (p=0.001). Trauma scores were also analyzed for the hospitalization time in intensive care unit (ICU). While NISS, RTS, and TRISS values were significant (p=0.048, p=0.048, and p=0.017, respectively), ISS value was not significant (p=0.257) for predicting the ICU hospitalization time. Only TRISS was a good predictor for the mechanically ventilation time in ICU patients (p=0.01). CONCLUSION In conclusion, we determined that the anatomical trauma scores (NISS, ISS) predicted the hospitalization and ICU necessities better, whereas TRISS, an anatomo-physiological trauma score, defined the ICU hospitalization and mechanically ventilation time better.

Quail consumption can be harmful.

BACKGROUND Intoxication due to quail consumption is rarely seen. Such a toxicological syndrome (also called coturnism) occurs during the migration of quails from north to south, when they consume hemlock seeds. The clinical symptoms and laboratory results are indicative of acute rhabdomyolysis. OBJECTIVES Acute rhabdomyolysis has a wide range of etiologies. Coturnism is a rare cause of acute rhabdomyolysis that can be lethal due to renal failure and shock. To avoid severe complications, coturnism may be considered if the history is appropriate. CASE REPORT We report four cases of coturnism from quail consumption; the patients were admitted with some combination of symptoms including muscle tenderness, extremity pain, nausea, and vomiting. They were treated with vigorous isotonic crystalloid hydration and urine alkalinization. Consequently, the laboratory results returned to normal ranges and the clinical symptoms disappeared. CONCLUSION Although coturnism is a rarely seen toxicological syndrome that causes rhabdomyolysis, we present this case to increase awareness that it may present with symptoms of muscle tenderness, extremity pain, nausea, and vomiting after quail consumption.

The Relationship Between Oxidative Stress, Paraoxanase and Injury Severity in Blunt Trauma Patients

1 İlhan Korkmaz1, Hüseyin Aydın2, Şevki Hakan Eren3, Fatma Mutlu Kukul Güven4, Birdal Yıldırım5, İnan Beydilli6, Mehmet Eren7, 1Cumhuriyet Üniversitesi Tıp Fakültesi Acil Tıp A.D., 2Cumhuriyet Üniversitesi Tıp Fakültesi Klinik Biyokimya Laboratuarı, 3Cumhuriyet Üniversitesi Tıp Fakültesi Acil Tıp A.D., 4Cumhuriyet Üniversitesi Tıp Fakültesi Acil Tıp A.D., Sivas, 5Muğla Devlet Hastanesi Acil Servis, Muğla, 6Antalya Eğitim Araştırma Hastanesi Acil Servis, Antalya, 7Atatürk Eğitim Araştırma Hastanesi Ortopedi ve Travmatoloji, Ankara, Türkiye Travma Hastalarında Paraoksanaz / Paraoxanase Levels in Trauma Patients The Relationship Between Oxidative Stress, Paraoxanase and Injury Severity in Blunt Trauma Patients

Acil Servis Çalışanların da El Florasının Nöbet Süresince Değişimi

Ozet: Acil Servis Calisanlarin da El Florasinin Nobet Suresince Degisimi Amac: Calismamiz Cumhuriyet Universitesi Tip Fakultesi Hastanesi Acil servisimizde gorev yapan hastane personelinden nobet oncesi ve sonrasi el kulturleri alinarak; nobet suresince el florasinda degisiklik olup olmayacagi, ellerimizde patojen mikroorganizma olup olmadigi ortaya konulmasi amaclanmistir. Materyal ve metod: Calismamiz, Cumhuriyet Universitesi acil servisinde gorev yapan 10 hekim, 13 hemsire, 10 tasima ve 7 temizlik personelinin nobet oncesi ve sonrasi her 2 ellerinden kulturleri alinarak el floralarindaki degisimleri degerlendirilmek uzere planlanmistir. Ayrica, ozel mudahale alanlarindaki (resusitasyon, kirmizi alan) hava numunelerindeki mikro organizmalar analiz edildi. Tartisma: Temas oncesi (4,%11.1) ve temas sonrasi (16,%44.4) el yikama durumu karsilastirildiginda farklilik istatiksel acidan onemli bulunmustur. (p<0,05) Nobet oncesinde alinan sag ve sol el ornekleri ile nobet sonrasi alinan sag ve sol el orneklerinde uretilen mikroorganizmalar arasinda herhangi bir fark bulunmadi. nobet oncesinde alinan sag ve sol el orneklemeleri, uretilen mikroorganizmalarin toplam sayilari acisindan karsilastirildiginda fark anlamli olarak bulunmustur. (t = 7,48; p = 0,001). Sonuc: Calismamizdaki sonu c lari genel olarak degerlendirecek olursak hastanede el yikama sikligi ve suresinin uluslararasi kilavuzlar ve belirtilen sinirlara yakin oldugu fakat temas o ncesi ve sonrasi el y ikama aliskanliginin beklenen duzeyde olmadigi saptandi . El y ikama davranisi ile ilgili eksiklerin giderilmesi acisindan personelin egitimi, uyumun kontrolu ve geri bildirimin yapilmasinin etkili olacagi ortaya cikmistir. Yapilan hava o rneklemeleri degerlendirildiginde tanimlanan bakteri c esitliligi acisindan alanlarda farklilik olmadigi ve bunlarin normal hava ortaminda bulunan mikroorganizmalar olduklari tespit edilmis oldu. U reme sayilari acisindan hasta bakiminin daha fazla oldugu yesil alanda ve sari alanlarda daha c ok ureme oldugu ortaya cikti. Anahtar Sozcukler: El hijyeni, Hastane kaynakli enfeksiyon kontrolu, El yikama, Saglik calisani, Metisiline rezistans staphyloccus aerius

Serum Paraoxonase, Arylesterase, and Glutathione-S-Transferase Activities and Oxidative Stress Levels in Patients with Mushroom Poisoning

OBJECTIVES: Consumption of toxic species of mushrooms may have detrimental effects and increase oxidative stress. Paraoxonase, arylesterase and glutathione-S-transferase are antioxidants that resist oxidative stress. In this study, we analyzed the changes in these enzymes during intoxication due to mushrooms. METHODS: The study enrolled 49 adult patients with a diagnosis of mushroom poisoning according to clinical findings and 49 healthy volunteers as the control group. The patients with mild clinical findings were hospitalized due to the possibility that the patient had also eaten the mushrooms and due to clinical findings in the late period, which could be fatal. Paraoxonase, arylesterase, and glutathione-S-transferase concentrations, as well as total antioxidant and oxidant status, were determined in the 49 patients and 49 healthy volunteers by taking blood samples in the emergency department. RESULTS: While paraoxonase, arylesterase, and total antioxidant status were significantly decreased in the patient group (p<0.05), glutathione-S-transferase, total oxidant status and the oxidative stress index were significantly higher (p<0.05). There was a positive correlation between the hospitalization time and the oxidative stress index (r=0.752, p<0.001), whereas a negative correlation was found with glutathione-S-transferase (r=-0.420, p=0.003). CONCLUSION: We observed a significant decrease in paraoxonase and arylesterase and an increase in glutathione-S-transferase and oxidative stress indexes in patients with mushroom poisoning, indicating that these patients had an oxidative status. In particular, a low total antioxidant status and high oxidative stress index may gain importance in terms of the assessment of hospitalization duration.

Predicting of neuropsychosis in carbon monoxide poisoning according to the plasma troponin, COHb, RDW and MPV levels

OBJECTIVE Carbon monoxide (CO) poisoning is very common worldwide. In this study, we aimed to evaluate the predictivity of neuro psychosis in carbon monoxide poisoning by the admission levels of red cell distribution (RDW), mean platelet volume (MPV) and troponin I levels which can be measured quickly and easily in the emergency department (ED). PATIENTS AND METHODS This single center observational study included a total of 216 consecutive patients who presented to the ED due to CO poisoning between January 2009 and December 2013. The diagnosis of CO poisoning was made according to the medical history and carboxyhemoglobin (COHb) level of >5%. According to the carboxyhemoglobin levels, the patients were classified as mildly (COHb < 20%) and severely poisoned (COHb > 20%). In addition, patients were divided into 2 groups, i.e., those with positive (>0.05 ng/mL for our laboratory) and negative (<0.05 ng/mL for our laboratory) troponin levels. RESULTS Patients mean age was 52.58 ± 10.58. 57.9% of the patients had high troponin levels and 51.9% were poisoned severely according to COHb levels. Patients with positive troponin and COHb had longer CO exposure time and higher neutrophil, lymphocyte, mean platelet volume (MPV), COHb and red cell distribution width (RDW) levels at the index admission following CO poisoning than patients with negative troponin (p < 0.05). Age, COHb level, CO exposure time, MPV and RDW (p = 0.001, p < 0.05) remained associated with an increased risk of troponin positivity following adjustment for the variables that were statistically significant. CONCLUSIONS In patients presenting to the ED with CO poisoning, RDW and MPV can be helpful for risk stratification of neuropsychosis.

METHANOL POISONING IN THREE CASES: DIAGNOSIS AND TREATMENT IN EMERGENCY DEPARTMENT

ABSTRACT Methanol is a very poisonous substance that is used as an industrial solvent and automotive antifreeze. Toxic dose is between 20-250 ml and causes neurological symptoms such as headache, cerebral edema and putamen necrosis within the first 12 to 14 hours. Central nervous system and visual cortex are the main areas which are damaged by methanol poisoning. Methyl alcohol is not toxic until its toxic metabolites turn into formic acid. Formic acid is especially responsible for the clinical findings. Serum half-life of methanol is 14 to 20 hours in mild and 24 to 30 hours in severe toxicity. Gastric lavage, fomepizole, ethanol and hemodialysis are used in the treatment. In this study, we aimed to review and discuss information from literature about the treatment and monitoring of methanol poisoning in three cases followed at emergency department. Key words: Methanol poisoning, emergency, blurred vision, hemodialysis

Analyses of The Risc Factors for Atrial Fibrillation Among the Patients Who were Admitted to Emergency Service

1 Ethem Arisoy1, İlhan Korkmaz2, Şevki Hakan Eren3, Fatma Mutlu Kukul Güven4, Mehmet Birhan Yilmaz5, İnan Beydilli6, Birdal Yıldırım7 1Zonguldak Devlet Hastanesi Acil Servis, Zonguldak, 2Cumhuriyet ÜniversitesiTıp Fakültesi Acil Servis, Sivas, 3Cumhuriyet Üniversitesi Tıp Fakültesi Acil Servis, Sivas, 4Cumhuriyet Üniversitesi Tıp Fakültesi Acil Servis, Sivas, 5Cumhuriyet Üniversitesi Tıp Fakültesi Kardiyoloji A.D, Sivas, 6Kayseri Eğitim Araştırma Hastanesi Kayseri, 7Muğla Devlet Hastanesi Muğla, Türkiye Atrial Fibrillation / Atrial Fibrilasyon Analyses of the Risc Factors for Atrial Fibrillation Among the Patients Who were Admitted to Emergency Service

Kronik obstruktif akciğer hastalığı akut alevlenmeli hastalarda prokalsitonin ve diğer akut faz belirteçleri

Objectives: The aim of this study was to investigate the correlation between procalcitonin and other acute phase reactants, and also analyze their relationship with clinical situation in chronic obstructive pulmonary disease (COPD) acute exacerbations. Materials and methods: The study was made with 122 acute COPD exacerbated patients, who were admitted to emergency service. Patients with below 0.25 ng/ml PCT value included Group 1, and the patients with PCT values ≥ 0.25 ng/ml Group 2. Serum procalcitonin levels, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) values and white blood cell (WBC) counts were measured. Also, patients hospitalization time and mortality rates were recorded and compared with PCT. Results: Patients were divided in 3 groups according to their clinical diagnosis; Pneumonia (n=27), MycoplasmaChlamydia pneumonia (n=11) and the patients with only COPD exacerbation(n=84). Mean PCT values according to the groups were 9.47 ± 8.1 ng/ml, 0.41 ± 0.2 ng/ ml, and 0.21 ± 0.05 ng/ml respectively. The relationship between PCT with CRP and white blood cell has been found between significiant (p=0.001, p=0.005 respec tively), whereas the relationship between PCT and ESR was nonsignificant (p=0.55). Procalcitonin and CRP had a positive correlation with the hospitalization time (p=0.034, p=0.022 respectively). The mean ± standard error of PCT for the patients who died was 28.3 ± 27.5 ng/ml, and the difference between patients who died or were discharged was statistically significant (p= 0.012). Conclusion: PCT can be a useful indicator for morbidity and prognosis in COPD patients.