Isa Kilicaslan

Entire pneumorrhachis due to isolated head trauma

Air contained within the spinal canal is termed pneumorrhachis, and very rarely, traumatic pneumocephalus can cause pneumorrhachis. Pneumorrhachis can be classified as epidural or subarachnoid space pneumorrhachis.

The Need for First Aid Awareness among Candidate Teachers

SUMMARY Objectives Students at schools may require first aid due to illness, deterioration in their condition, or accidents. Therefore, educators should know first aid procedures and be able to put them into practice. In this study, the objective was to determine the level of first aid knowledge among students at a Faculty of Education and evaluate the efficacy of the first aid training (FAT) provided to them. Methods This study included 88 students at Gazi University, Faculty of Education (Ankara). All students were provided 20 hours of FAT over a period of three months. Participants completed pre- and post-FAT questionnaires and a final examination. Results Sixty-one percent of participants (n=54) had attended FAT within the previous five years. Average pre- and and post-test scores were 47.89±11.29 and 75.28±12.62, respectively. There was a significant increase between the average scores (p<0.001). The proportion of correct responses on basic life support issues was also significantly higher after the training. Significantly more participants felt they had sufficient first aid knowledge and skills after the training (58%) compared to pre-training (8%) levels (p<0.001). Conclusions First aid knowledge among students at a Faculty of Education was considered to be insufficient. FAT should be standard in educational programs at all teacher training schools and the results show such training needs to be updated regularly.

Artificial neural network in predicting craniocervical junction injury: an alternative approach to trauma patients.

Objective The aim of this study is to determine the efficiency of artificial intelligence in detecting craniocervical junction injuries by using an artificial neural network (ANN) that may be applicable in future studies of different traumatic injuries. Materials and methods Major head trauma patients with Glasgow Coma Scale ≤8 of all age groups who presented to the Emergency Department were included in the study. All patients underwent brain computerized tomography (CT), craniocervical junction CT, and cervical plain radiography. A feedforward with back propagation ANN and a stepwise forward logistic regression were performed to test the performances of all models. Results A total of 127 patients fulfilling inclusion criteria were included in the study. The mean age of the study patients was 31±17.7, 77.2% (n=98) of them were male, 13.4% of the patients (n=17) had craniocervical junction pathologies. About 64.7% (n=11) of these pathologies were detected only by CT; 23.5% (n=4) of them by both craniocervical CT and cervical plain radiography; and 11.8% (n=2) of them only by cervical plain radiography. A logistic regression model had a sensitivity of 11.8% and specificity of 99.1%. Positive predictive value was 66.7% and negative predictive value was 87.9%. Area under the curve for logistic regression model was 0.794 (P=0.000). ANN had a sensitivity of 82.4% and specificity of 100%. Positive predictive value was 100% and negative predictive value was 97.3%. Area under the curve for ANN model was 0.912 (P=0.000). Conclusion ANN as an artificial intelligence application seems appropriate for detecting and excluding craniocervical junction injury but it should not replace craniocervical junction CT. However, these findings should lead us to test the applicability of ANN on hard-to-diagnose trauma patients or in constructing clinical decision rules.

Serum tau protein level for neurological injuries in carbon monoxide poisoning

Abstract Introduction. Carbon monoxide (CO) poisoning causes hypoxia that results tissue injury, especially in the brain and heart. Delayed neurologic sequela is one of the most serious complications that may occur up to 40% of severe CO poisoning cases. Objective. The aim of the study was to determine an association between the serum tau protein and severe neurologic symptoms/signs upon presentation. Methods. Seventy-eight patients with CO poisoning were evaluated in this cross-sectional study. The patients were divided into two groups, Group 1: those with loss of consciousness (LOC)/syncope, seizure, coma, altered mental status (n = 19), and Group 2; without LOC (n = 59). Serum tau protein levels were studied on admission. Results. Mean age of the patients was 37.3 ± 15.4 and 53.6% were male. Headache was the most common presenting symptom observed among 67 patients (86%). The median serum tau protein level was 76.54 pg/mL (35.56–152.65) within group 1, 64.04 pg/mL (23.85–193.64) in patients within group 2 (p = 0.039), respectively. The median serum tau protein levels were 79.80 pg/mL (35.56–193.64) in patients who received HBO therapy and 65.79 pg/mL (23.85–167.29) in patients who did not receive HBO therapy (p = 0.032). The value of area under the curve was 0.642 for detecting CO poisoning with severe neurological symptoms. Conclusion. Although tau protein levels were significantly higher in patients with severe neurological symptoms; the difference did not reach a clinical significance. Further studies are needed in order to reveal the validity of tau protein for detecting neurological injuries in patients with CO toxicity.

Endogenous carboxyhemoglobin concentrations in the assessment of severity in patients with community-acquired pneumonia☆ , ☆☆

INTRODUCTION Previous studies have shown that carbon monoxide, which is endogenously produced, is increased in community-acquired pneumonia (CAP). However, it has not been studied enough whether severity of pneumonia is correlated with increased carboxyhemoglobin (COHb) concentrations in CAP. The aim of this study was to determine whether endogenous carbon monoxide levels in patients with CAP were higher compared with the control group and, if so, to determine whether COHb concentrations could predict severity in CAP. MATERIALS AND METHODS Eighty-two patients with CAP were evaluated in this cross-sectional study during a 10-month period. Demographic data, pneumonia severity index and confusion, uremia, rate respiratory, pressure blood, age>65 (CURB-65) scores, hospital admission or discharge decisions, and 30-day hospital mortality rate were recorded. In addition, 83 control subjects were included to study. The COHb concentration was measured in arterial blood sample. RESULTS The levels of COHb in patients with CAP were 1.70% (minimum-maximum, 0.8-3.2), whereas those in control subjects, 1.40% (minimum-maximum, 0.8-2.9). The higher COHb concentrations in patients with CAP were statistically significant (P < .05). Concentration of COHb correlated with pneumonia severity index (P = .04, r = 0.187); however, it did not correlate with CURB-65 (P = .218, r = 0.112). CONCLUSION Although COHb concentrations show an increase in patients with pneumonia, it was concluded that this increase did not act as an indicator in diagnosis process or prediction of clinical severity for the physicians.

Aşırı Miktarda Kayısı ve Muz Tüketimi Sonrası Ciddi Hiperkalemi: İki Olgu Sunumu ve Literatürün Gözden Geçirilmesi

Hyperkalemia is well-known sequela of consumption of diet rich in potassium. It has also been reported in patients who consume large amount of fruits or fruit juice. Disorders of plasma potassium can have profound effects, especially on cardiac function. A potentially life threatening hyperkalemia is described in two female patients who consumed excessive amount of apricot and banana. Despite emergent treatment for hyperkalemia was initiated, serum potassium levels remained high. Therefore hemodialysis was chosen as definitive treatment for these patients. Upon reviewing their food intake and medication history, their relatives stated patients have consumed excessive amount of apricot and banana for the past 10 days. Hidden source of potassium intake, such as apricot and banana, should not be overlooked, especially in patients presenting with catastrophic cardiac and neuromuscular effects.

Evaluating Unscheduled Readmission to Emergency Department in the Early Period.

BACKGROUND The readmission in the early period (RAEP) is defined as the admission of a patient to emergency department (ED) for the second time within 72 hours after discharge from the ED. AIMS The aim of this study was to determine the disease, patient, doctor, and system related causes of RAEP. STUDY DESIGN Descriptive study. METHODS This study is a two-stage study that was conducted at Department of Emergency, Gazi University Faculty of Medicine. The causes of RAEP were defined as disease, patient, doctor, and system related causes. RESULTS A total of 46,800 adult patients admitted to ED during the study period and 779 (1.66%) patients required RAEP. After the exclusion criteria, 429 of these patients were included the study. The most common reasons for RAEP were renal colic in 46 (10.7%) patients. It was detected that 60.4% of the causes of RAEP were related to disease, 20.0% were related to the doctor, 12.1% were related to the patient, and 7.5% were related to the hospital management system. CONCLUSION This study revealed that there are patient-, doctor-, and system-related preventable reasons for RAEP and the patients requiring RAEP constitute the high risk group.

Spontaneous stone passage: is it Ammi visnaga effect?

Ammi visnaga was used in Ancient Egypt as an herbal remedy for renal colic. “Khellin”, a chemical obtained from Ammi visnaga, was used as a smooth muscle relaxant and has been thought to have pleiotropic effects on urolithiasis. We report a case with multiple ureteral stone passages possibly as a result of medication with an herb preparation, Khellin.

Greater weever fish: A case of poisoning with sea creatures far away from the sea.

SUMMARY Trachinus Draco, known as greater weever fish, probably seen more frequently than has been reported. However, only a few clinical cases have been reported in the literature that describes Trachinus species envenomation. Here, we presented a case poisoned by a weever fish and tried to describe the signs/symptoms and treatment modalities of the weever fish envenomation and also tried to emphasize poisonings that could be far from the sea with dead sea creatures. OZET