Mehmet Ozgur Erdogan

Local differences in the epidemiology of traumatic spinal injuries

BACKGROUND Spinal cord injury (SCI) has a serious lifetime impact as well as obvious social and economic effects for both patients and society. The aim of this study was to collect recent information and analyze changes in the epidemiology of traumatic spinal injuries. METHODS Data included traumatic SCI (TSCI) patients admitted to the emergency department of Haydarpaşa Numune Training and Research Hospital between January 2007 and December 2011. 409 TSCI patients were included in the study. Categorical variables were analyzed with Fishers exact test and parametric variables with independent samples t test. RESULTS The most common injury mechanism was high falls. 85 (20.8%) patients were injured in low falls, which was the second most common injury mechanism. The most common injury was lumbar spine injury (196 [48%] patients suffered isolated lumbar spine injury), followed by thoracal spine injuries. Lumbar spinal injuries (p=0.00011) were observed at a higher rate in high falls. Low fall was a significant mechanism for thoracal spine injuries (p=0.003). Automobile accidents had a significant relation with cervical (p=0.00001) and lumbar (p=0.004) spinal injuries. CONCLUSION Although cervical injuries were higher in automobile accidents, the ratio of automobile accident-related TSCI was less than reported in other studies. Cervical injury ratio of the population decreased due to the decrease in the number of automobile accident-related TSCIs.

Emergency diagnosis of upper gastrointestinal bleeding by detection of haemoglobin in nasogastric aspirate

Objective To determine the accuracy of the Faecal Occult Blood–Transferrin test (FOB–T; Certest Biotec, San Mateo de Gállego, Spain) for detection of blood in nasogastric aspirate, and its emergency diagnostic value for upper gastrointestinal bleeding (UGIB). Methods Nasogastric aspirate was collected from patients with haematemesis on admission to hospital. Haemoglobin was quantified on admission and after 12 h. FOB–T test was used to assess each nasogastric aspirate sample for the presence of haemoglobin and transferrin. Results Of 64 patients included in the study, 28 (43.8%) were hospitalized for UGIB based on physical examination, haemoglobin level. 24 were confirmed with endoscopy findings. Four were excluded from study due to lack of endoscopic confirmation. The remaining 36 patients had no clinical evidence of UGIB. FOB–T test findings were positive in 26/60 patients, including all 24 patients with UGIB. The FOB–T test had sensitivity 100%, specificity 94.4%, positive predictive value 92.3% and negative predictive value 100% for UGIB. Conclusions A negative FOB–T test may be sufficient to exclude the possibility of UGIB without other diagnostic tests.

Roles of Motorcycle Type and Protective Clothing in Motorcycle Crash Injuries

Background. The aims of this study were to identify subgroups of motorcyclists with a higher accident risk and evaluate the efficiency of protective clothing for preventing injuries. Methods. A 1-year prospective study of motorcycle crashes was conducted beginning in June 2012. Participants were patients involved in motorcycle crashes and admitted to our emergency department. Results. A total of 226 patients were included in the study. In total, 174 patients were involved in crashes with light motorcycles. Patients involved in a motorcycle accident without a helmet had a higher incidence of head and maxillofacial trauma. Motorcycle jackets were not protective for systemic injuries (P > 0.05) or upper extremity fractures (P > 0.05). Motorcycle pants (P > 0.05) and motorcycle shoes (P > 0.05) were not protective against leg and foot fractures. However, motorcycle protective clothes were protective against soft-tissue injuries (P = 0.001). Conclusion. Riders of heavy motorcycles rode more safely than riders of light motorcycles. Light motorcycle riders were the most vulnerable and comprised the largest percentage of motorcyclists. Helmets may be effective for preventing head and facial injuries. Other protective clothes were not effective against fractures or systemic injuries.

Associations of Trauma Severity with Mean Platelet Volume and Levels of Systemic Inflammatory Markers (IL1β, IL6, TNFα, and CRP).

We investigated the associations of injury severity scores (ISSs) with the mean platelet volume, the serum levels of two interleukins (IL1β and IL6), and the serum levels of tumour necrosis factor-α (TNFα) and C-reactive protein (CRP). We sought to identify biochemical parameters that could be used as components of a new biochemical parameter-based ISS system. The levels of CRP, TNFα, IL1β, and IL6 differed significantly (all p values < 0.05) between severely injured patients and controls. The mean platelet volume (MPV) did not correlate with the ISSs (p > 0.05). The TNFα and IL6 levels were useful for determining the severity of injury, and the CRP level was elevated in all trauma patients but did not correlate with the ISS. The IL1β level was higher in the study group but did not increase as the ISS increased. IL6 and TNFα levels were higher in the study group and increased as the ISS increased. We found no significant difference between the trauma group and healthy individuals in terms of MPV values. IL6 and TNFα levels can be used to assess trauma severity. However, neither the MPV nor the CRP or IL1β level is useful for this purpose.

Hemostatic Efficacy of a Traditional Medicinal Plant Extract (Ankaferd Blood Stopper) in Bleeding Control

The aim of this study is to assess the in vivo hemostatic effect of Ankaferd Blood Stopper (ABS) on rats using a tail bleeding model. Wistar rats were randomized into 4 groups of 9 each: group 1, control, no pretreatment, irrigated with saline; group 2, no pretreatment, irrigated with ABS; group 3, control, heparin pretreatment, irrigated with saline; and group 4, heparin pretreatment, irrigated with ABS. To control bleeding, compressive dressings were placed after instilling 1 mL of either ABS or saline to the bleeding area. Without heparin pretreatment, ABS shortened hemostasis time by 1.57 minutes and reduced the amount of bleeding by 0.85 g. With heparin pretreatment, ABS shortened hemostasis time by 3.29 minutes and reduced the amount of bleeding by 1.32 g. The ABS was more effective than saline irrigation for treating tail tip bleeding in rats, with or without heparin pretreatment, while also using a compressive dressing.

Isolated Hyoid Bone Fracture due to Blunt Trauma: Case Report

Fractures of the hyoid bone are very rare. Diagnosis of hyoid fracture is difficult and can be made only with a strong degree of suspicion. We report a case of isolated hyoid bone fracture due to blunt trauma to the neck. A 26-year-old woman was admitted to emergency department for motor vehicle accident. She complained of dysphagia and anterior neck discomfort. Physical examination showed hyperemia and tenderness of neck. A tomographic scan of neck was performed. The findings demonstrated hyoid fracture. Patient was observed with medical therapy for 24 hours and discharged with recommendation of outpatient control.Emergency physician has to be aware of the possibility of hyoid fractures in blunt traumas. Patients with hyoid fracture should be observed for 24 hours. Generally, medical treatment is satisfactory in isolated hyoid fractures.

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.

Anisocoria due to Datura inoxia

We report a case of unilateral fixed dilated pupil induced by a Datura inoxia plant product. This report focus on a rare side effect due to Datura inoxia. These plant products may be the cause of fixed and unilateral dilated pupil.

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.

Relationship between serum Pentraxin 3 and pro-adrenomedullin levels with acute cholecystitis

OBJECTIVES The perforation of the gallbladder (GP) is one of the most significant complications of acute cholecystitis. A biochemical marker indicating the GP has not been determined fully to date. Pentraxin 3 and pro-adrenomedullin (Pro-ADM) proteins are novel acute phase reactants. We aimed to investigate the relationship between serum Pentraxin 3 and Pro-ADM and the GP in patients with acute cholecystitis. METHODS This prospective cross-sectional study was conducted on patients with acute cholecystitis in a tertiary care emergency department during the six-month period. The acute cholecystitis patients were divided into two groups as with GP, and without GP. Additionally, patients with GP were evaluated according to pericholecystic fluid and gallbladder wall thickness. Serum levels of pro-ADM and pentraxin 3, WBC, CRP and sedimentation rate were measured in all patients. RESULTS A total of 60 patients with acute cholecystitis were included in the study. Pro-ADM and pentraxin 3 levels were significantly higher in patients with GP and the with pericholecystic free fluid (p < 0.0001). There was no significant relationship between serum pentraxin 3 and pro-ADM with gallbladder wall thickness (p > 0.05) According to the ROC analysis, serum Pentraxin 3 levels of ≥4.9 ng/mL could predict GP with a sensitivity of 75% and a specificity of 85% and serum pro-ADM levels of ≥97 nmol/L with sensitivity and specificity of 100% and 95%. CONCLUSION Our study results reveal that serum Pentraxin 3 and pro-ADM may be novel biochemical parameters in the detection of GP in acute cholecystitis cases.