Murat Orak

Falls from flat-roofed houses: a surgical experience of 1643 patients

PURPOSE High falls from flat-roofed houses are a common cause of death and disability in the south-east part of Turkey; the aim of this study was to describe our experience of such falls seen over a 4-year period in Diyarbakir. METHODS One thousand six hundred and forty-three patients (570 females and 1073 males) who sustained injuries after an accidental fall from a flat-roofed house were entered into the study. RESULTS The mean age was 18 (1-95) years; 49.4% of patients were under 10 years old; 81.5% were under 30 years old. The mean fall height was 4.5m (1-20 m). The mortality rate was 5.8% (96 patients). The mean fall height in children under the age of 15 years who died from the fall was 4m (67 patients) and in patients over the age of 15 years, 9m (29 patients). The most common injuries were to the head (45.1%) and 93.75% of those (n = 90) who died had a head injury. One hundred patients (6%) were followed because of abdominal bleeding: one of these had fallen from 2m, the reminder from 4 to 9 m; 12 were operated on and 88 treated conservatively. CONCLUSION Craniocerebral trauma is the most common injury in fatal falls from flat roofs and blunt abdominal trauma is an uncommon injury after falling from less than 4m.

Trauma Scores and Neuron-Specific Enolase, Cytokine and C-Reactive Protein Levels as Predictors of Mortality in Patients with Blunt Head Trauma

This study evaluated serum neuron-specific enolase (NSE), cytokine and high-sensitivity C-reactive-protein (hs-CRP) levels, along with the Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS), as predictors of mortality in the early post-traumatic period, in 100 Turkish patients with blunt head trauma. Overall patient mortality was 27%. There was a significant association between age and mortality, and mortality was negatively correlated with GCS and RTS. Head injury severity (GCS) was significantly related to NSE, hs-CRP, interleukin (IL)-6, IL-8 and tumour necrosis factor (TNF)-α levels. Mortality correlated positively with IL-6, IL-8, TNF-α and hs-CRP levels. NSE, hs-CRP, IL-6, IL-8 and TNF-α levels were significantly higher in non-survivors compared with survivors. GCS score ≤ 8, younger age and NSE levels were significant independent predictors of mortality. During the early post-traumatic period, NSE may be an objective alternative criterion to the GCS, in the management of patients with blunt head trauma.

The Role of Serum Osteoprotegerin and S-100 Protein Levels in Patients with Acute Ischaemic Stroke: Determination of Stroke Subtype, Severity and Mortality

This study investigated correlations between mortality, stroke subtype and stroke severity with serum osteoprotegerin (OPG) and S-100 protein levels prior to the treatment of patients admitted to the emergency department and diagnosed with ischaemic stroke. Pretreatment serum samples were collected from patients (n = 90) to determine OPG and S-100 protein levels. Age- and sex-matched healthy individuals (n = 16) served as controls. Compared with controls, OPG and S-100 protein levels were significantly higher in the cardioembolic and atherothrombotic stroke groups. Within the stroke group, OPG levels were significantly higher in the cardioembolic and atherothrombotic stroke groups compared with the transient ischaemic attack (TIA) group. S-100 protein levels were significantly higher in the atherothrombotic stroke group than in the lacunar stroke and TIA groups, and in the cardioembolic stroke group compared with the lacunar stroke group. Serum OPG and S-100 protein levels were significantly higher in patients who died compared with survivors. In predicting stroke subtype and severity, although both OPG and S-100 protein levels were indicators, S-100 protein was more valuable for mortality prediction.

Comparative diagnostic accuracy of serum levels of neutrophil activating peptide-2 and pentraxin-3 versus troponin-I in acute coronary syndrome.

OBJECTIVE We measured the levels of neutrophil activating peptide-2 (NAP-2) and pentraxin-3 (PTX-3) in acute coronary syndromes (ACS) patients and compared their diagnostic accuracy with cardiac troponin I (cTnI). METHODS We conducted a prospective cohort study to determine the diagnostic accuracy of PTX-3, NAP-2 and cTnI for the prediction of ACS. Consecutively eighty-three patients with sudden chest pain admitted to Dicle University Emergency Department within the first six hours of symptom onset were included in our study. Mean serum levels of PTX-3, NAP-2 and cTnI were compared between control and patient groups and ACS subgroups. Their sensitivities and specificities in early diagnosis of ACS were identified. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic validity of the markers, and areas under the ROC curve (AUC) were compared. RESULTS In the patient group, mean serum concentrations of NAP-2 (53.03+22.77 ng/ml) and PTX-3 (1.73+0.82 ng/ml) were considerably higher than those of the control group (24.54+9.50 and 0.50+0.39 ng/ml, respectively) (p<0.01). When compared with the control group, PTX-3 levels of all three ACS subtypes (unstable angina pectoris (USAP) - 1.62+0.41 ng/ml, non-ST elevation myocardial infarction (NSTEMI) -1.63+0.31 ng/ml and ST-elevation myocardial infarction (STEMI) - 1.75+0.89 ng/ml) were higher, whereas NAP-2 levels were higher in USAP (56.29+22.60 ng/ml) and STEMI (52.05+20.99 ng/ml) patients (p<0.01). For diagnosing ACS within the first six hours of presentation, PTX-3 sensitivity was 98.5% and specificity was 92.3%, and NAP-2 sensitivity - 98.1% and specificity - 41.3%. The ROC curve AUC values were: 0.962 for PTX-3 (95% CI 0.802 - 1.073), 0.840 for NAP-2 (95% CI 0.684 - 0.991), and 0.683 for cTnI (95% CI 0.610 - 0.940). CONCLUSION Pentraxin-3 is a sensitive and specific marker for ACS diagnosis when compared with cardiac markers in patients admitted to the emergency department (ED) within the first six hours of onset of chest pain.

Analysis of amitriptyline overdose in emergency medicine

Introduction Amitriptyline is a tricyclic antidepressant. In general, toxicity effects develop within 30 min of overdose and peak from 2 h to 6 h. Anticholinergic effects predominate in cases of low dose ingestion. In cases of high dose ingestion, marked depression of the central nervous system is coupled with cardiotoxicity, seizures and hypotension. Patients and methods Amitriptyline-intoxicated patients admitted to the emergency department (ED) of Dicle University Hospital were evaluated between January 2005 and April 2007. Social and demographic status, clinical and laboratory findings, treatments and outcomes were recorded. Age, sex, marital status, time of hospital admission, consciousness levels, ECG findings, requirement for respiratory support, follow-up periods and antidepressant overdose risk assessment (ADORA) criteria were analysed using SPSS software. Results A total of 110 cases of overdose by amitriptyline was evaluated. Suicide attempts by amitriptyline overdose in adult single women were the commonest finding. The commonest symptoms seen during initial examinations were sinus tachycardia (66.3%), altered mental state (78.1%) and hypotension (7.3%). Mechanical ventilatory support was required in 9.1% of cases. Most patients (n=76, 69.1%) were treated in the ED (p=0.001). 60 (54.5%) patients were discharged from the ED within 24 h after admission (p<0.0001). Conclusion Most of the patients were young single women. Altered mental state and tachycardia were the commonest symptoms. The initial symptoms of amytriptyline overdose patients may be life threatening, but effective supportive treatments were helpful. There was high correlation between ADORA criteria and the dose ingested.

The role of the heart-type fatty acid binding protein in the early diagnosis of acute coronary syndrome and its comparison with troponin I and creatine kinase-MB isoform.

OBJECTIVES The aim of this study was to research the effectiveness of the heart-type fatty acid binding protein (H-FABP) in the early diagnosis of acute coronary syndrome (ACS) in patients admitted to emergency service (ES) within 6 hours of onset of chest pain. EQUIPMENT AND METHOD: A total of 83 patients admitted with chest pain to our ES were included in this study. The patients were divided into 2 groups: those with a diagnosed ACS and those diagnosed with non-cardiac-related chest pain. Patients were also were divided into 2 groups according to the time of admission: those admitted within 0 to 3 hours and 3 to 6 hours of onset of chest pain. Peripheral venous blood samples were obtained from all patients for H-FABP, troponin I, and creatine kinase-MB (CK-MB) serum concentration measurements. RESULTS Of a total of 83 patients, 21.6% (n = 18) were in the control group and 78.3% (n = 65) were in the ACS group. The average H-FABP value for the patients in the control group was 0.86 ± 0.54 ng/mL. When the ACS and control groups were compared in means of cardiac markers for CK-MB (P = .000) and H-FABP (P = .000), there was a statistically significant difference, whereas no difference was observed for troponin I (P = .013). In the ACS group, H-FABP sensitivity for diagnosis was found to be 98% and specificity was 71%; CK-MB sensitivity was 86% and specificity was 52%; and troponin I sensitivity was 77% and specificity was 20%. CONCLUSIONS For patients admitted with chest pain to ES, H-FABP was found to be more sensitive and specific than troponin I and CK-MB in the early diagnosis of ACS.

Mortality and morbidity in children caused by falling televisions: a retrospective analysis of 71 cases.

ObjectivesTo quantify injuries in children that result from toppled televisions.MethodsChildren presenting directly to emergency department due to injuries caused by falling televisions were identified from our digital patient database, and a retrospective chart review of 71 children was performed. Descriptive statistics were applied.Results71(1.8%) out of 3856 admissions due to injuries sustained at home were TV-related injuries. There were 50 (70.4%) boys and 21(29.6%) girls. Mean age was 39.79 ± 20.14 SD months. Almost three quarters of the children (49/71) sustained various head and facial injuries. There was traumatic brain injury in 14 patients, extremity injuries in 30 patients, thoracic injuries in 13 patients and abdominal injuries in ten patients. 16 patients were hospitalized. 14 of them required follow-up in intensive care unit. Two patients (one with epidural hematoma and one with subdural hematoma) underwent surgical intervention. Four patients with subarachnoid bleeding died. The mean length of hospital stay was 71.25 hours (range, 48-168) in hospitalised patients. The overall mortality rate was 5.6%.ConclusionsFalling TVs may cause significant morbidity and mortality in children particularly those younger than 3 years old. Head and facial injuries are the most common body region involved and traumatic brain injury is the major cause of death.

The Role of Serum D-Dimer Level in the Diagnosis of Patients Admitted to the Emergency Department Complaining of Chest Pain

This study investigated D-dimer levels in 241 patients admitted to the emergency department with sudden-onset chest pain. The patient group included those diagnosed with acute coronary syndrome (ACS; i.e. unstable angina pectoris [USAP], non-ST elevated myocardial infarction [NSTEMI], ST-elevated myocardial infarction [STEMI]); the control group included those diagnosed with non-cardiac chest pain. Mean serum levels of D-dimer, creatine kinase-MB (CK-MB) and troponin I (TPI) were compared between the groups. Levels of D-dimer, CK-MB and TPI in the patient group were significantly higher than in the control group. There were also significantly higher D-dimer, CK-MB and TPI levels in the STEMI and NSTEMI patient subgroups compared with the control group. Only the D-dimer level was significantly higher in the USAP subgroup versus the control group. The sensitivity and specificity of D-dimer for ACS were 83.7% and 95.4%, respectively, suggesting that evaluating D-dimer levels might be useful in the emergency room for diagnosing ACS and predicting mortality in patients presenting with acute chest pain.

A case of neuroleptic malignant syndrome induced by olanzapine in postpartum period

Neuroleptic malignant syndrome (NMS) is a life-threatening medical complication that occurs as a result of dopaminergic receptor blockage in nigrostriatal pathways. This syndrome is mainly accepted to be an idiosyncratic reaction for antipsychotic medications. Incidence of NMS induced by olanzapine - an atypical antipsychotic - is extremely rare. However, there has been contradiction on postpartum period as a risk factor for NMS. This case is of interest due to the fact that it happens on postpartum period and is induced by olanzapine. We aimed in this study to evaluate the successfully cured case of neuroleptic malignant syndrome induced by olanzapine in postpartum period with the literature view.

Paroxysmal Atrial Fibrillation After Smokeless Tobacco (Maras Powder) Use

Use of cigarettes and smokeless tobacco is a considerable public health problem. In Turkey, a type of smokeless tobacco called Maras powder (MP) is widely used in the Southeastern region. We present a case of paroxysmal atrial fibrillation that was suspected to be caused by the use of MP, which has never previously been noted in the literature. A 46-year-old man was admitted to our emergency department with angina pectoris and palpitation. He was a long time cigarette smoker and had begun using MP the fortnight before. Electrocardiography showed atrial fibrillation with rapid ventricular response. The patient had no medical history of alcohol use, surgery, palpitation, coronary arterial illness, hypertension or chronic bronchitis. Atrial fibrillation was converted to sinus rhythm after antiarrhythmic medication. Our patient was discharged from the emergency department with a suggestion to quit MP usage immediately. In conclusion, the use of MP may lead to the occurrence of paroxysmal atrial fibrillation.