Nurettin Ozgur Dogan

Nontraumatic Massive Spontaneous Hemothorax with Concomitant Warfarin Use

Hemorrhagic complications due to warfarin use are frequently seen in emergency departments. However, nontraumatic massive hemothorax is an unexpected complication. We report a 59-year-old woman with warfarin overdose, who had massive hemothorax in right lung without any history of trauma. Her main complaint was significant dyspnea, which has gradually increased in three days. On her physical examination, she was tachypneic and had decreased lung sounds on her right hemithorax. She took warfarin regularly for aortic and mitral valve replacement for 18 years. Her INR level was 12.9 (0.8–1.2). Computed tomography of thorax revealed massive hemothorax with mediastinal shift. Fresh frozen plasma infusion was started immediately. Tube thoracostomy was performed for reexpansion of right lung and 2000 cc blood was drained in 5 minutes. Although hemorrhagic complications can be expected in warfarin therapy, thoracic hemorrhage related to warfarin therapy is relatively rare (3% of all hemorrhagic complications due to warfarin therapy). To our knowledge, massive hemothorax due to warfarin use is an extremely rare condition.

Herbal Weight Loss Pill Overdose: Sibutramine Hidden in Pepper Pill

Supposedly herbal weight loss pills are sold online and are widely used in the world. Some of these products are found to contain sibutramine by FDA and their sale is prohibited. We report a case of a female patient who presented to the emergency department after taking slimming pills. 17-year-old female patient presented to the emergency room with palpitations, dizziness, anxiety, and insomnia. She stated that she had taken 3 pills named La Jiao Shou Shen for slimming purposes during the day. Her vital signs revealed tachycardia. On her physical examination, she was restless, her oropharynx was dry, her pupils were mydriatic, and no other pathological findings were found. Sibutramine intoxication was suspected. She was given 5u2009mg IV diazepam for restlessness. After supportive therapy and observation in emergency department for 12 hours there were no complications and the patient was discharged home. Some herbal pills that are sold online for weight loss have sibutramine hidden as an active ingredient, and their sale is prohibited for this reason. For people who use herbal weight loss drugs, sibutramine excessive intake should be kept in mind at all times.

Delay in Diagnosis of Pulmonary Thromboembolism in Emergency Department Is it Still a Problem

Background and Aim: Pulmonary embolism (PE) is a common and serious disease that can result in death unless emergent diagnosis is made and treatment is initiated. In this study, we aimed to identify whether there is still a delay in the diagnosis of PE and to identify the time to delay in diagnosis and factors leading to this delay. Methods: This is a prospective observational cohort study performed in an emergency department (ED) of a tertiary care university hospital between September 2008 and September 2010. The rate and cause of delay in diagnosis were analyzed among patients with PE. The “delay” was defined as diagnosing after first 24 hours of symptom onset. Results: Among the 53 patients who were diagnosed with PE, a delay in diagnosis was present in 49 (93%) of them. Total delay time was 6.8 ± 7.7 days. In 33 (62%) patients, there was a delay of 4.6 ± 6.5 days due to patient-related factors. Delay in diagnosis after admission to hospital was 2.2 ± 2.9 days in 40 (75%) patients. In multivariate regression analysis, being female and having chest pain and cough were identified as significant factors causing patient-related delay. Unilateral leg edema, recent operation, and previous venous thromboembolism (VTE) history were the significant factors causing PE diagnosis without a delay. On the other hand, systemic hypertension as comorbidity was the only factor leading to physician-related delay. Conclusion: The delay in diagnosis of PE in EDs still remains as an important problem. While being female and having chest pain and cough are significantly and independently associated with patient delay in diagnosis, the unilateral leg edema, recent operation, and previous VTE history cause physicians to diagnose on time. On the other hand, having hypertension as comorbidity may lead to physician delay. In order to prevent the delay in diagnosis, hospital-associated factors must be elucidated totally and more interventions must be made to increase public and professional awareness of the disease.

Change in Complete Blood Count Parameters and Vital Signs After Intravenous Infusion of 1 Liter of Normal Saline

Aim: In patients with suspected acute hemorrhage in the emergency department, the first-line of treatment is intravenous fluid therapy. The most frequently used parameters to estimate the amount of hemorrhage and to plan the management are the vital signs, hemoglobin (Hb), and hematocrit (Hct) values. In this study, we aimed to define possible changes in the vital signs, Hb, and Hct values after intravenous infusion of 1 L normal saline in non-hemorrhagic patients to interpret the Hb and Hct values in hemorrhagic patients who receive the same treatment.

A New Packet Scheduling Algorithm for Real-Time Multimedia Streaming

Delivering the real-time services over converged networks is a big challenge. Real-time services need to high Quality of Service (QoS). For this purpose, bandwidth reservation and packet prioritization techniques are used. Thus, real-time data packets can be reached to their targets with minimum delays and losses.xa0 But, this situation creates unintended consequences for other internet services such as HTTP and FTP. In this case, establishing a balance between the real-time services and the other services is a must. In this study we introduce a new research question: how to transport real-time multimedia IP packets just in time? Just in time means that transportation of the packets neither early, nor late. For this purpose we developed a scheduling/prioritizing algorithm called just in time transport (JITT). Following a cross-layer design approach, JITT controls delay and jitter over whole communication path. We evaluated JITT on the different simulations and one experimental testbed for performance analysis. Our findings support that JITT provides stable delay and low jitter and transports the packets nearly just in time.

The Role of Atypical Antipsychotics in Neuroleptic Malignant Syndrome: Report of Two Cases and Review of the Literature

Introduction: Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal reaction to an antipsychotic drug. The main features of NMS are muscle rigidity and hyperthermia that may be accompanied by other extrapyramidal effects, autonomic instability, and mental status changes. NMS is thought to occur more frequently with typical antipsychotics than with atypical or low-potency antipsychotics. Case Report: Two cases with NMS were reported in this manuscript, which were previously treated with quetiapine and clozapine regimens for schizophrenia and acute psychosis. Both of the cases had prominent fever and muscular rigidity. One of the patients presented with syncope to the emergency department; the other patient had significant alterations in mental status. Differential diagnosis with other infectious and neurological diseases, including stroke and meningitis, was conducted. Both of the cases survived with standard supportive care, and none of them required dantrolene. Conclusion: Due to the widespread use of atypical agents in treatment regimens, the syndrome tends to occur with atypical antipsychotic drugs much more often.

Cerebral Venous Sinus Thrombosis Presenting with Seizure in Pregnancy

Introduction: Cerebral venous sinus thrombosis is a rare condition. The most frequent symptoms and signs are headache, focal seizures with or without secondary generalization, unilateral or bilateral paresis, and papilledema. We report a case of left transverse sinus and sigmoid sinus thrombosis that presented with seizure in a pregnant woman. Case Report: A 31-year-old woman at 33 weeks of pregnancy was admitted with sudden onset of seizure to the emergency department. The magnetic resonance scan of her brain showed the presence of a cortical-subcortical infarction in the cerebellar hemisphere, and magnetic resonance venography ultimately revealed left transverse sinus and sigmoid sinus thrombosis. The patient was treated with phenytoin and enoxaparin; the fetus was delivered after an urgent cesarean section. Conclusion: In pregnant women presenting with seizure, cerebral venous sinus thrombosis should be also considered in the differential diagnosis.

Using one-way-delay as QOS routing metric in Mobile Ad Hoc Networks

The main metric that is used in the computer networks to packet forwarding is “shortest path”. The shortest path is decided according to some other sub metrics. In wired networks these metrics can be more complex. Generally, in Mobile Ad Hoc Networks (MANETs) simpler metrics are used such as hop count. In this study we suggest a new routing metric for MANETs: one-way-delay (OWD). Simulation results showed that OWD can be used alone as a routing metric and with other metrics.

Van earthquake: development of emergency medicine in a country

Turkey experienced a destructive earthquake with a magnitude of 7.2 near the city of Van on 23 October 2011. The earthquake caused significant mortality and morbidity with a large number of homeless and jobless people. According to official records, 644 people died and 252 people survived from the wreckage.1 However, the destructive effect of the earthquake was greater than expected for two reasons: (1) Seasonal and local characteristics of Van complicated appropriate transport of relief to the region. (2) Public buildings, including hospitals and other health centres, were destroyed or seriously damaged.nnIn Turkey, emergency medicine was declared as a new specialty in 1993. Since that year, the emergency viewpoint has been raised in many emergency departments and prehospital settings. Turkey is one of the countries in which natural disasters such as earthquakes or floods commonly occur. For example, …