Polat Durukan

Epidemiological features of irritable bowel syndrome in a Turkish urban society.

Background and Aim:  Irritable bowel syndrome (IBS) is a widespread functional bowel disorder and its prevalence in Western societies ranges from 3‐20%. The present study aimed to determine the prevalence of IBS in eastern Turkey, particularly in urban parts of Elazig where 250 000 people live.

Syncope Associated with Carbon Monoxide Poisoning due to Narghile Smoking

Narghile smoking is a traditional method of tobacco use, and it has been practiced extensively for 400 years. Traditionally, narghile smoking is a matter of culture mainly in Middle East, Asia, and Africa. In recent years, its use as a social activity has increased worldwide, especially among young people. Narghile smoking is an unusual cause of carbon monoxide poisoning. Narghile smoking, compared to cigarette smoking, can result in more smoke exposure and greater levels of carbon monoxide. We present an acute syncope case of a 19-year-old male patient who had carbon monoxide poisoning after narghile smoking.

Traumatic floating clavicle

We report a case of traumatic floating clavicula in a man aged 21 years. He was admitted to our emergency department with polytrauma sustained in a motor car accident, successfully treated 21 days after the accident with bipolar open reduction and wire stabilization.

Effects of tirofiban on acute systemic inflammatory response in elective percutaneous coronary interventions

SUMMARY Objective: In this study the effect of a specific glycoprotein IIb/IIIa inhibitor, tirofiban [which also has antiplatelet activity on acute systemic inflammatory responses (IR) during elective percutaneous coronary intervention (PCI)] was evaluated. Patients and methods: Patients with stable angina pectoris and similar baseline characteristics who angiographically had a single lesion in their coronary arteries with a PCI performed on that lesion were enrolled in the study. One group of patients (control group, n = 52) received 0.9% NaCl (15 mL/h for 24h) and the other group (tirofiban group, n = 55) had tirofiban (10|ig/kg bolus infusion in 3min and 0.15jj,g/kg/mir for 24h) in addition to stenting without pre-dilatation. The effect of interventional procedure on levels of cardiac troponin T (cTnT) and several parameters of acute IR (leukocytes, fibrinogen, C-reactive protein, interleukin-1, interleukin-6, interleukin-8 and tumor necrotizing factor-α) was assessed on blood samples obtained from all patients before PCI and at pre-specified time points after PCI. Results: During the follow-up after PCI, the number of patients becoming cTnT-positive (> 0.1 ng/mL) was greater in the control group [12 (23%) patients vs. 3 (5%) patients, p = 0.01]. However, both groups had changes (generally observed as elevations) in their levels of all inflammatory parameters during the study and C-reactive protein, interleukin-6 and tumor necrotizing factor-α levels were elevated significantly. Yet, no significant difference occurred between groups due to these changes in any phase of the study (p > 0.05). Conclusions: Based on the findings of this study, it was concluded that although tirofiban limits development of myocardial necrosis during elective PCI, it does not directly affect the acute systemic inflammatory responses.

Contrast-induced nephropathy risk due to emergency contrast-enhanced computed tomography.

Objective In this study, we aimed to compare serum creatinine, blood urea, and glomerular filtration rate (GFR) levels of patients at baseline and 48 h after the administration of radiocontrast agent in the emergency department. Method We prospectively enrolled 114 patients who underwent contrast-enhanced computed tomography scan and had a baseline creatinine level of 1.5 mg/dl or less. Serum creatinine and blood urea levels were measured at baseline and 48 h after the administration of radiocontrast agent. GFR and Mehran risk score were calculated at baseline and 48 h after the administration of radiocontrast agent. Results Baseline mean serum creatinine was 1.03±0.25 mg/dl. Forty-eight hours after the administration of radiocontrast agent, mean serum creatinine was 1.04±0.31 mg/dl, baseline mean blood urea was 8.14±4.04 mmol/l, mean blood urea was 8.42±4.42 mmol/l, baseline mean GFR was 76.74±27.08 ml/min, and mean GFR was 77.21±27.92 ml/min. There were no significant differences between baseline and 48 h after the administration of radiocontrast agent serum creatinine, blood urea levels, and GFR (P>0.05). Conclusion There was no statistically significant difference between basal and 48 h after the administration of radiocontrast agent serum creatinine and GFR levels of patients who were enrolled in this study. Results had shown that administration of intravenous radiocontrast agent (⩽100 ml) for emergency imaging in the emergency department did not produce a risk for contrast-induced nephropathy in patients with serum creatinine levels of 1.5 mg/dl or less.

Importance of Neutrophil Gelatinase-Associated Lipocalin in Differential Diagnosis of Acute and Chronic Renal Failure

Background: Neutrophil Gelatinase-associated Lipocalin (NGAL) protein is easily detected in the blood and urine soon after acute renal injury. NGAL gains features of an early, sensitive and noninvasive biomarker for acute renal injury. Recent evidences suggest that its expression is also increased in CRF reflecting the severity of disease. Objectives: In the present study, we aimed to investigate whether blood NGAL level plays a role in the differential diagnosis of acute and chronic renal failure. Patients and Methods: This was a prospective case-control study. Fifty patients presented to emergency department with acute renal failure (ARF), 30 with chronic renal failure (CRF) and 20 healthy individuals as control group were included in this study. Blood pH, HCO3-, BUN, creatinine and potassium values were evaluated in all patients. Blood NGAL values were evaluated in all groups. BUN, serum creatinine and NGAL values were statistically compared between patients and controls. Results: Median NGAL levels in patients was 304.50 (29), and 60 (0) in control, which was statistically significant between the two groups (Z = -6.477, P < 0.001). The median NGAL values were 261.50 ± 291 in ARF group and 428.50 ± 294 in CRF group. There was a significant difference in NGAL level between ARF and CRF groups (Z = -2.52, P = 0.012). Median BUN values were 153.46 ± 82.47 in ARF group and 169.40 ± 93.94 in CRF group. There was no significant difference in BUN value between ARF and CRF groups (P > 0.05). Median creatinine values were 2.84 ± 2.95 in ARF group and 4.78 ± 4.32 in CRF group. In serum creatinine values, a significant difference was found between ARF and CRF groups (P < 0.05). Conclusions: Serum NGAL levels of ARF and CRF patients were significantly higher than healthy individuals. In addition, NGAL values of patients with CRF were significantly higher than those of ARF. Serum NGAL values can be used to detect renal injury and differentiate ARF and CRF.

A rare entity in ED: posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome is a clinico-neuroradiologic entity with typical symptoms and symmetric high-signal intensity lesions in the bilateral parietooccipital lobes on T2-weighted or fluid-attenuated inversion recovery magnetic resonance imaging. In this presentation, we report a case of posterior reversible encephalopathy syndrome who was admitted to our emergency department because of seizure and deterioration of consciousness. The aim of this presentation is to alert the emergency physicians about one of the hypertensive emergencies with neurologic symptoms associated with hypertension.

GASTROİNTESTİNAL SİSTEM KANAMALI HASTALARDA ŞOK İNDEKSİ VE HEMATOKRİT DÜZEYLERİNİN MORTALİTE ÜZERİNE ETKİSİ

Giris ve Amac : Şok indeksi ve hematokrit duzeyinin gastrointestinal sistem kanamali hastalarda mortalite uzerine etkisinin arastirilmasi. Gerec ve Yontem: Calisma 01.01.2013-30.09.2015 tarihleri arasinda acil servise gastrointestinal sistem kanama semptomlari ile basvuran, endoskopik yontemler ile tanisi konulan hastalarin dosyalari ve laboratuvar sonuclari geriye donuk degerlendirilerek yapilmistir. Dosya degerlendirilmesi sonucu acil servise basvuru anindaki vital bulgulari, ilk alinan kan tahlillerinin sonuclari, yapilan endoskopik islemlerin sonuclari ve hastanin yatis ve taburculugu degerlendirilmeye alinmistir. Calisma icin 709 hasta belirlenip 266 hasta uygun bulunmustur ve dosya taramasi sonucu, dosyalarina eksiksiz ulasilan 150 hasta calismaya dâhil edilmistir. Bulgular : Calismada 150 hastanin 94’u erkek olarak bulunmustur. 65 yas ve ustu olanlarin toplam hasta sayisinin yarisina tekabul ettigi gorulmustur. En sik sikâyet kanli kusma ve siyah diskilama bulunmustur. Hastalarin mortalite oranina bakildiginda %25 olarak hesaplanmistir. Hastalarin basvuru vitalleri degerlendirilmesi sonucu sok indeksinin mortalite uzerine etkisinin olmadigi bulunmustur (p>0,05). Ilk alinan kan numuneleri sonucuna gore hematokrit degerlerlerinin mortalitenin ongorulmesinde yetersiz oldugu saptanmistir (p>0,05). Sonuc: Şok indeksi ve hematokrit duzeyini mortaliteyi on gormede yetersiz kaldigi, baska verilerle desteklenmesi gerektigi sonucu ulasilmistir.

Nargile İçimi Sonrası Gelişen Karbon Monoksit İntoksikasyonu: İki Vaka Sunumu

Nargile son 400 yilda ozellikle yaslilar tarafindan, 1980’lerden sonra da gencler tarafindan yaygin olarak kullanilmistir. Nargile icicilerinde karbonmonoksit (CO) intoksikasyonu nadir izlenir. Bu sunumda, 21 ve 20 yaslarinda olan ve nargile icimi sonrasinda CO intoksikasyonu sonucu bayilma ile gelen iki kadin hasta irdelenmistir. Acil servise baygin halde getirilen hastalarin karboksihemoglobin seviyeleri sirasiyla 26.5 ve 21,4 olarak olculmustur. Nargile kullanimi son yillarda, ozellikle genc populasyonda artmistir. Bu artisa bagli olarak, halsizlik, yorgunluk, bayilma gibi nonspesifik sikayetler ile CO intoksikasyonu orani da artmaktadir. Acil servise basvuran nonspesifik sikayetleri olan ozellikle genc hastalarda nargile kullanimi/maruziyeti derinlemesine sorgulanmali ve bu konuda uyanik olunmalidir.

Comparison of Different Suture Techniques

Aim: Traumas are frequent causes of presentation to emergency departments. Suturing is usually required in treatment of patients with scalp laceration. This study aimed to investigate different suture methods with respect of patient satisfaction, wound healing, and treatment cost in patients with scalp laceration. Material and Method: A total of 60 patients were included in the study. The patients were divided into 3 groups; traditional suturing (Group 1), stapling (Group 2), and the tissue adhesive (Group 3) groups. ChiSquare and Kruskal-Wallis tests were used for comparison of the groups. A p value less than 0.05 was considered statistically significant. Results: Twothirds of the patients were male. The patient satisfaction was highest in the Group 3 (p<0.05). Tissue adhesive group had the lowest treatment cost (p<0.05).Discussion: In contrast to existing traditional belief, the alternative suture methods, i.e. tissue adhesives and staples are not expensive. The patient satisfaction was highest in the tissue adhesive group.