Yavuz Katirci

Neuropsychiatric disorders and risk factors in carbon monoxide intoxication

Neuropsychiatric sequelae may be observed in the late phases of carbon monoxide (CO) intoxication. Establishing a link between CO-related neuropsychiatric disorders and associated risk factors may decrease morbidity and mortality by means of appropriate treatment and counseling. The aim of the present study was to determine the relationship between neuropsychiatric outcomes of CO intoxication and demographic and clinical variables. Thirty patients who presented with CO intoxication and had no known neuropsychiatric disease, and 30 healthy controls were included. Physical examinations and laboratory tests were performed. Following the 1st therapy, they underwent mental and psychiatric tests 5 times (the time of discharge, during the 1st week, and during the 1st, 3rd, and 6th months). They underwent cerebral magnetic resonance imaging (MRI) at the end of the 1st month. They were evaluated by cognitive function tests at the 6th month. Lesions relevant to CO intoxication were detected in 46.7% of the patients via cranial computed tomography and in 13.3% via MRI. Evaluation of psychiatric tests revealed a clear decrease in cognitive functions, such as immediate memory, learning, reaching the criterion, spontaneous recall, attention, visual memory, and logical memory. It was found that the patients had anxiety within the 1st month, and the frequency of anxiety reached to the value of the control group by the end of the 6th month. In conclusion, we suggested that CO intoxication might lead to neuropsychiatric disorders. Our results emphasized that in addition to standard treatment, neuropsychiatric evaluation should also be performed in patients with CO intoxication.

Comparison of success and pain levels of supination-flexion and hyperpronation maneuvers in childhood nursemaid's elbow cases.

OBJECTIVE The aim of this study was to compare the hyperpronation (HP) and the supination-flexion (SF) reduction techniques for reducing nursemaids elbow in terms of efficacy and pain. METHODS This prospective, pseudorandomized, controlled, nonblinded study was conducted in an urban tertiary care emergency department between October 1, 2009, and October 1, 2010. A total of 150 patients (51 males [34%] and 99 females [66%] between the ages of 0 to 6 years) were included in the study. When the first reduction attempt failed, second attempt was performed using the same technique. After failure of the second attempt, reduction technique was changed to an alternate technique. Level of pain was evaluated using the Modified Childrens Hospital of Eastern Ontario Pain Scale in 113 patients older than 1 year who had a successful reduction process on the first attempt. RESULTS Successful reduction was accomplished in 121 (80.7%) of the patients during the first attempt, in 56 (68.3%) of the patients using the SF technique and in 65 (95.6%) of the patients using the HP technique (P < .001). At the end of total attempts, we found that the SF (59/84) technique was less successful than the HP (91/93) technique (P < .001). The pain levels of the both techniques were not statistically different. CONCLUSION The HP technique was found to be more successful compared with the SF technique in achieving reduction. We were unable to find any significant difference in pain levels observed between the 2 techniques.

Amitraz: an unusual aetiology of Ogilvie's syndrome

Amitraz is an insecticide/acaricide of formamidine pesticides used worldwide for ectoparasites in animals. Because of its widespread use, amitraz poisoning is frequently encountered in Turkey. Case report: A 36-year-old, comatose female was admitted to the hospital. Although it was stated that she had taken a glass of water containing amitraz, the exact volume of the substance was unknown. On admission, her Glasgow Coma Scale score was 10/15. Clinical findings were vomiting, miosis, bradycardia and hypotension. The patients vital signs were body temperature 37.28C, pulse 54 bpm, blood pressure 80/50 mmHg and pulse-oximetry 84%. Supportive treatment consisting of oxygen, fluid replacement and gastric lavage, activated charcoal and atropine was administered. On the second day, signs of Ogilvies syndrome characterized by severe tenderness, distension and pain in the abdomen were seen. On the third day, the patients condition improved except for abdominal distension and pain, inability to pass faeces or flatus through the anus. Although continuous nasogastric tube decompression was performed, her complaints were not resolved completely. Neostigmine was administered on the fourth day. On the fifth day, abdominal pain and distension were decreased, and stool passage began. She had a complete clinical and laboratory improvement, which warranted her discharge on the seventh day of admission.

The effects of spinal immobilization at 20° on intracranial pressure

OBJECTIVE In this study, it was aimed to evaluate whether spinal immobilization at 20°, instead of the traditional 0°, affects intracranial pressure (ICP) via the ultrasonographic (USG) measurement of optic nerve sheath diameter (ONSD). METHODS 140 healthy, adult, non-smoking volunteers who had no acute or chronic diseases were included this study. Volunteers were randomly divided into two groups; performed spinal immobilization at 0° (Group 1) and at 20° (Group 2). After spinal immobilization (at 0 or 20°), measurements of ONSD were performed at 0, 30, and 60 min in an immobilized position. RESULTS When evaluating the change in ONSD over time (at 30 and 60 min) as compared to basal measurements at 0 min, it was found that the ONSD values of both sides (the right and left eyes) were significantly increased in Group 1 and Group 2. For Groups 1 and 2, these differences existed both between 0 and 30 min and between 30 and 60 min. In addition, in this study, the amounts of increase in the ONSD measurements from 0 to 30 min and from 30 to 60 min (ΔONSD0-30 min and ΔONSD30-60 min) in both groups were compared. The results showed that there was no significant difference between Group 1 and Group 2 in terms of ΔONSD measurements. CONCLUSIONS Spinal immobilization at 0° as a part of routine trauma management increased ONSD and thus ICP. Secondly, we found that similar to immobilization at 0°, spinal immobilization at 20° increased ONSD.

Effects of erdosteine on alpha amanitin-induced hepatotoxicity in mice

Abstract The aim of this study was to investigate beneficial effects of erdosteine in the alpha amanitine-induced hepatotoxicity in mice. Three hours after giving alpha amanitin (0.5 mg/kg, i.p.) to the mice, they were administered silibinin (50 mg/kg/d, i.p.) or erdosteine (100 mg/kg/d, oral) therapies once a day for 3 d. A histopathological examination of their liver tissues was carried out 24 h after the last treatment; transaminase levels, blood urea nitrogen, urea, and creatinine were analyzed in serum. Erdosteine showed a beneficial effect by significantly improving the functional parameters particularly in alpha amanitin-induced hepatotoxicity and partially in renal toxicity. In the histopathological evaluation, the toxicity that was generated with alpha amanitin was significantly reduced by erdosteine, showing a possible hepatoprotective effect.

Patients admitted to emergency units with injuries related to the four Hajj-associated annual animal sacrifice feasts from 2010 to 2013.

BACKGROUND During the Eid al-Adha (“Sacrifice Feast”) religious holiday in Muslim communities animal sacrifices are made over a period of 3 days every year. OBJECTIVES The aim of this study was to determine the type of sacrifice-related injuries, the characteristics of patients, treatments for injuries, and relationships between these factors to determine precautions that could be taken to avoid or mitigate sacrifice-related injuries. DESIGN Retrospective study of medical records. SETTING Emergency units at two hospitals from 2010 to 2013. PATIENTS AND METHODS Patients admitted for treatment for injuries associated with sacrificial cutting during the four annual sacrifice feasts were classified as professional butchers, apprentice butchers, and third persons who were neither professional butchers nor apprentices. MAIN OUTOME MEASRE(S) Injuries associated with animal sacrifice. RESULTS Of 592 patients, 22 (3.7%) were professional butchers, 149 (25.2%) apprentice butchers, and 421 (71.1%) third persons. Significant relationships were found between the profession of the injured person and the injury and subsequent treatment (P<.05). CONCLUSION To prevent and minimize the injuries associated with sacrificial cutting, there should be an area designated for sacrificing animals. Moreover, sacrifices should be performed by professionals in possession of a sacrificial cutting certificate. If owners of sacrificial animals insist on slaughtering animals, they should be trained by professional butchers who have a teaching certificate. To deal with an increasing number of such injuries during the sacrifice feast, hospital emergency units need to be adequately resourced with adequate equipment and staff. LIMITATIONS Regional and local data could not be assessed completely. Patients who presented on the 4th day were not included in the study.

Acil Servise Başvuran Doğurganlık Yaş Grubu Kadınlardan İstenilen β-HCG Testinin Pozitifliğinin Araştırılması

Amac: Bu calismayla acil servise basvuran dogurganlik yas grubu (15-49 yas) kadinlardan istenilen β-HCG testinin pozitifliginin arastirilmasi amaclanmistir. Gerec ve Yontem: Arastirmanin orneklemini 01-30.04.2014 tarihleri arasinda herhangi bir hastalik nedeniyle Ankara Egitim ve Arastirma Hastanesi Acil Tip Klinigi Eriskin Acil Servisine basvuran, gebe olmayan ve tetkikleri icerisinde β-HCG istemi olan 15-49 yas arasindaki tum kadinlar olusturmustur. Calisma retrospektif tipte bir arastirmadir. Veri kaynagi olarak olgularin yas, saglik guvencesi, tani, tedavi sonucu ve β-HCG sonucunun yer aldigi onceden hazirlanan veri formu kullanilmistir. Bulgular SPSS 15.0 programi kullanilarak degerlendirilmistir. Bulgular: Arastirmamizda olgularin %46.8’inin 20-29 yas araliginda bulundugu, %95.8’inin saglik guvencesinin bulundugu, %98.6’sinin dahili sikayetlerle basvurdugu, %53.5’inin karin agrisi on tanisiyla tedavi edildigi ve %94’unun taburcu oldugu saptanmistir. Acil servise bir ay icerisinde basvuran dogurganlik cagindaki toplam 8208 kadin hastanin %11.6’sindan β-HCG tetkiki istenmis ve bunlarin sadece %4.6’sinin pozitif olarak sonuclandigi belirlenmistir. Sonuc: β-HCG’nin acil servislerde daha secici hasta gruplarinda kullanilabilmesi ve maliyetin azaltilabilmesi icin; fizik muayeneden elde edilecek bulgular ile ayrintili ve etkin anamnez alinmasinin bu istem sayisinin azalmasina yapabilecegi katkinin daha genis katilimli prospektif calismalarla degerlendirilmesi gerektigi dusunulmektedir. Anahtar Kelimeler: Acil Servis, anamnez, kadin, karin agrisi, β-HCG

Anaphylaxis after intravenous infusion of dexketoprofen trometamol.

Dexketoprofen trometamol (DT), a nonsteroidal anti-inflammatory drug, is a highly water-soluble salt and active enantiomer of rac-ketoprofen. Its parenteral form is commonly used for acute pain management in emergency departments of our country. Side effects such as diarrhea, indigestion, nausea, stomach pain, and vomiting may be seen after the use of DT. Anaphylactic shock (AS) secondary to infusion of DT is very rare and, to our knowledge, it is the first case report describing this side effect. This case report was presented to emphasize that AS may be seen after the use of DT.