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Methyl alcohol intoxication causes severe morbidity and mortality, especially in developing countries. Formic acid is formed as a result of methanol metabolism. Formic acid accumulation and inhibition of adenosine triphosphate synthesis result in ophthalmic issues. This study aimed to demonstrate that the optic nerve sheath diameter (ONSD) measurement is an accurate prognostic marker and can be helpful in the diagnosis of methanol intoxication. This prospective study was conducted with 52 patients who were admitted to the emergency department after alcohol consumption and agreed to participate in the study. Age, gender, comorbid diseases, vital signs, ONSD ultrasonography measurements, hospitalization and discharge status, in-hospital mortality status, dialysis need, presence of visual impairment, blood gas parameters, respiratory status, time since alcohol intake, ethanol levels, urea levels, and creatinine levels were analyzed. ROC curve analysis was performed to evaluate the predictive power of ONSD to diagnose methanol intoxication. The area under the curve was 0.857 for the cut-off value of 5.05 mm (95 % CI: 0.728–0.985; p < 0.001), with a sensitivity of 80.8 % and a specificity of 100 %. In the regression analysis performed to determine the prognostic value of the parameters in estimating mortality in methanol intoxication cases, an increase in ONSD (OR: 3.619; 95 % CI: 0.057–0.199; p = 0.001), an increase in lactate levels (OR: 5.653; 95 % CI: 0.040–0.085; p < 0.001), and increased duration after alcohol intake (OR: 2558; 95 % CI: 0.004–0.034; p = 0.014) were identified as independent predictors of mortality, but pH, HCO3, and base deficit levels were not significant predictors. We believe that ONSD can be helpful for the differential diagnosis and prognosis of patients with suspected methanol toxicity who presented with alcohol intake. •As a result of our study, it was observed that ONSD increased in cases of methanol intoxication, but there was no increase in ONSD in patients who took ethyl alcohol.•ONSD can be used in the differential diagnosis of cases with suspected methanol intoxication due to alcohol intake.•We think that ONSD can be used to predict the prognosis of cases with suspected methanol intoxication and admitted due to alcohol consumption.

Background The rapid aging of global populations necessitates evidence-based optimization of emergency medical services for elderly patients. This study evaluates helicopter emergency medical services (HEMS) utilization patterns, clinical outcomes, and disease distribution in elderly patients transported to a metropolitan tertiary care facility. Methods Prospective observational study of 119 elderly patients (≥ 65 years) transported via HEMS to Istanbul Başakşehir Çam and Sakura City Hospital between January 2021 and January 2023. Data analysis included disease distribution, transport performance metrics, seasonal variation, and clinical outcomes using descriptive statistics and inferential testing. Results Mean patient age was 74.2 ± 8.4 years. Stroke (30.3%) and cardiovascular conditions (47.1%) represented predominant diagnoses. Mean total transport time was 31.1 min (95% CI: 28.3–33.9). In-hospital mortality was 4.2% (95% CI: 1.4–9.5%), with 28.6% requiring intensive care unit (ICU) admission. Significant seasonal variation occurred ( p  < 0.001, η²=0.42), with 74.8% of cases during spring-summer months. Geographic analysis revealed disparities with 73.1% of patients originating from Çatalca region. Conclusions HEMS represents an essential component of elderly emergency care with favorable clinical outcomes. Age-stratified disease patterns support development of specialized geriatric protocols. Significant seasonal variation and geographic disparities necessitate dynamic resource allocation and policy consideration for equitable HEMS accessibility.

HELLP (hemolysis, elevated liver enzyme levels, low platelet counts)-syndrome is a rare but dramatic pregnancy-related illness. The difficult part of this syndrome is the lack of standardised diagnostic criterias and tests to be used to predict it. The aim of this study is determining the role of APRI score in the diagnosis of HELLP syndrome. In this cross sectional, retrospective study, patients with HELLP syndrome as case group and age-matched healthy pregnants at the similar pregnancy trimester as control group were included between January 12,017 and May 31, 2018. Data including sex, age, laboratory values, prognosis were recorded from the computerized system of the hospital. The p-value <0.05 was considered statistically significant. 40 patients with HELLP syndrome and 124 age-matched healthy pregnants included in the study. There was a statistically significant difference between control group and HELLP patients in terms of the mean urinary protein, platelet count, ALT, AST, creatinin, D dimer levels and also the mean APRI score. In the multivariate regression analysis, APRI score was found a better predictor than AST and both were in a good significant in predicting HELLP. On the ROC curve in order to distinguish the patients with HELLP from the control group for AST and APRI score, the sensitivity was found to be 71.7% and 82.6%, specificity to be 91.2% and 87.6% respectively. Maternal mortality rate of HELLP syndrome was 10%. We concluded that the APRI score was robustly predicted HELLP syndrome than AST alone in this study. Further studies are needed to support our data with prospective, multicentre, larger patient groups.

In the emergency departments (ED), the incidence of admission is increasing gradually due to gastrointestinal system (GIS) complications of hemodialysis (HD) patients. With this increasing number of patients, there are many classification systems developed in early risk assessment before endoscopy. In this study, we aimed to evaluate the Glasgow-Blatchford Score’s (GBS) effectiveness in HD patients with suspected GIS hemorrhage in the ED.The files of 169 patients who received HD treatment were retrospectively reviewed. 64 patients who were examined and treated for reasons other than GIS hemorrhage in the ED were excluded, and the files of a total of 105 were analyzed retrospectively. The demographic characteristics and laboratory values of the patients were recorded from the patient files. When the patients were evaluated according to GBS parameters, a significant difference was found between the two groups in terms of pulse pressure, systolic blood pressure, hemoglobin value, melena, and accompanying comorbid diseases (p < 0.05). Of the 16 patients who presented to the ED due to syncope, 2 were in the GIS hemorrhage (+) group, and 14 patients were in the control group. In this study, we aimed to show that the increase in the number of admissions in the ED due to complications secondary to HD treatment and the accompanying serious changes in laboratory parameters may cause misleading results in patients with suspected GIS hemorrhage, and it is necessary to plan comprehensive and multi-center studies on new alternative scoring systems to GBS in specific patient groups such as HD patients.

Because the vital signs of the patient were stabilized during the follow-up, we did not give the fresh-frozen plasma that was ready to use. Furthermore, the hemogram values of the patients did not have any decline that would require the transfusion of red blood cell concentration. Because the repeated testing of hemogram and hematocrit values did not show any decline and the overall state was improved, he was discharged and referred to the dermatology clinic for oral antibiotic treatment after his 10- to 12-hour follow-up at the ED.

Introduction Acute pain in the right lower quadrant during pregnancy is difficult to approach and acute appendicitis must be excluded. The complication rate in pregnant acute appendicitis increases as a result of delayed diagnosis due to physiological and anatomic changes. The systemic immune inflammatory index (SII), which includes several inflammatory tests, is considered to be a good indicator of acute inflammation. The aim of the present study was to investigate the diagnostic value of SII in the diagnosis of acute appendicitis and complicated appendicitis in pregnant women. Material-method This was designed as a retrospective, single-center case-control study. This study was performed in pregnant women over 12 weeks of gestation who were diagnosed with acute appendicitis as indicated by pathology report and met the inclusion criteria. Vital parameters, demographic characteristics, laboratory values, presence of complicated appendicitis, and pathology reports were taken into analysis. Results The present study was performed with 76 pregnant women, including 38 pregnant women with acute appendicitis and 38 pregnant women with healthy controls. SII had a sensitivity of 82.0% and specificity of 66.7% with a cut-off value of 840.13 in pregnant acute appendicitis cases (AUC: 0.790; 95% CI: 0.686–0.984; p  < 0.001) and SII level was significantly higher in complicated appendicitis cases with a sensitivity and specificity of 66.7% and 91.3%, respectively, with a cut-off value of 2301.66 (AUC: 0.812; 95% CI: 0.665–0.958; p  = 0.001). Conclusion SII is a cost-effective, rapid, easily calculated, and powerful marker that can be used for the diagnosis of both acute and complicated appendicitis in pregnant patients.

Background Cases of intoxication are increasing day by day and these patients are presenting to emergency departments. These patients are usually individuals with poor self-care, inadequate oral intake, and unable to meet their own needs, and may have significant dehydration due to the agents they have taken. The caval index (CI) is a recently used index to determine fluid requirement and response. Aims We aimed to evaluate the success of CI in determining and monitoring dehydration in intoxication patients. Methods Our study was conducted prospectively in the emergency department of a single tertiary care center. A total of ninety patients were included in the study. Caval index was calculated by measuring inspiratory and expiratory inferior vena cava diameters. Caval index measurements were repeated after 2 and 4 h. Results Patients who were hospitalized, took multiple drugs, or needed inotropic agents had significantly higher caval index levels. A further increase in caval index levels was observed on second and third caval index evaluations in patients who received inotropic agents along with fluid resuscitation. Levels of systolic blood pressure recorded at admission (0. hour) showed a significant correlation with caval index and shock index. Caval index and the shock index were highly sensitive and specific at predicting mortality. Conclusion In our study, we found that CI can be used as an index to assist emergency clinicians in determining and monitoring fluid requirement in cases of intoxication presenting to the emergency department.

IntroductionEarthquakes are unpredictable catastrophes that lead to an increase in critical care requirements, particularly for children. Concurrently, these often calamities decimate indispensable healthcare infrastructure, as exemplified by the Kahramanmaraş earthquake. This study aimed to examine the clinical features and outcomes of pediatric patients admitted to a remote pediatric intensive care unit (PICU) after a post-earthquake. This study further attempts to highlight the challenges in post-disaster healthcare provision.MethodsThe research involved a retrospective examination of pediatric patients transferred to the PICU of University of Health Sciences Türkiye, Başakşehir Çam and Sakura City Hospital following the Kahramanmaraş earthquake on February 6, 2023.ResultsThis study analyzed 35 pediatric patients admitted to the PICU, with an average age of 12 years. The median Glasgow Coma Score upon admission was 14, and the median Pediatric Trauma Score was 6. Injuries included head, spine, pelvis, and limb fractures, as well as lung injuries, renal bleeding, and splenic bleeding. The median creatine kinase level was 6591 U/L, and the median hemoglobin and serum creatinine levels were 11.8 g/dL and 0.45 mg/dL, respectively. All patients were successfully discharged from the PICU (median stay: 13 days. Twelve patients received hyperbaric oxygen therapy (HOT), with a median of 23 sessions. Only one patient required amputation, highlighting the potential of HOT for preventing limb loss.ConclusionEarthquakes pose significant challenges and necessitate rapid and effective critical care responses, particularly for children. The current study highlights the importance of a multidisciplinary approach in managing pediatric critical care needs during and after a disaster. This underscores the efficacy of HOT in preventing limb loss and the significance of antimicrobial treatment and postdisaster infection control measures. Furthermore, this study addresses the complexities of patient transfers and the identification of accompanying family members during disasters.

Background: Thrombolytic therapy is the mainstay therapy for acute ischemic stroke (AIS) in the modern era. Intracranial hemorrhage (ICH) is one of the most common thrombolytic therapy complications and can cause significant problems. Non-invasive methods, such as ultrasonography (USG), are becoming prominent to detect ICH early. Objective: We aimed to measure the USG optic nerve sheath diameter (ONSD) in patients with AIS before and after thrombolytic therapy and to find out whether there is any correlation with the complications at 24 hours. Method: Patients aged 18 years and over who were deemed suitable for thrombolytic treatment in AIS patients who presented to the emergency department of two tertiary training and research hospitals were included in the study, which was planned to be two-center, prospective observational, and cross-sectional study between March 25, 2022, and October 25, 2022. Before and after the thrombolytic treatment (0.hour, 1.hour, and 4.hour), ONSD was measured by an emergency physician at the bedside with an USG device. Patients with and without complications after thrombolytic therapy were grouped, and the ONSD measurements were compared. Results: The most common complications in 116 patients included in the study were ICH in 10.3% (n = 12), brain edema in 8.6% (n = 10), and shift in 0.9% (n = 1). We found statistically significant high values in the 4th-hour ONSD measurements in the group with complications (right, P = 0.004, left, P = 0.053). We found statistically significantly higher ONSD values in the group with complications in the 24th-hour measurements with computed tomography (CT) compared to the group without complications (P < 0.001). Conclusion: We think that the follow-up of ONSD values with USG is a useful parameter in predicting the complications that may develop after thrombolytic therapy and in monitoring intracranial pressure (ICP).