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Lactic acid is the end-product of anaerobic glycolysis. It is generally believed that elevated blood lactate levels are associated with poor patient outcomes. Literature reports that lactic acidosis can be related to supplementary food intake in the pediatric age group however, in adult patients, it is not common to see lactic acidosis due to oral ingestion unless the patient has a history of short bowel syndrome or jejunoileal bypass surgery. With the current case presentation, we report an accidental cheese starter culture intake that resulted in resistant lactic acidosis with no signs of critical illnesses.

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: The treatment of benign paroxysmal positional vertigo (BPPV) has not been well studied. Many clinicians are indifferent about canalith reposition maneuvers and frequently prefer medical treatments. Objectives: We aimed to detect efficacy of Epley maneuver in relieving symptoms of benign paroxysmal positional vertigo patients diagnosed in emergency department and if medical treatments are useful in patients whose symptoms were not relieved. Methods: The study was conducted as a prospective cohort study in the emergency department of a tertiary hospital. Patients who were over 18 years of age and presented to emergency department with complaints of vertigo symptoms and nausea and had a positive Dix-Hallpike test were included in the study. Patients' demographic data, possible etiological factors, affected ear, and benign paroxysmal positional vertigo diagnosis in the history were recorded on the study data form. The European Evaluation of Vertigo scale and the Visual Analogue Scale (VAS) score of nausea and vertigo symptoms were graded and recorded for each patient before and after treatment. Results: Ninety patients were included in the study in total. Epley maneuver was carried out to all patients. Vertigo symptoms VAS (VAS d) score (p < 0.001), nausea and vomiting VAS (VAS nv) score (p < 0.001), and European Evaluation of Vertigo scale score (p < 0.001) of all patients showed a statistically significant decrease after Epley maneuver. A combination of dimenhydrinate and metoclopramide helped to reduce VAS d (p = 0.048), VAS nv (p = 0.031), and European Evaluation of Vertigo scale scores (p = 0.001) at a statistically significant level more than dimenhydrinate treatment alone. Conclusions: Epley maneuver may be applied to every patient with benign paroxysmal positional vertigo. Dimenhydrinate and/or metoclopramide helps to control patients' symptoms whose symptoms remain despite Epley maneuver.

Background Acute appendicitis (AA) is a common cause of abdominal pain resulting in admission to the emergency room. Imaging methods such as ultrasonography and CT are usually used for diagnosing acute appendicitis. Reports regarding CT scans conducted during night shifts are prepared by private teleradiologists. Aims The aim of this study was to compare the accuracy of point-of-care ultrasound performed by an emergency medicine specialist and private teleradiologists in the diagnosis of AA. Methods This study was conducted prospectively and in a single center in the emergency department of a tertiary hospital. Patients who were admitted to the study between 15.09.2020 and 15.09.2021 and were diagnosed with AA who met the study criteria were included. A total of 134 patients diagnosed with AA, who met the inclusion criteria, out of 158 operated patients were included in the study. Results In the study, 77 were male and 57 were female. The mean age of patients with histopathologically positive AA was 31 and 31.5 in negative patients. The sensitivity and specificity of POCUS performed by the emergency physician and private teleradiology for the diagnosis of AA were 78.4% and 59.3% and 58.8% and 53.1%, respectively. Conclusions POCUS performed by an emergency medicine specialist showed a higher sensitivity for the diagnosis of AA compared with private teleradiology. Hence, POCUS is more successful in diagnosing AA than private teleradiology. In conclusion, we recommend the concurrent use of AS and POCUS in emergency departments rather than private teleradiology for the diagnosis of AA.

[LANGUAGE= \"English\"] BACKGROUND: In earthquakes and other natural disasters, there is a significant number of injuries directly resulting from trauma. Additionally, due to the disaster’s impact on overloaded health institutions, healthcare providers face significant challenges during earthquakes. In this context, nearby hospitals providing health services play a crucial role. Nonetheless, with proper planning, the health crisis can be managed in the best possible way.METHODS: A single-center retrospective study was conducted on patients admitted to Mersin City Training and Research Hospital due to injuries attributed to the earthquake that occurred in the southern and mid-eastern regions of Türkiye on February 6, 2023. A total of 2,155 patients meeting the study criteria were included in the analysis.RESULTS: Of the 2,155 patients enrolled in the study, 46.8% (n=1009) were male, with a mean age of 45.86±17.68 years. Falls (57.2%, n=1233) were the most common mechanism of injury, and 71.9% (n=1550) of cases presented to the hospital on their own. Among the head injuries, the most common types were soft tissue injury and lacerations, while soft tissue injury and rib fractures were most common in the thoracic region. Soft tissue injury and retroperitoneal bleeding were the most commonly recorded types among abdominal injuries, whereas soft tissue injury and fractures were most common in the upper and lower extremities. Fractures were identified in 11.1% (n=240) of cases in the upper extremities and 21.3% (n=458) in the lower extremities. Rhabdomyolysis was one of the most frequently observed injury types (n=443, 20.6%). Crush syndrome and acute kidney injury were recorded in 9.2% (n=198) of cases, leading to a total of 46 amputations in 40 (1.8%) patients and 164 fasciotomies in 132 (6.1%) patients. The orthopedics department performed the most frequent surgical interventions and hospitalizations. Mortality was noted in 2.87% (n=62) of cases.CONCLUSION: This study demonstrated a significant increase in workload and patient volume following the earthquake. There is a need for a large number of healthcare professionals for expedient intervention in conditions such as fractures, crush syndrome, amputation, and fasciotomy in disasters with a high risk of serious trauma, such as earthquakes. Disaster planning and preparedness for possible consequences will mitigate the healthcare crisis involving the hospitals and lead to significant reductions in mortality and morbidity.[LANGUAGE= \"Turkish\"] AMAÇ: Deprem ve diğer doğal afetlerde doğrudan travmaya bağlı olarak ciddi sayıda yaralanma meydana gelmektedir. Ayrıca afetin aşırı iş yükü yüklenen sağlık kurumlarını da etkilemesi nedeniyle sağlık çalışanları deprem sırasında önemli zorluklarla karşı karşıya kalmaktadır. Bu bağlamda yakın çevrede sağlık hizmeti veren hastaneler önemli bir rol oynamaktadır. Ancak doğru planlamayla sağlık krizi en iyi şekilde yönetilebilir.GEREÇ VE YÖNTEM: 6 Şubat 2023'te Türkiye'nin güney ve ortadoğu bölgelerinde meydana gelen depreme bağlı yaralanma nedeniyle Mersin Şehir Eğitim ve Araştırma Hastanesi'ne başvuran hastalar üzerinde tek merkezli retrospektif bir çalışma yapıldı. Çalışma kriterlerini karşılayan toplam 2155 hasta analize dahil edildi.BULGULAR: Çalışmamıza dahil edilen 2155 hastanın %46.8'i (n=1009) erkek olup yaş ortalaması 45.86±17.68 yıl idi. Düşmeler (% 57.2, n=1233) en sık görülen yaralanma mekanizması olup, vakaların %71.9'u (n=1550) hastanemize kendi imkanları ile başvurmuştur. Kranial bölgede en sık görülen yaralanmalar yumuşak doku yaralanması ve cilt kesileri iken, torasik bölgede yumuşak doku yaralanması ve kaburga kırıkları en sık görülen yaralanmalardı. Abdominal yaralanmalar içindeen sık yumuşak doku yaralanması ve retroperitoneal kanama saptanırken, üst ve alt ekstremitede ise yumuşak doku yaralanması ve kırıkları en sık olarak saptandı. Olguların %11,1'inde (n=240) üst ekstremitede, %21.3'ünde (n=458) alt ekstremitede kırık tespit edildi.Rabdomiyoliz en sık görülen yaralanma türlerinden biriydi (n=443, %20,6). Vakaların %9.2'sinde (n=198)Crushsendromu ve akut böbrek hasarı saptandı; bu durum 40 (%1.8) hastada toplam 46 amputasyona ve 132 (%6.1) hastada 164 fasiyotomiye yol açtı. Ortopedi bölümü en sık cerrahi müdahale ve hastaneye yatışları gerçekleştirdi. Vakaların %3.0'ında (n=62) mortalite gözlendi.SONUÇ: Bu çalışma deprem sonrasında iş yükünde ve hasta hacminde önemli bir artış olduğunu ortaya koymuştur. Deprem gibi ciddi travma riski yüksek olan afetlerde kırık, ezilme sendromu, amputasyon, fasiyotomi gibi durumlara hızlı müdahale için çok sayıda sağlık profesyoneline ihtiyaç vardır. Afet planlaması ve olası sonuçlara karşı hazırlıklı olmak, hastaneleri ilgilendiren sağlık krizini hafifletecek ve mortalite ve morbiditede önemli azalmalara yol açacaktır.

Giriş: Metformin biguanid ailesine ait ve dünyada diyabet tedavisinde en sık kullanılan ilaçlardan biridir. İlk kez 1957 yılında ticarileştirildi ve sonrasında kullanımı giderek arttı. Metformin tip 2 diyabet tedavisinde ilk farmakolojik ajan olarak önerilmektedir. Vaka: 29 yaşında kadın hasta acil servise bulantı kusma nedeni ile acil servisimize başvurdu. Hastanın öyküsü sorgulandığında; ishal olmadığını belirtti, üriner enfeksiyon tariflemedi, aldığı gıdalar sorgulandığında sadece kahvaltı yaptığını ve 5 adet yeşil zeytin, avuç içi kadar da ekmek yediğini belirtti, herhangi bir ilaca maruziyeti olmadığını gün boyunca evde olduğunu belirtti. Başvuru anında hastanın genel durum iyi, bilinç açık koopere ve oryante idi. Aynı günün ilerleyen saatlerinde (yaklaşık 8 saat sonra), hasta bilinç düzeyinde azalma ile acil tıbbi hizmetler aracılığıyla acil servise geri getirildi. Paramedikler, 30 mg/dL'lik kan şekeri seviyesi nedeniyle 50 mg intravendekstroz uyguladıklarını bildirdi. Sonuç: Son dönemde metformin tedavi amacıyla kullanılabildiği gibi zayıflama amacıylada kullanılmaktadır.Metforminin tek doz kullanımının bile ciddi yan etkilere yol açtığı görülmektedir. Hem endikasyon dahilinde hem de endikasyon dışı metformin kullanan kişilerin dikkatli olması gerekir.

The aim compares the blood gases, vital signs, mechanical ventilation requirement, and length of hospitalization in patients with hypertensive pulmonary edema treated with standard oxygen therapy (SOT) and high-flow oxygen therapy (HFOT).OBJECTIVEThe aim compares the blood gases, vital signs, mechanical ventilation requirement, and length of hospitalization in patients with hypertensive pulmonary edema treated with standard oxygen therapy (SOT) and high-flow oxygen therapy (HFOT).This prospective observational study was conducted in patients with tachypneic, hypoxemic, hypertensive pulmonary edema. The patients' 0th, 1st, and 2nd hour blood gas results; 0th, 1st, and 2nd hour vital signs; requirement of endotracheal intubation, length of hospitalization, and the prognosis were recorded on the study form.METHODSThis prospective observational study was conducted in patients with tachypneic, hypoxemic, hypertensive pulmonary edema. The patients' 0th, 1st, and 2nd hour blood gas results; 0th, 1st, and 2nd hour vital signs; requirement of endotracheal intubation, length of hospitalization, and the prognosis were recorded on the study form.A total of 112 patients were included in this study, of whom 50 underwent SOT and 62 received HFOT. The initial blood gas analysis revealed significantly lower levels of pH, PaO2, and SpO2 and significantly higher levels of PaCO2 in the HFOT group. Patients in the HFOT group had significantly higher respiratory rate and pulse rate and significantly lower SpO2 values. The recovery of vital signs was significantly better in the HFOT group (p<0.05). Similarly, follow-up results of arterial blood gas analysis were better in the HFOT group (p<0.05). Both length of stay in the emergency department (p<0.05) and length of intensive care unit hospitalization s significantly shorter in the HFOT group (p<0.05).RESULTSA total of 112 patients were included in this study, of whom 50 underwent SOT and 62 received HFOT. The initial blood gas analysis revealed significantly lower levels of pH, PaO2, and SpO2 and significantly higher levels of PaCO2 in the HFOT group. Patients in the HFOT group had significantly higher respiratory rate and pulse rate and significantly lower SpO2 values. The recovery of vital signs was significantly better in the HFOT group (p<0.05). Similarly, follow-up results of arterial blood gas analysis were better in the HFOT group (p<0.05). Both length of stay in the emergency department (p<0.05) and length of intensive care unit hospitalization s significantly shorter in the HFOT group (p<0.05).HFOT can be much more effective in patients with hypertensive pulmonary edema than SOT as it shortens the length of stay both in the emergency service and in the intensive care unit. HFOT also provides better results in terms of blood gas analysis, heart rate, and respiratory rate in the follow-up period.CONCLUSIONHFOT can be much more effective in patients with hypertensive pulmonary edema than SOT as it shortens the length of stay both in the emergency service and in the intensive care unit. HFOT also provides better results in terms of blood gas analysis, heart rate, and respiratory rate in the follow-up period.

[LANGUAGE= \"English\"] BACKGROUND: Fingertip amputations are common injuries presenting to the emergency room. However, all amputations do not have a chance of replantation, and composite graft is among the salvage treatments in this case. This treatment is both easy to apply and economical. Our study compares the success and cost of composite grafting in the emergency and operating rooms.METHODS: Thirty-six patients who met the criteria were included in the study. The decision on the repair site was made by the sur-geon according to patient compliance and the intensity of the emergency clinic. Demographic and disease information of the patients were recorded. P<0.05 was accepted as the significance level.RESULTS: Twenty-two cases were pediatric patients. Eighteen cases of crush injuries and 22 cases were treated in the emergency room. There was no significant difference in terms of complications, need for additional intervention, and short fingers related to interventions performed in the emergency room and operating room. Interventions in the emergency department were significantly lower in cost and shorter hospitalization times. There was no significant difference in terms of patient satisfaction.CONCLUSION: Composite grafting is a simple and reliable method in fingertip injuries and gives satisfactory results in terms of patient satisfaction. In addition, composite graft application in fingertip injuries in the emergency department will both reduce the cost and prevent hospital infections that may occur due to the reduction in hospitalization.[LANGUAGE= \"Turkish\"] AMAÇ: Parmak ucu amputasyonları, acil servise başvuran yaygın yaralanmalardır. Ancak tüm amputasyonların replantasyon şansı yoktur ve bu durumda kompozit greft kurtarma tedavileri arasındadır. Bu tedavi hem uygulaması kolay hem de ekonomiktir. Çalışmamızda acil serviste ve ameli-yathanede kompozit greftlemenin başarısını ve maliyetini karşılaştırdık.GEREÇ VE YÖNTEM: Kabul ölçütlerini karşılayan 36 hasta çalışmaya alındı. Tamir yeri kararı hasta uyumuna ve acil servisin yoğunluğuna göre cerrah tarafından verildi. Hastaların demografik ve hastalık bilgileri kaydedildi. Anlamlılık düzeyi olarak p<0.05 kabul edildi.BULGULAR: Yirmi iki olgu pediatrik hastaydı. Acil serviste 18 ezilme yaralanması ve 22 vaka tedavi edildi. Acil serviste ve ameliyathanede yapılan girişimlere göre komplikasyonlar, ek girişim gereksinimi ve parmak kısalığı açısından anlamlı fark yoktu. Acil servisteki müdahaleler, maliyet açısından önemli ölçüde daha düşük ve hastanede kalış süreleri daha kısaydı. Hasta memnuniyeti açısından anlamlı bir fark yoktu.TARTIŞMA: Kompozit greft parmak ucu yaralanmalarında basit ve güvenilir bir yöntemdir ve hasta memnuniyeti açısından yüz güldürücü sonuçlar vermektedir. Ayrıca acil serviste parmak ucu yaralanmalarında kompozit greft uygulaması hem maliyeti düşürecek hem de hastane yatışlarının azal-ması nedeniyle oluşabilecek hastane enfeksiyonlarını önleyecektir.

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 Trauma is one of the common reasons for emergency department (ED) presentations. Specifically, severe-trauma patients often present with mortal complications, including traumatic shock or respiratory or multiorgan failure/dysfunction, and these situations cause high-mortality risk. Scoring systems in the triage of trauma patients can help determine the injury’s severity and the patient’s prognosis. Aim In this study, we aimed to compare Early-Warning Score (EWS), Revised Trauma Score (RTS), and CRAMS to predict the severity and prognosis of damage among high-energy-trauma patients. Methods This retrospective study included adult high-energy-trauma patients (> 18 years of age) assessed in our emergency department (ED) from April 1, 2020, to September 31, 2020. We included a total of 177 high-energy-trauma patients in the study. We compared the effectiveness of EWS; RTS; and circulation, respiration, abdomen, motor, and speech (CRAMS) in predicting mortality. The primary outcome of this study was mortality. Results We included 67 females and 110 males with a mean age of 39.2 in our study. Of those patients, 6 died during ICU hospitalization and 104 were discharged from the ward. RTS (AUC: 0.978, CI: 0.945–0.994, p  < 0.001) and CRAMS (AUC: 0.978, CI: 0.944–0.994, p  < 0.001) had the same AUC values, but the AUC value of EWS (AUC: 0.966, CI: 0.927–0.987, p  < 0.001) was lower. Sensitivity of EWS was 93.1 (CI: 77.2–99.2%), and sensitivity of RTS was 96.55 (CI: 82.2–99.9) and CRAMS’ sensivity was 96.55% (CI: 82.2–99.9). RTS showed the highest specivity level (96.62%, CI: 92.3–98.9). Conclusion In conclusion, RTS and CRAMS better predicted mortality in high-energy-trauma patients than EWS.