Aims: The effect of smoking on patients hospitalized in the intensive care unit (ICU) due to Covid-19 infection is unknown.The study aims to determine the relationship between Covid 19 and smoking status on the development of disease and critical illness.
Materials and Methods: The patient files and hospital information system records of COVID 19 patients over the age of eighteen who were hospitalized in ICU of our hospital between March 2020 and January 2021 and confirmed by PCR(Polymerase Chain Reaction) method were retrospectively reviewed.
Results: 1003 of 226 Covid 19 patients included in the study, 58% were male, and the mean age was 65.38 (± 14.99).The patients' smoking status was categorized as non-smokers, ex-smokers, and current daily smokers (74.8%; 23%; 2.2%; respectively).The most common comorbid disease of the patients was hypertension (58%).One hundred seventy-nine patients were given respiratory support with Invasive Mechanical Ventilation (IMV), and 37.2% were discharged.The mean duration of IMV application, hospitalization, and hospitalization in the ICU was 7.11 (± 5.51); 14.42 (± 10.25), respectively; It was 7.58 (± 6.29) days.The average Apache II score was 23.87 ± 8.86.Mortality was statistically significantly higher in those who received mechanical ventilator support from patients with no smoker stage and without the comorbid disease (p: 0.009).
Conclusion: Although the percentage of current smokers in patients hospitalized in the ICU due to Covid-19 is relatively low,we believe that polygenetic and multiple factors can explain it.It should not be recommended that tobacco products be administered for either preventive or therapeutic purposes in the case of Covid-19 infection.

Aim: We aimed to investigate the characteristics of patients involved in bicycle accidents, along with mechanisms of accidents and clinical outcomes in children. Our secondary aim was to assess the characteristics of patients with serious clinical consequences such as traumatic brain injury and permanent neurological sequelae.
Materials and Methods: Children admitted to the pediatric emergency department of a tertiary referral hospital during a four-year period due to bicycle accidents were included. The mechanism of accident was classified into two groups; high-energy trauma and low-energy trauma. Statistical analyses were performed to recognize injury patterns and clinical outcomes associated with mechanism of accident.
Results: 360 children were included. Two of the injured patients were using a bicycle helmet. 29 patients (8.1%) required surgery. Fourteen patients had clinically important traumatic brain injury. 18 patients had handlebar trauma to the abdomen. Eight patients had permanent neurologic sequelae (vision loss in three, hearing loss in three, spasticity and hemiparesis in two patients) and two patients had finger amputations. Abrasions/soft tissue injuries, scalp fractures, maxillofacial fractures and traumatic brain injury were also significantly more common types of injury in high-energy trauma.
Conclusions: Although the recommendation of using helmets while riding was made two decades ago, the rate of helmet use is still very low in our country. In this retrospective cohort with low rate and no obligatory regulation of helmet use, high-energy bicycle accidents have caused significant clinical outcomes, including maxillofacial-scalp fractures, traumatic brain injury, permanent sensory (visual and hearing) or motor (spasticity and hemiparesis) disability.

Objective The aim of this study is to examine the relationship between immature granulocyte (IG) counts and the severity of the disease and to evaluate the effectiveness of IG in predicting the poor outcomes in PCR-confirmed COVID-19 cases.
Methods The study was carried out prospectively and observationally at the emergency department. Patients were divided into three groups according to the clinical severity indicators such as mild, moderate and severe. The IG level was measured from the whole blood samples taken at the admission to the emergency department. Intensive care unit admission, ventilation support, and death within the first 28 days after the admission were evaluated as composite outcomes.
Results The study group consisted of 203 adults, of whom 91 (44.8%) were women. According to the severity of the illness, 40 patients (19.7%) were classified as mild, 67 patients (33.0%) as moderate, and 96 patients (47.3%) as severe. When comparing IG levels between the groups, there was a statistically significant difference between the mild and severe groups (p = 0.047) and between the moderate and severe disease groups (p = 0.036). There was no statistically significant relationship between IG counts and the composite outcome (p> 0.05)
Conclusion The IG level which could be measured faster than other laboratory tests without any additional cost, could be used for the determination of the clinical severity of patients with COVID-19. However, we conclude that this parameter is not effective in determining poor outcomes during the admission.

Abstract | Full Text PDF

Mesenteric cysts are rare benign intra-abdominal pediatric lesions. It has a variable clinical presentation from an asymptomatic mass to an acute abdomen that appears in the omentum or mesentery of the gastrointestinal tract. Abdominal Ultrasound and complete surgical resection are the modality of choice for diagnosis and treatment. Here, we present a 15 months old boy who presented to the Emergency department with constipation and abdominal pain and found to have a huge mesenteric cyst that was excised surgically.

Objectives: Vertigo is a common presenting complaint to the emergency department (ED). Distinguishing between acute central and peripheral vertigo can be challenging. During recent years, several biomarkers have been introduced for use in distinguishing central and peripheral vertigo. The current study aimed to determine if S100B and neuron-specific enolase (NSE) serum concentrations could effectively predict central causes of vertigo.
Material and methods: This was a prospective study performed on 117 patients with acute vertigo who were admitted to the ED. All patients underwent magnetic resonance imaging (MRI) and the results of the MRI were considered as the gold standard. S100B and NSE from blood samples taken <8 hours after the onset of symptoms were measured in all patients.
Results: Finally, 117 patients were enrolled in the study, of which 43 patients had central vertigo and 74 patients had peripheral vertigo. The serum level of S100B and NSE in the central group were significantly higher (60.62 vs 28.01 pg/mL, and 11.86 vs 7 ng/ml, P<0.001, respectively). The ROC analysis demonstrated an AUC of 0.91 (95% CI: 0.84–0.96) and 0.93 (95% CI: 0.87–0.97) for S100B and NSE to predict central vertigo and reported a sensitivity of 97.7% and 93% and a specificity of 87.8% and 89.2% for detecting a central cause of vertigo with S100B and NSE.
Conclusion: The serum S100B and NSE concentrations in central vertigo were significantly higher, and could be useful markers in screening central from peripheral vertigo in the ED.

Objective: The aim of this study was to increase the awareness of physicians working in adult and pediatric emergency departments (ED) about malpractice allegations.
Methods: A retrospective analysis was made of cases with malpractice allegations occurring in EDs from among the lawsuit files decided by the First Specialization Board of the Istanbul Forensic Medicine Institute between 01/01/2012 -31/12/2014.
Results: Evaluation was made of 556 cases, comprising 357 (64.2%) males and 199 (35.8%) females, with a mean age of 38.92±24.8 years (min: 0, max: 87), with the highest number of cases in the 40-59 years age group (n=157, 28.2%). Two-thirds (n=377, 67.8%) of the cases with alleged medical malpractice occurred in a public hospital. The Board decided that 24.4% (n: 136) of the cases were medical malpractice. In a total of 556 cases, 1102 physicians were accused and 151 physicians (13.7%) were found to be at fault by the Board.
More than half of the physicians accused of medical malpractice (51.7%) were general practitioners. The most common cause of malpractice in 136 files was diagnostic error (n= 79, 58.1%). The most common actions of malpractice were failure to diagnose on time, and misdiagnosis (n=29, 21.3%). The most frequent diagnosis was trauma (n: 156, 28.1%).
Conclusions: Most of the malpractice allegations against the physicians working in the ED were unfounded and dismissed by the Board. In order to avoid diagnostic errors, it can be recomended that novice general practitioners should not be employed alone in EDs without the support of more experienced colleagues.