Appendicitis is a condition characterized by inflammation of the appendix. All cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of peritonitis and shock.[1] Reginald Fitz first described acute and chronic appendicitis in 1886,[2] and it has been recognized as one of the most common causes of severe acute abdominal pain worldwide.

Appendicitis

Objectives Pain is a common complaint in the emergency department (ED). Its management currently depends heavily on pharmacologic treatment, but evidence suggests that nonpharmacologic interventions may be beneficial. The purpose of this systematic review and meta-analysis was to assess whether nonpharmacologic interventions in the ED are effective in reducing pain. Methods We conducted a systematic review of the literature on all types of nonpharmacologic interventions in the ED with pain reduction as an outcome. We performed a qualitative summary of all studies meeting inclusion criteria and meta-analysis of randomized controlled studies measuring postintervention changes in pain. Interventions were divided by type into five categories for more focused subanalyses. Results Fifty-six studies met inclusion criteria for summary analysis. The most studied interventions were acupuncture (10 studies) and physical therapy (six studies). The type of pain most studied was musculoskeletal pain (34 studies). Most (42 studies) reported at least one improved outcome after intervention. Of these, 23 studies reported significantly reduced pain compared to control, 24 studies showed no difference, and nine studies had no control group. Meta-analysis included 22 qualifying randomized controlled trials and had a global standardized mean difference of -0.46 (95% confidence interval = -0.66 to -0.27) in favor of nonpharmacologic interventions for reducing pain. Conclusion Nonpharmacologic interventions are often effective in reducing pain in the ED. However, most existing studies are small, warranting further investigation into their use for optimizing ED pain management.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/acem.13411

Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta-analysis.

Mortality Factors in Geriatric Blunt Trauma Patients

Transcriptional abundance of antioxidant enzymes in endometrium and their circulating levels in Zebu cows with and without uterine infection

This study evaluated the demographic and clinical properties, diagnostic and therapeutic approaches, and outcomes of patients with traumatic diaphragmatic injury. Among 853 patients who presented with blunt or penetrating thoracic injury between January 2010 and December 2016, 22 patients with traumatic diaphragmatic rupture were retrospectively studied. The analysed parameters included age, sex, accompanying injuries, surgical management approach, postoperative morbidity and mortality rates, and duration of hospital stay. Among 853 patients treated at our clinic for blunt or penetrating thoracic trauma, 22 patients with diaphragmatic injury (16 males, 6 females) were evaluated. The mean age was 32 (range 19-67 y). Twenty-one patients were evaluated in the acute setting and 1 in the chronic setting (with a history of trauma 8 years earlier). The most common complaints and physical examination findings were dyspnea, chest pain, abdominal distention, and loss of breath sounds over the affected hemithorax. On chest X-Ray the most common signs included loss of dipahragma shadow, diaphragmatic elevation, and visceral organ herniation into thoracic cavity. All patients were operated. As the surgical method, thoracotomy was carried out in 18 patients and laparotomy+thoracotomy was performed in 4 patients. Three patients underwent diagnostic video-assisted thoracoscopy before thoracotomy. Diaphragma was repaired on the left side in 20 patients and on the right side in 2. In 21 patients, a diaphragmatic injury was accompanied by intraabdominal organ injuries, lung injuries, and other system injuries. Stomach was the organ whose injury most commonly accompanied blunt and penetrating injuries. Pulmonary complications were more common in blunt traumas (10%). Death was seen in only one (5%) patient with penetrating trauma. The mean duration of chest drainage tube staying in place was 3 (range 2-8 d); the mean duration of hospital stay was 6 (range 4-10 d).

/pdf/traumatic-rupture-of-the-diaphragm-a-22-patient-experience-4m87dghlbw.pdf

Traumatic rupture of the diaphragm: A 22-patient experience

Background/aim: We aimed to show the role of determination of optic nerve sheath diameter (ONSD) by bedside ultrasonography in an emergency department in the diagnosis of cerebrovascular disorders and its correlation with the clinical picture. Materials and methods: This prospective cross-sectional study included 55 patients with cerebrovascular disorders and 53 controls. Age, sex, ONSD, comorbid disease status, and multidetector computed tomography results of all subjects and application periods and National Institutes of Health Stroke Scale (NIHSS) scores of the patient group were evaluated. Results: The ONSD of the patient and control groups was determined as a median of 5.7 mm and 3.6 mm, respectively. The ONSD of the patient group was determined to be significantly higher than that of the control group (P < 0.05). A positive relationship was determined between NIHSS scores and ONSD values (P < 0.05). The specificity and sensitivity values were determined as 98.1% and 81.8%, respectively, for a cutoff value of 5 mm and as 100% and 72.7%, respectively, for a cutoff value of 6 mm. Conclusion: This study showed that bedside measurement of ONSD is an easy, cheap, and noninvasive method that can be used to support the diagnosis and evaluation of patients with acute stroke.

https://journals.tubitak.gov.tr/medical/issues/sag-18-48-1/sag-48-1-17-1707-207.pdf

Bedside measurement of the optic nerve sheath diameter with ultrasound in cerebrovascular disorders

Objective To assess the value of lactate measurements in addition to standard diagnostic measurement of white blood cell count (WBC) and C-reactive protein (CRP) in the accuracy of preoperative acute appendicitis (AA) diagnosis. Methods A total of thirty-six consecutive patients with histopathologically confirmed acute appendicitis were retrospectively included in the study. Fifteen volunteers were included as control group. Patient characteristics, preoperative ultrasonography (US) and laboratory assessment including WBC, C-reactive protein (CRP) and lactate values were collected. Receiver Operator Characterstics (ROC) curves for discriminant values and sensitivity, specificity, positive and negative predictive values (PPV,NPV) were calculated. Results The male/female ratio of groups 1 and 2 were 25/11 and 9/6 respectively. Mean age: 34.13 +/- 9.6 years. Area under ROC values for lactate were found significant and discriminant value was found to be 8 mg/dl. Specificity, sensitivity, PPV and NPV calculated for lactate were as follows: 53%, 80%, 77% and 57%. Conclusions Increased lactate levels as well as other inflammatory parameters should be considered as a diagnostic parameter in diagnosis of AA.

Diagnostic value of lactate levels in acute appendicitis.

Damage to lung parenchyma due to blunt thoracic trauma often appears as contusion or hematoma. Cavitary lung lesions or pseudocyst formation due to trauma is a rare phenomenon. In the literature traumatic pseudocysts are also known as pseudocystic hematomas, traumatic lung cavity and traumatic pneumotocel. Traumatic pseudocysts usually have good clinical prognosis, recover spontaneously with supportive treatment and do not require surgery. In this article, we present the case of 52 year old male who was brought to the emergency department after a fall from height and was diagnosed with lung contusions and traumatic cyst.

https://www.journalagent.com/tatd/pdfs/TATD-86619-CASE_REPORT-PAMUKCU_GUNAYDIN.pdf

Traumatic pseudocyst due to blunt trauma: Case report

Introduction We hypothesized that the geographic distributions of COVID-19 and alpha-1 antitrypsin alleles prevalence are similar. We investigate whether there is a relationship between the geographical density of the COVID-19 pandemic and the distributions of alpha-1 antitrypsin alleles. Methods This research is a cross-sectional study. Alpha-1 antitrypsin PI*MS, PI*MZ, PI*SS, PI*SZ, and PI*ZZ genotypes frequencies of European countries were compared with the case and death data related to the COVID-19 pandemic as of March 1, 2022. Results A significant relationship was found between the rates of COVID-19 cases and the rates of individuals with alpha-1 antitrypsin PI*MS, PI*MZ, PI*SS, PI*SZ, and PI*ZZ genotypes allele in European countries. Conclusions The findings showed that the prevalence distribution of the alleles of the gene defect that causes alpha-1 antitrypsin insufficiency is related to the prevalence of COVID-19 pandemic data.

/pdf/comparison-of-covid-19-outcomes-with-alpha-1-antitrypsin-2680parg.pdf

Comparison of COVID-19 Outcomes With Alpha-1 Antitrypsin Deficiency Prevalence in Europe: A Cross-Sectional Study

Amac: Bu calismada acil servise basvuran torakoabdominal travmali hastalarda tespit edilen diyafram yaralanmalarinda hastalarin ozellikleri ve tedavi yonetimi gozden gecirildi. Ca­lis­ma­ pla­ni:­ Nisan 2005 ve Aralik 2011 tarihleri arasinda Ankara Ataturk Egitim ve Arastirma Hastanesi Acil Servise torakoabdominal travma nedeni ile basvuran ve diyafram yaralanmasi tanisi konulan 20 hastanin (18 erkek, 2 kadin; ort. yas 44.4±13.8 yil; dagilim 18-72 yil) tibbi dosyasi retrospektif olarak incelendi. Hastalarin demografik ozellikleri, hastaligin altta yatan etyolojisi, tanisal degerlendirme, eslik eden yaralanmalar, uygulanan tedavi ve travma skorlarinin [Glascow Koma Skoru (GCS), Revize Travma Skoru (RTS), Yaralanma Siddet Skoru (ISS), Travma Yaralanma Siddet Skoru (TRISS)] yatis suresi uzerindeki etkisi degerlendirildi. Bul gu lar: Hastalarin dordunde penetran yaralanma, 16’sinda kunt travma vardi. Acil serviste yapilan ilk muayenede, GCS: 13.4±2.8, RTS:5.8±3.1 ISS:18.8±7.6 TRISS’a gore ongorulen olum orani 6.4±10.4 idi. Revize Travma Skoru ve GKS ile yatis surelerinde istatistiksel olarak anlamli bir fark olmamakla birlikte, ISS ≥16 olan hastalarin hastanede yatis sureleri, ISS skoru <16 olan hastalara kiyasla, anlamli olarak daha uzundu. Hastalarin hastanede ortalama kalis sureleri 20.4±23.1 gundu. Hastalarin hicbirinde mortalite izlenmedi. So­nuc:­Ozellikle ust karin veya alt torakal bolgeyi iceren torakoabdominal travmalarda diyafram yaralanmasinin da olabilecegi akilda tutulmali ve yapilan incelemeler dikkatli bir sekilde degerlendirilmelidir. Ayrica diyafram rupturu gibi tek basina hayati tehlike yaratabilecek belirli anatomik bozuklugu olan hastalarda mortalite ve hastanede kalis suresinin uzunlugunu tahmin etmede anatomik skorlama sistemlerinin (ISS), fizyolojik skorlama sistemlerinden (RTS, GKS) daha on planda kullanilmasi gerektigi kanisindayiz.

Evaluation of the patients diagnosed with diaphragmatic rupture in emergency room

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