1 The Effect of Lactate and Lactate Clearance on Mortality in Sepsis Patients Admitted to the Emergency Department , Duha Tuba Seyhoglu, Yonca S. Akdeniz, Afsin Ipekci, Ibrahim Ikizceli
Objective: Early prognosis of sepsis, which affects millions of people all over the world every year and, can have a mortality of more than 25%, is very important especially for emergency rooms where patients spend their most critical golden hours. Lactate and lactate clearance are also potential marker candidates that can be used to predict mortality, which has now started to take place in sepsis guidelines. The aim of this study is to investigate the power of lactate and lactate clearance to predict mortality in sepsis. Material and Method: All patients over the age of 18 with a diagnosis of severe sepsis and septic shock who presented to the emergency department during a one-year period were included in this prospective observational cohort study. The lactate clearance was calculated by taking the blood gase samples of the patients at the time of admission and six hours later, and evaluated in terms of predicting mortality along with other parameters. Results: The decrease in lactate values at the sixth hour of 90 patients included in the study was found to be statistically significant (p=0.001). A positive and significant correlation was found between the lactate values of the patients at admission and mortality (p=0.046). A negative significant correlation was found between lactate clearance of the patients and mortality (p=0.001). Conclusion: In patients with sepsis, lactate level is important in determining prognosis. Regardless of arrival lactate level, the rise of lactate reduction rate at the sixth hour indicates a good prognosis. In addition, it was determined that the sixth hour lactate level also had an effect on predicting mortality. When all these results are taken into consideration, it can be said that the lactate level and lactate clearance are useful predictors of prognosis in sepsis patients admitted to the emergency department. However, they are not sufficient on their own to determine the prognosis and should be used together with other markers and clinical evaluation.
2 SARS-CoV-2 Variants of Concern and Their Properties , Nejat SİRAJ MOHAMMED
Since its first detection in December 2019, SARS-CoV-2 has resulted in the morbibidity of 174 million and mortality of 3.74 million people. As a typical Ribo nucleic acid virus, SARS-CoV-2 undergoes genomic changes during its replication to maintain its evolutionary adaptation. Continous mutation has led into the emergence of numerous variants. Currently, the strains distinguished as the ‘Variants of Concern’ are the B.1.1.7 lineage (The United Kingdom variant) , B.1.351 (The South African variant), B.1.1.248/B1.1.28/P1(Brazilian Variant) , B.1.427/B.1.429 lineage (The Californian variant) and B.1.617.2 lineage (Indian variant). These variants impose a huge concern due to their properties of higher transmission and evasion of the immune system. The continuous emergence of such variants can be contained by vaccinating the population to reduce the circulation of the virus and by maintaining the major protective measures against the disease.
3 Serum Lactate may be a Marker for Determining 30-Day Mortality in Patients with Acute Upper Gastrointestinal System Bleeding , Kaan CELİK  Beliz ÖZTOK TEKTEN  Tamer ÇOLAK  Gülsüm KAVALCI  Cemil KAVALCI 
Objective: We aimed to examine the role of serum lactate level in predicting 30-day mortality in patients with upper gastrointestinal bleeding (GIB). Matarial and Method: 377 upper GIB cases included in the study. Age, gender, symptoms and signs, comorbidity and drugs, hemoglobin, amount of red blood cells administered, lactate level, mortality rates were recorded. The patients were divided into 2 groups as those who died and those who survived after GI bleeding. The clinical and laboratory variables of the groups were compared. Chi-square test and Mann-Witney U test were used to compare the groups. The ROC curve was plotted to determine the sensitivity and specificity of serum lactate level in determining 30-day mortality. A p value of <0.05 was considered statistically significant. Results: The median lactate level of 42 (11.1%) deceased patients was 3 mmol/L (QR: 3.3 mmol/L), and the median lactate level of the surviving patients was 1.7 mmol/L (QR: 1.3 mmol/L). The lactate level of the patients who died was found to be significantly higher (p<0.001). The ROC curve was plotted to determine the sensitivity and specificity of serum lactate in determining 30-day Mortality. for 3 mmol/L; sensitivity was 79.5% and specificity was 53.8%. Conclusion: It was determined that patients with high serum lactate levels were more mortal.
4 The Relationship of Attachment with Functionality, Insight and Adaptation to The Treatment in Patients with Schizophrenia , Meltem PUŞUROĞLU  Fatma Gül HELVACI ÇELİK  Mehmet BALTACIOĞLU  Bulent BAHCECİ  Cicek HOCAOGLU 
This study was conducted with patients diagnosed with schizophrenia registered in Rize State Hospital Community Mental Health Center. The aim of the study is to examine the relationship between attachment styles of patients with schizophrenia, functionality, adherence to treatment and insight. In schizophrenia, which is a chronic disease, adherence to treatment, insight and functionality are important concepts for the good prognosis of the disease. 100 schizophrenic patients registered at Rize State Hospital Community Mental Health Center for at least 3 years were included in the study. Patients were selected according to exclusion criteria. Clinical interviews were made with the patients, and informed consent was obtained from the patients who could be included in the study and their legal guardians. Socio-demographic data form prepared by us, Evaluation scale of the three components of Insight, Brief functionality scale, Medical treatment compliance rate scale, Adult attachment style scale were used in the study. In the evaluation of scale scores, no significant relationship was found between the Functioning scale and avoidant attachment, secure attachment, and anxious attachment. A significant negative correlation was found between insight scale scores and avoidant attachment. No significant correlation was found between insight scale scores and secure attachment. A positive and significant relationship was found between the insight scale scores and the anxious attachment scale scores. There was no significant relationship between adherence to treatment scale scores and avoidant attachment, secure attachment and anxious attachment.
5 Examination of Geriatric Trauma Patients Presenting to the Emergency Department , Necmi BAYKAN  Polat DURUKAN  Ömer SALT  Şule YAKAR  Yusuf KANTAR  Nesıj KAYMAZ  Seda ÖZKAN 
Objective: We aimed to determine the demographic characteristics, trauma severity scores, place of occurrence of the trauma, consultations requested and the way it ended in geriatric trauma patients. At the same time, we aimed to reveal the relationship between the occurrence of the event and admission to the emergency department and the relationship between trauma scores and mortality. Material and Method: This study was conducted retrospectively with 250 patients aged 65 and over who applied to the Emergency Department of Erciyes University Faculty of Medicine between 01.01.2011 and 31.12.2011. Gender, age, time elapsed after trauma, trauma mechanism, diagnoses, requested consultations, injury site, GCS, ISS and outcome patterns were investigated. Results: 51.6% of these patients were female and 48.4% were male. The mean age of the patients is 73.3. While 32.4% of the patients were in the first 1-hour period, 11.2% of them applied to the emergency department after the first 24-hour period. While soft tissue trauma (36.4%) was the most common in the patients, when the trauma areas were examined, it was determined that the extremities were the most common with 51.6%. While 86 of the patients did not want consultation from any branch; Orthopedics consultation was requested for 79 patients and neurosurgery consultation was requested for 44 patients. 54.8% of the patients in the study were discharged from the emergency room after treatment, 28.4% were hospitalized, 12% were followed up under intensive care conditions, and 4.8%, 12 patients, died. The duration of admission to the emergency department, GCS and ISS scores of the patients and their outcomes in the emergency department were compared and a statistically significant relationship was found. Conclusion: Geriatric trauma patients are more mortal and morbid than younger patients. Depending on the old age, there are usually additional medical problems. Treatment processes are more laborious and demanding. Therefore, patients should be evaluated more carefully and multisystemically.
6 Evaluation of DNA Versus Collagen Perception in Scientific Articles Examining Cancer Chemotherapy: Implication for Collagen-Based Approaches , Şule KARAMAN  Özge KARAÇAY  Yavuz DİZDAR 
Objective: Although cancer chemotherapy has been used for more than seventy years, its definitive mechanism of action is not known. Many studies indicate that beyond DNA the collagen connective tissue matrix is also affected. This database analysis aims to determine the extent of DNA versus collagen perception in scientific papers indexed under PubMed. Materials and methods: The PubMed database scanned on September, 15, 2021 using following keywords and combinations; "cancer", "cancer chemotherapy", "cancer chemotherapy AND damage”, “chemotherapy AND mechanism AND damage”, "chemotherapy AND clinical" as nominator. The number of items found for each search was proportioned in terms “DNA versus collagen” and the ratio was accepted as the perception shift coefficient. Results: Tested with the p1-p2 analysis to calculate the difference between the two proportions in both search items. Based on the main rule under the assumption that “all cells have DNA and all cells live in the collagen matrix”. In the p1-p2 analysis of the data, a significant (p <0.001) difference was obtained for all dichotomy scans. Conclusion: This data analysis supports the argument that both cancer and chemotherapy perception is DNA-based rather than collagen, since the synthesis and degradation process of very slow; it is not possible to observe it in short term studies. Chemotherapy should be further analyzed by this manner in purpose of collagen matrix.
7 Clinical Comparison of MASCC and CISNE Scores in Neutropenic Febrile Patients in the Emergency Department , Ahmet Burak ERDEM  Emine SARCAN  Afşin KAYIPMAZ  Cemil KAVALCI 
Objective: Febrile neutropenia is an important condition that needs to be well managed in the emergency department. Home treatment and hospitalization requirements of the patients are made according to some risk classifications. The most commonly used MASCC score may involve risks in terms of early discharge. Our aim in this study is to show that these risks can be reduced if the MASCC score is supported by the CISNE score. In addition, it is to determine the contribution of procalcitonin values to these classifications. Material and Method: Neutropenic febrile patients over the age of 18 who came to the emergency department between 2019 and 2020 were included in the study. MASCC and CISNE scores of the patients were calculated. The relationship between scores and mortality was examined. Mortality estimation was made by using MASCC and CISNE scores together. In addition, patients were divided into 4 groups according to their proclacytonin values. The relationship between MASCC, CISNE and mortality between the groups was examined. Results: Of the 103 patients included in the study, 70.9% were male. The most common reason for admission was found to be acute gastroenteritis with 22.3%. 40.8% of the patients died. According to the MASCC score, 35.9% of the patients were found to be at high risk. Despite this, 85.4% of them were hospitalized and treated. There was an inverse, moderate statistically significant correlation with MASCC (r=-0.542, p=0.000), and a weak statistically significant correlation with CISNE (r=0.385, p=0.000). There was a moderately significant correlation between procalcitonin, one of the acute phase indicators, and mortality (r=-0.555, p=0.000). Conclusion: Evaluating neutropenic febrile patients with MASCC score for high-risk patients and CISNE score for low-risk patients in the emergency department gives more accurate results in determining poor prognosis. If these two scores are evaluated together with procalcitonin, the out-of-hospital mortality rate can be further reduced. For this, prospective studies in which risk scores are modified with a marker such as procalcitonin are needed.
8 A Rare Case: Myocardial Infarction during Pregnancy , Murat ÖZDEMİR  Gülşen ÇIĞŞAR  Handan ÇİFTÇİ  Elnare GUNAL 
Acute myocardial infarction (AMI) is rare during reproductive ages, but is three to four times more common in pregnant women than nonpregnant women. AMI during pregnancy is associated with high maternal and fetal mortality. We present a 22-year-old patient with 28 weeks pregnancy who was admitted to emergency department with chest pain and diagnosed with AMI in her follow-up.
9 Spontaneous Pneumothorax Developing in the Late Period in Association with COVID-19 infection: A Case Report , Serenay KANDUR TUNÇ  Mücahit ŞENTÜRK  İlker GÜNDÜZ  Erkan DUMAN  Asım KALKAN 
Several studies have been published concerning radiological findings in COVID-19 pneumonia. Spontaneous pneumothorax is one very rarely reported such finding. Spontaneous pneumothorax can develop in association with fibrotic changes occurring in the lungs, or with long-term positive-pressure intubation. In report we describe a case of a 27-year-old man who presented to the emergency department due to fever, who had no thoracic computed tomography (CT) findings at his first presentation, but who re-presented with spontaneous pneumothorax as the infection progressed.
10 Peripartum Cardiomyopathy in Emergency Department: A Case Report , Melih ÇAMCI 
Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy, which is one of the potential life-threatening complications of pregnancy. Peripartum cardiomyopathy is observed between the last 4 weeks of the pregnancy and the postpartum 5th month. It is related to high rate of maternal and infant mortality. Although the underlying factor has not been clearly understood yet, many factors such as infections, myocarditis, immunological factors or oxidative stress caused by prolactin have been attributed. We aimed to discuss the emergency management of postpartum PPCM in our case report.
11 Bennett's Fracture , Serdar ÖZDEMİR  Bahadir TASLİDERE  Abuzer ÖZKAN 
Bennett's fracture is the retention of the bone to which the beak ligament is attached, and the dorsoradial and proximal subluxation of the base of the metacarpal detached from this part. Key features are intra-articular fracture, oblique fracture pattern, and volar-dorsal fragment. The medial small piece remains in place and maintains its relationship with the second finger via the volar oblique ligament.
12 Increasing Importance of Infectious Diseases Specialization in the Management of Healthcare-Related Infections in the Pandemic , Emine Kübra DİNDAR DEMİRAY  Serpil MIZRAKÇI 
We read the article "When Will the COVID-19 Pandemic End? How Close Are We to the Target?" published by Ozdemir Sirekbasan and Yıldız in your journal in July 2021 with interest. As stated in that article, it does not seem possible to end the pandemic yet. We aimed to emphasize the importance of healthcare-associated infections, which is another danger in the pandemic, and to increase awareness.