Acta Medica

A conflict choice of treatment during defibrillation in cardiopulmonary resuscitation: Lidocaine, amiodarone or both? A retrospective study

Erkan Bayram — 2024-06-30

Objective: Cardiopulmonary arrest is considered to be an unpredicted event leading to sudden death. The primary purpose of the study is to investigate the effects of antiarrhythmic drugs during defibrillation within cardiopulmonary resuscitation (d-CPR) on survival outcomes.

Materials and Methods: The antiarrhythmic drug treatment during d-CPR management in our hospital from 2015 to 2022 were evaluated retrospectively. Demographic information, and details related to resuscitation were obtained from the “Cardiopulmonary Resuscitation and Code Blue Forms”. According to inclusion criteria, from 898 patient data 135 were included. The treatment of anti-arrhythmic drugs administered during d-CPR management were lidocaine, amiodarone, or amiodarone&lidocaine together. Data recorded related to the present study were evaluated primarily according to the return of spontaneous circulation (ROSC) and survival outcomes.

Results: The mean cardiopulmonary resuscitation duration was 31.82±22.37 minutes in patients with ROSC and 42.40±9.28 minutes in non-ROSC, p<0.01. Amiodarone administration during d-CPR was the highest preffered treatment from 2015 to 2022, when compared with the usage of amiodarone&lidocaine together (14.1%), p<0.01. However the administration of lidocaine during d-CPR (39.3% of all) appered to be performed before 2020 in our hospital. Additionally amiodarone revealed a positive effect on systolic blood pressure and mean arterial pressure in ROSC patients (p=0.02, p=0.04 respectively), while the choice of antiarrhythmic drug treatment during d-CPR management showed no significant difference on survival status.

Conclusion: The observed ROSC was 42.2%. The choice of antiarrhythmic drug treatment during d-CPR management showed no significant difference on survival status, although amiodarone revealed a positive effect on systolic blood pressure and mean arterial pressure in the patients with ROSC.

Evaluation of pediatric patients with palpitations via cardiac event recorder, Holter monitoring and transesophageal electrophysiologic study in detecting arrhythmia

Neslihan Ekşi — 2024-06-30

Objective: Palpitations are a common reason for referral to pediatric cardiologists, the diagnostic workup involves ambulatory, non-invasive recording devices and invasive procedures. We aimed to evaluate arrhythmic symptoms of pediatric patients with a cardiac event recorder, Holter monitoring and transesophageal electrophysiologic study (TEEPS) results.

Materials and Methods: Retrospective evaluation of pediatric patients who fitted an event recorder at tertiary University Hospital between January 2002 and August 2012. The data obtained from the same patients’ as cardiac event recorder, Holter monitoring and TEEPS results were studied for comparison.

Results: During the study period, 40 patients who had all data of cardiac event recorder, Holter monitoring and TEEPS were included. The median age of the patients included in the study was 12 [interquartile range, 7-15] years. Using the Holter monitoring, supraventricular extrasystoles (SVEs) were detected in six (15%) patients and ventricular extrasystoles (VESs) in three (7.5%). According to the event recorder data of the 40 patients, there was sinus tachycardia in 20 (50%), supraventricular tachycardia (SVT) in three (7.5%), and SVEs in two (5%) patients. The event recorder data of the remaining 15 patients were assessed as normal. The analysis of the TEEPS results revealed atrioventricular nodal reentrant tachycardia in four (10%), atrioventricular reentry tachycardia in three (7.5%), and normal results in the remaining 33 (82.5%) patients.

Conclusions: This study demonstrated that a cardiac event recorder may also be considered as an important diagnostic tool in the diagnosis and ruling out of SVT in pediatric patients for whom the cause of arrhythmia cannot be identified with the Holter monitor, in patients who do not accept the use of TEEPS method following the use of Holter monitor, and in patients in whom SVT cannot be stimulated by TEEPS yet complaints persist.

The level of implementation of COVID-19 measures in workplaces: Ideas for the future

Mümine Yüksel — 2024-06-30

Objective: The initial phases of Coronavirus Disease 2019 (COVID-19) pandemic required a wide range of preventive measures for various settings, including workplaces. The evaluation of workplace applications may guide all stakeholders for future similar outbreaks. This study aimed to evaluate the practice of Turkish occupational safety and health (OSH) professionals regarding COVID-19.

Materials and Methods: The study included responses of OSH professionals who were members of three national organizations. Data were collected during the third peak of COVID-19 cases in Turkey.

Results: Of 457 respondents, 92.6% reported at least one infected worker, and 12.7% reported mortality among workers due to COVID-19. Multiple regression analyses revealed an association with workplace size ≥250 for any COVID-19 infection among workers (OR=6.70, 95% CI:2.64–16.98, p<0.001) and for COVID-19 related mortality (OR=3.37, 95% CI:1.59–7.13, p=0.002). Moreover, working in governmental business enterprises was related to COVID-19 related mortality (OR=4.83, 95% CI:2.33–10.01, p<0.001). The mean number of available measures was significantly lower (p<0.001) in governmental business enterprises, the service sector, and workplaces with less than 250 workers.

Conclusion: The results indicate a need for improvement in small- and large-sized workplaces, governmental business enterprises, and service sector workplaces.

Haglund’s deformity: Clinical outcomes of endoscopic calcaneoplasty

İbrahim Halil Rızvanoğlu — 2024-06-30

Objective: Haglund’s deformity is characterized by a bony prominence of the calcaneus, leads to posterior heel pain, swelling, and morning stiffness. Endoscopic calcaneoplasty is becoming increasingly popular due to its numerous advantages over conventional surgical methods. This study aims to evaluate the clinical and radiological results of patients who underwent endoscopic calcaneoplasty.

Materials and Methods: A total of 17 patients were diagnosed with Haglund’s deformity and underwent endoscopic calcaneoplasty surgery in our clinic between June 2019 and January 2023 were included in this retrospective study. Pre-operative and post-operative parameters of patients with 6 months or more of follow-up were compared. The VAS was used for pain assessment, the AOFAS score for functional outcomes, and the length of bone deformity for radiological assessment.

Results: Significant pain resolution was observed at the final follow-up compared to the preoperative period. The mean VAS score decreased from 6.77±1.3 pre-operatively to 1.62±1.12 post-operatively (p<0.001). The AOFAS score showed a significant increase from 61.23±7.7 preoperatively to 92.46±6.04 postoperatively (p<0.001). Bony hump length decreased significantly from 4.12±1.14 preoperatively to -2.29±1.56 postoperatively (p<0.001).

Conclusion: Endoscopic calcaneoplasty is a reliable method in Haglund’s deformity, that provides rapid recovery, early return to daily activities and sports, and a low complication rate.

A potential prognostic indicator in methanol intoxication: Body temperature

Ali Batur — 2024-06-30

Objective: Methanol intoxication is a type of poisoning with high mortality and morbidity. The current study aims to examine patients diagnosed with methanol intoxication and treated with standardized treatment to collect data that may be used to predict patient outcomes and mortality.

Materials and Methods: The current study was a retrospective study and included patients over 18 years of age diagnosed with methanol intoxication between 1st March, 2011 and 1st March, 2021. All patients were treated with the treatment protocol determined by the clinic in accordance with the guidelines. Sociocultural characteristics, vital and laboratory findings, and clinical outcomes of the patients were analyzed.

Results: Of the 28 patients included in the study, 80% were male, and the median age was 49. Patients were divided into two groups: survived and deceased. The median time since last alcohol intake was higher in surviving group (7 hours (Q1-Q3:6-12) vs 4 hours (Q1-Q3:2-17), p=0.005) and the amount of alcohol per kilogram of weight was lower in surviving group (3.13 ml/kg (Q1-Q3: 1.34-4.46) vs 8.81 ml/kg (Q1-Q3:5.22-9.49), p=0.002). The body temperature was lower in deceased group (35.40 °C (Q1-Q3:34.95-35.50) vs 36.40 °C (Q1-Q3:36.10-36.55), p=0.001). The current study showed that the other diagnostic factors of mortality in methanol intoxication are serum pH, lactate levels, bicarbonate levels, base deficit, anion deficit, the level of consciousness of the patient at admission, the time since the last alcohol consumption, and the amount of methanol ingested.

Conclusion: In this study, it was concluded that moderate hypothermia may be an indicator of mortality in addition to classical findings. Thus, it has been shown that hypothermia will be effective in methanol intoxication in addition to other early markers for early diagnosis and rapid initiation of treatment.

The role of reconstructive plastic surgery in the treatment of victims of the 2023 Kahramanmaraş earthquake

Dicle Aksöyler — 2024-06-30

Objective: As a result of the 2023 Kahramanmaraş earthquake, medical institutions experienced a large influx of patients requiring acute multidisciplinary surgical and medical care. This study aimed to evaluate the patient demographics and treatment management of survivors admitted to our reconstructive plastic surgery department.

Materials and Methods: We retrospectively analyzed the age, sex, time under the wreckage, time of admission, types and locations of injuries, treatment modalities, receipt of hyperbaric oxygen therapy, and receipt of vacuum-assisted closure therapy of the earthquake victims referred to our department.

Results: The definitive management of all 42 earthquake survivors admitted to our department was reviewed. This included five free flaps, four regional flaps, 18 split-thickness skin grafts, and one maxillofacial fracture repair. Eight patients were treated conservatively including two with non-displaced maxillofacial fractures. Of the 26 patients treated for lower extremity injuries, four were already amputees. Among the remaining 22 patients with such injuries, one underwent Charcot amputation plus free flap reconstruction to preserve extremity length and one underwent below-the-knee amputation. Of the 16 upper extremity injuries, two patients referred with extensive forearm necrosis underwent forearm amputation. To preserve extremity length and ensure the limbs were suitable for biomechanical orthoses, free transverse upper gracilis musculocutaneous flaps and free chimeric Anterolateral- Vastus Lateralis musculocutaneous flaps were performed.

Conclusion: This study illustrates the value of multi-modal reconstructive plastic surgery in the treatment of disaster survivors, particularly in the management of multi-trauma.

Isolated sphenoid sinus mycetoma: An unusual cause of chronic headache

Okan Sökmen — 2024-06-30

Central nervous system involvement of chronic lymphocytic leukaemia: A rare case report

Derya Koyun — 2024-06-30

Central nervous system (CNS) involvement in chronic lymphocytic leukemia (CLL) is unfamiliar. The diagnosis is delayed commonly, because of underdiagnosis or subclinical symptoms. We describe a 80-year-old woman with a previous diagnosis of CLL who presented to the emergency service with tonic clonic seizure. The new therapies, eg, ibrutinib and venetoclax, can be effective treatment strategies for CLL with CNS involvement. In our case, treatment with ibrutinib led to a resolution of the cerebralspinal fluid (CSF) neoplastic infiltration, but the patient died afterwards.

Neoadjuvant endocrine treatment: Precious but insufficiently discovered issue

Arzu Oğuz — 2024-06-30

We would like to emphazise the importance of neoadjuvant endocrine treatment which is overshadowed by neoadjuvant chemotherapy for breast cancer patients. Missing knowledge is evaluation in terms of conventional notion of neoadjuvant chemotherapy that is it better to complete before surgery at least for some selected patients? Another point is, since it is a long term treatment, may be it will be a way give patients the chance to follow up without surgery. So this correspondence tries to ask two questions; shall we think about lengthening the duration of neoadjuvant endocrine treatment in selected patients and who are these patients?