Background: Telephones, internet-connected devices (phablets, personal computers), chat platforms, and mobile apps (eg, Skype, Facebook Messenger, WhatsApp) can be exploited for telemedicine applications. WhatsApp and similar apps are also widely used to facilitate clinical communication between physicians. Moreover, WhatsApp is used by emergency department (ED) physicians and consulting physicians to exchange medical information during ED consultations. This platform is regarded as a useful app in the consultation of dermatological and orthopedic cases. Preventing overcrowding in the ED is key to reducing the risk of disease transmission, and teleconsulting practice is thought to be effective in the diagnosis, treatment, and reduction of transmission risk of disease, most notably during the COVID-19 pandemic. Video consultation is highly recommended in some countries on the grounds that it is likely to reduce the risk of transmission. WhatsApp-like apps are among the video consultation platforms that are assumed to reduce the risk of contamination by minimizing patient-physician contact. Objective: The aim of this study was to investigate the effects of WhatsApp video consultation on patient admission and discharge times in comparison to bedside consultation in the evaluation of potential patients with COVID-19 visiting a COVID-19 outpatient clinic during the pandemic. Methods: Patients who presented to the ED COVID-19 outpatient clinic between March 11 and May 31, 2020, and for whom an infectious disease specialist was consulted (via WhatsApp or at bedside) were included in the study in accordance with the inclusion and exclusion criteria. Eventually, 54 patients whose consultations were performed via WhatsApp and 90 patients whose consultations were performed at bedside were included in our study. Results: The median length of stay in the ED of discharged patients amounted to 103 minutes (IQR 85-147.75) in the WhatsApp group and 196 minutes (IQR 141-215) in the bedside group. In this regard, the length of stay in the ED was found to be significantly shorter in the WhatsApp group than in the bedside group (P<.001). Among the consulted and discharged patients, 1 patient in each group tested positive for SARS-CoV-2 by polymerase chain reaction test and thus was readmitted and hospitalized (P=.62). The median length of stay of the inpatients in the ED was found to be 116.5 minutes (IQR 85.5-145.5) in the WhatsApp group and 132 minutes (IQR 102-168) in the bedside group. The statistical analysis of this time difference revealed that the length of stay in the ED was significantly shorter for patients in the WhatsApp group than in the bedside group (P=.04). Conclusions: Consultation via WhatsApp reduces both contact time with patients with COVID-19 and the number of medical staff contacting the patients, which contributes greatly to reducing the risk of COVID-19 transmission. WhatsApp consultation may prove useful in clinical decision making as well as in shortening process times. Moreover, it does not result in a decreased accuracy rate. The shortened discharge and hospitalization timespans also decreased the length of stay in the ED, which can have an impact on minimizing ED crowding. Trial Registration: ClinicalTrials.gov NCT04645563; https://clinicaltrials.gov/ct2/show/NCT04645563.

Background: Carbon monoxide (CO) results from incomplete combustion of carbon-based materials, causing symptoms such as headaches, dizziness, nausea, chest pain, confusion, and, in severe cases, unconsciousness. Normobaric oxygen therapy (NBOT) is the standard therapy, whereas hyperbaric oxygen therapy (HBOT) is recommended in severe cases of organ damage. This study examined the early and late adverse outcomes in patients with severe CO poisoning. Materials and methods: This study analyzed severe cases of CO poisoning among patients admitted to the emergency department between January 2020 and May 2022. The demographic, clinical, and laboratory data of symptomatic individuals and those requiring HBOT were examined. The study recorded early outcomes, such as intubation and in-hospital mortality, and late outcomes, such as delayed neurological sequelae and 1-year mortality. Chi-square tests, Spearman’s rho correlation tests, and logistic regression analyses were performed to identify factors affecting these outcomes. Results: Patients who received HBOT showed a significant difference in delayed neurological sequelae (DNS) compared to those who received NBOT (p = 0.037). Significant differences were observed in the need for intubation, in-hospital mortality, and 1-year mortality between patients based on COHb levels, but no significant differences were found in DNS. The 1-year mortality probability was significantly influenced by COHb level (odds ratio = 1.159, 95% CI [1.056–1.273]). Patients receiving NBOT had a higher odds ratio for DNS risk than those receiving HBOT (odds ratio = 8.464, 95% [1.755–40.817], p = 0.008). Conclusion: The study showed no differences in intubation, in-hospital mortality, and 1-year mortality rates between the HBOT and NBOT groups. However, significant differences in DNS suggest that treatment modalities have different effects on neurological outcomes. High COHb levels are associated with an increased risk of intubation, and mortality underscores the significance of monitoring COHb levels in clinical evaluations.

Introduction: Accidental head injuries are known to cause serious traumatic brain injury (TBI). Children younger than 2 years of age build a separate group that is more difficult to assess clinically. Investigations targeting TBIs in pediatric cases, particularly in those between 0 and 2 years of age, are limited. Objective: In this study, we reviewed a number of severe accidental head injuries in a cohort of children aged 0–2 years to evaluate the relative incidence, distribution, and clinical success in determining the nature of the cases in the Kars Province of Turkey. Methods: The study targeted 26 ­cases who presented to the Emergency Department of Kars Harakani Hospital for TBI between 2017 and 2019 through retrospective chart review. Results and Conclusions: Among the children who presented to the emergency clinic, 2 were newborns, 7 were <1 year of age, and the remaining 17 cases were between 1 and 2 years old. The number of male and female patients was equal, and 5 fatality cases were observed. The most frequent cause of head trauma were falls. We deduced that 6 cases had subarachnoid hemorrhage, 2 cases had subdural hemorrhage, 3 cases had epidural hemorrhage, and 4 cases had contusion. We compared the mean level of the two blood parameters hemoglobin (HGB) and hematocrit (HCT) between fatal and surviving cases and detectedthat both values decreased dramatically in exitus cases. The higher fatality rate in the present study could be attributed to the fact that we targeted only the severe TBI cases. Severe TBI in children younger than 2 years results in a life-threating situation. The risk of fatality might be deduced from the reduction of the HGB and HCT levels as it is significantly lower in fatal cases than in surviving cases.

The objective of this study was to evaluate the usefulness of the serum biomarkers myeloperoxidase (MPO), paraoxonase (PON), and plasma asprosin in acute myocardial infarction (AMI) diagnosis and assess their compatibility with routinely screened cardiac biomarkers. This study was conducted using a prospective cross-sectional design and included 90 patients, consisting of 60 patients diagnosed with AMI (30 with ST-segment elevation and 30 with non-ST-segment elevation on ECG) and 30 controls (without a diagnosis of AMI). Changes in the levels of cardiac biomarkers (Hs-cTnI, CK, CK-MB), lipid profile (TC, TG, LDL, HDL), MPO, PON, asprosin, and routine biochemical parameters of patients were evaluated. Furthermore, receiver operating characteristic curve analysis revealed the diagnostic value of Hs-cTnI, MPO, PON, and asprosin in predicting AMI. Binary logistic regression analysis of cardiac marker concentrations was used to predict the presence of AMI. In contrast, multinomial logistic regression analysis was conducted to predict the type of AMI and the control group. The median levels of MPO and plasma asprosin were found to be higher in the patient group (3.22 [interquartile range {IQR}: 2.4–4.4] ng/ml and 10.84 [IQR: 8.8–17.8] ng/ml, respectively) than in the control group (2.49 [IQR: 1.9–2.9] ng/ml and 4.82 [IQR: 4.6–8.0] ng/ml, respectively) (p = 0.001 and p < 0.001, respectively). The median levels of PON were 8.94 (IQR: 7.6–10.4) ng/ml in the patient group and 10.44 (IQR: 9.1–20.0) ng/ml in the control group (p < 0.001). In the binary logistic regression model, compared with the control group, a 1 ng/ml increase in MPO level increased the odds of having AMI by 3.61 (p = 0.041, 95% CI: 1.055–12.397), whereas a 1 ng/ml increase in asprosin level increased the odds of having AMI by 2.33 (p < 0.001, 95% CI: 1.479–3.683). In the multinominal logistic regression model, compared with the control group, a 1 ng/ml increase in the MPO level increased the odds of having NSTEMI by 4.14 (p = 0.025, 95% CI: 1.195–14.350), whereas a 1 ng/ml increase in asprosin concentrations increased the odds of having NSTEMI by 2.35 (p < 0.001, 95% CI: 1.494–3.721). Herein, MPO and asprosin concentrations increased with Hs-cTnI, and a decrease in PON concentration indicated that oxidant–antioxidant parameters and adipokines were related to AMI pathogenesis.

Objective The present study evaluated the work-related anxiety scores of healthcare workers in emergency departments (ED) and aimed to determine the factors affecting these scores.Methods The data was obtained through a survey administered to the emergency staff. Beck’s Anxiety Inventory (BAI) and the Mini-International Neuropsychiatric Interview (MINI) work anxiety interview were used to predict and determine the type of anxiety experienced by the participants. The survey was administered to 147 volunteers, and questionnaires from 130 participants were included in the study.Results It was found that 43.8% of the participants had a BAI score greater than 7. The study results showed a negative correlation and a linear regression model between age and the BAI score. Additionally, the BAI score was significantly higher in female, singles, physicians, those who were dissatisfied with their jobs, and those who were dissatisfied with their salaries (p<0.05). The results also showed that having a history of anxiety disorder or depression, being a physician, and being dissatisfied with one’s job were 6.277, 5.583, and 4.005 times higher, respectively, in terms of suspicion of anxiety (p<0.001). In the MINI job anxiety interview, work-related posttraumatic stress disorder (38.6%) was predicted most frequently, and indiscriminative work-related social phobia (5.3%) was predicted least frequently in participants at risk for anxiety according to the BAI score.Conclusion This study suggests that teaching healthcare workers how to cope with workplace trauma and workplace-related situational phobias can be an effective solution to prevent anxiety disorders in healthcare workers working in ED.