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BackgroundTo evaluate the etiological and demographic characteristics of adult poisoning patients followed up in a toxicology unit in Konya, Turkey.MethodsPatients (≥ 15 years old) followed up with the diagnosis of poisoning in our toxicology unit in 2011 were included in this retrospective study. The patients’ medical records were investigated. Age, gender, medical history, the first medical center the patient had been admitted to, the routes and causes of poisoning, the toxins involved, the number of the pills taken, treatments, complications, the length of stay in the hospital and the outcome were recorded.ResultsA total of 623 patients were included in the study. The mean age of patients was 28.1 ± 15.1. Four hundred and forty-five (71.4%) of patients were female, 541 (86.9%) of them were poisoned via the oral route and 75 (12.0%) of them were poisoned by inhalation. The causes of poisoning were drugs in 408 (65.5%) patients, pesticides/insecticides in 58 (9.3%) patients and carbon monoxide in 49 (7.9%) patients. The commonly used drugs were as follows: analgesics (57.2%), antidepressants (25.4%) and gastrointestinal system drugs (15.8%). The poisonings were suicidal in 489 (78.5%) patients, accidental in 120 (19.3%) patients and overdose in 14 (2.2%) patients. The number of women was higher in the suicide group. At the end of the treatment, 604 (97.0%) of the patients were discharged and 3 (0.4%) of them died. The duration of follow-up was 39.2 ± 37.5 h.ConclusionThe most common causes of poisoning are drugs, pesticides/insecticides and carbon monoxide. Health and educational policies at a national level are needed in order to prevent this medicosocial problem. Furthermore, specially equipped toxicology units should be constructed for the treatment and follow-up of the poisoned patients in order to reduce the morbidity and mortality to a significant extent.

ObjectiveIn this study, we aimed to determine whether plasma NGAL levels could be used as a biomarker for distinguishing between AKI and CKD in emergency medicine.Materials and methodsThis prospective study was conducted at the ED of a training and research hospital over a six-month period in 2015. Three groups were defined: an AKI group – defined as a new onset of at least a 1.5-fold or ≥0.3 mg increment increase of SCr values from the normal baseline, a stable CKD group – only included presence of stages 2 through 4 of CKD according to the National Kidney Foundation's KDIGO 2012, and a control group. After the initial evaluation of patients, venous blood samples were taken for routine biochemical, counter blood cell, and plasma NGAL measurement at admission.ResultsA total of 25 patients with AKI, 22 patients with stable CKD, and 22 control subjects were enrolled. Level of plasma NGAL in AKI group was higher than those of the stable CKD group (median: 794 ng/ml IQR: 317–1300 & 390 ng/ml IQR: 219–664, p < 0.001). AUC was measured as 0.68 (p = 0.02, 95% CIs: 0.54–0.84) to assess the utility of plasma NGAL levels at varying cut-off values for distinguishing between AKI and CKD. For plasma NGAL, the best cut-off level was found to be 457 ng/ml (sensitivity: 72.0%, specificity: 64%).ConclusionThis study has clearly demonstrated that plasma NGAL levels were higher in AKI patients than in CKD patients. However, in clinical practice, the use of plasma NGAL levels to distinguish between AKI and CKD is limited.

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Vertigo is encountered frequently in emergency services. Researchers have explored the role of serologic markers in the differentiation of central and peripheral vertigo. The study reported here was designed to evaluate the diagnostic efficacy of serologic markers (fibrinogen, D-dimer, and C-reactive protein [CRP]) in the differential diagnosis of peripheral and central vertigo. A total of 116 patients who sought treatment for vertigo at Gazi University Hospital Adult Emergency Services during a 3-mo period were included in the study. CRP, fibrinogen, and D-dimer levels were assessed in an effort to differentiate between cases of peripheral and central vertigo. In all, 65.5% of patients (76 patients) were women. Patients younger than 50 y of age accounted for 60.3% (70 patients). The average D-dimer level for the entire group of patients was 181.9+/-132.2 microg/mL, the average CRP level, 4.2+/-8.4 mg/L, and the average fibrinogen level, 421.9+/-176.0 mg/dL. Although serum D-dimer, fibrinogen, and CRP values appeared to be higher in patients with central vertigo than in those with peripheral vertigo, no statistically significant differences were noted between the 2 groups in terms of these 3 parameters (P>.05). When 6 mg/L was used as the cutoff point for CRP and 320 mg/dL was used for fibrinogen, the numbers of patients with CRP and fibrinogen levels higher than these values were significantly higher for central vertigo than for peripheral vertigo (P<.05). The present study shows that blood D-dimer, fibrinogen, and CRP levels cannot be significant markers for the differentiation of central and peripheral vertigo.

IntroductionAntiepileptic drugs, which are also called anticonvulsants, are used in the therapy and prophylaxis of epileptic seizures. The purpose of this paper was to investigate the relevant epidemiological data and to determine which of these drugs was the most frequent cause of intoxication. Another purpose of this study was to determine the neurological, cardiac, and biochemical problems caused by antiepileptics.Material and methodThis retrospective study included 95 consecutive patients under 18 years of age with antiepileptic intoxication, presenting to and being followed-up in, the Toxicology Unit between January 2010 and February 2013. The data were obtained by screening the patient files.ResultsOf the cases, 67 (70.5%) were self-poisoned by first generation antiepileptics (FGAEs) and 28 (29.5%) by second generation antiepileptics (SGAEs). The Glasgow Coma Scale (GCS) scores and the serum lactate levels of the patients poisoned by FGAEs and SGAEs on admission to emergency department were 15 (25th: 12; 75th: 15; 95th: 15; IQR: 3) and 1.9 (25th: 1.4; 75th: 3.1; 95th: 5.6; IQR: 1.7), and 15 (25th: 14.3; 75th: 15; 95th: 15; IQR: 0.75) and 1.07 (25th: 0.9; 75th: 1.6; 95th: 5.5; IQR: 0.71), respectively. The serum lactate levels of patients poisoned by FGAEs were significantly higher (p < 0.001). Among the cases poisoned by carbamazepine, the most frequent cause of intoxication, the GCS score was significantly lower and serum lactate level was significantly higher in the group with high serum levels of carbamazepine (p = 0.004 and p < 0.001, respectively). In cases poisoned by valproic acid (VPA), the second frequent cause of intoxication, there was neither a significant association between the serum VPA level and the GCS score, nor between the serum lactate level and the systolic blood pressure (p = 0.470, p = 0.897, and p = 0.088, respectively). However, there was a positive correlation between the serum VPA level and the serum ammonia level (kk = 0.742, p < 0.001).ConclusionFirst generation antiepileptics are more toxic than SGAEs. In patients with serum carbamazepine level, particularly those over 30 mg/L, serious disorders of consciousness, cardiovascular toxicity, and metabolic disorders may occur. In VPA intoxication, there is a positive correlation between the serum VPA levels and ammonia levels. On account of this finding, one should be more careful about hyperammonemic hepatic encephalopathy as the serum VPA level rises.