The aim of this study was to reveal how the pandemic process affected the number of ED visits and the reasons for application. Methods: The daily number of ED visits during the pandemic were analyzed in 3 different periods; prepandemic period (February 1st to March 11th, declaration of the first COVID-19 case in Turkey), early pandemic period (March 12th to May 31th, period of strict measures), and late pandemic period (June 1st to July 31st, period of new norms). The pandemic periods were compared with the same timeframes in 2019 (comparison periods). Demographic variables and complaints of the patients on admission were investigated. Results: The total number of ED visits in the study period in 2020 was 78,907, which was only the half of the applications in the same period in 2019 (n: 149,387). Data showed a sharp decrease at the number of daily visits to green and yellow zones after the announcement of the first case however red zone applications were more than twice that of the previous year. During pandemic nonspecific complaints was decreased and there was an increase at the percentages of respiratory, cardiac, and neurological complaints. Conclusion: Number of ED visits during the pandemic were decreased by half when compared to the previous year. It was an advantage of the pandemic to decrease ED visits due to "nonemergent" complaints, and thus, unnecessary patient burden. However, on the other hand, patients avoided seeking medical attention, even for lifethreatening conditions which led to increased mortality and morbidity.

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IntroductionCarbon monoxide (CO) poisoning is a health problem that frequently occurs in Turkey and worldwide. In Turkey, it accounts for 30% of the poisoning cases that end with death (1).This colorless, odorless, tasteless, and nonirritating gas is produced as a result of the incomplete burning of organic matter that can easily be absorbed by the lungs. CO poisoning can cause cerebral, cardiac, and general ischemia. The poisoning can be diagnosed according to the blood carboxyhemoglobin (COHb) levels. There is a weak correlation between blood COHb levels and organ damage. Poisonings higher than 60% end with death and at lower levels clinical findings range from mild to severe. It is not always possible to identify this using the COHb level (2). Biochemical markers other than COHb are being studied to identify the clinical outcomes of this poisoning with neurotoxic and cardiotoxic effects in particular (3).Copeptin is excreted from the posterior hypophysis simultaneously with vasopressin and reflects the amount of vasopressin in circulation. Copeptin is more stable than vasopressin in plasma and serum. Studies conducted have reported that copeptin and vasopressin levels float parallel to each other both in healthy individuals and in the critically ill patient population. Recently copeptin has been investigated as a diagnostic and prognostic factor in many diseases like pneumonia, heart failure, and hemorrhagic and septic shock and it has been identified that its levels rise in correlation with the severity of the disease (4-7).The aim of this study is to identify the copeptin levels in patients presenting to the emergency department with CO poisoning and to investigate its correlation with neurological damage.Background/aim: The aim of this study is to identify the copeptin levels in patients presenting with carbon monoxide (CO) poisoning to the emergency department and to investigate its correlation with the neurological effects. Materials and methods:The study group consisted of patients presenting with CO poisoning and carboxyhemoglobin levels >10%. Blood samples for copeptin levels were obtained twice, first at presentation then at the fourth hour of observation. The data were analyzed using SPSS 16 for Windows. Results:The median copeptin levels of the patient group were identified as 0.63 (0.39-1.06) ng/mL at hour 0 and 0.41 (0.31-0.49) at hour 4. The copeptin levels of the control group were 0.34 (0.25-0.42) ng/mL and were significantly lower than those of the patient group (P < 0.000). According to our results, 0.345 ng/mL for plasma copeptin level as the best cut-off level may be used with sensitivity of 94.0% and specificity of 60%. The copeptin levels at hour 0 were statistically significantly higher in the neurologically affected patients than those not affected (P < 0.001). Conclusion:In this study it was shown that blood copeptin levels increase in patients presenting to the emergency department with CO poisoning.

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Background: Acute gastroenteritis is a clinical syndrome that may cause severe dehydration in affected individuals and a reason of mortality and morbidity in all age groups. Measurement of perfusion index and plethysmography variability index may provide emergency physicians valuable information about hemodynamics of the patient. Objectives: Our study aimed to investigate the role of perfusion index and plethysmography variability index measurement at admission for estimating dehydration severity and determiningthe possible change in those parameters after fluid replacement among patients presenting to emergency department with acute gastroenteritis. Methods: This was a prospective cross-sectional study. Patients diagnosed with acute gastroenteritis at the emergency department were consecutively enrolled. The two groups were defined according to the severity of dehydration: mild and moderate/severe dehydration groups. The values of perfusion index and plethysmography variability index of all patients were measured. Results: A total of 180 patients were included in the study. As compared with the mild dehydration group, moderate/severe dehydration group had a significantly lower perfusion index value and significantly higher plethysmography variability index value on admission (p < 0.001 for both comparisons). Among moderate/severe dehydration patients, perfusion index value significantly increased and plethysmography variability index significantly decreased after treatment (p < 0.001). There was a significant positive correlation between osmolarity and plethysmography variability index (r = 0.298; p = 0.007) and a significant negative correlation between osmolality and perfusion index (r = −0.259; p = 0.019) in the patients with moderate/severe dehydration. Conclusion: The study show that perfusion index and plethysmography variability index may be useful for determining the severity of dehydration in acute gastroenteritis and may be use for assessing the response to fluid replacement especially in patients with severe dehydration at emergency department.