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Bizim çalışmamızdaki amacımız ülkemizde karbonmonoksit (CO) zehirlenmesinin en sık nedeni olan kömür sobasından kaynaklanan zehirlenmeler ile doğal gaz kaçaklarının yol açtığı zehirlenmeler arasındaki epidemiyolojik, klinik, laboratuar ve prognoz farklılıklarını ortaya koymaktır. Ayrıca CO zehirlenmelerinde oluşan klinik tablonun şiddeti, prognozu, komplikasyonları ile başvuru sırasındaki nötrofil/lenfosit oranı (NLO) arasındaki ilişkiyi incelemeyi amaçladık. Yöntemler: Bu prospektif çalışmaya Ankara Eğitim ve Araştırma Hastanesi Acil Tıp Kliniği'ne 2009 Ekim-2010 Nisan tarihleri arasında başvuran akut karbonmonoksit zehirlenmesi olgularının tümü alındı. CO zehirlenmesi tanısı, anemnezinde CO zehirlenmesine neden olabilecek öykünün olması ile birlikte karboksihemoglobin (COHb) konsantrasyonunun % 10'nun üstünde olması şeklinde konuldu. Çalışmamıza toplam 100 hasta dahil edildi. Bulgular: 55 (%55) hasta kömür sobasıyla zehirlenirken, 45 (%45) hasta doğal gaz kaynaklı zehirlenmişti. Doğal gazdan zehirlenen grubun ortalama COHb düzeyi anlamlı bir şekilde daha yüksekti (p=0,01). Doğal gaz grubunun ortalama Glaskow koma skoru (GKS) değeri anlamlı bir şekilde daha düşüktü (p=0,018). Doğal gazdan zehirlenen grupta 17 hastanın HBO (hiperbarik oksijen) tedavisi ihtiyacı olurken, kömür sobasından zehirlenen grupta ise sadece 6 hastanın HBO tedavisi ihtiyacı oldu. Doğal gazdan zehirlenen grupta kömür sobasından zehirlenen gruba göre anlamlı bir şekilde HBO tedavisi ihtiyacı daha fazlaydı. (p=0,001) NLO ile COHb oranı, troponin ve GKS değerleri arasında istatistiki olarak anlamlı bir ilişki bulunmadı (Sırasıyla; p=0,872, p=0,470, p=0,896). Sonuç: Doğal gaz kaynaklı CO zehirlenmeleri kömür sobası zehirlenmelerine göre daha toksik olabilmektedir. CO zehirlenmelerinde oluşan klinik tablonun şiddeti, prognozu, komplikasyonları ile başvuru sırasındaki NLO arasında her hangi bir ilişki yoktur.

Aluminum phosphide (AlP) is a relatively low cost and highly toxic pesticide. Besides being lethal to the patient poisoned by AlP, this substance may easily contaminate emergency medicine personnel through the release of toxic gases such as phosphine. Furthermore, these toxic gases are flammable and may explode during certain patient interventions, such as gastric lavage. We present a case of lethal poisoning of a patient caused by the intentional ingestion of AlP and secondary intoxication of emergency medicine personnel with the explosive phosphine gas.

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Cardiovascular diseases (CVDs) are the most important cause of morbidity and mortality worldwide, and the incidence is increasing rapidly (1). Coronary artery diseases constitute 44% of the cause of death in Turkey (2). Acute coronary syndromes (ACSs) occur as a result of decreased blood flow to the coronary artery. Chest pain accounts for about 5% of the admissions to the emergency department (ED), and the rate of ACS among these cannot be underestimated (3). ACS has been studied in four groups: unstable angina pectoris, ST segment elevated acute myocardial infarction (AMI), non-ST-segment elevated myocardial infarction (MI), and sudden cardiac death (3). Insulin-like growth factors (IGFs) are involved in cell proliferation, usually depending on the growth hormone (GH) (4). This effect is local and systemic, and starts in the prenatal period (4). Two subtypes are defined as IGF-1 and IGF-2, and they circulate in the body fluids together with insulin-like growth factor-binding proteins (IGFBPs) (5). IGF-1 is a polypeptide with endocrine, paracrine, and autocrine functions, which is synthesized in the liver. Approximately 75%-80% of circulating IGF-1 is found to bind with IGFBP-3 (6). IGF-1 has been found to have positive effects on the development of cardiac structure, contractile function, heart rate, and ejection fraction (7). IGF-1 and IGFBP-3 levels have also been shown to exhibit a complex relationship with local and systemic effects in patients with ACS (7). Previous experimental studies have reported that IGF-1 increases ABSTRACT This study aimed to determine the role of the serum growth hormone and insulin-like growth factor-binding proteins 3 levels measured in the first 24 h in the diagnosis and pathophysiology of acute myocardial infarction (AMI). The levels of serum Growth hormone, insulin-like growth factors1, and insulin-like growth factor-binding proteins 3 of the patients diagnosed with AMI in the first 24 h of onset and that of the control group at the time of admission were compared between January 1 and August 31, 2010. The average age of the patient group was 59.36 ± 13:25 years, and 79.4% of the patients were males. The serum growth hormone and insulin-like growth factor-binding proteins 3 levels were significantly higher in the patient group (P < 0.05). However, no differences were found between insulin-like growth factors 1 levels in both the groups (P > 0.05). The sensitivity of growth hormone was 84.1% with a cutoff value of 0.14; the sensitivity of insulin-like growth factors1 was 33.6% with a cutoff value of 162; and the sensitivity of insulin-like growth factor-binding proteins 3 was 75.7% with a cutoff value of 2862. The present study showed that growth hormone and insulin-like growth factor binding proteins 3 markers play important roles in the pathophysiology of myocardial infarction. Hence, it is thought that they can be used in the diagnosis of AMI. Further studies are needed to validate the conclusion.