Aim: To compare the diagnostic accuracy of HACOR score in predicting non-invasive ventilation (NIV) failure among acute exacerbation of chronic obstructive airway disease (AECOAD)and acute decompensated heart failure (ADHF)patients,and study the correlation of HACOR score with length of stay and hospital mortality rate.

Materials and Methods: A prospective observational study conducted in emergency department of Hospital Melaka.We enrolled patients who presented with acute respiratory distress started with NIV.The efficacy of the HACOR score is evaluated at several interval time points, before NIV initiation, 1 hour, 2 hours post NIV initiation.

Result: HACOR score is much lower in NIV success subgroups and 100% NIV failure rate for the HACOR score >7 at 1 hour and 2 hours of NIV.With a cut-off value of >5 at 1 hour of NIV, the diagnostic power is 86.27% with the sensitivity of 62.50% and specificity of 90.70%. Whereas at 2 hours of NIV with the HACOR score of >5,its diagnostic power is 87.50% with the sensitivity of 50% and specificity of 95%. At 0-2 hours of NIV, area under curve (AUC) for the prediction of NIV failure are 0.788, 0.868 and 0.925 respectively.

Conclusion: The HACOR has a good diagnostic accuracy when it is assess at 1–2 hours of NIV. It is convenient to use to assess the efficacy of NIV especially for heart failure patients. However, HACOR score is a weak predictor for mortality in our study. Length of hospital stay is also found to be longer for those who failed to respond to NIV in our study.

Objective: This study was performed to evaluate the effectiveness of topical lidocaine-ibuprofen combination compared to lidocaine-prilocaine combination (Xyla-P) in reduction of the pain during central venous catheter (CVC) insertion.
Methods: In this randomized clinical trial, 100 adult patients requiring CVC insertion in the emergency department (ED) were enrolled. These patients were divided randomly into two groups. The site of CVC insertion was covered with topical Xyla-P cream (2 g) in the first group, and topical lidocaine-ibuprofen (2 g) cream in the second group. The primary outcome was assessment of pain during CVC implantation. The secondary outcomes were physician’s satisfaction and the incidence of side effects.
Results: The mean age was 41.67 ± 9.66 years (range 18–61), and 36% of patients were female. The mean VAS pain score during CVC insertion was 4.61 ± 2.05 in the LP group and 3.86 ± 2.09 in the LI group, respectively (mean difference of 0.75 [95% confidence interval (CI): -0.80 to 1.56]), The mean VAS pain score during lidocaine injection was 1.78 ± 0.79 in the LP group and 1.52 ± 0.79 in the LI group, respectively (mean difference of 0.26 [95% CI: -0.05 to 0.57]), The physician’s satisfaction did not show statistically significant differences between two groups.
Conclusion: This study showed that topical lidocaine-ibuprofen is as effective as Xyla-P in relieving acute pain during CVC insertion.

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Aim: Identifying patients presenting with suicide attempt, determining risk groups, and taking appropriate precautions for risky patients can prevent injuries and death. This study aims to determine the usability and possible benefits of the hospital anxiety and depression scale (HADS) in patients presenting to the emergency department with suicide attempt.
Materials and Methods: This cross-sectional observational survey study conducted in the emergency department of a tertiary hospital. One hundred and two patients were included in the study. Cronbach's alpha coefficient was used in the reliability analysis and determined as> 0.7.
Results and Conclusion: There was a significant difference between patients who had a previous suicide attempt in terms of HAD-A, HAD-D score, and HADS total scores compared to patients who had not attempted suicide before (p = 0.043, p = 0.031, p = 0.034, respectively). HADS is a beneficial scale that can be used by emergency physicians for patients who are admitted to the emergency department with a suicide attempt. HADS detected that patients who attempted suicide had a significant level of anxiety and depression. Besides, we concluded that patients who presented to the emergency department with repeated suicide attempts were in the higher risk group for anxiety and depression.

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Introduction
In this study, we aimed to evaluate changes of transmyocardial repolarization parameters in renal colic patients with severe pain. Our secondary aim was to evaluate the changes in these parameters after pain relief.
Materials and Methods
The study was a prospective observational study. Patients with known urolithiasis and severe pain and without any cardiac disease were included. A control group was created from healthy volunteers of similar ages and sex. Electrocardiographies (ECG) were taken at the time of admittance and one hour after pain relief. The data were analyzed with the SPSS 16 program.
Results
100 renal colic patients and 100 healthy volunteers were included in the study. Median age and sex of the patients in the patient group and the control group were similar. The heart rates and myocardial parameters of the patients were higher than those in the control group. In the patient group, heart rate, P wave duration, QTc, Tp-e interval and Tp-e/QTc rates were decreased in the ECGs that were taken after pain relief, and these differences were statistically significant (p<0.005 all values).
Conclusion
We observed several responses in the cardiovascular system due to acute pain. Myocardial parameters were prolonged during severe acute pain. Severe pain, such as that from renal colic, may cause cardiac responses, such as arrhythmias.

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Aim: Dynamic changes in troponin levels have been shown to be effective indicators of acute injury and useful for distinguishing acute injuries from chronic injuries. This study investigates the role of the change in troponin I (TnI) values in the prediction of acute myocardial infarction (AMI) and its relationship with the findings of percutaneous coronary angiographies.
Methods: The patients included herein were divided into two groups: the group of patients with AMI and the group of patients without AMI. The patients diagnosed with AMI were subsequently divided into two subgroups as those with and without critical stenosis. The relative troponin change (ΔTnI) in these patients was calculated as the percentage of the difference between the first and second troponin measurements; the second measurement was taken two hours later after admission.
Results: The receiver operating curve (ROC) analysis revealed that increases of more than 83.18% in ΔTnI were significant predictors of AMI and critical stenosis (sensitivity 45.24%, specificity 89.67%, AUC=0.698 [95% CI: 0.639-0.752, p=0.001], sensitivity 56.00%, specificity 87.92%, AUC value of 0.681 [95% CI: 0.620-0.738, p<0.001], respectively)
Conclusion: The ΔTnI value is a useful marker with high negative and positive predictive values for detecting AMI in patients admitted with chest pain. It can be beneficial as an adjunctive tool to predict the critical lesion, in conjunction with percutaneous angiography.

Aim: In our study, in Northwest Syria, where healthcare is provided with humanitarian support, with investigating the demographic and clinical characteristics of people who has been detected COVID-19, we aimed to investigate their situation in the pandemic.

METHODS:
The demographic and clinical characteristics of people whose COVID-19 PCR tests were studied and found positive in the World Health Organization supported ACU laboratories in Northwest Syria, were retrospectively investigated. All patients except healthcare workers were included in the study between 01/05 - 22/12/2020.
RESULTS:
17070 non-healthcare workers who were positive for COVID-19 PCR were included in the study. 6368(37.3%) of the participants were female and 10702(62.7%) were male. The average age of the participants was 37.7∓16.4 years. The data obtained that there were 1090(6.4%) people hospitalized or undergoing isolation. When comorbid diseases were investigated, hypertension was found in 435(2.5%), diabetes in 426(2.5%), and heart disease in 139(0.8%) people. When evaluated in terms of prognosis, 56%(n = 9584) of the patientsshowed complete recovery, 41.8%(n = 7141) recovered and their symptoms persist, but a total of 345(2%) patients died of COVID-19, including 106 of them are women (female crude death rate: 1.6%) and 239 of them are men (crude death rate: 2.23%).

Conclusion:
In our study, we have presented a cross-sectional analysis of almost all people with COVID-19 in the last half of 2020 by investigating the demographic and clinical characteristics of people with COVID-19 in Northwest Syria. COVID-19 diagnoses were evaluated according to the PCR test result.

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Background: Inconsistent results were reported in studies on the relationship between pneumothorax and meteorological conditions.
Aim: We aimed to investigate whether meteorological variables increase the incidence of pneumothorax applications in a region with intense southwestern winds.
Methods: The study was conducted retrospectively using the hospital records of patients diagnosed with spontaneous pneumothorax at the emergency department or thoracic surgery outpatient clinics between January 2016 and December 2018. The admissions were grouped according to the months and seasons. Meteorological data, including daily mean temperatures (°C), atmospheric pressure (millibars), moisture (%), and wind (m/s), were obtained from the local meteorological directorate. The meteorological data on the days with and without spontaneous pneumothorax were compared.
Results: ‎ Total 264 patients diagnosed as pneumothorax included to this study. Of the patients, 27 (10.2%) were female, and 237 (89.8%) were male. The mean age was 36.71±17.95 years (between 18-92). Of these patients, 185 (70.0%) had primary SP, while 79 (29.9%) had secondary SP. During the study period, lower atmospheric pressure, humidity and higher temperature were detected in July, August and September (<0.05). Secondary spontaneous pneumothorax was significantly higher in August and September (p<0.05). While southwestern winds were recorded in 703 days (74.5%), there were 214 days (22.7%) without such winds. Regarding the daily number of pneumothorax patient admissions, there was no statistically significant relationship between southwestern winds and SP.
Conclusions: Secondary spontaneous pneumothorax was significantly higher in August and September due to lower atmospheric pressure, humidity and higher temperature.

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Aim: We aimed first to investigate patients who received C1 inhibitor therapy in the ED. The patients’ complaints, examination findings, length of stay in the ED and whether the patients were treated with anything other than C1 inhibitor were investigated. Secondly, we aimed the response of patients who received C1 inhibitor therapy in the presence of Angiotensin Converting Enzyme Inhibitor (ACEI) -induced angioedema.
Materials and Methods: A retrospective descriptive study was designed. Patients who received C1 inhibitor therapy between January 2011 and February 2018 were reviewed using the hospital’s records on file.
Results: Data were evaluated for 62 admissions in 23 different patients. The diagnosis of hereditary angioedema (HAE) was present in 65.2% (n=15) of the patients, and 85.5% (n=53) of the admissions were related to acute HAE episodes. The main complaints of these patients were nausea, vomiting and abdominal pain and swelling of the face, lips, throat and extremities. It was determined that C1 inhibitor treatment was given to 8% (n=5) of admissions due to ACEI-induced angioedema. The complaints of these patients (5 admissions for 4 patients) were swelling of the tongue (n=3), lip (n=1) and face (n=1). Clinical improvement was observed in admission symptoms after treatment of C1 inhibitor in all patients with angioedema induced by HAE episodes or ACEIs.
Conclusion: C1 inhibitor treatment is effective in treating acute HAE episodes. Although more evidence is needed for treatment of ACEI-induced angioedema attacks, C1 inhibitor therapy may be considered in patients who do not respond to classical treatment.

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Introduction: Air transport is very useful for transporting patients between hospitals in the case of a trauma or illness that requires special care. Transporting trauma patients who require early intervention to large centers for effective treatment ensures both effective treatment and reduction in mortality.
Methods: In our study, a retrospective review was performed using data collected for cases transported by airway organized by the Ministry of Health between January2020 and May2021.Patients transported by plane and helicopter due to trauma were included in the study.The patients were examined in terms of reason for transport, gender,age,medical condition, cities of transport,route of transport,transport vehicle.
Results: 287 trauma patients were transferred,125 by air ambulance and162 by helicopter ambulance.When the transported patients were evaluated in terms of indication; the most common indication for transportation of patients is multitrauma (blunt thoracic trauma, fracture) patients with78 patients. Considering the major centers where patients were transferred,Ankara was in the first place with107 patients in total.Considering the flight times, the average flight time for air transport was77 minutes, and the average flight time for helicopter ambulance was69 minutes.
Conclusion: Transporting patients by air is very important in countries such as Turkey,which have a large area and difficult geographical conditions. Transporting trauma patients who require early intervention to large centers for effective treatment ensures both effective treatment and reduction in mortality.We think that our country's successful air transport system plays a major role in the effective treatment of patients, thanks to its short average flight time and successful transport procedure.

Aim: Accumulated evidence shows that COVID-19 pandemic related challenges have severely affected the mental well-being of many people around the globe including adolescents. This study examined the relationship between romantic relationship quality in parents and psychological resilience levels in adolescents during the COVID-19 pandemic.
Materials And Methods: This cross-sectional online survey used self-reported measures of romantic relationship quality and resilience. Participants were 12.099 adults (99.2% female; mean age = 35.27±5.37).
Results: Results showed that romantic relationship quality was positively related to resilience. Those who reported an increased marital satisfaction also reported higher levels of resilience, marital adjustment, and better relationship with adolescents.
Conclusion: The study provided a new avenue for research that focuses on the link between romantic relationship quality, resilience and seeking emergency care within the context of the pandemic. Based on these results, prevention and intervention programs can be tailored and implemented to improve satisfaction in a romantic relationship.

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The sternoclavicular joint (SCJ) is a rather uncommon site of septic arthritis (SA), which usually develops in patients with predisposing factors, such as intravenous drug use or diabetes mellitus. Up until now, there has been no description of SCJ SA associated with a pericardiostomy procedure. A young African Brazilian female presented with a two-month history of shoulder pain and elevated inflammatory markers. She had been diagnosed with systemic lupus erythematosus eight months earlier, at which time she required a pericardiostomy for a large pericardial effusion due to lupus pericarditis and nephrotic syndrome. Four months before the current presentation, she treated a soft tissue abscess on the previous site of the pericardiostomy caused by a Pseudomonas aeruginosa. After extensive evaluation, the cause of her shoulder pain was concluded to be due to septic arthritis of the SCJ with adjacent osteomyelitis. Computed tomography-guided bone biopsy and aspiration of synovial fluid yielded a Pseudomonas aeruginosa, which may have spread from the pericardiostomy orifice into the bloodstream, colonized the joint, and later developed a full-blown infection manifesting as referred pain to the shoulder. We presented a highly unusual case of SCJ SA with adjacent osteomyelitis of the sternum manifesting as shoulder pain in an immunosuppressed SLE patient.