INTRODUCTION: Agitated patients make up a significant part of psychiatric emergencies. Intervening with an agitated patient causes the use of a significant part of emergency department (ED) resources. In the present study, the purpose was to evaluate the knowledge and skills of emergency medicine (EM) physicians in agitated patient management and identify the fields they are lacking.
METHODS: A questionnaire was prepared under certain topics for the data collection tool (15 questions). The questions were evaluated in a pilot implementation. A questionnaire prepared in Google Forms was sent to EM resident physicians and EM attending physicians who were working in the ED, through an instant messaging and communication application (WhatsApp).
RESULTS: The response rate was 81% (158 of 195). A total of 158 participants who agreed to participate were included in the study. When the participants’ answers were analyzed, it was found that less than 50% of correct answers were given to the questions that questioned the points to be considered in communication with an agitated patient, pharmacotherapy in the management of agitated patients, and the purpose of the verbal de-escalation technique.
DISCUSSION AND CONCLUSION: EM physicians should be trained more in the verbal de-escalation technique that can be applied in the management of agitated patients and pharmacotherapy in the management of agitated patients.

INTRODUCTION: Breast cancer is the most frequently diagnosed type of cancer worldwide. Magnetic resonance spectroscopy (MRS) is a diagnostic method that non-invasively measures metabolite levels in tissues and analyzes their biochemical composition. In this study, we aimed to examine the choline metabolite levels in patients with BIRADS category 4 and 5 breast lesions through MRS performed before biopsy.
METHODS: We included 30 female patients with lesions detected in examinations, ultrasonography, or mammography and performed dynamic contrast-enhanced breast magnetic resonance imaging (MRI), diffusion-weighted imaging, and MRS. We compared the conventional findings of breast masses on MRI with histopathological results and choline level measurements separately.
RESULTS: Although the median choline level in the malignant group was clinically found to be higher compared to the benign group, there was no significant difference between the groups (p=0.473). The area under the ROC curve was 0.580 (95% Confidence Interval: 0.369–0.792), indicating that choline levels were not statistically significantly predictive (p=0.454). Among all cases, there was no correlation between choline levels and tumor diameter, minimum, mean, and maximum ADC measurements (p>0.05). The choline levels in the HER-2 positive group were higher compared to the HER-2 negative group (p=0.009).
DISCUSSION AND CONCLUSION: Although the choline level was found to be higher in malignant breast lesions, there was no statistically significant correlation. It is evident that interpreting MRS data in conjunction with morphological data is much more valuable than evaluating it alone.

INTRODUCTION: Postoperative pulmonary complications (PPCs) significantly contribute to morbidity and mortality, particularly in patients undergoing major abdominal cancer surgery. Bronchospasm, atelectasis, pneumonia, and respiratory failure occur more frequently in cancer patients due to immunosuppression, reduced physiological reserves, and surgical complexity. Positive end-expiratory pressure (PEEP) is used during mechanical ventilation to reduce atelectasis and improve lung compliance; however, its effect on PPCs and mortality remains unclear. This study aims to investigate the relationship between PEEP levels, PPC occurrence, and their impact on mortality rates.
METHODS: In this retrospective study, 410 patients who underwent major abdominal cancer surgery between January 2019 and December 2020 were analyzed. Patients were divided into two groups based on intraoperative PEEP levels: Group 1 (0-5 cm H2O PEEP) and Group 2 (6 cm H2O and above). Patient demographics, including age, sex, ASA scores, duration of surgery, body mass index (BMI), administered PEEP values, ARISCAT scores, as well as preoperative SpO2 and hemoglobin levels were documented, and their association with PPC was analyzed using appropriate statistical methods.
RESULTS: The overall PPC rate was found to be 12%, with a significantly higher incidence in Group 2 (23%) compared to Group 1 (9%) (p<0.05). However, no significant difference in 30-day mortality was observed between the two groups (p>0.05). Additionally, co morbidities and preoperative pulmonary dysfunction were strongly associated with an increased risk of PPCs.
DISCUSSION AND CONCLUSION: Although lung-protective strategies like low tidal volume and PEEP are commonly recommended, the findings indicate that higher PEEP levels might be linked to a higher incidence of PPCs, possibly due to hemodynamic instability. However, no definitive correlation between PEEP levels and mortality was observed. Individualized PEEP settings may be critical in minimizing the risk of PPCs and improving outcomes in major abdominal cancer surgeries.

INTRODUCTION: Atherosclerosis is the leading cause of mortality and morbidity. Statins alleviate the atherosclerotic process, as these drugs have been shown to decrease serum levels of C-reactive protein. Ezetimibe is another hypolipidemic drug. The ankle-brachial index (ABI) is a non-invasive method of diagnosing peripheral arterial disease, and carotid intima-media thickness (CIMT) is a measure of subclinical atherosclerosis. We sought to evaluate the effect of ezetimibe, simvastatin, and their combination on lipid parameters, ABI, and CIMT.
METHODS: Sixty patients without a history of atherosclerotic vascular disease were included in this study. Patients were divided into three groups: the first group received 10 mg/day ezetimibe, the second group received 20 mg/day simvastatin, and the third group received a combination of 20 mg/day simvastatin and 10 mg/day ezetimibe. Baseline cholesterol levels, creatine kinase, alanine aminotransferase, aspartate aminotransferase, hsCRP levels, ABI, and CIMT were measured. Blood tests were repeated at the 6th week, and all baseline measurements were performed at the end of the 3rd month.
RESULTS: All groups exhibited a significant decrease in total and LDL cholesterol levels at the end of the 6th week. There was a significant decrease in hsCRP levels in the simvastatin-only and simvastatin-ezetimibe combination groups. The ABI increased significantly in the ezetimibe-simvastatin combination group but not in the others. No change in CIMT was noted in any group.
DISCUSSION AND CONCLUSION: The cholesterol profile improved in all groups. The hsCRP levels decreased significantly in the simvastatin and combination groups but not in the ezetimibe-only group, possibly due to ezetimibe lacking pleiotropic effects. The ABI values improved in the combination group, likely due to ezetimibe potentiating the positive effects of simvastatin on the endothelium. There was no change in CIMT in any group, probably due to the short follow-up period and small sample size.

INTRODUCTION: Adrenal incidentalomas (AI) are adrenal tumors discovered incidentally during imaging. While the metabolic effects of high cortisol levels are well-documented, the association between AI and metabolic syndrome (MetS) remains underexplored. This study investigates the frequency of MetS in patients with AI and compares it to a healthy control group.
METHODS: This cross-sectional, single-center study was conducted from January 2018 to January 2019 and involved 50 patients with AI and 50 age- and sex-matched healthy controls. We compared waist circumference, blood pressure, fasting plasma glucose (FPG), and MetS prevalence between groups.
RESULTS: Patients with AI had significantly higher waist circumference (p=0.001), FPG levels (p=0.007), and both systolic (SBP) and diastolic (DBP) blood pressure values (p=0.001; p=0.006, respectively) compared to controls. Similarly, patients with non-functioning adrenal adenomas (NFA) also exhibited increased waist circumference (p=0.002), FPG levels (p=0.005), SBP (p=0.001), and DBP (p=0.017) compared to the control group. The frequency of MetS was significantly higher in both the AI (p=0.039) and NFA (p=0.023) groups compared to controls.
DISCUSSION AND CONCLUSION: Our study found a higher prevalence of MetS among patients with AI and NFA, as well as increased waist circumference, FPG levels, and blood pressure in these groups. These findings suggest that patients with AI should be regularly screened for MetS and cardiovascular diseases to manage and reduce long-term health risks.

“Reversible splenial lesion syndromes” (RESLES) is a rare and complex syndrome, involving diseases or conditions characterized by an isolated reversible lesion in the splenium of the corpus callosum with a transient and abnormal diffusion restriction detected by magnetic resonance imaging (MRI). The pathogenesis of this syndrome is unclear, and the prognosis is good. It can often present with a clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in children. This study presents two cases of RESLES in 16-year-old and 5-year-old male patients who were found to have abnormal diffusion restriction in the splenium on MRI and presented with two different clinical presentations. RESLES and MERS should be kept in mind in the differential diagnosis of acute encephalitis/encephalopathy and nonspecific neurological symptoms.

Primary yolk sac tumor of the liver is a highly infrequent category of germ cell tumors, especially in adults. Therefore, it is critical to differentiate the disease from more common hepatic cancers that are also characterized by high serum alpha-fetoprotein (AFP) levels, such as hepatocellular carcinoma and hepatoblastoma. We report a male patient in his early 30s who presented with abdominal pain, elevated serum AFP concentration, and a cystic mass on the liver. The patient underwent two lines of chemotherapeutic treatment. We discuss adult patients with primary yolk sac tumors of the liver and the management of their condition in the literature.

Gastric diverticulum is an abnormal protrusion of the stomach wall, typically manifesting as outpouching in the fundus, particularly along the posterior wall. Gastric diverticulum is a condition commonly observed in individuals and usually remains asymptomatic. However, certain patients may present with a range of abdominal symptoms, including but not limited to epigastric pain and discomfort, nausea, vomiting, dyspepsia, early satiety, a vague sensation of postprandial fullness, belching, halitosis, anorexia, and dysphagia. A 73-year-old male patient who had a colectomy several months ago
was admitted to the general surgery clinic because of a massive abdominal hernia presenting with abdominal pain, halitosis, frequent belching, and dyspepsia symptoms. Esophagogastroduodenoscopy revealed an approximately 5 cm diverticulum localized to the gastric fundus and also found erosive pangastritis and duodenitis. Gastric diverticula share similar characteristics with their intestinal counterparts, characterized by a size ranging from 1 to 11 cm, and can be either congenital or acquired. The treatment strategy for gastric diverticulum largely depends on the patient’s clinical symptoms. In the case of asymptomatic diverticula, which are usually incidentally discovered, there is currently no consensus on treatment. EGD and radiological imaging play essential roles in diagnosing GD. Treatment options for GD are primarily dependent upon the patient’s symptoms, and surgical intervention is generally recommended in cases when GD is significant in size.