Ertan Sonmez

Cardiogenic pulmonary edema (CPE) is a serious condition that can result in impaired gas exchange and acute respiratory failure, often leading to high mortality. Diuretics are considered to be the cornerstone of CPE treatment. The doses of furosemide should be individualized according to the patient status and response. Lung ultrasonography has emerged as a reliable bedside tool for diagnosing and monitoring pulmonary congestion. By considering the extent of extravascular lung water and the inferior vena cava (IVC) size, clinicians can obtain objective data to guide them in determining the appropriate level of diuresis for the safe and effective treatment of pulmonary edema. However, data on the use of structured ultrasound protocols, such as the Reverse-FALLS protocol, to guide and monitor diuretic therapy in the emergency department are limited. This prospective, single-center observational study was conducted between April 1 and June 30, 2023, in an emergency department. Adult patients diagnosed with acute CPE were included. Bedside lung ultrasonography and IVC measurements were performed using the Reverse-FALLS protocol before and after intravenous loop diuretic therapy. The number of B-lines in 4 lung regions and IVC diameter changes were recorded. The primary outcome was the change in B-line counts following diuretic treatment. Secondary outcomes included IVC diameter changes and clinical outcomes. A total of 40 patients (mean age 73.7 ± 12.7 years; 65% female) were included. After diuretic therapy, 82.5% of patients demonstrated a significant reduction in B-lines on lung ultrasonography. B-line counts decreased significantly in all lung regions (right upper P = .005, right lower P = .013, left upper P < .001, left lower P < .001). The mean interval between ultrasound assessments was 6.2 ± 3.4 hours. Changes in IVC diameter were not statistically significant ( P = .061). Higher brain natriuretic peptide levels were significantly associated with worse clinical outcomes ( P = .021). Bedside lung ultrasonography using the Reverse-FALLS protocol effectively demonstrated a reduction in pulmonary congestion following diuretic therapy in patients with CPE. Monitoring B-line changes may allow individualized diuretic management without significant intravascular volume depletion, supporting the clinical utility of ultrasound-guided treatment in the emergency department.

Objective: The objective of this study is to evaluate the diagnostic accuracy of Extended Focused Assessment with Sonography for Trauma (E‐FAST) performed by senior emergency medicine residents compared with computed tomography (CT) in patients with blunt thoracoabdominal trauma. Methods: This prospective observational diagnostic accuracy study was conducted at a Level 1 trauma center between December 2023 and June 2024. Adult patients presenting with isolated blunt thoracoabdominal trauma who underwent both E‐FAST and thoracoabdominal CT were included. E‐FAST examinations were performed at the bedside by senior emergency medicine residents certified in ultrasonography. CT served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of E‐FAST were calculated. Concordance between E‐FAST and CT findings was analyzed using Fisher's exact test wherever appropriate. Results: A total of 170 patients were analyzed (124 males [72.9%] and mean age: 38.2 ± 14.7 years). E‐FAST demonstrated a sensitivity of 100%, specificity of 98.7%, PPV of 88.2%, and NPV of 100% compared to CT. Concordance between E‐FAST and CT findings was statistically significant for intra‐abdominal free fluid, pneumothorax, and hemothorax ( p < 0.001 for each). No pericardial effusion was detected by either modality. Conclusion: E‐FAST performed by adequately trained emergency medicine residents is a rapid, reliable, and highly accurate diagnostic tool in the initial evaluation of blunt thoracoabdominal trauma. Incorporating E‐FAST into standard trauma assessment protocols can enhance diagnostic efficiency and reduce unnecessary CT utilization.

Artificial intelligence (AI) has shown promise in generating multiple-choice questions (MCQs) for medical education, yet the psychometric quality of such items remains underexplored. This study aimed to compare the psychometric properties of MCQs created by ChatGPT-4o and those written by emergency medicine clinicians. Eighteen emergency medicine residents completed a 100-item examination comprising 50 AI-generated and 50 clinician-authored questions across core emergency medicine topics. Each item was analyzed for difficulty (P_index), discrimination (D_index), and point-biserial correlation (PBCC). Items were also categorized based on standardized index classifications. ChatGPT-4o-generated questions exhibited a higher mean difficulty index (P_index: 0.76 ± 0.23) compared to those created by clinicians (0.65 ± 0.24; p = 0.02), indicating that the AI-generated items were generally easier. Participants achieved significantly higher scores on AI-generated items (76.8 ± 8.18) than on clinician-authored questions (67.3 ± 9.65; p = 0.003). The mean discrimination index did not differ significantly between AI-generated (0.172 ± 0.23) and clinician-generated items (0.196 ± 0.26; p = 0.634). Likewise, the mean point-biserial correlation coefficient (PBCC) was nearly identical between the two groups (AI: 0.23 ± 0.28; clinicians: 0.23 ± 0.25; p = 0.99), suggesting similar internal consistency. Categorical analysis revealed that 56% of AI-generated items were classified as “easy,” compared to 36% of clinician-designed items. Furthermore, based on PBCC values, 36% of AI-generated items and 24% of clinician items were identified as “problematic” (p = 0.015), indicating a higher rate of psychometric concerns among AI-generated questions. The findings suggest that AI-generated questions, while generally easier and associated with higher participant scores, may pose psychometric limitations, as evidenced by a greater proportion of items classified as problematic. Although the overall internal consistency and discrimination indices were comparable to clinician-authored items, careful quality control and validation are essential when integrating AI-generated content into assessment frameworks.

Introduction: During the COVID-19 pandemic, there were difficulties in diagnostic applications in patients who applied to the emergency department with dyspnea. We aimed to compare the Oxygen, Predisposing factors, Effusion, Radiology, Age (OPERA) scoring that we determined to be fast in diagnosis and treatment, with the Modified Early Warning Score (MEWS) scoring and imaging findings. We investigated the effectiveness of scoring in predicting prognosis and mortality. Method: Our retrospective cross-sectional study included 271 patients who presented to a university emergency department between 07 April and 31 July 2020 with dyspnea. MEWS and OPERA scores, demographic characteristics, vital signs, serological tests and detailed findings of computed tomography (CT) of the patients included in the study were scanned. Patients were analyzed in terms of diagnosis, need for intensive care, and two-month mortality. Results: A total of 271 patients (149 (55%) women, mean age 60.6 ± 18.1 years old) who presented to the emergency department with dyspnea were included in our study. While 43 (15.9%) patients died in the last two months, 69 (25.5%) patients needed intensive care. When the value of 4 was determined as the limit for the MEWS score, 21 (14.1%) patients admitted to the intensive care unit were found to be

Objective: For the phenotype classification, it is important to determine the relationship between enzyme activity and the severity of the COVID-19 disease. Reaching significant differences between healthy and infected individuals in terms of genotype and allele distributions may be a guide in the fight against the COVID-19 pandemic. This study, it was aimed to investigate the relationship between serum arylesterase PON1 enzyme activity and disease severity in COVID-19 patients. Methods: Patients over the age of 18 who applied to the Emergency Service between 01-30 April 2020 and were examined with a preliminary diagnosis of COVID-19 were included in the study. In the study, serum PON1 activity was measured in the venous blood of 56 patients diagnosed with Covid-19 disease by either CT or RT-PCR and who have not received any systemic treatment yet. Results: The Arylesterase (AREase) and Paraoxonase (POase) activity levels of the study and control groups were 131.49 ± 52.75 kU/L 142.29 ± 38.82 kU/L, 276.48 ± 220.4 U/L 505.30 ± 301.4 U/L, respectively. It was found that 64.3 % of those infected with Covid-19 had the low-activity PON1 phenotype (p= 0.007) Conclusion: Genetic variability in PON1 may be associated with exposure to or risk of developing the disease. As a result, vaccination of individuals with low activity phenotype can be given priority at the vaccination stage in order to reduce the mortality rate in the fight against the pandemic. Awareness and protection measures of societies with low activity phenotypes can be increased.

History, electrocardiogram, age, risk factors, troponin risk score and troponin level follow-up are used to safely discharge low-risk patients with suspected non-ST elevation acute coronary syndrome from the emergency department for a 1-month period. We aimed to comprehensively investigate the 6-month mortality of patients with the history, electrocardiogram, age, risk factors, troponin risk score.