INTRODUCTIONThe objective of this study was to determine the necessity of further evaluation of patients presented with herpes zoster (HZ) to the Emergency Department for the underlying decreased cell-mediated immunity.

MATERIALS AND METHODSThe data of 132 adult patients presenting with HZ to the Emergency Department were collected from the computerised database of Akdeniz University Hospital. The following data were recorded: demographic data and underlying diseases during onset of HZ and laboratory results (white blood cell counts, blood glucose levels).

RESULTSThere were 132 patients with HZ in the study period. The mean age of patients was 52.98 +/- 18.91 years (range, 14 to 96) and 53% (70 patients) were male. Of the study patients, 70.5% (93 patients) were over 45 years old. Eight (6.1%) patients had been diagnosed to have a malignancy, 18 (13.6%) had diabetes mellitus and 3 (2.3%) patients had undergone organ transplantation during their admission. Malignancy, diabetes mellitus and organ transplantation prevalence in the HZ group was significantly higher than the whole Emergency Department population.

CONCLUSIONSOur results indicate a relationship between the presence of HZ and increasing age and cell-mediated immunosuppressive disorders in Emergency Department patients over the age of 45 years. HZ should be considered as a clinical marker of cell-mediated immunosuppressive disorders, particularly in elderly patients.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Herpes Zoster ; epidemiology ; etiology ; immunology ; Humans ; Immune Tolerance ; immunology ; Immunity, Cellular ; immunology ; Immunosuppressive Agents ; adverse effects ; therapeutic use ; Incidence ; Lymphoproliferative Disorders ; complications ; drug therapy ; immunology ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; T-Lymphocyte Subsets ; immunology ; Young Adult

INTRODUCTIONPrevious studies revealed fewer visits for congestive heart failure (CHF) to emergency departments (EDs) in New Jersey, USA and fewer admissions for CHF to a Southern Indian and an Israeli hospital during warmer months. Using hospital admission rate for CHF as a marker for illness severity, we hypothesized that CHF would also be less severe in warmer months.

MATERIALS AND METHODSThis is a retrospective cohort study which included all ED visits from 1 January 2004 to 31 January 2006. We analysed the monthly CHF hospital admission rates. We a priori chose to compare the admission rates for the 4 warmest to the 4 coldest months.

RESULTSOf a total of 136,347 ED visits, 1083 (0.8%) were accounted for CHF. Hospital admission rate was 55.8%. Although there was a statistically significant increase in ED visits for CHF during the colder months, the 4 warmer months from June to September had 1.15 times higher hospital admission rate than the 4 coldest months from November to February.

CONCLUSIONSContrary to our hypothesis, we found a statistically significant increase in the percentage of CHF visits admitted to the hospital during the warmer months. This suggests that although there are less ED CHF visits in the warmer months, a greater percentage tend to be severe.

Aged ; Cohort Studies ; Emergency Service, Hospital ; Female ; Heart Failure ; epidemiology ; Hot Temperature ; Humans ; Male ; Retrospective Studies ; Seasons ; Severity of Illness Index

Background: Adductor canal block (ACB) provides effective analgesia after arthroscopic knee surgery. However, there is insufficient data regarding whether ACB should be performed before or after inflation of a thigh tourniquet. We aimed to investigate the efficacy of ACB performed before and after placement of a thigh tourniquet and evaluate associated quadriceps motor weakness. Methods: ACB was performed before tourniquet inflation in the PreT group, and it was performed after inflation in the PostT group. In the PO group, ACB was performed at the end of surgery after deflation of the tourniquet. Results: There were no statistically significant differences between the groups in terms of demographic data. There was no statistically significant difference among the three groups in terms of total postoperative opioid consumption (P = 0.513). Patient satisfaction and the amount of rescue analgesia administered were also not significantly different between the groups. There was no significant difference in terms of static and dynamic visual analog scale scores between the groups (for 24 h: P = 0.306 and P = 0.271, respectively). The incidence of motor block was higher in the PreT group (eight patients) than in the PostT group (no patients) and the PO group (one patient) (P = 0.005). Conclusions Using a tourniquet before or after ACB did not result in differences in terms of analgesia quality; however, applying a tourniquet immediately after ACB may lead to quadriceps weakness.