Ahmet Bilal Genc

Lack of Variation in Inflammatory Hematological Parameters between Benign Nodular Goiter and Papillary Thyroid Cancer

BACKGROUND Inflammatory hematological parameters like the neutrophil/lymphocyte (N/L) ratio have been investigated in many cancer types and significant relationships found with prognosis, for example. The aim of this present study was to investigate the impact of hematological parameters notably on N/L ratio and mean platelet volume (MPV) in papillary thyroid cancer cases. MATERIALS AND METHODS A total of 79 patients who underwent a thyroidectomy operation in Findikli, Goiter Research and Treatment Center during 2011- 2015 period were enrolled in the study, 41 with papillary thyroid cancer and 38 with benign goiter confirmed by pathological examination. We collected clinical and laboratory data for the patients from hospital records retrospectively. Blood samples taken at admission were assessed for parameters compared between the groups. RESULTS No significant differences between papillary thyroid cancer and benign goiter groups were apparent in terms of age, the N/L ratio, MPV, white blood cell count (WBC), red blood cell count (RBC), hemoglobin, hematocrit, platelet, neutrophil, lymphocyte, red blood cell distribution width (RDW) and platelet crit (PCT) levels (>0.05). Only the level of platelet distribution width (PDW) significantly differed, being lower in the papillary cancer group (<0.05). CONCLUSIONS No significant relationship between papillary thyroid cancer and inflammatory hematological parameters including in particular the N/L ratio and MPV. The relevance of the PDW values remains unclear.

Retrospective evaluation of patients at follow‑up with acute poisoning in Intensive Care Unit

OBJECTIVE Poisonings are among the major causes of emergency visits and intensive care hospitalizations. The aim of our study is to evaluate intoxicated patients at follow-up and treated in the Intensive Care Unit (ICU) in terms of demographic characteristics, type of poisonings and results of treatment. MATERIALS AND METHODS Patients at follow-up aged 17 or older admitted with intoxication to the ICU between January 1, 2009 and December 31, 2011 were included in the study. Age, gender, presenting symptoms, duration of hospitalization, type of poisoning, the way of poisoning, medical history, seasons, hospitalization costs, treatment and prognosis of the patients were analyzed. RESULTS Totally, 153 (8.9%) out of 1375 follow-up patients in the ICU had acute intoxication. The mean age of intoxicated patients was 29.4 ± 11, 68% of them were female, 78.4% of them were under 35 years old, and intoxication was most common in the 17-25 age group. 114 of them (94.1%) were suicidal. The most common cause of poisoning was drug-poisoning by 88.2%, and most common presenting symptoms were nausea and vomiting by 71.2%. Mean length of stay was 2.4 ± 1.6 days, and the average cost of hospitalization was 761 ± 884 Turkish Liras or 271 ± 315 USD. 5 patients (3.3%) were intubated because of respiratory failure. There was no mortal case. CONCLUSION Suicide attempts are prominent in acute poisoning, and the young female population is at higher risk. It was found that drugs, particularly antidepressants and antipsychotic agents were the most common cause of poisoning. The high cost of treatment of acute intoxication cases is a major cause of economic burden. Clinicians should be more careful when prescribing such drugs.

Agreement of serum potassium measured by blood gas and biochemistry analyzer in patients with moderate to severe hyperkalemia

PURPOSE Several studies investigated the agreement between central laboratory biochemistry analyzers and blood gas analyzers for potassium measurements. However, data are scarce when the potassium level is moderate to severely high. We aimed to evaluate the agreement between central laboratory biochemistry analyzers and blood gas analyzer in terms of serum potassium level measurement because differences in potassium at this level translate into very different clinical actions. BASIC PROCEDURES This was a retrospective medical record review study in which patients who presented to the emergency department and had serum potassium levels ≥6mmol/L were included. Patients who did not have simultaneous potassium measurement by blood gas analyzer were excluded. We included all patients meeting potassium criteria irrespective of their underlying disease or comorbidities. We evaluated agreement between the measurement methods with Pearson correlation, Bland-Altman plot, and Sign test. MAIN FINDINGS A total of 118 blood sample pairs were included. The mean serum potassium level measured by biochemistry analyzer was 6.78±0.79mmol/L, whereas it was 6.16±0.86mmol/L by blood gas analyzer (P<.001, Sign test). There was a strong correlation (P<.001, r=0.864) between the 2 methods, but agreement was relatively poor. Blood gas analyzer tended to measure potassium significantly lower than measured by biochemistry analyzer. The mean difference between the methods was 0.62±0.43mmol/L. PRINCIPAL CONCLUSIONS In patients with moderate to severe hyperkalemia, blood gas analyzer and biochemistry analyzer gives significantly different serum potassium results which may be clinically important.

A rare cause of pancytopenia: Sheehan's syndrome

Sheehans syndrome is characterized by varying degrees of anterior pituitary dysfunction due to postpartum ischemic necrosis of the pituitary gland after massive bleeding. Pancytopenia is rarely observed in patients with Sheehans syndrome. We present a patient of Sheehans syndrome presenting with pancytopenia. Complete recovery of pancytopenia was observed after the treatment. Clinicians should consider the possibility of hypopituitarism as a cause of pancytopenia and indicate a series of hormonal examinations. A high index of suspicion is required in women with pancytopenia for possible treatable cause like Sheehans syndrome.

Spontaneous abdominal hemorrhage due to warfarin treatment

Warfarin is an anticoagulant used in the prevention of thromboembolism. Common clinical indications for warfarin use are atrial fibrillation, artificial heart valves, deep venous thrombosis. Common side effect of warfarin is hemorrhage. Intra-peritoneal hemorrhage is one of the complications, usually following trauma. We report spontaneous intra-abdominal hemorrhage secondary to warfarin therapy. A 79 year-old male patient was admitted to emergency clinic with the complaints of one day duration of abdominal pain. There was no history of trauma. He had been on warfarin for the prophylaxis of atrial fibrillation.The diagnosis of the spontaneous intra-abdominal bleeding secondary to warfarin was made and the patient was admitted internal medicine inpatient clinic.This case provides a learning lesson to the physicians to consider this rare but significant complication of warfarin in the differential diagnosis of all the cases of abdominal pain in patients who are on warfarin therapy.

Nicolau syndrome caused by the "self-injection" of diclofenac

Nicolau syndrome (NS) is a rare injection-related local complication. Some drugs have been implicated to cause this syndrome. Several cases were previously reported in the literature. In this paper, an interesting case of NS in a 30-year-old male patient after intramuscular self-injection of diclofenac was presented.

A Case Report: Thrombocytosis After Oral Ciprofloxacine Therapy

Olgu Sunumu / Case Report Yazışma Adresi / Correspondence: Alı TAMER Korucuk SAKARYA Türkiye E-mail: atamer2002@yahoo.com Telefon: 2642552110 Tamer ve Ark. / Bir Olgu Sunumu: Siprofloksasin Tedavisi Sonrası Gelişen Trombositoz Sakarya Med J 2015;5(3):155-158 156 Giriş Trombositoz; tombosit sayısının 400.000/mm üzerinde olması olarak tanımlanır. Extrem (aşırı) trombositoz ise trombosit sayısının 1000.000/mm olmasıdır. İlaçlar, sekonder trombositoz (ST) etiyolojisinde yer almaktadır. Literatürde daha önce siprofloksasine bağlı trombositoz rapor edilmiştir. Ancak ekstrem trombositoz gelişen olgu sunumu tanımlanmamıştır. Bu sunumda siprofloksasin tedavisi sonrası ekstrem trombositoz gelişen olguyu sunmayı amaçladık. Olgu 23 yaşında bayan olgu; 3 gündür devam eden ateş, dizüri ve halsizlik yakınmalarıyla İç Hastalıkları kliniğine interne edildi. Özgeçmişi ve soygeçmişinde özellik saptanmadı. Fizik muayenede; ateş 38.5oC, arteryel kan basıncı 110/60 mm/Hg ve diğer sistem muayeneleri doğal olarak saptandı. Laboratuvar incelemelerinde Hb:7,1 gr/dl, CRP: 114,5 mg/L, sedimentasyon: 50 mm/saat olarak tespit edildi. Diğer kan analizleri normal sınırlarda idi (Tablo 1). Tam idrar tahlilinde lökosit esteraz testi ve nitrit testi negatif idi. İdrar sedimentinde 5-6 lökosit μL/ mm görüldü. Periferik yaymada hipokrom mikrositer anemi bulguları saptandı. İdrar yolu enfeksiyonu ön tanısı ile olguya oral siprofloksasin 750 mg tb 2x1 olarak başlandı. Alınan idrar kültüründe üreme olmadı. Tedavinin 3. gününde trombosit sayısı 970.000/ mm3 olarak saptandı. Tedavinin 6. gününde trombosit sayısı 1 245 000/ mm3’e yükseldi. Trombositoza neden olabilecek primer ve sekonder sebepler dışlandı. Siprofloksasin tedavisi kesildi. Trombosit sayısı iki hafta içinde hızlı bir şekilde normal seviyelere geriledi. Tartışma Trombositoz genel olarak trombosit sayısının 400.000/ mm3 üzerinde olması olarak tanımlanır. Trombositoz saptanan olgularda trombositozun reaktif ya da hematolojik bir hastalığa bağlı olup olmadığı araştırılmalıdır. Primer trombositoz kronik myeloproliferatif veya myelodisplastik hastalıklara bağlı olarak gelişen trombositoz olarak tanımlanır. Klinikte sıkça karşımıza çıkan ST’dir. ST myeloproliferatif hastalık olmadan trombosit sayısında artma olarak tanımlanır. ST, sistemik inflamasyon, tümörler, kanama, travma, postsplenektomi, yanık, büyük cerrahi girişimler, demir eksikliği anemisi, şiddetli fizik egzersiz, böbrek patolojileri, akut pankreatit, ilaçlara bağlı olarak gelişebilir ve genellikle benign ve geçicidir . Öncelikle trombositoz varlığı tekrarlayan kan sayımları ile doğrulanmalıdır. Daha sonra anamnez, fizik muayene, laboratuvar bulguları (Periferik yayma, kemik iliği incelemesi vb) ile primer ve sekonder ayırımı yapılmalıdır. Olgunun yatışında demir eksikliği anemisi ve üriner enfeksiyon muhtemel ST nedeni olarak mevcuttu. Diğer ST nedenleri saptanamadı. Yaş grubu, yatışında trombositozun olmaması, fizik muayenede lenfadenopati ve hepatosplenomegali olmaması, periferik yaymanın normal olması nedeniyle öncelikli olarak ST nedenleri araştırıldı. Olguya verilen ilaçlar incelendiğinde siprofloksasin başlandıktan üç gün sonra trombosit değerlerinin yükseldiği tespit edildi. Üriner enfeksiyon yakınma ve laboratuvar bulguları düzelmesine rağmen trombosit düzeylerinin yükselmesi nedeniyle siprofloksasine bağlı olabileceği Tablo 1. Olgunun Laboratuvar Parametreleri Parametreler Hastaneye giriş 7.gün Taburcu (10.gün) 22.gün Hb (gr/dl) 7.1 7.4 7.1 8.1 Lökosit (/mm3) 9.700 7.000 6.400 7.400 Trombosit (/ mm3) 231.000 1.245.000 1.020.000 306.000

Sinus bradycardia caused by flurbiprofen intoxication

Flurbiprofen is a powerful nonsteroidal anti-inflammatory agent that has analgesic, anti-inflammatory, and antipyretic effects. Its most frequent side-effects are the gastrointestinal side-effects. In this study, we present a case with sinus bradycardia developed due to high-dose flurbiprofen consumption.

Electrocardiographic changes in patients with acute pancreatitis

Background and Aims: Multiple organ system dysfunctions especially cardiovascular manifestations are frequently seen in severe acute pancreatitis (AP). The aim of this study was to investigate the frequency and type of electrocardiographic (ECG) abnormalities present in patients with AP. Materials and Methods: Patients with AP admitted to our hospital, the National Tertiary Referral Center, from January 2009 to December 2010 were included in the study. The diagnosis of AP was made by acute abdominal pain and tenderness, elevated serum enzymes and typical findings detected by abdominal ultrasonography and/or contrast-enhanced computed tomography. A 12-lead derivation ECG was recorded, and serum electrolytes were performed on admission in all cases. ECG abnormalities were recorded. ECG findings were summarized in terms of frequencies, means, and standard deviations. Results: A total of 64 AP cases 19 males (29, 7%), 45 females (70, 3%) were included into the study. Among patients included in the study, 42 (65.7%) were biliary, 20 (31.2%) were idiopathic, and 2 (3.1%) were drug-related. There were 42 (65.6%) patients with one or more serum electrolyte disturbances. 56.3% of the patients with AP had normal sinus rhythm, 43.7% had changes in ECG; and the T-wave negativity was the most frequent ECG abnormality. Twenty-five (89.2%) of the 28 patients with ECG abnormalities had one or more electrolyte abnormalities. Conclusion: The study results suggested that ECG changes may be observed frequently in patients with AP, and more attention should be paid to the cardiac patients with electrolyte imbalance.

Investıgatıon of malignancy in diabetic patients with anemia

Introduction: The etiology of anemia is multifactorial in diabetes and covers inflammation, diabetes, nutritional deficiencies, autoimmune diseases, medications and hormonal changes, in addition to the kidney diseases or may be malignancy. In this study, it was aimed to study the profile of the malignancy in patients with type 2 diabetes mellitus (DM) and anemia. Materials and Methods: The files of the follow-up patients with type 2 diabetes were retrospectively reviewed and 103 patients with type 2 DM and anemia were included in the study. The demographic, hematological and biochemical analysis of the data was performed in the diabetic patients with anemia. The frequency of malignancy in diabetic patients with anemia, the etiology of malignancy, the relationship between the presence of malignancy and anemia type and depth, biochemical parameters in the determination of malignancy, the effects of endoscopic and imaging methods, the presence of anemia in patients without malignancy and the effect of in-depth glomerular filtration rate were investigated. Results: The iron deficiency anemia (69.9%) was the most common. Malignancy was found in 11 of the 103 patients (10.7%). 2 patients (1.9%) had stomach cancer, 4 patients (6.3%) had colon cancer in endoscopic procedures. In computerized tomography images, 5 patients were found to be malignant in addition to the stomach and colon cancer. The erythrocyte sedimentation rate was significantly higher in the group with malignancy. No correlation was found between malignancy and anemia type and depth. Conclusion: Screening for malignancy should be considered in diabetic patients with anemia, especially in patients with elevated erythrocyte sedimentation rate, regardless of the type and depth of the anemia. In addition, tomography should be recommended for malignancy screening in diabetic patients with anemia that have a normal gastrointestinal examination.