Ali Duman

Mean platelet volume is increased in patients with hypertensive crises

Abstract Platelets may be activated in hypertension (HT). Hypertensive crisis is an extreme phenotype of HT and HT-related thrombotic complications. We aimed to assess mean platelet volume (MPV) in patients with hypertensive crises. This study included 215 hypertensive urgency (HU) patients (84 male, mean age = 66 ± 15 years) and 60 hypertensive emergency (HE) patients (26 male, mean age = 68 ± 13 years), who were admitted to the emergency department with a diagnosis of hypertensive crises. Control group was composed of age- and sex-matched 39 normotensive patients. Blood samples were withdrawn for whole blood count and routine biochemical tests. Systolic blood pressure (BP) was significantly higher in the HE group than in the HU group (p < 0.001). Median mean platelet volume (MPV) was higher in the HE group compared with HU and control groups [9.5 (Interquartile range, IQR: 8.7–10.1), 8.4 (IQR: 7.7–9.1), and 8.3 (IQR: 7.7–8.7) fl, each p < 0.001, respectively). In linear regression analysis, systolic BP (β = 0.18, 95% confidence intervals (CI): 0.002–0.015, p = 0.007) and diabetes mellitus (β = 0.24, 95% CI: 0.28–0.95, p < 0.001) were independently associated with MPV levels. Our findings show that MPV can be elevated in patients with HE and HU. It can be independently associated with systolic BP and diabetes mellitus. These findings imply that platelet activation contribute to the pathogenesis of thrombotic complications in hypertensive crises.

Mean Platelet Volume in Patients With Carbon Monoxide Poisoning

Carbon monoxide (CO) poisoning is frequent and can lead to high morbidity and mortality. Some studies have indicated increased platelet activation and aggregation in CO poisoning. Thus, we investigated mean platelet volume (MPV), an indicator of platelet activation, in patients with CO poisoning. We included 193 (117 women) patients who presented with a diagnosis of CO poisoning between June 2011 and March 2013. Control group was composed of 39 (15 women) patients. Troponin and creatine kinase MB levels were significantly higher in the CO poisoning group. Platelet counts were significantly higher in patients with CO poisoning (281 ± 76 vs 248 ± 65 × 109, respectively; P = .01). Similarly, MPV was significantly higher in the CO poisoning group (8.9 ± 0.8 vs 7.9 ± 0.9 fL, respectively; P < .001). Elevated MPV values may indicate that patients with CO poisoning have a higher risk of thromboembolic and cardiovascular complications due to platelet activation.

Bir Devlet hastanesi acil servisi demografik özellikleri: 2011 yılı meta analizi

Objective: The examination and treatment modalities should be measurable for improve the service quality of emergency service. This may be possible with the data collection system which is comprehensive and world-wide known. The aim of this study is to investigate the demographical features of patients who admitted to our service by computer based patient recording system and create a better service quality in the view of these data. Methods: Registered 115,185 patients were included whom admitted to our service between January 2011 and December 2011. The demographic characteristics, symptoms, triage distributions, the average length of stay, consultation rates, hospital admission forms, hospitalization and discharge rates were classified according to the Inter national Classification of Diseases-10 (ICD-10). Results: The mean age of patients was 38.70±19.92 years and 44.8% of the patients were male. Triage categories of the patients in category red, yellow and green 5.5%, 53.1%, 41.4%, respectively. Patients older than 65 years old were 14,643 (12.7%). Most common presentation day was Monday and the time period was between 20 p.m. and 24 p.m. The mean length of emergency service stay was 47 minutes, consultation and admission rates were 8.5% and 3.2%, respectively. 1,876 patients of older than 65 years old were admitted to the services. Conclusions: Emergency service admission registrations should be stored and analyzed by using the digital and sharable systems to serving a better qualified service in emergency services which provides continued service step to health care. This will allow the national standardization and determine the international location. J Clin Exp Invest 2013; 4 (3): 274-278

Contrast-induced nephropathy risk due to emergency contrast-enhanced computed tomography.

Objective In this study, we aimed to compare serum creatinine, blood urea, and glomerular filtration rate (GFR) levels of patients at baseline and 48 h after the administration of radiocontrast agent in the emergency department. Method We prospectively enrolled 114 patients who underwent contrast-enhanced computed tomography scan and had a baseline creatinine level of 1.5 mg/dl or less. Serum creatinine and blood urea levels were measured at baseline and 48 h after the administration of radiocontrast agent. GFR and Mehran risk score were calculated at baseline and 48 h after the administration of radiocontrast agent. Results Baseline mean serum creatinine was 1.03±0.25 mg/dl. Forty-eight hours after the administration of radiocontrast agent, mean serum creatinine was 1.04±0.31 mg/dl, baseline mean blood urea was 8.14±4.04 mmol/l, mean blood urea was 8.42±4.42 mmol/l, baseline mean GFR was 76.74±27.08 ml/min, and mean GFR was 77.21±27.92 ml/min. There were no significant differences between baseline and 48 h after the administration of radiocontrast agent serum creatinine, blood urea levels, and GFR (P>0.05). Conclusion There was no statistically significant difference between basal and 48 h after the administration of radiocontrast agent serum creatinine and GFR levels of patients who were enrolled in this study. Results had shown that administration of intravenous radiocontrast agent (⩽100 ml) for emergency imaging in the emergency department did not produce a risk for contrast-induced nephropathy in patients with serum creatinine levels of 1.5 mg/dl or less.

The diagnostic significance of signal peptide-complement C1r/C1s, Uegf, and Bmp1-epidermal growth factor domain-containing protein-1 levels in pulmonary embolism

Background: Pulmonary embolism (PE) is a common and potentially life-threatening disorder. Patients with PE often have nonspecific symptoms, and the diagnosis is often delayed. Aim: The aim of our study was to investigate the role of signal peptide-complement C1r/C1s, Uegf, and Bmp1-epidermal growth factor domain-containing protein 1 (SCUBE1) used in the diagnosis of PE. Methods: The study was designed prospectively. A total of 57 patients who were admitted to emergency service with clinically suspected PE were included in the study. The patients diagnosed with PE were defined as PE group (n = 32), and the patients with undetectable embolism on computerized tomographic pulmonary angiography were defined as non-PE group (n = 25). Twenty-five age- and sex-matched healthy cases were chosen for the study. Routine biochemical analysis, complete blood count, D-dimer, SCUBE1, and arterial blood gas analysis were performed early after admission. Results: Mean SCUBE1 levels were higher in the PE group (0.90 ng/mL) than in the non-PE (0.38 ng/mL) and control groups (0.47 ng/mL) (P < 0.01). A cutoff point of 0.49 ng/mL for SCUBE1 indicated 100% sensitivity and 64% specificity in patients with PE. Mean D-dimer levels were not different between PE and non-PE groups (P = 0.591). A multivariable logistic regression analysis (with dichotomous PE groups as the response variable; age, gender, chest pain, syncope, diabetes mellitus, chronic obstructive pulmonary disease, hypertension, D-dimer, neutrophil-lymphocytes ratio, and SCUBE1 variables as predictors) showed that the significant and independent predictors of PE diagnosis were SCUBE1 and chest pain. Conclusion: This study suggests that serum SCUBE1 measurement might be used as a diagnostic biomarker in PE.

Importance of Neutrophil Gelatinase-Associated Lipocalin in Differential Diagnosis of Acute and Chronic Renal Failure

Background: Neutrophil Gelatinase-associated Lipocalin (NGAL) protein is easily detected in the blood and urine soon after acute renal injury. NGAL gains features of an early, sensitive and noninvasive biomarker for acute renal injury. Recent evidences suggest that its expression is also increased in CRF reflecting the severity of disease. Objectives: In the present study, we aimed to investigate whether blood NGAL level plays a role in the differential diagnosis of acute and chronic renal failure. Patients and Methods: This was a prospective case-control study. Fifty patients presented to emergency department with acute renal failure (ARF), 30 with chronic renal failure (CRF) and 20 healthy individuals as control group were included in this study. Blood pH, HCO3-, BUN, creatinine and potassium values were evaluated in all patients. Blood NGAL values were evaluated in all groups. BUN, serum creatinine and NGAL values were statistically compared between patients and controls. Results: Median NGAL levels in patients was 304.50 (29), and 60 (0) in control, which was statistically significant between the two groups (Z = -6.477, P < 0.001). The median NGAL values were 261.50 ± 291 in ARF group and 428.50 ± 294 in CRF group. There was a significant difference in NGAL level between ARF and CRF groups (Z = -2.52, P = 0.012). Median BUN values were 153.46 ± 82.47 in ARF group and 169.40 ± 93.94 in CRF group. There was no significant difference in BUN value between ARF and CRF groups (P > 0.05). Median creatinine values were 2.84 ± 2.95 in ARF group and 4.78 ± 4.32 in CRF group. In serum creatinine values, a significant difference was found between ARF and CRF groups (P < 0.05). Conclusions: Serum NGAL levels of ARF and CRF patients were significantly higher than healthy individuals. In addition, NGAL values of patients with CRF were significantly higher than those of ARF. Serum NGAL values can be used to detect renal injury and differentiate ARF and CRF.

A rare complication of scorpion venom: atrial fibrillation

Although the clinical findings of scorpion stings are often mild, they may lead to multiorgan failure and even cardiogenic shock. The toxin has both local and systemic effects. Local effects include edema, bruising(ecchymosis), and burning pain,whereas systemic effects include nausea,vomiting, hypotension or hypertension, cardiovascular toxicity, renal failure,and hemorrhage at different areas. The toxins have been implicated in a number of cardiac arrhythmias, including torsade de pointes, long QT syndrome, and atrial fibrillation. Here, we present a 90-year-old woman with no history of drug use or complaints due to dysrhythmias who developed atrial fibrillation after being stung by a scorpion.

Infection Diseases in Geriatric Patients Who Admitted to Emergency Department

1 Orhan Akpınar1, Kenan Ahmet Türkdoğan2, Münevver Şen3, Ali Duman1, Mustafa Karabacak4 1Acil Servis, Isparta Devlet Hastanesi, Isparta, 2Acil Tıp Anabilimdalı, Bezmialem Üniversitesi Tıp Fakültesi, İstanbul, 3 Klinik Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilimdalı, Cumhuriyet Üniversitesi Tıp Fakültesi, Sivas, 4Kardiyoloji Departmanı, Isparta Devlet Hastanesi, Isparta, Türkiye Geriatri Hastalarında Enfeksiyonlar / Infection Diseases in Geriatric Patients Infection Diseases in Geriatric Patients Who Admitted to Emergency Department

Role of H-FABP values in determining the etiologic factors of the cardiac injuries

Introduction Cardiac injury resulting from blunt thoracic trauma is a frequent clinical occurrence which is difficult to diagnose. Our purpose in this study was to research whether H-FABP, which is a new marker for the diagnosis of cardiac injury, can be used in this patient group. Methods 50 patients with blunt thoracic injury who were admitted to our emergency service within a period of 8 months and 50 cases as controls were included in our study. Results Of the 50 patients with blunt thoracic injury in our study, 88% were male while 12% were female. The average age of the patients was 43 ± 15.15. While 27 (54%) of the 50 patients with blunt thoracic injury had cardiac injury, 23 (46%) did not have cardiac injury. The results of the statistical analyses showed a significant association between thorax trauma and cTnI, CPK, CPKMB and H-FABP (p<0.05). While there was a significant association between cardiac injury resulting from thoracic trauma and cTnI, ECG and TTE (p<0.05), there was no significant association between CPK, CPKMB and H-FABP (p>0.05). Conclusion In thoracic traumas, cardiac injury diagnosis can be made as a result of the assessment with Troponin-I, ECG and ECHO. For cardiac injury diagnosis, wide scale prospective studies are needed for H-FABP use.

Brucellar Spondylodiscitis İn Chronic Low Back Pain Patients

Brucellosis is a disease that is common all over the world and that indicates the involvement of many organs and systems. In this article, the aim is to discuss a patient who was referred to our clinic because of fever and back pain; the patient’s diagnosis of brucellar spondylodiscitis was based on MRI (magnetic resonance imaging) and clinical suspicion. We report a case of Brucellar spondylodiscitis in a 58-year-old male patient complaining of back pain for approximately 5 months was treated in various clinics. The patient was also was directed to spinal MRI Especially for people living in endemic areas, symptoms of fever and back pain should be considered potential signs of brucellosis in the differential diagnosis.