Mucahit Kapci

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 Blood samples were withdrawn for whole blood count and routine biochemical tests.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.

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

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.

Diagnosis of pulmonary embolism in patients Mean Platelet Volume (MPV), neutrophil / lymphocyte ratio (NLR) and platelet / lymphocyte ratio (PLR) \'s foresight -

Pulmonary thromboembolic (PTE) is a disease the mortality and the incidence of which is high.Diagnosing PTE can be overlooked because PTE hasn’t a hard and an original clinic tableau. Recently, new marker studies continue in the diagnosis and the mortality prudence of MPV, NLR and PLR in pulmonary embolic diagnosis. Also, in our study we purposed to search the foresight of MPV, NLR and PLR in the diagnosis of pulmonary embolic. Through the patients who applied to our emergency room between 1 January 2014 and 1 January 2015, 42 patients diagnosed with pulmonary thromboembolic were taken by scanning retrospective. Thirty healthy people were taken to study for control group. The average age of 42 patients taken to study was 67,90 ± 14,85. 24 (%57,1) of patients are women and 18 (%42,9) of are men. The average D-dimer of patients was 5052,40 ± 5839,95 , the average PLR was 0,19 ± 0,12 , the average NLR was 8,07 ± 6,00 and the average MPV was 9,95 ± 1,01. In the control group, the average PLR was 0,18 ± 0,19 , the average NLR was 4,34 ± 4,26 and the average MPV was 8,79 ± 0,57. The average MPV, NLR and PLR of patient’s group was higher than control group’s. When comparing the patients’ and the control’s group , NLR and MPV was signficantly high (p< 0.005) but PLR was not significantly high. In our study when we compare the group of patients and control, NLR was significantly high but PLR wasn’t.

Simultaneous Use of Intravenous Lipid Emulsion and Plasma Exchange Therapies in Multiple Drug Toxicity.

Objective: The aim of this study was to highlight the use of combined intravenous lipid emulsion (ILE) and plasma exchange (PE) therapies in multidrug toxicity. Clinical Presentation and Intervention: A 45-year-old woman who attempted suicide by ingesting large quantities of amisulpride (28 g), diazepam (250 mg), valsartan (2,240 mg), aripiprazole (45 mg) and paliperidone (21 mg) was taken to the hospital of Adnan Menderes University School of Medicine. Upon arrival, she exhibited signs of cardiotoxicity and severe depression of the central nervous and respiratory systems. She was treated successfully with ILE for 4 h and PE therapy for 36 h, consecutively. She was discharged on the fourth day of hospitalization having fully recovered. Conclusion: The patient was successfully treated with the combination of ILE and PE.

Phenytoin intoxication with no symptoms correlated with serum drug level: a case study

In high-dose intake of phenytoin, which is used frequently to treatepilepsy, nystagmus, diplopia, nausea-vomiting, lethargy, confusion, seizure, and coma can be observed. In recent studies on phenytoin intoxication, in which seizure and coma were observed in drug levels greater than 50 ug/mL. The serum phenytoin level of apatient, who consumed approximately 100 pcs of 100 mg phenytoin tablets in an effort to commit suicide, and who had no pathological finding in her neurologic examination, was 124 ug/mL. High drug level and the absence of toxic effect (or the absence of toxic effect correlated with the drug level) indicates that cytochrome P450 is functioning, but there can be a mutation in the MDR1 gene. In our case study, we report on phenytoin intoxication in a patient having a high level of phenytoin but no symptoms correlated with serum drug level, as supported by the findings in the literature.

ACİL SERVİSE BAŞVURAN TRAVMA OLGULARININ DEĞERLENDİRİLMESİ

Evaluation of trauma patients in emergency departmentIntroduction: : Trauma is an important public health problem and one of the most important causes of death,especially in young adults, with financial and spiritual losses. Our study examines post-traumatic injuriesin the emergency service. Material and Method: In our study there were 14775 patients, applied to Ispartapublic hospital emergency service, between 01.01.2011 and 31.12.2011. Demographic characteristics of patient,application conditions, results, mechanisms and diagnosis of trauma are examined, respectively. Results:14775 patients (%12,83) applied to our emergency service were traumatic. 14150 patients (%95,8) dischargedwith healing, 521 patients (%3,5) are made admission to hospital, and 104 patients (%0,7) are referred toother centers. Traumatic mechanisms were traffic accidents (%21,5), falling down (%46,2), traumatic incisions(%15,7). Diagnoses were low extremity injuries (%32,4), top extremity injuries (%26,2), traumatic incisions(%15,7). Conclusions: Case distributions and demograhic characteristics were similar with other studiesmade in different emergency medicine departments. Insufficiencies and deficiences in file records anddiagnostic ICD codes in electronic registration system are observed at retrospective examinations

Is PR Depression and Electrical Alternans in the ECG Finding Specific to Pericarditis

Introduction: It is important to remember that pericarditis in young patients are associated with chest pain and accompanying electrocardiogram (ECG) signs, such as PR-segment depression and electrical alternans, in emergency departments. However, similar ECG changes may be found in patients with pneumothorax without pericarditis. The aim of this case study is to review the ECG changes of pneumothorax. Case Report: A male patient was admitted to our department with chest pain. The ECG examination showed sinus tachycardia, electrical alternans in all leads, PR-segment depression in inferior derivations, and loss of R progression in V5-V6. Chest X-ray radiography was taken for differential diagnosis, and it revealed pneumothorax in the left hemithorax. A chest tube was inserted on the left mid-axillar line. Control chest X-ray radiography revealed disappearance of the pneumothorax border. The control ECG showed that all changes were improved. Conclusion: Young patients with chest pain who are admitted to the emergency department should be evaluated for lifethreatening cardiac and pulmonary emergencies with early ECG examination. Electrical alternans, sinus tachycardia, and PR-segment depression are major signs in pericarditis. However, pneumothorax, especially occurring in the left hemithorax, may show similar findings.