Orhan Akpınar

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 Blood samples were withdrawn for whole blood count and routine biochemical tests.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

The neuroprotective action of dexmedetomidine on apoptosis, calcium entry and oxidative stress in cerebral ischemia-induced rats: Contribution of TRPM2 and TRPV1 channels

Dexmedetomidine (DEX) may act as an antioxidant through regulation of TRPM2 and TRPV1 channel activations in the neurons by reducing cerebral ischemia-induced oxidative stress and apoptosis. The neuroprotective roles of DEX were tested on cerebral ischemia (ISC) in the cultures of rat primary hippocampal and DRG neurons. Fifty-six rats were divided into five groups. A placebo was given to control, sham control, and ISC groups, respectively. In the third group, ISC was induced. The DEX and ISC+DEX groups received intraperitoneal DEX (40 μg/kg) 3, 24, and 48 hours after ISC induction. DEX effectively reversed capsaicin and cumene hydroperoxide/ADP-ribose-induced TRPV1 and TRPM2 densities and cytosolic calcium ion accumulation in the neurons, respectively. In addition, DEX completely reduced ISC-induced oxidative toxicity and apoptosis through intracellular reactive oxygen species production and depolarization of mitochondrial membrane. The DEX and ISC+DEX treatments also decreased the expression levels of caspase 3, caspase 9, and poly (ADP-ribose) polymerase in the hippocampus and DRG. In conclusion, the current results are the first to demonstrate the molecular level effects of DEX on TRPM2 and TRPV1 activation. Therefore, DEX can have remarkable neuroprotective impairment effects in the hippocampus and DRG of ISC-induced rats.

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

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

Urticaria and Anaphylaxis in a Child after Skin Contact of Lentil Soup

To the Editor: Lentil allergies result in anaphylaxis and urticaria which may be fatal [1]. We present a case of unusually developed anaphylaxis due to skin contact of lentil soup. A 9y-old boy had sudden onset of nausea, vomiting, swelling in eyes and lips and redness and swelling all over the body after taking lentil soup. He received medical aid for anaphylaxis. The prick test was not done in the hospital because even very low test doses could cause anaphylaxis in our patient. After the treatment he was discharged with the recommendation to remove lentil from the diet. He did not eat these foods and was extremely sensitive about the content of ready-made products. So he did not have any more allergic reactions until he was 9y-old. At the age of 9 y, at a wedding he had meal without soup because the menu had a lentil soup. But the lentil soup of the person sitting next to him was accidentally spilled on the patient’s arm. Just after skin contact with a little amount of lentil soup he suffered from itching, redness and swelling of the skin. He received medical aid for anaphylaxis. Removing lentil and lentil-added products from the diet of children with lentil allergy is a very important measure, but it does not fully protect patients from allergic reactions. In a kitchen cooked with lentils, steam inhalation [2, 3] and skin contact, such as in our case, can lead to anaphylaxis. There is no report of anaphylaxis after skin contact of other food items. But local reactions were only developed in the skin contact area [4, 5]. To our knowledge, our report is the first case of hypersensitivity to lentils by skin contact described in literatüre. Our case underlined that a diet of exclusion does not absolutely protects patients from allergic reactions, that can develop also after their skin contact. This risk, even if rare, should be taken under consideration in cases when a child shows an allergic reaction to a particular food. In children with allergies, these conditions must be taken into account and precautions should be taken accordingly.

Investıgatıon Of The Rubella And Cytomegalovirus Seroprevalences By ELISA Method İn Pregnant Women

GİRİŞ: Rubella ve CMV enfeksiyonları fetal hasar yapma potansiyeli olması nedeniyle gebelik esnasında önemli risk faktörleridir. Bu enfeksiyonlar için antenatal riskin belirlenmesi konjenital sendromunun önlenmesi için çok önemlidir. Bu çalışmanın amacı, gebe kadınlarda retrospektif olarak rubella virüs ve CMV seroprevalansını belirlemektir YÖNTEMLER: Ocak 2013-Aralık 2013 yılları arasında gebe kadınlardan alınan serum örnek sonuçları retrospektif incelendi. Serolojik testler otomatize makro ELİSA (siemens ımmulıte 2000 xpi ımmunoassay system) yöntemi kullanılarak yapıldı. İstatistiksel değerlendirmeler için SPSS 18 istatistik paket programı kullanıldı. BULGULAR: Toplam1829 serum örneğinin 91’inde (%4.9) Rubella IgM pozitifliği saptanırken, Rubella IgG için test edilen 805 serum örneğinde 785 (%97.5) seropozitiflik belirlendi. Sitomegelovirus açısından değerlendirildiğinde İse; 1324 serum örneğinin 10 unda ( %0.7) Sitomegalovirus IgM pozitifliği saptanırken, Sitomegalovirus IgG için test edilen 532 serum örneğinin 497 sinde (%93.4) seropozitiflik saptandı. Olguların yaş grupları incelendiğinde her iki grupta da seropozitiflik en fazla 20-25 yaş grubunda olduğu görüldü. SONUÇ: Gebelik esnasında görülen primer CMV ve Rubella infeksiyonları ciddi fetal anomalilere yol açabilir. Anne adayları, bu enfeksiyonların bulaş yolları, korunma ve kontrolü konusunda eğitilmelidir. Antenatal risk gruplarının saptanması konjenital sendromların önlenmesinde önemli bir adımdır. Bu yüzden öncelikle o bölgeye ait seropozitiflik oranlarının bilinmesi çok önemlidir. Anahtar Kelimeler: Rubella virüs, Sitomegalovirüs, seroprevalans, gebe kadın

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.

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

Response to letter to the editor: mean platelet volume and platelet count values in patients with carbon monoxide poisoning

We thank Beyan et al for their interest in our article. Beyan et al emphasized that the statement ‘‘the role of platelet function in carbon monoxide (CO) poisoning is not completely clear, but some studies have reported increased platelet activation and aggregation’’ related to cigarette smoking and not to CO poisoning. They are right in that the references are not directly related to CO poisoning. On the other hand, the mechanism mentioned in the study relates to the effect of CO on platelets. In our study, we found that CO poisoning caused platelet activation by measuring mean platelet volume (MPV) which is the opposite of this effect. We believe that this might be responsible for cardiovascular complications of CO poisoning like myocardial infarction (MI). The sentence mentioned by Beyan et al, ‘‘CO and CO releasing molecules inhibit human platelet aggregation mediated by activation of guanylatecyclase,’’ relates to inhibition of platelet aggregation. We found that MPV is elevated in patients with CO poisoning, showing increased platelet activation contrary to the finding of inhibition of platelet aggregation. In research studies, it is not unusual to show differing results that may relate to several factors like the methodology used or the population studied. Also, we discuss subsequently the validity of MPV as a marker of platelet activation. Beyan et al emphasized that the measurement of platelet indices including MPV are not representative of platelet function. In their previous study, they investigated whether platelet indices correlated with platelet aggregation responses using an optical method in healthy adults. They did not observe any correlation between platelet indices measured including platelet count, MPV, platelet distribution width, and platelet crit and platelet aggregation responses obtained with turbidometric platelet aggregometry in healthy patients. However, Shah et al recently investigated the association of MPV with platelet activity and demonstrated that increasing MPV tertiles was associated with collagenand thrombin receptor-activated, peptide-induced platelet aggregation but not with adenosine diphosphateor arachidonic acid-induced or spontaneous platelet aggregation. They concluded that MPV is modestly associated with some, but not all, markers of platelet activity. Numerous large prospective studies demonstrated that MPV is elevated in cardiovascular disorders, and it is a significant predictor of cardiovascular adverse events including death. A recent meta-analysis showed that elevated MPV is associated with acute MI, mortality following MI, and restenosis following coronary angioplasty. Beyan et al did not observe any correlation between platelet indices measured including MPV and platelet aggregation responses obtained with turbidometric platelet aggregometry in healthy patients. But this might not be valid in patients with cardiovascular disorders. Platelets might act in a different manner in patients with cardiovascular disorders in contrast to healthy patients. Also, cardiovascular risk factors including hypertension, hyperlipidemia, diabetes mellitus, prediabetes, smoking, metabolic syndrome, and obesity cause elevated MPV. Cardiovascular disorders are complex. They are associated with endothelial dysfunction, insulin resistance, inflammation, and oxidative stress. All these factors cause platelet activation and elevated MPV. Another point is that there is a statistically significant gender difference between the groups. The P value must have been .01 instead of .13. However, when we searched the literature, we