Tarik Ocak

A New Diagnostic Marker For Acute Pulmonary Embolism In Emergency Department: Mean Platelet Volume

OBJECTIVE To investigate the diagnostic importance of mean platelet volume (MPV) on acute pulmonary embolism (APE) in the emergency Department (ED). METHODS Subjects were selected from patients admitted to ED with clinically suspected APE. Demographic, anthropometric and serologic data were collected for each patient. RESULTS A total of 315 consecutive patients were analyzed, including 150 patients (53.44 ± 15.14 y; 92 men/58 women) in APE group and 165 patients (49.80 ±13.76y; 94 men/71 women) in the control group. MPV in the APE group was significantly higher than in the control group (9.42±1.22 fl vs. 8.04±0.89 fl, p<0.0001). The best cut-off values for MPV when predicting APE in patients with clinically suspected APE presenting at the ED were 8.55 fl (sensitivity 82.2%; specificity 52.3%). CONCLUSIONS MPV is a helpful parameter for the diagnosis of APE in ED, for the first time in the literature.

Woven coronary artery anomaly associated with acute coronary syndrome.

The woven coronary artery anomaly is a rare congenital anomaly in which a coronary artery is divided into thin channels that merge again into the distal lumen. Only a few cases of woven coronary artery have been reported in the literature. This anomaly is accepted as a benign condition. We describe a case of acute coronary syndrome in a patient with woven coronary artery anomaly.

A hypothermic case with giant Osborn waves and atrial fibrillation after using synthetic cannabinoid

Hypothermia is a condition wherein the body temperature drops below 35°C when an individual is unconscious. In prolonged moderate hypothermia (28–32°C), progressive drops in the pulse rate and increases in atrial and ventricular arrhythmia and Osborn waves are observed in electrocardiography (ECG). Unconsciously, staying outside for an extended time in extreme cold is the most important cause of hypothermia. In recent years, a significant social problem is the increase in the number of people using synthetic cannabinoids (SC) in public places. A frequent result of SC use is severe deterioration in consciousness and perception. A 22-year-old male patient, who was found unconscious in a park and was brought to the emergency department by 112 emergency services, was reported to have used SC. During vital sign examination, body temperature was too low to be measured, SpO2 level was 93%, and the other parameters were normal. There was no obvious sign of injury on his body. The initial assessment led us to believe that the patient was in a hypothermic condition because of unconsciousness after drug use and exposure to cold. Atrial fibrillation and giant Osborn waves were observed in his ECG (Fig.1, 2). Four hours later, the body temperature increased to 35.7°C. ECG performed for control revealed that Osborn waves disappeared, and the rhythm returned to a normal sinus rhythm (Fig. 3). Although there was no thermometer that measures body temperature below 35°C in our department, typical Osborn waves observed in ECG led us to consider that the body temperature was between 28 and 32°C and to intervene in the patient early. Serkan Doğan, Canan Akman, Alp Yılmaz, Utku Murat Kalafat, Tarık Ocak Department of Emergency, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul-Turkey

Methemoglobinemia after local anesthesia with prilocaine: a case report

• Local anesthetic agent is usually used in the emergency department, and local anesthetic agent oxidizes hemoglobin and may cause methemoglobinemia.

Evaluation of patients with Tularemia in Bolu province in northwestern Anatolia, Turkey

INTRODUCTION Tularemia is a zoonotic disease caused by Francisella tularensis. Here we present an epidemic occurring in Bolu province, located in northwestern Anatolia in Turkey, and some features of the cases. METHODOLOGY The data was provided by the Bolu Provincial Health Directorate. All of the antibody response tests were studied in the National Health Institute (formerly named Refik Saydam Hygiene Department), the reference laboratory of the Ministry of Health of the Turkish Republic. A total of 393 individuals were tested by microagglutination test (MAT) for tularemia between 2006 and 2011. A total of 218 patients whose demographical data were available were included in the study; 83 were accepted as the patient group and 135 were the controls. Of the patients, 31 (37.3%) were male and 52 (62.7%) were female. RESULTS Fever (p < 0.001), URTI symptoms (p = 0.047), conjunctivitis (p = 0.004), and rash (p = 0.026) were significantly higher in the patient group. A positive association was found between MAT and fever (r = 0.324; p < 0.001), and a negative association was found between MAT and both lymphoadenopathy (r = -0.25; p = 0.013) and chills (r = -0.218; p = 0.035). Higher MAT titers were detected in oropharyngeal tularemia (r = 0.306; p = 0.003). CONCLUSIONS In conclusion, tularemia must be considered in differential diagnosis in patients presenting with fever and LAP in non-endemic regions. Furthermore, water sources and contact with rodents must be investigated.

Frequency of MEFV mutation and genotype–phenotype correlation in cases with dysmenorrhea

We aimed to investigate the relation between mutations and polymorphisms playing roles in the onset of clinical findings of Familial Mediterranean Fever (FMF) and clinical phenotypic reflections manifesting with painful episodes, such as dysmenorrhea.

The importance of the mean platelet volume in the diagnosis of supraventricular tachycardia

BACKGROUND The diagnosis of palpitation can be difficult in the emergency department (ED) and the waiting time for a first appointment with an arrhythmia clinic can be very long. The inflammation is sufficient to facilitate the initiation of supraventricular tachyarrhythmia (SVT). The increased mean platelet volume (MPV) is closely correlated with inflammation and to reflect inflammatory burden in different condition. OBJECTIVE In this study, we aimed to investigate the relation between MPV and SVT in patient with documented atrial tachyarrhythmia in ED. METHODS Two study groups were compared; a SVT group with arrive at the ED with documented SVT (n=122) and 100 healthy adult without any palpitation symptom, arrhythmic disease, and with normal physical examination results that were brought for checkups to the cardiology polyclinic were classified as control group. Blood samples were obtained from all patients for determining the hematologic counts and MPV during first hour in ED period. RESULTS In terms of the focus of the study, hemoglobin, neutrophil count, mean cell volume (MCV), red cell distribution width (RDW), platelet, white blood cell (WBC), and lymphocyte counts were similar in both group (p>0.05). MPV in the SVT group was signifi cantly higher than in the control group (9.12±1.22 fl vs 8.64±0.89 fl , p<0.001). Multivariate logistic regression analysis showed that just MPV was independent predictor of SVT in patients with palpitation in ED (odds ratio [OR] 8.497, 95% confidence interval (6.181 to 12.325), p=0.012). CONCLUSIONS Our study described that MPV is helpful parameter for the diagnosis of SVT in emergency department, for the first time in the literature.

A Mobitz type II atrioventricular block in multicentric ischemic stroke

Cardiac and cerebrovascular illnesses are major causes of mortality and morbidity. Thromboembolisms, which are the result of cardiac arrhythmia, are important causes of ischemic stroke. In this study, we present a rare case of multicentric ischemic stroke induced by Mobitz type II atrioventricular block.

Uveitis attack and drug reaction due to cefuroxime axetil.

Abstract Antibiotics are natural or synthetic substances that are used to control bacterial infections because antibiotics are by definition only effective against bacteria. A 30-year-old female came to our emergency clinic complaining rubor in both eyes, especially in the left eye, with swelling, rubor and pain in ears, and eruption in lips extremities. In her anamnesis, it has been determined that she did not have any medical disease that requires regular utilization of drugs. After the patient received cefuroxime axetil for acute tonsillitis, she observed eruptions in lip extremities on the 3rd day, but she did not care about it. On the 5th day, rubor in both eyes and, especially in the left eye, have been developed, and complaints such as unable to look toward light and pain have started together with swelling, rubor, and pain in both ears. She came to our clinic because she was very much worried about the situation. In this study, we aimed to discuss a drug reaction characterized by face and ear skin observations, due to uveitis after the use of antibiotics including cefuroxime axetil for acute tonsillitis.

Anaphylactic Shock Diagnosed with Bedside Abdominal Ultrasonography and Computerized Tomography

Aim: The utility of ultrasound in assisting with the presentation of undifferentiated shock is becoming widely accepted as an invaluable tool with triaging both etiology and treatment. We believe this case highlights the utility of ultrasound in assisting with the clinical care of patients with anaphylactic shock. Case: Here, we present a 29-year-old man with no medical history, who was brought to our emergency department (ED) as intubated due to unconsciousness, hypotension, severe dyspnea and pruritus. On arrival to our ED, his pulse was filiform, and his extremities were cold and cyanotic. FAST examination to rule out trauma revealed anechoic cysts in liver. His abdominal CT revealed ruptured pouch of a hydatid cyst. He was admitted to ICU after 2-day follow up in the surgery clinics. He was discharged with full recovery. Conclusion: In conclusion, when critically ill patients with undifferentiated shock present in areas where animal husbandry is common, anaphylaxis due to hydatid cyst rupture should be kept in mind. Given the age, local agricultural practices, and presentation of distributive shock with concomitant liver cysts on ultrasonography we were able to triage the patient to abdominal computerized tomography scan and ultimately to definitive treatment.