What a Family Doctor Should Know about Incidental Finding of High Mean Platelet Volume, Metabolic Syndrome, and Pre-diabetes.

BACKGROUND: Mean platelet volume (MPV), an essential component of the complete blood count (CBC) indices, is underutilized in common practice. In recent years, MPV has drawn strong interest, especially in clinical research. During inflammation, the MPV has a higher value because of platelet activation. OBJECTIVES: To verify whether high MPV values discovered incidentally in healthy naïve patients indicates the development or the presence of cardiovascular risk factors, particularly metabolic syndrome and pre-diabetes. METHODS: A cohort study was used to assess the diagnostic value of high MPV discovered incidentally, in naïve patients (without any known cause of an abnormal high MPV, greater than  upper limit of the normal range, such as active cardiovascular diseases and metabolic syndrome). RESULTS: The mean MPV value in the patient group was 12.3 femtoliter. There was a higher incidence of metabolic syndrome in our research group than in the general population and a non-significant tendency of pre-diabetes. Family doctors more frequently meet naïve patients with high MPV than a hospital doctor. The results of our study are more relevant for him, who should know the relevance of such a finding and search for a hidden pre-diabetes or metabolic syndrome. CONCLUSIONS: High MPV values discovered incidentally in healthy naïve subjects suggest the development or the presence of cardiovascular risk factors, particularly metabolic syndrome and pre-diabetes. No statistically significant association was found between MPV and the presence of cardiovascular disease.

Is There a Predictive Value of High Mean Platelet Volume in Early Diagnosis of Venous Thromboembolism?

BACKGROUND: Venous thromboembolism (VTE) is a serious disease, which demands a fast accurate diagnosis to begin suitable treatment. It presents a major problem in the emergency department (ED), and its confirmation requires adequate evaluation. OBJECTIVES: To evaluate a potential role of mean platelet volume (MPV) in differentiating VTE from other potential diagnosis in patients with suspected VTE. METHODS: We conducted a retrospective case-controlled study of 440 consecutive patients who presented to the ED of our hospital with clinical VTE, but only 316 with proven VTE. A control group was composed of patients (124) who presented with clinical VTE but without proven VTE. We checked the MPV value in all 440 patients and the correlation with VTE occurrence in the study group vs. control group. RESULTS: Statistical analysis of the acquired results indicated that MPV value could not aid in determining the difference of real VTE vs. patients with VTE-like clinical picture presenting to the ED. We found an inverse correlation between MPV value and proven VTE, in contrast to most researchers who have studied the same issue. CONCLUSIONS: Although MPV can be a useful diagnostic marker in many diseases, we found no definite association between low MPV and VTE.

Matching actual treatment with patient administration-route-preference improves analgesic response among acute low back pain patients-a randomized prospective trial.

BACKGROUND: Accommodating a patient's treatment preference has been reported to promote greater responsiveness and better clinical outcomes. The effect of administration route preference (ARP) on the individual analgesic response has not been extensively examined to date. This study aimed to investigate whether ARP-matched treatment, i.e., individualized intramuscular (IM) or oral (PO) analgesic administration according to patient choice, would increase the analgesic effect. METHODS: In this prospective randomized study, we collected 38 patients with acute low back pain (aLBP) presenting at the emergency room of the Galilee Medical Center (Naharia, Israel) and asked them to report their ARP for analgesics. Regardless of their reported preference, they received either PO or IM diclofenac according to the treating physician's preference. Pain intensity was self-reported using the numeric pain score (NPS) before and during the first hour after drug administration. RESULTS: Both groups receiving PO or IM administration reported similar initial pain on admission, (NPS 8.63 ± 1.5 and 8.74 ± 1.6, respectively) and the same magnitude of pain reduction. However, patients who received the drug in their desired route (oral or injection) had a significantly greater reduction in pain levels (4.05 ± 2.8) as compared with patients who received the undesired route (2.08 ± 1.8), p < 0.05. CONCLUSIONS: These findings support the hypothesis that individualized ARP-matched treatment in aLBP improves therapeutic outcomes, although further studies with larger cohorts are needed.

[INCREASED MORTALITY OF DELAYED PATIENTS IN THE EMERGENCY DEPARTMENT OF A TERTIARY MEDICAL CENTER].

INTRODUCTION: Boarding patients awaiting hospitalization in the emergency department increases mortality and complications, and stands in contrast to the recommendations of emergency medicine associations worldwide. Although Israel's Ministry of Health and the media are addressing the issue, boarding patients in emergency departments is common in hospitals throughout the country. There are no current studies that assess the influence of boarding in emergency departments on the patient's mortality and hospitalization. In 2011, a decision was made in our hospital to board patients in a separate section of the emergency department due to the lack of beds in the inpatient wards. AIMS: This study aimed to demonstrate the scale of boarding patients in a tertiary hospital in Israel and its influence on mortality and length of hospitalization. We examine effects of a deliberate boarding policy on mortality and describe the boarding phenomena, and its causes, to Israeli physicians. STUDY METHODS: This is a retrospective study, comparing patients hospitalized through the emergency department to internal medicine wards in a tertiary hospital during three consecutive years, and studying the effects of deliberate boarding policy in the emergency department on mortality and length of stay [LOS] in the hospital. RESULTS: Roughly half the patients stayed in the emergency department for more than 10 hours. The mortality of patients during the year they were deliberately boarded in a separate section in the emergency department was significantly higher than in other years, when such policy did not take place. A direct link was demonstrated between LOS in the emergency department and mortality. LOS of patients who died was significantly higher than that of patients who did not die. CONCLUSIONS: Boarding patients in the emergency department increases mortality and LOS. Ways to minimize the phenomena should be explored. DISCUSSION: For the first time, the effects of boarding patients in the emergency department in Israel are studied. The issue of boarding patients in emergency departments should be a central issue addressed by Israel's health system.

[Health hazards of energy drinks--the situation in Israel and the world].

Since 1987, with the introduction of the first commercial energy drink in Europe, the level of sale of these drinks increased rapidly throughout the western world. These drinks are based on caffeine that is found in them ndependently, and in other ingredients. Other ingredients in these drinks potentiate the effects of caffeine. Caffeine acts in the organism through inhibition and activation of various receptors, and thus affects almost all the body systems. There is an increasing body of evidence about the medical hazards of uncontrolled use of these drinks, with neurologic, psychiatric, cardiovascular and metabolic complications. There is a direct link between use of energy drinks and abuse of alcohol and drugs. Due to the above, health authorities in Israel and around the world have started addressing the regulatory, medical and informative aspects of the issue. In spite all of the above, there is lack of awareness of the public and medical teams about the hazards of cousuming these drinks.

Shifting up cutoff value of d-dimer in the evaluation of pulmonary embolism: a viable option? Possible risks and benefits.

Objectives. To evaluate the viability of the possibility to use a higher D-dimer value than the one used today in the clinical algorithms evaluating patients suspected to have pulmonary embolism. Methods. A retrospective analysis of 300 serial patients for whom D-dimer values were taken during a 10 month period in the emergency room of a tertiary medical center. Results. Our analysis showed that it may be safe and cost effective to use a D-dimer value of 900 ng/ml rather than the value of 500 ng/ml accepted today, with sensitivity of 94.4%. In younger patients [under 40 years] the sensitivity reached was even higher-100%. Conclusions. Raising cutoff values of D-dimer in screening for pulmonary embolism seems a viable option. There may be a place for "tailoring" cutoff values according individual patient characteristics, such as according age groups. More studies of the subject are warranted.

Perforated gastrointestinal ulcers presenting as acute respiratory distress.

BACKGROUND: Dyspnea is one of the most common complaints facing the emergency medicine physician. Some of the gastrointestinal causes of dyspnea are self-limited and not life-threatening, yet others are, and early diagnosis and treatment are crucial. METHODS: In this article we presented one of these life-threatening conditions through a clinical description of a patient presenting with acute respiratory distress that was finally diagnosed to be the result of a perforated gastric ulcer. RESULTS: An emergent thoracotomy revealed a small ulcer with perforation in the fundus of the stomach. The patient was transferred after the operation to the intensive care unit and after a prolonged hospitalization discharged home. Biopsies taken from the ulcer showed diffuse inflammation, with no evidence of microorganisms or malignancy. CONCLUSION: Perforation of gastric and duodenal ulcers is a rare yet existing cause of dyspnea and respiratory failure and should be kept in mind by the emergency physician, especially when other more common causes are ruled out.

ST elevation myocardial infarction in a young patientafter ingestion of caffeinated energy drink and ecstasy.

BACKGROUND: Caffeinated energy drinks are widely used worldwide. They are associated with a variety of adverse effects and are of concern to health authorities, yet there is still scarce information about their adverse effects and inadequate awareness among medical personnel. METHODS: Case description and discussion of a patient presenting to the emergency room after overdose of energy drinks in combination with 3,4-methylenedioxymethamphetamine (MDMA). RESULTS: Despite best medical efforts, the patient died of fatal cardiac arrhythmias. There is a paucity of information about adverse effects of energy drinks. CONCLUSION: Although energy drinks are widely used, there is a lack of awareness in the population and medical staff about their hazards.

ST elevation myocardial infarction in a young patient after ingestion of caffeinated energy drink and ecstasy / 世界急诊医学杂志（英文）

BACKGROUND: Caffeinated energy drinks are widely used worldwide. They are associated with a variety of adverse effects and are of concern to health authorities, yet there is still scarce information about their adverse effects and inadequate awareness among medical personnel. METHODS: Case description and discussion of a patient presenting to the emergency room after overdose of energy drinks in combination with 3,4-methylenedioxymethamphetamine (MDMA). RESULTS: Despite best medical efforts, the patient died of fatal cardiac arrhythmias. There is a paucity of information about adverse effects of energy drinks. CONCLUSION: Although energy drinks are widely used, there is a lack of awareness in the population and medical staff about their hazards.

Perforated gastrointestinal ulcers presenting as acute respiratory distress / 世界急诊医学杂志（英文）

BACKGROUND: Dyspnea is one of the most common complaints facing the emergency medicine physician. Some of the gastrointestinal causes of dyspnea are self-limited and not life-threatening, yet others are, and early diagnosis and treatment are crucial.METHODS: In this article we presented one of these life-threatening conditions through a clinical description of a patient presenting with acute respiratory distress that was finally diagnosed to be the result of a perforated gastric ulcer.RESULTS: An emergent thoracotomy revealed a small ulcer with perforation in the fundus of the stomach. The patient was transferred after the operation to the intensive care unit and after a prolonged hospitalization discharged home. Biopsies taken from the ulcer showed diffuse inflammation, with no evidence of microorganisms or malignancy.CONCLUSION: Perforation of gastric and duodenal ulcers is a rare yet existing cause of dyspnea and respiratory failure and should be kept in mind by the emergency physician, especially when other more common causes are ruled out.