The Prognostic Role of Platelet-to-Lymphocyte Ratio in Acute Coronary Syndromes: A Systematic Review and Meta-Analysis.

This study aimed to investigate the potential prognostic role of the platelet-to-lymphocyte (PLR) ratio in patients presenting with suspected acute coronary syndromes (ACS). A systematic search of PubMed Central, Scopus, EMBASE, and the Cochrane Library from conception through 20 August 2023 was conducted. We used odds ratios (OR) as the effect measure with 95% confidence intervals (CIs) for dichotomous data and mean differences (MD) with a 95% CI for continuous data. If I2 was less than 50% or the p value of the Q tests was less than 0.05, a random synthesis analysis was conducted. Otherwise, a fixed pooled meta-analysis was performed. Nineteen studies fulfilled the eligibility criteria and were included in the meta-analysis. PLR was higher in MACE-positive (164.0 ± 68.6) than MACE-negative patients (115.3 ± 36.9; MD = 40.14; 95% CI: 22.76 to 57.52; p < 0.001). Pooled analysis showed that PLR was higher in AMI patients who died (183.3 ± 30.3), compared to survivors (126.2 ± 16.8; MD = 39.07; 95% CI: 13.30 to 64.84; p = 0.003). It was also higher in the ACS vs. control group (168.2 ± 81.1 vs. 131.9 ± 37.7; MD = 39.01; 95% CI: 2.81 to 75.21; p = 0.03), STEMI vs. NSTEMI cohort (165.5 ± 92.7 vs. 159.5 ± 87.8; MD = 5.98; 95% CI: -15.09 to 27.04; p = 0.58), and MI vs. UAP populations (162.4 ± 90.0 vs. 128.2 ± 64.9; MD = 18.28; 95% CI: -8.16 to 44.71; p = 0.18). Overall, our findings confirmed the potential prognostic role of the plate-let-to-lymphocyte (PLR) ratio in patients presenting with suspected acute coronary syndromes (ACS). Its use as a risk stratification tool should be examined prospectively to define its capability for evaluation in cardiovascular patients.

Assessment of serum glucose potassium ratio as a predictor for morbidity and mortality of blunt abdominal trauma.

BACKGROUND: Our hypothesis is that glucose-potassium (GLU/K) ratio can be used to predict morbidity and mortality in the evaluation of patients with blunt abdominal trauma in emergency departments. The aim of the study is to demonstrate the effect of changes in serum GLU/K ratio on morbidity and mortality and to ensure that patient management is performed more quickly and effectively. METHODS: The hemogram and biochemical parameters of 99 patients with isolated blunt abdominal trauma, applied to our hospital between January 2016 and January 2020, have been retrospectively reviewed. Patients were divided into two groups as non-survivors and survivors. The GLU/K ratio was calculated, and their ability to predict mortality and morbidity was statistically evaluated between the groups. RESULTS: In the non-survivor (mortal) group; blood urea nitrogen, serum creatinine, serum GLU and GLU/K ratio were statistically higher than the living group (p<0.005). Moreover, the sensitivity and specificity of the serum GLU/K ratio were found 72.7% and 84.1% respectively. CONCLUSION: We think that serum GLU/K ratio can have an important role in the follow-up and management of patients using it as a simple, quickly accessible, and easy predictor in evaluating patients with blunt abdominal trauma.

The Impact of Lung Ultrasound on Coronavirus Disease 2019 Pneumonia Suspected Patients Admitted to Emergency Departments.

OBJECTIVE: The aim of this study was to identify the sensitivity and specificity of lung ultrasound (LUS) and show its place in diagnosing patients with known coronavirus disease 2019 (COVID-19) pneumonia, according to chest computed tomography and the COVID-19 reporting and data system (CO-RADS). METHODS: Nineteen patients who admitted to a single university hospital emergency department between March 5, 2020, and April 27, 2020, describing dyspnea were included in the study and underwent LUS by a single emergency specialist. The patient population was divided into 2 groups, COVID-19 positive and negative, and the sensitivity and specificity of LUS according to chest computed tomography were calculated for COVID-19 pneumonia diagnosis. In the subgroup analysis, the patient group was divided into real-time reverse transcription-polymerase chain reaction positive (n = 7) and negative (n = 12), and sensitivity and specificity were calculated according to the CO-RADS. RESULTS: According to the CO-RADS, significant differences were detected between the LUS positive and negative groups in terms of COVID-19 pneumonia presence. Only 1 patient was evaluated as CO-RADS 2 in the LUS positive group, and 2 patients were evaluated as CO-RADS 4 in the LUS negative group (P = 0.04). The sensitivity of LUS according to the CO-RADS for COVID-19 pneumonia diagnosis was measured to be 77.78% (95% confidence interval [CI], 39.9%-97.1%), specificity was 90% (95% CI, 55.5%-99.75%), positive predictive value was 87.5% (95% CI, 51.35%-97.8%), and accuracy was 84.21% (95% CI, 60.4%-96.62%; P = 0.004). CONCLUSIONS: In conclusion, LUS is easily used in the diagnosis of COVID-19 pneumonia because it has bedside application and is fast, easy to apply, reproducible, radiation free, safe for pregnant women, and cheap.

How should we teach cardiopulmonary resuscitation? Randomized multi-center study.

BACKGROUND: A 2017 update of the resuscitation guideline indicated the use of cardiopulmonary resuscitation (CPR) feedback devices as a resuscitation teaching method. The aim of the study was to compare the influence of two techniques of CPR teaching on the quality of resuscitation performed by medical students. METHODS: The study was designed as a prospective, randomized, simulation study and involved 115 first year students of medicine. The participants underwent a basic life support (BLS) course based on the American Heart Association guidelines, with the first group (experimental group) performing chest compressions to observe, in real-time, chest compression parameters indicated by software included in the simulator, and the second group (control group) performing compressions without this possibility. After a 10-minute resuscitation, the participants had a 30-minute break and then a 2-minute cycle of CPR. One month after the training, study participants performed CPR, without the possibility of observing real-time measurements regarding quality of chest compression. RESULTS: One month after the training, depth of chest compressions in the experimental and control group was 50 mm (IQR 46-54) vs. 39 mm (IQR 35-42; p = 0.001), compression rate 116 CPM (IQR 102-125) vs. 124 CPM (IQR 116-134; p = 0.034), chest relaxation 86% (IQR 68-89) vs. 74% (IQR 47-80; p = 0.031) respectively. CONCLUSIONS: Observing real-time chest compression quality parameters during BLS training may improve the quality of chest compression one month after the training including correct hand positioning, compressions depth and rate compliance.

Evaluating Stable Chronic Obstructive Pulmonary Disease by Ultrasound.

BACKGROUND AND AIM: The purpose of the study was to evaluate the relationship between COPD severity and the diaphragmatic function measured by point-of-care US in patients with stable COPD. METHOD: A total of 61 patients with COPD and 40 healthy subjects who had been admitted to Ufuk University Hospital between December 2018 and May 2019 were enrolled. Point-of-care US was performed, and lung silhouette and anterior, right, and left hemidiaphragm method in M-mode were used to evaluate the diaphragm. RESULTS: The point-of-care US measurements, lung silhouette method right (Lung Sil R), lung silhouette method left (Lung Sil L), right hemidiaphragm US method in B-mode (Ant B-Mode R), and right hemidiaphragm US method in M-mode (Ant M-Mode R), were significantly different among groups (P < 0.001 for each). FEV1 was strongly correlated with Lung Sil R, Lung Sil L, Ant B-Mode R, and Ant M-Mode R (r = 0.963, P < 0.001; r = 0.956, P < 0.001; r = 0.953, P < 0.001; and r = 0.917, and P < 0.001, respectively). Negative correlations were detected between the number of exacerbations per year and Lung Sil R and the number of exacerbations per year and Ant M-Mode R (r = -0.599, P < 0.001 and r = -0.587, and P < 0.001, respectively). CONCLUSION: In this study, FEV1 and annual number of exacerbations turned out to be strongly correlated US findings. The use of US in COPD patients could help to support clinical decision, but further clinical studies are necessary to confirm those findings.

Comparison of Different Intubation Methods in Difficult Airways during Simulated Cardiopulmonary Resuscitation with Continuous Chest Compression: A Randomized Cross-Over Manikin Trial.

INTRODUCTION: Airway management is one of key elements of resuscitation. Endotracheal intubation is still considered the gold standard for airway management during resuscitation. AIM: The aim of the study was to compare success rates and intubation time of different endotracheal intubation methods during emergency intubation with difficult airways in the conditions of cardiopulmonary resuscitation in a standardized manikin model. METHODS: The study was designed as a prospective, randomized, cross-over simulation study. It involved 46 paramedics with at least 5 years of experience in Emergency Medical Service. The participants performed endotracheal intubation under difficult airway conditions during continuous chest compression, implemented with the LUCAS3 chest compression system. Three methods of tracheal intubation were applied: (1) standard Macintosh laryngoscope without a bougie stylet; (2) standard laryngoscope and a standard bougie stylet; (3) standard laryngoscope and a new bougie stylet. RESULTS: The overall intubation success rate was 100% in the standard bougie and new bougie groups and lower (86.9%) when no bougie stylet was used (P=0.028). The intubation success rate with the 1st attempt equalled 91.3% for the new bougie group, 73.9% for standard bougie, and only 23.9% in the no-bougie group. The median intubation time was shortest in the new bougie group, where it amounted to 29 s (interquartile range [IQR]: 25-38); the time equalled 38s (IQR:31-44.5) in the standard bougie group and 47.5s (IQR:36-58) in the no-bougie group. The ease of use was lowest in the no-bougie group (85, IQR:63-88), average in the standard bougie group (44, IQR:30-51), and highest in the new bougie stylet group (32, IQR:19-41). CONCLUSION: In this manikin-based study, paramedics were able to perform endotracheal intubation with higher efficacy and in a shorter time using the new bougie stylet as compared with the standard bougie stylet.

Diaphragmatic thickness in chronic obstructive lung disease and relationship with clinical severity parameters

Background/aim: Sonographic assessment of diaphragm structure and function would be a useful clinical tool in patients with chronic obstructive pulmonary disease (COPD). Our aim was to determine the muscle thickness of the diaphragm and the usefulness of clinical practice in patients with COPD. Materials and methods: The diaphragmatic thickness of 34 COPD patients and 34 healthy subjects was measured during tidal volume (Tmin) and deep inspiration (Tmax) on both sides using a B-mode ultrasound. The body mass index and the modified Medical Research Council (mMRC) index values were reported. Results: There was no correlation among TminR (P = 0.134), TminL (P = 0.647), TmaxR (P = 0.721), and TmaxL (P = 0.905) between the patients with COPD and the control group. There was also no significant difference between diaphragmatic thickness and COPD severity, respiratory function (P = 0.410), and frequency of exacerbations (P = 0.881) and mMRC (P = 0.667). Conclusion: Diaphragmatic dysfunction in COPD is related to mobility restriction rather than muscle thickness.

Assessment of the Accuracy of Cardiopulmonary Resuscitation Videos in English on YouTube according to the 2015 AHA Resuscitation Guidelines.

Over the last decade, YouTube has become one of the largest online resources for medical information. However, uploaded videos are published without any peer review or quality control, so incorrect and incomplete information can be easily disseminated via the virtual platform and can be perceived as correct. The YouTube website was searched for videos in English uploaded between 15 October 2015 and 21 October 2016 using the following keywords: "CPR," "cardiopulmonary resuscitation," and "basic life support." This study had a cross-sectional analytical design. In the first evaluation, the accuracy of the videos was checked according to the information contained in the basic cardiac life support algorithm. In the second evaluation, we assessed whether advanced-level, innovative medical information was included in these videos; when included, the accuracy of such information was checked. Of 774 videos evaluated, 92 videos were included in the study after application of the exclusion criteria. The videos were scored on a scale ranging from 0 to 20 points. The mean total score, based on all criteria, was 4.79 ± 2.88. The highest mean total score was achieved by videos uploaded by official medical organizations (6.43 ± 3.57), followed by those uploaded by health professionals and organizations (4.25 ± 2.49), and those uploaded by unidentified sources. YouTube videos are insufficient in providing information about the basic life support algorithm and advanced-level information according to the 2015 AHA resuscitation guidelines for health professionals. The educational material published by health institutions that are constantly working in the area is a more reliable source of information on subjects that directly affect human life, such as cardiopulmonary resuscitation.

The diagnostic value of ischaemia-modified albumin in acute abdominal pain.

AIM: The differential diagnosis of paediatric patients admitted to the emergency department presenting with acute abdominal pain may be difficult. This study aims to investigate the diagnostic value of ischaemia-modified albumin (IMA) in the differential diagnosis of acute abdominal pain in children and in distinguishing surgical from non-surgical cases. METHODS: The study was conducted with a total of 152 subjects who provided informed consent, including 112 patients admitted to the paediatric emergency department and paediatric surgical clinic and 40 healthy control subjects. Blood samples were collected after initial examination to determine IMA, white blood cell (WBC) and C-reactive protein (CRP) values. RESULTS: Mean IMA values of patients with acute appendicitis (AA), perforated appendicitis (PA) and non-specific abdominal pain were significantly higher compared to the control group. Mean IMA values of the AA and PA cases were also significantly higher compared to the group with non-specific abdominal pain. No significant difference was determined in mean IMA between the AA and PA groups. WBC and CRP levels of the AA and PA groups were significantly higher compared to the group with non-specific abdominal pain. CONCLUSION: Our study shows that IMA, together with WBC and CRP, may be a biomarker capable of assisting the differential diagnosis of acute abdominal pain in children and distinguishing surgical from non-surgical cases.

Diagnostic Value of Plasma Pentraxin-3 in Acute Appendicitis.

PURPOSE: To measure serum PTX3 levels in patients admitted with right lower quadrant pain to emergency department and to investigate whether this parameter will be helpful for the diagnosis of acute appendicitis. MATERIALS AND METHODS: This study was conducted with a group of 89 patients over 17 years of age who were admitted with the complaint of right lower quadrant pain to ED and had a preliminary diagnosis of acute appendicitis clinically and the control group of 31 healthy volunteers in a tertiary university hospital for 3 months. RESULTS: Median PTX3 levels were 3.28 (1.08-30.24) ng/mL in the acute appendicitis groups and 0.97 (0.34-2.62) ng/mL in the control group. A significant difference was observed between acute appendicitis groups and the control group (p < 0.05). CONCLUSION: PTX3 was found to be significantly higher in patient with acute appendicitis compared to the control group and the patients with non-specific abdominal pain. PTX3 can be used as an aid in the diagnosis of acute appendicitis.

Urine Dipstick of Sputum for the Rapid Diagnosis of Community Acquired Pneumonia.

INTRODUCTION: Community acquired pneumonia (CAP) is responsible for an important part of treatment costs across the world. Even though posterior-anterior lung radiography (PALG) and direct sputum smear microscopy are required or routine diagnoses. The purpose of this study is to determine the diagnostic value of the bedside urine strip tests in CAP. METHODS: Patients who attended the emergency department (ED) between from February 2016 to September 2016 with expectoration complaints and suspicion of pneumonia. The sensitivity, specificity, and accuracy rate of the urine strip tests, direct sputum smear microscopy, and PALG were calculated and analyzed using SPSS 15.0. RESULTS: During the study period, 100 patients with pneumonia suspicion were evaluated in the ED. The sample was divided into two groups: negative and positive diagnosis of CAP. The leukocytes detecting by urine strip tests are statistical differences between the two groups (p: 0.003). The results show that the sensitivity, specificity, and accuracy rate of leukocytes detected in sputum with urine strip tests in the pneumonia diagnosis were 83.3%, 44.2% and 63% respectively. CONCLUSION: According to the study, it is believed that the method of determination of leukocytes with urine strip tests in sputum combined with more detailed results. They can become part of CAP diagnosis methods.

A bedside ultrasound technique for fluid therapy monitoring in severe hypovolemia: Tissue Doppler imaging of the right ventricle.

Fluid therapy is one of the main issues for hemodynamic resuscitation. Tissue Doppler imaging (TDI) of the right ventricle (RV) with bedside ultrasound (BUS) technique is a new dynamic method to identify fluid responsiveness in patients with hypotension. Here, we present the case of a hypotensive patient monitored with TDI measurements of RV. A 75-year-old male patient was admitted to the emergency department (ED) with the complaint of diarrhea. He was in severe hypovolemia, with hypotension, tachycardia, and tachypnea. His laboratory results were normal. BUS was performed on the patient by the ED physician. The velocity of the excursion of the tricuspid valve measured at presentation was 14.47 cm/s and, together with collapsed inferior vena cava (IVC), this finding led to the decision to begin fluid therapy immediately. The patient underwent 2 L of fluid therapy with 0.9% NaCl in a 2-h period. Control BUS after fluid therapy revealed decreased TDI velocity of tricuspid annulus to 11.81 cm/s and dilated IVC not collapsing sufficiently with respiration. The patient received his maintenance therapy after admission to the internal medicine department and was discharged from the service after 3 days. TDI in fluid responsiveness may find a clinical role in the future by the clinical studies.

The diagnostic value of serum pentraxin 3 levels in pulmonary contusion.

PURPOSE: To investigate the difference in pentraxin 3 (PTX 3) levels between patients with pulmonary contusion and healthy volunteers. MATERIALS AND METHODS: This study was conducted with a group of 20 trauma patients diagnosed with pulmonary contusion and 30 healthy individuals enrolled as a control group in a tertiary university hospital. RESULTS: Median PTX 3 levels were 7.05 (3.29-13.1), ng/ml in the contusion group and 1.03 (0.7-1.58) ng/ml in the control group. PTX 3 titers were significantly higher in patients with pulmonary contusion compared to those of the control group (p<0.001). An area under the curve (AUC) value of 0.968 investigated using ROC analysis to determine the diagnostic value of the PTX-3 in pulmonary contusion patients was measured. A PTX-3 cut-off value of 2.06 produced 95.5% sensitivity and 86.7% specificity. CONCLUSION: PTX 3 levels in pulmonary contusion increased significantly compared to the healthy control group. If supported by wider series, PTX 3 may be expected to be capable of use as a marker in pulmonary contusion.