A New Marker for the Diagnosis of Acute Pelvic Inflammatory Disease: Immature Granulocyte.

BACKGROUND: The goal is to assess the role of immature granulocytes (IG) in the diagnosis of acute pelvic-inflammatory-disease (PID) and to determine whether they are useful for discriminating mild/moderate and severe PID. METHODS: Patients admitted with the diagnosis of acute PID were retrospectively assessed. Diagnosis was based on CDC criteria. Patients were grouped as severe and mild/moderate PID based on need for hospitalization. Control group consisted of patients in whom PID was excluded by laparoscopy. Sample size was calculated with statistical methods. IGs were compared within the groups. Cutoff values were determined for prediction of diagnosis and severity of acute PID. RESULTS: There were 74 severe, 32 mild/moderate acute PID, and 41 control patients. Thirty patients had surgery following no response to antibiotic treatment or tubo-ovarian abscess. IGs were significantly higher in the severe group compared to mild/moderate and control groups. ROC analysis showed IG counts (≥ 0.035 µL) and percentages (≥ 0.35%) were significantly effective in predicting acute PID and were associated with severity when they were ≥ 0.055 µL and ≥ 0.42%, respectively. IG count ≥ 0.085 was found to have 58.6% sensitivity and 63.1% speci-ficity for prediction of surgical intervention need. CONCLUSIONS: IGs are components of simple CBC tests and are easily obtainable, cheap markers. They were found to be elevated in acute PID and correlated significantly with the severity of the disease. These markers may serve as adjunctive markers for the diagnosis of acute PID and may be useful in discrimination between mild/moderate and severe PID.

Demographic and Clinical Characteristics of Earthquake Victims Presented to the Emergency Department with and without Crush Injury upon the 2023 Kahramanmaras (Turkey) Earthquake.

INTRODUCTION: Earthquakes are sudden-onset natural disasters that are associated with substantial material damage, resulting in the collapse of built environment with a high rate of mortality, injury, and disability. Crush syndrome, which can be seen after devastating earthquakes, can lead to acute kidney injury (AKI) and patients may require amputation, fasciotomy, and dialysis. Supportive treatment has an important role in the prognosis of these patients. STUDY OBJECTIVE: The aim of this study was to investigate the demographic and clinical characteristics of traumatic earthquake survivors admitted to the emergency department (ED) of a hospital, which was close to the earthquake zone but not affected by the earthquake, after the February 6, 2023 Kahramanmaras (Turkey) earthquakes. MATERIALS AND METHODS: This study was conducted by retrospectively analyzing the data of 1,110 traumatized earthquake survivors admitted to the ED of a tertiary care university hospital from February 6th through February 20th, 2023. Age; gender; time of presentation; presence of comorbid diseases; ED triage category; duration of stay under debris; presence of additional trauma; laboratory tests; presence of AKI; presence of crush injury and injury sites; supportive treatment (fluid replacement and intravenous [IV] sodium bicarbonate); need for amputation, dialysis, and fasciotomy; duration of hospitalization; and outcome of ED were evaluated. RESULTS: Of the 1,110 traumatic victims in this study, 55.5% were female patients. The mean age of the patients was 45.94 (SD = 16.7) years; the youngest was 18 years old and the oldest was 95 years old. Crush injury was detected in 18.8% and AKI in 3.0% of the patients. Dialysis, amputation, and fasciotomy were required in 1.6%, 2.8%, and 1.4% of the patients, respectively. In total, 29.2% of patients were hospitalized, including 2.9% admitted to the intensive care unit (ICU) and 26.3% to the relevant ward. In total, 0.3% of the patients included in the study died at ED. CONCLUSION: Post-earthquake patients may present with crush injury, AKI may develop, and fasciotomy, amputation, and dialysis may be needed, so hospitals and EDs should be prepared for natural disasters such as earthquakes.

Risk factors and mortality in elderly patients with severe hyponatremia admitted to the emergency department.

BACKGROUND: This study was aimed at determining the risk factors associated with mortality in elderly patients with severe hyponatremia admitted to the emergency department. MATERIALS AND METHODS: The data of patients aged ≥ 65 years who were admitted to the emergency department and whose serum sodium levels were < 125 mEq/L were retrospectively collected. RESULTS: Mortality was associated with chronic liver disease/cirrhosis (p = 0.036), metastatic tumor (p = 0.007) and solid tumor (p = 0.013) cancers, antiarrhythmic drug use (p = 0.003), potassium-sparing diuretic use (p = 0.044), antineoplastic drug use (p = 0.0029), and dialysis treatment (p = 0.015). The following cutoff values were determined to be predictive of mortality: urea > 63.6 (AUC: 0.771; p = 0.0001), creatinine > 1.39 (AUC: 0.675; p = 0.0003), potassium > 4.64 (AUC: 0.711; p = 0.0001), C-reactive protein > 44 (AUC: 0.765; p = 0.0001), white blood cell count > 12.21 (AUC: 0.688; p = 0.0001), hemoglobin < 11.2 (AUC: 0.611; p = 0.0103), and Charlson comorbidity index > 2 (AUC: 0.739; p = 0.0001). The use of antineoplastic drugs (OR: 4.502; p = 0.010) and increased values of the following were associated with an increased risk of mortality: urea (OR: 1.007; p = 0.024), C-reactive protein (OR: 1.005; p = 0.026), glucose (OR: 1.008; p = 0.001), and Charlson comorbidity index (OR: 1.198; p = 0.025). CONCLUSION: Malignancy; liver cirrhosis; dialysis treatment; increased Charlson comorbidity index, urea, and C-reactive protein values and the use of antineoplastic drugs are associated with mortality.

Platelet Indexes for Predicting Disease Severity and Prognosis in Elderly Patients with Coronavirus Disease-19.

BACKGROUND: This study aimed to investigate the usefulness of platelet indices in predicting prognosis in coronavirus disease-19 (COVID-19). METHODS: Patients aged ≥ 65 years who presented to the emergency department with a positive polymerase chain reaction test were retrospectively analyzed. RESULTS: Significant differences were found in the mean values of platelet (PLT) and plateletcrit (PCT) parameters in those with severe disease, those who died, and those who required intensive care unit (ICU) admission. Mean PLT and PCT values were higher in patients with severe COVID-19 (p-values < 0.001, for both), those requiring ICU admission (p = 0.016; p = 0.006; respectively), and those who died (p = 0.015; p = 0.005, respectively). PLT and PCT were found to be statistically significant in predicting death [PLT (area under the curve (AUC): 0.598; p = 0.0145) and PCT (AUC: 0.617; p = 0.0034)], severity [PLT (AUC: 0.653; p = 0.0002) and PCT (AUC: 0.654; p = 0.0002)], and ICU admission [PLT (AUC: 0.598; p = 0.0235) and PCT (AUC: 0.605; p = 0.0148)]. CONCLUSIONS: PLT and PCT values were significantly higher in patients with high disease severity, those requiring ICU admission, and those who died. Furthermore, they were statistically significant in predicting disease severity, ICU admission, and death.

Analysis of Clinical and Radiological Findings in Oncology Patients Undergoing Thoracic Tomography for Suspected Pulmonary Embolism.

In the present study, we aimed to compare clinical and radiological findings between patients with and without pulmonary embolism (PE) and determine possible risk factors for PE development among patients with cancer. This was a retrospective study that examined the clinical features and tomographic findings of patients with cancer who underwent thoracic tomography for suspected PE. A total of 487 cases were included in the study. Of which, 45 (9.2%) patients were found to have PE. The effect of gender on PE was found to be significant (p = 0.018). Patients with PE compared to those without PE are 2.828 times more likely to be women than men. It was determined that the probability of not having a history of coronary artery disease (CAD) was 2.930 times (p = 0.036), probability of shortness of breath was 4.153 times (p < 0.001), syncope/presyncope was 6.859 times (p = 0.007), and palpitation was 5.613 times (p = 0.040) more in those with PE compared to those without PE. The mean pulse rate per minute was significantly higher in patients with PE than in those without (p = 0.009). Ninety-one percent of patients had parenchymal abnormalities, 43.7% had mediastinal and cardiovascular abnormalities, 35.5% had pleural abnormalities, 32.9% had thoracic wall abnormalities (p = 0.109, p < 0.001, p = 0.022, p = 0.685, respectively). Our study demonstrated that patients with PE were more likely to be women, patients with a history of palpitations, shortness of breath, syncope/presyncope, and those not having a history of CAD. More comprehensive studies are required in the future to clearly identify the risk factors for PE in patients with cancer and clarify the indications for tomography.

Skin Necrosis, Diffuse Urticaria, and Cellulitis Due to Presumed Loxosceles Spider Bite.

The clinical manifestations of a recluse spider bite range from local erythema to necrotic skin reactions; bites rarely lead to a systemic disease known as viscerocutaneous loxoscelism. A 29-y-old female patient was admitted to the emergency department with a wound, swelling, and pain on her left leg and a rash on her whole body as a result of a spider bite. On physical examination, a round, hard, black, irregularly shaped necrotic area was found in the bite zone on the lower posterior part of the left thigh, as were lesions in the form of erythematous papules around the area. There was a color change around the lesion, extending from posterior to medial of the thigh, and a papule on a diffuse erythematous surface on the trunk and arms. At follow-up, the necrotic area had become more apparent. After approximately 1 mo, the necrotic area was surgically debrided and a flap was formed on the necrotic tissue area. In this article, a case that was thought to be caused by a Loxosceles spider bite and which started with erythema, progressed to lymphangitis, cellulitis, and severe necrosis, and was surgically debrided, was evaluated in light of the clinical findings and previously reported cases of verified loxoscelism. In patients with a history suggestive of a bite and with these clinical findings, the diagnosis of a bite by Loxosceles spp. should be carefully considered based on clinical and epidemiologic findings.

The Effect of Emergency Department Visits and Inflammatory Markers on One-Year Mortality in Patients with Heart Failure.

The neurohumoral and inflammatory pathways proposed for the development and progression of heart failure (HF) remain up-to-date. We aimed to investigate the effect of emergency department (ED) visits and inflammatory markers on mortality in HF patients. Two-hundred patients with stable chronic HF followed by the cardiology clinic were included in this study. The patients were divided into two groups as patients who had visited the ED due to worsening HF symptoms within the last 6 months (ED visit Group) and who had not (No ED visit Group). The demographical properties, clinical characteristics, and laboratory values including inflammatory markers of the patients were recorded. During the follow-up period, 38 patients (19%) died. In HF patients with previous ED visits, the mortality risk was 2.091 times higher (relative risk, RR). It was identified that the HF patients who died during the follow-up had higher initial NLR (p = 0.004), IG% (p = 0.029), hs-CRP (p = 0.001), and NT-proBNP (p = 0.004) values. It was observed that the area under the curve (AUC) values, NLR (AUC: 0.705, p < 0.001), IG% (AUC: 0.652, p = 0.003), and hs-CRP (AUC: 0.732, p < 0.001) were very strong predictors of the 1-year mortality. According to the cut-off points, the mortality risk (RR) was 3.39 times higher in patients with NLR > 3.7 (95% CI 1.783-6.444), 2.39 times higher when IG% > 0.4 (95% CI 1.16-4.957), and 4,2 times higher when hs-CRP > 9.9 mg/dl (95% CI 2.16-8.16) (p < 0.05). The patients with chronic stable HF who visited the ED within the last six months and having increased NLR, IG%, and CRP levels among inflammatory markers were associated with a higher mortality risk at 1 year.

The value of hematological parameters in acute pancreatitis.

BACKGROUND: Acute pancreatitis (AP) is a common inflammatory disease in the emergency department (ED). This study aims to assess the role of CRP and hematologic parameters in mild/severe AP patients and biliary/nonbiliary AP at the time of admission to the ED. METHODS: 168 patients who were diagnosed as AP in the ED, and as a control group, 100 patients were included in this study. At the time of application to the ED, the demographic information (age, sex) and the amylase, lipase, CRP, hematological parameters (WBC, MPV, RDW, PLT, NLR) of all patients and the control group were recorded and compared. According to the etiology of the patients, the patients were divided into biliary and nonbilary AP groups and according to the severity, they were divided into mild and severe AP groups, then, the same parameters were evaluated. RESULTS: Significant differences were found out between WBC, CRP, NLR, MPV and PLT values between patient and the control group (p<0.001). The length of hospitalization and the parameters were not significant between the biliary and the nonbiliary group. Ranson and APACHE II scores were correlated with WBC, CRP and NLR. There was a statistically significant difference between the mild and severe AP groups in terms of duration of the hospital stay, CRP, WBC and NLR values (p=0.003 for CRP, p<0.001 for the others). In severe AP, the cut-off value of NLR was found to be 8.05, sensitivity %93.48, specificity %86.89 and AUC 0.937 (p<0.001). CONCLUSION: The use of parameters, such as WBC, CRP, and NLR, in combination with other diagnostic and prognostic tools in emergency service can provide convenience to clinicians at the time of admission and prognosis.