Evaluation of Hemogram Parameters in the Diagnosis of Pulmonary Embolism: Immature Granulocytes and Other New Tips.

Pulmonary embolism (PE) is an important cause of sudden death and is difficult to diagnose. Therefore unnecessary radiological investigations are often resorted to. Although some inflammatory parameters in the hemogram have been found to play a role in the diagnosis of PE, many parameters have not been adequately investigated. We aimed to evaluate potential inflammatory parameters in hemogram in the diagnosis of PE and to determine the parameters with the highest diagnostic value. This single-center, retrospective study was performed by evaluating 114 cases with suspected PE admitted to the emergency department between January 2017 and June 2022. Among 114 cases, 62 cases with a definitive diagnosis of PE by pulmonary computed tomography angiography served as the PE group and 52 cases without PE served as the control group. Admission hemogram parameters of both groups were recorded. Potential chronic diseases and acute conditions affecting hemogram were excluded from the study. In the multivariate model; immature granulocyte (IG), neutrophil/lymphocyte ratio (NLR), monocyte % and platelet large cell ratio (P-LCR) were found to be significantly and independently effective in differentiating cases with and without PE (P˂.05). Our findings suggest that high IG, high NLR, high monocyte %, and low P-LCR values have diagnostic value in cases with suspected PE. However the usability of IGs in the diagnosis of PE is a new finding. Hemogram is cheap, easily accessible, and potential inflammatory biomarkers in hemograms may increase physicians' awareness in the diagnosis of PE.

Antibiotic versus cranberry in the treatment of uncomplicated urinary infection: a randomized controlled trial

SUMMARY OBJECTIVE: This study was designed to determine the effect of cranberry extract used in patients with single urinary tract infections. METHODS: Patients with simple-type urinary tract infections were divided into two groups. Treatment with fosfomycin or cranberry tablet was started. On days 1, 3, and 7 of the treatment, whether there was a decrease in the complaints was evaluated with a Likert-type scale. The recovery status of urinary tract infections and the well-being of patients were compared via antibiotic and cranberry groups. RESULTS: After the treatment, the leukocyte levels of the cranberry users were at the same level as those of the other group, and the rate of well-being and the portion of patients that reported to be "very well" on days 3 and 7 in the cranberry group was significantly higher compared with the fosfomycin group (p<0.05). CONCLUSION: Considering the results of this study, it was determined that the patient's complaints decreased from day 3 and their well-being increased with the use of cranberry only. Specifically, on day 7, the well-being of the cranberry group was higher than that of the fosfomycin group. For this reason, cranberry is a favorable alternative to antibiotics in uncomplicated and simple urinary tract infections.

Antibiotic versus cranberry in the treatment of uncomplicated urinary infection: a randomized controlled trial.

OBJECTIVE: This study was designed to determine the effect of cranberry extract used in patients with single urinary tract infections. METHODS: Patients with simple-type urinary tract infections were divided into two groups. Treatment with fosfomycin or cranberry tablet was started. On days 1, 3, and 7 of the treatment, whether there was a decrease in the complaints was evaluated with a Likert-type scale. The recovery status of urinary tract infections and the well-being of patients were compared via antibiotic and cranberry groups. RESULTS: After the treatment, the leukocyte levels of the cranberry users were at the same level as those of the other group, and the rate of well-being and the portion of patients that reported to be "very well" on days 3 and 7 in the cranberry group was significantly higher compared with the fosfomycin group (p<0.05). CONCLUSION: Considering the results of this study, it was determined that the patient's complaints decreased from day 3 and their well-being increased with the use of cranberry only. Specifically, on day 7, the well-being of the cranberry group was higher than that of the fosfomycin group. For this reason, cranberry is a favorable alternative to antibiotics in uncomplicated and simple urinary tract infections.

Utilizing the lymphocyte-monocyte ratio in predicting the recurrence of spontaneous pneumothorax.

OBJECTIVE: Lymphocyte-to-monocyte ratio (LMR) has been introduced as a predictor and a prognostic factor for multiple diseases. This study aimed to determine the efficiency of LMR in predicting the recurrence of spontaneous pneumothorax. MATERIALS AND METHODS: A total of 374 patients who had received chest tubes at the first episode of primary spontaneous pneumothorax were examined in terms of age, gender, side of the pneumothorax, status of recurrence, LMRs at the time of admittance and recurrence, and the interval until the recurrence. RESULTS: Recurrence was diagnosed in 106 (28.3%) patients, whereas the mean time until the recurrence was 15.32 ± 5.57 months. Significantly, the recurrence rate was higher, while the time until the relapse was shorter for patients with elevated levels of LMR. Moreover, LMR counting over 1.25 demonstrated a 70.8% sensitivity and a 94.4% specificity in predicting a potential recurrence. CONCLUSIONS: Calculation of LMR at the first episode of spontaneous pneumothorax contributes to predict a potential recurrence when combined with traditional risk factors.

OBJETIVOS: La proporción de linfocitos a monocitos (PLM) se ha introducido como un predictor y un factor pronóstico para múltiples enfermedades. Este estudio tuvo como objetivo determinar la eficiencia de LMR en la predicción de la recurrencia del neumotórax espontáneo. MATERIALES Y MÉTODOS: Un total de 374 pacientes que habían recibido tubos de tórax en el primer episodio de neumotórax espontáneo primario fueron examinados en términos de edad, género, lado del neumotórax, estado de recurrencia, PLM al momento del ingreso y recurrencia, y el intervalo hasta la recurrencia. RESULTADOS: Se diagnosticó recidiva en 106 (28.3%) pacientes, siendo el tiempo medio hasta la recidiva de 15.32 ± 5.57 meses. Significativamente, la tasa de recurrencia fue mayor, mientras que el tiempo hasta la recaída fue más corto para los pacientes con niveles elevados de PLM. Además, el recuento de PLM superior a 1.25 demostró una sensibilidad del 70.8 % y una especificidad del 94.4 % para predecir una posible recurrencia. CONCLUSIÓN: Calcular la PLM en el primer episodio de neumotórax espontáneo predice una posible recurrencia cuando se combina con los factores de riesgo tradicionales.

The Effect of the COVID-19 Pandemic on Emergency Department (ED) Admissions in the Only Hospital of City Center ED.

AIM: This study aimed to examine the effect of the pandemic on emergency service visits, together with the pre- and post-pandemic period data. MATERIAL AND METHODS: The charts of patients who applied to the emergency department between 2019 and 2021 were included in the study. We analysed patients' charts from the pre-pandemic period (January 1, 2019-February 29, 2020), the pandemic period (March 1, 2020-June 30, 2021; from the date of detection of the first COVID-19 case to the date of the second dose of the vaccine), and normalisation period (July 1, 2021-December 31, 2021; the date from the completion of vaccination to the end of the year). Demographic characteristics, triage codes, diagnoses, hospitalisation or referral status, population ratio, admission rate, and mortality were examined in these data. RESULTS: In total, 529,706 patient charts were examined. When the pre-pandemic period (15,983.29±1,493.19) was compared with the pandemic period (11,342.94±2,350.15), it was observed that there was a decrease in the number of visit period. In the post-pandemic period, patients coming to the hospital decreased following vaccination. It was determined that there were more visits (20742.17±967.61) compared to the pre-pandemic period. CONCLUSION: The data demonstrate that, during the pandemic period, visits decreased in general, and the rate of critical patients increased gradually. Accordingly, there are unnecessary visits and inappropriate use of emergency services.

The effectiveness of Glasgow-Blatchford Score in early risk assessment of hemodialysis patients.

In the emergency departments (ED), the incidence of admission is increasing gradually due to gastrointestinal system (GIS) complications of hemodialysis (HD) patients. With this increasing number of patients, there are many classification systems developed in early risk assessment before endoscopy. In this study, we aimed to evaluate the Glasgow-Blatchford Score's (GBS) effectiveness in HD patients with suspected GIS hemorrhage in the ED.The files of 169 patients who received HD treatment were retrospectively reviewed. 64 patients who were examined and treated for reasons other than GIS hemorrhage in the ED were excluded, and the files of a total of 105 were analyzed retrospectively. The demographic characteristics and laboratory values of the patients were recorded from the patient files. When the patients were evaluated according to GBS parameters, a significant difference was found between the two groups in terms of pulse pressure, systolic blood pressure, hemoglobin value, melena, and accompanying comorbid diseases (p < 0.05). Of the 16 patients who presented to the ED due to syncope, 2 were in the GIS hemorrhage (+) group, and 14 patients were in the control group. In this study, we aimed to show that the increase in the number of admissions in the ED due to complications secondary to HD treatment and the accompanying serious changes in laboratory parameters may cause misleading results in patients with suspected GIS hemorrhage, and it is necessary to plan comprehensive and multi-center studies on new alternative scoring systems to GBS in specific patient groups such as HD patients.

TICK INFESTATION: A 200-PATIENTS' SERIES.

BACKGROUND: A great number of zoonotic diseases with high mortality rate are transmitted by ticks. We performed this study in order to investigate patients admitted to emergency department following a tick bite. We examined the patients and get knowledge about the infestation and we followed up them for possible tick-conducted disease symptoms and laboratory findings both clinically and serologically. MATERIALS AND METHODS: The study presented was hold for one year, between 01.01.2012 and 31.12.2012. 200 tick infested cases, admitted to Emergency Department of Haydarpasa Numune Training and Research Hospital, were subjected in the study. Demographic patterns of the patients and the region they come from, infested area on body, admission time and blood analyzing results were detected. RESULTS: Rate of adult patients to pediatric was 2:1; gender distribution was similar to each other. The most common body areas that ticks were removed from were lower extremity. The highest tick bite incidence was in summer and on weekends. No tick bite incident of Istanbul surrounding from the year 2012 progressed to a zoonotic disease. CONCLUSIONS: Although non-of the patients of our study has been diagnosed with Crimean-Congo hemorrhagic fever we informed all of them for the incubation period and call for observation during the time. Tick borne infections may present with vary of symptoms, the most sever of which is hemorrhagic diathesis and patients should be informed for the risks. Knowledge of local area fauna risks may guide physicians so studies on this topic are essential.