[Predictive calue of leucocyte count, neutrophil percent and C-reactive protein concentration "cut-off value" on the diagnosis of appendicitis]. / Lökosit sayisi, yüzde nötrofil orani ve C-reaktif protein konsantrasyonlarinin "kesim degeri" düzeylerinde apandisit tanisindaki degerleri.

BACKGROUND: The present study aimed to investigate the predictive importance of cut-off levels of preoperative WBC, neutrophil and CRP concentrations in operated appendicitis patients. METHODS: Patients operated for acute appendicitis between January 2008 and November 2010 were retrospectively screened. Patients were divided into three groups according to postoperative histopathology. Group I: normal appendix, Group II: Uncomplicated appendicitis, Group III: complicated appendicitis. ROC curves are intended for positive distinguishing pathological laboratory measurements. Cut-off values were determined and distinguishing performances were assessed. RESULTS: 175 of the 320 patients were males (54.7%) and 145 were females (45.3%). Average age was 35.95±14.75. While cut-off value for WBC was 12.080 and it was found significant in distinguishing total appandisitis (group II+group III) from normal appendixes and distinguishing group II from group I (p<0.001), it was determined that it was not significant in distinguishing group II from group III (p=0.768). While cut-off value for neutrophil was 73% and it was significant in distinguishing group II+group III from group I and group II from group I (p<0.001), it was detected that it was not significant in distinguishing group II from group III (p=0.681). While cut-off value for CRP was 45.98, it was not found significant in distinguishing group II+group III from group I and group II from group I; however it was significant in distinguishing group II from group III (p<0.001). When all measurements were evaluated together, it was detected that the increase in only the neutrophil percentage rised the non-complicated acute appendisitis (OR: 1.082; p<0.001), and the increase in both neutrophiles and CRP resulted in a rise in the risk of complication (OR: neutrophil=1.066; p=0.009- CRP=1.005; p=0.013). DISCUSSION: The cut-off value of labaratuary tests may help determine the diagnosis and treatment. Especially, cut-off value of CRP may be helpful to determine the method of incision during the operation as conventional appendectomy or laparoscopic appendectomy.

An investigation of the emergency medicine journals published in Turkey.

INTRODUCTION: There are many academic journals in Turkey and the world. Medical journals have a significant place among those publications. The aim of this study is to examine qualitatively and categorize the scientific studies of the two journals in Turkey. It also aims to contribute the related literature in the area. MATERIAL-METHOD: Academic journals of medical emergencies published in Turkey between January 1, 2003 and December 20, 2014 were investigated in detail. All the works in journals were categorized briefly as research articles, case presentations, review articles, and other works. Moreover, research articles were investigated as observational and experimental, and discussed according to the including topics. RESULTS: 943 scientific works in 86 issues were fully investigated. The total number was found to be 472 for research articles (50.1%), 242 for case presentations (25.7%), 108 for review articles (11.5%), and finally it was 12.8% for other works. Research articles included 450 observational (95.3%) and 22 experimental studies (4.7%). The key topics covered in research articles were the management and training of medical emergencies, trauma 96 (20.3%), toxicology 50 (10.6%), and gastrointestinal tract 36 (7.6%). CONCLUSION: Despite its relatively short history, medical emergencies have improved progressively in Turkey. The number of domestic research articles has demonstrated an increase over the years. However, extra efforts are needed in order to improve the quality of articles. The most common contents encountered in research articles were the management and training of medical emergencies, trauma and toxicology.

Determining risk factors of bleeding in patients on warfarin treatment.

Background. Warfarin is a commonly used oral anticoagulant agent. The most common adverse effects of warfarin are bleeding complications. Methods. We performed a 1-year retrospective chart review of emergency department patients using warfarin. A total of 65 patients with bleeding disorder (study group) and 63 patients without bleeding (control group) were included, making up a total of 128 subjects. Demographic data, frequency of international normalized ratio (INR) checks, and routine blood results were extracted. Logistic regression analysis was used to determine which factors were most closely associated with bleeding complications. Results. Median age was 62.0 ± 14.4 and 61.9 ± 14.5 for study group and control group, respectively. Educational status and frequency of INR checks were similar in both groups (P = 0.101 and P = 0.483, resp.). INR levels were higher in the study group (5.45 ± 3.98 versus 2.63 ± 1.71, P < 0.001). Creatinine levels were also higher in the study group (1.14 ± 0.57 mg/dL versus 0.94 ± 0.38 mg/dL, P = 0.042). Acetylsalicylic acid use was more frequent in the study group and was associated with a 9-fold increase in bleeding complications (P < 0.001). Conclusions. High INR levels, high creatinine levels, and acetylsalicylic acid use were associated with bleeding complications in ED patients using warfarin.