Comparison of immunogenicity for Sinovac-CoronaVac vaccine vs. natural infection during cancer treatment.

OBJECTIVE: Efficacy of the COVID-19 vaccines in cancer patients, especially during their active treatment, are lacking. Most of the studies in the literature compared the immunity in cancer patients with a cross-sectional cohort or retrospectively. Our study investigated Sinovac-CoronaVac COVID-19 vaccine immunogenicity and compared it with natural COVID-19 disease in cancer patients during their cancer therapy. PATIENTS AND METHODS: A total of 111 patients with cancer and who are on active treatment were included in the study. This is a single-center study and was designed prospectively. Two group of patients were included in the study, natural disease and vaccinated group. RESULTS: A total of 111 patients were included in the study, 34 of whom had natural COVID-19 disease. Antibody levels following the first dose vaccine were 0.4 (0-1.9) U/ml while after the second dose of vaccine were 2.6 (1.0-7.25) U/ml. Immunogenicity levels were 82.4% in the natural disease group and 75.8% in the vaccinated group after the second shot of the vaccine. Immunogenicity rate was significantly higher in non-chemotherapy (receiving immunotehrapy/targeted therapy or biologic agent) group compared to chemotherapy drug (92.9% vs. 63.3%, p=0.004). There was a difference between the antibody levels following the first and second vaccination [median (IQR): 0.3 (0-1.0) and 3.3 (2.0-6.7), p=0.001, respectively]. CONCLUSIONS: The present study revealed that the Sinovac-CoronaVac vaccine showed an acceptable immunogenicity following two shots in cancer patients who were receiving active systemic therapy. On the other hand, natural disease immunogenicity was higher than vaccinated group.

The aggregate index of systemic inflammation may predict mortality in COVID-19 patients with chronic renal failure.

OBJECTIVE: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was first detected in December 2019 and then spread globally, resulting in a pandemic. Initially, it was unknown if chronic kidney disease (CKD) contributed to the mortality caused by COVID-19. The immunosuppression associated with this disease may minimize the COVID-19-described hyper-inflammatory state or immunological dysfunction, and a high prevalence of comorbidities may lead to a poorer clinical prognosis. Patients with COVID-19 have abnormal circulating blood cells associated with inflammation. Risk stratification, diagnosis, and prognosis primarily rely on hematological features, such as white blood cells and their subpopulations, red cell distribution width, mean platelet volume, and platelet count, in addition to their combined ratios. In non-small-cell lung cancer, the aggregate index of systemic inflammation (AISI), (neutrophils x monocytes x platelets/lymphocytes) is evaluated. In light of the relevance of inflammation in mortality, the objective of this study is to determine the impact of AISI on the hospital mortality of CKD patients. PATIENTS AND METHODS: This study is an observational retrospective study. Data and test outcomes of all CKD patients, stages 3-5, hospitalized for COVID-19 and followed between April and October 2021 were analyzed. RESULTS: Patients were divided into two groups according to death (Group 1-Alive, Group 2-Died). Neutrophil count, AISI and C-reactive protein (CRP) levels were increased in Group-2 [10.3±4.6 vs. 7.65±4.22; p=0.001, 2,084.1 (364.8-2,577.5) vs. 628.9 (53.1-2,275); p=0.00 and 141.9 (20.5-318) vs. 84.75 (0.92-195); p=0.00; respectively]. Receiver operating characteristic (ROC) analysis demonstrated 621.1 as a cut-off value for AISI to predict hospital mortality with 81% sensitivity and 69.1% specificity [area under ROC curve 0.820 (95% CI: 0.733-0.907), p<.005]. Cox regression analysis was used to analyze the effect of risk variables on survival. In survival analysis, AISI and CRP were identified as important survival predictors [hazard ratio (HR): 1.001, 95% CI: 1-1.001; p=0.00 and HR: 1.009, 95% CI: 1.004-1.013; p=0.00]. CONCLUSIONS: This study demonstrated the discriminative effectiveness of AISI in predicting disease mortality in COVID-19 patients with CKD. Quantification of AISI upon admission might assist in the early detection and treatment of individuals with a bad prognosis.

The significance of a novel inflammatory biomarker, presepsin, in predicting disease prognosis in patients with COVID-19.

OBJECTIVE: This study aims at determining the significance of a novel inflammatory biomarker, presepsin, in predicting disease prognosis in patients with COVID-19. PATIENTS AND METHODS: This retrospective study was concluded at the University Hospital between April and August 2020. The study involved 88 COVID-19 patients (48 men and 40 women). The patients were categorized into two groups: the patients admitted to the COVID-19 clinic, described as the moderate COVID-19 patients (Group-1; n=44), and those admitted to the internal medicine outpatient clinic, who were the mild COVID-19 patients (Group-2; n=44). The groups were compared using inflammatory markers: presepsin, C-Reactive Protein to Albumin Ratio, Neutrophil to Lymphocyte Ratio, and procalcitonin. RESULTS: Serum presepsin levels (195.29 vs. 52.12 pg/ml) were significantly higher in the Group-1 compared to the Group-2 (p=0.001). The gender distribution and average age were similar in both groups (p > 0.05). While ferritin, lactate dehydrogenase, D-Dimer, platelet lymphocyte ratio, C-Reactive Protein to Albumin Ratio (p=0.001), erythrocyte sedimentation ratio, C-Reactive Protein and presepsin were significantly higher in the Group-1 compared to Group-2 (p<0.05), while hemoglobin and lymphocyte were significantly lower in the Group-1 than in Group-2 (p<0.05). CONCLUSIONS: Serum presepsin levels were found to be significantly higher in moderate clinical group COVID-19 patients compared to mild group. Presepsin, a new inflammatory biomarker, may be useful in predicting the prognosis and early treatment of COVID-19 infection.

The novel biomarker, neopterin, can predict the severity of COVID-19.

OBJECTIVE: SARS-CoV-2 infection primarily affects T-lymphocytes, particularly CD4+ and CD8+ T cells. However, there is a need for simpler and less expensive laboratory tests with predictive values comparable to CD4+ cell counts. Thus, the goal of this study was to investigate the role of neopterin levels in predicting intensive care and mortality in coronavirus disease patients in 2019. PATIENTS AND METHODS: This retrospective study included 87 hospitalized patients who were diagnosed with COVID-19. Patients were divided into two groups: those receiving intensive care (Severe COVID-19; S-COVID-19) and those receiving non-intensive care (Moderate COVID-19; M-COVID-19). Patients' clinical characteristics, serum neopterin levels, and other laboratory data were compared across groups. RESULTS: The average age was 63.9±155.2 years, and 44 (%) of the participants were male. WBC (p = 0.008), neutrophil (p = 0.002), HDL (p = 0.009), ferritin, calcium, albumin, LDH, APTT, lymphocyte, INR, D-dimer, troponin, prothrombin time sedimentation, and PaO2 (p = 0.001) were all associated with death. The neopterin level in the M-COVID-19 group was 3 (min-max; 3.1-5.9) and 3.2 (2.3-7) in the S-COVID-19 group, with no statistically significant difference (p = 0.456). Gender differences between groups were not significant (p = 0.183). According to the ROC analysis, if parameters such as age, D-Dimer, troponin, ferritin, albumin, LDH, CRP, procalcitonin, and PaO2 exceed the cut-off values and lymphocyte levels are below, it can predict the need for intensive care and mortality in COVID-19 patients. CONCLUSIONS: Although we did not find statistically significant results with neopterin in terms of mortality in COVID-19 individuals in our study, more thorough, prospective, randomized controlled studies with expanded patient populations at various phases of the disease are needed.

The role of neutrophil albumin ratio in predicting the stage of non-small cell lung cancer.

OBJECTIVE: Inflammation forms the basis of cancer development and progression. It causes changes in complete blood count parameters, such as neutrophil counts. Low albumin levels are associated with poor prognosis in cancer patients. We aimed to investigate the association between neutrophil to albumin ratio (NAR) and the stage of non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: 257 NSCLC patients (24 females and 198 males) were included in the study. Patients were divided into two groups. Group 1 (n=61) included patients with early stage cancer (stage 1 and 2), while group 2  (n=196) included those with advanced stage cancer (stage 3 and 4). Demographic data, neutrophil, lymphocyte, platelet, white blood cell counts (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), ferritin and albumin levels at the time of diagnosis were recorded. The NAR of 2 groups were compared. RESULTS: There were no significant differences between the lymphocyte count (2.0 vs. 2.0 103/mm3) and platelet count (291 vs. 311 103/mm3) of the two groups (p > 0.05). ESR (38.8 vs. 57.5 mm/h), CRP (158 vs. 57 mg/l), ferritin (85 vs. 261 ng/ml), WBC count (8.6 vs. 10.6 103/mm3), neutrophil count (5.6 vs. 7.5 103/mm3), albumin values (2.9 vs. 3.7 gr/dl), and (p < 0.05) NAR levels (1.6 vs. 2.3) (p < 0.05) were significantly higher in group 2. CONCLUSIONS: NAR can be used in predicting the stage of NSCLC.

THE FAMILIAL HYPOCALCIURIC HYPERCALCEMIA PRESENTED WITH ADVANCED HYPERCALCEMIA AND EXTREMELY HIGH PARATHORMON LEVELS (CASE REPORT).

Familial Hypocalciuric Hypercalcemia (FHH) is a rare benign condition inherited in an autosomal dominant pattern with high penetrance. This rare genetic condition is detected in approximately 2% of cases examined as primary hyperparathyroidism (PH). The Calcium Sensing Receptor (CaSR) gene's inactivating mutations result in a calcium-parathormone level-saturation curve shift to the right. Generally, the calcium level does not exceed 11,5 mg/dl and the PTH is seen normal. In our case and in her family, extreme high blood calcium levels up to 14 mg/dl and accompanying advanced parathyroid hormone levels rising up to five times the upper limit of normal were detected. Due to these high PTH levels and advanced hypercalcemia, she was thought to have PH as a primary diagnosis. The case and her family are an interesting phenomenon that do not clinically fit classical FHH.

Establishing a new screening 17 hydroxyprogesterone cut-off value and evaluation of the reliability of the long intramuscular ACTH stimulation test in the diagnosis of nonclassical congenital adrenal hyperplasia.

OBJECTIVE: Nonclassical congenital adrenal hyperplasia (NCAH) is a common genetic transmitted endocrinological disease. The validity of screening by using a 17 hydroxyprogesterone (17 OH-P) cut-off level of 2 ng/ml is controversial due to the frequent overlap with the polycystic ovary syndrome (PCOS). The availability of the standard intravenous cosyntropin (ACTH) formula is a problem in many countries including our country and the diagnostic test is performed by using the intramuscular depot form. In this study, we aimed to determine our own cut-off value for screening and to test the reliability of long intramuscular ACTH stimulation test in our patients. PATIENTS AND METHODS: One hundred and seventy-five fertile age women whose basal follicular phase 17 OH-P level above 2 ng/ml were included in the study. All of the patients underwent an intramuscular long cosyntropin (ACTH) stimulation test. RESULTS: 17 OH-P levels were above 10 ng/ml in 16 of 175 (9.14%) patients who were compatible with the diagnosis of NCAH. There was no significant difference between NCAH, PCOS and idiopathic hyperandrogenism (IH) groups in terms of hirsutism and hyperandrogenemia. In ROC analysis, 3.19 ng/ml was found to be a reliable cut-off value (AUC: 0.698, 95% GA: 0.540-0.855, p <0.05). In the extended intramuscular ACTH stimulation test, sensitivity increased from 56.2% to 91.6% at 180th minute CONCLUSIONS: Our study gives a perspective about the detection of screening threshold value for the diagnosis of NCAH and the availability of the intramuscular long ACTH stimulation test.

INFLAMMATORY CELL RATIOS IN THE PATIENTS WITH FIBROMYALGIA.

Fibromyalgia is a chronic disease with undefined aetiology which commonly results in muscle sensitivity, pain, and sensitivity at certain anatomical points. The pathogenesis and aetiology of fibromyalgia are not yet fully understood. The objective of this study was to assess the diagnostic value of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/ monocyte ratio (LMR) as simple systemic inflammatory response biomarker sin patients with fibromyalgia. A total of 489 patients with fibromyalgia (group1) and 227 healthy controls (group2) were included in the study. Demographic data, Body Mass Index (BMI) neutrophil, lymphocyte and platelet counts, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were recorded. Baseline NLR, PLR, and LMR were calculated by dividing the absolute neutrophil, platelet and lymphocyte counts by the respective divisor absolute values. The NLR, PLR, and LMR levels of the two groups were then compared. There were no significant differences in gender and age between the two groups (p>0,05). BMI levels (29.6 vs 24.8 kg/m2), mean NLR (3.63 vs. 2.11) and PLR (222.55 vs. 114.28) values were found to be statistically higher (p <0.001), and mean LMR (2.73 vs. 3.85) values were found to be statistically lower, in the patient group (p <0.001). The present study showed that NLR, PLR, AND LMR levels can be used in the diagnosis of fibromyalgia and systemic inflammation may play a role in fibromyalgia.

The relationship between serum calprotectin levels and disease activity in patients with subacute thyroiditis.

OBJECTIVE: Increased calprotectin (S100A8/A9) levels have been demonstrated in many acute and chronic inflammatory processes. Subacute thyroiditis is an inflammatory disease of the thyroid gland. In our study, we investigated the value of this inflammation marker in the diagnosis and follow-up of subacute thyroiditis. PATIENTS AND METHODS: Patients with subacute thyroiditis admitted to our clinic between November 2018 and January 2020 were included in the study. In the acute phase of the disease, fT4 (free thyroxin), TSH (Thyroid Stimulant Hormone), CRP (C Reactive Protein), ESR (Erythrocyte Sedimentation Rate), ALT (Alanine Aminotransferase), AST (Aspartate Aminotransferase), Creatinine, WBC (White Blood Cell), Absolute Lymphocyte and Neutrophil Count (ALC, ANC) parameters were detected and recorded. After complete resolution of the disease, the same laboratory parameters and acute phase reactants were again detected. Additionally, Calprotectin determination was performed in the acute phase and recovery period. Persistent hypothyroidism was determined by 6th-month TSH levels. RESULTS: Thirty-six patients were included in the study. Along with the classical acute phase reactants and ANC, there was a significant increase in the Calprotectin levels in the acute inflammatory phase of the disease compared to the recovery period (96. 92-37.98, p<0.001). Neither classical acute phase reactants and nor calprotectin were found to have a significant effect on the development of permanent hypothyroidism. Calprotectin did not correlate with other acute phase reactants, absolute neutrophil count and TSH levels in both the acute phase and resolution period. CONCLUSIONS: Calprotectin appears to be an important marker in the diagnosis and follow-up of subacute thyroiditis.

CLINICAL CHARACTERISTICS OF BLOOD TRANSFUSION IN GERIATRIC PATIENTS.

In the presented study, the etiology was defined in geriatric patients who received transfusions with erythrocyte suspension due to anemia; the amount of transfusion was investigated and practical systems and methods to prevent the overuse of transfusions were developed. A retrospective patient records analysis was performed for a total of 328 patients aged ≥65 who received transfusions for any reason between July 2015 and 2018 at Sakarya Research and Training Hospital. Laboratory data at initial presentation, number of erythrocyte transfusions (NES), and total volume of erythrocyte suspension transfusions (TNES) performed during all admissions over the study period were recorded. Also recorded were the demographic data, concurrent conditions, and laboratory values. Patients were divided into two groups based on their age and hemoglobin levels. Age group A1 consisted of patients between 65 and 75 years of age (inclusive), while age group A2 consisted of patients over 75 years of age (exclusive). Based on the hemoglobin levels, the patients were identified as those with a hemoglobin <8 g/dl severe anemia (group H1), hemoglobin level ranging 8-9,5 g/dl moderate anemia (H2), and hemoglobin >9,5 g/dl - mild anemia (H3). The amount of transfusion and etiological factors responsible for anemia were examined. With respect to the incidence of iron deficiency, volume of transfused erythrocyte suspensions (ES), and total number of erythrocyte suspensions (TNES) were significantly higher in the H1 group, compared to the H2 group (p:0.012 and p:0.001, respectively). Comparing H2 and H3 groups, in terms of B12 deficiency, ES, and TNES were significantly higher in the H3 group than in the H2 group (p:.0001, p:.001, p:.001, respectively). In our study, transfusion indications in patients between 65 and 75 years of age and patients aged over 75 years differed significantly in terms of cardiac conditions and hypertension. The age groups were not significantly different in terms of transfusions performed for gastrointestinal bleeding. Also, the gender distribution across these two age groups was well balanced. No significant differences were noted related either to the age or to comorbid conditions between two groups. The higher average NES and TNES values in Group A2 (> 75 years) compared to Group A1 (65-75 y) were attributed to the need for achieving cardiovascular hemodynamic stability, and to the reduced tolerance of anemia due to accompanying comorbid conditions. Despite a wide array of etiological factors in anemic geriatric patients requiring transfusions, it is of utmost importance to develop a management plan for the underlying cause of anemia in order to reduce the indications for repeated transfusions. The anemia threshold for identifying the need for transfusion should be individualized based on the physiological status of each case.

USE OF NEUTROPHILS TO LYMPHOCYTES RATIO AS AN INFLAMMATION MARKER IN PATIENTS WITH CHRONIC TONSILLITIS.

The aim of this study was to assess the neutrophil to lymphocyte ratio (NLR) as an inflammation marker in patients with chronic tonsillitis and to compare the NLR values to other inflammation markers, such as antistreptolysin-O (ASO), C-Reactive Protein (CRP) and erythrocyte sedimentation rate (ESR). Thirty patients aged between 4 and 15 y.o. who had undergone surgery for chronic tonsillitis were included in this retrospective study. Blood samples including haemogram, ASO, CRP and ESR were taken from the patients the day before and one month after the surgery and were analysed retrospectively. Preoperative ASO values were 170±75.5 U, CRP values were 7.6±5 mg/L, ESR values were 15.7±10 mm/H and NLR values were 0.9±0.2. Postoperative ASO values were 140.9±58.5 U, CRP values were 6.8±3.4 mg/L, ESR values were 12.5±5.4 mm/H and NLR values were 1.2±0.4. Statistically significant decreases were observed in the white blood cell count (WBC), lymphocytes, ASO and ESR results, with increase in NLR values after the surgery (p<0.05). The neutrophil and CRP values after the surgery have shown statistically insignificant decrease (p>0.05). The NLR values were compared with the ASO, CRP and ESR values, which were used as inflammation markers. Negative correlation was found between decrease in ASO and ESR and increase in the NLR values after the surgery.

THE USEFULNESS OF MONITORING THE NEUTROPHIL TO LYMPHOCYTE RATIO IN PATIENTS WITH PERIPHERAL VERTIGO.

The purpose of this study was to evaluate the usefulness of the neutrophil to lymphocyte ratio (NLR) in a differential diagnosis and follow-up of patients with peripheral vertigo. Twenty patients with benign positional paroxysmal vertigo (BPPV) and 20 patients diagnosed with vestibular neuritis (VN) were included in the study. Serum samples were analysed at the initial presentation and on the seventh day of admission retrospectively. The WBC (white blood cell) count was 10500±2100 /mm3, the neutrophil count was 4700±1100/mm3, the lymphocyte count was 5000±1200/mm3 and the NLR was 0.9±0.2 in the VN group. In patients with BPPV, the WBC count was 9200±1300/mm3, the neutrophil count was 5200±1200/mm3, the lymphocyte count was 3100±1200/mm3 and the NLR was 1.9±0.9. The NLR was lower in patients with VN than in patients diagnosed with BPPV. The WBC and lymphocyte count was significantly higher in the patients with VN than in the patients diagnosed with BPPV. Within the first week of admission, the WBC and lymphocyte counts in patients with VN decreased, and the NLR was more elevated than at the admission. It is highly recommended that NLR is used in the diagnosis and follow-up of the most commonly observed aetiological factors of peripheral vertigo, BPPV and VN.

ASSESSMENT OF WARFARIN TREATMENT EFFICACY BY MEANS; OF USING COAGULATION TEST RESULTS WITHIN THE THERAPEUTIC RANGE.

Time in Therapeutic Range (TTR) is a value used to assess the efficacy of Warfarin treatment. The aim of our study is to determine the effective INR levels and the rate of TTR in patients on Warfarin regimen due to Atrial Fibrillation (AF) or Mechanical Prosthetic Valve (MPV). A total of 94 patients (58 female, and 36 male, mean age: 64.9±11years) on Warfarin treatment due to AF or MPV with at least 10 INR levels measurements in the last 6 months were included in this retrospective study. The patients were divided into 2 groups. Group 1 consisted of the patients with Valvular AF (n=47); Group 2 included the patients with Non-Valvular AF (n=47); TTR and INR levels were compared. The average of INR values were found as 2,4 (min: 1,3, max: 4,3) in all patients; 2,3 (min: 1,3, max: 4,2) in Group 1; 2,6 (min: 1,3, max: 4,3) in Group 2. The average of TTR values was found 40.3% (min: 10%, max: 80%) in all patients; 43.8% (min: 10%, max: 80%) in Group 1; 36,8% (min: 10%, max: 80%) in Group 2. INR and TTR values are needed to assess the effectiveness of the Warfarin treatment. The patients in treatment with Warfarin should be well trained and frequently monitored. On the other hand, the underlying factors of the TTR values being determined as lower in the Turkish patient population might be due to the lower socio-economic and socio-cultural status, inadequate education levels, and the insufficient information on use of the medication provided by the doctors to the patients.

EFFECTS OF VITAMIN D ANALOGS ON ERYTHROPOIESIS-STIMULATING AGENT DASAGE AND SECONDARY ANEMIA IN HEMODIALYSIS PATIENTS.

To investigate the effects of Vitamin D Analogs, paricalcitol and alphacalcidol, on hemoglobin levels and erythropoietin-stimulating agents' dosage in hemodialysis patients with chronic renal failure. A total of 310 patients under hemodialysis treatment for chronic renal failure were included in this retrospective multicenter study. Data on serum parathormone and hemoglobin levels, erythropoietin-stimulating agents' doses, C-reactive protein, calcium and phosphate levels were collected from medical records to comparatively evaluate paricalcitol, alphacalcidol and no treatment groups. Apart from significantly higher levels for hematocrit in patients treated with paricalcitol compared to pre-treatment values (32.3(3.8) vs. 34.1(3.1) p=0.007), pre-treatment and post-treatment values for biochemical parameters were similar in paricalcitol and alphacalcidol groups including ESA dose. A significant increase in parathormone levels (p=0.000 for each) while a significant decrease in calcium (p=0.003 and 0.040, respectively), Hb (p=0.001 and 0.009, respectively) and hematocrit (p=0.001 and 0.021, respectively) levels were determined in paricalcitol and alphacalcidol treated patients compared with untreated patients. Also, phosphate levels in alphacalcidol treated patients were significantly higher (p=0.018) than untreated patients. Our findings revealed insufficient suppression of parathormone levels and there of lower hemoglobin and hematocrit levels, but similar ESA dosage among CRF patients treated with Vitamin D analogs compared with untreated patients.

Is there a difference in mad honey poisoning between geriatric and non-geriatric patient groups?

OBJECTIVE: This study aims to investigate the demographic, toxicological characteristics of the mad honey intoxication at ages 65 and above, to analyze the electrocardiographic parameters, and to compare with the mad honey intoxication at ages below 65 years. PATIENTS AND METHODS: Eighty-two patients, who had been treated and followed-up between June 2013 and November 2014 in the Emergency Service of the Findikli State Hospital, Turkey, due to diagnosis of mad honey intoxication, were included in our observational study. Age, gender, toxicological characteristics, laboratory parameters, heart rates, systolic and diastolic blood pressures, laboratory analyses and electrocardiographic data of the patients were recorded and analyzed. Patients with known coronary artery disease, chronic renal failure, arrhythmias, valvular heart disease, history of thyroid disease and electrolyte imbalance were not included in the study. RESULTS: Eighty-two (80.5% was male and the mean age was 53 ± 15 years) patients followed-up due to mad honey intoxication were included in our study. There were 64 (78%) patients aged below 65 years, and 18 (22%) patients aged 65 and above. The mean heart rate was 45 ± 7 beats/min, systolic blood pressure was 83 ± 12 mmHg and diastolic blood pressure was 52 ± 9 mmHg on admission. The onset of symptoms of the patients was found as 0.84 hours on average after mad honey consumption, the average amount of honey consumed was 3.7 ± 1.1 tablespoons, and the mean recovery time of the symptoms was found to be 1.04 hours. The most common presenting symptoms were nausea-vomiting in 82 (100%) patients and dizziness in 73 (89%) patients. Patients were found to consume mad honey mostly for achieving a remission in gastrointestinal complaints (n=18, 22%), and for utilizing its blood pressure lowering properties (n=11, 13.4%), in addition to the dietary consumption. Looking at the heart rates of the patients on admission to the emergency service, 65 (79.3%) patients had normal sinus rhythm/sinus bradycardia, 12 (14.6%) patients had a 1st degree atrioventricular block, 3 (3.7%) patients had nodal rhythm, 1 (1.2%) patient had atrial fibrillation and 1 (1.2%) patient had preexcitation. There were no significant pathological findings in the routine laboratory examinations of patients. It was found that all patients achieved normal sinus rhythm and normal blood pressure values after medical treatment, and were discharged approximately 5.65 hours after observation and follow-up. In our study, prolonged intensive-care need, pacemaker need and mortality caused by mad honey intoxication were not found. In the comparison of data of all patients above and below 65 years of age, there was a statistically significant finding that the geriatric patients consume mad honey mostly for hypotensive purposes and gastrointestinal complaints; in addition, the symptoms were starting early and the recovery period was longer in geriatric patients. CONCLUSIONS: The mad honey poisoning should be considered in previously healthy patients with unexplained symptoms of bradycardia, hypotension, and atrioventricular block. Therefore, diet history should carefully be obtained from the patients admitted with bradycardia and hypotension. And, in addition to the primary cardiac, neurological and metabolic disorders, mad honey intoxication should also be considered in the differential diagnosis. In geriatric patients admitted due to mad honey intoxication, the mad honey is usually consumed to reduce blood pressure and resolve gastrointestinal problems; and, their symptoms begin early, and last longer after mad honey consumption. In terms of other parameters, the geriatric age group has similar characteristics to non-geriatric age group.

Chronic myeloid leukemia presented with priapism: Effective management with prompt leukapheresis.

Priapism is a painful medical condition in which the erect penis does not return to its flaccid state, despite the absence of both physical and psychological stimulation, within 4 h. Priapism is considered a medical emergency, which should receive proper treatment by a qualified medical practitioner. Treatment initially involves conservative measures, such as corporeal aspiration and irrigation with saline or dilute phenylephrine. If this fails, embolization or surgical shunting may be required. Priapism is more commonly associated with sickle cell hemoglobinopathy. However, hyperviscosity resulting from leukemia is a rare cause of priapism. We report a case of a 19-year-old man with an 18-h history of priapism secondary to undiagnosed chronic myeloid leukemia. We discuss the method of leukapheresis (mechanical white cell depletion) to reduce viscosity.

Immediate primary transcatheter closure of left ventricular free wall rupture after myocardial infarction.

Left ventricular free wall rupture due to acute myocardial infarction (MI) is an infrequent but fatal complication that occurs especially during the 1st week of MI. Emergency surgical intervention is essential but conveys significant operative mortality. Most of the patients die before they reach the operating room. We present a case of percutaneous left ventricular free wall rupture closure complicating acute inferior MI to bridge the time until the patient can be transferred to the surgical department and subjected to surgery.