An investigation of the effects of the mean platelet volume, platelet distribution width, platelet/lymphocyte ratio, and platelet counts on mortality in patents with sepsis who applied to the emergency department.

AIM: The aim of this study is to examine the role of the mean platelet volume (MPV), platelet distribution width (PDW), platelet/lymphocyte ratio (PLR), and platelet values for predicting mortality in patients with sepsis. MATERIALS AND METHODS: This is a retrospective study, involving patients 18 years and above who were diagnosed with sepsis. Blood samples were analyzed for platelets characteristics (counts, MPV, PDW, and PLR). The patients were separated into two groups namely the survivors and deceased. The two groups' MPV, PDW, PLR, and platelet counts which were considered to have an effect on mortality, were compared. RESULTS: Three hundred and thirty patients who were diagnosed with sepsis in our emergency department and complying with the study participation criteria were studied retrospectively. Comparison of the MPV, PDW, PLR, and platelet counts of the deceased and survivors showed that the MPV, PDW, and PLR were higher in the deceased while the platelet counts were higher in the survivors. CONCLUSION: The low number of platelets in patients with sepsis at the moment of application and the high PDW and PLR values are valuable for predicting a high mortality.

Effect of L-ornithine L-aspartate on Liver Injury Due to Acute Ethyl Alcohol Intoxication in Rats.

OBJECTIVE: Ethyl alcohol is a substance that is widely used worldwide and known to exert toxic effects on liver. In this study, we aimed to examine the effect of L-ornithine L-aspartate (LOLA) on the toxicity of a single dose of ethyl alcohol in rats. SUBJECTS AND METHOD: We used 32 randomly selected male Sprague-Dawley rats weighing 200-250 g. The rats were grouped into four groups with each group containing eight rats: Group 1: the control group, Group 2: the ethyl alcohol group, Group 3: the LOLA group and Group 4: the ethyl alcohol+LOLA group. Ethyl alcohol was administered orally through a nasogastric tube at a dose of 6 g/kg after diluting with distilled water. One hour after ethyl alcohol administration, LOLA was administered to pre-specified groups orally through a nasogastric tube at a dose of 200 mg/kg after diluting with distilled water. Liver tissue and blood samples were obtained from all rats 24 hours later to study total antioxidant capacity (TAC), total oxidant status (TOS) and oxidative stress index (OSI) levels in liver samples, and aspartate aminotransferase (AST), alanine transferase (ALT), TAC, TOS and OSI levels in blood samples. RESULTS: Serum TAC, TOS and OSI levels were higher in the groups that were administered ethyl alcohol. In addition, tissue TAC level was higher and TOS and OSI levels were lower in groups that were given ethyl alcohol. No significant changes were observed in serum and tissue TAC, TOS, OSI, ALT and AST levels in the LOLA administered groups. CONCLUSION: This study showed that LOLA was not biochemically effective and exerts no oxidative stress reducing activity in liver injury due to acute ethyl alcohol toxicity.

Peripheral neuropathy after burn injury.

OBJECTIVES: Peripheral neuropathy is a well-documented disabling sequela of major burn injury. These lesions are associated with both thermal and electrical injuries that may be frequently undiagnosed or overlooked in clinical settings. The purpose of this study was to evaluate the prevalence of burn-related neuropathy in our database and to investigate the clinical correlates for both mononeuropathy and generalized peripheral polyneuropathy. PATIENTS AND METHODS: Out of 648 burn patients, admitted to our clinic forty-seven burn patients with the diagnosis of peripheral neuropathy were evaluated retrospectively. The demographic and clinical data collected were gender, age, degree, site and percent surface area of burn, type of burn, and the results of electrodiagnostic examination, including electromyography and nerve conduction assessments and associated pathology if existed. RESULTS: Peripheral neuropathy is the most frequent disabling neuromuscular complication of burn, that may be undiagnosed or overlooked. In current study, peripheral neuropathy associated with burn all of our patients were identified by electrodiagnostic study. After treatment in Burn Unit, clinical and electrodiagnostic studies were applied. Motor and sensory distal latencies were prolonged and sensory nerve action potentials reduced in amplitude. CONCLUSIONS: The findings of our study have shown that polyneuropathies and axonal neuropathy were more frequent than mononeuropathy and demyelination.  

Neutrophil lymphocyte ratios in stroke subtypes and transient ischemic attack.

OBJECTIVES: This investigation was conducted to test the value of Neutrophil Lymphocyte Ratio (NLR), which has been shown in some recent studies to be a prognostically important and an easy-to-measure inflammatory marker, in patients presenting to Emergency Service with stroke (ischemic and hemorrhagic) and transient ischemic attack. MATERIALS AND METHODS: A total of 868 patients were enrolled, who presented to our Emergency Service with cerebrovascular accident (stroke and transient ischemic attack) and admitted to Neurology Clinic. Demographic characteristics and comorbidities of patients were recorded. The patients were divided into 3 groups as acute ischemic stroke (AIS), acute hemorrhagic stroke (AHS) and transient ischemic attack (TIA). Patients with AIS were classified into subgroups in terms of TOAST (trial of 10172 stroke treatment) criteria. Admission NLR levels were compared across all groups. RESULTS: A total of 868 patients were enrolled, 51.6% of which were male and 48.4% were female. AIS rate was 75.3%, AHS rate was 14.3% and TIA rate was 10.7%. In all of patients, mortality rate was 10.7%. NLR was significantly higher in patients who died (p < 0.001). NLR level in patients with TIA was significantly lower than those of AIS and AHS groups (p < 0.001). Among AIS subgroups, NLR level was significantly higher in group with great artery atherosclerosis or atherothrombosis compared to other groups (p < 0.001). CONCLUSIONS: NLR may be used as a simple and easy-to-measure marker for prediction of short-term prognosis and in-hospital mortality in both ischemic and hemorrhagic stroke patients.

Benefit of hemodialysis in carbamazepine intoxications with neurological complications.

AIM: It is aimed to share the fact that hemodialysis is also useful in carbamazepine intoxications with prominent neurological side effects in cases hemoperfusion is not available. PATIENTS AND METHOD: Files of 49 patients presenting our Emergency Room with a prediagnosis of carbamazepine intoxication were analyzed retrospectively. Demographic and laboratory data of patients were recorded on study form. Patients were divided into two groups as those applied hemodialysis (Group 1) and those not applied hemodialysis (Group 2). Group 1 included 13 patients while group 2 did 36. RESULTS: Statistically significant differences were detected between groups in terms of heart rate, Glasgow Coma scale score, presence of convulsions, midriasis and blood carbamazepine levels at the time of presentation. It was observed that carbamazepine levels decreased by 58% via hemodialysis in those receiving hemodialysis. DISCUSSION: Hemodialysis is simple, cheap, widespread and easier to apply compared to hemoperfusion. It has been shown that acute carbamazepine intoxication can be treated with low flow-high activity standard hemodialysis and it is a good therapeutic option.

The role of serum D-dimer level in the diagnosis of patients admitted to the emergency department complaining of chest pain.

This study investigated D-dimer levels in 241 patients admitted to the emergency department with sudden-onset chest pain. The patient group included those diagnosed with acute coronary syndrome (ACS; i.e., unstable angina pectoris [USAP], non-ST elevated myocardial infarction [NSTEMI], ST-elevated myocardial infarction [STEMI]); the control group included those diagnosed with non-cardiac chest pain. Mean serum levels of D-dimer, creatine kinase-MB (CK-MB) and troponin I (TPI) were compared between the groups. Levels of D-dimer, CK-MB and TPI in the patient group were significantly higher than in the control group. There were also significantly higher D-dimer, CK-MB and TPI levels in the STEMI and NSTEMI patient subgroups compared with the control group. Only the D-dimer level was significantly higher in the USAP subgroup versus the control group. The sensitivity and specificity of D-dimer for ACS were 83.7% and 95.4%, respectively, suggesting that evaluating D-dimer levels might be useful in the emergency room for diagnosing ACS and predicting mortality in patients presenting with acute chest pain.

Trauma scores and neuron-specific enolase, cytokine and C-reactive protein levels as predictors of mortality in patients with blunt head trauma.

This study evaluated serum neuron-specific enolase (NSE), cytokine and high-sensitivity C-reactive-protein (hs-CRP) levels, along with the Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS), as predictors of mortality in the early posttraumatic period, in 100 Turkish patients with blunt head trauma. Overall patient mortality was 27%. There was a significant association between age and mortality, and mortality was negatively correlated with GCS and RTS. Head injury severity (GCS) was significantly related to NSE, hs-CRP, interleukin (IL)-6, IL-8 and tumour necrosis factor (TNF)-alpha levels. Mortality correlated positively with IL-6, IL-8, TNF-alpha and hs-CRP levels. NSE, hs-CRP, IL-6, IL-8 and TNF-alpha levels were significantly higher in non-survivors compared with survivors. GCS score < or =8, younger age and NSE levels were significant independent predictors of mortality. During the early post-traumatic period, NSE may be an objective alternative criterion to the GCS, in the management of patients with blunt head trauma.

Serum myeloperoxidase levels in predicting the severity of stroke and mortality in acute ischemic stroke patients.

OBJECTIVE: The aim of this study was to examine the level of myeloperoxidase (MPO) measured before specific treatment in patients presenting to the Emergency Department with acute ischemic stroke and its correlation to mortality and the severity of the stroke. PATIENTS AND METHODS: The study was carried out on 55 patients with a confirmed diagnosis of ischemic stroke, and on 44 healthy control group. Before specific intervention, serum samples were taken to measure levels of MPO. The medical records, demographic, clinical, laboratory and neuro-imaging data were noted.  The National Institutes of Health Stroke Scale was used to determine the severity of the stroke. RESULTS: A total of 55 patients, of whom 32 (58.2%) were male, who had presented within 24 hours of the onset of symptoms of acute ischemic stroke were included in the study. Fifteen of these patients (27.2%), of whom five were women, died. There was a statistically significant difference in the serum MPO levels of patients who survived and those who died. When the patients were grouped as high or normal in terms of plasma MPO levels, a significant correlation was found between MPO level, cortical + subcortical stroke location and strokes with a lesion diameter of more than 4 cm. In the high MPO group, Troponin T and CRP levels were significantly higher than those of the normal MPO group. CONCLUSIONS: The level of myeloperoxidase in the serum of acute ischemic stroke patients rises and there is a correlation between myeloperoxidase level and prognosis.

The role of serum osteoprotegerin and S-100 protein levels in patients with acute ischaemic stroke: determination of stroke subtype, severity and mortality.

This study investigated correlations between mortality, stroke subtype and stroke severity with serum osteoprotegerin (OPG) and S-100 protein levels prior to the treatment of patients admitted to the emergency department and diagnosed with ischaemic stroke. Pretreatment serum samples were collected from patients (n = 90) to determine OPG and S-100 protein levels. Age- and sex-matched healthy individuals (n = 16) served as controls. Compared with controls, OPG and S-100 protein levels were significantly higher in the cardioembolic and atherothrombotic stroke groups. Within the stroke group, OPG levels were significantly higher in the cardioembolic and atherothrombotic stroke groups compared with the transient ischaemic attack (TIA) group. S-100 protein levels were significantly higher in the atherothrombotic stroke group than in the lacunar stroke and TIA groups, and in the cardioembolic stroke group compared with the lacunar stroke group. Serum OPG and S-100 protein levels were significantly higher in patients who died compared with survivors. In predicting stroke subtype and severity, although both OPG and S-100 protein levels were indicators, S-100 protein was more valuable for mortality prediction.

Iodine status and goiter prevalence in Turkey before mandatory iodization.

Endemic goiter is an important public health problem in Turkey. Legislation for mandatory iodization of household salt was passed in July 1999. Current study is aimed at ascertaining the goiter prevalence and iodine nutrition in school-age children (SAC) living in known endemic areas of Turkey. Sonographic thyroid volumes (STV) and urinary iodine concentrations (UIC) of 5,948 SAC from 20 cities were measured between 1997-1999. STV of 31.8% of the SAC examined stayed above the upper-normal limits for the same age and gender recommended by the World Health Organization (WHO). Goiter prevalence ranged between 5 to 56% and median UIC ranged between 14 to 78 microg/l, indicating severe to moderate iodine deficiency (ID) in 14 and mild ID in 6 of the cities surveyed. Neither of the cities was found to have sufficient median UIC levels. The current study shows that endemic goiter is an important public health problem and iodine nutrition is inadequate nationwide. It also provides reliable scientific evidence and shows the need for a controlled and effective iodine supplementation program nationwide. Mandatory iodization of household salt seems to be the essential measure taken for the moment, additional measures may be needed in the near future.