Analysis of postoperative emergency admission and hospitalization of patients who underwent bariatric surgery: A single-center experience.

BACKGROUND: Bariatric surgery is a treatment with a low risk of complications that is becoming common in obesity treatment. OBJECTIVE: The aim of this study is to evaluate postoperative visits to the emergency department by patients who underwent bariatric surgery and to investigate what postoperative conditions are encountered in these patients and what can be done to prevent emergency room admission and hospitalization. SETTING: University Hospital. METHODS: The study included 394 patients aged 18 years underwent bariatric surgery for obesity. Emergency department (ED) admissions and diagnoses of patients who underwent bariatric surgery were analyzed in two groups, surgery-related and surgery-unrelated. RESULTS: It was found that 22% (n: 87) of patients visited the ED at least once; 4.8% (n: 19) of them were hospitalized; and 78.1% (n: 68) of 87 patients did not need to be hospitalized. Low preoperative iron, folic acid, and ferritin levels increase the number of visits to ED with a bariatric surgery-related complaint, urinary tract infection was the most common diagnosis and did not require hospitalization; the most common diagnosis of hospitalized patients was gastrointestinal perforation, pulmonary embolism, intra-abdominal abscess. CONCLUSION: Despite the low risk of complications, bariatric surgery is a surgery associated with a high number of preventable postoperative emergency visits. ED visits can be reduced by calling these patients for more frequent outpatient check-ups, providing intravenous hydration therapy in outpatient clinics and, if necessary, providing prescribed treatment.

The relationship between morning blood pressure surge and serum IGF-1 level in acromegaly patients with hypertension.

OBJECTIVE: High levels of insulin-like growth factor 1 (IGF-1) in patients with acromegaly cause structural and functional changes specific to the disease. These changes lead to mortality if the disease is not treated. Circadian blood pressure (BP) rhythm as measured by 24-h ambulatory blood pressure monitoring (ABPM) can change with a decrease in BP during sleep and a sudden increase in wakefulness. AIM: We aim to evaluate the relationship between changes in BP and IGF-1 levels in patients with acromegaly. METHODS: Patients who were diagnosed with acromegaly and the patient group with hypertension were included. Serum biochemistry parameters, serum IGF-1 level and ABPM follow-ups were compared in these patients. RESULTS: In our study, 30 patients with acromegaly and 30 patients with hypertension without acromegaly were included. Thirty of the patients were male and 30 were female. There was a statistically significant difference between the groups in terms of IGF-1(p = < 0.001) and GH(p = 0.004). There was no significant difference between patients' office systolic/diastolic BP measurements, day/night, systolic/diastolic BP measurements and all systolic/diastolic BP measurements in ambulatory blood pressure follow-ups. There was a significant difference in morning blood pressure surge(p = < 0.001). A statistically significant difference was found between the acromegaly patient groups with MBPS below and above 25 mmHg in terms of IGF-1 (p = 0.025) and platelet levels (p = 0.004). CONCLUSION: As a result, cardiovascular disease risks can be predicted in patients with high serum IGF-1 levels by planning ambulatory blood pressure in the early period.

Serum Periostin Levels are Significantly Higher in Patients with Primary Hyperparathyroidism and Closely Related to Osteoporosis.

BACKGROUND: Periostin is an emerging biomarker that plays a role in bone metabolism and may be associated with bone mineral density (BMD). This study is aimed to investigate serum periostin levels in patients with primary hyperparathyroidism (PHPT) and its correlation with BMD in these patients. METHODS: Forty patients with newly diagnosed PHPT without co-morbidities and 30 healthy controls were included. Laboratory tests for the diagnosis of PHPT and serum levels of periostin were measured for all patients. BMD was measured on lumbar spines L1 and L4 by dual-energy X-ray absorptiometry (DEXA). Serum periostin levels were detected using an enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum periostin levels were significantly higher in patients with PHPT than in healthy controls (p<0.001). Serum periostin levels were also significantly higher (mean 59.7±11.0 ng/mL) in PHPT patients with osteoporosis than those without osteoporosis (p=0.004). In logistic regression analysis, only serum periostin levels independently predicted the patients with osteoporosis. According to this analysis, every 1 ng/mL increase in serum periostin increased the risk of having osteoporosis by 20.6%. When the cut-off for serum periostin level was 49.75 ng/mL, the patients with osteoporosis were predicted with 71.4% sensitivity and 69.2% specificity. Multivariate regression analysis revealed a negative correlation between serum periostin levels and L1-L4 T scores on DEXA. CONCLUSION: This is the first study to determine that serum periostin levels are higher in PHPT patients than those without PHPT and to demonstrate a significant association between serum periostin levels and T scores on DEXA in patients with PHPT. These findings will aid in detecting osteoporosis in patients with PHPT and making the decision for surgery in PHPT patients with no need for DEXA imaging that involves radiation.

Transient ischemic liver injury and respiratory failure in a COVID-19-positive patient after multiple bee stings.

We present a patient with multiple bee stings who developed lung and liver injuries and subsequently tested positive for coronavirus disease 2019 (COVID-19). A 65-year-old male patient presented to the emergency department after being stung by more than 100 honeybees. His physical examination revealed pustular lesions distributed across his chest, arms, back, legs, and head, marking the sting zones. While the patient had no history of liver disease, initial laboratory test results showed elevated liver enzyme levels. A chest computer tomography scan was ordered, revealing bilateral ground-glass opacities suggesting COVID-19. His condition worsened over the course of the following day, and when he was admitted to the intensive care unit (ICU), his SpO2 decreased to 83% despite oxygen support with a mask. The second polymerase chain reaction test taken in the ICU was positive for COVID-19 infection. After stung with multiple bees, the patient developed acute liver injury and suffered from concomitant COVID-19-related respiratory insufficency, and he was treated accordingly. Starting on the 5th day, the patient's liver markers began to improve, and on the 13th day, he was discharged with normal vital signs and liver enzyme values. There seem to be varying outcomes across different studies with regard to the relationship between bee stings and COVID-19. Further research is needed to explore the possibility of this complementary treatment with bee venom in the prevention of severe acute respiratory syndrome coronavirus-2 infection.

Serum Elabela level is significantly increased in patients with acromegaly.

BACKGROUND: Although the bioactive peptides associated with the apelinergic system are known to be associated with heart failure and ischemic heart disease, there are no data on their association with acromegaly. AIM: We aimed to investigate the change in serum Elabela levels, a novel peptide of the apelinergic system, in patients with acromegaly. METHODS: Our study included 30 treatment naive patients who were recently diagnosed with acromegaly, and 50 age-and-sex-matched healthy controls. In addition to routine history, physical examination and laboratory examinations, serum Elabela level was measured. Participants were divided into two groups as individuals with and without acromegaly and compared to each other. RESULTS: Diastolic blood pressure (DBP) and systolic blood pressure (SBP) were found to be higher in patients with acromegaly. Serum glucose, Hs-CRP, NT-proBNP, insulin-like growth factor-1, growth hormone and serum Elabela levels were higher in patients with acromegaly (p < 0.05 for each). Left ventricular ejection fraction (LV-EF) was found to be lower in patients with acromegaly than the patients in healthy control group (p < 0.05). In multivariate analysis; age, systolic blood pressure, NT-proBNP, Insulin-like growth factor 1 and growth hormone levels were found to be very closely and positively related to serum Elabela level (p < 0.05 for each). CONCLUSIONS: Serum Elabela level can be used as an early and objective indicator of early cardiovascular involvement in patients with acromegaly. Further research is needed to clarify the role of serum Elabela levels on cardiovascular system in acromegaly patients.

The relationship between infarct volume and high sensitivity troponin I level in patients diagnosed with ischemic stroke.

BACKGROUND: Various biomarkers and clinical variables are used to determine the probability risk, diagnosis, and the prognosis of acute ischemic stroke, but effective markers are still warranted. AIM: We aimed to determine the effectiveness of Hs-cTnI levels to predict the prognosis of AIS. METHODS: This study was planned as a retrospective observational study. Patients with available data and over 18 years old were included in the study. Diffusion magnetic resonance images were evaluated by a senior radiologist and the infarct size was calculated. RESULTS: We included 110 (54.2%) males and 93 (45.8%) females; a total of 203 patients with a mean age of 68.9 were included in the present study. Patients were divided into two groups according to the cut-off level of Hs-troponin-I (group I: lower than 8.5 mg/dL; group 2: higher than 8.5 mg/dL). These two groups were compared for mortality and infarct volume. Infarct volume and the mortality ratio of the group 2 was significantly higher [p = 0.041, U = 4294.5, LV = 6.5 (IQR = 1.8-25.4)]. CONCLUSIONS: Hs-troponin I may be an effective biomarker in predicting the prognosis of patients with acute ischemic stroke. Multicenter comprehensive prospective studies are warranted to obtain stronger results.

RDW Predicts Fibrosis in Patients with Chronic Hepatitis B Having Persistently Normal ALT Levels.

Background: There are studies on the determination of hepatic fibrosis with noninvasive markers but data about liver biopsy results and noninvasive markers in patients with chronic hepatitis B (CHB) are limited. The aim of this study is to determine the relationship between pathological findings and noninvasive markers, and to determine the marker that predicts fibrosis in patients with consistently normal serum alanine aminotransferase (ALT) levels, diagnosed with CHB and undergoing liver biopsy. Methods: A total of 122 patients with CHB, 29 of them with HbeAg (+), aged 30 years and older, HBV DNA > 2000 IU / ml, and serum ALT levels measured four times in the last year, were consistently normal, and 93 of them with HbeAg (-) were included in the study. Demographic characteristics of patients, laboratory parameters, histological activity index (HAI) and fibrosis values obtained in liver biopsy, and noninvasive markers (AP (age-platelet) index, APRI (AST/Platelet ratio) and FIB-4 score, neutrophil/lymphocyte ratio, mean platelet volume (MPV) and erythrocyte distribution width (RDW) were recorded. Results: The relationship between RDW value and fibrosis was statistically significant in the HbeAg (+) group (p<0.001). The relationship between AP index, APRI and FIB-4 score, neutrophil/lymphocyte ratio and MPV with fibrosis was not statistically significant (>0.05 for each). Conclusion: It has been shown that the RDW value can be used to predict fibrosis in CHB patients with normal ALT and HbeAg (+), and the cut-off value for RDW is 12.

Aumento da Espessura Médio-intimal Aórtica e sua Relação com Estresse Oxidativo Elevado em Pacientes com Talassemia Menor / Aortic Intima Media Thickness is Increased and Closely Related to Elevated Oxidative Stress Increases in Beta Thalassemia Minor

Resumo Fundamento A espessura médio-intimal (EMI) da artéria aorta abdominal (EMI-A) pode ser um marcador precoce de aterosclerose subclínica e um indicador objetivo de estresse oxidativo em pacientes com talassemia menor. Objetivo Avaliar se as EMIs da artéria aorta e da artéria carótida (EMI-C) se alteram com estresse oxidativo, e examinar a relação entre esses parâmetros em pacientes com talassemia menor. Métodos O estudo incluiu 80 pacientes diagnosticados com talassemia menor, e 50 indivíduos sadios com idade e sexo similares. Após procedimentos de rotina, as amostras de sangue foram coletadas dos grupos de estudo para a medida da homeostase tiol/dissulfeto e da albumina modificada pela isquemia (AMI). As medidas da EMI-C foram realizadas a partir de quatro regiões diferentes (artéria carótida externa direita e esquerda e artéria carótida interna direita e esquerda) por ultrassonografia, e a medida da EMI-A foi realizada por ultrassonografia abdominal. Um valor de p<0,05 foi definido como estatisticamente significativo. Resultados Nos pacientes com talassemia menor, os níveis de tiol nativo e tiol total, e a razão tiol nativo/tiol total foram mais baixos, e os valores de AMI, razão dissulfeto/tiol nativo, e razão dissulfeto/tiol total foram mais altos que no grupo controle. A EMI-A foi significativamente maior no grupo de pacientes com talassemia menor que nos controles (1,46±0,37 vs 1,23±0,22 e p<0,001). Quando os parâmetros associados com EMI-A na análise univariada foram avaliados por regressão linear multivariada, EMI-A apresentou uma relação positiva, e os níveis de tiol nativo e tiol total apresentaram uma forte relação negativa com AMI (p<0,01). Conclusão Nós demonstramos, pela primeira vez, um aumento no estresse oxidativo com a elevação da EMI-A, e valores inalterados da EMI-C em pacientes com talassemia menor.

Abstract Background Abdominal aortic intima media thickness (A-IMT) may be an early marker of subclinical atherosclerosis and an objective indicator of increased oxidative stress in beta-thalassemia minor patients. Objective To evaluate whether aortic and carotid IMTs change with oxidative stress and to assess the relationship between these parameters in beta-thalassemia minor patients. Methods The study included 80 patients diagnosed with beta-thalassemia minor, and 50 healthy individuals with similar age and gender. After routine procedures, blood samples were collected from the study groups for thiol-disulfide hemostasis and ischemia-modified albumin (IMA). C-IMT measurements were performed in four different regions (right and left internal and external carotid artery) by ultrasonography. In addition, A-IMT measurement was performed by abdominal ultrasonography. Statistically significant p value was set as <0.05 for all comparisons. Results In beta-thalassemia minor patients, native thiol, total thiol and native thiol / total thiol ratio were lower, and the IMA, disulfide / native thiol ratio and disulfide / total thiol ratios were higher than in healthy control group. A-IMT measurement was significantly higher in beta-thalassemia minor group than controls (1.46±0.37 vs 1.23±0.22 and p<0.001). When the parameters associated with A-IMT in univariate analysis were evaluated by multivariate linear regression analysis, A-IMT was positively related, and native thiol and total thiol levels were negatively and closely related to IMA (p<0.01). Conclusion We demonstrated, for the first time, that oxidative stress status increased with increased A-IMT, while C-IMT remained unchanged in beta-thalassemia minor patients.

Aortic Intima Media Thickness is Increased and Closely Related to Elevated Oxidative Stress Increases in Beta Thalassemia Minor. / Aumento da Espessura Médio-intimal Aórtica e sua Relação com Estresse Oxidativo Elevado em Pacientes com Talassemia Menor.

BACKGROUND: Abdominal aortic intima media thickness (A-IMT) may be an early marker of subclinical atherosclerosis and an objective indicator of increased oxidative stress in beta-thalassemia minor patients. OBJECTIVE: To evaluate whether aortic and carotid IMTs change with oxidative stress and to assess the relationship between these parameters in beta-thalassemia minor patients. METHODS: The study included 80 patients diagnosed with beta-thalassemia minor, and 50 healthy individuals with similar age and gender. After routine procedures, blood samples were collected from the study groups for thiol-disulfide hemostasis and ischemia-modified albumin (IMA). C-IMT measurements were performed in four different regions (right and left internal and external carotid artery) by ultrasonography. In addition, A-IMT measurement was performed by abdominal ultrasonography. Statistically significant p value was set as <0.05 for all comparisons. RESULTS: In beta-thalassemia minor patients, native thiol, total thiol and native thiol / total thiol ratio were lower, and the IMA, disulfide / native thiol ratio and disulfide / total thiol ratios were higher than in healthy control group. A-IMT measurement was significantly higher in beta-thalassemia minor group than controls (1.46±0.37 vs 1.23±0.22 and p<0.001). When the parameters associated with A-IMT in univariate analysis were evaluated by multivariate linear regression analysis, A-IMT was positively related, and native thiol and total thiol levels were negatively and closely related to IMA (p<0.01). CONCLUSION: We demonstrated, for the first time, that oxidative stress status increased with increased A-IMT, while C-IMT remained unchanged in beta-thalassemia minor patients.

FUNDAMENTO: A espessura médio-intimal (EMI) da artéria aorta abdominal (EMI-A) pode ser um marcador precoce de aterosclerose subclínica e um indicador objetivo de estresse oxidativo em pacientes com talassemia menor. OBJETIVO: Avaliar se as EMIs da artéria aorta e da artéria carótida (EMI-C) se alteram com estresse oxidativo, e examinar a relação entre esses parâmetros em pacientes com talassemia menor. MÉTODOS: O estudo incluiu 80 pacientes diagnosticados com talassemia menor, e 50 indivíduos sadios com idade e sexo similares. Após procedimentos de rotina, as amostras de sangue foram coletadas dos grupos de estudo para a medida da homeostase tiol/dissulfeto e da albumina modificada pela isquemia (AMI). As medidas da EMI-C foram realizadas a partir de quatro regiões diferentes (artéria carótida externa direita e esquerda e artéria carótida interna direita e esquerda) por ultrassonografia, e a medida da EMI-A foi realizada por ultrassonografia abdominal. Um valor de p<0,05 foi definido como estatisticamente significativo. RESULTADOS: Nos pacientes com talassemia menor, os níveis de tiol nativo e tiol total, e a razão tiol nativo/tiol total foram mais baixos, e os valores de AMI, razão dissulfeto/tiol nativo, e razão dissulfeto/tiol total foram mais altos que no grupo controle. A EMI-A foi significativamente maior no grupo de pacientes com talassemia menor que nos controles (1,46±0,37 vs 1,23±0,22 e p<0,001). Quando os parâmetros associados com EMI-A na análise univariada foram avaliados por regressão linear multivariada, EMI-A apresentou uma relação positiva, e os níveis de tiol nativo e tiol total apresentaram uma forte relação negativa com AMI (p<0,01). CONCLUSÃO: Nós demonstramos, pela primeira vez, um aumento no estresse oxidativo com a elevação da EMI-A, e valores inalterados da EMI-C em pacientes com talassemia menor.

The Role of Procalcitonin in Predicting Necessity of Antivenom Administration and Clinical Severity in Snake Bites.

One of the most important steps for preventing deaths due to snake bites is to administer snake antivenom to the eligible patients in a swift manner. In our study, we aimed to investigate whether procalcitonin is useful for predicting the clinical severity and the necessity of antivenom therapy at the early stages in patients presenting with snake bite. A total of 78 patients over the age of 18 who applied to the emergency department within the first 24 hours were included in this retrospective cross-sectional study. Age and sex of patients, severity of snake bites, total antivenom vials administered, observation periods and outcomes were recorded. Patients were graded according to their clinical severity after the snake bite. Procalcitonin, complete blood count and biochemical parameters of the patients were recorded. According to their clinical severity, the patients' grades were as follows: 21 (26.9%) patients were grade 0; 21 patients (26.9%) were grade 1; 16 patients (20.5%) were grade 2; and 20 patients (25.6%) were grade 3. Snake antivenom was administered to 57 (73.1%) patients. There was a statistically significant difference between procalcitonin levels of patients in respect to their grade (P < 0.001). Sensitivity and specificity of procalcitonin levels of 13.45 and above were 100% and 100% respectively, both for the need of antivenom administration and for the blister formation in the patients. According to our study, we believe that elevated procalcitonin levels should alert the clinicians for possible blister formation, higher clinical severity, and increased requirement for antivenom administration.

Ovarian Stiffness Is Significantly Increased in Polycystic Ovary Syndrome and Related With Anti-Mullerian Hormone: A Point Shear Wave Elastography Study.

OBJECTIVES: Parenchymal stiffness obtained by point shear-wave elastography (pSWE) in solid organs is used as a sign of damage in these organs. However, its clinical use and whether patients with polycystic ovary syndrome (PCOS) have increased ovarian tissue stiffness are still unclear. The aim of this study is to determine the parameters related to ovarian stiffness and whether there is an increase in ovarian stiffness in patients with PCOS compared with healthy controls. METHODS: Forty-five women who were followed up regularly with the diagnosis of PCOS and 30 healthy controls similar to age and sex were included in this study. In addition to the routine follow-up parameters for PCOS, serum homeostatic model assessment of insulin resistance and anti-Mullerian hormone (AMH) levels were examined in all patients, and pSWE examination was performed with pelvic ultrasound (US) and ElastPQ technique. RESULTS: Serum dehydroepiandrosterone sulfate, luteinizing hormone/follicle-stimulating hormone, testosterone, homeostatic model assessment of insulin resistance, and AMH were higher in PCOS compared with healthy controls (P < 0.001). Right, left, and mean ovary stiffness and volumes were significantly higher in PCOS group than healthy controls (P < 0.001). Correlation analysis was performed between mean ovary stiffness and dehydroepiandrosterone sulfate, luteinizing hormone/follicle-stimulating hormone, testosterone, homeostatic model assessment, and AMH and ovary volumes (P < 0.01 for each one). In linear regression analysis, only AMH was found to be related to mean ovary stiffness (P < 0.001 and ß = 0.734). CONCLUSIONS: Ovarian stiffness value obtained by ElastPQ technique and pSWE method increases in PCOS patients compared with healthy controls and is closely related to serum AMH levels. In patients with PCOS, in addition to the conventional US, ovarian stiffness measured by pSWE may be an auxiliary examination in the follow-up of the disease. However, it was concluded that the ovarian stiffness measurement obtained in our current study should be supported by studies involving more patients and the transvaginal US method.

Serum Elabela level is related to endoscopic activity index in patients with active ulcerative colitis.

BACKGROUND: In ulcerative colitis patients, Elabela levels and the relation of Elabela with laboratory parameters is unknown. AIM: The purpose of this study was to investigate the serum Elabela levels in UC patients and its relationship with other clinical and laboratory findings. METHODS: Forty-three patients with UC and 40 healthy controls (group I) similar in age and gender were included in the study. Routine patient history, physical examination, and laboratory tests were followed by analysis of serum Elabela levels. Endoscopic activity index (EAI) of patients with UC was calculated. There were two groups of patients: those in remission (group II) and with active disease (group III). RESULTS: Groups I, II, and III had 40, 22, and 21 participants, respectively. Serum Elabela levels were found to be 3.32 ± 1.25 ng/mL in group I, 3.38 ± 0.88 ng/mL in group II, and 5.48 ± 1.61 ng/mL in group III. Comparing the serum Elabela levels, a statistically significant difference was found between three groups (p < 0.001). Serum Elabela level showed a significant and positive correlation with EAI, leukocyte count, and hs-CRP, while a negative correlation was found with hemoglobin levels in univariate analysis (p < 0.001, for each). In linear regression analysis, these parameters were found to be associated with EAI and hs-CRP (p = 0.049, ß = 0.337, and p = 0.015, ß = 0.396, respectively). CONCLUSION: Elabela concentrations in patients with active UC was significantly higher and was associated with EAI and hs-CRP. Blood Elabela concentrations can be useful in the diagnosis and follow-up of patients with active UC.

QTc, Tp-e Interval and Tp-e/QTc Ratio in Patients with Hypocalcemia-case Control Study

Abstract Background: To the best of our knowledge, there are studies related to QT and QTc interval in patients with hypocalcemia, but there are no studies evaluating T wave peak and end interval (Tp-e interval), Tp-e/QT and Tp-e/QTc ratios used to evaluate cardiac arrhythmia risk and ventricular repolarization changes rates. Objectives: Therefore, we aimed to investigate whether there is a change in Tp-e interval, Tp-e/QT and Tp-e/QTc ratios in patients with hypocalcemia. Methods: Retrospectively, 29 patients with hypocalcemia in the emergency department were included in the study. Twenty-nine patients with similar age and sex distribution were included in the study as the control group. All patients underwent 12-lead electrocardiography (ECG). In addition to routine measurements, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were measured on ECG. The study data were grouped as patients with and without hypocalcemia. Results: The mean age of the patients was 66.24 ± 4.95 years. QTc interval, Tp-e interval and Tp-e/QTc values were found to be significantly higher in patients with hypocalcemia (p <0.001 for each). QTc interval, Tp-e interval and Tp-e/QTc ratio showed a significant negative correlation with calcium levels. Conclusion: Tp-e interval and Tp-e/QTc ratios are significantly increased in patients with hypocalcemia compared to those without hypocalcemia and this can be used more effectively in the follow-up of cardiac fatal arrhythmias.

The efficacy of hemogram parameters in the differential diagnosis of renal colic and acute appendicitis in the emergency department.

BACKGROUND: To investigate the efficacy of WBC, PLR and NLR for use in the differential diagnosis of acute appendicitis and renal colic in the emergency department. METHODS: This study was conducted after consent was received from the Cukurova University Medicine Faculty Noninvasive Clinical Research Ethics Committee. In this study, 440 patients for whom file data could be accessed in the hospital automation and archive system who were admitted to the hospital with abdominal pain were included. RESULTS: Of the 440 patients included in this study, 59.5% were male and 40.5% were female. The average age of the patients was 37.74±13.39 years. According to the pathological diagnosis, 207 patients were diagnosed with acute appendicitis. When the efficacy of differential diagnosis using hematological parameters was examined with ROC analysis, the neutrophil/lymphocyte ratio (NLR) value had the strongest predictive ability (AUC, 0.716, SS=0.024, 95% GA 0.668-0.764). After NLR, the platelet/lymphocyte ratio (PLR) value was the second-best concerning predictive ability for differential diagnosis (AUC, 0.608 SS=0.027, 95%, GA 0.555-0.661). CONCLUSION: Patients with acute appendicitis and renal colic often present to the emergency department with abdominal pain. While patients with acute appendicitis are usually treated with surgical methods, medical treatment is used for renal colic in the acute period. The differential diagnosis of these two patient groups is important. We believe that the PLR and NLR values can be used when an exact differential diagnosis cannot be made.

The new prognostic factor for pulmonary embolism: The ratio of monocyte count to HDL cholesterol.

PURPOSE: Aim of this study is to investigate effectiveness of the monocyte to HDL cholesterol ratio in patients diagnosed with pulmonary embolism for predicting intra-hospital mortality. METHOD: A total of 269 patients diagnosed with pulmonary embolism in the emergency clinic were included in the study. Study was conducted retrospectively. Pulmonary Embolism Severity Index (PESI), Monocyte count and high density lipoprotein cholesterol (HDL) values were determined. MHR values of the patients were calculated. SPSS 26 package program was used to investigate the effectiveness of MHR in predicting mortality. FINDINGS: Mean age of the patients was 64.51 ± 12.4 years. PESI, Number of monocytes and MHR were significantly higher in the group with mortality than the group without mortality (p < .05). HDL values were significantly lower (p < .05) in mortality group. Sensitivity of MHR 19 cut off value was 89.3%, and its specificity was 82.0%. CONCLUSION: Use of predictors for mortality estimation in patients diagnosed with acute pulmonary embolism is important for faster administration of treatment modalities. We think MHR values can be used as a strong predictor according to the hemogram parameters and biochemical results.

Relationship With Calcium, Nutrition Risk, QTc Interval, Tp-e Interval, and Tp-e/QTc Ratio of Critical Care Patients.

BACKGROUND: To our knowledge, there are studies related to QTc interval in critical care patients whose nutrition scores are evaluated but no studies evaluating T-wave peak and end interval (Tp-e interval), Tp-e/QT ratio, and Tp-e/QTc ratio, used to evaluate cardiac arrhythmia risk and ventricular repolarization change rates. Therefore, we aimed to investigate whether there is a change in Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients whose nutrition scores are evaluated. METHODS: This study was planned as a retrospective cross-sectional study. Forty-four patients with a risk score of ≤3 were defined as low-risk group, and 45 patients with a score of ≥4 were defined as high-risk group. Forty-five healthy patients of similar age and gender were included in the control group. All patients underwent 12-lead electrocardiography (ECG). The Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were measured on ECG. The study data were grouped as patients with high Nutritional Risk Screening 2002 (NRS-2002) risk score, low NRS-2002 risk score, and healthy control. RESULTS: QTc interval, Tp-e interval, and Tp-e/QTc ratios were significantly higher in patients with high nutrition risk. In a correlation analysis, Tp-e interval and Tp-e/QTc ratio were found to be independently associated with calcium, corrected calcium, and serum albumin level. CONCLUSION: QTc interval, Tp-e interval, and Tp-e/QTc ratios are significantly increased in patients with high nutrition risk score compared with healthy people and are independently associated with calcium and serum albumin levels; thus, they can be used more effectively in the follow-up of cardiac fatal arrhythmias.

Monocyte High Density Lipoprotein Cholesterol Ratio as a New Prognostic Factor for Mesenteric Embolism.

OBJECTIVE: To determine the effectiveness of the ratio of monocyte count to high density lipoprotein cholesterol in predicting in-hospital mortality. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Intensive Care Unite, Adana Numune Research and Training Hospital, Turkey, from January 2018 to December 2019. METHODOLOGY: Patients admitted to the intensive care unit with the diagnosis of mesenteric embolism were included in the study. Monocyte count and high-density lipoprotein cholesterol (HDL) values were determined. Monocyte HDL Ratio (MHR) values of the patients were calculated. SPSS 26 package programme was used to investigate the effectiveness of MHR in predicting mortality. RESULTS: The mean age of the 81 patients was 69.9 ±10.6 years. In the group with mortality, the number of monocytes and MHR were significantly higher than the group without mortality (p<0.05). In the mortality group, HDL value was significantly lower (p<0.05) than the non-mortality group. Sensitivity of the MHR cutoff value of 19 was 81.8%, positive predictive value was 96.4%, specificity value was 97.9%, negative predictive value was 88.7%. CONCLUSION: For patients diagnosed with acute mesenteric embolism, the use of predictors in terms of mortality estimation is very important for the faster implementation of treatment modalities. MHR value can be used as a strong predictor. Key Words: Mesenteric embolism, Monocyte, HDL cholesterol, MHR, Mortality.