The effect of indicators of CALLY index on survival in glioblastoma.

INTRODUCTION: Glioblastoma is the most common primary brain tumor in adults. Recently, research has been published on the potential prognostic indicators associated with different types of cancer. Due to the limited availability of data investigating the relationship between the CALLY index and glioblastoma patients, we aimed to conduct this study. MATERIALS AND METHODS: Between January 2017 and December 2023, we conducted a study on patients diagnosed with glioblastoma. We collected demographic data and routine laboratory tests at the time of admission. To calculate the CALLY index, we used the formula (albumin value × lymphocyte count) / CRP value × 104. Parameters were compared for in-hospital mortality across different groups. RESULTS: The study analyzed 202 patients who met the inclusion criteria. Of these, 165 (81.7%) were classified as "survivors" and 37 (18.3%) as "deceased." A comparison of hematologic parameters between the two groups showed a significantly lower CALLY index in the "deceased" group (3.05 (4.92)) compared to the "survivor" group (10.13 (13.69)) (p < 0.001). The study compared the parameters between groups with regard to in-hospital mortality. CONCLUSIONS: Based on the results of the study, we conclude that the CALLY index can be considered an easily applicable indicator for the mortality of glioblastoma patients.

Evaluation of Tpeak-end interval, Tpeak-end/QT, and Tpeak-end/Qtc ratio during acute migraine attack in the emergency department.

INTRODUCTION: During an acute migraine attack, changes in ventricular repolarisation parameters may occur due to an imbalance in the autonomic nervous system. Tpeak-tend (Tp-e) interval, Tp-e/QT ratio, and Tp-e/corrected QT (QTc) ratio are novel parameters of arrhythmogenesis and can be easily calculated in electrocardiography (ECG). The objective of this study is to demonstrate that novel ventricular repolarisation parameters can anticipate the risk of ventricular dysrhythmia in the migraine attack period. METHODS: This research was a prospective case-control study, which recruited a total of 144 participants, including 74 migraine patients and 70 healthy volunteers in the control group (CG) who met the criteria for migraine with or without aura. All participants underwent 12-lead ECG recordings, and the study compared the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio with those of the CG. RESULTS: The average age of patients experiencing migraine attacks was 38.14 ± 10.82, with 58 (76%) of these patients being female. The Tp-e interval mean was higher in the migraine attack group than the CG, with a statistically significant difference discovered (74.22 ± 20.20 ms [ms] compared to 65.39 ± 11.33 ms, p = 0.001). However, there were higher mean Tp-e/QT and Tp-e/QTc ratios in the migraine attack group compared to the CG, and this difference was found to be statistically significant (0.20 ± 0.05 vs. 0.17 ± 0.03, p = 0.001, 0.18 ± 0.52 vs 0.16 ± 0.29, p = 0.003, respectively). CONCLUSION: Prolonged Tp-e interval and elevated Tp-e/QT and Tp-e/QTc ratios were observed in migraine patients who presented to the emergency department, indicating a potential risk of ventricular dysrhythmia.

A Case of Ticagrelor-induced Seizure.

Ticagrelor is available as an oral antiplatelet agent that can bind reversibly to the adenosine diphosphate receptor P2Y12 on platelets without first having to be activated. Main side effects such as dizziness, bleeding gums, nausea in common, difficulty in speaking, fever, and change in mental status are rare. Herein, we report a patient who had seizures after the usage of ticagrelor.

Usefulness of Immature Granulocytes as A Prognostic Factor in ST-Elevation Myocardial Infarction

ABSTRACT Objective: ST-segment elevation myocardial infarction (STEMI) is a serious, life-threatening disease. Inflammatory markers have recently become the focus of attention in the assessment of severity in the early stages of STEMI. This study aimed to evaluate the importance of immature granulocytes (IG) as a prognostic marker in STEMI. Methods: Patients admitted to the coronary care unit with a diagnosis of STEMI and who underwent primary percutaneous coronary intervention (pPCI) within the period from January 1, 2019 to January 1, 2020, were retrospectively scanned. A total of 146 patients were analised; of these, 112 (76.7%) were male and 34 (33.3) were female, with a mean age of 62.65±14.06 years. Patients' age, gender, haemogram, biochemistry, and mortality results were recorded. The patients were divided into two groups as low (<0.6) and high (≥0.6) IG levels and compared. Results: The mean IG levels were significantly higher in the non-survivor group compared to the survivor group (1.12±0.22 vs. 0.50±0.28, P<0.001). Mortality rates were significantly higher in the high IG group compared to the low IG group (26.9% vs. 9.6%, P=0.006). IG was shown to predict mortality with a sensitivity of 72.2% and a specificity of 77.8% at a cut-off value of 0.65 (area under the curve: 0.740, 95% CI: 0.635-0.846, P<0.001). Conclusion: High IG values in the blood collected at the time of admission to the emergency department are a marker of mortality in patients with STEMI.

Abducens paralysis-a rare complication of spinal anesthesia at an emergency department: a case report.

The sixth cranial nerve (CN VI) is a rare site of complication associated with spinal anesthesia and can produce secondary symptoms of ocular muscle palsy. A 38-year-old man was admitted to the emergency department with complaint of diplopia and limited lateral gaze in the first week after endoscopic urological surgery under spinal anesthesia. Isolated unilateral CN VI palsy was considered after excluding differential diagnoses. Ocular palsy and diplopia regressed with conservative treatment during follow-up, and the patient was discharged. This article aims to show that CN VI palsy is a rare complication of spinal anesthesia, which can be observed in the emergency department.

Echocardiographic epicardial fat thickness and immature granulocyte are novel inflammatory predictors of acute ischemic stroke: a prospective study

ABSTRACT BACKGROUND: Acute ischemic stroke (AIS) is the most common type of stroke. Inflammation is the primary factor in the pathogenesis of atherosclerosis. Use of immature granulocytes (IGs) has been recommended as a new indicator of systemic inflammation. However, data on the association between echocardiographic epicardial fat tissue thickness (EFT) and IGs in patients with AIS are limited. OBJECTIVE: To evaluate the association between the presences of IGs, epicardial fat tissue and AIS. DESIGN AND SETTING: Prospective study in a tertiary-care university hospital in Antalya, Turkey. METHODS: Our study included 53 AIS patients and 41 healthy controls with age and gender compatibility. Blood samples and transthoracic echocardiography of all participants were compared. RESULTS: IG levels were significantly higher in patients with AIS than in controls (0.62 ± 0.36 versus 0.28 ± 0.02, P < 0.001). The mean EFT was 3.74 ± 0.61 mm in the control group and 6.33 ± 1.47 mm in the AIS patient group. EFT was significantly greater in AIS patients than in controls (P < 0.001). For the optimum cut-off value for IG (0.95), the area under the curve (AUC) was determined to be 0.840; sensitivity was determined to be 81.1% and specificity, 92.5%. For the optimum cut-off value for EFT (4.95 mm), the AUC was determined to be 0.953; sensitivity was determined to be 90.6% and specificity, 90%. CONCLUSIONS: IG and echocardiographic EFT are clinical markers that can be used to predict AIS risk.

Echocardiographic epicardial fat thickness and immature granulocyte are novel inflammatory predictors of acute ischemic stroke: a prospective study.

BACKGROUND: Acute ischemic stroke (AIS) is the most common type of stroke. Inflammation is the primary factor in the pathogenesis of atherosclerosis. Use of immature granulocytes (IGs) has been recommended as a new indicator of systemic inflammation. However, data on the association between echocardiographic epicardial fat tissue thickness (EFT) and IGs in patients with AIS are limited. OBJECTIVE: To evaluate the association between the presences of IGs, epicardial fat tissue and AIS. DESIGN AND SETTING: Prospective study in a tertiary-care university hospital in Antalya, Turkey. METHODS: Our study included 53 AIS patients and 41 healthy controls with age and gender compatibility. Blood samples and transthoracic echocardiography of all participants were compared. RESULTS: IG levels were significantly higher in patients with AIS than in controls (0.62 ± 0.36 versus 0.28 ± 0.02, P < 0.001). The mean EFT was 3.74 ± 0.61 mm in the control group and 6.33 ± 1.47 mm in the AIS patient group. EFT was significantly greater in AIS patients than in controls (P < 0.001). For the optimum cut-off value for IG (0.95), the area under the curve (AUC) was determined to be 0.840; sensitivity was determined to be 81.1% and specificity, 92.5%. For the optimum cut-off value for EFT (4.95 mm), the AUC was determined to be 0.953; sensitivity was determined to be 90.6% and specificity, 90%. CONCLUSIONS: IG and echocardiographic EFT are clinical markers that can be used to predict AIS risk.

Usefulness of Immature Granulocytes as A Prognostic Factor in ST-Elevation Myocardial Infarction.

OBJECTIVE: ST-segment elevation myocardial infarction (STEMI) is a serious, life-threatening disease. Inflammatory markers have recently become the focus of attention in the assessment of severity in the early stages of STEMI. This study aimed to evaluate the importance of immature granulocytes (IG) as a prognostic marker in STEMI. METHODS: Patients admitted to the coronary care unit with a diagnosis of STEMI and who underwent primary percutaneous coronary intervention (pPCI) within the period from January 1, 2019 to January 1, 2020, were retrospectively scanned. A total of 146 patients were analised; of these, 112 (76.7%) were male and 34 (33.3) were female, with a mean age of 62.65±14.06 years. Patients' age, gender, haemogram, biochemistry, and mortality results were recorded. The patients were divided into two groups as low (<0.6) and high (≥0.6) IG levels and compared. RESULTS: The mean IG levels were significantly higher in the non-survivor group compared to the survivor group (1.12±0.22 vs. 0.50±0.28, P<0.001). Mortality rates were significantly higher in the high IG group compared to the low IG group (26.9% vs. 9.6%, P=0.006). IG was shown to predict mortality with a sensitivity of 72.2% and a specificity of 77.8% at a cut-off value of 0.65 (area under the curve: 0.740, 95% CI: 0.635-0.846, P<0.001). CONCLUSION: High IG values in the blood collected at the time of admission to the emergency department are a marker of mortality in patients with STEMI.

Evaluation of vapocoolant spray effect on pain reduction during digital nerve block: A randomized clinical trial.

INTRODUCTION: The digital nerve block is an effective method of anesthesia before minor surgical interventions on the fingers. However, patients may experience a lot of pain and anxiety during this procedure. The efficacy of topical vapocoolant spray during minor procedures has been demonstrated in previous studies. we aimed to evaluate the effectiveness of topical vapocoolant spray in reducing pain during digital nerve block. METHODS: This prospective, randomized clinical study was conducted to evaluate the effectiveness of vapocoolant spray application in reducing pain during digital block. The patients were categorized into 2 groups as spray-treated and control group. A routine digital block process was applied to the control group. Spray application was performed in two groups of 50 each, in a manner of bilateral and unilateral to the finger. Demographic data of the patients, such as gender, age, dominant hand, injury patterns, injection site and injury sites, were recorded. After the application, the patients' visual analog scale (VAS) was evaluated. RESULTS: Of the participants, 100 were randomly assigned to the vapocoolant spray-treated group, and 50 were included in the control group. The VAS pain score during penetration in both spray groups was significantly lower than the control group (p < 0.001). Pain change during penetration was found to be significantly lower in the bilateral spray-treated group compared to the control group (p < 0.001). Pain change during infiltration was significantly lower in both spray groups compared to the control group (p < 0.001). CONCLUSIONS: Spray application prior to digital nerve blocking can be used to reduce needle penetration pain associated with this procedure and pain associated with local anesthetic infiltration.

Comparison of ETCO2 Value and Blood Gas PCO2 Value of Patients Receiving Non-invasive Mechanical Ventilation Treatment in Emergency Department.

Capnography is the non-invasive measurement and graphic representation of the partial pressure of CO2 in expiration. Although there are many studies in the literature comparing the partial pressure of carbon dioxide (pCO2) and end-tidal CO2 (ETCO2) values in patients who underwent IMV (invasive mechanical ventilation), there are no studies showing their interchangeable applicability in patients who received NIMV (non-IMV). We aimed to evaluate whether the use of ETCO2 in the treatment process can replace pCO2 use in patients scheduled for NIMV treatment in the emergency department. Patients who applied to the emergency department with respiratory distress between March 2019 and January 2020, who were diagnosed with acute cardiogenic edema or acute chronic obstructive pulmonary disease (COPD) exacerbation, and who needed NIMV were included in the study. General characteristics of the patients and the pCO2 and ETCO2 values were measured in the blood gas 1 h after the NIMV application was started. 64.2% (99 patients) of the patients included in the study were male, and 35.8% (55 patients) were female. The mean age of the patients included in the study was 69.1 ± 12.2 years. The mean pCO2 values ​​were measured as 52.6 ± 13.2. The mean of ETCO2 values ​​measured simultaneously was 33.6 ± 10.1. There was a significant difference between the controlled pCO2 values ​​and ETCO2 values ​​at the first hour of NIMV treatment (Z: - 10.640, p < 0.001). The ETCO2 level was found to be different in our patients who received NIMV treatment, which could not be used instead of the pCO2 level.

Can NLR, PLR and LMR be used as prognostic indicators in patients with pulmonary embolism? A commentary.

We read with great interest the article "Prognostic role of NLR, PLR, and LMR in patients with pulmonary embolism" by Köse et al.[1]. They found that the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) were related to the prognosis and clinical severity of patients with pulmonary embolism (PE). First of all, we congratulate the authors for their invaluable contribution to literature. However, we think that some points should be discussed regarding the use of these laboratory parameters. White blood cell subtypes NLR, PLR, and LMR, have been associated with many inflammatory diseases, including PE [2,3]. These parameters, which can be easily determined by simple and easy measurement of systemic inflammation, maintain their importance today. However, these parameters are affected by many factors such as trauma, local or systemic infection, acute coronary syndromes, and malignancy [3-5]. For these reasons, it would be better for the authors to mention these factors and exclude them from the tables that included malignancy and trauma patients in the study. It is known that drugs, including steroids, can increase neutrophils and decrease lymphocytes and therefore affect NLR, PLR, and LMR values [6]. Consequently, it will be more valuable to exclude patients who use drugs that may affect laboratory parameters. Besides, plasma inflammatory biomarkers are time-dependent variables. The time of sample collection and the time from the onset of the symptom to the sampling may impact the parameters [3-6]. Therefore, it is essential to identify the time from the first symptom to sample collection and the factors that may affect it. In conclusion, because NLR, PLR, and LMR can be affected by many factors, prospective studies with large populations are needed to show the accuracy of use in critically ill patients.

NLR, d-NLR and PLR can be affected by many factors.

We have read the article by Yang et al, entitled "The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients" with great interest. The authors emphasized that the NLR (Neutrophil to lymphocyte ratio) is an independent prognostic biomarker for COVID-19 patients. First of all, we congratulate the authors for their valuable contribution to the literature in these difficult conditions. However, we would like to add on a few cases that need more attention.