Is having a moderate or low history, electrocardiogram, age, risk factors, troponin risk score a handicap for long-term mortality?

OBJECTIVE: History, electrocardiogram, age, risk factors, troponin risk score and troponin level follow-up are used to safely discharge low-risk patients with suspected non-ST elevation acute coronary syndrome from the emergency department for a 1-month period. We aimed to comprehensively investigate the 6-month mortality of patients with the history, electrocardiogram, age, risk factors, troponin risk score. METHODS: A total of 949 non-ST elevation acute coronary syndrome patients admitted to the emergency department from 01.01.2019 to 01.10.2019 were included in this retrospective study. History, electrocardiogram, age, risk factors, troponin scores of all patients were calculated by two emergency clinicians and a cardiologist. We compared the 6-month mortality of the groups. RESULTS: The mean age of the patients was 67.9 (56.4-79) years; 57.3% were male and 42.7% were female. Six-month mortality was significantly lower in the high-risk history, electrocardiogram, age, risk factors, troponin score group than in the low- and moderate-risk groups: 11/80 (12.1%), 58/206 (22%), and 150/444 (25.3%), respectively (p=0.019). CONCLUSION: Patients with high history, electrocardiogram, age, risk factors, troponin risk scores are generally treated with coronary angioplasty as soon as possible. We found that the mortality rate of this group of patients was lower in the long term compared with others. Efforts are also needed to reduce the mortality of moderate and low-risk patients. Further studies are needed on the factors affecting the 6-month mortality of moderate and low-risk acute coronary syndrome patients.

Investigation of the effectiveness of the Quick Sequential Organ Failure Assessment-Troponin scores in non- ST-elevation myocardial infarction.

OBJECTIVE: A reliable predictor is needed for non-ST-elevation myocardial infarction patients with high mortality risk. The aim of this study was to assess the effectiveness of the Global Registry of Acute Coronary Events and Quick Sequential Organ Failure Assessment-Troponin (qSOFA-T) scores on in-hospital mortality rate in non-ST-elevation myocardial infarction patients. METHODS: This is an observational and retrospective study. Patients admitted to the emergency department with acute coronary syndrome were evaluated consecutively. A total of 914 patients with non-ST-elevation myocardial infarction who met inclusion criteria were included in the study. The Global Registry of Acute Coronary Events and qSOFA scores were calculated and investigated its contribution to prognostic accuracy by adding cardiac troponin I (cTnI) concentration to the qSOFA score. The threshold value of the investigated prognostic markers was calculated by receiver operating characteristic curve analysis. RESULTS: We found the in-hospital mortality rate to be 3.4%. The area under the receiver operating characteristic curve for Global Registry of Acute Coronary Events and qSOFA-T is 0.840 and 0.826, respectively. CONCLUSION: The qSOFA-T score, which can be calculated easily, quickly, and inexpensively and obtained by adding the cTnI level, had excellent discriminatory power for predicting in-hospital mortality. Difficulty in calculating the Global Registry of Acute Coronary Events score, which requires a computer, can be considered a limitation of this method. Thus, patients with a high qSOFA-T score are at an increased risk of short-term mortality.

Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis.

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. There is a need for biomarkers that can be used for the diagnosis of sepsis and the early identification of patients at high risk of death. In this study, we aimed to investigate the relationship between Mid-regional pro-adrenomedullin (MR-proADM), procalcitonin (PCT), and copeptin in sepsis. A total of 28 sepsis, 32 septic shock, and 30 control patients were included in our prospective study. Patients' MR-proADM, PCT, and copeptin levels were recorded. Sequential organ failure assessment scores, length of hospital stay, and 30-day mortality were also recorded. These values were compared between the sepsis, septic shock, and control groups. The mean age of all participants was 64.04 ± 15.83 years. In the study, 37 (61.6%) patients were female and 23 (39.3%) were male. There was no statistically significant difference in gender/age between all patient groups and the control group (for all, p > 0.05). We found a significant difference between the survivors and nonsurvivors in terms of MR-proADM, PCT, and copeptin levels. There was a significant difference between the sepsis and septic shock groups in terms of MR-proADM and PCT. A significant correlation was found between the length of hospital stay and MR-proADM and copeptin. MR-proADM, PCT, and copeptin may be useful in the prognosis of sepsis and to predict the length of stay in hospital and mortality.

Evaluation of MINOCA syndrome and HEART score in patients presenting to the emergency department with panic attack and chest pain complaints.

BACKGROUND: Patients presenting with chest pain may or may not be experiencing a panic attack. Is chest pain caused by a panic attack or myocardial infarction with non-obstructive coronary arteries (MINOCA) syndrome? AIM: In this study, we evaluated both MINOCA syndrome and HEART score in patients who presented to the emergency department with panic attacks and chest pain. METHOD: Patients who applied to the emergency department with panic disorder and chest pain complaints were included. Patients who met the MINOCA diagnostic criteria were identified. The study was completed with 143 eligible patients out of a total of 217 patients evaluated. The patients were divided into two groups. The first group was those whose symptoms and test results were consistent with MINOCA. The second group was composed of those whose chest pain was considered non-specific. The HEART score of all patients was calculated. The demographic characteristics, symptoms, and HEART scores were compared between the groups. RESULTS: Of the 143 patients evaluated in the study, 62 (43.3%) were male and 81 (56.7%) were female. While the mean HEART score was 4.7 ± 1.5 in the MINOCA group, it was 2.0 ± 1.0 in the non-cardiac group, a statistically significant difference. CONCLUSION: Clinicians should pay attention to the patient's age, gender, number of attacks per week, HEART score, and which symptoms (palpitations, shortness of breath, and fear of death) are present in patients who meet the panic attack diagnostic criteria. Clinicians should be alert to the MINOCA syndrome in panic attack patients.

Comparison of the quick SOFA score with Glasgow-Blatchford and Rockall scores in predicting severity in patients with upper gastrointestinal bleeding.

INTRODUCTION: Upper gastrointestinal bleeding is one of the common causes of mortality and morbidity. The Rockall score (RS) and Glasgow-Blatchford score (GBS) are frequently used in determining the prognosis and predicting in-hospital adverse events, such as mortality, re-bleeding, hospital stay, and blood transfusion requirements. The quick Sepsis Related Organ Failure Assessment (qSOFA) score is easy and swift to calculate. The commonly used scores and the qSOFA score were compared and why and when these scores are most useful was investigated. METHOD: 133 patients admitted to the emergency department with upper gastrointestinal bleeding over the period of a year, were evaluated in this retrospective study. The RS, GBS and qSOFA score were calculated for each patient, and their relationship with in-hospital adverse events, such as length of hospitalization, rebleeding, endoscopic treatment, blood transfusion requirements, and mortality, was investigated. RESULTS: The mean overall GBS was 9.72 ± 3.72 (0-19), while that of patients who did not survive was 14.0 ± 1.1 (13-16), with an area under the curve (AUC) of 0.901, a cutoff value of 12.5, and specificity (Spe) and sensitivity (Sen) of 1 and 0.82, respectively. The median value of the GBS, in terms of transfusion need, was 7.12 ± 4.01 (0-15). (AUC = 0.752, cut-off = 9.5, Spe = 0.79, Sen = 0.69). The median value of the qSOFA score, in terms of intensive care need, was 1.73 ± 0.7 (0-3) (AUC = 0.921, cut-off = 0.5, Spe = 0.93, Sen = 0.79). The RS median, in terms of re-bleeding, was 8.22 ± 0.97 (6-9). CONCLUSION: Early use of risk stratification scores in upper gastrointestinal bleeding is important due to the high risk of morbidity and mortality. All scoring systems were effective in predicting mortality, the need for intensive care, and re-bleeding. The GBS had a greater predictive power in terms of mortality and transfusion need, the qSOFA score for intensive care need, and the RS for re-bleeding. The simpler, more efficient, and more easily calculated qSOFA score can be used to estimate the severity of patients with upper gastrointestinal bleeding.

Melkersson-Rosenthal Syndrome Induced by COVID-19.

Melkersson-Rosenthal syndrome is a rare condition characterized by a triad of orofacial edema, facial paralysis, and fissured tongue. Histopathological examination of the disease has demonstrated areas of inflammation involving mast cells. Activated mast cells also play a part in the pathogenesis of COVID-19 infection, as they release cytokines in the lungs. We present a case of a female patient presenting with edema. We present a case of a female patient presenting with edema. Her examination revealed edema in the right lower lip, right facial paralysis, and fissured tongue. COVID-19 may be associated with which was not previously included in the etiology of the disease.

The microbiology of necrotizing pancreatitis and its impact on in-hospital and 1-year all-cause mortality.

BACKGROUND/OBJECTIVES: The data regarding the microbial spectrum in necrotizing pancreatitis and its impact on mortality is limited. Therefore, in this study, we aimed to investigate the agents identified in cultures and their impact on in-hospital and 1-year all-cause mortality. METHODS: Patients with necrotizing pancreatitis were retrospectively included in the study. Based on culture results, patients were classified as either negative culture or positive culture necrotizing acute pancreatitis. The main outcomes of the study were the identification of agents isolated in patients with pancreatic necrosis and to assess in-hospital, 30-day and 1-year all-cause mortality according to culture results. RESULTS: In total, 109 patients of whom 33 had positive cultures were included in the study. Most positive cultures were polymicrobial (66%) with a marked gram-negative bacterial dominance (63%). Klebsiella spp. were the most common identified pathogens. The patients a with positive culture had worse outcomes in terms of in-hospital, 30-day and 1-year all-cause mortality compared to patients with sterile culture results (n = 9, 27.3% vs. n = 4, 5.3%, P < 0.01 for in-hospital mortality; n = 11, 33.3% vs. n = 5, 6.6%, P < 0.01 for 30-day mortality; and n = 14, 42.4% vs. n = 10, 13.2%, P < 0.01 for 1-year mortality). CONCLUSION: When a microorganism was identified in patients with necrotizing acute pancreatitis, it was mostly polymicrobial in etiology with a gram-negative bacterial dominance. In our cohort, Klebsiella spp. were the most common isolated organisms. Especially the patients with polymicrobial etiology showed a very poor outcome both in-hospital and in the long-term. Local hospital flora may have an impact on culture results.

Comparison of scoring systems used in acute pancreatitis for predicting major adverse events.

OBJECTIVES: Timely identification of patients with acute pancreatitis who are likely to have a severe disease course is critical. Based on that, many scoring systems have been developed throughout the years. Although many of them are currently in use, none of them has been proven to be ideal. In this study, we aimed to compare the discriminatory power of relatively newer risk scores with the historical ones for predicting in-hospital major adverse events, 30-day mortality and 30-day readmission rate. PATIENTS AND METHODS: Patients who had been admitted due to acute pancreatitis were retrospectively investigated. Five risk scoring systems including HAPS, Ranson, BISAP, Glasgow, and JSS were calculated using the data of the first 24h of admission. Predictive accuracy of each scoring system was calculated using the area under the receiver-operating curve method. RESULTS: Overall 690 patients were included in the study. In-hospital major adverse events were observed in 139 (20.1%) patients of whom, 19 (2.5%) died during hospitalization. 30-day all-cause mortality and 30-day readmission were observed in 22 (3.2%) and 27 (3.9%) patients respectively. Negative predictive value of each score was markedly higher compared to positive predictive values. Among all, JSS scoring system showed the highest AUC values across all end-points (0.80 for in-hospital major adverse events; 0.94 for in-hospital mortality; 0.91 for 30-day mortality). However, all five scoring systems failed to predict 30-day readmission. DISCUSSION: JSS was the best classifier among all five risk scoring systems particularly owing to its high sensitivity and negative predictive value.

A role of the endothelial nitric oxide system in acute renal colic caused by ureteral stone.

BACKGROUND AND AIMS: Endothelial nitric oxide synthase gene polymorphisms play a role in some pathophysiological processes. In this study, the possible effects of endothelial nitric oxide synthase gene polymorphisms on ureteral stone disease in patients who were admitted to the emergency department with severe pain due to renal colic are examined. MATERIALS AND METHODS: The study groups were designed as controls and patients. The control group was formed from the healthy volunteers who applied to the blood center next to the emergency service. The patient group comprised patients who were diagnosed with ureteral stone disease with severe pain. All of the genetic studies were based on extracted peripheral blood samples using the necessary procedures from the Genome and Stem Cell Center at Erciyes University (GENKOK). The data were analyzed with SPSS (IBM, ver 20, United Sate). RESULTS: The study group comprised 62 females and 138 males, and the control group comprised 64 females and 136 males. All of the stones that caused renal colic were found to be localized in the ureters and the ureterovesical junction. The genotypes of the intron 4 polymorphism were found to be as follows: 4a/4a in 10 people, 4b/4a in 115, and 4b/4b in 275 people. The GG genotype of the eNOS-G894T polymorphism was found in 108 patients in the study group and in117 of the healthy individuals. There was no statistically significant difference between the two groups regarding these data. CONCLUSION: Although this study is the first in the literature to examine the relationship between renal colic and endothelial nitric oxide synthase gene polymorphisms, our study demonstrated that no relation was found.

Role of endothelial nitric oxide synthases system on acute appendicitis.

BACKGROUND: Obstruction and inflammation of the appendix lumen is the leading physiopathological process during acute appendicitis (AA). Although the relationship between inflammation and endothelial nitric oxide synthases (eNOS) has been well described, no recent data describing the relationship between inflammation during AA and polymorphism of the eNOS gene has been reported. Given the limited data available, we believed that defining the relationship between AA and eNOS would be a beneficial contribution. METHODS: A total of 201 patients admitted to the emergency department with AA and 201 healthy volunteers selected from among the relatives of patients were included. Polymorphism of the eNOS was assessed. RESULTS: Intron 4a/4a was positive in 119 participants, genotype G894T GT was positive in 71 patients with AA, and 786-1 was positive in 71 patients with AA. These results suggest that no statistically significant correlation exists between genotypes of AA patients and control subjects regarding 4a/b, G894-GT, and 786-1 eNOS polymorphisms. CONCLUSION: Though the present results suggest that no statistically significant correlation exists between AA and eNOS gene polymorphism, to claim otherwise is also impractical. We believe that the present results will lay the groundwork for future, larger studies.

Acute coronary syndrome presenting with earache and sore throat.

Chest pain and discomfort are regarded as the hallmark symptoms of acute coronary syndrome, and the absence of these symptoms are described as "atypical" presentation. In this case, we aimed to report an acute coronary syndrome­diagnosed patient who was admitted to our emergency service with unilateral earache.