The Effect of Iron Deficiency Anemia Treatment on Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio

Background: Both neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are cost-effective and readily available biomarkers. An increment in either NLR or PLR is an indicative of a prolonged chronic inflammatory condition and increased host inflammatory response. Iron deficiency anemia (IDA) is frequently associated in chronic disorders. Aims: We decided to investigate whether the efficient treatment of IDA should affect NLR and/or PLR values in an adult population with IDA. Methods: This was a retrospective (case-series) observational study conducted at an adult Hematology clinic in Turkey. Patients were ? 18 years-old, with IDA defined according to the World Health Organisation criteria. The hematological parameters, NLR, and PLR levels were noted before and after oral iron (Fe+2) repletion treatment. Results: A total of 200 patients with IDA (median age 44 years, IQR 32-52 years, women 91%) were included. NLR values did not differ significantly in terms of IDA treatment (2.07 vs. 2.01, p= .558). PLR levels were significantly decreased after IDA treatment (170.63 vs. 140.32, p< .001). The NLR and PLR were positively correlated (p= .01). A low-unremarkable inverse correlation between NLR, and serum iron levels (p= .024) and Tfsat (p= .038) was observed; a similar negative correlation was also observed between PLR, and serum iron (p= .002) and Tfsat (p= .013) levels. Conclusion: The treatment of IDA did not affect NLR, whereas it was associated with significant decrease in PLR. The NLR and PLR were positively correlated. However, both the NLR and PLR were inversely correlated with serum iron and Tfsat levels

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Acil serviste genişletilmiş acil travma ultrasonografisi ve hedefe yönelik acil ekokardiyografi uygulamaları

Amaç: Çalışmamızda; acil tıp hekimi tarafından gerçekleştirilen, hedefe yönelik acil kardiyak ultrasonografiyi kapsayan, genişletilmiş acil travma ultrasonografi kullanımının (GATUS), acil tanı ve tedavi sürecinde katkısını ve travmaya bağlı kardiyak yaralanma, pnömotoraks, hemotoraks, intraabdominal kanama saptamada duyarlılığını ve özgüllüğünü göstermeyi amaçladık. Yöntem: Çalışma, 19 Ocak - 19 Ekim 2010 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Hastanesi acil servisine giriş yapan toplam 48627 hastadan multitravmalı 356 hasta kaydedilerek ileriye yönelik, gözleme dayalı olarak gerçekleştirildi. Çalışmaya, acil servise başvuran, birden fazla sistem, yaralanma şüphesi olan tüm çoklu travmalı hastalar dahil edildi. Başvuruda, torakoabdominal BT endikasyonu koyulmayan ve onamı alınmayan hastalar dışlandı. Çalışmaya alınan vakaların yaş, cinsiyet, geliş zaman dilimleri, travma şekilleri, vital ve fizik muayene bulguları ile ilk ön tanısı hastanın bakımından birincil sorumlu hekim tarafından olgu rapor formuna kaydedildi. Daha önce GATUS ve hedefe yönelik acil ekokardiyografi eğitimi almı, 2 yıl üzerinde kıdeme sahip, hasta hakkında klinik bilgisi olmayan araştırmacı Acil Tıp Asistanları (ATA) tarafından hastaların ultrasonografik değerlendirilmesi yapıldı. Yapılan GATUS sonrası birincil hekimin ön tanısı tekrar değerlendirilip, kayda alındı. Supin akciğer grafi (SAG) bulguları, radyoloji araştırma görevlisi tarafından gereçekleştirilen batın USG bulguları, yapılan invaziv girişimler ve hastanın akibeti eklendi. Ayrıca radyoloji uzman düzeyinde batın BT ve toraks BT sonuçları değerlendirildi ve kıyaslamalar için 0-4 arası bir skorlama sistemi ile pnömotoraks toraks BT evrelendirmesi yapıldı. İstatiksel analizde kategorik değişkenler için ki-kare ve Fisher's exact testi kullanıldı. Güvenlik aralığı % 95 ve p<0.05 olan istatistiksel farklılıklar anlamlı olarak kabul edildi. Bulgular: Dışlama kriterlerine göre çalışmaya dahil olan 107 hastanın 86'sı (% 80.4) erkek olup, genel yaş ortalaması 36.7 olarak hesaplandı. Travma şekline göre hastaların 40'ı (% 37.4) araç içi trafik kazası, 26'sı (% 24.3) yüksekten düşme, 20'si (% 18.7) araç dışı trafik kazası, 17'si (% 15.9) motorlu taşıt kazası (motorsiklet), 4'ü (% 3.7) darp ve/veya penetran yaralanma sonucu başvurmuştu. Çoklu travma ile gelen hastalarda, batın içi serbest sıvı varlığını tespit etme konusunda ATA ile radyoloji araştırma görevlisi arasında bir fark yoktu (p:0.0001). GATUS'un travmada altın standart olarak kabul edilen batın BT'ye göre duyarlılığı % 54.5 (% 95 CI =% 33.7 ile % 75.3), özgüllüğü % 100, olumlu öngörü değeri % 100, olumsuz öngörü değeri de % 89.5 (% 95 CI =% 83.3 ile %95.6) olarak bulundu. GATUS normal saptanan 10 (% 9.3) hastada batın BT'de patoloji saptanmıştır. Bu hastalar, solid organ patolojileri olan acil operasyona gitmeyen hastalardı. Toraks BT'de hemotoraks saptanan 21 (% 19.6) hastadan 15'inde (% 14) GATUS'da hemotoraks görülürken, SAG ile 7 (% 6.5) hastaya bu tanı koyulmuştur (hemotoraks için SAG; duyarlılığı % 33.3, özgüllüğü % 97 - GATUS; duyarlılığı % 71, özgüllüğü % 100'dür). GATUS ile saptanamayan BT'de saptanan hemotorakslı hastaların hiçbirisine tüp torakostomi (TT) uygulanmadı ve izleme alındı. Toraks BT'de saptanan 1-4 derece pnömotorakslı 33 (% 30.8) hastadan GATUS ile 27 (%25.2), SAG ile 3 (% 2.8) hastaya pnömotoraks tanısı koyulabildi. Bu hastalardan 15'ine (% 14) TT uygulandı. TT uygulanan hastaların tamamında GATUS pozitifti. GATUS ile değerlendirilen 107 çoklu travma hastasından 1'inde bası bulgusu vermeyen perikardiyal sıvı tespit edilmişti. Toraks BT'de kardiyak patoloji ayırt edilemeyen hasta yattığı klinikte problemsiz izlendi ve taburcu edildi. GATUS değerlendirmesinde kardiyak patoloji saptanmayan 106 hastanın 1'inde toraks BT'de ekokardiyografi ile tanınması mümkün olmayan transeksiyon saptandı ve opere edildi. GATUS sonrası ilk ön tanı, 95 (% 88.8) hastada değişirken, 12 (%11.2) hastada aynı kalmıştır (P:0.0001). Hastaların 27'sine (% 25.2) endotrakeal entübasyon, 15'ine (% 14) TT, 6'sına (% 5.6) laparotomi, 1'ine (% 0.9) torakotomi uygulanmıştır. 13 (%12.1) hasta ortopedi, 12 (%11.2) hasta anestezi ve reanimasyon yoğun bakım, 11 (%10.2) hasta genel cerrahi, 11 (%10.2) hasta göğüs cerrahisi, 7 (% 6.5) hasta nöroşirurji, 3 (% 2.8) hasta pediyatri yoğun bakım, 1 (% 0.9) hasta kalp damar cerrahisi, 1 (% 0.9) hasta çocuk cerrahisi olmak üzere toplam 59 (% 55.1) hasta ilgili kliniklere yatırılmış; 36 (% 33.6) hasta izlem sonrası acil servisten taburcu olmuştur. İzlem ve tedavisi esnasında 15 (% 14) hasta ex olmuştur. Sonuç: Acil hekimi tarafından uygulanan GATUS, multitravmada altın standart olarak kabul edilen BT kadar güvenilir olmamasına rağmen, SAG'den daha fazla güvenilirdir. Operasyon ve invaziv işlem gerektiren pnömotoraks, hemotoraks, intraabdominal kanamaların saptanmasında yüksek duyarlılık ve özgüllüğe sahiptir. Maliyetinin azlığı ve kısa uygulanma zamanı düşünüldüğünde avantajlı olmakla birlikte, kişi bağımlı bir tekniktir. GATUS sonucu ile hastanın muayenesi, ilk değerlendirmesi ve SAG ile düşünülen ön tanıları ve dolayısı ile hasta yönetimi değişmektedir

An unexpected and devastating adverse event of dasatinib: Rhabdomyolysis

We, herein, describe a 52-year-old male whom developed rhabdomyolysis and acute renal failure likely related to dasatinib shortly after the administration of treatment. After withdrawal of dasatinib, the myalgia reduced, and his CK returned to normal levels within a week. On follow-up acute renal failure did resolve without requiring dialysis, but unfortunately the patient died of severe respiratory distress. We recommend that musculoskeletal symptoms should be monitorized during therapy with dasatinib, and CML patients with musculoskeletal symptoms should have CK levels checked in order to prevent this unexpected but devastating adverse event

Retrospective evaluation of emergency department admissions in patients with ventricular assist device

Background: Ventricular assist devices, improve morbidity and survival in patients with end-stage heart failure. Objectives: To evaluate the major causes of emergency department admissions in patients with ventricular assist device support. Methods: The charts of 200,000 adult patients who presented to our emergency department between January 2016 and January 2018 were reviewed retrospectively. A total of 444 emergency department visits made by 99 patients with ventricular assist device were included in the study. Results: The annual incidence of emergency department admissions of patients with ventricular assist device was 0.1%. The mean age was 55.5 +/- 11.1 years and 85.9% of the study population were men. The most commonly encountered diagnoses were abnormal international normalized ratio or international normalized ratio follow-up (18.2%); heart failure, non-specific chest pain, and chronic obstructive pulmonary disease (15.3%); minor/major bleeding (12.1%); neurological disorders such as ischemic stroke, transient ischemic attack, vertigo, migraine, and syncope (11.2%); non-device related infections (10.8%); ventricular tachycardia/fibrillation episode (8.5%); musculoskeletal disorders (7.2%); and device-related complications such as driveline infection and pump thrombosis (6.3%). Of the patients with bleeding, 31.1% had intracranial bleeding, 31.1% had epistaxis, 24% had gastrointestinal bleeding, 11.1% had hematuria, and 1.8% had gingival hemorrhage. Of the 15 patients who died, 73.3% were diagnosed with intracranial hemorrhage. Conclusion: Even though the mortality rates of patients with ventricular assist device tends to decrease, these patients still have significant morbidity due to the increase in the prevalence of ventricular assist device use. Except for device-related problems, emergency department management of this patient group does not differ much from other patient groups. As early diagnosis of any device-related problems is mandatory for decreasing mortality, emergency department physicians should be familiar with mechanical support systems

Retrospective evaluation of emergency department admissions in patients with ventricular assist device

WOS: 000476186400001Background: Ventricular assist devices, improve morbidity and survival in patients with end-stage heart failure. Objectives: To evaluate the major causes of emergency department admissions in patients with ventricular assist device support. Methods: The charts of 200,000 adult patients who presented to our emergency department between January 2016 and January 2018 were reviewed retrospectively. A total of 444 emergency department visits made by 99 patients with ventricular assist device were included in the study. Results: The annual incidence of emergency department admissions of patients with ventricular assist device was 0.1%. The mean age was 55.5 +/- 11.1 years and 85.9% of the study population were men. The most commonly encountered diagnoses were abnormal international normalized ratio or international normalized ratio follow-up (18.2%); heart failure, non-specific chest pain, and chronic obstructive pulmonary disease (15.3%); minor/major bleeding (12.1%); neurological disorders such as ischemic stroke, transient ischemic attack, vertigo, migraine, and syncope (11.2%); non-device related infections (10.8%); ventricular tachycardia/fibrillation episode (8.5%); musculoskeletal disorders (7.2%); and device-related complications such as driveline infection and pump thrombosis (6.3%). Of the patients with bleeding, 31.1% had intracranial bleeding, 31.1% had epistaxis, 24% had gastrointestinal bleeding, 11.1% had hematuria, and 1.8% had gingival hemorrhage. Of the 15 patients who died, 73.3% were diagnosed with intracranial hemorrhage. Conclusion: Even though the mortality rates of patients with ventricular assist device tends to decrease, these patients still have significant morbidity due to the increase in the prevalence of ventricular assist device use. Except for device-related problems, emergency department management of this patient group does not differ much from other patient groups. As early diagnosis of any device-related problems is mandatory for decreasing mortality, emergency department physicians should be familiar with mechanical support systems

Fat embolism syndrome after gluteal augmentation with hyaluronic acid: A case report

WOS: 000582710000022PubMed: 33107954Fat embolism syndrome (FES) occurs classically characterized by the combination of acute respiratory failure, neurologic abnormalities, and a petechial rash. Forty-six-year-old female presented to our emergency department with agitation, altered mental status, and drowsiness. We learned that the patient had received a hyaluronic acid (HA) injection into her buttocks at a beauty center a few hours before her admission. She had no skin findings, but she was hypoxemic. She had lung computed tomography (CT) findings bilateral ground-glass opacities and pleural effusion and had multiple cerebral white lesion on brain magnetic resonance images (MRI). Patients presenting to the emergency department with sudden alteration in mental status should be questioned for recent surgical or invasive aesthetic procedures. Fat embolism syndrome should be considered even if the patient has no petechial rash. Brain MRI and lung CT should be the imaging modality of choice in these patients

The Effect of Lactate and Lactate Clearance on Mortality in Patients with Acute Pulmonary Embolism in Emergency Department

Aim: Pulmonary embolism (PE) is the third leading cause of death due to cardiovascular disease. The presence of shock or hypotension remains the main prognostic clinical marker and to date, it is the only factor that indicates the need for aggressive treatment. Most patients with pulmonary embolism are normotensive. Prognostic indicators are needed to better classify patients with pulmonary embolism. This study aimed to investigate the effect of lactate level on predicting hospital mortality in patients diagnosed with pulmonary embolism in the emergency department, and the effect of lactate clearance on mortality in patients with high lactate levels (lactate ?2 mmol/L). Material and Methods: This study was designed as a retrospective study. Adult patients (;gt;18-years old) who were diagnosed with PE by computed tomography angiography of the thorax in the university hospital emergency between January 1, 2018, and December 31, 2019, were analyzed. Results: A total of 367 patients were diagnosed with pulmonary embolism in the emergency department. In-hospital mortality rate of the patients was 29.8% and the pulmonary embolism-related mortality rate was 12.4%. Lactate clearance was not significant in predicting mortality risk. In the logistic regression analysis performed among the risk factors affecting mortality in patients with pulmonary embolism, lactate ?3 mmol/L and normotensive + lactate ?3 mmol/L were significant in predicting in-hospital mortality. Conclusion: The lactate level in the emergency department could be an effective screening method for identifying mortality in acute pulmonary embolism patients