The prognostic value of neutrophil–to-lymphocyte ratio and platelet–to-lymphocyte ratio in the severe COVID-19 cases

Aim: COVID-19 is a cause of high-mortality pandemic with the RNA virus in its etiology and has an effect all over the world. In the present study, the relationship between in-hospital prognosis and mortality was investigated by comparing neutrophil-to-lymphocyte ratio (NLR), platelet –to-lymphocyte ratio (PLR) values ​​with C-reactive protein (CRP) and with a detailed analysis of complete blood count and biochemical parameters in mild and severe COVID-19 cases. Method: A total of 271 patients who were diagnosed with pneumonia because of COVID-19 and 278 healthy control groups were included in the study.  In our study, COVID-19 cases were divided into 2 groups as mild and severe, and the data were compared with healthy people without COVID-19. Lung tomography results of the cases that were diagnosed with COVID-19 were examined. Those with positive RT-PCR (Real-Time Polymerized Chain Reaction) test results were recorded from the system. Biochemical tests and complete blood count parameters of the patients, NLR/ lymphocyte- to- monocyte ratio (LMR)/PLR N/L, and CRP levels were compared with the control group. The results were evaluated and analyzed in statistical terms. Results: When all the data were analyzed, NLR/PLR and CRP levels were found to be higher at statistically significant levels in the severe patient group than in the control group, and LMR was lower (p<0.01). In ROC analysis, NLR/PLR and CRP had a high AUC (area under the curve) (0.844/0.719/0.501) and LMR had a low AUC (0.225). Conclusion: NLR and PLR might be useful in demonstrating the prognosis in severe COVID-19 cases

Determination of the Level of Emergency Medicine Resident Physicians to Recognize the Electrocardiography Findings

Abstract Objective: The aim of this study is to determine the accuracy and reliability of the interpretation of electrocardiography (ECG) findings by emergency medicine resident physicians (EMPs) and to provide training recommendations in line with emerging deficiencies. Material and Methods: This research depended on the data from a questionnaire that we conducted among EMPs in Ankara. The survey included multiple-choice questions, selected through conceived cases presented in major textbooks or congresses. EMP ECG assessment levels were compared according to the duration of residency education and the presence of ECG education. The data were evaluated by using the Statistical Package for Social Sciences 17.0 (SPSS Inc., Chicago, IL, USA). Results: A total of 112 volunteers participated. Mean age was 29.6±4.4; also, 47 were female and 65 were male. When all of the questions were taken into account, the mean number of total correct answers was higher for those who had received ECG training than who had not received it, those who underwent more training than those who underwent less training, and those whose duration of assistantship was longer than those whose duration was shorter. Conclusion: The results of our study revealed that the evaluation of ECG is improved by increasing clinical knowledge and training. Depending on these results, we suggest that effective and practical ECG courses and training programs should be organized for EMPs. (JAEM 2014; 13: 108-11

THE PROGNOSTIC RELATIONSHIP BETWEEN COMPLETE BLOOD COUNT PARAMETERS AND INFARCT-POSITIVE TRANSIENT ISCHEMIC ATTACK, INFARCT-NEGATIVE TRANSIENT ISCHEMIC ATTACK, AND ISCHEMIC STROKE

WOS: 000375337700015Introduction: Stroke is an important health problem that may lead to serious disabilities or even to death. In the present study we aimed to investigate whether complete blood count parameters can aid in the detection and the differential diagnosis of infarct positive Transient Ischemic Attack (TIA), infarct-negative TIA, and ischemic stroke (IS) in patient followed up in the emergency department. Materials and methods: This study retrospectively reviewed the medical records of 252 patients meeting the medical history and physical examination criteria for TIA (n=99) and IS (n=153) Neutrophil, lymphocyte, and platelet counts, platelet distribution width (PDW), and mean platelet volume (MPV) levels obtained from the complete blood count taken at the time of emergency department admission were recorded for both patient and control groups; platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) were calculated from these parameters. The ischemic stroke, TIA, and control groups, as well as other subgroups were compared with one another with respect to the complete blood count parameters. Results: Neutrophil count, MPV, and NLR levels were higher in the IS group compared to the control group whereas IS group had a lower lymphocyte count, platelet count, and a PDW level compared to the control group. TIA group had a higher neutrophil count, NLR and PLR than the control group whereas lymphocyte count and PDW level were lower in the TIA group compared to the control group. MPV level was higher in the IS and infarct-positive TIA patient group than both the control group and infarct-negative TIA patient group. Conclusion: Owing to high MPV levels in both infarct-positive TIA and IS, we suggest that MPV can be a good marker for infarction. Furthermore, lower platelet count in the IS group and higher PLR in the TIA group can both be used in the differential diagnosis of both conditions

Concurrent Spontaneous Sublingual and Intramural Small Bowel Hematoma due to Warfarin Use

Introduction. We present a case of concurrent spontaneous sublingual and intramural small bowel hematoma due to warfarin anticoagulation. Case. A 71-year-old man presented to the emergency department complaining of a swollen, painful tongue. He was on warfarin therapy. Physical examination revealed sublingual hematoma. His international normalized ratio was 11.9. The computed tomography scan of the neck demonstrated sublingual hematoma. He was admitted to emergency department observation unit, monitored closely; anticoagulation was reversed with fresh frozen plasma and vitamin K. 26 hours after his arrival to the emergency department, his abdominal pain and melena started. His abdomen tomography demonstrated intestinal submucosal hemorrhage in the ileum. He was admitted to surgical floor, monitored closely, and discharged on day 4. Conclusion. Since the patient did not have airway compromise holding anticoagulant, reversing anticoagulation, close monitoring and observation were enough for management of both sublingual and spontaneous intramural small bowel hematoma

Subcutaneous Emphysema, Pneumomediastinum, and Pneumorrhachis after Cocaine Inhalation

Introduction. The most prominent complications of cocaine use are adverse effects in the cardiovascular and central nervous systems. Free air in the mediastinum and subcutaneous tissue may be observed less frequently, whereas free air in the spinal canal (pneumorrhachis) is a very rare complication of cocaine abuse. In this report we present a case of pneumorrhachis that developed after cocaine use. Case. A 28-year-old male patient was admitted to the emergency department with shortness of breath, chest pain, and swelling in the neck and face which started four hours after he had sniffed cocaine. On physical examination, subcutaneous crepitations were felt with palpation of the jaw, neck, and upper chest area. Diffuse subcutaneous emphysema, pneumomediastinum, and pneumorrhachis were detected in the computed tomography imaging. The patient was treated conservatively and discharged uneventfully. Discussion. Complications such as pneumothorax, pneumomediastinum, and pneumoperitoneum that are associated with cocaine use may be seen due to increased intrathoracic pressure. The air then may flow into the spinal canal resulting in pneumorrhachis. Emergency physicians should know the possible complications of cocaine use and be prepared for rare complications such as pneumorrhachis