Mallory-Weiss syndrome is characterized by a mucosa rupture on the gastroesophageal junction and usually associated with intense retching, cough, straining, or vomiting. Methanol intoxication is a cause for severe mortality and morbidity. We aimed to emphasize the lifesaving importance of history taking, rapid diagnosis, and treatment for Mallory-Weiss syndrome secondary to methanol intoxication in the present case. A 54-year old male patient admitted to the emergency service by ambulance with the complaint of bloody vomiting. The patient's overall condition was moderate, and he was confused. He was taken into the resuscitation room. The patient was admitted to urgent endoscopy because of active bleeding. It was detected that he had drunk the alcohol that he made at home and presented bloody vomiting when he woke up in the morning. The patient was diagnosed with methanol intoxication and upper gastrointestinal system (GIS) bleeding. After intravenous infusion of 10 mL/kg loading dose of 10% ethanol, infusion continued by 1.5 mL/kg/hour. Urgent hemodialysis was implemented after infusion of 1 mEq/kg NaHCO 3 into the patient presenting severe acidosis. The patient was admitted for further tests and treatment after hemodialysis; he was discharged by cure after nine days. Mallory-Weiss syndrome may develop in GIS bleeding cases triggered by vomiting and have mortal causes. The complaints that start with severe vomiting may be caused by fatal conditions such as methanol intoxication like in the present case. Therefore, a detailed patient history, as well as rapid diagnosis and treatment by emergency clinicians, have vital importance.
Aims: Acute pancreatitis is a severe inflammation of the pancreas presenting sudden onset with high morbidity and mortality. Simple, accessible, cost-efficient and feasible laboratory tests are still needed to demonstrate the prognosis of the patients. The aim of the present study was to search the efficiency of CRP/Alb ratio as a biochemical marker on mortality and clinical progress in the patients diagnosed with acute pancreatitis in correlation with APACHE-2.
Methodology: This prospective case-control study was conducted with the patients diagnosed with acute pancreatitis through Atlanta criteria and healthy volunteers as a control group in the emergency department. Demographic characteristics, vital signs, ultrasound reports, clinical outcomes, neutrophil, lymphocyte, neutrophil/lymphocyte ratio (NLR), CRP, albumin and CRP/Alb ratio, APACHE-2 score within control and patient groups were recorded. Logistic regression analysis was performed to distinguish healthy volunteers from acute pancreatitis cases.
Results: There was a statistically significant difference between CRP/Albumin and NLR measurements according to the groups and we found that the measurements of the patient group were significantly higher than the control group. The cut-off point for CRP/Albumin and NLR was found to be respectively 1.08, 4.04 and above. (Respectively; sen: 76.64%, 78.50%; spe: 97.20%, 97.20%; PPV: 96.47%, 96.55%; NPV: 80.62%, 81.89%; the accuracy: 86.92%, 87.85%). APACHE-2 scores ranged from 0 to 16, with a mean of 5.80±3.92. The probability of acute pancreatitis was significantly higher in patients with high CRP/Albumin and NLR.
Conclusion: This study showed that CRP/Alb ratio and NLR were positively correlated with APACHE-2 scores that designed for prognosis in patients with acute pancreatitis.
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