Our study aims to ascertain the diagnostic value of the Monocyte-lymphocyte ratio (MLR) and red cell distribution width (RDW)-lymphocyte ratio (RLR) by comparing them with other biomarkers in distinguishing patients with and without acute appendicitis (AA). A total of 223 children were recruited in the study conducted according to the Cross-Sectional Study design. Patients under 18 years were assigned to 3 groups; AA, nonspecific abdominal pain (NAP), and a control group. According to the outcome of our research, while C-reactive protein (CRP), white blood cell (WBC), neutrophil count (NEU), neutrophil to lymphocyte ratio (NLR), and MLR had excellent diagnostic power, RLR had acceptable diagnostic power, and platelet to lymphocyte ratio (PLR) had only fair diagnostic power. MLR and NLR, which are simple, inexpensive, and easily accessible parameters, can be recommended to be used together with other biomarkers in diagnosing AA in children.

No abstract

In February 2023, two major earthquakes in Turkey affected 10 cities. We wanted to share our experience with the equipment that the first responders in the earthquake area should take with them, apart from medical supplies.The equipment required for patient care is as follows; stethoscope, trauma scissors, flashlight, and headlamp (for power outage situation), safety glasses, scrubs (spare), mask, medical gloves, regularly used drugs (such as decongestants, antibiotics, analgesics), battery, hospital ID, notepad, pen. Personal equipment that is not necessary for patient care is as follows; backpack (with name tag), power bank (to keep in touch), list of basic contact numbers, thermos (for tea and coffee), enough ready-made food to last at least three days (dry foods, energy, and protein bars, instant sachet soup, etc.), water bottle, fork, spoon, glass, garbage bag, whistle, work gloves, ear protection, sleeping bag and mat (tent if possible), personal hygiene items (soap, toothbrush, toothpaste, wet wipes, napkins).

Multiple sclerosis (MS) is the most prevalent immune-mediated inflammatory demyelinating central nervous system disorder, with a diverse set of clinical signs and symptoms. This study aimed to investigate the diagnostic values of the monocyte/lymphocyte ratio (MLR), red cell distribution width/lymphocyte ratio (RLR), and systemic immune-inflammation index (SII) in detecting multiple sclerosis attacks in patients with Relapsing-remitting MS (RRMS) presenting to the emergency department (ED). This retrospective observational study was conducted among patients with RRMS presenting to the ED of a third-level hospital. The laboratory parameters of 165 patients were compared during the attack and non-attack periods. The paired t-test statistic was used to compare means of inflammatory biomarker measurements between attack and non-attack groups. The neutrophil/lymphocyte ratio (NLR), MLR, RLR, and SII mean of the patients in the MS attack periods were higher than those in the non-attack period. The mean difference of NLR, MLR, RLR, and SII between both groups was 5.40±7.25, 0.37±0.43, 7.77±11.61, 1469.19±1978.88, respectively (p<0.001). In ROC analysis, NLR, RLR, MLR, and SII had excellent diagnostic power in detecting MS relapse (AUC: 0.87, 0.81, 0.86, and 0.87, respectively). According to our findings, SII, MLR, NLR, and RLR may be beneficial in confirming the diagnosis of attack in patients with RRMS.

Anaphylaxis is a sudden onset of systemic hypersensitivity caused by mast cell and basophil degranulation. Food, Hymenoptera venom, and drug allergy are among the leading causes of anaphylaxis, particularly in adults. We can consider anaphylaxis caused by swallowing food or medication as a form of poisoning. Because in anaphylaxis, just like in poisoning, an allergen entering the body poses a life-threatening risk. Therefore, the allergen should be removed from the digestive system immediately. However, the decontamination of the gastrointestinal tract is not routinely used to prevent further absorption of allergens from the intestine into the systemic circulation. Among the gastrointestinal decontamination methods is the use of activated charcoal. In this article, we present four patients who developed anaphylaxis due to drug and food intake and were administered oral activated charcoal after their primary treatment (on average, 15-45 minutes after the first presentation) was completed. The youngest of the patients was 22 years old, and the oldest was 40. No side effects, prolonged anaphylactic state, and biphasic reactions were observed in the follow-up of the patients. All patients were discharged after 48-72 hours of hospitalization. The routine approach to poisoning treatment includes patient stabilization, toxidrome recognition, antidote administration, and supportive care, as well as measures to enhance toxin elimination. In anaphylaxis caused by oral allergens, the substance that initiates the reaction can be compared to a kind of toxin. Eliminating the allergen and reducing its absorption could be achieved by administering activated charcoal. Activated charcoal should be considered adjunctive therapy in treating food and oral drug-induced anaphylaxis. This treatment, when administered in a timely manner, might prevent the development of biphasic reactions and the prolongation of the allergic process in anaphylaxis.

Purpose: The aim of the study was to evaluate the mortality prediction performances of delta bicarbonate, delta anion gap, and delta ratio in methanol poisoning (MP) cases. Materials and Methods: This clinical study, which followed a cross-sectional study design, involved patients with MP who were still alive when they initially arrived at the emergency department of a tertiary care hospital. Patients were divided into two groups mortality and non-mortality. Patients who died during treatment and follow-up were assigned to the mortality group, while others were assigned to the non-mortality group. Receiver Operating Characteristic (ROC) analysis was used to determine the cut-off in the diagnostic value measurements of biomarkers predicting mortality. Results: Nine (20%) of the 45 patients in the study died during their follow-up. The two groups showed a significant difference in the averages of pH, bicarbonate (HCO3-), lactate, anion gap, delta anion gap, delta HCO3-, and delta ratio, but not in the averages of partial carbon dioxide pressure (pCO2). In predicting mortality, pH, anion gap, and delta anion gap were found to have outstanding diagnostic power (AUC>0.9), while HCO3-, delta HCO3-, delta ratio were found to have acceptable diagnostic power (AUC: 0.7-0.8). Conclusion: Delta anion gap, delta bicarbonate, and delta ratio can be used as prognostic factors in predicting mortality in MP cases.

Aim: It is the determination of D-dimer threshold levels according to age in patients diagnosed with pulmonary embolism (PE) by pulmonary computed tomography (CT) angiography. Material and Methods: Patients with D-dimer levels and who underwent pulmonary angiography CT between January 01, 2015, and December 30, 2019, were included in the study. The demographic characteristics of the patients, imaging reports, and 1-month mortality of the patients were evaluated retrospectively by examining the hospital information management system and patient files. Patients with missing file data and imaging and laboratory studies other than the pre-diagnosis of PE were excluded from the study. Results: 2613 (41,9%) of the patients included in the study were male, and 362,8 (58,1%) were female. The mean age of the patients was 43.27±17.43 years. Pulmonary angiography was performed in 1507 (24,2%) patients. Of these 1507 patients, 147 (9,8%) had PE. When the 1-month mortality of 6240 patients, whose D-dimer level was requested with the preliminary diagnosis of PE, was examined, it was seen that 20 (0.3%) patients died. The 1-month mortality rate of patients with high D-dimer levels was 0.7% (17 patients), while the mortality rate of patients with normal D-dimer test results was 0.1% (3 patients). A weak but statistically significant correlation was found between the localization of the pulmonary embolism on pulmonary CT angiography and the D-dimer level spearman’s rho value of 0.251). The cut-off D-dimer value in predicting the presence of PE in all age groups was calculated as 1.34 mg/L. The cut-off values of D-dimer value to predict the presence of PE according to age ranges respectively 1.18 mg/L (80 years) was calculated as. Conclusion: As age increases, the D-dimer cut-off value for the diagnosis of PE also increases. There is a weak but significant correlation between D-dimer level and pulmonary embolism severity.

BackgroundHyponatremia is a common electrolyte balance disorder. It may result in brain edema and increased intracranial pressure (ICP). Optic nerve sheath diameter (ONSD) measurement remains an increasingly sought-after method in many situations associated with ICP elevations. The aim of our study was to investigate the relationship between the change of ONSD before and after hypertonic saline (3% sodium chloride) treatment and the clinical improvement with increased sodium levels in patients with symptomatic hyponatremia who presented to the emergency department. MethodologyThis study was conducted in the emergency department of a tertiary hospital, according to the design of a prospective, self-controlled, non-randomized trial study. Determined by power analysis, 60 patients were included in the study. The statistical analysis of the continuous data was performed using the means, standard deviations, and minimum and maximum values of the feature values. The frequency and percentage values were used to define categorical variables. The mean difference comparison of pre-and post-treatment measurements was evaluated by paired t-test. P<0.05 was considered to be significant. ResultsThe measurement parameters' differences before and after hypertonic saline treatment were evaluated. While the mean of the right eye ONSD was 5.27±0.22 mm before treatment, it declined substantially to 4.52±0.24 mm after treatment (p<0.001). It was also found that the left eye ONSD was 5.26±0.23 mm before the treatment and declined to 4.53±0.24 mm after the treatment (p<0.001). In addition, the mean of the overall ONSD was 5.26±0.23 mm before treatment and 4.52±0.24 mm after treatment (p<0.001). ConclusionsUltrasonic measurement of ONSD can be used to monitor the clinical improvement of patients receiving hypertonic saline therapy for symptomatic hyponatremia.