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.

BackgroundAcute appendicitis (AA) is one of the most frequent causes of abdominal pain requiring emergency intervention in adults. Approximately one-third of cases present with atypical clinical symptoms. This study aims to compare the monocyte-to-lymphocyte ratio (MLR), red cell distribution width (RDW) to lymphocyte ratio (RLR), and systemic immune inflammation index (SII) with other biomarkers in distinguishing patients with and without AA. MethodologyA total of 347 patients (AA 125, nonspecific abdominal pain 90, and control group 132) were enrolled in the study according to the cross-sectional study design. Receiver operating characteristic (ROC) analysis was used to determine the cutoff in diagnostic value measurements. Statistical significance was determined by the statistics of sensitivity, specificity, positive predictive value, and negative predictive value. Comparison of ROC curves of C-reactive protein (CRP), white blood cell (WBC), neutrophil count (NEU), neutrophil-tolymphocyte ratio (NLR), MLR, and SII was evaluated with the pairwise comparison of ROC curves and 95% confidence interval. ResultsIn detecting AA, CRP, WBC, NEU, NLR, MLR, and SII have excellent diagnostic power (area under the curve [AUC] 0.80-0.88), while RDW, lymphocyte count, monocyte (MON) count, and RLR had acceptable diagnostic power (AUC 0.70-0.77). When the power in the diagnosis of AA was compared, a significant difference was found between CRP and NEU, CRP and SII, WBC and NEU, and WBC and SII. ConclusionsThe diagnosis of AA remains dependent on many factors. Inflammatory biomarkers assist this process. MLR and SII may be recommended to use in diagnosing AA in adults, along with other clinical findings. RLR is adequate but not superior.

Background: Acute pulmonary embolism (APE) is a cardiovascular emergency that has a high morbidity and mortality probability. The aim of this study is to investigate the clinical value of the systemic immune inflammation index (SII) in predicting high-risk patients admitted to the emergency department with a diagnosis of Acute pulmonary embolism (APE). Materials and Methods: This clinical study, which was conducted according to a cross-sectional study design, included 193 patients diagnosed with APE who presented to the emergency department of a tertiary hospital. According to the guideline, patients with Pulmonary Embolism Severity Index (PESI) class III–V or sPESI ≥I were identified as high risk. ROC (Area Under the Curve) analysis was used to determine the cut-off in predicting high-risk APE. Results: In our research, 71 of the patients had high-risk APE. In detecting high-risk APE, SII was found to have excellent diagnostic power (AUC: 0.84), while neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte (MLR) were found to have acceptable diagnostic power (AUC: 0.76-0.78), red cell distribution width (RDW) to lymphocyte (RLR) was of fair diagnostic power (AUC: 0.68). Conclusion: We have shown that SII can be a valuable and useful potential biomarker to identify high-risk patients in patients with APE. We also found that MLR and RLR are biomarkers that can be used to predict severe APE.

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.

Hydrocephalus is a common neurological disorder in both childhood and adulthood. Non-communicating hydrocephalus may occur due to obstruction of the cerebrospinal fluid (CSF) flow pathways by structural anomalies such as tumors, infections, adhesions, and developmental defects while communicating hydrocephalus might develop due to CSF absorption disorders or excess production. In symptomatic cases, treatment is divided into two approaches as medical and surgical. The most commonly used method in surgical treatment is the ventriculoperitoneal (VP) shunt system. The ventriculoperitoneal (VP) shunt system can have numerous advantages and complications and is expected to yield continuous and long-term solutions. One of its advantages is that CSF samples can be taken from the reservoir located on it. In cases suspected of intracranial infection but for whom Lumbar puncture (LP) cannot be performed, the shunt reservoir in the patient provides sufficient opportunity for CSF retrieval.

Emergency departments are facing an increasing number of drug-related health problems with difficult medicolegal and social consequences. A 25-year-old male with no past medical history arrived to our emergency department. He was brought to the emergency room of our hospital by the security forces, as he suffered a gunshot wound while traveling to a place. Cocaine-filled capsule was seen on plain abdominal film. The plain abdominal film is the most commonly used radiological tool to detect 2-8 cm drug-filled packages within the gastrointestinal tract of body packers. In a study that analyzed the role of drugs in firearm deaths in New York between 1990 and 1998, more than half of firearm deaths had positive drug toxicology. Physicians working in the emergency unit should be prepared for secondary diagnoses. In addition, different examination and imaging findings should be kept in mind in suspicious cases.

The elbow is the second most frequently dislocated major joint in adults. Elbow dislocation is a common traumatic injury, occurring in approximately 20% of all joint dislocations. Falling onto an outstretched hand is the most prevalent cause of elbow dislocation. Simultaneous bilateral elbow dislocation is a rare presentation, and reports of similar injuries are very limited. A 21-year-old male patient was brought to the emergency department after landing on both hands with flexed elbows from a height of one meter while doing home decoration work. The posterolateral dislocations was detected in both elbows without a fracture on the plain radiographs. The patient's elbows were reduced under procedural sedation analgesia in the emergency department. The patient's splints were removed in the orthopedics outpatient clinic after a 2-week follow-up, and he had no complications. It should be noted that serious bilateral dislocations can occur even in minor traumas like this. Procedural sedation not only prevents the delay of the procedure and the occurrence of complications, especially during the treatment of such multiple dislocations, but also increases patient comfort.