Unexpected Aetiology in Elderly Patient Presenting with Acute Hypercapnic Coma

In an emergency room setting, hypercapnic respiratory failure is a clinical entity infrequently encountered. It results from inadequate removal of carbon dioxide from distal alveoli. Goitre is defined as abnormal enlargement of the thyroid gland. It may cause compression of surrounding structures including trachea as thyroid dimension increases. Goitre associated with breathing difficulty is a very well-known situation. Retrosternal goitre can be misinterpreted as asthma and can lead to diagnostic delay. We report a case in which the patient with retrosternal goitre presented rarely with acute hypercapnic coma.

Evaluation of SCUBE-1 and sCD40L biomarkers in patients with hypothyroidism due to Hashimoto's thyroiditis: a single-blind, controlled clinical study

OBJECTIVE

This study was performed to investigate the levels of platelet activation marker SCUBE-1 and sCD40L which plays some role in the progression of atherosclerosis, in patients with hypothyroidism due to Hashimoto's thyroiditis.

PATIENTS AND METHODS

The cohort of this study includes 90 patients and 35 healthy volunteers, who admitted to the internal medicine out-patient. Simultaneously in the same samples; SCUBE-1 and sCD40L measurements were accomplished by enzyme-linked immunosorbent assay (ELISA). The data obtained were analyzed statistically.

RESULTS

Hypothyroidism due to Hashimoto's thyroiditis in comparison to the control group that includes healthy volunteers; SCUBE-1 and sCD40L, were increased. And these results were statistically significant (p < 0.05).

CONCLUSIONS

SCUBE-1 and sCD40L levels were increased in Hashimoto's hypothyroidism patients. This may indicate an increased endothelial dysfunction, platelet activation and cardiovascular risk in hypothyroidism. SCUBE-1 and sCD40L may be helpful in cardiovascular risk assessment of hypothyroid patients.

Neutrophil-to-lymphocyte ratio in obstructive sleep apnea; a multi center, retrospective study

OBJECTIVE

Systemic inflammation is important in pathophysiology of obstructive sleep apnea (OSA) and its comorbidity. Neutrophil to lymphocyte ratio (N/L ratio) is a novel inflammation index that has been shown to independently predict poor clinical outcomes. In this study, we aimed to evaluate the role of N/L ratio in OSA patients and comparing with other well-known inflammatory marker, C-reactive protein (CRP).

PATIENTS AND METHODS

We conducted a retrospective analysis of 481 patients with mild, moderate and severe OSA (163,158 and 160 patients, respectively) and leukocyte profiles of 80 sex-, age- and body mass index- matched healthy controls. Patients were excluded if they had underlying cancer, chronic inflammatory disease, any systemic infection, uncontrolled hypertension and diabetes mellitus, a known acute coronary syndrome, valvular heart disease, a known thyroid, renal or hepatic dysfunction.

RESULTS

We found that N/L Ratio in severe OSA patients was significantly higher compared with mild, moderate, OSA patients and healthy controls (p < 0.001). However, there was no difference between mild and moderate OSA patients (p = 0.636). There was also no significant difference between mild-moderate OSA patients and healthy groups (p = 0.150). CRP levels were not different in all OSA stages (p = 0.595). By Spearman correlation, there was no correlation between CRP and N/L ratio.

CONCLUSIONS

N/L ratio, which is quick, cheap, easily measurable novel inflammatory marker with routine complete blood count analysis, is a surrogate marker of obstructive sleep apnea severity.

Risk stratification in submassive pulmonary embolism via alveolar-arterial oxygen gradient

AIM

This study investigated the utility of the alveolar-arterial (AaDO2) gradient in predicting the short-term prognosis of submassive pulmonary embolism (PE).

MATERIAL AND METHODS

This study retrospectively enrolled 124 patients with acute submassive PE. During the first 24 h of admission, all patients had initial artery blood gas collected under room air. Cardiac troponin T (cTn-T) was measured and on spiral computed tomography pulmonary angiography (CTPA) and echocardiography both right ventricle diameter and left ventricle diameter was calculated (RV/LV ratio). Patients who did not have objectively confirmed submassive PE and who had curative anticoagulant treatment for more than 24 hours and had a life expectancy less than 3 months were excluded from the study.

RESULTS

The best cut-off value for AaDO2 was 42.38 mmHg and using this, fourteen of 15 patients who died had AaO2 ≥ 42.38 and 71 of 109 patients who survived had a AaO2 lower than 42.38 with a sensitivity, specificity and negative predictive value (NPV) for overall deaths were 93.3%, 65.1% and 98.6% respectively. In addition, AaDO2 < 42.38 showed significant survival benefit for overall mortality rates. In this study, having high cTn-T and PaO2/ PaCO2 < 1.83 and pulmonary artery pressure > 47.5 were also an indicator of poor prognosis for patients with submasssive PE.

CONCLUSION

The AaDO2 measurement is a highly useful and simple measurement for predicting short-term prognosis in patients with submassive PE. It may be used in risk stratification of patients with submassive PE. Aggressive thrombolytic treatment strategies may be considered for patients who have AaO2 < 42.38. Hippokratia 2014; 18 (4): 333-339.

Differential serodiagnosis for cystic and alveolar echinococcosis using fractions of Echinococcus granulosus cyst fluid (antigen B) and E. multilocularis protoscolex (EM18)

Echinococcus granulosus cyst fluid and E. multilocularis protoscolex extract were fractionated by a single step of preparative isoelectric focusing, resulting in an antigen B-rich fraction (8-kD) and an Em18-rich fraction, respectively. The usefulness of both fractions for differential serodiagnosis of cystic (CE) and alveolar (AE) echinococcosis was evaluated by a large-scale immunoblot analysis on a battery of 354 serum samples. These included 66 from AE patients originating from four different endemic areas, 173 from CE patients originating from seven different endemic areas, 71 from patients with other parasitic diseases, 15 from patients with hepatomas, and 29 from healthy individuals. In an immunoblot with the antigen B-rich fraction, 92% (158 of 173) of the CE sera as well as 79% (52 of 66) of the AE sera reacted with the 8-kD subunit. No cross-reactivity occurred with any sera from patients with cysticercosis, other parasitic diseases, or with hepatomas, or from healthy controls. In an immunoblot with the Em18-rich fraction, all but two sera from AE patients (64 of 66, 97%) recognized Em18, and only nine of 34 CE sera from China reacted with it. All other (139) CE sera from six other countries were negative as were all (115) other non-echinococcosis sera. These findings indicate that antigen B (8-kD) is not species-specific for E. granulosus but is genus-specific for Echinococcus, and that the Em18 antigen is a reliable serologic marker for species-specific differentiation of AE from CE.

A sero-epidemiological study of visceral leishmaniosis in Izmir District, Turkey

Visceral leishmaniosis caused by Leishmania infantum have been reported in Turkey. A total of 2055 blood samples collected in Izmir and six surrounding villages were tested for anti-Leishmania antibodies. Three established immunodiagnostic techniques, indirect fluorescence antibody (IFA), enzyme-linked immunosorbent assay (ELISA) and direct agglutination test (DAT), were employed using promastigotes and rK39 as antigens for the detection of anti-Leishmania antibodies. Five sero-positive cases (0.24%) were detected by the three tests used.

Toxoplasmosis in last four years in Agean region, Turkey

Anti-Toxoplasma antibodies were determined with IFA and ELISA tests in 9410 patients who were different age groups, attended Department of Parasitology between 1991-1995. Anti-Toxoplasma IgG antibodies were found positive in 4651 (49.4%) of these patients. 2287 (21.4%) patients were pregnant women and the positivity was 55% of them. According to history of these patients, seropositivity was found 50% in women having spontaneous abortion, 52% in women having stillbirth, in 55% women having abnormal fetal births. These patients and their culinary habits, the presence of cats and relationship with other clinical symptoms were also evaluated.