Objective: The aim of this study is to investigate the relationship between procalcitonin (PCT) level and the severity of acute cholecystitis. Materials and Methods: This study included 200 patients diagnosed with acute cholecystitis. To diagnose and assess the severity of acute cholecystitis; physical examination and abdominal ultrasound findings were evaluated and blood samples were taken to determine white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and levels of coagulation factors, blood gas, C-reactive protein (CRP) and PCT. Patients were classified into three stages, namely, mild, moderate, and severe, according to the severity of acute cholecystitis using the Tokyo guidelines. The role of PCT level in the assessment of severity of acute cholecystitis and the correlation between the stages and PCT level were statistically analyzed. Results: Among patients with acute cholecystitis, 110 (55%) were classified as mild, 61 (30.5%) as moderate, and 29 (14.5%) as severe. Leukocytosis or leukopenia was positive in 48.5%, ESR elevation was found in 72.5%, CRP positivity in 55.5%, PCT elevation in 27%, and positive findings of ultrasonographic imaging in 54.5% of the patients. Serum WBC count, ESR, and CRP and PCT levels increased as the severity of disease increased (p<0.05). PCT could discriminate grade I from grade II–III with 95.45% sensitivity and 46.67% specificity at the best cut-off value of ≤0.52 (p0.8 (p<0.001). Conclusion: PCT level may be considered to be a parameter that could be added to the assessment of the severity of acute cholecystitis in the Tokyo guidelines, although further studies are needed to support our findings.

Chronic kidney disease (CKD), a common progressive renal failure characterized by the permanent loss of functional nephrons can rapidly progress to end-stage renal disease, which is known to be an irreversible renal failure. In the therapy of ESRD, there are controversial suggestions about the use of regular dialysis, since it is claimed to increase oxidative stress, which may increase mortality in patients. In ESRD, oxidative-stress-related DNA damage is expected to occur, along with increased inflammation. Many factors, including heavy metals, have been suggested to exacerbate the damage in kidneys; therefore, it is important to reveal the relationship between these factors in ESRD patients. There are very few studies showing the role of oxidative-stress-related genotoxic events in the progression of ESRD patients. Within the scope of this study, genotoxic damage was evaluated using the comet assay and 8-OHdG measurement in patients with ESRD who were undergoing hemodialysis. The biochemical changes, the levels of heavy metals (aluminum, arsenic, cadmium, lead, and mercury) in the blood, and the oxidative biomarkers, including superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and malondialdehyde (MDA) levels were evaluated, and their relationship with genotoxic damages was revealed. Genotoxicity, oxidative stress, and heavy-metal levels, except mercury, increased significantly in all renal patients. DNA damage, 8OHdG, and MDA significantly increased, and GSH significantly decreased in patients undergoing dialysis, compared with those not having dialysis. The duration and the severity of disease was positively correlated with increased aluminum levels and moderate positively correlated with increased DNA damage and cadmium levels. In conclusion, this study revealed that the oxidative-stress-related DNA damage, and also the levels of Al and Cd, increased in ESRD patients. It is assumed that these changes may play an important role in the progression of renal damage. Approaches for reducing oxidative-stress-related DNA damage and heavy-metal load in ESRD patients are recommended.

Acute appendicitis (AA) is one of the most common surgical emergencies. Despite extraordinary advances in modern investigations, the accurate diagnosis of AA remains an enigmatic challenge. The aim of this study was to compare and evaluate the diagnostic accuracy of inflammatory parameters [C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR)], ultrasound (US) and Alvarado score (AS) in reducing the rate of negative appendectomies. Two hundred seventy-eight patients were included in this study. Patients were separated into two main groups as the surgery group (n=184) and non-operative group (n=94). Complete blood count, ESR and PCT levels were assessed, abdominal US was performed and AS was calculated for all patients. In the surgery group, clinical predictive factors for histopathologic results such as AS ≥7, AA signs on US, neutrophilia and leukocytosis were significant. Neutrophilia and leukocytosis had the highest accuracy rate among these factors. Inflammatory parameters were not predictive for histopathologic results, although higher CRP and PCT levels were significant in perforated and necrotizing appendicitis. Multifactorial regression analyses showed that AS was not of significant predictive value in the non-operative group. There was no superiority of AS and/or US in the diagnosis of AA. Recent findings have shown the most reliable parameters in the diagnosis of AA to be primarily 'neutrophilia' and secondarily 'leukocytosis'. Other results of this study indicated that inflammatory parameters (CRP, PCT, ESR) were not superior to other parameters but CRP and PCT levels were significantly high in complicated cases.

En tr Amaç : Bu çalışmanın konusu karbon monoksit (CO) zehirlenmelerinde, başvuru anındaki laktat düzeylerinin ölçülmesi ve 6 saat sonra alınan laktat düzeylerine göre laktat klirens hızına bakarak tedavide metabolik cevabı değerlendirilmesindeki kullanılabilirliğini belirlemektir. Gereç ve Yöntemler : Keçiören Eğitim ve Araştırma Hastanesi Acil servise, Kasım 2010- Şubat 2011 tarihleri arası CO zehirlenmesi nedeniyle başvuran 18 yaş üstü hastalar dâhil edildi. Geliş laktatı (laktat 1) ve 6. saatteki laktat (laktat 2) sonuçlarından laktat klirensi hesaplandı. Laktat> 1.7 mmol/lt ve üzeri pozitif kabul edildi. Bulgular : Çalışmaya 100 hasta dâhil edilmiştir. Hastaların %62'si kadın, %38'i erkektir. Hastaların %94’ünde hastaneye başvuru anlarındaki laktat oranları yüksekti. Hastaların laktat düzeyleri ile CO seviyelerine bakıldığında, laktat düzeyi yüksek olan grupta, normal olan gruba göre CO düzeyi anlamlı olarak daha büyüktü. Standart oksijen tedavisi alan grupta laktat klirensi %52 iken hiperbarik alan grupta %64 idi ve bu durum hiperbarik oksijen tedavisi alan grupta laktatın ortadan kaldırılması daha hızlı olduğunu göstermektedir. Sonuç : Bizim çalışmamıza göre CO zehirlenmelerinde laktat yükselmektedir ve düzeyleri karboksi hemoglobin (COHb) düzeyleri ile koreledir. Tedavi etkinliğini değerlendirmede laktatklirens hızı kullanılabilir. Özellikle belirgin laktat yüksekliği ve metabolikasidozu olan hastalar erken dönemde hiperbarik oksijen tedavisine gönderilmelidir. Objective : This study aims to determine the feasibility of using the rate of lactate clearance to evaluate the metabolic response to treatment in patients with carbon monoxide (CO) poisoning after their lactate levels were measured on initial presentation to the emergency department (ED). Material and Methods : Patients older than 18, who presented with CO poisoning to the ED of Keçiören Training and Research Hospital between November 2010 and February 2011 were enrolled in the study. Lactate levels upon admission (Lactate-1) and after 6 hours of treatment (Lactate-2) were compared to calculate the lactate clearance rate. Lactate levels of 1.7 mmol/l or greater were considered as positive. Results : A total of 100 patients were enrolled in the study (62 females and 38 males). We found that 94% of patients had elevated lactate levels on admission to the ED. When lactate levels and CO values were compared, the CO values were found to be significantly higher in the elevated lactate level group compared to non-elevated patients. The rate of lactate clearance was 52% in the standard oxygen therapy group compared to 64% in the hyperbaric oxygen therapy (HOT) group, which suggests a faster removal of lactate with this treatment modality. Conclusion : We conclude that lactate levels increase in patients with CO poisoning, and that those levels are correlated with carboxyhemoglobin (COHb) levels. The rate of lactate clearance can be used to evaluate the effectiveness of therapy. Patients with metabolic acidosis and significantly increased lactate should be referred for HOT in early phases of management.