Article

Red cell distribution width and mean platelet volume in carbon monoxide poisoning

red cell distribution width and mean pla”>1196 Correspondence / American Journal of Emergency Medicine 37 (2019) 11911213

that can be rapidly diagnosed using urine-based assays. Sci Rep 2017. https://doi. org/10.1038/c41598-017-09895-7.

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  • with disseminated intravascular coagulation. Kekkaku 1987;62:469-74 [Article in Japanese. Abstract in English].

    Patial T, Sharma K, Jaswal AS, Thakur V, Nedl S. Symmetrical peripheral gangrene and tuberculosis: a rare kinship. Int J Mycobacteriol 2017;6:407-9.
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  • a cryptic miliary tuberculosis. Acta Clin Belg 2005;60:36-40.

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  • Chlamydia and gonorrhea screening in the ED setting: increasing evidence of utility and need for further research

    I applaud the work of Garlock et al. in investigating the utility of chla- mydia (CT) and gonorrhea (GC) screening in emergency departments (ED). In the time of record levels of these infections and the specter of antimicrobial resistant gonorrhea (AMR GC) on the horizon, new means to identify and treat those at risk are sorely needed [1-3].

    I would like to point out that somewhat similar work has been done before, and complements to a large extent the findings presented by this study. Two of our previous studies of prospective screening of emer- gency department patients found both relatively high rates of infection and individual-level factors suitable to refine screening criteria. The first study of universal urine-based screening of females aged 15-35 years for CT/GC found a disease prevalence of 9.1% (CT only 5.7%; GC only 2.5%; CT and GC 0.9%) [4]. Further, restricting screening to only those “…reporting 2+ male partners in the past year or those who thought their sex partner had other partners resulted in a 52% decrease in the number of tests administered and a 73% increase in screened patient prevalence.” Our second universal screening study, including males and oropharyngeal swabs in additional to urine specimens, found an overall prevalence of 7.7% with similar risk between Males and females [5]. Further, 26.3% of infected individuals had an oral infection, and the majority of oral GC infections would not be identified with urine- based screening. Both of these studies were pilots at a single hospital site and require further exploration.

    The clinical setting (primary and emergency) has been and will likely continue to be a critical aspect of addressing sexually transmitted disease screening and treatment [6,7]. Still, universal screening in rela- tively low prevalence settings is not generally considered cost- effective [8].

    As Hull et al. describe in their review, there are multiple factors impacting both cost-effectiveness and even full implementation of cur- rent guidelines [8]. Of particular concern for emergency department- based screenings is the potential loss to follow up, leading to presump- tive treatment as a frequently-preferred paradigm. While efficient from an operations perspective, it is unattractive in terms of waste, potential for inadequate treatment (for those truly infected), and adverse per- sonal and social outcomes (for those not infected). Whereas the Primary care setting has an established framework for long-term patient

    engagement and follow up, none such exists in the emergency setting. Models of linkages between ED-based screening and other agency fol- low up and treatment have been explored, and I would suggest that fur- ther study in this regard is warranted [9,10]. While truly new strategies for addressing increasing rates of STDs and AMR GC are needed, expanding and refining evidence-based practices in existing Clinical sites may be comparably low cost and easily generalized.

    Acknowledgements

    There is no funding associated with this letter.

    Wiley D. Jenkins, PhD, MPH, FACE1 , 2 Southern Illinois University, School of Medicine, 201 E. Madison Street, Springfield, IL 62794-9664, United States of America

    E-mail address: [email protected].

    12 September 2018

    https://doi.org/10.1016/j.ajem.2018.10.033

    References

    1. Garlock J, Lee L, Cucci M, Frazee LA, Mullen C. Suspected gonorrhea and chlamydia: incidence and utilization of Empiric antibiotics in a health system emergency de- partment setting. Am J Emerg Med Aug 7 2018. https://doi.org/10.1016/j.ajem. 2018.08.015 [pii: S0735-6757(18)30651-X., Epub ahead of print].
    2. Centers for Disease Control and Prevention. STDs at record high, indicating urgent need for prevention. Available at: https://www.cdc.gov/media/releases/2017/ p0926-std-prevention.html. (Accessed Sept 12 2018).
    3. Centers for Disease Control and Prevention. Antibiotic-resistant gonorrhea. Available

      at: https://www.cdc.gov/std/gonorrhea/arg/default.htm. (Accessed Sept 12 2018).

      Jenkins WD, Kovach R, Wold B, Zahnd W. Using patient provided information to re- fine sexually transmitted infection screening criteria among females presenting in the emergency department. Sex Transm Dis Dec 2012;39(12):965-7. https://doi. org/10.1097/OLQ.0b013e31826e882f.

    4. Jenkins WD, Nessa LL, Clark T. Cross-sectional study of pharyngeal and genital chla- mydia and gonorrhea infections in emergency department patients. Sex Transm In- fect May 2014;90(3):246-9. https://doi.org/10.1136/sextrans-2013-051358 [Epub 2013 Dec 23].
    5. Jenkins WD, Rabins C, Bhattacharya D. Importance of physicians in chlamydia trachomatis control. Prev Med Oct 2011;53(4-5):335-7.
    6. Jenkins WD, Zahnd W, Kovach R, Kissinger P. Chlamydia and gonorrhea screening in

      United States emergency departments. J Emerg Med Oct 25 2012;44(2):558-67. https://doi.org/10.1016/j.jemermed.2012.08.022 [pii: S0736-4679(12)01088-8. Epub ahead of print].

      Hull S, Kelley S, Clarke JL. Sexually transmitted infections: compelling case for an im- proved screening strategy. Popul Health Manag Sep 2017;20(S1):S1-S11.

    7. Irvin CB, Nowak B, Moore M, Flynn K, Vretta C. Emergency department chlamydia screening through partnership with the public health department. Acad Emerg Med 2009;16:1217-20.
    8. Finelli L, Schillinger JA, Wasserheit JN. Are emergency departments the next frontier for sexually transmitted disease screening? Sex Transm Dis 2001;28:40-2.

      Red cell distribution width and mean platelet volume in carbon monoxide poisoning

      Dear Editor,

      We read the article “Predicting of neuropsychosis in carbon monox- ide poisoning according to the plasma troponin, carboxyhemoglobin (COHb), Red Cell Distribution Width and Mean platelet volume levels” by Coskun et al. [1] They aimed to determine the predictivity of Neuro psychosis in carbon monoxide poisoning by the admission levels of RDW, MPV and Troponin I levels which can be mea- sured quickly and easily in the emergency department (ED). They

      1 Chief, Epidemiology and Biostatistics, Department of Population Science and Policy.

      2 Associate Professor, Family and Community Medicine.

      Correspondence / American Journal of Emergency Medicine 37 (2019) 11911213 1197

      concluded that RDW and MPV can be helpful for risk stratification of neuropsychosis in carbon monoxide poisoning. This study gives impor- tant information on this clinically relevant condition.

      A complete blood count is a comparatively routine, cheap, practical and easy examination method that gives important information about inflammation. [2] MPV as a part of Platelet function is a commonly used inflammatory marker related to many clinical conditions. [3] In this respect, Coskun et al. [1] have mentioned that demographic, clinical, and laboratory data from the date of presenting to the ED due to CO poi- soning, including the COHb, RDW, MPV, neutrophil, lymphocyte and troponin levels, were assessed using review of the hospital’s medical re- cords. In accordance with the recent article, [1] MPV and RDW levels were obtained medical records. However, this paremeters can change many conditions. At present, increased MPV levels were observed in coronary artery diseases, atrial fibrillation [4], cerebrovascular disease, peripheral artery disease, stroke, malignancy, inflammatory diseases [5], all of them are strongly correlated with endothelial dysfunction on the basis of inflammation [6]. Also, medications like aspirin, statins that may affect the MPV values should also be reported with medica- tions of the patients. [7] Morever, the authors did not mention about the type of the tube (EDTA or citrate) which contains blood collection material. It is clearly known that MPV levels rise over time in EDTA- anticoagulated samples. The MPV levels increase up to 30% within five minutes of exposure with EDTA and increases further by 10 to 15% over the next two hours with impedance technology. So, the ideal time of MPV measurement is about two hours after blood sample collec- tion in EDTA tube. [7] Also, EDTA generates a small shape change and swelling in platelets, so that the MPV measured in citrated blood can dif- fer from that assessed in EDTA blood of the same donor. [8]

      In addition, RDW, another marker of the complete blood count pa- rameters, represents the variability in the red blood cell volume distri- bution and can be considered an index of heterogeneity in size of circulating erythrocytes. [9] This parameter is readily measured by auto- mated hematology analyzers and reported as a component of complete blood count. [10] RDW has recently been defined to highly correlate with short- and long-term outcomes in different clinical settings. [11] However, RDW may reflect ethnicity, neurohumoral activation, renal dysfunction, thyroid disease, Hepatic dysfunction, nutritional deficien- cies (i.e. iron, vitamin B12, and folic acid), bone marrow dysfunction, in- flammatory diseases, chronic or acute systemic inflammation [12], recent transfusion within the past 3 months and use of some medica- tions. Last but not least, it would be better if the authors might define how much time they specified on measuring RDW levels, because of the delaying blood sampling can cause abnormal results in RDW mea- surements.

      Sevket Balta

      Department of Cardiology, Hayat Hospital, Kisla St., 04400 Battalgazi,

      Malatya, Turkey E-mail addresses: [email protected], [email protected].

      12 September 2018

      Balta S, Demirkol S, Kucuk U, Unlu M. Hemostatic markers can be pivotal roles of risk factors for new-onset atrial fibrillation. Platelets Jan 3 2014;25(7):554-5.

    9. Ekiz O, Balta I, Sen BB, Rifaioglu EN, Ergin C, Balta S, et al. Mean platelet volume in

      recurrent aphthous stomatitis and Behcet disease. Angiology Feb 13 2014;65(2): 161-5.

      Balta S, Celik T, Mikhailidis DP, Ozturk C, Demirkol S, Aparci M, et al. The relation be- tween atherosclerosis and the neutrophil-lymphocyte ratio. Clin Appl Thromb Hemost Jul 9 2016;22(5):405-11.

    10. Balta S, Mikhailidis DP, Kurtoglu E, Demirkol S. Mean platelet volume in patients un- dergoing percutaneous coronary intervention. Platelets Jan 31 2015;26(3):269-70.
    11. Uslu AU, Inal S, Balta S. Assessment of platelet-lymphocyte ratio based on EDTA- dependent pseudothrombocytopenia. Angiology Jan 29 2016;67(1):96-7.
    12. Balta S, Demirkol S, Cakar M, Ardic S, Celik T, Demirbas S. Red cell distribution width: a novel and simple predictor of mortality in acute pancreatitis. Am J Emerg Med Jun 17 2013;31(6):991-2.
    13. Celik T, Balta S, Demir M, Yildirim AO, Kaya MG, Ozturk C, et al. Predictive value of admission red cell distribution width-platelet ratio for No-reflow phenomenon in acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiol J Oct 27 2016;23(1):84-92.
    14. Balta S, Aydogan M, Kurt O, Karaman M, Demirkol S, Akgul EO. Red cell distribution width as a novel, simple, inexpensive predictor of mortality in patients with chronic heart failure. Int J Cardiol May 3 2013;168(3):3049-50.

      Letter to the editor Regarding Article, “Esmolol reduces apoptosis and inflammation in early sepsis rats with Abdominal infection

      Dear editor,

      We have read with interest the article by Lu et al. [1] published in American Journal of Emergency Medicine, and thought that some issues should be addressed.

      Lu et al. [1] reported that the rats were randomly divided into a sham-operated control group, sepsis group, antibiotic group and esmolol + antibiotic group. They suggested that sham-operated control group with 5 rats, while experimental group with 10 rats in each group. After reading this article carefully and consulting some relevant lit- eratures, the purpose of the authors were investigated whether esmolol can alleviate the combined organ dysfunction caused by sepsis. According to Jacquet-Lagreze et al. [2], we thought that their experi- mental animals are more suitable to randomly assign to five groups: sham-operated control group, sepsis group and esmolol group, which is further divided into low dosage (L group), medium dosage (M group) and high dosage (H group) esmolol groups. Moreover, to control the unrelated variables, we thought it may be better that the number of animals in their control group is consistent with the experimental group

      with 10 rats, which is like most experimental studies.

      As we all know, the experimental method has great influence on the result. Therefore, although the article has been published for more than one year, in order to improve quality to make it more readable, we pro- pose to correct this error.

      Conflicts of interest disclosures

      https://doi.org/10.1016/j.ajem.2018.10.034

      None disclose.

      References

      Funding sources

      None.

      Feng Chen

      Coskun A, Eren FA, Eren SH, Korkmaz I. Predicting of neuropsychosis in carbon mon- oxide poisoning according to the plasma troponin, COHb, RDW and MPV levels. Am J Emerg Med Sep 2018 (Article in press).

    15. Balta S, Aparci M, Ozturk C, Demirkol S, Celik T. Red cell distribution width in organ- ophosphate exposure patients. Am J Emerg Med Sep 2014;32(9):1132.
    16. Balta S, Demirkol S, Cakar M, Celik T. Mean platelet volume as a surrogate marker of low-grade inflammation in osteoarthritis. Platelets Apr 15 2013:1-2.

      Department of Emergency, The First Affiliated Hospital of Guangxi Medical

      University, Nanning, China

      Zhi-Qing Chen

      Department of Cardiology, The First Affiliated Hospital of Guangxi Medical

      University, Nanning, China

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