This is the first known case report of electrocardiographic (ECG) changes suggestive of coronary vasospasm following a centipede envenomation. A 60-year-old man presented to the emergency department (ED) 1 hour after being stung by a 12-cm centipede. He complained of right great toe pain that did not radiate to his leg. The patient had no known ischemic heart disease. He did not describe any exertional symptoms but admitted experiencing weakness. During the ED course, concurrent with obtaining peripheral intravenous access, the patient experienced diaphoresis, dizziness, hypotension, and bradycardia. His ECG showed new ST-T wave changes, which suggested an acute ischemic process. The patient's blood pressure was 89/60 mm Hg, his pulse rate was 47 beats/min, and his respiration rate was 28 breaths/min. In the following hours, ECG findings returned to baseline. His blood pressure improved gradually with fluid resuscitation after approximately 5 hours. Cardiac markers returned to normal in the 13th hour after the event, and the patient underwent exercise stress testing, which was negative. The patient was discharged with cardiology follow-up. Adult patients with centipede envenomation should be closely monitored in anticipation of possible myocardial ischemia due to vasospasm, hypotension, and myocardial toxic effects of the venom. A child receiving the same amount of venom would be potentially at greater risk.

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BackgroundGBS, MEWS, and PER scoring systems are not commonly used for patients presenting to emergency department with GIS bleeding. This study aimed to determine the value of MEWS, GBS, and PER scores in predicting bleeding at follow-up, endoscopic therapy and blood transfusion need, mortality, and rebleeding within a 1-month period.MethodsA total of 202 consecutive patients with upper GIS bleeding between July 2013 and November 2014 were prospectively enrolled in the study. The relationship between MEWS, GBS, and PER scores and hospital outcome, bleeding at follow-up, endoscopic therapy, transfusion need, rebleeding, and death were examined.ResultsThe study included a total of 202 subjects, with 84 (41.6 %) females and 118 (58.4 %) males. There was a significant correlation between GBS, MEWS, and PER scores and hospital outcomes (p <0.004, p <0.001, p <0.001, respectively). A GBS score greater than 11 succesfully predicted bleeding at follow-up (p = 0.0237). GBS score's sensitivity for predicting endoscopic therapy was greater than those of other scoring systems. The discriminatory power of each scoring system was significant for predicting transfusion (p <0.0001, p = 0.0470, and p = 0.0014, respectively). A GBS score greater than 13, a MEWS score greater than 2, and a PER score greater than 3 predicted death. A PER score greater than 3 predicted rebleeding (p <0.0001).ConclusionThe scoring systems in question can be easily calculated in patients presenting to ED with upper GIS bleeding and may be beneficial for risk stratification, determination of transfusion need, prediction of rebleeding, and decisions of hospitalization or discharge.

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Background: Pulmonary embolism is a common disease with a high mortality risk. It has recently been reported that platelet indices may be diagnostic in pulmonary embolism. Objective: In this study, we aimed to determine the diagnostic value of platelet indices in acute pulmonary embolism. Methods: The study group was composed of 61 patients diagnosed with pulmonary embolism and a control group of 67 subjects without pulmonary embolism. Patient age, sex, leukocyte and platelet number, hemoglobin concentration (Hb), mean platelet volume, platelet distribution width, red blood cell distribution width, C-reactive protein, D-Dimer, and troponin I levels were retrospectively analyzed and compared between the two groups. Results: There was no significant difference between age and platelet number of pulmonary embolism and control group. In pulmonary embolism group, platelet distribution width level was significantly high (p = 0.002), whereas mean platelet volume level was significantly lower (p = 0.038). Receiver operating characteristic curve analysis revealed that a mean platelet volume cut-off of 9 fL had a sensitivity of 35%, a specificity of 89.55%, and area under the curve of 0.589 for pulmonary embolism, while a platelet distribution width cut-off of 12.8 fL had a sensitivity of 61%, a specificity of 71.64%, and area under the curve of 0.661. Platelet distribution width and D-dimer levels had a significant positive correlation with each other, whereas there was no significant correlation between mean platelet volume and D-dimer. Conclusion: Platelet distribution width values of the pulmonary embolism group were higher than those of control group. Although the area under the curve of platelet distribution width is slightly better than for platelet number or mean platelet volume, it does not seem that this parameter has better diagnostic accuracy than the other two.