Relationship between platelet indices in acute cholecystitis: A case-control study

INTRODUCTION AND AIMS

We aimed to investigate changes in initial platelet indices in patients arriving at the emergency department with acute cholecystitis.

MATERIAL AND METHODS

A retrospective case-control study was conducted at a tertiary care teaching hospital. Demographics, comorbidities, laboratory data, length of hospital stay, and mortality data for the acute cholecystitis group were retrospectively obtained from the hospital digital database. Platelet count, mean platelet volume, plateletcrit, platelet distribution width, and platelet mass index were collected.

RESULTS

A total of 553 patients with acute cholecystitis were the study cases, and 541 hospital employees were the study controls. According to the results of the multivariate analysis of the platelet indices studied, only mean platelet volume and platelet distribution width showed significant differences between the two groups (adjusted odds ratio: 2, 95% confidence interval: 1.4-2.7, p < 0.001 and adjusted odds ratio: 5.88, 95% confidence interval: 2.44-14.4, p < 0.001, respectively). The multivariate regression model created had an area under the curve of 0.969 in the prediction of acute cholecystitis (accuracy: 0.917, sensitivity: 89%, and specificity: 94.5%).

CONCLUSION

The study results indicate that the initial mean platelet volume and platelet distribution width were independent predictors of acute cholecystitis.

MUSCULAR HYPERTROPHY AS ATYPICAL INITIAL PRESENTATION OF HYPOTHYROIDISM

Hypothyroidism is a common endocrine disease with characteristic symptoms and signs such as fatigue, weight gain, intolerance of cold, constipation, depression, mental slowdown and muscle cramps. Myopathic changes are observed in 30-80% of patients with hypothyroidism, but muscular hypertrophy with muscle stiffness has been reported in less than 10% of patients. Hoffmann's syndrome is a specific form of the hypothyroid-associated myopathy, rarely seen. Symptoms of this syndrome include proximal muscle weakness, hypertrophies in extremities, stiffness, muscle cramps, spontaneous muscle pain; and are associated with increased muscle enzymes. These findings can be seen at any time during hypothyroidism. Hofmann's syndrome has a very good prognosis. Its response to hormone replacement therapy is very good. Therefore, in patients with myopathy-like symptoms, considering in the differential diagnosis that the myopathy may be a reflection of hypothyroidism will facilitate the diagnosis and treatment. In this case, we aimed to present together Hashimoto thyroiditis and muscular hypertrophy, which is an atypical presentation of hypothyroidism and rarely seen in the literature, namely Hoffmann's syndrome.