Showing papers in "Medical Science and Discovery in 2021"
TL;DR: The long waiting time obtained from the current study is mostly attributable to delays from the records/registration unit, therefore conceited efforts aimed at improvement of service delivery in this unit will reduce patient waiting time and invariably patient satisfaction.
Abstract: Objective: Waiting time is a resource investment by the patient for the desired goal of being attended to by the physician. It is the time taken or spent in waiting to be attended to by a physician in a health facility. It is important because waiting time is an essential determinant of patient satisfaction in health care practice, and its study would expose the bottleneck areas in patient’s time-flow so that the facility can improve services with that regard.
Materials and Methods: A cross-sectional study of time spent by paediatric patients in the outpatient department of Alex Ekwueme Federal University Teaching Hospital Abakaliki by secretly following the patients from arrival at CHOP till after consultation. Means were calculated of time spent in various areas.
Results: Of the 384 patients observed, the mean (SD) total time spent in the hospital was 142.58 (23.17) minutes while waiting time and consultation time were 113.15(18.01) and 24.43 (10.38) minutes respectively. The mean time spent at the nurse’s bay was 23.79 (6.47) minutes, while that spent at the queue was 22.94 (8.98) minutes. The time spent at the records unit was the highest, with a mean time of 47.2 (17.42) minutes.
Conclusion: The long waiting time obtained from the current study is mostly attributable to delays from the records/registration unit, therefore conceited efforts aimed at improvement of service delivery in this unit will reduce patient waiting time and invariably patient satisfaction.
4 citations
TL;DR: Cardiac anomalies are common findings in SCA children, and severe anaemia was a significant predictor of LVH, but there was no significant association between the degree of anaemia and the occurrence of ST-segment abnormalities.
Abstract: Objective: The prevalence and burden of Sickle Cell Anaemia (SCA) in Nigeria are high and they contribute to childhood morbidity and mortality. Chronic anaemia and vaso-occlusion usually involve different organs. The involvement of the heart is a common complication of SCA, thus the need for early detection of cardiac abnormalities in children with SCA. To assess cardiac structure using ECG in children with SCA in steady-state and to determine the relationship between abnormal ECG findings and the participants’ haemoglobin concentration.
Material and Method: It was a cross-sectional study done in one of the tertiary hospitals in southeast Nigeria. The study participants were 164 children with SCA in steady state within the ages of 2 -17 years. A 12-lead ECG was carried out on the participants and their haemoglobin concentrations determined. The relationship between the presence of cardiac abnormality and independent variables like haemoglobin concentration, age and gender were analyzed.
Result: The prevalence of cardiac abnormality was 59.1%. The commonest cardiac structure abnormality was Left ventricular hypertrophy (LVH) (39.6%). Abnormality in the P-R interval was seen in 14.6%, while ST segment abnormality was seen in 18.3%. The mean Hb of those with abnormal ECG was lower than that of those without abnormal ECG, across each age group. Severe anaemia was a significant (p< 0.01) predictor of LVH. However, there was no significant association between the degree of anaemia and the occurrence of ST-segment (p: 0.26) and PR interval abnormalities (p: 0.52).
Conclusion: Cardiac anomalies are common findings in SCA children.
3 citations
TL;DR: NCEP-2020 has an important place in terms of scope in determining, developing and standardizing the educational curricula of medical faculties according to the innovations and the requirements of the era.
Abstract: Objective: Many branches of science are constantly changing and developing according to the innovations and the requirements of the era. Developments and medical information, especially in the field of medicine, renew itself every year. In this study, we aimed to analyze comparatively the place of anatomy education, which has an important place in undergraduate medical education, in the National Core Education Program (NCEP)-2020.
Material and Methods: In this study, the categories of basic medical practices in NCEP-2020, clinical symptoms/findings/situations, core diseases/clinical problems and the relationship between learning levels and anatomy education were evaluated one by one. Parameters were expressed in percentile using a descriptive statistical method. There are 157 Basic Medical Practices in 9 sub-categories (A-I) within the scope of NCEP-2020.
Results: It was determined that 48 of these were related to anatomy education. The number of basic medical practice was mostly in the E sub-category (n=23, 47.92%). The second sub-category with the highest number of basic medical practices was determined as B (n=16, 33.33%).
Conclusion: One of the important conclusions we have reached within the scope of the study is that NCEP-2020 has an important place in terms of scope in determining, developing and standardizing the educational curricula of medical faculties.
3 citations
TL;DR: It is thought that in cases with stroke, NLR, LMR and PMR levels can be used in predicting the prognosis of this disease and also significant in terms of showing that CVD type is hemorrhagic or ischemic.
Abstract: Objective: The aim of this study is to investigate whether Neutrophil / lymphocyte (NLR), Lymphocyte / MPV (mean platelet volume) (LMR) and thrombocyte / MPV (PMR) ratios obtained from the complete blood count, can be used as an effective marker in acute stroke for determining the prognosis and subtype of stroke.
Material and methods: Patients admitted to the emergency department with acute stroke symptoms between January 1, 2020 and December 31, 2020 were evaluated retrospectively. The patients were divided into two groups as hemorrhagic or ischemic cerebrovascular disease (CVD) according to the radiological findings. NLR, LMR and PMR ratios were calculated. The last diagnosis and hospitalization information were recorded and their 28-day mortality status was evaluated.
Results: A total of 764 patients were included in the study. The median age of the patients included in the study was 68 (IQR 25-75: 59-78) and 404 (52.9%) of the patients were male. In the analysis performed; it was observed that the LMR, NLR and PMR levels were significantly different in those who developed mortality on the 28th day (p = 0.009), (p = 0.002), (p = 0.026). In addition, only the NLR level was found to be significantly different in the ischemic group (p <0.001).
Conclusion: We think that in cases with stroke, NLR, LMR and PMR levels can be used in predicting the prognosis of this disease. Also, NLR is significantly higher in ischemic stroke, and also significant in terms of showing that CVD type is hemorrhagic or ischemic.
3 citations
TL;DR: The levels of VD do not have a significant role in the development of hematological toxicity after AC chemotherapy in patients with breast cancer, and VD level was inversely correlated with PLR-1 and MLR- 1, which is generally accepted as inflammatory markers.
Abstract: Objective: To investigate the relationship between serum Vitamin D (VD) level and the change of hematological parameters after chemotherapy in patients with breast cancer (BC) who received adjuvant Adriamycin and Cyclophosphamide (AC)
Material and Methods: A total of 74 BC patients who were treated with adjuvant 60 mg/m2 Adriamycin and 600 mg/m2 Cyclophosphamide (AC) were included in the study VD levels, complete blood count (CBC) findings after 1st cycle AC were retrospectively recorded The relationship between changes in CBC parameters according to VD levels and the presence of hematological toxicity was examined
Results: The mean age was 5511±997 years and the median VD level was 1278 (4-5340) ng/mL In all patient groups, there was a significant decrease in the values of lymphocytes and monocytes after chemotherapy (p=0030, p=0024 respectively) In the correlation analysis, there was no correlation between VD levels and hemoglobin levels, the number of cells in CBC-1, and the amount of change in the number of cells in after chemotherapy However, there was a negative correlation between VD level and platelet/lymphocyte ratio-1 (PLR-1), monocyte/lymphocyte ratio-1 (MLR-1) (p=0025, r:-0237; p=0001, r:-0370, respectively), but there was no correlation with PLR-2 and MLR-2 (p>005 all)
Conclusion: There was no relationship between VD levels and changes in hematological parameters and hematological toxicity related to AC chemotherapy in the patient with BC VD level was inversely correlated with PLR-1 and MLR-1, which is generally accepted as inflammatory markers This result showed that the levels of VD do not have a significant role in the development of hematological toxicity after AC chemotherapy in BC
3 citations
TL;DR: Four main mechanisms that may contribute to the development of Parkinson's disease and different diagnostic modalities will form the basis for the algorithm for the diagnosis and treatment of Parkinson’s disease and related conditions.
Abstract: Tarek Elshourbagy, Alveena Batool Syed, James Robert Brasic May 26, 2021 IntroductionParkinson's disease (PD) is the second most common neurodegenerative disorder afflicting 10 million people worldwide and the fourteenth leading cause of death in the United States. PD is caused by the death of dopaminergic neurons that regulate movement in the substantia nigra pars compacta. Mechanisms contributing to the development of PD in vulnerable individuals include protein misfolding, protein aggregation, and mitochondrial dysfunction. We have developed algorithms for diagnosis and treatment based on review of available knowledge.MethodsWe reviewed the key literature on the pathogenesis of PD in order to propose guidelines for the development of diagnostic and therapeutic interventions for people with PD and related conditions.We approximated qualitative ratings of the available tools in the form of categorical discrete measurements. We then utilized the discrete measurements to distinguish people with PD and other movement disorders, and healthy controls. We then correlated clinical ratings with output of instrumentation measuring the movements at the same time. We then utilized transforms of output signals and clinical measurements to apply machine learning to general proposed algorithms.Results and DiscussionIn about 25 percent of patients, clinicians incorrectly diagnose the PD. Causes of misdiagnosis include a lack of algorithm and inadequate use of diagnostic modalities. Four main mechanisms that may contribute to the development of PD (misfolding of alpha synuclein, mitochondrial dysfunction, dysfunctional ubiquitin proteosomal pathways, and abnormal autophagy) and specific diagnostic modalities (structured interview and examination, laboratory assessments, neuropathology, genetic testing, neuroimaging)) form the basis for our algorithm for the diagnosis and treatment of PD.. Clinicians, administrators, policy planners, advocates, and other concerned individuals will benefit from the adoption of our guidelines for the diagnosis and treatment of Parkinson’s disease and related conditions. ConclusionClinicians, administrators, policy planners, advocates, and other concerned individuals will benefit from the adoption of our guidelines for the diagnosis and treatment of Parkinson’s disease and related conditions.
2 citations
TL;DR: Low serum VD levels were found to be an independent risk factor for the development of Type 2 Diabetes Mellitus and its complications in patients and those having complications of T2DM than the healthy individuals.
Abstract: Objective: Vitamin D (VD) could play a role in pathogenesis of Type 2 Diabetes Mellitus (T2DM) by affecting either insulin sensitivity or pancreatic β-cell function. This article is about the relationship between T2DM and VD levels.
Material and Methods: The 4678 individuals were included in the study. Of these, 1764 were T2DM patients and 2914 were healthy individuals. Correlation analysis was carried out between VD, age, Body Mass Index (BMI), Hemoglobin A1c (HbA1c), and duration of illness in the T2DM patients. Logistic regression analysis was used to determine the independent predictors.
Results: VD levels were significantly lower in the T2DM patients compared to the control group. The VD level of T2DM patients with HbA1c >7% was lower than those with HbA1c <7%. The VD level of T2DM patients using insulin was found to be significantly lower compared to those not using insulin. Among the T2DM patients, VD level was found to be the highest in those without complications and the lowest in those with nephropathy. The cut-off value for VD was calculated as 16.95 ng/mL. According to the logistic regression test, low serum VD levels were found to be an independent risk factor for the development of T2DM and its complications.
Conclusion: VD deficiency may be a risk factor for the development of T2DM. In our study, VD levels were significantly lower in the T2DM patients and those having complications of T2DM than the healthy individuals.
2 citations
TL;DR: In rare RCC subtypes such as nccRCC and sRCC, lower PLR may be associated with better PFS and OS, and in the Cox-regression model only PLR was the independent predictive factor for both PSF and OS.
Abstract: Objective: Inflammatory markers have prognostic significance for renal cell carcinomas (RCC) as in many types of cancer. The prognostic effect of inflammatory markers in the rare histological subtypes of RCC has not been adequately evaluated. In our study, we aimed to evaluate the relationship between basal inflammatory indices (neutrophil to lymphocyte ratio [NLR], platelet to lymphocyte ratio [PLR], lymphocyte to monocyte ratio [LMR], and systemic immune-inflammation [SII]) and survival (progression-free survival [PFS] and overall survival [OS]).
Material and Methods: Patients with metastatic non-clear cell RCC (nccRCC) or RCC with sarcomatoid differentiation (sRCC) were included in the study. The relationship between inflammatory indices, which was calculated before any systemic treatment and survival, were retrospectively assessed.
Results: Thirty patients, predominantly males (n = 20, 66.7%), with a median age of 59.1 (IQR, 52.5-70.3) years, were included in the study. Median PFS achieved with first-line tyrosine kinase inhibitors for patients with a PLR level less or greater than the median value (238) was 12.6 (95% CI 1.4-23.9) months and 4.8 (95% CI, 2.3-7.3) months, respectively (p = 0.021). Median OS for patients with a PLR level less or greater than the median (238) was 16.7 (95% CI, 3.7-29.7) months and 8.6 (95% CI, 4.9-12.3) months (p = 0.008), respectively. In the Cox-regression model (including gender, age, presence of metastasis at diagnosis, NLR, PLR, LMR, SII) only PLR was the independent predictive factor for both PSF (HR = 0.131; 95% Cl 0.028-0.620, p = 0.010) and OS (HR = 0.199; 95% Cl 0.048-0.819, p = 0.025).
2 citations
TL;DR: The study showed that there were scatter radiations to the breast during lumbosacral X-Ray investigations which was lowest among the age group 50-59years, and the cancer risk was approximately 1 in 2,155 indicating that there might be a need to shield the breast while performing lumbo-ray.
Abstract: Objective: Exposure to ionizing radiation during radiographic examination is associated with some biological effects. The study was aimed to determine the amount of scatter radiation to the breast during lumbosacral x-ray examination.
Materials and Methods: The study was a prospective, cross-sectional study carried out among 60 women referred for Lumbosacral spine radiography from September 2019 to December 2019. Ethical approval was granted by the hospital ethical committee. A single-phase mobile X-ray unit was used to dispense the radiation while a thermoluminescent dosimeter (TLD) chip was used to measure the radiation dose. The TLD chip was attached to the peri-areolar region of the left breast and held in place by a transparent adhesive tape. The TLD was carefully enclosed in a black polythene sachet before and after the investigation to shield it from background radiation. After the investigation the TLD,s were sent to the Centre for Energy Research and Training (CERT) for reading and annealing.
Results: The mean age and BMI of participants were 55.32±12.35years and 29.70±7.09kg/m2 respectively. The cumulative mean (±SD) ESD to the breast was 3.87±0.87mGy. The highest scatter radiation dose was observed in the age group 60-69 years. Pearson’s correlation showed a week correlation between age and ESD.
Conclusion: The study showed that there were scatter radiations to the breast during lumbosacral X-Ray investigations which was was lowest among the age group 50-59years. No significant difference was seen between AP and lateral positions. The cancer risk was 1 in 6,000 indicating that there might be needed to shield the breast while performing lumbosacral X-ray.
2 citations
TL;DR: This is the first Saudi child with succinyl-CoA:3-ketoacid CoA transferase (SCOT) deficiency case report as searched in the literature, and highlights the importance of suspecting SCOT deficiency in the differential diagnosis of pediatric metabolic ketoacidosis in preventing life-threatening of severe Metabolic keto Acidosis.
Abstract: Objective: Succinyl-CoA:3-ketoacid CoA transferase (SCOT) deficiency is a rare genetic disorder of ketone utilization and isoleucine catabolism caused by mutations in the OXCT1 gene,
Case: A Saudi girl case of SCOT deficiency confirmed by genetic analysis has been reported in this study. A 5-year-old girl presented to the emergency with the first episode of severe metabolic ketoacidosis after a febrile illness. On admission, she was drowsy lethargic, and severely dehydrated needs to admit in a highly dependent area. Initial investigations were done during the crisis showed refractory severe metabolic acidosis (pH of 7.18, HCO3- of 7.4 mmol/L), normal ammonia, lactic acidosis, and urine organic acid profile revealed elevations in 3-hydroxybutyrate and acetoacetate. Genetic analysis was done by CentoMito Comprehensive (Large extended screening panel), sequencing of OXCT1 gene revealed that the proband is homozygous for the missense likely pathogenic variant c.1402C>T p.(Arg468Cys) confirming the diagnosis of SCOT deficiency.
Conclusion: This is the first Saudi child with succinyl-CoA:3-ketoacid CoA transferase (SCOT) deficiency case report as searched in the literature. This case highlights the importance of suspecting SCOT deficiency in the differential diagnosis of pediatric metabolic ketoacidosis in preventing life-threatening of severe Metabolic ketoacidosis
2 citations
TL;DR: Amikacin, imipenem and meropenem were the most effective antibiotics against E. cloacae and K. aerogenes infections, and TMP-SMX and ciprofloxacin may be the first choice for parenteral antibiotics therapy.
Abstract: Objective: Enterobacter cloacae and Klebsiella aerogenes species have multiple drug resistance and antibiotic resistance is a growing problem regarding to treating infections.
Objective: The aim of this study was to determine and evaluate the antimicrobial resistance profiles of E. cloacae and K. aerogenes isolated from various clinical samples in our laboratory, retrospectively.
Material and Methods: Totally 223 patients who applied to Karabuk University Training and Research Hospital microbiology laboratory between October2016-December2020 were included in this study. Conventional methods and automated systems were used for the identification and antibiotic susceptibilities of strains. Antibiotic susceptibility results were evaluated as per the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines.
Results: Total of 223 clinical samples (urine 68.6%, blood 12.6%, endotracheal aspirate 7.2%, wound 4.9%, sputum 3.6%, bronchoalveolar lavage fluid 2.7%, and ear fluid 0.4%) obtained from 223 patients; 119 (53%) females and 104 (47%) females, were analysed. The identified species were E. cloacae (132 strains, 59.2%) and K. aerogenes (91 strains, 40.8%). The Enterobacter cloacae and Klebsiella aerogenes positivity was detected as 30(13.4%) and 20(9.0%) in the samples. The highest resistance was found against cefixime at a rate of 60%; the lowest resistance was against amikacin, meropenem and imipenem ranged between 3% and 4% in both E. cloacae and K. aerogenes strains.
Conclusions: Amikacin, imipenem and meropenem were the most effective antibiotics against E. cloacae and K. aerogenes. We may prefer TMP-SMX and ciprofloxacin, as oral antibiotic agents in the treatment of E. cloacae/K. aerogenes infections. Amikacin, gentamicin and carbapenems may be the first choice for parenteral antibiotics therapy
TL;DR: It is concluded that phthalates cause structural and functional changes within rat internal organs such as lungs, brain, and heart.
Abstract: Objective: Phthalates, despite their endocrine disrupting effects, are widely used as plastifiants. Environmental exposure of phthalates was demonstrated to cause fetal death and reproductive toxicity in human beings, as well as in laboratory animals. However, underlying mechanisms are not clear.
Material and Methods: Here, we examine the impact of di(2-ethylhexyl) phthalate (DEHP) and dibutyl phthalate (DBP)on rat lungs, brain and heart by scanning acoustic microscopy (SAM) and inductively coupled plasma optical emission spectroscopy (ICP-OES). First, we evaluate tissues of mother rats and we show that the acoustic impedance values oftissues of DEHP and DBP delivered rats differ from those of tissues of the control rat. Then, element level analyses withinthese tissues are done and element levels within tissues of DEHP and DBP delivered pregnant rats are found to be higherthan those within tissues of the control pregnant rat. We then evaluate the tissues of offspring female rats.
Results: It is shown that acoustic impedance values of tissues of offspring rats of DEHP and DBP delivered mother rats are higher than those of tissues of the control offspring rats of the control mother rat. Besides, element analysis revealshigher element levels in the tissues of offspring rats of DEHP and DBP delivered mother rats.
Conclusion: Therefore, we can conclude that phthalates cause structural and functional changes within rat internal organs such as lungs, brain and heart. In summary, both modalities are confirmatory in a way that tissues of DEHP and DBP exposed pregnant rats and their offspring rats are differentiated by different acoustic impedance values obtained by SAM and higher element levels specified by ICP-OES.
TL;DR: Scientific articles argue about the short and long term consequences on bone health resulting from the social isolation and the subsequent sedentary behaviors, whereas experts focus their scientific interest at guidelines for diagnosis, management and prevention of osteoporosis in the era of the COVID-19 pandemic.
Abstract: The worldwide predominance of coronavirus disease 2019 (COVID-19) pandemic will have tremendous consequences on bone health of the general population and specifically to the bone mineral density of both young and elderly adolescents, due to sedentary lifestyle resulting from the prolonged and repeated lockdown. Scientific articles argue about the short and long term consequences on bone health resulting from the social isolation and the subsequent sedentary behaviors, whereas experts focus their scientific interest at guidelines for diagnosis, management and prevention of osteoporosis in the era of the COVID-19 pandemic
TL;DR: In patients with Vitamin D levels >20, there was a significant correlation between vitamin D and NLR and a moderate correlation between Vitamin D andCRP and a positive correlation of Vitamin D with CRP andNLR.
Abstract: Objective: Objective: We aimed to evaluate the association of neutrophil-lymphocyte ratio (NLR) and C reactive protein (CRP), ferritin, sedimentation levels with vitamin D concentrations in Covid-19 patients and to investigate their effect of levels on Covid-19 patients.
Materials and Methods: Forty-six patients aged 18-85 were included in our study. Our study is a retrospective study. Patients were divided into 2 groups with the first group consisting of those with vitamin D level 20 and below and 2nd group consisting of those with vitamin D level above 20. After Vitamin D, CRP, neutrophil, and lymphocyte values were retrospectively investigated with the hospital database, vitamin D levels were compared to CRP and neutrophil/lymphocyte ratio.
Results: A positive correlation between CRP and SED, CRP and ferritin, NLR, and ferritin was observed in Covid-19 positive patients with Vitamin D level > 20. A positive correlation between NLR and CRP was observed in Covid-19 positive patients with Vitamin D level ≤ 20.
Conclusion: In patients with Vitamin D levels >20, there was a significant correlation between vitamin D and NLR and a moderate correlation between Vitamin D and CRP. In patients with Vitamin D levels <20, there was a positive correlation of Vitamin D with CRP and NLR.
TL;DR: It is found that the cast ends’ being marked by folding during plastering in idiopathic clubfoot patients treated with Ponseti technique is costless, easy to apply, significantly shortens cast removal time, does not require the use of cutting tools, and thus is a notably safe method for these patients.
Abstract: Objective: In our study, it is aimed to remove the cast more easily and safely without using the cutting tools by leaving the cast ends marked by folding in the idiopathic clubfoot patients treated with Ponseti method.
Material and Methods: Forty feet of 29 patients treated for Pes Equinovarus were included in the study. Patients were followed up in two groups. The group treated with Ponseti method by cast marking were named as “modified group” and cast wrapped group without marking were named as “classical group”. Neurological, teratologic and syndromic clubfoot patients were not included in the study. During the six series of casting, cast removal times for each extremity are recorded in minutes and it is noted that whether any additional cutting tool is used during cast removal or not. A summary of the data was presented as mean, standard deviation and percentage. Comparisons of the categorical characteristics were analysed by using the Chi-square test and the Mann-Whitney test. IBM-SPSS 20 program was used for analysis. In all tests, the level of significance was adjusted to 0.05.
Results: Thirteen (44.8%) of the 29 patients were male and 16 (55.2%) were female. While the mean time to start treatment for the 15 patients in the modified group was 3.46 (2-7) days, mean time for the 14 patients in the classical group was 3.78 (2-10) days. While the mean cast removal time of the 20 extremities of 15 patients in the modifying group was 10.9 minutes (8-14.3 min);it was 22.2 minutes (17.1-29.5 min) for the 20 extremities of 14 patients in the classical group. While no additional cutting tool was used during cast removal in the modified group, additional cutting tools were used during removal of cast in 75% (15/20) of the patients in the classical group and statistically significant difference was found between two groups in terms of the use of cutting tools (p<0.001).
Conclusion: We found that the cast ends’ being marked by folding during plastering in idiopathic clubfoot patients treated with Ponseti technique is costless, easy to apply, significantly shortens cast removal time, does not require the use of cutting tools, and thus is a notably safe method for these patients.
TL;DR: There is a need for well-standardized phenotypic tests with defined evaluation criteria and further studies to verify these tests genotypically for antibiotic resistance and inducible betalactamase rates in P. aeruginosa isolates.
Abstract: Objective: This study aimed to determine the antibiotic resistance, inducible beta-lactamase (IBL), and Metallo beta-lactamase (MBL) rates in P. aeruginosa isolates.
Material and Methods: In our study, 100 P. aeruginosa isolates obtained from various clinical samples were used. Antibiotic susceptibility was performed by using the Kirby-Bauer disk diffusion method. Carbapenem resistance to imipenem and meropenem was verified by the E test. The disk induction method was used to determine the IBL production while the Modified Hodge test, MBL E test, and combined imipenem/ EDTA disk were used to determine the production of MBL.
Results: According to the results of antibiotic susceptibility tests, 58% of P. aeruginosa isolates were susceptible to all antipseudomonal drugs, while resistance rates to other drugs were as follows; ceftazidime 7%, cefoperazone sulbactam 8%, cefepime 13%, piperacillin 14%, piperacillin-tazobactam 12%, imipenem 9%, meropenem 11%, aztreonam 8%, amikacin 8%, gentamicin 13%, tobramycin 12%, netilmicin 19%, There was a 10% resistance to ciprofloxacin. 8% of the isolates were resistant to at least three drugs, of which two isolates were positive for MBL enzyme production. IBL production was detected in 86% of the isolates with the disk induction method.
Conclusion: The results we obtained in our study are consistent with other researchers globally and in Turkey. It was concluded that there is a need for well-standardized phenotypic tests with defined evaluation criteria and further studies to verify these tests genotypically.
TL;DR: Examination of histologic features of parotid glands and glossopharyngeal nerves in a rabbit model of SAH concluded that decreased salivary secretion due to secretory gland atrophy originated from ischemia-induced GPN network degeneration at the brainstem, which may be responsible for cranial hyperthermia following SAH.
Abstract: Objective: We speculated that subarachnoid hemorrhage (SAH) induces ischemic lesions in the cranial parasympathetic nerves, which may decrease saliva secretion and lead to hyperthermia. We tested this hypothesis by examining histologic features of parotid glands and glossopharyngeal nerves (GPNs) in a rabbit model of SAH.
Material and Methods: Rabbits (n = 25) were divided into control (n = 5), sham (n = 5), and SAH (n = 15) groups. Animals in the sham and SAH groups were examined over a 3-week period before sacrifice. Salivation score (SC) was determined by measuring the mean wetted area of an orally inserted cotton ball. Sections of parotid glands and intracranial and intraparotideal branches of the GPNs were stained with hematoxylin and eosin and SAH-induced damage was analyzed by terminal deoxynucleotidyl transferase dUTP nick end labeling of apoptotic cells. Specimens were stereologically examined to determine saliva-filled total vesicle volume (TVV) per cubic meter; vasospasm index (VSI) based on wall/lumen ratio of parotid glands arteries, and degenerated neuron density (DND) of glossopharyngeal ganglia.
Results: The mean oral temperature was 36.9°C. In the control group, mean values were as follows: SC, 46±8 mm2; DND, 19±4/mm3; VSI, 1.065±0.049; and TVV, (780±1187) × 106/µm3. In the sham group, mean values were as follows: SC, 31±6 mm2; DND, 98±23/mm3; VSI, 1.67±0.32; and TVV, (617±110) × 106/µm3. In the low hyperthermia SAH group, mean values were as follows: SC, 16±5 mm2; DND, 1520±261/mm3; VSI, 2.12±0.21, and TVV, (314±98) × 106/µm3. In the high hypothermia SAH group, mean values were as follows: SC, 9±2 mm2; DND, 3210±912/mm3; VSI, 3.18±0.30; and TVV, (432±99) × 106/µm3.
Conclusions: Decreased salivary secretion due to secretory gland atrophy originated from ischemia-induced GPN network degeneration at the brainstem, which may be responsible for cranial hyperthermia following SAH.
TL;DR: In this article, the authors assessed the characteristics and predictors of outcomes of patients with solid tumors in medical ICU and identified the predictors for ICU mortality and ICU long stay (≥21 days).
Abstract: Objective: There is a paucity of research on the factors predicting mortality and a length of stay in the Intensive Care Unit (ICU) with solid tumor patients. This study will assess the characteristics and predictors of outcomes of patients with solid tumors in medical ICU.
Material and Methods: This research has been designed as a retrospective observational study using an ICU database. Patients who have a solid tumor were included in the study (May 2015 to July 2018). Post-surgical and those with a length of stay of more than one day are excluded from the study. We identified the predictors for ICU mortality and ICU long stay (≥21 days).
Results: Out of 2883 patients, 364 patients with solid tumors were enrolled. The commonest sites for solid tumors were breast (15.9%), colorectal (11.5%), and lung (9.9%). 158 (43.4%) had metastatic disease, and 264 (72.5%) with progressive disease. The major reasons for ICU admission were a respiratory failure (52.7%) and severe sepsis (52.2%). The ICU and hospital mortality rates were 32.4% and 47%, respectively. Fifty patients (13.7%) had long stayed (≥ 21 days) in ICU. The independent predictors for mortality were Sequential Organ Failure Assessment (SOFA) score (OR, 1.2; 95% CI, 1.1–1.3; P=.000), invasive ventilation (OR, 3.5; 95% CI, 1.5–8.3; P=.004) and vasopressor (OR, 2.6; 95% CI, 1.1–5.9; P=.018), while the independent predictors of long-stay were ICU infections (odds ratio [OR], 18.9; 95% CI, 5.3 – 66.7; P=.0001), SOFA score (OR, 1.5; 95% CI, 1.2–1.8; P=.0001), invasive ventilation (OR, 8.2; 95% CI, 1.6–40.4; P=.009), bilirubin (OR, .5; 95% CI .2–.9; P=.049).
Conclusion: Irrespective of the cancer stage, patients had a reasonable survival, and most do not require a long stay in the ICU. Flexibility in admission should be considered as disease progression and metastatic disease were not independent predictors of ICU mortality or long stay in this study.
TL;DR: A 22 year old female presenting with pain and localized swelling in the dorsum of the midfoot was found to have a ganglion cyst emerging from an articulating os intermetatarsium.
Abstract: Objective: Sesamoid and accessory bones are commonly found in the foot and ankle with varying incidence. The Os intermetatarsium, located between the medial cuneiform and the base of the first and second metatarsal, occurs rarely and is frequently asymptomatic. Few symptomatic cases of this condition are reported in the literature. The development of synovial ganglion cyst over an os intermetatarsium is a more occasional finding not clearly reported in the literature.
Case: Here we report the case of a 22 year old female presenting with pain and localized swelling in the dorsum of the midfoot who was found to have a ganglion cyst emerging from an articulating os intermetatarsium.
Conclusion: Although not a common entity, an Os intermetarsium, with its associated complications, can be one of the causes of dorsal foot pain.
TL;DR: The possibility of metastasis is also present in cases with a single lesion and whose primary diagnosis is unknown, and histomorphological analysis become inevitable due to the increase in molecular examinations and the development of patient-specific treatment protocols.
Abstract: Objective: The aim of this study is to determine the demographic and clinical findings of cases which have been operated for a brain mass and have metastasis, to analyse the histopathological findings, to draw attention to the molecular tests that are effective in the treatment of the primary tumour, and to compare our results with the literature data.
Material and Methods: One hundred seventy cases diagnosed with brain metastasis tumour between January 2012-2021 were analysed retrospectively. The clinical findings and demographic information of the cases were recorded from the hospital information system. The diagnoses of the patients diagnosed with metastasis, the analysis of the cases with or without a primary tumour at the time of diagnosis, and the immunohistochemical staining applied to detect the primary metastasis were recorded.
Results: Sixty-seven of the cases were female, and one hundred three were male. The youngest case was 14, and the oldest case was 90 years old (Mean 55.6 ± 14). While the clinical findings in 35 of the cases were solely headache, 41 patients also had at least one of the symptoms such as dizziness, seizure, weakness, and ataxia in addition to headache. The primary was unknown at the time of diagnosis of brain metastasis in 63 of the cases. There was a single focus in 107 cases, and multiple metastasis focus in 63 patients. Among all cases, lung (84), breast (24) colorectal (15), kidney (9) metastases were the most common. Primary focus could not be detected in 2 of the cases (neuroendocrine carcinoma and adenocarcinoma) despite all imaging techniques as well as immunohistochemical findings.
Conclusion: The possibility of metastasis is also present in cases with a single lesion and whose primary diagnosis is unknown, and histomorphological analysis become inevitable due to the increase in molecular examinations and the development of patient-specific treatment protocols. Besides, it should not be forgotten that the most common tumour-causing brain metastasis -whether or not the primary is known- is the lung. Kidney tumours may also present with metastasis without manifesting themselves.
TL;DR: Treatment approaches utilized in rural hospitals are in line with the universal trends, however, considerably higher MDA compared to previous studies show that; to provide early diagnosis and better prognosis for ASD patients who live in rural areas, new interventions should be promoted by the local and/or general authorities.
Abstract: Objective: In addition to the core symptoms of Autism Spectrum Disorder (ASD); symptoms such as aggression, self-harm, impulsivity, hyperactivity, anxiety, and mood problems are also often present Medication use is frequent and studies report that 27-40% of ASD patients use at least one psychotropic medication We aimed to examine the clinical and sociodemographic features and treatment modalities of ASD patients who were referred to a rural hospital in the last two years
Material and Methods: Age, gender, mean diagnosis age (MDA), type of ASD, psychiatric symptoms, medication (if they use one) types, and doses were recorded for 200 children with ASD (who were referred between August 2018 – August 2020) were retrospectively evaluated Also, patients who were diagnosed with “childhood autism (CA)” and “other ASD diagnoses” were compared
Results: The majority of the patients were male, the MDA value of the all patients was 456 (±22) years and there were no significant differences between groups regarding MDA (p = 0053) Most frequently seen psychiatric symptoms were behavioral (33%) and attention problems (21%) and 525% of patients (n=105) were using at least one psychotropic medication Patients with CA had higher rates of psychotropic medication use (p=0010) and the most frequently used medication group was antipsychotic drugs (924%)
Conclusion: Treatment approaches utilized in rural hospitals are in line with the universal trends However, considerably higher MDA compared to previous studies show that; to provide early diagnosis and better prognosis for ASD patients who live in rural areas, new interventions should be promoted by the local and/or general authorities
TL;DR: Tocilizumab appears as an effective therapeutic option for improving oxygenation, symptoms and laboratory surrogates of ongoing inflammation in subjects with severe COVID-19.
Abstract: Objective: This study aimed to investigate the impact of tocilizumab, an IL6R inhibitor, on clinical features and laboratory tests of subjects admitted with severe COVID-19 and respiratory failure.
Material and Methods: A total of 30 patients with positive polymerase chain reaction for COVID-19 and respiratory failure were analyzed in a retrospective manner. All patients received 8mg/kg body weight tocilizumab i.v. once in addition to the standard COVID-19 treatment protocol, including Oseltamivir phosphate 75mg twice daily, hydroxychloroquine 200 mg twice daily, and azitromycine 250 mg once daily following a 500 mg loading dose. Demographic characteristics, and clinical features including oxygen saturation, the concentration of oxygen inhalation, body temperature, mean arterial pressure and heart rate, and SpO2, end-tidal CO2, and blood tests including complete blood count, procalcitonin, C-reactive protein (CRP), Troponin-I, D-dimer, and liver and kidney function tests were recorded before and after treatment with tocilizumab.
Results: A significant increase occurred in SaO2 on first and third days following treatment with tocilizumab (84.3 % and 90.3%, respectively, p<0.001 for both recordings compared to baseline). There was also a significant increase in end-tidal CO2. The increase in mean SaO2 after tocilizumab was followed by a decline in respiratory rate on the first and third days of treatment. A dramatic decline was observed in body temperature from the first day of treatment with tocilizumab. Lymphocyte count increased following tocilizumab and C-reactive protein and Troponin I levels were reduced.
Conclusion: Tocilizumab appears as an effective therapeutic option for improving oxygenation, symptoms and laboratory surrogates of ongoing inflammation in subjects with severe COVID-19.
TL;DR: It is unanimous that further educational and promotional campaigns are needed to enhance the students; help-seeking behaviors, reduce stigmatizing behaviors and create more preventive public health services on campus, but also out-campus due to the Covid-19 pandemic.
Abstract: Objective: The university medical services vary around the world (even within each university), but there are only a few publications on the utilization of these services by the students. The available on-campus services of public health care might include general health care, women’s centers, mental health care, disability services, wellness resource centers, career counseling, and alcohol and other drug education programs.
Evidence Acquisition: This paper reviews the current literature on the overtime and current (due to Covid-19 pandemic) public health needs of college students based on studies that report the commonest specific diagnostic reasons for using the on-campus health care services.
Results: Special reference is done on mental health problems among students generally and the students of health professions fields (a specific category themselves). Besides, other issues of interest are the substance-related problems among students and their perceptions about mental health problems and on- campus help- seeking services.
Conclusions: It is unanimous that we need further educational and promotional campaigns to enhance the students; help-seeking behaviors, reduce stigmatizing behaviors and create more preventive public health services on campus, but also out-campus due to the Covid-19 pandemic.
TL;DR: The lymphocyte value of ≤ 1500/mm3 and D-dimer value of ≥ 2 mg/L can be used in the early determination of patients with poor prognosis in COVID-19 and will help predict prognosis and make rapid treatment decisions in patients with CO VID-19.
Abstract: Objective: Coronavirus Disease 2019 (COVID-19) is characterized by high fever, sudden developing respiratory distress, and radiological findings failing to respond to conventional treatments. The purpose of this study is to identify the association of D-dimer levels and lymphocyte counts with poor prognosis and to predict the clinical course in patients with COVID-19.
Methods: A total of 118 hospitalized adult patients diagnosed with COVID-19 were included in the study. According to the National Institutes of Health (NIH) COVID-19 treatment guidelines, patients were divided into two groups with severe disease (n= 26) and non-severe (n= 92) disease. Detected at the time of diagnosis, D-dimer levels and lymphocyte counts were compared between severe and non-severe COVID-19 patient groups. Distinctive performance analysis of these values was performed, and cut-off values were determined.
Results: The mean age of patients was 62 ± 7 years (range 42-80 years), and 63 (53.4 %) were female. The lymphocyte count was lower (p <0.001), and D-dimer was higher in patients with severe COVID-19 compared to non-severe patients (p <0.001). D-dimer's cut-off point when the sum of specificity and sensitivity is maximized was 2 mg/L (sensitivity, 0.731; specificity, 0.913), and 1500/mm3 was for lymphocyte count (sensitivity, 0.692; specificity, 0.609). Lymphocyte count and D-dimer had a significant discrimination power (AUC: 0.745 [95 CI: 0.644 - 0.846 ], AUC: 0.928 [95% CI: 0.879 - 0.978] respectively, p <0.0001).
Conclusion: The lymphocyte value of ≤ 1500/mm3 and D-dimer value of ≥ 2 mg/L can be used in the early determination of patients with poor prognosis in COVID-19. Using these cut-off values for D-dimer and lymphocyte count will help predict prognosis and make rapid treatment decisions in patients with COVID-19.
TL;DR: Breast cancer risk increases in pregnant and breastfeeding patients and it is important to perform a breast examination by a physician before or at the beginning of pregnancy and breast self-examination to reduce the incidence of breast cancer.
Abstract: Objective: Pregnancy-associated breast cancer is breast cancer that occurs during pregnancy or within 1 year after birth. It occurs in one out of 3000-10000 pregnancies and is the most common cancer occurring during pregnancy and the postpartum period. It was aimed to reveal the incidence of pregnancy-associated breast cancer in pregnant and lactating patients in a city with high fertility rates.
Methods; Patients who presented with breast pain and palpable mass in the breast in the first year of pregnancy and lactation between December 2018 and November 2020 were prospectively recorded. 314 patients were included in the study.
Results; The mean age of the patients was 28.7 ± 6.1 years. 258 (82.1%) of the patients were Turkish and 56 (17.8%) were Syrian nationals. The most common complaints were pain in the breast, palpable mass, redness, and breast swelling. A palpable mass in the breast was detected in 39 (12.4%) patients. As a result of the examinations and tests performed in both patients, a diagnosis of malignancy was made.
Conclusion; Breast cancer risk increases in pregnant and breastfeeding patients. To reduce the incidence of breast cancer, it is important to perform a breast examination by a physician before or at the beginning of pregnancy and breast self-examination. From the moment of diagnosis, general surgery, obstetrics and oncology clinics should be followed with a multidisciplinary approach
TL;DR: Shortened APTT levels in cases without a history of anticoagulant use at the time of admission can be considered to be a predictive and effective tool for clinicians in arterial embolic events (AIS and ACS).
Abstract: Objective: The main causes of thromboembolic events are atherosclerosis, vascular endothelial injury, and hypercoagulability Coagulation is activated through two basic mechanisms, including intrinsic and extrinsic pathways, leading to thrombin production as a result of a series of enzymatic reactions The intrinsic pathway is evaluated with activated partial thromboplastin time (aPTT) and extrinsic pathway with prothrombin time (PT) This study aimed to investigate the relationship between thromboembolic diseases and coagulation parameters
Material and Methods: Patients diagnosed with acute ischemic stroke (AIS) (n=216), acute coronary syndrome (ACS) (n=25), pulmonary thromboembolism (PTE) (n=15), and patients without an emergency pathology (n=71) (Control Group) in the emergency department were retrospectively reviewed in the period from 01 November 2016 to 31 March 2019
Results: The aPTT (2561±593 sec), PT (1205±226 sec), and INR (104±019) values of the AIS group were statistically significantly lower compared to values of the control group (p = ˂0001, ˂0001 and ˂0001 respectively) Similarly, the aPTT (2715±897 sec), PT (1226±275 sec), and INR (103±025) values of the ACS group were statistically significantly lower compared to those of the control group (p=0012, 0030, and 0001, respectively) There was no statistically significant difference between the PTE group and control group in terms of aPTT, PT, and INR values (p= 0133, 0758, and 0711, respectively)
Conclusion: Shortened aPTT levels in cases without a history of anticoagulant use at the time of admission can be considered to be a predictive and effective tool for clinicians in arterial embolic events (AIS and ACS)
TL;DR: In this article, the authors investigated the relation of platelet count (PLT), mean platelet volume (MPV) and platelet distribution width (PDW) with other acute phase reactants in COVID-19 new corona virus.
Abstract: Objective: We aimed to investigate the relation of platelet count (PLT), mean platelet volume (MPV) and platelet distribution width (PDW) with other acute phase reactants in COVID-19 new corona virus.
Material and Methods: Thirty one patients with COVID-19 were included in to study. There were three groups as outpatient (Group 1, OP)(n=6), hospital (Group 2, H)(n=16) and intensive care unit (Group 3, IC)(n=9) in this analytic study.
Results: WBC (White Blood Cell), CRP (C-Reactive Protein) values were significantly different in all groups. PDW values were significantly lower in Group 3 than Group 1, 2. The result of ROC analysis was 10.9 as a cut-off value (Area under the curve, AUC)=0.407)
Conclusions: This study indicates that lower PDW may frequently develop in COVID-19 cases and there is a relation between thrombocytosis and acute phase reactants, that is, the inflammatory response. So we can offer that PDW should be used as a marker of Covid-19 disease severity, but it needs more studies in the future.
TL;DR: In this article, a systematic review of published MCDAs in oncology to identify the criteria considered valuable by the stakeholders, evaluate the adherence to best practice recommendations, and propose a value tree, based on the findings of the systematic review, reflecting the most important criteria for the different stakeholders.
Abstract: Objective: This study aims for three purposes: a) review the published MCDAs in oncology to identify the criteria considered valuable by the stakeholders, b) evaluate the adherence to best practice recommendations, and c) Propose a value tree, based on the findings of the systematic review, reflecting the most important criteria for the different stakeholders.
Material and Methods: This systematic review consisted of the following phases: identification, screening, eligibility assessment, assessment of adherence to best practices, and extraction of the information. The identification was conducted in PUBMED, EMBASE, EBSCO, SCIENCE DIRECT, SCOPUS, LILACS, and Web of Science including records from January 1st, 1990, to February 28th, 2021. The adherence to best practices in MCDA were evaluated. A new value tree was made.
Results: Thirteen articles were included. Colon, breast, and hematological cancer were the most frequently evaluated (n=10, 69,2%). Physicians and patients were the most representative participants. The value measurement approach was the most used (n=11, 84,6%). The overall adherence rate to the recommendations was 77,3%. One hundred ninety-five criteria were identified. The relevant criteria for all stakeholders were “Improvement clinical efficacy" (24,5%), "Severity of disease" (13,5%), and "Improvement of safety & tolerability." (10,3%). The physicians valued "Improvement clinical efficacy" (28,4%), "Severity of disease" (10,5%), and "Improvement of safety & tolerability." (8,4%) The most relevant criterion for the patients was "Severity of disease" (34,4%), "Improvement of clinical efficacy." (24,1%), and "Improvement of perceived health status" (13,8%). The significant criteria for administrative and academics were "Innovativeness of intervention" (37%) and "Improvement clinical efficacy" (14,8%).
Conclusion: The number of MCDAs in oncology is scarce and with moderate adherence to best practice recommendations. A value tree based on relevant criteria was proposed.
TL;DR: Measurement of LUS, in patients who had previous cesarean section, can be used for risk assessment and management and is a non-invasive, reliable and, easily applicable method.
Abstract: Objective: The purpose of the study was to establish the validity of the abdominal evaluation of lower uterine segment (LUS) thickness in patients having a previous cesarean section (CS) in predicting uterine rupture, and to evaluate if there is any effect of the number of a previous surgeries on adverse maternal and perinatal outcomes.
Materials and methods: A prospective case-control study was carried out between December 2017 and June 2018 in Dr. Zekai Tahir Burak Women’s Health Education and Research Hospital. 555 patients were classified into three groups; Group 1: patients having one previous CS, Group 2: patients having two previous CS, Group 3: patients having more than the two previous CS). Ultrasonographic measurements of the LUS, intraoperative findings and, adverse pregnancy outcomes were assessed.
Results: LUS thickness of group 2 was significantly less than the LUS thickness of the other groups (p=0.022). The feeling of pain was significantly more in the patients of group 2, when compared with the other groups (p=0.019). Pregnancy interval was the only parameter that had significant predictivity for adverse pregnancy outcomes for group 1(#CS=2) and group 3 (#CS≥4) (p=0.042, and p=0.021, respectively). In group 2 (#CS=3), age, the thickness of LUS, and thickness of subcutaneous adipose tissue were found to have significantly high predictivity for adverse pregnancy outcomes (p=0.012, p≤0.001, and p=0.007, respectively).
Conclusion: Measurement of LUS, in the patients who had previous CS, can be used for risk assessment and management. It is a non-invasive, reliable and, easily applicable method. Standardization of the measurement technique is a necessity.
TL;DR: Branchial cleft cysts should be excised before reaching large sizes, as they may cause pain and pressure on the surrounding tissue, although rare.
Abstract: Objective: Branchial anomalies are congenital pathologies that are seen in the lateral region of the neck and are generally benign. The branchial clefts develop in the 2nd-7th weeks of fetal life as embryonal development. The branchial anomalies are caused by non-disappearance, abnormal development and, incomplete emerger of the branchial clefts and pockets during embryonal development. The branchial anomalies are generally seen as the cyst. The most common cyst was the second branchial cleft cyst with 95%. Their diameter is usually a few centimeters.
Case: A 37-year old male patient was admitted to the hospital because of a swelling on the left side of his neck for four years. Physical examination revealed a mobile cystic mass in level 2 at the upper left jugular region of the neck. The cystic mass and the surrounding lymph nodes were excised and sent to the pathology laboratory. A cystic mass, approximately 5x4x3.5 cm in size, containing cystic areas was observed macroscopically. Microscopically, the cyst was lined with squamous epithelium and contained large lymphocyte groups in the subepithelial area. The case was reported as the branchial cleft cyst.
Conclusion: Branchial cleft cysts should be excised before reaching large sizes, as they may cause pain and pressure on the surrounding tissue. In addition, it should be kept in mind that malignancy may develop from branchial cleft cysts, although rare.