Mortality Factors in Crush Syndrome.

BACKGROUND: Crush Syndrome is a major cause of morbidity and mortality following large-scale catastrophic earthquakes. Since there are no randomized controlled studies on Crush Syndrome, knowledge on this subject is limited to expert experience. The primary objective is to analyze the epidemiological and demographic characteristics, clinical outcomes, and mortality factors of earthquake victims after the Pazarcik and Elbistan earthquakes on February 6, 2023. METHODS: This cross-sectional and observational retrospective study evaluated 610 earthquake victims who presented to our center between February 6 and April 30, 2023. Among these patients, 128 with Crush Syndrome were included in the study. Patient information was gathered from hospital records during their stay and from national registries upon referral. The primary outcome was to identify risk factors for mortality. Demographic and laboratory data were analyzed by acute kidney injury (AKI) stages; mortality-affecting factors were identified through regression analysis. RESULTS: Of the 128 Crush Syndrome patients (100 adults, 28 children), 64 were female. The AKI rate was 32.8%. Among patients with AKI, the frequency of hemodialysis requirement was 69%, and the mortality rate was 14.2%. The overall mortality rate for patients with Crush Syndrome was 4.6%, compared to 3.9% (19/482) in earthquake victims without Crush Syndrome (p=0.705). Notably, low systolic blood pressure at admission was the only factor significantly affecting mortality in Crush Syndrome patients (Hazard Ratio [HR]: 1.088, p=0.021, 95% Confidence Interval [CI]). CONCLUSION: Our study highlights low systolic blood pressure upon admission as a significant risk factor for increased mortality in Crush Syndrome patients. This finding may contribute to the literature by emphasizing the importance of monitoring blood pressure under rubble and administering more aggressive fluid therapy to patients with low systolic blood pressure.

Diagnostic Performance of Thyroid Nodule Risk Stratification Systems: Comparison of ACR-TIRADS, EU-TIRADS, K-TIRADS, and ATA Guidelines.

ABSTRACT: The purpose of this study was to compare the diagnostic performance of 4 different ultrasound-based risk scoring systems for thyroid nodules (TNs). This study consecutively included 256 patients (mean age: 43.98 ± 12.94 years, min-max: 18-89 years; 225 females, 31 males) with 266 TNs. Each nodule was evaluated and classified according to the American Thyroid Association (ATA), American College of Radiology (ACR), European Thyroid Association, and Korean Thyroid Imaging Reporting and Data System (ACR-TIRADS, EU-TIRADS, and K-TIRADS, respectively) before performing ultrasound-guided fine-needle aspiration biopsy. Pathological results were reported according to the Bethesda system. Outcomes of the 4 classification systems were compared with respect to Bethesda results. Twenty-eight (10.5%) nodules had malignant cytology results. Diagnostic performances of the scoring systems were comparable with similar area under the curve values according to the reference standards of category 5 of each scoring system. The sensitivity and specificity values of these guidelines were as follows: ACR-TIRADS, 60.7% and 95.4%; EU-TIRADS, 71.4% and 93.3%; ATA-2015, 71.4% and 93.3%; and K-TIRADS, 67.9% and 93.3%. The biopsy rate of malignant nodules was 57.1% for K-TIRADS and ATA, whereas this value was 46.4% for ACR and EU-TIRADS. ACR-TIRADS had the lowest unnecessary biopsy rate (141 of 238 benign nodules, 46%). The diagnostic performance of 4 risk stratification systems appears to be comparable, as shown by similar sensitivity, specificity, and area under the curve values. However, the ACR-TIRADS had slightly higher accuracy and necessitated fewer unnecessary biopsies for benign nodules.

Gastric wall fat halo sign in patients without intestinal disease.

PURPOSE: To investigate the relationship between gastric wall fat halo sign and visceral obesity with potentially associated diseases. MATERIALS AND METHODS: Between September 2015 and April 2017, 90 patients with gastric wall fat halo signs and 130 controls were prospectively evaluated. Patient height, weight, body mass index (BMI), sex, age, subcutaneous fat area (SFA), visceral fat area (VFA), total fat area (TFA), percentage of visceral fat (VF%) and the presence of colic or ileal fat halo signs, hepatic steatosis and aortic calcified plaques were recorded for the two groups. Cut-off values for the VFA, TFA, and VF% were determined and the diagnostic efficacy was calculated using receiver operating characteristic (ROC) curve analysis. RESULTS: No significant differences were found in age, BMI and SFA, but the VFA, VF%, TFA and frequencies of colic or ileal fat halo signs, hepatic steatosis and aortic calcified plaques were significantly higher in the patient group. The areas under the ROC curve (AUCs) were 0.803, 0.770 and 0.596 for VFA, VF% and TFA, respectively. The diagnostic efficacies of VFA and VF% were significantly higher than those of the TFA. CONCLUSION: Gastric wall fat halo signs may be observed in overweight people, especially those with increased VFA and VF%. Additionally, these signs are usually observed along with fat halo signs of the colon or terminal ileum. However, extensive studies are needed to clarify the relationship between gastric wall fat halo signs and type 2 diabetes, cardiovascular diseases and metabolic syndrome.