Can affinity of hemoglobin to oxygen to be a prognostic marker in critically ill COVID-19 patients?

Background: This study's objective is to determine the slope of the hemoglobin oxygen dissociation curve in critically ill patients who have COVID-19 along with blood gas measurements and how mortality might be impacted by this circumstance. Aim: It has been reported that the hemoglobin oxygen dissociation curve is not different from healthy patients in COVID-19. However, there are insufficient data on the behavior of the curve in patients who require intensive care. Patients and Methods: This retrospective study was conducted between 01.03.2021 and 01.07.2021 with patients who were followed up due to COVID-19 in adult intensive care unit. P50 and lactate value obtained from in vitro calculated blood gas analysis. The survival status of the patients was recorded. Results: The mean P50 value at the admission of nonsurvivors was significantly higher than survivors. In correlation analysis, a significant positive correlation was seen between P50, mortality, and lactate level at admission. SpO2, PaO2/FiO2 ratio, and length of stay in intensive care unit were significantly negatively correlated with P50 levels. Conclusion: A right shift in the hemoglobin oxygen dissociation curve is associated with mortality. Lactate levels were also associated with a right shift. Prospective experimental studies are needed to provide a better understanding of this process.

Ki-67, p-53, E-Cadherin, and ß-Catenin expression of advanced glotto-subglottic and supraglottic larynx carcinomas.

Background: Identifying tumor markers that can be used to determine the biological behavior of tumors and predicting their prognosis may be helpful in choosing treatment strategies. Besides the differences in the embryological and histological anatomy of the larynx in this regard, the possibility of molecular causes that can explain the different clinical behaviors has always been a question for the scientific world. Aim: In this study, we aimed to investigate whether there were any immunohistochemically molecular differences among laryngeal carcinoma cases originating from two different anatomical regions of the larynx. Patients and Methods: The study group consisted of 43 patients. The rate of supraglottic cancers was 41.8%, while the rest had glotto-subglottic tumors. Ki67, ß-catenin, E-cadherin, and p53 were examined in pathology preparations obtained by laryngectomy surgeries. The data obtained were analyzed by comparing factors that may affect the prognosis of the disease and between tumors originating from the two different anatomical regions. Results: We did not see any statistically significant difference between groups for stage and grade of tumor, tumor recurrence rate, or lymphovascular or perineural invasion rated in terms of the investigated markers. In addition, there was no statistically significant difference between the two distinct groups in survival analysis. Conclusions: With these results, our study differs from some studies in the literature, and we think that this difference could be because the cases in our study consisted of advanced stage tumors and the groups investigated had similar survival rates.

The relationship between immature granulocyte count and mortality in ARDS Due to COVID-19.

Background: Acute phase reactants and inflammation biomarkers such as ferritin, procalcitonin, C-reactive protein (CRP), and complete blood count parameters (White blood cell, platelet count) are usually used to evaluate and monitor the disease severity and treatment response of systemic inflammatory diseases. In addition to these parameters, Immature granulocytes (IG) that increase during systemic infection, hematological malignancy, and drug treatments (such as chemotherapy and glucocorticoids) are important parameters for evaluating systemic inflammation. The sensitivity and specificity of IG are as high as the abovementioned inflammatory biomarkers for monitoring disease severity and treatment response. Aim: The aim of the study is to evaluate the relationship between IG count and the need for mechanical ventilation and mortality in patients hospitalized in the intensive care unit (ICU) due to coronavirus disease 2019 (COVID-19). Patients and Methods: The medical records of the 401 patients who were followed up in the ICU due to COVID-19-related acute respiratory distress syndrome between October 2020 and February 2021 were retrospectively reviewed. On the day of admission to the ICU complete blood count (CBC), arterial blood gas analysis, coagulation parameters (fibrinogen, D-dimer) are recorded. CRP, procalcitonin, and ferritin levels are also recorded at the day of admission. During the follow-up period, the survival status and mechanical ventilation status of the patients were recorded and the relation between IG count and these parameters was evaluated. Results: The mean IG at the admission was 0.2 ± 0.4 109/L. The IG level of the intubated patients at the time of intubation was 0.3 ± 0.5 109/L. There was a significant positive correlation between mortality and IG levels at admission and at the time of intubation (IG admission; P = 0.001, r = 0.347 and IG at intubation; P = 0.001, r = 0.228). Conclusion: IG levels in CBC data could be a potential practical biomarker. This issue requires further research and the development of therapies targeting IG cells is needed.

The association between coronaphobia and attitude towards COVID-19 Vaccine: A sample in the east of Turkey.

PURPOSE: This study was conducted to examine the association between coronaphobia and attitude towards COVID-19 vaccine in the society. METHODS: This cross-sectional descriptive study was conducted with snowball sampling method between December 30, 2020 and January 10, 2021. The survey form was sent online to individuals who were 18 years of age and older. 1252 individuals who responded to the surveys were included in the study. The data were collected by using "Descriptive Information Form", "Attitudes towards the Covid-19 vaccine scale" and "Coronavirus 19 Phobia Scale (CP19-S)". Descriptive statistics and Pearson Correlation analysis were used in the evaluation of data. RESULTS: In the study, it was found that the participants had a mean ATV-COVID-19 scale positive attitude sub-dimension score of 2.81±1.04, while they had a mean negative attitude sub-dimension score of 2.95±0.78 and a mean total score of 2.89±0.78. It was found that the participants had a mean C19P-S psychological sub-dimension score of 21.03±5.36, a mean psychosomatic sub-dimension score of 10.30±4.11, a mean social sub-dimension score of 15.04±4.71, a mean economic sub-dimension score of 8.89±3.46 and a mean total scale score of 55.28±15.00. It was found in the study that there was a positive association between the participants' C19P-S and social sub-dimension and ATV-COVID-19 and positive attitude sub-dimension, while there was a negative association between ATV-COVID-19 and negative attitude sub-dimension (p<0.05). CONCLUSIONS: It was found that the participants had a moderate level of coronavirus phobia and positive attitudes towards the vaccine. It was found that positive attitudes towards COVID-19 vaccine increased as the coronavirus phobia increased.

The effect of gadolinium-based contrast agents on rat testis.

Previous studies have reported that repeated administrations of linear gadolinium-based contrast agents lead to their accumulation in the brain and other tissues in individuals with normal renal functions. The purpose of this prospective animal study was to investigate the effect of multiple administrations of macrocyclic ionic (gadoteric acid) and linear nonionic (gadodiamide) gadolinium-based contrast agents (GBCAs) on rat testis tissue and to compare these molecules in terms of tissue damage. Thirty-two male Sprague-Dawley rats were kept without drugs for 5 weeks after administration of 0.1 mmol mg-1 kg-1 (0.2 ml/kg) gadodiamide and gadoteric acid for 4 days over 5 weeks. Biochemical, histopathological and immunohistochemical changes in testis tissue were evaluated at the end of 10 weeks. When used in repeated clinical doses, gadolinium was observed to increase apoptosis in the Leydig cells of the rat testis, and to increase serum Ca+2 levels and reduce testosterone levels (p < .05). Although the difference was not statistically significant, a greater loss of spermatozoa and immature germinal cell accumulation were observed in the seminiferous tubule lumen in the GBCA groups compared with the control and saline groups (p > .05). Both linear and macrocyclic contrast agents have toxic effects on testis tissue, irrespective of the type of drug.

The association of impaired gestational glucose tolerance with maternal and fetal outcomes.

The aim of the present study was to examine the associations of gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT) with maternal and fetal outcomes.A total of 200 pregnant women were included in this cross-sectional study. A 50-gram oral glucose challenge test (GCT) was performed between 24 and 28 weeks of gestation, followed by glucose tolerance test (OGTT) with 100 grams of oral glucose in those with an abnormal one-hour test result. The following were not significantly different between groups. Preterm labour (PL), pregnancy induced hypertension(PIH), pre-eclampsia, polyhydramnios, and macrosomia. However, a significant increase was noted in the fetal birth weight as well as in number of cesarean deliveries among GDM subjects. Neonatal outcomes were also similar between the two groups. In conclusion, the present results suggest that single high glucose readings in OGTT may be as important as a diagnosis of GDM in terms of fetomaternal complication risk.

ED50 and ED95 of intrathecal isobaric levobupivacaine coadministered with fentanyl for transurethral resections: randomized, double-blind trial.

BACKGROUND: Levobupivacaine use is progressively increased for intrathecal anesthesia in transurethral resections. The aim was to determine ED(50) and ED(95) of intrathecal isobaric levobupivacaine by addition of 25 mcg fentanyl for patients undergoing transurethral resections. METHODS: A total of 100 patients undergoing transurethral resections with ASA I-III, were randomized to groups receiving intrathecal 0.5% isobaric levobupivacaine in doses of 6, 8, 10, 12 or 14 mg in equal volumes with 25 mcg intrathecal fentanyl addition. Sensorial block level was determined by pinprick and motor block by Bromage scale. RESULTS: Mean onset time of sensorial block in 6 mg group was significantly longer than that of sensorial block in 10 mg, 12 mg and 14 mg groups (p<0.01), 8 mg was longer than 12 mg and 14 mg (p<0.01), and 10 mg onset time of sensorial block was significantly longer than 12 mg and 14 mg (p<0.01). Mean onset time of T10 sensory level in 6 mg group was significantly longer than mean onset time of T10 sensory level in 10 mg, 12 mg and 14 mg (p<0.01), the mean onset time of T10 sensory level in 8 mg group was also significantly longer than that of 12 mg, 14 mg groups (p<0.01). ED(50) and ED(95) of levobupivacaine coadministered with 25 mcg fentanyl were 7.32 mg and 10.88 mg, respectively. CONCLUSION: Levobupivacaine with opioid co-administration can be used in doses considerably lower than doses proposed for routine use as it is a safe drug depending on its hemodynamic effects, side effects.

Endometrial pathology in postmenopausal women with no bleeding.

OBJECTIVE: The aim of this study was to determine the rate of unexpected uterine pathology in postmenopausal women admitted to a gynecology clinic with symptoms other than vaginal bleeding and who were scheduled to undergo hysterectomy. MATERIALS AND METHODS: We reviewed retrospectively the medical records of 283 postmenopausal patients who had gynecological surgery between September 2007 and January 2014. We reviewed their presenting symptoms on admission, the indications for surgery, and their transvaginal ultrasonographic findings. Postoperative histopathological results based on uterine specimens were also recorded. The results were analyzed statistically. RESULTS: Of 283 patients who had surgery, 209 had no vaginal bleeding at the time of admission. From this group, 75.6% were found to have unsuspected pathology, including endometrial hyperplasia, endometrial polyps, uterine fibroids, adenomyosis, and one case of endometrial carcinoma (0.5%). The remaining 74 patients had experienced postmenopausal bleeding and in 87.8% there were pathological findings including 13 cases (17.6%) of endometrial cancer (p = 0.0001). CONCLUSION: Vaginal bleeding in postmenopausal women is indicative of a wide array of gynecological pathologies, including endometrial carcinoma. However, uterine fibroids, pelvic masses, or even endometrial cancer may develop without co-morbid vaginal bleeding. Therefore we advocate that postmenopausal women should undergo yearly screening and consultation, without waiting for an episode of vaginal bleeding.

Effect of Ramadan fasting on metabolic markers, dietary intake and abdominal fat distribution in pregnancy.

BACKGROUND: The aim of this study is to evaluate the effect of Ramadan intermittent fasting on metabolic markers, dietary intake, anthropometric measurements, and abdominal visceral fat thickness (VFT) in pregnancy. METHODS: Seventy-eight healthy pregnant subjects who had fasted for at least 15 days during the month of Ramadan in 2012 and 2013 and 78 controls were included in this study. Metabolic markers, dietary intake, anthropometric measurements, and ultrasonographic VFT were calculated for each subject before and after Ramadan fasting. RESULTS: When before and after Ramadan values in the fasting group were compared, we found that daily protein intake was increased (p <0.001), but fat and carbohydrate intake remained unchanged. A significant reduction was observed in liquid consumption while the frequency of asymptomatic bacteriuria was increased. High-density lipoprotein significantly increased, and glycated hemoglobin, insulin, and homeostasis model index significantly decreased (p =0.005, p =0.01, p <0.001, and p =0.03, respectively). A significant increase in ferritin was found (p =0.02). No change was observed in subcutaneous fat thickness, while VFT significantly decreased (p =0.08, p =0.005). However, in the control group, only ferritin level increased. CONCLUSION: A combined change in the number and timing of meals and the portioning of the entire daily intake into only two meals per day may have beneficial metabolic effects and reduction in VFT during pregnancy. Hippokratia 2015; 19 (4): 298-303.

Acute effects of static stretching on isokinetic thigh strength on modern dancers.

AIM: The aim of this study was to examine the acute effects of static stretching in dominant leg flexor muscle groups on concentric isokinetic leg extension and flexion peak torque (PT), peak torque % body weight (PT%BW) and total work (TW) at 60, 180 and 300 °.s-1 in stretched and non-stretched limbs of modern dancers. METHODS: Twenty-six trained modern dancers volunteered in this study. On the first measurement, isokinetic tests were performed on dominant and non-dominant legs. On the second measurement, the dominant leg flexors were stretched using 3 unassisted and 1 assisted static stretching exercises (each 4x15 seconds; 10-second rest). After the stretching, isokinetic tests were repeated on both legs. RESULTS: The results indicated a positive increase in strength in the stretched (PT%BW, TW) and non-stretched (PT, PT%BW, TW) limbs in flexion at 180°s-1 (P<0.05). We observed a positive increase (P<0.05) in the stretched limb (180 and 300°.s-1, TW; 300°.s-1, PT%BW) in extension whereas an acute decrease (P<0.05) was observed in both legs (60˚.s-1, PT and PT%BW). CONCLUSION: Our findings indicated a possible positive effect of static stretching at high angular velocities on the strength production of isokinetic contraction in stretched and non-stretched muscles. However, due to its negative effect on the extensor muscle groups, we think using static stretching is required attention before maximal strength exercises.

[Dynamic left ventricular outflow tract obstruction in pulmonary embolism]. / Dynamische Obstruktion des linksventrikulären Ausflusstrakts bei Lungenembolie.

Left ventricular hypertrophy, dehydration, sepsis, vasodilatation, excessive sympathetic stimulation, pericardial tamponade and surgical treatment of the atrioventricular valve are known causes of left ventricular outflow tract (LVOT) obstruction. We report the rare case of a patient who developed dynamic LVOT obstruction as a complication of acute pulmonary embolism.

Effects of exercise training on mobilization and functional activity of blood-derived progenitor cells in patients with acute myocardial infarction.

BACKGROUND: The aim of the present study was to determine whether regular exercise training (ET) is effective at promoting the mobilization of CPCs and improving their functional activity in patients with recently acquired myocardial infarction (STEMI). Regular physical training has been shown to improve myocardial perfusion and cardiovascular function. This may be related in part to a mobilization of bone marrow-derived circulating progenitor cells (CPCs) as well as an enhanced vascularisation. METHODS: 37 patients with STEMI were randomly assigned to an ET group or a non-ET group (controls). Two weeks after STEMI, three weeks after regular ET and three months after ET, BNP levels, exercise echocardiography and exercise spiroergometry were evaluated. The number of CD34+/CD45+ and CD133+/CD45+ CPCs was measured by flow cytometry analysis. The migration capacity of the CPCs was determined with a boyden chamber and the clonogenic capacity by CFU-assay. RESULTS: In the ET-group the number and migration capacity of CPCs increased significantly after regular exercise training. The BNP level decreased significantly from 121 +/- 94 to 75 +/- 47 pg/ml (p<0.001) after the ET period, the left ventricular ejection fraction raised in parallel at peak exercise, and the cardiorespiratory condition improved as demonstrated by an increase of VO2max (from 1641 +/- 522 to 1842 +/- 724 ml/min, p<0.02). These three effects persist till three months after the ET period. CONCLUSIONS: Regular physical activity appears to predispose the mobilization and enhanced functional activity of CPCs, a phenomenon which might lead to an improved cardiac function in patients with recently acquired acute myocardial infarction.

Bloodstream infections in a medical-surgical intensive care unit: incidence, aetiology, antimicrobial resistance patterns of Gram-positive and Gram-negative bacteria.

In the present study, the incidence and antimicrobial resistance patterns of the microorganisms that caused bloodstream infections (BSIs) in a medical-surgical intensive care unit during the years 2005-2007 were determined. The mean BSI incidence density was 6.56 per 1000 patient-days. The incidence density increased linearly during the study period (from 3.57 to 9.60 per 1000 patient-days). Staphylococcus aureus was most frequently isolated (47.3%), followed by Enterococcus spp. (10.8%) and Candida spp. (10.1%). There was a high rate of resistance to several of the prescribed antimicrobials among the bacteria isolated from patients with BSIs.

Advantageous effects of dexmedetomidine on haemodynamic and recovery responses during extubation for intracranial surgery.

BACKGROUND AND OBJECTIVE: The anaesthetic method for intracranial neurosurgery must provide haemodynamic stability on emergence and allow early evaluation of the neurological status. In this study, we examined the effects of the alpha-2 agonist dexmedetomidine given at the end of the procedure to prevent hyperdynamic responses during extubation and to allow a comfortable and high-quality recovery. METHODS: Forty ASA I-III patients, aged between 18 and 75 yr, having elective intracranial surgery, were divided into two random groups. Standard procedures and drugs were used for monitoring, induction and maintenance. Isoflurane was reduced by 50% 5 min before the end of the surgery, and in Group I dexmedetomidine 0.5 microg kg(-1) and in Group II 20 mL of 0.9% NaCl were administrated intravenously over 60 s. Systolic, diastolic and mean arterial pressures, and heart rate were recorded before intravenous administration and also at 1, 3 and 5 min after administration, 1 min before extubation, during extubation, 1, 3, 5, 10, 15, 20 and 30 min after extubation. Duration of extubation and recovery were noted, and the quality of extubation was evaluated on a 5-point scale. RESULTS: Mean arterial pressure and heart rate were significantly higher in Group II than in Group I (P < 0.01). There were no statistically significant differences between groups regarding the duration of extubation and recovery (P > 0.05). Extubation quality score of all the patients were 1 in Group I and in Group II, the quality scores were 1 for 35%, 2 for 45% and 3 for 20% of the patients (P < 0.001). None of the patients in Group I and Group II showed respiratory depression, nausea or vomiting. CONCLUSION: Without interfering in recovery time, dexmedetomidine 0.5 microg kg(-1) administered 5 min before the end of surgery stabilizes haemodynamics, allows easy extubation, provides a more comfortable recovery and early neurological examination following intracranial operations.