RESUMO
Objective: The Turkish Ministry of Health offered two types of vaccines by January 13, 2021, which are CoronaVac (Sinovac Biotech, China) and Pfizer-BioNTech. We aimed to describe the impact of the CoronaVac and Pfizer-BioNTech vaccines on clinical outcomes among hospitalized patients during a six-month period. Methods: We included patients older than 18 years old and hospitalized because of COVID-19 when the vaccines were available. We conducted the study at Koç University Hospital and American Hospital between June 2021, six months after the vaccination started, and December 2021. Results: In total, 444 RT-PCR confirmed hospitalized patients were included. The mean age of the patients was 59 (standard deviation [SD]=18), and 42.8% were female. The most common comorbidity was hypertension (39%), followed by diabetes mellitus (27%), cardiovascular diseases (18.4%), chronic lung diseases (14.6%), cancer (9.2%), and chronic renal diseases (8%). In multivariate analysis, no vaccination (OR=4.7, CI=2.25-10.06; p<0.001), age >65 (OR=5.2, CI=2.25-11.98; p<0.001), cancer (OR=7.6, CI=3.04-19.31; p<0.001), and chronic kidney disease (OR=3.1, CI=1.14-8.74; p=0.026) significantly increased mortality in COVID-19 patients. Eighteen percent of patients were in the intensive care unit (ICU). One hundred eighty-one patients (40.8%) were non-vaccinated before their admission, and their mortality (17.6%) was higher compared to the patients who were vaccinated with at least one type of vaccine (p=0.002). None of the patients who received two doses of Pfizer-BioNTech vaccines died. Conclusion: Among the inpatients with COVID-19, the predictors for mortality were being unvaccinated, older age, cancer, chronic kidney disease, and cardiovascular diseases. Among the vaccinated inpatients, having two doses of the Pfizer-BioNTech vaccine was the only effective protective measure against mortality, and two doses of the CoronaVac vaccine had no significant effect in preventing fatality.
RESUMO
Objective: COVID-19 pandemic has put a tremendous amount of stress on people, which can negatively affect nursing. Previous studies showed that perceived stress and cortisol levels in the postpartum period correlate with the LATCH scores, which is a simple tool to assess the pattern of nursing. Likewise, greater prenatal anxiety was associated with a shorter breastfeeding duration. We aimed to evaluate whether pregnant women were under extra stress due to the COVID-19 pandemic and if this stress affected their breastfeeding patterns and anthropometric measures of the neonates. Methods: Pregnant women giving birth to healthy neonates were included. Coronavirus Anxiety Scale (CAS) and Beck Anxiety Inventory (BAI) were used to assess the anxiety levels of the mothers, and LATCH breastfeeding assessment tool was used to assess the nursing. The results of these scales and anthropometric measures of the neonates were recorded. Results: Only one mother showed coronavirus-specific anxiety. Therefore, further analysis was done based on the Beck Anxiety (BA) levels of the mothers. CAS and BA scores were positively correlated (p<0.001, r=0.444), indicating that coronavirus-specific anxiety increased with increasing general anxiety. None of the variables changed depending on the anxiety levels of the mothers, except for the % weight gain at day five (p=0.020, r=-0.248). Even though anxiety seemed to show a small effect on weight loss during the first neonatal days, percent weight gain results did not seem to correlate with the anxiety levels in later stages (first month of life). Furthermore, LATCH scores of the infants on day one were positively correlated with BA scores of the mothers (p=0.045, r=0.175). Conclusion: COVID-19 seemed to have no additional effect on the stress levels of the mothers. The more the mothers have anxiety, the more they may stress about the well-being of their infants, which can improve their nursing pattern.
RESUMO
Hypofractionated stereotactic radiosurgery has become an alternative for metastatic brain tumors (METs). We aimed to analyze the efficacy and safety of frameless hypofractionated Gamma Knife radiosurgery (hfGKRS) in the management of unresected, large METs. All patients who were managed with hfGKRS for unresected, large METs (> 4 cm3) between June 2017 and June 2020 at a single center were reviewed in this retrospective study. Local control (LC), progression-free survival (PFS), overall survival (OS), and toxicities were investigated. A total of 58 patients and 76 METs with regular follow-up were analyzed. LC rate was 98.5% at six months, 96.0% at one year, and 90.6% at 2 years during a median follow-up of 12 months (range, 2-37). The log-rank test indicated no difference in the distribution of LC for any clinical or treatment variable. PFS was 86.7% at 6 months, 66.6% at 1 year, and 58.5% at 2 years. OS was 81% at 6 months, 63.6% at one year, and 50.7% at 2 years. On the log-rank test, clinical parameters such as control status of primary cancer, presence of extracranial metastases, RTOG-RPA class, GPA group, and ds-GPA group were significantly associated with PFS and OS. Patients presented with grade 1 (19.0%), grade 2 (3.5%) and grade 3 (5.2%) side effects. Radiation necrosis was not observed in any patients. Our current results suggest that frameless hfGKRS for unresected, large METs is a rational alternative in selected patients with promising results.