Risk indices that predict in-hospital mortality of elderly patients

Background/aim: Mortality in the elderly population tends to be higher than in all other age groups; the risk factors that predict mortality among those in this age cohort are not fully understood. This large-scale clinical study aimed to identify effective risk factors that predict mortality in the elderly population with a particular focus on age and hospitalization status. Material and methods: We retrospectively analyzed outcomes from patients with clinical follow-up between July 2015 and January 2020 at 29 Mayis State Hospital, Ankara, Turkey. Patient records with missing or ambiguous data were excluded. Age, sex, length of hospital stay, comorbidities, consultation requests and diagnoses that include infectious diseases were evaluated for their role in predicting in-hospital mortality using binary logistic regression analysis. Primary outcomes focused on factors that had an impact on overall in-hospital mortality in the elderly population. Results: Our study included 11,430 patients; of this group, 39.9% were elderly, which we defined as 65 years of age or older. Risk factors for in-hospital mortality in this cohort included consultation requests (AOR = 1.95, CI (1.53­2.49), P < 0.001) and length of hospital stay of ≥4 days (AOR = 2.49, CI (1.90­3.26), P < 0.001). Conclusion: Elderly patients are at significantly higher risk for in-hospital mortality than are younger patients. Among the factors that may be used to predict the risk of in-hospital mortality in the elderly patient cohort, the most important factor is the length of hospital stay.

Is prehospital endotracheal intubation associated with improved outcomes in isolated severe head injury? A matched cohort analysis.

INTRODUCTION: Prehospital endotracheal intubation (ETI) following traumatic brain injury in urban settings is controversial. Studies investigating admission arterial blood gas (ABG) patterns in these instances are scant. HYPOTHESIS: Outcomes in patients subjected to divergent prehospital airway management options following severe head injury were studied. METHODS: This was a retrospective propensity-matched study in patients with isolated TBI (head Abbreviated Injury Scale (AIS) ≥ 3) and Glasgow Coma Scale (GCS) score of ≤ 8 admitted to a Level 1 urban trauma center from January 1, 2003 through October 31, 2011. Cases that had prehospital ETI were compared to controls subjected to oxygen by mask in a one to three ratio for demographics, mechanism of injury, tachycardia/hypotension, Injury Severity Score, type of intracranial lesion, and all major surgical interventions. Primary outcome was mortality and secondary outcomes included admission gas profile, in-hospital morbidity, ICU length of stay (ICU LOS) and hospital length of stay (HLOS). RESULTS: Cases (n = 55) and controls (n = 165) had statistically similar prehospital and in-hospital variables after propensity matching. Mortality was significantly higher for the ETI group (69.1% vs 55.2% respectively, P = .011). There was no difference in pH, base deficit, and pCO2 on admission blood gases; however the ETI group had significantly lower pO2 (187 (SD = 14) vs 213 (SD = 13), P = .034). There was a significantly increased incidence of septic shock in the ETI group. Patients subjected to prehospital ETI had a longer HLOS and ICU LOS. CONCLUSION: In isolated severe traumatic brain injury, prehospital endotracheal intubation was associated with significantly higher adjusted mortality rate and worsened admission oxygenation. Further prospective validation of these findings is warranted.

Mapping and prediction of organ procurement in cases resulting in mortality due to traumatic injuries: A matched cohort analysis.

BACKGROUND: The prediction of posttraumatic potential organ donors is a complex process. The aim of this study is to evaluate the organ procurement process in trauma-related injuries and determine the medical markers in organ donors and posttraumatic mortal patients at the first level emergency, in emergency surgical service, and surgical intensive care departments. METHODS: In this retrospective study, after the approval of the ethics committee, the records of the patients in the emergency surgery unit, the operating room, and the organ donors in surgical intensive care unit between the years 2000 January-2011 December were examined. Patient demographics, distribution of donated organs, intubation area, transfer to the hospital, patient's service, trauma type, injury mechanism, and severity of the injury were examined. Continuous variables were evaluated with independent samples by the Student's t-test or Mann-Whitney U test and binary variables with the Pearson Chi-Square test. The patients who lost their lives and survived in the emergency department (ED) were compared with an age ratio of 1: 3. Final results were evaluated by multiple logistic regression. RESULTS: The patients with ≤90 mmHg systolic blood pressure (SBP) or penetrant serious injuries were more likely to be candidates for organ donation in ED, respectively; 68.2% vs. 15.2% [AOR: 4.59 (1.14, 18.40), p<0.031] and 63.6% vs. 37.9% (AOR: 6.25 [1.27-30.49] [p<0.024]). Patients with AIS head ≥3 and in-hospital blood replacement of 1500 cc or more, were more likely to be organ donors after ED: 54.5% vs. 97% (AOR: 0.074 [0.014 kan0.548], [p<0.01]) and 10% vs. 58.1% (AOR: 0.098 [0.016-0.591], p<0.01]). CONCLUSION: In terms of predictive traits for organ procurement, a SBP of ≤90 mmHg and presence of serious penetrant injuries were found to be more predictive for organ transplantation than other factors such as AIS Head ≥3 or 1500 cc or more replacement of blood and blood products.

The correlation between Injury Severity Score, vital signs, and hemogram values on mortality in firearm injuries.

BACKGROUND: Several scoring systems have been and continue to be developed in numerous countries with the goal of quickly and accurately assessing the severity of trauma injuries. The aim of this study was to identify factors that help to determine the gravity of damage and to minimize it, in order to reduce mortality and morbidity. It is important that the criteria set for the determination of the severity of trauma are objective, measurable, and comparable. This study was an assessment of the contribution of vital signs, hemogram values, and trauma severity scores recorded at initial admission in the prediction of mortality in patients with firearm trauma wounds. METHODS: This was a retrospective cohort study. Patients with gunshot injuries who were admitted to the emergency department (ED) of a single facility between December 2015 and March 2016 were included in the study. Statistical software was used to perform bivariate analyses using a t-test or the Mann-Whitney U test for continuous variables, depending on the distribution of variables, and logistic regression analysis was utilized to determine independent predictors of mortality after ED admission. A p value of <0.05 was considered statistically significant. RESULTS: A total of 418 patients were included. A statistically significant difference was found between the white blood cell count, respiratory rate, Glasgow Coma Scale score, Abbreviated Injury Scale score, and the Injury Severity Score (ISS) of the patients who survived and those who died (p<0.05). The analysis also indicated that a systolic blood pressure below 90 mmHg and a heart rate above 100 beats/minute were independent variables in terms of the expectation of mortality. CONCLUSION: The objective assessment of the ISS at admission to the ED is an important element in the calculation of hemoglobin requirements, mortality, and morbidity.

Is inguinal hernia a risk factor for varicocele in the young male population? / ¿Es la hernia inguinal un factor de riesgo para varicocele en el varón joven?

OBJECTIVES: The aim of this study is to investigate the role of the inguinal hernia over the development of varicocele, in cases with accompanying inguinal hernia. METHODS: The continuous variables were calculated from mean and standard deviation, and intermittent variables were calculated over percentage and frequency. Normality testing was performed on continuous variables using the Kolmogorov-Smirnov test. Univariate analyses were performed using the unpaired Mann-Whitney U test and Chi-squared test was used for proportions. Kendall's tau-b correlation coefficient was used for correlition coefficient. Logistic regression modeling were used to identify the impact of inguinal hernias on selected cases. The data were analyzed with SPSS™ for Windows 22 (SPSS,Chicago, IL). RESULTS: Twelve cases (23.1%) in the inguinal hernia group also had varicocele, which was relatively high, whereas 12 cases with inguinal hernia in the varicocele group corresponded to only were 4.02% (12/52 (23.1%) vs 12/298 (4.02%) ). On the other hand, as a result of the binary logistic regression, we found statistically significant difference in the probability of being diagnosed varicocele among the patients with inguinal hernia as 1.94 times. CONCLUSIONS: We think that in addition to the direct compression of some of the inguinal hernias on testicular veins, the potential for a combination of common enzymatic and biochemical disorders in some of the cases involving these two disorders may be play role.

OBJETIVOS: La finalidad de este estudio es investigar el rol de la hernia inguinal respecto al desarrollo de varicocele, en casos con acompañamiento de hernia inguinal.MÉTODOS: Las variables continuas fueron calculadas a partir de media y desviación standard, y las variables discontinuas se calcularon con porcentaje y frecuencia. Se desarrollaron pruebas de normalidad para variables continuas utilizando el test de Kolmogorov-Smirnov. Se realizó análisis univariante usando el test U de Mann-Whitney sin emparejamiento y para proporciones y utilizó el test de Chi cuadrado. Se aplicó el coeficiente de correlación tau-b de Kendall para los coeficientes de correlación. Se usaron modelos de regresión logística para identificar el impacto de la hernia inguinal en casos seleccionados. La información fue analizada con SPSS™ 22 para Windows (SPSS, Chicago, IL). RESULTADOS: Doce casos (23,1%) en el grupo de hernia inguinal tenían también varicocele, incidencia relativamente alta, mientras que solo había 12 casos con hernia inguinal en el grupo de varicocele, que correspondían a un 4,02 % [12/52 (23,1%) vs 12/298 (4,02%)]. Por otro lado, como resultado de la regresión logística binaria, descubrimos una diferencia estadísticamente significativa en la probabilidad de ser diagnosticado varicocele en los pacientes con hernia inguinal (1,94 veces). CONCLUSIONES: Pensamos que además de la compresión directa de algunas de las hernias inguinales de las venas testiculares, el potencial para una combinación de alteraciones comunes enzimáticas y bioquímicas en algunos de los casos, implicando estas dos anomalías, podría desempeñar un papel importante/clave.

Effects of B2O3 (boron trioxide) on colon cancer cells: our first-step experience and in vitro results.

Boron oxide (B2O3) is derived from dehydration of boric acid and is a colorless, semitransparent, crystalline compound that is moderately soluble in water. On the other hand, boron oxide is chemically hygroscopic. This gives the molecule the ability to soak up water and adhere to tissues. Boron oxide can be used locally after tumor debulking in inoperable tumors and especially when the tumor-free margin distance cannot be provided. For all these reasons we aimed to evaluate the in vitro test results of B2O3 in terms of cytotoxicity, genotoxicity, apoptosis, and necrotic effects on L929 fibroblast cells and DLD-1 colorectal adenocarcinoma cells. Our studies demonstrated that boron oxide compounds appear to be highly cytotoxic for both cell lines according to WST cell viability assay (44.22% and 18.36% on DLD-1 and L929, respectively). Although no genotoxic effects were observed, boron oxide compounds showed antiproliferative effects for both cell lines. The prepared boron oxide compounds may hold the potential to be applied locally to the remaining tissue after surgery and further research and evaluation will be needed to determine its effectiveness.

Can serum progranulin levels be a biomarker following gastric ulcer therapy?

INTRODUCTION: Progranulin is a novel growth factor that has several physiological and pathological roles such as cell growth, tumourigenesis, embryogenesis, wound healing, and inflammation. AIM: To compare the pre-treatment and post-treatment serum levels of the angiogenic factor vascular endothelial growth factor (VEGF), pro-inflammatory cytokine tumor necrosis factor α (TNF-α), and progranulin in peptic ulcer (PU) patients with a healthy control group. MATERIAL AND METHODS: Serum VEGF, TNF-α, and progranulin levels were studied with ELISA in 42 PU patients (antral ulcer (AU): 22, duodenal ulcer (DU): 20) and 15 healthy controls. RESULTS: The serum progranulin levels before treatment were 4237.35 ±1091.30 pg/ml in the patients with AU, 4682.64 ±1501.46 pg/ml in the patients with DU, 3055.66 ±626.88 pg/ml in the control group, and 4460 ±1315 pg/ml in the ulcer (AU and DU) group. The serum progranulin levels were 3607.7 ±869.4 pg/ml in the AU group, 4286.5 ±1208.78 pg/ml in the DU group, and 3947.1 ±1094.64 pg/ml in the ulcer group after the treatment. When comparing pre-treatment serum progranulin levels of the AU group, DU group, and ulcer group with the control group there were statistically significant differences (p < 0.001, p < 0.0001, p < 0.0001, respectively). CONCLUSIONS: The disappearance of the difference in terms of post-treatment serum levels of progranulin between the AU group and the control group suggests that serum levels of progranulin can be used as a biomarker of gastric ulcer healing.

Predictive Factors of Operative Hemodynamic Instability for Pheochromocytoma.

Pheochromocytoma is an uncommon catecholamine-secreting tumor in which resection is often associated with hemodynamic instability (HI). In this study, we aim to clarify the factors affecting surgical HI in patients who underwent surgery with the diagnosis of pheochromocytoma. All patients who underwent surgery with the diagnosis of pheochromocytoma between 2008 and 2015 were analyzed retrospectively. Patients with inconsistent diagnosis or missing outcomes and follow-up data were excluded. A total of 37 patients were included in this study. Patient demographics, operative time, tumor size, period of medical treatment until surgery, catecholamine levels in urine, and HI patterns were analyzed. There were 23 (62%) male and 14 (38%) female patients. Hemodynamic instability occurred in 13 (35%) patients. Overall, HI was higher in patients with tumor size <6 cm (P < 0.02); moreover, urine catecholamine levels were detected significantly higher than a cutoff value of 2000 µg/24 hours in hemodynamically instable group. In this study, tumor diameter of <6 cm and urine catecholamine levels >2000 µg/24 hours were associated with HI. Preoperative management is essential for preventing hypertensive crisis and HI before or during surgery.

Seat Belt Use and its Effect on Abdominal Trauma: A National Trauma Databank Study.

We sought to use the National Trauma Databank to determine the demographics, injury distribution, associated abdominal injuries, and outcomes of those patients who are restrained versus unrestrained. All victims of motor vehicle collisions (MVCs) were identified from the National Trauma Databank and stratified into subpopulations depending on the use of seat belts. A total of 150,161 MVC victims were included in this study, 72,394 (48%) were belted. Young, male passengers were the least likely to be wearing a seat belt. Restrained victims were less likely to have severe injury as measured by Injury Severity Score and Abbreviated Injury Score. Restrained victims were also less likely to suffer solid organ injuries (9.7% vs 12%, P < 0.001), but more likely to have hollow viscous injuries (1.9% vs 1.3%, P < 0.001). The hospital and intensive care unit length of stay were significantly shorter in belted victims with adjusted mean difference: -1.36 (-1.45, -1.27) and -0.96 (-1.02, -0.90), respectively. Seat belt use was associated with a significantly lower crude mortality than unrestrained victims (1.9% vs 3.3%, P < 0.001), and after adjusting for differences in age, gender, position in vehicle, and deployment of air bags, the protective effect remained (adjusted odds ratio for mortality 0.50, 95% confidence interval 0.47, 0.54). In conclusion, MVC victims wearing seat belts have a significant reduction in the severity of injuries in all body areas, lower mortality, a shorter hospital stay, and decreased length of stay in the intensive care unit. The nature of abdominal injuries, however, was significantly different, with a higher incidence of hollow viscous injury in those wearing seat belts.

Is inguinal hernia a risk factor for varicocele in the young male population? / ¿Es la hernia inguinal un factor de riesgo para varicocele en el varón joven?

Objectives: The aim of this study is to investigate the role of the inguinal hernia over the development of varicocele, in cases with accompanying inguinal hernia. Methods: The continuous variables were calculated from mean and standard deviation, and intermittent variables were calculated over percentage and frequency. Normality testing was performed on continuous variables using the Kolmogorov-Smirnov test. Univariate analyses were performed using the unpaired Mann-Whitney U test and Chi-squared test was used for proportions. Kendall's tau-b correlation coefficient was used for correlition coefficient. Logistic regression modeling were used to identify the impact of inguinal hernias on selected cases. The data were analyzed with SPSS(TM) for Windows 22 (SPSS,Chicago, IL). Results: Twelve cases (23.1%) in the inguinal hernia group also had varicocele, which was relatively high, whereas 12 cases with inguinal hernia in the varicocele group corresponded to only were 4.02% (12/52 (23.1%) vs 12/298 (4.02%) ). On the other hand, as a result of the binary logistic regression, we found statistically significant difference in the probability of being diagnosed varicocele among the patients with inguinal hernia as 1.94 times. Conclusions: We think that in addition to the direct compression of some of the inguinal hernias on testicular veins, the potential for a combination of common enzymatic and biochemical disorders in some of the cases involving these two disorders may be play role

Objetivos: La finalidad de este estudio es investigar el rol de la hernia inguinal respecto al desarrollo de varicocele, en casos con acompañamiento de hernia inguinal. MÉTODOS: Las variables continuas fueron calculadas a partir de media y desviación standard, y las variables discontinuas se calcularon con porcentaje y frecuencia. Se desarrollaron pruebas de normalidad para variables continuas utilizando el test de Kolmogorov-Smirnov. Se realizó análisis univariante usando el test U de Mann-Whitney sin emparejamiento y para proporciones y utilizó el test de Chi cuadrado. Se aplicó el coeficiente de correlación tau-b de Kendall para los coeficientes de correlación. Se usaron modelos de regresión logística para identificar el impacto de la hernia inguinal en casos seleccionados. La información fue analizada con SPSS™ 22 para Windows (SPSS, Chicago, IL). RESULTADOS: Doce casos (23,1%) en el grupo de hernia inguinal tenían también varicocele, incidencia relativamente alta, mientras que solo había 12 casos con hernia inguinal en el grupo de varicocele, que correspondían a un 4,02 % [12/52 (23,1%) vs 12/298 (4,02%)]. Por otro lado, como resultado de la regresión logística binaria, descubrimos una diferencia estadísticamente significativa en la probabilidad de ser diagnosticado varicocele en los pacientes con hernia inguinal (1,94 veces). CONCLUSIONES: Pensamos que además de la compresión directa de algunas de las hernias inguinales de las venas testiculares, el potencial para una combinación de alteraciones comunes enzimáticas y bioquímicas en algunos de los casos, implicando estas dos anomalías, podría desempeñar un papel importante/clave