COMPARISON OF BODY MASS INDEX LEVEL BY TRIAGE LEVEL IN THE EMERGENCY DEPARTMENT

INTRODUCTION: Obesity is a high cause of death in both non-communicable and communicable diseases such as COVID-19. The aim of this study is to increase the awareness of emergency department (ED) managers and employees about this problem by showing obesity rates according to triage level in patients admitted to the ED. MATERIAL AND METHODS: BMI levels and complaints of 1246 patients admitted to the ED according to the 3-level triage were re-evaluated with the 5-level ESI (Emergency Severity Index) triage for this study. RESULTS: The mean BMI of 1246 patients was found to be 27.25 ± 5.88 (overweight). 26% of the ED patients were found to be obese and 37.7% of them were overweight. While the mean BMI score of the 6-11 age group was found to be class 1 obesity, the other pediatric and adult age groups were found to be overweight. The highest mean BMI according to both the 3-stage triage system and the 5-stage ESI triage system was found in triage 1 patients (28.8011 ± 7.98;28.18 ± 6.78, respectively). Obese patients mostly applied to the ED with orthopedic problems and trauma (26.5%). Also, of the patients with class 3 severe obesity, 50% presented with trauma. CONCLUSIONS: The higher the BMI, the higher the triage severity level. BMI levels should be evaluated in the field of triage together with vital signs, especially in trauma patients, and obesity should be considered in ED and hospital management. Copyright © 2023 Via Medica.

Hybrid-Patch-Alex: A new patch division and deep feature extraction-based image classification model to detect COVID-19, heart failure, and other lung conditions using medical images

COVID-19, chronic obstructive pulmonary disease (COPD), heart failure (HF), and pneumonia can lead to acute respiratory deterioration. Prompt and accurate diagnosis is crucial for effective clinical management. Chest X-ray (CXR) and chest computed tomography (CT) are commonly used for confirming the diagnosis, but they can be time-consuming and biased. To address this, we developed a computationally efficient deep feature engineering model called Hybrid-Patch-Alex for automated COVID-19, COPD, and HF diagnosis. We utilized one CXR dataset and two CT image datasets, including a newly collected dataset with four classes: COVID-19, COPD, HF, and normal. Our model employed a hybrid patch division method, transfer learning with pre-trained AlexNet, iterative neighborhood component analysis for feature selection, and three standard classifiers (k-nearest neighbor, support vector machine, and artificial neural network) for automated classification. The model achieved high accuracy rates of 99.82%, 92.90%, and 97.02% on the respective datasets, using kNN and SVM classifiers.

Frontal QRS-T angle in patients with the suspicion of Coronavirus disease 2019 (COVID-19): could it be used as a predictive gravity sign even before the diagnosis by PCR?

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has been an ongoing global public health concern, causing serious challenges in diagnosing the disease timely. We investigated the value of the frontal QRS-T (fQRS-T) angle in patients visiting the emergency department with the suspicion of COVID-19. PATIENTS AND METHODS: A hundred and thirty-seven patients with the complaint of dyspnea were evaluated retrospectively. The patients with a history of coronary artery disease, heart failure, pulmonary disease, hypertension, diabetes mellitus, or using any medication such as heart rate controllers or antiarrhythmic drugs were excluded from the study. The angle between frontal QRS- and T-wave axis was defined as the fQRS-T angle, and the patients were divided into two groups based on the fQRS-T angle (group 1, <90° and group 2, ≥90°). Demographic, clinical, electrocardiographic data and rRT-PCR results were compared between the groups. RESULTS: The mean value of the fQRS-T angle of all participants was 45.26°. There was no significant difference between the groups according to the demographic and clinical data. Subjects with wider fQRS-T angle (group 2) had higher heart rates (p = 0.018), higher corrected QT values (p = 0.017), and higher QRS axis (p = 0.001). The patients in group 2 had a higher number of positive COVID-19 rRT-PCR test results compared to subjects with the normal fQRS-T angle (p = 0.002). In multivariate regression analysis, fQRS-T angle (p = 0.027, OR: 1.013, 95% CI: 1.001-1.024) was found as an independent variable affecting the PCR test results. CONCLUSIONS: Prompt diagnosis, initiating preventive and protective measures in an early stage of COVID-19 are crucial. In suspected COVID-19 infection, the use of faster-resulting tests and diagnostic tools for COVID-19 allows patients to be diagnosed and treated in a timely manner for recovery, thereby optimizing patient management. Therefore, the fQRS-T angle can be used in patients with dyspnea as a part of diagnostic scores of COVID-19, even before the rRT-PCR test results and overt disease.

The effect of the severity of COVID-19 infection on electrocardiographic findings

Background and Aim: Acute myocardial damage is detected in a significant portion of patients with coronavirus 2019 disease (COVID-19) infection, with a reported prevalence of between 7% and 28%. The aim of this study was to investigate the relationship between electrocardiographic findings and the indicators of the severity of COVID-19 detected on electrocardiography (ECG). Method(s): A total of 219 patients that were hospitalized due to COVID-19 between April 15 and May 5, 2020 were enrolled in this study. Patients were divided into two groups according to the severity of COVID-19 infection: severe (n = 95) and non-severe (n = 124). ECG findings at the time of admission were recorded for each patient. Clinical characteristics and laboratory findings were retrieved from electronic medical records. Result(s): Mean age was 65.2 +/- 13.8 years in the severe group and was 57.9 +/- 16.0 years in the non-severe group. ST depression (28% vs 14%), T-wave inversion (29% vs 16%), ST-T changes (36% vs 21%), and the presence of fragmented QRS (fQRS) (17% vs 7%) were more frequent in the severe group compared to the non-severe group. Multivariate analysis revealed that hypertension (odds ratio [OR]: 2.42, 95% confidence interval [CI]:1.03-5.67;P = .041), the severity of COVID-19 infection (OR: 1.87, 95% CI: 1.09-2.65;p=0.026), presence of cardiac injury (OR: 3.32, 95% CI: 1.45-7.60;p=0.004), and d-dimer (OR: 3.60, 95% CI: 1.29-10.06;p=0.014) were independent predictors of ST-T changes on ECG. Conclusion(s): ST depression, T-wave inversion, ST-T changes, and the presence of fQRS on admission ECG are closely associated with the severity of COVID-19 infection.

The effect of q-RT-PCR analysis method on saline gargle samples in SARS-CoV-2 clinical diagnostic methods

COVID-19 is a devastating disease, and its control is difficult due to its high transmissibility rate and a long incubation average period (6.4 days). Additionally, more than half of the infected patients were asymptomatic young people or children. The asymptomatic virus transmission is the actual challenge to controlling the disease. Because of limited treatment options, diagnosis techniques have been the first focus all over the world, involving q-RT-PCR as a gold standard, serological tests, point of care studies, or RT-LAMP. Generally, nasopharyngeal, and oropharyngeal samples are preferred clinically as sources. However, alternative sources are being researched, particularly for healthcare professionals who have difficulty taking samples, patients who are afraid of giving samples, and pediatric patients. Herein, physiological saline has been utilized to offer an alternative source besides the swab samples for use in q-RT-PCR. In this study, 212 randomly chosen patients' samples were studied, and we evaluated the concordance and accurate q-RT-PCR results in two different sources, obtained from swab and gargle samples of patients. Herein, physiological saline is utilized, which is widely used medically as a recommended irrigating and wound dressing solution. We obtained in our experiments with this method, the confidence interval determines 74.50% positivity when compared to the routine q-RT-PCR procedure as summarized. In addition, when only the gargle sampling method is studied in low-income countries, the cost of testing for COVID-19 will decrease significantly. Because this method does not require vNAT or VTM transport solution sterile swab sticks as shown. The plastic container with a lid in which the patient can gargle with SF and spit it out is an ideal method for this. Additionally, it provides a great cost-benefit in low-income countries.

A CASE WITH SYSTEMIC LUPUS ERITHEMATOSUS MIMICKING COVID-19 PNEUMONIA

Coronavirus-19 disease (COVID-19) is a worldwide health emergency which has a high mortality ratio. Diagnosis requires a positive quantitative real-time polymerase chain reaction (qRT-PCR) test however there are radiological findings strongly suggest the diagnosis of COVID-19. Here we reported a 63-year-old woman presented with cough and dyspnea and medical history of lung cancer and systemic lupus erythematosus (SLE). Chest computed tomography demonstrated widespread ground glass opacities in both lung fields that have been reported to be compatible with COVID-19 pneumonia. qRT-PCR test was negative for twice and radiological regression after hydroxychloroquine, azithromycin and piperacillin-tazobactam was not significant. Considering lung involvement of SLE methylprednisolone was initiated, symptoms and radiological findings improved. The underlying diseases may mimic the COVID-19 infection or the signs and symptoms of the disease may be seen together with COVID-19. © 2021 Universidad Compultense Madrid. All right reserved.

Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure

Introduction: The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF). Methods: A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis. Results: A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of comorbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NTpro- BNP levels but had decreased levels of hemoglobin. By multivariable analysis;age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86;95% CI: 0.76-0.97). Conclusion: The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases.

Prognostic significance of cardiac injury in COVID-19 patients with and without coronary artery disease

Objective: COVID-19 is a disease with high mortality, and risk factors for worse clinical outcome have not been well-defined yet. The aim of this study is to delineate the prognostic importance of presence of concomitant cardiac injury on admission in patients with COVID-19. Methods: For this multi-center retrospective study, data of consecutive patients who were treated for COVID-19 between March 20 - April 20 2020 were collected. Clinical characteristics, laboratory findings and outcomes data were obtained from electronic medical records. In-hospital clinical outcome was compared between patients with and without cardiac injury. Results: A total of 607 hospitalized patients with COVID-19 were included in the study;the median age was 62.5±14.3 years, and 334 (55%) were male. Cardiac injury was detected in 150 (24.7%) of patients included in the study. Mortality rate was higher in patients with cardiac injury (42% vs. 8%;p<0.01). The frequency of patients who required intensive care unit (ICU) (72% vs.19%), who developed acute kidney injury (AKI) (14% vs. 1%) and acute respiratory distress syndrome (ARDS) (71% vs. 18%) were also higher in patients with cardiac injury. In multivariate analysis, age, coronary artery disease (CAD), elevated CRP levels, and presence of cardiac injury (OR: 10.58, 95% CI: 2.42-46.27;p<0.001) were found to be independent predictors of mortality. In subgroup analysis, including patients free of history of CAD, presence of cardiac injury on admission also predicted mortality (OR: 2.52, 95% CI: 1.17-5.45;p=0.018). Conclusion: Cardiac injury on admission is associated with worse clinical outcome and higher mortality risk in COVID-19 patients including patients free of previous CAD diagnosis.

Oxidative stress index can be a new marker related to disease severity in COVID-19

Objectives: The aim of this study was to evaluate the relationship between systemic oxidative balance, and the severity of the disease in patients with COVID 19. Methods: Sixty-four patients were divided into three groups according to the severity of the disease:mild (n=28), moderate (n=11) and severe (n=25). Twenty-four healthy controls included to the study. Proinflammatory cytokines (IL-6 and TNF-α), D-dimer, fibrinogen, total oxidative status (TOS), total antioxidant status (TAS) were measured and oxidative stress index (OSI) was calculated. Results: The mean age of severe group was significantly higher than the other groups (p=0.001). TAS levels were significantly decreased in all patient groups compared to controls, while serum TOS and OSI levels were significantly different in all three stages of the disease. Serum IL-6 and TNF- α levels were significantly elevated in severe group compared to other groups. TOS and OSI levels were also significantly correlated with IL-6, CRP, ferritin, fibrinogen, LDH and D-dimer. Conclusions: TOS and OSI levels are an indicator of systemic oxidative balance in COVID-19 and related to the disease severity. They can be an important marker for evaluating the disease severity and used in the management of patients with COVID-19 2021 Serdar Dogan et al.

Brand anthropomorphism, love and defense: does attitude towards social distancing matter? (Special Issue: Transformative service research and COVID-19.)

Several hospitality brands changed their logos to reinforce the importance of social distancing in reducing the risk of virus infection. Since social distancing is a polarizing topic, this research intends to understand consumers' attitudes towards social distancing and their response to branding change by hospitality brands. Study 1 creates and validates a multiple-item scale to examine consumers' attitudes towards social distancing, which is then adopted for two subsequent studies. Study 2 tests consumers' awareness and perceived brand anthropomorphism during a sensitive situation like a global pandemic and the impact of perceived brand anthropomorphism on brand love and brand defense. Study 3 tests the proposed model in study 2 across two customer segments, i.e. those in favor of social distancing and its effectiveness and those against it. Results indicate that brand anthropomorphism and brand love have a significantly positive impact on brand defense. Additionally, these relationships differ for consumers who favor or oppose social distancing. Our research contributes to the hospitality branding literature by studying relatively understudied branding constructs in an unprecedented context and offers insights for hospitality branding and marketing managers.

Prediction of mortality, hospitalization and mechanical ventilation needs of patients with pneumonia in COVID-19 outbreak

Objective: The COVID-19 pandemic has brought considerable loss to the world by means of pneumonia related mortality. In the current study, we aimed to discover the predictors of mortality and other worse outcomes in atypical pneumonia cases during the COVID-19 outbreak.

The impact of Coronavirus Disease 2019 (COVID-19) on urinalysis parameters.

BACKGROUND: Creatinine elevation and changes in urinalyse parameters may be seen due to acute kidney injury during COVID-19. In the present study, we aimed to investigate the changes in urinalysis of COVID-19 patients with normal kidney function. METHODS: The data of COVID-19 patients with normal renal functions were retrospectively analyzed. Urinalysis parameters of these patients were recorded. The patients were divided into three groups as mild, moderate and severe with respect to the clinical course of the disease. It was examined whether the urine analysis values in the groups were different from normal reference values and whether these values were different between the groups. In addition, possible relationship between the urinalysis parameters and the clinical severity of the disease was investigated. RESULTS: There are three groups; mild (n:40), moderate (n:38) and severe (n:42). Mean age were significantly higher in the severe group, while gender distribution of the groups was similar. (p=0.033) (p=0.091) Creatinine values of all patients were normal. There were 6.7% glucose positivity, 13.4% protein positivity, 5.8% urobilinogen positivity and 7.5% ketone positivity in urine dipstick analysis and these changes were all significantly higher than the reference values. (p=0.008, p<0.0001, p=0.016, p=0.016) Pyuria and hematuria were detected in 8.3% and 9.2%, respectively. The urinalysis parameters and urine microscopy findings were not affected by the severity of the disease. CONCLUSIONS: Glycosuria, proteinuria, pyuria and hematuria may occur during COVID-19 disease, regardless of comorbidity and renal dysfunction. However, these urine parameters were not correlated with the severity of the disease.

Lymphocyte-to-C-reactive protein ratio may serve as an effective biomarker to determine COVID-19 disease severity

Objectives: We aimed to evaluate the ability of lymphocyte-C-reactive protein ratio (LCR) to discriminate between different levels of severity of COVID-19 disease. Methods: This retrospective observational single-center study was performed on 61 confirmed (PCR positive) COVID-19 patients between March and June 2020. The study population was separated into three groups: mild/moderate (n=24), severe (n=25) and critically ill (n=12). The optimal cutoff values of the LCR and neutrophil-to-lymphocyte ratio (NLR) in discriminating between patients with different severity levels were calculated by applying the receiver operating curve (ROC) analysis. Results: At baseline, the LCR decreased significantly across the three severity groups (mild/moderate > severe > critically ill). ROC analysis showed that a mean LCR of 43.21 was the cut-off value which best discriminated patients with the critically ill disease from severe patients (sensitivity: 84% and specificity: 69%). The discriminative performance of LCR (ROC AUC 0.820) was better than that of NLR (0.751) in this regard. LCR, unlike NLR was able to distinguish severe patients from mild/moderate patients, with a cut off value of 458.19 (sensitivity: 80% and specificity: 45%). Conclusion: LCR was observed to be able to distinguish COVID-19 infected patients of different severity (mild/moderate, severe and critically ill) and was superior to NLR in this regard.

Thorax computed tomography imaging findings of COVID-19 at Kocaeli University

Objective: The objective of this study was to evaluate imaging findings and differences of thorax computed tomography (CT) of coronavirus disease 2019 (COVID-19) at Kocaeli University.

Coincidental respiratory findings of COVID-19 on abdominal CT in patients with predominant abdominal indications

Objective: Our aim in this study was to report the findings related to coronavirus disease (COVID-19) in abdominal Computed Tomography (CT) in patients presenting with abdominal symptoms.

An automated Residual Exemplar Local Binary Pattern and iterative ReliefF based COVID-19 detection method using chest X-ray image

Coronavirus is normally transmitted from animal to person, but nowadays it is transmitted from person to person by changing its form. Covid-19 appeared as a very dangerous virus and unfortunately caused a worldwide pandemic disease. Radiology doctors use X-ray or CT images for the diagnosis of Covid-19. It has become crucial to help diagnose such images using image processing methods. Therefore, a novel intelligent computer vision method to automatically detect the Covid-19 virus was proposed. The proposed automatic Covid-19 detection method consists of preprocessing, feature extraction, and feature selection stages. Image resizing and grayscale conversion are used in the preprocessing phase. The proposed feature generation method is called Residual Exemplar Local Binary Pattern (ResExLBP). In the feature selection phase, a novel iterative ReliefF (IRF) based feature selection is used. Decision tree (DT), linear discriminant (LD), support vector machine (SVM), k nearest neighborhood (kNN), and subspace discriminant (SD) methods are chosen as classifiers in the classification phase. Leave one out cross-validation (LOOCV), 10-fold cross-validation, and holdout validation are used for training and testing. In this work, SVM classifier achieved 100.0% classification accuracy by using 10-fold cross-validation. This result clearly has shown that the perfect classification rate by using X-ray image for Covid-19 detection. The proposed ResExLBP and IRF based method is also cognitive, lightweight, and highly accurate.