Can scoring systems be used for the triage of COVID-19 patients?

Background and Aim: Whether to send COVID-19 patients home with quarantine measures or to hospitalize and treat them on an inpatient basis is a very important decision in the treatment of COVID-19 patients. This study aimed to introduce a scoring system that will enable making decisions on inpatient or outpatient treatment of patients by scoring their symptoms, clinical, radiological, and laboratory results during the initial assessment. Materials and Methods: Data of patients over 18 years of age, examined for COVID-19 between March 11, 2020, and May 31, 2020, and who had a positive PCR result, and their radiological (computed tomography reports) and blood test (complete blood count, blood gas and laboratory results) results were recorded to develop our scoring system. Results: A comparison of COVID-19 patients, who received outpatient and inpatient treatments by age variable, revealed a significant result (P < 0.001). The comparison of laboratory results showed a significant difference between both groups (P < 0.001). The comparison of the groups by the presence of comorbidity also revealed a significant result (P < 0.001). According to the scoring system that we developed (Cebeci score), a score of 5 points and above had a specificity of 81% and a sensitivity of 88% for indicating the probability of receiving inpatient treatment. Conclusion: We believe that the scoring system we developed will be a simple, practical, and leading guide for physicians to avoid dilemmas regarding the issue of whether to quarantine patients at home or to hospitalize them in order to use medical resources effectively.

RELATION OF APELIN, TUMOR NECROSIS FACTOR ALPHA AND CLAUDIN-5 TO BODY MASS INDEX IN CHOLECYSTECTOMIES.

Objective: The aim of this study was to investigate the relationship of Claudin-5, Apelin, Tumor Necrosis Factor Alpha (TNF-α) expression, and body mass index (BMI) of cholecystectomies. Materials and methods: Sixty-eight paraffin embedded cholecystectomy specimens diagnosed as chronic cholecystitis were collected in the Pathology Department of the Training and Research Hospital between 2015-2017. The samples were stained with Apelin, Claudin-5 and TNF-α. The immunohistochemical study was carried out using the system in an automatic staining machine. Results: There was a significant positive correlation between BMI and TNF-α staining (p=0.010). This result indicated that the degree of staining increased together with BMI. When age, BMI, and the other biochemical parameters were evaluated, a significant correlation was found between BMI and blood glucose only (p=0.029); correlations of BMI with the other parameters were not statistically significant. Conclusion: Although there is no relationship between inflammation and BMI with Claudin-5 and Apelin in this study, there is a significant relationship between BMI and TNF-α.

The frequency of osteoporosis in patients with predialysis chronic renal failure and the factors affecting the development of osteoporosis.

BACKGROUND: Osteoporosis is a common public health problem in chronic kidney patients. The risk factors for osteoporosis in patients with nondialysis CKD have not been fully investigated. It is not known exactly whether the risk factors of osteoporosis in the general population are also valid for the nondialysis CKD patients. Aims: This study aims to determine the frequency of osteoporosis and the risk factors for osteoporosis in nondialysis CKD patients. PATIENTS AND METHODS: Our study was performed with 283 nondialysis stage 3-5 CKD patients. According to the BMD results, the patients were classified into groups as normal, osteopenia and osteoporosis according to World Health Organization criteria. Monocyte/high-density lipoprotein-cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) were calculated individually for all cases. RESULTS: According to our BMD results, 67 (24%) patients were found to have osteoporosis. In the osteoporosis patient group, compared to the normal BMD group, females were higher and the mean age was higher (P = 0.025, P = 0.028). Body mass index (BMI) and eGFR were lower in the osteoporosis group (P = 0.013). Parathyroid Hormone and Platelet-to-lymphocyte ratio in the patients in the osteoporosis group was higher than of those in the normal group (P = 0.026, P = 0.035). In the multivariate logistic regression analysis, advanced age, female gender, and low BMI were determined as independent risk factors for the development of osteoporosis in nondialysis CKD patients. CONCLUSION: Advanced age, female gender and low BMI are the risk factors for osteoporosis in nondialysis CKD patients. It may be a rational approach to measure BMD for the diagnosis of osteoporosis in nondialysis CKD patients who are elderly, female and have low BMI.

Prevalence study for postoperative nausea vomiting: A training hospital example.

BACKGROUND: Simplified risk models, such as the Apfel score, have been developed to calculate the risk of postoperative nausea-vomiting (PONV) for adult patients. In the absence of any risk factors, PONV risk is assumed to be 10%. While the presence of one of the four risk factors determined as female gender, non-smoking, PONV/car sickness history, and postoperative opioid use is associated with 20% risk for PONV, the risk increases by 20% with the addition of each risk factor, and reaches to 80% if four factors are present. AIM: : Our aim in this study is to investigate the prevalence of PONV, and whether the scoring systems used for nausea-vomiting in the literature are still valid. PATIENTS AND METHODS: Five groups of patients were included in the study with an Apfel score of 0, 1, 2, 3, 4. Each case was taken to the recovery room at the end of the operation. They were observed whether had nausea-vomiting was recorded according to the Abramowitz emesis score. RESULTS: While the PONV risk for women is 24.637 times higher than men, the PONV risk of those who had gynecological surgery is 6.27 times higher than that of the other type of surgery. Those who had urological surgery are 0.345 times less than the other type of surgery. Those who had lower abdominal surgery had a risk of PONV of 4.56 times higher than the others. As the duration of the case increases, the risk of PONV increases 1.01 times (P values P < 0.001, P < 0.001, P < 0.001, P = 0.048, P < 0.001, respectively). CONCLUSION: As a result, our PONV prevalence is considerably lower than the frequency rates mentioned in the literature. PONV scoring systems need long-term studies with larger populations to be updated.

A retrospective analysis of intensive care unit patients during the pandemic period.

aimed to evaluate the laboratory parameters, risk factors, and success in predicting mortality in COVID-19 patients admitted to our hospital's intensive care units (ICUs). METHODS: Levels of procalcitonin, ferritin, D-dimer, CRP and albumin measured on days 1 and 7 were recorded. Patients were divided into two groups as non-survivors and patients, who were discharged from ICUs. The predictive values of laboratory parameters in predicting COVID-19 mortality were investigated. RESULTS: A statistically significant difference was detected between the two groups in the mean values of all laboratory parameters tested on days 1 and 7, including D-dimer, procalcitonin, CRP, WBC, ferritin (excluding only D-dimer levels and WBC counts on day 1; p=0.061 and p=0.243, respectively) (p<0.001, p<0.001, p<0.001, p=0.013, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001; respectively). CONCLUSION: . It can be argued that procalcitonin, ferritin, and D-dimer can be guiding parameters in predicting mortality in COVID-19 because their levels were found to be significantly higher in non-survivors. D-dimer, procalcitonin, and ferritin showed an almost high level of sensitivity and specificity in predicting mortality (Tab. 5, Fig. 3, Ref. 19).

Acute acetaminophene-induced hepatotoxicity and nephrotoxicity; therapeutic effect of dexmedetomidine.

OBJECTIVE AND BACKGROUND: Acute acetaminophen (APAP) overdose has been shown to cause toxicity and the primary treatment medication is N-acetylcysteine (NAC). Dexmedetomidine (DEX) is a sedative drug with known antioxidant properties. We researched whether DEX has an injury-reducing effect on toxicity. METHODS: Rats were divided into: Group I (control), Group II (APAP) Group III (NAC) Group IV (DEX) and Group V (NAC+DEX). Histopathologic investigations of tissues were performed and glutathione peroxidase (GSH-Px), catalase (CAT), malondialdehyde (MDA), myeloperoxidase (MPO) and beta trace protein (PGD2S) levels were studied in blood samples. RESULTS: DEX administration for hepatotoxicity and nephrotoxicity induced with APAP, caused a significant reduction in oxidative injury markers like MDA and MPO, a significant increase in GSH-Px level and a significant degree of amelioration in liver histopathologic scores. CONCLUSION: DEX administration for APAP toxicity causes a reduction in oxidative injury biomarkers, increased antioxidant biomarker levels and significant reduction in liver histopathologic scores. The beneficial effect of DEX use for detection of toxicity induced by acute APAP overdose, was shown in this study for the first time (Tab. 5, Fig. 2, Ref. 41).

Comparison of sleep quality and quality of life indexes with sociodemographic characteristics in patients with chronic kidney disease.

AIMS: Chronic kidney disease (CKD) is a serious health problem due to high mortality and morbidity, negative impact on the patients' quality of life (QOL), high diagnostic and therapeutic cost, and the burden on society. Sleep, which is one of the main needs of the human body, is important regarding the health and QOL in all ages. The objective of our study was to plan the quality of sleep and life quality in adults with CKD. MATERIALS AND METHODS: Total 240 cases (91 healthy volunteers, 75 predialysis patients, and 74 hemodialysis (HD) patients) were included in our study. Our study was designed as a prospective survey with a face-to-face interview method. The sleep quality was evaluated with Pittsburgh Sleep Quality Index (PSQI). The WHO Quality of Life-short version (BREF) survey questions were used for QOL, and scoring was performed. RESULTS: The analysis showed that the results of PSQI scores, QOL scores, and evaluation of the age variable were statistically significant (P = 0.001, P < 0.001, P < 0.001, respectively). Likewise, the PSQI scores were low in healthy volunteers but were the highest in predialysis patients. The scores of the HD patients were between the scores of predialysis and healthy volunteers. The score of the QOL increased with educational level. There was a positive correlation between Modification of Diet in Renal Disease (MDRD) level and QOL (P < 0.001; r = 0.260) and a negative correlation between MDRD level and PSQI score (P < 0.001, r = -0.202). CONCLUSION: Like in HD patients, close follow-up of predialysis patients with CKD is critical considering the resolution of the encountered problems. We believe that the increase in QOL and sleep in patients with CKD may decrease the morbidity.

Preoperative Vitamin D levels and respiratory complications of general anesthesia.

AIMS: This research aims to investigate whether there is a correlation between the respiratory complications occurring in patients under general anesthesia and preoperative Vitamin D levels. SETTINGS AND DESIGN: The study was a prospective observational study. MATERIALS AND METHODS: This study included 95 adult cases. The cases had total 25-hydroxyvitamin D (25OHD) levels identified in blood samples before the operation. Patients given routine general anesthesia and were assessed in terms of respiratory complications during anesthesia induction, extubation, anesthesia recovery, and the first 24-h postoperative. STATISTICAL ANALYSIS USED: The Shapiro-Wilk test, Student's-t-test, one-way ANOVA test, Pearson correlation coefficient, and Chi-square tests were used. RESULTS: The mean 25OHD vitamin level identified in the preoperative period was 13.00 ± 6.57 ng/mL, with 25OHD vitamin levels found to be significantly low in female cases compared to male cases (P < 0.05). There was a statistically significant negative relationship between age and 25OHD vitamin levels identified (P = 0.045). When assessed in terms of surgery types, there was no significant difference found in Vitamin D levels in terms of surgery type. When examined for complications in the induction, extubation period, and postoperative recovery period, there was a significant difference identified between 25OHD vitamin levels and these complications (P < 0.01). CONCLUSIONS: This research observed that patients with low preoperative 25OHD vitamin levels encountered respiratory complications related to general anesthesia more often. Especially, in the early postoperative period, there is a very significant difference between complications and low 25OHD vitamin levels.

Relationship of epicardial fat tissue thickness with oxidant biomarkers in chronic kidney disease.

INTRODUCTION AND OBJECTIVE: IMA and MPO are elevated in serum in case of end-stage renal disease. Epicardial fat tissue thickness has been considered an indicator for cardiovascular diseases recently. The present study was aimed to examine the relationship of epicardial fat tissue thickness (EFTT) with IMA and MPO levels in patients with CKD. MATERIALS AND METHODS: Predialysis CKD patients admitted to the Nephrology outpatient clinic, patients on haemodialysis and healthy volunteers were included, 111 patients were in the study. EFTT measurement was performed with the transthoracic view using an ECHO device. RESULTS: The analysis conducted among the groups in terms of IMA, MPO levels, and EFTT revealed a statistically significant difference (p < 0.001). It was determined to be the lowest in the healthy volunteers, slightly increased in the pre-dialysis group whereas it was quite high in the haemodialysis group. According to the correlation test performed, we observed that IMA, MPO levels, and EFTT were found to be highly correlated to progression of CKD. CONCLUSION: We believe that we have introduced three novel follow-up parameters, such as: IMA, MPO, EFTT to literature for the follow-up of CKD. As the levels of IMA MPO and EFTT increase, the severity of CKD increases (Tab. 4, Fig. 1, Ref. 25).

Endurance training attenuates the oxidative stress due to acute exhaustive exercise in rat liver.

The aim of this study was to investigate whether an 8-week treadmill training attenuates exercise-induced oxidative stress in rat liver. Male rats were divided into untrained and trained groups. Endurance training consisted of treadmill running at a speed of 2.1 km/h, 1.5 h/day, 5 days a week for 8 weeks. To see the effects of endurance training on acute exhaustive exercise induced oxidative stress, untrained and trained rats were further devided into two groups: animals killed at rest and those killed after acute exhaustive exercise, in which the rats run at 2.1 km/h (10% uphill) until exhaustion. Acute exhaustive exercise increased malondialdehyde level in untrained but not in trained rats. It decreased the activity of glutathione peroxidase and total (enzymatic plus non-enzymatic) superoxide scavenger activity in untrained rats and catalase activity in trained rats. However, it did not affect glutathione S-transferase, glutathione reductase, superoxide dismutase and non-enzymatic superoxide radical scavenger activities in both trained and untrained rats. On the other hand, endurance training decreased glutathione peroxidase and glutathione S-transferase activities. The results suggested that endurance training attenuated exercise-induced oxidative stress in liver, probably by preventing the decreases in glutathione peroxidase and total superoxide scavenger activities during exercise.

Effects of endurance training on antioxidant defense mechanisms and lipid peroxidation in testis of rats.

Male rats were equally divided into trained rest (TR), trained exhaustive exercise (TE), untrained rest (UR), and untrained exhaustive exercise (UE). Endurance training consisted of treadmill running for 1.5 h/d, 5 days a week for 8 weeks reaching the speed of 2.1 km/h at the fortieth week. For acute exhaustive exercise, graded treadmill running was conducted reaching the speed of 2.1 km/h at 95th min, 10% uphill, continued until exhaustion. Testicular tissue malondialdehyde (MDA), antioxidant potential (AOP) levels, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), glutathione-S-transferase (GST), glutathione reductase (GR) and catalase (CAT) activities were determined. There was a slight decrease, but not significant, in the SOD activity in UE group compared to TE and TR groups. Activity of GSH-Px decreased in the UE group compared to UR, TR and TE groups. Acute exhaustive exercise did not affect testicular tissue GSH-Px activity in trained rats. Testicular tissue GST activity of the UE group was similar to TE group, but lower than UR and TR groups. In UE group, testicular tissue AOP values were lower than UR, TR and TE groups. The oxidative effects of acute exhaustive exercise on the rat testis decreased with endurance training. Endurance training prevents oxidative injuries by eliminating oxygen radicals and inhibiting lipid peroxidation via preventing decreases in antioxidant enzyme activities.