An Important Clinical Condition in Differential Diagnosis of Coronavirus Disease 2019: Crack Lung.

Crack cocaine has been associated with a variety of pulmonary manifestations. We report a 44-year-old man been diagnosed with severe acute respiratory syndrome coronavirus 2 infection, presenting shortness of breath, non-productive cough, chest pain, headache, dizziness, and fever lasting for 2 days. At first, all findings of our patient called for an impression of coronavirus disease 2019. During admission, he presented with acute respiratory symptoms, patchy ground-glass opacities, and laboratory abnormalities, such as elevated acute phase response and lymphopenia. After, the presence of transient lung infiltrations in the follow-up triggered the cause for a re-evaluation of the diagnosis of coronavirus disease 2019. After a detailed inquiry, it was revealed that he had had a history of intense inhaled cocaine use 2 days before hospitalization. We speculate that the crack lung should also be considered in the differential diagnosis in patients with suspected coronavirus disease 2019 pneumonia.

Comparison of Pneumonia Severity Indices, qCSI, 4C-Mortality Score and qSOFA in Predicting Mortality in Hospitalized Patients with COVID-19 Pneumonia.

This is a retrospective and observational study on 1511 patients with SARS-CoV-2, who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. 1511 patients, 879 male (58.17%) and 632 female (41.83%) with a mean age of 60.1 ± 14.7 were included in the study. Survivors and non-survivors groups were statistically compared with respect to survival, discharge, ICU admission and in-hospital death. Although gender was not statistically significant different between two groups, 80 (60.15%) of the patients who died were male. Mean age was 72.8 ± 11.8 in non-survivors vs. 59.9 ± 14.7 in survivors (p < 0.001). Overall in-hospital mortality was found to be 8.8% (133/1511 cases), and overall ICU admission was 10.85% (164/1511 cases). The PSI/PORT score of the non-survivors group was higher than that of the survivors group (144.38 ± 28.64 versus 67.17 ± 25.63, p < 0.001). The PSI/PORT yielding the highest performance was the best predictor for in-hospital mortality, since it incorporates the factors as advanced age and comorbidity (AUROC 0.971; % 95 CI 0.961−0.981). The use of A-DROP may also be preferred as an easier alternative to PSI/PORT, which is a time-consuming evaluation although it is more comprehensive.

Depression in frail older adults: Associations and gender difference.

Objective: Depression is highly prevalent in frail older adults and both clinical situations share similar clinical and prognostic factors. The aim of this study was to investigate the relationship between frailty and depression by considering each component of frailty, in both genders. Methods: Six hundred and forty-one patients aged 60 years and older, admitted to a Geriatrics outpatient clinic in a tertiary hospital, were included in this cross-sectional study. FRIED criteria were used for defining frailty. Depression was assessed by the Geriatric depression scale (GDS). Evaluations related to disability, nutrition, and cognition were performed by the Katz/Lawton scales, mini nutritional assessment (MNA), and the mini mental state examination (MMSE), respectively. Results: Prevalence of frailty and depression was 48.7% and 36.7%, respectively. Co-occurrence of frailty and depression was observed as 24.0%. Both in men (OR: 3.977, CI: 1.423-11.114, p=0.008) and in women (OR: 2.704, CI: 1.695-4.315, p<0.001), depression was independently associated with frailty, after adjusting with confounders regarding frailty. All FRIED criteria were significantly correlated with the higher GDS scores in women. Two FRIED criteria regarding physical activity and strength measures were not related to depressive symptoms in men. Lawon (p<0.001), MMSE (p=0.004), and MNA scores (p<0.001) were lower in patients with co-occurring frailty and depression, than both as separate conditions. Conclusion: Depression may play a key role in the development of frailty in both genders. Albeit, depressed men seem to be at a higher risk than women for development of frailty are, physical activity and strength measures in the FRIED criteria had a high impact in women for depressive symptoms. Patients with co-occurring frailty and depression are more prone to develop geriatric syndrome related disabilities.

Changing characteristics of cancer patients during the COVID-19 pandemic.

INTRODUCTION: Cancer patients are more sensitive to infections, and, compared to other patients, may have more serious outcomes. Thus, cancer patients are a high-risk group in the COVID-19 pandemic. The aim of this study was to evaluate how cancer patients are affected by COVID-19 infection; the prevalence, and factors affecting mortality. METHODOLOGY: This single-centre, retrospective study included cancer patients under follow-up treatment at our hospital with a laboratory-confirmed diagnosis of COVID-19. Demographic and clinical data were obtained from electronic medical records. The effects of tumour subtype and patient demographic data on COVID-19 prevalence and mortality were analyzed using univariate and multivariate models. RESULTS: Evaluation was made of 217 cancer patients, comprising140 (64.5%) males and 77 (35.5%) females with a mean age of 62.05 ± 12.95 years. Mortality was seen in 84 (38.7%) patients. Disease grade, chemotherapy within the last 3 months and CT findings were determined to be related to mortality. In logistic regression analysis, the most important factors affecting survival were determined to be severe lung involvement (p < 0.001) and hematological malignancy. CONCLUSIONS: It is clear that cancer patients are at greater risk from COVID-19 infection than individuals without a malignant disease. The results showed that cancer patients with different tumour types had different levels of sensitivity to COVID-19. It is clear that with ongoing viral mutations, the duration of the pandemic is unknown. Therefore, the continuation of cancer screening and cancer treatments should not be interrupted.

Validation of the five-item version of the Geriatric Depression Scale (GDS-5) in a Turkish elderly population.

BACKGROUND: Late-life depression is a geriatric syndrome which should be taken seriously. Many clinical scales have been developed for the screening of geriatric depression. Most of these have been validated at different times and in diverse populations. A five-question version of the Geriatric Depression Scale (GDS-5) was developed in 1997. This test has been validated and used in different populations. In the present study, we plan to validate the GDS-5 for the Turkish elderly population. METHODS: Patients aged 60 years and older who applied to the Geriatrics Clinic of our hospital between November 2018 and November 2019 were included in the study. We compared the effectiveness of Yesavage Geriatric Depression Scale-30 (YGDS-30) and GDS-5 in screening depression, based on Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) depression criteria. RESULTS: Four hundred participants were included in the study. A significant positive correlation was found between the DSM-5 scale and the GDS-5 scale (rho = 0.726, P <0.001). According to DSM-5, YGDS-30 and GDS-5, 112 participants (28%), 154 patients (%38.5) and 199 patients (%49.8) were diagnosed with depression respectively. When the cut-off value was taken as ≥2, the sensitivity, specificity, positive predictive and negative predictive values for the GDS-5 scale were determined as 96%, 68%, 54%, and 98%, respectively. We obtained these diagnostic measures with 95% confidence intervals. CONCLUSION: This study demonstrated the validity and reliability of the GDS-5 for Turkish elderly populations. This five-question scale will be significant in daily use to screen for depression in elderly individuals with multiple problems.

Comparison of systemic immune-inflammation index (SII), early warning score (ANDC) and prognostic nutritional index (PNI) in hospitalized patients with malignancy, and their influence on mortality from COVID-19.

INTRODUCTION: We evaluated several biological indicators based on inflammation and/or nutritional status, such as systemic immune-inflammation index (SII), early warning score (ANDC) and prognostic nutritional index (PNI) in hospitalized COVID-19 patients with and without malignancies for a prognostic significance. METHODOLOGY: This is a retrospective and observational study on 186 patients with SARS-CoV-2, who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. 75 patients had various malignancies, and the rest (111), having a similar age and comorbidity profile based on propensity score matching, had no malignancy. RESULTS: None of the measures as neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, monocyte to lymphocyte ratio, SII, PNI or ANDC was found to be significantly different between two groups. Odds ratio for the mortality, OR 2.39 (%95 CI 1.80-3.16) was found to be significantly higher for the malignancy group, even though the duration of hospitalization was statistically similar for both groups. PNI was found to be significantly lower for deceased patients compared with survivors in the malignancy group. Contrarily, ANDC was found to be significantly higher for deceased patients in the malignancy group. CONCLUSIONS: PNI and ANDC have independent predictive power on determining the in-hospital death in COVID-19 malignancy cases. It is suggested that ANDC seems to be a more sensitive score than SII in COVID-19 cases with malignancies.

Unacceptable Antibiotic Resistance Rates for Helicobacter pylori in Turkey: Something Must Change.

BACKGROUND: It is known that clarithromycin resistance has increased over the years (success rate 60%). The aim of the study was to investigate the importance of regional antimicrobial resistance rates for full accuracy of both diagnosis and treatment of Helicobacter pylori infection. METHODS: This study was carried out in the University Hospital Department of Gastroenterology. A total of 116 patients were evaluated with upper gastrointestinal endoscopy. Gastric antrum and corpus biopsy samples were taken for the rapid urease test (RUT), culture, and antimicrobial susceptibility testing for the presence of H. pylori. Antimicrobial susceptibilities of isolated H. pylori strains for clarithromycin and levofloxacin were determined by the epsilometer test (E-test). Minimal inhibitory concentration values for clarithromycin and levofloxacin were ≥1 and >1 µg/mL, respectively. RESULTS: H. pylori infection was considered clinically positive in 93 (80.2%) patients with either the RUT, culture, or histopathological examination. Seventy (60.3%) of the patients had RUT positivity. Sixty (85.7%) of these 70 patients had RUT positivity within the first 20 min. Among the 90 patients, who had a histopathological examination, HLO was positive in 76 (84.4%) patients. Fifty-two (44.8%) out of 116 patients were culture positive. Resistance rates for both clarithromycin and levofloxacin were high. In these 52 culture-positive patients, resistance rates determined for clarithromycin and levofloxacin were 26.9% and 25.5%, respectively. CONCLUSION: Clarithromycin or levofloxacin-based treatment regimen may not be an ideal alternative therapy for Turkish patients regardless of culture.

Relationship Between Dysphagia and Sarcopenia with Comprehensive Geriatric Evaluation.

Oropharyngeal dysphagia has features of geriatric syndromes and is strongly associated with sarcopenia. In this cross-sectional study, we aimed to evaluate the association between dysphagia and sarcopenia, in a practical way, accompanied by comprehensive geriatric assessment. Dysphagia and sarcopenia were defined by the EAT-10 and SARC-F questionnaires, respectively. Cognition and mood, was evaluated by the Mini-mental State Examination (MMSE) and Geriatric Depression Scale (GDS), respectively. Physical performance was assessed by the Timed up and Go Test (TUG) and muscle strength was determined by Hand Grip Strength (HGS). Functionality was stated by Katz and Lawton Indexes. Serum levels of hemoglobin, triglyceride, albumin, and total cholesterol were recorded. A total of 512 (151 male/361 female) patients age 60 and older were included in the study. Prevalences of dysphagia and sarcopenia were 23% and 40.6%, respectively. In multivariate analysis sarcopenia (OR:2.596, p = 0.008), depressive symptoms (OR:1.115, p < 0.001), and lower KATZ scores (OR:0.810, p = 0.036) were independently related with dysphagia. Dysphagic patients with sarcopenia had lower scores on the Katz and Lawton scales (p < 0.001, rpb = 0.380 and p < 0.001, rpb = 0.447 respectively) and TUG performances were worse (p = 0.009, rpb = - 0.254). Serum hemoglobin and albumin levels were significantly low in dysphagic patients with sarcopenia (p < 0.001, rpb = 0.345, p = 0.008, rpb = 0.243). Dysphagia is independently associated with sarcopenia, depressive symptoms, and functionality. Dysphagia coexist with sarcopenia is associated with worse clinical consequences than without sarcopenia.

Neutrophil- and Platelet- to Lymphocyte Ratio in Patients with Euthyroid Hashimoto's Thyroiditis.

BACKGROUND: Hashimoto's thyroiditis (HT) is the most prevalent autoimmune thyroid disorder. Both neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are reported to be increased in various inflammation-related diseases, but their clinical significance in HT remains unclear. OBJECTIVES: The aim of this study was to investigate the relationship between thyroid autommunity and NLR and PLR as markers of systemic inflammation in HT. METHODS: In this study, we evaluated 145 women with HT and 60 age-matched healthy controls. We compared the PLR and the NLR of HT patients with controls and the correlation between the NLR, PLR, and C-reactive protein (CRP), thyroid-stimulating hormone (TSH) and thyroid antibody titers in the patient group. Also we compared the PLR and the NLR of HT patients that received levothyroxine with those who did not receive levothyroxine RESULTS: There were no significant differences between patient and control groups in terms of overall leukocyte counts, neutrophil counts, and other laboratory tests. In the patient group lymphocyte counts were lower while the platelet counts, NLR (2.29±0.65 vs1.68±0.40), PLR (164.95±55.14 vs106.88±32.19) were higher than those of the control (p<0.001 for all comparisons). CONCLUSION: In this study we found that NLR and PLR were higher in euthyroid Hashimoto patients than in a healthy control group. NLR and PLR are likely non-specific indicators of immune disorder and their implications for HT and other conditions remain to be elucidated.

Successful intracavitary tissue plasminogen activator treatment of gastrocnemius intramuscular hematoma in a patient following anticoagulant therapy with warfarin: case report.

Warfarin is an anticoagulant used in a variety of clinical indications and may rarely cause severe bleeding that can be life-threatening. Although intramuscular bleeding frequently occurs, secondary to trauma, it can be induced in cases with bleeding tendency. Hematoma is often treated with conventional methods. However, surgical decompression can also be applied. In this article, we report a case of gastrocnemius intramuscular hematoma, which was successfully treated with intracavitary tissue plasminogen activator that was recently used in the treatment of abdominal and pelvic abscess.