What are the mortality markers in elderly patients with acute pulmonary embolism?

OBJECTIVE: This study investigates characteristics and predictors of mortality among elderly patients with acute pulmonary embolism (APE). PATIENTS AND METHODS: Data on patients with the diagnosis of APE at the first admission to two centers between January 2012 and March 2022 were screened retrospectively. Patients aged 65 years and older were categorized as the elderly group while patients between 18 and 64 years of age constituted the non-elderly group. RESULTS: Among the 361 enrolled patients, the average age in the non-elderly group was 51.0 (18.0-64.0) years and the average age in the elderly group was 76 (65.0-92) years. While male patients were the majority in the non-elderly group, there was a higher proportion of female patients in the elderly group (p=0.001). In multivariate regression analysis, the independent risk factors of mortality among elderly patients were oxygen saturation [odds ratio (OR): 1.163, 95% confidence interval (CI): 1.613-9.476; p=0.044], C-reactive protein (CRP) (OR: 1.133, 95% CI: 1.041-1.234; p=0.004), simplified Pulmonary Embolism Severity Index (sPESI) score (OR: 3.910, 95% CI: 1.613-9.476; p=0.003), absence of deep vein thrombosis (OR: 12.88, 95% CI: 1.321-125.739; p=0.028), and leukocyte count (OR: 2.591, 95% CI: 1.015-6.617; p=0.047). In ROC analysis, the cut-off values for mortality prediction were ≥7.7 mg/dL for CRP, >0.125 ng/mL for troponin, and ≥2 for the sPESI score. CONCLUSIONS: If CRP of ≥7.7, troponin of >0.125, and sPESI score of ≥2 are present in elderly patients with APE, extra attention should be paid to the risk of mortality and the utmost care should be taken in planning the monitoring of these patients.

Length of hospital stay and risk factors associated with prognosis in COVID-19 patients: surprising results.

OBJECTIVE: In this study, we aimed to investigate the risk factors that may affect the prognosis and length of hospital stay of COVID-19 patients, particularly immunoglobulin A. MATERIALS AND METHODS: Patients admitted to the relevant department or intensive care unit with a diagnosis of COVID-19 between April 2020 and January 2021 were included in the study. Demographic characteristics of the patients and blood type, immunoglobulin A (IgA), C-reactive protein, D-dimer, procalcitonin, ferritin, troponin I, complete blood count, biochemical, and COVID-19 (SARS-CoV-2) reverse transcription polymerase chain reaction test results were evaluated retrospectively from the hospital files and data system. RESULTS: A total of 164 COVID-19 patients were included in this study. The median age was 72 (range: 30-95) years and the gender distribution of women and men was 66/98 (40.2% vs. 59.8%, respectively). There was no statistically significant relationship between blood type and hospitalization time or mortality (p=0.497 and p=0.923, respectively). There was furthermore no statistically significant relationship between Rh group and the duration of hospitalization or prognosis (p=0.198 and p=0.827, respectively). There was no statistically significant correlation between IgA level and hospitalization time or prognosis (p=0.066, r=0.144). In the analysis of defined risk factors independently associated with death, the following were found to be significant indicators of mortality: leukopenia [beta: -2.973, OR (95% CI): 0.051 (0.003-0.891), p=0.041], glucose [beta: 0.014, OR (95% CI): 1.014 (1.001-1.028), p=0.037], D-dimer [beta: 0.001, OR (95% CI): 1.001 (1.000-1.001), p=0.023], duration of hospitalization [beta: -0.218, OR (95% CI): 0.804 (0.708-0.913), p=0.001], and duration of stay in the intensive care unit [beta: 0.348, OR (95% CI): 1.416 (1.186-1.690), p<0.001]. CONCLUSIONS: In our study, no relationship was found between IgA level and hospitalization time or mortality among COVID-19 patients. However, leukopenia and increased glucose, D-dimer, neutrophil count, urea, and durations of hospital and intensive care stays were found to be important predictors of mortality.

Pulmonary embolism due to an indefinite plug: 5-year follow-up.

Thoracic computed tomography angiography revealed a filling defect with an internal air density in the lower lobar branch of the left pulmonary artery accompanied by pleural fluid, in a patient who applied with sudden onset chest pain and dyspnoea. The filling defect remained stable after anticoagulant treatment. No progression or complications were observed in 5-year follow-up. In pulmonary embolism that does not resolve despite adequate treatment, non-thrombotic sources, particularly foreign body, should be considered.

Evaluation of the relationships between procalcitonin and neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in patients with pneumonia.

OBJECTIVE: The aim of this study is to examine whether there is a relationship between procalcitonin and neutrophil/lymphocyte ratio or platelet/lymphocyte ratio in patients with pneumonia. PATIENTS AND METHODS: The data of 54 patients hospitalized in the respiratory unit of the Adiyaman University Faculty of Medicine Hospital (Adiyaman, Turkey) with the diagnosis of pneumonia between January 2018 and July 2019 were reviewed retrospectively. The patients' complete blood count, procalcitonin, erythrocyte sedimentation rate, and C-reactive protein data were obtained. Diagnosis was made by chest X-ray and, for some patients, by thorax computed tomography together with appropriate clinical findings. Patients with a history of tumors, trauma, burns, surgery, kidney failure, inflammatory diseases or non-pulmonary infections were excluded from the study. RESULTS: The mean age of the patients was 59.04±20.00 years in the group with normal procalcitonin and 66.04±18.28 years in the group with elevated procalcitonin (p: 0.186). The female/male sex ratio of the patients was 15/13 in the group with normal procalcitonin and 8/18 in the group with elevated procalcitonin (p: 0.090). Neutrophil/lymphocyte ratio was 3.97 (1.20-10.77) in the group with normal procalcitonin and 7.21 (0.60-29.50) in the group with elevated procalcitonin (p: 0.012). Platelet/lymphocyte ratio was 155.54±68.89 in the group with normal procalcitonin and 157.48±81.38 in the group with elevated procalcitonin (p: 0.925). In ROC analysis performed to predict elevated levels of procalcitonin, cut-off values were 16.4 ×103/mm3 for white blood cells (p: 0.003), 11.7 ×103/mm3 for neutrophils (p: 0.001), 5.47 for neutrophil/lymphocyte ratio (p: 0.005), and 7.4 mg/dL for C-reactive protein (p: 0.005). CONCLUSIONS: In our study, white blood cell, neutrophil, neutrophil/lymphocyte ratio, and C-reactive protein values were found to be significantly higher in patients with elevated procalcitonin. The neutrophil/lymphocyte ratio was also significantly correlated with white blood cell count and platelet/lymphocyte ratio.

Effect of first application laboratory values on the prognosis of COVID-19 patients hospitalized in the intensive care unit.

OBJECTIVE: The aim of the study was to investigate the effect of blood values at first admission to the hospital on predicting mortality in COVID-19 patients hospitalized in the intensive care unit (ICU). PATIENTS AND METHODS: The blood parameters of 284 intensive care patients, who were diagnosed with COVID-19 via the Real-Time Polymerase Chain Reaction (RT-PCR) for SARS-CoV-2 RNA test, at first admission to the hospital, were evaluated. The contribution of these parameters to predicting mortality was analyzed. RESULTS: No significant relationship was found between complete blood count and mortality. However, it was determined that the ferritin, ALT, D-dimer, and urea levels significantly affected the mortality rates in intensive care patients. CONCLUSIONS: The ferritin, ALT, D-dimer, and urea levels of patients who were admitted to the ICU due to COVID-19, at first admission to the hospital, were significant in predicting mortality. Therefore, it is recommended that these parameters will be evaluated at the first application.

The effects of high intensity-interval training on vaspin, adiponectin and leptin levels in women with polycystic ovary syndrome.

AIM: We aimed to investigate the metabolic effects of HIIT exercise on PCOS patients and how it affects adiponectin, vaspin and leptin. MATERIAL AND METHODS: Twenty women with PCOS were included in the study and were divided into two groups. HIIT program was applied for 10 PCOS and Medium Intensity Continuous Training (MICT) program was applied for other 10 PCOS. At the beginning and at the end of the study, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride(TG), insulin, Adiponectin, Leptin, Vaspin levels of both PCOS groups were evaluated. RESULTS: When PCOS patients by performed HIIT exercise for 12 weeks, we found that the levels of leptin and vaspin did not change while adiponectin levels increased. Moreover serum levels of insulin, TG, total cholesterol, LDL-C decreased but levels of HDL-C increased. CONCLUSION: HIIT increased in the adiponectin levels in women with PCOS and provided more weight loss.

The antiandrogen enzalutamide downregulates TMPRSS2 and reduces cellular entry of SARS-CoV-2 in human lung cells.

SARS-CoV-2 attacks various organs, most destructively the lung, and cellular entry requires two host cell surface proteins: ACE2 and TMPRSS2. Downregulation of one or both of these is thus a potential therapeutic approach for COVID-19. TMPRSS2 is a known target of the androgen receptor, a ligand-activated transcription factor; androgen receptor activation increases TMPRSS2 levels in various tissues, most notably prostate. We show here that treatment with the antiandrogen enzalutamide-a well-tolerated drug widely used in advanced prostate cancer-reduces TMPRSS2 levels in human lung cells and in mouse lung. Importantly, antiandrogens significantly reduced SARS-CoV-2 entry and infection in lung cells. In support of this experimental data, analysis of existing datasets shows striking co-expression of AR and TMPRSS2, including in specific lung cell types targeted by SARS-CoV-2. Together, the data presented provides strong evidence to support clinical trials to assess the efficacy of antiandrogens as a treatment option for COVID-19.

Neurological symptoms in COVID-19 patients.

OBJECTIVES: Our study aimed to investigate neurological symptoms in patients with COVID-19 and contribute to this area of limited knowledge. BACKGROUND: Increasing evidence shows that neurotropism is a common feature of Coronaviruses (CoVs). Like the other CoVs, SARS-CoV 2 uses angiotensin-converting enzyme 2 (ACE2). The brain is thought to express ACE2 receptors detected on glial cells and neurons. There are also ACE2 receptors in skeletal muscles. Our study aimed to investigate neurological symptoms in patients with COVID-19 and contribute to this area of limited knowledge. METHODS: A total of 51 patients, presented to hospitalized in our hospital between March 23, 2020 and April 16, 2020 were included in the study. The diagnosis of all patients included in the study was made according to the WHO interim guideline. The patients were divided into two subgroups as mild and severe course according to the severity of the disease. RESULTS: Neurological symptoms were detected in 16 (31.37 %) patients. Muscle injury was detected in 10 (19.61 %) patients. The most common neurological symptom was headache (n: 9, 17.65 %). When the frequency of all neurological symptoms was compared in those with severe and mild disease, no significant differences were found between the groups. When the frequency of muscular involvement was compared in patients with severe and mild course, no significant differences were found between the groups. CONCLUSION: The nervous system and skeletal muscle system may be among viral targets. Detection of some neurological findings may be valuable in predicting the course of the disease. Some laboratory values can allow predicting disease severity and neurological symptoms (Tab. 5, Ref. 23) Keywords: COVID-19, neurotropism, muscle injury, headache.

Endocan is markedly overexpressed in severe erectile dysfunction.

This study aimed to measure the serum endocan level of patients with erectile dysfunction (ED) and to investigate the possible association between this and vasculogenic severe ED. We performed a prospective analysis of 86 consecutive patients affected by ED. Patients were divided into severe ED (IIEF-5 score < 7) and mild or moderate ED (IIEF-5 score > 7). A strong negative correlation was found between serum endocan levels and peak systolic velocity (p < .001 and r = -.665) in men with severe ED. Univariate logistic regression analysis demonstrated that tobacco consumption (p < .05), serum total 25-hydroxyvitamin D (p < .01), serum endocan levels (p < .01), peak systolic velocity (p < .01), hypertension (p < .001), dyslipidaemia (p < .001), metabolic syndrome (p = .026) and a history of a cardiovascular event (p < .001) significantly increase the risk of severe ED. In the multivariate logistic regression model, we also found that age, hypertension, metabolic syndrome, cardiovascular events and higher serum endocan levels were independently associated with severe ED. Circulating endocan may be used in daily practice as a new marker that correlates with cardiovascular risks and the severity of ED disease.

Vascular endothelial growth factor +405 G/C,-460 T/C and -2578 A/C polymorphisms are not associated with insulin resistance in polycystic ovary syndrome.

Insulin resistance (IR) and pancreatic beta-cell dysfunction are usual comorbidities in polycystic ovary syndrome (PCOS). Vascular endothelial growth factor (VEGF) is known to play an important role in the pathogenesis of PCOS. This study examined firstly the possible association of common +405 G/C,-460 T/C and -2578 A/C polymorphisms of VEGF gene with fasting glucose, fasting insulin and the indices of IR [glucose/insulin ratio (GIR), homoeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI)] in 137 patients with PCOS. None of the studied polymorphisms were found to affect IR indices significantly. However, there was a trend towards higher HOMA in +405 G and -460 T allele carriers in comparison with homozygotes +405 CC and -460 CC, respectively. With regard to -2578 A/C polymorphism, although not significant, in -2578 C carriers HOMA was lower, and GIR was higher in comparison with -2578 AA genotype. Alteration of QUICKI between genotypes was minimal and varied from 4% to 7%. Because of the relatively small sample size, more studies with greater number of cases are necessary to confirm our observations before any statement can be made about the relationship between VEGF gene polymorphism and IR parameters in PCOS.

Cardiac thrombus in Omenn syndrome.

Omenn syndrome is characterized by a generalized erythematous skin rash, lymph node enlargement, hepatosplenomegaly, Increased serum IgE levels, eosinophilia, and evidence of severe combined immune deficiency. Patients develop fungal, bacterial, and viral infections. We present the case of a 3-month-old girl with Omenn syndrome who developed right ventricular thrombosis. Echocardiographic study revealed a round structure that filled the apex and corpus of the the right ventricle. We investigated this patient for hypercoagulation and made a diagnosis of ventricular thrombosis, which is an uncommon finding in Omenn syndrome.

Relationship between endomyometritis and the duration of premature membrane rupture.

In this study, correlation between duration of premature rupture of the membranes (PROM) and the degree of membrane, decidua, and myometrium infections were histologically investigated. The study was carried on 61 women with term pregnancy (30 with PROM, 31 control group). During cesarean section, a full-thickness biopsy specimen of the uterine wall from serosa to decidua was obtained with scissors. Chorioamnionitis was histopathologically identified by neutrophilic leukocyte (NL) infiltration of the membranes. Endometritis or myometritis were diagnosed when the acute inflammatory process extended to the decidua or the myometrium successively. It was found that the presence and depth of NL infiltration significantly correlates with the interval between rupture of membranes and termination of pregnancy.

Delayed hemopericardium due to trivial chest trauma.

We report two cases of hemopericardium occurring in seven-month-old and 12-year-old boys, who had no history of major trauma. The possible cause of the hemopericardium for the infant was falling from a bed which was 75 cm high two weeks prior to the admission. The 12-year-old boy had fallen from a chair and damaged his chest 4 weeks previously. Their coagulation tests were all normal. By means of pericardiotomy, we drained 120 ml and 1200 ml of blood, respectively. The boys have now been well over follow-up periods of 24 and 18 months, respectively.

The angiocardiographic analysis of 73 patients with double-outlet right ventricle.

The purpose of this study was to determine the cardiac anatomy of patients with double-outlet right ventricle by angiocardiography. A total of 73 patients between the ages of one day and 11 years were examined. The aorta was on the right side of the pulmonary artery in 23 cases (32%), right anterior in 20 (27%) and right posterior in 17 cases (23%). Pulmonary stenosis was found in 53 patients (73%) and subaortic stenosis in six cases. Ventricular septal defect (VSD) was subaortic in 39 cases (52%), remote type in 17 (23%), doubly committed in 10 (13%), and subpulmonic in 9 (12%). Double VSD was noted in two patients. Pulmonary hypertension was more frequent in subpulmonic ventricular septal defect (78%). The most common associated anomalies were atrial septal defect (34%), anomalous coronary arteries (12%) and endocardial cushion defect (10%). Aortic root angiography was not satisfactory in half of the cases with coronary arterial anomaly. In conclusion, double-outlet right ventricle is a complex anomaly, all of whose cardiac features can be successfully demonstrated in detail by echocardiography and angiocardiography. However, in order to determine the anatomy of the coronary arteries, selective coronary angiography may be necessary in some patients.

Gastric emptying time in children with progressive muscular dystrophy.

Gastric emptying was evaluated in 11 male children (mean age 8.2 +/- 3.2 years) with progressive muscular dystrophy to detect gastrointestinal smooth muscle involvement. No patient had gastrointestinal symptoms. Gastric emptying studies were performed by using 500 microCi of technetium 99 m sulfur colloid bound to a scrambled egg, and scintigraphic measurements were taken continuously for 60 to 90 minutes. The gastric emptying studies were compared with those of eight male children (mean age 8.2 +/- 2.8 years) without gastrointestinal or muscular disorders. The mean percentage of retention of gastric isotope was significantly greater in the study group than in the control group. These data suggest that dysfunction of the smooth muscle of the upper gastrointestinal tract is detectable in children with progressive muscular dystrophy, even when gastrointestinal symptoms are absent.

Echocardiography for the diagnosis of congenital cardiac anomalies with multiple lesions.

The purpose of this study was to determine the sensitivity and specificity of echocardiography for the diagnosis of congenital cardiac abnormalities with multiple lesions. The study was carried out on 80 patients (ages 1 day to 14 years). After clinical evaluation all patients were studied by echocardiography. Cardiac catheterization and angiocardiography were performed, and echocardiographic findings were compared with those obtained by cardiac catheterization. The sensitivity and specificity of echocardiographic diagnosis were determined based on the false-negative and false-positive results. Of the 80 patients, 19 had double-outlet right ventricle, 17 transposition of the great arteries, 10 common atrium, 9 atrioventricular septal defect, 7 single ventricle, 7 corrected transposition, 6 tricuspid atresia, 3 Ebstein's anomaly, and 2 cor triatriatum. All of these entities were visualized correctly by echocardiography (sensitivity 100%, specificity 100%). There were also 12 instances of atrial isomerism with one false-negative diagnosis, 6 pulmonary atresia with two false-negative diagnoses, and 5 total anomalous pulmonary venous connections with one false-negative diagnosis. The total number of individual cardiac lesions was 291. Nineteen false-negative and four false-positive echocardiographic diagnoses were obtained (sensitivity 93%, specificity 99%). It is concluded that double-outlet right ventricle, transposition of the great arteries, atrioventricular septal defect, single ventricle, corrected transposition, and tricuspid atresia can be accurately diagnosed by echocardiography. However, the role of echocardiography is limited for evaluation of right ventricular outflow tract and small patent ductus arteriosus, especially when associated with pulmonary hypertension.

Sonographic evaluation of the wall thickness of the lower uterine segment in patients with previous cesarean section.

In pregnant women with a history of cesarean section, wall thickness of the lower uterine segment may help determine the risk and safety of vaginal delivery. Determination of wall thickness may help identify the potential risk of uterine rupture in pregnant women who do not wish to have another cesarean section or who are not eligible for surgery due to other systemic disorders. In this study, 50 pregnant women with previous cesarean sections were evaluated with ultrasound preoperatively, and measurements of the lower uterine segment wall thickness were compared with intraoperative assessment of uterine thinning. These findings correlated highly with each other (sensitivity: 100%; specificity: 82% positive predictive value: 87%; negative predictive value: 100%), suggesting the reliability and safety of ultrasound in evaluating uterine wall thickness.

Cardiorespiratory function in Duchenne and Becker muscular dystrophy.

The purpose of this study was to investigate the cardiorespiratory function in Duchenne (DMD) and Becker muscular dystrophy (BMO) patients and to determine whether there is a correlation between these functions and muscular strength. The study involved 32 patients with progressive muscular dystrophy (28 DMD and four BMD). The mean age of the patients was 9.6 +/- 3.5 years. Cardiac investigations were performed in all of the patients, and pulmonary function tests were obtained in 16 cases. In five cases (31%), vital capacity (VC) was less than 80 percent of the predicted value. There was a good correlation between VC and muscular strength. There were various cardiologic findings in 50 percent of the cases with DMD. Electrocardiographic changes were present in 43 percent of the patients. Left ventricular systolic function in the patients who could not walk was significantly lower than that of the patients who could walk. There may be some unknown mechanisms that preserve left ventricular function relatively in the normal range in spite of cardiac involvement.