Is virtual nutritional counseling efficacious for cancer patients during the COVID-19 pandemic?

This study investigates the outcomes of virtual nutritional counseling (VNC) for oncology patients during the Covid-19 pandemic. Our study evaluated the nutritional status data of cancer patients at the baseline and after VNC. An oncology dietitian evaluated the patients by video calling each patient via WhatsApp and sent an individual nutrition diet plan and recommendations via e-mail. Patient-Generated Subjective Global Assessment (PG-SGA) was used as a screening and evaluation tool to assess nutritional status. A total of 157 patients with a mean age of 55.8 ± 14.7 (r = 19-89) were included in the study. Researchers detected at least one nutrition-related sign in 77.7% of patients. After the VNC and based on the final PG-SGA assessments, 62.2% of the patients whose baseline PG-SGA Score-B improved to Score-A, 12.5% with a baseline PG-SGA Score-C improved to Score-A and 54.2% with a baseline Score-C improved to a Score-B (χ2 = 55,000, P < 0.001). Based on the number of VNCs, the improvement in malnutrition status following two sessions and three or more sessions was found to be 17.6% and 35.7%, respectively (P < 0.001). Our results confirm that VNC can improve the nutritional status of cancer patients. Hence, nutritional counseling should be an integral part of oncological treatment.

Effect of Palmar Grasp Reflex Stimulation on Physiological Parameters and Crying Time During Neonatal Bath: A Randomized Controlled Trial.

OBJECTIVE: This study aimed to determine the effect of palmar grasp reflex stimulation during a neonatal bath on the physiological parameters and crying time of the newborn. DESIGN, SETTING, AND PARTICIPANTS: This study was designed as a parallel randomized clinical trial. Parents fully understood the study procedure at the Neonatal Intensive Care Unit in Turkey (N = 82). Both written and verbal consent was obtained from the parents. Newborns who were ineligible for tub bathing were excluded from the study. The babies in the control group were given baths according to the tub bathing standards. Babies in the experimental group were given palmar grasp reflex stimulation during the baths. The variables examined included body temperature, respiratory rate, pulse, oxygen saturation levels, and crying time. In all analyses, p < 0.05 was accepted as statistically significant. RESULTS: The heart rate of the experimental group was 5.2 beats per minute slower than the control group (χ2 = 12.272; p < 0.001). The respiratory rate of the experimental group was 1.3 lower per minute compared to the control group (χ2 = 43.219; p < 0.001). In addition, the oxygen saturation level (%) of the experimental group was 0.4 higher than the control group (χ2 = 5.793; p < 0.016). Crying time was higher in the control group during bathing (p < 0.001). CONCLUSION: The results showed that the palmar grasp reflex in newborn bathing helps to maintain the stability of physiological parameters and shortens the crying time of babies. Palmar grasp reflex stimulation is recommended in interventions that may cause stress.

Design and synthesis of novel caffeic acid phenethyl ester (CAPE) derivatives and their biological activity studies in glioblastoma multiforme (GBM) cancer cell lines.

Glioblastoma Multiforme (GBM) is the most aggressive brain tumor and classified as one of the deadliest cancers. The current treatment plans for GBM remains to be ineffective because of its rapid progress and inability of the drugs used to cross the blood-brain barrier (BBB). Thus, developing more effective and potent medicines for GBM are needed. There have been several reports demonstrating that CAPE presents reasonably good anti-cancer activity in certain cancer cell lines and can penetrate the blood-brain barrier. Accordingly, in this study we synthesized several novel CAPE analogs with the addition of more druggable handles and solubilizing entities and subsequently evaluated their in vitro therapeutic efficacies in GBM cell lines (T98G and LN229). The most potent compound was then examined extensively and results showed that the 50 µM novel CAPE analog (compound 10) significantly decreases the viability of both T98G and LN229 GBM cells as compared to CAPE itself. Moreover, the compound 10 was not cytotoxic to healthy human cells (fibroblast-like mesenchymal stem cells) at the same concentration. Apoptotic (32.8%, and 44.6%) cell populations were detected in the compound 10 treated groups for LN229 and T98G, respectively. As an indication of apotosis, significantly increased PARP cleavage was detected in compound 10 versus CAPE treated LN229. In addition, we conducted molecular docking and molecular dynamics (MD) simulations studies on certain targets playing roles on GBM disease pathway such as NF-κB, EGFR, TNF-α, ERK2, PAPR1, hCA IX and hCA XII. Our findings demonstrated that designed CAPE analogs have anti-cancer activity on GBM cells and in silico studies also demonstrate the inhibitory ability of suggested compounds via interactions with critical residues in binding pockets of studied targets. Here, we suggest the novel CAPE analog to study further against GBM. Therefore, identification of the compound related molecular signature may provide more to understand the mechanism of action.

Synthesis of novel oxadiazole derivatives and their cytotoxic activity against various cancer cell lines.

Caffeic acid (CA), ferulic acid (FA) and caffeic acid phenethyl ester (CAPE) have a broad anticancer effect on various cell lines. In this study, nine ferulic and caffeic acid-based 1,2,4 and 1,3,4 oxadiazole molecular hybrids were synthesized and their cytotoxic activity was evaluated mainly against Glioblastoma (GBM) cell lines. Compounds 1 and 5 exhibited the highest inhibitory activity against three different GBM cell lines (LN229, T98G, and U87), without toxicity to healthy human mesenchymal stem cells (hMSC). In addition, their cytotoxicity was also evaluated against three additional cancer cell lines and more inhibitory results were found than GBM cell lines. The IC50 values of compound 5 in U87, T98G, LN229, SKOV3, MCF7, and A549 cells were determined as 35.1, 34.4, 37.9, 14.2, 30.9, and 18.3 µM. In the light of biological activity studies, the developed compounds have a high potential to lead studies for the development of new drug candidates for the treatment of cancer.

Post COVID-19 irritable bowel syndrome.

OBJECTIVES: The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut-brain interaction after hospitalisation for SARS-CoV-2 infection. DESIGN: GI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires. RESULTS: The study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrolment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p<0.001). At the 12-month follow-up, constipation and hard stools were significantly more prevalent in controls than in patients with COVID-19 (16% vs 9.6%, p=0.019 and 17.7% vs 10.9%, p=0.011, respectively). Compared with controls, patients with COVID-19 reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% versus 3.2%, p=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors and presence of dyspnoea. At the 6-month follow-up, the rate of patients with COVID-19 fulfilling the criteria for depression was higher than among controls. CONCLUSION: Compared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls. TRIAL REGISTRATION NUMBER: NCT04691895.

Prevalence of Gastrointestinal Symptoms in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results of the Prospective Controlled Multinational GI-COVID-19 Study.

INTRODUCTION: Gastrointestinal (GI) symptoms in coronavirus-19 disease (COVID-19) have been reported with great variability and without standardization. In hospitalized patients, we aimed to evaluate the prevalence of GI symptoms, factors associated with their occurrence, and variation at 1 month. METHODS: The GI-COVID-19 is a prospective, multicenter, controlled study. Patients with and without COVID-19 diagnosis were recruited at hospital admission and asked for GI symptoms at admission and after 1 month, using the validated Gastrointestinal Symptom Rating Scale questionnaire. RESULTS: The study included 2036 hospitalized patients. A total of 871 patients (575 COVID+ and 296 COVID-) were included for the primary analysis. GI symptoms occurred more frequently in patients with COVID-19 (59.7%; 343/575 patients) than in the control group (43.2%; 128/296 patients) (P < 0.001). Patients with COVID-19 complained of higher presence or intensity of nausea, diarrhea, loose stools, and urgency as compared with controls. At a 1-month follow-up, a reduction in the presence or intensity of GI symptoms was found in COVID-19 patients with GI symptoms at hospital admission. Nausea remained increased over controls. Factors significantly associated with nausea persistence in COVID-19 were female sex, high body mass index, the presence of dyspnea, and increased C-reactive protein levels. DISCUSSION: The prevalence of GI symptoms in hospitalized patients with COVID-19 is higher than previously reported. Systemic and respiratory symptoms are often associated with GI complaints. Nausea may persist after the resolution of COVID-19 infection.

The effects of 5-degree, 10-degree and 20-degree reverse Trendelenburg positions on intraoperative bleeding and postoperative Edemea and ecchymosis around the eye in open rhinoplasty.

PURPOSE: In this study, we investigated the effect of reverse Trendelenburg position (RTP), with five, ten, and twenty degrees, on intraoperative bleeding and postoperative edema and ecchymosis around the eye in open rhinoplasty operations. MATERIALS AND METHODS: Ninety patients undergoing open rhinoplasty were divided into three groups, 5° angle RTP (Group 5; n = 30), 10° angle RTP (Group 10; n = 30), and 20° angle RTP (Group 20; n = 30). After 3 min of preoxygenation, anesthesia was induced with 3 mg.kg-1 propofol, 1 µg.kg-1 fentanyl, and 0.6 mg/kg rocuronium for muscle relaxation. Maintenance of anesthesia was provided with a minimum alveolar concentration of 1-1.5 with sevoflurane, 1:1 O2/N2O. Hemodynamic variables, intraoperational bleeding, postoperative 1st, 3rd and 7th days ecchymosis and edema around the eyes of the patients were compared between the groups. RESULTS: Edema changes on postoperative 1st, 3rd and 7th days and ecchymosis changes around the eyes on postoperative 1st and 3rd days in Group 20 were found significantly lower than Group 5 (p < 0.017). Besides, the change of ecchymosis on the postoperative 1st day was found significantly lower in Group 20 compared to Group 10 (p < 0.017). The amount of intraoperative bleeding and surgical field evaluation score were found to be significantly lower in Group 10 and Group 20 compared to Group 5 (p < 0.017). CONCLUSION: We concluded that in open rhinoplasty surgeries, 20° degree RTP reduces intraoperative blood loss and provides a more bloodless surgical field, as well as reducing edema and ecchymoses around the eyes in the postoperative period.

COVID-19 induced haemobilia: a novel entity.

Hemobilia which is firstly described in 1948 is a rare cause of gastrointestinal bleeding. Since its main clinic takes time to occur and may cause mortality, early diagnosis and management have a great importance. Almost for 3 years, the world has been facing with an unknown viral infection called COVID-19 whose clinic changes from asymptomatic respiratory infection to symptoms associated with multiple system involvement. The clinical presentation of Covid-19 infection varies tremendously depending on the severity of the illness. In this report, we present the first two cases of severe COVID-19 induced hemobilia.

Mesenchymal stem cell treatment in a critically ill COVID-19 patient: a case report.

An outbreak of a new coronavirus causing severe respiratory disease (COVID-19) was first reported in China and rapidly spread worldwide. Clinical spectrum changes from asymptomatic infection to severe illness and even death, and no specific treatment is currently available. A range of antiviral, antimalarial and antibiotic agents are being used. We report a case of a COVID-19 patient that progressed to severe disease requiring intubation and intensive care. We performed mesenchymal stem cell (MSC) transplantation considering the signs showing persistent excessive immune response and deterioration despite all supportive and drug therapies. The two rounds of transplantation did not result in any severe complications and was well-tolerated. Clinical signs were improved. The use of MSC therapy may be considered for compassionate use in selected patients.

Value of ABO blood group in predicting the severity of children with Crimean-Congo hemorrhagic fever.

PURPOSE: The aim of this study was to assess the role of ABO blood groups in predicting disease severity and bleeding potential in children with Crimean-Congo hemorrhagic fever (CCHF). METHODS: One hundred fifty-one hospitalized patients with CCHF were enrolled in this retrospective study. The patients were divided according to O- and non-O- (A, B and AB) blood groups (n=91 and n=60, respectively). They were also classified into two groups (severe and non-severe) based on disease severity (n=29 and n=122, respectively). Demographic characteristics, clinical findings, and hematologic and biochemical parameters of all patients were recorded on admission and discharge. RESULTS: Although, in all cases, compared to the non-O blood group, the ratio of the blood group O was considerably higher (60% vs. 40%) and similarly so in severe cases (58.6% vs. 41.4%), this difference was not statistically significant (p>0.05). The aPTT at discharge and fever duration of the O-blood group were significantly higher than those of the non-O-blood group (p=0.042, p=0.034, respectively). The factor VIII level of the O-blood group was significantly lower than that of the non-O-blood group (p=0.040). Although the ratios of bleeding and severity were higher in the O-blood group compared to the other group, statistical significance was not reached (p>0.05). CONCLUSIONS: Consideration of the ABO blood group is important during diagnostic follow-up to assess the severity of CCHF. In clinical practice, pediatric CCHF patients with the O blood group need to be followed closely for tendency to bleed.

Acute colchicine intoxication complicated with extramedullary hematopoiesis due to filgrastim in a child.

Colchicine is a widely used alkaloid extract in children and adults for standard therapy and prophylaxis for amyloid deposition in different rheumatologic disorders. Colchicine intoxication is a rare but severe complication. The aim of this study was to report the extramedullary hematopoiesis as a complication of filgrastim usage in a child with acute colchicine intoxication. Herein, we report a 3-year-old boy with colchicine intoxication associated with neutropenia, disseminated intravascular coagulation, liver injury, and rhabdomyolysis without hepatosplenomegaly. Filgrastim was started at the fourth day of administration for severe neutropenia with fever; 3 days after the start of filgrastim, the patient experienced hepatosplenomegaly with severe leukocytosis (51,110/mm) and myeloid precursors at peripheral blood smear. Bone marrow aspiration was normal; the clinical outcome of the child was eventful without any complication. The clinicians managing colchicine intoxications must be vigilant about the possible side effect of extramedullary hematopoiesis caused by filgrastim used for neutropenia in colchicine intoxication.