Electrocardiographic abnormalities are prognostic of the clinical outcomes and mortality of patients with subarachnoid hemorrhages.

PURPOSE: We explored the relationships between electrocardiographic (ECG) abnormalities and the clinical outcomes and mortality of patients with non-traumatic aneurysmal subarachnoid hemorrhages (SAHs). METHODS: This retrospective cohort study enrolled consecutive adult patients who presented to emergency departments with non-traumatic aneurysmal SAHs. We recorded their demographics, clinical characteristics, and ECG findings, and explored the relationships between ECG abnormalities, on the one hand, and 28-day mortality and prognosis, on the other. RESULTS: We enrolled 158 patients, 76 females (48.10%) and 82 males (51.90%) of average age 54.70 ± 7.07 years. A total of 107 patients (67.72%) exhibited at least one ECG abnormality, most commonly a T-wave change (n = 54, 34.18%). Such patients evidenced significantly higher Hunt-Hess and Fisher scale scores than those without abnormalities (both p < 0.001). Patients with abnormal ECG findings experienced more unfavorable outcomes and higher mortality than others (both p < 0.001). ECG abnormalities, including PR prolongation, pathological Q waves, QRS widening, left bundle branch blocks, premature ventricular contractions, ST segment changes, and T-wave changes, were more common in non-survivors and patients with Hunt-Hess scores of 4-5 compared to survivors and those with Hunt-Hess scores <4, respectively. Moreover, increased age and presence of abnormal ECG findings were independent predictors of mortality in aneurysmal SAHs. CONCLUSIONS: Patients with abnormal ECG findings exhibited unfavorable clinical outcomes and increased mortality rates. Abnormal ECG findings combined with higher Hunt-Hess or Fischer grade scores usefully predict adverse clinical outcomes in and mortality of SAH patients.

Untangling Tetanus: A Comprehensive Case Report Describing Its Diagnosis and Treatment.

Tetanus, caused by a grave and potentially lethal bacteria, is a medical condition that severely affects the central nervous system and demands vigilant attention and comprehensive preventive measures to safeguard public health. The onset of this condition is sudden and characterized by the emergence of intense tonic muscle spasms, underscoring its critical nature. In Türkiye, around 50 cases are officially reported each year; however, it is widely suspected that numerous cases remain unreported, contributing to an even more significant impact. This report aims to shed light on a remarkable case involving a 24-year-old male patient. Despite having a complete vaccination history, this individual contracted tetanus and required intensive care and mechanical ventilation due to the severity of his tetanus infection. This case serves as a poignant reminder of the importance of booster administration, highlighting the significance of continued and timely reinforcement of vaccinations.

Systemic inflammatory markers for distinguishing uncomplicated and complicated acute appendicitis in adult patients.

OBJECTIVE: This study aimed to investigate the predictive power of serum systemic inflammatory markers including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-eosinophil ratio (MER), and C-reactive protein (CRP) levels for distinguishing uncomplicated and complicated acute appendicitis in adult patients admitted to the emergency department (ED). METHODS: This retrospective, cross-sectional, observational, and single-center study enrolled 212 consecutive adult patients with acute appendicitis who were admitted to the ED of our tertiary care university hospital between January 1, 2019 and December 31 2021. Patients were divided into two groups (Group I, uncomplicated acute appendicitis; Group II, complicated appendicitis) according to their surgical findings and histopathological examination. Systemic inflammatory markers measured on admission were compared among patients to identify factors associated with complicated acute appendicitis. RESULTS: A total of 132 patients, 83 male (62.9%) and 49 female (37.1%), were included in the study. The mean age was 34.7±13.40 years. Based on the histopathological examination, the number of patients in Group I was 103 (78.03%) and 29 (21.96%) in Group II. Laboratory findings on admission revealed no significant differences between Groups I and II patients in terms of mean serum NLR, MER, and CRP values (p=0.096, p=0.248, and p=0.297, respectively). However, the mean serum PLR in Group II patients was statistically significantly higher than those in Group I (p=0.032). The mean serum monocyte and monocyte fraction (%) values were significantly lower, and the mean serum neutrophil fraction (%) value was higher in Group II patients compared to those with Group I. Receiving operator characteristic (ROC) analysis identified a serum PLR cutoff value of ≥133.73 for distinguishing uncomplicated and complicated acute appendicitis in adult patients, with 60% sensitivity and 58.4% specificity. In addition, ROC analysis revealed a cutoff monocyte fraction (%) level of ≤6, with 72% sensitivity and 64% specificity, for distinguishing uncomplicated and complicated acute appendicitis in adult patients. CONCLUSION: Our findings indicate that the mean serum NLR, MER, and CRP values measured on admission to ED in adult patients with acute appendicitis could not predict complicated acute appendicitis. However, mean serum PLR and neutrophil and monocyte counts can be useful in distinguishing complicated cases.

The utility of serum miRNA-93 and miRNA-191 levels for determining injury severity in adults with multiple blunt trauma.

BACKGROUND: Various scoring systems have been developed to determine the trauma severity and prognosis of patients following multiple blunt trauma (MBT). However, these scoring systems do not provide exactly the desired severity assessment. In recent years, serum concentration of many specific microRNAs (miRNAs), especially for head trauma, has been shown to play an important role in determining the diagnosis, severity, and prognosis of injury. To date, however, no studies have investigated serum miRNAs in patients with MBT. Thus, this study measured the expression of miRNA-93 and -191 in the serum of adults with MBT and examined the correlations of Injury Severity Score (ISS) and Revised Trauma Score values with serum miRNA-93 and -191 levels in these patients with the aim of predicting trauma severity based on the miRNA levels. METHODS: This prospective case-control study enrolled 50 consecutive adults with MBT and age- and sex-matched 60 healthy controls. The patients were divided into ISS >16 (Group 1, major or severe trauma) and ISS ≤16 (Group 2, minor or mild-moderate trauma) groups. Serum miRNA-93 and -191 levels were assessed using quantitative real-time reverse transcription-PCR. We evaluated whether the miRNAs were differentially expressed in major and minor MBT patients and determined their utility for assessing the severity of injury. RESULTS: The mean serum miRNA-93 and -191 levels were significantly elevated in the patients compared to the controls and were higher in patients with ISS >16 compared to those with ISS ≤16, although the difference was not significant. In the patients with multitrauma, ISS was significantly, negative and weak correlated with serum miRNA-191 level (rho=-0.320, p=0.023) but not with the serum miRNA-93 level. No optimal cutoff for the serum miRNA-93 level was found with respect to trauma severity (AUC 0.617, [0.455-0.779]). However, an optimal cutoff value for serum miRNA-191 was identified, with values <1.94 indicating severe trauma (AUC 0.668 [0.511-0.826]; 65.6% sensitivity, 77.8% specificity). CONCLUSION: miRNA-191 and -93 levels were significantly upregulated in multitrauma patients compared to controls. The level of miRNA-191 in conjunction with ISS, but not that of miRNA-93, may be a useful biomarker for determining injury severity in patients with multitrauma.

Impacts of Demographic and Clinical Characteristics on Disease Severity and Mortality in Patients with Confirmed COVID-19.

BACKGROUND: We investigated potential predictive factors for mortality and disease severity from demographic and clinical data, comorbidities, and laboratory findings in patients with confirmed COVID-19 who were consecutively admitted to our tertiary hospital. METHODS: In this retrospective, single-center, observational study, we enrolled consecutive 540 adult patients who had COVID-19 confirmed by a molecular method. Patients were categorized into three groups based on disease severity. Patients' demographic and clinical characteristics, mortality rates, and mortality-associated factors were analyzed. RESULTS: The overall mortality rate was 4.3% (23/540). Disease severity was mild in 40.9% (n = 221), severe in 53.7% (n = 290), and critical in 5.4% (n = 29) of the patients. There were significant differences among groups in terms of median white blood cell (WBC), hemoglobin, neutrophil, lymphocyte, and thrombocyte counts, as well as C-reactive protein (CRP), procalcitonin, lactate dehydrogenase (LDH), creatinine, albumin, D-dimer, ferritin, troponin, and fibrinogen levels. Furthermore, there were significant differences between surviving and non-surviving patient groups in terms of median WBC, hemoglobin, neutrophil, and lymphocyte counts, as well as CRP, procalcitonin, LDH, creatinine, albumin, D-dimer, and ferritin levels. CRP level (odds ratio [OR]: 1.020, 95% confidence interval [CI]: 1.009-1.032; p < 0.001), and CURB-65 score (OR: 4.004, 95% CI: 1,288-12,447; p = 0.017) were independently associated with disease severity and mortality. CONCLUSION: On admission, WBC, neutrophil, lymphocyte, and platelet counts can be used to predict disease severity in patients with COVID-19. CRP, ferritin, LDH, creatinine, troponin, D-dimer, fibrinogen, and albumin levels can also be used to predict disease severity in these patients. Finally, elevated CRP level and high CURB-65 score were predictors of disease severity and mortality.

Safety and efficacy of hydroxychloroquine in 152 outpatients with confirmed COVID-19: A pilot observational study.

PURPOSE: We investigated the efficacy and safety of hydroxychloroquine for empirical treatment of outpatients with confirmed COVID-19. METHODS: In this prospective, single-center study, we enrolled ambulatory outpatients with COVID-19 confirmed by a molecular method who received hydroxychloroquine. The patients were divided into low- and moderate-risk groups based on the Tisdale risk score for drug-associated QT prolongation, and the QT interval was corrected for heart rate using the Bazett formula (QTc). The QTc interval was measured by electrocardiography both pretreatment (QTc1) and 4 h after the administration of hydroxychloroquine (QTc2). The difference between the QTc1 and QTc2 intervals was defined as the ΔQTc. The QTc1 and QTc2 intervals and ΔQTc values were compared between the two risk groups. RESULTS: The median and interquartile range (IQR) age of the patients was 47.0 (36.2-62) years, and there were 78 men and 74 women. The median (IQR) QTc1 interval lengthened from 425.0 (407.2-425.0) to 430.0 (QTc2; 412.0-443.0) milliseconds (ms). However, this was not considered an increased risk of ventricular tachycardia associated with a prolonged QTc interval requiring drug discontinuation, because none of the patients had a ΔQTc of >60 ms or a QTc2 of >500 ms. Moreover, the median (quartiles; minimum-maximum) ΔQTc value was higher in patients in the moderate-risk group than those in the low-risk group (10.0 [-4.0-18.0; -75.0-51.0] vs. 7.0 [-10.5-23.5; -53.0-59.0 ms]) (p = 0.996). Clinical improvement was noted in 91.4% of the patients, the exceptions being 13 patients who presented with non-serious adverse drug reactions or who had severe COVID-19 and were hospitalized. Adverse effects related to hydroxychloroquine were non-serious and occurred in 52.8% (n = 80) of the patients. CONCLUSIONS: Our findings show that hydroxychloroquine is safe for COVID-19 and not associated with a risk of ventricular arrhythmia due to drug-induced QTc interval prolongation. Additionally, hydroxychloroquine was well tolerated, and there were no drug-related non-serious adverse events leading to treatment discontinuation in the majority of patients who were stable and did not require hospitalization.