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.

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.

Clinical effects of TB sequelae in patients with COPD.

BACKGROUND: TB is a risk factor for chronic obstructive pulmonary disease (COPD) development and causes the global burden of COPD to increase. The impact of TB sequelae on COPD has been ignored for years.OBJECTIVE: To determine the prevalence of TB sequelae in patients with COPD and investigate the effect of TB sequelae on COPD clinic burden.METHODS: A total of 172 patients who attended the chest diseases outpatient clinic were included in the study. Detailed anamneses of their TB were taken, and pulmonary function tests were performed. The COPD Assessment Test (CAT) questionnaire was administered to determine the health status, and the modified Medical Research Council (mMRC) scale was used to assess the severity of dyspnoea. Thorax computed tomography images were reviewed. The patients were divided into two groups based on the presence of TB sequelae. All data from the two groups were compared.RESULTS: Of 172 patients with COPD, 66 (38%) had TB sequelae; 28 (46%) patients with TB sequelae had no history of TB. Two patients with TB history had no TB sequelae. The group with TB sequelae had lower body mass index (P < 0.001), more emergency admissions (P = 0.018), and higher CAT and mMRC scores (P = 0.002 and P = 0.004, respectively). In the group with TB sequelae, bronchiectasis was more common (P = 0.001).CONCLUSION: In patients with COPD, TB sequelae are very common and increase the COPD clinic burden. The presence of TB sequelae causes an increase in the use of healthcare services by patients with COPD and, therefore, an increase in the burden of COPD. Prevention, early diagnosis and timely treatment of TB are therefore very important.

Favorable outcome with sentinel lymph node biopsy alone after neoadjuvant chemotherapy in clinically node positive breast cancer at diagnosis: Turkish Multicentric NEOSENTI-TURK MF-18-02-study.

PURPOSE: Factors affecting local outcome were evaluated in patients with clinically node-positive (cN+) breast cancer at diagnosis, who underwent sentinel lymph node biopsy (SLNB) alone after neoadjuvant chemotherapy (NAC). METHODS: Between 2004 and 2018, 303 cytopathology-proven cN (+) patients in a multicentric registry, who received NAC and underwent SLNB alone were analysed. All patients had regional nodal irradiation. RESULTS: Median age was 46 (23-70). Of those, 211 patients had ypN0 disease (69.6%), whereas 92 patients had ypN (+) disease including 19 (20.6%) isolated tumor cells (ITC), 33 micrometastases (35.9%) and 40 macrometastases (43.5%). At a median follow-up of 36 months (24-172), one patient (0.3%) with macrometastatic SLN was found to have locoregional recurrence as chest wall and supraclavicular LN metastases at the 60th month. Five-year disease-free survival (DFS) and disease specific survival (DSS) rates were 87% and 95%, respectively. Patients with cT3/4 (HR = 2.41, 95% CI; 1.14-5.07), non-luminal molecular pathology (HR = 2.60, 95% CI, 1.16-5.82), and non-pCR in the breast (HR = 2.11, 95% CI, 0.89-5.01) were found to have an increased HR compared to others in 5-year DFS. However, no difference could be found between ypN0 and ypN ITC and micrometastasis (HR = 1.23, 95% CI, 0.44-3.47), whereas there was a slight increase in HR of patients with ypN macrometastasis versus ypN0 (HR = 1.91, 95% CI, 0.63-5.79). CONCLUSION: ALND could be avoided in meticulously selected cN (+) patients who underwent SLNB after NAC having breast and/or nodal pCR, cT1-2, or low volume residual nodal disease with luminal pathology, as long as axillary radiotherapy is provided.

Nurses' perceptions of medication errors.

This study reports nurses' perceptions of medication errors and of their appropriate reporting. Thirty-three percent of the participants believed the main cause of medication errors was nurses' tiredness or exhaustion, while 30% of participants indicated that the main cause was the poor legibility or illegibility of physcians' writing on the doctor's order form. Some medication errors were not reported because nurses were afraid of reprisals (63%).

Analysis of job-related risks faced by hospital nurses.

The aim of this study was to analyze the job-related risks nurses face during training such as needle-stick injuries, contaminated blood and infectious fluids. From May to July 2003 we conducted a survey of a sample of 242 nurses who were working in the the Pediatric Hospital, Government Hospital, the Training Hospital of Celal Bayar University, the Gynecology Hospital and the Psychiatric Hospital in Manisa City in Turkey. Two hundred sixteen nurses (89.3%) had needlestick injuries and 107 (44.2%) had injuries by contaminated cutting utensils. A total of 104 nurses (43.0%) used gloves, while 65 (26.9%) used gloves and mask. In medical and surgical staff nurses, injuries due to contaminated cutting utensils were statistically significant (p < 0.05). Awareness of accidents was significant between the two groups (p < 0.05).

An evaluation of nursing care in cancer patients.

The aim of the present study was to identify what hospitalized cancer patients expect from nurses in terms of the care they receive. The specific aims of this study were: (i) to identify those individuals to whom the patients felt closest in the hospital setting and (ii) to evaluate nurses' management of cancer patients during their stay in the hospital. The sample included patients hospitalized at Ege University Hospital and Suat Seren District Hospital, Izmir, Turkey. We found significant differences between the scores of satisfaction and dissatisfaction and gender age, education, occupation, type of cancer and the mode of treatment (p < 0.05). The majority of the cancer patients reported that nursing management was unsatisfactory. Some demographic factors such as cultural and social status affected patients' expectations.

Differences in the cellular and humoral immune system between middle-aged men with different intensity and duration of physically training.

AIM: The effects of acute exercise on immune system and serum magnesium and iron have been investigated in recent years. However, data related to the comparisons of long-term physical training with different intensity and duration are limited. METHODS: The association between long-term physical training and cellular (lymphocyte phenotyping) and humoral immune parameters (serum immunoglobulins) and serum magnesium and iron values in the middle-aged men was investigated. Eleven male master athletes (MA) performing high intensity and long duration training, 11 male recreational athletes (RA) performing moderate intensity and duration training (>10 years) participated. Eleven male sedentary individuals were enrolled as control group (CG). RESULTS: The percentages of total CD3+ T cells, CD4+ T helper, CD8+ T suppressor/cytotoxic, CD19+ B cells, natural killer cells, HLA-DR+ active T cells and CD4/CD8 ratios did not show any significant difference among 3 groups. In MA, VO2max values showed a significant negative correlation with CD4+ T helper cells. There were no significant differences among MA, RA and CG in terms of IgG, IgA, and IgM concentrations. There was a significant correlation between VO2max and IgG in RA. Iron, iron binding capacity and ferritin were found similar in all groups, but serum magnesium level in MA was significantly lower than RA and CG. CONCLUSION: No exact data to support immunosuppression or immunostimulation could be obtained except a significant negative correlation between CD4+ T helper cells and VO2max values in MA and a positive correlation between serum IgG and VO2max ivalues in RA. These findings may be the indirect markers of cellular immune system suppression by intensive exercises and stimulation of IgG production by moderate exercises.