ABSTRACT
Sarcomatoid urothelial carcinoma is a rare and aggressive variant. Serum beta-hCG levels are used as a tumor marker in gestational trophoblastic diseases and germ cell tumors, but may also be elevated in high-grade bladder cancers. Here, we report two urothelial carcinoma cases with sarcomatoid differentiation that relapsed early after surgery with elevated serum beta-hCG levels. The first case was a 65-year-old female and the second case was a 67-year-old man with sarcomatoid urothelial carcinoma located in the ureter and renal pelvicalyceal system, both of them relapsed with elevated beta-hCG serum level to 146.8 mIU/ mL and 242 mIU/mL, respectively. They died a few months after initial diagnosis;4.9 and 2.5 months respectively. Both sarcomatoid variant and beta-hCG expression were associated with poor prognosis and advanced stage. However, beta-hCG is not used as a tumor marker in urinary tract cancers yet, and its relationship with variant pathologies has not been clarified. We need multi-centered studies to reveal this relationship.Copyright © 2023, Derman Medical Publishing. All rights reserved.
ABSTRACT
Aim: The aim of this study is to analyze the effectiveness of the leukocyte albumin ratio (LAR) in predicting mortality in critical COVID-19 patients. Material(s) and Method(s): In this retrospectively-designed study, we evaluated a total of 98 critical patients who were hospitalized in the intensive care unit. Patients were divided into two groups according to hospital mortality as survivors (n=43) and non-survivors (n=55). Result(s): The non-survivors group was statistically significantly older (67.3+/-9.7 versus 62.5+/-10.9;p=0.023). HT and DM were detected more in the non-survivors group than in the survivors group (p=0.031, p=0.018, respectively). Mean LAR values were significantly higher in non-survivors than in survivors (5.9+/-3.5 versus 3.3+/-1.4;p<0.001). LAR values was positively correlated with urea (r=0.43, p<0.001), LDH (r=0.35, p<0.001), ferritin (r=0.25, p=0.015), procalcitonin (r=0.34, p<0.001), and pro-BNP (r=0.24, p=0.015) levels. A cut-off value of 3.71 ng/mL for LAR predicted mortality with a sensitivity of 76% and a specificity of 70% (AUC:0.779 95% Cl:0.689-0.870;p<0.001). Multivariable logistic regression analysis revealed that older age (OR:1.114, 95% CI:1.020-1.218;p=0.017) and increased ferritin (OR:1.003, 95% CI:1.001-1.004;p=0.002) and LAR (OR:1.583, 95% CI:1.073-2.337;p=0.021) values were independent predictors of mortality in patients with critical COVID-19. Discussion(s): LAR can be a useful and prognostic marker that can be used to predict mortality in COVID-19 patients admitted to the intensive care unit.Copyright © 2022, Derman Medical Publishing. All rights reserved.
ABSTRACT
Following the end of World War II, the West under the US leadership constituted the liberal international order. In recent years, this liberal order has already been suffering from a series of threats and its reliability has also been criticized by many scholars. However, the spread of the COVID-19 pandemic has amplified the interrogation of the existing US-led liberal international order. It has had serious implications on the world's political, economic, and social fabric. Instead of international solidarity and coordination, selfishness and self-centeredness have become prominent in different parts of the world since the onset of the pandemic. In this regard, this chapter addresses the principal foundations of the dominant liberal international order and discusses the effects of COVID-19 on them. The chapter analyses the leadership role of the US during pandemic, the response of multilateral institutions, the degree of international cooperation, and rising political tendencies in the Western world. © 2022 by World Scientific Publishing Europe Ltd.
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Introduction: The efficacy and safety of immunosuppressive therapy in Coronavirus disease-2019 (COVID-19) still controversial. We evaluated the effects of immunosuppressive therapy on mortality in patients followed in the intensive care units (ICU) due to critical COVID-19 pneumonia. Methods: We compared patients followed up in the ICUs due to severe COVID-19 pneumonia who received immunosuppressive therapy with those who did not in terms of 1-month mortality, retrospectively. Results: A total of 362 patients followed up in ICUs with a diagnosis of critical COVID-19 pneumonia were included in the study. The patients were divided into two groups as patients who received immunosuppressive therapy [n=249, 165 patients (45.5%) who received only corticosteroids, 25 patients (7%) who received only tocilizumab, and 59 patients (16.5%) who received tocilizumab + corticosteroid] and patients who did not (n=113). One hundred and ninety-two of the patients died (54.1%). There was no statistical difference between the groups in terms of 1-month mortality (p=0.38). Secondary bacterial infection was detected in 25.1% (n=91) n of the patients. The frequency of secondary infections was higher in the patients who received immunosuppressive therapy than in patients who did not receive immunosuppressive therapy (28% vs 17% respectively, p=0.03). The most common secondary bacterial infection was detected in patients who received tocilizumab + corticosteroids (n=25, 42.2%). Conclusion: In this study, no difference in 1-month mortality was found between patients who received immunosuppressive therapy and those who did not. The frequency of secondary bacterial infections in patients who received immunosuppressive therapy was higher than in patients who did not.
ABSTRACT
Introduction: Pediatric COVID-19 cases are typically known to be mildly symptomatic and show a good prognosis. However, more severe condition termed Multisystem inflammatory syndrome (MIS-C) is encountered in children. This research aimed to evaluate the differences between MIS-C and non-MIS-C (children who were infected with SARS-CoV-2 but did not develop MIS-C) patients according to demographics, comorbidities, and symptoms conditions, as well as clinical, laboratory, radiological findings, treatment, and prognosis. Materials and Methods: This systematic review and meta-analysis were performed in accordance with PRISMA guidelines using electronic databases of PubMed, Scopus, Science-Direct, and LitCovid including articles on observational studies comparing the MIS-C and non-MIS-C cases published between 01 January 2020-15 January 2021. Results: Seventeen articles meeting the criteria were included. No difference was found in terms of gender and age from the demographic characteristics of the MIS-C and non-MIS-C groups. Black race and clinical findings such as fever, rash, fatigue, loss of appetite, vomiting and diarrhea, and laboratory findings CRP and ferritin were found to be higher in the MISC group compared to the nonMISC group (p<0.05). Cardiac complications, use of some medical treatments (steroids, IVIG, inotropic therapy), and need for intensive care were also higher (p< 0.05). Conversely, the presence of comorbidity, presence of rhinoirhea, hemoglobin, lymphocyte, and platelet values were higher in the non-MIS-C group (p< 0.05). Conclusion: Evaluation of MIS-C and non-MIS-C patients for various characteristics revealed differences that will guide the diagnosis of and approach to MIS-C cases.
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Aim: The aim of this study is to analyze the effectiveness of the leukocyte albumin ratio (LAR) in predicting mortality in critical COVID-19 patients. Material and Methods: In this retrospectively-designed study, we evaluated a total of 98 critical patients who were hospitalized in the intensive care unit. Patients were divided into two groups according to hospital mortality as survivors (n=43) and non-survivors (n=55). Results: The non-survivors group was statistically significantly older (67.3 +/- 9.7 versus 62.5 +/- 10.9;p=0.023). HT and DM were detected more in the non-survivors group than in the survivors group (p=0.031, p=0.018, respectively). Mean LAR values were significantly higher in non-survivors than in survivors (5.9 +/- 3.5 versus 3.3 +/- 1.4;p<0.001). LAR values was positively correlated with urea (r=0.43, p<0.001), LDH (r=0.35, p<0.001), ferritin (r=0.25, p=0.015), procalcitonin (r=0.34, p<0.001), and pro-BNP (r=0.24, p=0.015) levels. A cut-off value of 3.71 ng/mL for LAR predicted mortality with a sensitivity of 76% and a specificity of 70% (AUC:0.779 95% Cl:0.689-0.870;p<0.001). Multivariable logistic regression analysis revealed that older age (OR:1.114, 95% CI:1.020-1.218;p=0.017) and increased ferritin (OR:1.003, 95% CI:1.001-1.004;p=0.002) and LAR (OR:1.583, 95% CI:1.073-2.337;p=0.021) values were independent predictors of mortality in patients with critical COVID-19. Discussion: LAR can be a useful and prognostic marker that can be used to predict mortality in COVID-19 patients admitted to the intensive care unit.
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Aim: It is aimed to evaluate the epidemiological features of COVID-19 patients and risk factors affecting hospitalization. Methods: This cross-sectional study included 883 adult patients whose Polymerase Chain Reaction tests were positive for SARS-CoV-2 in Kütahya province until July 2020. The patients were questioned in terms of their socio-demographic characteristics, drugs, comorbidities, and symptoms. They were divided into two groups according to their hospitalization status and outpatient treatment status. Results: There were 473 female and 410 male participants in the study. 532 of 883 adult patients were hospitalized. The most common symptoms were fatigue (47.9%), myalgia (44.7%), and loss of smell and taste (32.4%). Hospitalization was associated with advanced age, low income, presence of additional disease, several symptoms, smoking, comorbidities including diabetes mellitus, chronic kidney diseases, cardiovascular and respiratory system. In multivariant analyses, advance age, low income, fever, dyspnea and chronic lung diseases were associated with increased odds of hospital admission. Conclusion: In our study, it was found that independent risk factors for hospitalization were advanced age, low income, fever, shortness of breath, and chronic lung diseases. We think that determining risk factors for hospitalization may be a guide for clinicians in predicting patient prognosis. © 2021, Eurasian Society of Family Medicine. All rights reserved.
ABSTRACT
OBJECTIVES: The internet has become one of the most important resources for the general population when searching for healthcare information. However, the information available is not always suitable for all readers because of its difficult readability. We sought to assess the readability of online information regarding the novel coronavirus disease (COVID-19) and establish whether they follow the patient educational information reading level recommendations. STUDY DESIGN: This is a cross-sectional study. METHODS: We searched five key terms on Google and the first 30 results from each of the searches were considered for analysis. Five validated readability tests were utilized to establish the reading level for each article. RESULTS: Of the 150 gathered articles, 61 met the inclusion criteria and were evaluated. None (0%) of the articles met the recommended 5th to 6th grade reading level (of an 11-12-year-old). The mean readability scores were Flesch Reading Ease 44.14, Flesch-Kincaid Grade Level 12.04, Gunning-Fog Index 14.27, Simple Measure of Gobbledygook SMOG Index 10.71, and Coleman-Liau Index 12.69. CONCLUSIONS: Online educational articles on COVID-19 provide information too difficult to read for the general population. The readability of articles regarding COVID-19 and other diseases needs to improve so that the general population may understand health information better and may respond adequately to protect themselves and limit the spread of infection.