Effects of comorbidities associated with COVID-19 cases in Intensive Care Unit on mortality and disease progression.

OBJECTIVE: The patient's age, gender and the presence of certain concomitant diseases have been reported to play a part in the course and progression of COVID-19 in the literature. In this study, we aimed to compare the comorbidities causing mortality in critically ill Intensive Care Unit (ICU)-patients diagnosed with COVID-19. PATIENTS AND METHODS: The data as regards the COVID-19 cases followed up in the ICU were retrospectively reviewed. 408 COVID-19 patients with positive PCR test were included in the study. In addition, a subgroup analysis was performed in patients treated with invasive mechanical ventilation. While the primary aim of this study was to evaluate the difference in survival rates due to comorbidities in critical COVID-19 patients, we also aimed to assess the comorbidities in severely intubated COVID-19 patients in terms of mortality. RESULTS: A statistically significant increase in mortality was observed in patients with underlying hematologic malignancy and chronic renal failure (p=0.027, 0.047). Body mass index value in the mortal group was significantly higher in both the general study group and subgroup analysis (p=0.004, 0.001). CONCLUSIONS: Advanced age and comorbidities such as chronic renal failure and hematologic malignancy in COVID-19 patients are associated with poor survival prognosis in critically ill COVID-19 patients.

The postoperative effects of use of trimetazidine before the coronary artery bypass graft surgery.

BACKGROUND: In this study, postoperative cardiac functions were observed in patients undergoing coronary artery bypass grafting (CABG) surgery following preoperative administration of the anti-ischemic drug trimetazidine. MATERIALS AND METHODS: The study included a total of 50 CABG patients; 25 were administered with trimetazidine preoperatively and 25 did not receive trimetazidine. A retrospective evaluation was made of the parameters of age, gender, preoperative echocardiography (ECHO) results, cross-clamping durations, postoperative inotropic requirements, and postoperative 4th-h troponin-I levels and the groups were compared. RESULTS: There was no statistically significant difference determined between the 2 groups in respect of the data of age, gender, comorbidity, preoperative ECHO signs [(ejection fraction (EF), left ventricle end systolic diameter (lvsd), left ventricle end diastolic diameter (lvdd), left atrium diameter (LA), and intraventricular septum thickness (IVS)], inotropic requirements, and postoperative troponin-I levels. In the control group, a positive correlation was determined between postoperative troponin-I levels and DM (r: 0.597, p: 0.002). There was no correlation determined in the trimetazidine group (r:-0.042, p: 0.844). CONCLUSION: The results of this study demonstrated a positive correlation between postoperative troponin-I levels and DM in the group not administered with trimetazidine. There was no such correlation determined in the group administered with trimetazidine. This result may suggest that DM may increase troponin-I levels in the absence of trimetazidine, and therefore that the drug may be cardioprotective in such cases. Further studies on more extensive patient populations are required to confirm these results.

Blunt trauma - related isolated pancreatic injury.

BACKGROUND: Pancreatic injuries arising from blunt trauma are rarely seen. Diagnosis and treatment are difficult because of retroperitoneal localization of the organ. We present four pancreatic cases with isolated pancreatic injury due to blunt abdominal trauma. METHODS: This retrospective study included four pancreatic patients who were operated on due to isolated injury caused by blunt abdominal trauma at our department between January 2004 and October 2010. RESULTS: The patients consisted of three males and one female. One of them was in stage IV and the rest were in stage III. All underwent pancreaticojejunostomy, distal pancreatectomy, distal pancreatectomy + splenectomy and drainage, respectively. Fistula developed in two of them, and abscess developed in one, while the other one died. CONCLUSION: Diagnosis may be delayed since the clinical condition is initially stable. Tomography remains one of the most important diagnostic tools. Common risk factors for morbidity and mortality are the presence of ductal injury and delayed laparotomy (Tab. 1, Fig. 4, Ref. 22).

A novel report generation approach for medical applications: the SISDS methodology and its applications.

BACKGROUND: Despite exciting innovation in information system technologies, the medical reporting has remained static for a long time. Structured reporting was established to address the deficiencies in report content but has largely failed in its adoption due to concerns over workflow and productivity. The methods used in medical reporting are insufficient in providing with information for statistical processing and medical decision making as well as high quality healthcare. OBJECTIVE: The aim of this study is to introduce a novel method that enables professionals to efficiently produce medical reports that are less error-prone and can be used in decision support systems without extensive post-processing. METHODOLOGY: We first present the formal definition of the proposed method, called SISDS, that provides a clear separation between the data, logic and presentation layers. It allows free-text like structured data entry in a structured form, and reduces the cognitive effort by inline editing and dynamically controlling the information flow based on the entered data. Then, we validate the usability and reliability of the method on a real-world testbed in the field of radiology. For this purpose, a sample esophagus report was constructed by a focus group of radiologists and real patient data have been collected using a web-based prototype; these data are then used to build a decision support system with off-the-shelf tools. The usability of the method is assessed by evaluating its acceptability by the users and the accuracy of the resulting decision support system. For reliability, we conducted a controlled experiment comparing the performance of the method to that of transcriptionist-oriented systems in terms of the rate of successful diagnosis and the total time required to enter the data. RESULT: The most noticeable observation in the evaluation is that the rate of successful diagnosis improves significantly with the proposed method; in our case study, a success rate of 81.25% has been achieved by using the SISDS method compared to 43.75% for the transcriptionist-oriented system. In addition, the average time required to obtain the final approved reports decreased from 29 min to 14 min. Based on questionnaire responses, the acceptance rate of the SISDS methodology by users is also found to outperform the rates of the current methods. CONCLUSION: The empirical results show that the method can effectively help to reduce medical errors, increase data quality, and lead to more accurate decision support. In addition, the dynamic hierarchical data entry model proves to provide a good balance between cognitive load and structured data collection.

Surgical management of pyogenic liver abscess.

BACKGROUND AND AIM: Although Pyogenic Liver Abscess (PLA) has lower mortality rate in recent years due to the broad spectrum antibiotic usage, developed imaging techniques and improved intensive care services, it is still a potentially fatal disease. The objective of this study is to examine the treatment methods and our case load with the current literature. MATERIALS AND METHODS: Of 55 patients with PLA, between January 2000 and December 2009, records of 28 who received surgical drainage treatment have retrospectively been analysed. RESULTS: Nineteen (67.9%) of the patients were male, while 9 (32.1%) were female. Average age was 41.07 (15-76). Seven (25%) had associated disease. The most common symptoms were fever and abdominal pain. Twenty three (82.1%) patients had single and 5 (17.9%) had multiple cavitary lesion. Nineteen (67.9%) patients had abscess on the right and 7 (25%) had on the left one, while 2 (7.1%) had on both lobes. All were treated surgically, because of 11 (39.3%) inappropriate localization for percutaneous treatment, 6 (21.5%) insufficient percutaneous drainage, 6 (21.5%) intraabdominal free rupture and 5 (17.7%) multiple cavitary lesion. We observed 5 pulmonary complications, 5 wound infections and 2 perihepatic collections. The average hospital stay was 11.2 days. We observed only two deaths (7.1%). CONCLUSIONS: Surgical treatment is the sole option for the patients with PLA who; (a) can't be treated by percutaneous drainage or had an unsuccessful one, (b) have multiple abscess cavity, (c) are thought to have perforated abscess, (d) have additional abdominal pathology requiring laparatomy.

Retroperitoneal schwannoma.

Retroperitoneal schwannomas are rare tumors and a correct pre-operative diagnosis is often not possible. They are usually identified incidentally via cross-sectional imaging. Diagnosis is based on histopathologic examination and immunohistochemistry. A 57-year-old man with a retroperitoneal schwannoma, as an unusual localisation, is presented.

Bochdalek hernia with concomitant partial situs inversus in an adult.

We report the case of 44-year-old woman with a left-sided Bochdalek hernia (BH) with concomitant partial situs inversus. The patient was presented from the outpatient clinic with lower chest discomfort. She had suffered from abdominal pain for one year, with no history of trauma, previous surgery, or extreme physical exertion. Chest radiograph revealed a large left-sided BH. The patient underwent thoracotomy. Intestinal organs, containing bowel, small intestine, caecum, and appendix were seen in the left hemithorax. Because of the failure to reduce the intestinal organs into the peritoneal cavity, laparotomy was performed. The right side of the abdominal cavity was empty. In conclusion, partial situs inversus was diagnosed. The diaphragmatic defect was repaired with non-absorbable sutures via laparotomy, and with a prolene mesh via thoracotomy. Bochdalek hernia with partial situs inversus is a rare clinical entity with none reported in medical literature.

N-acetylcysteine prevents deleterious effects of ischemia/reperfusion injury on healing of colonic anastomosis in rats.

This study was designed to determine the effects of intraperitoneally or orally administered N-acetylcysteine (NAC) on wound healing following resection and anastomosis of a colon segment with ischemia/reperfusion injury. Forty female Sprague-Dawley rats were randomly allocated to one of four groups containing 10 rats each: (1) normal resection plus anastomosis; (2) ischemia/reperfusion plus resection plus anastomosis; (3) ischemia/reperfusion plus resection plus anastomosis plus intraperitoneal NAC; (4) ischemia/reperfusion plus resection plus anastomosis plus oral NAC. Group comparison showed that the anastomosis bursting pressure was significantly higher in group 3 than in the other groups. The mean tissue hydroxyproline concentration in the anastomotic tissue was significantly lower in group 2 than in the other groups. The collagen deposition was significantly increased on day 7 in groups 3 and 4 compared to the other groups. In conclusion, this study demonstrates that NAC significantly prevents the effects of reperfusion injury on colonic anastomoses in a rat model.

The independent risk factors of mortality and morbidity from upper gastrointestinal system haemorrhages after surgery.

BACKGROUND: The aim this study was to determine the variables influencing the morbidity and mortality of operated patients with upper gastrointestinal haemorrhage (UGIH) and to define the independent risk factors. PATIENTS AND METHODS: The medical records of 62 patients with upper gastrointestinal haemorrhage who underwent operation were reviewed for variables including age, gender, shock, association with co-morbidity, pulse rate, haemoglobin levels, white blood cell count, serum urea, creatinine, sodium and potassium level, time of operation, blood transfusion unit, Rockall risk score and the length of hospital stay. In order to determine the independent risk factors related to mortality and morbidity, we carried out logistic regression analysis. RESULTS: Morbidity and mortality rates were 35.4% (22 patients) and 29.1% (18 patients), respectively. The independent risk factors affecting morbidity were serum albumin level and Rockall score > or = 5, and the independent risk factors affecting mortality were advanced age, and high Rockall score. CONCLUSION: To decrease the postoperative morbidity and mortality rates in patients with UGIH requiring surgery, their pre-operative risk factors should be demonstrated. We believe that the establishment of interventional indication on time and the evaluation of the intra-operative surgical region and technique in combination with the patient- and disease-related factors would help reduce morbidity and mortality rates.

Risk factors affecting morbidity in typhoid enteric perforation.

INTRODUCTION: Typhoid enteric perforation is a cause of high morbidity and mortality. This study aim is to determine the factors affecting morbidity in patients with typhoid enteric perforation. MATERIALS AND METHODS: Ninety-six patients with typhoid enteric perforation were reviewed. The variables are defined as follows: Age, gender, complaints, perforation-operation interval, typhoid fever treatment before the perforation or not, white blood cell (WBC) count, hemoglobin level (Hgb), intraoperative peritonitis intensity, the number of perforations, and type of surgery were examined. To determine the independent risk factors that might affect morbidity in typhoid enteric perforation, we made use of multivariate logistic regression analysis. RESULTS: Nine variables were applied the univariate analysis, which were greater than 30 years (P = 0.218), male gender (P = 0.02), preoperative treatment (P = 0.147), less than or equal to 48 h perforation-operation interval (P = 0.013), greater than 4,000 K/UL WBC (P = 0.388), less than 8 g/dL Hgb (P = 0.026), greater than 29 Mannheim Peritonitis Index (P < 0.0001), multiple perforation number (P = 0.614), and primary repair (P = 0.105). Logistic regression analysis showed that Mannheim Peritonitis Index (P = 0.014) and perforation-operation interval (P = 0.047) were defined as independent risk factors affecting morbidity. CONCLUSIONS: If liquid electrolyte, blood, antibiotics, and parenteral nutrition are applied in typhoid enteric perforation cases adequately, then severe peritonitis becomes an independent risk factor that affects morbidity. Early diagnosis and appropriate surgery type would decrease morbidity and mortality.

Asymptomatic thyroid tuberculosis in a multinodular goitre patient: a case report.

Thyroid tuberculosis is a very rare disease of the thyroid gland. In recent years, the incidence of extra-pulmonary tuberculosis has been showing a progressive increase. We present the case of a 41-year old female patient, operated for an asymptomatic multinodular goiter, and who had a histopathological diagnosis of thyroid tuberculosis. Thyroid tuberculosis should be kept in mind in the differential diagnosis of thyroid nodules, even in patients with no history and no symptom of tuberculosis disease.

An unusual bilateral mastitis in a postmenopausal woman caused by brucellosis.

Breast involvement of brucella can be frequently detected in animals, however, it is extremely rare in humans. Clinical findings and complications may cause difficulties in diagnosis. We report the case of a 52-year old woman with bilateral brucella mastitis, which is difficult to differentiate from inflammatory breast carcinoma.

Factors affecting morbidity and mortality in gangrenous cholecystitis.

INTRODUCTION: Gangrenous cholecystitis is a serious complication of acute cholecystitis. Male gender, older age, leukocytosis, cardio-vascular diseases and diabetes were reported as factors that increase the risk of gangrenous cholecystitis. The aim our study was to determine variables affecting morbidity and mortality as well as to define the independent risk factors in Gangrenous Cholecystitis. METHODS: Fifty three patients who had been treated for Gangrenous Cholecystitis were reviewed. The variables are defined as follows: age, gender, systemic diseases, Mannheim Peritonitis index, aspartate aminotransferase, alanine aminotransferase, white blood cell count and type of surgery. In order to determine the independent risk factors that might affect morbidity and mortality in Gangrenous Cholecystitis, we made use of multivariate logistic regression analysis. RESULTS: The independent risk factors affecting on morbidity were age (P = 0.037), existing systemic disease (P = 0.047) and > or = 29 Mannheim Peritonitis index (P = 0.008), and the independent risk factors affecting on mortality were age (P = 0.046), white blood cell count (P = 0.035). Pre-operative and post-operative third day aspartate amino-transferase and alanine aminotransferase average values were compared, there was a significant difference (P < 0.0001, P < 0.0001 respectively). CONCLUSIONS: We found that older age, > or = 29 Mannheim Peritonitis index and existence of systemic diseases were independent risk factors affecting morbidity. Older age and lower of white blood cell count were independent risk factors affecting mortality. We believe that further comprehensive studies, involving prospective, multi-center and a large number of patients, are needed.

Gunshot injuries of the ureter: one centre's 15-year experience.

PURPOSE: Ureteral injury is a rare condition. It is difficult to identify the best diagnostic methods and treatment. We report our experience with penetrating ureteral injuries secondary to gunshot wounds. The methods of diagnosis and treatment options of these cases are described and discussed. MATERIALS AND METHODS: A retrospective review of ureteral injuries due to penetrating trauma between January 1990 and December 2005, in the Urology and General Surgery departments of our hospital. Ureteral injures were graded according to the AAST-OIS. We evaluated mechanism of injury, initial urinalysis, radiologic and operative procedure, associated injuries, and postoperative complications. RESULTS: A total of twenty-one (sixteen male, five female) cases of gunshot ureteral injuries were evaluated retrospectively. The median patient age was 27.85 years (16-48 years). All patients had signs and symptoms of an acute abdomen and only nine patients were evaluated radiologically. Haematuria was absent in 71.4% of patients (15 of 21). All patients had associated injuries and were evaluated from grade I to V. Grade I had none, grade II had 1 (4.76%), grade III had 3 (14.29%), grade IV had 14 (66.6%), grade V had 3 (14.29%). Ureteral stent or nephrostomy tubes were used in all primarily repaired patients. Two patients developed urinary leakage, which resolved spontaneously. CONCLUSIONS: Ureteral injury should always be borne in mind and, when suspected, the surgeon should dissect and visualize the ureter during exploration. Adequate debridment, and ureteral stenting or nephrostomy drainage are good techniques for successful treatment.

Predicting factors for mortality in the penetrating abdominal trauma.

PURPOSE: penetrating abdominal trauma (PAT) is still a serious problem all over the world. This study was made to define and discuss the factors that could affect mortality in the PAT. METHODS: the records of 1048 patients hospitalized and operated for PAT at Dicle University Hospital (DUH) between January 1990 and December 2001 were retrospectively reviewed. Patients (n = 1048) were divided into two groups: "Healthy Group" (HG) (n = 942) and "Deathly Group" (DG) (n = 106). The epidemiological and clinical features were evaluated as probable risk factors for mortality. The risk factors for mortality were revealed using univariate and multivariate analyses. RESULTS: a total of 1048 patients [937 (89.4%) male, 111(10.6%) female] with PAT were included in this study. The mortality rate (22.5%) of female patients was significantly higher than (8.6%) that of male patients (p = 0.000). The mean age was 30.01+/-63.9 (14-74) years and 30+/-12.5(15-71) years in the HG and DG consecutively (p = 0.85). The average interval between injury and operation (IBIO) was 2.09+/-1.3 (0.5-3) and 6.9+/-11.4 (1-6.1) hours in the HG and DG respectively (p = 0.000). Presence of shock on admission (PSDA) was determined in 87 patients and in 96 patients in the HG and DG respectively (p = 0.000). The mortality rate (14.9%) in patients presenting gunshot wounds (GSW) was significantly higher than (2.7%) that of patients with stab wounds (SW) (p = 0.000). The average number of injured intraabdominal organs (NIAOI) was 1.98+/-1.08 (1-7) and 4.67+/-1.99 (1-13) in the HG and DG respectively (p = 0.000). Mortality rates were 72.7% in cardiac injury, 30% in great vessels injuries, 32.6% in cranial injury, and 21.5% in major extremity and pelvic injury (p = 0.000). The average penetrating abdominal trauma index (PATI) was 11.78+/-9.44 (1-58) and 46.24+/-22.18 (15-119) in the HG and DG respectively (p = 0.000). In multivariate analyses, female gender [Odds Ratio (OR) = 10.74, 95% Confidence Interval (CI) = 3.03-38.12, P = 0.000], the long IBIO (OR = 1.82, CI = 1.39-2.40, P = 0.000), PSDA (OR = 94.45, CI = 28.32-314.95, P = 0.000), presence of cranial injury (OR = 0.03, CI = 0.002-0.363, P = 0.006) and high PATI (OR = 1.14, CI = 1.09-1.19, P = 0.000), were found significantly important for mortality. CONCLUSION: we determined that conditions such as, female gender, long interval between injury and operation, presence of shock on admission, presence of cranial injury and high PATI were predicting factors for mortality in PAT.

Ordination and classification of macroinvertebrates and environmental data of a stream in Turkey.

Macroinvertebrate communities and environmental variables were assessed in an Ankara Stream receiving high organic and industrial wastes. Environmental data were used to explain biological variation using multivariate techniques provided by the program CANOCO. The ordination method CCA (Canonical Correspondence Analysis) was applied to evaluate the relationships between environmental variables and distribution of macroinvertebrate genera. Data sets were classified by TWINSPAN (Two Way Indicator Species Analysis). In this investigation, macroinvertebrate communities have been shown by CCA ordination to be related to TOM (total organic matter), ammonia, cadmium, pH, lead, dissolved oxygen, conductivity (EC), phosphate, boron, nitrite and hardness, with TOM, ammonia, cadmium and pH emerging as the most significant environmental variables. Epeorus was a TWINSPAN indicator for the slightly polluted upstream site 1. Physa was a TWINSPAN indicator for the polluted downstream sites.

Physico-chemical and biological characteristics of thermal springs in Köycegiz and Dalaman basins in south-western Turkey and recommendations for their protection.

Many hydrogeological researches exist on the thermal springs of Turkey but limnological researches are very deficient. The results of the limnological research of the thermal springs in the basin of the meromictic lake Köycegiz and Dalaman Basin are as follows; the thermal springs are of euthermal or chliarothermal types. In the thermal springs thermotolerant diatoms constituted the major plankton flora. Recommendations for the protection of thermal springs are given according to the results of this research.

[Granulomatous peritonitis due to Ascaris lumbricoides]. / Ascaris lumbricoides'e bagli granülomatöz peritonit.

Ascaris lumbricoides is one of the most common and most widespread helminthic infections of humans. Infection with ascaris appears to be asymptomatic in the vast majority of cases, but may produce serious pulmonary disease or obstruction of biliary or intestinal tract in a small proportion of infected people. We examined under the light of literature this case which caused the granulomatous peritonitis by ascaris, the adult worm, without any evidence of intestinal perforation.