Clinical characteristics and hematological parameters associated with disease severity in COVID-19 positive pregnant women undergoing cesarean section: A single-center experience.

AIM: The study aimed to describe clinical characteristics and outcomes of pregnant women with COVID-19 undergoing cesarean section, and evaluated the association of blood values at admission with severe COVID-19 disease in this group of patients. METHOD: We retrospectively analyzed the clinical data of 110 patients infected with COVID-19 who underwent cesarean section at Adana City Education and Research Hospital in Turkey. The COVID-19 severity of the patients was classified as either severe or nonsevere disease according to World Health Organization of COVID-19 clinical management guidance. We compared blood values, clinical characteristics, and outcomes between severe and nonsevere patients. Receiver operating characteristics (ROC) curves analyses and area under the ROC curve (AUC) value was calculated to evaluate the predictive value of blood parameters on the COVID-19 severity. RESULTS: Of the 110 women, 12 were severe cases. Severe patients had higher ferritin, neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH), alanine transaminase (ALT), aspartate transaminase (AST), and procalcitonin levels on admission (p < 0.05). The ROC analysis demonstrated AUC of NLR, LDH, AST, ALT, ferritin, and procalcitonin was 0.757, 0.856, 0.840, 0.771, 0.821, and 0.698, respectively. The LDH had a maximum specificity (90.8%), with the cutoff value of 365. The O-blood group was more likely to have severe illness than the non-O-blood group (relative risk: 3.6; 95% confidence interval; 1.2-10.4). CONCLUSION: This study shows that LDH values at admission are an early and powerful predictor of severe infection for pregnant women with COVID-19 who will undergo a cesarean section.

Telmisartan decreases microalbuminuria in patients with type 2 diabetes mellitus following coronary artery bypass grafting

Objective: This prospective study aimed to investigate the effects of the selective angiotensin receptor antagonist, telmisartan, on microalbuminuria after coronary artery bypass surgery in patients with diabetes mellitus.Methods: Patients were divided into two groups with block randomisation, using the sealed envelope technique: group T (telmisartan group) consisted of patients who received the angiotensin receptor blocking agent telmisartan 80 mg daily for at least six months in the pre-operative period; group N-T (non-telmisartan group) consisted of patients who received no telmisartan treatment. Clinical and demographic characteristics, operative and postoperative features, microalbuminuria and high-sensitivity C-reactive protein levels were compared.Results: Forty patients met the eligibility criteria for the study. The groups did not differ with regard to clinical and demographic characteristics, and operative and postoperative features. Microalbuminuria levels between the groups differed significantly in the pre-operative period, first hour postoperatively and fifth day postoperatively. C-reactive protein levels between the groups differed significantly on the fifth day postoperatively.Conclusion: Telmisartan was useful for decreasing systemic inflammation and levels of urinary albumin excretion in patients who had type 2 diabetes mellitus and had undergone coronary artery bypass surgery

A comparative analysis of arterial blood flow in unexplained infertility, tubal infertility and fertile groups.

We aimed to compare ovarian (O), uterine (U) and spiral (S) artery (A) resistance of patients diagnosed as fertile, unexplained infertility (UI) and tubal factor infertility (TFI) in the peri-implantation period and independent from the impact of the treatment. UI (n = 70), TFI (n = 75) and fertile (n = 72) patients' ovarian, uterine and spiral artery pulsatility index (PI), resistance index (RI) and the endometrial thickness, serum estradiol and progesterone levels were compared. The specificity and sensitivity values were calculated according to determined cutoff values. Both TFI and control groups' UA PI values were significantly lower than the UI group's PI values. The highest UA RI values were found in UI group and the lowest values were in the control group. UI and TFI groups' OA PI/RI values were significantly higher than the control group. Both the control and TFI groups' SA PI/RI values were significantly lower than UI group's PI/RI values. UI patients' uterine and spiral arteries PI values >1.86 and >0.85, RI values >0.80 and >0.53 can be used as a valuable test showing reduced uterine perfusion. Ovarian artery PI values >0.96 and RI values >0.58 can be used as tests showing decreased ovarian perfusion in patients with TFI. In these patients, embryo cryopreservation can be considered.

The effect of endometrial polyps on pregnancy rates in intracytoplasmic spenn injection cycles.

OBJECTIVE: The purpose of this study was to determine reproductive results of intracytoplasmic sperm injection (ICSI) for different endometrial polyps subgroup divided according to polyp size and number. MATERIALS AND METHODS: Eighty-three primer infertile patients were retrospectively analyzed. Group A consisted of 36 patients having an endometrial polyp with a diameter ≤ one cm; whereas 47 patients were included in Group B who had a polyp with a diameter > one cm or more than one polyps. All patients underwent a hysteroscopic polypectomy and ICSI treatments were started in the following cycle. RESULTS: Pregnancy was achieved in 16 patients (44.4%) in Group A and 23 patients (48.9%) in Group B. The pregnancy ratios did not reveal a statistically significant difference between the two groups. CONCLUSION: The authors concluded that in patients who have undergone hysteroscopic polypectomy before the Intracytoplasmic sperm injection (ICSI) cycle, the pregnancy rates do not depend on the diameter of the endometrial polyps.

Location of the appendix at the third trimester of pregnancy: A new approach to old dilemma.

The aim of this study was to determine the location of the appendix at the third trimester of pregnancy as there are conflicting results in literature. Distances from the base of the appendix were measured intra-operatively to the anterior iliac spine (A), symphysis pubis (B) and the xyphoid process (C). The same measurements were taken from McBurney's point on the abdominal wall (A1, B1 and C1). In the allocated 21 pregnant and 18 non-pregnant women, distance A and B were 10.3 ± 0.9 cm and 18.3 ± 3.2 cm in pregnant and 6.7 ± 0.9 cm and 13.2 ± 0.9 cm in non-pregnant women (p < 0.001), respectively. Distance C was shorter in pregnant women (14.7 ± 2.5 cm vs. 23.8 ± 1.9, p < 0.001). Conversely, distance C1 was longer in pregnant women (30.3 ± 3.0 vs. 24.8 ± 5.1 cm, p = 0.004). This study provides evidence that the appendix moves cranially late in the course of the pregnancy. Therefore, McBurney's point cannot be used as a reference point to localise the appendix at the third trimester of pregnancy.

The effect of different ß-blockers on vascular graft nitric oxide levels: comparison of nebivolol versus metoprolol.

OBJECTIVES: The aim of this study was to investigate the effects of the vasodilating ß-blocker nebivolol and the cardioselective ß-blocker metoprolol on nitric oxide (NO) levels at vascular graft endothelium and vasa vasorum compared to controls in patients undergoing coronary artery bypass graft surgery. METHODS: This was a prospective study. Fifty-five patients were divided into three groups: nebivolol group (group N, n = 23), metoprolol group (group M, n = 16), and control group (group A, n = 16). Group N received nebivolol 5 mg once daily, and group M received metoprolol 50 mg once daily for 15 days in the preoperative period. Control patients did not use ß-blocker therapy. Tissue samples of both left internal mammary artery (LIMA) and saphenous vein grafts were investigated for NO activity using immunohistochemical methods. RESULTS: Demographic characteristics and risk factors were similar between groups. We observed the highest NO activity in group N in both endothelial and vasa vasorum samples of LIMA and saphenous veins. NO activity of metoprolol group was similar to controls. CONCLUSIONS: According to our results, we think that nebivolol may be safer and preferable in order to diminish graft spasm in patients undergoing coronary artery bypass graft surgery due to the NO-mediated vasodilating effect.

Influence of intracoronary shunt on myocardial ischemic injury during off-pump coronary artery bypass surgery.

AIM: The aim of the study was to evaluate the role of intracoronary shunt during off-pump coronary artery bypass surgery in patients with isolated left anterior descending coronary artery lesion. METHODS: Forty patients undergoing off-pump coronary artery bypass using the left internal mammary artery to bypass the left anterior descending coronary artery were randomly assigned to have the bypass performed with intracoronary shunt or by occlusive snaring. Potential damage from the shunt or from snaring was monitored by clinical follow-up, monitoring of cardiac enzymes (cardiac troponin I, CK, CK-MB), electrocardiography, and echocardiography before and 24 h. after the surgery. Left ventricular myocardial biopsies were performed during surgery for histopathological analysis. RESULTS: None of the patients in this study died during or after the surgery. Duration of the anastomosis was significantly longer in the shunt group. No significant difference concerning the preoperative and postoperative CK levels between groups. The preoperative CK-MB levels of the groups were not significantly different, whereas postoperative levels was significantly lower in the shunt group. The preoperative troponin I levels of the groups were not significantly different, whereas postoperative levels was significantly higher in the snare group. Myocardial edema was significantly less in shunt group compared with snare group. There were no electrocardiographic abnormalities, severe CK-MB elevation, or hemodynamic deterioration after the operation in both groups. CONCLUSION: Intracoronary shunt may have beneficial effects due to the reduction of postoperative troponin I levels and myocardial edema during grafting of the left anterior descending coronary artery. However, further trials need to be performed for the documentation of their impacts precisely.

Do the medical treatment reduces the rate of surgical treatment in suspected cases of chronic prostatitis before prostatectomy?

AIM: Our aim is to investigate how the chronic intraprostatic inflammation affect the course of the BPH (benign prostatic hyperplasia). PATIENTS AND METHODS: Between the dates of 2007-2011, the files of the patients who had TUR-P (transurethral resection of the prostate) and underwent open surgery were retrospectively reviewed because of BPH, and the patients were divided into two groups who were operated due to AUR (acute urinary retention) or LUTS (lower urinary tract symptoms) and the clinical data and pathology results of the two groups were compared in terms of chronic intraprostatic inflammation. RESULTS: There were evaluable data of 130 of 150 patients. The age range of the patients was 50-88. 52 of the 130 patients due to AUR and 78 of them due to LUTS underwent surgery. While there was chronic inflammation in 59 of the 130 patients, there was not in 71. The volume of the prostate and the average age of those who had chronic prostatitis with the combination of AUR were greater compared to the LUTS. CONCLUSIONS: It seems that chronic prostatitis is a factor which is often accompanied by BPH and affects the progression and pathology of the disease. The risk of acute urinary retention is more frequent in patients with chronic inflammation than in those who lack. In the future, related clinical trials with the relationship between the intraprostatic inflammation and BPH treatment are necessary and should include more cases and longer period of follow-up for these studies.

Management of extensive venous thrombosis following cardiac surgery in a patient with Behcet's disease.

Behçet's disease is a multisystemic vasculitis of unknown etiology, which is characterized by recurrent urogenital ulceration, cutaneous eruptions, ocular manifestations, arthritis and vasculitis, and its diagnosis is based on clinical criteria. Herein, we report a case of a patient with Behcet's disease, who was successfully managed with anticoagulant and anti-inflammatory therapy for disseminated venous thrombosis leading to pleural effusion, Budd-Chiari syndrome and central nervous system involvement following coronary artery bypass grafting surgery.

Protective effects of hyperbaric oxygen and iloprost on ischemia/reperfusion-induced lung injury in a rabbit model.

BACKGROUND: The role of multiorgan damage in the mortality caused by ischemic limb injury is still not clarified. The objective of this study was to examine the potential protective effects of hyperbaric oxygen (HBO) and iloprost (IL) therapy on lung damage induced by limb ischemia/reperfusion injury in a rabbit model, using both biochemical and histopathological aspects. METHODS: Forty New Zealand white rabbits were randomly allocated into one of five study groups: HBO group (single session of HBO treatment); IL group (25 ng/kg/min infusion of IL); HBO + IL group (both HBO and IL); Control group (0.9% saline only); and a sham group. Acute hind limb ischemia-reperfusion was established by clamping the abdominal aorta for 1 h. HBO treatment and IL infusion were administrated during 60 min of ischemia and 60 min of reperfusion period. Blood pH, partial pressure of oxygen, partial pressure of carbon dioxide and levels of bicarbonate, sodium, potassium, creatine kinase, lactate dehydrogenase, and tumor necrosis factor alpha were determined at the end of the reperfusion period. Malondialdehyde was measured in the plasma and lung as an indicator of free radicals. After sacrifice, left lungs were removed and histopathological examination determined the degree of lung injury. RESULTS: In the control group, blood partial pressure of oxygen and bicarbonate levels were significantly lower and creatine kinase, lactate dehydrogenase, malondialdehyde and tumor necrosis factor-α levels were significantly higher than those of the HBO group, IL group, HBO + IL group and sham group. Similarly, the malondialdehyde levels in the lung tissue and plasma levels were significantly lower in the treatment groups compared with the control group. The extent of lung injury according to the histological findings was significantly higher in the control group. CONCLUSIONS: These results suggest that both HBO and IL therapies and their combination might be effectively used in the prevention of lung injury after ischemia/reperfusion injury of the lower extremities.

Protection of the spinal cord from ischemia: comparative effects of levosimendan and iloprost.

BACKGROUND: The purpose of the study was to investigate and compare iloprost and levosimendan on spinal cord ischemia in an experimental model. MATERIALS AND METHODS: The study was done in two stages. For the 4-hour short survival study, 50 New Zealand white rabbits were randomly allocated into five groups. Spinal cord ischemia was induced by clamping the aorta just below the left renal artery and just proximal to the aortic bifurcation with bulldog artery clamps. The aortic clamps were removed after 40 min and restoration of blood flow was verified visually. The groups were analyzed at 1 and 4 h after reperfusion. For the 48-hour survival study, two different groups (iloprost plus levosimendan, n = 10; saline-treated controls, n = 10) were analyzed at 24 and 48 h after reperfusion. RESULTS: The neurologic status of the animals in the treatment and sham groups was better than that in the control group both at 1 and 4 h after reperfusion. Viability index values in the levosimendan, iloprost and iloprost plus levosimendan groups were statistically higher than in the control group indicating less or no neuronal damage. DISCUSSION: The results suggest that levosimendan, as well as iloprost, may reduce ischemic damage in transient spinal ischemia and provide better neurologic outcome.

Management of recurrent thrombosis in liver transplant recipients: a case report.

Intra-abdominal thrombotic complications in orthotopic liver transplantation can cause devastating results. The management of these patients after thrombosis remains a difficult clinical problem. We present a case report of a patient who developed recurrent venous, thrombosis after liver transplantation performed because of cirrhosis due to autoimmune hepatitis. She had bleeding episodes during and early after the transplantation procedure and developed portal vein thrombosis after a single dose of recombinant factor VII, which was given for treatment of hemorrhage. She had her second thrombotic attack while she was on warfarin therapy which was initiated after the first bout. No hereditary or immunologic risk factors were found. Management of these patients can be difficult because of the liver's effect on the coagulation profile.