Analysis of Age-Specific Predictors of Mortality in Patients with Coronavirus Disease 2019.

AIM: We investigated predictors of mortality, including demographic, clinical, and laboratory parameters, in hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia. PATIENTS AND METHODS: This retrospective, single-center study included 651 consecutive Turkish adults who had been admitted to the emergency department with a diagnosis of COVID-19. We recorded the demographic, clinical, and laboratory parameters of the patients. The patients were divided into two groups: patients aged ≥65 years and patients aged <65 years. The predictors of mortality for hospitalized COVID-19 patients were evaluated. RESULTS: The study included 651 patients (354 [54.4%] men and 297 [45.6%] women; mean age, 56.40 ± 15.70 years). The most common comorbidities were hypertension (37.6%), diabetes mellitus (28.9%), and coronary artery disease (CAD) (16.1%). The overall mortality rate was 10.6% (n = 69); the mortality rate was higher in men than in women. Advanced age; chronic renal failure (CRF); prolonged activated partial thromboplastin time; high serum neutrophil and platelet counts; high C-reactive protein to albumin (CRP/albumin) ratio; and high levels of albumin, lactate dehydrogenase (LDH), and high-sensitivity troponin I (TnI-hs) were independent predictors of mortality in all age groups. CONCLUSION: Multivariate logistic regression analysis showed that chronic obstructive pulmonary disease (COPD), high serum platelet count, high CRP/albumin ratio, and high levels of albumin, TnI-hs, and D-dimer were independent predictors of mortality in patients aged <65 years. Conversely, advanced age, CAD, CRF, and high levels of serum CRP and LDH were independent predictors of mortality in patients aged ≥65 years.

The impact of meteorological factors on the spread of COVID-19.

Background: Clinical studies suggest that warmer climates slow the spread of viral infections. In addition, exposure to cold weakens human immunity. Aim: This study describes the relationship between meteorological indicators, the number of cases, and mortality in patients with confirmed coronavirus disease 2019 (COVID-19). Patients and Methods: This was a retrospective observational study. Adult patients who presented to the emergency department with confirmed COVID-19 were included in the study. Meteorological data [mean temperature, minimum (min) temperature, maximum (max) temperature, relative humidity, and wind speed] for the city of Istanbul were collected from the Istanbul Meteorology 1st Regional Directorate. Results: The study population consisted of 169,058 patients. The highest number of patients were admitted in December (n = 21,610) and the highest number of deaths (n = 46) occurred in November. In a correlation analysis, a statistically significant, negative correlation was found between the number of COVID-19 patients and mean temperature (rho = -0.734, P < 0.001), max temperature (rho = -0.696, P < 0.001) or min temperature (rho = -0.748, P < 0.001). Besides, the total number of patients correlated significantly and positively with the mean relative humidity (rho = 0.399 and P = 0.012). The correlation analysis also showed a significant negative relationship between the mean, maximum, and min temperatures and the number of deaths and mortality. Conclusion: Our results indicate an increased number of COVID-19 cases during the 39-week study period when the mean, max, and min temperatures were consistently low and the mean relative humidity was consistently high.

Bleeding events in the emergency department with warfarin versus novel oral anticoagulants: A five-year analysis.

Background: Although warfarin is the most effective treatment approved to prevent atrial fibrillation-associated stroke, it remains underused in clinical practice due to patient noncompliance. Therefore, novel oral anticoagulants (NOACs) have been developed. Aims: This study aimed to identify bleeding complications in patients who were taking oral anticoagulants and compare the rates of major and minor bleeding events between NOACs and warfarin groups. Patients and Methods: We conducted a retrospective, observational study of warfarin- and NOAC-treated patients who presented to an emergency department between January 2015 and December 2019 with bleeding events. We compared patients with major and minor bleeding in terms of age, gender, comorbid diseases, type of anticoagulant, and site of bleeding. Results: An electronic search yielded 95 (21.9%) cases of patients taking a NOAC (i.e., dabigatran [19], rivaroxaban [45], apixaban [29], or edoxaban [6]) and 354 taking warfarin. There were no significant differences between the warfarin and NOACs groups in the frequency of minor bleeding complications. Similarly, there were no significant differences between the groups in the frequency of major bleeding complications. No significant difference in intracranial bleeding was seen between the NOACs- and warfarin-treated patients, although the incidence of gastrointestinal bleeding was significantly higher in the NOACs (P = 0.102 and P = 0.021, respectively). Conclusion: Our findings indicate that rates of major and minor bleeding complications in patients taking NOACs are similar to those in patients taking warfarin. While warfarin was associated with fewer complications than NOACs in terms of gastrointestinal bleeding, the risk of intracranial bleeding, was similar between the groups.

Usefulness of C1 esterase inhibitor protein concentrate in the management of hereditary angioedema of oropharyngeal tissue.

Hereditary angioedema is an autosomal-dominant disorder caused by mutation of the gene encoding the C1 esterase inhibitor (C1-INH). It manifests as painless, nonpruritic, nonpitting episodic swelling of the subcutaneous tissues, gastrointestinal, and upper respiratory tracts in the absence of urticaria. An attack typically takes 24 h to peak and resolves over 48-72 h. The most serious manifestation is a laryngeal attack associated with upper airway swelling. The aim of this case report is to describe the lifesaving use of a novel C1-INH protein concentrate in a patient with mild-to-moderate dyspnea caused by swelling of the upper airway (larynx) and tongue.

Role of oxidative stress in the clinical outcome of patients with multiple blunt trauma.

OBJECTIVE: This prospective study evaluated serum total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI), along with the Revised Trauma Score (RTS) and Injury Severity Score (ISS), as predictors of clinical outcome in the early post-traumatic period in patients with multiple blunt trauma (MBT). METHODS: The study included 52 patients admitted to the emergency department with MBT and 40 age- and sex-matched healthy control subjects. RESULTS: The overall MBT patient mortality was 32.7% (17/52). There was no significant association between age and mortality in MBT patients, but there was a negative correlation between mortality and RTS, and a positive correlation between mortality and ISS. TOS levels were significantly higher in nonsurvivors compared with survivors. There was no correlation between TAS or OSI and survival. ISS and RTS showed positive and negative correlations with TOS level, respectively, but neither was significantly related to TAS or OSI. CONCLUSIONS: These findings suggest that TOS, as an early oxidative stress biomarker, may be an objective alternative criterion to the ISS and RTS for managing patients with MBT during the early period following traumatic injury.

Diagnostic accuracy of proximal enamel subsurface demineralization and its relationship with calcium loss and lesion depth.

OBJECTIVE: The aim of this study was to determine the relationship between the amount of calcium loss, lesion depth, and the accuracy of storage phosphor plate (SPP) and film radiographs for the detection of artificial proximal demineralization. METHODS: Standard enamel windows of extracted premolars were exposed to a demineralizing solution for 60 h, 80 h, 100 h and 120 h. Solutions were analysed for calcium concentration by atomic absorption spectrometer and the lesion depths were calculated by a specific formula. All teeth were radiographed with SPPs and F-speed films before and after acid application. Images were evaluated by five observers. Stereomicroscopic and scanning electron microscopic (SEM) observations were carried out to visualize enamel surfaces after acid exposure. Receiver operating characteristic analysis was used for diagnostic accuracy (A(z)). A(z)s were compared with factorial analysis of variance and t-tests. The relationship between A(z)s and lesion depths was determined with Pearson's correlation test. RESULTS: Strong positive correlation was found between A(z)s of both radiographic methods and lesion depths. No difference was found between the A(z)s of two radiographic systems for any of the demineralization durations (p > 0.05). Pair-wise comparisons revealed no significant difference in A(z)s of SPPs (p > 0.05), while significant differences were obtained for the A(z)s of films for different demineralization periods (p < 0.05). Stereomicroscopic and SEM observations confirmed demineralizations from superficial to deeper layers of enamel. CONCLUSION: Subsurface enamel demineralization was not accurately detectable with either storage phosphor plates or F-speed films. The amount of calcium loss and the depth of demineralization have a strong relationship with diagnostic accuracy with a significant effect particularly on F-speed films.

Trauma scores and neuron-specific enolase, cytokine and C-reactive protein levels as predictors of mortality in patients with blunt head trauma.

This study evaluated serum neuron-specific enolase (NSE), cytokine and high-sensitivity C-reactive-protein (hs-CRP) levels, along with the Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS), as predictors of mortality in the early posttraumatic period, in 100 Turkish patients with blunt head trauma. Overall patient mortality was 27%. There was a significant association between age and mortality, and mortality was negatively correlated with GCS and RTS. Head injury severity (GCS) was significantly related to NSE, hs-CRP, interleukin (IL)-6, IL-8 and tumour necrosis factor (TNF)-alpha levels. Mortality correlated positively with IL-6, IL-8, TNF-alpha and hs-CRP levels. NSE, hs-CRP, IL-6, IL-8 and TNF-alpha levels were significantly higher in non-survivors compared with survivors. GCS score < or =8, younger age and NSE levels were significant independent predictors of mortality. During the early post-traumatic period, NSE may be an objective alternative criterion to the GCS, in the management of patients with blunt head trauma.

An attempt to predict daily erythrocyte lithium fluctuations.

Erythrocyte lithium concentration, which is a better predictor of brain lithium levels than plasma lithium concentrations, possesses the disadvantage of precise hourly determination following the last intake. The variability in RBC lithium accumulation increases as the extracellular lithium concentration increases. This increase is also time dependent and it would be very useful if the pharmacokinetic rate constant were known. Unfortunately, low lithium levels do not allow measurements within confidence intervals. In this work, we tried to determine, in vitro, the kinetic rate constants in erythrocytes of healthy volunteers. Different high lithium loaded plasma-like media were used for an extrapolation procedure of constants allowing the determination of an erythrocyte load constant namely K0 = 0.0161 +/- 0.0005 h-1 at corresponding plasma lithium concentrations. The abnormalities of lithium transport determined by in vitro procedures would be very useful in understanding the etiology of affective illness. Lithium flux pre-controls corrected with this rate constant would be very helpful in enlarging laboratory time management.