The ROX, shock and diastolic shock indexes in the prediction of mortality in COVID-19.

OBJECTIVES: The aim of this study is to determine the role of Respiratory Rate Oxygenation (ROX), shock, and diastolic shock indexes ​​in predicting mortality in coronavirus disease 2019 (COVID-19) patients admitted to the emergency department. BACKGROUND: The COVID-19 spread worldwide in a short time and caused a major pandemic. The ROX, shock, and diastolic shock indexes are used in various life-threatening clinical situations. The use of these indexes in triage at emergency departments can accelerate the determination of COVID-19 patients' severity. METHODS: The ROX, shock and diastolic shock indices were calculated and recorded. Patients were divided into three groups; 1) who were discharged from the hospital, 2) who were admitted to the hospital and 3) who were admitted to the intensive care unit. RESULTS: Increased diastolic shock index and decreased ROX index were found to be independent risk factors for mortality. In the prediction of mortality, the sensitivity and specificity of the diastolic shock index were 61.2% and 60.8%, respectively. However, the sensitivity and specificity of ROX index was 73.1% and 71.5%, respectively. CONCLUSION: In conclusion, we found that the ROX index had higher sensitivity and specificity than other indexes in predicting mortality in the evaluation of COVID-19 patients (Tab. 3, Fig. 2, Ref. 18).

An Outbreak of Home Distillation Methanol Poisoning in Turkey During the COVID-19 Pandemic: A Single Center Experience.

BACKGROUND: Causes of methanol poisoning may include accidental or suicidal use, as well as self home-distillation. In this study, it was aimed to evaluate clinical characteristics, laboratory findings, and outcomes of home-distillation methanol poisoning in two different time periods as an outbreak during the pandemic. The source of the methanol poisoning in all patients was home-brewing or distillation of methanol. METHODS: The study was a single-center, retrospective, and observational case-control study. Patients over 18 years of age, in 2 different periods in the form of an outbreak due to home-distillation of methanol between April 1, 2020, and April 1, 2022, when the coronavirus disease 19 pandemic was intensely experienced in Turkey, were included in this study. RESULTS: A total of 43 patients were included in the study. Of these patients, 22 were exposed to methanol between July and August 2020, and 21 patients were exposed to methanol in December 2021. Overall, 20 patients (46.5%) died, while 23 (53.5%) out of 43 patients recovered with or without sequelae. Patients with low blood pressure, oxygen saturation values, Glasgow Coma Scale (GCS) scores, high blood glucose levels, metabolic acidosis (pH<7.11), and high lactate levels (lactate>4.50 mmol/L) at admission had a statistically significantly worse prognosis. CONCLUSION: In methanol poisoning due to home brewing, low blood pressure, oxygen saturation, and impaired consciousness at the time of admission were clinical findings associated with mortality. In terms of laboratory findings, especially severe metabolic acidosis and lactate elevation were observed in the group that was mortal despite treatment.

Effect of Target Temperature Management on Optic Nerve Sheath Diameter in Post-Cardiac Arrest Patients.

Target Temperature Management (TTM) is a procedure used in post-cardiac arrest (CA) patients to reduce mortality and morbidity. The goal of this study was to investigate the link between intracranial pressure (ICP) and optic nerve sheath diameter (ONSD) in this patient group, which has a high mortality rate, despite TTM, and to see if ONSD may be used to predict mortality. The research was designed to be a retrospective observational study. The study comprised patients who were followed up on in a tertiary intensive care unit, had post-CA TTM, and had brain computed tomography (BCT) before and 0-6 hours after TTM. ONSD measurements were acquired from patients' BCT images recorded before and after TTM. The difference in pre-TTM ONSD and post-TTM ONSD measurements in all post-CA patients, as well as the difference in pre-TTM ONSD and post-TTM ONSD measurements in surviving and deceased patients, was compared. The study involved 33 participants. The patients' average age was 60.58-12.39 years, and 75.8% were male. Around 51.5% of the patients died. When the pre-TTM and post-TTM ONSDs of all patients were compared, there was no statistically significant difference (p = 0.856). When the percentage change (Δ) values between the post-TTM ONSD and pre-TTM ONSD and post-TTM ONSD measures of the surviving patients and the deceased patients were compared, a difference was observed (p < 0.01). Increased ICP in post-CA patients is a significant clinical issue associated with mortality and poor neurological prognosis. ONSD measurement may be useful in monitoring ICP, which may rise, despite TTM, and higher ONSD measurements may be used as an indicator for mortality in post-CA patients, who have received TTM.

Treatment of fibromyalgia among patients with mastalgia and fibromyalgia improved mastalgia.

OBJECTIVES: The aim of this study is to examine the effect of fibromyalgia (FM) treatment on mastalgia by performing fibromyalgia screening in patients who applied for mastalgia and whose underlying cause could not be found. METHODS: Patients who applied to Kocaeli University General Surgery Outpatient Clinic between November 2017 and November 2020 with breast pain were included (n=120). Patients without cancer, systemic disease, previous breast surgery, and breast mass larger than 3 cm (n=30) were referred to the Physical Therapy and Rehabilitation Outpatient Clinic. A total of 13 patients (43%) were diagnosed with FMS. Twelve of them were given selective serotonin-noradrenaline reuptake inhibitor (duloxetine) treatment for 3 months. Turkish version of the Short Form - 36 (SF-36) quality of life scores, Visual Analog Scale (VAS), Cardiff breast pain score before and after treatment were compared. The remaining 17 patients were followed as only mastalgia. RESULTS: Patients with fibromyalgia and mastalgia had similar demographic results. At the end of the 3rd month, the complaints of breast pain completely regressed in all of the patients. Statistically significant changes were detected in VAS score, the number of trigger points, and SF-36 quality of life scores, Cardiff breast pain score after duloxetine treatment. CONCLUSION: In the presence of unexplained mastalgia, fibromyalgia should be kept in mind. Duloxetine treatment improved the breast pain and quality of life in patients with mastalgia and fibromyalgia.

Emergent approach to small bowel tumors: diagnosis and treatment.

BACKGROUND: This study presents the diagnosis and treatment of rare small bowel tumors through clinical cases. METHODS: Patients treated between 2000 and 2023 were included in the study. The clinical records of the patients were analyzed retrospectively. RESULTS: A total of 34 patients were included in the study. Of these patients, 26 (75.5%) were male and eight (23.5%) were female. The mean age of the patients was 62.1 years. The most common symptoms and signs were abdominal pain (76.4%), bloating (38.2%), and nausea and vomiting (17.6%). Diagnostic methods included computed tomography (CT) (82.3%), upper gastrointestinal double balloon enteroscopy (35.2%), and capsule endoscopy (5.8%). Diagnoses included adenocarcinoma in 13 cases, gastrointestinal stromal tumors (GISTs) in 12 cases, and neuroendocrine tumors (NETs) in two cases. CONCLUSION: Small bowel tumors frequently present with abdominal pain, bloating, and nausea and vomiting. CT and endoscopic procedures are the primary diagnostic tools. Small bowel cancers are often diagnosed late due to subtle clinical findings and the limitations of endoscopic imaging. Targeted screening strategies may be beneficial for certain at-risk and symptomatic patient groups. Early surgical intervention offers significant advantages for diagnosed patients.

The Effect of Urea/Albumin Ratio on Mortality in the Geriatric Patients Admitted in the Intensive Care Unit.

OBJECTIVE: To analyse the effect of urea albumin ratio on mortality in intensive care patients aged over 65 years. STUDY DESIGN: An observational study. Place and Duration of the Study: Health Sciences University, Ankara Training and Research Hospital, Emergency Critical Intensive Care Unit, from October 2021 to March 2022. METHODOLOGY: Patients over 65 years of age admitted in the intensive care unit were included in this study, and the laboratory and clinical data were recorded within the first 24 hours after the admission of the patient. The urea : albumin ratio was calculated using serum urea and albumin concentrations. All the patients were monitored during intensive care admission and mortality rates were recorded; additionally 1-month mortalities of the patients were also recorded. The data of the survivors and non-survivors were compared. RESULTS: There were 362 patients with mean age of 79.00±8.40 years; 53.9% were females. The median urea : albumin ratio was found to be 22.8 mg/gr. The area under curve, sensitivity and specificity values were found to be 0.631, 68%, and 56% at a cut-off value of 22.1 mg/gr for urea : albumin ratio, respectively. In addition, urea : albumin ratio >22.1mg/gr was found to be significant in univariate regression analysis (p<0.001) and multivariate regression analysis (p<0.002) for the predictive value of 1-month mortality. CONCLUSION: Urea : albumin ratio is a simple and potentially useful prognostic factor in the geriatric patient population admitted in the intensive care unit. KEY WORDS: Geriatrics intensive care unit, Urea:albumin ratio, Mortality (MeSH database).

The Effect of Residual Gastric Volume on Body Mass Index, Excess Weight Loss Rate and Metabolic Response after Sleeve Gastrectomy.

BACKGROUND/AIM: To investigate the metabolic response and body mass index reduction according to the remaining stomach volume between 6-12 months after the operation in patients who underwent sleeve gastrectomy surgery for obesity and to determine the relationship between the remaining stomach volume and metabolic improvement. Materials and Methods: Patients underwent sleeve gastrectomy in a single center by the same team and with the same standardized method. Residual gastric volumes were calculated from three-dimensional computed tomography images obtained 6-12 months postoperatively. BMI, excess weight loss (EWL), total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), very low density lipoprotein (VLDL), triglyceride, hemoglobin A1c (HbA1c), total protein, albumin values were recorded preoperatively and at the time of residual volume measurement. Results: There were 49 subjects with a mean SD preoperative BMI of 47.26+-6.21 kg/m2 and mean age 37.51+-10.88 years. Mean residual volume was 155.36+-56.71 cc. Residual volume was associated with postoperative mean BMI (28.44+-3.23 kg/m2; p 0.001) and postperative mean EWL%(29.27+-7.66; p=0.001). Residual gastric volume was also negative correlated with postoperative mean HbA1c (p=0.004). HbA1c (p=0.828), LDL (p=0.661), HDL (p=0.848), triglycerides (p=0.641), VLDL (p=0.794), total protein relation (p=0.539) and albumin (p=0.824) were analyzed before and after surgery and were not correlated with residual gastric volume. CONCLUSION: The smaller the residual gastric volume after laparoscopic sleeve gastrectomy, the higher the %EWL and the greater the decrease in HbA1c. This study show that laparoscopic sleeve gastrectomy is an effective surgical procedure in patients with Type 2 diabetes mellitus.

Modified pectoral nerve block versus bi-level erector spinae plane block for postoperative analgesia after radical mastectomy surgery: a prospective, randomized, controlled trial.

BACKGROUND: Regional anesthesia techniques constitute an important part of successful analgesia strategies in the perioperative care of patients undergoing breast surgery. The advent of ultrasound-guided regional anesthesia has led to the development of fascial plane blocks. The large array of blocks available for postoperative analgesia in breast surgery has increased the accessibility of regional anesthesia but has also created a dilemma of choice. This study compared the analgesic efficacy of the ultrasound-guided modified pectoral nerve (PECS) block and erector spinae plane block (ESPB) in patients undergoing radical mastectomy. METHODS: Seventy women were enrolled in this prospective, double-blind, randomized control trial. After exclusion, 67 female patients who underwent radical mastectomy were finally analyzed. Ultrasound-guided PECS blocks and ESPBs were performed with 30 ml 0.25% bupivacaine. Postoperative morphine and pain scores were compared between the groups. RESULTS: Postoperative total morphine consumption in the first 24 h was significantly higher in the PECS group (P < 0.001). The ESPB group exhibited significantly reduced morphine consumption at all postoperative time points. Numeric rating scale scores were lower in the ESPB group at 6, 12, and 24 h postoperatively at rest and when coughing. CONCLUSIONS: Ultrasound-guided bi-level ESPBs provided better postoperative analgesia than PECS blocks after radical mastectomy surgery.

Utility of positron emission tomography for determination of axillary metastasis of breast cancer.

Objectives: The involvement of axillary lymph nodes plays a key role in breast cancer staging. Positron emission tomography is a promising modality for detecting axillary lymph node metastasis. In addition, nomograms are used to predict the status of axillary lymph nodes. In this study, the role of positron emission tomography in determining axillary metastasis and its correlation with the nomogram was evaluated. Material and Methods: The axillary maximum standard uptake value (SUVmax) values of the patients in the preoperative period, the features in the perioperative and postoperative specimen and Memorial Sloan Kettering Cancer Center nomogram data were evaluated. Results: As axillary SUVmax detected by Positron emission tomography in the preoperative period increased, so did the likelihood of lymph node involvement. Axillary SUVmax value were compared with Memorial Sloan Kettering Cancer Center nomogram data but no correlation was found. Age, lymph node number, histopathology results, mass diameter, presence or absence of lymphovascular invasion and/or perineural invasion, tumor type, estrogen receptor status, Ki67 and Cerb-B2 statuses were not correlated. However, axillary SUVmax was inversely correlated with grade and progesterone receptor status. Conclusion: Results from positron emission tomography of axillary lymph nodes in breasts cancer patients showed that SUVmax was only inversely related to cancer grade and progesterone receptor status while not correlating with other accepted parameters for tumor assessment. Thus there is insufficient reliability for the use of axillary SUVmax alone for accurate assessment of tumor characteristics at present.

A case report of furosemide extravasation in the hand: a rare cause of compartment syndrome.

In emergency departments, many drugs, fluids, and materials for medical examinations and treatment are typically administered to patients intravenously. One of the most common complications of the intravenous bolus or infusion of drugs is extravasation injuries. These injuries may cause certain morbidities for the patient, increase the cost of treatment, and prolong hospital stays. At the same time, these injuries also carry medicolegal risks for health personnel. Furosemide is a potent diuretic that is commonly used in emergency departments for volume overload conditions. To the best of our knowledge, there have been no cases reported in the literature of furosemide-induced extravasation injury with subsequent compartment syndrome that has required surgical intervention. Presented herein is the case of a 70-year-old female patient who was administered intravenous furosemide from the dorsum of the left hand and whose extravasation injury progressed to compartment syndrome requiring an emergency fasciotomy.

Tissue proteome analysis revealed an association between cancer, immune system response, and the idiopathic granulomatous mastitis.

Idiopathic Granulomatous Mastitis (IGM) is a disease that clinically mimics breast cancers with symptoms of pain, edema, erythema, nipple discharge, nipple retraction, and fistula. Although IGM is considered to be formed by autoimmune responses or infections, the molecular mechanism behind formation and progress is unknown. Therefore, in this study, we aimed to investigate molecular mechanisms underlying IGM formation, progress, and recurrence by monitoring the changes at the proteome level. Protein extracts prepared from IGM (n = 15) and within-control tissues (n = 15) were subjected to nHPLC followed by LC-MS/MS proteomic analysis. Label-free quantitation analysis revealed that sixty differentially regulated between the two groups. Those proteins were classified based on their role in metabolic pathways using bioinformatics tools. Based on DAVID analysis, 16 of the differently regulated proteins were associated with the immune system, while 17 proteins were involved in cancer metabolism. STRING analysis showed that five of the differentially regulated proteins were associated with combined immune deficiency which were PNP, TAP1, ITGAL, PRKDC, and PTPRC while the other proteins were involved in insulin response and neutrophil degranulation. This study is one of the very few studies that investigated the changes in protein expressions of IGM tissues compared to controls. For the first time, we have shown the relationship of IGM with the immune system at the protein level and also underlined the cancer-like behavior of the disease. Furthermore, the proteins that were pointed out as combined immune deficiency-related proteins may have value as diagnostic markers for idiopathic granulomatous mastitis although further studies are needed to shed more light on the pathogenesis of the disease.

An Atypical Presentation of Hydatid Disease, Accompanied by a Pancreatic Pseudocyst: A Case Report.

Hydatid disease (HD) is a zoonotic disease, which typically affects the liver and the lungs. Primary retroperitoneal localization of the disease is infrequent. The most common symptom is abdominal pain; however, the clinical features of HD may be generally dependent on the location of the cyst. A 53-year-old female patient presented to Kocaeli University General Surgery Clinic, Turkey in September 2019 with complaints of flank pain, constipation and vomiting. The MRI revealed cystic lesions in the pancreas and psoas muscle. Both cysts were excised totally during laparotomy. Histopathology reports showed that the lesion in psoas muscle was hydatid cyst whereas the lesion in pancreas was pancreatic pseudocyst. Postoperative period was uneventful and the patient was discharged with albendazole treatment. No recurrence occurred during follow-up period. Atypical localization for hydatid disease is a diagnostic dilemma for surgeons, especially in endemic countries. Hydatid disease should always be considered in the differential diagnosis of retroperitoneal lesions, inadequate management can lead to complications and fatalities. Surgery combined with antiparasitic therapy, may be an option in the presence of obstruction of gastrointestinal and/or urinary tract.

Elucidation of the changes occurring at the proteome level in ovaries of high-fat diet-induced obese rats.

High-fat diet-induced obesity adversely affects the female reproductive system. The metabolic changes that the high-fat diet causes on the ovaries have not been elucidated. Herein, to understand the molecular and cellular mechanisms underlying the effects of long-term high-fat diet-fed, the changes in the global proteomic profile of the rat ovaries were investigated. The female rats were randomly divided into two groups based on their diets: the ones that were fed with the high-fat diet and the other ones that were fed with the control diet for 18 weeks. To identify differentially expressed proteins, the changes in ovary proteomes were investigated by two-dimensional electrophoresis coupled to matrix-assisted laser desorption/ionization-time-of-flight/time-of-flight and label-free quantification with nano-high performance liquid chromatography to tandem mass spectrometry (nHPLC-MS/MS). A total of 80 proteins were differentially regulated. The upregulated proteins were involved in responses to chemical and organic substances, cytokines, external stimuli, and lipids. These proteins were particularly associated with vesicles, microbodies, and cell surface proteins. The downregulated proteins were involved in biological processes associated with cellular respiration. Those proteins created a network consisting of proteins involved in aerobic respiration and energy generation. Our results demonstrated that the mechanisms related to energy production in the ovary tissue were particularly affected by the high-fat diet.

Etanercept Prevents Endothelial Dysfunction in Cafeteria Diet-Fed Rats.

Obesity is associated with endothelial dysfunction and this relationship is probably mediated in part by inflammation. Objective: The current study evaluated the effects of etanercept, a tumor necrosis factor-alpha (TNF-α) inhibitor, on endothelial and vascular reactivity, endothelial nitric oxide synthase (eNOS) immunoreactivity, and serum and aortic concentrations of TNF-α in a diet-induced rat model. Design and results: Male weanling Wistar rats were exposed to a standard diet and cafeteria diet (CD) for 12 weeks and etanercept was administered during CD treatment. Isolated aortas of the rats were used for isometric tension recording. Carbachol-induced relaxant responses were impaired in CD-fed rats, while etanercept treatment improved these endothelium-dependent relaxations. No significant change was observed in papaverine- and sodium nitroprusside (SNP)-induced relaxant responses. eNOS expression decreased in CD-fed rats, but no change was observed between etanercept-treated CD-fed rats and control rats. CD significantly increased both the serum and the aortic levels of TNF-α, while etanercept treatment suppressed these elevated levels. CD resulted in a significant increase in the body weight of the rats. Etanercept-treated (ETA) CD-fed rats gained less weight than both CD-fed and control rats.

The new normal for breast cancer surgery during COVID-19 pandemic: An international survey conducted by SENATURK.

PURPOSE: The COVID-19 pandemic has changed the way many health institutions approach their workload. Physicians managing patients with cancer now have to deal not only with the disease but also the restrictions and limitations imposed because of the global pandemic. We aimed to determine how surgical preferences in breast cancer management were affected globally using a questionnaire-based survey. METHODS: Under the auspices of the Turkish Senology Society (SENATURK) we asked 122 surgeons from 27 countries to reply to a 26-question survey designed to measure the impact of COVID-19 on their surgical practice when treating patients with breast cancer. RESULTS: The characteristics of participant surgeons were statistically similar when comparing the participants' answers from Turkey and other countries. From the responses given to our questionnaire, it was understood that breast cancer surgery decreased by 25% (p<0.05) in institutions all over the world, including Turkey, but there was no change in the approach technique to the axilla. CONCLUSIONS: Globally breast surgeons have adapted to the new normal due to the COVID-19 pandemic. Many surgical approaches and some follow up protocols have been changed, although the degree of change has varied from country to country. In addition, the availability of multidisciplinary case conferences has been reduced in some centers which may affect the quality of services provided to patients.

Breast Recurrence of Acute Myeloid Leukemia After Bone Marrow Transplantation: A Case Report About Myeloid Sarcoma of the Breast.

Myeloid sarcoma of the breast is a rare malignancy, can be seen after bone marrow transplantation. Although there are no specific features for this malignancy which is difficult to diagnose, some common features draw attention in the published case reports. Since there is no consensus on the treatment of myeloid sarcoma of the breast, we aimed to explain our own diagnosis and treatment methods in this case report.

The Art of Medical Photography in Breast Surgery: Clinical, Intra-operative and Specimen Photography - Standards and Recommendations.

Medical visual documentation is an especially important source of information for medicine. Medical photography has become the main method of medical visual documentation. In breast surgery, as in all other medical branches, medical photography has a major role in education and patient follow-up. The published literature was reviewed for medical photography techniques. In co-operation with the University fine arts faculty photography unit, standards for clinical, intra-operative and specimen photography in breast surgery were analyzed and identified. As a result, we have made recommendations for obtaining high quality and academically more effective medical photographs in breast surgery.

Changes and disruptions in diagnosis, treatment and follow-up of breast cancer during two periods of the COVID-19 pandemic in Turkey.

OBJECTIVES: COVID-19 disease, which rapidly became a pandemic, led to significant changes in the provision of health services. This included radical changes to the supply and delivery of routine services to release resources for emergency care. During this process, a range of restrictions were imposed including the recommended rules to be followed before, during and after surgery. Health services provided for breast cancer diagnosis, treatment and follow-up have also undergone enforced changes meaning the diagnosis, treatment, and follow-up of patients with priority has come to the fore. In this study, the effect of the COVID-19 pandemic in Turkey, between March 11, 2020 and May 31, 2020 was assessed in comparison to pre-pandemic practice in terms of divided into two periods, and breast cancer diagnosis, treatment, and follow-up. MATERIAL AND METHODS: Surgeons dealing with breast cancer treatment and registered to SENATURK (Turkish Senology Academy) were contacted online. The period was divided into two, between March 11th and April 30th and May 1st to May 31st, 2020. Surgeons were requested to complete two electronic evaluation forms, one for each period, investigating change in practice. Only complete responses for both periods were included in the analysis. RESULTS: There were 93 respondents. Except for less multidisciplinary breast councils, there was no delay in radiological and pathological diagnoses. The number of breast cancer surgeries increased in Period 2, and more COVID-19 positive breast cancer patients were operated in Period 2. Benign breast patients were delayed less frequently in Period 2. In the statistical analysis performed between the two groups, it was found that only a significant difference was in the number of outpatients with benign breasts. CONCLUSION: With sufficient awareness of the risks of COVID-19 and with individual protection, breast cancer treatment was not affected during the assessed period of active pandemic in Turkey.

Cutaneous adverse effects of methylene blue in an animal skin-flap model.

Background and objectives: Sentinel lymph node biopsy is important for metastasis surveillance in the management of a number of human cancers. Identification of sentinel lymph nodes may be facilitated by the use of several methods including methylene blue injection. However tissue necrosis is a known effect of methylene blue application. This study aimed to investigate the effects of methylene blue injection on skin flaps using a rodent model.Methods: Modified McFarlane flaps were prepared using Wistar Albino rats. Local injection of methylene blue was given to one group while saline was injected into the control group. A third group received systemic methylene blue via intraperitoneal injection. Observational and histological comparison was made between the groups to investigate the necrotic effects of methylene blue on skip flaps.Results: The control group's surviving flap areas were significantly larger than local methylene blue group's surviving flap area. However, there was no significant difference in skin flap survival area between the control group and the systemic methylene blue group. Furthermore, there is no significant difference between local and systemic methylene blue group's surviving flap areas.Conclusions: Local methylene blue injection increases skin necrosis and decreases rates of surviving flap areas in an experimental rat models.