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.

Treatment of the Refractory Atrophic Humeral Nonunion with Autogenous Block Iliac Crest Graft and Spongioplasty: a Retrospective Study.

PURPOSE OF THE STUDY Most humeral nonunions can be successfully treated with a single procedure, but some are more difficult to heal. Humeral nonunions which have two or more surgical procedures were defined as refractory humeral nonunions, and this condition is a very challenging condition. The aim of the study is to show the results of atrophic refractory humeral nonunion treated with open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty. MATERIAL AND METHODS Refractory humeral nonunions treated with open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty from January 2010 to March 2019 were included this study retrospectively. Patient baseline information, number of previous surgeries, comorbidities, follow-up time, fracture union time, and complications were recorded. The functional outcome was evaluated with the Constant scores and Mayo scores at the end of the first year. The primary outcome variable was mentioned as bony union. RESULTS A total of 13 refractory humeral nonunions included this study. The average age of the patients was 50.92±15.55 years (range, 26-78 years), and 8 of them were female. Preoperative and postoperative mean Mayo scores were; 56.54±17.84, and 85.38±7.49 respectively (p<0.001). Preoperative and postoperative mean Constant scores were; 45±11.71, and 80.62±5.38 respectively (p<0.001). DISCUSSION The strict application of basic nonunion principles can result in successful salvage of refractory humeral nonunions. But this concept may not provide sufficient solution for each situation. On the other hand, we also applied the basic nonunion principles. Compression plating and autogenous bone grafting and spongioplasty have been considered as the gold standard in the management of humeral shaft nonunion. CONCLUSIONS Open reduction and internal fixation and autogenous block iliac crest graft and spongioplasty should be considered as an alternative for the treatment of refractory atrophic humeral nonunions, whose treatment is a very challenging condition for surgeons. Key words: block graft, bone grafting, nonunion, refractory humeral nonunion, spongioplasty.

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.

Analysis of glenohumeral morphological factors for anterior shoulder instability and rotator cuff tear by magnetic resonance imaging.

OBJECTIVE: The aim of this study was to investigate whether there are glenohumeral morphological differences between normal population, glenohumeral instability, and rotator cuff pathology. METHOD: In this study, shoulder magnetic resonance (MR) images of 150 patients were evaluated. Patients included in the study were studied in three groups of 50 individuals: patients with anterior shoulder instability in group 1, patients with rotator cuff tear in group 2, and control subjects without shoulder pathology in group 3. RESULTS: There were statistically significant differences between groups in evaluations for glenoid version, glenoid coronal height, glenoid coronal diameter, humeral axial and coronal diameters, and coracohumeral interval distances. Significant differences were observed between groups 2 and 3 in glenoid axial diameter, glenoid coronal height, glenoid depth, humeral coronal diameter, and coracohumeral distances. CONCLUSION: The results obtained in this study suggest that glenoid version, glenoid coronal height and diameter, humeral diameter, and coracohumeral interval parameters in glenohumeral morphology-related parameters in patients with anterior instability are different from those of normal population and patients with rotator cuff pathology. In cases where there is a clinically difficult diagnosis, these radiological measurements will be helpful to clinicians in diagnosis and treatment planning, especially in cases of treatment-resistant cases.

Impact of L-carnitine and Selenium Treatment on Testicular Apoptosis in Rats Exposed to 2.45 GHz Microwave Energy.

OBJECTIVE: It has been suggested that electromagnetic radiation (EMR) by wireless devices (2.45 GHz) induces testicular apoptosis. We investigated if supplemental selenium (Se) and L-carnitine may reduce this adverse effect. MATERIAL: Twelve-week old male Wistar albino rats were used in this study. Twenty-four rats were equally divided into four groups which were named as: sham group, EMR-only, EMR+L-carnitine (1.5 mg L-carnitine/kg/day) and EMR+Se (1.5 mg Se/kg/-every other day). RESULTS: The level of Bcl-2, Bax, caspase-3 and -8 were compared and a significant difference was found between the sham and EMR-only groups (p < 0.05), and Bcl-2, Bax, caspase-3 and -8 expressions increased in the EMR-only group. The level of Bcl-2, Bax, tumour necrosis factor-alpha (TNF-α), caspase-3 and -8 were compared and a significant difference was found between the sham and EMR+L-carnitine groups (p < 0.05) and Bcl-2, Bax, TNF-α, caspase-3 and -8 expressions increased in the EMR+L-carnitine group. The level of Bcl-2, Bax, TNF-α, caspase-3 and -8 were compared and a significant difference was found between the sham and EMR+Se groups (p < 0.05) and Bcl-2, Bax, TNF-α, caspase-3 and -8 expressions increased in the EMR+Se group. When the expression of caspase-8 was compared, a significant difference was found between the EMR-only and EMR+Se groups (p < 0.05). Caspase-8 expression decreased in EMR+Se group compared with EMR-only group. CONCLUSION: Electromagnetic radiation exposure resulted in testicular apoptosis in rats, mainly by the intrinsic pathways by down-regulated expression of caspase-8. Reduction in the activation of the intrinsic pathway of apoptosis was found higher with selenium administration compared with L-carnitine administration.

Testicular apoptosis and histopathological changes induced by a 2.45 GHz electromagnetic field.

There is a growing public concern about the potential human health hazard caused by exposure to electromagnetic radiation (EMR). The objective of this study is to investigate the effects of 2450 mhz electromagnetic field on apoptosis and histopathological changes on rat testis tissue. Twelve-week-old male Wistar Albino rats were used in this study. Eighteen rats equally divided into three different groups which were named group I, II and III. Cage control (group I), sham control (group II) and 2.45 GHz EMR (group III) groups were formed. Group III were exposed to 2.45 GHz EMR, at 3.21 W/kg specific absorption rate for 60 minutes/ day for 28 days. There was no difference among the groups for the diameter of the seminiferous tubules, pyknotic, karyolectic and karyotic cells. However, the number of Leydig cells of testis tissue of the rats in group III was significantly reduced comparing with the group I (p < 0.05). Estimation of spermatogenesis using the Johnsen testicular biopsy score revealed that the difference between groups is statistically significant. The level of TNF-α, Caspase-3 and Bcl-2 were compared, and no significant difference was found between the groups. When Bax apoptosis genes and Caspase-8 apoptosis enzyme were compared, there were significant differences between the groups (p < 0.05). Electromagnetic field affects spermatogenesis and causes to apoptosis due to the heat and other stress-related events in testis tissue.

Immunohistochemical expression of MMP-2, MMP-9 and COX-2 in Stage IA malignant polyps of the endometrium.

OBJECTIVE: To study whether endometrioid type malignant endometrial polyps (MEP) are different from endometrium cancer not associated with polyps (ECNAP) in means of immunohistochemical expressions of MMP-2, MMP-9 and COX-2. METHODS: Archived tissue samples of eight MEP, eight ECNAP and 16 benign endometrial polyps were selected and immunohistochemically analyzed for MMP-2, MMP-9 and COX-2 expression. RESULTS: MMP-2 and MMP-9 were overexpressed in ECNAP compared to MEP and benign endometrial polyps (p < 0.05). MMP-2 and MMP-9 expressions were not different in the malignant part of MEP, benign part of MEP and benign endometrial polyps. COX-2 expression was found to be higher in benign lesions, although this was not statistically significant. CONCLUSION: Similar immunohistochemical expression of MMP-2, MMP-9 and COX-2 within a polyp and with benign polyps may indicate an immunohistochemically indolent characteristic of MEP.

Expression of gelatinase (MMP-2 and MMP-9) and cyclooxygenase-2 (COX-2) in endometrial carcinoma.

OBJECTIVE: Matrix metalloproteinases (MMPs) are key players in the degradation of extracellular matrix and basement membranes, and are thus important in tumor invasion. Gelatinases (MMP-2 and MMP-9) in particular are prognostic factors in many solid tumors. In this study the immunohistochemical expression of both COX-2 and matrix metalloproteinases has been shown for the first time in endometrium carcinoma. METHODS: Forty-two endometrial carcinoma tissues were immunostained for MMP2 antibody (1:100, Rabbit polyclonal), MMP9 antibody (1:100, Rabbit polyclonal) and CoX2 antibody (1:100, Epitope specific rabbit antibody). RESULTS: 90.5% of the cases were positive for MMP-2 and MMP-9, and 83.3% of the cases were positive for COX-2. A statistically significant association was found between COX-2 overexpression and FIGO stage (p = 0.001). A positive correlation was also found with histological grade (p = 0.006), myometrial invasion (p = 0.033), vascular invasion (p = 0.017), and lymphatic invasion (p = 0.007). A positive correlation was found between MMP-2 overexpression and vascular and lymphatic invasion (p = 0.030 and p = 0.003, respectively). MMP-9 overexpression was also found to be correlated with vascular and lymphatic invasion (p = 0.001 and p = 0.012, respectively). Furthermore, there was a statistically significant correlation between MMP-2 and MMP-9 overexpression (p = 0.0001). CONCLUSION: The results showed that COX-2, MMP-2 and MMP-9 were expressed in a high percentage of primary endometrial carcinomas and their expressions may be associated closely with parameters of tumor aggressiveness.

CD24 expression is a poor prognostic marker in endometrial carcinoma.

OBJECTIVE: CD24 is a cell adhesion molecule that has been implicated in metastatic tumor progression of various solid tumors. Its expression is known to be related to the prognosis of several kinds of tumors. This study was designed to examine the prognostic significance of CD24 in endometrial cancer patients. METHODS: Forty-four endometrial carcinoma tissues were immunostained for CD24 antibody (Ab2, clone 24 C02). Cytoplasmic and membranous immunoreactivity were scored semiquantitatively by Fisher's exact test. RESULTS: CD24 expression was detected in 34 (77.3%) out of 44 cases. Membranous and cytoplasmic staining of CD24 was significantly associated with the International Federation of Gynecology and Obstetrics (FIGO) grade (p = 0.011 and p = 0.002, respectively) and nodal status (p = 0.002 and p = 0.000, respectively). CONCLUSION: Our data suggests that CD24 expression in endometrial carcinoma as detected by immunohistochemistry might be a new marker for a more aggressive endometrial cancer biology. CD24 is commonly up-regulated in endometrial cancer and this corroborates the importance of CD24 in tumor progression among these cases.

The effects of subchronic methidathion toxicity on rat liver: role of antioxidant vitamins C and E.

Methidathion (MD) phosphorodithioic acid S-[(5-methoxy-2-oxo-1,3,4-thiadiazol-3(2H)-yl)methyl] O,O-dimethyl ester is the organophosphate insecticide (OPI) most commonly used worldwide in the pest control of crops. Subchronic MD exposure was evaluated for its effects on lipid peroxidation, the serum activities of cholinesterase (ChE), and enzymes concerning liver damage, and the protective effects of combination of vitamins E and C in albino rats. Additionally, the histopathological changes in liver tissue were examined. Experimental groups were as follows: control group; a group treated with 5 mg/kg body weight MD (MD group); and a group treated with 5 mg/kg body wight MD plus vitamin E plus vitamin C (MD+AO group). The MD and MD+AO groups were treated orally with MD on five days a week for 4 weeks. The serum activities of cholinesterase (ChE), alanine transferase (ALT), aspartate amiotransferase (AST), lactate dehydrogenase (LDH), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), and the concentration of malondialdehyde (MDA) and liver histopathology were studied. In serum samples, MD significantly increased MDA concentration and ALP, AST, GGT, LDH activities but decreased the ALT and ChE activities. In the MD+AO group, MDA level and ALP, AST, LDH activities were significantly decreased and ChE activity was increased compared to the MD group. Histopathological changes found in liver tissue of rats treated with MD included were infiltration with mononuclear cells in all portal areas, sinusoidal dilatation, and focal microvesicular steatosis and hydropic degenerations in parenchymal tissue. The severity of these lesions was reduced by administration of vitamins. From these results, it can be concluded that subchronic MD causes liver damage, and lipid peroxidation may be a molecular mechanism involved in MD-induced toxicity. Furthermore, the combination of vitamins E and C can reduce the toxic effects of MD on liver tissue of rats.

The effect of pentoxifylline on the lung during cardiopulmonary bypass.

Cardiopulmonary bypass (CPB) produces an inflammatory response due to the interaction of blood with a foreign body surface. The lungs are most affected by this inflammatory response. Pentoxifylline (PTX), a phosphodiesterase inhibitor and an inhibitor of leukocyte activation, is used to minimize damage in lungs where leukocytes play an important role. Twenty patients with mitral valve stenosis with planned mitral valve surgery were included in the study. The ten patients receiving pentoxifylline (PTX group) were administered 400 mg PTX orally TID for 3 days preoperatively and, following anesthetic induction, a 300 mg PTX infusion was given. The ten patients receiving no PTX were the control group (CT). Platelet and leukocyte counts, mean pulmonary arterial pressure (mPAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), pulmonary vascular resistance (PVR), alveolar-arterial PO2 gradient (AaDO2) were measured just before and after CPB, and 2 h postoperatively. The number of the leukocytes increased in the blood samples drawn 15 min after CPB in both groups and 2 h postoperatively showed no statistical change. The number of platelets had decreased significantly at the end of the CPB in both groups and, 2 h postoperatively, there was a further decrease in the blood count in the control group (P < 0.05). There was no significant difference in either the preoperative or postoperative PAP, PAWP, and CI. Pulmonary vascular resistance increased in both groups following the CPB (CT, before: 136 +/- 44, after: 177 +/- 94 dyne. sec.cm-5; PTX, before: 151 +/- 82, after 182 +/- 43 dynes.sec.cm-5). Two hours postoperatively, a considerable increase continued in the control group (CT 219 +/- 170 dynes.sec. cm-5), while there was an insignificant increase in the PTX group (PTX 193 +/- 51 dynes.sec.cm-5) (P < 0.05). The alveolar-arterial PO2 gradient increased after the CPB in both groups but a moderate decrease was observed 2 h postoperatively. In lung biopsy specimens taken before and after the CPB, there was marked leukocyte sequestration in the control group, whereas the number of leukocytes was seen to be insignificant in the PTX group (P < 0.005). This dosage regimen of PTX inhibits the postoperative increase in PVR and greatly minimized leukocyte sequestration in the lung due to CPB.