The relation between thrombus burden and early mortality risk in inpatients diagnosed with COVID-19-related acute pulmonary embolism: a retrospective cohort study

Abstract Background COVID-19-related acute pulmonary thromboembolism (APE) is associated with poor outcomes in patients with COVID-19. There are studies investigating the association between thrombus burden and high risk of early mortality in the pre-COVID-19 period. This study aimed to evaluate the relationship between clot burden and early mortality risk in COVID-19-related APE patients. Methods In this single-center retrospective cohort study, the data of hospitalized adult patients followed up for COVID-19-related APE between April 1, 2020, and April 1, 2021, were electronically collected. A radiologist evaluated the computed tomography (CT) findings and calculated the Mastora scores to determine clot burden. The early mortality risk group of each patient was determined using 2019 the European Society of Cardiology guidelines. Results Of the 87 patients included in the study, 58 (66.7%) were male, and the mean age was 62.5±16.2 years. There were 53 (60.9%) patients with a low risk of mortality, 18 (20.7%) with an intermediate-low risk, and 16(18.4%) with an intermediate-high/high risk. The median total simplified Mastora scores were 11.0, 18.5, and 31.5 in the low, the intermediate-low, and the intermediate-high/high-risk groups, respectively (p = 0.002). With the 80.61% of post-hoc power of the study, intermediate-high/high early mortality risk was associated statistically significantly with the total simplified Mastora score (adj OR = 1.06, 95%CI = 1.02–1.11,p = 0.009). Total simplified Mastora score was found to predict intermediate-high/high early mortality risk with a probability of 0.740 (95% CI = 0.603–0.877): At the optimal cut-off value of 18.5, it had 75.0% sensitivity, 66.2% specificity, 33.3% positive predictive value, and 92.2% negative predictive value. Conclusions The total simplified Mastora score was found to be positively associated with early mortality risk and could be useful as decision support for the risk assessment in hospitalized COVID-19 patients. Evaluation of thrombus burden on CT angiography performed for diagnostic purposes can accelerate the decision of close monitoring and thrombolytic treatment of patients with moderate/high risk of early mortality

Deteriorations of pulmonary function, elevated carbon monoxide levels and increased oxidative stress amongst water-pipe smokers

Objectives: A water pipe (hookah) is a tobacco smoking tool which is thought to be more harmless than a cigarette, and there are no adequate studies about its hazards to health. Water-pipe smoking is threatening health of the youth in the world today. The objective of this study has been to investigate the carbon monoxide (CO) levels in breath, examine the changes in pulmonary function tests (PFT) and to assess the change of the oxidative stress parameters in blood after smoking a water pipe. Material and Methods: This study is a cross-sectional analytical study that has included 50 volunteers who smoke a water pipe and the control group of 50 volunteers who smoke neither a cigarette nor a water pipe. Carbon monoxide levels were measured in the breath and pulmonary function tests (PFTs) were performed before and after smoking a water pipe. Blood samples were taken from either the volunteer control group or water-pipe smokers group after smoking a water pipe for the purpose of evaluation of the parameters of oxidative stress. Results: Carbon monoxide values were measured to be 8.08±7.4 ppm and 28.08±16.5 ppm before and after smoking a water pipe, respectively. This increment was found statistically significant. There were also significant reductions in PFTs after smoking a water pipe. Total oxidative status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were found prominently higher after smoking a water pipe for the group of water-pipe smokers than for the control group. Conclusions: This study has shown that water-pipe smoking leads to deterioration in pulmonary function and increases oxidative stress. To the best of our knowledge this study is the only one that has shown the effect of water-pipe smoking on oxidative stress. More studies must be planned to show the side effects of water-pipe habit and protective policies should be planned especially for young people in Europe. Int J Occup Med Environ Health 2017;30(5):731–74

The effects of left ventricular function on right heart in the patients with acute pulmonary embolism

The optimal treatment approach of haemodynamically stable patients with acute pulmonary embolism (PE) remains controversial. Absence of RV dilatation or the ratio of RVD/LVD ( [Med-Science 2020; 9(4.000): 939-49