Pulmonary Embolism Due To Metal Coil: Case Report

Radiological studies may sometimes reveal unexpected findings. A 42-year-old male patient was referred to our center because of metallic opacities observed on the chest X-ray. Physical examination was unremarkable except for macular lesions on both lower extremities. A detailed medical history revealed that the patient had a varicocele in the right testis which was obliterated with coil embolization 12 years ago. The metallic opacities observed on the chest X-ray were considered to result from the migration of the coils from testis to the lungs. Coil embolization is an effective and safe procedure in the treatment of varicocele. However, as presented in the case, the procedure may cause complications in a certain subgroup of patients. Migration of coils from the varicose testicular veins to the pulmonary vessels may be clinically insignificant; however, when found incidentally, it may pose a diagnostic problem that needs to be solved by the clinician.WoSScopu

Daily Surveillance With Early Warning Scores Help Predict Hospital Mortality In Medical Wards

Background/aim: To analyze the potency of a modified early warning score (EWS) to help predict hospital mortality when used for surveillance in nonacute medical wards. Materials and methods: Patients in internal medicine wards were prospectively recruited. First, highest, and last scores; and mean daily score recordings and values were recorded. Nurses calculated scores for each patient upon admission and every 4 h. The last score was the score before death, discharge, or transfer to another ward. The highest scores in total and for each single parameter were used for analysis. 9 Results: Fifty-nine percent of 182 recruited patients had recordings eligible for data analysis. Patients admitted from the emergency room had higher mortality rates than patients admitted from outpatient clinics (15% vs. 1.5%; P = 0.01) as well as patients whose first (40% vs. 4.9%; P = 0.033) and highest scores (18.8% vs. 1.3%; P = 0.003) were equal to or more than 3. The first recorded EWS was not predictive for mortality while the maximum score during the admission period was. Conclusion: This study underlines the fact that each physiological variable of EWS may not have the same weight in determining the outcome.WoSScopu

Common diagnoses in internal medicine in Europe 2009: a pan-European, multi-centre survey

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldOBJECTIVE: Information on the medical problems and diseases encountered by practicing Internists in the hospital environment is lacking. The aim of this study is to assess the prevalence of various diagnostic categories that present to internists in the hospital setting in Europe. DESIGN: A pan-European study used the Young Internists Research Network of the European Federation of Internal Medicine. RESULTS: Data on 1501 patients from 31 physicians in 18 European countries were included in the study. The patients carried an average of 2.75 (+/-2.22) chronic medical diagnoses, ranging from 0 to 18. The most common presenting complaint was shortness of breath, followed by chest pain and abdominal pain. A cardiac condition was most common, followed by infectious disease. The complexity of patients averaged 2.5 (+/-1.14). CONCLUSIONS: The results of this study will be useful for the development of a modern internal medicine curriculum, both at the graduate and postgraduate level, which reflects the competencies required for the delivery of comprehensive patient care in internal medicine wards

Perceptions And Attitudes Of Patients About Adult Vaccination And Their Vaccination Status: Still A Long Way To Go?

Background Immunization is one of the most effective public health measures to prevent disease, but vaccination rates in adult populations still remain below the targets. Patient and physician attitudes about vaccination are important for adult vaccination. In this study, we aimed to determine patient attitudes and perceptions about vaccination and the vaccination coverage rates of adult patients in a university hospital in Turkey. Material/Methods A survey was conducted between October 2014 and May 2015 at the Internal Medicine Outpatient Clinics of a university hospital. Adult patients were asked to fill out a questionnaire on their perceptions and attitudes about vaccination and their vaccination status. Results We interviewed 512 patients ages 19–64 years. Eighty percent of the study population thought that adults should be vaccinated, while only 36.1% of the patients stated that vaccination was ever recommended to them in their adult life. Forty-eight percent of the patients stated that they were vaccinated at least once in their adulthood. The most commonly received vaccine was tetanus vaccine in general, while influenza vaccine was the leading vaccine among patients with chronic medical conditions. While 71.4% of the patients to whom vaccination was recommended received the vaccine, 34.9% of the patients received a vaccine without any recommendation. Conclusions Although the vaccine coverage rates among adults in this survey were low, the perceptions of patients about adult vaccination were mainly positive and of many of them positively reacted when their physician recommended a vaccine.PubMedWo

Mortality Related Factors In Patients Requiring Hospitalization For Influenza Like Illness

The knowledge about the viral etiologies causing respiratory disease in adults is limited. Viral respiratory diseases may lead deterioration in certain patient populations. The aim of this study was to determine the viral etiologies of influenza-like illness among patients requiring hospitalization and to document the risk factors for mortality. This prospective study was performed in one of the 7 centers in Turkey in the context of influenza surveillance by the Global Influenza Hospital Surveillance Network. A 35-bed Adult Emergency Service and 10-bed Acute Care Unit were screened for consequent recruitment of eligible patients daily, on weekdays only. ICD-10 codes in the electronic health records and direct patient encounters were used to screen for the following eligibility diagnoses: acute respiratory tract infection, asthma, heart failure, pneumonia, influenza, chronic obstructive lung disease, dyspnea/respiratory abnormality, respiratory symptoms, cough and fever. A total of 334 patients who were admitted with the eligible ICD-10 codes within the 24th and 48th hours were screened during the study period and of those eligible ones, 106 consented and were swabbed. Nasal or nasopharyngeal swabs were collected using Virocult (Medical Wire & Equipment, UK) and sent to the central laboratory in 1-3 days. Swabs were collected and specimens were introduced to real-time polymerase chain reaction based multiplex kits, as well as, ABI 7500 platform with CDC primers and probes. A total of 106 patients were swabbed. Hospital mortality was 12.2%. More than one fourth of the patients needed a sort of mechanical ventilation support and at least one organ failure developed in one third of the patients. One or more viral pathogens were detected in 56 (52.8%) of the swabbed patients, with influenza H3N2 being the most prevalent one. Having a lower body mass index (OR, 0.845, p=0.034) was associated with mortality. Chronic lung diseases were shown to confer a survival advantage (OR, 0.127, p=0.009). Community acquired viral respiratory infections might lead to significant compromise in adult patients. Prevention of malnutrition might result in better outcomes in patients who need acute admission. The survival advantage of those with chronic lung diseases warrants further investigation.WoSScopu

Efficacy and safety of an inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac): interim results of a double-blind, randomised, placebo-controlled, phase 3 trial in Turkey

Background CoronaVac, an inactivated whole-virion SARS-CoV-2 vaccine, has been shown to be well tolerated with a good safety profile in individuals aged 18 years and older in phase 1/2 trials, and provided a good humoral response against SARS-CoV-2. We present the interim efficacy and safety results of a phase 3 clinical trial of CoronaVac in Turkey. Methods This was a double-blind, randomised, placebo-controlled phase 3 trial. Volunteers aged 18-59 years with no history of COVID-19 and with negative PCR and antibody test results for SARS-CoV-2 were enrolled at 24 centres in Turkey. Exclusion criteria included (but were not limited to) immunosuppressive therapy (including steroids) within the past 6 months, bleeding disorders, asplenia, and receipt of any blood products or immunoglobulins within the past 3 months. The K1 cohort consisted of health-care workers (randomised in a 1:1 ratio), and individuals other than health-care workers were also recruited into the K2 cohort (randomised in a 2:1 ratio) using an interactive web response system. The study vaccine was 3 mu g inactivated SARS-CoV-2 virion adsorbed to aluminium hydroxide in a 0.5 mL aqueous suspension. Participants received either vaccine or placebo (consisting of all vaccine components except inactivated virus) intramuscularly on days 0 and 14. The primary efficacy outcome was the prevention of PCR-confirmed symptomatic COVID-19 at least 14 days after the second dose in the per protocol population. Safety analyses were done in the intention-to-treat population. This study is registered with ClinicalTrials.gov (NCT04582344) and is active but no longer recruiting. Findings Among 11 303 volunteers screened between Sept 14, 2020, and Jan 5, 2021, 10 218 were randomly allocated. After exclusion of four participants from the vaccine group because of protocol deviations, the intention-to-treat group consisted of 10 214 participants (6646 [65.1%] in the vaccine group and 3568 [34.9%] in the placebo group) and the per protocol group consisted of 10 029 participants (6559 [65.4%] and 3470 [34.6%]) who received two doses of vaccine or placebo. During a median follow-up period of 43 days (IQR 36-48), nine cases of PCR-confirmed symptomatic COVID-19 were reported in the vaccine group (31.7 cases [14.6-59.3] per 1000 person-years) and 32 cases were reported in the placebo group (192.3 cases [135.7-261.1] per 1000 person-years) 14 days or more after the second dose, yielding a vaccine efficacy of 83.5% (95% CI 65.4-92.1; p0.0001). The frequencies of any adverse events were 1259 (18.9%) in the vaccine group and 603 (16.9%) in the placebo group (p=0.0108) with no fatalities or grade 4 adverse events. The most common systemic adverse event was fatigue (546 [8.2%] participants in the vaccine group and 248 [7.0%] the placebo group, p=0.0228). Injection-site pain was the most frequent local adverse event (157 [2.4%] in the vaccine group and 40 [1.1%] in the placebo group, p0.0001). Interpretation CoronaVac has high efficacy against PCR-confirmed symptomatic COVID-19 with a good safety and tolerability profile. Copyright (C) 2021 Elsevier Ltd. All rights reserved.We are grateful to all participants who volunteered to be part of this study and to all members of the clinical research teams of the participating sites. We thank TUSEB for funding the study and Omega-CRO for the statistical analyses and production of figures, and providing the study protocol. We also thank the members of the data and safety monitoring board for their contributions in the safe execution of this study.TUSE