Survival Analyses of COVID-19 Patients in a Turkish Cohort: Comparison between Using Time to Death and Time to Release

Survival analyses of COVID-19 data has its own unique features, in particular, the existence of two distinct events: death and release from the hospital within a very short period of time. This multiple-event situation belongs to a type where the occurrence of the first event prevents the second event to happen, and vice versa. We carried out two cause-specific univariate Cox regression survival analyses, one for time-to-death and another for time-to-release. Each survival analysis is further split into one for onset of symptom to event time and another for hospitalization to event time. We have also carried out a case-control (death vs. release) analysis without considering the time to event information. We observed that risk factors can be detected by either case-control or survival analysis, even though the goal of the two is quite different. We also observed that the two survival analyses may not both reveal a factor being a risk factor, but only one of them does. We prefer this two rounds of Cox regressions over mixture cure model which is only focused on time-to-death events which usually are sample size limited. By utilizing time-to-release events may greatly increase the sample size needed for revealing risk factors for COVID-19.   Doi: 10.28991/SciMedJ-2021-03-SI-1 Full Text: PD

Diabetes and bacterial co-infection are two independent risk factors for respiratory syncytial virus disease severity

Diabetes mellitus (DM) is common among older adults hospitalized with lower respiratory tract infection, yet information on the impact of DM on disease severity is limited. This study retrospectively analyzed 46 Turkish patients infected with respiratory syncytial virus (RSV), with information on their comorbidities, co-infection status, and symptoms. Patients are grouped into four severity levels from mild to severe, according to lung parenchymal infiltration status and oxygen level. Similar to previously published studies, we found that comorbidities of diabetes, heart failure, hypertension, co-infection of any type, bacterial co-infection, and age are associated with the disease severity. Cough is the most common symptom (89%) followed by fever (26%) and myalgia, dyspnea, and weakness (around 20%). Using a second-order analysis (two-variable regression), we identified two independent risks for disease severity, the first is represented by diabetes, and the second is represented by bacterial co-infection. We observed two patients whose more severe symptoms were not associated with an older age, but associated with a combination of diabetes and bacterial co-infection. To confirm the true causality from the statistical correlation, further studies are needed

The Evaluation of Consultations Performed by the Internal Medicine Clinic of a Tertiary University Hospital: Single Center Study

<p><strong>Objective</strong>: The aim of this study was to determine the general characteristics of patients who applied to the outpatient and inpatient clinics of our hospital and for whom internal medicine consultation was requested.</p><p><strong>Materials and Methods</strong>: Patients aged 18 years and older who requested internal medicine consultation in tertiary university hospital between 01.06.2022 and 01.6.2023 were evaluated.</p><p><strong>Results</strong>: During this period, internal medicine consultation was requested from 2559 patients whose consultation texts and diagnoses were fully recognized in our hospital. The mean age of the patients for whom consultation was requested was 61.54±18.91 (62; 18-97) years and 51.1% (1307) were male and 48.9% (1252) were female. The most common departments for consultation were emergency and surgical departments (48.1%, 30.3%). The most common reasons for consultation were general internal medicine reasons (27%-699%) such as general condition disorder, oedema, heart failure; gastronteological reasons (26.9%-693%) such as gastrointestinal bleeding, acute pancreatitis, liver dysfunction and nephrological reasons (21.7%-599%) such as elevated BUN, creatinine and electrolyte imbalance.</p><p><strong>Conclusion</strong>: Determining the profiles of patients for whom internal medicine consultation is requested will be useful in shaping the training programs in institutions that educate staff in this specialty and in improving the quality of health care.</p&gt

Preoperative biochemical values are correlated with adenoma volume, but not predictive factors for hungry bone syndrome in patients with primary hyperparathyroidism

We aimed to investigate correlation between perioperative biochemical values and adenoma volume, the effects of perioperative biochemical values and clinicopathological variables on postoperative hypocalcemia after parathyroidectomy. A retrospective study planned in tertiary university hospital on patients undergone surgery for primer hyperparathyroidism. Preoperative calcium (first, close to surgery, maximum), PTH (first, close to surgery, maximum), alkaline phosphatase (ALP) and phosphorus (P) values, postoperative calcium (early, late), postoperative PTH (early, late), 24-hour urinary calcium calculation, time from the first diagnosis of elevated calcium until surgery, preoperative hypercalcemia treatments, excised parathyroid gland, histopathologic diagnosis, maximum diameter and volume of the excised parathyroid on histopathologic examination, postoperative intravenous calcium supplement were analyzed. 73 patients were included in the study. The median age of the patients was 54 years (range, 18-82), and 83.6% were female. In univariate analysis, patients who were administrated intravenous (IV) calcium supplement had higher preoperative PTH (p=0.024). adenoma volume correlated moderate with preoperative PTH first (r=0.396, p=0.001), preoperative maximum parathormone (r=0.380, p=0.001), preoperative PTH CS (r=0.432, p [Med-Science 2023; 12(1.000): 271-7

Alpha variant (B.1.1.7) of SARS-CoV-2 increases fatality-rate for patients under age of 70 years and hospitalization risk overall

The emergence of new SARS-CoV-2 variants is a challenge to the control of this pandemic. It is therefore important to collect and to analyze data related to the infection caused by different variants. We have obtained more than 3,700 COVID-19 patients between April 2020 and March 2021 from Tokat, Turkey (roughly 3,100 outpatients and close to 600 inpatients) where about 30% were infected with Alpha variant (B.1.1.7). Descriptive statistics was used to characterize different subgroups. Both logistic regression and cause-specific Cox survival analysis of competing-risk was run on inpatients, to examine the impact of Alpha variant on hospitalization, on mortality and on other factors. We observed that the Alpha variant is over-represented in inpatients than outpatients so infection by Alpha variant increases the chance for hospitalization. The impact of Alpha variant on mortality seems to depend on the patient's age. For patients under age of 70, the case-fatality-rate was 0.84% (5.3%) for patients without (with) Alpha variant (Fisher's test P-value = 2.4 x 10(-10)). For patients above age of 70, the trend is opposite: the case-fatality-rate is 31.5% (13.6%) for patients without (with) Alpha variant (Fisher's test P-value = 0.0016). The two opposite trends would cancel each other, making other analyses such as cause-specific Cox regression and logistic regression non-significant. The Alpha variant increases the risk for hospitalization, increases the case-fatality-rate for lower age group, and decreases the case-fatality-rate for the upper age group. if the increase of case-fatality-rate in not the most senior group holds true, it should provide useful information for a vaccination planning to counter the impact of Alpha variants

The Effect of Cerium Oxide on Lung Tissue in Lower Extremity Ischemia Reperfusion Injury in Sevoflurane Administered Rats

Introduction: We aimed to investigate the effects of cerium oxide, applied before the sevoflurane anesthesia, on lung tissue in rats with lower extremity ischemia-reperfusion (IR)

A Rare Cause of Pericardial Effusion: Giant Cell Arteritis

Giant cell arteritis is a granulomatous vasculitis characterized by medium or large sized vessel involvement. Although extracranial branches of the carotid artery are typically involved, involvement of aorta and its major branches can also be seen. Cardiac involvement has been encountered less frequently and pericardial effusion is rarely encountered. In this paper, a case has been presented in which pericardial effusion was determined during the examination and diagnosis was giant cell arteritis

The Effect of Cerium Oxide on Lung Tissue in Lower Extremity Ischemia Reperfusion Injury in Sevoflurane Administered Rats

Introduction: We aimed to investigate the effects of cerium oxide, applied before the sevoflurane anesthesia, on lung tissue in rats with lower extremity ischemia-reperfusion (IR)

Effects of hydroxyethyl starch 130/0.4 on the kidney tissue of rats with ureteral obstruction

Objective: This study was conducted since the effects of colloid solutions on the renal system remain controversial and need to be adequately studied in animals. We aimed to evaluate the effects of hydroxyethyl starch (Voluven) on the kidney tissue of rats with late renal failure due to ureteral obstruction. Materials and methods: Rats were divided into four groups: Group C, control; Group HES, hydroxyethyl starch solution (HES) 130/0.4 (Voluven (R)); Group UUO, unilateral ureteral obstruction (UUO); and Group UUO-HES, UUO-HES 130/0.4 (Voluven (R)). In the groups with ureteral obstruction, the distal part of the right ureter was accessed and sutured through a lower abdominal incision under ketamine anesthesia. Any signs of late-stage renal failure were evaluated after three weeks. Rats in the HES group and the renal failure-HES group were administered with HES 130/0.4 as a single intravenous dose of 20 mL/kg. After a follow-up of 24 hours, intra-abdominal blood sample was collected, and the rats were sacrificed. Biochemical and histopathological parameters were then evaluated. Results: Ureteral obstruction significantly increased urea and creatinine levels. In addition, when the UUO-HES and HES groups were compared, the administration of HES increased urea and creatinine levels in the UUO-HES group. Nitric oxide enzyme activity and malondialdehyde levels have significantly increased in the UUO groups. In addition, HES significantly increased nitric oxide activity and malondialdehyde levels in the UUO-HES group, in comparison with the LIES group. The activity of caspases 3 and 8 was significantly increased in the UUO groups. In addition, HES significantly increased the activity of caspases 3 and 8 in the UUO-HES group, in comparison with the HES group. Light microscopy revealed significant changes in the UUO groups, especially in the obstructed kidneys. Conclusion: If indicated, HES should be used with caution in cases of UUO, but not in the cases of bilateral ureteral obstruction. Other aspects of these findings, including the clinical significance and practical applications, merit further experimental and clinical investigation

CLINICAL CHARACTERISTICS, POST-TREATMENT ASSESSMENT AND PROGNOSTIC FACTORS AFFECTING PATIENT SURVIVAL OF PATIENTS AT 65 YEARS OF AGE OR OLDER WITH HODGKIN LYMPHOMA: A RETROSPECTIVE MULTICENTER STUDY FROM TURKEY

Introduction: During the last three decades, major advances have been made in the therapy of Hodgkin's lymphoma. However, despite these advances, Hodgkin's lymphoma has a poor prognosis in the elderly. The proportion of Hodgkin's lymphoma patients aged > 60 ranges in the different reports between 15% and 35%. This study aimed to examine clinical characteristics, treatment outcomes and prognostic factors affecting patient survival in Hodgkin's lymphoma patients aged 65 years or older