Hipoteza studije: dob, spol, prisutnost šećerne bolesti ili hipertenzije i antihipertenzivni lijekovi su neovisni čimbenici rizika za smrtnost kod infekcije COVID-19

We aimed to investigate the effects of comorbid diseases and antihypertensive drugs on the clinical outcome of hospitalized patients with COVID-19 infection. A total of 1045 patients whose data could be gathered and confirmed from both hospital files and Turkish National Health Network records were retrospectively screened, and 264 of 1045 patients were excluded because of having more than one comorbid disease. The study population consisted of a total of 781 patients, of which 482 had no comorbid disease, while the remaining 299 patients had only one comorbid disease. The mortality risk was 7.532 times higher in those over 65 years of age compared to cases younger than 30 years (OR: 7.532; 95% CI: 1.733-32.730); the risk of mortality in men was 2.131 times higher than in women (OR: 2.131; 95% CI: 1.230-3.693); and presence of diabetes mellitus (DM) increased mortality risk 2.784 times (OR: 2.784; 95% CI: 1.288-6.019). While hypertension was not found to be an independent risk factor for COVID-19 mortality, age, gender, and presence of DM were independent risk factors for COVID-19 mortality. There was no association between antihypertensive drugs and mortality. Accordingly, age (>65 years), gender (male), and presence of DM were independent risk factors for COVID-19 mortality, whereas hypertension and use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and their combinations with other antihypertensive drugs were not risk factors for COVID-19 mortality.Cilj istraživanja bio je ispitati učinak supostojećih bolesti i antihipertenzivnih lijekova na klinički ishod hospitaliziranih bolesnika s infekcijom COVID-19. Retrospektivnim probirom obuhvaćeno je ukupno 1045 bolesnika čije podatke smo mogli prikupiti i potvrditi iz bolničkih kartona i zapisa Turske nacionalne zdravstvene mreže; od tih bolesnika njih 264 je isključeno, jer su imali više od jedne supostojeće bolesti. Tako je u studiju uključen ukupno 781 bolesnik, od kojih njih 482 nisu imali nikakve supostojeće bolesti, dok je preostalih 299 imalo samo jednu supostojeću bolest. Rizik od smrtnog ishoda bio je 7,532 puta veći kod bolesnika starijih od 65 godina u usporedbi sa slučajevima mlađim od 30 godina (OR: 7,532; 95% CI: 1,733-32,730); rizik od smrtnog ishoda bio je 2,131 puta veći kod muškaraca u nego kod žena (OR: 2,131; 95% CI: 1,230-3,693); prisutnost dijabetes melitusa (DM) povećala je rizik od smrti 2,784 puta (OR: 2,784; 95% CI: 1,288-6,019). Hipertenzija nije utvrđena kao čimbenik rizika za smrtnost kod infekcije COVID-19, ali su se dob, spol i prisutnost DM pokazali neovisnim rizičnim čimbenicima za smrtnost kod infekcije COVID-19. Prema tome, dob (iznad 65 godina), spol (muški) i prisutnost DM utvrđeni su kao neovisni čimbenici rizika za smrtnost kod infekcije COVID-19, dok hipertenzija i uzimanje inhibitora angiotenzin-konvertirajućeg enzima, blokatora receptora angiotenzina i njihovih kombinacija s drugim antihipertenzivnim lijekovima nisu utvrđeni kao rizični čimbenici smrtnosti kod infekcije COVID-19

Učinak mamografskog postupka na serumske razine upalnih i/ili tumorskih biljega

Mammography is one of the gold standard screening tests for breast cancer. The effects of mammography procedure on blood parameters are not known. This study aimed to investigate whether the procedure-associated breast compression affects the widely and simultaneously performed blood measurements of C-reactive protein (CRP), carcinoembryonic antigen (CEA), and cancer antigen (CA) 15-3. According to breast ultrasound examination results, participants were divided into 3 groups as follows: group 1 (participants with breast mass size ≥20.0 mm, n=48); group 2 (participants with breast mass size <20.0 mm, n=17); and group 3 (participants with no breast mass, n=23). In groups 1 and 2, on the day of the mammographic imaging study, serum CRP, CEA, and CA 15-3 levels were measured before and after the imaging study. Participants in group 3 had their blood parameters measured without mammography and/or any breast compression. Post-mammography blood measurements displayed a significant increase in serum CRP levels, and a significant decrease in serum CEA and CA 15-3 levels in group 1 (in comparison with the same day pre-mammography blood sampling levels; p<0.05 all). Although pre-mammography serum CEA levels in group 1 participants were significantly higher than those in group 2 and 3 participants, this significant elevation became nonsignificant at post-mammography measurements (p0.05, respectively). On the day of the mammographic imaging study, the optimal time of blood sampling for testing CRP, CEA and CA 15-3 levels in persons with a breast mass is before, but not after the mammographic imaging procedure. This issue requires additional detailed studies.Mamografija je jedan od ‘zlatnih’ standardnih testova probira za rak dojke. Učinci mamografskog postupka na krvne parametre nisu poznati. Cilj ovog istraživanja bio je ispitati djeluje li kompresija dojke povezana s ovim postupkom na često i istodobno izvođena mjerenja C-reaktivnog proteina (CRP), karcinoembrijskog antigena (CEA) i karcinom antigen (CA) 15-3 u krvi. Ispitanice su podijeljene u 3 skupine prema rezultatima ultrazvučnog pregleda dojki: 1. skupina (ispitanice s masom u dojci ≥20,0 mm, n=48); 2. skupina (ispitanice s masom u dojci <20,0 mm, n=17); 3. skupina (ispitanice bez mase u dojci, n=23). U 1. i 2. skupini serumske razine CRP, CEA i CA 15-3 mjerene su prije i nakon mamografskog postupka. Kod ispitanica 3. skupine krvni parametri mjereni su bez mamografije i/ili bilo kakve kompresije dojke. Mjerenja provedena nakon mamografije pokazala su značajan porast serumskih razina CRP i značajan pad serumskih razina CEA i CA-15-3 u 1. skupini u usporedbi s razinama tih parametara zabilježenim istoga dana prije mamografije (p<0,05 sve). Iako su razine CEA u serumu prije mamografije bile značajno više u 1. skupini u usporedbi s 2. i 3. skupinom, značajnost tog porasta izgubila se kod mjerenja nakon mamografije (p0,05). Dakle, u danu kad je zakazana mamografija optimalno vrijeme za uzorkovanje krvi za mjerenje razina CRP, CEA i CA 15-3 kod osoba s masom u dojci je prije, a ne poslije mamografskog postupka. Ovo pitanje zahtijeva daljnje podrobne studije

Comparison of Survival Rates, Tumor Stages, and Localization in between Obese and Nonobese Patients with Gastric Cancer

Purpose. In this study we tried to determine the association between body-mass index (BMI), survival rate, and the stage of tumor at the time of diagnosis in patients with gastric cancer. Methods. A total of 270 gastric cancer patients’ hospital records were retrospectively evaluated. Patients were grouped according to their BMI at the time of tumor diagnosis. Tumor stages at admission were compared according to their BMI values. Results. There were no differences in OS among BMI subgroups (p=0.230). The percent of patients with stage III tumor was significantly higher in nonobese while the percent of stage IV tumor was surprisingly higher in obese patients (p was 0.011 and 0.004, resp.). Percent of patients who did not have any surgical intervention was significantly lower in overweight and obese patients than normal and/or underweight patients. Conclusions. At the time of diagnosis, obese patients had significantly higher percent of stage IV tumor than nonobese patients. Despite of that, there were no differences in survival rates among BMI subgroups. Our study results are consistent with “obesity paradox” in gastric cancer patients. We also did not find any relationship between BMI and localization of gastric tumor

Wilson's disease

Wilson's disease is an autosomal-recessive disorder caused by mutation in the ATP7B gene. Absent or reduced function of ATP7B protein leads to decreased hepatocellular excretion of copper into bile. Subsequent copper accumulation, first in the liver but ultimately in the brain and other tissues, produces different clinical manifestations such as hepatic, neurological, hematological, ophthalmological, and psychiatric problems. Diagnosis is based on clinical suspicion, parameters of copper metabolism, ophthalmic examination (Kayser-Fleischer rings) and a liver biopsy. Genetic studies are of limited use. Early diagnosis and initiation of therapy with chelators and therapeutic plasma exchange therapy are essential for prognosis. Liver transplantation corrects the underlying pathophysiology and can be lifesaving in fulminant hepatic failure. Screening of siblings and 1st degree relatives of the patients is also important

Porast enzima kreatin kinaze povezan sa sintetskim kanabinoidom bonzai: istraživanje centra u Turskoj

Synthetic cannabinoid (locally named ‘Bonzai’ in Turkey) use is increasing worldwide (especially among people with low income). One of its harmful adverse effects is an increase in serum levels of muscle enzymes (i.e., creatine kinase [CK]). The aim of this study was to determine the prevalence of Bonzai use in patients admitted with elevated CK levels and to compare the 1-month survival status of Bonzai users with that of non-Bonzai users. This retrospective study was conducted on a total of 468 patients, median (min-max) age 48±22 (18-93) years. It was found that 10.68% (n=50) of the patients presenting with elevated CK levels were using Bonzai (group 1), while the remaining 418 (89.32%) patients were non-Bonzai users (group 2). Median age was higher in group 2 as compared with group 1 (p=0.001). In group 1, the predominance of male (M) over female (F) patients was interestingly high, yielding a F:M ratio of 1/49 (χ2=110.03, p<0.001). The prevalence of Bonzai use among patients admitted to our center with elevated CK levels was 10.68%. The Bonzai group patients were younger and mostly males, and none of them died at 1 month of admission. These findings may help in the management of such clinical conditions and could be a pathfinder for further studies in this field.Uporaba sintetskog kanabinoida (u Turskoj nazvan “bonzai”) povećava se diljem svijeta (osobito među osobama nižih primanja). Jedan od štetnih učinaka ove tvari je porast razina mišićnih enzima (tj. kreatin kinaze, CK) u serumu. Cilj istraživanja bio je utvrditi učestalost uporabe tvari bonzai kod bolesnika primljenih s povišenim razinama CK i usporediti jednomjesečno preživljenje korisnika tvari bonzai i bolesnika koji ne uzimaju bonzai. Ovo retrospektivno istraživanje obuhvatilo je ukupno 468 bolesnika, medijan (minimum-maksimum) dobi 48±22 (18-93) godine. Utvrđeno je da 10,68% (n=50) bolesnika primljenih s povišenim razinama CK uzima bonzai (1. skupina), dok preostalih 418 (89,32%) bolesnika nije uzimalo bonzai (2. skupina). Medijan dobi bio je viši u 2. skupini u usporedbi s 1. skupinom (p=0,001). U 1. skupini muški bolesnici (M) uvelike su prevladavali nad bolesnicama (F), s F:M omjerom 1/49 (χ2=110,03; p<0,001). Učestalost uporabe tvari bonzai među bolesnicima primljenima u naš centar s povišenim razinama CK bila je 10,68%. Bolesnici iz skupine koja je uzimala bonzai bili su mlađi i uglavnom muškarci i nitko od njih nije umro unutar mjesec dana od prijma u bolnicu. Ovi nalazi mogli bi pomoći u liječenju ovakvih kliničkih stanja te uputiti na daljnja istraživanja u ovom području

Evaluation of the Prevalence of Barotrauma and Affecting Factors in Patients with COVID-19 during Follow-Up in the Intermediate Care Unit

It is known that pneumothorax (PX) and pneumomediastinum (PM) develop due to COVID-19 disease. The objective of our study was to determine the prevalence of PX/PM due to COVID-19 in the intermediate intensive care unit (IMCU) and to evaluate the factors causing barotrauma and also the clinical outcomes of these patients. A total of 283 non-intubated patients with COVID-19 pneumonia followed up in the IMCU in a 1-year period were included in the study. The patients were classified as group 1 (having barotrauma) and group 2 (without barotrauma). The rate of barotrauma was 8.1% (n = 23, group 1). PX developed on the right hemithorax in 12 (70.6%) patients. Group 1 had statistically significantly higher 28-day mortality rates compared with group 2 (p = 0.014). The eosinophil and d-dimer levels of the patients in group 1 were higher, while C-reactive protein (CRP), fibrinogen, and albumin levels were lower than Group 2 (p p = 0.017, p = 0.001, p p < 0.001, respectively). The similar rates of NIMV administration in our study groups support that barotrauma is not the only mechanism in the development of PX/PM. The findings of high blood eosinophil count and low blood levels of CRP, albumin, and fibrinogen in the barotrauma group of our study might be a pathfinder for future studies

Secondary cold agglutinin disease associated with Hashimoto disease

Our case involves a 53 year old woman. Three years ago, she was investigated because of normal hemoglobin levels despite very a low erythrocyte count, which was revealed during the preoperative evaluation for ovarian cyst operation. The Direct Coombs test was found to be positive against complement and negative against IgG. Cold agglutinin titer was 1/448 (+). Due to the polyclonal IgM increase, secondary cold agglutinin disease (CAD) was considered but no factor could be found that would lead to cold agglutinin disease. During the post-operative follow-up, cold agglutinin titers increased with fluctuations in the patient. Twenty-four months after transabdominal hysterectomy and bilateral salpingooopherectomy operation, diagnosis of Hashimoto disease was made upon detection of subclinical hypothyroidism. No case of Hashimoto disease associated with CAD caused by polyclonal IgM has been reported until the present time

Heat shock protein 70 is a useful marker for predicting colorectal cancer

Purpose: In colorectal cancer (CRC), as in most of other malignancies, heat shock proteins (HSPs) are overexpressed and are associated with apoptosis, cancer cell proliferation, differentiation, invasion, and metastasis. HSP70 is one of the HSPs and has a promising future in cancer studies for both diagnostic and therapeutic applications. In this study, we tried to evaluate the serum levels of HSP70 in CRC patients, and to evaluate its predictive value of detecting CRC