Disease and treatment experiences of COVID-19 patients: A qualitative study

BACKGROUND/AIMS The study aimed to explore the perceptions of hospitalized COVID-19 patients' experiences regarding the disease and treatment process. MATERIAL and METHODS The study was carried out as qualitative research at a hospital in Turkey between June 17, 2020 and July 7, 2020. The sample consisted of eight COVID-19 patients hospitalized in service after intensive care treatment. The data were collected through an in-depth individual interview form. Each interview was transcribed verbatim, and a thematic analysis was performed. The Standards for Reporting Qualitative Research checklist was followed. RESULTS Three main themes were identified for patients' perceptions of the disease experiences and treatment process. The patients experienced negative emotions after being diagnosed with COVID-19, and they spent the isolation and treatment process communicating with their beloved ones over the phone, watching television, and praying. Having an infectious disease caused them to have anxiety and sadness, and they reported satisfaction with the physicians and nurses during the treatment process. CONCLUSION Psychological and sociocultural factors, religious values, and health policies can be effective in patients' perception of disease and treatment. It is recommended for healthcare professionals to be aware of the psychosocial problems of the hospitalized COVID-19 patients during the disease and treatment process, monitor them for post-traumatic stress disorder, and provide the necessary support

Predictive Factors of Complete Tumor Response to First Line Chemotherapy in Patients with Extensive-stage Small Cell Lung Cancer

Objective: We aimed to investigate the factors affecting the complete response (CR) rate and the effect of treatment response on survival in patients with extensive stage-small cell lung cancer (ES-SCLC) who received a combination of cisplatin and etoposide as first-line therapy. Method: This retrospective analysis included 140 ES-SCLC patients, who were followed in an oncology clinic. Patients were divided into two groups as CR and non-CR according to radiological evaluation after first line chemotherapy. Clinical and demographic characteristics and pretreatment hemogram parameters were obtained from electronic medical record system. Results: While CR was seen in 34 (24.3%) of all patients after the first line chemotherapy, 106 (75.7%) patients were in the non-CR group. On univariate analysis, predictors for CR to treatment were the absence of brain metastasis, receiving 6 chemotherapy cycles and good performance status (p<0.001; p=0.020; p=0.001, respectively). In multivariate analysis, the absence of brain metastasis and good performance status were independent predictive factors for CR (p=0.033; p=0.019, respectively). Better treatment response rate to first-line chemotherapy was found to be associated with improved disease-free survival, and overall survival (log-rank p<0.001; log-rank p<0.001, respectively). Conclusion: Good performance status and the absence of brain metastases were identified as independent predictive factors for CR in ES-SCLC patients at the time of diagnosis. Patients who achieved CR had a significantly longer survival rate than patients with lower treatment response

Upgraded Deadlock Averting Algorithms in Distributed Systems

Distributed system deadlock is like ordinary deadlock but it is difficult to prevent or detect when it is traced down. In the distributed system all, the related information is distributed over many machines. However, deadlock in distributed systems is tremendously serious. Therefore, it is important to understand how this deadlock is different from the ordinary deadlock and how to prevent it. To prevent deadlock in the distributed system there are two techniques to prevent it one wound-wait and other is wait-die. Therefore, the problem in these algorithms are that they just attend to the timestamp of the process but not the priority of them but in the real operating system priority of the process is very important. In this paper, we present upgraded deadlock averting algorithms and these algorithms are deal with both priority and time stamp of processes

Flexural response of polypropylene/E-glass fibre reinforced unidirectional composites

This paper presents a study of the flexural response of continuous E-glass fibre reinforced polypropylene composites. Experiments were designed to investigate monotonic and cyclic flexural response using three point bending test for laminates with different angle-ply and cross-ply arrangements. Results show that the monotonic and cyclic flexural response of the composites are influenced by the plastic deformation of the matrix. The study observed that increasing numbers of cyclic loads led to significant energy dissipation, stiffness reduction and micro-damage accumulation within the composite and especially at the matrix-fibre interface. Significant energy dissipation and damage were observed to dominate the first load-unload cycle. With subsequent cycles, the magnitude of energy dissipation and global damage reduces to a threshold value which is cycle independent. This study has also developed a phenomenological model to predict the dependence of energy dissipation with number of cycles. The experimental data generated here will be useful in the development of holistic macroscale constitutive models and finite element studies of the chosen test composite

Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy

Background: There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based). Methods: A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n:175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n:202), second-line (group B, n: 153) and ≥ 3rd-line (group C, n: 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy. Results: The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0–14.0) months in the ET arm of group A, and 5.3 (3.9–6.8) months in the CT arm (p = 0.073). It was 6.7 (5.8–7.7) months in the ET arm of group B, and 5.7 (4.6–6.7) months in the CT arm (p = 0.311). It was 5.3 (2.5–8.0) months in the ET arm of group C and 4.0 (3.5–4.6) months in the CT arm (p = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 (p = 0.047), 6.7 vs. 5.0 (p = 0.164), 6.7 vs. 3.9 (p = 0.763) months. Conclusion: Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET.Breast Cancer Consortiu

First-line treatment of patients with HER2-positive metastatic gastric and gastroesophageal junction cancer

Fluoropyrimidine+cisplatin/oxaliplatin+trastuzumab therapy is recommended for the first-line treatment of HER2-positive metastatic gastric adenocarcinoma. However, there is no comprehensive study on which platinum-based treatment should be preferred. This study aimed to compare the treatment response and survival characteristics of patients with HER2-positive metastatic gastric or gastroesophageal junction (GEJ) cancer who received fluorouracil, oxaliplatin, and leucovorin (mFOLFOX)+trastuzumab or cisplatin and fluorouracil (CF)+trastuzumab as first-line therapy. It was a multicenter, retrospective study of the Turkish Oncology Group, which included 243 patients from 21 oncology centers. There were 113 patients in the mFOLFOX+trastuzumab arm and 130 patients in the CF+trastuzumab arm. The median age was 62 years in the mFOLFOX+trastuzumab arm and 61 years in the CF+trastuzumab arm (P = 0.495). 81.4% of patients in the mFOLFOX+trastuzumab arm and 83.1% in the CF+trastuzumab arm had gastric tumor localization (P = 0.735). The median progression-free survival (PFS) was significantly higher in the mFOLFOX+trastuzumab arm (9.4 months vs. 7.3 months, P = 0.024). The median overall survival (OS) was similar in both groups (18.4 months vs. 15.1 months, P = 0.640). Maintenance trastuzumab was continued after chemotherapy in 101 patients. In this subgroup, the median OS was 23.3 months and the median PFS was 13.3 months. In conclusion, mFOLFOX+trastuzumab is similar to CF+trastuzumab in terms of the median OS, but it is more effective in terms of the median PFS in the first-line treatment of HER2-positive metastatic gastric and GEJ cancer. The choice of treatment should be made by considering the prominent toxicity findings of the chemotherapy regimens

Role of consolidative stereotactic body radiation therapy in oligoresistant/oligoprogressive pulmonary parenchymal metastases

Aim: To extend the survival of patients by providing local control of metastases in oligoresistance/oligoprogressive disease. Methods: We retrospectively evaluated the efficacy of stereotactic body radiotherapy (SBRT) applied to 30 lesions in the lungs of 19 patients who were considered inoperable by the tumor board upon the development of oligoresistance/oligoprogressive lung metastasis while undergoing chemotherapy between January 2016 and December 2017. Each patient had one to five metastases in their lungs. The median SBRT biologic effective dose at α/β of 10 (BED10) was 180.0 (IQR: 115.5–180.0) Gy. Results: We obtained effective, low-toxicity results. The rates of local control were 89.4%, 84.2%, and 78.9% for the 1st, 2nd, and 3rd years, respectively. The median local control time was 4 (IQR: 3–6) months. The median overall survival (OS) was 36.3 (IQR: 29.7– 42.9) months. The rates of OS for the 1st, 2nd, and 3rd years were 89.5%, 73.7%, and 61.4%, respectively. Despite the nonoccurrence of grade 4–5 toxicity in the lungs, six (31.6%) patients had grade 1–3 pulmonary pneumonia, one patient had a grade 4 skin ulceration, and two patients had increased chronic obstructive pulmonary disease in the follow-up period. Discussion: In patients with oligometastatic lung tumors, SBRT is very effective in terms of progression-free survival and OS

Rhabdomyolysis Developed Due to Hypothyroidism: Two Case Reports

Introduction: Rhabdomyolysis is a clinical and biochemical syndrome, resulting from the exposure of the skeletal muscle to toxic substances or from diseases. The etiology of the rhabdomyolysis consists of the hereditary deficiency of muscle enzymes; drugs like colchicine, statins, and lithium; convulsion; trauma; viral infections; excessive exercise; and so on. Hypothyroidism is a clinical setting in which thyroid hormones are produced and secreted ineffectively

The association of Visfatin levels with metabolic parameters and inflammation in diabetic nephropathy

© 2020, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.To investigate the visfatin levels at the stages of diabetic nephropathy(DNP), changes in visfatin levels according to stages of DNP, and the association of visfatin levels with other anti-inflammatory parameters including high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumor necrosis factor alpha(TNFα). Patients were divided into 4 groups based on the glomerular filtration rate (GFR) and albuminuria as follows; Group I: Albuminuria60ml/min, Group II:albuminuria 30 to 300 mg per day and GFR>60ml/min, Group III:albuminuria>300mg per day and GFR>60ml/min, and Group IV: Albuminuria>300 mg per day and GFR<60 ml/min. Of the 141 patients included in the study, 83(58.8%) were female. The mean age of patients was 55.3±8.2 years. Microalbuminuria was found to be 10.1±9.8 mg per day in group I, 89.4±68.2 mg per day in group II, 525.1±280.7 mg per day in group III, and 1034±1893 mg per day in group IV (p<0.001). When the correlation analysis was repeated separately in each group, there was a positive correlation between Visfatin and IL-6 levels in only group III (r=0.926; p<0.001). When the patients in group III and IV were combined in a single group and considered as macro-albuminuric, multivariate analysis showed that visfatin had a positive correlation with IL-6 (r=0.380, p=0.006) In this study, we could not determine any association between visfatin levels and other anti-inflammatory markers (IL-6, TNFα, and hsCRP). However, we found a close relationship between visfatin levels and IL-6 which is one of the most important markers of inflammation in diabetic patients with overt nephropathy, namely macro-albuminuric patients

Tracheobronchial amiloidosis

Sistemik tutulum olmadan lokalize pulmoner amiloidozis; nodüler parankimal opasiteler, diffüz parankimal opasiteler veya trakeobronşial amiloidozis (TBA) şeklinde görülebilmektedir. TBA daha ziyade erkeklerde, 5 veya 6. dekatta görülen bir durum olup, trakeobronşial ağaçtaki bening lezyonların %1 kadarıdır. TBA, immun globulin hafif zincirden oluşan amiloid materyelin submukozal plaklar ve/veya polipoid tümorler şeklinde birikimi ile karakterizedir ve ilerleyici hastalık sonucu hava yolu obstrüksiyonuna yol açabilir. Tedavide başlıca lazer eksiyonu olmak üzere tekrarlayan eksizyonel tedaviler açık cerrahiye tercih edilmektedir. Bu yazımızda lokalize TBA tanısı alan bir erkek olgu nadir görülmesi sebebi ile sunuldu.Localized pulmonary amyloidosis without systemic involvement differentiates as nodular parenchymal opacities, diffuse parenchymal opacities, or tracheobronchial amyloidosis (TBA). TBA is a condition mostly seen in males aged up to 50–60 years, accounting for approximately 1% of benign lesions in the tracheobronchial tree. TBA is characterized by the accumulation of the amyloid material comprising immunoglobulin light chain (AL), which are observed as submucosal plaques and/or polypoid tumors; progressive form of tracheobronchial amyloidosis can lead to airway obstruction. Repeated excisional treatments, mainly laser treatment is preferable to open surgery. Here, we have presented the case of a patient diagnosed with the rarely occurring localized TBA