Routine laboratory parameters in estimating mortality and morbidity in COVID-19 diagnosed cases followed in the intensive care unit

OBJECTIVE

In this study, our goal was to assess the neutrophil/lymphocyte, platelet/lymphocyte ratios, urea/albumin, lactate, C-reactive protein/albumin procalcitonin/albumin, dehydrogenase/albumin, and protein/albumin rates in 368 critical COVID-19 cases following the entrance to the intensive care unit (ICU) to investigate the effects of biomarkers on prognosis and mortality.

PATIENTS AND METHODS

The Ethics Committee approved this study carried out in our hospital's intensive care units between March 2020 and April 2022. 368 patients, 220 (59.8%) male, and 148 (40.2%) female, diagnosed with COVID-19 and aged between 18 and 99 years were included in this research.

RESULTS

The average age of non-survivors was statistically considerably higher than survivors (p<0.05). There was no numerical significance in terms of gender concerning mortality (p>0.05). The duration of ICU stay was statistically considerably prolonged in survivors than in those who did not survive (p<0.05). The leukocytes, neutrophils, urea, creatinine, ferritin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), creatine kinase (CK), C-reactive protein (CRP), procalcitonin (PCT), and pro-brain natriuretic peptide (pro-BNP) levels were numerically considerably higher in the non-survivors (p<0.05). The platelet, lymphocyte, protein, and albumin levels statistically considerably declined in non-survivors in comparison with survivors (p<0.05).

CONCLUSIONS

Acute renal failure (ARF) increased mortality by 31.815-fold, ferritin by 0.998-fold, pro-BNP by 1-fold, procalcitonin by 574.353-fold, neutrophil/lymphocyte by 1.119-fold, CRP/albumin by 2.141-fold, and protein/albumin by 0.003-fold. It was found that the number of days in the ICU increased mortality by 1.098-fold, creatinine by 0.325-fold, CK by 1.007-fold, urea/albumin by 1.079-fold, and LDH/albumin by 1.008-fold.

Are the perfusion İndex and pleth variability index title an early İndicator of brachial plexus block?

BACKGROUND

Studies on the evaluation of the Perfusion Index (PI) and the Pleth Variability Index (PVI) and the success of PI and PVI block in patients undergoing brachial plexus are limited and quite inadequate.

AIM

In our study, we aimed to compare PI and PVI between the interscalen block and infraclavicular block and evaluate its use as an early marker in block success.

PATIENTS AND METHODS

Single-center prospective randomized controlled trials. Preoperative unit, operating room. Patients over 18 years of age who have had upper extremity surgery. Brachial plexus block (interscalene, infraclavicular). Demographic data, Hemodynamic parameters, Perfusion index and Pleth Variability Index. 40 patients, including ASA1-2, 20 patients over the age of 18, who were planned for upper extremity surgery, in the interscalen group, and 20 in the supraclavicular group, were included in the study. Demographic data of the patients were recorded by measuring PI and PVI values at baseline before the block and at the 1^st, 5^th, 10^th, 15^th, and 20^th minutes after the block, both simultaneously.

RESULTS

62.5% (n = 25) of the patients included in the study were female. The mean age of the patients was detected as 52.63 ± 16.472, the mean BMI as 26.57 ± 4.423, and the mean entry hemoglobin level as 13.71 ± 1.87 g/dL. The hemodynamic data of the groups were similar across the time periods. The increase in PI increased significantly after 1 minute in both groups. The PVI was similar between the groups at all measurement times.

CONCLUSION

In our study, we observed an increase in PI from the 1^st minute compared to the non-blocked arm in successful block applications. We consider the early indicator of PI in the evaluation of block success. In our study, we did not observe a significant change in the arm that was blocked and the arm that was not treated with PVI.

Evaluation of plethysmographic variability index and hemoglobin monitoring in patients who underwent laparoscopic cholecystectomy

OBJECTIVE

The aim of the study was to determine the interaction of Pleth Variability Index, Perfusion Index (PI) and Peripheral Blood Hemoglobin (SpHb) values during the surgical phases of laparoscopic cholecystectomy.

PATIENTS AND METHODS

After the approval of the Ethics Committee, the patients who experienced laparoscopic cholecystectomy between October 2020 and January 2021 in our hospital were included in the study. We analyzed peripheral blood hemoglobin, pleth variability index, and the perfusion index values of 87 patients who underwent cholecystectomy. We performed the study with Masimo Radical 7 pulse oximeter probe (Masimo Radical 7; Masimo Corp., Irvine, CA, USA) in this present study.

RESULTS

According to the analysis of our results it has been found that hemoglobin, T5, T6, T7 values were found to be significantly higher than T3, T4, T8 values (p<0.05). The PVI T4 value was the highest within the periods, and it was found to be statistically significantly higher between T5, T6, and T7 values (p<0.05). Close values were detected in PI, T1 and T8 periods. T2 value measured during the period of mechanical ventilator was found to be significantly higher than the in T1, T3, T6 values (p<0.05).

CONCLUSIONS

In this study, we followed the SpHb, SPOC, and ORI values in these steps (T1-T8) and investigated the interaction between them. Knowing the response of monitoring to these conditions is important for the treatments to be performed.

Predicting Chronic Leukaemias from Assessment of Complete Peripheral Blood Counts

The chronic leukaemias include two distinct chronic neoplastic disease states, namely chronic myelogenous leukaemia (CML) and chronic lymphocytic leukaemia (CLL). The aim of this study was to assess the utility of leucocyte count, neutrophil percentage and absolute lymphocyte count from differential complete blood count analyses as indicators of the possible presence of CML and CLL. Blood counts from 102 patients with histopathologically confirmed CML and CLL were compared with counts for 858 cancer-free control subjects. Optimal cut-off values were identified by selecting values with the highest sensitivity–specificity combination for each blood count parameter for the two diseases. The results indicated that any individual with mature-appearing lymphocytes at a level > 6.65 × 109/l in the peripheral blood should be examined further for CLL, and that any individual with a leucocyte count > 18.0 × 109/l or a neutrophil proportion > 72.6% should be investigated for CML.

Breast cancer in octogenarian women: clinical characteristics and outcome

PURPOSE

Breast cancer incidence increases in the elderly but data on treatment and outcomes of elderly patients is limited. We assessed the clinicopathological features and outcomes of our patients with breast cancer aged ≥80 years in comparison with their younger postmenopausal counterparts.

METHODS

The records of 83 patients diagnosed with breast cancer after the age of 80 (group 1) between 2003 and 2011 in 4 different centers were retrospectively evaluated and the clinicopathological features and outcomes were assessed in comparison with a control group (group 2) of 249 patients aged between 60-70 years.

RESULTS

Median ages at diagnosis were 82 years (range 80-95) and 64 years (range 60-70) for group 1 and group 2, respectively. The incidence of invasive cancers other than ductal or lobular type was higher in group 1 than in group 2 (20 vs 8%; p=0.0177rpar;. More patients in group 1 had Charlson Comorbidty scores ≥1 than those in group 2 (49 vs 36%; p=0.011). Patients in group 1 had more conservative operations and less axillary node dissections (ALND) and they received chemotherapy, trastuzumab or radiotherapy less frequently compared to their younger counterparts in group 2. Median follow up period was 36 months (range 1-178) in group 1 and 24 months (range 12-217) in group 2. Five-year disease free survival (DFS) was 53.7 and 75.9) (p=0.005), 5-year overall survival (OS) was 61.9% and 80.47percnt; in group 1 and group 2 (p=0.001), respectively. Advanced stage (stage IV vs stage I, II, III, p=0.051) and cerbB2 positivity (p<0.001) were found to be associated with shorter DFS in patients ≥80 years of age.

CONCLUSION

Although the majority of patients were undertreated in our study according to the current guidelines, mortality rates were quite low. Different biology of the disease in the elderly might explain this difference.

Effects of Imatinib Mesylate on Renin–Angiotensin System (RAS) Activity during the Clinical Course of Chronic Myeloid Leukaemia

The renin–angiotensin system (RAS) is involved in cell growth, proliferation and differentiation in bone marrow in an autocrine–paracrine manner, and it modulates normal and neoplastic haematopoietic cell proliferation. This study aimed to assess expressions of the RAS components, renin, angiotensinogen and angiotensin-converting enzyme (ACE), during imatinib mesylate treatment of patients with chronic myeloid leukaemia (CML). Expressions of RAS components were studied in patients with CML at the time of diagnosis ( n = 83) and at 3, 6 and 12 months after diagnosis ( n = 35) by quantitative real-time polymerase chain reaction. De novo CML patients had increased ACE, angiotensinogen and renin mRNA levels and these expression levels decreased following administration of imatinib. The RAS activities were significantly different among Sokal risk groups of CML, highlighting the altered biological activity of RAS in neoplastic disorders. The results of this study confirm that haematopoietic RAS affects neoplastic cell production, which may be altered via administration of tyrosine kinase inhibitors such as imatinib mesylate.

Successful treatment of myelodysplastic syndrome-induced pyoderma gangrenosum

We report successful treatment of a refractory myelodysplastic syndrome-associated pyoderma gangrenosum with the combination of thalidomide and interferon-alpha2a in a single patient. A non-healing wound developed on a 40-year-old woman's left thumb after minor trauma. Massive ulcerovegetative lesions developed after reconstruction surgery. Histopathological examination of the bone marrow and cytogenetic studies revealed an atypical myeloproliferative/myelodysplastic syndrome. The skin lesions resolved dramatically after two months of thalidomide and interferon-alpha2a combination therapy and the haematological status improved.

Overt gastrointestinal bleeding in haematologic neoplasms

BACKGROUND AND AIM

Patients with acute leukaemia suffer from various haemorrhages, most frequently due to thrombocytopenia. We could not reach any information regarding the frequency of gastrointestinal bleeding in acute leukaemia and decided to search this complication in patients with acute and chronic leukaemias and myeloproliferative disorders, retrospectively.

PATIENTS AND METHODS

During a 6-year period, 291 patients with acute leukaemia, 52 patients with chronic leukaemia and 108 patients with myeloproliferative disorders had been followed. Thirty-two cases of overt gastrointestinal haemorrhage episodes (25 upper, 7 lower) were observed during the mentioned period.

RESULTS

The frequency of bleeding episodes was 7.1% (32/451) in haematologic malignancies as a whole, 5.8% (17/291) for acute leukaemia, 1.9% (1/52) for chronic leukaemia and 13% (14/108) for myeloproliferative disorders. If the patients with myeloproliferative disorders in blastic phase were analysed separately, the ratio was 30% (6/20). Oesophagogastroduodenoscopy, which could be performed in 8 of 25 upper gastrointestinal haemorrhage episodes, revealed erosive gastritis in five patients and duodenal ulcers in three patients. Neutropenic enterocolitis was the underlying cause in all of the seven patients with lower gastrointestinal haemorhage. Five out of the seven patients had acute leukaemia. In 7 bleeding attacks, out of 32, the ultimate result was death. Generally, the haemorrhage was only a contributing cause of mortality. All of the mortality cases were patients with acute leukaemia.

CONCLUSION

Especially, the patients with myeloproliferative disorders are prone to develop gastrointestinal haemorrhage. The manifestation is generally as upper gastrointestinal bleeding due to gastric erosions and duodenal ulcers. Lower gastrointestinal bleeding is frequently a problem of the patients with acute leukaemia. It is commonly a sign of neutropenic enterocolitis.

A patient presenting with spinal cord compression who had two distinct follicular cell type thyroid carcinomas

A 61-yr-old woman presented with complaints of weakness and pain in her legs. A magnetic resonance imaging showed a 3 x 5.6 x 7.8 cm mass lesion destructing the T1 and T2 vertebral bodies and compressing the spinal cord. The mass was excised surgically. It was follicular carcinoma metastasis of the cervicodorsal region. Then, she underwent a total thyroidectomy. Pathological examination showed two different types of carcinomas in two different focuses; follicular carcinoma in the left lobe and follicular variant papillary carcinoma in the isthmic lobe. After the operation she was given 100 mCi 131I. This is the first report of a patient who had both metastatic follicular carcinoma and follicular variant papillary carcinoma together.

Plasma leptin levels of large for gestational age and small for gestational age infants

The hormone leptin produced in the adipose tissue is involved in the regulation of body weight. This study investigates whether plasma leptin levels are related to an infant's birthweight, and whether the levels change with feeding. We measured plasma leptin levels from infants who were large for gestational age (n = 21), small for gestational age (n = 21), and appropriate for gestational age (n = 20). Two blood samples were collected before and after breastfeeding from each infant and plasma leptin concentrations were determined by radioimmunoassay. Leptin concentration was found to be increased in large for gestational age infants and to be decreased in small for gestational age infants compared with the level in appropriate for gestational age infants. There was a positive correlation between plasma leptin levels and both the infants' birthweights and the body mass indexes. Plasma leptin concentrations were found to be decreased during fasting and to be increased after feeding (p < 0.01). It is concluded that the plasma leptin levels correlate with the size of adipose tissue mass and are related to the nutritional status.

[Test of electrical stimulation of the round window. Diagnostic and prognostic value of the rehabilitation of total deafness by cochlear implant]

The round window electrical stimulation (RWES) test has been performed in 708 cases of total deafness. Among them 244 have successfully benefited with a cochlear implant. Electrical Brain Stem Evoked (EBSE) potential elicited by this stimulation have been registrated in 283 cases, 113 of them during general anesthesia necessary in children. This test supplies the patient with a subjective sound sensation and/or EBSE in 93% of cases. The correlation between electrical data of this RWES test and clinical results of the cochlear implant is described. This test is discussed regarding the simple transtympanique promonotory stimulation test.