Evaluation of Patients with COVID-19 Followed Up in Intensive Care Units in the Second Year of the Pandemic: A Multicenter Point Prevalence Study

OBJECTIVE

A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic.

MATERIAL AND METHODS

All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded.

RESULTS

A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%).

CONCLUSION

The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.

Comparison of thromboembolic risk scores for evaluating in-hospital events of COVID-19 patients

Aim: To compare the effectiveness of thromboembolic risk scores in determining in-hospital events of COVID-19 patients. Methods: This retrospective study included a total of 410 consecutive COVID-19 patients. Scores including CHA₂DS₂-VASc-HS (congestive heart failure, hypertension, age, diabetes mellitus, stroke/transient ischemic attack, vascular disease, sex, hyperlipidemia, smoking); modified R₂CHA₂DS₂-VASc (CHA₂DS₂-VASc plus renal function), m-ATRIA (modified Anticoagulation and Risk Factors in Atrial Fibrillation score), ATRIA-HSV (ATRIA plus hyperlipidemia, smoking and vascular disease) and modified ATRIA-HSV were calculated. Participants were divided by in-hospital mortality status into two groups: alive and deceased. Results: Ninety-two (22.4%) patients died. Patients in the deceased group were older, predominantly male and had comorbid conditions. CHA₂DS₂-VASc-HS (adjusted odds ratio [aOR]: 1.31; p = 0.011), m-R₂CHA₂DS₂-VASc (aOR: 1.33; p = 0.007), m-ATRIA (aOR: 1.18; p = 0.026), ATRIA-HSV (aOR: 1.18; p = 0.013) and m-ATRIA-HSV (aOR: 1.24; p = 0.001) scores were all associated with in-hospital mortality. m-R₂CHA₂DS₂-VASc and modified ATRIA-HSV had the best discriminatory performance. Conclusion: We showed that m-R₂CHA₂DS₂-VASc and m-ATRIA-HSV scores were better than the rest in predicting mortality among COVID-19 patients.

Impact of Aqueous Extracts of Turkish Wild Edible Plants on Acrylamide Formation in Potato Crisps

Background: Antioxidants have the ability to influence acrylamide formation. This study aimed to evaluate the impact of aqueous extracts of six wild edible plants on the acrylamide formation in potato crisps. Methods: Sliced potatoes were submerged in the plant extracts at a concentration of 0, 5, and 10 g/L for 1, 5, and 10 min. Before being fried and their acrylamide levels were calculated by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS). Results: Aqueous extract of ribwort plantain was found the most effective trial at 10 g/L for 5 min because it reduced acrylamide concentration by 57% compared to control without significantly affecting potato crisps’ sensory and color parameters (p>0.05). The aqueous extract of shepherd’s-needle yielded the highest Total Antioxidant Capacity (TAC) in 2,2′-Azino-bis (3-ethylbenzothiazoline-6-sulfonic acid; ABTS) and Cupric ion Reducing Antioxidant Capacity (CUPRAC) assay, the highest Total Phenolic Content (TPC), and Total Flavonoid Content (TFC). Similarly, no significant correlation was found between TAC, TPC, and TFC of watery plant extracts with acrylamide level of potato crisps produced after immersion of these extracts (at 5 g/L for 5 min). Conclusion: Wild edible plants have the potential to be used for acrylamide reduction in potato crisps.

A diagnostic dilemma for solid ovarian masses: the clinical and radiological aspects with differential diagnosis of 23 cases

OBJECTIVE

This study aimed to analyze the clinical characteristics and diagnostic features of ovarian fibromatous masses.

MATERIALS AND METHODS

The authors reviewed the records of 23 women who underwent laparotomic surgeries and whose final histopathological diagnoses were ovarian fibroma, cellular fibroma, or fibrothecoma from January 2005 to January 2013. The clinical, ultrasonographic, magnetic resonance imaging, tumor marker, therapeutic, and histologic data were analyzed.

RESULTS

The mean age of the patients was 50.9 years. Sixteen patients were menopausal. The preoperative ultrasonography examination incorrectly diagnosed seven lesions as uterine fibromas, and the magnetic resonance imaging examination incorrectly labeled three lesions as pedunculated subserous uterine fibromas. The cancer antigen-125 levels of 17 cases were measured, with four being abnormal. Twenty-three patients underwent a laparotomy. Twenty patients underwent a total hysterectomy with bilateral salpingo-oophorectomy, and three underwent a tumorectomy. The histological diagnosis was fibrothecoma in 21 cases, fibroma in one case, and cellular fibroma in one case. Histopathologic examination of the endometrium of seven of the 20 patients who underwent hysterectomy revealed simple endometrial hyperplasia without atypia.

CONCLUSION

Ovarian fibromas and fibrothecomas are often misdiagnosed as uterine fibromas and occasionally mistaken for malignant tumors of the ovary preoperatively. As these tumors originate from ovarian stroma, they may be hormone-active tumors. Therefore, they may lead to premalignant changes in the endometrium. The preoperative evaluation of the endometrium is recommended.

Bilateral Krukenberg tumor in a 16-week pregnant woman

The authors present the case of a G2P1001 who presented in 16-week gestation with bilateral Krukenberg tumor, abdominal pain, and iterative vomiting episodes. Although a few cases of Krukenberg tumor in pregnant women have been reported, no case reports asymptomatic and free of disease at 18 months were found in the English literature. Early detection followed by surgery and chemotherapy during pregnancy could possibly result in a favorable outcome in such patients.

Comparison of the chemopreventive potentials of melatonin and vitamin E plus selenium on 7,12-dimethylbenz[a]anthracene-induced inhibition of mouse liver antioxidant enzymes

Chemoprevention is a rapidly growing area of oncology that is identifying agents with a potentially preventive role in cancer. In this study, it was our goal to compare the chemopreventive effects of vitamin E plus selenium, and melatonin. Forty female mice were divided into four equal groups. The first group served as control. The second group had i.p. injections of 7,12-dimethylbenz[a]anthracene (DMBA) (20 mg/kg body weight) in corn oil for 21 days. The third group had the same procedure of DMBA injections as the second group and received vitamin E + selenium (90 microg + 1.8 microg/day), simultaneously. The fourth group had DMBA injections and melatonin (4.2 mg/kg body weight), simultaneously. DMBA alone caused significant inhibition of hepatic glutathione peroxidase (GSHPx), catalase (CAT), and superoxide dismutase (SOD) in the second group. In the third group, vitamin E + selenium restored DMBA-induced GSHPx inhibition significantly whereas CAT and SOD inhibition remained essentially unchanged. In the fourth group, melatonin not only significantly decreased DMBA-induced GSHPx inhibition but also fully reversed CAT and SOD inhibitions caused by DMBA. We speculate that melatonin alone provides better chemoprevention against DMBA-induced oxidative stress than the vitamin E+selenium combination.

Syphilis in pregnancy

Syphilis can seriously complicate pregnancy and result in spontaneous abortion, stillbirth, non-immune hydrops, intrauterine growth restriction, and perinatal death, as well as serious sequelae in liveborn infected children. While appropriate treatment of pregnant women often prevents such complications, the major deterrent has been inability to identify the infected women and get them to undergo treatment. Screening in the first trimester with non-treponemal tests such as rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) test combined with confirmation of reactive individuals with treponemal tests such as the fluorescent treponemal antibody absorption (FTA-ABS) assay is a cost effective strategy. Those at risk should be retested in the third trimester. Treatment during pregnancy should be with penicillin. In determining a penicillin regimen, the clinician must consider the stage of the maternal infection and the HIV status of the mother. Patients who are allergic to penicillin should be desensitized before treatment. Despite appropriate treatment, as many as 14% will have a fetal death or deliver infected infants. Treatment may further be complicated by the Jarich-Herxheimer reaction, a complex allergic response to antigens released from dead micro-organisms, which can cause fetal distress and uterine contractions. Thanks to effective intervention strategies and inexpensive penicillin, syphilis rarely complicates pregnancy in the Western world today. In parts of the world where the traditional sexually transmitted diseases have not been controlled, the magnitude of problems associated with syphilis during pregnancy is reminiscent of that faced by the West during the early 1900's.

Health care of female commercial sex workers

This article highlights health issues related to prostitution, with special reference to the situation in Europe. Strategies aimed at improving the health care of commercial sex workers, including programs for screening for sexually transmitted infections, are discussed. Problems related to failure to follow-up, particularly of mobile (migratory, international) commercial sex workers, are considered. Other topics covered include counselling on sexual risk reduction, including medical hotline telephone services and clinical outreach work. Counselling commercial sex workers on contraception, desired termination of pregnancy and hazards of illicit drug use are also highlighted. The public-health consequences of delivering poor health care to commercial sex workers are generally severely underestimated, particularly in societies where prostitution is illegal.

Determination of trans-10-hydroxy-2-decenoic acid content in pure royal jelly and royal jelly products by column liquid chromatography

In this research, several royal jellies and commercial products containing royal jelly were analysed for their trans-10-hydroxy-2-decenoic acid (10-HDA) content by using a column liquid chromatography technique. Ten samples claimed to be pure royal jelly, containing 10-HDA between 0.75 and 2.54%. Seven samples claimed to contain royal jelly as an ingredient which ranged from non-detectable to 0.054%. The technique was found to be rapid with high recovery.

Cost-effective treatment of uncomplicated gonorrhoea including co-infection with Chlamydia trachomatis

We evaluated the cost effectiveness of treating uncomplicated gonorrhoea in a theoretical cohort of 1000 adults (nonpregnant women of reproductive age, or men) with either intramuscular ceftriaxone 125 mg or a single oral dose of cefixime 400 mg, ofloxacin 400 mg or ciprofloxacin 500 mg. We assumed that all patients were also empirically treated for uncomplicated chlamydial infection, with either a single oral dose of azithromycin 1 g, or oral doxycycline 100 mg twice daily for 7 days. Treatment of gonorrhoea with intramuscular ceftriaxone was found to be the most cost-effective alternative. This was followed by treatment with the either of the fluoroquinolones (ofloxacin or ciprofloxacin), then cefixime. For empirical treatment of uncomplicated chlamydial infection, doxycycline was more cost effective than azithromycin when approximately more than 80% of the patients were assumed to comply with the doxycycline regimen. When patients' compliance was poor with the doxycycline regimen, the azithromycin therapy became more cost effective from a societal viewpoint. Nevertheless, its relatively high cost to the individual patient with limited financial resources might prevent him or her from filling prescriptions. Any decrease in patients' compliance with the azithromycin therapy would favour treatment with doxycycline.

A cost-effectiveness analysis of screening and treatment for Chlamydia trachomatis infection in asymptomatic women

OBJECTIVE

To assess the cost-effectiveness of identifying and treating asymptomatic female carriers of Chlamydia trachomatis.

DESIGN

Cost-effectiveness analysis based on previously reported cohort analytic studies and average salaries and costs of medical care in Sweden.

SETTING

Women attending youth, family planning, and gynecology clinics.

PARTICIPANTS

1000 women and their male sex partners.

INTERVENTION

Screening with tissue cell culture, confirmed enzyme immunoassay, and DNA amplification assays based on either polymerase chain reaction or ligase chain reaction was compared with no screening (no treatment and no tracing of sexual contacts). The effect of antibiotic regimens on the outcome of the screening strategies was also evaluated.

RESULTS

When the prevalence of chlamydial infection exceeded 6%, screening of women with DNA amplification assay and treatment of positive patients with a single oral dose of azithromycin given under supervision in the clinic was the most cost-effective intervention strategy. At greater prevalences, screening with enzyme immunoassay also generated savings and improved the cure rates compared with no screening, but such screening was less cost-effective than screening with a DNA amplification assay. Compared with no intervention, tissue cell culture is cost-effective only when the prevalence of infection is greater than 14%. Compared with the azithromycin regimen, the standard 7-day, twice-daily doxycycline regimen resulted in significantly lower cure rates because of patients' poor compliance with this regimen.

CONCLUSION

For asymptomatic female carriers of C. trachomatis, screening with a DNA amplification assay combined with the single-dose azithromycin treatment of positive patients is the most cost-effective strategy when the prevalence is 6%. When the prevalence is lower than 6%, the decision to choose a competing strategy depends on the physician's view of the value of preventing an illness caused by untreated chlamydial infection.

Familial glioma in two siblings

We report two siblings who had intracranial gliomas, one with glioblastoma multiforme and the other with mixed oligo-astrocytoma. The genetic influences in the development of glioma are discussed.

Migratory Prostitution with Emphasis on Europe

In many European countries, foreigners constitute the majority of certain groups of prostitutes, e.g., approximately 90% of the window prostitutes in the red light district of Amsterdam are not native to the Netherlands. The same is true for prostitutes working in bars in Vienna. In cities where registered prostitution is legal, unregistered prostitutes, most of whom are foreigners, often outnumber the registered ones. Central European countries often receive "sex workers" from eastern Europe, e.g., from Bulgaria, the Czech Republic, Slovakia, Hungary, and Romania, whereas the majority of migratory prostitutes in Great Britain and continental western Europe come from Africa, the Caribbean, and South America. In northern Europe, women from Russia, the Czech Republic, Slovakia, Poland, and the Baltic states are prostituting themselves in increasing numbers. Scandinavia has so far been affected relatively less by this mobility. In Spain, France, and Italy, women from Arabic and subSaharan countries are common among prostitutes. Foreign prostitutes move into Turkey along two main routes: women from the Balkan countries come to the western part of the country, whereas those from the former Soviet Union cross the border from Georgia, where they usually operate at resorts along the eastern Black Sea coast. Prostitutes are also mobile within the former communist bloc. For instance, women from Russia prostitute themselves in Lithuania, the Czech Republic, Slovakia, and Hungary. the customers are locals, particularly those with "hard currency", such as businessmen and "sex tourists" from the West. Following the outbreak of civil war in the former Yugoslavia, women from that country are now more frequently seen among the population of migratory prostitutes in Europe.

An economic evaluation of screening for Chlamydia trachomatis in adolescent males

OBJECTIVE

To assess the cost-effectiveness of identifying asymptomatic carriers of Chlamydia trachomatis among adolescent males.

DESIGN

Cost-effectiveness analysis based on cohort analytic studies previously reported and average salaries and costs of medical care in Sweden.

SETTING

Adolescent males attending a primary care center for routine health checks.

PARTICIPANTS

Estimates of costs and benefits are based on a cohort of 1000 adolescent males and their female contacts.

INTERVENTION

Screening with enzyme immunoassay (EIA), either on leukocyte esterase (LE)--positive urine samples (LE-EIA screening) or on all urine samples (EIA screening), was compared with no screening (no treatment or contact tracing). The effects of confirming positive EIA results with a blocking assay and alternative antibiotic regimens on the outcome of the screening strategies were also evaluated.

RESULTS

Compared with no screening, the LE-EIA and EIA screening strategies reduced the overall costs when the prevalence of chlamydial infection in males exceeded 2% and 10%, respectively. Enzyme immunoassay screening achieved an overall cure rate that was 12.2% to 12.6% (95% confidence interval) better, but reduced the incremental savings by at least $2144 per cured male, in comparison with LE-EIA screening. Confirmation of positive EIA results reduced the overall cost of the LE-EIA screening strategy when the prevalence of C trachomatis among males was less than 8%. Compared with a 7-day course of doxycycline, a single oral dose of azithromycin administered under supervision in the clinic improved the cure rates of both EIA and LE-EIA screening strategies by 15.1% to 16.3% and 11.2% to 12.0%, respectively, while reducing the corresponding overall costs by 5% and 9%, respectively, regardless of the prevalence of chlamydial infection in males.

CONCLUSION

The use of LE-EIA screening combined with treatment of positive cases with azithromycin was the most cost-effective intervention strategy focusing on asymptomatic male carriers of C trachomatis. Positive EIA results should be confirmed when screening low-risk populations.

Age-dependent antichlamydial activity of human saliva. A study of infants, children and adults

Saliva samples from 51 children ranging from 1 month to 12 years of age were studied for their effect on the capacity of Chlamydia trachomatis, serotypes I and L2 elementary bodies (EB), to form inclusions in cycloheximide-treated McCoy cell cultures. The results were compared to those of tests using saliva from adults. No antibodies against C. trachomatis or Chlamydia pneumoniae could be detected by microimmunofluorescence tests in either group. Saliva of children between 1-4 years of age showed an age-related decrease in the chlamydial inclusion count (i.c.). Saliva from children older than 4 years of age, like saliva from healthy adults, showed a pronounced reduction of the i.c. (up to 70%). The study indicates that children between 1-4 years gradually develop a natural antichlamydial activity against C. trachomatis, and above that age they exhibit the same level of antichlamydial activity as adults. The inhibitory activity was heat-resistant.

Detection of Chlamydia trachomatis antigens in first-void urine to identify asymptomatic male carriers

Early morning first-void urine collected from 279 sexually active Swedish male recruits (mean age 19.5 years) was tested by two commercial enzyme immunoassay (EIA) kits, MicroTrak and IDEIA III, and by MicroTrak direct fluorescence assay (DFA), to detect Chlamydia trachomatis antigens. A result was assumed to be true-positive when any of the two non-culture tests were positive for the same specimen. In one case where only DFA was positive, confirmatory chlamydial testing was performed by isolating the organism from a urethral swab. On these premises, the number of true-positive men was 26 (9.3% of all men studied). The sensitivity, specificity, positive predictive value and negative predictive value for MicroTrak EIA were 85%, 98%, 85%, and 98%, respectively. IDEIA III was less sensitive than MicroTrak EIA (42% vs 85%). In conclusion, the diagnosis of asymptomatic chlamydial infections in men can be established with reasonable accuracy by the detection of Chlamydia antigens in urine samples using MicroTrak EIA.

Chlamydial antigen detection in urine samples by immunofluorescence tests

To investigate the diagnostic value of a direct immunofluorescence test (DIF-test), urethral samples and first catch urine (FCU) from 153 male patients attending an outpatient clinic for sexually transmitted diseases (STD) were studied. Of the male patients, 40 (26.1%) had a positive urethral culture, 39 (25.5%) had a positive urethral DIF-test, and 32 (20.9%) were positive in urine according to the DIF-test. The sensitivity and the specificity of the DIF-test in male urine specimens were 75% and 98.2%, respectively, as compared with the chlamydial culture, and 69.2% and 95.6%, respectively, as compared to the DIF-test of the urethral samples. Out of the positive urethral samples, 31% had less than 5 elementary bodies (EBs) and 41% greater than 10 EBs, detected by the DIF-test. The corresponding data for FCU were 47% and 22%, indicating a smaller number of chlamydiae in urine than in urethral samples. False negative results in the urine DIF-test were mostly observed in males with a low number of EBs in the urethra. The DIF-test was less sensitive for FCU than for urethral specimens. Therefore, urine DIF-tests cannot replace conventional methods for chlamydial diagnosis in symptomatic STD patients, but may be recommended when genital sampling is not possible and may serve as an important approach in the control of genital chlamydial infections.

Detection of Chlamydia trachomatis in first-void urine collected from men and women attending a venereal clinic

Cervical, urethral and first-void urine (FVU) specimens from 196 men and 245 women attending a venereal outpatient clinic were studied by culture and a commercial enzyme immunoassay (EIA) (CHLAMYDIAZYME). Confirmatory chlamydial testing by a direct fluorescence assay (DFA) (MICROTRAK) was performed on the sediments of the positive EIA samples from culture-negative patients. Chlamydia trachomatis was isolated from 11% of the men and 12% of the women. Of the women, 67% were positive in both sampling sites and 33% in the cervix only. No further cases were found when a female urethral swab was cultured. All the chlamydia-positive urine samples were obtained from women who were positive in the urethra. The denominator used to calculate sensitivities was the combination of patients with culture- and EIA-positive results which could be confirmed by DFA. The sensitivity of our culture method was 85% for men and 77% for women. In men, the sensitivity of EIA was greater on urine than on urethral specimens (77% vs 62%; p less than 0.1). In women, the sensitivity of EIA on urine was significantly poorer than that on cervical specimens (54% vs 85%, p less than 0.001). The specificity of EIA ranged between 94 and 100%. Our study suggests that it may be worth using FVU in a trial for the diagnosis of genital chlamydial infections in symptomatic men, but not in symptomatic women.

Influence of whole human milk, and fractions thereof, on inclusion-formation of Chlamydia trachomatis in McCoy cells

A study of the effect of human breast milk, and components thereof, on the capacity of Chlamydia trachomatis to form inclusions in cycloheximide-treated McCoy cells, was undertaken. Pooled whole milk collected during the first week of breast feeding caused a concentration-dependent inhibition of the chlamydial inclusion-formation. The activity resided in the fat and fat globule membrane (FGM) components of the milk. The active principle in the FGM fraction is heat-stable and pronase-sensitive, but resistant to both neuraminidase and periodate. Immunoglobulins was not responsible for the inhibition. Whey and casein fractions of milk increased the chlamydial inclusion-formation. The activity of the whey was heat-stable, dose-related, and had a mol. wt. of greater than or equal to 12,000. The casein fraction was still active after heat treatment. Whey samples collected up to 28 days after delivery varied slightly in their stimulatory activity, with an optimum between the 7th and 14th days. The present study demonstrated a multieffect of breast milk on chlamydial inclusion-formation: an inhibitory activity due to a protein compound as well as another factor in the fat fraction and an enhancing effect due to a heat-stable factor(s).

Antichlamydial activity of saliva

Saliva collected from adults with no antichlamydial antibodies in their serum or saliva, was tested for its capacity to inhibit the formation of inclusions of Chlamydia trachomatis in McCoy cell cultures. Pooled saliva, diluted in tissue culture medium and sterilized by filtration, was found to reduce the inclusion count by up to about 40%. However, the pretreatment of the chlamydial organisms for 2 hours with diluted saliva caused a 75% decrease in the number of inclusions. The inhibitory activity, which was concentration-dependent, seems to affect the attachment of the chlamydial elementary body to the host cell by acting on both the chlamydiae and the McCoy cells. Saliva did not seem to affect the intracellular development of the chlamydiae. The inhibitory activity was not affected by trypsin treatment, while absorbtion with a gel of a chelating agent caused total loss of the antichlamydial effect. The purpose of our study was to test saliva for its possible antichlamydial activity and to partially characterize the active principle.